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Sample records for performed fourteen patients

  1. Neutronal ceroidlipofuscinosis: CCT findings in fourteen patients

    International Nuclear Information System (INIS)

    Lagenstein, I.; Schwendemann, G.; Kuehne, D.; Koepp, P.; Stahnke, N.; Sterowsky, H-J.

    1981-01-01

    CTT was performed in 14 children/adolescents with juvenile ceroid lipofuscinosis (JNCL) at different stages of the disease. CTT was normal in 7 patients; mildly abnormal in 3, clearly abnormal in another 3 and severely abnormal in 1 patient. Characteristic findings were symmetrical enlargement of subarachnoid spaces and of the lateral and third ventricles. White matter showed no changes in density. In later stages also the fourth ventricle was enlarged and cerebellar atrophy was seen. CTT findings were not closely correlated with onset and/or severity of the neurological abnormalities. CTT findings were positively correlated with age of the patients: CTT was usually normal if patients were less than 10 years old, and usually abnormal if patients were more than 14 years old. (Author)

  2. THYMOMA -A Review of Fourteen Patients

    International Nuclear Information System (INIS)

    Kim, S. K.; Lee, H. S.; Cho, K. H.; Suh, C. O.; Kim, G. E.

    1985-01-01

    Between Jan. 1977 and Dec. 1984, 14 patients diagnosed of thymoma has been analyzed retrospectively. 6 patients(6/14 patients 43%) had myasthenia gravis. 12 patients (12/14 patients 86%) had invasive thymoma. Complete resection was carried out in 6 patients (43%), 2 patients had partial resection (14%) and 6 patients had only biopsy (43%). Postoperative or radical radiotherapy was given to 8 patients, of whom 5 patients was still alive (4 yr. 2.8 yr. 1.6 yr. 1.4 yr. 1.3 yr) and 3 patients died (1 yr. 0.6 yr. 0.6 yr). External irradiation ranges 1,950-7,000 rads (mean 4,500, median 4,000 rads)

  3. THYMOMA -A Review of Fourteen Patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, S. K.; Lee, H. S.; Cho, K. H.; Suh, C. O.; Kim, G. E. [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1985-06-15

    Between Jan. 1977 and Dec. 1984, 14 patients diagnosed of thymoma has been analyzed retrospectively. 6 patients(6/14 patients 43%) had myasthenia gravis. 12 patients (12/14 patients 86%) had invasive thymoma. Complete resection was carried out in 6 patients (43%), 2 patients had partial resection (14%) and 6 patients had only biopsy (43%). Postoperative or radical radiotherapy was given to 8 patients, of whom 5 patients was still alive (4 yr. 2.8 yr. 1.6 yr. 1.4 yr. 1.3 yr) and 3 patients died (1 yr. 0.6 yr. 0.6 yr). External irradiation ranges 1,950-7,000 rads (mean 4,500, median 4,000 rads)

  4. Persistent hyperCKemia: fourteen patients studied in retrospect

    NARCIS (Netherlands)

    Brewster, L. M.; de Visser, M.

    1988-01-01

    Fourteen patients with persistently raised serum creatine kinase activity (hyperCKemia) were studied in retrospect. Clinical and laboratory findings did not point to any established neuromuscular disorder. In 8, manual occupation with local muscle strain apparently caused the hyperCKemia despite a

  5. Performance of fourteen improved pea lines (Pisum sativum L. in Challapata zone, Oruro

    Directory of Open Access Journals (Sweden)

    Maiza Benedicto

    2015-02-01

    Full Text Available In Challapata zone, cultivated pea varieties are low yielding and long cycle. The research objective was to determine the performance of fourteen pea lines developed by “Pairumani Fitoecogenetics Investigation Center” (CIFP in Challapata zone (Oruro. The 14 pea lines with local pea variety, were planted in row and column generalized experimental design with four replications in tree location randomly selection in Challapata zone (Oruro, between October 2011 and April 2012. The results indicate, that, in general, all the improved lines were superior in green pod yield to the local pea variety (3.69 t.ha-1, between 6.13 and 16.58 t.ha-1, (65.9 and 349.3% respectively. among the improved lines, Pea5_102-1, Pea5_102-6, Pea5_102-5, Pea5_102-2, Pea5_102-3 and Pea5_102-4, with high green pod yield (13.05 and 16.58 t.ha-1, large pod (8.49 to 9.25 cm, mayor number of grains for pod (5.27 to 7.20 grains and intermediate cycle (85 days to the floración, are the superior performance. The lines Pea5_102-14, Pea5_102-10 (Pairumani 3 and Pea5_102-13, because of their characteristics of high green pod yield, the longest pod, the mayor number of grains for pod, early maturity, preference and wide adaptability, and according to the farmer’s criteria, are the most recommend for their use in Challapata zone (Oruro.

  6. ANCA-associated vasculitis in scleroderma: a case series of fourteen patients

    Directory of Open Access Journals (Sweden)

    Kimberly P. Liang

    2011-01-01

    Full Text Available Antimyeloperoxidase (MPO, perinuclear antineutrophil cytoplasmic antibodies (pANCA, and/or clinically evident vasculitis in patients with scleroderma have been reported only rarely. The clinical significance and prognosis of ANCA-associated vasculitis in systemic sclerosis is uncertain. To report a case and identify the clinical characteristics of scleroderma patients with ANCA-associated vasculitis. Patients with both vasculitis and scleroderma occurring between 1976 to 2006 were identified using an electronic diagnostic index. These diagnoses were confirmed by retrospective review of complete medical records. Clinical features and outcomes recorded included age at vasculitis diagnosis, connective tissue disease (CTD features, type of scleroderma (limited or diffuse; ANCA serology, vasculitic organ system manifestations; and death. Fourteen cases of scleroderma patients with ANCA-associated and/or small vessel vasculitis were identified. The majority (71% were female, with mean age at vasculitis diagnosis 53 years. Seven patients (50% had overlap CTD features, and the majority (79% had limited variant of scleroderma. All of the 10 patients tested were MPO and pANCA positive. Seven patients (50% had glomerulonephritis, 11 (79% pulmonary involvement including 3 with pulmonary-renal syndrome, 6 skin purpura, and 5 mononeuritis multiplex and/or peripheral neuropathy. Six patients (43% died during followup to 2008. The presence of pANCA-associated small vessel vasculitis is a rarely reported complication of scleroderma. It occurs most commonly in women with limited scleroderma and most commonly includes pulmonary and/or renal involvement, including severe organ-threatening manifestations and death. Further studies are needed to clarify the role and clinical impact of ANCA in scleroderma patients with and without vasculitis.

  7. Perceptions of health care providers and patients on quality of care in maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a mixed-method study.

    Science.gov (United States)

    Islam, Farzana; Rahman, Aminur; Halim, Abdul; Eriksson, Charli; Rahman, Fazlur; Dalal, Koustuv

    2015-06-19

    Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals. Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines. The hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85 % of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health

  8. Fourteen days oral administration of therapeutic dosage of some ...

    African Journals Online (AJOL)

    Fourteen days oral administration of therapeutic dosage of some antibiotics reduced serum testosterone in male rats. FO Awobajo, Y Raji, II Olatunji-Bello, FT Kunle-Alabi, AO Adesanya, TO Awobajo ...

  9. Photometric Study of Fourteen Low-mass Binaries

    International Nuclear Information System (INIS)

    Korda, D.; Zasche, P.; Wolf, M.; Kučáková, H.; Vraštil, J.; Hoňková, K.

    2017-01-01

    New CCD photometric observations of fourteen short-period low-mass eclipsing binaries (LMBs) in the photometric filters I, R, and V were used for a light curve analysis. A discrepancy remains between observed radii and those derived from the theoretical modeling for LMBs, in general. Mass calibration of all observed LMBs was performed using only the photometric indices. The light curve modeling of these selected systems was completed, yielding the new derived masses and radii for both components. We compared these systems with the compilation of other known double-lined LMB systems with uncertainties of masses and radii less then 5%, which includes 66 components of binaries where both spectroscopy and photometry were combined together. All of our systems are circular short-period binaries, and for some of them, the photospheric spots were also used. A purely photometric study of the light curves without spectroscopy seems unable to achieve high enough precision and accuracy in the masses and radii to act as meaningful test of the M–R relation for low-mass stars.

  10. Photometric Study of Fourteen Low-mass Binaries

    Energy Technology Data Exchange (ETDEWEB)

    Korda, D.; Zasche, P.; Wolf, M.; Kučáková, H.; Vraštil, J. [Astronomical Institute, Charles University, Faculty of Mathematics and Physics, CZ-180 00, Praha 8, V Holešovičkách 2 (Czech Republic); Hoňková, K., E-mail: korda@sirrah.troja.mff.cuni.cz [Variable Star and Exoplanet Section of Czech Astronomical Society, Vsetínská 941/78, CZ-757 01, Valašské Meziříčí (Czech Republic)

    2017-07-01

    New CCD photometric observations of fourteen short-period low-mass eclipsing binaries (LMBs) in the photometric filters I, R, and V were used for a light curve analysis. A discrepancy remains between observed radii and those derived from the theoretical modeling for LMBs, in general. Mass calibration of all observed LMBs was performed using only the photometric indices. The light curve modeling of these selected systems was completed, yielding the new derived masses and radii for both components. We compared these systems with the compilation of other known double-lined LMB systems with uncertainties of masses and radii less then 5%, which includes 66 components of binaries where both spectroscopy and photometry were combined together. All of our systems are circular short-period binaries, and for some of them, the photospheric spots were also used. A purely photometric study of the light curves without spectroscopy seems unable to achieve high enough precision and accuracy in the masses and radii to act as meaningful test of the M–R relation for low-mass stars.

  11. 29 CFR 570.119 - Fourteen-year minimum.

    Science.gov (United States)

    2010-07-01

    ... Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS CHILD LABOR REGULATIONS, ORDERS AND STATEMENTS OF INTERPRETATION General Statements of Interpretation of the Child Labor Provisions of the Fair Labor Standards Act of 1938, as Amended Oppressive Child Labor § 570.119 Fourteen-year...

  12. Isolation and characterization of fourteen novel microsatellite loci ...

    Indian Academy of Sciences (India)

    [Liu Q., Li Y., Liang H. and Liu X. 2014 Isolation and characterization of fourteen ... management and conservation, little information is available on the genetic structure and genetic variation of B. lenok tsin- lingensis. Microsatellites are currently the markers of choice ... sue according to the simplified method of Laird et al.

  13. Evaluation of 14 patients performed radiotherapy due to Kaposi sarcoma

    Directory of Open Access Journals (Sweden)

    Fatma Teke

    2015-09-01

    Full Text Available Methods: The patients undergoing radiotherapy (RT because of the KS between the years 2005-2012 in Radiation Oncology Department of Dicle University Hospital were included. All patients underwent RT with different dose-fractionation schemes to increase quality of life and to palliate the symptoms. Patients with lesions in multiple regions underwent RT in the same or different dates. Responses to radiotherapy were recorded as complete or partial response. Results: Fourteen patients received radiotherapy because of f KS were evaluated retrospectively. Twenty two different regions of 14 patients underwent RT . Only one patient (4.5% was performed RT to glans penis as a third region while performed to the two regions in six patients (27.3%. At irradiations, 6 MV and 10 MV photon energies with 6 MeV, 9 MeV and 12 MeV electron energy were used. Water phantom or bolus material was used to obtain a homogeneous dose distribution in the photon irradiation. RT dose administered to a total of 22 different regional was median 800 cGy (Range: 800-3000 cGy. Median number of RT fractions was 1 (Range: 1-10. When treatment response were evaluated stable disease was present in the 4 (18.1% regions. Partial response was achieved in eight (36.4% regions, complete response in 10 (45.5%. RT-related common lymphedema in the feet and legs was observed in the four (57.3% regions in the acute period. Complication of pain was present in two (28.7% regions. Conclusion: RT is an appropriate and effective treatment regimen in the palliative treatment of KS lesions. Excellent response rates of skin lesions may be obtained by RT. Lesions and symptoms such as itching may be lost after RT. Side effects such as edema and pain may be relieved by supportive treatment.

  14. Exhumation of radioactive solid wastes buried for fourteen years

    International Nuclear Information System (INIS)

    Horton, J.H.

    1977-03-01

    Twenty-five linear feet of a low-level beta-gamma waste trench was excavated fourteen years after the waste was buried. The waste included wood, steel, plastics, cotton cloth, rubber, and paper. Cardboard boxes not enclosed in plastic were the only materials to deteriorate visibly. Apparently, decades would be required for all cellulose materials to decompose, and plastics and metals would survive indefinitely

  15. Cognitive performance in patients with COPD

    NARCIS (Netherlands)

    Liesker, JJW; Postma, DS; Beukema, RJ; ten Hacken, NHT; van der Molen, T; Riemersma, RA; van Zomeren, EH; Kerstjens, HAM

    Background: Hypoxemic patients with Chronic Obstructive Pulmonary Disease (COPD) have impaired cognitive performance. These neuropsychological impairments are related to the degree of hypoxemia. So far, cognitive performance has not been tested in non-hypoxemic patients with COPD. Methods: We

  16. Morphological diversity in fourteen cultivars Tiron village, Kediri, Indonesia

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    Nur Azis Fuad

    2016-01-01

    Full Text Available Tiron village, Kediri is one of central mangoes in Indonesia. Many cultivar of mangoes encountered at this location. This study aims to look at the diversity of mango cultivars in the Tiron Village, Kediri, Indonesia. Mangoes diversity is based on qualitative and quantitative character of each cultivar. The diversity among cultivar indicated by the standard deviation and variance in the eleven quantitative characters of mango. Mango cultivars categorized by phylogeny morphological characters. The method used for phylogeny analysis is an UPGMA method (unweighted pair group method with arithmetic mean. Phylogenic analysis is based by the qualitative character of the plant. The results showed there were fourteen cultivars of mango in the village of Tiron Kediri have high diversity. Fourteen mango cultivars were categorized four groups. Based on a qualitative character, there are four classes of mango. The first group is the Katul, Podang Urang, and Podang Lumut. The second group is the Gadung, Jaran, Madu, Endog, Pakel, Dodonilo, Ireng, Lanang and Cantek. Santok Kapur into groups to form groups of three and Kopyor fourth. The high diversity in the village mango Tiron Kediri potential for resource in situ germplasm.

  17. Cognitive performance of neuromyelitis optica patients: comparison with multiple sclerosis

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    Sandra Vanotti

    2013-06-01

    Full Text Available The aim of the present research was to investigate cognitive pattern of patients with neuromyelitis optica (NMO and to compare it with multiple sclerosis (MS patients' performance. Methods: Fourteen NMO, 14 relapsing remitting multiple sclerosis (RRMS, and 14 healthy control patients participated in the investigation. Neuropsychological functions were evaluated with the Brief Repeatable Neuropsychological Battery for MS; Symbol Digit Modalities Test; Digit Span; and Semantic Fluency. Results: Fifty-seven percent of NMO patients and 42.85% of the MS ones had abnormal performance in at least two cognitive tests. The NMO Group showed abnormal performance in verbal fluency, verbal and visual memories, with greater attention deficits. NMO patients outperformed healthy control in the paced auditory serial addition test (PASAT. However, no difference was found between NMO and RRMS patients. Conclusions: The NMO Group showed more dysfunction in attention and verbal fluencies than in verbal and visual memories. When compared with the MS patients, a similar dysfunction pattern was found. O objetivo da presente pesquisa foi investigar o padrão cognitivo de pacientes com neuromielite óptica (NMO e compará-lo com o desempenho de pacientes com esclerose múltipla (EM. Métodos: Quatorze pacientes com NMO, 14 com esclerose múltipla recorrente remitente (EMRR e 14 participantes do Controle saudáveis participaram da presente investigação. As funções neuropsicológicas foram avaliadas com a Bateria Breve de Testes Neuropsicológicos de Rao, Teste Símbolo Digit e a Fluência Semântica. Resultados: Cinquenta e sete por cento dos pacientes com NMO e 42,85% daqueles com EM apresentaram desempenho anormal em pelo menos dois testes cognitivos. O Grupo NMO apresentarou desempenho anormal na fluência verbal e nas memórias visual e verbal, com maiores déficits de atenção. Pacientes com NMO superaram os controles saudáveis em PASAT. No entanto, não foi

  18. Homeopathic Treatment of Vitiligo: A Report of Fourteen Cases

    Science.gov (United States)

    Mahesh, Seema; Mallappa, Mahesh; Tsintzas, Dionysios; Vithoulkas, George

    2017-01-01

    Case series Patient: — Final Diagnosis: — Symptoms: Skin lesions Medication: — Clinical Procedure: — Specialty: Dermatology Objective: Unusual or unexpected effect of treatment Background: Vitiligo, also known as leukoderma, is an autoimmune skin condition that results in the loss of melanin pigment. Vitiligo is not a rare condition but is difficult to treat and is associated with psychological distress. Case Reports: A series of 14 cases of vitiligo are presented that were treated with individualized homeopathic remedies that were based on plant, animal, or mineral compounds. There were 13 women and one man in the case series, with a mean age 29.8 years, and a mean follow-up from treatment of 58 months. The mean time between the onset of the appearance of vitiligo and the first consultation at our clinic was 96 months. Homeopathic treatment for patients is holistic and was performed on an individualized basis as described in this case series. Photographic images of the skin are presented before and after treatment. Conclusions: In 14 patients with vitiligo treated with individualized homeopathy, the best results were achieved in the patients who were treated in the early stages of the disease. We believe that homeopathy may be effective in the early stages of vitiligo, but large controlled clinical studies are needed in this area. PMID:29196612

  19. Fourteen-Year Long-Term Results after Gastric Banding

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    Christine Stroh

    2011-01-01

    Full Text Available Background. Gastric banding (GB is a common bariatric procedure that is performed worldwide. Weight loss can be substantial after this procedure, but it is not sufficient in a significant portion of patients. Long-term rates for associated complications increase with every year of follow up, and only a few long-term studies have been published that examine these rates. We present our results after 14 years of postoperative follow up. Methods. Two hundred patients were operated upon form 01.02.1995 to 31.01.2009. Data collection was performed prospectively. In retrospective analysis, we analyzed weight loss, short- and long-term complications, amelioration of comorbidities and long-term outcome. Results. The mean postoperative follow up time was 94.4 months (range 2–144. The follow up rate was 83.5%. The incidence of postoperative complications for slippage was 2.5%, for pouch dilatation was 9.5%, for band migration was 5.5% and 12.0% for overall band removal. After 14 years, the reoperation rate was 30.5% with a reoperation rate of 2.2% for every year of follow up. Excess weight loss was 40.2% after 1 year, 46.3% after 2 years, 45.9% after 3 years, 41.9% after five years, 33.3% after 8 years, 30.8% after 10 years, 33.3% after 12 years and 15.6% after 14 years of follow up. Conclusion. The complication and reoperation rate after GB is high. Nevertheless, GB is still a therapeutic option in morbid obese patients, but the criteria for patient selection should be carefully evaluated.

  20. Stereotactic Radiosurgery for Poor Performance Status Patients

    Energy Technology Data Exchange (ETDEWEB)

    Kubicek, Gregory J., E-mail: kubicek-gregory@cooperhealth.edu [Department of Radiation Oncology, Cooper University Hospital, Camden, New Jersey (United States); Turtz, Alan [Department of Neurological Surgery, Cooper University Hospital, Camden, New Jersey (United States); Xue, Jinyu; Patel, Ashish; Richards, Gregory; LaCouture, Tamara [Department of Radiation Oncology, Cooper University Hospital, Camden, New Jersey (United States); Cappelli, Louis; Diestelkamp, Tim [Rowan Graduate School, Camden, New Jersey (United States); Saraiya, Piya [Department of Diagnostic Radiology, Cooper University Hospital, Camden, New Jersey (United States); Bexon, Anne [Department of Neurological Surgery, Cooper University Hospital, Camden, New Jersey (United States); Lerman, Nati [Department of Medical Oncology, Cooper University Hospital, Camden, New Jersey (United States); Goldman, Howard Warren [Department of Neurological Surgery, Cooper University Hospital, Camden, New Jersey (United States)

    2016-07-01

    Purpose: Patients with poor performance status (PS), usually defined as a Karnofsky Performance Status of 60 or less, were not eligible for randomized stereotactic radiosurgery (SRS) studies, and many guidelines suggest that whole-brain radiation therapy (WBRT) is the most appropriate treatment for poor PS patients. Methods and Materials: In this retrospective review of our SRS database, we identified 36 patients with PS of 60 or less treated with SRS for central nervous system (CNS) metastatic disease. PS, as defined by the Karnofsky Performance Status, was 60 (27 patients), 50 (8 patients), or 40 (1 patient). The median number of CNS lesions treated was 3. Results: Median overall survival (OS) was 7.2 months (range, 0.73-25.6 months). Fifteen patients (41%) were alive at 6 months, and 6 patients (16.6%) were alive at 1 year. There was no difference in OS in patients who underwent previous WBRT. There were no local failures or cases of radiation toxicity. Distant CNS failures were seen in 9 patients (25%). Conclusions: Our patients with poor PS had reasonable median OS and relatively low distant CNS failure rates. Patients in this patient population may be ideal candidates for SRS compared with WBRT given the low incidence of distant failure over their remaining lives and the favorable logistics of single-fraction treatment for these patients with debility and their caregivers.

  1. Homeopathic Treatment of Vitiligo: A Report of Fourteen Cases.

    Science.gov (United States)

    Mahesh, Seema; Mallappa, Mahesh; Tsintzas, Dionysios; Vithoulkas, George

    2017-12-02

    BACKGROUND Vitiligo, also known as leukoderma, is an autoimmune skin condition that results in the loss of melanin pigment. Vitiligo is not a rare condition but is difficult to treat and is associated with psychological distress. CASE REPORT A series of 14 cases of vitiligo are presented that were treated with individualized homeopathic remedies that were based on plant, animal, or mineral compounds. There were 13 women and one man in the case series, with a mean age 29.8 years, and a mean follow-up from treatment of 58 months. The mean time between the onset of the appearance of vitiligo and the first consultation at our clinic was 96 months. Homeopathic treatment for patients is holistic and was performed on an individualized basis as described in this case series. Photographic images of the skin are presented before and after treatment. CONCLUSIONS In 14 patients with vitiligo treated with individualized homeopathy, the best results were achieved in the patients who were treated in the early stages of the disease. We believe that homeopathy may be effective in the early stages of vitiligo, but large controlled clinical studies are needed in this area.

  2. Cavernous sinus hemangioma: a fourteen year single institution experience.

    Science.gov (United States)

    Bansal, Sumit; Suri, Ashish; Singh, Manmohan; Kale, Shashank Sharad; Agarwal, Deepak; Sharma, Manish Singh; Mahapatra, Ashok Kumar; Sharma, Bhawani Shankar

    2014-06-01

    Cavernous sinus hemangioma (CSH) is a rare extra-axial vascular neoplasm that accounts for 2% to 3% of all cavernous sinus tumors. Their location, propensity for profuse bleeding during surgery, and relationship to complex neurovascular structures are factors which present difficulty in excising these lesions. The authors describe their experience of 22 patients with CSH over 14 years at a tertiary care center. Patients were managed with microsurgical resection using a purely extradural transcavernous approach (13 patients) and with Gamma Knife radiosurgery (GKRS; Elekta AB, Stockholm, Sweden) (nine patients). Retrospective data analysis found headache and visual impairment were the most common presenting complaints, followed by facial hypesthesia and diplopia. All but one patient had complete tumor excision in the surgical series. Transient ophthalmoparesis (complete resolution in 6-8 weeks) was the most common surgical complication. In the GKRS group, marked tumor shrinkage (>50% tumor volume reduction) was achieved in two patients, slight shrinkage in five and no change in two patients, with symptom improvement in the majority of patients. To our knowledge, we describe one of the largest series of CSH managed at a single center. Although microsurgical resection using an extradural transcavernous approach is considered the treatment of choice in CSH and allows complete excision with minimal mortality and long-term morbidity, GKRS is an additional tool for treating residual symptomatic lesions or in patients with associated comorbidities making surgical resection unsuitable. Copyright © 2013. Published by Elsevier Ltd.

  3. Altered Functional Performance in Patients with Fibromyalgia

    OpenAIRE

    Costa, Isis da Silva; Gamund?, Antoni; Miranda, Jos? G. Vivas; Fran?a, Lucas G. Souza; De Santana, Charles Novaes; Montoya, Pedro

    2017-01-01

    Fibromyalgia is a common chronic pain condition that exerts a considerable impact on patients' daily activities and quality of life. Objectives: The main objective of the present study was to evaluate kinematic parameters of gait, functional performance, and balance in women with fibromyalgia syndrome. Methods: The study included 26 female patients with fibromyalgia (49.2 ± 8.0 years) according to the criteria of the American College of Rheumatology, as well as 16 pain-free women (43.5 ...

  4. Computed tomography-guided needle biopsy of lung lesions in fourteen cats and dogs

    International Nuclear Information System (INIS)

    Yoshida, K.; Mori, T.; Yamada, M.; Sakaida, M.; Yonemaru, K.; Murakami, M.; Sakai, H.; Maruo, K.

    2007-01-01

    Computed tomography (CT)-guided fine-needle aspirates (FNA) or core biopsies of lung lesions were performed in nine dogs and five cats. A clinical diagnosis was obtained in twelve of fourteen animals (85%), namely 80% FNA and 100% core biopsies. Eight animals had other mass (es) apart from the lung, and five were diagnosed to metastases. In only one case, the lung mass was histopathologically diagnosed as a malignant primary tumor. Iatrogenic complications through the lung biopsies were noted in four animals, and three showed mild pneumothorax on CT images and one was bleeding from the needle. However, between fifteen and thirty minutes after the biopsy, no animal indicated signs of pneumothorax or hemorrhage

  5. Living unrelated donor kidney transplantation: A fourteen-year experience

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    Ignjatović Ljiljana

    2010-01-01

    Full Text Available Background. In countries without a national organization for retrieval and distribution of organs of the deceased donors, problem of organ shortage is still not resolved. In order to increase the number of kidney transplantations we started with the program of living unrelated - spousal donors. The aim of this study was to compare treatment outcome and renal graft function in patients receiving the graft from spousal and those receiving ghe graft from living related donors. Method. We retrospectively identified 14 patients who received renal allograft from spousal donors between 1996 and 2009 (group I. The control group consisted of 14 patients who got graft from related donor retrieved from the database and matched than with respect to sex, age, kidney disease, immunological and viral pretransplant status, the initial method of the end stage renal disease treatment and ABO compatibility. In the follow-up period of 41 ± 38 months we recorded immunosuppressive therapy, surgical complications, episodes of acute rejection, CMV infection and graft function, assessed by serum creatinine levels at the beginning and in the end of the follow-up period. All patients had pretransplant negative cross-match. In ABO incompatible patients pretransplant isoagglutinine titer was zero. Results. The patients with a spousal donor had worse HLA matching. There were no significant differences between the groups in surgical, infective, immunological complications and graft function. Two patients from the group I returned to hemodialysis after 82 and 22 months due to serious comorbidities. Conclusion. In spite of the worse HLA matching, graft survival and function of renal grafts from spousal donors were as good as those retrieved from related donors.

  6. Development of a freshwater lens in the inverted Broad Fourteens Basin, Netherlands offshore

    NARCIS (Netherlands)

    Bouw, Laurien; Oude Essink, Gualbert

    2003-01-01

    The Mesozoic Broad Fourteens Basin is a northwest-southeast trending structural element, situated in the southern North-Sea,Netherlands offshore. Biodegraded and water-washed oils in the southern Broad Fourteens Basin indicate topography-driven meteoric water flow during Late Cretaceous inversion.

  7. Fourteen-years experience with cochlear implantation in Ramathibodi Hospital.

    Science.gov (United States)

    Kasemsuwan, Lalida; Cheewaruangroj, Wichit; Tungkeeratichai, Jumroon; Bhongmakapat, Thongchai; Thawin, Cheamchit; Lertsukprasert, Krisna; Tiravanitchakul, Rattinan; Dara, Rada; Laothamatas, Jiraporn

    2010-12-01

    To review the cochlear implant program in Ramathibodi Hospital and share experience of cochlear implantation emphasized on clinical and surgical outcomes. Retrospective review of 143 ears (140 patients) operated with cochlear implant between 1995 and 2009. The demographic data including etiology of deafness and findings from temporal bone CTscans were reviewed. The authors' experience with cochlear implant surgery in terms of patient selection, patient advisory clinic, necessary equipment, pre- and postoperative evaluations, surgical techniques and complications were discussed. Most congenital origin was unknown etiology and congenital rubella was the most common known cause. From the CT scans of congenital deafness, vestibular aqueduct dilatation was the most common and found in 29.31% while Mondini malformation was shown to be 16.37%. The authors' surgical technique of using the pocket method and designed bony ridge at cortical mastoid rim had helped stabilizing the implant and electrode fancoil. During the last two years, no complication or revision surgery was detected. Cochlear implant surgery in both children and adults can result in good surgical outcome and fewer complications under experienced surgeons and a good team.

  8. 29 CFR 779.507 - Fourteen-year minimum.

    Science.gov (United States)

    2010-07-01

    ... RETAILERS OF GOODS OR SERVICES Other Provisions Which May Affect Retail Enterprises Child Labor Provisions... interfere with the minors' schooling and to conditions which will not interfere with their health and well... in a limited number of occupations where the work is performed outside school hours and is confined...

  9. Neuropsychological performance in patients with myasthenia gravis

    Directory of Open Access Journals (Sweden)

    María Bárbara Eizaguirre

    2017-04-01

    Full Text Available Myasthenia gravis is a chronic autoimmune disease that affects the neuromuscular transmission. Controversial findings had been reported about cognitive impairment in this disease. The aim of this study was to investigate the cognitive pattern of patients with myasthenia gravis. There were enrolled 24 patients with myasthenia gravis, anti-acetylcholine receptor antibodies (ACRA positive, and 24 healthy controls. Patients: age 43.9 ± 14.8, years of education 10.9 ± 3.3. Controls: age 44.5 ± 15.4, years of education 11.5 ± 3.3. The following areas were evaluated: verbal memory: (long-term storage, retrieval, delayed recall of the Selective Remained Test; attention: Paced Auditory Serial Addition Task (PASAT 2 and 3 seconds; executive functions: analogies and numbers-letters sequence. Also, it was administered the Beck Depression Inventory II (BDI II. About 33.3% of patients obtained abnormal performance in two or more cognitive tests. 37.5% showed deterioration in attention; 33.3% in verbal memory; 29.2% in executive functions. Significant differences between patients and healthy controls were found in long-term storage (p = 0.001; retrieval (p = 0.007; delayed recall (p = 0.000; PASAT 3 (p = 0.009; PASAT 2 (p = 0.009 and analogies (p = 0.003. Evidence of depression was found: mild in 4.2% of patients; moderate in 25% and severe in 29.2%. Neuropsychological performance declines in patients with myasthenia gravis: attention was more affected than other cognitive areas

  10. [Neuropsychological performance in patients with myasthenia gravis].

    Science.gov (United States)

    Eizaguirre, María Bárbara; Aguirre, Florencia; Yastremiz, Cecilia; Vanotti, Sandra; Villa, Andrés

    2017-01-01

    Myasthenia gravis is a chronic autoimmune disease that affects the neuromuscular transmission. Controversial findings had been reported about cognitive impairment in this disease. The aim of this study was to investigate the cognitive pattern of patients with myasthenia gravis. There were enrolled 24 patients with myasthenia gravis, anti-acetylcholine receptor antibodies (ACRA) positive, and 24 healthy controls. age 43.9 ± 14.8, years of education 10.9 ± 3.3. age 44.5 ± 15.4, years of education 11.5 ± 3.3. The following areas were evaluated: verbal memory: (long-term storage, retrieval, delayed recall) of the Selective Remained Test; attention: Paced Auditory Serial Addition Task (PASAT 2 and 3 seconds); executive functions: analogies and numbers-letters sequence. Also, it was administered the Beck Depression Inventory II (BDI II). About 33.3% of patients obtained abnormal performance in two or more cognitive tests. 37.5% showed deterioration in attention; 33.3% in verbal memory; 29.2% in executive functions. Significant differences between patients and healthy controls were found in long-term storage (p = 0.001); retrieval (p = 0.007); delayed recall (p = 0.000); PASAT 3 (p = 0.009); PASAT 2 (p = 0.009) and analogies (p = 0.003). Evidence of depression was found: mild in 4.2% of patients; moderate in 25% and severe in 29.2%. Neuropsychological performance declines in patients with myasthenia gravis: attention was more affected than other cognitive areas.

  11. Altered Functional Performance in Patients with Fibromyalgia.

    Science.gov (United States)

    Costa, Isis da Silva; Gamundí, Antoni; Miranda, José G Vivas; França, Lucas G Souza; De Santana, Charles Novaes; Montoya, Pedro

    2017-01-01

    Fibromyalgia is a common chronic pain condition that exerts a considerable impact on patients' daily activities and quality of life. Objectives: The main objective of the present study was to evaluate kinematic parameters of gait, functional performance, and balance in women with fibromyalgia syndrome. Methods: The study included 26 female patients with fibromyalgia (49.2 ± 8.0 years) according to the criteria of the American College of Rheumatology, as well as 16 pain-free women (43.5 ± 8.5 years). Gait and balance parameters were extracted from video recordings of participants performing several motor tasks. Non-linear dynamic of body sway time series was also analyzed by computing the Hurst exponent. In addition, functional performance and clinical pain were obtained by using standardized motor tests (Berg's balance scale, 6-min walking test, timed up and go task, Romberg's balance test) and self-report questionnaires (Fibromyalgia Impact Questionnaire). Results: Walking speed was significantly diminished ( p fibromyalgia and pain-free controls on body sway in the medial-lateral and anterior-posterior axes (all ps gait and balance were significantly associated with high levels of pain, depression, stiffness, anxiety, and fatigue in fibromyalgia. Conclusion: Our data revealed that both gait and balance were severely impaired in FM, and that subjective complaints associated with FM could contribute to functional disability in these patients. These findings suggest that optimal rehabilitation and fall prevention in fibromyalgia require a comprehensive assessment of both psychological responses to pain and physical impairments during postural control and gait.

  12. Chapter Fourteen

    African Journals Online (AJOL)

    User

    of the songs are rendered in Yoruba and then translated into English (17-18). An example is .... Also, Madam Omeaku reports that she has sent her children abroad, erected three buildings, set up ... The Teaching of English. Studies. Ibadan: ...

  13. Masticatory performance in patients with myasthenia gravis

    NARCIS (Netherlands)

    Weijnen, FG; Kuks, JBM; van der Glas, HW; Oudenaarde, [No Value; Bosman, F

    Masticatory muscle electromyograms (EMGs) were recorded while patients with bulbar myasthenia gravis chewed artificial food and compared with those of patients with ocular myasthenia gravis, patients in clinical remission who had previously suffered from bulbar myasthenia gravis and healthy

  14. Reflections on fourteen cryptic issues concerning the nature of statistical inference

    NARCIS (Netherlands)

    Kardaun, O.J.W.F.; Salomé, D.; Schaafsma, W; Steerneman, A.G.M.; Willems, J.C; Cox, D.R.

    The present paper provides the original formulation and a joint response of a group of statistically trained scientists to fourteen cryptic issues for discussion, which were handed out to the public by Professor Dr. D.R. Cox after his Bernoulli Lecture 1997 at Groningen University.

  15. General movements in the first fourteen days of life in extremely low birth weight (ELBW) infants

    NARCIS (Netherlands)

    de Vries, N. K. S.; Erwich, J. J. H. M.; Bos, A. F.

    2008-01-01

    Objective: To assess the quality of general movements (GMs) in the first fourteen days of life in relation to obstetric and postnatal risk factors and neurodevelopmental outcome in extremely low birth weight (ELBW) infants. Study design: The GMs of nineteen infants were assessed on days 2, 4, 6, 10

  16. Determination of fourteen sunscreen agents in cosmetics using high-performance liquid chromatography.

    Science.gov (United States)

    Chang, N I; Yoo, M Y; Lee, S H

    2015-04-01

    Commercial sunscreens consist of various compounds ranging from inorganic mineral pigments to organic chemical absorbents to achieve the required degree of protection against sunlight. However, the UV radiation screening ingredients have side effects. In this study, therefore, to ensure compliance with the maximum permissible chemical concentrations in sunscreen cosmetic products, a simultaneous and improved determination method for sunscreen chemicals was assessed. Waters 2690 separations module HPLC system equipped with a Waters 486 tunable absorbance detector (UV-visible detector) has been employed and optimized to detect 14 compounds. For the separation, a Waters C18 column (5 μm, 4.6 mm i.d. 150 mm) and 1% of 0.1 M phosphoric acid in ethanol (solvent A) and in distilled water (solvent B) as mobile phases were used. The correlation coefficients of 14 standard mixture solutions exceeded 0.9993 in the range 2.5-200 μg mL(-1). The intra- and interday recovery and precision (relative standard deviation) of the method were 90.91-109.98% and within 10%, respectively, indicating that the developed method could provide reliable, precise and reproducible data. The detection limit was determined to be 0.01-1.99 μg mL(-1), and the quantization limit was determined to be 0.02-6.02 μg mL(-1), which were relatively lower than previous studies. This method was highly optimized in terms of selectivity, reproducibility and efficiency for the detection of 14 compounds. The validation data indicated that the improved method was quite suitable for their quantitative analysis of commercial product samples. Therefore, this method was applied to the determination of 14 compounds in commercial sunscreen cosmetic products. We verified that the amounts of sunscreen ingredients in the five currently sold sunscreens were >0.5% and within the designated limit, which means those could produce the safe and desired sunscreen effects on the skin. The present method could be applied to effectively monitor the process management and quality control of the cosmetics that are sold in the market. © 2014 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

  17. Impact of distal median neuropathy on handwriting performance for patients with carpal tunnel syndrome in office and administrative support occupations.

    Science.gov (United States)

    Kuo, Li-Chieh; Hsu, Hsiao-Man; Wu, Po-Ting; Lin, Sheng-Che; Hsu, Hsiu-Yun; Jou, I-Ming

    2014-06-01

    This study investigates the handwriting performance of patients with carpal tunnel syndrome (CTS) and healthy controls in office and administrative support occupations, adopting both biomechanical and functional perspectives. This work also explores how surgical intervention altered the performance of the CTS patients. Fourteen CTS patients and 14 control subjects were recruited to complete a self-reported survey and participate in sensory tests, hand strength, dexterity and handwriting tasks using a custom force acquisition pen along with motion capture technology. Based on the results of these, the sensory measurements, along with functional and biomechanical parameters, were used to determine the differences between the groups and also reveal any improvements that occurred in the CTS group after surgical intervention. The CTS patients showed significantly poorer hand sensibility and dexterity than the controls, as well as excessive force exertion of the digits and pen tip, and less efficient force adjustment ability during handwriting. After surgery and sensory recovery, the hand dexterity and pen tip force of the CTS patients improved significantly. The force adjustment abilities of the digits also increased, but these changes were not statistically significant. This study provides the objective measurements and novel apparatus that can be used to determine impairments in the handwriting abilities of office or administrative workers with CTS. The results can also help clinicians or patients to better understand the sensory-related deficits in sensorimotor control of the hand related to CTS, and thus develop and implement more suitable training or adaptive protocols.

  18. Are performance-based measures predictive of work participation in patients with musculoskeletal disorders? A systematic review.

    Science.gov (United States)

    Kuijer, P P F M; Gouttebarge, V; Brouwer, S; Reneman, M F; Frings-Dresen, M H W

    2012-02-01

    Assessments of whether patients with musculoskeletal disorders (MSDs) can participate in work mainly consist of case history, physical examinations, and self-reports. Performance-based measures might add value in these assessments. This study answers the question: how well do performance-based measures predict work participation in patients with MSDs? A systematic literature search was performed to obtain longitudinal studies that used reliable performance-based measures to predict work participation in patients with MSDs. The following five sources of information were used to retrieve relevant studies: PubMed, Embase, AMA Guide to the Evaluation of Functional Ability, references of the included papers, and the expertise and personal file of the authors. A quality assessment specific for prognostic studies and an evidence synthesis were performed. Of the 1,230 retrieved studies, eighteen fulfilled the inclusion criteria. The studies included 4,113 patients, and the median follow-up period was 12 months. Twelve studies took possible confounders into account. Five studies were of good quality and thirteen of moderate quality. Two good-quality and all thirteen moderate-quality studies (83%) reported that performance-based measures were predictive of work participation. Two good-quality studies (11%) reported both an association and no association between performance-based measures and work participation. One good-quality study (6%) found no effect. A performance-based lifting test was used in fourteen studies and appeared to be predictive of work participation in thirteen studies. Strong evidence exists that a number of performance-based measures are predictive of work participation in patients with MSDs, especially lifting tests. Overall, the explained variance was modest.

  19. Neuropsychological performance in patients with myasthenia gravis

    OpenAIRE

    María Bárbara Eizaguirre; Florencia Aguirre; Cecilia Yastremiz; Sandra Vanotti; Andrés Villa

    2017-01-01

    Myasthenia gravis is a chronic autoimmune disease that affects the neuromuscular transmission. Controversial findings had been reported about cognitive impairment in this disease. The aim of this study was to investigate the cognitive pattern of patients with myasthenia gravis. There were enrolled 24 patients with myasthenia gravis, anti-acetylcholine receptor antibodies (ACRA) positive, and 24 healthy controls. Patients: age 43.9 ± 14.8, years of education 10.9 ± 3.3. Controls: age 44.5 ± 15...

  20. Fourteen polymorphic microsatellite markers for the fungal banana pathogen Mycosphaerella fijiensis.

    Science.gov (United States)

    Yang, Bao Jun; Zhong, Shao Bin

    2008-07-01

    Fourteen polymorphic microsatellite markers were developed for Mycosphaerella fijiensis, a fungus causing the black sigatoka disease in banana. The sequenced genome of M. fijiensis was screened for sequences with single sequence repeats (SSRs) using a Perl script. Fourteen SSR loci, evaluated on 48 M. fijiensis isolates from Hawaii, were identified to be highly polymorphic. These markers revealed two to 19 alleles, with an average of 6.43 alleles per locus. The estimated gene diversity ranged from 0.091 to 0.930 across the 14 microsatellite loci. The SSR markers developed would be useful for population genetics studies of M. fijiensis. © 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd.

  1. Performance of activities of daily living among hospitalized cancer patients

    DEFF Research Database (Denmark)

    Lindahl-Jacobsen, Line; Hansen, Dorte Gilså; Wæhrens, Eva Ejlersen

    2015-01-01

    and characterize ADL task performance problems among a group of adult disabled hospitalized cancer patients using interview and questionnaire data. METHODS: Cross-sectional study on prevalence of ADL task performance problems experienced by disabled hospitalized cancer patients using the Activities of Daily Living...... Questionnaire (ADL-Q) (n = 118) and the Canadian Occupational Performance Measure (COPM) (n = 55). RESULTS: All 118 patients reported problems with ADL task performance. Based on the ADL-Q patients reported more problems within instrumental (I-)ADL than personal (P-)ADL. In both I-ADL and P-ADL the results......BACKGROUND: Many cancer patients report unmet rehabilitation needs. Rehabilitation may include activities of daily living (ADL) tasks, but little is known about how cancer patients perform these tasks and how they prioritize their daily activities. Hence, this study aims to identify...

  2. Measuring elderly dysphagic patients' performance in eating--a review

    DEFF Research Database (Denmark)

    Hansen, Tina; Kjaersgaard, Annette; Faber, Jens

    2011-01-01

    criteria concerning the study design, the statistics used for the psychometric evaluation and the reported values. Results. Eight of fourteen identified assessment tools met the inclusion criteria. Three assessment tools were specific to dementia, two were specific to stroke and three targeted a range...

  3. International to domestic price transmission in fourteen developing countries during the 2007-08 food crisis

    DEFF Research Database (Denmark)

    Baltzer, Kenneth Thomas

    -through in China and India, over close relationship between international and domestic prices in Brazil and South Africa, to substantial domestic price overshooting in Ethiopia and Nigeria. Much of this variation can be explained by price stabilization policies, public policy failure, incomplete market integration......This paper synthesizes the evidence on price transmission from international maize, rice and wheat markets to domestic markets in fourteen developing countries during the global food crisis in 2007-08. A great variation in the price transmission patterns is observed; from almost no price pass...

  4. Uniformity and stability of LiF sensitivity - a review of fourteen years' monitoring experience

    International Nuclear Information System (INIS)

    Grogan, D.; Bradley, R.P.; Mattioli, A.

    1990-01-01

    The Personnel Dosimetry Services of the Bureau of Radiation and Medical Devices have utilised an increasingly large pool of thermoluminescence dosimetry (TLD) plaques since 1976. Between 1975 and 1981, the volume increased from 60,000 to 180,000 to implement a change from films to TLDs. As of 1989, 317,000 plaques are in service. Most, but not all, of the thick and thin LiF-100 chips contained on each dosemeter plaque have been individually calibrated. Because the TLDs have been obtained over a period of fourteen years, it is possible to quantify the variation of response sensitivities for each batch purchased. A continued increase in sensitivity has been noted. Furthermore, because detailed records of use have been maintained, it is also possible to quantify information relating the purchased batch sensitivities to other parameters such as cumulative exposure, time of use, and number of readings. Some selected examples are given. Of most interest is the variation of sensitivity factors for individual LiF crystals in relation to the above parameters. Results for periods of one to fourteen years are presented. (author)

  5. SKread predicts handwriting performance in patients with low vision.

    Science.gov (United States)

    Downes, Ken; Walker, Laura L; Fletcher, Donald C

    2015-06-01

    To assess whether performance on the Smith-Kettlewell Reading (SKread) test is a reliable predictor of handwriting performance in patients with low vision. Cross-sectional study. Sixty-six patients at their initial low-vision rehabilitation evaluation. The patients completed all components of a routine low-vision appointment including logMAR acuity, performed the SKread test, and performed a handwriting task. Patients were timed while performing each task and their accuracy was recorded. The handwriting task was performed by having patients write 5 5-letter words into sets of boxes where each letter is separated by a box. The boxes were 15 × 15 mm, and accuracy was scored with 50 points possible from 25 letters: 1 point for each letter within the confines of a box and 1 point if the letter was legible. Correlation analysis was then performed. Median age of participants was 84 (range 54-97) years. Fifty-seven patients (86%) had age-related macular degeneration or some other maculopathy, whereas 9 patients (14%) had visual impairment from media opacity or neurologic impairment. Median Early Treatment Diabetic Retinopathy Study acuity was 20/133 (range 20/22 to 20/1000), and median logMAR acuity was 0.82 (range 0.04-1.70). SKread errors per block correlated with logMAR acuity (r = 0.6), and SKread time per block correlated with logMAR acuity (r = 0.51). SKread errors per block correlated with handwriting task time/accuracy ratio (r = 0.61). SKread time per block correlated with handwriting task time/accuracy ratio (r = 0.7). LogMAR acuity score correlated with handwriting task time/accuracy ratio (r = 0.42). All p values were handwriting performance in patients with low vision better than logMAR acuity. Copyright © 2015 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

  6. A serious game for COPD patients to perform physiotherapeutic exercises

    NARCIS (Netherlands)

    Tabak, Monique; Marin Perianu, Raluca; Hermens, Hermanus J.

    The goal of this research was 1) to investigate the usability of the Orange Submarine game, and 2) to explore the changes in saturation and pulse rate in COPD patients while playing the game. The game was positively received by the patients and could provide a new fun way for performing exercises,

  7. Patient Experience: A Critical Indicator of Healthcare Performance.

    Science.gov (United States)

    Guler, Pamela H

    2017-01-01

    Patient experience has become a critical differentiator for healthcare organizations, and it will only grow in importance as transparency and consumerism dominate the healthcare landscape. Creating and sustaining a consistently exceptional experience that promotes patient engagement and the best outcomes is far more than just "satisfying" patients, going well beyond amenities that may be provided.Perception of care experience is often shaped by methods we use to address the biopsychosocial needs of patients. Building relationships and communicating well with our patients and families are primary approaches. In a complex healthcare situation, patients may not fully understand or remember the highly clinical nature of treatment. However, they always remember how we made them feel, how we communicated with them as a team, and what interactions they experienced while in our care.Patients who are fully informed and feel connected to their caregivers are often less anxious than those who are disengaged. Informed and engaged patients are enabled to participate in their healthcare. Organizations that focus on developing an accountable culture-one that inspires caregivers to communicate in a way that connects to patients' mind, body, and spirit while leveraging standard, evidence-based patient experience practices-find that patients' perception of care, or "the patient experience," is vastly improved.Adventist Health System has embarked on a journey to patient experience excellence with a commitment to whole-person care and standard patient experience practice across the system. Recognized with several national awards, we continue to strengthen our approach toward bringing all of our campuses and patient settings to sustained high-level performance. We have found that a combination of strong, accountable leadership; a focus on employee culture; engagement of physicians; standardized patient experience practices and education; and meaningful use of patient feedback are top

  8. Fourteen years of geomagnetic daily variation at Mario Zucchelli Station (Antarctica

    Directory of Open Access Journals (Sweden)

    A. Meloni

    2007-06-01

    Full Text Available During the 1986-87 austral summer a geomagnetic observatory was installed at the Italian Antarctic Base Mario Zucchelli Station. In the first three years continuous time variation monitoring and absolute measurements of the geomagnetic field were carried out only during summer expeditions. Starting 1991 an automatic acquisition system, operating through all the year, was put in operation. We present here some peculiarities of the daily variation as observed for fourteen years (1987-2000. The availability of a long series of data has allowed the definition of seasonal, as well as solar cycle effects, on short time variations as observed at a cusp-cap observatory. In particular, contrary to mid latitude behaviour, a clear dependence of the daily variation amplitude on the global geomagnetic K index was well defined.

  9. Review of the Berosus Leach of Venezuela (Coleoptera, Hydrophilidae, Berosini with description of fourteen new species

    Directory of Open Access Journals (Sweden)

    Adriana Oliva

    2012-07-01

    Full Text Available The species of the water scavenger beetle genus Berosus Leach occurring in Venezuela are reviewed. Thirty-six species are recorded, including fifteen new species, fourteen of which are described here as new: B. aragua sp. n., B. asymmetricus sp. n., B. capanaparo sp. n., B. castaneus sp. n., B. corozo sp. n., B. ebeninus sp. n., B. garciai sp. n., B. humeralis sp. n., B. jolyi sp. n., B. llanensis sp. n., B. megaphallus sp. n., B. ornaticollis sp. n., B. repertus sp. n., and B. tramidrum sp. n. The fifteenth new species, known from a single female, is left undescribed pending the collection of males. Twelve species are recorded from Venezuela for the first time: B. ambogynus Mouchamps, B. consobrinus Knisch, B. elegans Knisch, B. geayi d’Orchymont, B. ghanicus d’Orchymont, B. guyanensis Queney, B. holdhausi Knisch, B. marquardti Knisch, B. olivae Queney, B. reticulatus Knisch, B. wintersteineri Knisch, and B. zimmermanni Knisch.

  10. Polyphenol content and antioxidant activity of fourteen wild edible fruits from Burkina Faso.

    Science.gov (United States)

    Lamien-Meda, Aline; Lamien, Charles Euloge; Compaoré, Moussa M Y; Meda, Roland N T; Kiendrebeogo, Martin; Zeba, Boukare; Millogo, Jeanne F; Nacoulma, Odile G

    2008-03-06

    A total of fourteen (14) species of wild edible fruits from Burkina Faso were analyzed for their phenolic and flavonoid contents, and their antioxidant activities using the DPPH, FRAP and ABTS methods. The data obtained show that the total phenolic and total flavonoid levels were significantly higher in the acetone than in the methanol extracts.Detarium microcarpum fruit had the highest phenolic and the highest flavonoid content,followed by that of Adansonia digitata, Ziziphus mauritiana, Ximenia americana and Lannea microcarpa. Significant amounts of total phenolics were also detected in the other fruit species in the following order of decreasing levels: Tamarindus indica > Sclerocaryabirrea > Dialium guineense > Gardenia erubescens > Diospyros mespiliformis > Parkiabiglobosa > Ficus sycomorus > Vitellaria paradoxa. Detarium microcarpum fruit also showed the highest antioxidant activity using the three antioxidant assays. Fruits with high antioxidant activities were also found to possess high phenolic and flavonoid contents. There was a strong correlation between total phenolic and flavonoid levels and antioxidant activities.

  11. Polyphenol Content and Antioxidant Activity of Fourteen Wild Edible Fruits from Burkina Faso

    Directory of Open Access Journals (Sweden)

    Odile G. Nacoulma

    2008-03-01

    Full Text Available A total of fourteen (14 species of wild edible fruits from Burkina Faso wereanalyzed for their phenolic and flavonoid contents, and their antioxidant activities usingthe DPPH, FRAP and ABTS methods. The data obtained show that the total phenolic andtotal flavonoid levels were significantly higher in the acetone than in the methanol extracts.Detarium microcarpum fruit had the highest phenolic and the highest flavonoid content,followed by that of Adansonia digitata, Ziziphus mauritiana, Ximenia americana andLannea microcarpa. Significant amounts of total phenolics were also detected in the otherfruit species in the following order of decreasing levels: Tamarindus indica > Sclerocaryabirrea > Dialium guineense > Gardenia erubescens > Diospyros mespiliformis > Parkiabiglobosa > Ficus sycomorus > Vitellaria paradoxa. Detarium microcarpum fruit alsoshowed the highest antioxidant activity using the three antioxidant assays. Fruits with highantioxidant activities were also found to possess high phenolic and flavonoid contents.There was a strong correlation between total phenolic and flavonoid levels and antioxidantactivities.

  12. Changes in performance status of elderly patients after radiotherapy

    International Nuclear Information System (INIS)

    Yamazaki, Hideya; Inoue, Takehiro; Yoshida, Ken

    2001-01-01

    The purpose of this study was to examine the feasibility of external radiation therapy for patients 80 years old and older. We analyzed changes in the performance status (PS) of 1353 patients by external radiotherapy at Osaka Teishin Hospital. In addition, factors influencing PS change and interruption of treatment were assessed in patients undergoing radical and palliative radiotherapy. Among elderly patients aged 80 years or more (n=67), two patients showed deterioration in PS (3%), whereas 128 (10%) did so among those 79 years old or younger. The rate of treatment completion was 90% (60/67) for patients aged 80 years and over compared with 89% (1146/1286) for younger patients. Changes in PS were more frequent for palliative treatment (improvement 83/683, 12%; deterioration 77/683, 11%) than for radical treatment (improvement 12/305, 4%:, deterioration 21/305, 7%) because patients with better performance status and early disease stages underwent radical treatment. For radical radiotherapy, patients with advanced disease (stages III and IV) showed more changes (improvement 4/108, 4%; deterioration 17/108, 16%) than those with early ones (stages I and II) (improvement 7/132, 5%; deterioration 3/132, 2%) (p<0.01). Better treatment results showed a higher treatment completion rate (CR 99%, PR 86%) than poor treatment results (NC 75%, PD 50%) (p<0.01). For palliative therapy, better performance status (PS 0-2) showed a better correlation with completion of treatment (403/451 or 89%) than did poor performance status (PS 3-4) (174/232, 75%) (p<0.01). Age is not a limiting factor for external radiation therapy. Poor performance status is a significant predisposing factor for interruption of palliative radiotherapy. (author)

  13. Managing patient safety through NPSGs and employee performance.

    Science.gov (United States)

    Adair, Liberty

    2010-01-01

    Patient safety can only exist in a culture of patient safety, which implies it is a value perceived by all. Culture predicts safety outcomes and leadership predicts the culture. Leaders are obligated to continually mitigate hazard and take action consciously. Healthcare workers should focus on preventing and reporting mistakes with the National Patient Safety Goals (NPSGs) in mind. These include: accuracy of patient identification, effectiveness of communication among caregivers, improving safety of medications, reducing infections, reducing risk of falls, and encouraging patients to be involved in care. Poor performers and reckless behavior need to be mitigated. If employees recognize their roles in the process, feel empowered,and have appropriate tools, resources,and data to implement solutions, errors can be avoided and patient safety becomes paramount.

  14. Cooling improves the writing performance of patients with writer's cramp.

    Science.gov (United States)

    Pohl, Christoph; Happe, Jörg; Klockgether, Thomas

    2002-11-01

    Cooling of hand and forearm muscles by immersion in 15 degrees C cold water for 5 minutes improved the writing performance of patients with writer's cramp. Since abnormal processing of muscle spindle afferent discharges contributes to the pathology of writer's cramp, this effect might result from a reduction in muscle spindle activity by lowering muscle temperature. Cooling is a simple, cheap, and safe procedure, providing temporary relief for patients with writer's cramp. Copyright 2002 Movement Disorder Society

  15. Improved Functional Performance in Geriatric Patients During Hospital Stay

    DEFF Research Database (Denmark)

    Karlsen, Anders; Loeb, Mads Rohde; Andersen, Kristine Bramsen

    2017-01-01

    OBJECTIVE: The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients. DESIGN: This was a prospective observational study in elderly medical patients of age 65 years or older at a geriatric department.Measurement......OBJECTIVE: The aim of this work was to evaluate the time course of changes in strength and functional performance in elderly hospitalized medical patients. DESIGN: This was a prospective observational study in elderly medical patients of age 65 years or older at a geriatric department.......Measurements were obtained on days 2 to 4, day 5 to 8, and days 9 to 13. Functional performance was measured with De Morton Mobility Index (DEMMI) test and a 30-second chair stand test (30-s CST). Muscular strength was measured with handgrip strength. Activity level was determined with accelerometry (Activ...... in 30-s CST (P performance of the lower extremities in geriatric patients improves moderately over the time of a hospital stay...

  16. Neuropsychological performance in patients with asymptomatic HIV-1 infection.

    Science.gov (United States)

    Martínez-Banfi, Martha; Vélez, Jorge I; Perea, M Victoria; García, Ricardo; Puentes-Rozo, Pedro J; Mebarak Chams, Moises; Ladera, Valentina

    2018-05-01

    Human immunodeficiency virus (HIV-1) infection and acquired immunodeficiency syndrome (AIDS) lead to neurocognitive disorders; however, there is still much knowledge to be gained regarding HIV-associated neurocognitive disorders. The purpose of this study was to assess the cognitive performance, instrumental activities of daily living, depression, and anxiety in patients with asymptomatic HIV-1 infections compared with seronegative participants without neurocognitive impairment. We studied a sample consisted of 60 patients with asymptomatic HIV-1 infections and 60 seronegative participants without neurocognitive impairment from the city of Barranquilla, Colombia, with a mean age of 36.07 years. A protocol of neuropsychological and psychopathological tests was applied to the participants. The group of patients with asymptomatic HIV infections significantly underperformed on tasks that assessed global cognitive screening, attention span, learning, phonemic verbal fluency, auditory-verbal comprehension, information processing speed, cognitive flexibility, and motor skills compared to the group of seronegative participants. No significant differences were found in memory, visual confrontation naming, vocabulary, inhibition, and instrumental activities of daily living. Additionally, the patients with asymptomatic HIV-1 infection had a higher anxiety index than the seronegative participants, but no significant difference was found in depression. A correlation was found between depression and anxiety. In conclusion, the patients with asymptomatic HIV-1 infection had lower cognitive performances than the seronegative participants in the cognitive functions mentioned above and more anxiety but still performed the instrumental activities of daily living.

  17. Applying importance-performance analysis to patient safety culture.

    Science.gov (United States)

    Lee, Yii-Ching; Wu, Hsin-Hung; Hsieh, Wan-Lin; Weng, Shao-Jen; Hsieh, Liang-Po; Huang, Chih-Hsuan

    2015-01-01

    The Sexton et al.'s (2006) safety attitudes questionnaire (SAQ) has been widely used to assess staff's attitudes towards patient safety in healthcare organizations. However, to date there have been few studies that discuss the perceptions of patient safety both from hospital staff and upper management. The purpose of this paper is to improve and to develop better strategies regarding patient safety in healthcare organizations. The Chinese version of SAQ based on the Taiwan Joint Commission on Hospital Accreditation is used to evaluate the perceptions of hospital staff. The current study then lies in applying importance-performance analysis technique to identify the major strengths and weaknesses of the safety culture. The results show that teamwork climate, safety climate, job satisfaction, stress recognition and working conditions are major strengths and should be maintained in order to provide a better patient safety culture. On the contrary, perceptions of management and hospital handoffs and transitions are important weaknesses and should be improved immediately. Research limitations/implications - The research is restricted in generalizability. The assessment of hospital staff in patient safety culture is physicians and registered nurses. It would be interesting to further evaluate other staff's (e.g. technicians, pharmacists and others) opinions regarding patient safety culture in the hospital. Few studies have clearly evaluated the perceptions of healthcare organization management regarding patient safety culture. Healthcare managers enable to take more effective actions to improve the level of patient safety by investigating key characteristics (either strengths or weaknesses) that healthcare organizations should focus on.

  18. Aphysiologic performance on dynamic posturography in work-related patients.

    Science.gov (United States)

    Larrosa, F; Durà, M J; Menacho, J; González-Sabaté, L; Cordón, A; Hernández, A; García-Ibáñez, L

    2013-01-01

    It has been suggested that malingering should be suspected in patients suffering from dizziness or imbalance and who had a potential gain associated with insurance and worker's compensation claims. This study aimed to assess and compare the prevalence of aphysiologic performance on computerized dynamic posturography (CDP) in patients with the potential for secondary gain using a retrospective review of two groups of patients: work-related patients referred for dizziness and/or imbalance (Group 1) were compared against a group of patients with complaints of dizziness or imbalance, who had no history of work-related injury, or litigation procedures (Group 2). CDP and videonystagmography (VNG) were carried out in all patients. The Sensory Organization Test summaries were scored as normal, aphysiologic, or vestibular using the scoring method published by Cevette et al. in Otolaryngol Head Neck Surg 112:676-688 (1995). 24 out of 88 (27%) patients had aphysiologic CDP in Group 1 and 9 out of 51 (18%) in Group 2 but these differences were not significant (p > 0.05). Definite signs of vestibular dysfunction were found in 12 out of 24 (50%) of patients with aphysiologic performance in Group 1 although the presence of VNG abnormalities was significantly higher (p = 0.005) in Group 2. The hypothesis that the occupational group could show a significantly higher rate of aphysiologic results than a control group is not confirmed. Furthermore, VNG abnormalities were found in 50% of the work-related cases with non organic sway patterns. These results suggest that patient's complaints should be considered genuine in work-related cases and due caution exercised when evaluating aphysiologic CDP patterns.

  19. Effects Of Drought Stress on Germination in Fourteen Provenances of Pinus Brutia Ten. Seeds in Turkey

    Directory of Open Access Journals (Sweden)

    Hakan Şevik

    2015-02-01

    Full Text Available Pinus brutia Ten., Red pine, known to be tough drought resistant pine specie, could effectively be used for afforestation of disturbed areas. It is of great interest for the afforestation in arid zones. Appropriate seed sources for the specific areas guarantees reforestation success. Away from its native areas Pinus brutia Ten. is planted for its ornamental value and timber production purposes. Selection of drought resistant provenances can very well increase the survival success. In this study, the effects of water potential on germination were studied in fourteen provenances of Pinus brutia Ten. from Turkey. Water potentials between 0 and -8 bars were obtained using polyethylene glycol 6000 (PEG-6000 solutions. Seeds were kept for 35 day at 20 ± 0.5°C. A decrease in water potential produced a marked reduction in germination percentage and germination value. As a result, significant variations between the provenances were found. It was determined that, under a -8 bar water stress, Isparta-Bucak and Mersin-Silifke, respectively corresponding to 58% and 57% of the control group, were the least water stress affected provenances.

  20. Fourteen lessons learned from the successful nuclear power program of the Republic of Korea

    International Nuclear Information System (INIS)

    Choi, Sungyeol; Jun, Eunju; Hwang, IlSoon; Starz, Anne; Mazour, Tom; Chang, SoonHeung; Burkart, Alex R.

    2009-01-01

    This paper summarized a development history and lessons of Korean nuclear power infrastructures from the beginning of the nuclear power program in 1956 to the localization of complete scope of PWR technology in 1990. The objective of this paper is to show the guideline on the issues that the development of a national infrastructure for nuclear power using the realistic experiences in order to help the developing countries newly starting nuclear power program as a long-term energy supply option. Development strategies and lessons learned from the successful Korean experience have been presented based on milestones structure of IAEA in order to help decision makers, advisers, senior managers and national planners of nuclear power program. Lessons for national nuclear power programs include considerations before launching a program, preparation and decision making, and the construction of the first nuclear power plant. Scope of these lessons includes knowledge and human resources management, financial and industrial infrastructure development, nuclear safety, legislative and regulatory experiences, fuel cycle and waste management, international cooperation. Fourteen lessons learned either positive or not are derived from the Korean case and are suggested for incorporation in the IAEA's efforts in support of developing countries' development of nuclear infrastructure and planning.

  1. Patient Satisfaction at America’s Lowest Performing Hospitals

    Science.gov (United States)

    Girotra, Saket; Cram, Peter; Popescu, Ioana

    2012-01-01

    BACKGROUND Previous studies have identified hospitals with poor performance on cardiac process measures. How these hospitals fare in other domains such as patient satisfaction remains unknown. METHODS We used Hospital Compare data to identify hospitals that reported acute myocardial infarction (AMI) and heart failure (HF) process measures for 2006–2008 and calculated respective composite performance scores. Using these scores, we classified hospitals as low-performing (bottom decile for all three years), top-performing (top decile for all three years), and intermediate (all others). We used Hospital Consumer Assessment of Healthcare Providers and Systems 2008 data to compare overall satisfaction between low, intermediate, and top-performing hospitals. RESULTS Low-performing hospitals had fewer beds, fewer nurses per-patient, and were more likely rural, safety-net hospitals located in the South, compared to intermediate and top-performing hospitals (Ppatient satisfaction (kappa statisticpatient satisfaction on average suggesting that these hospitals have overall poor quality of care. However, there is discordance between the two measures in profiling hospital quality. PMID:22496113

  2. Metrics for Performance Evaluation of Patient Exercises during Physical Therapy.

    Science.gov (United States)

    Vakanski, Aleksandar; Ferguson, Jake M; Lee, Stephen

    2017-06-01

    The article proposes a set of metrics for evaluation of patient performance in physical therapy exercises. Taxonomy is employed that classifies the metrics into quantitative and qualitative categories, based on the level of abstraction of the captured motion sequences. Further, the quantitative metrics are classified into model-less and model-based metrics, in reference to whether the evaluation employs the raw measurements of patient performed motions, or whether the evaluation is based on a mathematical model of the motions. The reviewed metrics include root-mean square distance, Kullback Leibler divergence, log-likelihood, heuristic consistency, Fugl-Meyer Assessment, and similar. The metrics are evaluated for a set of five human motions captured with a Kinect sensor. The metrics can potentially be integrated into a system that employs machine learning for modelling and assessment of the consistency of patient performance in home-based therapy setting. Automated performance evaluation can overcome the inherent subjectivity in human performed therapy assessment, and it can increase the adherence to prescribed therapy plans, and reduce healthcare costs.

  3. Evaluation of biol`s effect on fourteen accession of native potato (Solanum ssp. at the experimental station kallutaca

    Directory of Open Access Journals (Sweden)

    Condori-Mamani Pastor

    2017-05-01

    Full Text Available In Bolivia the productive potato regions, you characterize for an extensive agriculture in blankets (of traditional form, of car subsistence and not much diversified, the little properties for the cultivation of potato possess the greater part of the productive, and they locate at little plots of land that annually they go rotating. The present research work has the objective to make a comparison and to characterize fourteen accessions of native potato of germoplasma's collection, of Agronomic Ingeniería's race, (UPEA. The study carried completion at Kallutaca's experiment station itself, becoming established on the basis of a Design Bloques Complete at random (DBCA with three repetitions each accession, the second factor is diligent biol's dose, considered himself like a stimulant compound fito, for cultivations, where increments in the capability of photosynthesis and the production allow principal. Whose moral values place between 2.0 2.6% themselves (% in dry material and that they yielded 3.3 %'s concentration of total N to 3.7%. The analysis of microcomputer Hierro's (132 ppm, Manganeso's, Cobre's and Zinc's presence with 12.1 and 6 ppm detected nutrient in the obtained effluent. Accessions Pole, Sacampaya, Sani imilla, Janq'o, collide, Runic Bola, Q'aysalla and Laramq'aysa had bigger development, the same the remainders have bigger performances they did not have the same incidence. This answer is due to a positive effect of the biol on the performance of tubers in accordance with dose of diligent biol the accessions of native potato where 1 with the application of dose of 25 % of Biol obtained to 10 t.h-1 an equivalent yield.

  4. Factors influencing obstacle crossing performance in patients with Parkinson's disease.

    Directory of Open Access Journals (Sweden)

    Ying-Yi Liao

    Full Text Available BACKGROUND: Tripping over obstacles is the major cause of falls in community-dwelling patients with Parkinson's disease (PD. Understanding the factors associated with the obstacle crossing behavior may help to develop possible training programs for crossing performance. This study aimed to identify the relationships and important factors determining obstacle crossing performance in patients with PD. METHODS: Forty-two idiopathic patients with PD (Hoehn and Yahr stages I to III participated in this study. Obstacle crossing performance was recorded by the Liberty system, a three-dimensional motion capture device. Maximal isometric strength of the lower extremity was measured by a handheld dynamometer. Dynamic balance and sensory integration ability were assessed using the Balance Master system. Movement velocity (MV, maximal excursion (ME, and directional control (DC were obtained during the limits of stability test to quantify dynamic balance. The sum of sensory organization test (SOT scores was used to quantify sensory organization ability. RESULTS: Both crossing stride length and stride velocity correlated significantly with lower extremity muscle strength, dynamic balance control (forward and sideward, and sum of SOT scores. From the regression model, forward DC and ankle dorsiflexor strength were identified as two major determinants for crossing performance (R(2 = .37 to.41 for the crossing stride length, R(2 = .43 to.44 for the crossing stride velocity. CONCLUSIONS: Lower extremity muscle strength, dynamic balance control and sensory integration ability significantly influence obstacle crossing performance. We suggest an emphasis on muscle strengthening exercises (especially ankle dorsiflexors, balance training (especially forward DC, and sensory integration training to improve obstacle crossing performance in patients with PD.

  5. Pattern of neuropsychological performance among HIV positive patients in Uganda

    Directory of Open Access Journals (Sweden)

    Parsons Thomas D

    2007-04-01

    Full Text Available Abstract Background Few studies have examined cognitive functioning of HIV positive patients in sub-Saharan Africa. It cannot be assumed that HIV positive patients in Africa exhibit the same declines as patients in high-resource settings, since there are differences that may influence cognitive functioning including nutrition, history of concomitant disease, and varying HIV strains, among other possibilities. Part of the difficulty of specifying abnormalities in neuropsychological functioning among African HIV positive patients is that there are no readily available African normative databases. The purpose of the current study was to evaluate the pattern of neuropsychological performance in a sample of HIV positive patients in comparison to HIV negative control subjects in Uganda. Methods The neuropsychological test scores of 110 HIV positive patients (WHO Stage 2, n = 21; WHO Stage 3, n = 69; WHO Stage 4, n = 20 were contrasted with those of 100 control subjects on measures of attention/concentration, mental flexibility, learning/memory, and motor functioning. Results Analysis of covariance (ANCOVA revealed significant group differences on measures of verbal learning and memory, speed of processing, attention and executive functioning between HIV seropositive and seronegative subjects. Conclusion Ugandan patients with HIV demonstrated relative deficits on measures of verbal learning and memory, speed of processing, attention, and executive functioning compared to HIV negative controls. These results from a resource limited region where clades A and D are prevalent are consistent with previous findings in the developed world where clade B predominates.

