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Sample records for positive clinical experience

  1. Clinical Positioning Space

    DEFF Research Database (Denmark)

    Williams, Lars Peter Hedegaard; Christensen, Mette Krogh; Rytter, Carsten

    2014-01-01

    In this article, we present a case study of residents’ clinical experiences and communication in outpatient oncology consultations. We apply positioning theory, a dynamic alternative to role theory, to investigate how oncology residents and patients situate themselves as persons with rights...... and duties. Drawing from seven qualitative interviews and six days of observation, we investigate the residents’ social positioning and their conversations with patients or supervisors. Our focus is on how (a) relational shifts in authority depend on each situation and its participants; (b) storylines...... establish acts and positions and narratively frame what participants can expect from a medical consultation viewed as a social episode; and (c) the positioning of rights and duties can lead to misunderstandings and frustrations. We conclude that residents and patients locate themselves in outpatient...

  2. Ethnographic experiences of HIV-positive nurses in managing stigma at a clinic in rural Uganda

    NARCIS (Netherlands)

    Kyakuwa, M.

    2009-01-01

    This paper explores the workplace experiences of HIV-positive nurses and their attempts to manage HIV/AIDS stigma. An HIV diagnosis can have a major impact on an individual's psychological and emotional wellbeing. Moreover, caring for those suffering from chronic HIV-related illnesses comes with

  3. CT colonography without cathartic preparation: positive predictive value and patient experience in clinical practice

    Energy Technology Data Exchange (ETDEWEB)

    Zueco Zueco, Carmen; Sobrido Sampedro, Carolina; Corroto, Juan D.; Rodriguez Fernandez, Paula; Fontanillo Fontanillo, Manuela [Complexo Hospitalario Universitario de Vigo - CHUVI, Vigo, Pontevedra (Spain)

    2012-06-15

    To determine the positive predictive value (PPV) for polyps {>=}6 mm detected at CT colonography (CTC) performed without cathartic preparation, with low-dose iodine faecal tagging regimen and to evaluate patient experience. 1920 average-risk patients underwent CTC without cathartic preparation. Faecal tagging was performed by diatrizoate meglumine and diatrizoate sodium at a total dose of 60 ml (22.2 g of iodine).The standard interpretation method was primary 3D with 2D problem solving. We calculated per-patient and per-polyp PPV in relation to size and morphology. All colonic segments were evaluated for image quality (faecal tagging, amount of liquid and solid residual faeces and luminal distension). Patients completed a questionnaire before and after CTC to assess preparation and examination experience. Per-polyp PPV for detected lesions of {>=}6 mm, 6-9 mm, {>=}10 mm and {>=}30 mm were 94.3%, 93.1%, 94.7% and 98%, respectively. Per-polyp PPV, according to lesion morphology, was 94.6%, 97.3% and 85.1% for sessile, pedunculated and flat polyps, respectively. Per-patient PPV was 92.8%. Preparation without frank cathartics was reported to cause minimal discomfort by 78.9% of patients. CTC without cathartic preparation and low-dose iodine faecal tagging may yield high PPVs for lesions {>=}6 mm and is well accepted by patients. circle Computed tomographic colonography (CTC) without cathartic preparation is well accepted by patients circle Cathartic-free faecal tagging CTC yields high positive predictive values circle CTC without cathartic preparation could improve uptake of colorectal cancer screening. (orig.)

  4. Gathering positive experience

    CERN Document Server

    2009-01-01

    Last Monday, the new CERN Machine Advisory Committee (CMAC) met for the first time, and we had good news to tell its members. Over the weekend, injection tests for both LHC beams were successfully carried out. In other words, we’ve had beam in the LHC for the first time since September 2008. That’s a good feeling, but it’s no reason for complacency. There’s still a long way to go before first physics at the new energy frontier. As the Bulletin has reported over recent weeks, we’re gathering a lot of positive experience with the new quench detection and protection system (QPS), which is already allowing us to monitor the LHC far better than we were able to in the past. So far, the QPS for three of the LHC’s eight sectors has been put through its paces, and we’ve also power tested those sectors to 2000 amperes, the equivalent of around 1.2 TeV per beam. The next step is to slowly increase the current to 4000 amperes, and...

  5. Clinical relevance of positive voltage-gated potassium channel (VGKC)-complex antibodies: experience from a tertiary referral centre.

    Science.gov (United States)

    Paterson, Ross W; Zandi, Michael S; Armstrong, Richard; Vincent, Angela; Schott, Jonathan M

    2014-06-01

    Voltage-gated potassium channel (VGKC)-complex antibodies can be associated with a range of immunotherapy-responsive clinical presentations including limbic encephalitis, Morvan's syndrome and acquired neuromyotonia. However, there are patients with positive levels in whom the significance is uncertain. To evaluate the clinical significance associated with positive (>100 pM) VGKC-complex antibodies. Over a 4-year period, 1053 samples were sent for testing of which 55 were positive. The clinical presentations, final diagnoses and responses to immunotherapies, when given, were assessed retrospectively and the likelihood of autoimmunity was categorised as definite, possible, unlikely or undetermined (modified from Zuliani et al 2012). Only 4 of the 32 patients with low-positive (100-400 pM) levels were considered definitely autoimmune, 3 with peripheral nerve hyperexcitability and 1 with a thymoma; 3 were given immunotherapies. Of the remaining 28 with low-positive levels, 13 (3 of whom had tumours) were considered possibly autoimmune, and 15 were unlikely or undetermined; 1 was given immunotherapy unsuccessfully. Of the 23 patients with high-positive (>400 pM) levels, 12 were given immunotherapies, 11 of whom showed a good response. 11 were considered definitely autoimmune, 10 with limbic encephalitis (antibody specificity: 5 LGI1, 1 contactin2, 2 negative, 2 untested) and 1 with a tumour. In the remaining 12, autoimmunity was considered possible (n=9; most had not received immunotherapies), or unlikely (n=3). As antibody testing becomes more widely available, and many samples are referred from patients with less clear-cut diagnoses, it is important to assess the utility of the results. VGKC-complex antibodies in the range of 100-400 pM (0.1-0.4 nM) were considered clinically relevant in rare conditions with peripheral nerve hyperexcitability and appeared to associate with tumours (12.5%). By contrast high-positive (>400 pM; >0.4 nM) levels were considered definitely

  6. ESC Working Group on Valvular Heart Disease position paper--heart valve clinics: organization, structure, and experiences.

    Science.gov (United States)

    Lancellotti, Patrizio; Rosenhek, Raphael; Pibarot, Philippe; Iung, Bernard; Otto, Catherine M; Tornos, Pilar; Donal, Erwan; Prendergast, Bernard; Magne, Julien; La Canna, Giovanni; Piérard, Luc A; Maurer, Gerald

    2013-06-01

    With an increasing prevalence of patients with valvular heart disease (VHD), a dedicated management approach is needed. The challenges encountered are manifold and include appropriate diagnosis and quantification of valve lesion, organization of adequate follow-up, and making the right management decisions, in particular with regard to the timing and choice of interventions. Data from the Euro Heart Survey have shown a substantial discrepancy between guidelines and clinical practice in the field of VHD and many patients are denied surgery despite having clear indications. The concept of heart valve clinics (HVCs) is increasingly recognized as the way to proceed. At the same time, very few centres have developed such expertise, indicating that specific recommendations for the initial development and subsequent operating requirements of an HVC are needed. The aim of this position paper is to provide insights into the rationale, organization, structure, and expertise needed to establish and operate an HVC. Although the main goal is to improve the clinical management of patients with VHD, the impact of HVCs on education is of particular importance: larger patient volumes foster the required expertise among more senior physicians but are also fundamental for training new cardiologists, medical students, and nurses. Additional benefits arise from research opportunities resulting from such an organized structure and the delivery of standardized care protocols. The growing volume of patients with VHD, their changing characteristics, and the growing technological opportunities of refined diagnosis and treatment in addition to the potential dismal prognosis if overlooked mandate specialized evaluation and care by dedicated physicians working in a specialized environment that is called the HVC.

  7. Initial clinical experience with an interactive, video-based patient-positioning system for head and neck treatment

    International Nuclear Information System (INIS)

    Johnson, L.; Hadley, Scott W.; Milliken, Barrett D.; Pelizzari, Charles A.; Haraf, Daniel J.; Nguyen, Ai; Chen, George T.Y.

    1996-01-01

    Objective: To evaluate an interactive, video-based system for positioning head and neck patients. Materials and Methods: System hardware includes two B and W CCD cameras (mounted to provide left-lateral and AP-inferior views), zoom lenses, and a PC equipped with a frame grabber. Custom software is used to acquire and archive video images, as well as to display real-time subtraction images revealing patient misalignment in multiple views. Live subtraction images are obtained by subtracting a reference image (i.e., an image of the patient in the correct position) from real-time video. As seen in the figure, darker regions of the subtraction image indicate where the patient is currently, while lighter regions indicate where the patient should be. Adjustments in the patient's position are updated and displayed in less than 0.07s, allowing the therapist to interactively detect and correct setup discrepancies. Patients selected for study are treated BID and immobilized with conventional litecast straps attached to a baseframe which is registered to the treatment couch. Morning setups are performed by aligning litecast marks and patient anatomy to treatment room lasers. Afternoon setups begin with the same procedure, and then live subtraction images are used to fine-tune the setup. At morning and afternoon setups, video images and verification films are taken after positioning is complete. These are visually registered offline to determine the distribution of setup errors per patient, with and without video assistance. Results: Without video assistance, the standard deviation of setup errors typically ranged from 5 to 7mm and was patient-dependent. With video assistance, standard deviations are reduced to 1 to 4mm, with the result depending on patient coopertiveness and the length of time spent fine-tuning the setups. At current levels of experience, 3 to 4mm accuracy is easily achieved in about 30s, while 1 to 3mm accuracy is achieved in about 1 to 2 minutes. Studies

  8. Promoting positive condom use experiences among young black MSM: a randomized controlled trial of a brief, clinic-based intervention.

    Science.gov (United States)

    Crosby, Richard A; Mena, Leandro; Smith, Rachel Vickers

    2018-06-01

    The aim of this study is to determine, among young Black men who have sex with men (YBMSM), the 12-month efficacy of a single-session, clinic-based intervention promoting condom use to enhance sexual pleasure (purpose 1) and the use of condoms from the start-to-finish of anal sex (purpose 2). A pre-test, post-test randomized controlled trial was conducted, using a 12-month period of follow-up observation, in STI clinics. Data from 394 YBMSM completing baseline and 12-month follow-up assessments were analyzed. The experimental condition comprised a one-to-one, interactive program (Focus on the Future) designed for tailored delivery. Regarding study purpose 1, in an age-adjusted linear regression model for 277 HIV-uninfected men, there was a significant effect of the intervention (Beta=0.13, P =0.036) relative to more favorable sexual experiences when using condoms. Regarding study purpose 2, in an adjusted logistic regression model, for HIV-uninfected men, there was a significant effect of the intervention (AOR=0.54, P =0.048) relative to using condoms from start-to-finish of anal sex. Significant effects for HIV-infected men were not observed. A small, but non-significant, effect was observed relative to men's self-report of always using condoms. This single-session program may be a valuable counseling tool for use in conjunction with pre-exposure prophylaxis-related care for HIV-uninfected YBMSM.

  9. Doripenem: position in clinical practice.

    Science.gov (United States)

    Dedhia, Harakh V; McKnight, Richard

    2009-06-01

    Doripenem is a novel carbapenem with a broad spectrum of activity against Gram-positive pathogens, anerobes and Gram-negative bacteria, including Pseudomonas aeruginosa. Doripenem exhibits rapid bactericidal activity with two- to fourfold lower MIC values for Gram-negative bacteria, compared with other carbapenems such as imipenem. Doripenem is approved for the treatment of complicated intra-abdominal infection and urinary tract infections. It has been successfully used in the treatment of nosocomial and ventilator-associated pneumonia. It has a potential to be the drug of choice for these conditions. This evaluation focuses on the general review of the drug, including mechanisms of resistance, clinical efficacy and the position of doripenem in clinical practice. Stability against numerous beta-lactamases, low adverse-event potential and more potent in vitro and possibly in vivo activity against P. aeruginosa and Acinetobacter baumanni compared with existing carbapenems are attractive features.

  10. Menopausal women's positive experience of growing older

    DEFF Research Database (Denmark)

    Hvas, Lotte

    2006-01-01

    This paper aims to describe menopausal women's positive experience of growing older and becoming middle-aged.......This paper aims to describe menopausal women's positive experience of growing older and becoming middle-aged....

  11. Transgressive first clinical experiences

    DEFF Research Database (Denmark)

    Jensen, Carsten Juul; Jeppesen, Lise Kofoed; Drachmann, Merete

    2014-01-01

    . The nursing students’ learning seems to be oriented towards socialization in the clinic as a workplace. This means that the nursing students seek to deal with overwhelming experiences concerning the naked bodies of patients and death, useful application of theoretical knowledge, the path from novice...... to advanced beginner, and adjusting to the workplace community. The conclusion is that the learning of nursing students during their first clinical in-service placement appears informal and not founded on evident best practice....... graduation as a Nurse. The Study has a qualitative methodology, inspired by Michael Eraut’s thoughts on learning in the workplace. When the workplace perspective is applied, learning seems to be concentrated on actual situations which the Learner is in, in contrast to employing constructed concepts...

  12. Clinical experience of laboratory follow-up with noninvasive prenatal testing using cell-free DNA and positive microdeletion results in 349 cases.

    Science.gov (United States)

    Schwartz, S; Kohan, M; Pasion, R; Papenhausen, P R; Platt, L D

    2018-02-01

    Screening via noninvasive prenatal testing (NIPT) involving the analysis of cell-free DNA (cfDNA) from plasma has become readily available to screen for chromosomal and DNA aberrations through maternal blood. This report reviews a laboratory's experience with follow-up of positive NIPT screens for microdeletions. Patients that were screened positive by NIPT for a microdeletion involving 1p, 4p, 5p, 15q, or 22q who underwent diagnostic studies by either chorionic villus sampling or amniocentesis were evaluated. The overall positive predictive value for 349 patients was 9.2%. When a microdeletion was confirmed, 39.3% of the cases had additional abnormal microarray findings. Unrelated abnormal microarray findings were detected in 11.8% of the patients in whom the screen positive microdeletion was not confirmed. Stretches of homozygosity in the microdeletion were frequently associated with a false positive cfDNA microdeletion result. Overall, this report reveals that while cfDNA analysis will screen for microdeletions, the positive predictive value is low; in our series it is 9.2%. Therefore, the patient should be counseled accordingly. Confirmatory diagnostic microarray studies are imperative because of the high percentage of false positives and the frequent additional abnormalities not delineated by cfDNA analysis. © 2018 John Wiley & Sons, Ltd.

  13. Meta-analysis of positive effects, side effects and adverse events of holistic mind-body medicine (clinical holistic medicine): experience from Denmark, Sweden, United Kingdom and Germany.

    Science.gov (United States)

    Ventegodt, Søren; Merrick, Joav

    2009-01-01

    About 50% of the general population has a chronic disease not cured by biomedicine. Meta-analysis of holistic clinical medicine for which chronic patients were treated and outcomes were, 1) global quality of life, 2) self-rated physical/mental health, quality of life or ability of functioning, or 3) patients felt cured for a specific disease of dysfunction. MEDLINE and PsycLNFO and specific journals were searched in January 2009. Eleven clinical studies (18,500 participants) were identified. Positive effects: Quality of life Number Needed to Treat (NNT) = 2, physical health problems NNT = 3, mental health problems NNT = 2, sexual dysfunctions NNT = 2, self esteem NNT = 2, working/studying ability NNT = 2, anorgasmia NNT = 1, other specific sexual dysfunctions NNT = 2. Of 791 patients treated was 617, or 78.0% cured (NNT = 1). Side effects and adverse events: re-traumatization Number Needed to Harm (NNH) > 18,500; brief reactive psychosis (if mentally ill) NNH = 4,625; brief reactive psychosis (if not mentally ill) NNH > 9,250; brief reactive psychosis, all patients NNH = 9,250; depression NNH > 18,500; depersonalization and derealization NNH > 18,500; iatrogenic disturbances NNH > 18,500; minor bone fractures (ribs, hand) NNH = 4,625; serious bone fractures (spine, scull, pelvis) NNH > 18,500; suicides during or less than three month after therapy NNH > 18,500; suicide attempts during or less than three month after therapy NNH > 18,500. Suicide was prevented NNT = 1. Therapeutic value TV = NNH/NNT = 9,250. Holistic clinical medicine is an efficient complementary and alternative medicine (CAM) treatment for chronic illnesses and health related problems. Every second patient with physical and mental disorders, sexual dysfunctions, and existential problems were healed. Holistic clinical medicine had no significant side effects or adverse events.

  14. Digital radiology. Clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Stacul, F; Smathers, R L

    1985-01-01

    The authors report the experience achieved ad the Stanford University (USA) with a digital radiography system which allows the digitization of the film and of the images collected with photostimulable phophors. The phophor is essentially an intensifying screen where a latent image is stored after exposure to X-rays and is extracted by a laser scanning. The images collected with the digitized film and with the phophor (chest, breast, bone) have been analyzed. The digitized film offers potential diagnostic advantages over the conventional film, because of the contrast manipulation and many other processing options. The possibility to recover the information of overexposed films appears very attractive. The photostimulable phophors allow to get good quality images, with a consistent reduction of dose and costs. These plates offer the possibility, in the next future, to replace the conventional screen-film systems.

  15. Assessing student clinical learning experiences.

    Science.gov (United States)

    Nehyba, Katrine; Miller, Susan; Connaughton, Joanne; Singer, Barbara

    2017-08-01

    This article describes the use of an activity worksheet and questionnaire to investigate the learning experience of students on clinical placement. The worksheet measures the amount of time students spend in different learning activities, and the questionnaire explores student satisfaction and preferred learning activities. An activity worksheet and questionnaire … investigate[d] the learning experiences of students on clinical placement METHODS: The activity worksheet and questionnaire were used in a cohort pilot study of physiotherapy students on clinical placement. The activity worksheet provides details of the amount of time students engage in a range of clinical and non-clinical tasks while on placement, such as time spent treating patients, working individually, working with their peers and engaging in reflective practice. In combination with the questionnaire results, it allows clinicians to gain an understanding of the clinical learning environment experienced by their students. The data collected using these tools provide a description of the students' activities while undertaking the clinical placement. This information may guide the refinement of the clinical experience, and offers an opportunity to individualise learning activities to match students' needs and preferences. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

  16. Ethnographic experiences of HIV-positive nurses in managing ...

    African Journals Online (AJOL)

    Data were gathered through clinical participant observation, informal conversations, recorded life histories, open-ended in-depth interviews and topical focus group discussions. Nurses are in a position to help people through negative life events, yet they may personally experience the same types of negative life events.

  17. Medical students, early general practice placements and positive supervisor experiences.

    Science.gov (United States)

    Henderson, Margaret; Upham, Susan; King, David; Dick, Marie-Louise; van Driel, Mieke

    2018-03-01

    Introduction Community-based longitudinal clinical placements for medical students are becoming more common globally. The perspective of supervising clinicians about their experiences and processes involved in maximising these training experiences has received less attention than that of students. Aims This paper explores the general practitioner (GP) supervisor perspective of positive training experiences with medical students undertaking urban community-based, longitudinal clinical placements in the early years of medical training. Methods Year 2 medical students spent a half-day per week in general practice for either 13 or 26 weeks. Transcribed semi-structured interviews from a convenience sample of participating GPs were thematically analysed by two researchers, using a general inductive approach. Results Identified themes related to the attributes of participating persons and organisations: GPs, students, patients, practices and their supporting institution; GPs' perceptions of student development; and triggers enhancing the experience. A model was developed to reflect these themes. Conclusions Training experiences were enhanced for GPs supervising medical students in early longitudinal clinical placements by the synergy of motivated students and keen teachers with support from patients, practice staff and academic institutions. We developed an explanatory model to better understand the mechanism of positive experiences. Understanding the interaction of factors enhancing teaching satisfaction is important for clinical disciplines wishing to maintain sustainable, high quality teaching.