  6. Comorbidity and performance status in acute myeloid leukemia patients

    DEFF Research Database (Denmark)

    Ostgård, L S G; Nørgaard, J M; Sengeløv, H

    2015-01-01

    As the world population ages, the comorbidity burden in acute myeloid leukemia (AML) patients increases. Evidence on how to integrate comorbidity measures into clinical decision-making is sparse. We determined the prognostic impact of comorbidity and World Health Organization Performance Status (PS...... with an increased short- and long-term mortality (adjusted 90 day MR, PS⩾2=3.43 (95%CI=2.30-5.13); adjusted 91 day-3 year MR=1.35 (95%CI=1.06-1.74)). We propose that more patients with comorbidity may benefit from intensive chemotherapy.Leukemia advance online publication, 2 September 2014; doi:10.1038/leu.2014.234....

  7. Differences in finger localisation performance of patients with finger agnosia.

    Science.gov (United States)

    Anema, Helen A; Kessels, Roy P C; de Haan, Edward H F; Kappelle, L Jaap; Leijten, Frans S; van Zandvoort, Martine J E; Dijkerman, H Chris

    2008-09-17

    Several neuropsychological studies have suggested parallel processing of somatosensory input when localising a tactile stimulus on one's own by pointing towards it (body schema) and when localising this touched location by pointing to it on a map of a hand (body image). Usually these reports describe patients with impaired detection, but intact sensorimotor localisation. This study examined three patients with a lesion of the angular gyrus with intact somatosensory processing, but with selectively disturbed finger identification (finger agnosia). These patients performed normally when pointing towards the touched finger on their own hand but failed to indicate this finger on a drawing of a hand or to name it. Similar defects in the perception of other body parts were not observed. The findings provide converging evidence for the dissociation between body image and body schema and, more importantly, reveal for the first time that this distinction is also present in higher-order cognitive processes selectively for the fingers.

  8. Exercise performance during captopril and atenolol treatment in hypertensive patients.

    OpenAIRE

    Van Baak, M A; Koene, F M; Verstappen, F T; Tan, E S

    1991-01-01

    1. Maximal aerobic exercise capacity, submaximal endurance exercise performance, and exercise haemodynamics have been studied in sixteen patients with mild to moderate essential hypertension during treatment with captopril and atenolol. 2. Administration of atenolol (1 x 100 mg day-1) or captopril (1 x 100 mg day-1) for 6 weeks resulted in similar supine and erect systolic and diastolic blood pressures. Heart rate was significantly lower during atenolol treatment. 3. Exercise heart rate and s...

  9. Performance of the "CCS Algorithm" in real world patients.

    Science.gov (United States)

    LaHaye, Stephen A; Olesen, Jonas B; Lacombe, Shawn P

    2015-06-01

    With the publication of the 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation, the Canadian Cardiovascular Society Atrial Fibrillation Guidelines Committee has introduced a new triage and management algorithm; the so-called "CCS Algorithm". The CCS Algorithm is based upon expert opinion of the best available evidence; however, the CCS Algorithm has not yet been validated. Accordingly, the purpose of this study is to evaluate the performance of the CCS Algorithm in a cohort of real world patients. We compared the CCS Algorithm with the European Society of Cardiology (ESC) Algorithm in 172 hospital inpatients who are at risk of stroke due to non-valvular atrial fibrillation in whom anticoagulant therapy was being considered. The CCS Algorithm and the ESC Algorithm were concordant in 170/172 patients (99% of the time). There were two patients (1%) with vascular disease, but no other thromboembolic risk factors, which were classified as requiring oral anticoagulant therapy using the ESC Algorithm, but for whom ASA was recommended by the CCS Algorithm. The CCS Algorithm appears to be unnecessarily complicated in so far as it does not appear to provide any additional discriminatory value above and beyond the use of the ESC Algorithm, and its use could result in under treatment of patients, specifically female patients with vascular disease, whose real risk of stroke has been understated by the Guidelines.

  10. Neurocognitive performance in unmedicated patients with hoarding disorder.

    Science.gov (United States)

    Sumner, Jennifer M; Noack, Carolyn G; Filoteo, J Vincent; Maddox, W Todd; Saxena, Sanjaya

    2016-02-01

    Hoarding disorder (HD) is an often incapacitating psychiatric illness associated with a wide range of neurocognitive abnormalities. Some prior neuropsychological studies have found executive dysfunction in HD, but no clear pattern has emerged. One potential reason for discrepant results in previous studies might be the inclusion of patients on psychotropic and other medications that can affect neurocognitive performance. Therefore, we examined neurocognitive functioning in medication-free HD patients. We also added a novel investigation of implicit learning, which has been found to be abnormal in obsessive-compulsive disorder (OCD) and related disorders. Twenty-six participants meeting the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) diagnostic criteria for HD and 23 normal controls were administered a battery of neuropsychological tests and symptom rating scales. All participants were free of psychotropic medications for at least 6 weeks prior to the study. HD participants showed no significant differences from normal controls on measures of verbal memory, attention, or executive functioning, including response inhibition, planning, organization, and decision making. However, HD participants demonstrated a trend toward less implicit learning and greater use of explicit learning strategies during perceptual categorization compared to normal controls. HD participants who used an implicit strategy performed significantly worse than controls who used an implicit strategy. Hoarding symptom severity was not associated with neurocognitive performance. HD patients may have a tendency to use explicit rather than implicit learning strategies for perceptual categorization but perform as well as normal controls on many other neurocognitive measures. Future studies should assess unmedicated participants and examine test strategies, not just outcomes. PsycINFO Database Record (c) 2016 APA, all rights reserved.

  11. Guidelines for patient selection and performance of carotid artery stenting.

    Science.gov (United States)

    Bladin, Christopher; Chambers, Brian; New, Gishel; Denton, Michael; Lawrence-Brown, Michael

    2010-06-01

    The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy remains the benchmark in terms of procedural mortality and morbidity. At present, there are no consensus Australasian guidelines for the safe performance of CAS. We applied a modified Delphi consensus method of iterative consultation between the College representatives on the Carotid Stenting Guidelines Committee (CSGC). Selection of patients suitable for CAS needs careful consideration of clinical and patho-anatomical criteria and cannot be directly extrapolated from clinical indicators for carotid endarterectomy (CEA). Randomized controlled trials (including pooled analyses of results) comparing CAS with CEA for treatment of symptomatic stenosis have demonstrated that CAS is more hazardous than CEA. On current evidence, the CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. The evidence for CAS in patients with symptomatic severe carotid stenosis who are considered medically high risk is weak, and there is currently no evidence to support CAS as a treatment for asymptomatic carotid stenosis. The use of distal protection devices during CAS remains controversial with increased risk of clinically silent stroke. The knowledge requirements for the safe performance of CAS include an understanding of the evidence base from randomized controlled trials, carotid and aortic arch anatomy and pathology, clinical stroke syndromes, the differing treatment options for stroke and carotid atherosclerosis, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre-procedural neuro-imaging and an independent, standardized neurological assessment before and after the procedure. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and

  12. Sex differences of troponin test performance in chest pain patients.

    Science.gov (United States)

    Slagman, Anna; Searle, Julia; Vollert, Jörn O; Storchmann, Harald; Büschenfelde, Dirk Meyer Zum; von Recum, Johannes; Vlasny, Daniela; Ale-Abaei, Angela; Koch, Matthias; Müller, Christian; Müller, Reinhold; Somasundaram, Rajan; Möckel, Martin

    2015-01-01

    Current guidelines recommend troponin as the preferred biomarker to diagnose acute myocardial infarction (AMI) irrespective of the patient's sex. Recent reports have shown that sex-specific cut-offs should be considered but studies investigating sex-differences in the diagnostic accuracy of cardiac troponins are sparse. To evaluate whether the diagnostic performance of cardiac troponin at admission (cTn) under routine conditions is influenced by patient's sex. Between 15th of February 2009 and 15th of February 2010, women (n=1648) and men (n=2305) who presented to the emergency department with chest pain (n=3954) were enrolled. The diagnostic performance of the routine, contemporary sensitive cTn assays (TnI; Stratus® CS, Siemens and TnT; Roche Diagnostics) at baseline for the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) was analyzed. NSTEMI was diagnosed in 7.3% (n=287) of all patients. Men were more likely to be diagnosed with NSTEMI (8.8%; n=202) as compared to women (5.2%; n=85; psex, with a lower sensitivity and NPV in women. The definition and implementation of sex-specific cut-off values for cTn into clinical routine seems to be highly recommendable. Copyright © 2015. Published by Elsevier Ireland Ltd.

  13. Commitment to COT verification improves patient outcomes and financial performance.

    Science.gov (United States)

    Maggio, Paul M; Brundage, Susan I; Hernandez-Boussard, Tina; Spain, David A

    2009-07-01

    After an unsuccessful American College of Surgery Committee on Trauma visit, our level I trauma center initiated an improvement program that included (1) hiring new personnel (trauma director and surgeons, nurse coordinator, orthopedic trauma surgeon, and registry staff), (2) correcting deficiencies in trauma quality assurance and process improvement programs, and (3) development of an outreach program. Subsequently, our trauma center had two successful verifications. We examined the longitudinal effects of these efforts on volume, patient outcomes and finances. The Trauma Registry was used to derive data for all trauma patients evaluated in the emergency department from 2001 to 2007. Clinical data analyzed included number of admissions, interfacility transfers, injury severity scores (ISS), length of stay, and mortality for 2001 to 2007. Financial performance was assessed for fiscal years 2001 to 2007. Data were divided into patients discharged from the emergency department and those admitted to the hospital. Admissions increased 30%, representing a 7.6% annual increase (p = 0.004), mostly due to a nearly fivefold increase in interfacility transfers. Severe trauma patients (ISS >24) increased 106% and mortality rate for ISS >24 decreased by 47% to almost half the average of the National Trauma Database. There was a 78% increase in revenue and a sustained increase in hospital profitability. A major hospital commitment to Committee on Trauma verification had several salient outcomes; increased admissions, interfacility transfers, and acuity. Despite more seriously injured patients, there has been a major, sustained reduction in mortality and a trend toward decreased intensive care unit length of stay. This resulted in a substantial increase in contribution to margin (CTM), net profit, and revenues. With a high level of commitment and favorable payer mix, trauma center verification improves outcomes for both patients and the hospital.

  14. Intentional Weight Loss Improved Performance in Obese Ischaemic Heart Patient

    DEFF Research Database (Denmark)

    Geiker, Nina; Myint, Khin Swe; Heck, Patrick

    2014-01-01

    Aims: The risk of heart failure (HF) increases with BMI, but paradoxically obesity has been associated with reduced mortality in patients with HF. The effect of intentional or therapeutic weight loss on HF is not well known. We examined the effect of weight loss induced by low energy diet (LED......) on physical performance and cardiovascular risk factors in obese patients with moderate-to-severe HF and/or ischaemic heart disease (IHD). Methods and Results: Results from two weight loss interventions at two centres, one in Denmark (DK - 12 week intervention in 21 subjects (14 LED, 7 controls)) and one.......1 in the intervention group versus -22.1% ± 25.6 in the control group (P=0.000). Treatment also improved triglycerides (P=0.000), very low lipoprotein (P=0.001) and C-reactive protein (P=0.010). Conclusion: Weight loss induced by LED in obese patients with moderate-to-severe HF or IHD resulted in clinically significant...

  15. Guidance for laboratories performing molecular pathology for cancer patients

    Science.gov (United States)

    Cree, Ian A; Deans, Zandra; Ligtenberg, Marjolijn J L; Normanno, Nicola; Edsjö, Anders; Rouleau, Etienne; Solé, Francesc; Thunnissen, Erik; Timens, Wim; Schuuring, Ed; Dequeker, Elisabeth; Murray, Samuel; Dietel, Manfred; Groenen, Patricia; Van Krieken, J Han

    2014-01-01

    Molecular testing is becoming an important part of the diagnosis of any patient with cancer. The challenge to laboratories is to meet this need, using reliable methods and processes to ensure that patients receive a timely and accurate report on which their treatment will be based. The aim of this paper is to provide minimum requirements for the management of molecular pathology laboratories. This general guidance should be augmented by the specific guidance available for different tumour types and tests. Preanalytical considerations are important, and careful consideration of the way in which specimens are obtained and reach the laboratory is necessary. Sample receipt and handling follow standard operating procedures, but some alterations may be necessary if molecular testing is to be performed, for instance to control tissue fixation. DNA and RNA extraction can be standardised and should be checked for quality and quantity of output on a regular basis. The choice of analytical method(s) depends on clinical requirements, desired turnaround time, and expertise available. Internal quality control, regular internal audit of the whole testing process, laboratory accreditation, and continual participation in external quality assessment schemes are prerequisites for delivery of a reliable service. A molecular pathology report should accurately convey the information the clinician needs to treat the patient with sufficient information to allow for correct interpretation of the result. Molecular pathology is developing rapidly, and further detailed evidence-based recommendations are required for many of the topics covered here. PMID:25012948

  16. Integrating patient satisfaction into performance measurement to meet improvement challenges.

    Science.gov (United States)

    Smith, J E; Fisher, D L; Endorf-Olson, J J

    2000-05-01

    A Value Compass has been proposed to guide health care data collection. The "compass corners" represent the four types of data needed to meet health care customer expectations: appropriate clinical outcomes, improved functional status, patient satisfaction, and appropriate costs. Collection of all four types of data is necessary to select processes in need of improvement, guide improvement teams, and monitor the success of improvement efforts. INTEGRATED DATA AT BRYANLGH: BryanLGH Medical Center in Lincoln, Nebraska, has adopted multiple performance measurement systems to collect clinical outcome, financial, and patient satisfaction data into integrated databases. Data integration allows quality professionals at BryanLGH to identify quality issues from multiple perspectives and track the interrelated effects of improvement efforts. A CASE EXAMPLE: Data from the fourth quarter of 1997 indicated the need to improve processes related to cesarean section (C-section) deliveries. An interdisciplinary team was formed, which focused on educating nurses, physicians, and the community about labor support measures. Physicians were given their own rates of C-section deliveries. The C-section rate decreased from 27% to 19%, but per-case cost increased. PickerPLUS+ results indicated that BryanLGH obstetric patients reported fewer problems with receiving information than the Picker norm, but they reported more problems with the involvement of family members and friends. The data collected so far have indicated a decrease in the C-section rate and a need to continue to work on cost and psychosocial issues. A complete analysis of results was facilitated by integrated performance management systems. Successes have been easily tracked over time, and the need for further work on related processes has been clearly identified.

  17. Ventricular emptying performance in patients with tetralogy of Fallot

    International Nuclear Information System (INIS)

    Takeda, Kan; Maeda, Hisato; Nakagawa, Tsuyoshi; Ito, Tsunao; Yamaguchi, Nobuo; Matsuda, Akira

    1989-01-01

    Comparison of emptying patterns between left and right ventricles (LV, RV) was performed with Fourier analysis of gated blood-pool data in patients with tetralogy of Fallot (TF). Using global time-activity curves, the phase and amplitude at the first-harmonic component of Fourier series were calculated and emptying patterns of both ventricles were evaluated by phase difference {D(phase)=RV phase minus LV phase} and RV/LV amplitude ratio {R(amp)}. In 20 patients with normal cardiac function, D(phase) was minimal (mean 2.0±6.6 degrees) and R(amp) was less than 1.0 (mean 0.60±0.19). In 11 patients with TF, D(phase) was significantly larger than normal, with a mean value of 24.3±10.0 degrees (p<0.01) and became greater in a reversed proportion to the ratio of the pulmonary-to-systemic blood flow (p<0.01). In all but one cases with TF, R(amp) was greater than 1.0 with a mean value of 1.4±0.4, significantly larger than normal (p<0.001). Furthermore, using time-activity curves approximated by terms up to the 3rd-harmonic component, the temporal difference in emptying patterns between both ventricles was investigated. In TF cases, the time from end-diastole to minimum count (T2) was significantly larger in RV than in LV (p<0.001). The elongated T2 interval of RV seemed to play an important role in producing RV phase lag. Thus, this non-invasive method is valuable for pathophysiologic investigation of patients with TF and can be of help in estimating the severity of their disease. (author)

  18. Semiclosed thromboendoarterectomy on femoro-popliteal tract revisited after a fourteen years experience on 595 cases.

    Science.gov (United States)

    Vercellio, G; Castelli, P; Coletti, M; Carlesi, R; Agrifoglio, G

    1986-01-01

    In the seventies atherosclerotic femoropopliteal lesions were extensively treated by means of retrograde semiclosed thromboendarterectomy (FP-TEA) an analytic follow-up of cases, until 1980, induced the modification of the indications to FP-TEA. Currently the FP-TEA technique is only employed for patients at the 2nd Fontaine's stage with disabling claudication (generally less than 100 mt) with a good distal run-off (at least 2 tibial vessels patent). The report deals with a series of 595 cases operated in the period January 1971-December 1984. In 45% of cases FP-TEA was associated with a proximal revascularization. In an attempt to focus on the factors that may influence the outcome, the patients operated in 1976, 1980, 1984, were assessed and the results related to clinical stage, angiographic pattern and postoperative treatment.

  19. Constructing a Patient Education System: A Performance Technology Project

    Science.gov (United States)

    Bell, Edith E.

    2009-01-01

    The purpose of the patient education system described here was to distribute patient education material to and within medical practices managed by a small medical practice management company. The belief was that patient education opportunities improved health care outcomes and increased patient participation in health care decisions and compliance…

  20. Marine Gastrotricha of the Near East: 1. Fourteen new species of Macrodasyida and a redescription of Dactylopodola agadasys Hochberg, 2003

    Directory of Open Access Journals (Sweden)

    William Hummon

    2011-05-01

    Full Text Available The near eastern geographical region is almost devoid of reports of macrodasyidan gastrotrichs, the exceptions themselves being part of this study. Here, as Part 1 are described fourteen new Macrodasyida from countries of the Near East (Cyprus, Egypt and Israel, representing both the Mediterranean and the Red Seas, and a redescription of the previously described Dactylopodolidae: Dactylopodola agadasys Hochberg, 2002. The new species are: Cephalodasyidae (2 - Cephalodasys dolichosomus; Cephalodasys saegailus; Dactylopodolidae (1 Dendrodasys rubomarinus; Macrodasyidae (5 - Macrodasys imbricatus; Macrodasys macrurus; Macrodasys nigrocellus; Macrodasys scleracrus; Urodasys toxostylus; Thaumastodermatidae (4 - Tetranchyroderma corallium; Tetranchyroderma rhopalotum; Tetranchyroderma sinaiensis; Tetranchyroderma xenodactylum; Turbanellidae (2 - Paraturbanella levantia; Turbanella erythrothalassia - spp. n.

  1. Long-term implant performance and patients' satisfaction in oligodontia

    NARCIS (Netherlands)

    Filius, Marieke A P; Vissink, Arjan; Cune, Marco S; Raghoebar, Gerry M; Visser, Anita

    Objectives: To assess long-term (>= 10 years) implant survival, peri-implant health, patients' satisfaction and oral health related quality of life (OHQoL) in oligodontia patients rehabilitated with implant-based fixed prosthodontics. Methods: All oligodontia patients treated >= 10 years previously

  2. Thyroid Follicular Carcinoma in a Fourteen-year-old Girl with Graves' Disease.

    Science.gov (United States)

    Kojima-Ishii, Kanako; Ihara, Kenji; Ohkubo, Kazuhiro; Matsuo, Terumichi; Toda, Naoko; Yamashita, Hiroyuki; Kono, Shinji; Hara, Toshiro

    2014-04-01

    Here we present the case of a 14-yr-old girl who developed thyroid follicular carcinoma accompanied by Graves' disease. She was diagnosed with Graves' disease at 10 yr of age and soon achieved a euthyroid state after starting treatment. When she was 13 yr of age, her hyperthyroidism and goiter worsened despite medical therapy. Multiple nodules were found in her enlarged thyroid gland by ultrasonography. Her serum Tg level seemed within the normal range. She underwent near-total thyroidectomy for control of thyroid function. Histopathological study demonstrated that multiple oxyphilic follicular neoplasms were surrounded by the thyroid tissue compatible with Graves' disease. Capsular invasion was identified in one of the nodules, and thus the histological diagnosis was minimally invasive follicular carcinoma. She did not have signs suggesting metastasis, and has had no relapse for 18 mo after the operation. Although some previous studies showed a high prevalence of thyroid cancer with an aggressive nature in adult patients with Graves' disease, few reports about thyroid cancer accompanied by Graves' disease are available in children. The present case, however, suggests that careful investigation is needed when we detect thyroid nodules or progressive thyroid enlargement, especially in children with Graves' disease.

  3. Fourteen-Month-Olds Adapt Their Imitative Behavior in Light of a Model’s Constraints

    Directory of Open Access Journals (Sweden)

    Kata Gellén

    2017-01-01

    Full Text Available Rather than reenacting every action they observe, preverbal infants adapt their imitative behavior. Although previous studies have revealed the capability of preverbal infants to imitate selectively, the question about the adaptability of this behavior on an individual level did not attract considerable scientific attention until now. In the current study, we investigated whether 14-month-old infants flexibly alternate their imitative response in accordance with a model’s changing physical constraints in a body-part imitation paradigm. Participants were presented with two novel actions whereby a model illuminated a light-box and turned on a sound-box, either by using her forehead (head touch or by sitting on the apparatus (sit-touch. Each participant observed these tasks in two conditions: once where the model’s hands were occupied and once where her hands were free while executing the head or sit-touch. Participants were more likely to reenact the observed novel behavior when the model had freely chosen to perform it than when she had to do so due to physical constraints. Not only did we replicate a number of previous findings, we show here that preverbal infants adapt their imitative behavior across conditions based on the physical constraints of the model. These results point towards the adaptable nature of imitative behavior also on an individual level. This ability might be one of the building blocks for children for learning their social group’s specific action repertoire.

  4. Utilization of a virtual patient for advanced assessment of student performance in pain management.

    Science.gov (United States)

    Smith, Michael A; Waite, Laura H

    2017-09-01

    To assess student performance and achievement of course objectives following the integration of a virtual patient case designed to promote active, patient-centered learning in a required pharmacy course. DecisionSim™ (Kynectiv, Inc., Chadsford, PA), a dynamic virtual patient platform, was used to implement an interactive patient case to augment pain management material presented during a didactic session in a pharmacotherapy course. Simulation performance data were collected and analyzed. Student exam performance on pain management questions was compared to student exam performance on nearly identical questions from a prior year when a paper-based case was used instead of virtual patient technology. Students who performed well on the virtual patient case performed better on exam questions related to patient assessment (p = 0.0244), primary pharmacological therapy (p = 0.0001), and additional pharmacological therapy (p = 0.0001). Overall exam performance did not differ between the two groups. However, students with exposure to the virtual patient case demonstrated significantly better performance on higher level Bloom's Taxonomy questions that required them to create pharmacotherapy regimens (p=0.0005). Students in the previous year (exposed only to a paper patient case) performed better in calculating conversions of opioids for patients (p = 0.0001). Virtual patient technology may enhance student performance on high-level Bloom's Taxonomy examination questions. This study adds to the current literature demonstrating the value of virtual patient technology as an active-learning strategy. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. The climate of HD 189733b from fourteen transits and eclipses measured by Spitzer

    Energy Technology Data Exchange (ETDEWEB)

    Agol, E.; /Washington U., Seattle, Astron. Dept. /Santa Barbara, KITP /UC, Santa Barbara; Cowan, Nicolas B.; /Washington U., Seattle, Astron. Dept.; Knutson, Heather A.; /UC, Berkeley, Astron. Dept.; Deming, Drake; /NASA, Goddard; Steffen, Jason H.; /Fermilab; Henry, Gregory W.; /Tennessee State U.; Charbonneau, David; /Harvard-Smithsonian Ctr. Astrophys.

    2010-07-01

    We present observations of six transits and six eclipses of the transiting planet system HD 189733 taken with the Spitzer Space Telescope IRAC camera at 8 microns, as well as a re-analysis of previously published data. We use several novel techniques in our data analysis, the most important of which is a new correction for the detector 'ramp' variation with a double-exponential function which performs better and is a better physical model for this detector variation. Our main scientific findings are: (1) an upper limit on the variability of the day-side planet flux of 2.7% (68% confidence); (2) the most precise set of transit times measured for a transiting planet, with an average accuracy of 3 seconds; (3) a lack of transit-timing variations, excluding the presence of second planets in this system above 20% of the mass of Mars in low-order mean-motion resonance at 95% confidence; (4) a confirmation of the planet's phase variation, finding the night side is 64% as bright as the day side, as well as an upper limit on the night-side variability of 17% (68% confidence); (5) a better correction for stellar variability at 8 micron causing the phase function to peak 3.5 hours before secondary eclipse, confirming that the advection and radiation timescales are comparable at the 8 micron photosphere; (6) variation in the depth of transit, which possibly implies variations in the surface brightness of the portion of the star occulted by the planet, posing a fundamental limit on non-simultaneous multi-wavelength transit absorption measurements of planet atmospheres; (7) a measurement of the infrared limb-darkening of the star, which is in good agreement with stellar atmosphere models; (8) an offset in the times of secondary eclipse of 69 seconds, which is mostly accounted for by a 31 second light travel time delay and 33 second delay due to the shift of ingress and egress by the planet hot spot; this confirms that the phase variation is due to an offset hot

  6. Performance of Dutch Hospitals in the Management of Splenectomized Patients

    NARCIS (Netherlands)

    Lammers, Jolanda; Veninga, Daphne; Speelman, Peter; Hoekstra, Joost; Lombarts, Kiki

    2010-01-01

    BACKGROUND: After splenectomy, patients are at increased risk of sepsis with considerable mortality. This risk can be reduced by taking preventive measures, such as prescribing immunizations and antibiotic prophylaxis. Studies from various countries show that a substantial percentage of patients are

  7. Communication during haematological consultations; patients' preferences and professionals' performances.

    NARCIS (Netherlands)

    Bruinessen, I.R. van; Hout, L.E. van der; Weel-Baumgarten, E.M. van; Gouw, H.; Zijlstra, J.M.; Dulmen, S. van

    2016-01-01

    Many patients with haematological malignancies experience barriers in clinical communication. Reaching effective communication is of great importance as it has been linked to a range of improved patient outcomes such as satisfaction, compliance to treatment, perceived quality of life and physical

  8. Communication during haematological consultations; patients' preferences and professionals' performances

    NARCIS (Netherlands)

    Bruinessen, I.R. van; Hout, L.E. van der; Weel-Baumgarten, E.M. van; Gouw, H.; Zijlstra, J.M.; Dulmen, A.M. van

    2016-01-01

    Many patients with haematological malignancies experience barriers in clinical communication. Reaching effective communication is of great importance as it has been linked to a range of improved patient outcomes such as satisfaction, compliance to treatment, perceived quality of life and physical

  9. Guidance for laboratories performing molecular pathology for cancer patients

    NARCIS (Netherlands)

    Cree, Ian A.; Deans, Zandra; Ligtenberg, Marjolijn J. L.; Normanno, Nicola; Edsjo, Anders; Rouleau, Etienne; Sole, Francesc; Thunnissen, Erik; Timens, Wim; Schuuring, Ed; Dequeker, Elisabeth; Murray, Samuel; Dietel, Manfred; Groenen, Patricia; Van Krieken, J. Han

    2014-01-01

    Molecular testing is becoming an important part of the diagnosis of any patient with cancer. The challenge to laboratories is to meet this need, using reliable methods and processes to ensure that patients receive a timely and accurate report on which their treatment will be based. The aim of this

  10. Guidance for laboratories performing molecular pathology for cancer patients

    NARCIS (Netherlands)

    Cree, Ian A.; Deans, Zandra; Ligtenberg, Marjolijn J. L.; Normanno, Nicola; Edsjo, Anders; Rouleau, Etienne; Sole, Francesc; Thunnissen, Erik; Timens, Wim; Schuuring, Ed; Dequeker, Elisabeth; Murray, Samuel; Dietel, Manfred; Groenen, Patricia; Van Krieken, J. Han

    Molecular testing is becoming an important part of the diagnosis of any patient with cancer. The challenge to laboratories is to meet this need, using reliable methods and processes to ensure that patients receive a timely and accurate report on which their treatment will be based. The aim of this

  11. Association between time of pay-for-performance for patients and community health services use by chronic patients.

    Directory of Open Access Journals (Sweden)

    Xi Sun

    Full Text Available BACKGROUND: Pay-for-performance for patients is a cost-effective means of improving health behaviours. This study examined the association between the pay time for performance for patients and CHS use by chronic patients. METHODS: A cross-sectional study was undertaken to estimate distribution characteristics of CHS use in 2011 and collect data of socio-demographic characteristics (sex, age, education level, occupation, disposable personal income in 2011, distance between home and community health agency, chronic disease number, and time of pay-for-performance for patients. Participants were 889 rural adults with hypertension or type II diabetes aged 35 and above. Standardized CHS use means chronic patients use CHS at least once per quarter. RESULTS: Patients who received incentives prior to services had 2.724 times greater odds of using standardized CHS than those who received incentives after services (95%CI, 1.986-3.736, P<0.001. For all subgroups (socio-demographic characteristics and chronic disease number, patients who received incentives prior to services were more likely to use standardized CHS than those receiving incentives after services. CONCLUSIONS: Pay time for performance for patients was associated with CHS use by chronic patients. Patients receiving incentive prior to services were more likely to use standardized CHS. And pay time should not be ignored when the policy on pay-for-performance for patients is designed.

  12. Cognitive performance on Piagetian tasks by Alzheimer's disease patients.

    Science.gov (United States)

    Thornbury, J M

    1992-02-01

    The purpose of this study was to examine cognitive abilities in Alzheimer's disease (AD) patients using Piaget's child developmental theory. Thirty elderly AD patients and 30 elderly control subjects were given two traditional Piagetian measures, the Infant Psychological Development Scale and the Concrete Operations Test. Half of the AD subjects (15) were in Piaget's sensorimotor or preoperational stages, while the remaining half of the AD subjects and all elderly control subjects were in Piaget's concrete operational stage, chi 2 [1, N = 60] = 17.42, p less than .001. If subsequent studies confirm that AD patients' cognitive characteristics are similar to Piaget's theoretical model, nursing care might be individualized based on mental competence, thus minimizing the commonly observed caregiver overestimation and underestimation of the AD patient's ability to understand and cooperate.

  13. [Analysis of fourteen French national programmes on physical activity and sports as determinants of health from 2001 to 2006].

    Science.gov (United States)

    Bréchat, Pierre-Henri; Vogel, Thomas; Berthel, Marc; Kaltenbach, Georges; Le Divenah, Aude; Segouin, Christophe; Rymer, Roland; Lonsdorfer, Jean

    2009-01-01

    Physical activity and sports are considered as one of the determinants of health. The aim of this study is to review the rationale for the formulation of this public health issue and its integration in national action plans. The study shows that fourteen national programmes were drafted and implemented between 2001 and 2006 by seven institutions. The research methodology was based on crossing data obtained from semi-directed interviews and documents regarding the design, implementation and follow-up of these programmes. For the conditions of the success, the fourteen actions scored an average of 175.0 +/- 66.9 out of 300%. Public health actors and professionals must be given more opportunities to involve themselves and engage in developing stronger relationships and linkages, in particular with the institutional and community settings. In general, the most invested parts of a programme are the structural and operational aspects of activities. Six significant points surfaced from the study: consideration of drug use as an addictive behaviour; recognition of the psychological stress of professional athletes; acknowledgment of youth as being at high risk for doping behaviour; integration of the concept that physical activity and sports must take the benefit/risk perspective into account; and the necessity to promote health. Through the exchange of numerous local and regional experiences, an optimisation of their synergistic connections was made possible on a continuum extending from "health promotion through physical activity and sports" to "prevention of drug-use and doping behaviours". Professionals have been able to develop actions in the above-mentioned domains across this continuum that have, to date, remained isolated. Proposals are made to strengthen these dynamics. Other health determinants and public health priorities could be investigated with the same methodology.

  14. PHYSICAL PERFORMANCE AND BODY COMPOSITION IN MAINTENANCE HEMODIALYSIS (MHD PATIENTS

    Directory of Open Access Journals (Sweden)

    M Zhang

    2012-06-01

    Conclusions: These findings indicate that adult MHD pts had a higher % body fat. Measures of physical performance were markedly reduced in MHD pts as compared to Normals. Physical performance in MHD, measured especially by 6-MW, correlated negatively with some measures of body composition, particularly with LBMI.

  15. Performance of PROMIS for Healthy Patients Undergoing Meniscal Surgery.

    Science.gov (United States)

    Hancock, Kyle J; Glass, Natalie; Anthony, Chris A; Hettrich, Carolyn M; Albright, John; Amendola, Annunziato; Wolf, Brian R; Bollier, Matthew

    2017-06-07

    The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed as an extensive question bank with multiple health domains that could be utilized for computerized adaptive testing (CAT). In the present study, we investigated the use of the PROMIS Physical Function CAT (PROMIS PF CAT) in an otherwise healthy population scheduled to undergo surgery for meniscal injury with the hypotheses that (1) the PROMIS PF CAT would correlate strongly with patient-reported outcome instruments that measure physical function and would not correlate strongly with those that measure other health domains, (2) there would be no ceiling effects, and (3) the test burden would be significantly less than that of the traditional measures. Patients scheduled to undergo meniscal surgery completed the PROMIS PF CAT, Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Knee Activity Rating Scale, Short Form-36 (SF-36), and EuroQol-5 Dimension (EQ-5D) questionnaires. Correlations were defined as high (≥0.7), high-moderate (0.61 to 0.69), moderate (0.4 to 0.6), moderate-weak (0.31 to 0.39), or weak (≤0.3). If ≥15% respondents to a patient-reported outcome measure obtained the highest or lowest possible score, the instrument was determined to have a significant ceiling or floor effect. A total of 107 participants were analyzed. The PROMIS PF CAT had a high correlation with the SF-36 Physical Functioning (PF) (r = 0.82, p ceiling effects, with 0% of the participants achieving the lowest and highest score, respectively. The PROMIS PF CAT correlates strongly with currently used patient-reported outcome measures of physical function and demonstrates no ceiling effects for patients with meniscal injury requiring surgery. It may be a reasonable alternative to more burdensome patient-reported outcome measures.

  16. Chernobyl: fourteen years on

    International Nuclear Information System (INIS)

    Dakhno, L.G.

    2000-01-01

    Current situation around Chernobyl is observed, special attention being paid to the status of SARCOPHAGUS and consequences for human health. The problem of low doses is reviewed, with an impact to what the hormesis is

  17. Importance of Functional Airway Surgery in Orthognathic Surgery Performed Patients

    Directory of Open Access Journals (Sweden)

    Erkan Yüce

    2017-06-01

    Full Text Available Le Fort I osteotomy is usually combined with mandibular ramus procedures (sagittal split in order to correct dentofacial deformities that cause malocclusion. Patients who have dentofacial anomalies involving the maxilla carry a higher risk of difficulty in breathing due to septal deviation and inferior turbinate hypertrophy. If these conditions are ignored preoperatively, severe airway problems may come up after orthognathic surgery. A detailed examination regarding nasal airway should be conducted in such patients, and they should be informed about their condition which may require an additional intervention during or after their main surgery.

  18. Simultaneous analysis of fourteen tertiary amine stimulants in human urine for doping control purposes by liquid chromatography-tandem mass spectrometry and gas chromatography-mass spectrometry

    International Nuclear Information System (INIS)

    Lu Jianghai; Wang San; Dong Ying; Wang Xiaobing; Yang Shuming; Zhang Jianli; Deng Jing; Qin Yang; Xu Youxuan; Wu Moutian; Ouyang Gangfeng

    2010-01-01

    A method for the simultaneous screening and confirmation of the presence of fourteen tertiary amine stimulants in human urine by gas chromatography-mass spectrometry (GC-MS) in combination with liquid chromatography-tandem mass spectrometry (LC-MS/MS) has been developed and validated. Solid phase extraction (SPE) and liquid-liquid extraction (LLE) approaches were utilized for the pre-treatment of the urine samples. The study indicated that the capillary temperature played a significant role in the signal abundances of the protonated molecules of cropropamide and crotethamide under positive ion electrospray ionization (ESI) conditions. In addition, comparison studies of two different pre-treatment approaches as well as the two ionization modes were conducted. The LODs of the developed method for all the analytes were lower than the minimum required performance limit (MRPL) as set forth in the World Anti-Doping Agency (WADA) technical document for laboratories. The human urine sample obtained after oral administration of prolintane.HCl was successfully analyzed by the developed method, which demonstrated the applicability and reliability of the method for routine doping control analysis.

  19. How does coconut oil affect cognitive performance in alzheimer patients?

    Science.gov (United States)

    De la Rubia Ortí, José Enrique; Sánchez Álvarez, Carmen; Selvi Sabater, Pablo; Bueno Cayo, Alma María; Sancho Castillo, Sandra; Rochina, Mariano Julián; Hu Yang, Iván

    2017-03-30

    Introduction: Alzheimer’s disease is one of the most prevalent neurodegenerative dementia in developed world. This fact, coupled with the lack cure, makes new no pharmacological therapeutic strategies such as nutrient management to investigate. In this regard, it stresses the possible influence of coconut oil as alternative energy source capable of stopping the progressively neuronal death that occurs in this disease. Objectives: To assess the cognitive impact of coconut oil in Alzheimer’s patients, and specifically in orientation, language-building, fixing, calculation-concentration and memory areas. Methods: Prospective, longitudinal, qualitative, analytical and experimental study through a clinical trial where 44 patients with Alzheimer’s in region of Ribera (Valencia), of which half was selected to receive during 21 days, 40 ml coconut oil daily divided between breakfast (20 ml) and food (20 ml). Before and after administration of the oil, they were evaluated through cognitive test Mini-Mental State Examination to determine possible changes. Results: It was observed in patients who received coconut oil, that cognitive improvement after completion of the intervention, statistically significant improved in the orientation and language-construction areas. Conclusions: Coconut oil appears to improve cognitive abilities of Alzheimer’s patients, with different intensity depending on the cognitive area.

  20. Correlations between patient satisfaction and ability to perform daily activities after total knee arthroplasty: why aren't patients satisfied?

    Science.gov (United States)

    Nakahara, Hiroyuki; Okazaki, Ken; Mizu-Uchi, Hideki; Hamai, Satoshi; Tashiro, Yasutaka; Matsuda, Shuichi; Iwamoto, Yukihide

    2015-01-01

    Patient satisfaction has become an important parameter for assessing overall outcomes after total knee arthroplasty (TKA). The level of difficulty in performing activities of daily life that affects overall patient satisfaction is unknown. We therefore evaluated the influence of difficulty in performing activities of daily life on patient satisfaction and expectations. The 2011 Knee Society Knee Scoring System Questionnaire was mailed to patients who had undergone TKA with 375 patients completing and returning it. We evaluated the relationship between the ability to perform daily activities, as assessed via the questionnaire, and patient satisfaction and expectations of the same score in each patient using linear regression analysis. We also determined which activities affected patient satisfaction and expectations using multivariate linear regression analyses. All patient-derived functional activities correlated significantly with the patient satisfaction score. In particular, "climbing up or down a flight of stairs" followed by "getting into or out of a car," "moving laterally (stepping to the side)" and "walking and standing" correlated strongly with patient satisfaction by linear regression analysis and were revealed to have significant contributions to patient satisfaction by multivariate linear regression analysis. Regarding expectations, all patient-derived functional activities correlated significantly with the patient expectation score, although none of the correlation coefficients was very high. "Squatting," followed by "walking and standing," contributed to the patient expectation score by multivariate linear regression analysis. Activities related to walking and standing are some of the most basic movements and basic demands for patients. In addition, "climbing up or down a flight of stairs," "getting into and out of a car" and "squatting" are very important and distressing activities that significantly correlate with patient satisfaction after TKA.

  1. Symptom burden and its relationship to functional performance in patients with chronic obstructive pulmonary disease

    OpenAIRE

    Melhem, Omar

    2016-01-01

    The aim of this study was to explore symptom burden and its relationship to functional performance in patients with COPD. A descriptive, cross-sectional, correlational survey design was used and a sample of 214 patients with COPD. The sample was recruited from patients attending one of the major teaching hospitals in Dublin. Symptom burden was measured using the Memorial Symptom Assessment Scale (MSAS), and the functional performance was measured using the Functional Performance Inventory-Sho...

  2. Assessment of right ventricular function by myocardial performance index in diabetic patients

    Directory of Open Access Journals (Sweden)

    Ayman Ahmed Abdelaziz

    2011-09-01

    Conclusion: Myocardial performance index is a useful noninvasive tool for the detection of early right ventricular systolic and diastolic dysfunction in diabetic patients, regardless of coexisting hypertension.

  3. Suboptimal performance on neuropsychological tests in patients with suspected chronic toxic encephalopathy

    NARCIS (Netherlands)

    van Hout, Moniek S. E.; Schmand, Ben; Wekking, Ellie M.; Hageman, Gerard; Deelman, Betto G.

    2003-01-01

    Suboptimal performance during neuropsychological testing can seriously complicate assessment in behavioral neurotoxicology. We present data on the prevalence of suboptimal performance in a group of Dutch patients with suspected chronic toxic encephalopathy (CTE) after long-term occupational exposure

  4. Suboptimal performance on neuropsychological tests in patients with suspected chronic toxic encephalopathy

    NARCIS (Netherlands)

    van Hout, MSE; Schmand, B; Wekking, EM; Hageman, G; Deelman, BG

    Suboptimal performance during neuropsychological testing can seriously complicate assessment in behavioral neurotoxicology. We present data on the prevalence of suboptimal performance in a group of Dutch patients with suspected chronic toxic encephalopathy (CTE) after long-term occupational exposure

  5. Motivators and barriers to using patient experience reports for performance improvement

    NARCIS (Netherlands)

    Geissler, K.H.; Friedberg, M.W.; SteelFisher, G.K.; Schneider, E.C.

    2013-01-01

    Increasingly, patient experience surveys are available to provide performance feedback to physician groups. However, limited published literature addresses factors influencing use of these reports for performance improvement. To address this gap, we conducted semistructured interviews with leaders

  6. Maximal exercise performance in patients with postcancer fatigue

    NARCIS (Netherlands)

    Prinsen, H.; Hopman, M. T. E.; Zwarts, M. J.; Leer, J. W. H.; Heerschap, A.; Bleijenberg, G.; van Laarhoven, H. W. M.

    2013-01-01

    The aim of this study is to examine whether physical fitness of severely fatigued and non-fatigued cancer survivors, as measured by maximal exercise performance, is different between both groups and, if so, whether this difference can be explained by differences in physical activity, self-efficacy

  7. [Implementation of the program of "Collaborative Development of Advanced Practical Education to Train Pharmacists in Leadership" under the joint operation of the pharmaceutical departments in fourteen national universities].

    Science.gov (United States)

    Hirata, Kazumasa; Tamura, Satoru; Kobayashi, Motomasa

    2012-01-01

    "Collaborative Development of Advanced Practical Education Program to Train Pharmacists with Leadership" applied jointly by the pharmaceutical departments of fourteen national universities was selected to receive the special expenditure support of Ministry of Education, Culture, Sports, Science and Technology for fiscal year 2010 under "the Training of Highly Skillful Professionals and Improvement of the Quality of the Function of Professional Education". This project is to promote the collaborative development of the educational program which will make it possible to further advance and substantiate the education of pharmacists in the six year course of the pharmaceutical department for the ultimate purpose to introduce pharmacists with leadership who can play an active role and fill in a leadership position in a wide range of responsibilities into the society which, more and more, has come to expect pharmacy to take the initiative in acting against health hazards caused by infections, foods and environmental pollution as well as to meet the diversification of healthcare. To be more specific, this project is to try and evaluate the following programs repeatedly based on the plan-do-check-act (PDCA) cycle: 1) Practical medical and pharmaceutical education program; 2) Program concerning research on long term themes and advanced education; 3) Program concerning training and education of SPs (standardized patients or simulated patients) and PBL (problem-based learning) tutorial education; and 4) Program concerning the method of evaluation of education. Through this repeated trial and evaluation, this project ultimately seeks to construct a highly effective practical educational program which integrates each university's achievements and educational attempts rich in originality.

  8. Predicting failing performance on a standardized patient clinical performance examination: the importance of communication and professionalism skills deficits.

    Science.gov (United States)

    Chang, Anna; Boscardin, Christy; Chou, Calvin L; Loeser, Helen; Hauer, Karen E

    2009-10-01

    The purpose is to determine which assessment measures identify medical students at risk of failing a clinical performance examination (CPX). Retrospective case-control, multiyear design, contingency table analysis, n = 149. We identified two predictors of CPX failure in patient-physician interaction skills: low clerkship ratings (odds ratio 1.79, P = .008) and student progress review for communication or professionalism concerns (odds ratio 2.64, P = .002). No assessments predicted CPX failure in clinical skills. Performance concerns in communication and professionalism identify students at risk of failing the patient-physician interaction portion of a CPX. This correlation suggests that both faculty and standardized patients can detect noncognitive traits predictive of failing performance. Early identification of these students may allow for development of a structured supplemental curriculum with increased opportunities for practice and feedback. The lack of predictors in the clinical skills portion suggests limited faculty observation or feedback.

  9. Reduced Dual-Task Performance in MS Patients Is Further Decreased by Muscle Fatigue.

    Science.gov (United States)

    Wolkorte, Ria; Heersema, Dorothea J; Zijdewind, Inge

    2015-06-01

    Multiple sclerosis (MS) can be accompanied by motor, cognitive, and sensory impairments. Additionally, MS patients often report fatigue as one of their most debilitating symptoms. It is, therefore, expected that MS patients will have difficulties in performing cognitive-motor dual tasks (DTs), especially in a fatiguing condition. To determine whether MS patients are more challenged by a DT than controls in a fatiguing and less-fatiguing condition and whether DT performance is associated with perceived fatigue. A group of 19 MS patients and 19 age-, sex-, and education-matched controls performed a cognitive task (2-choice reaction time task) separately or concurrent with a low-force or a high-force motor task (index finger abduction at 10% or 30% maximal voluntary contraction). MS patients performed less well on a cognitive task than controls. Cognitive task performance under DT conditions decreased more for MS patients. Moreover, under high-force DT conditions, cognitive performance declined in both groups but to a larger degree for MS patients. Besides a decline in cognitive task performance, MS patients also showed a stronger decrease in motor performance under high-force DT conditions. DT costs were positively related to perceived fatigue as measured by questionnaires. Compared with controls, MS patients performed less well on DTs as demonstrated by a reduction in both cognitive and motor performances. This performance decrease was stronger under fatiguing conditions and was related to the sense of fatigue of MS patients. These data illustrate problems that MS patients may encounter in daily life because of their fatigue. © The Author(s) 2014.

  10. Mediation analysis of severity of needs, service performance and outcomes for patients with mental disorders.

    Science.gov (United States)

    Roux, Paul; Passerieux, Christine; Fleury, Marie-Josée

    2016-12-01

    Needs and service performance assessment are key components in improving recovery among individuals with mental disorders. To test the role of service performance as a mediating factor between severity of patients' needs and outcomes. A total of 339 adults with mental disorders were interviewed. A mediation analysis between severity of needs, service performance (adequacy of help, continuity of care and recovery orientation of services) and outcomes (personal recovery and quality of life) was carried out using structural equation modelling. The structural equation model provided a good fit with the data. An increase in needs was associated with lower service performance and worse outcomes, whereas higher service performance was associated with better outcomes. Service performance partially mediated the effect of patient needs on outcomes. Poorer service performance has a negative impact on outcomes for patients with the highest needs. Ensuring more efficient services for patients with high needs may help improve their recovery and quality of life. © The Royal College of Psychiatrists 2016.

  11. Mixed-reproductive strategies, competitive mating-type distribution and life cycle of fourteen black morel species.

    Science.gov (United States)

    Du, Xi-Hui; Zhao, Qi; Xia, En-Hua; Gao, Li-Zhi; Richard, Franck; Yang, Zhu L

    2017-05-04

    Morchella species are well known world-round as popular and prized edible fungi due to their unique culinary flavor. Recently, several species have been successfully cultivated in China. However, their reproductive modes are still unknown, and their basic biology needs to be elucidated. Here, we use the morel genome information to investigate mating systems and life cycles of fourteen black morel species. Mating type-specific primers were developed to screen and genotype ascospores, hymenia and stipes from 223 ascocarps of the 14 species from Asia and Europe. Our data indicated that they are all heterothallic and their life cycles are predominantly haploid, but sterile haploid fruiting also exists. Ascospores in all species are mostly haploid, homokaryotic, and multinuclear, whereas aborted ascospores without any nuclei were also detected. Interestingly, we monitored divergent spatial distribution of both mating types in natural morel populations and cultivated sites, where the fertile tissue of fruiting bodies usually harbored both mating types, whereas sterile tissue of wild morels constantly had one MAT allele, while the sterile tissue of cultivated strains always exhibited both MAT alleles. Furthermore, MAT1-1-1 was detected significantly more commonly than MAT1-2-1 in natural populations, which strongly suggested a competitive advantage for MAT1-1 strains.

  12. Evaluation of carcinogenic potential of the herbicide glyphosate, drawing on tumor incidence data from fourteen chronic/carcinogenicity rodent studies.

    Science.gov (United States)

    Greim, Helmut; Saltmiras, David; Mostert, Volker; Strupp, Christian

    2015-03-01

    Abstract Glyphosate, an herbicidal derivative of the amino acid glycine, was introduced to agriculture in the 1970s. Glyphosate targets and blocks a plant metabolic pathway not found in animals, the shikimate pathway, required for the synthesis of aromatic amino acids in plants. After almost forty years of commercial use, and multiple regulatory approvals including toxicology evaluations, literature reviews, and numerous human health risk assessments, the clear and consistent conclusions are that glyphosate is of low toxicological concern, and no concerns exist with respect to glyphosate use and cancer in humans. This manuscript discusses the basis for these conclusions. Most toxicological studies informing regulatory evaluations are of commercial interest and are proprietary in nature. Given the widespread attention to this molecule, the authors gained access to carcinogenicity data submitted to regulatory agencies and present overviews of each study, followed by a weight of evidence evaluation of tumor incidence data. Fourteen carcinogenicity studies (nine rat and five mouse) are evaluated for their individual reliability, and select neoplasms are identified for further evaluation across the data base. The original tumor incidence data from study reports are presented in the online data supplement. There was no evidence of a carcinogenic effect related to glyphosate treatment. The lack of a plausible mechanism, along with published epidemiology studies, which fail to demonstrate clear, statistically significant, unbiased and non-confounded associations between glyphosate and cancer of any single etiology, and a compelling weight of evidence, support the conclusion that glyphosate does not present concern with respect to carcinogenic potential in humans.

  13. Molecular epidemiology and evolution of avian infectious bronchitis virus in Spain over a fourteen-year period.

    Science.gov (United States)

    Dolz, Roser; Pujols, Joan; Ordóñez, German; Porta, Ramon; Majó, Natàlia

    2008-04-25

    An in-depth molecular study of infectious bronchitis viruses (IBV) with particular interest in evolutionary aspects of IBV in Spain was carried out in the present study based on the S1 gene molecular characterization of twenty-six Spanish strains isolated over a fourteen-year period. Four genotypes were identified based on S1 gene sequence analyses and phylogenetic studies. A drastic virus population shift was demonstrated along time and the novel Italy 02 serotype was shown to have displaced the previous predominant serotype 4/91 in the field. Detailed analyses of synonymous to non-synonymous ratio of the S1 gene sequences of this new serotype Italy 02 suggested positive selection pressures might have contributed to the successful establishment of Italy 02 serotype in our country. In addition, differences on the fitness abilities of new emergent genotypes were indicated. Furthermore, intergenic sequences (IGs)-like motifs within S1 gene sequences of IBV isolates were suggested to enhance the recombination abilities of certain serotypes.

  14. NEUROPSYCHOLOGICAL PERFORMANCE IN A SAMPLE OF INSTITUTIONALIZED CHRONIC SCHIZOPHRENIC PATIENTS

    Directory of Open Access Journals (Sweden)

    Luis Maia

    2010-12-01

    Full Text Available We study the results of a descriptive and exploratory study, with the intent to understand the results of a 21 male schizophrenic patients interned in a Portuguese Mental Health Care Centre, evaluated with neuropsychological test. We tried also to link these tests with variables such as schooling, family contact or lengh of internment. The assessment instruments were: Digits Series and Vocabulary Task, both from WAIS, Raven Progressive Matrices, Rey’s Complex Figures, Luria’s Series Neuropsychological Screening, Clock Task - Neuropsychological Screening and Visual Search and Attention Test. Results show that there is not an attention deficit clinically significant, even that data suggests light attention affection; also variables like family contact and schooling appear as protective factors of memory and also seems to be important for the planning / organization functions.

  15. Iowa Gambling Task Performance in Parkinson Disease Patients with Impulse Control Disorders.

    Science.gov (United States)

    Biars, Julia W; Johnson, Nicole L; Nespeca, Michelle; Busch, Robyn M; Kubu, Cynthia S; Floden, Darlene P

    2018-04-27

    A subgroup of patients with Parkinson disease (PD) develops impulse control disorders (ICD) associated with their dopamine replacement therapy. Patients and their families may be reluctant to report ICD symptoms or unaware these symptoms are related to PD medication, which can make detecting an ICD difficult for clinicians. Ideally, a behavioral measure that is sensitive to ICD could be employed to ensure that patients with these behaviors are identified and treated. The Iowa Gambling Task (IGT), a standardized decision-making task, has proven sensitive in other populations with impulse control problems. We hypothesized that the IGT would differentiate between PD patients with and without ICD. We compared IGT performance and disease variables in 24 PD patients with ICD and 24 PD patients without ICD. Patient groups were matched in terms of age, sex, and duration of PD. There were no significant differences in IGT scores between PD groups. IGT performance declined with increasing age, but the majority of patients performed within normal limits based on published age- and education-corrected normative data. The IGT did not distinguish between PD patients with and without ICD. Increasing age negatively impacted performance in both groups. Other studies have found that IGT performance may decline in normal aging. Our results suggest that the IGT lacks the sensitivity and specificity needed to differentiate between age-related deficits and disruption in frontal-subcortical circuits underlying ICD associated with PD medications. Therefore, the IGT is not an appropriate behavioral measure for ICD in PD patients.

  16. Assessing the performance of mental health service facilities for meeting patient priorities and health service responsiveness.

    Science.gov (United States)

    Bramesfeld, A; Stegbauer, C

    2016-10-01

    The World Health Organisation has defined health service responsiveness as one of the key-objectives of health systems. Health service responsiveness relates to the ability to respond to service users' legitimate expectations on non-medical issues when coming into contact with the services of a healthcare system. It is defined by the areas showing respect for persons and patient orientation. Health service responsiveness is particularly relevant to mental health services, due to the specific vulnerability of mental health patients but also because it matches what mental health patients consider as good quality of care as well as their priorities when seeking healthcare. As (mental) health service responsiveness applies equally to all concerned services it would be suitable as a universal indicator for the quality of services' performance. However, performance monitoring programs in mental healthcare rarely assess health service performance with respect to meeting patient priorities. This is in part due of patient priorities as an outcome being underrepresented in studies that evaluate service provision. The lack of studies using patient priorities as outcomes transmits into evidence based guidelines and subsequently, into underrepresentation of patient priorities in performance monitoring. Possible ways out of this situation include more intervention studies using patient priorities as outcome, considering evidence from qualitative studies in guideline development and developing performance monitoring programs along the patient pathway and on key-points of relevance for service quality from a patient perspective.

  17. Treatment outcome in performance status 2 advanced NSCLC patients administered platinum-based combination chemotherapy

    DEFF Research Database (Denmark)

    Helbekkmo, Nina; Aasebø, Ulf; Sundstrøm, Stein H

    2008-01-01

    BACKGROUND: There is no consensus regarding chemotherapy to patients with advanced NSCLC (ANSCLC) and performance status (PS) 2. Using data from a national multicenter study comparing two third-generation carboplatin-based regimens in ANSCLC patients, we evaluated the outcome of PS 2 patients....... PATIENTS AND METHODS: The 123 PS 2 patients were compared to 309 PS 0/1 patients regarding survival, quality of life (QOL) and treatment toxicity. RESULTS: PS 2 patients had lower haemoglobin, lower global QOL and more pain, nausea/vomiting and dyspnea at inclusion. 68% of PS 2 patients received three...... chemotherapy courses vs. 85% in the PS 0/1 group (PPS 2 group, 4.5 vs. 8.9 months and 10% vs. 37% (PPS 2 patients needed blood transfusions (P=0.03) and hospitalization (PPS 2 patients had better relief of pain and dyspnea...

  18. Number of X-ray examinations performed on paediatric and geriatric patients compared with adult patients

    International Nuclear Information System (INIS)

    Aroua, A.; Bochud, F. O.; Valley, J. F.; Vader, J. P.; Verdun, F. R.

    2007-01-01

    The age of the patient is of prime importance when assessing the radiological risk to patients due to medical X-ray exposures and the total detriment to the population due to radiodiagnostics. In order to take into account the age-specific radiosensitivity, three age groups are considered: children, adults and the elderly. In this work, the relative number of examinations carried out on paediatric and geriatric patients is established, compared with adult patients, for radiodiagnostics as a whole, for dental and medical radiology, for 8 radiological modalities as well as for 40 types of X-ray examinations. The relative numbers of X-ray examinations are determined based on the corresponding age distributions of patients and that of the general population. Two broad groups of X-ray examinations may be defined. Group A comprises conventional radiography, fluoroscopy and computed tomography; for this group a paediatric patient undergoes half the number of examinations as that of an adult, and a geriatric patient undergoes 2.5 times more. Group B comprises angiography and interventional procedures; for this group a paediatric patient undergoes a one-fourth of the number of examinations carried out on an adult, and a geriatric patient undergoes five times more. (authors)

  19. Cochlear Implantation in Patients With Usher Syndrome Type IIa Increases Performance and Quality of Life.

    Science.gov (United States)

    Hartel, Bas P; van Nierop, Josephine W I; Huinck, Wendy J; Rotteveel, Liselotte J C; Mylanus, Emmanuel A M; Snik, Ad F; Kunst, Henricus P M; Pennings, Ronald J E

    2017-07-01

    Usher syndrome type IIa (USH2a) is characterized by congenital moderate to severe hearing impairment and retinitis pigmentosa. Hearing rehabilitation starts in early childhood with the application of hearing aids. In some patients with USH2a, severe progression of hearing impairment leads to insufficient speech intelligibility with hearing aids and issues with adequate communication and safety. Cochlear implantation (CI) is the next step in rehabilitation of such patients. This study evaluates the performance and benefit of CI in patients with USH2a. Retrospective case-control study to evaluate the performance and benefit of CI in 16 postlingually deaf adults (eight patients with USH2a and eight matched controls). Performance and benefit were evaluated by a speech intelligibility test and three quality-of-life questionnaires. Patients with USH2a with a mean age of 59 years at implantation exhibited good performance after CI. The phoneme scores improved significantly from 41 to 87% in patients with USH2a (p = 0.02) and from 30 to 86% in the control group (p = 0.001). The results of the questionnaire survey demonstrated a clear benefit from CI. There were no differences in performance or benefit between patients with USH2a and control patients before and after CI. CI increases speech intelligibility and improves quality of life in patients with USH2a.

  20. Self-reported quality of ADL task performance among patients with COPD exacerbations

    DEFF Research Database (Denmark)

    Bendixen, Hans Jørgen; Wæhrens, Eva Elisabet Ejlersen; Wilcke, Jon Torgny

    2014-01-01

    OBJECTIVE: Patients suffering from chronic obstructive pulmonary disease (COPD) experience problems in the performance of activities of daily living (ADL) tasks. The objective was to examine the self-reported quality of ADL task performance among COPD patients, and to investigate whether age...... concerning age, gender, and routine COPD characteristics were drawn from the patients' medical records. RESULTS: The patients reported being inefficient to markedly inefficient when performing ADL tasks within the personal hygiene, toileting, dressing, household, mobility, and transportation domains. While...... more than 90% of the participants reported increased effort and/or fatigue when performing the ADL tasks, up to 88% of the participants relied on help from others in the performance of general household chores like cooking and shopping. Self-reported ADL ability did not correlate with age, gender...

  1. Performance of New Thresholds of the Glasgow Blatchford Score in Managing Patients With Upper Gastrointestinal Bleeding

    DEFF Research Database (Denmark)

    Laursen, Stig B; Dalton, Harry R; Murray, Iain A

    2015-01-01

    BACKGROUND & AIMS: Upper gastrointestinal hemorrhage (UGIH) is a common cause of hospital admission. The Glasgow Blatchford score (GBS) is an accurate determinant of patients' risk for hospital-based intervention or death. Patients with a GBS of 0 are at low risk for poor outcome and could....... METHODS: We performed an observational study of 2305 consecutive patients presenting with UGIH at 4 centers (Scotland, England, Denmark, and New Zealand). The performance of each threshold and modification was evaluated based on sensitivity and specificity analyses, the proportion of low-risk patients...

  2. Judgment and memory performance for emotional stimuli in patients with alcoholic Korsakoff syndrome.

    Science.gov (United States)

    Labudda, Kirsten; Todorovski, Saso; Markowitsch, Hans J; Brand, Matthias

    2008-02-01

    In this study we investigated whether alcoholic Korsakoff patients are impaired in categorizing neutral and emotional stimuli according to their valence and whether memory performance for this material is reduced. In a group of Korsakoff patients and a comparison group two experimental tasks--one containing emotional and neutral pictures and the other containing words-were administered. Results showed that patients had difficulties in affective judgments due to problems in classifying neutral stimuli. Memory for emotional and neutral material was impaired to a similar degree. Thus, the facilitating effect of emotional valence on memory performance is absent in Korsakoff patients.

  3. Studying physician effects on patient outcomes: physician interactional style and performance on quality of care indicators.

    Science.gov (United States)

    Franks, Peter; Jerant, Anthony F; Fiscella, Kevin; Shields, Cleveland G; Tancredi, Daniel J; Epstein, Ronald M

    2006-01-01

    Many prior studies which suggest a relationship between physician interactional style and patient outcomes may have been confounded by relying solely on patient reports, examining very few patients per physician, or not demonstrating evidence of a physician effect on the outcomes. We examined whether physician interactional style, measured both by patient report and objective encounter ratings, is related to performance on quality of care indicators. We also tested for the presence of physician effects on the performance indicators. Using data on 100 US primary care physician (PCP) claims data on 1,21,606 of their managed care patients, survey data on 4746 of their visiting patients, and audiotaped encounters of 2 standardized patients with each physician, we examined the relationships between claims-based quality of care indicators and both survey-derived patient perceptions of their physicians and objective ratings of interactional style in the audiotaped standardized patient encounters. Multi-level models examined whether physician effects (variance components) on care indicators were mediated by patient perceptions or objective ratings of interactional style. We found significant physician effects associated with glycohemoglobin and cholesterol testing. There was also a clinically significant association between better patient perceptions of their physicians and more glycohemoglobin testing. Multi-level analyses revealed, however, that the physician effect on glycohemoglobin testing was not mediated by patient perceived physician interaction style. In conclusion, similar to prior studies, we found evidence of an apparent relationship between patient perceptions of their physician and patient outcomes. However, the apparent relationships found in this study between patient perceptions of their physicians and patient care processes do not reflect physician style, but presumably reflect unmeasured patient confounding. Multi-level modeling may contribute to better

  4. Will hypertension performance measures used for pay-for-performance programs penalize those who care for medically complex patients?

    Science.gov (United States)

    Petersen, Laura A; Woodard, Lechauncy D; Henderson, Louise M; Urech, Tracy H; Pietz, Kenneth

    2009-06-16

    There is concern that performance measures, patient ratings of their care, and pay-for-performance programs may penalize healthcare providers of patients with multiple chronic coexisting conditions. We examined the impact of coexisting conditions on the quality of care for hypertension and patient perception of overall quality of their health care. We classified 141 609 veterans with hypertension into 4 condition groups: those with hypertension-concordant (diabetes mellitus, ischemic heart disease, dyslipidemia) and/or -discordant (arthritis, depression, chronic obstructive pulmonary disease) conditions or neither. We measured blood pressure control at the index visit, overall good quality of care for hypertension, including a follow-up interval, and patient ratings of satisfaction with their care. Associations between condition type and number of coexisting conditions on receipt of overall good quality of care were assessed with logistic regression. The relationship between patient assessment and objective measures of quality was assessed. Of the cohort, 49.5% had concordant-only comorbidities, 8.7% had discordant-only comorbidities, 25.9% had both, and 16.0% had none. Odds of receiving overall good quality after adjustment for age were higher for those with concordant comorbidities (odds ratio, 1.78; 95% confidence interval, 1.70 to 1.87), discordant comorbidities (odds ratio, 1.32; 95% confidence interval, 1.23 to 1.41), or both (odds ratio, 2.25; 95% confidence interval, 2.13 to 2.38) compared with neither. Findings did not change after adjustment for illness severity and/or number of primary care and specialty care visits. Patient assessment of quality did not vary by the presence of coexisting conditions and was not related to objective ratings of quality of care. Contrary to expectations, patients with greater complexity had higher odds of receiving high-quality care for hypertension. Subjective ratings of care did not vary with the presence or absence of

  5. Self-reported quality of ADL task performance among patients with COPD exacerbations.

    Science.gov (United States)

    Bendixen, Hans Jørgen; Wæhrens, Eva Ejlersen; Wilcke, Jon Torgny; Sørensen, Lisbeth Villemoes

    2014-07-01

    Patients suffering from chronic obstructive pulmonary disease (COPD) experience problems in the performance of activities of daily living (ADL) tasks. The objective was to examine the self-reported quality of ADL task performance among COPD patients, and to investigate whether age, gender, and routine COPD characteristics correlate with the self-reported ADL ability. Eighty patients admitted to hospital with COPD exacerbations participated. In a cross-sectional study, the patients' self-reported ADL ability was assessed using the ADL-Interview (ADL-I) instrument. Data concerning age, gender, and routine COPD characteristics were drawn from the patients' medical records. The patients reported being inefficient to markedly inefficient when performing ADL tasks within the personal hygiene, toileting, dressing, household, mobility, and transportation domains. While more than 90% of the participants reported increased effort and/or fatigue when performing the ADL tasks, up to 88% of the participants relied on help from others in the performance of general household chores like cooking and shopping. Self-reported ADL ability did not correlate with age, gender, or routine COPD characteristics. Decreased quality of ADL task performance seemed to be extremely common among COPD patients. Therefore, addressing the problems in individually tailored pulmonary rehabilitation programmes may be advantageous.

  6. Impact of time on task on ADHD patient's performances in a virtual classroom.

    Science.gov (United States)

    Bioulac, Stéphanie; Lallemand, Stéphanie; Rizzo, Albert; Philip, Pierre; Fabrigoule, Colette; Bouvard, Manuel Pierre

    2012-09-01

    Use of virtual reality tool is interesting for the evaluation of Attention Deficit/Hyperactivity Disorder (ADHD) patients. The virtual environment offers the opportunity to administer controlled task like the typical neuropsychological tools, but in an environment much more like standard classroom. Previous studies showed that a virtual classroom was able to distinguish performances of children with and without ADHD, but the evolution of performances over time has not been explored. The aim of this work was to study time on task effects on performances of ADHD children compared to controls in a virtual classroom (VC). 36 boys aged from 7 to 10 years completed the virtual classroom task. We compared the performance of the children diagnosed with ADHD with those of the control children. We also compared attentional performances recorded in the virtual classroom with measures of the Continuous Performance Test (CPT II). Our results showed that patients differ from control subjects in term of time effect on performances. If controls sustained performances over time in the virtual reality task, ADHD patients showed a significant performance decrement over time. Performances at the VC correlated with CPT II measures. ADHD children are vulnerable to a time on task effect on performances which could explain part of their difficulties. Virtual reality is a reliable method to test ADHD children ability to sustain performances over time. Copyright © 2012 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  7. Residual Negative Symptoms Differentiate Cognitive Performance in Clinically Stable Patients with Schizophrenia and Bipolar Disorder

    Directory of Open Access Journals (Sweden)

    Rajeev Krishnadas

    2014-01-01

    Full Text Available Cognitive deficits in various domains have been shown in patients with bipolar disorder and schizophrenia. The purpose of the present study was to examine if residual psychopathology explained the difference in cognitive function between clinically stable patients with schizophrenia and bipolar disorder. We compared the performance on tests of attention, visual and verbal memory, and executive function of 25 patients with schizophrenia in remission and 25 euthymic bipolar disorder patients with that of 25 healthy controls. Mediation analysis was used to see if residual psychopathology could explain the difference in cognitive function between the patient groups. Both patient groups performed significantly worse than healthy controls on most cognitive tests. Patients with bipolar disorder displayed cognitive deficits that were milder but qualitatively similar to those of patients with schizophrenia. Residual negative symptoms mediated the difference in performance on cognitive tests between the two groups. Neither residual general psychotic symptoms nor greater antipsychotic doses explained this relationship. The shared variance explained by the residual negative and cognitive deficits that the difference between patient groups may be explained by greater frontal cortical neurophysiological deficits in patients with schizophrenia, compared to bipolar disorder. Further longitudinal work may provide insight into pathophysiological mechanisms that underlie these deficits.

  8. Assessment of patient radiation protection in external radiotherapy departments after inspections performed by the ASN 2008

    International Nuclear Information System (INIS)

    Franchi, Vincent; Marchal, Carole

    2009-10-01

    This report proposes an assessment of patient radiation protection in external radiotherapy. It is based on inter-regional syntheses of inspections performed by the ASN in external radiotherapy departments during 2008. It addresses 6 main themes related to patient radiation protection: human and material resources, organisation of medical physics, training in patient radiation protection, mastering of equipment (maintenance, internal quality controls of medical devices), safety and care quality management (formalization of the patient care process and definition of responsibilities, patient identity control, treatment preparation, and treatment execution), and risk management (a priori risk analysis, declaration, recording and internal processing of dysfunctions, improvements of care quality and safety management system)

  9. The 15-lipoxygenase inhibitory, antioxidant, antimycobacterial activity and cytotoxicity of fourteen ethnomedicinally used African spices and culinary herbs.