  18. Initial clinical experience with infrared-reflecting skin markers in the positioning of patients treated by conformal radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Soete, Guy; Steene, Jan van de; Verellen, Dirk; Vinh-Hung, Vincent; Berge, Dirk van den; Michielsen, Dirk; Keuppens, Frans; Roover, Patricia de; Storme, Guy

    2002-01-01

    Purpose: To evaluate an infrared (IR) marker-based positioning system in patients receiving conformal radiotherapy for prostate cancer. Methods and materials: During 553 treatments, the ability of the IR system to automatically position the isocenter was recorded. Setup errors were measured by means of orthogonal verification films and compared to conventional positioning (using skin drawings and lasers) in 184 treatments. Results: The standard deviation of anteroposterior (AP) and lateral setup errors was significantly reduced with IR marker positioning compared to conventional: 2 vs. 4.8 mm AP (p<0.01) and 1.6 vs. 3.5 mm laterally (p<0.01). Longitudinally, the difference was not significant (3.5 vs. 3.0 mm). Systematic errors were on the average smaller AP and laterally for the IR method: 4.1 vs. 7.8 mm AP (p=0.01) and 3.1 vs. 5.6 mm lateral (p=0.07). Longitudinally, the IR system resulted in somewhat larger systematic errors: 5.0 vs. 3.4 mm for conventional positioning (p=0.03). The use of an off-line correction protocol, based on the average deviation measured over the first four fractions, allowed virtual elimination of systematic errors. Inability of the IR system to correctly locate the markers, leading to an executional failure, occurred in 21% of 553 fractions. Conclusion: IR marker-assisted patient positioning significantly improves setup accuracy along the AP and lateral axes. Executional failures need to be reduced

  19. Antineutrophil cytoplasm antibody: positivity and clinical correlation.

    Science.gov (United States)

    Martínez Téllez, Goitybell; Torres Rives, Bárbara; Rangel Velázquez, Suchiquil; Sánchez Rodríguez, Vicky; Ramos Ríos, María Antonia; Fuentes Smith, Lisset Evelyn

    2015-01-01

    To determine positivity and clinical correlation of anti-neutrophil cytoplasmic antibodies (ANCA), taking into account the interference of antinuclear antibodies (ANA). A prospective study was conducted in the Laboratory of Immunology of the National Cuban Center of Medical Genetic during one year. Two hounded sixty-seven patients with indication for ANCA determination were included. ANCA and ANA determinations with different cut off points and assays were determined by indirect immunofluorescense. Anti proteinase 3 and antimyeloperoxidase antibodies were determined by ELISA. Most positivity for ANCA was seen in patients with ANCA associated, primary small-vessel vasculitides, rheumatoid arthritis and systemic lupus erythematosus. Presence of ANCA without positivity for proteinase 3 and myeloperoxidase was higher in patients with ANA and little relation was observed between the perinuclear pattern confirmed in formalin and specificity by myeloperoxidase. Highest sensibility and specificity values for vasculitides diagnostic were achieved by ANCA determination using indirect immunofluorescense with a cut off 1/80 and confirming antigenic specificities with ELISA. ANCA can be present in a great number of chronic inflammatory or autoimmune disorders in the population studied. This determination using indirect immunofluorescence and following by ELISA had a great value for vasculitis diagnosis. Anti mieloperoxidasa assay has a higher utility than the formalin assay when ANA is present. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  20. The clinical experiences of dyslexic healthcare students

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, Fred [Directorate of Radiography, School of Health Care Professions, University of Salford, Allerton Building, Salford, Greater Manchester M6 6PU (United Kingdom)], E-mail: f.j.murphy@salford.ac.uk

    2009-11-15

    This paper reflects on the experiences of healthcare students with dyslexia in order to raise awareness of the potential challenges for dyslexic student radiographers and their clinical educators. With widening participation policies it is likely that the number of student radiographers with specific learning difficulties such as dyslexia will continue to increase. A review of the literature associated with dyslexia in healthcare education was performed in order to provide an overview of the current position. Although Higher Education Institutions (HEIs) have embraced the support and learning opportunities for dyslexic students at university, evidence would suggest that this is not reflected in the clinical departments. The current literature strongly suggests that since the risk of errors with clinical information is far more significant within the clinical placement, there is an immediate requirement for greater understanding, robust support and risk assessment systems. This review considers the problems experienced by dyslexic students, coping strategies they employ and the possible implications for clinical radiography education.

  1. The clinical experiences of dyslexic healthcare students

    International Nuclear Information System (INIS)

    Murphy, Fred

    2009-01-01

    This paper reflects on the experiences of healthcare students with dyslexia in order to raise awareness of the potential challenges for dyslexic student radiographers and their clinical educators. With widening participation policies it is likely that the number of student radiographers with specific learning difficulties such as dyslexia will continue to increase. A review of the literature associated with dyslexia in healthcare education was performed in order to provide an overview of the current position. Although Higher Education Institutions (HEIs) have embraced the support and learning opportunities for dyslexic students at university, evidence would suggest that this is not reflected in the clinical departments. The current literature strongly suggests that since the risk of errors with clinical information is far more significant within the clinical placement, there is an immediate requirement for greater understanding, robust support and risk assessment systems. This review considers the problems experienced by dyslexic students, coping strategies they employ and the possible implications for clinical radiography education.

  2. Experience with the shift technical advisor position

    International Nuclear Information System (INIS)

    Melber, B.D.; Olson, J.; Schreiber, R.E.; Winges, L.

    1984-03-01

    The provision of engineering expertise on shift at commercial nuclear power plants has mainly taken the form of the Shift Technical Advisor (STA). This person, acting in a capacity that is part engineer and part operator, is expected to advise the operations crew in the event of an emergency and review plant operating experience during normal circumstances. The position was mandated by the Nuclear Regulatory Commission following the incident at Three Mile Island. This report expands on a growing body of knowledge regarding the effectiveness of the STA. The new data presented here come from interviews with plant personnel and utility officials from nine sites. Researchers from the Pacific Northwest Laboratory (PNL) interviewed plant personnel, including the STA and immediate management, the shift supervisor and management, the training department, and ancillary staff, all of whom affect the intended performance of the STA. The conclusions of the report are that the design of the STA position results in limited contribution during emergencies; more comprehensive ways should be sought to provide the variety and specificity of engineering expertise needed during such times

  3. Experience with the shift technical advisor position

    Energy Technology Data Exchange (ETDEWEB)

    Melber, B.D.; Olson, J.; Schreiber, R.E.; Winges, L.

    1984-03-01

    The provision of engineering expertise on shift at commercial nuclear power plants has mainly taken the form of the Shift Technical Advisor (STA). This person, acting in a capacity that is part engineer and part operator, is expected to advise the operations crew in the event of an emergency and review plant operating experience during normal circumstances. The position was mandated by the Nuclear Regulatory Commission following the incident at Three Mile Island. This report expands on a growing body of knowledge regarding the effectiveness of the STA. The new data presented here come from interviews with plant personnel and utility officials from nine sites. Researchers from the Pacific Northwest Laboratory (PNL) interviewed plant personnel, including the STA and immediate management, the shift supervisor and management, the training department, and ancillary staff, all of whom affect the intended performance of the STA. The conclusions of the report are that the design of the STA position results in limited contribution during emergencies; more comprehensive ways should be sought to provide the variety and specificity of engineering expertise needed during such times.

  4. Retrieval of past and future positive and negative autobiographical experiences.

    Science.gov (United States)

    García-Bajos, Elvira; Migueles, Malen

    2017-09-01

    We studied retrieval-induced forgetting for past or future autobiographical experiences. In the study phase, participants were given cues to remember past autobiographical experiences or to think about experiences that may occur in the future. In both conditions, half of the experiences were positive and half negative. In the retrieval-practice phase, for past and future experiences, participants retrieved either half of the positive or negative experiences using cued recall, or capitals of the world (control groups). Retrieval practice produced recall facilitation and enhanced memory for the practised positive and negative past and future experiences. While retrieval practice on positive experiences did not impair the recall of other positive experiences, we found inhibition for negative past and future experiences when participants practised negative experiences. Furthermore, retrieval practice on positive future experiences inhibited negative future experiences. These positivity biases for autobiographical memory may have practical implications for treatment of emotional disorders.

  5. Nursing students’ experiences of clinical education setting

    Directory of Open Access Journals (Sweden)

    Rahnama M

    2015-08-01

    Full Text Available Background and Objective: Appropriate clinical environment has an important role in preparing students to use learned knowledge in practice through providing learning opportunities. Since the students’ experiences in the clinical setting affect on quality of their learning, the current study aimed to explain the experiences of nursing students concerning clinical education setting. Materials and Method: The current study was conducted based on conventional content analysis. Sampling was done purposively and the participants were 13 last year nursing students in Zabol Nursing and Midwifery School in 2013-2014. Data collection was done through in-depth semi-structured interviews. Data analysis was conducted through qualitative content analysis approach. Results: Based on the results, five major categories including threats, vision, dual forces, mindset and students’ action to clinical education and also10 subcategorie were identified. Conclusion: Since the formation of students’ experiences in these environments is one of the predictive factors in achieving their learning and in facilitating the professionalization process, thus the attention of managers in clinical settings is very important for decreasing the threats and concerns for students. In this way, the marred prospects of profession can be recovered through the meeting students’ expectations, attractiveness of the profession can be increased and the positive belief, actions and feelings can be created in students.

  6. Experiences matter: Positive emotions facilitate intrinsic motivation

    OpenAIRE

    Løvoll, Helga Synnevåg; Røysamb, Espen; Vittersø, Joar

    2017-01-01

    This paper has two major aims. First, to investigate how positive emotions and intrinsic motivation affect each other over time. Second, to test the effect of positive emotions and intrinsic motivation on subsequent educational choices. Through two ordinary study semesters, 64 sport students in Norway reported on their intrinsic motivation for outdoor activities (twice) as well as positive emotions after two three-day outdoor events (four times). Next autumn, students study choice was collect...

  7. Experiences matter: Positive emotions facilitate intrinsic motivation

    OpenAIRE

    Løvoll, Helga Synnevåg; Røysamb, Espen; Vittersø, Joar

    2017-01-01

    https://doi.org/10.1080/23311908.2017.1340083 This paper has two major aims. First, to investigate how positive emotions and intrinsic motivation affect each other over time. Second, to test the effect of positive emotions and intrinsic motivation on subsequent educational choices. Through two ordinary study semesters, 64 sport students in Norway reported on their intrinsic motivation for outdoor activities (twice) as well as positive emotions after two three-day outdoor e...