    Science.gov (United States)

    Dzoyem, Jean Paul; Kuete, Victor; McGaw, Lyndy J; Eloff, Jacobus N

    2014-10-28

    Culinary herbs and spices are widely used ethnomedically across Africa. They are traditionally employed in the treatment of several ailments including inflammation disorders, pain alleviation and infectious diseases. Pharmacological studies are necessary to provide a scientific basis to substantiate their traditional use and safety. In this study, the 15-lipoxygenase inhibitory, antioxidant, antimycobacterial and the cytotoxic activities, total phenolic and flavonoid contents of fourteen edible plants were investigated. The 15-lipoxygenase inhibitory activity was evaluated by the ferrous oxidation-xylenol orange (FOX) assay method. The antioxidant activity was determined using free-radical scavenging assays. The antimycobacterial activity was determined by a broth microdilution method against three species of mycobacteria: Mycobacterium smegmatis, Mycobacterium aurum and Mycobacterium fortuitum using tetrazolium violet as growth indicator. The cytotoxicity was assessed by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay on Vero monkey kidney cells. All the extracts tested had some 15-lipoxygenase inhibitory activity ranging from 32.9 to 78.64%. Adansonia digitata (fruit) had the highest antioxidant capacity (IC₅₀ values of 8.15 μg/mL and 9.16 μg/mL in the DPPH and ABTS assays respectively; TEAC of 0.75 in the FRAP assay) along with the highest amount of total phenolics (237.68 mg GAE/g) and total flavonoids (16.14 mg E/g). There were good correlations between DPPH and ABTS values (R(2) 0.98) and between total phenolics and total flavonoids (R(2) 0.94). Tamarindus indica had significant antimycobacterial activity against Mycobacterium aurum (MIC 78 μg/mL). As could be expected with edible plants, all the extracts had a relatively low cytotoxicity with LC₅₀ values higher than 102 μg/mL with the exception of the two Aframomum species (33 and 74 μg/mL). This study provides scientific support for some of the the traditional uses

  10. The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

    Science.gov (United States)

    Otte-Trojel, Terese; Rundall, Thomas G; de Bont, Antoinette; van de Klundert, Joris; Reed, Mary E

    2015-12-16

    Patient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited. This paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development? We identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of

  11. What effects performance status of patients with hepatocellular carcinoma: stage of tumor versus underlying liver status

    International Nuclear Information System (INIS)

    Sarwar, S.; Tarique, S.

    2015-01-01

    Objective: To identify variables associated with poor performance status of hepatocellular carcinoma (HCC) patients and to compare impact of stage of liver disease and that of hepatoma on functional status of patient. Patients and Methods: We included 254 confirmed cases of liver cancer in a crosssectional analytical study carried out at Doctors Hospital Lahore. Patient's clinical, biochemical and radiological variables were correlated with Karnofsky's performance status (KPS) using pearson correlation. Model for End stage Liver Disease (MELD) and Cancer of Liver Italian Program (CLIP) were evaluated for predicting performance status using Receiver Operating Characteristic (ROC) curve. Results: Mean age of patients was 56.69 (±10.34) and male to female ratio was 2.47: 1 (181/73). On KPS evaluation 84 (33.1%) patients scored between 80-100, 147 (57.9%) had score of 50-70 while in 23 (9.1%) KPS score was between 0-40. Variables associated with poor performance status were bilirubin> 3mg/dl (p value 0.00), albumin< 2.5 g/dl (p value 0.00), creatinine > 1.2mg/dl (p 0.00), prothrombin time> 16seconds (p value 0.00), size of tumor >7cm (p value 0.02), tumor involving > 50% of liver mass (p value 0.00) and vascular invasion (p value 0.00). Both stage of liver disease as determined by MELD and stage of liver cancer as per CLIP scores had strong correlation (p value 0.00) with poor performance status of patient. Area under ROC curve was 0.764 for MELD score and 0.785 for CLIP score. Conclusion: Performance status of liver cancer patients is affected by both stage of liver disease and that of liver tumor. Patients with MELD score above 16 and CLIP score above 4 have poor performance status. (author)

  12. Building patient safety in intensive care nursing : Patient safety culture, team performance and simulation-based training

    OpenAIRE

    Ballangrud, Randi

    2013-01-01

    Aim: The overall aim of the thesis was to investigate patient safety culture, team performance and the use of simulation-based team training for building patient safety in intensive care nursing. Methods: Quantitative and qualitative methods were used. In Study I, 220 RNs from ten ICUs responded to a patient safety culture questionnaire analysed with statistics. Studies II-IV were based on an evaluation of a simulation-based team training programme. Studies II-III included 53 RNs from seven I...

  13. First-time urea breath tests performed at home by 36,629 patients

    DEFF Research Database (Denmark)

    Dahlerup, Søren; Andersen, Rikke Charlotte; Nielsen, Birgitte Sperling Wilms

    2011-01-01

    BACKGROUND: The aim of the current study was (1) to describe the use of a (13) C-urea breath test (UBT) that was performed by patients at their homes as a part of a test-and-treat strategy in primary care and (2) to investigate the prevalence of Helicobacter pylori in patients taking a first...

  14. Experimental investigation of performance of a novel ventilation method for hospital patient rooms

    DEFF Research Database (Denmark)

    Melikov, Arsen Krikor; Bolashikov, Zhecho Dimitrov; Brand, Marek

    2010-01-01

    A novel hospital bed integrated ventilation and cleaning unit (HBIVCU) was developed to reduce the exposure of medical staff, visitors, etc. to coughed air from a sick patient. The performance efficiency of the unit was studied in a full-scale mock-up of a hospital room with two beds with patients...

  15. Cognitive performance and psychosocial functioning in patients with bipolar disorder, unaffected siblings, and healthy controls

    OpenAIRE

    Vasconcelos-Moreno, Mirela P.; Bücker, Joana; Bürke, Kelen P.; Czepielewski, Leticia; Santos, Barbara T.; Fijtman, Adam; Passos, Ives C.; Kunz, Mauricio; Bonnín, Caterina del Mar; Vieta i Pascual, Eduard, 1963-; Kapczinski, Flávio; Rosa, Adriane R.; Kauer-Sant'Anna, Marcia

    2016-01-01

    Objective: To assess cognitive performance and psychosocial functioning in patients with bipolar disorder (BD), in unaffected siblings, and in healthy controls. Methods: Subjects were patients with BD (n=36), unaffected siblings (n=35), and healthy controls (n=44). Psychosocial functioning was accessed using the Functioning Assessment Short Test (FAST). A sub-group of patients with BD (n=21), unaffected siblings (n=14), and healthy controls (n=22) also underwent a battery of neuropsychologic...

  16. Medical students' clinical performance of dealing with patients in the context of domestic violence.

    Science.gov (United States)

    Kong, Hyun-Hee; Im, Sunju; Seo, Ji-Hyun; Kim, Do-Kyong; Roh, HyeRin

    2018-03-01

    The aim of this study was to inquire about the clinical performance and determine the performance pattern of medical students in standardized patient (SP) based examinations of domestic violence (DV). The clinical performance sores in DV station with SP of third-year (n=111, in 2014) and 4th-year (n=143, in 2016) medical students of five universities in the Busan-Gyeongnam Clinical Skills Examination Consortium were subjected in this study. The scenarios and checklists of DV cases were developed by the case development committee of the consortium. The students' performance was compared with other stations encountered in SP. The items of the checklists were categorized to determine the performance pattern of students investigating DV into six domains: disclosure strategy (D), DV related history taking (H), checking the perpetrator's psychosocial state (P), checking the victim's condition (V), negotiating and persuading the interviewee (N), and providing information about DV (I). Medical students showed poorer performance in DV stations than in the other stations with SP in the same examination. Most students did confirm the perpetrator and commented on confidentiality but ignored the perpetrator's state and patient's physical and psychological condition. The students performed well in the domains of D, H, and I but performed poorly in domains P, V, and N. Medical students showed poor clinical performance in the DV station. They performed an 'event oriented interview' rather than 'patient centered' communication. An integrated educational program of DV should be set to improve students' clinical performance.

  17. Association between academic performance and cognitive dysfunction in patients with juvenile systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Renan Bazuco Frittoli

    2016-06-01

    Full Text Available Abstract Objective To determine whether there is an association between the profile of cognitive dysfunction and academic outcomes in patients with juvenile systemic lupus erythematosus (JSLE. Methods Patients aged ≤18 years at the onset of the disease and education level at or above the fifth grade of elementary school were selected. Cognitive evaluation was performed according to the American College of Rheumatology (ACR recommendations. Symptoms of anxiety and depression were assessed by Beck scales; disease activity was assessed by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI; and cumulative damage was assessed by Systemic Lupus International Collaborating Clinics (SLICC. The presence of autoantibodies and medication use were also assessed. A significance level of 5% (p < 0.05 was adopted. Results 41 patients with a mean age of 14.5 ± 2.84 years were included. Cognitive dysfunction was noted in 17 (41.46% patients. There was a significant worsening in mathematical performance in patients with cognitive dysfunction (p = 0.039. Anxiety symptoms were observed in 8 patients (19.51% and were associated with visual perception (p = 0.037 and symptoms of depression were observed in 1 patient (2.43%. Conclusion Patients with JSLE concomitantly with cognitive dysfunction showed worse academic performance in mathematics compared to patients without cognitive impairment.

  18. Performance characteristics of SCC radioimmunoassay and clinical significance serum SCC Ag assay in patients with malignancy

    International Nuclear Information System (INIS)

    Kim, Dong Youn

    1986-01-01

    To evaluate the performance characteristics of SCC RIV and the clinical significance of serum SCC Ag assay in patients with malignancy, serum SCC Ag levels were measured by SCC RIV kit in 40 normal controls and 35 percents with various untreated malignancy, who visited Chonju Presbyterian Medical Center. The results were as follows; 1. The SCC RIA was simple to perform and can be completed in two workday. And the standard curve and reproducibility were both good. 2. The mean serum SCC Ag level in normal controls was 1.64 ± 0.93 ng/mL and normal upper limit of serum SCC Ag was defined as 2.6 ng/mL. 3 out of 40 (7.5%) normal controls showed elevated SCC Ag levels above the normal upper limit. 3. In 35 patients with various untreated malignancy, 18 patients (51.4%) showed elevated serum SCC Ag levels, 59.1% of 22 patients with cervical cancer, 80% of 5 patients with lung cancer, 33% of 3 patients with esophageal cancer, 0% of 2 patients with rectal cancer and 0% of 3 patients with breast cancer showed elevated serum SCC Ag levels. Above results represent that SCC RIV is simple method to perform followed by good standard curve and reproducibility, and may be a useful indicator reflecting diagnostic data of patients with cervical cancer and lung cancer

  19. Safety of performing a delayed anastomosis during damage control laparotomy in patients with destructive colon injuries.

    Science.gov (United States)

    Ordoñez, Carlos A; Pino, Luis F; Badiel, Marisol; Sánchez, Alvaro I; Loaiza, Jhon; Ballestas, Leonardo; Puyana, Juan Carlos

    2011-12-01

    Recent studies report the safety and feasibility of performing delayed anastomosis (DA) in patients undergoing damage control laparotomy (DCL) for destructive colon injuries (DCIs). Despite accumulating experience in both civilian and military trauma, questions regarding how to best identify high-risk patients and minimize the number of anastomosis-associated complications remain. Our current practice is to perform a definitive closure of the colon during DCL, unless there is persistent acidosis, bowel wall edema, or evidence of intra-abdominal abscess. In this study, we evaluated the safety of this approach by comparing outcomes of patients with DCI who underwent definitive closure of the colon during DCL versus patients managed with colostomy with or without DCL. We performed a retrospective chart review of patients with penetrating DCI during 2003 to 2009. Severity of injury, surgical management, and clinical outcome were assessed. Sixty patients with severe gunshot wounds and three patients with stab wounds were included in the analysis. DCL was required in 30 patients, all with gunshot wounds. Three patients died within the first 48 hours, three underwent colostomy, and 24 were managed with DA. Thirty-three patients were managed with standard laparotomy: 26 patients with primary anastomosis and 7 with colostomy. Overall mortality rate was 9.5%. Three late deaths occurred in the DCL group, and only one death was associated with an anastomotic leak. Performing a DA in DCI during DCL is a reliable and feasible approach as long as severe acidosis, bowel wall edema, and/or persistent intra-abdominal infections are not present.

  20. Myocardial performance and perfusion during exercise in patients with coronary artery disease caused by Kawasaki disease

    International Nuclear Information System (INIS)

    Paridon, S.M.; Ross, R.D.; Kuhns, L.R.; Pinsky, W.W.

    1990-01-01

    For a study of the natural history of coronary artery lesions after Kawasaki disease and their effect on myocardial blood flow reserve with exercise, five such patients underwent exercise testing on a bicycle. Oxygen consumption, carbon dioxide production, minute ventilation, and electrocardiograms were monitored continuously. Thallium-201 scintigraphy was performed for all patients. One patient stopped exercise before exhaustion of cardiovascular reserve but had no evidence of myocardial perfusion abnormalities. Four patients terminated exercise because of exhaustion of cardiovascular reserve; one had normal cardiovascular reserve and thallium scintiscans, but the remaining patients had diminished cardiovascular reserve. Thallium scintigrams showed myocardial ischemia in two and infarction in one. No patient had exercise-induced electrocardiographic changes. These results indicate that patients with residual coronary artery lesions after Kawasaki disease frequently have reduced cardiovascular reserve during exercise. The addition of thallium scintigraphy and metabolic measurements to exercise testing improved the detection of exercise-induced abnormalities of myocardial perfusion

  1. Radiation dose, driving performance, and cognitive function in patients with head and neck cancer

    International Nuclear Information System (INIS)

    Yuen, Hon K.; Sharma, Anand K.; Logan, William C.; Gillespie, M. Boyd; Day, Terry A.; Brooks, Johnell O.

    2008-01-01

    Seven head and neck cancer patients participated in a driving evaluation in a driving simulator. Radiation dose on the temporal lobes was moderately associated with time to complete a cognitive test and with driving performance. Results indicated that incidental irradiation may contribute to a decrease in cognition and in unsafe driving performance, which seems to be time-dependent

  2. Prognostic factors in patients with malignant pleural effusion: Is it possible to predict mortality in patients with good performance status?

    Science.gov (United States)

    Abrao, Fernando Conrado; Peixoto, Renata D'Alpino; de Abreu, Igor Renato Louro Bruno; Janini, Maria Cláudia; Viana, Geisa Garcia; de Oliveira, Mariana Campello; Younes, Riad Naim

    2016-04-01

    The aim of this study was to identify predictors of mortality only in patients with malignant pleural effusion (MPE) showing good performance status which required pleural palliative procedures. All patients with MPE submitted to pleural palliative procedure were enrolled in a prospective study between 2013 and 2014. Patients with Eastern cooperative oncology group (ECOG) score zero, one, and two were considered with good performance status. The possible prognostic factors were tested for significance using the log-rank test (Kaplan-Meier method) and those with significance on univariate analysis were entered into a multivariable Cox model. A total of 64 patients were included in the analysis. Median follow-up time for surviving patients was 263 days. Median survival for the entire cohort was not reached yet. In the multivariate analysis, gastrointestinal primary site (P = 0.006), low albumin concentration in the pleural fluid (P = 0.017), and high serum NLR (P = 0.007) were associated with mortality. In our cohort of ECOG 0-2 patients with MPE submitted to pleural palliative procedures, gastrointestinal malignancy compared to other sites, low pleural fluid albumin and high NLR were significantly associated with mortality. The identification of these prognostic factors may assist the choice of the optimal palliative technique. J. Surg. Oncol. 2016;113:570-574. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  3. Effects on neuropsychological performance and sleep quality in patients with obstructive sleep apnea syndrome

    Directory of Open Access Journals (Sweden)

    Cristina Staub

    2009-11-01

    Full Text Available Patients with obstructive sleep apnea syndrome (OSAS may have impaired neuropsychological performance. The aim of the study is to assess neuropsychological function in OSAS patients before and on continous positive airway pressure (CPAP therapy to assess different neuropsychological tests – especially of sensomotor memory – in OSAS patients, and to relate neuropsychological test results to polysomnographic findings. Therefore, 36 normal controls and 18 OSAS patients performed tests of attention capacity and memory with retrieval in the evening and the following morning. Six weeks later, the tests were repeated (patients on CPAP. Controls performed significantly better than patients in the tests of attention and of memory of facts without and on CPAP therapy. Moreover, good compliance of CPAP therapy was not associated with better performance. However, there was no significant difference between controls and patients in the tests of sensomotor memory. The neuropsychological results depended on oxygen values, the arousal index, and sleep stages. There is no group difference in overnight improvement in the neuropsychological tests, which could indicate that sleep has an important function in homeostatic regulation rather than in consolidation.

  4. Performance-Based Measures Associate With Frailty in Patients With End-Stage Liver Disease.

    Science.gov (United States)

    Lai, Jennifer C; Volk, Michael L; Strasburg, Debra; Alexander, Neil

    2016-12-01

    Physical frailty, as measured by the Fried Frailty Index, is increasingly recognized as a critical determinant of outcomes in patients with cirrhosis. However, its utility is limited by the inclusion of self-reported components. We aimed to identify performance-based measures associated with frailty in patients with cirrhosis. Patients with cirrhosis, aged 50 years or older, underwent: 6-minute walk test (cardiopulmonary endurance), chair stands in 30 seconds (muscle endurance), isometric knee extension (lower extremity strength), unipedal stance time (static balance), and maximal step length (dynamic balance/coordination). Linear regression associated each physical performance test with frailty. Principal components exploratory factor analysis evaluated the interrelatedness of frailty and the 5 physical performance tests. Of 40 patients with cirrhosis, with a median age of 64 years and Model for End-stage Liver Disease (MELD) MELD of 12.10 (25%) were frail by Fried Frailty Index ≥3. Frail patients with cirrhosis had poorer performance in 6-minute walk test distance (231 vs 338 m), 30-second chair stands (7 vs 10), isometric knee extension (86 vs 122 Newton meters), and maximal step length (22 vs 27 in. (P ≤ 0.02 for each). Each physical performance test was significantly associated with frailty (P test to a single factor-frailty. Frailty in cirrhosis is a multidimensional construct that is distinct from liver dysfunction and incorporates endurance, strength, and balance. Our data provide specific targets for prehabilitation interventions aimed at reducing frailty in patients with cirrhosis in preparation for liver transplantation.

  5. Organizational performance impacting patient satisfaction in Ontario hospitals: a multilevel analysis

    Science.gov (United States)

    2013-01-01

    Background Patient satisfaction in health care constitutes an important component of organizational performance in the hospital setting. Satisfaction measures have been developed and used to evaluate and improve hospital performance, quality of care and physician practice. In order to direct improvement strategies, it is necessary to evaluate both individual and organizational factors that can impact patients’ perception of care. The study aims were to determine the dimensions of patient satisfaction, and to analyze the individual and organizational determinants of satisfaction dimensions in hospitals. Methods We used patient and hospital survey data as well as administrative data collected for a 2008 public hospital report in Ontario, Canada. We evaluated the clustering of patient survey items with exploratory factor analysis and derived plausible dimensions of satisfaction. A two-level multivariate model was fitted to analyze the determinants of satisfaction. Results We found eight satisfaction factors, with acceptable to good level of loadings and good reliability. More than 95% of variation in patient satisfaction scores was attributable to patient-level variation, with less than 5% attributable to hospital-level variation. The hierarchical models explain 5 to 17% of variation at the patient level and up to 52% of variation between hospitals. Individual patient characteristics had the strongest association with all dimensions of satisfaction. Few organizational performance indicators are associated with patient satisfaction and significant determinants differ according to the satisfaction dimension. Conclusions The research findings highlight the importance of adjusting for both patient-level and organization-level characteristics when evaluating patient satisfaction. Better understanding and measurement of organization-level activities and processes associated with patient satisfaction could contribute to improved satisfaction ratings and care quality. PMID

  6. [Effect of preventive treatment on cognitive performance in patients with multiple sclerosis].

    Science.gov (United States)

    Shorobura, Maria S

    2018-01-01

    Introduction: cognitive, emotional and psychopathological changes play a significant role in the clinical picture of multiple sclerosis and influence the effectiveness of drug therapy, working capacity, quality of life, and the process of rehabilitation of patients with multiple sclerosis. The aim: investigate the changes in cognitive function in patients with multiple sclerosis, such as information processing speed and working memory of patients before and after treatment with immunomodulating drug. Materials and methods:33 patients examined reliably diagnosed with multiple sclerosis who were treated with preventive examinations and treatment from 2012 to 2016. For all patients with multiple sclerosis had clinical-neurological examination (neurological status using the EDSS scale) and the cognitive status was evaluated using the PASAT auditory test. Patient screening was performed before, during and after the therapy. Statistical analysis of the results was performed in the system Statistica 8.0. We used Student's t-test (t), Mann-Whitney test (Z). Person evaluated the correlation coefficients and Spearman (r, R), Wilcoxon criterion (T), Chi-square (X²). Results: The age of patients with multiple sclerosis affects the growth and EDSS scale score decrease PASAT to treatment. Duration of illness affects the EDSS scale score and performance PASAT. Indicators PASAT not significantly decreased throughout the treatment. Conclusions: glatiramer acetate has a positive effect on cognitive function, information processing speed and working memory patients with multiple sclerosis, which is one of the important components of the therapeutic effect of this drug.

  7. Treating Chronically Ill Diabetic Patients with Limited Life Expectancy: Implications for Performance Measurement

    Science.gov (United States)

    Woodard, LeChauncy D.; Landrum, Cassie R.; Urech, Tracy H.; Profit, Jochen; Virani, Salim S.; Petersen, Laura A.

    2012-01-01

    Background/Objectives To validly assess quality-of-care differences among providers, performance measurement programs must reliably identify and exclude patients for whom the quality indicator may not be desirable, including those with limited life expectancy. We developed an algorithm to identify patients with limited life expectancy and examined the impact of limited life expectancy on glycemic control and treatment intensification among diabetic patients. Design We identified diabetic patients with coexisting congestive heart failure, chronic obstructive pulmonary disease, dementia, end-stage liver disease, and/or primary/metastatic cancers with limited life expectancy. To validate our algorithm, we assessed 5-year mortality among patients identified as having limited life expectancy. We compared rates of meeting performance measures for glycemic control between patients with and without limited life expectancy. Among uncontrolled patients, we examined the impact of limited life expectancy on treatment intensification within 90 days. Setting 110 Veterans Administration facilities; October 2006 – September 2007 Participants 888,628 diabetic patients Measurements Hemoglobin A1c (HbA1c) Quality measurement and performance-based reimbursement systems should acknowledge the different needs of this population. PMID:22260627

  8. QUALITY OF NURSING CARE BASED ON ANALYSIS OF NURSING PERFORMANCE AND NURSE AND PATIENT SATISFACTION

    Directory of Open Access Journals (Sweden)

    Abdul Muhith

    2017-04-01

    Full Text Available Introduction: Nurses who frequently often contact to patients and most of their time serve patients in 24 hours, have an important role in caring for the patient. Patient satisfaction as quality indicator is the key success for competitiveness of service in hospital. The aim of this research was to develop nursing service quality model based on the nursing performance, nurse and patient satisfaction. Method: The research method used cross sectional study, at 14 wards of Gresik Hospital. Research factors were namely: oganization characteristic (organization culture and leadership, work factors (feedback and variety of nurses work, nurse characteristics (motivation, attitude, commitment and mental model, nursing practice, interpersonal communication, nurse and patient satisfaction. Statistical analysis of study data was analyzed by Partial Least Square (PLS. Results: The results of nursing performance revealed that nurse characteristic were not affected by organization culture and leadership style, nurse characteristics were affected by work factors, nurse characteristics affected nursing quality service (nursing practice, nursing professional, nurse and patient satisfaction, nurse satisfaction did not affect nursing professionals. Discussion: Based on the overall results of the development of nursing care model that was originally only emphasizes the process of nursing care only, should be consider the input factor of organizational characteristics, job characteristics, and characteristics of individual nurses and consider the process factors of nursing care standards and professional performance of nurses and to consider the outcome factors nurse and patient satisfaction. So in general the development model of quality of existing nursing care refers to a comprehensive system of quality.

  9. Comparative Performance Analysis of Different Fingerprint Biometric Scanners for Patient Matching.

    Science.gov (United States)

    Kasiiti, Noah; Wawira, Judy; Purkayastha, Saptarshi; Were, Martin C

    2017-01-01

    Unique patient identification within health services is an operational challenge in healthcare settings. Use of key identifiers, such as patient names, hospital identification numbers, national ID, and birth date are often inadequate for ensuring unique patient identification. In addition approximate string comparator algorithms, such as distance-based algorithms, have proven suboptimal for improving patient matching, especially in low-resource settings. Biometric approaches may improve unique patient identification. However, before implementing the technology in a given setting, such as health care, the right scanners should be rigorously tested to identify an optimal package for the implementation. This study aimed to investigate the effects of factors such as resolution, template size, and scan capture area on the matching performance of different fingerprint scanners for use within health care settings. Performance analysis of eight different scanners was tested using the demo application distributed as part of the Neurotech Verifinger SDK 6.0.

  10. Performance contracting to engage detoxification-only patients into continued rehabilitation.

    Science.gov (United States)

    Haley, Sean J; Dugosh, Karen Leggett; Lynch, Kevin G

    2011-03-01

    In 2006, only 18.7% of Delaware's detoxification patients were admitted to continuing recovery-oriented treatment within 30 days after discharge. In response, Delaware established financial contingencies to (1) maintain 90% detoxification occupancy, (2) make receipt of 10% of the facility's monthly reimbursement contingent on 25% of patients entering treatment, and (3) provide a $500 bonus for every patient with three or more prior detoxification visits who was retained in treatment. Under the performance contract, the detoxification provider (1) maintained the 90% occupancy requirement, (2) achieved the 25% treatment entry target for 7 of 12 months, and (3) observed only 8% (27/337) of detoxification completions that met the targeted length of stay. Continuation to and retention in treatment was even more constrained for patients with three or more prior detoxifications. Contrary to the policy intent, the number of patients with three or more detoxifications in fiscal year (FY) 2008 is nearly triple that of FY 2006. The modest gain in the transition rate was achieved without changes in patient access; the FY 2008 patient population reported significantly higher rates of homelessness and a younger age of first use than before the performance contract in FY 2006. Performance contracting may offer promise for improving transition to treatment rates. However, the unique needs of detoxification patients, the treatment capacity of each level of care to meet patient needs, and the structure of the performance contract must be carefully considered. Performance contracting efforts may be strengthened when service contracts across the system are tightly synchronized. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. Are urological procedures in tetraplegic patients safely performed without anesthesia? a report of three cases

    Directory of Open Access Journals (Sweden)

    Vaidyanathan Subramanian

    2012-02-01

    Full Text Available Abstract Background Some tetraplegic patients may wish to undergo urological procedures without anaesthesia, but these patients can develop autonomic dysreflexia if cystoscopy and vesical lithotripsy are performed without anaesthesia. Case presentation We describe three tetraplegic patients, who developed autonomic dysreflexia when cystoscopy and laser lithotripsy were carried out without anesthesia. In two patients, who declined anaesthesia, blood pressure increased to more than 200/110 mmHg during cystoscopy. One of these patients developed severe bleeding from bladder mucosa and lithotripsy was abandoned. Laser lithotripsy was carried out under subarachnoid block a week later in this patient, and this patient did not develop autonomic dysreflexia. The third patient with C-3 tetraplegia had undergone correction of kyphoscoliotic deformity of spine with spinal rods and pedicular screws from the level of T-2 to S-2. Pulmonary function test revealed moderate to severe restricted curve. This patient developed vesical calculus and did not wish to have general anaesthesia because of possible need for respiratory support post-operatively. Subarachnoid block was not considered in view of previous spinal fixation. When cystoscopy and laser lithotripsy were carried out under sedation, blood pressure increased from 110/50 mmHg to 160/80 mmHg. Conclusion These cases show that tetraplegic patients are likely to develop autonomic dysreflexia during cystoscopy and vesical lithotripsy, performed without anaesthesia. Health professionals should educate spinal cord injury patients regarding risks of autonomic dysreflexia, when urological procedures are carried out without anaesthesia. If spinal cord injury patients are made aware of potentially life-threatening complications of autonomic dysreflexia, they are less likely to decline anaesthesia for urological procedures. Subrachnoid block or epidural meperidine blocks nociceptive impulses from urinary bladder

  12. Organizational and market influences on physician performance on patient experience measures.

    Science.gov (United States)

    Rodriguez, Hector P; von Glahn, Ted; Rogers, William H; Safran, Dana Gelb

    2009-06-01

    To examine the extent to which medical group and market factors are related to individual primary care physician (PCP) performance on patient experience measures. This study employs Clinician and Group CAHPS survey data (n=105,663) from 2,099 adult PCPs belonging to 34 diverse medical groups across California. Medical group directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the adoption of patient experience improvement strategies. Primary care services area (PCSA) data were used to characterize the market environment of physician practices. We used multilevel models to estimate the relationship between medical group and market factors and physician performance on each Clinician and Group CAHPS measure. Models statistically controlled for respondent characteristics and accounted for the clustering of respondents within physicians, physicians within medical groups, and medical groups within PCSAs using random effects. Compared with physicians belonging to independent practice associations, physicians belonging to integrated medical groups had better performance on the communication ( p=.007) and care coordination ( p=.03) measures. Physicians belonging to medical groups with greater numbers of PCPs had better performance on all measures. The use of patient experience improvement strategies was not associated with performance. Greater emphasis on productivity and efficiency criteria in individual physician financial incentive formulae was associated with worse access to care ( p=.04). Physicians located in PCSAs with higher area-level deprivation had worse performance on the access to care ( p=.04) and care coordination ( pintegrated medical groups and groups with greater numbers of PCPs performed better on several patient experience measures, suggesting that organized care processes adopted by these groups may enhance patients' experiences. Physicians practicing in markets with high

  13. Survey of lands held for uranium exploration, development, and production in fourteen western states in the six month period ending December 31, 1975

    International Nuclear Information System (INIS)

    1976-04-01

    Details and data compilation on uranium exploration and mining are reported for Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas, Utah, Washington, and Wyoming. Comprehensive tables are furnished for distribution by ownership, distribution by states, and distribution by land category. A graph is given that shows the acres held by the uranium industry. Data are compiled on acreage held by each county and land category in each of the fourteen states

  14. Development of a Performance-Based Measure of Executive Functions in Patients with Schizophrenia.

    Directory of Open Access Journals (Sweden)

    En-Chi Chiu

    Full Text Available A performance-based measure for assessing executive functions (EF is useful to understand patients' real life performance of EF. This study aimed to develop a performance-based measure of executive functions (PEF based on the Lezak model and to examine psychometric properties (i.e., unidimensionality and reliability of the PEF using Rasch analysis in patients with schizophrenia. We developed the PEF in three phases: (1 designing the preliminary version of PEF; (2 consultation with experts, cognitive interviews with patients, and pilot tests on patients to revise the preliminary PEF; (3 establishment of the final version of the PEF and examination of unidimensionality and Rasch reliability. Two hundred patients were assessed using the revised PEF. After deleting items which did not satisfy the Rasch model's expectations, the final version of the PEF contained 1 practice item and 13 test items for assessing the four domains of EF (i.e., volition, planning, purposive action, and effective performance. For unidimensional and multidimensional Rasch analyses, the 4 domains showed good reliability (i.e., 0.77-0.85 and 0.87-0.90, respectively. Our results showed that the PEF had satisfactory unidimensionality and Rasch reliability. Therefore, clinicians and researchers could use the PEF to assess the four domains of EF in patients with schizophrenia.

  15. Subjective and neurovegetative changes in healthy volunteers and panic patients performing simulated public speaking.

    Science.gov (United States)

    Parente, Alexandre C B V; Garcia-Leal, Cybele; Del-Ben, Cristina M; Guimarães, Francisco S; Graeff, Frederico G

    2005-12-01

    Drug-free symptomatic panic patients, drug-treated nonsymptomatic patients and healthy controls were submitted to simulated public speaking. Subjective anxiety, cognitive impairment and discomfort measured by the visual analog mood scale as well as skin conductance level were higher in symptomatic patients than in controls at the beginning of the experimental session, nonsymptomatic patients lying in between. Subjective sedation, spontaneous fluctuations of skin conductance, heart rate and blood pressure were similar in the three groups. Preparation and performance of speech decreased sedation while increasing anxiety, cognitive impairment, level and fluctuations of skin conductance, heart rate and blood pressure. Anxiety, cognitive impairment and conductance level were less increased in symptomatic patients than in controls. Electrodermal activity, but not cardiovascular measures of sympathetic arousal correlated with anticipatory anxiety. Chronic treatment with serotonin uptake inhibitors attenuated the differences between panic patients and controls, supporting the participation of serotonin in panic disorder.

  16. Degree of patient satisfaction with health care performance assesed by marketing surveys.

    Science.gov (United States)

    Druguş, Daniela; Azoicăi, Doina

    2015-01-01

    Marketing surveys of the health system collect useful information to develop effective management strategies. The research aim consisted in measuring patient satisfaction with health care quality. The qualitative research was based on an online SurveyMonkey open-ended questionnaire. The analysis of patient satisfaction/dissatisfaction with healthcare professionals was performed in 1838 patients. Correlation analysis allowed the identification of some determinants associated with patient satisfaction. The variable most commonly associated with satisfaction was "I got adequate information about procedures/treatment" according to 32.2% of respondents. The patients who were dissatisfied most commonly complained that they were "Not adequately informed about maneuvers and treatment", reported by 40.0% of respondents. This study provides a basis for building an original model for determining the variables of an efficient healthcare system which to ensure a high degree of patient satisfaction.

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

    Science.gov (United States)

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

    2016-12-01

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

  18. PERFORM: a system for monitoring, assessment and management of patients with Parkinson's disease.

    Science.gov (United States)

    Tzallas, Alexandros T; Tsipouras, Markos G; Rigas, Georgios; Tsalikakis, Dimitrios G; Karvounis, Evaggelos C; Chondrogiorgi, Maria; Psomadellis, Fotis; Cancela, Jorge; Pastorino, Matteo; Waldmeyer, María Teresa Arredondo; Konitsiotis, Spiros; Fotiadis, Dimitrios I

    2014-11-11

    In this paper, we describe the PERFORM system for the continuous remote monitoring and management of Parkinson's disease (PD) patients. The PERFORM system is an intelligent closed-loop system that seamlessly integrates a wide range of wearable sensors constantly monitoring several motor signals of the PD patients. Data acquired are pre-processed by advanced knowledge processing methods, integrated by fusion algorithms to allow health professionals to remotely monitor the overall status of the patients, adjust medication schedules and personalize treatment. The information collected by the sensors (accelerometers and gyroscopes) is processed by several classifiers. As a result, it is possible to evaluate and quantify the PD motor symptoms related to end of dose deterioration (tremor, bradykinesia, freezing of gait (FoG)) as well as those related to over-dose concentration (Levodopa-induced dyskinesia (LID)). Based on this information, together with information derived from tests performed with a virtual reality glove and information about the medication and food intake, a patient specific profile can be built. In addition, the patient specific profile with his evaluation during the last week and last month, is compared to understand whether his status is stable, improving or worsening. Based on that, the system analyses whether a medication change is needed--always under medical supervision--and in this case, information about the medication change proposal is sent to the patient. The performance of the system has been evaluated in real life conditions, the accuracy and acceptability of the system by the PD patients and healthcare professionals has been tested, and a comparison with the standard routine clinical evaluation done by the PD patients' physician has been carried out. The PERFORM system is used by the PD patients and in a simple and safe non-invasive way for long-term record of their motor status, thus offering to the clinician a precise, long-term and

  19. Analysis of chest image performance in patients with acute chlorine poisoning

    International Nuclear Information System (INIS)

    Liu Liangqing; Zheng Jiangang; Yang Keyu; Wu Honglin; Tang Qingfang; Wu Huiming

    2012-01-01

    Objective: To explore chest image features of patients with acute chlorine poisoning and their clinical values. Methods: A retrospective analysis was performed by chest image features of 117 patients with acute chlorine poisoning. All the patients were classified according to Chinese management of occupational acute chlorine poisoning diagnosis standard. Results: Sixty-five patients presented with stimulus response, and normal or both lungs had a little more white on their chest images. Thirty-one cases presented with minor poisoning, and without or the texture of both lungs was increased, and grew hazy and coarse.seventeen cases were moderate, and small sample vague shadows or single or multiple limitations lamellar shadow. Four cases were serious,and two lungs had extensive and density homogeneous consolidation shadow. Conclusions: It would make the diagnosis and assessment of chlorine poisoning more easier based on the combination of chest image features, the clear history of acute chlorine poisoning and relevant clinical performance. (authors)

  20. Ability to perform Actvities of Daily Living among patients with bipolar disorder in remission

    DEFF Research Database (Denmark)

    Decker, Lone; Träger, Conny; Miskowiak, Kamilla

    2017-01-01

    in the community. While participants reported decreased ADL ability, especially within instrumental ADL, they had a tendency towards evaluating themselves as more competent than what was observed. No relationships between measures of observed and self-reported ADL ability were found. Conclusion: Overall, patients......ABSTRACT Aims: Patients with bipolar disorder often experience disability in terms of cognitive impairments and activity limitations even in remission. However, knowledge is sparse concerning the ability to perform Activities of Daily Living (ADL) during remission. The aim of this study was to (1......) investigate the observed and self-reported ability to perform ADL tasks and (2) examine the association between observed and self-reported ability to perform ADL in patients with bipolar disorder in remission. Methods: The observed ADL ability was assessed with the Assessment of Motor and Process Skills...

  1. Fourteen-day high-dose esomeprazole, amoxicillin and metronidazole as third-line treatment for Helicobacter pylori infection.

    Science.gov (United States)

    Puig, Ignasi; González-Santiago, Jesús M; Molina-Infante, Javier; Barrio, Jesús; Herranz, Maria Teresa; Algaba, Alicia; Castro, Manuel; Gisbert, Javier P; Calvet, Xavier

    2017-09-01

    The efficacy of currently recommended third-line therapies for Helicobacter pylori is suboptimal, even that of culture-guided treatments. Resistance to multiple antibiotics is the major factor related to treatment failure. The aim of this study was to evaluate the effectiveness and safety of a 14-day therapy using high-dose of amoxicillin, metronidazole and esomeprazole. Multicenter open-label study as a register in routine clinical practice in patients with two previous failures of eradication therapy. A triple therapy with esomeprazole 40 mg b.d., amoxicillin 1 g t.d.s and metronidazole 500 mg t.d.s for 2 weeks was administered as a third-line therapy after a first treatment including clarithromycin and a second treatment including a quinolone. Helicobacter pylori status was determined by either histology or 13 C-UBT both before and after treatment. A total of 68 patients were included in this study. An interim analysis showed that only three out of eight patients who had received metronidazole in previous eradication regimens were cured (37%, 95% CI 8-75); as a result, after this interim analysis only metronidazole-naïve patients were included. The ITT eradication rate in metronidazole-naive patients was 64% (95% CI 51-76). Adverse events occurred in 58% of patients, all of them mild-to-moderate. Two patients (3%) did not complete >90% of the treatment because of side effects. No severe adverse events occurred. Cure rates of this 14-day schedule using high-dose esomeprazole, amoxicillin and metronidazole as a third-line eradication regimen were suboptimal, especially in patients who had received metronidazole in previous failed eradication regimens. © 2017 John Wiley & Sons Ltd.

  2. The ethical framework for performing research with rare inherited neurometabolic disease patients

    OpenAIRE

    Giannuzzi, Viviana; Devlieger, Hugo; Margari, Lucia; Odlind, Viveca Lena; Ragab, Lamis; Bellettato, Cinzia Maria; D?Avanzo, Francesca; Lampe, Christina; Cassis, Linda; Cort?s-Saladelafont, Elisenda; Cazorla, ?ngels Garcia; Bari?, Ivo; Cvitanovi?-?ojat, Ljerka; Fumi?, Ksenija; Dali, Christine I

    2017-01-01

    The need for performing clinical trials to develop well-studied and appropriate medicines for inherited neurometabolic disease patients faces ethical concerns mainly raising from four aspects: the diseases are rare; include young and very young patients; the neurological impairment may compromise the capability to provide ?consent?; and the genetic nature of the disease leads to further ethical implications. This work is intended to identify the ethical provisions applicable to clinical resea...

  3. Evaluation of gait performance of knee osteoarthritis patients after total knee arthroplasty with different assistive devices

    OpenAIRE

    Tereso,Ana; Martins,Maria Manuel; Santos,Cristina Peixoto

    2015-01-01

    IntroductionNowadays Knee Osteoarthritis (KOA) affects a large percentage of the elderly, and one solution is to perform a Total Knee Arthroplasty (TKA). In this paper, one intends to study the gait and posture of these patients after the TKA, while walking with three assistive devices (ADs) (crutches, standard walker (SW) and rollator with forearm supports (RFS)).MethodsEleven patients were evaluated in 2 phases: 5 days and 15 days after surgery. This evaluation was conducted with two inerti...

  4. Feasibility of performing 123I MIBG scintigraphy in patients with neuroblastoma in the Maltese Islands

    International Nuclear Information System (INIS)

    Samuel, A.; Debattista, A.; Delia, M.; Grima, K.; Apap Bologna, G.

    2004-01-01

    Full text: The Maltese Islands lie in the middle of the Mediterranean Sea, 90 km south of Sicily and 300 km north of Libya. The supply of short-lived radioisotopes for medical use from mainland Europe is therefore logistically difficult. Due to this, several of our patients in the past were sent to centers in UK for various nuclear medicine procedures. Neuroblastoma is the commonest paediatric malignancy with an incidence in the Maltese islands similar to the figures in Western European. Tc-99m MDP and I-123 MIBG scans are important diagnostic tools in the management of these patients. We report our experience of I-123 MIBG scanning in paediatric patients with neuroblastoma. Between March 1997 and March 2003, 4 patients were examined and a total 8 scans were performed at the time of initial diagnosis and follow-up period. All these patients also underwent bone scintigraphy as a part of the protocol used in our hospital. We will discuss the problems encountered by us in obtaining the radiopharmaceutical and how these were circumvented. The procedure in place requires excellent coordination between all links of the supply chain namely manufacturers, overseas transporters, local customs officials, local delivery men, hospital staff and last but not least the patients (or their parents) themselves. Nowadays, these scans are performed on a routine basis whenever requested by the paediatric department and no patient in the last 4 years required rescheduling of the scan. The facts that the procedures are performed in the patient's own country rather than overseas reduces the psychological trauma that both the children as well as the parents go through. Furthermore, the convenience of performing the scans locally has resulted in significant cost savings to the National Health Service. (author)

  5. DMSA study performed during febrile urinary tract infection: a predictor of patient outcome?

    International Nuclear Information System (INIS)

    Camacho, V.; Estorch, M.; Tembl, A.; Mena, E.; Flotats, A.; Hernandez, Ma.; Fraga, G.; Carrio, I.

    2002-01-01

    DMSA study is an established method for the assessment of renal sequelae after acute pyelonephritis related to febrile urinary tract infection (UTI). However, at the moment is not established if the DMSA study performed during the acute UTI has any prognostic value for outcome assessment. Objectives: to assess the usefulness of DMSA study performed during febrile UTI as predictor of patient outcome. Methods: One hundred-fifty-two children (74 boys) with mean age 20 months (range 1m-12 y) with first febrile UTI were studied by DMSA planar scintigraphy during the acute illness period (first 5 days). All patients had positive grown bacillus in urine (78% E. coli, 8% P. mirabilis), and all followed the same antibiotic treatment. After acute UTI all patients were explored by voiding cysto urethrography for diagnosis of vesicoureteral reflux (VUR). Fifty-seven patients who had an abnormal DMSA study, VUR, or recurrent UTI underwent a DMSA control study (mean 8m after UTI). Results: DMSA study during febrile UTI was normal in 112 children (74%). In 95 of these children, follow-up DMSA studies were not performed due to a good clinical outcome (no VUR, no recurrent UTI). In the remaining 17 patients, follow-up DMSA studies were normal as well. Forty children (26%), who presented focal or diffuse cortical lesions during acute UTI, underwent a DMSA control study. Twenty-six of them presented a normal control DMSA, and 14 (9% of all patients) presented cortical lesions, 10 associated with a high-grade VUR. Fifty-seven children were followed by control DMSA, and no significant correlation between initial and follow-up study was found (κ= 0.250, p<0.007). Conclusion: These results indicate that DMSA study performed during febrile UTI may not be useful as predictor of patient outcome. Voiding cysto urethrography and control DMSA study seem to be more useful to select patients at risk of development of chronic cortical lesions

  6. Sleep Disturbance, Daytime Symptoms, and Functional Performance in Patients With Stable Heart Failure: A Mediation Analysis.

    Science.gov (United States)

    Jeon, Sangchoon; Redeker, Nancy S

    2016-01-01

    Sleep disturbance is common among patients with heart failure (HF) who also experience symptom burden and poor functional performance. We evaluated the extent to which sleep-related, daytime symptoms (fatigue, excessive daytime sleepiness, and depressive symptoms) mediate the relationship between sleep disturbance and functional performance among patients with stable HF. We recruited patients with stable HF for this secondary analysis of data from a cross-sectional, observational study. Participants completed unattended ambulatory polysomnography from which the Respiratory Disturbance Index was calculated, along with a Six-Minute Walk Test, questionnaires to elicit sleep disturbance (Pittsburgh Sleep Quality Index, Insomnia Symptoms from the Sleep Habits Questionnaire), daytime symptoms (Center for Epidemiologic Studies Depression Scale, Global Fatigue Index, Epworth Sleepiness Scale), and self-reported functional performance (Medical Outcomes Study SF36 V2 Physical Function Scale). We used structural equation modeling with latent variables for the key analysis. Follow-up, exploratory regression analysis with bootstrapped samples was used to examine the extent to which individual daytime symptoms mediated effects of sleep disturbance on functional performance after controlling for clinical and demographic covariates. The sample included 173 New York Heart Association Class I-IV HF patients (n = 60/34.7% women; M = 60.7, SD = 16.07 years of age). Daytime symptoms mediated the relationship between sleep disturbance and functional performance. Fatigue and depression mediated the relationship between insomnia symptoms and self-reported functional performance, whereas fatigue and sleepiness mediated the relationship between sleep quality and functional performance. Sleepiness mediated the relationship between the respiratory index and self-reported functional performance only in people who did not report insomnia. Daytime symptoms explain the relationships between sleep

  7. Schizotypal traits and cognitive performance in siblings of patients with psychosis.

    Science.gov (United States)

    Moreno-Samaniego, L; Gaviria, Ana M; Vilella, E; Valero, J; Labad, A

    2017-12-01

    Schizotypy has been proposed to be the expression of genetic vulnerability to schizophrenia. The available literature shows cognitive similarities between schizotypy and schizophrenia, with mildly impaired performance being associated with schizotypy. This study aims to determine the relationship between schizotypy and cognitive performance in siblings of patients with psychosis. Schizotypal features and cognitive performance on a neuropsychological battery were compared between 48 siblings of patients with psychosis and 44 healthy controls. The relationships between schizotypy and cognitive performance were analysed by controlling the condition of being a sibling. Siblings showed poorer performance on vigilance/sustained attention (M = 37.6; SD = 7.1) and selective attention/interference control/working memory (M = 23.28; SD = 2.7) tasks. The variance in vigilance/sustained attention performance was explained, at 30%, by the interpersonal factor of schizotypy on the suspiciousness dimension and the condition of being a sibling. Interpersonal features of schizotypy in siblings of patients with psychosis are associated with deficits in vigilance/sustained attention performance. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Opinion and Special Articles: Stress when performing the first lumbar puncture may compromise patient safety.

    Science.gov (United States)

    Henriksen, Mikael Johannes Vuokko; Wienecke, Troels; Kristiansen, Jesper; Park, Yoon Soo; Ringsted, Charlotte; Konge, Lars

    2018-05-22

    To quantify physician stress levels when performing lumbar puncture (LP) and explore operator stress effect on patient outcomes. This was a cross-sectional, multicenter study. Novices, intermediates, and experts in performing LP were recruited from 4 departments of neurology and emergency medicine. Stress was measured before and during performance of the LP using cognitive appraisal (CA), State-Trait Anxiety Inventory-Short (STAI-S) questionnaire, and the heart rate variability measure low frequency/high frequency index (LF/HF ratio). Patient-related outcomes were pain, confidence in the operator, and postdural puncture headache (PDPH). Forty-six physicians were included in the study: 22 novices, 12 intermediates, and 12 experts. Novices had the highest stress level and experts the lowest measured by cognitive appraisal and STAI-S before and during LP performance ( p < 0.001 for all comparisons). Novices had the highest sympathetic tonus indicated by the highest LF/HF ratio before ( p = 0.004) and during ( p = 0.056) LP performance. Physician stress level was not significantly related to patients' pain. However, there was a significant relationship between STAI-S during the procedure and patient confidence in the operator (regression coefficient = -0.034, p = 0.008). High physician heart rate during the procedure significantly increased the odds of PDPH (odds ratio = 1.17, p = 0.036). Novice stress levels were high before and during performance of LP. Stress was significantly related to patient confidence in the operator and risk of PDPH. Simulation-based training should be considered to reduce novice residents' stress levels and increase patient safety. © 2018 American Academy of Neurology.

  9. Comparing performance of 30-day readmission risk classifiers among hospitalized primary care patients.

    Science.gov (United States)

    Garrison, Gregory M; Robelia, Paul M; Pecina, Jennifer L; Dawson, Nancy L

    2017-06-01

    Hospital readmission within 30 days of discharge occurs in almost 20% of US Medicare patients and may be a marker of poor quality inpatient care, ineffective hospital to home transitions, or disease severity. Within a patient centered medical home, care transition interventions may only be practical from cost and staffing perspectives if targeted at patients with the greatest risk of readmission. Various scoring algorithms attempt to predict patients at risk for 30-day readmission, but head-to-head comparison of performance is lacking. Compare published scoring algorithms which use generally available electronic medical record data on the same set of hospitalized primary care patients. The LACE index, the LACE+ index, the HOSPITAL score, and the readmission risk score were computed on a consecutive cohort of 26,278 hospital admissions. Classifier performance was assessed by plotting receiver operating characteristic curves comparing the computed score with the actual outcome of death or readmission within 30 days. Statistical significance of differences in performance was assessed using bootstrapping techniques. Correct readmission classification on this cohort was moderate with the following c-statistics: Readmission risk score 0.666; LACE 0.680; LACE+ 0.662; and HOSPITAL 0.675. There was no statistically significant difference in performance between classifiers. Logistic regression based classifiers yield only moderate performance when utilized to predict 30-day readmissions. The task is difficult due to the variety of underlying causes for readmission, nonlinearity, and the arbitrary time period of concern. More sophisticated classification techniques may be necessary to increase performance and allow patient centered medical homes to effectively focus efforts to reduce readmissions. © 2016 John Wiley & Sons, Ltd.

  10. Tobacco and cognitive performance in schizophrenia patients: the design of the COGNICO study.

    Science.gov (United States)

    Al-Halabí, Susana; Fernández-Artamendi, Sergio; Díaz-Mesa, Eva M; García-Álvarez, Leticia; Flórez, Gerardo; Martínez-Santamaría, Emilia; Arrojo, Manuel; Saiz, Pilar A; García-Portilla, M Paz; Bobes, Julio

    2016-06-14

    People with schizophrenia constitute a substantial part of the people who still smoke. Regarding cognitive performance, the self-medication hypothesis states that patients smoke to improve their cognitive deficits based on the stimulating effects of nicotine. The aim of this paper is to describe in detail the methodology used in the COGNICO study. A quasi-experimental, observational, prospective, multicenter study with follow-ups over 18 months was conducted in three cities in northern Spain (Oviedo, Ourense and Santiago de Compostela). A total of 81 outpatient smokers with schizophrenia were recruited with a mean age 43.35 years (SD = 8.83), 72.8% of them male. They were assigned to 3 groups: a) control group (smokers); b) patients who quit smoking using nicotine patches; c) patients who quit smoking with Varenicline. The MATRICS neuropsychological battery was applied as a primary measure. In addition, a comprehensive assessment of patients was performed, including the number of cigarettes per day, physical and psychological dependence on nicotine and CO expired. Clinical evaluation (PANSS, HDRS, CGI, C-SSRS), anthropometric measurements and vital signs assessment was also performed. The aim is to identify the relationship between the pattern of tobacco use and cognitive performance by comparing scores on the neuropsychological battery MATRICS during the follow-up periods (3, 6, 12 and 18months). The importance of this study lies in addressing a topical issue often ignored by clinicians: the unacceptably high rates of tobacco use in patients with severe mental disorders.

  11. Cognitive performance and psychosocial functioning in patients with bipolar disorder, unaffected siblings, and healthy controls.

    Science.gov (United States)

    Vasconcelos-Moreno, Mirela P; Bücker, Joana; Bürke, Kelen P; Czepielewski, Leticia; Santos, Barbara T; Fijtman, Adam; Passos, Ives C; Kunz, Mauricio; Bonnín, Caterina Del Mar; Vieta, Eduard; Kapczinski, Flavio; Rosa, Adriane R; Kauer-Sant'Anna, Marcia

    2016-01-01

    To assess cognitive performance and psychosocial functioning in patients with bipolar disorder (BD), in unaffected siblings, and in healthy controls. Subjects were patients with BD (n=36), unaffected siblings (n=35), and healthy controls (n=44). Psychosocial functioning was accessed using the Functioning Assessment Short Test (FAST). A sub-group of patients with BD (n=21), unaffected siblings (n=14), and healthy controls (n=22) also underwent a battery of neuropsychological tests: California Verbal Learning Test (CVLT), Stroop Color and Word Test, and Wisconsin Card Sorting Test (WCST). Clinical and sociodemographic characteristics were analyzed using one-way analysis of variance or the chi-square test; multivariate analysis of covariance was used to examine differences in neuropsychological variables. Patients with BD showed higher FAST total scores (23.90±11.35) than healthy controls (5.86±5.47; p siblings (12.60±11.83; p 0.001). Siblings and healthy controls also showed statistically significant differences in FAST total scores (p = 0.008). Patients performed worse than healthy controls on all CVLT sub-tests (p Siblings did not differ from healthy controls in cognitive tests. Unaffected siblings of patients with BD may show poorer functional performance compared to healthy controls. FAST scores may contribute to the development of markers of vulnerability and endophenotypic traits in at-risk populations.

  12. Performance on the Wechsler Adult Intelligence Scale-III in Japanese patients with schizophrenia.

    Science.gov (United States)

    Fujino, Haruo; Sumiyoshi, Chika; Sumiyoshi, Tomiki; Yasuda, Yuka; Yamamori, Hidenaga; Ohi, Kazutaka; Fujimoto, Michiko; Umeda-Yano, Satomi; Higuchi, Arisa; Hibi, Yumiko; Matsuura, Yukako; Hashimoto, Ryota; Takeda, Masatoshi; Imura, Osamu

    2014-07-01

    Patients with schizophrenia have been reported to perform worse than non-schizophrenic populations on neuropsychological tests, which may be affected by cultural factors. The aim of this study was to examine the performance of a sizable number of patients with schizophrenia on the Japanese version of the Wechsler Adult Intelligence Scale-III (WAIS-III) compared with healthy controls. Performance on the WAIS-III was evaluated in 157 Japanese patients with schizophrenia and in 264 healthy control subjects. All IQ scores and four indices from the WAIS-III were impaired for patients with schizophrenia compared with healthy controls. Processing Speed was markedly disturbed, approximately 2 SD below that of the healthy control group. Among the 13 subtests, Comprehension (z = -1.70, d = 1.55), Digit Symbol Coding (z = -1.84, d = 1.88), and Symbol Search (z = -1.85, d = 1.77) were profoundly impaired relative to the healthy controls. These results indicate that the pattern and degree of impairment, as evaluated by the WAIS-III, in Japanese patients are similar to those previously reported in English-speaking patients and that the deficits of some neuropsychological domains relevant to functional outcomes are universally characteristic of schizophrenia. © 2014 The Authors. Psychiatry and Clinical Neurosciences © 2014 Japanese Society of Psychiatry and Neurology.

  13. Performance of patients with frontotemporal lobar degeneration on artistic tasks: A pilot study.

    Science.gov (United States)

    Anauate, Maria Cristina; Bahia, Valéria Santoro; Nitrini, Ricardo; Radanovic, Marcia

    2014-01-01

    Several studies have addressed visuospatial and executive skills in artistic activities in Frontotemporal Lobar Degeneration (FTLD) and Alzheimer's disease (AD). To investigate the performance of FTLD patients compared to controls on two artistic tasks. Four FTLD patients with mean age of 57 (8.7) years and schooling of 12.2 (4.5) years plus 10 controls with mean age of 62.9 (8.6) years and schooling of 12.3 (4.6) years, were assessed using the Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) and by a three-stage artistic protocol including visual observation, copying and collage, based on a Sisley painting. FTLD patients had lower scores than controls on Visuospatial Perception, Copy, Collage, Examiner's Observation, and Total, showing distinct patterns of performance according to FTLD sub-type: semantic PPA, nonfluent PPA and bvFTD. FTLD patients presented impairment in the visuospatial and executive skills required to perform artistic tasks. We demonstrated that the application of the instrument as a complimentary method for assessing cognitive skills in this group of patients is possible. Further studies addressing larger and more homogeneous samples of FTLD patients as well as other dementias are warranted.

  14. The ethical framework for performing research with rare inherited neurometabolic disease patients.

    Science.gov (United States)

    Giannuzzi, Viviana; Devlieger, Hugo; Margari, Lucia; Odlind, Viveca Lena; Ragab, Lamis; Bellettato, Cinzia Maria; D'Avanzo, Francesca; Lampe, Christina; Cassis, Linda; Cortès-Saladelafont, Elisenda; Cazorla, Ángels Garcia; Barić, Ivo; Cvitanović-Šojat, Ljerka; Fumić, Ksenija; Dali, Christine I; Bartoloni, Franco; Bonifazi, Fedele; Scarpa, Maurizio; Ceci, Adriana

    2017-03-01

    The need for performing clinical trials to develop well-studied and appropriate medicines for inherited neurometabolic disease patients faces ethical concerns mainly raising from four aspects: the diseases are rare; include young and very young patients; the neurological impairment may compromise the capability to provide 'consent'; and the genetic nature of the disease leads to further ethical implications. This work is intended to identify the ethical provisions applicable to clinical research involving these patients and to evaluate if these cover the ethical issues. Three searches have been performed on the European regulatory/legal framework, the literature and European Union-funded projects. The European legal framework offers a number of ethical provisions ruling the clinical research on paediatric, rare, inherited diseases with neurological symptoms. In the literature, relevant publications deal with informed consent, newborn genetic screenings, gene therapy and rights/interests of research participants. Additional information raised from European projects on sharing patients' data from different countries, the need to fill the gap of the regulatory framework and to improve information to stakeholders and patients/families. Several recommendations and guidelines on ethical aspects are applicable to the inherited neurometabolic disease research in Europe, even though they suffer from the lack of a common ethical approach. What is Known: • When planning and conducting clinical trials, sponsors and researchers know that clinical trials are to be performed according to well-established ethical rules, and patients should be aware about their rights. • In the cases of paediatric patients, vulnerable patients unable to provide consent, genetic diseases' further rules apply. What is New: • This work discusses which ethical rules apply to ensure protection of patient's rights if all the above-mentioned features coexist. • This work shows available data and

  15. Denaturing high-performance liquid chromatography mutation analysis in patients with reduced Protein S levels

    DEFF Research Database (Denmark)

    Bathum, Lise; Münster, Anna-Marie; Nybo, Mads

    2008-01-01

    diagnosis and risk estimation. The aim was to design a high-throughput genetic analysis based on denaturing high-performance liquid chromatography to identify sequence variations in the gene coding for Protein S. PATIENTS: In total, 55 patients referred to the Section of Thrombosis and Haemostasis, Odense......BACKGROUND: Patients with congenital Protein S deficiency have increased risk of venous thromboembolism. However, Protein S levels show large intra-individual variation and the biochemical assays have low accuracy and a high interlaboratory variability. Genetic analysis might aid in a more precise......, giving a precise diagnosis and subsequently a better risk estimation....

  16. Identification of tasks performed by stroke patients using a mobility assistive device

    DEFF Research Database (Denmark)

    Hester, Todd; Sherrill, Delsey M; Hamel, Mathieu

    2006-01-01

    of these devices. In this study, we propose the use of wearable sensors to identify tasks performed by stroke patients with a mobility assistive device. Subjects performed ten tasks with a three-axis accelerometer attached to their ankle and a neural network was trained to identify the task being performed...... tasks associated with the use of a cane. Therefore, we envision that the methodology presented in this paper could be used to evaluate the use of a cane in the context of the task being performed........ Results from 15 stroke patients indicated that these motor tasks can be reliably identified with a median sensitivity of 90 % at a median specificity of 95%. These results indicate that it is possible to use a single module with a three-axis accelerometer attached to the ankle to reliably identify motor...

  17. Patients' Experiences of Performing Self-care of Stomas in the Initial Postoperative Period.

    Science.gov (United States)

    Lim, Siew Hoon; Chan, Sally Wai Chi; He, Hong-Gu

    2015-01-01

    With the loss of an important bodily function and the distortion in body image, a stoma patient experiences physical, psychological, and social changes. With limited current studies exploring experiences of patients in the management of their stoma, there is a need to explore their experiences, their needs, and factors that influence their self-management. The aim of this study was to investigate patients' experiences of performing self-care of stomas in the initial postoperative period. This study adopted a descriptive qualitative approach from the interpretive paradigm. Semistructured interviews were conducted with 12 patients 1 month postoperatively in a colorectal ward in a hospital in Singapore. Thematic analysis was applied to the interview data. Five themes were identified: process of acceptance and self-management of stoma, physical limitations, psychological reactions, social support, and need for timely and sufficient stoma preparation and education. This study highlights the importance of health professionals' role in helping patients adjust preoperatively and postoperatively and accept the presence of a stoma. Health professionals need to be aware of the physical, psychological, and social impact of stoma on patients in the initial 30-day postoperative period. Research findings informed the type and level of assistance and support to be offered to patients by nurses and the importance of encouraging patients to be involved in stoma care at an early stage, which will ultimately contribute to effective and independent self-management. Patients can be prepared preoperatively to reduce the psychological and social impact of stoma after creation of their stoma.

  18. Evaluation of Exercise Tolerance in Dialysis Patients Performing Tai Chi Training: Preliminary Study

    Directory of Open Access Journals (Sweden)

    Wioletta Dziubek

    2016-01-01

    Full Text Available Introduction. Patients with end-stage renal disease (ESRD have poor physical performance and exercise capacity due to frequent dialysis treatments. Tai Chi exercises can be very useful in the area of rehabilitation of people with ESRD. Objectives. The aim of the study was to assess exercise capacity in ESRD patients participating in 6-month Tai Chi training. Patients and Methods. Twenty dialysis patients from Wroclaw took part in the training; at the end of the project, 14 patients remained (age 69.2±8.6 years. A 6-minute walk test (6MWT and spiroergometry were performed at the beginning and after 6 months of training. Results. After 6 months of Tai Chi, significant improvements were recorded in mean distance in the 6MWT (387.89 versus 436.36 m, rate of perceived exertion (7.4 versus 4.7, and spiroergometry (8.71 versus 10.08 min. Conclusions. In the ESRD patients taking part in Tai Chi training, a definite improvement in exercise tolerance was recorded after the 6-month training. Tai Chi exercises conducted on days without dialysis can be an effective and interesting form of rehabilitation for patients, offering them a chance for a better quality of life and fewer falls and hospitalisations that are the result of it.

  19. Performance of new thresholds of the Glasgow Blatchford score in managing patients with upper gastrointestinal bleeding.

    Science.gov (United States)

    Laursen, Stig B; Dalton, Harry R; Murray, Iain A; Michell, Nick; Johnston, Matt R; Schultz, Michael; Hansen, Jane M; Schaffalitzky de Muckadell, Ove B; Blatchford, Oliver; Stanley, Adrian J

    2015-01-01

    Upper gastrointestinal hemorrhage (UGIH) is a common cause of hospital admission. The Glasgow Blatchford score (GBS) is an accurate determinant of patients' risk for hospital-based intervention or death. Patients with a GBS of 0 are at low risk for poor outcome and could be managed as outpatients. Some investigators therefore have proposed extending the definition of low-risk patients by using a higher GBS cut-off value, possibly with an age adjustment. We compared 3 thresholds of the GBS and 2 age-adjusted modifications to identify the optimal cut-off value or modification. We performed an observational study of 2305 consecutive patients presenting with UGIH at 4 centers (Scotland, England, Denmark, and New Zealand). The performance of each threshold and modification was evaluated based on sensitivity and specificity analyses, the proportion of low-risk patients identified, and outcomes of patients classified as low risk. There were differences in age (P = .0001), need for intervention (P 97%). The GBS at cut-off values of ≤1 and ≤2, and both modifications, identified low-risk patients with higher levels of specificity (40%-49%) than the GBS with a cut-off value of 0 (22% specificity; P < .001). The GBS at a cut-off value of ≤2 had the highest specificity, but 3% of patients classified as low-risk patients had adverse outcomes. All GBS cut-off values, and score modifications, had low levels of specificity when tested in New Zealand (2.5%-11%). A GBS cut-off value of ≤1 and both GBS modifications identify almost twice as many low-risk patients with UGIH as a GBS at a cut-off value of 0. Implementing a protocol for outpatient management, based on one of these scores, could reduce hospital admissions by 15% to 20%. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  20. Evaluating the use of key performance indicators to evidence the patient experience.

    Science.gov (United States)

    McCance, Tanya; Hastings, Jack; Dowler, Hilda

    2015-11-01

    To test eight person-centred key performance indicators and the feasibility of an appropriate measurement framework as an approach to evidencing the patient experience. The value of measuring the quality of patient care is undisputed in the international literature, however, the type of measures that can be used to generate data that is meaningful for practice continues to be debated. This paper offers a different perspective to the 'measurement' of the nursing and midwifery contribution to the patient experience. Fourth generation evaluation was the methodological approach used to evaluate the implementation of the key performance indicators and measurement framework across three participating organisations involving nine practice settings. Data were collected by repeated use of claims, concerns and issues with staff working across nine participating sites (n = 18) and the senior executives from the three partner organisations (n = 12). Data were collected during the facilitated sessions with stakeholders and analysed in conjunction with the data generated from the measurement framework. The data reveal the inherent value placed on the evidence generated from the implementation of the key performance indicators as reflected in the following themes: measuring what matters; evidencing the patient experience; engaging staff; a focus for improving practice; and articulating and demonstrating the positive contribution of nursing and midwifery. The implementation of the key performance indicators and the measurement framework has been effective in generating evidence that demonstrates the patient experience. The nature of the data generated not only privileges the patient voice but also offers feedback to nurses and midwives that can inform the development of person-centred cultures. The use of these indicators will produce evidence of patient experience that can be used by nurse and midwives to celebrate and further inform person-centred practice. © 2015 John

  1. Retrobulbar optic neuritis and rhegmatogenous retinal detachment in a fourteen-year-old girl with retinitis pigmentosa sine pigmento.

    Science.gov (United States)

    Hatta, M; Hayasaka, S; Kato, T; Kadoi, C

    2000-01-01

    A 14-year-old girl complained of a sudden decrease in right visual acuity. The patient had night blindness, a mottled retina but no pigments, extinguished scotopic electroretinographic response, central scotoma in the right eye and rhegmatogenous retinal detachment. She had initially received laser photocoagulation around the retinal tear and then corticosteroid therapy, cryoretinopexy and segmental buckling. Her right visual acuity increased to 1.0. The association of retinitis pigmentosa sine pigmento, retrobulbar optic neuritis and rhegmatogenous retinal detachment, as demonstrated in our patient, may be uncommon. Copyright 2000 S. Karger AG, Basel

  2. Feasibility and Inter-Rater Reliability of Physical Performance Measures in Acutely Admitted Older Medical Patients

    DEFF Research Database (Denmark)

    Bodilsen, Ann Christine; Juul-Larsen, Helle Gybel; Petersen, Janne

    2015-01-01

    OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter-rater reliabi......OBJECTIVE: Physical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter......-rater reliability of four simple measures of physical performance in acutely admitted older medical patients. DESIGN: During the first 24 hours of hospitalization, the following were assessed twice by different raters in 52 (≥ 65 years) patients admitted for acute medical illness: isometric hand grip strength, 4......, and 30-s chair stand were 8%, 7%, and 18%, and the SRD95% values were 22%, 17%, and 49%. CONCLUSION: In acutely admitted older medical patients, grip strength, gait speed, and the Cumulated Ambulation Score measurements were feasible and showed high inter-rater reliability when administered by different...

  3. Depressed left ventricular performance. Response to volume infusion in patients with sepsis and septic shock

    International Nuclear Information System (INIS)

    Ognibene, F.P.; Parker, M.M.; Natanson, C.; Shelhamer, J.H.; Parrillo, J.E.

    1988-01-01

    Volume infusion, to increase preload and to enhance ventricular performance, is accepted as initial management of septic shock. Recent evidence has demonstrated depressed myocardial function in human septic shock. We analyzed left ventricular performance during volume infusion using serial data from simultaneously obtained pulmonary artery catheter hemodynamic measurements and radionuclide cineangiography. Critically ill control subjects (n = 14), patients with sepsis but without shock (n = 21), and patients with septic shock (n = 21) had prevolume infusion hemodynamic measurements determined and received statistically similar volumes of fluid resulting in similar increases in pulmonary capillary wedge pressure. There was a strong trend (p = 0.004) toward less of a change in left ventricular stroke work index (LVSWI) after volume infusion in patients with sepsis and septic shock compared with control subjects. The LVSWI response after volume infusion was significantly less in patients with septic shock when compared with critically ill control subjects (p less than 0.05). These data demonstrate significantly altered ventricular performance, as measured by LVSWI, in response to volume infusion in patients with septic shock

  4. What Limits Cardiac Performance during Exercise in Normal Subjects and in Healthy Fontan Patients?

    Directory of Open Access Journals (Sweden)

    André La Gerche

    2010-01-01

    Full Text Available Exercise is an important determinant of health but is significantly reduced in the patient with a univentricular circulation. Normal exercise physiology mandates an increase in pulmonary artery pressures which places an increased work demand on the right ventricle (RV. In a biventricular circulation with pathological increases in pulmonary vascular resistance and/or reductions in RV function, exercise-induced augmentation of cardiac output is limited. Left ventricular preload reserve is dependent upon flow through the pulmonary circulation and this requires adequate RV performance. In the Fontan patient, the reasons for exercise intolerance are complex. In those patients with myocardial dysfunction or other pathologies of the circulatory components, it is likely that these abnormalities serve as a limitation to cardiac performance during exercise. However, in the healthy Fontan patient, it may be the absence of a sub-pulmonary pump which limits normal increases in pulmonary pressures, trans-pulmonary flow requirements and cardiac output. If so, performance will be exquisitely dependent on pulmonary vascular resistance. This provides a potential explanation as to why pulmonary vasodilators may improve exercise tolerance. As has recently been demonstrated, these agents may offer an important new treatment strategy which directly addresses the physiological limitations in the Fontan patient.

  5. Implant overdentures: dental students' performance in fabrication, denture quality, and patient satisfaction.

    Science.gov (United States)

    Aragon, Cecilia E; Cornacchio, Angelica Lee Petrina; Ibarra, Lilia Marcela; Saad, Muhammed N; Zibrowski, Elaine

    2010-09-01

    The purpose of this study was to evaluate dental students' performance when fabricating a mandibular two-implant overdenture (OD) as compared to conventional dentures (CD) and to determine if these prostheses were successful. Twenty students and twenty patients were divided into two groups: complete denture group (CDG) and maxillary denture and two-implant OD group (ODG). Students' progress was evaluated at each appointment as they were given a clinical assessment score (CAS), which varied from 1 (unacceptable, needs to repeat procedure) to 4 (acceptable, no errors). The success of the prosthesis was evaluated by the patients using a visual analog scale (VAS) and an expert (a prosthodontist) using a denture quality assessment (DQA) form. Performance for both groups was not statistically different across all eight appointments (CDG 3.16 versus ODG 3.25; p=0.46). Patients with ODs reported greater stability with their dentures (p=0.048) and greater ability to chew than patients with CDs (p=0.03). There were no differences between the groups in terms of expert appraisal (ODG 71.1 versus CDG 67.5; p=0.59). The performance of dental students when fabricating a two-implant OD is thus not different from that of a CD. Students can successfully fabricate a two-implant OD as perceived by both patients and prosthodontists.

  6. [Prevalence of aphysiologic performance on dynamic posturography in work-related patients].

    Science.gov (United States)

    Larrosa, Francisco; Durà, María J; Cordón, Astrid; Hernández, Anabella; García-Ibáñez, Luis

    2012-01-01

    Medical-legal implications of dizziness and imbalance in work-related patients are important. In these cases, computerized dynamic posturography (CDP) adds information to standard vestibular tests and aphysiologic patterns have been described. The objective is to assess the prevalence of aphysiologic performance on CDP in work-related patients complaining of dizziness/imbalance. Retrospective review of patients referred by the workers' compensation board for assessment of dizziness, imbalance or both. Standard vestibular assessment including CDP was carried out in all patients. The sensory organization test (SOT) summaries were scored as normal, aphysiologic or vestibular using the scoring method published by Cevette et al. in 1995. Aphysiologic performance in SOT, evaluated with the Cevette formula, was found in 31 out of 100 cases. Low composite score results and aphysiologic SOT results had a statistically-significant association (P=.01). Videonystagmography (VNG) was altered in 14 out of 31 cases with aphysiologic SOT. The 31% prevalence of aphysiologic results on CDP among work-related patients complaining of dizziness/imbalance is relatively high in comparison with the 25% published by Longridge and Mallinson in 2005. However, aphysiologic performance should not necessarily be related to malingering or exaggeration and altered vestibular tests are found in some of these cases. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  7. Effects of Motor Learning on Clinical Isokinetic Test Performance in Knee Osteoarthritis Patients

    Directory of Open Access Journals (Sweden)

    José Messias Rodrigues-da-Silva

    Full Text Available OBJECTIVES: To analyze the effects of motor learning on knee extension-flexion isokinetic performance in knee osteoarthritis patients. METHODS: One hundred and thirty-six middle-aged and older sedentary individuals (111 women, 64.3±9.9 years with knee osteoarthritis (130 patients with bilateral and who had never performed isokinetic testing underwent two bilateral knee extension-flexion (concentric-concentric isokinetic evaluations (5 repetitions at 60°/sec. The tests were first performed on the dominant leg with 2 min of recovery between test, and following a standardized warm-up that included 3 submaximal isokinetic repetitions. The same procedure was repeated on the non-dominant leg. The peak torque, peak torque adjusted for the body weight, total work, coefficient of variation and agonist/antagonist ratio were compared between tests. RESULTS: Patients showed significant improvements in test 2 compared to test 1, including higher levels of peak torque, peak torque adjusted for body weight and total work, as well as lower coefficients of variation. The agonist/antagonist relationship did not significantly change between tests. No significant differences were found between the right and left legs for all variables. CONCLUSION: The results suggest that performing two tests with a short recovery (2 min between them could be used to reduce motor learning effects on clinical isokinetic testing of the knee joint in knee osteoarthritis patients.

  8. Cancer patient experience, hospital performance and case mix: evidence from England.

    Science.gov (United States)

    Abel, Gary A; Saunders, Catherine L; Lyratzopoulos, Georgios

    2014-01-01

      This study aims to explore differences between crude and case mix-adjusted estimates of hospital performance with respect to the experience of cancer patients. This study analyzed the English 2011/2012 Cancer Patient Experience Survey covering all English National Health Service hospitals providing cancer treatment (n = 160). Logistic regression analysis was used to predict hospital performance for each of the 64 evaluative questions, adjusting for age, gender, ethnic group and cancer diagnosis. The degree of reclassification was explored across three categories (bottom 20%, middle 60% and top 20% of hospitals). There was high concordance between crude and adjusted ranks of hospitals (median Kendall's τ = 0.84; interquartile range: 0.82-0.88). Across all questions, a median of 5.0% (eight) of hospitals (interquartile range: 3.8-6.4%; six to ten hospitals) moved out of the extreme performance categories after case mix adjustment. In this context, patient case mix has only a small impact on measured hospital performance for cancer patient experience.

  9. CONTRIBUTION OF COGNITIVE INTERFERENCE TO DECREMENTS IN WALKING PERFORMANCE IN HEMODIALYSIS PATIENTS

    Directory of Open Access Journals (Sweden)

    Ken Wilund

    2012-06-01

    These data indicate that walking impairments in hemodialysis patients are not due exclusively to declines in physical function, but that cognitive-motor interference also plays a significant role. This has significant clinical importance, as therapies designed to improve walking performance and physical function, such as nutritional and exercise interventions, may need to be augmented with cognitive training in order to have maximum benefits.

  10. Contralateral Bimodal Stimulation: A Way to Enhance Speech Performance in Arabic-Speaking Cochlear Implant Patients.

    Science.gov (United States)

    Abdeltawwab, Mohamed M; Khater, Ahmed; El-Anwar, Mohammad W

    2016-01-01

    The combination of acoustic and electric stimulation as a way to enhance speech recognition performance in cochlear implant (CI) users has generated considerable interest in the recent years. The purpose of this study was to evaluate the bimodal advantage of the FS4 speech processing strategy in combination with hearing aids (HA) as a means to improve low-frequency resolution in CI patients. Nineteen postlingual CI adults were selected to participate in this study. All patients wore implants on one side and HA on the contralateral side with residual hearing. Monosyllabic word recognition, speech in noise, and emotion and talker identification were assessed using CI with fine structure processing/FS4 and high-definition continuous interleaved sampling strategies, HA alone, and a combination of CI and HA. The bimodal stimulation showed improvement in speech performance and emotion identification for the question/statement/order tasks, which was statistically significant compared to patients with CI alone, but there were no significant statistical differences in intragender talker discrimination and emotion identification for the happy/angry/neutral tasks. The poorest performance was obtained with HA only, and it was statistically significant compared to the other modalities. The bimodal stimulation showed enhanced speech performance in CI patients, and it improves the limitations provided by electric or acoustic stimulation alone. © 2016 S. Karger AG, Basel.

  11. Effective doses associated with the common hybrid scans performed in nuclear medicine to adult patients

    International Nuclear Information System (INIS)

    Camacho Lopez, C.; Garcia Martinez, M. T.; Martin Vidal, J. F.; Falgas Lacuela, M.; Vercher Conejero, J. L.

    2011-01-01

    The main objective of this paper is to outline the effective dose (E) that can be taught in hybrid SPECT-CT scans and PET-CT performed more common in adult patients. E is expressed as the Natural Radiation Equivalent Time (TERN) and consider, for each scan, the percentage of the total dose due to TC.

  12. Standard Guidelines of Care: Performing Procedures in Patients on or Recently Administered with Isotretinoin.

    Science.gov (United States)

    Mysore, Venkataram; Mahadevappa, Omprakash H; Barua, Shyamanta; Majid, Imran; Viswanath, Vishalakshi; Bhat, Ramesh M; Talwar, Suresh; Thurakkal, Salim; Aurangabadkar, Sanjeev J; Chatterjee, Manas; Ganjoo, Anil

    2017-01-01

    Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13- cis -retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring. The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration. Data were extracted from the literature through a PubMed search using the keywords "isotretinoin," "safety," "scarring," "keloids," "hypertrophic scarring," and "pigmentation." The evidence was then labeled and circulated to all members of task force for review. The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.

  13. PERFORM: A System for Monitoring, Assessment and Management of Patients with Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Alexandros T. Tzallas

    2014-11-01

    Full Text Available In this paper, we describe the PERFORM system for the continuous remote monitoring and management of Parkinson’s disease (PD patients. The PERFORM system is an intelligent closed-loop system that seamlessly integrates a wide range of wearable sensors constantly monitoring several motor signals of the PD patients. Data acquired are pre-processed by advanced knowledge processing methods, integrated by fusion algorithms to allow health professionals to remotely monitor the overall status of the patients, adjust medication schedules and personalize treatment. The information collected by the sensors (accelerometers and gyroscopes is processed by several classifiers. As a result, it is possible to evaluate and quantify the PD motor symptoms related to end of dose deterioration (tremor, bradykinesia, freezing of gait (FoG as well as those related to over-dose concentration (Levodopa-induced dyskinesia (LID. Based on this information, together with information derived from tests performed with a virtual reality glove and information about the medication and food intake, a patient specific profile can be built. In addition, the patient specific profile with his evaluation during the last week and last month, is compared to understand whether his status is stable, improving or worsening. Based on that, the system analyses whether a medication change is needed—always under medical supervision—and in this case, information about the medication change proposal is sent to the patient. The performance of the system has been evaluated in real life conditions, the accuracy and acceptability of the system by the PD patients and healthcare professionals has been tested, and a comparison with the standard routine clinical evaluation done by the PD patients’ physician has been carried out. The PERFORM system is used by the PD patients and in a simple and safe non-invasive way for long-term record of their motor status, thus offering to the clinician a

  14. Improvement of the myocardial performance index in atrial fibrilation patients treated with amiodarone after cardioversion.

    Science.gov (United States)

    Besli, Feyzullah; Basar, Cengiz; Kecebas, Mesut; Turker, Yasin

    2015-03-01

    This study evaluated the response to electrical cardioversion (EC) and the effect on the myocardial performance index (MPI) in patients with persistent and long-standing persistent atrial fibrillation (AF). We enrolled 103 patients (mean age 69.6 ± 8.9 years, 40.7% males) with a diagnosis of persistent and long-standing persistent AF. EC was applied to all patients after one g of amiodarone administration. Echocardiographic findings before EC were compared in patients with successful versus unsuccessful cardioversions and in patients with maintained sinus rhythm (SR) versus those with AF recurrence at the end of the first month. We also compared echocardiographic data before EC versus at the end of the first month in the same patients with maintained SR. SR was achieved in 72.8% of patients and was continued at the end of the first month in 69.3% of the patients. The MPI value of all patients was found to be 0.73 ± 0.21. The size of the left atrium was determined to be an independent predictor of the maintenance of SR at 1 month. In subgroup analyses, when we compared echocardiographic findings before EC and at the end of the first month in patients with maintained SR, the MPI (0.66 ± 0.14 vs 0.56 ± 0.09, p < 0.001) values were significantly decreased. Our study is the first to show impairment of the MPI, which is an indicator of systolic and diastolic function, in patients with persistent and long-standing persistent AF and improvement of the MPI after successful EC.

  15. Ventricular performance during exercise in patients with chronic obstructive pulmonary disease (COPD)

    Energy Technology Data Exchange (ETDEWEB)

    Sasaki, Iwao; Akashiba, Tsuneto; Horie, Takashi [Nihon Univ., Tokyo (Japan). School of Medicine

    1992-01-01

    We assessed ventricular performance during exercise in 16 chronic obstructive pulmonary disease (COPD) patients and 8 normal control subjects by means of radionuclide equilibrium angiography using technetium-99m as a tracer. Supine exercise on a bicycle ergometer was performed until symptom-limited exhaustion. Data were accumulated for 300 heart beats at rest and 150 heart beats during exercise. We used the standard voxel count method to calculate the ventricular volumes. Age, FEV{sub 1.0}%, %VC, PaO{sub 2} and PaCO{sub 2} of the COPD patients were 63{+-}8 yr, 46{+-}11%, 69{+-}18%, 68{+-}11 Torr and 44{+-}7 Torr (mean{+-}SD), respectively. Systolic dysfunction of both the left and right ventricles was well confirmed in the present study. In 12 patients who also underwent hemodynamic studies, resting total pulmonary vascular resistance index (TPVRI) and mean pulmonary artery pressure (P-barpa) significantly correlated with right ventricular end-systolic volume index (RVESVI) obtained by RI angiography; {gamma}=0.769 (p<0.01) and {gamma}=0.631 (p<0.05), respectively. A significant relationship was also observed between left ventricular dysfunction and the degree of hypercapnia. In response to exercise testing, 10 of 16 patients exhibited insufficient augmentation of stroke volume, and both left and right end-diastolic volumes decreased in half of 10 patients. It is suggested that cardiac function may be disturbed by mechanical factors such as pulmonary hyperinflation in COPD patients. (author).

  16. PATELLAR REALIGNMENT AND FUNCTIONAL PERFORMANCE IN PATIENTS WITH PATELLOFEMORAL PAIN SYNDROME

    Directory of Open Access Journals (Sweden)

    Abeer Farag Hanafy

    2016-02-01

    Full Text Available Background: Patellar taping is used for pain relief in patients with patello-femoral pain syndrome (PFPS. Yet, there is lack of knowledge regarding its effect on the functional performance. The purpose of the study was to examine the effects of therapeutic patellar taping on the Visual Analogue Scale (VAS pain scores, number of bilateral squats, and stair climbing time in patients with PFPS. Methods: 30 female patients with PFPS with mean age 20.3± 1.46 years, weight 66.1± 9.68 kg, height 165.83 ± 3.89 cm and BMI 23.91 ± 3.50kg/m2 participated in the study. The subjects were tested randomly under three taping conditions;namely therapeutic, placebo and no-tape. The tested limb was determined to be the affected limb in patients with unilateral affection, and the symptomatic limb in patients with bilateral affection. Data was collected using the Visual Analogue Scale (VAS, Bilateral Squat Test and Timed Stair Ambulation Test. Results: Repeated measures Multivariate Analysis of Variance (MANOVA revealed that the number of bilateral squats increased significantly (p0.05 in between for the number of bilateral squats and stair climbing time. Conclusion: The findings indicated that therapeutic patellar taping is effective in improving functional performance and reducing pain in patients with patellofemoral pain syndrome (PFPS.

  17. Relationship Between Hospital Performance on a Patient Satisfaction Survey and Surgical Quality.

    Science.gov (United States)

    Sacks, Greg D; Lawson, Elise H; Dawes, Aaron J; Russell, Marcia M; Maggard-Gibbons, Melinda; Zingmond, David S; Ko, Clifford Y

    2015-09-01

    The Centers for Medicare and Medicaid Services include patient experience as a core component of its Value-Based Purchasing program, which ties financial incentives to hospital performance on a range of quality measures. However, it remains unclear whether patient satisfaction is an accurate marker of high-quality surgical care. To determine whether hospital performance on a patient satisfaction survey is associated with objective measures of surgical quality. Retrospective observational study of participating American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) hospitals. We used data from a linked database of Medicare inpatient claims, ACS NSQIP, the American Hospital Association annual survey, and Hospital Compare from December 2, 2004, through December 31, 2008. A total of 103 866 patients older than 65 years undergoing inpatient surgery were included. Hospitals were grouped by quartile based on their performance on the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Controlling for preoperative risk factors, we created hierarchical logistic regression models to predict the occurrence of adverse postoperative outcomes based on a hospital's patient satisfaction scores. Thirty-day postoperative mortality, major and minor complications, failure to rescue, and hospital readmission. Of the 180 hospitals, the overall mean patient satisfaction score was 68.0% (first quartile mean, 58.7%; fourth quartile mean, 76.7%). Compared with patients treated at hospitals in the lowest quartile, those at the highest quartile had significantly lower risk-adjusted odds of death (odds ratio = 0.85; 95% CI, 0.73-0.99), failure to rescue (odds ratio = 0.82; 95% CI, 0.70-0.96), and minor complication (odds ratio = 0.87; 95% CI, 0.75-0.99). This translated to relative risk reductions of 11.1% (P = .04), 12.6% (P = .02), and 11.5% (P = .04), respectively. No significant relationship was noted between patient satisfaction

  18. Effect of Advanced Trauma Life Support program on medical interns' performance in simulated trauma patient management.

    Science.gov (United States)

    Ahmadi, Koorosh; Sedaghat, Mohammad; Safdarian, Mahdi; Hashemian, Amir-Masoud; Nezamdoust, Zahra; Vaseie, Mohammad; Rahimi-Movaghar, Vafa

    2013-01-01

    Since appropriate and time-table methods in trauma care have an important impact on patients'outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns' performance in simulated trauma patient management. A descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant. Our findings showed that interns'ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P less than 0.001, P equal to 0.016 and P equal to 0.01 respectively). ATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

  19. An APOA1 promoter polymorphism is associated with cognitive performance in patients with multiple sclerosis.

    Science.gov (United States)

    Koutsis, G; Panas, M; Giogkaraki, E; Karadima, G; Sfagos, C; Vassilopoulos, D

    2009-02-01

    Elevated ApoA1 levels have been associated with decreased dementia risk. The A-allele of the APOA1 -75G/A promoter polymorphism has been associated with elevated ApoA1 levels. We sought to investigate the effect of the APOA1 -75G/A promoter polymorphism on cognitive performance in patients with multiple sclerosis (MS). A total of 138 patients with MS and 43 controls were studied and underwent neuropsychological assessment with Rao's Brief Repeatable Battery and the Stroop test. All patients were genotyped for APOA1. APOA1 A-allele carriers displayed superior overall cognitive performance compared with non-carriers (P 0.008) and had a three-fold decrease in the relative risk of overall cognitive impairment (OR 0.29, 95% CI 0.11-0.74). Regarding performance on individual cognitive domains, although APOA1 A-allele carriers performed better than non-carriers on all tests, this was significant only for semantic verbal fluency and the Stroop interference task (P 0.036 and 0.018, respectively). We found an association of the APOA1 -75G/A promoter polymorphism with cognitive performance in MS. This effect was most prominent on semantic verbal fluency and the Stroop interference task.

  20. Measuring trauma system performance: Right patient, right place-Mission accomplished?

    Science.gov (United States)

    Ciesla, David J; Pracht, Etienne E; Tepas, Joseph J; Namias, Nicholas; Moore, Frederick A; Cha, John Y; Kerwin, Andrew; Langland-Orban, Barbara

    2015-08-01

    A regional trauma system must establish and monitor acceptable overtriage and undertriage rates. Although diagnoses from discharge data sets can be used with mortality prediction models to define high-risk injury, retrospective analyses introduce methodological errors when evaluating real-time triage processes. The purpose of this study was to determine if major trauma patients identified using field criteria correlated with those retrospectively labeled high risk and to assess system performance by measuring triage accuracy and trauma center utilization. A statewide database was queried for all injury-related International Classification of Diseases, 9th Revision, code discharges from designated trauma centers and nontrauma centers for 2012. Children and burn patients were excluded. Patients assigned a trauma alert fee were considered field-triage(+). The International Classification Injury Severity Score methodology was used to estimate injury-related survival probabilities, with an International Classification Injury Severity Score less than 0.85 considered high risk. Triage rates were expressed relative to the total population; the proportion of low- and high-risk patients discharged from trauma centers defined trauma center utilization. There were 116,990 patients who met study criteria, including 11,368 (10%) high-risk, 70,741 field-triage(-) patients treated in nontrauma centers and 28,548 field-triage(-) and 17,791 field-triage(+) patients treated in trauma centers. Field triage was 86% accurate, with 10% overtriage and 4% undertriage. System triage was 66% accurate, with 32% overtriage and 2% undertriage. Overtriage patients more often, and undertriage patients less often, had severe injury characteristics than appropriately triaged patients. Trauma system performance assessed using retrospective administrative data provides a convenient measure of performance but must be used with caution. Residual mistriage can partly be attributed to error introduced by

  1. Mnesic performance and executive functions in patients with multiple sclerosis (MS

    Directory of Open Access Journals (Sweden)

    Isabel Introzzi

    2009-10-01

    Full Text Available The Episodic Memory (EM and the Executive Functions (EF are cognitive areas that are affected in patients with diagnosis of Multiple Sclerosis (MS. Nowadays there exists scarce works destined to explore the infl uence of the EF on measures of mnesic performance in MS. For this reason, we analyze the effect of the EF on the performance in a set of memory measures. We worked with a clinical group (n=36 and with a control group (n=36 compared by age and educational level. The results show that the clinical group obtained significantly low average values in all the mnesic indexes (with exception of recognition and in all the executive measures. All the executive indexes showed significant associations with some of the indexes of mnesic performance. These findings suggest that the problems in the episodic memory in EM patients could be analyzed as the manifestation of a global disorder that could be similar to the one that involves the EF.

  2. The role of the thalamus and hippocampus in episodic memory performance in patients with multiple sclerosis.

    Science.gov (United States)

    Koenig, Katherine A; Rao, Stephen M; Lowe, Mark J; Lin, Jian; Sakaie, Ken E; Stone, Lael; Bermel, Robert A; Trapp, Bruce D; Phillips, Micheal D

    2018-03-01

    Episodic memory loss is one of the most common cognitive symptoms in patients with multiple sclerosis (MS), but the pathophysiology of this symptom remains unclear. Both the hippocampus and thalamus have been implicated in episodic memory and show regional atrophy in patients with MS. In this work, we used functional magnetic resonance imaging (fMRI) during a verbal episodic memory task, lesion load, and volumetric measures of the hippocampus and thalamus to assess the relative contributions to verbal and visual-spatial episodic memory. Functional activation, lesion load, and volumetric measures from 32 patients with MS and 16 healthy controls were used in a predictive analysis of episodic memory function. After adjusting for disease duration, immediate recall performance on a visual-spatial episodic memory task was significantly predicted by hippocampal volume ( p memory measures, functional activation of the thalamus during encoding was more predictive than that of volume measures ( p episodic memory loss in patients with MS.

  3. Liver biopsy performance and histological findings among patients with chronic viral hepatitis

    DEFF Research Database (Denmark)

    Christensen, Peer Brehm; Krarup, Henrik Bygum; Møller, Axel

    2007-01-01

    We investigated the variance of liver biopsy frequency and histological findings among patients with chronic viral hepatitis attending 10 medical centres in Denmark. Patients who tested positive for HBsAg or HCV- RNA were retrieved from a national clinical database (DANHEP) and demographic data...... had developed in 23% after 20 y of infection. Age above 40 y was a better predictor of cirrhosis than elevated ALT. National database comparison may identify factors of importance for improved management of patients with chronic viral hepatitis......., laboratory analyses and liver biopsy results were collected. A total of 1586 patients were identified of whom 69.7% had hepatitis C, 28.9% hepatitis B, and 1.5% were coinfected. In total, 771 (48.6%) had a biopsy performed (range 33.3-78.7%). According to the Metavir classification, 29.3% had septal fibrosis...

  4. Liver biopsy performance and histological findings among patients with chronic viral hepatitis: a Danish database study

    DEFF Research Database (Denmark)

    Christensen, Peer Brehm; Krarup, Henrik Bygum; Møller, Axel

    2007-01-01

    We investigated the variance of liver biopsy frequency and histological findings among patients with chronic viral hepatitis attending 10 medical centres in Denmark. Patients who tested positive for HBsAg or HCV- RNA were retrieved from a national clinical database (DANHEP) and demographic data...... had developed in 23% after 20 y of infection. Age above 40 y was a better predictor of cirrhosis than elevated ALT. National database comparison may identify factors of importance for improved management of patients with chronic viral hepatitis. Udgivelsesdato: 2007-null......, laboratory analyses and liver biopsy results were collected. A total of 1586 patients were identified of whom 69.7% had hepatitis C, 28.9% hepatitis B, and 1.5% were coinfected. In total, 771 (48.6%) had a biopsy performed (range 33.3-78.7%). According to the Metavir classification, 29.3% had septal fibrosis...

  5. Case-mix adjustment and the comparison of community health center performance on patient experience measures.

    Science.gov (United States)

    Johnson, M Laura; Rodriguez, Hector P; Solorio, M Rosa

    2010-06-01

    To assess the effect of case-mix adjustment on community health center (CHC) performance on patient experience measures. A Medicaid-managed care plan in Washington State collected patient survey data from 33 CHCs over three fiscal quarters during 2007-2008. The survey included three composite patient experience measures (6-month reports) and two overall ratings of care. The analytic sample includes 2,247 adult patients and 2,859 adults reporting for child patients. We compared the relative importance of patient case-mix adjusters by calculating each adjuster's predictive power and variability across CHCs. We then evaluated the impact of case-mix adjustment on the relative ranking of CHCs. Important case-mix adjusters included adult self-reported health status or parent-reported child health status, adult age, and educational attainment. The effects of case-mix adjustment on patient reports and ratings were different in the adult and child samples. Adjusting for race/ethnicity and language had a greater impact on parent reports than adult reports, but it impacted ratings similarly across the samples. The impact of adjustment on composites and ratings was modest, but it affected the relative ranking of CHCs. To ensure equitable comparison of CHC performance on patient experience measures, reports and ratings should be adjusted for adult self-reported health status or parent-reported child health status, adult age, education, race/ethnicity, and survey language. Because of the differential impact of case-mix adjusters for child and adult surveys, initiatives should consider measuring and reporting adult and child scores separately.

  6. Comparison of performance on neuropsychological tests in amnestic Mild Cognitive Impairment and Alzheimer's disease patients

    Directory of Open Access Journals (Sweden)

    Patrícia Helena Figueirêdo do Vale

    Full Text Available Abstract Mild Cognitive Impairment (MCI can be an intermediate state between normality and dementia in some patients. An early diagnosis, through neuropsychological assessment, could identify individuals at risk of developing dementia. Objective: To verify differences in performance on neuropsychological tests among controls, amnestic MCI (aMCI and Alzheimer’s disease (AD patients. Methods: Sixty-eight AD patients (mean age 73.77±7.24; mean schooling 9.04±4.83; 40 women and 28 men, 34 aMCI patients (mean age 74.44±7.05; mean schooling 12.35±4.01; 20 women and 60 controls (mean age 68.90±7.48; mean schooling 10.72±4.74; 42 women were submitted to a neuropsychological assessment composed of tasks assessing executive functions, language, constructive abilities, reasoning and memory. Results: There were statistically significant differences in performance across all tests among control, aMCI and AD groups, and also between only controls and AD patients. On comparing control and aMCI groups, we found statistically significant differences in memory tasks, except for immediate recall of Visual Reproduction. There were also statistically significant differences between aMCI and AD groups on tasks of constructive and visuoperceptual abilities, attention, language and memory, except for delayed recall of Visual Reproduction. Conclusions: Neuropsychological assessment was able to discriminate aMCI from AD patients in almost all tests except for delayed recall of Visual Reproduction, visual organization (Hooper and executive functions (WCST; and discriminate controls from AD patients in all tests, and controls from aMCI patients in all memory tests except for immediate recall of Visual Reproduction.

  7. Diagnostic Performance of Self-Assessment for Constipation in Patients With Long-Term Opioid Treatment.

    Science.gov (United States)

    Tafelski, Sascha; Bellin, Felicitas; Denke, Claudia; Beutlhauser, Torsten; Fritzsche, Thomas; West, Christina; Schäfer, Michael

    2015-12-01

    Constipation is a prevalent comorbidity affecting ∼50% of patients with long-term opioid therapy. In clinical routine different diagnostic instruments are in use to identify patients under risk. The aim of this study was to assess the diagnostic performance of an 11-item Likert scale for constipation used as a self-assessment in opioid-treated patients. This trial was conducted as a retrospective cohort study in Berlin, Germany. Patients with long-term opioid therapy treated in 2 university-affiliated outpatient pain facilities at the Charité hospital were included from January 2013 to August 2013. Constipation was rated in a self-assessment using a numeric rating scale from 0 to 10 (Con-NRS) and compared with results from a structured assessment based on ROME-III criteria. Altogether, 171 patients were included. Incidence of constipation was 49% of patients. The receiver-operating characteristic of Con-NRS achieved an area under the curve of 0.814 (AUC 95% confidence interval 0.748-0.880, P < 0.001). Con-NRS ≥ 1 achieved sensitivity and specificity of 79.7% and 77.2%, respectively. The positive predictive value and the negative predictive value were 70.3% and 81.6%, respectively. Overall diagnostic performance of a concise 11-item Likert scale for constipation was moderate. Although patients with long-term opioid therapy are familiar with numeric rating scales, a significant number of patients with constipation were not identified. The instrument may be additionally useful to facilitate individualized therapeutic decision making and to control therapeutic success when measured repetitively.

  8. On the practice of ignoring center-patient interactions in evaluating hospital performance.

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    Varewyck, Machteld; Vansteelandt, Stijn; Eriksson, Marie; Goetghebeur, Els

    2016-01-30

    We evaluate the performance of medical centers based on a continuous or binary patient outcome (e.g., 30-day mortality). Common practice adjusts for differences in patient mix through outcome regression models, which include patient-specific baseline covariates (e.g., age and disease stage) besides center effects. Because a large number of centers may need to be evaluated, the typical model postulates that the effect of a center on outcome is constant over patient characteristics. This may be violated, for example, when some centers are specialized in children or geriatric patients. Including interactions between certain patient characteristics and the many fixed center effects in the model increases the risk for overfitting, however, and could imply a loss of power for detecting centers with deviating mortality. Therefore, we assess how the common practice of ignoring such interactions impacts the bias and precision of directly and indirectly standardized risks. The reassuring conclusion is that the common practice of working with the main effects of a center has minor impact on hospital evaluation, unless some centers actually perform substantially better on a specific group of patients and there is strong confounding through the corresponding patient characteristic. The bias is then driven by an interplay of the relative center size, the overlap between covariate distributions, and the magnitude of the interaction effect. Interestingly, the bias on indirectly standardized risks is smaller than on directly standardized risks. We illustrate our findings by simulation and in an analysis of 30-day mortality on Riksstroke. © 2015 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

  9. [Velopharyngeal closure pattern and speech performance among submucous cleft palate patients].

    Science.gov (United States)

    Heng, Yin; Chunli, Guo; Bing, Shi; Yang, Li; Jingtao, Li

    2017-06-01

    To characterize the velopharyngeal closure patterns and speech performance among submucous cleft palate patients. Patients with submucous cleft palate visiting the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University between 2008 and 2016 were reviewed. Outcomes of subjective speech evaluation including velopharyngeal function, consonant articulation, and objective nasopharyngeal endoscopy including the mobility of soft palate, pharyngeal walls were retrospectively analyzed. A total of 353 cases were retrieved in this study, among which 138 (39.09%) demonstrated velopharyngeal competence, 176 (49.86%) velopharyngeal incompetence, and 39 (11.05%) marginal velopharyngeal incompetence. A total of 268 cases were subjected to nasopharyngeal endoscopy examination, where 167 (62.31%) demonstrated circular closure pattern, 89 (33.21%) coronal pattern, and 12 (4.48%) sagittal pattern. Passavant's ridge existed in 45.51% (76/167) patients with circular closure and 13.48% (12/89) patients with coronal closure. Among the 353 patients included in this study, 137 (38.81%) presented normal articulation, 124 (35.13%) consonant elimination, 51 (14.45%) compensatory articulation, 36 (10.20%) consonant weakening, 25 (7.08%) consonant replacement, and 36 (10.20%) multiple articulation errors. Circular closure was the most prevalent velopharyngeal closure pattern among patients with submucous cleft palate, and high-pressure consonant deletion was the most common articulation abnormality. Articulation error occurred more frequently among patients with a low velopharyngeal closure rate.

  10. Improving health worker performance: The patient-perspective from a PBF program in Rwanda.

    Science.gov (United States)

    Lannes, Laurence

    2015-08-01

    The effect of performance-based financing (PBF) on patients' perception of primary health care services in developing countries in not well documented. Data from a randomized impact evaluation in Rwanda conducted between 2006 and 2008 in 157 primary level facilities is used to explore patients' satisfaction with clinical and non-clinical services and quantify the contribution of individual and facility characteristics to satisfaction including PBF. Improvements in productivity, availability and competences of the health workforce following the implementation of PBF have a positive effect on patients' satisfaction with clinical services even if patients' satisfaction is not tied to a reward. The positive effect of PBF on non-clinical dimensions of satisfaction also suggests that PBF incentivizes providers to raise patients' satisfaction with non-clinical services if it is associated with future financial gains. It is recommended that low and middle income countries build on the experience from high income countries to better listen to patients' voice in general and include an assessment of patients' satisfaction in incentive mechanisms as a way to increase the benefits of the strategy. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Exercise left ventricular performance in patients with chest pain, ischemic-appearing exercise electrocardiograms, and angiographically normal coronary arteries

    International Nuclear Information System (INIS)

    Berger, H.J.; Sands, M.J.; Davies, R.A.; Wackers, F.J.; Alexander, J.; Lachman, A.S.; Williams, B.W.; Zaret, B.L.

    1981-01-01

    Left ventricular performance was evaluated using first-pass radionuclide angiocardiography in 31 patients with chest pain, an ischemic-appearing exercise electrocardiogram, and angiographically normal coronary arteries at rest and during maximal upright bicycle exercise. 201 Tl imaging was done in all patients after treadmill exercise and in selected patients after ergonovine provocation. Resting left ventricular performance was normal in all patients. An abnormal ejection fraction response to exercise was detected in 12 of 31 patients. Regional dysfunction was present during exercise in four patients, all of whom also had abnormal global responses. Three of these 12 patients and two additional patients had exercise-induced 201 Tl perfusion defects. In all nine patients who underwent ergonovine testing, there was no suggestion of coronary arterial spasm. Thus, left ventricular dysfunction during exercise, in the presence of normal resting performance, was found in a substantial number of patients with chest pain, an ischemic-appearing exercise electrocardiogram, and normal coronary arteries

  12. Mental and physical performance of dementia patients in long-term residential care

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    Zbigniew Śliwiński

    2013-10-01

    Full Text Available Introduction: Dementia syndromes are an increasing medical and social problem in today’s world. Preservation of the best possible quality of life in dementia patients relies on prolonging their independence in daily life for as long as possible. Dementia patients require increasing support as the disease progresses and will ultimately become dependent on the help of others. Aim of the research: To assess the level of mental and physical performance and nutritional status in patients with dementia syndromes in long-term residential care. Material and methods : The study group comprised 62 patients with dementia syndromes resident in a Medical and Nursing Care Facility in Pustków. Selected aspects of quality of life were investigated with the Barthel scale, GDS scale according to Reissberg, Abbreviated Mental Test Score (AMTS and Mini-Nutritional Assessment (MNA scale. Results: In our study men performed better than women on the Barthel scale, 58% of all patients were rated moderately severe on that scale, 36% were severe and 7% were mild. Assessment of the current severity of dementia on the GDS scale showed that 28% of the patients had very severe dementia, 27% had mild deficits, 27% had moderate deficits, 11% had moderately severe dementia and 6% had borderline dementia. In a mental state assessment according to the AMTS scale, men scored higher than women. This difference indicates less memory deficit and better psychological and physical status among men. With regard to nutritional status, our study revealed a risk of malnutrition in 65% of the patient and actual malnutrition in 7%. Conclusions : The Barthel scale, rating the performance of dementia patients with regard to activities of daily life, classified more than half of the patients as „moderately severe”. Women had lower mean scores than men in the Barthel scale, AMTS scale and GDS scale, indicating that dementia is more prevalent among women than among men. The findings of the

  13. Quality of life and performance status in patients with pancreatic and periampullary tumors

    International Nuclear Information System (INIS)

    Velanovich, V.; Wollner, I.

    2011-01-01

    The background of this study was to determine if pretreatment quality of life is associated with performance status in patients with pancreatic and periampullary tumors. Eighty consecutive patients evaluated for surgical treatment of pancreatic or periampullary tumors completed the social functioning SF-36, a generic quality of life instrument. This instrument measures 8 domains of quality of life: physical functioning (PF), role-physical (RP), role-emotional, bodily pain, vitality, mental health, social functioning, and general health (GH). The best possible score is 100 and the worst possible score is 0. Each patient was then assigned a Karnofsky performance score (KPS), with the best possible score of 100 (normal, no complaints, no evidence of disease) and worst score of 0 (dead). Data recorded included age, gender, pathology, stage, resection, use of chemotherapy, and radiation therapy. Statistical analysis was done using single and multiple linear regression analysis, correlation coefficients (r) and coefficient of determination (r 2 ). KPS was significantly associated with all domains of the SF-36 by single linear regression. By multiple linear regression, KPS was significantly associated with the PF domain (p 2 values) suggest that there are additional factors determining both quality of life and performance status in patients with pancreatic and periampullary tumors. (author)

  14. Type 1 Diabetes Modifies Brain Activation in Young Patients While Performing Visuospatial Working Memory Tasks

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    Geisa B. Gallardo-Moreno

    2015-01-01

    Full Text Available In recent years, increasing attention has been paid to the effects of Type 1 Diabetes (T1D on cognitive functions. T1D onset usually occurs during childhood, so it is possible that the brain could be affected during neurodevelopment. We selected young patients of normal intelligence with T1D onset during neurodevelopment, no complications from diabetes, and adequate glycemic control. The purpose of this study was to compare the neural BOLD activation pattern in a group of patients with T1D versus healthy control subjects while performing a visuospatial working memory task. Sixteen patients and 16 matched healthy control subjects participated. There was no significant statistical difference in behavioral performance between the groups, but, in accordance with our hypothesis, results showed distinct brain activation patterns. Control subjects presented the expected activations related to the task, whereas the patients had greater activation in the prefrontal inferior cortex, basal ganglia, posterior cerebellum, and substantia nigra. These different patterns could be due to compensation mechanisms that allow them to maintain a behavioral performance similar to that of control subjects.

  15. Neurofeedback training improves the dual-task performance ability in stroke patients.

    Science.gov (United States)

    Lee, Young-Shin; Bae, Sea-Hyun; Lee, Sung-Hee; Kim, Kyung-Yoon

    2015-05-01

    Owing to the reduced capacity for information processing following a stroke, patients commonly present with difficulties in performing activities of daily living that combine two or more tasks. To address this problem, in the present study, we investigated the effects of neurofeedback training on the abilities of stroke patients to perform dual motor tasks. We randomly assigned 20 patients who had sustained a stroke within the preceding 6 months to either a pseudo-neurofeedback (n = 10) or neurofeedback (n = 10) group. Both groups participated in a general exercise intervention for 8 weeks, three times a week for 30 min per session, under the same conditions. An electrode was secured to the scalp over the region of the central lobe (Cz), in compliance with the International 10-20 System. The electrode was inactive for the pseudo-training group. Participants in the neurofeedback training group received the 30-min neurofeedback training per session for reinforcing the sensorimotor rhythm. Electroencephalographic activity of the two groups was compared. In addition, selected parameters of gait (velocity, cadence [step/min], stance phase [%], and foot pressure) were analyzed using a 10-m walk test, attention-demanding task, walk task and quantified by the SmartStep system. The neurofeedback group showed significantly improved the regulation of the sensorimotor rhythm (p neurofeedback training is effective to improve the dual-task performance in stroke patients.

  16. A study of complications affecting surgery performance: an ISM-based roadmap to patient flow.

    Science.gov (United States)

    Dev, Navin K; Shankar, Ravi; Arvind, Kamal

    2013-01-01

    The aim of this study is to highlight the value of the success rate performance of a surgery while planning patient flow within a supply chain of a health care organization/hospital. The paper has considered one of the common surgeries, cataract, and the complications that subsequently result from this surgery. The study employs interpretive structural modeling (ISM) approach to draw a roadmap to study various complications causing cataract that subsequently help in planning and coordination of patient flow. The study finds that there is a hierarchy of causes and certain complications, the persistence of which gives a higher success rate performance in cataract surgery as compared to others. The paper provides leverage to the decision maker while organizing the patient flow depending upon the information of hierarchy of complication of a disease, and accordingly ensures the availability of resources to the patient. The study is of value in identifying the degree of complications from cataract surgery. Given the degree of complication, the patient logistics can be planned myopically in a health care organization which largely depends upon the degree of success rate. The paper attempts to suggest that the hierarchy obtained through ISM can be implemented in the modules of an enterprise resource planning (ERP) set up.

  17. Evaluation of gait performance of knee osteoarthritis patients after total knee arthroplasty with different assistive devices

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    Ana Tereso

    Full Text Available IntroductionNowadays Knee Osteoarthritis (KOA affects a large percentage of the elderly, and one solution is to perform a Total Knee Arthroplasty (TKA. In this paper, one intends to study the gait and posture of these patients after the TKA, while walking with three assistive devices (ADs (crutches, standard walker (SW and rollator with forearm supports (RFS.MethodsEleven patients were evaluated in 2 phases: 5 days and 15 days after surgery. This evaluation was conducted with two inertial sensors, one attached to the operated leg ankle, to measure spatiotemporal parameters, and the other at the sacrum, to measure posture and fall risk-related parameters. Multivariate analysis of variance (MANOVA with repeated measures was performed to detect group differences.ResultsThe MANOVA results show that all spatiotemporal parameters are significantly different (p0.05. The interaction between time and ADs only affects significantly the velocity (p<0.05. In terms of fall risk parameters, time only significantly affects the antero-posterior direction (p<0.05 and ADs affects significantly root mean square in medio-lateral direction (p<0.05. In terms of interaction between time and ADs, there are no statistical significant differences.ConclusionThis study concludes that depending on the state of recovery of the patient, different ADs should be prescribed. On the overall, standard walker is good to give stability to the patient and RFS allows the patient to present a gait pattern closer to a natural gait.

  18. Radionuclide ventriculographic evaluation of exercised left ventricular performance in asymptomatic diabetic patients

    International Nuclear Information System (INIS)

    Fujii, Yusuke; Hara, Fumio

    1991-01-01

    Radionuclide ventriculography was made in 49 asymptomatic diabetic patients, aged 30∼70 years, to investigate cardiac function. Comparisons were made with 33 age- and sex-matched non-diabetic controls. Radionuclide ventriculography was performed at rest and during dynamic exercise by multigraded, supine bicycle ergometer. The resting left ventricular ejection fractions were similar between the diabetic patients and control subjects. No significant rise in the left ventricular ejection fractions during dynamic exercise was observed in the diabetic patients [58.4±9.8% (mean±SD) to 60.3±9.9]. In the control subjects, the left ventricular ejection fractions increased during dynamic exercise [59.3±8.4 to 63.0±11.4 (p -1 ) vs -2.66±0.52] and during dynamic exercise [-3.25±0.74 vs -3.23±0.90]. Time to end-systole were similar in both groups at rest [315±42 (ms) vs 309±42] and during dynamic exercise [258±37 vs 262±37]. The resting peak filling rates were similar in both groups [2.27±0.62 (s -1 ) vs 2.45±0.58], and the peak filling rates increased (p 1c in the diabetic patients. These results suggest that diabetic patients have less cardiac reserved performance. (author)

  19. Cognitive performance of neuromyelitis optica patients: comparison with multiple sclerosis Desempenho cognitivo de pacientes com neuromielite óptica: comparação com esclerose múltipla

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    Sandra Vanotti

    2013-06-01

    Full Text Available The aim of the present research was to investigate cognitive pattern of patients with neuromyelitis optica (NMO and to compare it with multiple sclerosis (MS patients' performance. Methods: Fourteen NMO, 14 relapsing remitting multiple sclerosis (RRMS, and 14 healthy control patients participated in the investigation. Neuropsychological functions were evaluated with the Brief Repeatable Neuropsychological Battery for MS; Symbol Digit Modalities Test; Digit Span; and Semantic Fluency. Results: Fifty-seven percent of NMO patients and 42.85% of the MS ones had abnormal performance in at least two cognitive tests. The NMO Group showed abnormal performance in verbal fluency, verbal and visual memories, with greater attention deficits. NMO patients outperformed healthy control in the paced auditory serial addition test (PASAT. However, no difference was found between NMO and RRMS patients. Conclusions: The NMO Group showed more dysfunction in attention and verbal fluencies than in verbal and visual memories. When compared with the MS patients, a similar dysfunction pattern was found. O objetivo da presente pesquisa foi investigar o padrão cognitivo de pacientes com neuromielite óptica (NMO e compará-lo com o desempenho de pacientes com esclerose múltipla (EM. Métodos: Quatorze pacientes com NMO, 14 com esclerose múltipla recorrente remitente (EMRR e 14 participantes do Controle saudáveis participaram da presente investigação. As funções neuropsicológicas foram avaliadas com a Bateria Breve de Testes Neuropsicológicos de Rao, Teste Símbolo Digit e a Fluência Semântica. Resultados: Cinquenta e sete por cento dos pacientes com NMO e 42,85% daqueles com EM apresentaram desempenho anormal em pelo menos dois testes cognitivos. O Grupo NMO apresentarou desempenho anormal na fluência verbal e nas memórias visual e verbal, com maiores déficits de atenção. Pacientes com NMO superaram os controles saudáveis em PASAT. No entanto, não foi

  20. Not just trust: factors influencing learners' attempts to perform technical skills on real patients.

    Science.gov (United States)

    Bannister, Susan L; Dolson, Mark S; Lingard, Lorelei; Keegan, David A

    2018-06-01

    As part of their training, physicians are required to learn how to perform technical skills on patients. The previous literature reveals that this learning is complex and that many opportunities to perform these skills are not converted into attempts to do so by learners. This study sought to explore and understand this phenomenon better. A multi-phased qualitative study including ethnographic observations, interviews and focus groups was conducted to explore the factors that influence technical skill learning. In a tertiary paediatric emergency department, staff physician preceptors, residents, nurses and respiratory therapists were observed in the delivery and teaching of technical skills over a 3-month period. A constant comparison methodology was used to analyse the data and to develop a constructivist grounded theory. We conducted 419 hours of observation, 18 interviews and four focus groups. We observed 287 instances of technical skills, of which 27.5% were attempted by residents. Thematic analysis identified 14 factors, grouped into three categories, which influenced whether residents attempted technical skills on real patients. Learner factors included resident initiative, perceived need for skill acquisition and competing priorities. Teacher factors consisted of competing priorities, interest in teaching, perceived need for residents to acquire skills, attributions about learners, assessments of competency, and trust. Environmental factors were competition from other learners, judgement that the patient was appropriate, buy-in from team members, consent from patient or caregivers, and physical environment constraints. Our findings suggest that neither the presence of a learner in a clinical environment nor the trust of the supervisor is sufficient to ensure the learner will attempt a technical skill. We characterise this phenomenon as representing a pool of opportunities to conduct technical skills on live patients that shrinks to a much smaller pool of

  1. Upper gastrointestinal symptoms in patients with advanced cancer: relationship to nutritional and performance status.

    Science.gov (United States)

    Bovio, G; Montagna, G; Bariani, C; Baiardi, P

    2009-10-01

    The goals of the study were to determine the relationship of upper gastrointestinal symptoms with nutritional status and to assess their association with performance status in patients with advanced cancer. We studied 143 patients (50 F, 93 M, mean age 68 +/- 11 years, mean body mass index 22.39 +/- 4.3 kg/m(2)). Assessed symptoms were the following: anorexia, nausea, vomiting, dysphagia for solids, dysphagia for liquids, xerostomia, hypogeusia, dysgeusia, hiccup and chewing disturbances. We determined anthropometric parameters, daily energy intake and serum albumin, prealbumin and transferrin. The most common upper gastrointestinal symptoms were xerostomia (73%), anorexia (49%) and chewing disturbances (40%). Fifty-four percent of patients had weight loss greater than 10%. Seventy-three patients (51%) had daily energy intake lower than their resting energy expenditure. Mean serum prealbumin, albumin and transferrin were below normal range. Mean Eastern Cooperative Oncology Group performance status scale was 3.1 +/- 0.49. Symptoms were often strongly correlated, and usually, patients experienced at least three upper gastrointestinal symptoms at the same time. Anorexia, nausea and vomiting were the symptoms mostly correlated with other symptoms. A correlation was found between vomiting and hiccup. Energy intake (EI) was the nutritional parameter mostly affected by upper gastrointestinal symptoms; moreover, EI is the most predictive factor of upper gastrointestinal symptoms, particularly xerostomia, anorexia and dysphagia for solids. Upper gastrointestinal symptoms are linked to nutritional parameters: In particular, energy intake represents the most predictive variable of symptom occurrence. The performance status is not affected by upper gastrointestinal symptoms. A rigorous nutritional assessment and the managing of upper gastrointestinal symptoms are crucial in patients with advanced cancer.

  2. Cognitive performance and psychosocial functioning in patients with bipolar disorder, unaffected siblings, and healthy controls

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    Mirela P. Vasconcelos-Moreno

    2016-01-01

    Full Text Available Objective: To assess cognitive performance and psychosocial functioning in patients with bipolar disorder (BD, in unaffected siblings, and in healthy controls. Methods: Subjects were patients with BD (n=36, unaffected siblings (n=35, and healthy controls (n=44. Psychosocial functioning was accessed using the Functioning Assessment Short Test (FAST. A sub-group of patients with BD (n=21, unaffected siblings (n=14, and healthy controls (n=22 also underwent a battery of neuropsychological tests: California Verbal Learning Test (CVLT, Stroop Color and Word Test, and Wisconsin Card Sorting Test (WCST. Clinical and sociodemographic characteristics were analyzed using one-way analysis of variance or the chi-square test; multivariate analysis of covariance was used to examine differences in neuropsychological variables. Results: Patients with BD showed higher FAST total scores (23.90±11.35 than healthy controls (5.86±5.47; p < 0.001 and siblings (12.60±11.83; p 0.001. Siblings and healthy controls also showed statistically significant differences in FAST total scores (p = 0.008. Patients performed worse than healthy controls on all CVLT sub-tests (p < 0.030 and in the number of correctly completed categories on WCST (p = 0.030. Siblings did not differ from healthy controls in cognitive tests. Conclusion: Unaffected siblings of patients with BD may show poorer functional performance compared to healthy controls. FAST scores may contribute to the development of markers of vulnerability and endophenotypic traits in at-risk populations.

  3. Performance predictors of brain-computer interfaces in patients with amyotrophic lateral sclerosis

    Science.gov (United States)

    Geronimo, A.; Simmons, Z.; Schiff, S. J.

    2016-04-01

    Objective. Patients with amyotrophic lateral sclerosis (ALS) may benefit from brain-computer interfaces (BCI), but the utility of such devices likely will have to account for the functional, cognitive, and behavioral heterogeneity of this neurodegenerative disorder. Approach. In this study, a heterogeneous group of patients with ALS participated in a study on BCI based on the P300 event related potential and motor-imagery. Results. The presence of cognitive impairment in these patients significantly reduced the quality of the control signals required to use these communication systems, subsequently impairing performance, regardless of progression of physical symptoms. Loss in performance among the cognitively impaired was accompanied by a decrease in the signal-to-noise ratio of task-relevant EEG band power. There was also evidence that behavioral dysfunction negatively affects P300 speller performance. Finally, older participants achieved better performance on the P300 system than the motor-imagery system, indicating a preference of BCI paradigm with age. Significance. These findings highlight the importance of considering the heterogeneity of disease when designing BCI augmentative and alternative communication devices for clinical applications.

  4. Attention Deficit ِDuring Dual-Task Performance in Alzheimer’s Disease Patients

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    Hamid Salehi

    2014-07-01

    Full Text Available Objectives: The aims of the present investigation was the evaluation of divided attention deficits in Alzheimer's disease (AD patients by using dual-task paradigm in order to ascertain whether this method can be useful in the early diagnosis of AD or not.  Methods & Materials: A total of 23 elderly individuals (11 females and 12 males voluntarily participated in the investigation: 13 patients with Alzheimer's disease (AD and 10 healthy elderly individuals. The experimental setup consisted of (a single -task and (b dual-task trials at two levels of difficulty. In singletask condition, the participants were asked to recite the months of the year continuously with normal order (easy and backward (difficult. They also performed a computerized visuospatial/motor tracking task. The participants then performed the tracking task in conjunction with each of the months reciting tasks as dual-task condition. Results: The results showed a significant interaction (disease×level of difficulty effect. So that, the performance impairment on combine performance in two simultaneous tasks was related to task difficulty, but the elderly control group did not differ in the easy and difficult conditions. Conclusion: These findings not only increase our understanding of the attention deficits in AD patients, but also have implications for the mediating effect of cognitive load in using dual-task paradigm for studying attention mechanisms of cognitively suffered individuals.

  5. Performance of mechanical ventilators at the patient's home: a multicentre quality control study.

    Science.gov (United States)

    Farré, R; Navajas, D; Prats, E; Marti, S; Guell, R; Montserrat, J M; Tebe, C; Escarrabill, J

    2006-05-01

    Quality control procedures vary considerably among the providers of equipment for home mechanical ventilation (HMV). A multicentre quality control survey of HMV was performed at the home of 300 patients included in the HMV programmes of four hospitals in Barcelona. It consisted of three steps: (1) the prescribed ventilation settings, the actual settings in the ventilator control panel, and the actual performance of the ventilator measured at home were compared; (2) the different ventilator alarms were tested; and (3) the effect of differences between the prescribed settings and the actual performance of the ventilator on non-programmed readmissions of the patient was determined. Considerable differences were found between actual, set, and prescribed values of ventilator variables; these differences were similar in volume and pressure preset ventilators. The percentage of patients with a discrepancy between the prescribed and actual measured main ventilator variable (minute ventilation or inspiratory pressure) of more than 20% and 30% was 13% and 4%, respectively. The number of ventilators with built in alarms for power off, disconnection, or obstruction was 225, 280 and 157, respectively. These alarms did not work in two (0.9%), 52 (18.6%) and eight (5.1%) ventilators, respectively. The number of non-programmed hospital readmissions in the year before the study did not correlate with the index of ventilator error. This study illustrates the current limitations of the quality control of HMV and suggests that improvements should be made to ensure adequate ventilator settings and correct ventilator performance and ventilator alarm operation.

  6. Outcome After Radiosurgery for Brain Metastases in Patients With Low Karnofsky Performance Scale (KPS) Scores

    International Nuclear Information System (INIS)

    Chernov, Mikhail F.; Nakaya, Kotaro; Izawa, Masahiro; Hayashi, Motohiro; Usuba, Yuki; Kato, Koichi; Muragaki, Yoshihiro; Iseki, Hiroshi; Hori, Tomokatsu; Takakura, Kintomo

    2007-01-01

    Purpose: The objective of this retrospective study was evaluation of the outcome after stereotactic radiosurgery (SRS) in patients with intracranial metastases and poor performance status. Methods and Materials: Forty consecutive patients with metastatic brain tumors and Karnofsky performance scale (KPS) scores ≤50 (mean, 43 ± 8; median, 40) treated with SRS were analyzed. Poor performance status was caused by presence of intracranial metastases in 28 cases (70%) and resulted from uncontrolled extracerebral disease in 12 (30%). Results: Survival after SRS varied from 3 days to 11.5 months (mean, 3.8 ± 2.9 months; median, 3.3 months). Survival probability constituted 0.50 ± 0.07 at 3 months and 0.20 ± 0.05 at 6 months posttreatment. Cause of low KPS score (p = 0.0173) and presence of distant metastases beside the brain (p = 0.0308) showed statistically significant associations with overall survival in multivariate Cox proportional hazards regression analysis. Median survival was 6.0 months if low KPS score was caused by cerebral disease and distant metastases in regions beyond the brain were absent, 3.3 months if low KPS score was caused by cerebral disease and distant metastases in regions beyond the brain were present, and 1.0 month if poor performance status resulted from extracerebral disease. Conclusions: Identification of the cause of low KPS score (cerebral vs. extracerebral) in patients with metastatic brain tumor(s) may be important for prediction of the outcome after radiosurgical treatment. If poor patient performance status without surgical indications is caused by intracranial tumor(s), SRS may be a reasonable treatment option

  7. Impaired Neurobehavioural Performance in Untreated Obstructive Sleep Apnea Patients Using a Novel Standardised Test Battery

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    Angela L. D'Rozario

    2018-05-01

    Full Text Available Objective/BackgroundAlthough polysomnography (PSG is the gold-standard measure for assessing disease severity in obstructive sleep apnea (OSA, it has limited value in identifying individuals experiencing significant neurobehavioural dysfunction. This study used a brief and novel computerised test battery to examine neurobehavioural function in adults with and without OSA.Patients/Methods204 patients with untreated OSA [age 49.3 (12.5 years; body mass index, [BMI] 33.6 (8.0 kg/m2; Epworth sleepiness scale 12 (4.9/24; apnea hypopnea index 33.6 (25.8/h] and 50 non-OSA participants [age 39.2 (14.0 years; BMI 25.8 (4.2 kg/m2, ESS 3.6 (2.3/24]. All participants completed a computerised neurobehavioural battery during the daytime in the sleep clinic. The OSA group subsequently underwent an overnight PSG. The 30 min test battery assessed cognitive domains of visual spatial scanning and selective attention (Letter Cancellation Test, executive function (Stroop task and working memory (2- and 3-Back tasks, and a validated sustained attention task (psychomotor vigilance task, PVT. Group differences in performance were compared. Associations between disease severity and performance were examined in the OSA group.ResultsAfter controlling for age, gender and education, OSA patients demonstrated impaired performance on the Stroop-Text, 2 and 3-Back tasks, and the PVT compared with the non-OSA group. OSA patients had worse performance on the LCT with fewer average hits albeit with better accuracy. Some OSA polysomnographic disease severity measures were weakly correlated with performance.ConclusionsThis brief test battery may provide a sensitive, standardised method of assessing daytime dysfunction in OSA.

  8. Total hip arthroplasty performed in patients with residual poliomyelitis: does it work?

    Science.gov (United States)

    Yoon, Byung-Ho; Lee, Young-Kyun; Yoo, Jeong Joon; Kim, Hee Joong; Koo, Kyung-Hoi

    2014-03-01

    Patients with residual poliomyelitis can have advanced degenerative arthritis of the hip in the paralytic limb or the nonparalytic contralateral limb. Although THA is a treatment option for some of these patients, there are few studies regarding THA in this patient population. We therefore reviewed a group of patients with residual poliomyelitis who underwent cementless THA on either their paralytic limb or nonparalytic limb to assess (1) Harris hip scores, (2) radiographic results, including implant loosening, (3) complications, including dislocation, and (4) limb length discrepancy after recovery from surgery. From January 2000 to December 2009, 10 patients with residual poliomyelitis (10 hips, four paralytic limbs and six nonparalytic contralateral limbs) underwent THA using cementless prostheses. Harris hip scores, complications, and leg length discrepancy were determined by chart review, and confirmed by questionnaire and examination; radiographs were reviewed by two observers for this study. Followup was available for all 10 patients at a minimum of 3 years (median, 7 years; range, 3.4-13 years). Surgery was done at the same side of the paralytic limb in four hips and contralateral to the paralytic limb in six. All patients had pain relief and improvement in function; the Harris hip score improved from mean of 68 preoperatively to 92 at last followup (p = 0.043). However, only three patients had complete pain relief. One hip dislocated, which was treated successfully with closed reduction and a hip spica cast for 2 months. There was no loosening or osteolysis in this series. Leg length discrepancy improved after the index operation, but only in the THAs performed in the paralytic limbs. Cementless THA may be suitable for painful hips in adult patients with residual poliomyelitis. Nonetheless, these patients should be informed of the possibility of mild residual pain and persistent leg length discrepancy, particularly patients whose THA is performed on the

  9. Evaluation of Functional Correlation of Task-Specific Muscle Synergies with Motor Performance in Patients Poststroke

    Directory of Open Access Journals (Sweden)

    Si Li

    2017-07-01

    Full Text Available The central nervous system produces movements by activating specifically programmed muscle synergies that are also altered with injuries in the brain, such as stroke. In this study, we hypothesize that there exists a positive correlation between task-specific muscle synergy and motor functions at joint and task levels in patients following stroke. The purpose here is to define and evaluate neurophysiological metrics based on task-specific muscle synergy for assessing motor functions in patients. A patient group of 10 subjects suffering from stroke and a control group of nine age-matched healthy subjects were recruited to participate in this study. Electromyography (EMG signals and movement kinematics were recorded in patients and control subjects while performing arm reaching tasks. Muscle synergies of individual patients were extracted off-line from EMG records of each patient, and a baseline pattern of muscle synergy was obtained from the pooled EMG data of all nine control subjects. Peak velocities and movement durations of each reaching movement were computed from measured kinematics. Similarity indices of matching components to those of the baseline synergy were defined by synergy vectors and time profiles, respectively, as well as by a combined similarity of vector and time profile. Results showed that pathological synergies of patients were altered from the characteristics of baseline synergy with missing components, or varied vector patterns and time profiles. The kinematic performance measured by peak velocities and movement durations was significantly poorer for the patient group than the control group. In patients, all three similarity indices were found to correlate significantly to the kinematics of movements for the reaching tasks. The correlation to the Fugl-Meyer score of arm was the highest with the vector index, the lowest with the time profile index, and in between with the combined index. These findings illustrate that the

  10. Treatment of subclinical fluid retention in patients with symptomatic heart failure: effect on exercise performance.

    Science.gov (United States)

    Chomsky, D B; Lang, C C; Rayos, G; Wilson, J R

    1997-08-01

    Patients with heart failure frequently have elevated intracardiac diastolic pressures but no clinical evidence of excess fluid retention. We speculated that such pressure elevations may indicate subclinical fluid retention and that removal of this fluid could improve exercise intolerance. To test this hypothesis, we studied 10 patients with right atrial pressure > or = 8 mm Hg but without rales, edema, or apparent jugular venous distension. Right-sided heart catheterization was performed, after which patients underwent maximal treadmill cardiopulmonary testing. Patients were then hospitalized and underwent maximal diuresis, after which exercise was repeated. Before diuresis, right atrial pressure averaged 16 +/- 5 mm Hg (+/-standard deviation), pulmonary capillary wedge pressure 30 +/- 6 mm Hg, and peak exercise Vo2 11.2 +/- 2.3 ml/min/ kg. Patients underwent diuresis of 4.5 +/- 2.2 kg over 4 +/- 2 days to a resting right atrial pressure of 6 +/- 4 and wedge pressure of 19 +/- 7 mm Hg. After diuresis, all patients reported overall symptomatic improvement. Maximal exercise duration increased significantly from 9.2 +/- 4.2 to 12.5 +/- 4.7 minutes. At matched peak workloads, significant improvements were also seen in minute ventilation (45 +/- 12 to 35 +/- 9 L/min), lactate levels (42 +/- 16 to 29 +/- 9 mg/dl), and Borg dyspnea scores (15 +/- 3 to 12 +/- 4) (all p < 0.05). Invasive hemodynamic monitoring allows the identification of excess fluid retention in patients with heart failure when there are no clinical signs of fluid overload. Removal of this subclinical excess fluid improves exercise performance and exertional dyspnea.

  11. Measuring physiotherapy performance in patients with osteoarthritis of the knee: a prospective study.

    Science.gov (United States)

    Jamtvedt, Gro; Dahm, Kristin Thuve; Holm, Inger; Flottorp, Signe

    2008-07-08

    Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into physiotherapy practice should be identified and evaluated.

  12. Measuring physiotherapy performance in patients with osteoarthritis of the knee: A prospective study

    Directory of Open Access Journals (Sweden)

    Holm Inger

    2008-07-01

    Full Text Available Abstract Background Patients with knee osteoarthritis [OA] are commonly treated by physiotherapists in primary care. Measuring physiotherapy performance is important before developing strategies to improve quality. The purpose of this study was to measure physiotherapy performance in patients with knee OA by comparing clinical practice to evidence from systematic reviews. Methods We developed a data-collection form and invited all private practitioners in Norway [n = 2798] to prospectively collect data on the management of one patient with knee OA through 12 treatment session. Actual practice was compared to findings from an overview of systematic reviews summarising the effect of physiotherapy interventions for knee OA. Results A total of 297 physiotherapists reported their management for patients with knee OA. Exercise was the most common treatment used, provided by 98% of the physiotherapists. There is evidence of high quality that exercise reduces pain and improves function in patients with knee OA. Thirty-five percent of physiotherapists used acupuncture, low-level laser therapy or transcutaneous electrical nerve stimulation. There is evidence of moderate quality that these treatments reduce pain in knee OA. Patient education, supported by moderate quality evidence for improving psychological outcomes, was provided by 68%. Physiotherapists used a median of four different treatment modalities for each patient. They offered many treatment modalities based on evidence of low quality or without evidence from systematic reviews, e.g. traction and mobilisation, massage and stretching. Conclusion Exercise was used in almost all treatment sessions in the management of knee OA. This practice is desirable since it is supported by high quality evidence. Physiotherapists also provide several other treatment modalities based on evidence of moderate or low quality, or no evidence from systematic reviews. Ways to promote high quality evidence into

  13. In Patients with Cirrhosis, Driving Simulator Performance is Associated With Real-life Driving

    DEFF Research Database (Denmark)

    Lauridsen, Mette Enok Munk; Thacker, Leroy R; White, Melanie B

    2016-01-01

    BACKGROUND & AIMS: Minimal hepatic encephalopathy (MHE) has been linked to higher real-life rates of automobile crashes and poor performance in driving simulation studies, but the link between driving simulator performance and real-life automobile crashes has not been clearly established. Further......, not all patients with MHE are unsafe drivers, but it is unclear how to distinguish them from unsafe drivers. We investigated the link between performance on driving simulators and real-life automobile accidents and traffic violations. We also aimed to identify features of unsafe drivers with cirrhosis...... and evaluated changes in simulated driving skills and MHE status after 1 year. METHODS: We performed a study of outpatients with cirrhosis (n=205; median 55 years old; median model for end-stage liver disease score, 9.5; none with overt hepatic encephalopathy or alcohol or illicit drug use within previous 6...

  14. Psychosocial Intervention In Prostate Cancer Patients

    Directory of Open Access Journals (Sweden)

    Potočníková Jana

    2015-05-01

    Full Text Available Prostate cancer is the second most common cancer worldwide for males, and the fifth most common cancer overall. Using of autogenic training could reduce the influence of ADT and raise quality of prostate cancer patients. The aim of this study was to determine the effects of autogenic training in patients with prostate cancer. Patients were divided to experimental and control group. Experimental group participated in fourteen weeks long autogenic training program. Control group performed usual daily activities. Every subject of research performed input and output diagnostics which monitored psychical states of patients by psychological standardized tests - Differential questionnaire of depression (DDF and Questionnaire of anxiety (STAI X1. Our data showed autogenic training program significant improved depressions symptoms and anxiety in experimental research group (p ≤ 0.05, however there was no main change of depression symptoms and anxiety values for control group (p = n.s..

  15. Body dysmorphic disorder in patients undergoing septorhinoplasty surgery: should we be performing routine screening?

    Science.gov (United States)

    Joseph, J; Randhawa, P; Hannan, S A; Long, J; Goh, S; O'Shea, N; Saleh, H; Hansen, E; Veale, D; Andrews, P

    2017-06-01

    Body dysmorphic disorder (BDD) is defined as having a preoccupation with a perceived flaw in one's appearance, which appears slight to others and significantly interferes with a person's functioning. When undetected in septorhinoplasty patients, it will often lead to poor outcomes. We performed a prospective cohort study to determine the prevalence of BDD in our patients and whether surgical correction could be considered. We recruited 34 patients being considered for septorhinoplasty in a tertiary referral rhinology clinic and a control group of 50 from the otology clinic giving a total of 84. Participants completed the Body Dysmorphic Disorder Questionnaire (BDDQ), the sino-nasal outcome test-23 (SNOT-23) and underwent nasal inspiratory peak flow (NIPF). Those found to be at high risk for BDD were referred to a clinical psychologist. Of the septorhinoplasty patients, 11 (32%) were high risk for BDD. Following psychological assessment, 7 (63%) patients were felt to be unsuitable for surgery and were offered psychological therapy. SNOT-23 scores were significantly higher in the BDD group indicating a negative impact on quality of life. NIPF readings were not significantly different in the BDD group compared to the control group. The BDDQ is a valid tool for identifying patients at risk of BDD. A close working relationship with clinical psychology has been advantageous to help the selection process of candidates for surgery when there is a high risk of BDD. © 2016 John Wiley & Sons Ltd.

  16. Effects of rapid digitalization on total and regional myocardial performance in patients with coronary artery disease.

    Science.gov (United States)

    Ferlinz, J; DelVicario, M; Aronow, W S

    1978-09-01

    In order to evaluate the effects of rapid digitalization on LV volumes, ejection fraction, and asynergy, 21 patients without heart failure were studied with a combination of hemodynamic and angiographic techniques before and after administration of intravenous ouabain (0.007 mg./Kg.). Seven patients had no CAD and served as normal (control) subjects (Group I), while 14 patients had extensive coronary disease (Group II). All pre-ouabain parameters were within the normal limits in Group I. After ouabain infusion, all indices of LV contractility: dP/dt, VCF, and ejection fraction rose significantly in the normal group, while LV filling pressure and end-diastolic volume remained unchanged. The baseline hemodynamic and volumetric values for Group II patients corresponded closely to their normal (Group I) counterparts, and exhibited similar changes after ouabain administration. Eight patients in Group II also had regional disorders of LV contractility, delineated by 23 abnormal hemiaxes of shortening. After ouabain, 15 out of 23 asynergic segments (65 per cent) improved, seven remained unchanged, and one worsened. It is therefore concluded that rapid digitalization not only enhances LV performance in normal subjects and in patients with CAD, but can also markedly reduce the extent of LV asynergy.

  17. Determination of language lateralization using functional MRI during the performance of shiritori tasks in neurosurgery patients

    International Nuclear Information System (INIS)

    Takayama, Hideichi; Kobayashi, Masahito; Sugishita, Morihiro; Onozuka, Satoshi; Kawase, Takeshi

    2001-01-01

    Assessment of language lateralization is crucial in patients considered for neurological surgery. The authors used functional MRI (fMRI) in conjunction with shiritori, a kind of word-generation task as paradigms, to determine language lateralization in the patients. We used a 1.5 Tesla magnetic resonance imaging devise with an echo-planar imaging sequence. Thirty-two patients undergoing neurological surgery would alternately rest and silently perform shiritori during fMRI acquisition. Language lateralization was determined in 29 out of 32 patients. Twenty-two patients were considered as left-hemisphere dominant and seven were right-hemisphere dominant. Brain activation was seen in the prefrontal area, premotor area, superior temporal gyrus and parietal lobe of the dominant hemisphere, which is consistent with the results in normal adults. Language lateralization was particularly useful in a case of meningioma in the left lateral ventricle and in a case of AVM in the left temporoparietal region. fMRI with shiritori tasks revealed right-hemisphere dominance in both cases, which was also confirmed by intracarotid amobarbital (Wada) testing. Both lesions were treated successfully without causing any further deficit to the patients' language function. These results suggest that fMRI with shiritori tasks can be used to assess language lateralization non-invasively, compared with the current techniques, such as intracarotid amobarbital testing and cortical electrostimulation mapping. Thus, fMRI with shiritori tasks has significant clinical potential as a presurgical evaluation tool. (author)

  18. Static and dynamic balance performance in patients with osteoporotic vertebral compression fracture.

    Science.gov (United States)

    Wang, Ling-Yi; Liaw, Mei-Yun; Huang, Yu-Chi; Lau, Yiu-Chung; Leong, Chau-Peng; Pong, Ya-Ping; Chen, Chia-Lin

    2013-01-01

    Patients with osteoporotic vertebral compression fracture (OVCF) have postural changes and increased risk of falling. The aim of this study is to compare balance characteristics between patients with OVCF and healthy control subjects. Patients with severe OVCF and control subjects underwent computerised dynamic posturography (CDP) in this case-control study. Forty-seven OVCF patients and 45 controls were recruited. Compared with the control group, the OVCF group had significantly decreased average stability; maximal stability under the `eye open with swayed support surface' (CDP subtest 4) and 'eye closed with swayed support surface' conditions (subtest 5); and decreased ankle strategy during subtests 4 and 5 and under the `swayed vision with swayed support surface' condition (subtest 6). The OVCF group fell more frequently during subtests 5 and 6 and had longer overall reaction time and longer reaction time when moving backward during the directional control test. OVCF patients had poorer static and dynamic balance performance compared with normal control. They had decreased postural stability and ankle strategy with increased fall frequency on a swayed surface; they also had longer reaction times overall and in the backward direction. Therefore, we suggest balance rehabilitation for patients with OVCF to prevent fall.