  8. Design -|+ Negative emotions for positive experiences

    NARCIS (Netherlands)

    Fokkinga, S.F.

    2015-01-01

    Experience-driven design considers all aspects of a product – its appearance, cultural meaning, functionality, interaction, usability, technology, and indirect consequences of use – with the aim to optimize and orchestrate all these aspects and create the best possible user experience. Since the

  9. Motivating students through positive learning experiences

    DEFF Research Database (Denmark)

    Lykke, Marianne; Coto Chotto, Mayela; Jantzen, Christian

    2015-01-01

    Based on the assumption that wellbeing, positive emotions and engagement influence motivation for learning, the aim of this paper is to provide insight into students’ emotional responses to and engagement in different learning designs. By comparing students’ reports on the experiential qualities...... of three different learning designs, their respective influence on students’ motivation for learning is discussed with the purpose of exploring the relationship between positive emotions, engagement and intrinsic motivation for learning. Our study thus aims at evaluating the motivational elements...

  10. First year clinical tutorials: students’ learning experience

    Directory of Open Access Journals (Sweden)

    Burgess A

    2014-11-01

    Full Text Available Annette Burgess,1 Kim Oates,2 Kerry Goulston,2 Craig Mellis1 1Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; 2Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Background: Bedside teaching lies at the heart of medical education. The learning environment afforded to students during clinical tutorials contributes substantially to their knowledge, thinking, and learning. Situated cognition theory posits that the depth and breadth of the students' learning experience is dependent upon the attitude of the clinical teacher, the structure of the tutorial, and the understanding of tutorial and learning objectives. This theory provides a useful framework to conceptualize how students' experience within their clinical tutorials impacts their knowledge, thinking, and learning. Methods: The study was conducted with one cohort (n=301 of students who had completed year 1 of the medical program at Sydney Medical School in 2013. All students were asked to complete a three-part questionnaire regarding their perceptions of their clinical tutor's attributes, the consistency of the tutor, and the best features of the tutorials and need for improvement. Both quantitative and qualitative data were collected and analyzed using descriptive statistics. Results: The response rate to the questionnaire was 88% (265/301. Students perceived that their tutors displayed good communication skills and enthusiasm, encouraged their learning, and were empathetic toward patients. Fifty-two percent of students reported having the same communications tutor for the entire year, and 28% reported having the same physical examination tutor for the entire year. Students would like increased patient contact, greater structure within their tutorials, and greater alignment of teaching with the curriculum. Conclusion: Situated cognition theory provides a valuable lens to view students' experience of learning within the

  11. Exploring Online Game Players' Flow Experiences and Positive Affect

    Science.gov (United States)

    Chiang, Yu-Tzu; Lin, Sunny S. J.; Cheng, Chao-Yang; Liu, Eric Zhi-Feng

    2011-01-01

    The authors conducted two studies to explore online game players' flow experiences and positive affect. Our findings indicated that online game are capable of evoking flow experiences and positive affect, and games of violent or nonviolent type may not arouse players' aggression. The players could be placed into four flow conditions: flow,…

  12. Clients' experiences of HIV positive status disclosure to sexual ...

    African Journals Online (AJOL)

    The purpose of the study was to describe the experiences of HIV positive clients as they disclose their HIV positive status to their sexual partners. A qualitative descriptive and phenomenological design was used. Purposive sampling was used to select 15 HIV positive clients to participate in the study. Semi-structured ...

  13. Clinical psychologists' experiences of NHS organisational change

    OpenAIRE

    Colley, Rich; Eccles, Fiona; Hutton, Cheryl

    2015-01-01

    Organisational-change experiences of eight clinical psychologists working in the NHS were captured. Three themes revealed the challenges they experienced and how their knowledge and skills have helped them understand, cope with, and respond to change.

  14. Positive Exercise Experience Facilitates Behavior Change via Self-Efficacy

    Science.gov (United States)

    Parschau, Linda; Fleig, Lena; Warner, Lisa Marie; Pomp, Sarah; Barz, Milena; Knoll, Nina; Schwarzer, Ralf; Lippke, Sonia

    2014-01-01

    Purpose: Motivational processes can be set in motion when positive consequences of physical exercise are experienced. However, relationships between positive exercise experience and determinants of the motivational and the volitional phases of exercise change have attracted only sparse attention in research. Method: This research examines direct…

  15. Physiotherapy clinical educators' perceptions and experiences of clinical prediction rules.

    Science.gov (United States)

    Knox, Grahame M; Snodgrass, Suzanne J; Rivett, Darren A

    2015-12-01

    Clinical prediction rules (CPRs) are widely used in medicine, but their application to physiotherapy practice is more recent and less widespread, and their implementation in physiotherapy clinical education has not been investigated. This study aimed to determine the experiences and perceptions of physiotherapy clinical educators regarding CPRs, and whether they are teaching CPRs to students on clinical placement. Cross-sectional observational survey using a modified Dillman method. Clinical educators (n=211, response rate 81%) supervising physiotherapy students from 10 universities across 5 states and territories in Australia. Half (48%) of respondents had never heard of CPRs, and a further 25% had never used CPRs. Only 27% reported using CPRs, and of these half (51%) were rarely if ever teaching CPRs to students in the clinical setting. However most respondents (81%) believed CPRs assisted in the development of clinical reasoning skills and few (9%) were opposed to teaching CPRs to students. Users of CPRs were more likely to be male (pphysiotherapy (pStudents are unlikely to be learning about CPRs on clinical placement, as few clinical educators use them. Clinical educators will require training in CPRs and assistance in teaching them if students are to better learn about implementing CPRs in physiotherapy clinical practice. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  16. Job-sharing a clinical teacher's position: an evaluation.

    Science.gov (United States)

    Williams, S; Murphy, L

    1994-01-01

    The aim of this study was to evaluate the effects on staff of having two teachers share one clinical teaching position in their intensive care unit (ICU). Three, six and 12 months after the job-sharing arrangement was initiated, an 11 item questionnaire was distributed to 26 students in post-registration critical care courses, 41 clinical staff in ICU and 9 RN-managers with responsibilities for the unit. The overall response rate to the three questionnaires was 58%. All groups agreed that job-sharing was a viable alternative to full-time work. Three months after the shared position was initiated, there was uncertainty about the consistency of the teachers' performance and the adequacy of communication between them. Nine months later, there was a high level of positive responses to all areas of the teachers' performance. Most respondents felt they could approach either teacher and that more diverse ideas were generated by having two people in the teaching position.

  17. [Clinical investigation of the positioning accuracy of acute pulpitis pain].

    Science.gov (United States)

    Wang, Jin; Sun, Wei; Ji, Aiping

    2013-10-01

    This study aims to investigate the positioning accuracy of acute pulpitis pain and its possible factors. The clinical symptoms and physical signs of 3 432 cases of acute pulpitis were recorded and analyzed by using questionnaire forms, which included age, gender, tooth position, infection origin, pain history, time of acute attack, duration and nature of pain, pain frequency, referred pain areas, percussion examination, temperature pulp test, pulp bleeding, and positioning accuracy. Univariate analysis and multivariate stepwise regression analysis were used for data processing. Pain location was accurately identified by 39.1% of the patients with acute pulpitis. Referred pain could reduce the positioning accuracy of pain (P 0.05). Some cases of acute pulpitis pain can be located accurately. Referred pain and periodontium infection origin are related to the positioning accuracy of acute pulpitis pain. The exact cause of this correlation needs further study.

  18. Leadership Is Positively Related to Athletic Training Students' Clinical Behaviors

    Science.gov (United States)

    Kutz, Matthew R.

    2012-01-01

    Context: Leadership development by health professionals positively affects patient outcomes. Objective: To 1) determine if there is any relationship between demonstrated leadership behaviors and clinical behaviors among entry-level AT students (ATS); 2) to explore if the level of leadership behavior changes between ATS level; and 3) to determine…

  19. Positive malignant margins in clinically diagnosed and excised be ...

    African Journals Online (AJOL)

    This study was aimed at utilizing retrospective descriptive data to evaluate the percentage of clini-cally benign breast lumps that turned out to be histologically malignant and the prevalence of posi-tive tumour margins among the malignant cases. A total of 2,917 registered cases of excised breast lump at the Department of ...

  20. The interpretation of static positional nystagmus in a balance clinic.

    Science.gov (United States)

    Jeffery, Hanna; Hopkins, Matthew; Anderson, Rebecca; Patel, Vignapti; Rogers, Jennifer

    2017-12-01

    To review the current criteria for the interpretation of positional nystagmus (PN). Videonystagmography data on PN was collected for 90 patients presenting for balance testing with a history of vertigo or imbalance (excluding those diagnosed with benign paroxysmal positional vertigo). These were compared to normative data from 90 asymptomatic subjects. A literature review was carried out regarding threshold criteria for clinically significant PN. These were evaluated using the data collected. Clinic group: 90 patients; 37 male, 53 female. Age range 15-82 years. Normative group: Ninety subjects; 31 male, 59 female. Age range 21-79 years. PN was seen in 75.6% of the clinic group and in 50% of the normative group. The prevalence of nystagmus of slow phase velocity (SPV) > 3°/s was significantly higher in the clinic group than the normative group. The maximum SPV recorded in each position was greater from the clinic group than the normative group. This study supports the use of normative thresholds for SPV for both horizontal and vertical PN. A normative threshold of >3°/s for horizontal and >7°/s for vertical nystagmus is proposed.