  19. Determination of language lateralization using functional MRI during the performance of shiritori tasks in neurosurgery patients

    Energy Technology Data Exchange (ETDEWEB)

    Takayama, Hideichi; Kobayashi, Masahito [Mihara Memorial Hospital, Isesaki, Gunma (Japan); Sugishita, Morihiro; Onozuka, Satoshi; Kawase, Takeshi

    2001-03-01

    Assessment of language lateralization is crucial in patients considered for neurological surgery. The authors used functional MRI (fMRI) in conjunction with shiritori, a kind of word-generation task as paradigms, to determine language lateralization in the patients. We used a 1.5 Tesla magnetic resonance imaging devise with an echo-planar imaging sequence. Thirty-two patients undergoing neurological surgery would alternately rest and silently perform shiritori during fMRI acquisition. Language lateralization was determined in 29 out of 32 patients. Twenty-two patients were considered as left-hemisphere dominant and seven were right-hemisphere dominant. Brain activation was seen in the prefrontal area, premotor area, superior temporal gyrus and parietal lobe of the dominant hemisphere, which is consistent with the results in normal adults. Language lateralization was particularly useful in a case of meningioma in the left lateral ventricle and in a case of AVM in the left temporoparietal region. fMRI with shiritori tasks revealed right-hemisphere dominance in both cases, which was also confirmed by intracarotid amobarbital (Wada) testing. Both lesions were treated successfully without causing any further deficit to the patients' language function. These results suggest that fMRI with shiritori tasks can be used to assess language lateralization non-invasively, compared with the current techniques, such as intracarotid amobarbital testing and cortical electrostimulation mapping. Thus, fMRI with shiritori tasks has significant clinical potential as a presurgical evaluation tool. (author)

  20. Incidental finding of knee osteoarthritis in bone scans performed in obese patients with neoplasia

    International Nuclear Information System (INIS)

    Regalado R, R.; Morales G, R.; Cano P, R.; Mendoza P, G.; Vidal N, L.

    1996-01-01

    Bone scanning performed in the Nuclear Medicine Center (IPEN-INEN) to patients with neoplastic diagnosis between January 1995 and June 1996, permitted the incidental finding of increased uptake images in the knees of 28 patients associated to an asymptomatic arthropathy: osteoarthritis. The histories and bone scanning of this patients were reviewed obtaining their weight, occupation, symptomatology, neoplastic diagnosis and previous scan diagnosis. Patients under 66 years old, asymptomatic, were included, not presenting secondary focuses, without arthropathia antecedent and with a body mass index equal or above class I. The arthropathy was classified according to the localization of the compromised compartment of the knee. >From the body mass index assessment of every patient it was obtained: Class I=12, Class II=11, Class III=3 and Class IV=1. The predominant localization of the osteoarthritic lesions was the patellar zone. We discuss factors that may influence the absence of symptoms of this disease, the relation obesity-osteoarthritis and the usefulness of bone scanning in the diagnosis of this arthropathy in these patients. (authors). 16 refs., 1 fig., 3 tabs

  1. The Effect of Septoplasty on Voice Performance in Patients With Severe and Mild Nasal Septal Deviation.

    Science.gov (United States)

    Atan, Doğan; Özcan, Kürşat Murat; Gürbüz, Ayşe Betül Topak; Dere, Hüseyin

    2016-07-01

    The authors aimed to analyze the effect of septoplasty, performed in 2 groups with different grades of nasal septal deviation (NSD), on voice performance. A total of 43 patients who had septoplasty due to NSD and were included in the study. The study groups were divided into 2 groups as groups A and B. The patients in group A had severe NSD, and 1 of the nasal cavity was obstructed totally or near totally. In group B, the NSD narrowed the nasal passage, and the deviation was not severe. The voice performance was analyzed preoperatively, and 1 month after surgery with both objective and subjective methods. Objective analysis included acoustic voice analysis, and measurement of F0, jitter %, shimmer %. Preoperative and postoperative F0, jitter %, shimmer %, and Voice Handicap Index-30 (VHI-30) were compared in groups A and B. F0 showed a statistically significant improvement after surgery in group A (P performed for severe NSD obstructing nasal lumen totally or near totally results in significant improvements in the voice performance.

  2. Oral Surgical Procedures Performed Safely in Patients With Head and Neck Arteriovenous Malformations: A Retrospective Case Series of 12 Patients.

    Science.gov (United States)

    Karim, Abdul Basit; Lindsey, Sean; Bovino, Brian; Berenstein, Alejandro

    2016-02-01

    This case series describes patients with head and neck arteriovenous malformations who underwent oral and maxillofacial surgical procedures combined with interventional radiology techniques to minimize blood loss. Twelve patients underwent femoral cerebral angiography to visualize the extent of vascular malformation. Before the surgical procedures, surgical sites were devascularized by direct injection of hemostatic or embolic agents. Direct puncture sclerotherapy at the base of surgical sites was performed using Surgiflo or n-butylcyanoacrylate glue. Surgical procedures were carried out in routine fashion. A hemostatic packing of FloSeal, Gelfoam, and Avitene was adapted to the surgical sites. Direct puncture sclerotherapy with Surgiflo or n-butylcyanoacrylate glue resulted in minimal blood loss intraoperatively. Local application of the FloSeal, Gelfoam, and Avitene packing sustained hemostasis and produced excellent healing postoperatively. Patients with arteriovenous malformations can safely undergo routine oral and maxillofacial surgical procedures with minimal blood loss when appropriate endovascular techniques and local hemostatic measures are used by the interventional radiologist and oral and maxillofacial surgeon. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Morganella morganii Pericarditis in a Patient with Multiple Myeloma

    Directory of Open Access Journals (Sweden)

    Takafumi Nakao

    2013-01-01

    Full Text Available Purulent pericarditis caused by Morganella morganii is extremely rare. We report herein a case of a 61-year-old man who presented with chest pain and dyspnea fourteen days after chemotherapy for multiple myeloma. Echocardiogram and computed tomography revealed a massive pericardial effusion and associated cardiac tamponade. Pericardiocentesis was performed. Pericardial fluid was found to be purulent, and Morganella morganii was isolated from the fluid. The patient was successfully treated with antibiotic therapy and surgical drainage of the fluid. Morganella morganii should be considered a possible pathogen when immunocompromised patients develop purulent pericarditis.

  4. Comparison of credible patients of very low intelligence and non-credible patients on neurocognitive performance validity indicators.

    Science.gov (United States)

    Smith, Klayton; Boone, Kyle; Victor, Tara; Miora, Deborah; Cottingham, Maria; Ziegler, Elizabeth; Zeller, Michelle; Wright, Matthew

    2014-01-01

    The purpose of this archival study was to identify performance validity tests (PVTs) and standard IQ and neurocognitive test scores, which singly or in combination, differentiate credible patients of low IQ (FSIQ ≤ 75; n = 55) from non-credible patients. We compared the credible participants against a sample of 74 non-credible patients who appeared to have been attempting to feign low intelligence specifically (FSIQ ≤ 75), as well as a larger non-credible sample (n = 383) unselected for IQ. The entire non-credible group scored significantly higher than the credible participants on measures of verbal crystallized intelligence/semantic memory and manipulation of overlearned information, while the credible group performed significantly better on many processing speed and memory tests. Additionally, credible women showed faster finger-tapping speeds than non-credible women. The credible group also scored significantly higher than the non-credible subgroup with low IQ scores on measures of attention, visual perceptual/spatial tasks, processing speed, verbal learning/list learning, and visual memory, and credible women continued to outperform non-credible women on finger tapping. When cut-offs were selected to maintain approximately 90% specificity in the credible group, sensitivity rates were highest for verbal and visual memory measures (i.e., TOMM trials 1 and 2; Warrington Words correct and time; Rey Word Recognition Test total; RAVLT Effort Equation, Trial 5, total across learning trials, short delay, recognition, and RAVLT/RO discriminant function; and Digit Symbol recognition), followed by select attentional PVT scores (i.e., b Test omissions and time to recite four digits forward). When failure rates were tabulated across seven most sensitive scores, a cut-off of ≥ 2 failures was associated with 85.4% specificity and 85.7% sensitivity, while a cut-off of ≥ 3 failures resulted in 95.1% specificity and 66.0% sensitivity. Results are discussed in light of

  5. Diagnostic performance of tumor markers AFP and PIVKA-II in Chinese hepatocellular carcinoma patients.

    Science.gov (United States)

    Huang, Shujing; Jiang, Feifei; Wang, Ying; Yu, Yanhua; Ren, Siqian; Wang, Xiaowei; Yin, Peng; Lou, Jinli

    2017-06-01

    Alpha-fetoprotein is an effective biomarker as an aid in hepatocellular carcinoma detection in many countries. However, alpha-fetoprotein has its limitations, especially in early hepatocellular carcinoma diagnosis. Protein induced by vitamin K absence or antagonist-II is another biomarker that is used for hepatocellular carcinoma detection. The aim of this study is to compare the diagnostic performance of alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II alone and in combination to explore improving biomarker performance as an aid in early hepatocellular carcinoma detection. In this study a total of 582 serum samples including 132 hepatocellular carcinoma patients, 250 non-hepatocellular carcinoma patients, and 200 healthy volunteers were collected. Alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II levels were measured by both chemiluminescent enzyme immunoassay on LUMIPULSE platform and by chemiluminescent microparticle immunoassay on ARCHITECT platform. Receiver operation characteristic curve analyses were performed for each biomarker and in combination. The results showed that Alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II in combination have shown higher area under the curve compared to alpha-fetoprotein alone for diagnosis in whole patients (0.906 vs 0.870) in hepatocellular carcinoma early-stage patients (0.809 vs 0.77) and in hepatitis B virus-related hepatocellular carcinoma patients (0.851 vs 0.788) with ARCHITECT platform. Protein induced by vitamin K absence or antagonist-II showed higher area under the curve than alpha-fetoprotein for diagnosis of hepatitis B virus-related hepatocellular carcinoma patients (0.901 vs 0.788).We conclude that Combining alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II may improve the diagnostic value for early detection of hepatocellular carcinoma. Protein induced by vitamin K absence or antagonist-II performs better

  6. Vitamin B-12 concentration, memory performance, and hippocampal structure in patients with mild cognitive impairment.

    Science.gov (United States)

    Köbe, Theresa; Witte, A Veronica; Schnelle, Ariane; Grittner, Ulrike; Tesky, Valentina A; Pantel, Johannes; Schuchardt, Jan Philipp; Hahn, Andreas; Bohlken, Jens; Rujescu, Dan; Flöel, Agnes

    2016-04-01

    Low-normal concentrations of vitamin B-12 (VitB12) may be associated with worse cognition. However, previous evidence has been mixed, and the underlying mechanisms remain unclear. We determined whether serum VitB12 concentrations within the normal range were linked to memory functions and related neuronal structures in patients with mild cognitive impairment (MCI). In a cross-sectional design, we assessed 100 amnestic MCI patients (52 women; age range: 50-80 y) with low- and high-normal VitB12 concentration (median split: 304 pmol/L) for memory functions with the use of the Auditory Verbal Learning Test. MRI was performed at 3 tesla (n= 86) for the estimation of the volume and microstructure of the hippocampus and its subfields as indicated by the mean diffusivity on diffusion-weighted images. With the use of a mediation analysis, we examined whether the relation between VitB12 and memory performance was partially explained by volume or microstructure. MCI patients with low-normal VitB12 showed a significantly poorer learning ability (P= 0.014) and recognition performance (P= 0.008) than did patients with high-normal VitB12. Also, the microstructure integrity of the hippocampus was lower in patients with low-normal VitB12, mainly in the cornu ammonis 4 and dentate gyrus region (P= 0.029), which partially mediated the effect of VitB12 on memory performance (32-48%). Adjustments for age, sex, education, apolipoprotein E e4 status, and total homocysteine, folate, and creatinine did not attenuate the effects. Low VitB12 concentrations within the normal range are associated with poorer memory performance, which is an effect that is partially mediated by the reduced microstructural integrity of the hippocampus. Future interventional trials are needed to assess whether supplementation of VitB12 may improve cognition in MCI patients even in the absence of clinically manifested VitB12 deficiency. This trial was registered at clinicaltrials.gov as NCT01219244. © 2016

  7. An instrument to perform automated quality assurance and patient dosimetry in diagnostic radiology

    International Nuclear Information System (INIS)

    Chapple, C.-L.; Faulkner, K.

    1992-01-01

    A computerised method of automatically monitoring tube and generator parameters to perform on-line quality assurance and patient dosimetry has been developed. A microcomputer has been interfaced to a microprocessor controlled X ray generator and dose-area product meter. The instrument prompts the operator to enter details of the examination and projection before an examination is made. The field size and dose-area product are monitored by the instrument. These data, together with information on the tube potential are used to deduce the patient entrance dose and energy imparted. Organ doses are estimated using normalised organ dose data. The accuracy and reproducibility of the instrument were investigated. Doses measured in a Rando phantom were compared with calculations made by the instrument. The instrument will compare various measured quality assurance parameters against their nominal values. The implications of this instrument for both patient dosimetry studies and effective continuous quality assurance are discussed. (author)

  8. Eye lens exposure to medical staff performing electrophysiology procedures: dose assessment and correlation to patient dose

    International Nuclear Information System (INIS)

    Ciraj-Bjelac, Olivera; Bozovic, Predrag; Arandjic, Danijela; Antic, Vojislav; Selakovic, Jovana; Pavlovic, Sinisa

    2016-01-01

    The purpose of this study was to assess the patient exposure and staff eye dose levels during implantation procedures for all types of pacemaker therapy devices performed under fluoroscopic guidance and to investigate potential correlation between patients and staff dose levels. The mean eye dose during pacemaker/defibrillator implementation was 12 μSv for the first operator, 8.7 μSv for the second operator/nurse and 0.50 μSv for radiographer. Corresponding values for cardiac re-synchronisation therapy procedures were 30, 26 and 2.0 μSv, respectively. Significant (p < 0.01) correlation between the eye dose and the kerma-area product was found for the first operator and radiographers, but not for other staff categories. The study revealed eye dose per procedure and eye dose normalised to patient dose indices for different staff categories and provided an input for radiation protection in electrophysiology procedures. (authors)

  9. Standard Guidelines of Care: Performing Procedures in Patients on or Recently Administered with Isotretinoin

    Science.gov (United States)

    Mysore, Venkataram; Mahadevappa, Omprakash H.; Barua, Shyamanta; Majid, Imran; Viswanath, Vishalakshi; Bhat, Ramesh M.; Talwar, Suresh; Thurakkal, Salim; Aurangabadkar, Sanjeev J.; Chatterjee, Manas; Ganjoo, Anil

    2017-01-01

    Background: Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13-cis-retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring. Objective: The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration. Materials and Methods: Data were extracted from the literature through a PubMed search using the keywords “isotretinoin,” “safety,” “scarring,” “keloids,” “hypertrophic scarring,” and “pigmentation.” The evidence was then labeled and circulated to all members of task force for review. Results: The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration. PMID:29491653

  10. Standard guidelines of care: Performing procedures in patients on or recently administered with isotretinoin

    Directory of Open Access Journals (Sweden)

    Venkataram Mysore

    2017-01-01

    Full Text Available Background: Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13-cis-retinoic acid states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring. Objective: The Association of Cutaneous Surgeons (I constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration. Materials and Methods: Data were extracted from the literature through a PubMed search using the keywords “isotretinoin,” “safety,” “scarring,” “keloids,” “hypertrophic scarring,” and “pigmentation.” The evidence was then labeled and circulated to all members of task force for review. Results: The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued.The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.

  11. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires.

    LENUS (Irish Health Repository)

    Haroon, Muhammad

    2013-05-01

    The objectives of this study were to: (1) assess the prevalence of psoriatic arthritis (PsA) among Psoriasis (Ps) patients attending dermatology clinics; (2) identify clinical predictors of the development of PsA; and (3) compare the performance of three PsA screening questionnaires: Psoriatic Arthritis Screening and Evaluation (PASE), Psoriasis Epidemiology Screening Tool (PEST) and Toronto Psoriatic Arthritis Screening (ToPAS).

  12. In Patients With Cirrhosis, Driving Simulator Performance Is Associated With Real-life Driving.

    Science.gov (United States)

    Lauridsen, Mette M; Thacker, Leroy R; White, Melanie B; Unser, Ariel; Sterling, Richard K; Stravitz, Richard T; Matherly, Scott; Puri, Puneet; Sanyal, Arun J; Gavis, Edith A; Luketic, Velimir; Siddiqui, Muhammad S; Heuman, Douglas M; Fuchs, Michael; Bajaj, Jasmohan S

    2016-05-01

    Minimal hepatic encephalopathy (MHE) has been linked to higher real-life rates of automobile crashes and poor performance in driving simulation studies, but the link between driving simulator performance and real-life automobile crashes has not been clearly established. Furthermore, not all patients with MHE are unsafe drivers, but it is unclear how to distinguish them from unsafe drivers. We investigated the link between performance on driving simulators and real-life automobile accidents and traffic violations. We also aimed to identify features of unsafe drivers with cirrhosis and evaluated changes in simulated driving skills and MHE status after 1 year. We performed a study of outpatients with cirrhosis (n = 205; median 55 years old; median model for end-stage liver disease score, 9.5; none with overt hepatic encephalopathy or alcohol or illicit drug use within previous 6 months) seen at the Virginia Commonwealth University and McGuire Veterans Administration Medical Center, from November 2008 through April 2014. All participants were given paper-pencil tests to diagnose MHE (98 had MHE; 48%), and 163 patients completed a standardized driving simulation. Data were collected on traffic violations and automobile accidents from the Virginia Department of Motor Vehicles and from participants' self-assessments when they entered the study, and from 73 participants 1 year later. Participants also completed a questionnaire about alcohol use and cessation patterns. The driving simulator measured crashes, run-time, road center and edge excursions, and illegal turns during navigation; before and after each driving simulation session, patients were asked to rate their overall driving skills. Drivers were classified as safe or unsafe based on crashes and violations reported on official driving records; simulation results were compared with real-life driving records. Multivariable regression analyses of real-life crashes and violations was performed using data on

  13. Performance of an automated electronic acute lung injury screening system in intensive care unit patients.

    Science.gov (United States)

    Koenig, Helen C; Finkel, Barbara B; Khalsa, Satjeet S; Lanken, Paul N; Prasad, Meeta; Urbani, Richard; Fuchs, Barry D

    2011-01-01

    Lung protective ventilation reduces mortality in patients with acute lung injury, but underrecognition of acute lung injury has limited its use. We recently validated an automated electronic acute lung injury surveillance system in patients with major trauma in a single intensive care unit. In this study, we assessed the system's performance as a prospective acute lung injury screening tool in a diverse population of intensive care unit patients. Patients were screened prospectively for acute lung injury over 21 wks by the automated system and by an experienced research coordinator who manually screened subjects for enrollment in Acute Respiratory Distress Syndrome Clinical Trials Network (ARDSNet) trials. Performance of the automated system was assessed by comparing its results with the manual screening process. Discordant results were adjudicated blindly by two physician reviewers. In addition, a sensitivity analysis using a range of assumptions was conducted to better estimate the system's performance. The Hospital of the University of Pennsylvania, an academic medical center and ARDSNet center (1994-2006). Intubated patients in medical and surgical intensive care units. None. Of 1270 patients screened, 84 were identified with acute lung injury (incidence of 6.6%). The automated screening system had a sensitivity of 97.6% (95% confidence interval, 96.8-98.4%) and a specificity of 97.6% (95% confidence interval, 96.8-98.4%). The manual screening algorithm had a sensitivity of 57.1% (95% confidence interval, 54.5-59.8%) and a specificity of 99.7% (95% confidence interval, 99.4-100%). Sensitivity analysis demonstrated a range for sensitivity of 75.0-97.6% of the automated system under varying assumptions. Under all assumptions, the automated system demonstrated higher sensitivity than and comparable specificity to the manual screening method. An automated electronic system identified patients with acute lung injury with high sensitivity and specificity in diverse

  14. SU-F-R-52: A Comparison of the Performance of Radiomic Features From Free Breathing and 4DCT Scans in Predicting Disease Recurrence in Lung Cancer SBRT Patients

    International Nuclear Information System (INIS)

    Huynh, E; Coroller, T; Narayan, V; Agrawal, V; Romano, J; Franco, I; Hou, Y; Mak, R; Aerts, H

    2016-01-01

    Purpose: There is a clinical need to identify patients who are at highest risk of recurrence after being treated with stereotactic body radiation therapy (SBRT). Radiomics offers a non-invasive approach by extracting quantitative features from medical images based on tumor phenotype that is predictive of an outcome. Lung cancer patients treated with SBRT routinely undergo free breathing (FB image) and 4DCT (average intensity projection (AIP) image) scans for treatment planning to account for organ motion. The aim of the current study is to evaluate and compare the prognostic performance of radiomic features extracted from FB and AIP images in lung cancer patients treated with SBRT to identify which image type would generate an optimal predictive model for recurrence. Methods: FB and AIP images of 113 Stage I-II NSCLC patients treated with SBRT were analysed. The prognostic performance of radiomic features for distant metastasis (DM) was evaluated by their concordance index (CI). Radiomic features were compared with conventional imaging metrics (e.g. diameter). All p-values were corrected for multiple testing using the false discovery rate. Results: All patients received SBRT and 20.4% of patients developed DM. From each image type (FB or AIP), nineteen radiomic features were selected based on stability and variance. Both image types had five common and fourteen different radiomic features. One FB (CI=0.70) and five AIP (CI range=0.65–0.68) radiomic features were significantly prognostic for DM (p<0.05). None of the conventional features derived from FB images (range CI=0.60–0.61) were significant but all AIP conventional features were (range CI=0.64–0.66). Conclusion: Features extracted from different types of CT scans have varying prognostic performances. AIP images contain more prognostic radiomic features for DM than FB images. These methods can provide personalized medicine approaches at low cost, as FB and AIP data are readily available within a large

  15. SU-F-R-52: A Comparison of the Performance of Radiomic Features From Free Breathing and 4DCT Scans in Predicting Disease Recurrence in Lung Cancer SBRT Patients

    Energy Technology Data Exchange (ETDEWEB)

    Huynh, E; Coroller, T; Narayan, V; Agrawal, V; Romano, J; Franco, I; Hou, Y; Mak, R; Aerts, H [Dana-Farber Cancer Institute, Brigham Women’s Hospital, Harvard Medical School, Boston, MA (United States)

    2016-06-15

    Purpose: There is a clinical need to identify patients who are at highest risk of recurrence after being treated with stereotactic body radiation therapy (SBRT). Radiomics offers a non-invasive approach by extracting quantitative features from medical images based on tumor phenotype that is predictive of an outcome. Lung cancer patients treated with SBRT routinely undergo free breathing (FB image) and 4DCT (average intensity projection (AIP) image) scans for treatment planning to account for organ motion. The aim of the current study is to evaluate and compare the prognostic performance of radiomic features extracted from FB and AIP images in lung cancer patients treated with SBRT to identify which image type would generate an optimal predictive model for recurrence. Methods: FB and AIP images of 113 Stage I-II NSCLC patients treated with SBRT were analysed. The prognostic performance of radiomic features for distant metastasis (DM) was evaluated by their concordance index (CI). Radiomic features were compared with conventional imaging metrics (e.g. diameter). All p-values were corrected for multiple testing using the false discovery rate. Results: All patients received SBRT and 20.4% of patients developed DM. From each image type (FB or AIP), nineteen radiomic features were selected based on stability and variance. Both image types had five common and fourteen different radiomic features. One FB (CI=0.70) and five AIP (CI range=0.65–0.68) radiomic features were significantly prognostic for DM (p<0.05). None of the conventional features derived from FB images (range CI=0.60–0.61) were significant but all AIP conventional features were (range CI=0.64–0.66). Conclusion: Features extracted from different types of CT scans have varying prognostic performances. AIP images contain more prognostic radiomic features for DM than FB images. These methods can provide personalized medicine approaches at low cost, as FB and AIP data are readily available within a large

  16. Cognitive remediation therapy (CRT) benefits more to patients with schizophrenia with low initial memory performances.

    Science.gov (United States)

    Pillet, Benoit; Morvan, Yannick; Todd, Aurelia; Franck, Nicolas; Duboc, Chloé; Grosz, Aimé; Launay, Corinne; Demily, Caroline; Gaillard, Raphaël; Krebs, Marie-Odile; Amado, Isabelle

    2015-01-01

    Cognitive deficits in schizophrenia mainly affect memory, attention and executive functions. Cognitive remediation is a technique derived from neuropsychology, which aims to improve or compensate for these deficits. Working memory, verbal learning, and executive functions are crucial factors for functional outcome. Our purpose was to assess the impact of the cognitive remediation therapy (CRT) program on cognitive difficulties in patients with schizophrenia, especially on working memory, verbal memory, and cognitive flexibility. We collected data from clinical and neuropsychological assessments in 24 patients suffering from schizophrenia (Diagnostic and Statistical Manual of mental Disorders-Fourth Edition, DSM-IV) who followed a 3-month (CRT) program. Verbal and visuo-spatial working memory, verbal memory, and cognitive flexibility were assessed before and after CRT. The Wilcoxon test showed significant improvements on the backward digit span, on the visual working memory span, on verbal memory and on flexibility. Cognitive improvement was substantial when baseline performance was low, independently from clinical benefit. CRT is effective on crucial cognitive domains and provides a huge benefit for patients having low baseline performance. Such cognitive amelioration appears highly promising for improving the outcome in cognitively impaired patients.

  17. Analysis of surgeries performed after hysteroscopic sterilization as tabulated from 3,803 Essure patient experiences.

    Science.gov (United States)

    Sills, E Scott; Li, Xiang; Wood, Samuel H; Jones, Christopher A

    2017-05-01

    Although previous research has suggested that risk for reoperation among hysteroscopic sterilization (HS) patients is more than ten times higher than for patients undergoing standard laparoscopic tubal ligation, little has been reported about these subsequent procedures. This descriptive cohort study used a confidential online questionnaire to gather data from women (n=3,803) who volunteered information on HS followed by device removal surgery performed due to new symptoms developing after Essure placement. In this sample, mean age was 35.6 years and women undergoing hysterectomy after HS comprised 64.9% (n=2,468). Median interval between HS and hysterectomy was 3.7 (interquartile range, 3.9) years and mean age at hysterectomy was 36.3 years. Some patients (n=1,035) sought removal of HS devices and fallopian tubes only, while other miscellaneous gynecological procedures were also occasionally performed for Essure-associated symptoms. When data from all patients who had any post-Essure surgery besides hysterectomy were aggregated (e.g., device removal + "other" cases, n=1,335) and compared to those cases undergoing hysterectomy, mean age was significantly lower than for the hysterectomy group (34.4 vs. 36.3 years, respectively; P Essure, and suggests that the predominant surgical answer to HS complaints is hysterectomy for many women. Dissatisfaction with HS may represent an important indication for hysterectomy and additional study is needed to quantify this phenomenon.

  18. Safety, efficacy, and performance of implanted recycled cardiac rhythm management (CRM) devices in underprivileged patients.

    Science.gov (United States)

    Hasan, Reema; Ghanbari, Hamid; Feldman, Dustin; Menesses, Daniel; Rivas, Daniel; Zakhem, Nicole C; Duarte, Carlos; Machado, Christian

    2011-06-01

    Patients in underdeveloped nations have limited access to life-saving medical technology including cardiac rhythm management (CRM) devices. We evaluated alternative means to provide such technology to this patient population while assessing the safety and efficacy of such a practice. Patients in the United States with clinical indications for extraction of CRM devices were consented. Antemortem CRM devices were cleaned and sterilized following a protocol established at our institution. Surveillance in vitro cultures were performed for quality assurance. The functional status of pulse generators was tested with a pacing system analyzer to confirm at least 70% battery life. Most generators were transported, in person, to an implanting institution in Nicaragua. Recipients with a Class I indication for CRM implantation, and meeting economical criteria set forth, were consented for implantation of a recycled device. Between 2003 and 2009, implantation was performed in 17 patients with an average age of 42.1 ± 20.3 years. Of the 17 patients, nine were male and eight were female. Mean follow-up was 68 ± 38 months. Device evaluation occurred prior to discharge, 4 weeks post implantation, and every 6 months thereafter. There were three deaths during the follow-up period secondary to myocardial infarction, stroke, and heart failure. Hematoma formation occurred in one patient. No infections, early battery depletion, or device malfunction were identified during follow-up. Our case series is the longest follow-up of recipients of recycled antemortem CRM devices. Our findings support the feasibility and safety of this alternative acquisition of life-saving technology. ©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.

  19. No sex differences in neuropsychological performance in first episode psychosis patients.

    Science.gov (United States)

    Ayesa-Arriola, Rosa; Rodriguez-Sanchez, Jose Manuel; Gomez-Ruiz, Elsa; Roiz-Santiáñez, Roberto; Reeves, Lauren L; Crespo-Facorro, Benedicto

    2014-01-03

    The purpose of this study was to verify whether male patients with psychosis have greater neurocognitive impairment than female patients at illness onset. Participants with a first episode of psychosis (74 women/86 men) and healthy controls (62 women/97 men) were assessed with an extensive neuropsychological test battery. Women in the clinical group were older at illness onset and had achieved higher formal education than men. This trend was the same for the control group. The patient group presented with lower premorbid IQ compared to healthy controls, and performed below for most neuropsychological tests. Women scored higher than men on a test of verbal memory, whereas men scored higher than women on a test of reaction time, visual memory, and a planning task. There were no group-by-sex interactions for any of the neuropsychological tests. The present study shows that at the onset of psychosis there are no differences between males and females in neuropsychological performance. The differential pattern of cognitive performance observed is similar to that in healthy males and females. Furthermore, females with a late onset of psychosis may represent a subgroup with specific visuospatial and problem solving impairments. © 2013.

  20. Hierarchy of Dysfunction Related to Dressing Performance in Stroke Patients: A Path Analysis Study.

    Science.gov (United States)

    Fujita, Takaaki; Nagayama, Hirofumi; Sato, Atsushi; Yamamoto, Yuichi; Yamane, Kazuhiro; Otsuki, Koji; Tsuchiya, Kenji; Tozato, Fusae

    2016-01-01

    Previous reports indicated that various dysfunctions caused by stroke affect the level of independence in dressing. These dysfunctions can be hierarchical, and these effects on dressing performance can be complicated in stroke patients. However, there are no published reports focusing on the hierarchical structure of the relationships between the activities of daily living and balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits. The purpose of this study was to elucidate the hierarchical and causal relationships between dressing performance and these dysfunctions in stroke patients. This retrospective study included 104 first-time stroke patients. The causal relationship between the dressing performance and age, time post stroke, balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits were examined using path analysis. A hypothetical path model was created based on previous studies, and the goodness of fit between the data and model were verified. A modified path model was created that achieved an almost perfect fit to the data. Balance function and abdominal muscle strength have direct effects on dressing performance, with standardized direct effect estimates of 0.78 and 0.15, respectively. Age, motor and sensory functions of the affected lower limb, and strength of abdominal muscle and knee extension on the unaffected side have indirect effects on dressing by influencing balance function. Our results suggest that dressing performance depends strongly on balance function, and it is mainly influenced by the motor function of the affected lower limb.

  1. Hierarchy of Dysfunction Related to Dressing Performance in Stroke Patients: A Path Analysis Study.

    Directory of Open Access Journals (Sweden)

    Takaaki Fujita

    Full Text Available Previous reports indicated that various dysfunctions caused by stroke affect the level of independence in dressing. These dysfunctions can be hierarchical, and these effects on dressing performance can be complicated in stroke patients. However, there are no published reports focusing on the hierarchical structure of the relationships between the activities of daily living and balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits. The purpose of this study was to elucidate the hierarchical and causal relationships between dressing performance and these dysfunctions in stroke patients. This retrospective study included 104 first-time stroke patients. The causal relationship between the dressing performance and age, time post stroke, balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits were examined using path analysis. A hypothetical path model was created based on previous studies, and the goodness of fit between the data and model were verified. A modified path model was created that achieved an almost perfect fit to the data. Balance function and abdominal muscle strength have direct effects on dressing performance, with standardized direct effect estimates of 0.78 and 0.15, respectively. Age, motor and sensory functions of the affected lower limb, and strength of abdominal muscle and knee extension on the unaffected side have indirect effects on dressing by influencing balance function. Our results suggest that dressing performance depends strongly on balance function, and it is mainly influenced by the motor function of the affected lower limb.

  2. Temporal lobe volume predicts Wada memory test performance in patients with mesial temporal sclerosis.

    Science.gov (United States)

    Ding, Kan; Gong, Yunhua; Modur, Pradeep N; Diaz-Arrastia, Ramon; Agostini, Mark; Gupta, Puneet; McColl, Roderick; Hays, Ryan; Van Ness, Paul

    2016-02-01

    The Wada test is widely used in the presurgical evaluation of potential temporal lobectomy patients to predict postoperative memory function. Expected asymmetry (EA), defined as Wada memory lateralized to the nonsurgical hemisphere, or a higher score after injection of the surgical hemisphere would be considered favorable in terms of postoperative memory outcome. However, in some cases, nonlateralized memory (NM) results, with no appreciable asymmetry, may occur because of impaired scores after both injections, often leading to denial of surgery. The reason for such nonlateralized Wada memory in patients with intractable temporal lobe epilepsy (TLE) remains unclear. Given that quantitative morphometric magnetic resonance imaging studies in TLE patients have shown bilateral regional atrophy in temporal and extratemporal structures, we hypothesized that the volume loss in contralateral temporal structures could contribute to nonlateralized Wada memory performance. To investigate this, we examined the relationship between the volume changes of temporal structures and Wada memory scores in patients with intractable TLE with mesial temporal sclerosis (MTS) using an age- and gender-matched control group. Memory was considered nonlateralized if the absolute difference in the total correct recall scores between ipsilateral and contralateral injections was memory was lateralized in 15 and nonlateralized in 6 patients, with all the nonlateralized scores being observed in left TLE. The recall scores after ipsilateral injection were significantly lower in patients with an NM profile than an EA profile (23 ± 14% vs. 59 ± 18% correct recall, p ≤ 0.001). However, the recall scores after contralateral injection were low but similar between the two groups (25 ± 17% vs. 25 ± 15% correct recall, p=0.97). Compared to controls, all the patients showed greater volume loss in the temporal regions. However, patients with a NM profile showed significantly more volume loss than those

  3. Interfraction and intrafraction performance of the Gamma Knife Extend system for patient positioning and immobilization.

    Science.gov (United States)

    Schlesinger, David; Xu, Zhiyuan; Taylor, Frances; Yen, Chun-Po; Sheehan, Jason

    2012-12-01

    The Extend system for the Gamma Knife Perfexion makes possible multifractional Gamma Knife treatments. The Extend system consists of a vacuum-monitored immobilization frame and a positioning measurement system used to determine the location of the patient's head within the frame at the time of simulation imaging and before each treatment fraction. The measurement system consists of a repositioning check tool (RCT), which attaches to the Extend frame, and associated digital measuring gauges. The purpose of this study is to evaluate the performance of the Extend system for patient repositioning before each treatment session (fraction) and patient immobilization between (interfraction) and during (intrafraction) each session in the first 10 patients (36 fractional treatments) treated at the University of Virginia. The RCT was used to acquire a set of reference measurements for each patient position at the time of CT simulation. Repositioning measurements were acquired before each fraction, and the patient position was adjusted until the residual radial difference from the reference position measurements was less than 1 mm. After treatment, patient position measurements were acquired, and the difference between those measurements and the ones obtained for patient position before the fraction was calculated as a measure of immobilization capability. Analysis of patient setup and immobilization performance included calculation of the group mean, standard deviation (SD), and distribution of systematic (components affecting all fractions) and random (per fraction) uncertainty components. Across all patients and fractions, the mean radial setup difference from the reference measurements was 0.64 mm, with an SD of 0.24 mm. The distribution of systematic uncertainty (Σ) was 0.17 mm, and the distribution of random uncertainty (σ) was 0.16 mm. The root mean square (RMS) differences for each plate of the RCT were as follows: right = 0.35 mm; left = 0.41 mm; superior = 0.28 mm

  4. Simple prognostic model for patients with advanced cancer based on performance status.

    Science.gov (United States)

    Jang, Raymond W; Caraiscos, Valerie B; Swami, Nadia; Banerjee, Subrata; Mak, Ernie; Kaya, Ebru; Rodin, Gary; Bryson, John; Ridley, Julia Z; Le, Lisa W; Zimmermann, Camilla

    2014-09-01

    Providing survival estimates is important for decision making in oncology care. The purpose of this study was to provide survival estimates for outpatients with advanced cancer, using the Eastern Cooperative Oncology Group (ECOG), Palliative Performance Scale (PPS), and Karnofsky Performance Status (KPS) scales, and to compare their ability to predict survival. ECOG, PPS, and KPS were completed by physicians for each new patient attending the Princess Margaret Cancer Centre outpatient Oncology Palliative Care Clinic (OPCC) from April 2007 to February 2010. Survival analysis was performed using the Kaplan-Meier method. The log-rank test for trend was employed to test for differences in survival curves for each level of performance status (PS), and the concordance index (C-statistic) was used to test the predictive discriminatory ability of each PS measure. Measures were completed for 1,655 patients. PS delineated survival well for all three scales according to the log-rank test for trend (P statistic was similar for all three scales and ranged from 0.63 to 0.64. We present a simple tool that uses PS alone to prognosticate in advanced cancer, and has similar discriminatory ability to more complex models. Copyright © 2014 by American Society of Clinical Oncology.

  5. Performance on a probabilistic inference task in healthy subjects receiving ketamine compared with patients with schizophrenia

    Science.gov (United States)

    Almahdi, Basil; Sultan, Pervez; Sohanpal, Imrat; Brandner, Brigitta; Collier, Tracey; Shergill, Sukhi S; Cregg, Roman; Averbeck, Bruno B

    2012-01-01

    Evidence suggests that some aspects of schizophrenia can be induced in healthy volunteers through acute administration of the non-competitive NMDA-receptor antagonist, ketamine. In probabilistic inference tasks, patients with schizophrenia have been shown to ‘jump to conclusions’ (JTC) when asked to make a decision. We aimed to test whether healthy participants receiving ketamine would adopt a JTC response pattern resembling that of patients. The paradigmatic task used to investigate JTC has been the ‘urn’ task, where participants are shown a sequence of beads drawn from one of two ‘urns’, each containing coloured beads in different proportions. Participants make a decision when they think they know the urn from which beads are being drawn. We compared performance on the urn task between controls receiving acute ketamine or placebo with that of patients with schizophrenia and another group of controls matched to the patient group. Patients were shown to exhibit a JTC response pattern relative to their matched controls, whereas JTC was not evident in controls receiving ketamine relative to placebo. Ketamine does not appear to promote JTC in healthy controls, suggesting that ketamine does not affect probabilistic inferences. PMID:22389244

  6. Handwriting performance in the absence of visual control in writer's cramp patients: Initial observations

    Directory of Open Access Journals (Sweden)

    Losch Florian

    2006-04-01

    Full Text Available Abstract Background The present study was aimed at investigating the writing parameters of writer's cramp patients and control subjects during handwriting of a test sentence in the absence of visual control. Methods Eight right-handed patients with writer's cramp and eight healthy volunteers as age-matched control subjects participated in the study. The experimental task consisted in writing a test sentence repeatedly for fifty times on a pressure-sensitive digital board. The subject did not have visual control on his handwriting. The writing performance was stored on a PC and analyzed off-line. Results During handwriting all patients developed a typical dystonic limb posture and reported an increase in muscular tension along the experimental session. The patients were significantly slower than the controls, with lower mean vertical pressure of the pen tip on the paper and they could not reach the endmost letter of the sentence in the given time window. No other handwriting parameter differences were found between the two groups. Conclusion Our findings indicate that during writing in the absence of visual feedback writer's cramp patients are slower and could not reach the endmost letter of the test sentence, but their level of automatization is not impaired and writer's cramp handwriting parameters are similar to those of the controls except for even lower vertical pressure of the pen tip on the paper, which is probably due to a changed strategy in such experimental conditions.

  7. Performance of a video-image-subtraction-based patient positioning system

    International Nuclear Information System (INIS)

    Milliken, Barrett D.; Rubin, Steven J.; Hamilton, Russell J.; Johnson, L. Scott; Chen, George T.Y.

    1997-01-01

    Purpose: We have developed and tested an interactive video system that utilizes image subtraction techniques to enable high precision patient repositioning using surface features. We report quantitative measurements of system performance characteristics. Methods and Materials: Video images can provide a high precision, low cost measure of patient position. Image subtraction techniques enable one to incorporate detailed information contained in the image of a carefully verified reference position into real-time images. We have developed a system using video cameras providing orthogonal images of the treatment setup. The images are acquired, processed and viewed using an inexpensive frame grabber and a PC. The subtraction images provide the interactive guidance needed to quickly and accurately place a patient in the same position for each treatment session. We describe the design and implementation of our system, and its quantitative performance, using images both to measure changes in position, and to achieve accurate setup reproducibility. Results: Under clinical conditions (60 cm field of view, 3.6 m object distance), the position of static, high contrast objects could be measured with a resolution of 0.04 mm (rms) in each of two dimensions. The two-dimensional position could be reproduced using the real-time image display with a resolution of 0.15 mm (rms). Two-dimensional measurement resolution of the head of a patient undergoing treatment for head and neck cancer was 0.1 mm (rms), using a lateral view, measuring the variation in position of the nose and the ear over the course of a single radiation treatment. Three-dimensional repositioning accuracy of the head of a healthy volunteer using orthogonal camera views was less than 0.7 mm (systematic error) with an rms variation of 1.2 mm. Setup adjustments based on the video images were typically performed within a few minutes. The higher precision achieved using the system to measure objects than to reposition

  8. A study of the performance of patients with frontal lobe lesions in a financial planning task.

    Science.gov (United States)

    Goel, V; Grafman, J; Tajik, J; Gana, S; Danto, D

    1997-10-01

    It has long been argued that patients with lesions in the prefrontal cortex have difficulties in decision making and problem solving in real-world, ill-structured situations, particularly problem types involving planning and look-ahead components. Recently, several researchers have questioned our ability to capture and characterize these deficits adequately using just the standard neuropsychological test batteries, and have called for tests that reflect real-world task requirements more accurately. We present data from 10 patients with focal lesions to the prefrontal cortex and 10 normal control subjects engaged in a real-world financial planning task. We also introduce a theoretical framework and methodology developed in the cognitive science literature for quantifying and analysing the complex data generated by problem-solving tasks. Our findings indicate that patient performance is impoverished at a global level but not at the local level. Patients have difficulty in organizing and structuring their problem space. Once they begin problem solving, they have difficulty in allocating adequate effort to each problem-solving phase. Patients also have difficulty dealing with the fact that there are no right or wrong answers nor official termination points in real-world planning problems. They also find it problematic to generate their own feedback. They invariably terminate the session before the details are fleshed out and all the goals satisfied. Finally, patients do not take full advantage of the fact that constraints on real-world problems are negotiable. However, it is not necessary to postulate a 'planning' deficit. It is possible to understand the patients' difficulties in real world planning tasks in terms of the following four accepted deficits: inadequate access to 'structured event complexes', difficulty in generalizing from particulars, failure to shift between 'mental sets', and poor judgment regarding adequacy and completeness of a plan.

  9. Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients.

    Science.gov (United States)

    Culley, Deborah J; Flaherty, Devon; Fahey, Margaret C; Rudolph, James L; Javedan, Houman; Huang, Chuan-Chin; Wright, John; Bader, Angela M; Hyman, Bradley T; Blacker, Deborah; Crosby, Gregory

    2017-11-01

    The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications. We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement. Patients were cognitively screened preoperatively using the Mini-Cog and demographic, medical, functional, and emotional/social data were gathered using standard instruments or review of the medical record. Outcomes included discharge to place other than home (primary outcome), delirium, in-hospital medical complications, hospital length-of-stay, 30-day emergency room visits, and mortality. Data were analyzed using univariate and multivariate analyses. Fifty of 211 (24%) patients screened positive for probable cognitive impairment (Mini-Cog less than or equal to 2). On age-adjusted multivariate analysis, patients with a Mini-Cog score less than or equal to 2 were more likely to be discharged to a place other than home (67% vs. 34%; odds ratio = 3.88, 95% CI = 1.58 to 9.55), develop postoperative delirium (21% vs. 7%; odds ratio = 4.52, 95% CI = 1.30 to 15.68), and have a longer hospital length of stay (hazard ratio = 0.63, 95% CI = 0.42 to 0.95) compared to those with a Mini-Cog score greater than 2. Many older elective orthopedic surgical patients have probable cognitive impairment preoperatively. Such impairment is associated with development of delirium postoperatively, a longer hospital stay, and lower likelihood of going home upon hospital discharge.

  10. Associations between physical function, dual-task performance and cognition in patients with mild Alzheimer's disease.

    Science.gov (United States)

    Sobol, Nanna Aue; Hoffmann, Kristine; Vogel, Asmus; Lolk, Annette; Gottrup, Hanne; Høgh, Peter; Hasselbalch, Steen G; Beyer, Nina

    2016-11-01

    Alzheimer's disease (AD) causes a gradual decline in cognition, limitations of dual-tasking and physical function leading to total dependence. Hence, information about the interaction between physical function, dual-task performance and cognition may lead to new treatment strategies with the purpose of preserving function and quality of life. The objective of this study was to investigate the associations between physical function, dual-task performance and cognition in community-dwelling patients with mild AD. Baseline results from 185 participants (50-90 years old) in the single blinded multicenter RCT 'ADEX' (Alzheimer's disease: the effect of physical exercise) were used. Assessments included tests of physical function: 400-m walk test, 10-m walk test, Timed Up and Go test and 30-s chair stand test; dual-task performance, i.e., 10-m walk while counting backwards from 50 or naming the months backwards; and cognition, i.e., Mini Mental State Examination, Symbol Digit Modalities Test, the Stroop Color and Word Test, and Lexical verbal fluency test. Results in the 30-s chair stand test correlated significantly with all tests of cognition (r = .208-.242) while the other physical function tests only randomly correlated with tests of cognition. Results in the dual-task counting backwards correlated significantly with results in all tests of cognition (r = .259-.388), which accounted for 7%-15% of the variation indicating that a faster time to complete dual-task performance was associated with better cognitive performance. The evidence of the associations between physical function, dual-task performance and cognition is important when creating new rehabilitation interventions to patients with mild AD.

  11. Contribution of temporal data to predictive performance in 30-day readmission of morbidly obese patients

    Directory of Open Access Journals (Sweden)

    Petra Povalej Brzan

    2017-04-01

    Full Text Available Background Reduction of readmissions after discharge represents an important challenge for many hospitals and has attracted the interest of many researchers in the past few years. Most of the studies in this field focus on building cross-sectional predictive models that aim to predict the occurrence of readmission within 30-days based on information from the current hospitalization. The aim of this study is demonstration of predictive performance gain obtained by inclusion of information from historical hospitalization records among morbidly obese patients. Methods The California Statewide inpatient database was used to build regularized logistic regression models for prediction of readmission in morbidly obese patients (n = 18,881. Temporal features were extracted from historical patient hospitalization records in a one-year timeframe. Five different datasets of patients were prepared based on the number of available hospitalizations per patient. Sample size of the five datasets ranged from 4,787 patients with more than five hospitalizations to 20,521 patients with at least two hospitalization records in one year. A 10-fold cross validation was repeted 100 times to assess the variability of the results. Additionally, random forest and extreme gradient boosting were used to confirm the results. Results Area under the ROC curve increased significantly when including information from up to three historical records on all datasets. The inclusion of more than three historical records was not efficient. Similar results can be observed for Brier score and PPV value. The number of selected predictors corresponded to the complexity of the dataset ranging from an average of 29.50 selected features on the smallest dataset to 184.96 on the largest dataset based on 100 repetitions of 10-fold cross-validation. Discussion The results show positive influence of adding information from historical hospitalization records on predictive performance using all

  12. EEG indices correlate with sustained attention performance in patients affected by diffuse axonal injury.

    Science.gov (United States)

    Coelli, Stefania; Barbieri, Riccardo; Reni, Gianluigi; Zucca, Claudio; Bianchi, Anna Maria

    2018-06-01

    The aim of this study is to assess the ability of EEG-based indices in providing relevant information about cognitive engagement level during the execution of a clinical sustained attention (SA) test in healthy volunteers and DAI (diffused axonal injury)-affected patients. We computed three continuous power-based engagement indices (P β /P α , 1/P α , and P β / (P α + P θ )) from EEG recordings in a control group (n = 7) and seven DAI-affected patients executing a 10-min Conners' "not-X" continuous performance test (CPT). A correlation analysis was performed in order to investigate the existence of relations between the EEG metrics and behavioral parameters in both the populations. P β /P α and 1/P α indices were found to be correlated with reaction times in both groups while P β / (P α + P θ ) and P β /P α also correlated with the errors rate for DAI patients. In line with previous studies, time course fluctuations revealed a first strong decrease of attention after 2 min from the beginning of the test and a final fading at the end. Our results provide evidence that EEG-derived indices extraction and evaluation during SA tasks are helpful in the assessment of attention level in healthy subjects and DAI patients, offering motivations for including EEG monitoring in cognitive rehabilitation practice. Graphical abstract Three EEG-derived indices were computed from four electrodes montages in a population of seven healthy volunteers and a group of seven DAI-affected patients. Results show a significant correlation between the time course of the indices and behavioral parameters, thus demonstrating their usefulness in monitoring mental engagement level during a sustained attention task.

  13. Humidification performance of humidifying devices for tracheostomized patients with spontaneous breathing: a bench study.

    Science.gov (United States)

    Chikata, Yusuke; Oto, Jun; Onodera, Mutsuo; Nishimura, Masaji

    2013-09-01

    Heat and moisture exchangers (HMEs) are commonly used for humidifying respiratory gases administered to mechanically ventilated patients. While they are also applied to tracheostomized patients with spontaneous breathing, their performance in this role has not yet been clarified. We carried out a bench study to investigate the effects of spontaneous breathing parameters and oxygen flow on the humidification performance of 11 HMEs. We evaluated the humidification provided by 11 HMEs for tracheostomized patients, and also by a system delivering high-flow CPAP, and an oxygen mask with nebulizer heater. Spontaneous breathing was simulated with a mechanical ventilator, lung model, and servo-controlled heated humidifier at tidal volumes of 300, 500, and 700 mL, and breathing frequencies of 10 and 20 breaths/min. Expired gas was warmed to 37°C. The high-flow CPAP system was set to deliver 15, 30, and 45 L/min. With the 8 HMEs that were equipped with ports to deliver oxygen, and with the high-flow CPAP system, measurements were taken when delivering 0 and 3 L/min of dry oxygen. After stabilization we measured the absolute humidity (AH) of inspired gas with a hygrometer. AH differed among HMEs applied to tracheostomized patients with spontaneous breathing. For all the HMEs, as tidal volume increased, AH decreased. At 20 breaths/min, AH was higher than at 10 breaths/min. For all the HMEs, when oxygen was delivered, AH decreased to below 30 mg/L. With an oxygen mask and high-flow CPAP, at all settings, AH exceeded 30 mg/L. None of the HMEs provided adequate humidification when supplemental oxygen was added. In the ICU, caution is required when applying HME to tracheostomized patients with spontaneous breathing, especially when supplemental oxygen is required.

  14. Functional impairment in patients with major depressive disorder: the 2-year PERFORM study.

    Science.gov (United States)

    Hammer-Helmich, Lene; Haro, Josep Maria; Jönsson, Bengt; Tanguy Melac, Audrey; Di Nicola, Sylvie; Chollet, Julien; Milea, Dominique; Rive, Benoît; Saragoussi, Delphine

    2018-01-01

    The Prospective Epidemiological Research on Functioning Outcomes Related to Major depressive disorder (PERFORM) study describes the course of depressive symptoms, perceived cognitive symptoms, and functional impairment over 2 years in outpatients with major depressive disorder (MDD) and investigates the patient-related factors associated with functional impairment. This was a 2-year observational study in 1,159 outpatients with MDD aged 18-65 years who were either initiating antidepressant monotherapy or undergoing their first switch of antidepressant. Functional impairment was assessed by the Sheehan Disability Scale and the Work Productivity and Activity Impairment questionnaire. Patients assessed depression severity using the nine-item Patient Health Questionnaire and severity of perceived cognitive symptoms using the five-item Perceived Deficit Questionnaire. To investigate which patient-related factors were associated with functional impairment, univariate analyses of variance were performed to identify relevant factors that were then included in multivariate analyses of covariance at baseline, month 2, months 6 and 12 combined, and months 18 and 24 combined. The greatest improvement in depressive symptoms, perceived cognitive symptoms, and functional impairment was seen immediately (within 2 months) following initiation or switch of antidepressant therapy, followed by more gradual improvement and long-term stabilization. Improvement in perceived cognitive symptoms was less marked than improvement in depressive symptoms during the acute treatment phase. Functional impairment in patients with MDD was not only associated with severity of depressive symptoms but also independently associated with severity of perceived cognitive symptoms when adjusted for depression severity throughout the 2 years of follow-up. These findings highlight the burden of functional impairment in MDD and the importance of recognizing and managing cognitive symptoms in daily practice.

  15. Initial Clinical Experience Performing Patient Treatment Verification With an Electronic Portal Imaging Device Transit Dosimeter

    Energy Technology Data Exchange (ETDEWEB)

    Berry, Sean L., E-mail: BerryS@MSKCC.org [Department of Applied Physics and Applied Mathematics, Columbia University, New York, New York (United States); Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Polvorosa, Cynthia; Cheng, Simon; Deutsch, Israel; Chao, K. S. Clifford; Wuu, Cheng-Shie [Department of Radiation Oncology, Columbia University, New York, New York (United States)

    2014-01-01

    Purpose: To prospectively evaluate a 2-dimensional transit dosimetry algorithm's performance on a patient population and to analyze the issues that would arise in a widespread clinical adoption of transit electronic portal imaging device (EPID) dosimetry. Methods and Materials: Eleven patients were enrolled on the protocol; 9 completed and were analyzed. Pretreatment intensity modulated radiation therapy (IMRT) patient-specific quality assurance was performed using a stringent local 3%, 3-mm γ criterion to verify that the planned fluence had been appropriately transferred to and delivered by the linear accelerator. Transit dosimetric EPID images were then acquired during treatment and compared offline with predicted transit images using a global 5%, 3-mm γ criterion. Results: There were 288 transit images analyzed. The overall γ pass rate was 89.1% ± 9.8% (average ± 1 SD). For the subset of images for which the linear accelerator couch did not interfere with the measurement, the γ pass rate was 95.7% ± 2.4%. A case study is presented in which the transit dosimetry algorithm was able to identify that a lung patient's bilateral pleural effusion had resolved in the time between the planning CT scan and the treatment. Conclusions: The EPID transit dosimetry algorithm under consideration, previously described and verified in a phantom study, is feasible for use in treatment delivery verification for real patients. Two-dimensional EPID transit dosimetry can play an important role in indicating when a treatment delivery is inconsistent with the original plan.

  16. Association of volume of patient encounters with residents' in-training examination performance.

    Science.gov (United States)

    McCoy, Christopher P; Stenerson, Matthew B; Halvorsen, Andrew J; Homme, Jason H; McDonald, Furman S

    2013-08-01

    Patient care and medical knowledge are Accreditation Council for Graduate Medical Education (ACGME) core competencies. The correlation between amount of patient contact and knowledge acquisition is not known. To determine if a correlation exists between the number of patient encounters and in-training exam (ITE) scores in internal medicine (IM) and pediatric residents at a large academic medical center. Retrospective cohort study Resident physicians at Mayo Clinic from July 2006 to June 2010 in IM (318 resident-years) and pediatrics (66 resident-years). We tabulated patient encounters through review of clinical notes in an electronic medical record during post graduate year (PGY)-1 and PGY-2. Using linear regression models, we investigated associations between ITE score and number of notes during the previous PGY, adjusted for previous ITE score, gender, medical school origin, and conference attendance. For IM, PGY-2 admission and consult encounters in the hospital and specialty clinics had a positive linear association with ITE-3 % score (β = 0.02; p = 0.004). For IM, PGY-1 conference attendance is positively associated with PGY-2 ITE performance. We did not detect a correlation between PGY-1 patient encounters and subsequent ITE scores for IM or pediatric residents. No association was found between IM PGY-2 ITE score and inpatient, outpatient, or total encounters in the first year of training. Resident continuity clinic and total encounters were not associated with change in PGY-3 ITE score. We identified a positive association between hospital and subspecialty encounters during the second year of IM training and subsequent ITE score, such that each additional 50 encounters were associated with an increase of 1 % correct in PGY-3 ITE score after controlling for previous ITE performance and continuity clinic encounters. We did not find a correlation for volume of encounters and medical knowledge for IM PGY-1 residents or the pediatric cohort.

  17. Decision-making performance of depressed patients within 72 h following a suicide attempt.

    Science.gov (United States)

    Hegedűs, Klára M; Szkaliczki, Andrea; Gál, Bernadett I; Andó, Bálint; Janka, Zoltán; Álmos, Péter Z

    2018-08-01

    The significance of decision-making in suicidal behaviour is often highlighted; however, the performance of persons in suicide crisis is unknown. This study aimed to explore the comprehensive decision-making profile of depressed patients following a suicide attempt. Decision-making was measured by reward- ("ABCD") and punishment- ("EFGH") sensitive versions of the Iowa Gambling Task (IGT) in 59 medication-free depressed patients within 72 h after a suicide attempt and in 46 healthy control subjects. Severity of depressive symptoms was assessed in the patient group by the Hamilton Depression Rating Scale. Performance of the two groups differed significantly on the IGT ABCD, while a trend towards significant differences was seen on the IGT EFGH. Severity of depressive symptoms did not affect the depressed participants' decision-making performance. Subjects were not matched for years of education. Administration of the IGT ABCD and IGT EFGH was not counterbalanced. Methods of suicide attempts and history of previous attempts were not collected. Individuals with a recent suicide attempt showed decision-making dysfunction on both IGT versions. However, on the EFGH, the overall difference between groups was not significant, depressed participants' performance remained poor during all blocks. Their behaviour reflected a focus on best immediate possible outcomes, not regarding future adverse consequences. This could be a result of psychological and cognitive alterations which modulate suicidal behaviour independent from mood. Further longitudinal studies should verify this possibility. Investigation of state-dependent neuropsychological characteristics of suicidal behaviour might be essential for detecting acute suicidal crisis. Copyright © 2018 Elsevier B.V. All rights reserved.

  18. Should we perform an echocardiogram in hypertensive patients classified as having low and medium risk?

    Science.gov (United States)

    Suárez, Carmen; Villar, José; Martel, Nieves; Extremera, Blas Gil; Suliman, Najaty; Campo, Carlos; Castellanos, Victoriano; Liébana, Antonio; Rodilla, Enrique; Nieto, Javier; Velasco, Olga; Ruilope, Luis M

    2006-01-04

    Left ventricular hypertrophy is an important predictor of cardiovascular risk and its detection contributes to risk stratification. However, echocardiography is not a routine procedure and electrocardiography (ECG) underestimates its prevalence. To evaluate the prevalence of echocardiographic left ventricular hypertrophy in low and medium risk non-treated hypertensive subjects, in order to find out the percentage of them who would be reclassified as high risk patients. Cross-sectional, multicenter study was performed in hospital located hypertension units. An echocardiogram was performed in 197 previously untreated hypertensive patients, > 18 years, classified as having low (61%) or medium (39%) risk, according to the OMS/ISH classification. The presence of left ventricular hypertrophy was considered if left ventricular mass index was > or = 134 or 110 g/m(2) in men and women, respectively (Devereux criteria). A logistic regression analysis was performed to identify factors associated to left ventricular hypertrophy. The prevalence of left ventricular hypertrophy was 23.9% (95% CI:17.9-29.9), 25.6% in men and 22.6% in women. In the low risk group its prevalence was 20.7% and in medium risk group 29.5%. Factors associated to left ventricular hypertrophy were: years since the diagnosis of hypertension, OR:1.1 (95% CI:1.003-1.227); systolic blood pressure, OR:1.08 (95% CI:1.029-1.138); diastolic blood pressure, OR:0.9 (95% CI:0.882-0.991); and family history of cardiovascular disease, OR:4.3 (95% CI:1.52-12.18). These findings underline the importance of performing an echocardiogram in low and high risk untreated hypertensive patients in which treatment would otherwise be delayed for even one year.

  19. Serum uric acid and subsequent cognitive performance in patients with pre-existing cardiovascular disease.

    Directory of Open Access Journals (Sweden)

    Noa Molshatzki

    Full Text Available High serum uric acid (UA levels are associated with numerous vascular risk factors, and vascular disease, that predispose patients to cognitive impairment, yet UA is also a major natural antioxidant and higher levels have been linked to slower progression of several neurodegenerative disease. In-order to test the association between UA and subsequent cognitive performance among patients that carry a high vascular burden, UA levels were determined by calorimetric enzymatic tests in a sub-cohort of patients with chronic cardiovascular disease who previously participating in a secondary prevention trial. After an average of 9.8±1.7 years, we assessed cognitive performance (Neurotrax Computerized Cognitive Battery as well as cerebrovascular reactivity (CVR and common carotid intima-media thickness (IMT. Among 446 men (mean age 62.3±6.4 yrs mean UA levels were 5.8±1.1 mg/dL. Adjusted linear regression models revealed that low UA levels (bottom quintile were associated with poorer cognitive performance. Adjusted differences between the bottom quintile and grouped top UA quintiles were (B coefficient±SE -4.23±1.28 for global cognitive scores (p = 0.001, -4.69±1.81 for memory scores (p = 0.010, -3.32±1.43 for executive scores (p = 0.020 and -3.43±1.97 for visual spatial scores (p = 0.082. Significant difference was also found for attention scores (p = 0.015. Additional adjustment for impaired CVR and high common carotid IMT slightly attenuated the relationship. Stronger UA effect on cognitive performance was found for older (age>65 patients with significant age interaction for global cognitive score (p = 0.016 and for executive (p = 0.018 and attention domains (p<0.001. In conclusion, we demonstrate that low UA levels in patients with preexisting cardiovascular disease are associated with poorer cognitive function a decade later. These findings lend support to the hypothesis that oxidative stress may be involved in the pathogenesis of age

  20. A performance improvement prescribing guideline reduces opioid prescriptions for emergency department dental pain patients.

    Science.gov (United States)

    Fox, Timothy R; Li, James; Stevens, Sandra; Tippie, Tracy

    2013-09-01

    In an effort to reduce prescription opioid abuse originating from our institution, we implement and measure the effect of a prescribing guideline on the rate of emergency department (ED) opioid prescriptions written for patients presenting with dental pain, a complaint previously associated with drug-seeking behavior. After implementing a departmental guideline on controlled substance prescriptions, we performed a structured before-and-after chart review of dental pain patients aged 16 and older. Before the guideline, the rate of opioid prescription was 59% (302/515). After implementation, the rate was 42% (65/153). The absolute decrease in rates was 17% (95% confidence interval 7% to 25%). Additionally, in comparing the 12-month period before and after implementation, the dental pain visit rate decreased from 26 to 21 per 1,000 ED visits (95% confidence interval of decrease 2 to 9 visits/1,000). A performance improvement program involving a departmental prescribing guideline was associated with a reduction in the rate of opioid prescriptions and visits for ED patients presenting with dental pain. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  1. Analysis of Trunk Rolling Performances by Mattress Mobility Detection System in Poststroke Patients: A Pilot Study.

    Science.gov (United States)

    Chiang, Shang-Lin; Lin, Chia-Huei; Lin, Chueh-Ho; Lu, Liang-Hsuan; Chang, Shin-Tsu; Sung, Wen-Hsu; Wei, Shun-Hwa

    2016-01-01

    The purpose of this study was to investigate the correlation of kinematic variables with quality of trunk control in poststroke patients. This cross-sectional study included stroke subjects with mild to moderate motor deficit corresponding to Brunnstrom stages 3-4. Trunk functional performance was measured using bed mobility monitor system. All tasks were repeated ten times for both directions in each subject. Outcome measurements included the movement time and displacement of center of pressure (CoP) from supine to side lying and returning. The results revealed that a significant longer turning time was observed when turning from the paretic side toward the nonparetic side compared to the other direction, with an estimated mean difference of 0.427 sec (P = 0.005). We found a significant difference in the time of rolling back to supine position between two directions. The displacement of CoP in rolling back from side lying on the nonparetic side was smaller than that from the paretic side with an estimated mean difference of -0.797 cm (P = 0.023). The impaired trunk mobility was associated with increased movement time and decreased displacement of CoP in poststroke patients. Trunk rolling performance has potential in assessment of stroke patients.

  2. Sex-sensitive cognitive performance in untreated patients with early onset gender identity disorder.

    Science.gov (United States)

    Haraldsen, I R; Opjordsmoen, S; Egeland, T; Finset, A

    2003-10-01

    We explored whether the cognitive performance of gender identity disorder patients (GID) was comparable to that of their biological sex or skewed towards that of their gender identity. We tested four potentially sex-sensitive cognitive factors (rotation, visualization, perception, and verbalization) as well as two neutral factors (logic and arithmetic) in GID patients from Norway (GID-N, n = 33) or the USA (GID-US, n = 19) and in a control group (C, n = 29). The testing was undertaken prior to cross sex hormone treatment. Four-way ANOVA was applied in the final analysis of the cognitive performance and its dependency on different predictors (age, biological sex, education, group). In both GID groups as well as in the control group (C) males excelled in visualization and rotation, also when controlling for potential confounders (biological sex, group, age and education). No female advantage was detected. Furthermore, no interaction between biological sex and group assignment was revealed in the samples. In this study the cognitive pattern of GID patients is consistent with that of their biological sex and not that of their gender identity.

  3. Do Psychosocial Factors Predict Muscle Strength, Pain, or Physical Performance in Patients With Knee Osteoarthritis?

    Science.gov (United States)

    Baert, Isabel A C; Meeus, Mira; Mahmoudian, Armaghan; Luyten, Frank P; Nijs, Jo; Verschueren, Sabine M P

    2017-09-01

    The aim of this study was to examine the relationship of psychosocial factors, namely, pain catastrophizing, kinesiophobia, and maladaptive coping strategies, with muscle strength, pain, and physical performance in patients with knee osteoarthritis (OA)-related symptoms. A total of 109 women (64 with knee OA-related symptoms) with a mean age of 65.4 years (49-81 years) were recruited for this study. Psychosocial factors were quantified by the Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Pain Coping Inventory. Clinical features were assessed using isometric and isokinetic knee muscle strength measurements, visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index, and functional tests. Associations were examined using correlation and regression analysis. In knee OA patients, pain catastrophizing, kinesiophobia, and coping strategy explained a significant proportion of the variability in isometric knee extension and flexion strength (6.3%-9.2%), accounting for more overall variability than some demographic and medical status variables combined. Psychosocial factors were not significant independent predictors of isokinetic strength, knee pain, or physical performance. In understanding clinical features related to knee OA, such as muscle weakness, pain catastrophizing, kinesiophobia, and coping strategy might offer something additional beyond what might be explained by traditional factors, underscoring the importance of a biopsychosocial approach in knee OA management. Further research on individual patient characteristics that mediate the effects of psychosocial factors is, however, required in order to create opportunities for more targeted, personalized treatment for knee OA.

  4. Internal qualification and credentialing of radiation oncology physicists to perform patient special procedures

    Directory of Open Access Journals (Sweden)

    Michael D Mills

    2014-01-01

    Full Text Available In the arena of radiation oncology special procedures, medical physicists are often the focus professionals for implementation and administration of advanced and complex technologies. One of the most vexing and challenging aspects of managing complexity concerns the ongoing internal qualification and credentialing of radiation oncology physicists to perform patient special procedures. To demonstrate ongoing qualification, a physicist must a document initial training and successful completion of competencies to implement and perform this procedure, b demonstrate familiarity with all aspects of the commissioning and quality assurance process, c demonstrate continuing education respecting this procedure, d demonstrate the peer-reviewed completion of a minimum number of patient special procedures during a specified time span, and e demonstrate satisfactory overall progress toward maintenance of specialty board certification. In many respects, this information complement is similar to that required by an accredited residency program in therapy physics. In this investigation, we report on the design of a management tool to qualify staff radiation oncology physicists to deliver patient procedures.

  5. Performance monitoring and error significance in patients with obsessive-compulsive disorder.

    Science.gov (United States)

    Endrass, Tanja; Schuermann, Beate; Kaufmann, Christan; Spielberg, Rüdiger; Kniesche, Rainer; Kathmann, Norbert

    2010-05-01

    Performance monitoring has been consistently found to be overactive in obsessive-compulsive disorder (OCD). The present study examines whether performance monitoring in OCD is adjusted with error significance. Therefore, errors in a flanker task were followed by neutral (standard condition) or punishment feedbacks (punishment condition). In the standard condition patients had significantly larger error-related negativity (ERN) and correct-related negativity (CRN) ampliudes than controls. But, in the punishment condition groups did not differ in ERN and CRN amplitudes. While healthy controls showed an amplitude enhancement between standard and punishment condition, OCD patients showed no variation. In contrast, group differences were not found for the error positivity (Pe): both groups had larger Pe amplitudes in the punishment condition. Results confirm earlier findings of overactive error monitoring in OCD. The absence of a variation with error significance might indicate that OCD patients are unable to down-regulate their monitoring activity according to external requirements. Copyright 2010 Elsevier B.V. All rights reserved.

  6. Reading performance of monofocal pseudophakic patients with and without glasses under normal and dim light conditions.

    Science.gov (United States)

    Radner, Wolfgang; Radner, Stephan; Raunig, Valerian; Diendorfer, Gabriela

    2014-03-01

    To evaluate reading performance of patients with monofocal intraocular lenses (IOLs) (Acrysof SN60WF) with or without reading glasses under bright and dim light conditions. Austrian Academy of Ophthalmology, Vienna, Austria. Evaluation of a diagnostic test or technology. In pseudophakic patients, the spherical refractive error was limited to between +0.50 diopter (D) and -0.75 D with astigmatism of 0.75 D (mean spherical equivalent: right eye, -0.08 ± 0.43 [SD]; left eye, -0.15 ± 0.35). Near addition was +2.75 D. Reading performance was assessed binocularly with or without reading glasses at an illumination of 100 candelas (cd)/m(2) and 4 cd/m(2) using the Radner Reading Charts. In the 25 patients evaluated, binocularly, the mean corrected distance visual acuity was -0.07 ± 0.06 logMAR and the mean uncorrected distance visual acuity was 0.01 ± 0.11 logMAR. The mean reading acuity with reading glasses was 0.02 ± 0.10 logRAD at 100 cd/m(2) and 0.12 ± 0.14 logRAD at 4 cd/m(2). Without reading glasses, it was 0.44 ± 0.13 logRAD and 0.56 ± 0.16 logRAD, respectively (P light conditions. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  7. Improving performance management for delivering appropriate care for patients no longer needing acute hospital care.

    Science.gov (United States)

    Penney, Christine; Henry, Effie

    2008-01-01

    The public, providers and policy-makers are interested in a service continuum where care is provided in the appropriate place. Alternate level of care is used to define patients who no longer need acute care but remain in an acute care bed. Our aims were to determine how subacute care and convalescent care should be defined in British Columbia (BC); how these care levels should be aligned with existing legislation to provide more consistent service standards to patients and what reporting requirements were needed for system planning and performance management. A literature review was conducted to understand the international trends in performance management, care delivery models and change management. A Canada-wide survey was carried out to determine the directions of other provinces on the defined issues and a BC survey provided a current state analysis of programming within the five regional health authorities (HAs). A provincial policy framework for subacute and convalescent care has been developed to begin to address the concerns raised and provide a base for performance measurement. The policy has been approved and disseminated to BC HAs for implementation. An implementation plan has been developed and implementation activities have been integrated into the work of existing provincial committees. Evaluation will occur through performance measurement. The benefits anticipated include: clear policy guidance for programme development; improved comparability of performance information for system monitoring, planning and integrity of the national acute care Discharge Abstracting Database; improved efficiency in acute care bed use; and improved equity of access, insurability and quality for patients requiring subacute and convalescent care. While a national reporting system exists for acute care in Canada, this project raises questions about the implications for this system, given the shifting definition of acute care as other care levels emerge. Questions are also

  8. Mortality risk in hemodialysis patients with increased arterial stiffness is reduced by attainment of classical clinical performance measures

    DEFF Research Database (Denmark)

    Scholze, Alexandra; Thies, Christina; Cheikhalfraj, Mohamed

    2009-01-01

    We determined whether attainment of classical clinical performance measures for hemodialysis care improves survival in hemodialysis patients with increased arterial stiffness.......We determined whether attainment of classical clinical performance measures for hemodialysis care improves survival in hemodialysis patients with increased arterial stiffness....

  9. Comparison of self-reported and performance-based measures of functional ability in elderly patients in an emergency department

    DEFF Research Database (Denmark)

    Nielsen, Louise M.; Kirkegaard, Hans; Østergaard, Lisa Gregersen

    2016-01-01

    Background Assessment of functional ability in elderly patients is often based on self-reported rather than performance-based measures. This study aims to compare self-reported and performance-based measures of functional ability in a population of elderly patients at an emergency department (ED)...

  10. Optimizing MRI Logistics: Prospective Analysis of Performance, Efficiency, and Patient Throughput.

    Science.gov (United States)

    Beker, Kevin; Garces-Descovich, Alejandro; Mangosing, Jason; Cabral-Goncalves, Ines; Hallett, Donna; Mortele, Koenraad J

    2017-10-01

    The objective of this study is to optimize MRI logistics through evaluation of MRI workflow and analysis of performance, efficiency, and patient throughput in a tertiary care academic center. For 2 weeks, workflow data from two outpatient MRI scanners were prospectively collected and stratified by value added to the process (i.e., value-added time, business value-added time, or non-value-added time). Two separate time cycles were measured: the actual MRI process cycle as well as the complete length of patient stay in the department. In addition, the impact and frequency of delays across all observations were measured. A total of 305 MRI examinations were evaluated, including body (34.1%), neurologic (28.9%), musculoskeletal (21.0%), and breast examinations (16.1%). The MRI process cycle lasted a mean of 50.97 ± 24.4 (SD) minutes per examination; the mean non-value-added time was 13.21 ± 18.77 minutes (25.87% of the total process cycle time). The mean length-of-stay cycle was 83.51 ± 33.63 minutes; the mean non-value-added time was 24.33 ± 24.84 minutes (29.14% of the total patient stay). The delay with the highest frequency (5.57%) was IV or port placement, which had a mean delay of 22.82 minutes. The delay with the greatest impact on time was MRI arthrography for which joint injection of contrast medium was necessary but was not accounted for in the schedule (mean delay, 42.2 minutes; frequency, 1.64%). Of 305 patients, 34 (11.15%) did not arrive at or before their scheduled time. Non-value-added time represents approximately one-third of the total MRI process cycle and patient length of stay. Identifying specific delays may expedite the application of targeted improvement strategies, potentially increasing revenue, efficiency, and overall patient satisfaction.

  11. Key performance outcomes of patient safety curricula: root cause analysis, failure mode and effects analysis, and structured communications skills.

    Science.gov (United States)

    Fassett, William E

    2011-10-10

    As colleges and schools of pharmacy develop core courses related to patient safety, course-level outcomes will need to include both knowledge and performance measures. Three key performance outcomes for patient safety coursework, measured at the course level, are the ability to perform root cause analyses and healthcare failure mode effects analyses, and the ability to generate effective safety communications using structured formats such as the Situation-Background-Assessment-Recommendation (SBAR) situational briefing model. Each of these skills is widely used in patient safety work and competence in their use is essential for a pharmacist's ability to contribute as a member of a patient safety team.

  12. Evaluating Service Quality from Patients' Perceptions: Application of Importance-performance Analysis Method.

    Science.gov (United States)

    Mohebifar, Rafat; Hasani, Hana; Barikani, Ameneh; Rafiei, Sima

    2016-08-01

    Providing high service quality is one of the main functions of health systems. Measuring service quality is the basic prerequisite for improving quality. The aim of this study was to evaluate the quality of service in teaching hospitals using importance-performance analysis matrix. A descriptive-analytic study was conducted through a cross-sectional method in six academic hospitals of Qazvin, Iran, in 2012. A total of 360 patients contributed to the study. The sampling technique was stratified random sampling. Required data were collected based on a standard questionnaire (SERVQUAL). Data analysis was done through SPSS version 18 statistical software and importance-performance analysis matrix. The results showed a significant gap between importance and performance in all five dimensions of service quality (p quality gap and "responsiveness" had the lowest gap (1.97). Also, according to findings, reliability and assurance were in Quadrant (I), empathy was in Quadrant (II), and tangibles and responsiveness were in Quadrant (IV) of the importance-performance matrix. The negative gap in all dimensions of quality shows that quality improvement is necessary in all dimensions. Using quality and diagnosis measurement instruments such as importance-performance analysis will help hospital managers with planning of service quality improvement and achieving long-term goals.

  13. Correlation among personal, social performance and cognitive impairment in male schizophrenic patient

    Science.gov (United States)

    Damanik, R.; Effendy, E.; Camellia, V.

    2018-03-01

    Schizophrenia is a dramatic mental illness with tragic manifestation. The consequences of the illness are for the individual, affected his or her family and society. Schizophrenia is one of the twenty illness that causes Years Lost due to Disability. Treating only the symptom is insufficient. The aim of treatment must include the quality of life of aschizophrenic person. This study aims to examine the relationship between cognitive impairment and performance of the person with schizophrenia. Cognitive test is scaled with Indonesian version of Montreal Cognitive Assessment (MoCA-Ina), while personal and social performance isscaled with Personal and Social Performance scale. There are many studies that search the relationship between cognitive impairment and social functioning of schizophrenic patients, but this is the first study that uses PSP and MoCA-Ina. Both PSP and MoCA-Ina are easy to use but still have high sensitivity and specificity, and perhaps can build people’s interest to use it in clinical practice. Twenty-five male schizophrenic patients were assessed in Prof. M. Ildrem Mental Hospital of North Sumatera Province of Indonesia. Positive correlations between MoCA-Ina and PSP score were identified. Clinicians should pay attention to cognitive and might give some early intervention to it.

  14. Comparison of patient doses in interventional radiology procedures performed in two large hospitals in Greece

    International Nuclear Information System (INIS)

    Papageorgiou, E.; Tsapaki, V.; Tsalafoutas, I. A.; Maurikou, E.; Kottou, S.; Orfanos, A.; Karidas, G.; Fidanis, T.; Zafiriadou, E.; Neofotistou, V.

    2007-01-01

    Purpose of the study was to determine patient doses in the most common interventional radiology (IR) procedures performed in two large Greek hospitals. A total of 164 patients who underwent 4 types of IR procedures were studied. Fluoroscopy time, total exposure time, number of frames, number of runs, radiation field size, and cumulative dose-area product (DAP) were recorded. The median DAP values for carotid arteriography and lower limb arteriography were 66 and 123 Gy cm 2 for hospital 'A' and 21 and 49 Gy cm 2 for hospital 'B'. For the cerebral arteriographies performed in hospital 'A', the median DAP was 116 Gy cm 2 while for the hepatic embolizations performed in hospital 'B', it was 104 Gy cm 2 . The DAP values observed in hospital 'A' for carotid arteriography and lower limb arteriography were almost three times than those of hospital 'B'. From the data analysis, it is evident that dose optimization in hospital 'A' should be pursued through revision of the techniques used. (authors)

  15. Evaluation of Muscle Performance in Patients with Vitamin D De ciency: Preliminary Study

    Directory of Open Access Journals (Sweden)

    Gökhan Tuna Öztürk

    2013-04-01

    Full Text Available Aim: Vitamin D de ciency is very common in general population and has potentially harmful effect on musculoskeletal system. We aimed to show the effect of vitamin D de ciency on the muscle performance by using isokinetic test. Meterial and Methods: This study includes 12 women with vitamin D de ciency for patient group and 12 healthy women for control group. We compared knee muscles performance of these two groups by using isokinetic test. Results: The mean age was 40.71 (26-57 years in patients and 41.43 (28-58 years in healthy group. There was no statistical difference between two groups at knee  exion and extension pick-torque values in 60°/s velocity and fatigue index in 180°/s velocity (respectively, p1=0.86, p2=0.12, p3=0.42. Conclusion: Vitamin D de ciency has no effect on muscle performance. Further invastigations that evaluating larger populations are needed. (Turkish Journal of Osteoporosis 2013;19: 17-9

  16. Development of key performance indicators to evaluate centralized intake for patients with osteoarthritis and rheumatoid arthritis.

    Science.gov (United States)

    Barber, Claire E; Patel, Jatin N; Woodhouse, Linda; Smith, Christopher; Weiss, Stephen; Homik, Joanne; LeClercq, Sharon; Mosher, Dianne; Christiansen, Tanya; Howden, Jane Squire; Wasylak, Tracy; Greenwood-Lee, James; Emrick, Andrea; Suter, Esther; Kathol, Barb; Khodyakov, Dmitry; Grant, Sean; Campbell-Scherer, Denise; Phillips, Leah; Hendricks, Jennifer; Marshall, Deborah A

    2015-11-14

    Centralized intake is integral to healthcare systems to support timely access to appropriate health services. The aim of this study was to develop key performance indicators (KPIs) to evaluate centralized intake systems for patients with osteoarthritis (OA) and rheumatoid arthritis (RA). Phase 1 involved stakeholder meetings including healthcare providers, managers, researchers and patients to obtain input on candidate KPIs, aligned along six quality dimensions: appropriateness, accessibility, acceptability, efficiency, effectiveness, and safety. Phase 2 involved literature reviews to ensure KPIs were based on best practices and harmonized with existing measures. Phase 3 involved a three-round, online modified Delphi panel to finalize the KPIs. The panel consisted of two rounds of rating and a round of online and in-person discussions. KPIs rated as valid and important (≥7 on a 9-point Likert scale) were included in the final set. Twenty-five KPIs identified and substantiated during Phases 1 and 2 were submitted to 27 panellists including healthcare providers, managers, researchers, and patients in Phase 3. After the in-person meeting, three KPIs were removed and six were suggested. The final set includes 9 OA KPIs, 10 RA KPIs and 9 relating to centralized intake processes for both conditions. All 28 KPIs were rated as valid and important. Arthritis stakeholders have proposed 28 KPIs that should be used in quality improvement efforts when evaluating centralized intake for OA and RA. The KPIs measure five of the six dimensions of quality and are relevant to patients, practitioners and health systems.

  17. Engaging Employees: The Importance of High-Performance Work Systems for Patient Safety.

    Science.gov (United States)

    Etchegaray, Jason M; Thomas, Eric J

    2015-12-01

    To develop and test survey items that measure high-performance work systems (HPWSs), report psychometric characteristics of the survey, and examine associations between HPWSs and teamwork culture, safety culture, and overall patient safety grade. We reviewed literature to determine dimensions of HPWSs and then asked executives to tell us which dimensions they viewed as most important for safety and quality. We then created a HPWSs survey to measure the most important HPWSs dimensions. We administered an anonymous, electronic survey to employees with direct patient care working at a large hospital system in the Southern United States and looked for linkages between HPWSs, culture, and outcomes. Similarities existed for the HPWS practices viewed as most important by previous researchers and health-care executives. The HPWSs survey was found to be reliable, distinct from safety culture and teamwork culture based on a confirmatory factor analysis, and was the strongest predictor of the extent to which employees felt comfortable speaking up about patient safety problems as well as patient safety grade. We used information from a literature review and executive input to create a reliable and valid HPWSs survey. Future research needs to examine whether HPWSs is associated with additional safety and quality outcomes.

  18. Cognitive performance of detoxified alcoholic Korsakoff syndrome patients remains stable over two years.

    Science.gov (United States)

    Fujiwara, Esther; Brand, Matthias; Borsutzky, Sabine; Steingass, Hans-P; Markowitsch, Hans J

    2008-07-01

    Excessive alcohol consumption is assumed to promote cognitive decline, eventually increasing the risk of dementia. However, little is known about the time course of cognitive functions in patients with chronic alcoholic Korsakoff syndrome (KS). Therefore, we assessed neuropsychological performance in 20 detoxified chronic KS inpatients at time 1 (T1) with a follow-up after two years (T2). The neuropsychological tests assessed verbal and visual short- and long-term memory, working memory, basic executive functions, language, general knowledge, and visual-spatial abilities. Surveys with caregivers and medical records provided information about current and previous disease-related parameters, drinking history, additional pathologies, as well as psychosocial and cognitive therapy within the two-year period. At both sessions, the majority of the KS patients' results were inferior to those of normal subjects. Comparing T1 and T2 revealed no significant decline in any of the investigated functions. Instead, general knowledge, visual long-term memory, and verbal fluency improved slightly after two years, though they still remained within pathological range. Comparing most improved and most deteriorated patients, better outcome occurred more frequently in men than women and was associated with higher premorbid education and fewer detoxifications in the past. In this sample of detoxified KS patients there was no indication of accelerated cognitive decline or onset of dementia-like symptoms over two years.

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

    Science.gov (United States)

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

    2015-07-01

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

  20. Improving working memory performance in brain-injured patients using hypnotic suggestion

    DEFF Research Database (Denmark)

    Lindeløv, Jonas K.; Overgaard, Rikke; Overgaard, Morten

    2017-01-01

    be effectively restored by suggesting to hypnotized patients that they have regained their pre-injury level of working memory functioning. Following four 1-h sessions, 27 patients had a medium-sized improvement relative to 22 active controls (Bayes factors of 342 and 37.5 on the two aggregate outcome measures...... group was crossed over to the working memory suggestion and showed superior improvement. By the end of the study, both groups reached a performance level at or above the healthy population mean with standardized mean differences between 1.55 and 2.03 relative to the passive control group. We conclude...... that, if framed correctly, hypnotic suggestion can effectively improve working memory following acquired brain injury. The speed and consistency with which this improvement occurred, indicate that there may be a residual capacity for normal information processing in the injured brain....

  1. Effect of gender on the hearing performance of adult cochlear implant patients.

    Science.gov (United States)

    Lenarz, Minoo; Sönmez, Hasibe; Joseph, Gert; Büchner, Andreas; Lenarz, Thomas

    2012-05-01

    To evaluate the role of gender on the hearing performance of postlingually deafened adult patients with cochlear implants. Individual retrospective cohort study. There were 638 postlingually deafened adults (280 men and 358 women) selected for a retrospective evaluation of their hearing performance with cochlear implants. Both genders underwent the same surgical and rehabilitative procedures and benefited from the latest technological advances available. There was no significant difference in the age, duration of deafness, and preoperative hearing performance between the genders. The test battery was composed of the Freiburger Monosyllabic Test, Speech Tracking, and the Hochmair-Schulz-Moser (HSM) sentence test in quiet and in 10-dB noise. The results of 5 years of follow-up are presented here. Genders showed a similar performance in Freiburger Monosyllabic Test and Speech Tracking Test. However, in the HSM test in noise, men performed slightly better than women in all of the follow-up sessions, which was statistically significant at 2 and 4 years after implantation. Although normal-hearing women use more predictive cognitive strategies in speech comprehension and are supposed to have a more efficient declarative memory system, this may not necessarily lead to a better adaptation to the altered auditory information delivered by a cochlear implant. Our study showed that in more complex listening situations such as speech tests in noise, men tend to perform slightly better than women. Gender may have an influence on the hearing performance of postlingually deafened adults with cochlear implants. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  2. Effect of novel patient interaction on students’ performance of pregnancy options counseling

    Directory of Open Access Journals (Sweden)

    Angela Shaddeau

    2015-12-01

    Full Text Available Background: Although options counseling is a fundamental skill for medical providers, previous research has identified gaps in medical school reproductive health education. Purpose: To determine if a 1-h novel patient interaction (NPI improves student performance when caring for a standardized patient with an unintended pregnancy. Methods: From September 2012 to June 2013 we randomized third-year medical students at the University of Colorado School of Medicine to the standard curriculum plus an NPI, or the standard curriculum only. The NPI consisted of a 1-h small-group session with a patient who discussed her experiences with options counseling and her decision to terminate her pregnancy. Students completed an Objective Structured Clinical Examination (OSCE at the rotation's end, which included options counseling. The primary outcome was the proportion of participants achieving ‘excellence’ on the OSCE checklist. ‘Excellence’ was defined as a score ≥90%. Examinations were flagged as ‘unsatisfactory encounters’ if core competencies were not addressed. OSCE standardized patients and evaluators were blinded to group assignment. Results: In total, 135 students were eligible and randomized: 75 to NPI; 60 to control. During the OSCE, few students achieved ‘excellence’ (24% NPI vs. 28% control, p=0.57.There were no differences between scores for components of options counseling. More students in the control group ‘appeared somewhat uncomfortable’ delivering the pregnancy test results (5% NPI vs. 18% control, p=0.006. More than half (54% of the intervention group and 67% of controls had ‘unsatisfactory encounters’ (p=0.16, almost exclusively due to omission of adoption. Most students addressed abortion (96% NPI vs. 92% control, p=0.29. Conclusions: A 1-h NPI does not improve medical students’ performance of pregnancy options counseling and the option of adoption is routinely omitted. Adoption is clearly an area that needs

  3. Performing concurrent operations in academic vascular neurosurgery does not affect patient outcomes.

    Science.gov (United States)

    Zygourakis, Corinna C; Lee, Janelle; Barba, Julio; Lobo, Errol; Lawton, Michael T

    2017-11-01

    OBJECTIVE Concurrent surgeries, also known as "running two rooms" or simultaneous/overlapping operations, have recently come under intense scrutiny. The goal of this study was to evaluate the operative time and outcomes of concurrent versus nonconcurrent vascular neurosurgical procedures. METHODS The authors retrospectively reviewed 1219 procedures performed by 1 vascular neurosurgeon from 2012 to 2015 at the University of California, San Francisco. Data were collected on patient age, sex, severity of illness, risk of mortality, American Society of Anesthesiologists (ASA) status, procedure type, admission type, insurance, transfer source, procedure time, presence of resident or fellow in operating room (OR), number of co-surgeons, estimated blood loss (EBL), concurrent vs nonconcurrent case, severe sepsis, acute respiratory failure, postoperative stroke causing neurological deficit, unplanned return to OR, 30-day mortality, and 30-day unplanned readmission. For aneurysm clipping cases, data were also obtained on intraoperative aneurysm rupture and postoperative residual aneurysm. Chi-square and t-tests were performed to compare concurrent versus nonconcurrent cases, and then mixed-effects models were created to adjust for different procedure types, patient demographics, and clinical indicators between the 2 groups. RESULTS There was a significant difference in procedure type for concurrent (n = 828) versus nonconcurrent (n = 391) cases. Concurrent cases were more likely to be routine/elective admissions (53% vs 35%, p returns to the OR (3.3% vs 6.9%; all p return to the OR and 30-day mortality were significantly lower in concurrent cases (odds ratio 0.55, 95% confidence interval 0.31-0.98, p = 0.0431, and odds ratio 0.81, p fashion. After adjusting for patient demographics, procedure type, and clinical indicators, concurrent cases had longer procedure times, but equivalent patient outcomes, as compared with nonconcurrent vascular neurosurgical procedures.

  4. Diagnostic performance of CT angiography in patients visiting emergency department with overt gastrointestinal bleeding

    International Nuclear Information System (INIS)

    Kim, Ji Hang; Kim, Young Hoon; Lee, Kyoung Ho; Lee, Yoon Jin; Park, Ji Hoon

    2015-01-01

    To investigate the diagnostic performance of computed tomography angiography (CTA) in identifying the cause of bleeding and to determine the clinical features associated with a positive test result of CTA in patients visiting emergency department with overt gastrointestinal (GI) bleeding. We included 111 consecutive patients (61 men and 50 women; mean age: 63.4 years; range: 28-89 years) who visited emergency department with overt GI bleeding. They underwent CTA as a first-line diagnostic modality from July through December 2010. Two radiologists retrospectively reviewed the CTA images and determined the presence of any definite or potential bleeding focus by consensus. An independent assessor determined the cause of bleeding based on other diagnostic studies and/or clinical follow-up. The diagnostic performance of CTA and clinical characteristics associated with positive CTA results were analyzed. To identify a definite or potential bleeding focus, the diagnostic yield of CTA was 61.3% (68 of 111). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value were 84.8% (67 of 79), 96.9% (31 of 32), 98.5% (67 of 68), and 72.1% (31 of 43), respectively. Positive CTA results were associated with the presence of massive bleeding (p = 0.001, odds ratio: 11.506). Computed tomography angiography as a first-line diagnostic modality in patients presenting with overt GI bleeding showed a fairly high accuracy. It could identify definite or potential bleeding focus with a moderate diagnostic yield and a high PPV. CTA is particularly useful in patients with massive bleeding.

  5. Assessing the performance and satisfaction of medical residents utilizing standardized patient versus mannequin-simulated training

    Directory of Open Access Journals (Sweden)

    Alsaad AA

    2017-07-01

    Full Text Available Ali A Alsaad,1 Swetha Davuluri,2 Vandana Y Bhide,3 Amy M Lannen,4 Michael J Maniaci3 1Department of Internal Medicine, Mayo Clinic, 2University of Miami, Coral Gables, 3Division of Hospital Internal Medicine, 4J. Wayne and Delores Barr Weaver Simulation Center, Mayo Clinic, Jacksonville, FL, USA Background: Conducting simulations of rapidly decompensating patients are a key part of internal medicine (IM residency training. Traditionally, mannequins have been the simulation tool used in these scenarios. Objective: To compare IM residents’ performance and assess realism in specific-simulated decompensating patient scenarios using standardized patients (SPs as compared to mannequin. Methods: Nineteen IM residents were randomized to undergo simulations using either a mannequin or an SP. Each resident in the two groups underwent four different simulation scenarios (calcium channel blocker overdose, severe sepsis, severe asthma exacerbation, and acute bacterial meningitis. Residents completed pretest and post-test evaluations as well as a questionnaire to assess the reality perception (realism score. Results: Nine residents completed mannequin-based scenarios, whereas 10 completed SP-based scenarios. Improvement in the post-test scores was seen in both groups. However, there were significantly higher post-test scores achieved with SP simulations in three out of the four scenarios (P=0.01. When compared with the mannequin group, the SP simulation group showed a significantly higher average realism score (P=0.002. Conclusions: Applying SP-based specific-simulation scenarios in IM residency training may result in better performance and a higher sense of a realistic experience by medical residents. Keywords: simulation, standardized patient, satisfaction, mannequin, assessment, resident education

  6. Performance enhancement using a balanced scorecard in a Patient-centered Medical Home.

    Science.gov (United States)

    Fields, Scott A; Cohen, Deborah

    2011-01-01

    Oregon Health & Science University Family Medicine implemented a balanced scorecard within our clinics that embraces the inherent tensions between care quality, financial productivity, and operational efficiency. This data-driven performance improvement process involved: (1) consensus-building around specific indicators to be measured, (2) developing and refining the balanced scorecard, and (3) using the balanced scorecard in the quality improvement process. Developing and implementing the balanced scorecard stimulated an important culture shift among clinics; practice members now actively use data to recognize successes, understand emerging problems, and make changes in response to these problems. Our experience shows how Patient-centered Medical Homes can be enhanced through use of information technology and evidence-based tools that support improved decision making and performance and help practices develop into learning organizations.

  7. The apoptotic machinery as a biological complex system: analysis of its omics and evolution, identification of candidate genes for fourteen major types of cancer, and experimental validation in CML and neuroblastoma

    Directory of Open Access Journals (Sweden)

    Li Destri Giovanni

    2009-04-01

    Full Text Available Abstract Background Apoptosis is a critical biological phenomenon, executed under the guidance of the Apoptotic Machinery (AM, which allows the physiologic elimination of terminally differentiated, senescent or diseased cells. Because of its relevance to BioMedicine, we have sought to obtain a detailed characterization of AM Omics in Homo sapiens, namely its Genomics and Evolution, Transcriptomics, Proteomics, Interactomics, Oncogenomics, and Pharmacogenomics. Methods This project exploited the methodology commonly used in Computational Biology (i.e., mining of many omics databases of the web as well as the High Throughput biomolecular analytical techniques. Results In Homo sapiens AM is comprised of 342 protein-encoding genes (possessing either anti- or pro-apoptotic activity, or a regulatory function and 110 MIR-encoding genes targeting them: some have a critical role within the system (core AM nodes, others perform tissue-, pathway-, or disease-specific functions (peripheral AM nodes. By overlapping the cancer type-specific AM mutation map in the fourteen most frequent cancers in western societies (breast, colon, kidney, leukaemia, liver, lung, neuroblastoma, ovary, pancreas, prostate, skin, stomach, thyroid, and uterus to their transcriptome, proteome and interactome in the same tumour type, we have identified the most prominent AM molecular alterations within each class. The comparison of the fourteen mutated AM networks (both protein- as MIR-based has allowed us to pinpoint the hubs with a general and critical role in tumour development and, conversely, in cell physiology: in particular, we found that some of these had already been used as targets for pharmacological anticancer therapy. For a better understanding of the relationship between AM molecular alterations and pharmacological induction of apoptosis in cancer, we examined the expression of AM genes in K562 and SH-SY5Y after anticancer treatment. Conclusion We believe that our data

  8. Safety of Performing Percutaneous Dilational Tracheostomy in Patients with Preexisting Barotrauma

    Directory of Open Access Journals (Sweden)

    Chau-Chyun Sheu

    2006-11-01

    Full Text Available Since its introduction in 1985 by Ciaglia et al, percutaneous dilational tracheostomy (PDT has gradually become the procedure of choice in establishing a long-term airway in many intensive care units (ICU. However, the safety of performing PDT in patients with barotrauma is still unknown and has never been reported. We present the case of a 35-year-old man with AIDS, who was admitted to our medical ICU for pneumonia and acute respiratory distress syndrome. He developed subcutaneous emphysema and pneumomediastinum as complications of mechanical ventilation. After stabilization of the barotrauma, he underwent PDT with the standard Ciaglia Blue Rhino technique. However, rapid and extensive progression of preexisting barotrauma occurred shortly after PDT. This severe complication was nearly fatal. The prolonged procedure during which the susceptible lung was exposed to longer duration of high airway pressure was thought to be the mechanism of rapid deterioration of the preexisting barotrauma. With aggressive supportive care, the patient survived. To prevent further deterioration of preexisting barotrauma during and after PDT in future cases, we propose some principles that should be strictly followed. Under administration of these principles, we safely performed PDT in another case with preexisting barotrauma 1 month later.

  9. Performance of an online translation tool when applied to patient educational material.

    Science.gov (United States)

    Khanna, Raman R; Karliner, Leah S; Eck, Matthias; Vittinghoff, Eric; Koenig, Christopher J; Fang, Margaret C

    2011-11-01

    Language barriers may prevent clinicians from tailoring patient educational material to the needs of individuals with limited English proficiency. Online translation tools could fill this gap, but their accuracy is unknown. We evaluated the accuracy of an online translation tool for patient educational material. We selected 45 sentences from a pamphlet available in both English and Spanish, and translated it into Spanish using GoogleTranslate™ (GT). Three bilingual Spanish speakers then performed a blinded evaluation on these 45 sentences, comparing GT-translated sentences to those translated professionally, along four domains: fluency (grammatical correctness), adequacy (information preservation), meaning (connotation maintenance), and severity (perceived dangerousness of an error if present). In addition, evaluators indicated whether they had a preference for either the GT-translated or professionally translated sentences. The GT-translated sentences had significantly lower fluency scores compared to the professional translation (3.4 vs. 4.7, P educational material, GT performed comparably to professional human translation in terms of preserving information and meaning, though it was slightly worse in preserving grammar. In situations where professional human translations are unavailable or impractical, online translation may someday fill an important niche. Copyright © 2011 Society of Hospital Medicine.

  10. Cardiorespiratory performance of coronary artery disease patients on land versus underwater treadmill tests: a comparative study.

    Science.gov (United States)

    Garcia, Mauricio Koprowski; Rizzo, Limanara; Yazbek-Júnior, Paulo; Yutiyama, Daniela; Silva, Fabiola Jomar da; Matheus, Denise; Mastrocolla, Luiz Eduardo; Massad, Eduardo

    2017-11-01

    To compare responses to a cardiopulmonary exercise test on land versus on an underwater treadmill, to assess the cardiorespiratory performance of coronary artery disease patients while immersed in warm water and to compare with the performance of healthy individuals. The sample population consisted of 40 subjects, which included 20 coronary artery disease patients aged 63.7±8.89 years old, functional class I and II, according to the New York Hearth Association, and 20 healthy subjects aged 64.7±7.09 years old. The statistical significances were calculated through an ANOVA test with a (1 - β) power of 0.861. ClinicalTrials.gov: NCT00989248 (22). Significant differences were uncovered in coronary artery disease group regarding the variables heart beats (HB), (p>0.01), oxygen consumption (VO2), (p>0.01) and carbon dioxide production (VCO2) (p<0.01). Also, for the same group, in relation to the environment, water versus on land for HB, VO2, VCO2 and oxygen for each heart beat (VO2/HB) all of than (p<0.01). The stages for data collected featured the subject's performance throughout the experiment, and within the given context, variables rating of perceived exertion (RPE), HB, VO2, VCO2 and VO2/HB (p<0.01) showed significant interactions between test stages and environment. Additionally, there was a significant interaction between the etiology and the test stages for the variables HB, VO2 and VCO2 (p<0.01). Electrocardiographic changes compatible with myocardial ischemia or arrhythmia were not observed. The subjects exhibited lower scores on Borg's perceived exertion scale in the water than at every one of the test stages on land (p<0.01). This study show that a cardiopulmonary exercise test can be safely conducted in subjects in immersion and that the procedures, resources and equipment used yielded replicable and reliable data. Significant differences observed in water versus on land allow us to conclude that coronary artery disease patients are able to do physical

  11. Cardiorespiratory performance of coronary artery disease patients on land versus underwater treadmill tests: a comparative study

    Directory of Open Access Journals (Sweden)

    Mauricio Koprowski Garcia

    Full Text Available OBJECTIVE: To compare responses to a cardiopulmonary exercise test on land versus on an underwater treadmill, to assess the cardiorespiratory performance of coronary artery disease patients while immersed in warm water and to compare with the performance of healthy individuals. METHODS: The sample population consisted of 40 subjects, which included 20 coronary artery disease patients aged 63.7±8.89 years old, functional class I and II, according to the New York Hearth Association, and 20 healthy subjects aged 64.7±7.09 years old. The statistical significances were calculated through an ANOVA test with a (1 - β power of 0.861. ClinicalTrials.gov: NCT00989248 (22. RESULTS: Significant differences were uncovered in coronary artery disease group regarding the variables heart beats (HB, (p>0.01, oxygen consumption (VO2, (p>0.01 and carbon dioxide production (VCO2 (p<0.01. Also, for the same group, in relation to the environment, water versus on land for HB, VO2, VCO2 and oxygen for each heart beat (VO2/HB all of than (p<0.01. The stages for data collected featured the subject’s performance throughout the experiment, and within the given context, variables rating of perceived exertion (RPE, HB, VO2, VCO2 and VO2/HB (p<0.01 showed significant interactions between test stages and environment. Additionally, there was a significant interaction between the etiology and the test stages for the variables HB, VO2 and VCO2 (p<0.01. Electrocardiographic changes compatible with myocardial ischemia or arrhythmia were not observed. The subjects exhibited lower scores on Borg’s perceived exertion scale in the water than at every one of the test stages on land (p<0.01. CONCLUSION: This study show that a cardiopulmonary exercise test can be safely conducted in subjects in immersion and that the procedures, resources and equipment used yielded replicable and reliable data. Significant differences observed in water versus on land allow us to conclude that

  12. Improvement in performance status after erythropoietin treatment in lung cancer patients undergoing concurrent chemoradiotherapy

    International Nuclear Information System (INIS)

    Casas, Francesc; Vinolas, Nuria; Ferrer, Ferran; Farrus, Blanca; Gimferrer, Josep Maria; Agusti, Carles; Belda, Josep; Luburich, Patricio

    2003-01-01

    Purpose: A prospective Phase II trial was carried out to evaluate the effectiveness of erythropoietin in improving or maintaining performance status as determined by the Karnofsky performance status (KPS) score and hemoglobin (Hb) levels in lung cancer patients treated with concurrent chemoradiation (CH-RT). Methods and Materials: A total of 51 patients with lung cancer (11 with small-cell, limited stage and 40 with non-small-cell disease, 17 with Stage IIIA and 23 with Stage IIIB), who underwent three different concurrent CH-RT protocols were enrolled. Baseline Hb and KPS values were recorded, as were the nadir Hb and KPS values before concurrent CH-RT. The final Hb and KPS values were recorded the last week of concurrent CH-RT. An Hb level of ≤11 g/dL before concurrent CH-RT was required before receiving erythropoietin. Prognostic factors for KPS improvement and survival were assessed by univariate and multivariate studies. Results: Of the 51 patients, 47 (92.3%) were men (mean age 63.6 years, range 40-75). The median baseline KPS score was 80, and the mean baseline Hb was 12.2 ± 1.76 g/dL (range 9-16.9). The mean nadir and final Hb value was 9.98±0.67 g/dL (range 8.6-11) and 11.33±1.59 g/dL (range 6.9-14.4), respectively. A significant increase was seen in the Hb and KPS score (p<0.05) in the final measurements. Differences were found between the final and nadir Hb in the predictive value for differences in performance status (p=0.001). On univariate study, pathologic findings (p=0.0234), weight loss (p=0.0049), baseline Hb (p=0.0057), and final Hb improvement (p=0.0237) were prognostic factors for survival. Nadir Hb (p=0.027), final Hb improvement (p=0.0069), pathologic findings (p = 0.0006), and weight loss (p=0.0001) had significant prognostic value for survival in multivariate analysis. Conclusion: In this study, erythropoietin appears to have a significant, beneficial impact on the KPS and Hb of patients undergoing concurrent CH-RT

  13. Semantic strategy training increases memory performance and brain activity in patients with prefrontal cortex lesions.

    Science.gov (United States)

    Miotto, Eliane C; Savage, Cary R; Evans, Jonathan J; Wilson, Barbara A; Martin, Maria G M; Balardin, Joana B; Barros, Fabio G; Garrido, Griselda; Teixeira, Manoel J; Amaro Junior, Edson

    2013-03-01

    Memory deficit is a frequent cognitive disorder following acquired prefrontal cortex lesions. In the present study, we investigated the brain correlates of a short semantic strategy training and memory performance of patients with distinct prefrontal cortex lesions using fMRI and cognitive tests. Twenty-one adult patients with post-acute prefrontal cortex (PFC) lesions, twelve with left dorsolateral PFC (LPFC) and nine with bilateral orbitofrontal cortex (BOFC) were assessed before and after a short cognitive semantic training using a verbal memory encoding paradigm during scanning and neuropsychological tests outside the scanner. After the semantic strategy training both groups of patients showed significant behavioral improvement in verbal memory recall and use of semantic strategies. In the LPFC group, greater activity in left inferior and medial frontal gyrus, precentral gyrus and insula was found after training. For the BOFC group, a greater activation was found in the left parietal cortex, right cingulated and precuneus after training. The activation of these specific areas in the memory and executive networks following cognitive training was associated to compensatory brain mechanisms and application of the semantic strategy. Copyright © 2012 Elsevier B.V. All rights reserved.

  14. Public reporting of antibiotic timing in patients with pneumonia: lessons from a flawed performance measure.

    Science.gov (United States)

    Wachter, Robert M; Flanders, Scott A; Fee, Christopher; Pronovost, Peter J

    2008-07-01

    The administration of antibiotics within 4 hours to patients with community-acquired pneumonia has been criticized as a quality standard because it pressures clinicians to rapidly administer antibiotics despite diagnostic uncertainty at the time of patients' initial presentations. The measure was recently revised (to 6 hours) in response to this criticism. On the basis of the experience with the 4-hour rule, the authors make 5 recommendations for the development of future publicly reported quality measures. First, results from samples with known diagnoses should be extrapolated cautiously, if at all, to patients without a diagnosis. Second, for some measures, "bands" of performance may make more sense than "all-or-nothing" expectations. Third, representative end users of quality measures should participate in measure development. Fourth, quality measurement and reporting programs should build in mechanisms to reassess measures over time. Finally, biases, both financial and intellectual, that may influence quality measure development should be minimized. These steps will increase the probability that future quality measures will improve care without creating negative unintended consequences.

  15. Skeletal muscle mass and exercise performance in stable ambulatory patients with heart failure.

    Science.gov (United States)

    Lang, C C; Chomsky, D B; Rayos, G; Yeoh, T K; Wilson, J R

    1997-01-01

    The purpose of this study was to determine whether skeletal muscle atrophy limits the maximal exercise capacity of stable ambulatory patients with heart failure. Body composition and maximal exercise capacity were measured in 100 stable ambulatory patients with heart failure. Body composition was assessed by using dual-energy X-ray absorption. Peak exercise oxygen consumption (VO2peak) and the anaerobic threshold were measured by using a Naughton treadmill protocol and a Medical Graphics CardioO2 System. VO2peak averaged 13.4 +/- 3.3 ml.min-1.kg-1 or 43 +/- 12% of normal. Lean body mass averaged 52.9 +/- 10.5 kg and leg lean mass 16.5 +/- 3.6 kg. Leg lean mass correlated linearly with VO2peak (r = 0.68, P < 0.01), suggesting that exercise performance is influences by skeletal muscle mass. However, lean body mass was comparable to levels noted in 1,584 normal control subjects, suggesting no decrease in muscle mass. Leg muscle mass was comparable to levels noted in 34 normal control subjects, further supporting this conclusion. These findings suggest that exercise intolerance in stable ambulatory patients with heart failure is not due to skeletal muscle atrophy.

  16. General quality of life of patients with acne vulgaris before and after performing selected cosmetological treatments

    Science.gov (United States)

    Chilicka, Karolina; Maj, Joanna; Panaszek, Bernard

    2017-01-01

    Background Achieving a satisfying quality of life for a patient by applying individually matched therapy is, simultaneously, a great challenge and a priority for contemporary medicine. Patients with visible dermatological ailments are particularly susceptible to reduction in the general quality of life. Among the dermatological diseases, acne causes considerable reduction in the quality of life and changes in self-perception that lead to the worsening of a patient’s mental condition, including depression and suicidal thoughts. As a result, difficulties in contact with loved ones, as well as social and professional problems are observed, which show that acne is not a somatic problem alone. To a large extent, it becomes a part of psychodermatology, becoming an important topic of public health in social medicine practice. Pharmacological treatment of acne is a challenge for a dermatologist and often requires the necessity of cooperating with a cosmetologist. Cosmetological treatments are aimed at improving the condition of the skin and reduction or subsiding of acne skin changes. Aim The aim of this study was to assess the influence of selected cosmetological treatments on the general quality of life of patients with acne. Materials and methods The study group consisted of 101 women aged 19–29 years (x¯=22.5 years, SD =2.3 years). All subjects were diagnosed with acne vulgaris of the face. In the study group, the acne changes occurred over the course of 3–15 years (x¯=8.1 years, SD =2.7 years). Selected cosmetological treatments (intensive pulsing light, alpha-hydroxy acids, cavitation peeling, needle-free mesotherapy, diamond microdermabrasion and sonophoresis) were performed in series in the number depending on the particular patient’s chosen treatment, after excluding contraindications. General quality of life of the patients was estimated using the Skindex-29 and Dermatology Life Quality Index (DLQI) questionnaires, before and after the cosmetological

  17. Polygenic signal for symptom dimensions and cognitive performance in patients with chronic schizophrenia.

    Science.gov (United States)

    Xavier, Rose Mary; Dungan, Jennifer R; Keefe, Richard S E; Vorderstrasse, Allison

    2018-06-01

    Genetic etiology of psychopathology symptoms and cognitive performance in schizophrenia is supported by candidate gene and polygenic risk score (PRS) association studies. Such associations are reported to be dependent on several factors - sample characteristics, illness phase, illness severity etc. We aimed to examine if schizophrenia PRS predicted psychopathology symptoms and cognitive performance in patients with chronic schizophrenia. We also examined if schizophrenia associated autosomal loci were associated with specific symptoms or cognitive domains. Case-only analysis using data from the Clinical Antipsychotics Trials of Intervention Effectiveness-Schizophrenia trials ( n  = 730). PRS was constructed using Psychiatric Genomics Consortium (PGC) leave one out genome wide association analysis as the discovery data set. For candidate region analysis, we selected 105-schizophrenia associated autosomal loci from the PGC study. We found a significant effect of PRS on positive symptoms at p -threshold ( P T ) of 0.5 ( R 2  = 0.007, p  = 0.029, empirical p  = 0.029) and negative symptoms at P T of 1e-07 ( R 2  = 0.005, p  = 0.047, empirical p  = 0.048). For models that additionally controlled for neurocognition, best fit PRS predicted positive ( p- threshold 0.01, R 2   =  0.007, p =  0.013, empirical p  = 0.167) and negative symptoms ( p- threshold 0.1, R 2   =  0.012, p =  0.004, empirical p  = 0.329). No associations were seen for overall neurocognitive and social cognitive performance tests. Post-hoc analyses revealed that PRS predicted working memory and vigilance performance but did not survive correction. No candidate regions that survived multiple testing corrections were associated with either symptoms or cognitive performance. Our findings point to potentially distinct pathogenic mechanisms for schizophrenia symptoms.

  18. Performance Evaluation of Different d-Dimer Cutoffs in Bedridden Hospitalized Elderly Patients.

    Science.gov (United States)

    Kassim, Nevine A; Farid, Tamer M; Pessar, Shaimaa Abdelmalik; Shawkat, Salma A

    2017-11-01

    A rapid and accurate diagnosis of venous thromboembolism (VTE) in the elderly individuals represents a dilemma due to nonspecific clinical presentation, confusing laboratory results, and the hazards of radiological examination in this age-group. d-Dimer test is used mainly in combination with non-high clinical pretest probability (PTP) to exclude VTE. d-Dimer testing retains its sensitivity, however, its specificity decreases in the elderly individuals. Raising the cutoff level improves the specificity of the d-dimer test without compromising its sensitivity. The current study aimed to explore the reliability of higher d-dimer cutoff values for the diagnosis of asymptomatic VTE in a population of bedridden hospitalized elderly patients with non-high clinical PTP. This retrospective study included 252 bedridden hospitalized elderly patients (>65 years) who were admitted to the Ain shams University Specialized Hospital with non-high clinical probability and developed later reduced mobility; all underwent quantitation of d-dimer and Doppler examination. Considering the whole population (>65 years), the age-adjusted cutoff achieved the best performance in comparison with the conventional and receiver operating characteristic (ROC)-derived cutoffs. When stratified according to age, the age-adjusted cutoff showed the best performance in the age-group 65-70 and comparable performance with the ROC-derived cutoff in the age-group 71-80, however, its sensitivity compromised in those older than 80 years. In conclusion, it is recommended to use age-adjusted cutoff value of d-dimer together with the clinical probability score in elderly individuals (65-80 years).

  19. [Prevalence of performing and prescribing physical exercise in patients diagnosed with anxiety and depression].

    Science.gov (United States)

    Iglesias Martínez, Bibiana; Olaya Velázquez, Inés; Gómez Castro, María José

    2015-01-01

    To estimate the prevalence of physical exercise practice in patients diagnosed with anxiety and/or depression. Cross-sectional, observational study. Sabugo and la Magdalena primary care centers in Avilés. Patients aged 18 to 75 years diagnosed with anxiety and/or depression, consumers of psychoactive drugs in the three months previous to the realization of the study. We selected 376 patients by simple random sampling stratified by health center, making them a telephone survey. Age, sex, physical exercise realization, type and duration of exercise, diagnosis of anxiety and/or depression, exercise prescription, prescriber health personnel and use of psychotropic medication. 294 participants (78.19% of selected) with a mean age of 55.33 years (55.32±12.53 SD) and 78.2% were female. 60.9% were diagnosed with anxiety, 59.5% with depression and 20.4% both diagnoses. 62.9% used antidepressants, benzodiazepines 76.9% and 39.79% both treatments. 58.5% (95%CI: 52.70-64.31) performed exercise of which 44.77% did it 3-5 times/week. The mean duration was 1.24h each time (95%CI: 0.53-1.96). The physical exercise was prescribed to the 59.18% (95%CI: 53.39-64.97); 90.23% by the family physician, 63.22% primary care nurse, 17.24% psychiatrist and 5.17% psychologist. The adherence to the prescription was 59.77% (95%CI: 52.20-67.34). The percentage of anxious and/or depressed patients who practiced exercise is similar to the general population but should be higher. The exercise prescription by health personnel is insufficient. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  20. The Effect of Therapeutic Touch Performed During Cataract Surgery on Anxiety and Patient Satisfaction

    Directory of Open Access Journals (Sweden)

    Emel Yılmaz

    2016-03-01

    Full Text Available Objective: The aim of the study was to determine the ef­fect of therapeutic touch (TT on anxiety and patient satis­faction when performed during a cataract surgery. Methods: A randomized controlled trial sample consisted of 114 individuals, 57 in the intervention group and 57 controls, who were hospitalized for cataract surgery and who conformed to the study criteria. Prior to the study approval was obtained from the ethics committee and informed consent was given by the patients. Data was collected using a personal information form, a visual analogue scale (VAS to measure anxiety, the Spielberg State/Trait Anxiety Inventory (STAI and the Newcastle Satisfaction with Nursing Care Scale (NSNCS. During the surgery, patients in the intervention group received a 15-minute session of TT. Results: In the intervention group, patients’ mean VAS anxiety score after TT was 3.56±1.85, while that of the control group in the 15th minute of the operation was 8,88±1,50. It was found that anxiety levels were reduced in the intervention group after TT compared with the con­trol group, and that vital signs were affected positively. NSNCS scores of patients in the intervention group were higher than those in the control group. Conclusion: It was observed that TT applied during sur­gery reduced anxiety, affected vital signs positively and increased patent satisfaction. The application of TT dur­ing surgery is recommended. J Clin Exp Invest 2016; 7 (1: 52-62

  1. Comparative performance of Aspergillus galactomannan ELISA and PCR in sputum from patients with ABPA and CPA.

    Science.gov (United States)

    Fayemiwo, Samuel; Moore, Caroline B; Foden, Philip; Denning, David W; Richardson, Malcolm D

    2017-09-01

    Galactomannan (GM) and Aspergillus DNA detection are useful tools for the diagnosis of invasive pulmonary aspergillosis (IPA), primarily in blood and bronchoscopy samples. This study aimed to evaluate the utility of both markers for detection of Aspergillus in sputum from patients with allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA). ABPA or CPA demographic patient data were retrieved. This retrospective observational audit included 159 patients with at least one sputum pair. 223 sputum sample pairs were analysed, as well as six control samples for GM only. Real time PCR was performed following sputum DNA extraction using the MycAssay™ Aspergillus kit and cycle thresholds were subtracted from 38 to give positive values (transformed Ct, TCt). The mean age of the patients was 61.81years (SD: ±11.06; range 29-100). One hundred and twenty-six (79.2%) had CPA. Cultures were positive for fungi in 13.1% of the samples, and A. fumigatus was the commonest (11.9%) fungus isolated. Receiver operating characteristic (ROC curve) analysis of sputum GM comparing TCt of >0.0, and >2.0 to derive GMI cut-off values showed a cut-off of 6.5. About 50% of sputa with strongly positive PCR values had GM values>6.5. Two of six (33%) control samples had GM indices>6.5. It is not clear that GM determinations in sputum are useful for diagnosis of either CPA or ABPA, or following therapy. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  2. A clinical observational study on patient-reported outcomes, hip functional performance and return to sports activities in hip arthroscopy patients

    NARCIS (Netherlands)

    Tijssen, M.P.W.; Cingel, R.E. van; Visser, E de; Nijhuis-Van der Sanden, M.W.G.

    2016-01-01

    OBJECTIVES: To describe data of short- and midterm results of hip arthroscopy patients based on patient-reported hip function, hip functional performance and return to sports activities. DESIGN: Observational cohort study. SETTING: Sports medical center. PARTICIPANTS: 37 recreational athletes (21

  3. The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: A qualitative study of Kaiser Permanente

    NARCIS (Netherlands)

    E.T. Otte-Trojel (Eva Terese); T.G. Rundall (Thomas); A.A. de Bont (Antoinette); J.J. van de Klundert (Joris); M.E. Reed (Mary E.)

    2015-01-01

    textabstractBackground: Patient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain

  4. Impact of Right Ventricular Performance in Patients Undergoing Extracorporeal Membrane Oxygenation Following Cardiac Surgery.

    Science.gov (United States)

    Bartko, Philipp E; Wiedemann, Dominik; Schrutka, Lore; Binder, Christina; Santos-Gallego, Carlos G; Zuckermann, Andreas; Steinlechner, Barbara; Koinig, Herbert; Heinz, Gottfried; Niessner, Alexander; Zimpfer, Daniel; Laufer, Günther; Lang, Irene M; Distelmaier, Klaus; Goliasch, Georg

    2017-07-28

    Extracorporeal membrane oxygenation following cardiac surgery safeguards end-organ oxygenation but unfavorably alters cardiac hemodynamics. Along with the detrimental effects of cardiac surgery to the right heart, this might impact outcome, particularly in patients with preexisting right ventricular (RV) dysfunction. We sought to determine the prognostic impact of RV function and to improve established risk-prediction models in this vulnerable patient cohort. Of 240 patients undergoing extracorporeal membrane oxygenation support following cardiac surgery, 111 had echocardiographic examinations at our institution before implantation of extracorporeal membrane oxygenation and were thus included. Median age was 67 years (interquartile range 60-74), and 74 patients were male. During a median follow-up of 27 months (interquartile range 16-63), 75 patients died. Fifty-one patients died within 30 days, 75 during long-term follow-up (median follow-up 27 months, minimum 5 months, maximum 125 months). Metrics of RV function were the strongest predictors of outcome, even stronger than left ventricular function ( P <0.001 for receiver operating characteristics comparisons). Specifically, RV free-wall strain was a powerful predictor univariately and after adjustment for clinical variables, Simplified Acute Physiology Score-3, tricuspid regurgitation, surgery type and duration with adjusted hazard ratios of 0.41 (95%CI 0.24-0.68; P =0.001) for 30-day mortality and 0.48 (95%CI 0.33-0.71; P <0.001) for long-term mortality for a 1-SD (SD=-6%) change in RV free-wall strain. Combined assessment of the additive EuroSCORE and RV free-wall strain improved risk classification by a net reclassification improvement of 57% for 30-day mortality ( P =0.01) and 56% for long-term mortality ( P =0.02) compared with the additive EuroSCORE alone. RV function is strongly linked to mortality, even after adjustment for baseline variables and clinical risk scores. RV performance improves

  5. The long-term effect of premier pay for performance on patient outcomes.

    Science.gov (United States)

    Jha, Ashish K; Joynt, Karen E; Orav, E John; Epstein, Arnold M

    2012-04-26

    Pay for performance has become a central strategy in the drive to improve health care. We assessed the long-term effect of the Medicare Premier Hospital Quality Incentive Demonstration (HQID) on patient outcomes. We used Medicare data to compare outcomes between the 252 hospitals participating in the Premier HQID and 3363 control hospitals participating in public reporting alone. We examined 30-day mortality among more than 6 million patients who had acute myocardial infarction, congestive heart failure, or pneumonia or who underwent coronary-artery bypass grafting (CABG) between 2003 and 2009. At baseline, the composite 30-day mortality was similar for Premier and non-Premier hospitals (12.33% and 12.40%, respectively; difference, -0.07 percentage points; 95% confidence interval [CI], -0.40 to 0.26). The rates of decline in mortality per quarter at the two types of hospitals were also similar (0.04% and 0.04%, respectively; difference, -0.01 percentage points; 95% CI, -0.02 to 0.01), and mortality remained similar after 6 years under the pay-for-performance system (11.82% for Premier hospitals and 11.74% for non-Premier hospitals; difference, 0.08 percentage points; 95% CI, -0.30 to 0.46). We found that the effects of pay for performance on mortality did not differ significantly among conditions for which outcomes were explicitly linked to incentives (acute myocardial infarction and CABG) and among conditions not linked to incentives (congestive heart failure and pneumonia) (P=0.36 for interaction). Among hospitals that were poor performers at baseline, mortality was similar in the two groups of hospitals at the start of the study (15.12% and 14.73%; difference, 0.39 percentage points; 95% CI, -0.36 to 1.15), with similar rates of improvement per quarter (0.10% and 0.07%; difference, -0.03 percentage points; 95% CI, -0.08 to 0.02) and similar mortality rates at the end of the study (13.37% and 13.21%; difference, 0.15 percentage points; 95% CI, -0.70 to 1.01). We

  6. Visual Search Performance in Patients with Vision Impairment: A Systematic Review.

    Science.gov (United States)

    Senger, Cassia; Margarido, Maria Rita Rodrigues Alves; De Moraes, Carlos Gustavo; De Fendi, Ligia Issa; Messias, André; Paula, Jayter Silva

    2017-11-01

    Patients with visual impairment are constantly facing challenges to achieve an independent and productive life, which depends upon both a good visual discrimination and search capacities. Given that visual search is a critical skill for several daily tasks and could be used as an index of the overall visual function, we investigated the relationship between vision impairment and visual search performance. A comprehensive search was undertaken using electronic PubMed, EMBASE, LILACS, and Cochrane databases from January 1980 to December 2016, applying the following terms: "visual search", "visual search performance", "visual impairment", "visual exploration", "visual field", "hemianopia", "search time", "vision lost", "visual loss", and "low vision". Two hundred seventy six studies from 12,059 electronic database files were selected, and 40 of them were included in this review. Studies included participants of all ages, both sexes, and the sample sizes ranged from 5 to 199 participants. Visual impairment was associated with worse visual search performance in several ophthalmologic conditions, which were either artificially induced, or related to specific eye and neurological diseases. This systematic review details all the described circumstances interfering with visual search tasks, highlights the need for developing technical standards, and outlines patterns for diagnosis and therapy using visual search capabilities.

  7. Tele-Operated Echography and Remote Guidance for Performing Tele-Echography on Geographically Isolated Patients

    Directory of Open Access Journals (Sweden)

    Philippe Arbeille

    2016-06-01

    Full Text Available Objective: To evaluate the performance of three tele-echography systems for routine use in isolated medical centers. Methods: Three systems were used for deep (abdomen, pelvis, fetal and superficial (muscle, thyroid, carotid artery examinations: (a a robotic arm (RA holding an echographic probe; (b an echograph with a motorized probe (MP; and (c remote guidance (RG where the patient site operator performed the examination assisted by an expert via videoconference. All systems were tested in the same medical center located 60 km away from the university hospital. Results: A total of 340 remote echography examinations were performed (41% RA and MP, 59% RG. MP and RA allowed full control of the probe orientation by the expert, and provided diagnoses in 97% of cases. The use of RG was sufficient for superficial vessel examinations and provided diagnoses in 98% of cases but was not suited for deep or superficial organs. Assessment of superficial organs was best accomplished using the MP. Discussion: Both teleoperated systems provided control of the probe orientation by the expert necessary for obtaining appropriate views of deep organs but the MP was much more ergonomic and easier to use than the RA. RG was appropriate for superficial vessels while the MP was better for superficial volumic organs.

  8. Detective quantum efficiency: a standard test to ensure optimal detector performance and low patient exposures

    Science.gov (United States)

    Escartin, Terenz R.; Nano, Tomi F.; Cunningham, Ian A.

    2016-03-01

    The detective quantum efficiency (DQE), expressed as a function of spatial frequency, describes the ability of an x-ray detector to produce high signal-to-noise ratio (SNR) images. While regulatory and scientific communities have used the DQE as a primary metric for optimizing detector design, the DQE is rarely used by end users to ensure high system performance is maintained. Of concern is that image quality varies across different systems for the same exposures with no current measures available to describe system performance. Therefore, here we conducted an initial DQE measurement survey of clinical x-ray systems using a DQE-testing instrument to identify their range of performance. Following laboratory validation, experiments revealed that the DQE of five different systems under the same exposure level (8.0 μGy) ranged from 0.36 to 0.75 at low spatial frequencies, and 0.02 to 0.4 at high spatial frequencies (3.5 cycles/mm). Furthermore, the DQE dropped substantially with decreasing detector exposure by a factor of up to 1.5x in the lowest spatial frequency, and a factor of 10x at 3.5 cycles/mm due to the effect of detector readout noise. It is concluded that DQE specifications in purchasing decisions, combined with periodic DQE testing, are important factors to ensure patients receive the health benefits of high-quality images for low x-ray exposures.

  9. Cervical spine surgery performed in ambulatory surgical centers: Are patients being put at increased risk?

    Science.gov (United States)

    Epstein, Nancy E

    2016-01-01

    Spine surgeons are being increasingly encouraged to perform cervical operations in outpatient ambulatory surgical centers (ASC). However, some studies/data coming out of these centers are provided by spine surgeons who are part or full owners/shareholders. In Florida, for example, there was a 50% increase in ASC (5349) established between 2000-2007; physicians had a stake (invested) in 83%, and outright owned 43% of ASC. Data regarding "excessive" surgery by ASC surgeon-owners from Idaho followed shortly thereafter. The risks/complications attributed to 3279 cervical spine operations performed in 6 ASC studies were reviewed. Several studies claimed 99% discharge rates the day of the surgery. They also claimed major complications were "picked up" within the average postoperative observation window (e.g., varying from 4-23 hours), allowing for appropriate treatment without further sequelae. Morbidity rates for outpatient cervical spine ASC studies (e.g. some with conflicts of interest) varied up to 0.8-6%, whereas morbidity rates for 3 inpatient cervical studies ranged up to 19.3%. For both groups, morbidity included postoperative dysphagia, epidural hematomas, neck swelling, vocal cord paralysis, and neurological deterioration. Although we have no clear documentation as to their safety, "excessive" and progressively complex cervical surgical procedures are increasingly being performed in ASC. Furthermore, we cannot rely upon ASC-based data. At least some demonstrate an inherent conflict of interest and do not veridically report major morbidity/mortality rates for outpatient procedures. For now, cervical spine surgery performed in ASC would appear to be putting patients at increased risk for the benefit of their surgeon-owners.

  10. The influence of assistive technology on occupational performance and satisfaction of leprosy patients with grade 2 disabilities

    Directory of Open Access Journals (Sweden)

    Lucas da Silva Muniz

    Full Text Available Abstract INTRODUCTION: We aimed to investigate the feasibility of assistive technology (AT devices to improve leprosy patients' occupational performances and satisfaction. METHODS: This is a pretest-posttest design study. The Canadian Occupational Performance Measure was used to assess the occupational performance and satisfaction of five leprosy participants with grade 2 disabilities before and after ten 45-minute interventions using assistive technology devices. RESULTS: The data showed a statistically significant 7-point average improvement (p<0.05 in participants' post-intervention performance and satisfaction scores. CONCLUSIONS: Assistive technology devices may be useful therapeutic tools to enhance autonomy/independence and satisfaction of leprosy patients with grade 2 disabilities.

  11. A fourteen-year review of radical cystectomy for transitional cell carcinoma demonstrating the usefulness of the concept of lymph node density

    Directory of Open Access Journals (Sweden)

    Chi W. Cheng

    2006-10-01

    Full Text Available OBJECTIVE: We studied the long-term outcome of radical cystectomy for transitional cell carcinoma and evaluated prognostic factors for disease specific survival. MATERIALS AND METHODS: A retrospective review was carried out for all cystectomies performed for transitional cell carcinoma between 1989 and 2002. Disease specific survival was correlated to patient, pathological and operative factors as well as to adjuvant therapy. RESULTS: Of the 133 cystectomies included, 100 were male and 33 were female patients. The median age was 69 years (range 43 to 86. The median follow up was 20 months (range 0 to 158. With univariate analysis, pT stage, N stage, lymph node density, carcinoma in-situ, surgical margin and post-operative radiotherapy to distant metastasis were predictive of disease specific survival. On the other hand, with multivariate analysis, only pT stage, lymph node density and post-operative radiotherapy to distant metastasis were predictive of disease specific survival. Within the group of node positive disease, lymph node density also predicted disease specific survival with both univariate and multivariate analyses. Patients with lymph node density 20% or below showed better disease specific survival. CONCLUSIONS: pT stage and lymph node density were found to be the most important predictive factors for disease specific survival after cystectomy in the Asian population.

  12. Performance in neurocognitive tasks in obese patients. Does somatic comorbidity matter?

    Directory of Open Access Journals (Sweden)

    Wibke eKiunke

    2013-08-01

    Full Text Available The aim of the present study was to examine if obese individuals with obesity-related somatic comorbidity (i.e., hypertension, diabetes, sleep apnea, dyslipidemia, pain disorder perform worse in neurocognitive tasks compared to obese individuals without any somatic disorder. Neurocognitive functioning was measured by a computerized test battery that consisted of the following tasks: Corsi Block Tapping Test, Auditory Word Learning Task, Trail Making Test-Part B, Stroop Test, Labyrinth Test, and a 4-disk version of the Tower of Hanoi. The total sample consisted of 146 patients, the majority (N=113 suffered from obesity grade 3, 26 individuals had obesity grade 2, and only 7 individuals obesity grade 1. Ninety-eight participants (67.1% reported at least one somatic disorder (Soma+-group. Hypertension was present in 75 individuals (51.4%, type 2 diabetes in 34 participants (23.3%, 38 individuals had sleep apnea (26.0%, 16 suffered from dyslipidemia (11.0%, and 14 individuals reported having a chronic pain disorder (9.6%. Participants without a coexisting somatic disorder were younger (MSoma-=33.7, SD=9.8 vs. MSoma+=42.7, SD=11.0, F(1,144=23.01, p<0.001 and more often female (89.6% and 62.2%, χ2(1= 11.751, p=0.001 but did not differ with respect to education, regular binge eating or depressive symptoms from those in the Soma+-group. The Soma--group performed better on cognitive tasks related to memory and mental flexibility. However, the group differences disappeared completely after controlling for age. The findings indicate that in some obese patients increasing age may not only be accompanied by an increase of obesity severity and by more obesity-related somatic disorders but also by poorer cognitive functioning.

  13. Presence of neuropathic pain may explain poor performances on olfactory testing in diabetes mellitus patients.

    Science.gov (United States)

    Brady, Shauna; Lalli, Paul; Midha, Nisha; Chan, Ayechen; Garven, Alexandra; Chan, Cynthia; Toth, Cory

    2013-07-01

    Olfactory dysfunction in neurodegenerative conditions such as Parkinson's syndrome and Alzheimer's disease can hallmark disease onset. We hypothesized that patients with diabetes mellitus, a condition featuring peripheral and central neurodegeneration, would have decreased olfaction abilities. We examined participants with diabetic peripheral neuropathy, participants with diabetes without diabetic peripheral neuropathy, and control participants in blinded fashion using standardized Sniffin' Sticks. Diabetic peripheral neuropathy severity was quantified using the Utah Early Neuropathy Scale. Further subcategorization of diabetic peripheral neuropathy based on presence of neuropathic pain was performed with Douleur Neuropathique 4 Questionnaires. Participants with diabetes had decreased olfactory sensitivity, impaired olfactory discrimination abilities, and reduced odor identification skills when compared with controls. However, loss of olfaction ability was, at least partially, attributed to presence of neuropathic pain on subcategory assessment, although pain severity was not associated with dysfunction. Those participants with diabetes without diabetic peripheral neuropathy and those with diabetic peripheral neuropathy without neuropathic pain had similar olfactory function as controls in general. The presence of neuropathic pain, associated with limited attention and concentration, may explain at least a portion of the olfactory dysfunction witnessed in the diabetic patient population.

  14. The Effect of Patient Characteristics and Sleep Quality on Visual Field Performance Reliability

    Directory of Open Access Journals (Sweden)

    Swarup S. Swaminathan

    2018-01-01

    Full Text Available Purpose. To investigate the association of automated visual field (VF reliability indices (false positive [FP], false negative [FN], and fixation loss [FL] and sleep quality, VF experience, and age. Methods. Prospective, cross-sectional study. Adult patients (age ≥ 18 years completing automated VF testing were invited to participate. Baseline participant characteristics were obtained, and all participants were asked to complete the Pittsburgh Sleep Quality Index (PSQI questionnaire. Nonparametric Spearman correlations and logistical regression models were performed. Results. 63 patients were enrolled. Lower PSQI score was correlated with higher percentage (% FL in the right eye (p=0.03. Fewer prior VF was significantly correlated with higher %FP in the right eye (p=0.008. Older age was significantly correlated with higher %FN in the left eye (p=0.01. Greater mean deviation (MD and pattern standard deviation (PSD were strongly correlated with higher %FN in the right (p=0.02 and 0.002, resp. and left eyes (p=0.01 and 0.02, resp.. Conclusion. In this prospective, cross-sectional study, worse MD and PSD are strongly correlated with increased FN in both eyes. Increased FN in the left eye associated with older age might be attributable to test fatigue. Worse sleep quality is associated with decreased FL in the right eye.

  15. Predictors of improved functioning in patients with psychosis: The role of amotivation and defeatist performance beliefs.

    Science.gov (United States)

    Pillny, Matthias; Lincoln, Tania M

    2016-10-30

    Defeatist performance beliefs (DPBs) are associated with the severe impairments in functioning of patients with negative symptoms of schizophrenia. This association has been found to be mediated by amotivation, a core aspect of negative symptoms. Although causality is assumed, longitudinal evidence for this is lacking. The current study aimed to extend previous findings by investigating both cross-sectional and longitudinal associations between DPBs, motivational impairments and functioning in a sample of patients with psychotic disorders (N=58). We hypothesized, that DPBs would be related to functioning in cross-sectional and longitudinal analyses and that this link would be mediated by motivational impairments. Data was assessed at baseline and post-treatment in a trial on the effects of cognitive behavior therapy for psychosis. At baseline, amotivation mediated the association between DPBs and functioning. From baseline to post-treatment, reduction of amotivation was associated with improvement of functioning significantly, whereas reduction of DPBs was unrelated to improvements in functioning or amotivation. The findings suggest that improvement in amotivation accounts for favorable treatment outcomes in regard to functioning but question the causal role of DPBs in negative symptoms and functioning. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  16. How many trials are needed to achieve performance stability of the Timed Up & Go test in patients with hip fracture?

    DEFF Research Database (Denmark)

    Kristensen, Morten T; Ekdahl, Charlotte; Kehlet, Henrik

    2010-01-01

    To examine the number of trials needed to achieve performance stability of the Timed Up & Go (TUG) test using a standardized walking aid in patients with hip fracture who are allowed full weight bearing (FWB).......To examine the number of trials needed to achieve performance stability of the Timed Up & Go (TUG) test using a standardized walking aid in patients with hip fracture who are allowed full weight bearing (FWB)....

  17. High diversity and endemism in the genus Cautires Waterhouse, 1879 (Coleoptera: Lycidae from the Malay mountain forests, with the descriptions of fourteen new species

    Directory of Open Access Journals (Sweden)

    Alice Jiruskova

    2016-08-01

    Full Text Available We identified a high diversity in the net-winged beetles of the genus Cautires in Peninsular Malaysia. Fourteen new species are described: Cautires alexae sp. nov., C. andujari sp. nov., C. arribasae sp. nov., C. berembanensis sp. nov., C. campestris sp. nov., C. communis sp. nov., C. jasarensis sp. nov., C. katarinae sp. nov., C. kirstenae sp. nov., C. kotatinggensis sp. nov., C. linardi sp. nov., C. maseki sp. nov., C. pahangensis sp. nov. and C. renatae sp. nov. Seven previously described species are discussed, illustrated and differential diagnoses provided; all species are keyed. The Cautires species differ in a limited number of diagnostic characters, namely in the shape of male antennae, the relative size of eyes and in the shape of the male genitalia. The females are difficult to assign to a conspecific male due to high intraspecific variability. The characteristically low dispersal propensity of net-winged beetles lead to the evolution of the unique fauna in the Malay mountains and despite an extensive study of the type material we recorded only a single species of Cautires occurring simultaneously in Sumatra. We suggest that the Malay mountain fauna is highly endemic and evolved in situ.

  18. Development and characterization of fourteen novel microsatellite markers for the chestnut short-tailed fruit bat (Carollia castanea), and cross-amplification to related species.

    Science.gov (United States)

    Cleary, Katherine A; Waits, Lisette P; Hohenlohe, Paul A

    2016-01-01

    Rapid anthropogenic land use change threatens the primary habitat of the Chestnut short-tailed bat (Carollia castanea) throughout much of its range. Information on population genetic structure can inform management strategies for this widespread frugivorous bat, and effective protection of C. castanea will also benefit the more than 20 mutualistic plant species of which this bat is the primary seed disperser. To facilitate understanding of population genetic structure in this species, fourteen novel microsatellite markers were developed using restriction-site-associated DNA libraries and Illumina sequencing and tested on 28 individuals from 13 locations in Costa Rica. These are the first microsatellite markers developed for C. castanea. All loci were polymorphic, with number of alleles ranging from 2-11 and average observed heterozygosity of 0.631. Markers were also cross-amplified in three additional frugivorous bat species threatened by habitat loss and fragmentation: Sowell's short-tailed bat (Carollia sowelli), Seba's short-tailed bat (Carollia perspicillata), and the Jamaican fruit bat (Artibeus jamaicensis), and 10, 11, and 8 were polymorphic, respectively.

  19. Objective instrumental memory and performance tests for evaluation of patients with brain damage: a search for a behavioral diagnostic tool.