  1. ASD Transition to Mainstream Secondary: A Positive Experience?

    Science.gov (United States)

    Neal, Sinead; Frederickson, Norah

    2016-01-01

    The transition to secondary school is considered difficult for children with autistic spectrum disorder (ASD), yet there has been little strength-based investigation of positive experiences of this population and the types of support they value most in managing anxiety about transition. The current article presents a qualitative exploration of the…

  2. Mandatory Parent Education Programs Can Create Positive Youth Sport Experiences

    Science.gov (United States)

    Christofferson, Jennifer; Strand, Bradford

    2016-01-01

    Youth sport leaders must not ignore the influence parents have on creating a positive developmental experience for young athletes. Therefore, expectations involving parental involvement and conduct must be addressed prior to athletes' participation. This article aims to examine the importance of creating mandatory parental training programs for…

  3. Exploring Positive Survivorship Experiences of Indigenous Australian Cancer Patients

    Science.gov (United States)

    Tam, Laura; Garvey, Gail; Meiklejohn, Judith; Martin, Jennifer; Adams, Jon; Walpole, Euan; Fay, Michael; Valery, Patricia

    2018-01-01

    Amongst Indigenous Australians, “cancer” has negative connotations that detrimentally impact upon access to cancer care services. Barriers to accessing cancer services amongst Indigenous Australians are widely reported. In contrast, factors that facilitate this cohort to successfully navigate cancer care services (“enablers”) are scarcely reported in the literature. Through qualitative interviews, this article examines factors that assist Indigenous Australians to have positive cancer experiences. Semi-structured interviews were conducted with twelve adult Indigenous oncology patients recruited from a tertiary hospital in Queensland, Australia during 2012–2014. Data generated from the interviews were independently reviewed by two researchers via inductive thematic analytical processes. Discussions followed by consensus on the major categories allowed conclusions to be drawn on potential enablers. Two major categories of enablers were identified by the researchers: resilience and communication. Individual’s intrinsic strength, their coping strategies, and receipt of support improved participant’s resilience and consequently supported a positive experience. Communication methods and an effective patient-provider relationship facilitated positive experiences for participants. Despite potential barriers to access of care for Indigenous cancer patients, participants in the study demonstrated that it was still possible to focus on the positive aspects of their cancer experiences. Many participants explained how cancer changed their outlook on life, often for the better, with many feeling empowered as they progressed through their cancer diagnosis and treatment processes. PMID:29342934

  4. Positive and negative caregiver experiences in first-episode psychosis

    DEFF Research Database (Denmark)

    Jansen, Jens Einar; Lysaker, Paul H.; Harder, Susanne

    2014-01-01

    influenced their reports of both positive and negative caregiving experiences. Design A prospective consecutive cross-sectional study. Methods Forty caregivers of patients with first-episode psychosis were interviewed using semi-structured interview and questionnaires. Results Greater levels of distress...

  5. Vantage sensitivity: individual differences in response to positive experiences.

    Science.gov (United States)

    Pluess, Michael; Belsky, Jay

    2013-07-01

    The notion that some people are more vulnerable to adversity as a function of inherent risk characteristics is widely embraced in most fields of psychology. This is reflected in the popularity of the diathesis-stress framework, which has received a vast amount of empirical support over the years. Much less effort has been directed toward the investigation of endogenous factors associated with variability in response to positive influences. One reason for the failure to investigate individual differences in response to positive experiences as a function of endogenous factors may be the absence of adequate theoretical frameworks. According to the differential-susceptibility hypothesis, individuals generally vary in their developmental plasticity regardless of whether they are exposed to negative or positive influences--a notion derived from evolutionary reasoning. On the basis of this now well-supported proposition, we advance herein the new concept of vantage sensitivity, reflecting variation in response to exclusively positive experiences as a function of individual endogenous characteristics. After distinguishing vantage sensitivity from theoretically related concepts of differential-susceptibility and resilience, we review some recent empirical evidence for vantage sensitivity featuring behavioral, physiological, and genetic factors as moderators of a wide range of positive experiences ranging from family environment and psychotherapy to educational intervention. Thereafter, we discuss genetic and environmental factors contributing to individual differences in vantage sensitivity, potential mechanisms underlying vantage sensitivity, and practical implications. 2013 APA, all rights reserved

  6. Components of Camp Experiences for Positive Youth Development

    Directory of Open Access Journals (Sweden)

    Karla A. Henderson

    2007-03-01

    Full Text Available Youth development specialists advocate that well designed, implemented, and staffed youth centered programs result in positive outcomes for young people. Youth organizations have provided opportunities for young people to participate in camping experiences for over a century. The purpose of this paper is to describe what program components were related to camp environments and positive youth development. We describe these program components related to positive youth development based on a large scale national study of ACA (American Camp Association accredited camps that included independent, religiously affiliated, government, and not-for-profit organizations. Based on the responses given by camp directors, contact and leadership from trained staff and the supportive relationships they provided were essential elements of camp. Other aspects leading to positive youth development in camps were program mission and structure along with elements of accountability, assessment of outcomes, and opportunities for skill building.

  7. Breast cancer patients' narratives about positive and negative communication experiences

    DEFF Research Database (Denmark)

    Thomsen, Dorthe K; Pedersen, Anette F; Johansen, Mikael B

    2007-01-01

    . Thus, qualitative studies of communication are also needed. Fifteen breast cancer patients were interviewed 3 months after finishing adjuvant treatment. They were asked to tell a 10 minute narrative and recall five experiences from treatment. Themes were extracted using categories derived from previous...... research while at the same time being sensitive to new elaborations and categories. The participants reported both positive and negative communication-related experiences from a wide range of treatment situations. Two major themes emerged: Information giving as professional care-giving and meeting......Health staff-patient communication is increasingly considered an important issue in cancer research. However, questionnaires addressing satisfaction with communication limit the issues patients can raise, do not address the context of communication and often show a strong positive skew in responses...

  8. Interprofessional student experiences on the HAVEN free clinic leadership board.

    Science.gov (United States)

    Scott, Elizabeth Anne; Swartz, Martha K

    2015-01-01

    In this study, we examined the experiences of students serving on the leadership board of HAVEN - the student-run free clinic of the Yale University health professional schools. Open-ended responses were collected from 18 of the 28 members of the 2011-2012 leadership board through an online survey. Students reported an overall positive experience participating on the board and valued the opportunity to be part of a committed community creating change. The majority of students reported that their time as a board member had improved their attitude towards interprofessional collaboration (78%) and had also fostered their leadership skills (67%). Around two thirds (67%) reported that their experience had positively impacted their future career plans, either reinforcing their desire to work with underserved populations or encouraging them to pursue leadership roles. Based on these data, it is suggested that the HAVEN Free Clinic offers a useful opportunity for students to experience the demands of clinical care leadership while working together in an interprofessional context.

  9. Experience with Fingolimod in Clinical Practice

    Science.gov (United States)

    Hersh, Carrie M.; Hara-Cleaver, Claire; Rudick, Richard A.; Cohen, Jeffrey A.; Bermel, Robert A.; Ontaneda, Daniel

    2015-01-01

    Aim To report experience with fingolimod in clinical practice. Design/Methods Patients in an academic medical center who were prescribed fingolimod from October 2010 to August 2011 were identified through the electronic medical record and followed for 12 months after fingolimod initiation. Adverse effects, clinical measures, MRI data, and quality of life measures were assessed. Results Three hundred seventeen patients started fingolimod. Eleven patients were treatment naïve (3.5%) and 76 (24.0%) had remote disease modifying therapy use prior to fingolimod. One hundred fifty-one (47.6%) switched because of patient preference and 79 (24.9%) switched because of breakthrough disease. About 11.6% transitioned from natalizumab. Follow-up data were available for 306 patients (96.5%) with mean follow-up time 332 days. Fingolimod was discontinued in 76 of 306 patients (24.8%) at mean 248 days after fingolimod start. Discontinuation most often was due to adverse effects (n=40) or breakthrough disease (n=22). Among patients who started fingolimod with available 12 month follow-up data, 267 (87.3%) remained relapse free and 256 (83.7%) had no relapses or gadolinium enhancement. Time to first relapse occurred at mean 282 days after fingolimod initiation. Quality of life measures remained stable at follow-up. Conclusions Fingolimod was discontinued at a higher rate in clinical practice than in clinical trials. Discontinuation was primarily due to adverse effects or breakthrough disease. Disease activity was adequately controlled in most patients who started fingolimod. This clinical practice cohort is consistent with efficacy data from phase 3 trials and describes the most common tolerability issues in clinical practice. PMID:25271798

  10. Position indicating split toroid for the RACE experiment

    International Nuclear Information System (INIS)

    Hurst, B.; Folkman, K.

    2007-01-01

    Aspects of the recent reactor accelerator coupled experiments (RACE) carried out at University of Texas Nuclear Engineering Teaching Laboratory will be discussed. In particular, a compact instrument that allowed a continuous non-invasive means of determining the relative electron beam position was developed. The operation of the instrument is similar to an inductive current pick up toroid except that the core is sectioned radially, which allows spatial information to be derived from the induced voltages. Results of initial tests, both in beam and with a pulser, will be presented along with plans to optimize future designs

  11. Clinicians’ experiences of becoming a clinical manager: a qualitative study

    Directory of Open Access Journals (Sweden)

    Spehar Ivan

    2012-11-01

    Full Text Available Abstract Background There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. Methods We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. Results We found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Conclusions Path dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers

  12. Clinicians' experiences of becoming a clinical manager: a qualitative study.

    Science.gov (United States)

    Spehar, Ivan; Frich, Jan C; Kjekshus, Lars Erik

    2012-11-22

    There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals' decisions to engage in management. The aim of this study is to explore clinicians' journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. We found that there were three phases in clinicians' journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants' experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management "on the fly". Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Path dependency and social pressure seems to influence clinicians' decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary support functions are available locally, especially

  13. Clinicians’ experiences of becoming a clinical manager: a qualitative study

    Science.gov (United States)

    2012-01-01

    Background There has been an increased interest in recruiting health professionals with a clinical background to management positions in health care. We know little about the factors that influence individuals’ decisions to engage in management. The aim of this study is to explore clinicians’ journeys towards management positions in hospitals, in order to identify potential drivers and barriers to management recruitment and development. Methods We did a qualitative study which included in-depth interviews with 30 clinicians in middle and first-line management positions in Norwegian hospitals. In addition, participant observation was conducted with 20 of the participants. The informants were recruited from medical and surgical departments, and most had professional backgrounds as medical doctors or nurses. Interviews were analyzed by systemic text condensation. Results We found that there were three phases in clinicians’ journey into management; the development of leadership awareness, taking on the manager role and the experience of entering management. Participants’ experiences suggest that there are different journeys into management, in which both external and internal pressure emerged as a recurrent theme. They had not anticipated a career in clinical management, and experienced that they had been persuaded to take the position. Being thrown into the position, without being sufficiently prepared for the task, was a common experience among participants. Being left to themselves, they had to learn management “on the fly”. Some were frustrated in their role due to increasing administrative workloads, without being able to delegate work effectively. Conclusions Path dependency and social pressure seems to influence clinicians’ decisions to enter into management positions. Hospital organizations should formalize pathways into management, in order to identify, attract, and retain the most qualified talents. Top managers should make sure that necessary

  14. Movement of Genetic Counselors from Clinical to Non-clinical Positions: Identifying Driving Forces.

    Science.gov (United States)

    Cohen, Stephanie A; Tucker, Megan E

    2018-03-05

    A previous study of genetic counselors (GCs) in the state of Indiana identified movement out of clinical positions within the past 2 years. The aims of this study were to determine if this trend is nationwide and identify reasons why GCs are leaving their positions and factors that might help employers attract and retain GCs. An email was sent to members of the American Board of Genetic Counseling with a link to an online confidential survey. There were 939 responses (23.5% response rate). Overall, 52% of GCs report being highly satisfied in their current position, although almost two thirds think about leaving and one third had changed jobs within the past 2 years. Of those who had changed jobs (n = 295), 74.9% had been working in a hospital/clinic setting but only 46.3% currently do, demonstrating a major shift out of the clinic (p < 0.001). The top three reasons cited for leaving a position were work environment/institutional climate, salary/benefits, and a lack of feeling valued/recognized as a professional. These results confirm that GCs are moving out of clinical positions and document elements of job satisfaction. We suggest points for employers to consider when trying to recruit or retain GCs.

  15. Positive psychology leadership coaching experiences in a financial organisation

    Directory of Open Access Journals (Sweden)

    Frans Cilliers

    2011-10-01

    Research purpose: The purpose of this research was to describe the positive psychology leadership coaching experiences of leaders in a large financial organisation. Motivation for the study: The researcher addressed the organisation’s need to develop leadership by structuring and presenting a coaching programme. He chose positive psychology as the paradigm and experiential learning as the method to meet the organisation’s goal of enabling its leaders to take up their roles with self-awareness, internal motivation and effective interpersonal connections. Research design, approach and method: The researcher used a qualitative and descriptive research design with a case study. Leaders attended ten experiential leadership-coaching sessions over three months. The sessions focused on work engagement, learned resourcefulness, sense of coherence, self-actualisation values and locus of control. The data gathering consisted of the coach’s field notes and the participants’ reflective essays, which they wrote after the last coaching session. The researcher analysed the data using discourse analysis. Main findings: The manifesting themes were the coaching context, engagement in roles, understanding role complexity, emotional self-awareness and demands, self-authorisation and inability to facilitate the growth of others. Contribution/value-add: Although intrapersonal awareness increased significantly, leaders struggled with the interpersonal complexity of the leadership role. Positive psychology leadership coaching should refine the operationalisation of interpersonal effectiveness. Practical/managerial implications: Organisations should integrate the methodology of leadership coaching with leadership development interventions to expose leaders to better intrapersonal awareness and functioning.

  16. Digital beam position monitor for the HAPPEX experiment

    International Nuclear Information System (INIS)

    Sherlon Kauffman; John Musson; Hai Dong; Lisa Kaufman; Arne Freyberger

    2005-01-01

    The proposed HAPPEX experiment at CEBAF employs a three cavity monitor system for high precision (1um), high bandwidth (100 kHz) position measurements. This is performed using a cavity triplet consisting of two TM110-mode cavities (one each for X and Y planes) combined with a conventional TM010-mode cavity for a phase and magnitude reference. Traditional systems have used the TM010 cavity output to directly down convert the BPM cavity signals to base band. The multi-channel HAPPEX digital receiver simultaneously I/Q samples each cavity and extracts position using a CORDIC algorithm. The hardware design consists of a RF receiver daughter board and a digital processor motherboard that resides in a VXI crate. The daughter board down converts 1.497 GHz signals from the TM010 cavity and X and Y signals from the TM110 cavities to 3 MHz and extracts the quadrature digital signals. The motherboard processes this data and computes beam intensity and X-Y positions with resolution of 1um, 100 kHz output bandwidth, and overall latency of 1us. The results are available in both the analog and digital format

  17. Local beam position feedback experiments on the ESRF storage ring

    International Nuclear Information System (INIS)

    Chung, Y.; Kahana, E.; Kirchman, J.

    1995-01-01

    This paper describes the results of local beam position feedback experiments conducted on the ESRF storage ring using digital signal processing (DSP) under the trilateral agreement of collaboration among ESRF, APS, and SPring-8. Two rf beam position monitors (BPMS) in the, upstream and downstream of the insertion device (ID) and two x-ray BPMs in the sixth cell were used to monitor the electron beam and the x-ray beam emitted from the ID, respectively. The local bump coefficients were obtained using the technique of singular value decomposition (SVD) on the global response matrix for the bump magnets and all the available BPMs outside the local bump. The local response matrix was then obtained between the two three-magnet bumps and the position monitors. The data sampling frequency was 4 kHz and a proportional, integral, and derivative (PID) controller was used. The result indicates the closed-loop feedback bandwidth close to 100 Hz and clear attenuation (∼ -40 dB) of the 7-Hz beam motion due to girder vibration resonance. Comparison of the results using the rf BPMs and x-ray BPMs will be also discussed

  18. Insomnia: clinical experience with zolpidem (sanval

    Directory of Open Access Journals (Sweden)

    Yakov Iosifovich Levin

    2010-01-01

    Full Text Available The paper describes the present view of the problem of insomnia and gives a classification of sleep disorders and basic methods for their drug and non-drug therapy. Emphasis is placed on the role of the objective sleep study - polysomnography. The use of the current hypnotics belonging to a three Zs group and the minimization of administration of benzodiazepines are most important in pharmacotherapy for insomnia. The results of a clinical polysomnographic study of the effect of Zolpidem (Sanval in patients with insomnia are presented. The subjective evaluation of the beneficial effect of a 10-day course of Sanval is confirmed by the objective studies of the sleep pattern undergoing positive changes in the most important indicators, such as the process of falling asleep, the time of intrasleep awakenings, and the duration of Δ-sleep. The high safety and good tolerability of Sanval permit the latter to be assessed as an effective agent for the treatment of insomnia.

  19. Comorbidities and recurrence of benign paroxysmal positional vertigo: personal experience.

    Science.gov (United States)

    Picciotti, P M; Lucidi, D; De Corso, E; Meucci, D; Sergi, B; Paludetti, G

    2016-01-01

    The aim of this study is to evaluate the correlation between clinical features of benign paroxysmal positional vertigo (BPPV) and age, sex, trauma, presence of one or more comorbidities such as cardiovascular, neurological, endocrinological, metabolic, psychiatric diseases. Retrospective review of medical records (chart review). A total of 475 patients aged from 14 to 87 years, affected by BPPV. Recurrence of BPPV occurred in 139/475 patients (29.2%). The recurrence rate was significantly higher in female and older patients. Comorbidities were present in 72.6% of subjects with recurrent BPPV vs. 48.9% of patients with no recurrence (p disorders, followed by neurological and vascular diseases. Collecting a complete medical history is important for prognostic stratification and detection of potential underlying pathological conditions.

  20. Positive expiratory pressure - Common clinical applications and physiological effects.

    Science.gov (United States)

    Fagevik Olsén, Monika; Lannefors, Louise; Westerdahl, Elisabeth

    2015-03-01

    Breathing out against resistance, in order to achieve positive expiratory pressure (PEP), is applied by many patient groups. Pursed lips breathing and a variety of devices can be used to create the resistance giving the increased expiratory pressure. Effects on pulmonary outcomes have been discussed in several publications, but the expected underlying physiology of the effect is seldom discussed. The aim of this article is to describe the purpose, performance, clinical application and underlying physiology of PEP when it is used to increase lung volumes, decrease hyperinflation or improve airway clearance. In clinical practice, the instruction how to use an expiratory resistance is of major importance since it varies. Different breathing patterns during PEP increase or reduce expiratory flow, result in movement of EPP centrally or peripherally and can increase or decrease lung volume. It is therefore necessary to give the right instructions to obtain the desired effects. As the different PEP techniques are being used by diverse patient groups it is not possible to give standard instructions. Based on the information given in this article the instructions have to be adjusted to give the optimal effect. There is no consensus regarding optimal treatment frequency and number of cycles included in each treatment session and must also be individualized. In future research, more precise descriptions are needed about physiological aims and specific instructions of how the treatments have been performed to assure as good treatment quality as possible and to be able to evaluate and compare treatment effects. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Clinical Experience in TCM Treatment of Insomnia

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ Insomnia is a sleeping disorder that affects 1 in 10 Americans and around 50% of the seniors. It is often more prevalent in women. Since September 11, 2005 these estimations have increased. Insomnia can affect not only your energy level and mood, but your health as well because sleep helps bolster your immune system. Insomnia is characterized by: 1) difficulty in falling asleep; 2) waking up frequently during the night with difficulty of returning to sleep; 3) waking up too early in the morning; and 4) with unrefreshing sleep, the patient has a low spirit, palpation, poor memory, viscera function disorder. All these seriously affect the patient's life and work. The following is an account of the authors' clinical TCM experience in treating insomnia.

  2. University of Limpopo student nurses' clinical learning experiences ...

    African Journals Online (AJOL)

    University of Limpopo student nurses' clinical learning experiences in a public hospital at ... was applied to explore and describe the experiences of student nurses' clinical learning ... The ethical principles relevant to the study were observed.

  3. Clouds and silver linings: positive experiences associated with primary affective disorders.

    Science.gov (United States)

    Jamison, K R; Gerner, R H; Hammen, C; Padesky, C

    1980-02-01

    Clinical psychiatry has focused almost entirely on the psychopathology of the affective disorders. The authors studied responses of 61 patients (35 bipolar. 26 unipolar) to questions about perceived short- and long-term benefits (increased sensitivity, sexuality, productivity, creativity, and social outgoingness) they attributed to their affective illness. Bipolar patients strongly indicated positive experiences associated with manic-depressive illness; few unipolar patients perceived their disorder in such a way. Significant sex differences emerged in the attributions made by bipolar patients.