    Science.gov (United States)

    Harness, B Z; Bental, E; Carmon, A

    1976-03-01

    Cognition and performance of patients with localized and diffuse brain damage was evaluated through the application of objective perceptual testing. A series of visual perceptual and verbal tests, memory tests, as well as reaction time tasks were administered to the patients by logic programming equipment. In order to avoid a bias due to communicative disorders, all responses were motor, and achievement was scored in terms of correct identification and latencies of response. Previously established norms based on a large sample of non-brain-damaged hospitalized patients served to standardize the performance of the brain-damaged patient since preliminary results showed that age and educational level constitute an important variable affecting performance of the control group. The achievement of brain-damaged patients, corrected for these factors, was impaired significantly in all tests with respect to both recognition and speed of performance. Lateralized effects of brain damage were not significantly demonstrated. However, when the performance was analyzed with respect to the locus of visual input, it was found that patients with right hemispheric lesions showed impairment mainly on perception of figurative material, and that this deficit was more apparent in the left visual field. Conversely, patients with left hemispheric lesions tended to show impairment on perception of visually presented verbal material when the input was delivered to the right visual field.

  20. Outcomes in 24 selected patients with stage IVB cervical cancer and excellent performance status treated with radiotherapy and chemotherapy

    International Nuclear Information System (INIS)

    Zighelboim, Israel; Taylor, Nicholas P.; Powell, Matthew A.; Gibb, Randall K.; Rader, Janet S.; Mutch, David G.; Grigsby, Perry W.

    2006-01-01

    We sought to review outcomes in patients with stage IVB carcinoma of the cervix treated with irradiation in combination with chemotherapy. We report outcomes of 24 consecutive patients with good performance status treated from 1998 to 2005. Most of these patients underwent concurrent irradiation with platinum-based chemotherapy. Some patients received subsequent systemic chemotherapy. All patients underwent external beam radiotherapy; 7 patients (29%) had additional high-dose-rate and 12 (50%) low-dose-rate brachytherapy. Two patients (8%) received an intensity modulated radiation therapy (IMRT) boost instead of brachytherapy. The mean dose to point A was variable (73.9±19.2 Gy). Twenty patients (83%) received radio-sensitizing platinum-based chemotherapy, and the remaining had radiotherapy alone. Seven patients (29%) had further combination chemotherapy. Therapy was well tolerated. The overall survival was 44% at 36 months and 22% at 5 years. Patients with stage IVB cervical cancer have mostly been treated with palliative intent. With the advent of concurrent chemoradiation, we have treated many of these cases with aggressive combination therapy. In this series, the use of radiotherapy and multiagent chemotherapy in patients with stage IVB cervical carcinoma and good performance status was well tolerated and resulted in higher survival rates than previously reported. (author)

  1. Short-Term Memory Performances during Sustained Wakefulness in Patients with Obstructive Sleep Apnea-Hypopnea Syndrome

    Science.gov (United States)

    Greneche, Jerome; Krieger, Jean; Bertrand, Frederic; Erhardt, Christine; Maumy, Myriam; Tassi, Patricia

    2011-01-01

    Both working and immediate memories were assessed every 4 h by specific short-term memory tasks over sustained wakefulness in 12 patients with obstructive sleep apnea and hypopnea syndrome (OSAHS) and 10 healthy controls. Results indicated that OSAHS patients exhibited lower working memory performances than controls on both backward digit span and…

  2. Recovery of lower extremity muscle strength and functional performance in middle-aged patients undergoing arthroscopic partial meniscectomy

    DEFF Research Database (Denmark)

    Ganderup, Tina; Jensen, Carsten; Holsgaard-Larsen, Anders

    2017-01-01

    PURPOSE: To investigate lower extremity muscle strength and functional performance before and after arthroscopic partial meniscectomy in middle-aged patients with degenerative meniscal tears. We hypothesized that patients would experience deficiencies in the affected leg at 3 months post-surgery,...

  3. A Comparison of the Effectiveness of Three Drug Regimens on Cognitive Performance of Patients with Parkinson's disease

    Science.gov (United States)

    Emsaki, Golit; Asgari, Karim; Molavi, Hossein; Chitsaz, Ahmad

    2013-01-01

    In the present study, the effectiveness of 3 drug regimen on cognitive performance of PD patients was compared. 12 patients who had been using pramipexole, levodopa and amantadine for at least 1 month entered the study and compared with those 12 who had been using trihexiphenidyle, levodopa and amantadine. There was also a control group…

  4. Effects of nutritional and psychological status of the patients with advanced stomach cancer on physical performance status.

    Science.gov (United States)

    Tian, Jun; Chen, Zhen-chun; Hang, Li-Fang

    2009-10-01

    The aim of this study was to assess the associations between coping mode, nutritional status, and psychological status and performance status of the patients with advanced stomach cancer. An epidemiological survey was conducted among 233 patients with advanced stomach cancer in Fujian, China. In-person interviews were performed for the participants with respect to information of psychological status prior to chemotherapy, nutritional status during chemotherapy, and physical performance status after chemotherapy. Multivariate logistic regression analyses showed that the level of hemoglobin (HB), level of daily calorie intake, score of Depression Status Inventory (DSI), and score of confrontation subscale of Medical Coping Modes Questionnaire had a significant influence on performance status (P or =40 versus DSI score confrontation versus high score of confrontation, respectively. Depression, low score of "Confrontation", low levels of HB, and low level of daily calorie intake may be the risk factors of poor performance status of the patients with advanced stomach cancer.

  5. Effect of hypoxia and hyperoxia on exercise performance in healthy individuals and in patients with pulmonary hypertension: a systematic review.

    Science.gov (United States)

    Ulrich, Silvia; Schneider, Simon R; Bloch, Konrad E

    2017-12-01

    Exercise performance is determined by oxygen supply to working muscles and vital organs. In healthy individuals, exercise performance is limited in the hypoxic environment at altitude, when oxygen delivery is diminished due to the reduced alveolar and arterial oxygen partial pressures. In patients with pulmonary hypertension (PH), exercise performance is already reduced near sea level due to impairments of the pulmonary circulation and gas exchange, and, presumably, these limitations are more pronounced at altitude. In studies performed near sea level in healthy subjects, as well as in patients with PH, maximal performance during progressive ramp exercise and endurance of submaximal constant-load exercise were substantially enhanced by breathing oxygen-enriched air. Both in healthy individuals and in PH patients, these improvements were mediated by a better arterial, muscular, and cerebral oxygenation, along with a reduced sympathetic excitation, as suggested by the reduced heart rate and alveolar ventilation at submaximal isoloads, and an improved pulmonary gas exchange efficiency, especially in patients with PH. In summary, in healthy individuals and in patients with PH, alterations in the inspiratory Po 2 by exposure to hypobaric hypoxia or normobaric hyperoxia reduce or enhance exercise performance, respectively, by modifying oxygen delivery to the muscles and the brain, by effects on cardiovascular and respiratory control, and by alterations in pulmonary gas exchange. The understanding of these physiological mechanisms helps in counselling individuals planning altitude or air travel and prescribing oxygen therapy to patients with PH.

  6. Impact of Frequent Interruption on Nurses' Patient-Controlled Analgesia Programming Performance.

    Science.gov (United States)

    Campoe, Kristi R; Giuliano, Karen K

    2017-12-01

    The purpose was to add to the body of knowledge regarding the impact of interruption on acute care nurses' cognitive workload, total task completion times, nurse frustration, and medication administration error while programming a patient-controlled analgesia (PCA) pump. Data support that the severity of medication administration error increases with the number of interruptions, which is especially critical during the administration of high-risk medications. Bar code technology, interruption-free zones, and medication safety vests have been shown to decrease administration-related errors. However, there are few published data regarding the impact of number of interruptions on nurses' clinical performance during PCA programming. Nine acute care nurses completed three PCA pump programming tasks in a simulation laboratory. Programming tasks were completed under three conditions where the number of interruptions varied between two, four, and six. Outcome measures included cognitive workload (six NASA Task Load Index [NASA-TLX] subscales), total task completion time (seconds), nurse frustration (NASA-TLX Subscale 6), and PCA medication administration error (incorrect final programming). Increases in the number of interruptions were associated with significant increases in total task completion time ( p = .003). We also found increases in nurses' cognitive workload, nurse frustration, and PCA pump programming errors, but these increases were not statistically significant. Complex technology use permeates the acute care nursing practice environment. These results add new knowledge on nurses' clinical performance during PCA pump programming and high-risk medication administration.

  7. Impaired exercise performance and muscle Na(+),K(+)-pump activity in renal transplantation and haemodialysis patients.

    Science.gov (United States)

    Petersen, Aaron C; Leikis, Murray J; McMahon, Lawrence P; Kent, Annette B; Murphy, Kate T; Gong, Xiaofei; McKenna, Michael J

    2012-05-01

    We examined whether abnormal skeletal muscle Na(+),K(+)-pumps underlie impaired exercise performance in haemodialysis patients (HDP) and whether these are improved in renal transplant recipients (RTx). Peak oxygen consumption ( O(2peak)) and plasma [K(+)] were measured during incremental exercise in 9RTx, 10 HDP and 10 healthy controls (CON). Quadriceps peak torque (PT), fatigability (decline in strength during thirty contractions), thigh muscle cross-sectional area (TMCSA) and vastus lateralis Na(+),K(+)-pump maximal activity, content and isoform (α(1)-α(3), β(1)-β(3)) abundance were measured. O(2peak) was 32 and 35% lower in RTx and HDP than CON, respectively (P Na(+),K(+)-pump activity was 28 and 31% lower in RTx and HDP, respectively than CON (P Na(+),K(+)-pump activity (r = 0.45, P = 0.02). O(2peak) and muscle Na(+),K(+)-pump activity were depressed and muscle fatigability increased in HDP, with no difference observed in RTx. These findings are consistent with the possibility that impaired exercise performance in HDP and RTx may be partially due to depressed muscle Na(+),K(+)-pump activity and relative TMCSA.

  8. Cost of nursing most frequent procedures performed on severely burned patients

    Directory of Open Access Journals (Sweden)

    Talita de Oliveira Melo

    Full Text Available ABSTRACT Objective: to identify the mean direct cost (MDC of the most frequent procedures performed by nursing professionals on severely burned patients in an Intensive Care Unit. Method: exploratory-descriptive quantitative single-case study. The MDC was calculated by multiplying time (timed spent by nursing professionals in the performance of the procedures by the unit cost of direct labor, and adding the costs of material and medicine/solutions. Results: a MDC of US$ 0.65 (SD=0.36 was obtained for "vital signs monitoring"; US$ 10.00 (SD=24.23 for "intravenous drug administration"; US$ 5.90 (SD=2.75 for "measurement of diuresis"; US$ 0.93 (SD=0.42 for "capillary blood glucose monitoring"; and US$ 99.75 (SD=129.55 for "bandaging". Conclusion: the knowledge developed can support managerial decision-making, contribute to the efficiency distribution of the resources involved and, when possible, provide cost-containment or cost-minimization strategies without impairing the quality of nursing care.

  9. Electronic adherence monitoring device performance and patient acceptability: a randomized control trial.

    Science.gov (United States)

    Chan, Amy Hai Yan; Stewart, Alistair William; Harrison, Jeff; Black, Peter Nigel; Mitchell, Edwin Arthur; Foster, Juliet Michelle

    2017-05-01

    To investigate the performance and patient acceptability of an inhaler electronic monitoring device in a real-world childhood asthma population. Children 6 to 15 years presenting with asthma to the hospital emergency department and prescribed inhaled corticosteroids were included. Participants were randomized to receive a device with reminder features enabled or disabled for use with their preventer. Device quality control tests were conducted. Questionnaires on device acceptability, utility and ergonomics were completed at six months. A total of 1306 quality control tests were conducted; 84% passed pre-issue and 87% return testing. The most common failure reason was actuation under-recording. Acceptability scores were high, with higher scores in the reminder than non-reminder group (median, 5 th -95 th percentile: 4.1, 3.1-5.0 versus 3.7, 2.3-4.8; p 90%) rated the device easy to use. Feedback was positive across five themes: device acceptability, ringtone acceptability, suggestions for improvement, effect on medication use, and effect on asthma control. This study investigates electronic monitoring device performance and acceptability in children using quantitative and qualitative measures. Results indicate satisfactory reliability, although failure rates of 13-16% indicate the importance of quality control. Favorable acceptability ratings support the use of these devices in children.

  10. PERFORMANCE

    Directory of Open Access Journals (Sweden)

    M Cilli

    2014-10-01

    Full Text Available This study aimed to investigate the kinematic and kinetic changes when resistance is applied in horizontal and vertical directions, produced by using different percentages of body weight, caused by jumping movements during a dynamic warm-up. The group of subjects consisted of 35 voluntary male athletes (19 basketball and 16 volleyball players; age: 23.4 ± 1.4 years, training experience: 9.6 ± 2.7 years; height: 177.2 ± 5.7 cm, body weight: 69.9 ± 6.9 kg studying Physical Education, who had a jump training background and who were training for 2 hours, on 4 days in a week. A dynamic warm-up protocol containing seven specific resistance movements with specific resistance corresponding to different percentages of body weight (2%, 4%, 6%, 8%, 10% was applied randomly on non consecutive days. Effects of different warm-up protocols were assessed by pre-/post- exercise changes in jump height in the countermovement jump (CMJ and the squat jump (SJ measured using a force platform and changes in hip and knee joint angles at the end of the eccentric phase measured using a video camera. A significant increase in jump height was observed in the dynamic resistance warm-up conducted with different percentages of body weight (p 0.05. In jump movements before and after the warm-up, while no significant difference between the vertical ground reaction forces applied by athletes was observed (p>0.05, in some cases of resistance, a significant reduction was observed in hip and knee joint angles (p<0.05. The dynamic resistance warm-up method was found to cause changes in the kinematics of jumping movements, as well as an increase in jump height values. As a result, dynamic warm-up exercises could be applicable in cases of resistance corresponding to 6-10% of body weight applied in horizontal and vertical directions in order to increase the jump performance acutely.

  11. General quality of life of patients with acne vulgaris before and after performing selected cosmetological treatments

    Directory of Open Access Journals (Sweden)

    Chilicka K

    2017-08-01

    Full Text Available Karolina Chilicka,1 Joanna Maj,2 Bernard Panaszek3 1Department of Cosmetology, Opole Medical School, Opole, 2Department of Dermatology, Venereology and Allergology, 3Department of Internal Medicine and Allergy, Wroclaw Medical University, Wrocław, Poland Background: Achieving a satisfying quality of life for a patient by applying individually matched therapy is, simultaneously, a great challenge and a priority for contemporary medicine. Patients with visible dermatological ailments are particularly susceptible to reduction in the general quality of life. Among the dermatological diseases, acne causes considerable reduction in the quality of life and changes in self-perception that lead to the worsening of a patient’s mental condition, including depression and suicidal thoughts. As a result, difficulties in contact with loved ones, as well as social and professional problems are observed, which show that acne is not a somatic problem alone. To a large extent, it becomes a part of psychodermatology, becoming an important topic of public health in social medicine practice. Pharmacological treatment of acne is a challenge for a dermatologist and often requires the necessity of cooperating with a cosmetologist. Cosmetological treatments are aimed at improving the condition of the skin and reduction or subsiding of acne skin changes.Aim: The aim of this study was to assess the influence of selected cosmetological treatments on the general quality of life of patients with acne.Materials and methods: The study group consisted of 101 women aged 19–29 years (x̅  =22.5 years, SD =2.3 years. All subjects were diagnosed with acne vulgaris of the face. In the study group, the acne changes occurred over the course of 3–15 years (x̅ =8.1 years, SD =2.7 years. Selected cosmetological treatments (intensive pulsing light, alpha-hydroxy acids, cavitation peeling, needle-free mesotherapy, diamond microdermabrasion and sonophoresis were performed in

  12. Cognitive performance change of pediatric patients after conducting frontal transcortical approach to treat lateral ventricular tumor.

    Science.gov (United States)

    Zhu, Wanchun; He, Jintao; Li, Xiang; Wang, Lei; Lu, Zheng; Li, Chunde; Gong, Jian

    2017-12-01

    Applying frontal transcortical approach to treat lateral ventricular tumor is one of the most common neurosurgical manipulations. The frontal transcortical approach generally passes through the middle frontal gyrus in which there is no major function involved in the traditional sense. However, current researches have suggested that the prefrontal cortex (PFC) plays a central role in the whole network of the brain cognitive frame. In addition, cognitive function is crucial in growing and developmental stages and essential for the educational achievement, especially for children. Based on this, the authors in this study analyzed cognitive performance change of pediatric patients who had accepted frontal transcortical operation in 1-year follow-up and discussed the possibility of higher cognitive functions of the damaged region. In this single-center study, 15 pediatric patients (median age at surgery, 9.21 years old; range, 6.42-14.17 years old) who had been treated with frontal transcortical approach for lateral ventricular tumors were selected as research objects. The cognitive function assessment was conducting by adopting the revised Wechsler Intelligence Scale for Children-fourth edition (WISC-IV). In addition, the resting-state functional magnetic resonance imaging (resting-state fMRI) and diffusion tensor imaging (DTI) were carried out to measure the level of co-activation and to explore the functional connectivity between the brain regions at the preoperative period and 1-year follow-up after surgery. GTR was achieved in all patients, and all patients were in good condition after surgery. Compared to the preoperative indices of WISC-IV, patients generally had a lower level of indices of the WISC-IV after surgery, for example, the total IQ was declined to M = 83.60, SD = 9.500 from M = 95.33, SD = 13.844 within 1 year convalescence. The data of perceptual reasoning (t = - 2.392, p = 0.016), processing speed (t = - 2.121, p = 0.033), and

  13. Characterization of cognitive and motor performance during dual-tasking in healthy older adults and patients with Parkinson's disease.

    Science.gov (United States)

    Wild, Lucia Bartmann; de Lima, Daiane Borba; Balardin, Joana Bisol; Rizzi, Luana; Giacobbo, Bruno Lima; Oliveira, Henrique Bianchi; de Lima Argimon, Irani Iracema; Peyré-Tartaruga, Leonardo Alexandre; Rieder, Carlos R M; Bromberg, Elke

    2013-02-01

    The primary purpose of this study was to investigate the effect of dual-tasking on cognitive performance and gait parameters in patients with idiopathic Parkinson's disease (PD) without dementia. The impact of cognitive task complexity on cognition and walking was also examined. Eighteen patients with PD (ages 53-88, 10 women; Hoehn and Yahr stage I-II) and 18 older adults (ages 61-84; 10 women) completed two neuropsychological measures of executive function/attention (the Stroop Test and Wisconsin Card Sorting Test). Cognitive performance and gait parameters related to functional mobility of stride were measured under single (cognitive task only) and dual-task (cognitive task during walking) conditions with different levels of difficulty and different types of stimuli. In addition, dual-task cognitive costs were calculated. Although cognitive performance showed no significant difference between controls and PD patients during single or dual-tasking conditions, only the patients had a decrease in cognitive performance during walking. Gait parameters of patients differed significantly from controls at single and dual-task conditions, indicating that patients gave priority to gait while cognitive performance suffered. Dual-task cognitive costs of patients increased with task complexity, reaching significantly higher values then controls in the arithmetic task, which was correlated with scores on executive function/attention (Stroop Color-Word Page). Baseline motor functioning and task executive/attentional load affect the performance of cognitive tasks of PD patients while walking. These findings provide insight into the functional strategies used by PD patients in the initial phases of the disease to manage dual-task interference.

  14. Benefits of cardiac sonography performed by a non-expert sonographer in patients with non-traumatic cardiopulmonary arrest.

    Science.gov (United States)

    Zengin, Suat; Yavuz, Erdal; Al, Behçet; Cindoruk, Şener; Altunbaş, Gökhan; Gümüşboğa, Hasan; Yıldırım, Cuma

    2016-05-01

    The purpose of this study was to evaluate a rapid cardiac ultrasound assessment performed by trained non-expert sonographers integrated into the advanced cardiac life support (ACLS). This study was prospectively performed in 179 patients (104 males and 75 females) who underwent cardiopulmonary resuscitation (CPR) in an emergency department (ED) during two calendar years (2013 and 2014). Two senior doctors, who had received emergency cardiac ultrasonography training, performed cardiac ultrasound through the apical, subxiphoid, or parasternal windows. Ultrasound evaluation and pulse controls were performed simultaneously. SPSS 18.0 was used for statistical analysis. A total of 63.7% (114) of the cardiopulmonary arrest incidents occurred out of the hospital. Only 13 patients had a femoral pulse during the initial evaluation, while 166 showed no femoral pulse. Initial monitoring showed a regular rhythm in 53 patients, ventricular fibrillation in 18 patients, and no rhythms in 108 patients. The first evaluation with ultrasound detected an effective heart rate in 26 patients and ventricular fibrillation in 14 patients, while no effective heart rate was observed in 139 patients. In addition, ultrasound revealed pericardial tamponade in seven patients and right ventricular enlargement in four cases. Global hypokinesia was detected in four patients and hypovolemia was observed in another four patients. The use of real-time ultrasonography during resuscitation with real-time femoral pulse check can help facilitate the distinguishing of pea-type arrest, ascertain the cause of the arrest, infer a suitable treatment, and optimize medical management decisions regarding CPR termination. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Are performance-based measures predictive of work participation in patients with musculoskeletal disorders? A systematic review

    NARCIS (Netherlands)

    Kuijer, P. P. F. M.; Gouttebarge, V.; Brouwer, S.; Reneman, M. F.; Frings-Dresen, M. H. W.

    Assessments of whether patients with musculoskeletal disorders (MSDs) can participate in work mainly consist of case history, physical examinations, and self-reports. Performance-based measures might add value in these assessments. This study answers the question: how well do performance-based

  16. Selective fine needle aspiration of parotid masses. FNA should be performed in all patients older than 60 years.

    LENUS (Irish Health Repository)

    Kieran, S M

    2012-02-01

    OBJECTIVES: The exact role of fine needle aspiration in the pre-operative assessment of patients presenting with parotid masses is controversial. Some surgeons propose that fine needle aspiration be performed only selectively in those patients with likely malignant disease, whilst others recommend it for all patients presenting with such a mass. Intuitively, one would expect older patients to be more likely to suffer from primary malignant parotid tumours and secondary deposits of malignant skin tumours. Therefore, we hypothesised that older patients with a parotid mass should undergo fine needle aspiration regardless of their medical history. DESIGN: We retrospectively reviewed 197 consecutive parotidectomies to test this hypothesis. RESULTS: One hundred and twenty-one patients (61.4 per cent) were diagnosed with benign disease, whilst 76 (38.6 per cent) were diagnosed with malignant disease. Eighty-three per cent of patients aged 60 years or younger had benign disease, as opposed to 35.6 per cent of patients aged more than 60 years. Malignant disease occurred more commonly in patients older than 60 years (odds ratio 8.962, 95 per cent confidence interval 4.607-17.434). CONCLUSION: In patients with a parotid mass, fine needle aspiration should be performed on all those aged 60 years or older.

  17. Knowledge and Performance about Nursing Ethic Codes from Nurses' and Patients' Perspective in Tabriz Teaching Hospitals, Iran.

    Science.gov (United States)

    Mohajjel-Aghdam, Alireza; Hassankhani, Hadi; Zamanzadeh, Vahid; Khameneh, Saied; Moghaddam, Sara

    2013-09-01

    Nursing profession requires knowledge of ethics to guide performance. The nature of this profession necessitates ethical care more than routine care. Today, worldwide definition of professional ethic code has been done based on human and ethical issues in the communication between nurse and patient. To improve all dimensions of nursing, we need to respect ethic codes. The aim of this study is to assess knowledge and performance about nursing ethic codes from nurses' and patients' perspective. A descriptive study Conducted upon 345 nurses and 500 inpatients in six teaching hospitals of Tabriz, 2012. To investigate nurses' knowledge and performance, data were collected by using structured questionnaires. Statistical analysis was done using descriptive and analytic statistics, independent t-test and ANOVA and Pearson correlation coefficient, in SPSS13. Most of the nurses were female, married, educated at BS degree and 86.4% of them were aware of Ethic codes also 91.9% of nurses and 41.8% of patients represented nurses respect ethic codes. Nurses' and patients' perspective about ethic codes differed significantly. Significant relationship was found between nurses' knowledge of ethic codes and job satisfaction and complaint of ethical performance. According to the results, consideration to teaching ethic codes in nursing curriculum for student and continuous education for staff is proposed, on the other hand recognizing failures of the health system, optimizing nursing care, attempt to inform patients about Nursing ethic codes, promote patient rights and achieve patient satisfaction can minimize the differences between the two perspectives.

  18. A Systematic Review of Early Warning Systems' Effects on Nurses' Clinical Performance and Adverse Events Among Deteriorating Ward Patients.

    Science.gov (United States)

    Lee, Ju-Ry; Kim, Eun-Mi; Kim, Sun-Aee; Oh, Eui Geum

    2018-04-25

    Early warning systems (EWSs) are an integral part of processes that aim to improve the early identification and management of deteriorating patients in general wards. However, the widespread implementation of these systems has not generated robust data regarding nurses' clinical performance and patients' adverse events. This review aimed to determine the ability of EWSs to improve nurses' clinical performance and prevent adverse events among deteriorating ward patients. The PubMed, CINAHL, EMBASE, and Cochrane Library databases were searched for relevant publications (January 1, 1997, to April 12, 2017). In addition, a grey literature search evaluated several guideline Web sites. The main outcome measures were nurses' clinical performance (vital sign monitoring and rapid response team notification) and patients' adverse events (in-hospital mortality, cardiac arrest, and unplanned intensive care unit [ICU] admission). The search identified 888 reports, although only five studies fulfilled the inclusion criteria. The findings of these studies revealed that EWSs implementation had a positive effect on nurses' clinical performance, based on their frequency of documenting vital signs that were related to the patient's clinical deterioration. In addition, postimplementation reductions were identified for cardiac arrest, unplanned ICU admission, and unexpected death. It seems that EWSs can improve nurses' clinical performance and prevent adverse events (e.g., in-hospital mortality, unplanned ICU admission, and cardiac arrest) among deteriorating ward patients. However, additional high-quality evidence is needed to more comprehensively evaluate the effects of EWSs on these outcomes.

  19. Cross-sex hormone treatment does not change sex-sensitive cognitive performance in gender identity disorder patients.

    Science.gov (United States)

    Haraldsen, Ira R; Egeland, Thore; Haug, Egil; Finset, Arnstein; Opjordsmoen, Stein

    2005-12-15

    Cognitive performance in untreated early onset gender identity disorder (GID) patients might correspond to their born sex and not to their perceived gender. As a current mode of intervention, cross-sex hormone treatment causes considerable physical changes in GID patients. We asked, as has been suggested, whether this treatment skews cognitive performance towards that of the acquired sex. Somatically healthy male and female early onset GID patients were neuropsychologically tested before, 3 and 12 months after initiating cross-sex hormone treatment, whereas untreated healthy subjects without GID served as controls (C). Performance was assessed by testing six cognitive abilities (perception, arithmetic, rotation, visualization, logic, and verbalization), and controlled for age, education, born sex, endocrine differences and treatment by means of repeated measures analysis of variance. GID patients and controls showed an identical time-dependent improvement in cognitive performance. The slopes were essentially parallel for males and females. There was no significant three-way interaction of born sex by group by time for the six investigated cognitive abilities. Only education and age significantly influenced this improvement. Despite the substantial somatic cross-sex changes in GID patients, no differential effect on cognition over time was found between C and GID participants. The cognitive performance of cross-sex hormone-treated GID patients was virtually identical to that of the control group. The documented test-retest effect should be taken into consideration when evaluating treatment effects generally in psychiatry.

  20. Intra-rater reliability and agreement of muscle strength, power and functional performance measures in patients with hip osteoarthritis

    DEFF Research Database (Denmark)

    Bieler, Theresa; Magnusson, S Peter; Kjær, Michael

    2014-01-01

    OBJECTIVE: To investigate the reliability and agreement of measures of lower extremity muscle strength, power and functional performance in patients with hip osteoarthritis at different time intervals, and to compare these with the same measures in healthy peers. DESIGN: Intra-rater test...... extensor power, and functional performance (8-foot Up & Go, stair climbing, chair stand and 6-min walk) were measured in patients, and quadriceps strength, leg extensor power and functional performance were measured in healthy peers. Systematic error, reliability and agreement were calculated. RESULTS......-retest separated by 1, 2, or 2.5 weeks in patients, and 1 week in healthy peers. SUBJECTS: Patients with hip osteoarthritis (age range 61-83 years) with 1 (n = 37), 2 (n = 35), or 2.5 weeks (n = 15) between tests, and 35 healthy peers (age range 63-82 years). METHODS: Maximal isometric hip and thigh strength, leg...

  1. COST ANALYSIS OF TUBERCULOSIS CONTROL ACTIVITIES CENTERED AT THE PATIENT AND PERFORMED ON THE OUT-PATIENT BASIS IN THE URBAN SETTINGS

    Directory of Open Access Journals (Sweden)

    I. E. Gelmanova

    2016-01-01

    Full Text Available Costs of out-patient patient-centered activities introduced into the existing standard model of the tuberculosis treatment have been evaluated in Tomsk TB Service. Additional measures enhancing compliance in the patients included the following: timely detection and management of side effects of chemotherapy, social support to the patients, treatment at home, psychological support and treatment by the Sputnik team of most socially vulnerable patients.The average additional costs for the patient-centered activities per 1 patient treated as per regimens I, II, III made 1367 RUR a month; per 1 PR TB patient – 2978 RUR; and per regimen IV – 4865 RUR. Patient-centered activities performed during the out-patient stage of treatment made 7% out of the total treatment costs for regimens I, II, III; 14% when treating polyresistant TB; and 16% for regimen IV. 

  2. Hip Fracture-Related Pain Strongly Influences Functional Performance of Patients With an Intertrochanteric Fracture Upon Discharge From the Hospital

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange

    2013-01-01

    .7 seconds to perform the TUG. No significant differences were observed in baseline characteristics or pain medication given for patients with a cervical versus an intertrochanteric fracture (P ≥ .22), but patients with an intertrochanteric fracture presented more often with moderate to severe pain during......OBJECTIVE: To examine whether functional performance upon hospital discharge is influenced by pain in the region of the hip fracture or related to the fracture type. DESIGN: Prospective observational study. SETTING: A 20-bed orthopedic hip fracture unit. PATIENTS: Fifty-five cognitively intact...... patients (20 men and 35 women; ages 75.8 ± 10 years), 33 with a cervical hip fracture and 22 with an intertrochanteric hip fracture, all of whom were allowed to bear full weight after surgery. METHODS: All patients were evaluated upon discharge from the hospital to their own homes at a mean of 10 ± 6 days...

  3. The influence of assistive technology on occupational performance and satisfaction of leprosy patients with grade 2 disabilities.

    Science.gov (United States)

    Muniz, Lucas da Silva; Amaral, Irmara Géssica Santos; Dias, Thiago da Silva; Rodrigues, Jorge Lopes

    2016-01-01

    We aimed to investigate the feasibility of assistive technology (AT) devices to improve leprosy patients' occupational performances and satisfaction. This is a pretest-posttest design study. The Canadian Occupational Performance Measure was used to assess the occupational performance and satisfaction of five leprosy participants with grade 2 disabilities before and after ten 45-minute interventions using assistive technology devices. The data showed a statistically significant 7-point average improvement (pgrade 2 disabilities.

  4. Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?

    Science.gov (United States)

    Yamashita, Shimpei; Kohjimoto, Yasuo; Hirabayashi, Yasuo; Iguchi, Takashi; Iba, Akinori; Higuchi, Masatoshi; Koike, Hiroyuki; Wakamiya, Takahito; Nishizawa, Satoshi; Hara, Isao

    2017-11-16

    It remains controversial as to whether active stone removal should be performed in patients with poor performance status because of their short life expectancy and perioperative risks. Our objectives were to evaluate treatment outcomes of active stone removal in patients with poor performance status and to compare life prognosis with those managed conservatively. We retrospectively reviewed 74 patients with Eastern Cooperative Oncology Group performance status 3 or 4 treated for upper urinary tract calculi at our four hospitals between January 2009 and March 2016. Patients were classified into either surgical treatment group or conservative management group based on the presence of active stone removal. Stone-free rate and perioperative complications in surgical treatment group were reviewed. In addition, we compared overall survival and stone-specific survival between the two groups. Cox proportional hazards analysis was performed to investigate predictors of overall survival and stone-specific survival. Fifty-two patients (70.3%) underwent active stone removal (surgical treatment group) by extracorporeal shock wave lithotripsy (n = 6), ureteroscopy (n = 39), percutaneous nephrolithotomy (n = 6) or nephrectomy (n = 1). The overall stone-free rate was 78.8% and perioperative complication was observed in nine patients (17.3%). Conservative treatment was undergone by 22 patients (29.7%) (conservative management group). Two-year overall survival rates in surgical treatment and conservative management groups were 88.0% and 38.4%, respectively (p performance status could be performed safely and effectively. Compared to conservative management, surgical stone treatment achieved longer overall survival and stone-specific survival.

  5. Performance adaptive training control strategy for recovering wrist movements in stroke patients: a preliminary, feasibility study

    Directory of Open Access Journals (Sweden)

    Sandini Giulio

    2009-12-01

    Full Text Available Abstract Background In the last two decades robot training in neuromotor rehabilitation was mainly focused on shoulder-elbow movements. Few devices were designed and clinically tested for training coordinated movements of the wrist, which are crucial for achieving even the basic level of motor competence that is necessary for carrying out ADLs (activities of daily life. Moreover, most systems of robot therapy use point-to-point reaching movements which tend to emphasize the pathological tendency of stroke patients to break down goal-directed movements into a number of jerky sub-movements. For this reason we designed a wrist robot with a range of motion comparable to that of normal subjects and implemented a self-adapting training protocol for tracking smoothly moving targets in order to facilitate the emergence of smoothness in the motor control patterns and maximize the recovery of the normal RoM (range of motion of the different DoFs (degrees of Freedom. Methods The IIT-wrist robot is a 3 DoFs light exoskeleton device, with direct-drive of each DoF and a human-like range of motion for Flexion/Extension (FE, Abduction/Adduction (AA and Pronation/Supination (PS. Subjects were asked to track a variable-frequency oscillating target using only one wrist DoF at time, in such a way to carry out a progressive splinting therapy. The RoM of each DoF was angularly scanned in a staircase-like fashion, from the "easier" to the "more difficult" angular position. An Adaptive Controller evaluated online performance parameters and modulated both the assistance and the difficulty of the task in order to facilitate smoother and more precise motor command patterns. Results Three stroke subjects volunteered to participate in a preliminary test session aimed at verify the acceptability of the device and the feasibility of the designed protocol. All of them were able to perform the required task. The wrist active RoM of motion was evaluated for each patient at the

  6. Predictive Performance of Echocardiographic Parameters for Cardiovascular Events Among Elderly Treated Hypertensive Patients.

    Science.gov (United States)

    Chowdhury, Enayet K; Jennings, Garry L R; Dewar, Elizabeth; Wing, Lindon M H; Reid, Christopher M

    2016-07-01

    Hypertension leads to cardiac structural and functional changes, commonly assessed by echocardiography. In this study, we assessed the predictive performance of different echocardiographic parameters including left ventricular hypertrophy (LVH) on future cardiovascular outcomes in elderly hypertensive patients without heart failure. Data from LVH substudy of the Second Australian National Blood Pressure trial were used. Echocardiograms were performed at entry into the study. Cardiovascular outcomes were identified over short term (median 4.2 years) and long term (median 10.9 years). LVH was defined using threshold values of LV mass (LVM) indexed to either body surface area (BSA) or height(2.7): >115/95g/m(2) (LVH-BSA(115/95)) or ≥49/45g/m(2.7) (LVH-ht(49/45)) in males/females, respectively, and ≥125g/m(2) (LVH-BSA(125)) or ≥51g/m(2.7) (LVH-ht(51)) for both sexes. In the 666 participants aged ≥65 years in this analysis, LVH prevalence at baseline was 33%-70% depending on definition; and after adjusting for potential risk factors, only LVH-BSA(115/95) predicted both short- and long-term cardiovascular outcomes. Participants having LVH-BSA(115/95) (69%) at baseline had twice the risk of having any first cardiovascular event over the short term (hazard ratio, 95% confidence interval: 2.00, 1.12-3.57, P = 0.02) and any fatal cardiovascular events (2.11, 1.21-3.68, P = 0.01) over the longer term. Among other echocardiographic parameters, LVM and LVM indexed to either BSA or height(2.7) predicted cardiovascular events over both short and longer term. In elderly treated hypertensive patients without heart failure, determining LVH by echocardiography is highly dependent on the methodology adopted. LVH-BSA(115/95) is a reliable predictor of future cardiovascular outcomes in the elderly. © American Journal of Hypertension, Ltd 2016. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. Dietary beetroot juice – effects on physical performance in COPD patients: a randomized controlled crossover trial

    Directory of Open Access Journals (Sweden)

    Friis AL

    2017-06-01

    Full Text Available Anne Louise Friis,1,* Carina Bjørnskov Steenholt,1,* Anders Løkke,2 Mette Hansen1 1Section for Sport Science, Department of Public Health, Aarhus University, Denmark; 2Department of Clinical Medicine, Aarhus University, Denmark *These authors contributed equally to this work Background and objective: Dietary beetroot juice (BR supplementation has been shown to reduce the oxygen (O2 consumption of standardized exercise and reduce resting blood pressure (BP in healthy individuals. However, the physiological response of BR in chronic obstructive pulmonary disease (COPD remains controversial. The objective was to test exercise performance in COPD, supplementing with higher doses of BR for a longer duration compared to previous trials in this patient group.Methods: Fifteen COPD patients consumed concentrated BR (2×70 mL twice daily, each containing 300 mg nitrate or placebo (PL (2×70 mL twice daily, nitrate-negligible in a randomized order for 6 consecutive days. On day 7, participants consumed either BR or PL 150 min before testing. BP was measured before completing 6-minute walk test (6MWT and two trials of submaximal cycling. The protocol was repeated after a minimum washout of 7 days.Results: Plasma nitrite concentration was higher in the BR condition compared to PL (P<0.01. There was no difference between the BR and PL conditions regarding the covered distance during the 6MWT (mean ± standard error of the mean: 515±35 m (BR vs 520±38 m (PL, P=0.46, O2 consumption of submaximal exercise (trial 1 P=0.31 vs trial 2 P=0.20, physical activity level (P>0.05, or systolic BP (P=0.80. However, diastolic BP (DBP was reduced after BR ingestion compared to baseline (mean difference: 4.6, 95% CI: 0.1–9.1, P<0.05.Conclusion: Seven days of BR ingestion increased plasma nitrite concentrations and lowered DBP in COPD patients. However, BR did not increase functional walking capacity, O2 consumption during submaximal cycling, or physical activity level

  8. Development of Rasch-based item banks for the assessment of work performance in patients with musculoskeletal diseases.

    Science.gov (United States)

    Mueller, Evelyn A; Bengel, Juergen; Wirtz, Markus A

    2013-12-01

    This study aimed to develop a self-description assessment instrument to measure work performance in patients with musculoskeletal diseases. In terms of the International Classification of Functioning, Disability and Health (ICF), work performance is defined as the degree of meeting the work demands (activities) at the actual workplace (environment). To account for the fact that work performance depends on the work demands of the job, we strived to develop item banks that allow a flexible use of item subgroups depending on the specific work demands of the patients' jobs. Item development included the collection of work tasks from literature and content validation through expert surveys and patient interviews. The resulting 122 items were answered by 621 patients with musculoskeletal diseases. Exploratory factor analysis to ascertain dimensionality and Rasch analysis (partial credit model) for each of the resulting dimensions were performed. Exploratory factor analysis resulted in four dimensions, and subsequent Rasch analysis led to the following item banks: 'impaired productivity' (15 items), 'impaired cognitive performance' (18), 'impaired coping with stress' (13) and 'impaired physical performance' (low physical workload 20 items, high physical workload 10 items). The item banks exhibited person separation indices (reliability) between 0.89 and 0.96. The assessment of work performance adds the activities component to the more commonly employed participation component of the ICF-model. The four item banks can be adapted to specific jobs where necessary without losing comparability of person measures, as the item banks are based on Rasch analysis.

  9. Authoring experience: the significance and performance of storytelling in Socratic dialogue with rehabilitating cancer patients.

    Science.gov (United States)

    Knox, Jeanette Bresson Ladegaard; Svendsen, Mette Nordahl

    2015-08-01

    This article examines the storytelling aspect in philosophizing with rehabilitating cancer patients in small Socratic dialogue groups (SDG). Recounting an experience to illustrate a philosophical question chosen by the participants is the traditional point of departure for the dialogical exchange. However, narrating is much more than a beginning point or the skeletal framework of events and it deserves more scholarly attention than hitherto given. Storytelling pervades the whole Socratic process and impacts the conceptual analysis in a SDG. In this article we show how the narrative aspect became a rich resource for the compassionate bond between participants and how their stories cultivated the abstract reflection in the group. In addition, the aim of the article is to reveal the different layers in the performance of storytelling, or of authoring experience. By picking, poking and dissecting an experience through a collaborative effort, most participants had their initial experience existentially refined and the chosen concept of which the experience served as an illustration transformed into a moral compass to be used in self-orientation post cancer.

  10. Comparison of speech performance in labial and lingual orthodontic patients: A prospective study

    Science.gov (United States)

    Rai, Ambesh Kumar; Rozario, Joe E.; Ganeshkar, Sanjay V.

    2014-01-01

    Background: The intensity and duration of speech difficulty inherently associated with lingual therapy is a significant issue of concern in orthodontics. This study was designed to evaluate and to compare the duration of changes in speech between labial and lingual orthodontics. Materials and Methods: A prospective longitudinal clinical study was designed to assess speech of 24 patients undergoing labial or lingual orthodontic treatment. An objective spectrographic evaluation of/s/sound was done using software PRAAT version 5.0.47, a semiobjective auditive evaluation of articulation was done by four speech pathologists and a subjective assessment of speech was done by four laypersons. The tests were performed before (T1), within 24 h (T2), after 1 week (T3) and after 1 month (T4) of the start of therapy. The Mann-Whitney U-test for independent samples was used to assess the significance difference between the labial and lingual appliances. A speech alteration with P appliance systems caused a comparable speech difficulty immediately after bonding (T2). Although the speech recovered within a week in the labial group (T3), the lingual group continued to experience discomfort even after a month (T4). PMID:25540661

  11. 198Au grain implantation for early tongue cancer in patients of advanced age or poor performance status

    International Nuclear Information System (INIS)

    Ryu, Yoshiharu; Shibuya, Hitoshi; Hayashi, Keiji

    2013-01-01

    Brachytherapy using 198 Au grains is minimally invasive and the only curative treatment for early tongue cancer in patients of advanced age or poor performance status available in our institution. From March 1993 to February 2008, 198 Au grains were used to treat a group of 96 Stage I–II tongue cancer patients who could not undergo surgery or brachytherapy using 192 Ir pins because of an advanced age (≥75 years) or poor performance status (≥2). The patients were followed for 3.9 ± 3.3 years, and the cause-specific survival and local control rates were determined. Survival analyses were performed using the Kaplan-Meier method, and univariate and multivariate analyses were performed using the Cox proportional hazard model. The results were compared with those for a group of 193 early tongue-cancer patients who underwent treatment using iridium pins. The 5-year cause-specific survival and local control rates of the 198 Au grains group were 71% and 68%, respectively, both of which were 16% lower than the corresponding rates for the 192 Ir pins group. Our study demonstrated that as the last curative treatment available, 198 Au grain implantation could be used to achieve moderate treatment results for early tongue cancer in patients of advanced age or poor performance status

  12. Impact on outcome of a targeted performance improvement programme in haemodynamically unstable patients with a pelvic fracture.

    Science.gov (United States)

    Perkins, Z B; Maytham, G D; Koers, L; Bates, P; Brohi, K; Tai, N R M

    2014-08-01

    We describe the impact of a targeted performance improvement programme and the associated performance improvement interventions, on mortality rates, error rates and process of care for haemodynamically unstable patients with pelvic fractures. Clinical care and performance improvement data for 185 adult patients with exsanguinating pelvic trauma presenting to a United Kingdom Major Trauma Centre between January 2007 and January 2011 were analysed with univariate and multivariate regression and compared with National data. In total 62 patients (34%) died from their injuries and opportunities for improved care were identified in one third of deaths. Three major interventions were introduced during the study period in response to the findings. These were a massive haemorrhage protocol, a decision-making algorithm and employment of specialist pelvic orthopaedic surgeons. Interventions which improved performance were associated with an annual reduction in mortality (odds ratio 0.64 (95% confidence interval (CI) 0.44 to 0.93), p = 0.02), a reduction in error rates (p = 0.024) and significant improvements in the targeted processes of care. Exsanguinating patients with pelvic trauma are complex to manage and are associated with high mortality rates; implementation of a targeted performance improvement programme achieved sustained improvements in mortality, error rates and trauma care in this group of severely injured patients. ©2014 The British Editorial Society of Bone & Joint Surgery.

  13. Design, development, and performance of an adapter for simulation of ocular melanoma patients in supine position for proton beam therapy

    International Nuclear Information System (INIS)

    Daftari, I.; Phillips, T.L.

    2003-01-01

    A patient assembly adapter system for ocular melanoma patient simulation was developed and its performance evaluated. The aim for the construction of the apparatus was to simulate the patients in supine position using a commercial x-ray simulator. The apparatus consists of a base plate, head immobilization holder, patient assembly system that includes fixation light and collimator system. The reproducibility of the repeated fixation was initially tested with a head phantom. Simulation and verification films were studied for seven consecutive patients treated with proton beam therapy. Patient's simulation was performed in a supine position using a dental fixation bite block and a thermoplastic head mask immobilization device with a patient adapter system. Two orthogonal x rays were used to obtain the x, y, and z coordinates of sutured tantalum rings for treatment planning with the EYEPLAN software. The verification films were obtained in treatment position with the fixation light along the central axis of the eye. The results indicate good agreement within 0.5 mm deviations. The results of this investigation showed that the same planning accuracy could be achieved by performing simulation using the adapter described above with a patient in the supine position as that obtained by performing simulation with the patient in the seated, treatment position. The adapter can also be attached to the head of the chair for simulating in the seated position using a fixed x-ray unit. This has three advantages: (1) this will save radiation therapists time; (2) it eliminates the need for arranging access to the treatment room, thus avoiding potential conflicts in treatment room usage; and (3) it allows the use of a commercial simulator

  14. Design, development, and performance of an adapter for simulation of ocular melanoma patients in supine position for proton beam therapy

    Science.gov (United States)

    Daftari, I.; Phillips, T. L.

    2003-06-01

    A patient assembly adapter system for ocular melanoma patient simulation was developed and its performance evaluated. The aim for the construction of the apparatus was to simulate the patients in supine position using a commercial x-ray simulator. The apparatus consists of a base plate, head immobilization holder, patient assembly system that includes fixation light and collimator system. The reproducibility of the repeated fixation was initially tested with a head phantom. Simulation and verification films were studied for seven consecutive patients treated with proton beam therapy. Patient's simulation was performed in a supine position using a dental fixation bite block and a thermoplastic head mask immobilization device with a patient adapter system. Two orthogonal x rays were used to obtain the x, y, and z coordinates of sutured tantalum rings for treatment planning with the EYEPLAN software. The verification films were obtained in treatment position with the fixation light along the central axis of the eye. The results indicate good agreement within 0.5 mm deviations. The results of this investigation showed that the same planning accuracy could be achieved by performing simulation using the adapter described above with a patient in the supine position as that obtained by performing simulation with the patient in the seated, treatment position. The adapter can also be attached to the head of the chair for simulating in the seated position using a fixed x-ray unit. This has three advantages: (1) this will save radiation therapists time; (2) it eliminates the need for arranging access to the treatment room, thus avoiding potential conflicts in treatment room usage; and (3) it allows the use of a commercial simulator.

  15. THE CLINICAL-SIGNIFICANCE OF CORONARY ANATOMY IN POST-INFARCT PATIENTS WITH LATE SUSTAINED VENTRICULAR-TACHYCARDIA OR VENTRICULAR-FIBRILLATION

    NARCIS (Netherlands)

    WIESFELD, ACP; CRIJNS, HJGM; HILLEGE, HL; TUININGA, YS; LIE, KI

    The role of ischaemia in post-infarct patients with ventricular tachyarrhythmias is not firmly established Using coronary angiography, 82 post-infarct patients with sustained ventricular tachycardia or fibrillation were subclassified into three groups. Fourteen patients (17%) had significant

  16. Diagnostic performance of {sup 18}F-dihydroxyphenylalanine positron emission tomography in patients with paraganglioma: a meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Treglia, Giorgio; Cocciolillo, Fabrizio; Castaldi, Paola; Rufini, Vittoria; Giordano, Alessandro [Catholic University of the Sacred Heart, Institute of Nuclear Medicine, Rome (Italy); De Waure, Chiara; Di Nardo, Francesco; Gualano, Maria Rosaria [Catholic University of the Sacred Heart, Institute of Hygiene, Rome (Italy)

    2012-07-15

    The aim of this study was to systematically review and conduct a meta-analysis of published data about the diagnostic performance of {sup 18}F-dihydroxyphenylalanine (DOPA) positron emission tomography (PET) in patients with paraganglioma (PG). A comprehensive computer literature search of studies published through 30 June 2011 regarding {sup 18}F-DOPA PET or PET/computed tomography (PET/CT) in patients with PG was performed in PubMed/MEDLINE, Embase and Scopus databases. Pooled sensitivity and specificity of {sup 18}F-DOPA PET or PET/CT in patients with PG on a per patient- and on a per lesion-based analysis were calculated. The area under the receiver-operating characteristic (ROC) curve was calculated to measure the accuracy of {sup 18}F-DOPA PET or PET/CT in patients with PG. Furthermore, a sub-analysis taking into account the different genetic mutations in PG patients was also performed. Eleven studies comprising 275 patients with suspected PG were included in this meta-analysis. The pooled sensitivity of {sup 18}F-DOPA PET and PET/CT in detecting PG was 91% [95% confidence interval (CI) 87-94%] on a per patient-based analysis and 79% (95% CI 76-81%) on a per lesion-based analysis. The pooled specificity of {sup 18}F-DOPA PET and PET/CT in detecting PG was 95% (95% CI 86-99%) on a per patient-based analysis and 95% (95% CI 84-99%) on a per lesion-based analysis. The area under the ROC curve was 0.95 on a per patient- and 0.94 on a per lesion-based analysis. Heterogeneity between the studies about sensitivity of {sup 18}F-DOPA PET or PET/CT was found. A significant increase in sensitivity of {sup 18}F-DOPA PET or PET/CT was observed when a sub-analysis excluding patients with succinate dehydrogenase subunit B (SDHB) gene mutations was performed. In patients with suspected PG {sup 18}F-DOPA PET or PET/CT demonstrated high sensitivity and specificity. {sup 18}F-DOPA PET or PET/CT are accurate methods in this setting. Nevertheless, possible sources of false

  17. Diagnostic performance of 18F-dihydroxyphenylalanine positron emission tomography in patients with paraganglioma: a meta-analysis

    International Nuclear Information System (INIS)

    Treglia, Giorgio; Cocciolillo, Fabrizio; Castaldi, Paola; Rufini, Vittoria; Giordano, Alessandro; De Waure, Chiara; Di Nardo, Francesco; Gualano, Maria Rosaria

    2012-01-01

    The aim of this study was to systematically review and conduct a meta-analysis of published data about the diagnostic performance of 18 F-dihydroxyphenylalanine (DOPA) positron emission tomography (PET) in patients with paraganglioma (PG). A comprehensive computer literature search of studies published through 30 June 2011 regarding 18 F-DOPA PET or PET/computed tomography (PET/CT) in patients with PG was performed in PubMed/MEDLINE, Embase and Scopus databases. Pooled sensitivity and specificity of 18 F-DOPA PET or PET/CT in patients with PG on a per patient- and on a per lesion-based analysis were calculated. The area under the receiver-operating characteristic (ROC) curve was calculated to measure the accuracy of 18 F-DOPA PET or PET/CT in patients with PG. Furthermore, a sub-analysis taking into account the different genetic mutations in PG patients was also performed. Eleven studies comprising 275 patients with suspected PG were included in this meta-analysis. The pooled sensitivity of 18 F-DOPA PET and PET/CT in detecting PG was 91% [95% confidence interval (CI) 87-94%] on a per patient-based analysis and 79% (95% CI 76-81%) on a per lesion-based analysis. The pooled specificity of 18 F-DOPA PET and PET/CT in detecting PG was 95% (95% CI 86-99%) on a per patient-based analysis and 95% (95% CI 84-99%) on a per lesion-based analysis. The area under the ROC curve was 0.95 on a per patient- and 0.94 on a per lesion-based analysis. Heterogeneity between the studies about sensitivity of 18 F-DOPA PET or PET/CT was found. A significant increase in sensitivity of 18 F-DOPA PET or PET/CT was observed when a sub-analysis excluding patients with succinate dehydrogenase subunit B (SDHB) gene mutations was performed. In patients with suspected PG 18 F-DOPA PET or PET/CT demonstrated high sensitivity and specificity. 18 F-DOPA PET or PET/CT are accurate methods in this setting. Nevertheless, possible sources of false-negative results should be kept in mind. Furthermore

  18. Diagnostic performance of 18F-dihydroxyphenylalanine positron emission tomography in patients with paraganglioma: a meta-analysis.

    Science.gov (United States)

    Treglia, Giorgio; Cocciolillo, Fabrizio; de Waure, Chiara; Di Nardo, Francesco; Gualano, Maria Rosaria; Castaldi, Paola; Rufini, Vittoria; Giordano, Alessandro

    2012-07-01

    The aim of this study was to systematically review and conduct a meta-analysis of published data about the diagnostic performance of (18)F-dihydroxyphenylalanine (DOPA) positron emission tomography (PET) in patients with paraganglioma (PG). A comprehensive computer literature search of studies published through 30 June 2011 regarding (18)F-DOPA PET or PET/computed tomography (PET/CT) in patients with PG was performed in PubMed/MEDLINE, Embase and Scopus databases. Pooled sensitivity and specificity of (18)F-DOPA PET or PET/CT in patients with PG on a per patient- and on a per lesion-based analysis were calculated. The area under the receiver-operating characteristic (ROC) curve was calculated to measure the accuracy of (18)F-DOPA PET or PET/CT in patients with PG. Furthermore, a sub-analysis taking into account the different genetic mutations in PG patients was also performed. Eleven studies comprising 275 patients with suspected PG were included in this meta-analysis. The pooled sensitivity of (18)F-DOPA PET and PET/CT in detecting PG was 91% [95% confidence interval (CI) 87-94%] on a per patient-based analysis and 79% (95% CI 76-81%) on a per lesion-based analysis. The pooled specificity of (18)F-DOPA PET and PET/CT in detecting PG was 95% (95% CI 86-99%) on a per patient-based analysis and 95% (95% CI 84-99%) on a per lesion-based analysis. The area under the ROC curve was 0.95 on a per patient- and 0.94 on a per lesion-based analysis. Heterogeneity between the studies about sensitivity of (18)F-DOPA PET or PET/CT was found. A significant increase in sensitivity of (18)F-DOPA PET or PET/CT was observed when a sub-analysis excluding patients with succinate dehydrogenase subunit B (SDHB) gene mutations was performed. In patients with suspected PG (18)F-DOPA PET or PET/CT demonstrated high sensitivity and specificity. (18)F-DOPA PET or PET/CT are accurate methods in this setting. Nevertheless, possible sources of false-negative results should be kept in mind

  19. Fourteen types of co-circulating recombinant enterovirus were associated with hand, foot, and mouth disease in children from Wenzhou, China.

    Science.gov (United States)

    Guo, Wen-Ping; Lin, Xian-Dan; Chen, Yi-Ping; Liu, Qi; Wang, Wen; Wang, Cai-Qiao; Li, Ming-Hui; Sun, Xiao-Yu; Shi, Mang; Holmes, Edward C; Zhang, Yong-Zhen

    2015-09-01

    Although hand, foot, and mouth disease (HFMD) is a major public concern in China, the prevalence and clinical symptoms associated with the different agents of HFMD in this country remain poorly understood. We investigated the clinical and molecular characteristics of enteroviruses in patients with HFMD from Wenzhou, China. Patients with laboratory-confirmed HFMD admitted to the Yuying Children's Hospital in Wenzhou, China during 2013 were included in this study. Viral RNA sequences were amplified using RT-PCR, determined by sequencing, and compared by phylogenetic analysis. A total of 955 clinically diagnosed HFMD cases were determined using PCR, with whole viral genomes obtained for each enterovirus type. 14 types of enterovirus belonging to two viral species were identified. Notably, Coxsackievirus A6 (CV-A6) was the most common species detected (77.8%), followed by EV-A71 (8.2%) and CV-A10 (8.1%). Phylogenetic analysis revealed multiple independent introductions of these viruses into Wenzhou. In addition, the enterovirus observed in Wenzhou had a recombinant history, with two or three recombination breakpoints. Although the illness associated with CV-A6 was milder than that of EV-A71, CV-A6 infection caused more widespread rash, larger blisters, and subsequent skin peeling and/or nail shedding. Our study revealed the co-circulation of 14 types of enteroviruses in a single location - Wenzhou, China - with CV-A6 virus the predominant agent of HFMD. This work highlights the need to perform larger-scale surveillance to fully understand the epidemiology of enteroviruses in China and the wider Asia-Pacific region. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. The efficacy of treatment performed for temporomandibular joint patients at dental school of Tehran University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Sahebi Majid

    2015-01-01

    Full Text Available   Background and Aims: Temporomandibular joint disorders are common problems among patients referring to dental schools and clinics. However appropriate treatment modalities are performed for the TMD patients in dental school, the results and success rate of these treatments are not studied distinctly. The aims of this study was to determine the treatment performed for temporomandibular patients at the TMJ department of Tehran University dental school in 2010-11 .   Materials and Methods: In a descriptive cross-sectional trial, 85 TMD patients treated at the TMJ department of Tehran University dental school were examined at least 3 months after the treatments. The patients demographic data ,TMD signs and symptoms and the improvements occurred in TMD disorder were determined (complete, partial and no improvement. The patients satisfaction regarding the treatment results were investigated and data were analyzed regarding the presence of different TMD signs and symptoms before and after the treatment using Mann-Whitney U test .   Results: TMJ pain (35 cases, 42.2%, click (33 cases, 39.8% and muscle tenderness (26 cases, 31.3% were the most prevalent obtained signs and symptoms. The mean age of the patients were 32.3 years old while females were the predominant group (72 cases vs.11 one. 44 individuals (53.0% were treated by splint, 11 ones (13.3% with anterior repositioning splint and 17 individuals (92.5% were managed by physiotherapy plus splint. 65 patients (87.3% were satisfied with the results and 16 ones (19.3% were not. After the treatment, patients with TMJ pain (P0.05 .   Conclusion: The results showed that the treatments presented for the TMD patients at Tehran University dental school were successful and most patients received satisfactory treatment.

  1. Performance of the hepatic encephalopathy scoring algorithm in a clinical trial of patients with cirrhosis and severe hepatic encephalopathy

    DEFF Research Database (Denmark)

    Hassanein, T.; Blei, A.T.; Perry, W.

    2009-01-01

    OBJECTIVES: The grading of hepatic encephalopathy (HE) is based on a combination of indicators that reflect the state of consciousness, intellectual function, changes in behavior, and neuromuscular alterations seen in patients with liver failure. METHODS: We modified the traditional West Haven...... criteria (WHC) to provide an objective assessment of the cognitive parameters to complement the subjective clinical ratings for the performance of extracorporeal albumin dialysis (ECAD) using a molecular adsorption recirculating system in patients with cirrhosis and severe (grade III / IV) encephalopathy...

  2. The patient work system: an analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers.

    Science.gov (United States)

    Holden, Richard J; Schubert, Christiane C; Mickelson, Robin S

    2015-03-01

    Human factors and ergonomics approaches have been successfully applied to study and improve the work performance of healthcare professionals. However, there has been relatively little work in "patient-engaged human factors," or the application of human factors to the health-related work of patients and other nonprofessionals. This study applied a foundational human factors tool, the systems model, to investigate the barriers to self-care performance among chronically ill elderly patients and their informal (family) caregivers. A Patient Work System model was developed to guide the collection and analysis of interviews, surveys, and observations of patients with heart failure (n = 30) and their informal caregivers (n = 14). Iterative analyses revealed the nature and prevalence of self-care barriers across components of the Patient Work System. Person-related barriers were common and stemmed from patients' biomedical conditions, limitations, knowledge deficits, preferences, and perceptions as well as the characteristics of informal caregivers and healthcare professionals. Task barriers were also highly prevalent and included task difficulty, timing, complexity, ambiguity, conflict, and undesirable consequences. Tool barriers were related to both availability and access of tools and technologies and their design, usability, and impact. Context barriers were found across three domains-physical-spatial, social-cultural, and organizational-and multiple "spaces" such as "at home," "on the go," and "in the community." Barriers often stemmed not from single factors but from the interaction of several work system components. Study findings suggest the need to further explore multiple actors, contexts, and interactions in the patient work system during research and intervention design, as well as the need to develop new models and measures for studying patient and family work. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  3. Performance of language tasks in patients with ruptured aneurysm of the left hemisphere worses in the post-surgical evaluation

    Directory of Open Access Journals (Sweden)

    Ana Cláudia C. Vieira

    2016-08-01

    Full Text Available ABSTRACT Sub-arachnoid hemorrhage (SAH promotes impairment of upper cortical functions. However, few information is available emphasizing changes in language after aneurismal SAH and aneurysm location influence. Objective To assess the language and verbal fluency performance in aneurismal SAH pre- and post-surgery in patients caused by an aneurysm of the anterior communicating artery (AcomA, left middle cerebral artery (L-MCA and left posterior comunicating artery (L-PcomA. Methods Assessment in 79 patients with SAH, on two occasions: pre- and post surgical treatment. They were divided into three groups by the aneurysms’ location. Results Deterioration is detected in the performance of all patients during the post-surgical period; L-MCA aneurysm patients displayed a reduction in verbal naming and fluency; L-PcomA patients deteriorated in the written language and fluency tasks. Conclusion After the surgical procedure the patients decreased in various language tasks and these differences in performance being directly related to the location of the aneurysm.

  4. Profiling Surgeon Performance for Breast Cancer Lumpectomy by Composite Measurement of Reoperations, Cosmetic Outcomes, and Patient Preferences.

    Science.gov (United States)

    Dunham, Annie L; Ramirez, Luis D; Vang, Choua A; Linebarger, Jared H; Landercasper, Jeffrey

    2018-07-01

    Patients want information to search for destination of care for breast-conserving surgery (BCS). To inform patients wanting a lumpectomy, we aimed to develop a pilot project that communicated composite quality measure (QM) results using a '4-star' rating system. Two patient-centered QMs were included in the model-reoperation rate (ROR) and cosmetic outcome (COSM). A prospective database was reviewed for stage 0-3 patients undergoing initial lumpectomy by three surgeons from 2010 to 2015. Self-reported COSM was assessed by survey. Multivariate analyses were used to test for interactions between surgeon and other variables known to influence RORs and COSMs. Models of surgeon profiling were developed that summed the ROR and COSM performance scores, then reported results using a Centers for Medicare and Medicaid Services (CMS) star-type system. Functionality for a patient to 'weight' the importance of the ratio of ROR:COSM before profiling was introduced. The unadjusted ROR for stage 1-3 patients for three surgeons was 9.5, 13.0, and 16.3%, respectively (p = 0.179) [overall rate 10.4% (38/366)]. After risk adjustment, differences between surgeons were observed for RORs, but not COSMs. Overall, patients reported excellent, good, fair, and poor COSMs of 55, 30, 11 and 4%, respectively. Composite star scores reflected differences in performance by surgeon, which could increase, or even disappear, dependent on the patient's weighting of the ROR:COSM ratio. Composite measures of performance can be developed that allow patients to input their weighted preferences and values into surgeon profiling before they consider a destination of care for BCS.

  5. Measurement Properties of Performance-Specific Pain Ratings of Patients Awaiting Total Joint Arthroplasty as a Consequence of Osteoarthritis

    Science.gov (United States)

    Stratford, Paul W.; Kennedy, Deborah M.; Woodhouse, Linda J.; Spadoni, Gregory

    2008-01-01

    Purpose: To estimate the test–retest reliability of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain sub-scale and performance-specific assessments of pain, as well as the association between these measures for patients awaiting primary total hip or knee arthroplasty as a consequence of osteoarthritis. Methods: A total of 164 patients awaiting unilateral primary hip or knee arthroplasty completed four performance measures (self-paced walk, timed up and go, stair test, six-minute walk) and the WOMAC. Scores for 22 of these patients provided test–retest reliability data. Estimates of test–retest reliability (Type 2,1 intraclass correlation coefficient [ICC] and standard error of measurement [SEM]) and the association between measures were examined. Results: ICC values for individual performance-specific pain ratings were between 0.70 and 0.86; SEM values were between 0.97 and 1.33 pain points. ICC estimates for the four-item performance pain ratings and the WOMAC pain sub-scale were 0.82 and 0.57 respectively. The correlation between the sum of the pain scores for the four performance measures and the WOMAC pain sub-scale was 0.62. Conclusion: Reliability estimates for the performance-specific assessments of pain using the numeric pain rating scale were consistent with values reported for patients with a spectrum of musculoskeletal conditions. The reliability estimate for the WOMAC pain sub-scale was lower than typically reported in the literature. The level of association between the WOMAC pain sub-scale and the various performance-specific pain scales suggests that the scores can be used interchangeably when applied to groups but not for individual patients. PMID:20145758

  6. Analysis of mental disorders in tinnitus patients performed with Composite International Diagnostic Interview.

    Science.gov (United States)

    Zirke, N; Seydel, C; Arsoy, D; Klapp, B F; Haupt, H; Szczepek, A J; Olze, H; Goebel, G; Mazurek, B

    2013-10-01

    Known association between tinnitus and psychological distress prompted us to examine patients with chronic tinnitus by using the Composite International Diagnostic Interview (CIDI), which is a standardized and reliable method used for the diagnosis of mental disorders. One hundred patients with chronic tinnitus admitted to the Tinnitus Center, Charité-Universitätsmedizin Berlin, were included in this study. Data were collected between February 2008 and February 2009. Besides CIDI, the Tinnitus Questionnaire according to Goebel and Hiller, the Hospital Anxiety Depression Scale, and the General Anxiety Disorder-7 were used. Using CIDI, we have identified one or more mental disorders in 46 tinnitus patients. In that group, we found persistent affective disorders (37 %), anxiety disorders (32 %), and somatoform disorders (27 %). Those patients who had affective or anxiety disorders were more distressed by tinnitus and were more anxious and more depressed than tinnitus patients without mental disorders. Psychological impairment positively correlated with tinnitus distress: Patients with decompensated tinnitus had significantly more affective and anxiety disorders than patients with compensated tinnitus. In the present study, we have detected a high rate (almost half of the cases) of psychological disorders occurring in patients with chronic tinnitus. The patients diagnosed with psychological disorders were predominantly affected by affective and anxiety disorders. Psychological disorders were associated with severity of tinnitus distress. Our findings imply a need for routine comprehensive screening of mental disorders in patients with chronic tinnitus.

  7. Feasibility of foot deformations corrective operations performing in patients with diabetes

    Directory of Open Access Journals (Sweden)

    S. D. Shapoval

    2017-08-01

    Full Text Available Objective: To improve methods of early diagnosis of diabetic neuropathy and suggest options for surgical prophylaxis possible purulent and necrotic complications in patients with diabetic foot syndrome. Materials and Methods. The study involved 64 patients with complicated diabetic foot syndrome (DFS. The average age of patients - 61,9 ± 3,8 years, duration of diabetes - 11,47 ± 3,2 years. The patients had neuropathic and mixed forms of DFS, fingers or arched foot deformations with the presence of pressor venous trophic ulcers in the forefoot. Patients were randomized into two groups: the main group - 34 and comparison group - 30 patients. There were representative characteristics for all groups: age, sex, comorbidity and did not differ significantly (P> 0,05. There were no statistically significant difference between the groups of these data (χ2 = 0,05; P = 0,8195. Results. After 6 months of complex treatment the ulcers were healed in more than half of patients in both groups - 19 (63,3% of patients in the comparison group and 25 (73,5% of the main group. In 8 (26,7% patients in the comparison and 7 (20,6% of the main group positive dynamics was observed, but over a longer period of treatment . After 12 months, the number of patients whose ulcers were completely healed differed significantly by the main group (P = 0,0007; χ2 = 11,41. Also in the main group was only 1 (3,0% patient with ulcer that was not healed, in contrast to the comparison group - 7 (23,3% patients (P = 0,0373; χ2 = 4,34. Conclusions. Operations aimed at correction of fingers and feet deformations in combination with standard therapy and unloading of the lower limb, allow improving the results of patients with complicated DFS treatment by reducing the number of relapses.

  8. Prediction of changes in memory performance by plasma homovanillic acid levels in clozapine-treated patients with schizophrenia.

    Science.gov (United States)

    Sumiyoshi, Tomiki; Roy, A; Kim, C-H; Jayathilake, K; Lee, M A; Sumiyoshi, C; Meltzer, H Y

    2004-12-01

    Cognitive dysfunction in schizophrenia has been demonstrated to be dependent, in part, on dopaminergic activity. Clozapine has been found to improve some domains of cognition, including verbal memory, in patients with schizophrenia. This study tested the hypothesis that plasma homovanillic acid (pHVA) levels, a peripheral measure of central dopaminergic activity, would predict the change in memory performance in patients with schizophrenia treated with clozapine. Twenty-seven male patients with schizophrenia received clozapine treatment for 6 weeks. Verbal list learning (VLL)-Delayed Recall (VLL-DR), a test of secondary verbal memory, was administered before and after clozapine treatment. Blood samples to measure pHVA levels were collected at baseline. Baseline pHVA levels were negatively correlated with change in performance on VLL-DR; the lower baseline pHVA level was associated with greater improvement in performance on VLL-DR during treatment with clozapine. Baseline pHVA levels in subjects who showed improvement in verbal memory during clozapine treatment ( n=13) were significantly lower than those in subjects whose memory performance did not improve ( n=14). The results of this study indicate that baseline pHVA levels predict the ability of clozapine to improve memory performance in patients with schizophrenia.

  9. Validation of Taiwan Performance-Based Instrumental Activities of Daily Living (TPIADL), a Performance- Based Measurement of Instrumental Activities of Daily Living for Patients with Vascular Cognitive Impairment.