  4. Vertigo in childhood: a clinical experience.

    Science.gov (United States)

    Erbek, Seyra H; Erbek, Selim S; Yilmaz, Ismail; Topal, Ozgul; Ozgirgin, Nuri; Ozluoglu, Levent N; Alehan, Fusun

    2006-09-01

    Vertigo in childhood is a complaint consisting of a wide spectrum of diagnoses. The aim of this study was to evaluate pediatric patients with vertigo with normal eardrum and middle ear findings and discuss the differential diagnoses. Patient records of 50 children under 18 years of age with vertigo as the chief complaint, examined at the Baskent University, Research and Application Centers at Konya and Adana otorhinolaryngology clinics between May 2003 and October 2005 were retrospectively reviewed. The questionnaires, laboratory tests including blood samples, audiological and vestibular tests, and final diagnoses were analyzed. Patients with perforated eardrums, otitis media with effusion, and acute upper respiratory tract infections were not included in the study. The study group consisted of 50 patients (33 females, 66%; 17 males, 34%), between 4 and 17 years of age (mean age, 11.5+/-3.9 years). Severe sensorineural hearing loss was present in one patient unilaterally (2%) and one patient bilaterally (2%). Bilateral low-frequency sensorineural hearing loss was present in one patient (2%). Electronystagmography revealed central vestibular abnormalities in three patients (6%). Canal paresis was established in six patients (12%). The Dix-Hallpike test was positive in six patients (12%). The most frequent cause of vertigo was migraine, occurring in 34% of patients (n=17). Other less-frequent etiologies of vertigo were benign paroxysmal vertigo (n=6; 12%), benign paroxysmal positional vertigo (n=6; 12%), psychogenic vertigo (n=5; 10%), epilepsy (n=3; 6%), metabolic disorders (n=3; 6%), vestibular neuritis (n=2; 4%), Meniere's disease (n=1; 2%), perilymphatic fistula (n=1; 2%), amblyopia (n=1; 2%), and unclassifiable (n=5; 10%). Migraine was found to be the most frequent presenting diagnosis in childhood vertigo, although several peripheral vestibular disorders also were diagnosed. Evaluation of vertigo in childhood should begin with a thorough neuro

  5. Developing a leadership pipeline: the Cleveland Clinic experience.

    Science.gov (United States)

    Hess, Caryl A; Barss, Christina; Stoller, James K

    2014-11-01

    The complexity of health care requires excellent leadership to address the challenges of access, quality, and cost of care. Because competencies to lead differ from clinical or research skills, there is a compelling need to develop leaders and create a talent pipeline, perhaps especially in physician-led organizations like Cleveland Clinic. In this context, we previously reported on a cohort-based physician leadership development course called Leading in Health Care and, in the current report, detail an expanded health care leadership development programme called the Cleveland Clinic Academy (CCA). CCA consists of a broad suite of offerings, including cohort-based learning and 'a la carte' half- or full-day courses addressing specific competencies to manage and to lead. Academy attendance is optional and is available to all physicians, nurses, and administrators with the requisite experience. Course selection is guided by competency matrices which map leadership competencies to specific courses. As of December 2012, a total of 285 course sessions have been offered to 6,050 attendees with uniformly high ratings of course quality and impact. During the past 10 years, Cleveland Clinic's leadership and management curriculum has successfully created a pipeline of health care leaders to fill executive positions, search committees, board openings, and various other organizational leadership positions. Health care leadership can be taught and learned.

  6. Transmyocardial laser revascularization. Early clinical experience

    Directory of Open Access Journals (Sweden)

    Oliveira Sérgio Almeida de

    1999-01-01

    Full Text Available OBJECTIVE: To analyze the initial clinical experience of transmyocardial laser revascularization (TMLR in patients with severe diffuse coronary artery disease. METHODS: Between February, 1998 and February, 1999, 20 patients were submitted to TMLR at the Heart Institute (InCor, University of São Paulo Medical School, Brazil, isolated or in association with conventional coronary artery bypass graft (CABG. All patients had severe diffuse coronary artery disease, with angina functional class III/IV (Canadian Cardiovascular Society score unresponsive to medical therapy. Fourteen patients were submitted to TMLR as the sole therapy, whereas 6 underwent concomitant CABG. Fifty per cent of the patients had either been previously submitted to a CABG or to a percutaneous transluminal coronary angioplasty (PTCA. Mean age was 60 years, ranging from 45 to 74 years. RESULTS: All patients had three-vessel disease, with normal or mildly impaired left ventricular global function. Follow-up ranged from 1 to 13 months (mean 6.6 months, with no postoperative short or long term mortality. There was significant symptom improvement after the procedure, with 85% of the patients free of angina, and the remaining 15 % of the patients showing improvement in functional class, as well as in exercise tolerance. CONCLUSION: This novel technique can be considered a low risk alternative for a highly selected group of patients not suitable for conventional revascularization procedures.

  7. Decontamination and decorporation: the clinical experience

    International Nuclear Information System (INIS)

    Poda, G.A.

    1979-01-01

    Decontamination and decorporation are quite interrelated when dealing with a contaminated person. Some clinical experiences from a transuranium production facility are offered. Skin decontamination is accomplished by washing with detergent and water. Stubborn cases are treated with sodium hypochlorite followed by rinsing, and emery cloth is used on more stubborn nail or finger pad contamination. If inhaled, the usual skin cleansing followed by nasal douche with normal saline decontaminates reachable areas and one of the DTPA salts given via aerosol both decontaminates and decorporates the inner recesses. Saline laxative reduces the time inhaled, and ingested particles remain in the gastro-intestinal tract. Conservatism prevails in general, but most persons found to have inhaled contamination are given a single chelation within the hour of discovery and if subsequently found to have over 10% M.P.P.B. of a soluble actinide are offered further chelation. Single dose chelation has been found to be relatively innocuous and usually sufficient. The longest case of chelation therapy spanned 2-1/4 years and encompassed 123 doses of CaNa-DTPA

  8. Ocular Causes of Abnormal Head Position: Strabismus Clinic Data

    Directory of Open Access Journals (Sweden)

    Kadriye Erkan Turan

    2017-08-01

    Full Text Available Objectives: To determine the most common ocular causes and types of abnormal head position (AHP and describe their clinical features. Materials and Methods: Patients with AHP who had been followed in the strabismus unit were retrospectively reviewed. Demographic features and orthoptic characteristics were recorded. Results: A total of 163 patients including 61 women (37.4% and 102 men (62.6%, with a mean age of 19.9±18.3 were recruited. The most common causes of AHP were determined as fourth cranial nerve palsy (33.7%, Duane retraction syndrome (21.5%, sixth cranial nerve palsy (11%, nystagmus blockage syndrome (9.8% and Brown syndrome (6.7%. Other less frequent causes were A-V pattern strabismus, comitant strabismus, thyroid orbitopathy and third cranial nerve palsy. The most common types of AHP were head tilt (45.4% and face turn (36.8%. Out of 142 patients whose visual acuity could be evaluated, 28.2% had amblyopia. The frequency of amblyopia varied depending on the diagnosis (p<0.001, while there was no relation between amblyopia and different types of AHP (p=0.497. Stereopsis and fusion could be tested in 128 patients and 43.8% of them had stereopsis and fusion. The presence of stereopsis and fusion was found to be related with the diagnosis (p=0.001, whereas it was not related with the types of AHP (p=0.580. The presence of amblyopia was not significantly associated with fusion (p=1.000 or stereopsis (p=0.602. Conclusion: There are many ocular pathologies that cause AHP. Patients with similar diagnoses may have different types of AHP. Patients may have amblyopia and impaired binocularity despite AHP. Therefore, all patients with AHP should be examined in detail and these points should be considered in the treatment plan.

  9. Review of Positive Psychology Applications in Clinical Medical Populations

    OpenAIRE

    Ann Macaskill

    2016-01-01

    This review examines the application of positive psychology concepts in physical health care contexts. Positive psychology aims to promote well-being in the general population. Studies identifying character strengths associated with well-being in healthy populations are numerous. Such strengths have been classified and Positive Psychology Interventions (PPIs) created to develop these strengths further in individuals. Positive psychology research is increasingly being undertaken in health care...

  10. The patient as experience broker in clinical learning.

    Science.gov (United States)

    Stockhausen, Lynette J

    2009-05-01

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

  11. Characterizing Positive and Negative Emotional Experiences in Young Adults With Borderline Personality Disorder Symptoms.

    Science.gov (United States)

    Chu, Carol; Victor, Sarah E; Klonsky, E David

    2016-09-01

    Some researchers suggest that borderline personality disorder (BPD) is characterized by elevated negative emotion; others argue that BPD involves both reduced positive and increased negative emotion. This study characterizes the emotional experiences of individuals with BPD symptoms in a combined university and community sample. Participants (N = 150) completed a clinical interview assessing BPD symptoms and self-report measures of positive and negative emotion. A subset (n = 106) completed a measure of emotion daily for 2 weeks. Pearson's correlations and multilevel modeling were used to examine the cross-sectional and longitudinal relationships between BPD symptoms and emotions. BPD symptoms were robustly related to increased negative emotion; this relationship remained after accounting for positive emotion. BPD symptoms were weakly related to decreased positive emotion; this relationship was no longer significant after accounting for negative emotion. BPD symptoms predicted higher levels of negative and not positive emotion over 14 days. These patterns held for subscales assessing intensity, frequency, and duration of negative and positive emotions. Findings suggest that individuals with BPD features are chiefly distinguished by elevated negative emotional experience. © 2016 Wiley Periodicals, Inc.