    Science.gov (United States)

    Chen, Hui-Mei; Lin, Hsiu-Fen; Huang, Mei-Feng; Chang, Chun-Wei; Yeh, Yi-Chun; Lo, Yi-Ching; Yen, Cheng-Fang; Chen, Cheng-Sheng

    2016-01-01

    Patients with cerebrovascular diseases often presented both cognitive and physical impairment. Disability in everyday functioning involving cognitive impairment among patients may be hard to completely rely on informants' reports, as their reports may be confounded with physical impairment. The aim of this study was to validate a performance-based measure of functional assessment, the Taiwan Performance-Based Instrumental Activities of Daily Living (TPIADL), for vascular cognitive impairment (VCI) by examining its psychometric properties and diagnostic accuracy. Ninety-seven patients with cerebrovascular diseases, including 30 with vascular dementia (VaD), 28 with mild cognitive impairment and 39 with no cognitive impairment, and 49 healthy control adults were recruited during study period. The TPIADL, as well as the Mini Mental State Examination (MMSE), Lawton-IADL and Barthel Index (BI), were performed. The internal consistency, convergent and criteria validity of the TPIADL were examined. Cronbach's alpha of the TPIADL test was 0.84. The TPIADL scores were significantly correlated with the Lawton IADL (r = -0.587, p cognitive domain of Lawton IADL (r = -0.663) than with physical domain of Lawton IADL (r = -0.541). The area under the relative operating characteristic curve was 0.888 (95% CI = 0.812-0.965) to differentiate VaD from other groups. The optimal cut-off point of the TPIADL for detecting VaD was 6/7, which gives a sensitivity of 73.3% and a specificity of 84.5%. The TPIADL is a brief and sensitive tool for the detection of IADL impairment in patients with VaD.

  10. Validation of Taiwan Performance-Based Instrumental Activities of Daily Living (TPIADL, a Performance- Based Measurement of Instrumental Activities of Daily Living for Patients with Vascular Cognitive Impairment.

    Directory of Open Access Journals (Sweden)

    Hui-Mei Chen

    Full Text Available Patients with cerebrovascular diseases often presented both cognitive and physical impairment. Disability in everyday functioning involving cognitive impairment among patients may be hard to completely rely on informants' reports, as their reports may be confounded with physical impairment. The aim of this study was to validate a performance-based measure of functional assessment, the Taiwan Performance-Based Instrumental Activities of Daily Living (TPIADL, for vascular cognitive impairment (VCI by examining its psychometric properties and diagnostic accuracy.Ninety-seven patients with cerebrovascular diseases, including 30 with vascular dementia (VaD, 28 with mild cognitive impairment and 39 with no cognitive impairment, and 49 healthy control adults were recruited during study period. The TPIADL, as well as the Mini Mental State Examination (MMSE, Lawton-IADL and Barthel Index (BI, were performed. The internal consistency, convergent and criteria validity of the TPIADL were examined.Cronbach's alpha of the TPIADL test was 0.84. The TPIADL scores were significantly correlated with the Lawton IADL (r = -0.587, p <0.01. Notably, the TPIADL had a higher correlation coefficient with the cognitive domain of Lawton IADL (r = -0.663 than with physical domain of Lawton IADL (r = -0.541. The area under the relative operating characteristic curve was 0.888 (95% CI = 0.812-0.965 to differentiate VaD from other groups. The optimal cut-off point of the TPIADL for detecting VaD was 6/7, which gives a sensitivity of 73.3% and a specificity of 84.5%.The TPIADL is a brief and sensitive tool for the detection of IADL impairment in patients with VaD.

  11. THE RELATION OF FAT FREE MASS TO LUNG FUNCTION, MUSCLE STRENGTH AND EXERCISE PERFORMANCE IN PATIENTS WITH EMPHYSEMA

    OpenAIRE

    竹中, 英昭

    2000-01-01

    The purpose of this study was to investigate changes of body composition in patients with pulmonary emphysema (PE) and their influence on physiological function. Body composition analysis by means of bioelectrical impedance analysis (BIA) was performed in 36 patients with stable PE and 19 age-matched healthy controls. I compared fat free mass (FFM) and body fat (BF), as a percentage of ideal body weight (FFM/IBW, BF/IBW), between patients with PE and healthy controls. FFM/IBW and BF /IBW were...

  12. Memory Test Performance on Analogous Verbal and Nonverbal Memory Tests in Patients with Frontotemporal Dementia and Alzheimer's Disease

    Directory of Open Access Journals (Sweden)

    Deanna Baldock

    2016-01-01

    Full Text Available Background: Patients with frontotemporal dementia (FTD typically have initial deficits in language or changes in personality, while the defining characteristic of Alzheimer's disease (AD is memory impairment. Neuropsychological findings in the two diseases tend to differ, but can be confounded by verbal impairment in FTD impacting performance on memory tests in these patients. Methods: Twenty-seven patients with FTD and 102 patients with AD underwent a neuropsychological assessment before diagnosis. By utilizing analogous versions of a verbal and nonverbal memory test, we demonstrated differences in these two modalities between AD and FTD. Discussion: Better differentiation between AD and FTD is found in a nonverbal memory test, possibly because it eliminates the confounding variable of language deficits found in patients with FTD. These results highlight the importance of nonverbal learning tests with multiple learning trials in diagnostic testing.

  13. Memory Test Performance on Analogous Verbal and Nonverbal Memory Tests in Patients with Frontotemporal Dementia and Alzheimer's Disease.

    Science.gov (United States)

    Baldock, Deanna; Miller, Justin B; Leger, Gabriel C; Banks, Sarah Jane

    2016-01-01

    Patients with frontotemporal dementia (FTD) typically have initial deficits in language or changes in personality, while the defining characteristic of Alzheimer's disease (AD) is memory impairment. Neuropsychological findings in the two diseases tend to differ, but can be confounded by verbal impairment in FTD impacting performance on memory tests in these patients. Twenty-seven patients with FTD and 102 patients with AD underwent a neuropsychological assessment before diagnosis. By utilizing analogous versions of a verbal and nonverbal memory test, we demonstrated differences in these two modalities between AD and FTD. Better differentiation between AD and FTD is found in a nonverbal memory test, possibly because it eliminates the confounding variable of language deficits found in patients with FTD. These results highlight the importance of nonverbal learning tests with multiple learning trials in diagnostic testing.

  14. Personality characteristics and affective status related to cognitive test performance and gender in patients with memory complaints.

    Science.gov (United States)

    Vestberg, Susanna; Passant, Ulla; Risberg, Jarl; Elfgren, Christina

    2007-11-01

    The aims are to study personality characteristics of patients with memory complaints and to assess the presence of objective (OMI) versus subjective (SMI) memory impairment, the affective status, as well as potential gender differences. The patients were assessed by means of a neuropsychiatric examination and a neuropsychological test-battery. The Swedish version of the revised NEO Personality Inventory (NEO PI-R) and the Hospital Anxiety and Depression Scale (HADS) were used. The 57 patients (38 women, 19 men, mean age 56.9) differed from the Swedish normative group in three of the five personality factors: neuroticism, extraversion and agreeableness. This was mainly because of the scores of the female patients. Approximately half of the patients had OMI. No differences regarding personality factors or affective status were found between OMI and SMI patients. The female patients scored significantly higher than the male patients on symptoms of anxiety and depression. Neuroticism and symptoms of depression interacted with memory performance and gender. Our findings demonstrate the importance of applying an objective assessment of memory functions and a gender perspective when studying patients with memory complaints.

  15. Changes in arm-hand function and arm-hand skill performance in patients after stroke during and after rehabilitation.

    Science.gov (United States)

    Franck, Johan Anton; Smeets, Rob Johannes Elise Marie; Seelen, Henk Alexander Maria

    2017-01-01

    Arm-hand rehabilitation programs applied in stroke rehabilitation frequently target specific populations and thus are less applicable in heterogeneous patient populations. Besides, changes in arm-hand function (AHF) and arm-hand skill performance (AHSP) during and after a specific and well-described rehabilitation treatment are often not well evaluated. This single-armed prospective cohort study featured three subgroups of stroke patients with either a severely, moderately or mildly impaired AHF. Rehabilitation treatment consisted of a Concise_Arm_and_hand_ Rehabilitation_Approach_in_Stroke (CARAS). Measurements at function and activity level were performed at admission, clinical discharge, 3, 6, 9 and 12 months after clinical discharge. Eighty-nine stroke patients (M/F:63/23; mean age:57.6yr (+/-10.6); post-stroke time:29.8 days (+/-20.1)) participated. All patients improved on AHF and arm-hand capacity during and after rehabilitation, except on grip strength in the severely affected subgroup. Largest gains occurred in patients with a moderately affected AHF. As to self-perceived AHSP, on average, all subgroups improved over time. A small percentage of patients declined regarding self-perceived AHSP post-rehabilitation. A majority of stroke patients across the whole arm-hand impairment severity spectrum significantly improved on AHF, arm-hand capacity and self-perceived AHSP. These were maintained up to one year post-rehabilitation. Results may serve as a control condition in future studies.

  16. Genital reconstruction in exstrophy patients

    Directory of Open Access Journals (Sweden)

    R B Nerli

    2012-01-01

    Full Text Available Introduction: Surgery for bladder exstrophy has been evolving over the last four to five decades. Because survival has become almost universal, the focus has changed in the exstrophy-epispadias complex to improving quality of life. The most prevalent problem in the long-term function of exstrophy patients is the sexual activity of the adolescent and adult males. The penis in exstrophy patients appears short because of marked congenital deficiency of anterior corporal tissue. Many patients approach for genital reconstruction to improve cosmesis as well as to correct chordee. We report our series of male patients seeking genital reconstruction following exstrophy repair in the past. Materials and Methods: Fourteen adolescent/adult male patients attended urology services during the period January 2000-December 2009 seeking genital reconstruction following exstrophy repair in the past. Results: Three patients underwent epispadias repair, four patients had chordee correction with cosmetic excision of skin tags and seven patients underwent chordee correction with penile lengthening. All patients reported satisfaction in the answered questionnaire. Patients undergoing penile lengthening by partial corporal dissection achieved a mean increase in length of 1.614 ± 0.279 cm dorsally and 1.543 ± 0.230 cm ventrally. The satisfactory rate assessed by the Short Form-36 (SF-36 showed that irrespective of the different genital reconstructive procedures done, the patients were satisfied with cosmetic and functional outcome. Conclusions: Surgical procedures have transformed the management in these patients with bladder exstrophy. Bladders can be safely placed within the pelvis, with most patients achieving urinary continence and cosmetically acceptable external genitalia. Genital reconstruction in the form of correction of chordee, excision of ugly skin tags and lengthening of penis can be performed to give the patients a satisfactory cosmetic and functional

  17. Medication adherence, work performance and self-esteem among psychiatric patients attending psychosocial rehabilitation services at Bangalore, India

    OpenAIRE

    Sailaxmi Gandhi; Rajitha Pavalur; Sivakumar Thanapal; Nirmala B Parathasarathy; Geetha Desai; Poornima Bhola; Mariamma Philip; Santosh K Chaturvedi

    2014-01-01

    Context: Work benefits mental health in innumerable ways. Vocational rehabilitation can enhance self-esteem. Medication adherence can improve work performance and thereby the individuals’ self-esteem. Aim: To test the hypothesis that there would be a significant correlation between medication adherence, work performance and self-esteem. Setting and Design: A quantitative, descriptive correlational research design was adopted to invite patients attending psychiatric rehabilitation services to ...

  18. Use of multiple-site performance-contingent SEMG reward programming in pediatric rehabilitation: a retrospective review.

    Science.gov (United States)

    Bolek, Jeffrey E

    2006-09-01

    We completed a retrospective review of the effectiveness of multi-site, performance-contingent reward programming on functional change in motor performance of 16 treatment resistant children. Patients were previously treated in physical or occupational therapy for head control, standing balance training, sitting and upper extremity use (brachial plexus injury). They then participated in a program that utilized multiple surface electromyography sites the use of which was rewarded with videos for performing the correct constellation of recruitment pattern (e.g., contracting some muscles while relaxing others). Onset of reward was calibrated for each patient and transfer of skill to outside the clinic was encouraged by linking a verbal cue to the correct motor plan. Fourteen of the 16 patients improved. The implications of the use of this technique in the treatment of motor dysfunction is discussed.

  19. Pretraining and posttraining assessment of residents' performance in the fourth accreditation council for graduate medical education competency: patient communication skills.

    Science.gov (United States)

    Chandawarkar, Rajiv Y; Ruscher, Kimberly A; Krajewski, Aleksandra; Garg, Manish; Pfeiffer, Carol; Singh, Rekha; Longo, Walter E; Kozol, Robert A; Lesnikoski, Beth; Nadkarni, Prakash

    2011-08-01

    Structured communication curricula will improve surgical residents' ability to communicate effectively with patients. A prospective study approved by the institutional review board involved 44 University of Connecticut general surgery residents. Residents initially completed a written baseline survey to assess general communication skills awareness. In step 1 of the study, residents were randomized to 1 of 2 simulations using standardized patient instructors to mimic patients receiving a diagnosis of either breast or rectal cancer. The standardized patient instructors scored residents' communication skills using a case-specific content checklist and Master Interview Rating Scale. In step 2 of the study, residents attended a 3-part interactive program that comprised (1) principles of patient communication; (2) experiences of a surgeon (role as physician, patient, and patient's spouse); and (3) role-playing (3-resident groups played patient, physician, and observer roles and rated their own performance). In step 3, residents were retested as in step 1, using a crossover case design. Scores were analyzed using Wilcoxon signed rank test with a Bonferroni correction. Case-specific performance improved significantly, from a pretest content checklist median score of 8.5 (65%) to a posttest median of 11.0 (84%) (P = .005 by Wilcoxon signed rank test for paired ordinal data)(n = 44). Median Master Interview Rating Scale scores changed from 58.0 before testing (P = .10) to 61.5 after testing (P = .94). Difference between overall rectal cancer scores and breast cancer scores also were not significant. Patient communication skills need to be taught as part of residency training. With limited training, case-specific skills (herein, involving patients with cancer) are likely to improve more than general communication skills.

  20. Patient-reported outcome measures versus inertial performance-based outcome measures: A prospective study in patients undergoing primary total knee arthroplasty.

    Science.gov (United States)

    Bolink, S A A N; Grimm, B; Heyligers, I C

    2015-12-01

    Outcome assessment of total knee arthroplasty (TKA) by subjective patient reported outcome measures (PROMs) may not fully capture the functional (dis-)abilities of relevance. Objective performance-based outcome measures could provide distinct information. An ambulant inertial measurement unit (IMU) allows kinematic assessment of physical performance and could potentially be used for routine follow-up. To investigate the responsiveness of IMU measures in patients following TKA and compare outcomes with conventional PROMs. Patients with end stage knee OA (n=20, m/f=7/13; age=67.4 standard deviation 7.7 years) were measured preoperatively and one year postoperatively. IMU measures were derived during gait, sit-stand transfers and block step-up transfers. PROMs were assessed by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS). Responsiveness was calculated by the effect size, correlations were calculated with Spearman's rho correlation coefficient. One year after TKA, patients performed significantly better at gait, sit-to-stand transfers and block step-up transfers. Measures of time and kinematic IMU measures demonstrated significant improvements postoperatively for each performance-based test. The largest improvement was found in block step-up transfers (effect size=0.56-1.20). WOMAC function score and KSS function score demonstrated moderate correlations (Spearman's rho=0.45-0.74) with some of the physical performance-based measures pre- and postoperatively. To characterize the changes in physical function after TKA, PROMs could be supplemented by performance-based measures, assessing function during different activities and allowing kinematic characterization with an ambulant IMU. Copyright © 2015 Elsevier B.V. All rights reserved.

  1. [The geriatric perioperative unit, a high performance care department for elderly surgical patients].

    Science.gov (United States)

    Papas, Anne; Caillard, Laurence; Nion, Nathalie

    2011-01-01

    For over a year Professor Marc Verny's geriatric department at Pitié-Salpêtrière hospital in Paris has had ten beds set aside for the perioperative care of elderly people. This geriatric perioperative unit (UPOG) offers patients the skills of a multidisciplinary team trained in the specificities of caring for elderly patients often suffering from polypathology. The team works closely together around a common goal: the rapid return of the patient's autonomy during the postoperative period, crucial for the future of elderly people. So far UPOG's results have been very positive, as more than 90% of patients regain their autonomy after a short and uncomplicated period of postoperative care.

  2. Right ventricle performances with echocardiography and 99mTc myocardial perfusion imaging in pulmonary arterial hypertension patients.

    Science.gov (United States)

    Liu, Jie; Fei, Lei; Huang, Guang-Qing; Shang, Xiao-Ke; Liu, Mei; Pei, Zhi-Jun; Zhang, Yong-Xue

    2018-05-01

    Right heart catheterization is commonly used to measure right ventricle hemodynamic parameters and is the gold standard for pulmonary arterial hypertension diagnosis; however, it is not suitable for patients' long-term follow-up. Non-invasive echocardiography and nuclear medicine have been applied to measure right ventricle anatomy and function, but the guidelines for the usefulness of clinical parameters remain to be established. The goal of this study is to identify reliable clinical parameters of right ventricle function in pulmonary arterial hypertension patients and analyze the relationship of these clinical parameters with the disease severity of pulmonary arterial hypertension. In this study, 23 normal subjects and 23 pulmonary arterial hypertension patients were recruited from January 2015 to March 2016. Pulmonary arterial hypertension patients were classified into moderate and severe pulmonary arterial hypertension groups according to their mean pulmonary arterial pressure levels. All the subjects were subjected to physical examination, chest X-ray, 12-lead electrocardiogram, right heart catheterization, two-dimensional echocardiography, and technetium 99m ( 99m Tc) myocardial perfusion imaging. Compared to normal subjects, the right heart catheterization indexes including right ventricle systolic pressure, right ventricle end diastolic pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, pulmonary vascular resistance, and right ventricle end systolic pressure increased in pulmonary arterial hypertension patients and were correlated with mean pulmonary arterial pressure levels. Echocardiography parameters, including tricuspid regurgitation peak velocity, tricuspid regurgitation pressure gradient, tricuspid annular plane systolic excursion and fractional area, right ventricle-myocardial performance index, were significantly associated with the mean pulmonary arterial pressure levels in pulmonary arterial hypertension patients

  3. Knowledge and Performance about Nursing Ethic Codes from Nurses' and Patients' Perspective in Tabriz Teaching Hospitals, Iran

    Directory of Open Access Journals (Sweden)

    Sara Moghaddam

    2013-08-01

    Full Text Available Introduction: Nursing profession requires knowledge of ethics to guide performance. The nature of this profession necessitates ethical care more than routine care. Today, worldwide definition of professional ethic code has been done based on human and ethical issues in the communication between nurse and patient. To improve all dimensions of nursing, we need to respect ethic codes. The aim of this study is to assess knowledge and performance about nursing ethic codes from nurses' and patients' perspective.Methods: A cross-sectional comparative study Conducted upon 345 nurses and 500 inpatients in six teaching hospitals of Tabriz, 2012. To investigate nurses' knowledge and performance, data were collected by using structured questionnaires. Statistical analysis was done using descriptive and analytic statistics, independent t-test and ANOVA and Pearson correlation coefficient, in SPSS13.Results: Most of the nurses were female, married, educated at BS degree and 86.4% of them were aware of Ethic codes also 91.9% of nurses and 41.8% of patients represented nurses respect ethic codes. Nurses' and patients' perspective about ethic codes differed significantly. Significant relationship was found between nurses' knowledge of ethic codes and job satisfaction and complaint of ethical performance. Conclusion: According to the results, consideration to teaching ethic codes in nursing curriculum for student and continuous education for staff is proposed, on the other hand recognizing failures of the health system, optimizing nursing care, attempt to inform patients about Nursing ethic codes, promote patient rights and achieve patient satisfaction can minimize the differences between the two perspectives.

  4. Quality of Care Improves for Patients with Diabetes in Medicare Shared Savings Accountable Care Organizations: Organizational Characteristics Associated with Performance.

    Science.gov (United States)

    Fraze, Taressa K; Lewis, Valerie A; Tierney, Emily; Colla, Carrie H

    2017-12-06

    Accountable care organizations (ACOs), a primary care-centric delivery and payment model, aim to promote integrated population health, which may improve care for those with chronic conditions such as diabetes. Research has shown that, overall, the ACO model is effective at reducing costs, but there is substantial variation in how effective different types of ACOs are at impacting costs and improving care delivery. This study examines how ACO organizational characteristics - such as composition, staffing, care management, and experiences with health reform - were associated with quality of care delivered to patients with diabetes. Secondary data were analyzed retrospectively to examine Medicare Shared Savings Program (MSSP) ACOs' performance on diabetes metrics in the first 2 years of ACO contracts. Ordinary least squares was used to analyze 162 MSSP ACOs with publicly available performance data and the National Survey of ACOs. ACOs improved performance significantly for patients with diabetes between contract years 1 and 2. In year 1, also having a private payer contract and an increased number of services within the ACO were positively associated with performance, while having a community health center or a hospital were negatively associated with performance. Better performance in year 1 was negatively associated with improved performance in year 2. This study found that ACOs substantively improved diabetes management within initial contract years. ACOs may need different types of support throughout their contracts to ensure continued improvements in performance.

  5. Assessment of the performance of the American Urological Association symptom score in 2 distinct patient populations.

    Science.gov (United States)

    Johnson, Timothy V; Schoenberg, Evan D; Abbasi, Ammara; Ehrlich, Samantha S; Kleris, Renee; Owen-Smith, Ashli; Gunderson, Kristin; Master, Viraj A

    2009-01-01

    Recent research suggests that low education and illiteracy may drive misunderstanding of the American Urological Association Symptom Score, a key tool in the American Urological Association benign prostatic hyperplasia guidelines. It is unclear whether misunderstanding is confined to patients of low socioeconomic status. Therefore, we reevaluated the prevalence and impact of this misunderstanding in a county vs university hospital population. This prospective study involved 407 patients from a county hospital and a university hospital who completed the American Urological Association Symptom Score as self-administered and then as interviewer administered. Responses were compared by calculating correlation coefficients and weighted kappa statistics to assess patient understanding of the American Urological Association Symptom Score. Multivariate logistic regression analyses were used to examine the association between patient characteristics and poor understanding of the American Urological Association Symptom Score. Of the patients 72% understood all 7 American Urological Association Symptom Score questions. Of the measured demographic variables only education level significantly affected this understanding. Compared to patients with more than 12 years of education county hospital patients with less than 9 years of education were 57.06 times more likely to misunderstand the American Urological Association Symptom Score (95% CI 14.32-329.34) while university hospital patients with less than 9 years of education were 38.27 times more likely to misunderstand the American Urological Association Symptom Score (95% CI 1.69-867.83). Of county hospital patients 31% and of university hospital patients 21% significantly misrepresented their symptom severity according to current guidelines. Patients with low education regardless of location are more likely to misunderstand the American Urological Association Symptom Score, misrepresent their symptoms and, therefore, receive

  6. The Effects of Performance Fatigability on Postural Control and Rehabilitation in the Older Patient

    OpenAIRE

    Papa, Evan V.; Hassan, Mahdi; Bugnariu, Nicoleta

    2016-01-01

    Fatigue is common in older adults and has a significant effect on quality of life. Despite the high prevalence of fatigue in older individuals, several aspects are poorly understood. It is important to differentiate subjective fatigue complaints from fatigability of motor performance because the two are independent constructs with potentially distinct consequences on mobility. Performance fatigability is the magnitude of change in a performance criterion over a given time of task performance....

  7. The association of clinical guideline adherence and pay-for-performance among patients with diabetes

    Directory of Open Access Journals (Sweden)

    Chiu-Ling Lai

    2013-02-01

    Conclusion: When physicians participated in the P4P program, this increased the likelihood that patients would receive guideline-recommended tests or examinations. Increasing the DM-P4P participation rates for physicians and patients are important and worthwhile objectives that can assist in the effort to more effectively manage diabetes in the general population.

  8. The kidney disease quality of life cognitive function subscale and cognitive performance maintenance hemodialysis patients

    Science.gov (United States)

    Background: Cognitive impairment is common but often undiagnosed in patients with end-stage renal disease, in part reflecting limited validated and easily administered tools to assess cognitive function in dialysis patients. Accordingly, we assessed the utility of the Kidney Disease Quality of Life ...

  9. Biceps brachii can add to performance of tasks requiring supination in cerebral palsy patients

    NARCIS (Netherlands)

    de Bruin, M.; Veeger, H.E.J.; Kreulen, M.; Smeulders, M.J.C.; Bus, S.A.

    2013-01-01

    The aim of this study was to assess whether cerebral palsy patients can use biceps brachii for supination during movement tasks requiring supination and pronation. 3D upper extremity kinematic and EMG-data of 12 patients (mean age 13. y 8. mo. ±. 36. mo) were compared to 10 healthy age-matched

  10. Biceps brachii can add to performance of tasks requiring supination in cerebral palsy patients

    NARCIS (Netherlands)

    de Bruin, M.; Veeger, H. E. J.; Kreulen, M.; Smeulders, M. J. C.; Bus, S. A.

    2013-01-01

    The aim of this study was to assess whether cerebral palsy patients can use biceps brachii for supination during movement tasks requiring supination and pronation. 3D upper extremity kinematic and EMG-data of 12 patients (mean age 13 y 8 mo ± 36 mo) were compared to 10 healthy age-matched controls.

  11. Differences between terminally ill cancer patients who died after euthanasia had been performed and terminally ill cancer patients who did not request euthanasia.

    Science.gov (United States)

    Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D; van der Wal, Gerrit; van der Heide, Agnes; van der Maas, Paul J

    2005-12-01

    Palliative care, directed at improving the quality of life of terminally ill patients, is generally not aimed at any form of postponing or hastening death. It is possible that high quality palliative care could prevent requests for euthanasia. However, empirical evidence on this issue is scarce. In a national survey of end-of-life medical decisions in The Netherlands the subject of care at the end of life has been addressed. Data on terminally ill cancer patients who died after their request was granted and euthanasia had been performed were compared with those of terminally ill cancer patients who did not request euthanasia. The results show that the prevalence and severity of symptoms e.g., pain, feeling unwell, nausea, was higher in patients who died after their request was granted and euthanasia had been performed. No differences concerning the treatment of symptoms or the care provided were found between the two groups. The results suggest that the practice of euthanasia is mainly related to the patient's suffering.

  12. Intranasal insulin influences the olfactory performance of patients with smell loss, dependent on the body mass index: A pilot study.

    Science.gov (United States)

    Schöpf, V; Kollndorfer, K; Pollak, M; Mueller, C A; Freiherr, J

    2015-12-01

    The application of intranasal insulin in healthy humans has been linked to improved memory function, reduced food intake, and increased olfactory thresholds. There has also been some correlation between the morbidities associated with central nervous system (CNS) insulin resistance, such as type II diabetes mellitus, Alzheimer's disease, obesity, and impaired odour recognition. Given that impaired odour recognition is an important component of olfactory performance, mechanisms that govern these effects may account for impaired olfactory functions in anosmic patients. Ten patients with post-infectious olfactory loss received intranasal administration of 40 IU insulin or a placebo solution, as well as olfactory performance tests before and after administration. When administered insulin, patients exhibited an immediate performance improvement with regard to olfactory sensitivity and olfactory intensity ratings. In addition, more odours were correctly identified. Furthermore, an improvement in the odour identification task was detected in patients with higher body mass index. Results of this pilot study shed light on the link between cerebral insulin level and an impaired sense of smell. This research line might provide a better understanding of olfactory loss in relation to eating and dietary behavior, and could offer opportunities to develop faster therapeutic intervention for patients with olfactory dysfunction.

  13. Performance Evaluation of Five Different Disseminated Intravascular Coagulation (DIC) Diagnostic Criteria for Predicting Mortality in Patients with Complicated Sepsis.

    Science.gov (United States)

    Ha, Sang Ook; Park, Sang Hyuk; Hong, Sang Bum; Jang, Seongsoo

    2016-11-01

    Disseminated intravascular coagulation (DIC) is a major complication in sepsis patients. We compared the performance of five DIC diagnostic criteria, focusing on the prediction of mortality. One hundred patients with severe sepsis or septic shock admitted to intensive care unit (ICU) were enrolled. Routine DIC laboratory tests were performed over the first 4 days after admission. The overall ICU and 28-day mortality in DIC patients diagnosed from five criteria (International Society on Thrombosis and Haemostasis [ISTH], the Japanese Association for Acute Medicine [JAAM], the revised JAAM [R-JAAM], the Japanese Ministry of Health and Welfare [JMHW] and the Korean Society on Thrombosis and Hemostasis [KSTH]) were compared. Both KSTH and JMHW criteria showed superior performance than ISTH, JAAM and R-JAAM criteria in the prediction of overall ICU mortality in DIC patients (odds ratio 3.828 and 5.181, P = 0.018 and 0.006, 95% confidence interval 1.256-11.667 and 1.622-16.554, respectively) when applied at day 1 after admission, and survival analysis demonstrated significant prognostic impact of KSTH and JMHW criteria on the prediction of 28-day mortality (P = 0.007 and 0.049, respectively) when applied at day 1 after admission. In conclusion, both KSTH and JMHW criteria would be more useful than other three criteria in predicting prognosis in DIC patients with severe sepsis or septic shock.

  14. Changes of Motivational Variables in Patients with Multiple Sclerosis in an Exercise Intervention: Associations between Physical Performance and Motivational Determinants

    Directory of Open Access Journals (Sweden)

    Wiebke Geertz

    2015-01-01

    Full Text Available Objectives. This study examines the effects of a standardized fitness training on motivational factors such as the intention to be physically active, self-efficacy, perceived barriers, counterstrategies, and exercise specific social support in patients with progressive Multiple Sclerosis (MS and the relation of these factors to physical performance. Methods. Moderately disabled patients with secondary or primary progressive MS (Expanded Disability Status Scale of 4–6 were randomized to a training group or a waitlist control group. Patients completed on average 20 sessions of training tailored to their individual fitness at baseline over a course of 8–12 weeks. Motivational variables (stage of change according to the transtheoretical model (TTM, self-efficacy, perceived barriers, counterstrategies, and exercise specific social support were assessed via questionnaires at baseline and follow-up. Results. Forty patients completed the trial. We found significant effects on stages of change p=.016 and self-efficacy p=.014 and a trend in counterstrategies p=.08. Significant correlations between change of physical performance during the exercise training and change in the TTM, perceived barriers, and counterstrategies were detected. Conclusion. This study indicates that tailored individual endurance training could stabilize self-efficacy and increase exercise motivation in patients with progressive MS. Motivational variables were related to the physical performance.

  15. Comparative cross-sectional study of masticatory performance and mastication predominance for patients with missing posterior teeth.

    Science.gov (United States)

    Iwashita, Hayato; Tsukiyama, Yoshihiro; Kori, Hidehiro; Kuwatsuru, Rika; Yamasaki, Yo; Koyano, Kiyoshi

    2014-10-01

    Missing posterior teeth can decrease masticatory function and cause horizontal mastication deviation, i.e., mastication predominance. Mastication predominance may lead to abnormal tooth attrition and temporomandibular disorders. This study evaluated masticatory performance and mastication predominance in patients with missing posterior teeth to investigate effects of missing posterior teeth on masticatory performance and mastication predominance. Thirty volunteers with normal dentition (control group), 30 patients with unilateral missing posterior teeth (unilateral group), and 23 patients with bilateral missing posterior teeth (bilateral group) participated. Gummy jellies were used to evaluate participants' masticatory performance, and electromyography was used to assess the degree of mastication predominance. Chewing gums, gummy jellies, and peanuts were used as foods of various hardnesses for evaluating mastication predominance. Compared with the control group, masticatory performance did not differ in the unilateral group but was significantly decreased in the bilateral group. With chewing gum and gummy jellies, the degree of mastication predominance was significantly increased in both unilateral and bilateral groups than the control group. With peanuts, the degree of mastication predominance was significantly increased in the unilateral group than the control group. Although masticatory performance was not decreased in the unilateral group, the degree of mastication predominance was increased. Decreased masticatory performance was observed in the bilateral group, and for foods with normal hardness and soft foods, the degree of mastication predominance was increased. These results suggested that mastication predominance should be considered in the recovery of masticatory performance in patients with missing posterior teeth. Copyright © 2014 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  16. Correlation between the Oswestry Disability Index and objective measurements of walking capacity and performance in patients with lumbar spinal stenosis

    DEFF Research Database (Denmark)

    Jespersen, Annette Bennedsgaard; Gustafsson, Malin Eleonora Av Kák

    2018-01-01

    PURPOSE: The Oswestry Disability Index (ODI) plays a significant role in lumbar spinal stenosis research and is used to assess patient's walking limitations. The World Health Organisation describes the constructs of walking capacity and performance and recommend measuring both to fully describe...

  17. Assisting Patients with Disabilities to Actively Perform Occupational Activities Using Battery-Free Wireless Mice to Control Environmental Stimulation

    Science.gov (United States)

    Shih, Ching-Hsiang; Wang, Shu-Hui; Chang, Man-Ling; Kung, Ssu-Yun

    2012-01-01

    The latest studies have adopted software technology to turn the battery-free wireless mouse into a high performance object location detector using a newly developed object location detection program (OLDP). This study extended OLDP functionality to assess whether two patients recovering from cerebral vascular accidents would be able to actively…

  18. Quantitation of bilirubin conjugates with high-performance liquid chromatography in patients with low total serum bilirubin levels

    NARCIS (Netherlands)

    Jansen, P. L.; Cuypers, H. T.; Peters, W. H.

    1984-01-01

    Bilirubin mono- and diconjugates were determined by alkaline methanolysis and high-performance liquid chromatography (HPLC) in serum from patients with metastatic liver disease and liver cirrhosis. Conjugates could be detected and quantitated at normal or low total bilirubin levels. Comparison with

  19. Performance monitoring in lung cancer patients pre- and post-chemotherapy using fine-grained electrophysiological measures

    Directory of Open Access Journals (Sweden)

    M. Simó

    Full Text Available No previous event-related potentials (ERPs study has explored the error-related negativity (ERN - an ERP component indexing performance monitoring - associated to cancer and chemotherapy-induced cognitive impairment in a lung cancer population. The aim of this study was to examine differences in performance monitoring in a small-cell lung cancer group (SCLC, C+ 1-month following chemotherapy and two control groups: a non-small cell lung cancer patient group (NSCLC, C− prior to chemotherapy and a healthy control group (HC.Seventeen SCLC (C+ underwent a neuropsychological assessment and an ERP study using a flanker and a stop-signal paradigm. This group was compared to fifteen age-, gender- and education-matched NSCLC (C− and eighteen HC.Between 20 and 30% of patients in both lung cancer groups (C+ and C− met criteria for cognitive impairment. Concerning ERPs, lung cancer patients showed lower overall hit rate and a severe ERN amplitude reduction compared to HC.Lung cancer patients exhibited an abnormal pattern of performance monitoring thus suggesting that chemotherapy and especially cancer itself, may contribute to cognitive deterioration. ERN appeared as an objective laboratory tool sensitive to cognitive dysfunction in cancer population. Keywords: Event-related potentials-ERP, Error-related negativity (ERN, Performance monitoring, Lung cancer, Cognitive impairment, Chemobrain

  20. Patients' Perceptions on the Performance of a Local Health System to Eliminate Leprosy, Paraná State, Brazil

    Science.gov (United States)

    Pieri, Flávia Meneguetti; Touso, Michelle Mosna; Rodrigues, Ludmila Barbosa Bandeira; Yamamura, Mellina; Pinto, Ione Carvalho; Dessunti, Elma Mathias; Crispim, Juliane de Almeida; Ramos, Antônio Carlos Vieira; Arroyo, Luiz Henrique; Neto, Marcelino Santos; Garcia, Maria Concebida da Cunha; Popolin, Marcela Paschoal; Silveira, Tatiane Ramos dos Santos; Arcêncio, Ricardo Alexandre

    2014-01-01

    Background In Brazil, leprosy has been listed among the health priorities since 2006, in a plan known as the “Pact for life” (Pacto pela Vida). It is the sole country on the American continent that has not reached the global goal of disease elimination. Local health systems face many challenges to achieve this global goal. The study aimed to investigate how patients perceive the local health system's performance to eliminate leprosy and whether these perceptions differ in terms of the patients' income. Methodology/Principal Findings A cross-sectional study was conducted in Londrina, State of Paraná, Brazil. Interviews were performed with the leprosy patients. The local health system was assessed through a structured and adapted tool, considering the domains judged as good quality of health care. The authors used univariate, bivariate and multivariate analyses. One hundred and nineteen patients were recruited for the study, 50.4% (60) of them were male, 54.0% (64) were between 42 and 65 years old and 66.3% (79) had finished elementary school. The results showed that patients used the Primary Health Care service near their place of residence but did not receive the leprosy diagnosis there. Important advances of this health system were verified for the elimination of leprosy, verifying protocols for good care delivery to the leprosy patients, but these services did not develop collective health actions and did not engage the patients' family members and community. Conclusions/Significance The patients' difficulty was observed to have access to the diagnosis and treatment at health services near their homes. Leprosy care is provided at the specialized level, where the patients strongly bond with the teams. The care process is individual, with limited perspectives of integration among the health services for the purpose of case management and social mobilization of the community to the leprosy problem. PMID:25412349

  1. Performance of the modified Richmond Agitation Sedation Scale in identifying delirium  in older ED patients.

    Science.gov (United States)

    Grossmann, Florian F; Hasemann, Wolfgang; Kressig, Reto W; Bingisser, Roland; Nickel, Christian H

    2017-09-01

    Delirium in older emergency department (ED) patients is associated with severe negative patient outcomes and its detection is challenging for ED clinicians. ED clinicians need easy tools for delirium detection. We aimed to test the performance criteria of the modified Richmond Agitation Sedation Scale (mRASS) in identifying delirium in older ED patients. The mRASS was applied to a sample of consecutive ED patients aged 65 or older by specially trained nurses during an 11-day period in November 2015. Reference standard delirium diagnosis was based on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria, and was established by geriatricians. Performance criteria were computed. Analyses were repeated in the subsamples of patients with and without dementia. Of 285 patients, 20 (7.0%) had delirium and 41 (14.4%) had dementia. The sensitivity of an mRASS other than 0 to detect delirium was 0.70 (95% confidence interval, CI, 0.48; 0.85), specificity 0.93 (95% CI 0.90; 0.96), positive likelihood ratio 10.31 (95% CI 6.06; 17.51), negative likelihood ratio 0.32 (95% CI 0.16; 0.63). In the sub-sample of patients with dementia, sensitivity was 0.55 (95% CI 0.28; 0.79), specificity 0.83 (95% CI 0.66; 0.93), positive likelihood ratio 3.27 (95% CI 1.25; 8.59), negative likelihood ratio 0.55 (95% CI 0.28; 1.06). The sensitivity of the mRASS to detect delirium in older ED patients was low, especially in patients with dementia. Therefore its usefulness as a stand-alone screening tool is limited. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. The effects of high frequency subthalamic stimulation on balance performance and fear of falling in patients with Parkinson's disease

    Directory of Open Access Journals (Sweden)

    Jarnlo Gun-Britt

    2009-04-01

    Full Text Available Abstract Background Balance impairment is one of the most distressing symptoms in Parkinson's disease (PD even with pharmacological treatment (levodopa. A complementary treatment is high frequency stimulation in the subthalamic nucleus (STN. Whether STN stimulation improves postural control is under debate. The aim of this study was to explore the effects of STN stimulation alone on balance performance as assessed with clinical performance tests, subjective ratings of fear of falling and posturography. Methods Ten patients (median age 66, range 59–69 years with bilateral STN stimulation for a minimum of one year, had their anti-PD medications withdrawn overnight. Assessments were done both with the STN stimulation turned OFF and ON (start randomized. In both test conditions, the following were assessed: motor symptoms (descriptive purposes, clinical performance tests, fear of falling ratings, and posturography with and without vibratory proprioceptive disturbance. Results STN stimulation alone significantly (p = 0.002 increased the scores of the Berg balance scale, and the median increase was 6 points. The results of all timed performance tests, except for sharpened Romberg, were significantly (p ≤ 0.016 improved. The patients rated their fear of falling as less severe, and the total score of the Falls-Efficacy Scale(S increased (p = 0.002 in median with 54 points. All patients completed posturography when the STN stimulation was turned ON, but three patients were unable to do so when it was turned OFF. The seven patients with complete data showed no statistical significant difference (p values ≥ 0.109 in torque variance values when comparing the two test situations. This applied both during quiet stance and during the periods with vibratory stimulation, and it was irrespective of visual input and sway direction. Conclusion In this sample, STN stimulation alone significantly improved the results of the clinical performance tests that mimic

  3. Effect of chronic nonmalignant pain on highway driving performance.

    Science.gov (United States)

    Veldhuijzen, D S; van Wijck, A J M; Wille, F; Verster, J C; Kenemans, J L; Kalkman, C J; Olivier, B; Volkerts, E R

    2006-05-01

    Most pain patients are treated in an outpatient setting and are engaged in daily activities including driving. Since several studies showed that cognitive functioning may be impaired in chronic nonmalignant pain, the question arises whether or not chronic nonmalignant pain affects driving performance. Therefore, the objective of the present study was to determine the effects of chronic nonmalignant pain on actual highway driving performance during normal traffic. Fourteen patients with chronic nonmalignant pain and 14 healthy controls, matched on age, educational level, and driving experience, participated in the study. Participants performed a standardized on-the-road driving test during normal traffic, on a primary highway. The primary parameter of the driving test is the Standard Deviation of Lateral Position (SDLP). In addition, driving-related skills (tracking, divided attention, and memory) were examined in the laboratory. Subjective assessments, such as pain intensity, and subjective driving quality, were rated on visual analogue scales. The results demonstrated that a subset of chronic nonmalignant pain patients had SDLPs that were higher than the matched healthy controls, indicating worse highway driving performance. Overall, there was a statistically significant difference in highway driving performance between the groups. Further, chronic nonmalignant pain patients rated their subjective driving quality to be normal, although their ratings were significantly lower than those of the healthy controls. No significant effects were found on the laboratory tests.

  4. Hypogammaglobulinemia and Poor Performance Status are Predisposing Factors for Vancomycin-Resistant Enterococcus Colonization in Patients with Hematological Malignancies

    Directory of Open Access Journals (Sweden)

    Elif Gülsüm Ümit

    2017-03-01

    Full Text Available Objective: Vancomycin-resistant enterococci (VRE are common pathogens of hospital-acquired infection. Long hospitalization periods, use of broadspectrum antibiotics, and immunosuppression are major risks for VRE colonization. We aimed to evaluate patients’ characteristics and factors that may contribute to VRE colonization. Materials and Methods: Data of 66 patients with colonization and 112 patients without colonization who were hospitalized in the hematology clinic were collected. Hematological malignancies, preexisting gastrointestinal complaints, the presence of hypogammaglobulinemia at the time of diagnosis, complications like neutropenic enterocolitis (NEC, and Eastern Cooperative Oncology Group (ECOG and Karnofsky performance statuses were recorded. Results: Ages of the patients ranged between 19 and 95 years (mean: 55.99. Karnofsky and ECOG scores were statistically related to VRE colonization (p7 days may also be accepted as a risk factor, independent of diagnosis or antibiotic use. Performance status is also an important factor for colonization, which may be related to poorer hygiene and increased external help.

  5. [Features of dual--postural and calculation--task performance in patients with consequences of traumatic brain injury].

    Science.gov (United States)

    Zharikova, A V; Zhavoronkova, L A; Maksakova, O A; Kuptsova, S V

    2012-01-01

    Dual tasks with voluntary postural control and calculation have been done by 14 patients (25.7 +/- 4.7 yo.) after traumatic brain injury and 40 healthy volunteers (29.8 +/- 2.5 y.o.). Complex clinical (MMSE, FIM, MPAI-3 and Berg scales) and stabilographic evaluation has been performed. According to clinical evaluation 8 patients were included into group 1 with less severe functional deficit and 6 patients formed group 2 with more severe deficit. Parameters of motor and especially cognitive sub-tasks in patients were lower than in healthy subjects in both separate and dual tasks. In group 2 these parameters were lower than in group 1. Certain types of dual task where the quality of sub-tasks, especially of the motor-one increased in healthy subjects and patients of the first group were revealed. The complex of stabilographic parameters which could be used for estimation of quality of sub-tasks performance has been revealed. Dual tasks could be an additional method of evaluation of patients' adaptive possibilities and certain type of dual task could become a promising approach to recovery at late period of rehabilitation.

  6. The Demographics of Patients with Skin Cancer who Underwent Surgery in Diyarbakır and Performed Surgical Techniques

    Directory of Open Access Journals (Sweden)

    Burhan Özalp

    2018-06-01

    Full Text Available Objective: The major factor for developing malignant skin cancers is sunlight exposure. This study aimed to evaluate the demographics of patients with skin cancers who underwent surgery in Diyarbakır where the population is exposed to more sunlight than most other Turkish cities. Methods: The medical records of patients who underwent surgery for malignant skin cancer excision between 2011 and 2016 were searched using University Hospital’s patient database program. Data about patients’ demographics, cancer features, and the surgical techniques performed were collected. Results: Over a 5-year period, 190 patients underwent surgical excision. The male to female ratio was 1.56, and the mean age was 65.8 ± 15.7 (range, 20-94 years. The most common skin cancer was basal cell carcinoma (n=138, 72.7%, followed by squamous cell carcinoma (n=45, 23.7% and malignant melanoma (n=5, 2.6%. The most common surgery was primary excision, which was performed in 90 of 190 patients (47.36%; tissue reconstruction with a skin graft or flap surgery was required for the remaining 100 (52.63%, showing a significant difference (p<0.001. Conclusion: Basal cell carcinoma is the most common skin cancer, and less than half of the patients sought treatment immediately after they recognized the lesion. The public should be educated about skin cancers to increase early diagnosis and encourage timely treatment, thereby decreasing morbidity and mortality from skin cancer.

  7. Effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery: A meta-analysis

    Science.gov (United States)

    FANG, YU; QIU, ZHANDONG; HU, WENTAO; YANG, JIA; YI, XIYAN; HUANG, LIANGJIANG; ZHANG, SUMING

    2014-01-01

    Cognitive impairments are observed in numerous patients following coronary bypass surgery, and piracetam are nootropic compounds that modulate cerebral functions by directly enhancing cognitive processes. The present meta-analysis was conducted to evaluate the protective effect of piracetam on the cognitive performance of patients undergoing coronary bypass surgery. The relevant studies were identified by searching Medline, EMBASE, PubMed and the Cochrane Library up to June 2013 and the pertinent bibliographies from the retrieved studies were reviewed. Data were selected from the studies according to predefined criteria. The meta-analysis included two randomized control trials involving 184 patients and including the Syndrom-Kurz test (SKT). Findings of the meta-analysis showed that following treatment the change from baseline observed in five SKT subtest scores, conducted with piracetam patients, indicated a significant advantage over those patients that were in the placebo group. The subtests included immediate pictured object recall, weighted mean difference (WMD)=0.91, 95% confidence interval (CI) 0.51–1.31, Ppiracetam may have been effective in improving the short-term cognitive performance of patients undergoing coronary bypass surgery. High quality, well-controlled and longer randomized trials are required to corroborate this result. PMID:24396419

  8. Linear and non-linear analyses of Conner's Continuous Performance Test-II discriminate adult patients with attention deficit hyperactivity disorder from patients with mood and anxiety disorders.

    Science.gov (United States)

    Fasmer, Ole Bernt; Mjeldheim, Kristin; Førland, Wenche; Hansen, Anita L; Syrstad, Vigdis Elin Giæver; Oedegaard, Ketil J; Berle, Jan Øystein

    2016-08-11

    Attention Deficit Hyperactivity Disorder (ADHD) is a heterogeneous disorder. Therefore it is important to look for factors that can contribute to better diagnosis and classification of these patients. The aims of the study were to characterize adult psychiatric out-patients with a mixture of mood, anxiety and attentional problems using an objective neuropsychological test of attention combined with an assessment of mood instability. Newly referred patients (n = 99; aged 18-65 years) requiring diagnostic evaluation of ADHD, mood or anxiety disorders were recruited, and were given a comprehensive diagnostic evaluation including the self-report form of the cyclothymic temperament scale and Conner's Continuous Performance Test II (CPT-II). In addition to the traditional measures from this test we have extracted raw data and analysed time series using linear and non-linear mathematical methods. Fifty patients fulfilled criteria for ADHD, while 49 did not, and were given other psychiatric diagnoses (clinical controls). When compared to the clinical controls the ADHD patients had more omission and commission errors, and higher reaction time variability. Analyses of response times showed higher values for skewness in the ADHD patients, and lower values for sample entropy and symbolic dynamics. Among the ADHD patients 59 % fulfilled criteria for a cyclothymic temperament, and this group had higher reaction time variability and lower scores on complexity than the group without this temperament. The CPT-II is a useful instrument in the assessment of ADHD in adult patients. Additional information from this test was obtained by analyzing response times using linear and non-linear methods, and this showed that ADHD patients with a cyclothymic temperament were different from those without this temperament.

  9. Reliability, validity and description of timed performance of the Jebsen-Taylor Test in patients with muscular dystrophies.

    Science.gov (United States)

    Artilheiro, Mariana Cunha; Fávero, Francis Meire; Caromano, Fátima Aparecida; Oliveira, Acary de Souza Bulle; Carvas, Nelson; Voos, Mariana Callil; Sá, Cristina Dos Santos Cardoso de

    2017-12-08

    The Jebsen-Taylor Test evaluates upper limb function by measuring timed performance on everyday activities. The test is used to assess and monitor the progression of patients with Parkinson disease, cerebral palsy, stroke and brain injury. To analyze the reliability, internal consistency and validity of the Jebsen-Taylor Test in people with Muscular Dystrophy and to describe and classify upper limb timed performance of people with Muscular Dystrophy. Fifty patients with Muscular Dystrophy were assessed. Non-dominant and dominant upper limb performances on the Jebsen-Taylor Test were filmed. Two raters evaluated timed performance for inter-rater reliability analysis. Test-retest reliability was investigated by using intraclass correlation coefficients. Internal consistency was assessed using the Cronbach alpha. Construct validity was conducted by comparing the Jebsen-Taylor Test with the Performance of Upper Limb. The internal consistency of Jebsen-Taylor Test was good (Cronbach's α=0.98). A very high inter-rater reliability (0.903-0.999), except for writing with an Intraclass correlation coefficient of 0.772-1.000. Strong correlations between the Jebsen-Taylor Test and the Performance of Upper Limb Module were found (rho=-0.712). The Jebsen-Taylor Test is a reliable and valid measure of timed performance for people with Muscular Dystrophy. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. Effect of Engaging Trainees by Assessing Peer Performance: A Randomised Controlled Trial Using Simulated Patient Scenarios

    Directory of Open Access Journals (Sweden)

    Charlotte Loumann Krogh

    2014-01-01

    Full Text Available Introduction. The aim of this study was to explore the learning effect of engaging trainees by assessing peer performance during simulation-based training. Methods. Eighty-four final year medical students participated in the study. The intervention involved trainees assessing peer performance during training. Outcome measures were in-training performance and performance, both of which were measured two weeks after the course. Trainees’ performances were videotaped and assessed by two expert raters using a checklist that included a global rating. Trainees’ satisfaction with the training was also evaluated. Results. The intervention group obtained a significantly higher overall in-training performance score than the control group: mean checklist score 20.87 (SD 2.51 versus 19.14 (SD 2.65 P=0.003 and mean global rating 3.25 SD (0.99 versus 2.95 (SD 1.09 P=0.014. Postcourse performance did not show any significant difference between the two groups. Trainees who assessed peer performance were more satisfied with the training than those who did not: mean 6.36 (SD 1.00 versus 5.74 (SD 1.33 P=0.025. Conclusion. Engaging trainees in the assessment of peer performance had an immediate effect on in-training performance, but not on the learning outcome measured two weeks later. Trainees had a positive attitude towards the training format.

  11. Resistance training enhances muscular performance in patients with anorexia nervosa: A randomized controlled trial

    OpenAIRE

    Fernández del Valle, María; Larumbe Zabala, Eneko; Villaseñor Montarroso, Ángel; Cardona González, Claudia Andrea; Díez Vega, Ignacio; López Mojares, Luis Miguel; Pérez Ruiz, Margarita

    2014-01-01

    OBJECTIVE: Low-intensity exercise applied in anorexia nervosa patients has been shown to have a harmless effect on body composition and to effect short-term improvements in muscular strength and agility. The aim of this study was to determine the effects of a high-intensity resistance training program designed for adolescents to improve strength and agility in anorexia nervosa restricting-type patients (AN-R). METHODS: From a total of 36 female patients with AN-R, one group (interven...

  12. "Hand surgeons probably don't starve": Patient's perceptions of physician reimbursements for performing an open carpal tunnel release.

    Science.gov (United States)

    Kokko, Kyle P; Lipman, Adam J; Sapienza, Anthony; Capo, John T; Barfield, William R; Paksima, Nader

    2015-12-01

    The purpose of this study is to evaluate patient's perceptions of physician reimbursement for the most commonly performed surgery on the hand, a carpal tunnel release (CTR). Anonymous physician reimbursement surveys were given to patients and non-patients in the waiting rooms of orthopaedic hand physicians' offices and certified hand therapist's offices. The survey consisted of 13 questions. Respondents were asked (1) what they thought a surgeon should be paid to perform a carpal tunnel release, (2) to estimate how much Medicare reimburses the surgeon, and (3) about how health care dollars should be divided among the surgeon, the anesthesiologist, and the hospital or surgery center. Descriptive subject data included age, gender, income, educational background, and insurance type. Patients thought that hand surgeons should receive $5030 for performing a CTR and the percentage of health care funds should be distributed primarily to the hand surgeon (56 %), followed by the anesthesiologist (23 %) and then the hospital/surgery center (21 %). They estimated that Medicare reimburses the hand surgeon $2685 for a CTR. Most patients (86 %) stated that Medicare reimbursement was "lower" or "much lower" than what it should be. Respondents believed that hand surgeons should be reimbursed greater than 12 times the Medicare reimbursement rate of approximately $412 and that the physicians (surgeons and anesthesiologist) should command most of the health care funds allocated to this treatment. This study highlights the discrepancy between patient's perceptions and actual physician reimbursement as it relates to federal health care. Efforts should be made to educate patients on this discrepancy.

  13. HEART score performance in Asian and Caucasian patients presenting to the emergency department with suspected acute coronary syndrome.

    Science.gov (United States)

    de Hoog, Vince C; Lim, Swee Han; Bank, Ingrid Em; Gijsberts, Crystel M; Ibrahim, Irwani B; Kuan, Win Sen; Ooi, Shirley Bs; Chua, Terrance Sj; Tai, E Shyong; Gao, Fei; Pasterkamp, Gerard; den Ruijter, Hester M; Doevendans, Pieter A; Wildbergh, Thierry X; Mosterd, Arend; Richards, A Mark; de Kleijn, Dominique Pv; Timmers, Leo

    2017-03-01

    The HEART score is a simple and effective tool to predict short-term major adverse cardiovascular events in patients suspected of acute coronary syndrome. Patients are assigned to three risk categories using History, ECG, Age, Risk factors and Troponin (HEART). The purpose is early rule out and discharge is considered safe for patients in the low risk category. Its performance in patients of Asian ethnicity is unknown. We evaluated the performance of the HEART score in patients of Caucasian, Chinese, Indian and Malay ethnicity. The HEART score was assessed retrospectively in 3456 patients presenting to the emergency department with suspected acute coronary syndrome (1791 Caucasians, 1059 Chinese, 344 Indians, 262 Malays), assigning them into three risk categories. The incidence of major adverse cardiovascular events within six weeks after presentation was similar between the ethnic groups. A smaller proportion of Caucasians was in the low risk category compared with Asians (Caucasians 35.8%, Chinese 43.5%, Indians 45.3%, Malays 44.7%, p<0.001). The negative predictive value of a low HEART score was comparable across the ethnic groups, but lower than previously reported (Caucasians 95.3%, Chinese 95.0%, Indians 96.2%, Malays 96.6%). Also the c-statistic for the HEART score was not significantly different between the groups. These results show that the overall performance of the HEART score is equal among Caucasian and Asian ethnic groups. The event rate in the low risk group, however, was higher than reported in previous studies, which queries the safety of early discharge of patients in the low risk category.

  14. The efficacy of tourniquet assisted total knee arthroplasty on patient-reported and performance-based physical function

    DEFF Research Database (Denmark)

    Lohmann-Jensen, Rasmus; Holsgaard-Larsen, Anders; Emmeluth, Claus

    2014-01-01

    surgery. The non-tourniquet assisted TKA group will have surgery performed without application of a tourniquet. The primary aim is to compare tourniquet assisted to non-tourniquet assisted TKA on patient-reported physical function (KOOS-ADL). The secondary aim is to compare post-surgery pain, function...... in sports and recreation, quality of life, and performance-based physical function. The explorative outcomes include; use of pain medication, single-fiber muscle damage, and changes in mechanical muscle function. The primary endpoint will be at 3-months following surgical treatment, and the time...... randomized clinical trial comparing the efficacy of tourniquet assisted TKA on patient-reported physical function supported by a range of performance-based secondary outcome measures. As such it will provide high quality evidence that may help determine whether tourniquet should be used in future TKA...

  15. Transfer from point-of-care Ultrasonography training to diagnostic performance on patients--a randomized controlled trial

    DEFF Research Database (Denmark)

    Todsen, Tobias; Jensen, Morten Lind; Tolsgaard, Martin Grønnebæk

    2016-01-01

    BACKGROUND: Clinicians are increasingly using point-of-care ultrasonography for bedside examinations of patients. However, proper training is needed in this technique, and it is unknown whether the skills learned from focused Ultrasonography courses are being transferred to diagnostic performance...... test and binary logistic regression, respectively. RESULTS: There was a significant difference in the performance score between the intervention group (27.4%) and the control group (18.0%, P = .004) and the diagnostic accuracy between the intervention group (65%) and the control group (39%, P = .014......). CONCLUSIONS: Clinicians could successfully transfer learning from an Ultrasonography course to improve diagnostic performance on patients. However, our results also indicate a need for more training when new technologies such as point-of-care ultrasonography are introduced....

  16. The Effects of Performance Fatigability on Postural Control and Rehabilitation in the Older Patient.

    Science.gov (United States)

    Papa, Evan V; Hassan, Mahdi; Bugnariu, Nicoleta

    2016-09-01

    Fatigue is common in older adults and has a significant effect on quality of life. Despite the high prevalence of fatigue in older individuals, several aspects are poorly understood. It is important to differentiate subjective fatigue complaints from fatigability of motor performance because the two are independent constructs with potentially distinct consequences on mobility. Performance fatigability is the magnitude of change in a performance criterion over a given time of task performance. Performance fatigability is a compulsory element of any strength training program, yet strength training is an important component of rehabilitation programs for older adults. The consequences of fatigability for older adults suggest that acute exercise of various types may result in acute impairments in postural control. The effects of performance fatigability on postural control in older adults are evaluated here to aid the rehabilitation clinician in making recommendations for evaluation of fall risks and exercise prescription.

  17. Clinical comparison of masticatory performance and electromyographic activity of patients with complete dentures, overdentures, and natural teeth.

    Science.gov (United States)

    Rissin, L; House, J E; Manly, R S; Kapur, K K

    1978-05-01

    In this study, which is the first of its kind, it has been shown that overdenture patients, when compared to complete denture patients, while chewing a test food for a constant number of strokes, expended an equivalent amount of muscle effort, chewed more slowly and efficiently, and evidenced significantly better masticatory performance by producing an increased volume of fine test food particles. These findings provide a sound justification for the extra effort required to retain some natural teeth to provide overdenture services to patients. The fact that patients can masticate food more efficiently with overdentures than with complete dentures justifies the increased cost and time involved in their construction. The longitudinal effects that overdentures have on the basic physiopathologic processed involved in the progression of ridge resorption and the advantages of maintaining periodontal proprioception also should be studied.

  18. Patient Perception of Disclosure Performance of Informed Consent Elements in the Preanesthesia Interview

    National Research Council Canada - National Science Library

    Hartgerink, Bradley

    1997-01-01

    ...) were discussed in the preanesthesia interview. A survey composed of 21 questions pertaining to demography and informed consent elements was devised and administered to 53 patients immediately following their preanesthesia interview...

  19. Functional Performances on Admission Predict In-Hospital Falls, Injurious Falls, and Fractures in Older Patients: A Prospective Study.

    Science.gov (United States)

    Hars, Mélany; Audet, Marie-Claude; Herrmann, François; De Chassey, Jean; Rizzoli, René; Reny, Jean-Luc; Gold, Gabriel; Ferrari, Serge; Trombetti, Andrea

    2018-05-01

    Falls are common among older inpatients and remain a great challenge for hospitals. Despite the relevance of physical impairments to falls, the prognostic value of performance-based functional measures for in-hospital falls and injurious falls remains unknown. This study aimed to determine the predictive ability and accuracy of various functional tests administered at or close to admission in a geriatric hospital to identify in-hospital fallers and injurious fallers. In this prospective study, conducted in a geriatric hospital in Geneva, Switzerland, 807 inpatients (mean age 85.0 years) were subjected to a battery of functional tests administered by physiotherapists within 3 days (interquartile range 1 to 6) of admission, including Short Physical Performance Battery (SPPB), simplified Tinetti, and Timed Up and Go tests. Patients were prospectively followed up for falls and injurious falls until discharge using mandatory standardized incident report forms and electronic patients' records. During a median length of hospital stay of 23 days (interquartile range 14 to 36), 329 falls occurred in 189 (23.4%) patients, including 161 injurious falls of which 24 were serious. In-hospital fallers displayed significantly poorer functional performances at admission on all tests compared with non-fallers (p performances on all functional tests predicted in-hospital falls and injurious falls (p poor functional performances, as assessed by SPPB, are independent predictors of in-hospital falls, injurious falls, and fractures in patients admitted to a geriatric hospital. These findings should help to design preventive strategies for in-hospital falls and support the adoption of objective performance-based functional measures into routine hospital practice. © 2018 American Society for Bone and Mineral Research. © 2018 American Society for Bone and Mineral Research.

  20. Evaluation of the predictive performance of bleeding risk scores in patients with non-valvular atrial fibrillation on oral anticoagulants.

    Science.gov (United States)

    Beshir, S A; Aziz, Z; Yap, L B; Chee, K H; Lo, Y L

    2018-04-01

    Bleeding risk scores (BRSs) aid in the assessment of oral anticoagulant-related bleeding risk in patients with atrial fibrillation. Ideally, the applicability of a BRS needs to be assessed, prior to its routine use in a population other than the original derivation cohort. Therefore, we evaluated the performance of 6 established BRSs to predict major or clinically relevant bleeding (CRB) events associated with the use of oral anticoagulant (OAC) among Malaysian patients. The pharmacy supply database and the medical records of patients with non-valvular atrial fibrillation (NVAF) receiving warfarin, dabigatran or rivaroxaban at two tertiary hospitals were reviewed. Patients who experienced an OAC-associated major or CRB event within 12 months of follow-up, or who have received OAC therapy for at least 1 year, were identified. The BRSs were fitted separately into patient data. The discrimination and the calibration of these BRSs as well as the factors associated with bleeding events were then assessed. A total of 1017 patients with at least 1-year follow-up period, or those who developed a bleeding event within 1 year of OAC use, were recruited. Of which, 23 patients experienced a first major bleeding event, whereas 76 patients, a first CRB event. Multivariate logistic regression results show that age of 75 or older, prior bleeding and male gender are associated with major bleeding events. On the other hand, prior gastrointestinal bleeding, a haematocrit value of less than 30% and renal impairment are independent predictors of CRB events. All the BRSs show a satisfactory calibration for major and CRB events. Among these BRSs, only HEMORR 2 HAGES (C-statistic = 0.71, 95% CI 0.60-0.82, P performance for major bleeding events. All the 6 BRSs, however, lack acceptable predictive performance for CRB events. To the best of our knowledge, this is the first evaluation study of the predictive performance of these 6 BRSs on clinically relevant bleeding events applied to

  1. A systematic review of cognitive performance in patients with childhood craniopharyngioma.

    Science.gov (United States)

    Özyurt, Jale; Müller, Hermann L; Thiel, Christiane M

    2015-10-01

    Craniopharyngiomas are rare brain tumors of the sellar/suprasellar region, often adversely affecting patients' physical and psychosocial functioning. Until a few years ago, knowledge on cognitive deficits in craniopharyngioma patients was based on little valid evidence, with considerable inconsistencies across studies. Findings from recent research, with partly larger sample sizes, add to existing evidence to provide a more clear and reliable picture. The current review aims to summarize and systemize current findings on cognitive deficits in childhood craniopharyngioma, taking account of patient- and treatment-related variables where possible. Those studies were included that reported results of childhood craniopharyngioma patients tested with formalized neuropsychological tests (irrespective of their age at study, group size ≥10). A systematic assignment of test results to subcomponents of broader cognitive domains (e.g. to specific memory systems and processes) allows for a first comprehensive overview of patterns of spared and impaired cognitive functions. We show that episodic memory recall in particular is impaired, largely sparing other memory components. In accordance with recent knowledge on mammillary function, patients with hypothalamic involvement appear to be at particular risk. Deficits in higher cognitive processes, relying on the integrity of the prefrontal cortex and its subcortical pathways, may also occur, but results are still inconsistent. To gain deeper insight into the pattern of deficits and their association with patient- and treatment-related variables, further multi-site research with larger cohorts is needed.

  2. Feasibility of Performing Total Skin-Sparing Mastectomy in Patients With Prior Circumareolar Mastopexy or Reduction Mammoplasty Incisions.

    Science.gov (United States)

    Vaughn, Carolyn J; Peled, Anne Warren; Esserman, Laura J; Foster, Robert D

    2013-06-19

    Total skin-sparing mastectomy (TSSM) techniques with preservation of the nipple-areolar complex (NAC) skin are becoming increasingly popular due to improved cosmesis without compromise in oncologic safety. However, these techniques are not routinely offered to patients who have undergone previous breast surgery involving circumareolar incisions due to concern for NAC viability. We reviewed the outcomes of TSSM in 11 patients who underwent 21 TSSM procedures at our institution between 2008 and 2011. All patients had undergone previous breast surgery including reduction mammaplasty (7 breasts), mastopexy (4 breasts), augmentation (3 breasts), and combined mastopexy-augmentation (7 breasts). Incisions from previous breast surgery included circumareolar (11 cases) and Wise pattern (10 cases) incisions. All patients underwent TSSM through an inframammary incision followed by immediate tissue expander reconstruction and subsequent implant exchange. Patient demographics, previous breast surgery details, tumor and treatment characteristics, and postoperative complications were reviewed. Mean patient age was 43 years (range, 35-53 years) and mean body mass index was 24 kg/m (range, 19-32 kg/m). Mean follow-up was 10.2 months (range, 3-20 months).Indications for TSSM included prophylactic risk reduction in 10 cases, in situ cancer in 2 cases, and invasive cancer in 9 cases. Mean time from previous breast surgery to mastectomy was 6.9 years (range, 6 months-26 years). Major complications requiring operative reintervention included 1 (4.8%) case of cellulitis requiring expander removal and 2 (9.5%) cases of wound breakdown requiring operative closure. There were no complications involving the NAC. Total skin-sparing mastectomy with immediate reconstruction can safely be performed in patients who have undergone previous breast surgery involving circumareolar incisions. Our preferred technique in this group of patients is to perform TSSM through an inframammary incision with 2

  3. Diagnostic performance of {sup 68}Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients

    Energy Technology Data Exchange (ETDEWEB)

    Afshar-Oromieh, Ali; Haberkorn, Uwe [Heidelberg University Hospital, Department of Nuclear Medicine, Heidelberg (Germany); German Cancer Research Centre, Clinical Cooperation Unit Nuclear Medicine, Heidelberg (Germany); Holland-Letz, Tim [German Cancer Research Center, Department of Biostatistics, Heidelberg (Germany); Giesel, Frederik L.; Kratochwil, Clemens; Mier, Walter; Haufe, Sabine; Debus, Nils [Heidelberg University Hospital, Department of Nuclear Medicine, Heidelberg (Germany); Eder, Matthias [German Cancer Research Centre, Clinical Cooperation Unit Nuclear Medicine, Heidelberg (Germany); Eisenhut, Michael; Schaefer, Martin; Neels, Oliver; Kopka, Klaus [German Cancer Research Center, Division of Radiopharmaceutical Chemistry, Heidelberg (Germany); Hohenfellner, Markus [Heidelberg University Hospital, Department of Urology, Heidelberg (Germany); Kauczor, Hans-Ulrich [Heidelberg University Hospital, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Debus, Juergen [Heidelberg University Hospital, Department of Radiation Oncology and Therapy, Heidelberg (Germany)

    2017-08-15

    Since the clinical introduction of {sup 68}Ga-PSMA-11 PET/CT, this imaging method has rapidly spread and is now regarded as a significant step forward in the diagnosis of recurrent prostate cancer (PCa). The aim of this study was to analyse the influence of several variables with possible influence on PSMA ligand uptake in a large cohort. We performed a retrospective analysis of 1007 consecutive patients who were scanned with {sup 68}Ga-PSMA-11 PET/CT (1 h after injection) from January 2014 to January 2017 to detect recurrent disease. Patients with untreated primary PCa or patients referred for PSMA radioligand therapy were excluded. The possible effects of different variables including PSA level and PSA doubling time (PSA{sub DT}), PSA velocity (PSA{sub Vel}), Gleason score (GSC, including separate analysis of GSC 7a and 7b), ongoing androgen deprivation therapy (ADT), patient age and amount of injected activity were evaluated. In 79.5% of patients at least one lesion with characteristics suggestive of recurrent PCa was detected. A pathological (positive) PET/CT scan was associated with PSA level and ADT. GSC, amount of injected activity, patient age, PSA{sub DT} and PSA{sub Vel} were not associated with a positive PET/CT scan in multivariate analysis. {sup 68}Ga-PSMA-11 PET/CT detects tumour lesions in a high percentage of patients with recurrent PCa. Tumour detection is clearly associated with PSA level and ADT. Only a tendency for an association without statistical significance was found between higher GSC and a higher probability of a pathological PET/CT scan. No associations were found between a pathological {sup 68}Ga-PSMA-11 PET/CT scan and patient age, amount of injected activity, PSA{sub DT} or PSA{sub Vel}. (orig.)

  4. Diagnostic performance of 68Ga-PSMA-11 (HBED-CC) PET/CT in patients with recurrent prostate cancer: evaluation in 1007 patients.

    Science.gov (United States)

    Afshar-Oromieh, Ali; Holland-Letz, Tim; Giesel, Frederik L; Kratochwil, Clemens; Mier, Walter; Haufe, Sabine; Debus, Nils; Eder, Matthias; Eisenhut, Michael; Schäfer, Martin; Neels, Oliver; Hohenfellner, Markus; Kopka, Klaus; Kauczor, Hans-Ulrich; Debus, Jürgen; Haberkorn, Uwe

    2017-08-01

    Since the clinical introduction of 68 Ga-PSMA-11 PET/CT, this imaging method has rapidly spread and is now regarded as a significant step forward in the diagnosis of recurrent prostate cancer (PCa). The aim of this study was to analyse the influence of several variables with possible influence on PSMA ligand uptake in a large cohort. We performed a retrospective analysis of 1007 consecutive patients who were scanned with 68 Ga-PSMA-11 PET/CT (1 h after injection) from January 2014 to January 2017 to detect recurrent disease. Patients with untreated primary PCa or patients referred for PSMA radioligand therapy were excluded. The possible effects of different variables including PSA level and PSA doubling time (PSA DT ), PSA velocity (PSA Vel ), Gleason score (GSC, including separate analysis of GSC 7a and 7b), ongoing androgen deprivation therapy (ADT), patient age and amount of injected activity were evaluated. In 79.5% of patients