  12. Tinnitus: clinical experience of the psychosomatic connection

    Directory of Open Access Journals (Sweden)

    Salviati M

    2014-02-01

    Full Text Available Massimo Salviati,1 Francesco Saverio Bersani,1 Samira Terlizzi,1 Claudia Melcore,1 Roberta Panico,1 Graziella Francesca Romano,1 Guiseppe Valeriani,1 Francesco Macrì,1 Giancarlo Altissimi,2 Filippo Mazzei,2 Valeria Testugini,2 Luca Latini,1 Roberto Delle Chiaie,1 Massimo Biondi,1 Giancarlo Cianfrone21Department of Neurology and Psychiatry, Acute Psychiatric Ward (Servizio Psichiatrico di Diagnosi e Cura - SPDC, Sapienza University of Rome, Rome, Italy, 2Department of Sense Organs, Sapienza University of Rome, Rome, ItalyBackground: The connection between psychopathology and tinnitus is complex and not adequately studied. The aim of this study is to investigate the relationship between tinnitus and psychiatric comorbidities from different points of view: categorical, dimensional, temperamental, and perceived stress level.Methods: Two hundred and thirty-nine patients affected by tinnitus were recruited between January and October 2012. Patients underwent a preliminary battery of tests including the Tinnitus Handicap Inventory (THI, Symptom Check List (SCL90-R, Temperament and Character Inventory (TCI, and Stress-Related Vulnerability Scale (VRS, and eventually a full psychiatric evaluation. Results: One hundred and fourteen patients (48% of the total sample presented psychiatric comorbidity. Among these, a higher prevalence of depression, somatization, obsession, and anxiety was found. More than 41% of patients affected by decompensated tinnitus reported a family history of psychiatric disorders. Significant positive correlations between the psychopathological screening tools (SCL90-R and VRS and THI were found. Patients affected by comorbid psychiatric disorder showed specific temperamental and characterial predispositions.Conclusion: Psychiatric comorbidity in subjects affected by tinnitus is frequent. Stress can be considered as a factor leading to damage and dysfunction of the auditory apparatus. The vulnerability to neurotic disorders and

  13. Experiments with positive, negative and topical relevance feedback

    NARCIS (Netherlands)

    Kaptein, R.; Kamps, J.; Li, R.; Hiemstra, D.

    2008-01-01

    This document contains a description of experiments for the 2008 Relevance Feedback track. We experiment with different amounts of feedback, including negative relevance feedback. Feedback is implemented using massive weighted query expansion. Parsimonious query expansion using Dirichlet smoothing

  14. Integrating Positive and Clinical Psychology: Viewing Human Functioning as Continua from Positive to Negative Can Benefit Clinical Assessment, Interventions and Understandings of Resilience

    OpenAIRE

    Johnson, J; Wood, AM

    2017-01-01

    In this review we argue in favour of further integration between the disciplines of positive and clinical psychology. We argue that most of the constructs studied by both positive and clinical psychology exist on continua ranging from positive to negative (e.g., gratitude to ingratitude, anxiety to calmness) and so it is meaningless to speak of one or other field studying the “positive” or the “negative”. However, we highlight historical and cultural factors which have led positive and clinic...

  15. Connecting experience and economy - aspects of disguised positioning

    DEFF Research Database (Denmark)

    Christensen, Bo Allesøe

    2013-01-01

    The focus of this article is the use of experience made within the literature of the “new” economical discipline of experience economy. By combining a methodological individualism with a causal and dehumanising picture of the process of experience, this discipline conceives economic interactions ...

  16. Patient Experiences with the Preoperative Assessment Clinic (PEPAC): validation of an instrument to measure patient experiences

    NARCIS (Netherlands)

    Edward, G. M.; Lemaire, L. C.; Preckel, B.; Oort, F. J.; Bucx, M. J. L.; Hollmann, M. W.; de Haes, J. C. J. M.

    2007-01-01

    Background. Presently, no comprehensive and validated questionnaire to measure patient experiences of the preoperative assessment clinic (PAC) is available. We developed and validated the Patient Experiences with the Preoperative Assessment Clinic (PEPAC) questionnaire, which can be used for

  17. Experiences with an application of industrial robotics for accurate patient positioning in proton radiotherapy.

    Science.gov (United States)

    Allgower, C E; Schreuder, A N; Farr, J B; Mascia, A E

    2007-03-01

    Protons beams deliver targeted radiation doses with greater precision than is possible with electrons or megavoltage X-ray photons, but to retain this advantage, patient positioning systems at proton clinics must meet tighter accuracy requirements. For this and other reasons, robots were incorporated into the treatment room systems at MPRI. The Midwest Proton Radiotherapy Institute (MPRI) is the first radiotherapy facility in the United States to use commercial robots with six degrees of freedom for patient positioning, rather than a traditional bed with four degrees of freedom. This paper outlines the ways in which robots are used at MPRI and attempts to distil insights from the experience of treating over 200 radiotherapy patients with a robotic system from February 2004 to late 2006. The system has performed well, and with great reliability, but there is room for future improvement, especially in ease of use and in reducing the time to get patients into position. Copyright 2006 John Wiley & Sons, Ltd.

  18. Resident Evaluation of a Required Telepsychiatry Clinical Experience.

    Science.gov (United States)

    Teshima, John; Hodgins, Michael; Boydell, Katherine M; Pignatiello, Antonio

    2016-04-01

    The authors explored resident experiences of telepsychiatry clinical training. This paper describes an analysis of evaluation forms completed by psychiatry residents following a required training experience in telepsychiatry. Retrospective numeric and narrative data were collected from 2005 to 2012. Using a five-point Likert-type scale (1 = strongly disagree and 5 = strongly agree), residents ranked the session based on the following characteristics: the overall experience, interest in participating in telepsychiatry in the future, understanding service provision to underserved areas, telepsychiatry as mode of service delivery, and the unique aspects of telepsychiatry work. The authors also conducted a content analysis of narrative comments in response to open-ended questions about the positive and negative aspects of the training experience. In all, 88% of residents completed (n = 335) an anonymous evaluation following their participation in telepsychiatry consultation sessions. Numeric results were mostly positive and indicated that the experience was interesting and enjoyable, enhanced interest in participating in telepsychiatry in the future, and increased understanding of providing psychiatric services to underserved communities. Narrative data demonstrated that the most valuable aspects of training included the knowledge acquired in terms of establishing rapport and engaging with patients, using the technology, working collaboratively, identifying different approaches used, and awareness of the complexity of cases. Resident desire for more training of this nature was prevalent, specifically a wish for more detail, additional time for discussion and debriefing, and further explanation of the unique aspects of telepsychiatry as mode of delivery. More evaluation of telepsychiatry training, elective or required, is needed. The context of this training offered potential side benefits of learning about interprofessional and collaborative care for the

  19. Satisfaction and improvement of clinical experiment of student radiotechnologists

    International Nuclear Information System (INIS)

    Lyu, Kwang Yeul; Kim, Hyun Soo

    2006-01-01

    Clinical experiment is a set of experience to help student acquire technic, attitude and knowledge by participating in the clinical work. The radiotechnologists who are employed in departments of radiology serve as clinical instructors. Their responsibilities include teaching students them to become competent radiotechnologist. Clinical instructors often have no formal preparation in teaching student. The purpose of this study is to review some principals that will help clinical instructors support and foster the professional development of student radiotechnologists. The clinical instructor should be able to identify the qualities of instructor, the characteristics of feedback and use facilitation skills when is evaluated student performance. And the survey was performed to evaluate the satisfaction of student participated in clinical experiment, the purpose of this research is to fine the problems and improvements in clinical experiment of student radiotechnologist in Korea

  20. The Group Objective Structured Clinical Experience: building communication skills in the clinical reasoning context.

    Science.gov (United States)

    Konopasek, Lyuba; Kelly, Kevin V; Bylund, Carma L; Wenderoth, Suzanne; Storey-Johnson, Carol

    2014-07-01

    Students are rarely taught communication skills in the context of clinical reasoning training. The purpose of this project was to combine the teaching of communication skills using SPs with clinical reasoning exercises in a Group Objective Structured Clinical Experience (GOSCE) to study feasibility of the approach, the effect on learners' self-efficacy and attitude toward learning communication skills, and the effect of providing multiple sources of immediate, collaborative feedback. GOSCE sessions were piloted in Pediatrics and Medicine clerkships with students assessing their own performance and receiving formative feedback on communication skills from peers, standardized patients (SPs), and faculty. The sessions were evaluated using a retrospective pre/post-training questionnaire rating changes in self-efficacy and attitudes, and the value of the feedback. Results indicate a positive impact on attitudes toward learning communication skills and self-efficacy regarding communication in the clinical setting. Also, learners considered feedback by peers, SPs, and faculty valuable in each GOSCE. The GOSCE is an efficient and learner-centered method to attend to multiple goals of teaching communication skills, clinical reasoning, self-assessment, and giving feedback in a formative setting. The GOSCE is a low-resource, feasible strategy for experiential learning in communication skills and clinical reasoning. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. 3 Level Ventilation: the First Clinical Experience

    Directory of Open Access Journals (Sweden)

    P. Torok

    2008-01-01

    Full Text Available Considering the issues of artificial ventilation (AV in non-homogenous pathological lung processes (acute lung injury (ALI, acute respiratory distress syndrome (ARDS, pneumonia, etc., the authors applied the three-level lung ventilation to a group of 12 patients with non-homogenous lung injury. Three-level ventilation was defined as a type (modification of AV whose basic ventilation level was produced by the modes CMV, PCV or PS (ASB and add-on level, the so-called background ventilation was generated by two levels of PEEP. PEEP (constant and PEEPh (PEEP high with varying frequency and duration of transition between the individual levels of PEEP. Objective: to elucidate whether in cases of considerably non-homogenous gas distribution in acute pathological disorders, three-level ventilation (3LV can correct gas distribution into the so-called slow bronchoalveolar compartments, by decreasing the volume load of the so-called fast compartments and to improve lung gas exchange, by following the principles of safe ventilation. Results. 3LV was applied to 12 patients with severe non-homogenous lung injury/disorder (atypic pneumonia and ARDS/ALI and low-success PCV ventilation after recruitment manoeuvre (PaO2 (kPA /FiO2 = 5—6. There were pronounced positive changes in pulmonary gas exchange within 1—4 hours after initiation of 3LV at a fPCV of 26±4 breaths/min-1 and PEEPh at a fPEEPH of 7±2 breaths/min-1 with a minute ventilation of 12±4 l/min. 3LV reduced a intrapulmonary shunt fraction 50±5 to 30±5%, increased CO2 elimination, with PaCO2 falling to the values below 6±0.3 kPa, and PaO2 to 7.5±1.2 kPa, with FiO2 being decreased to 0.8—0.4. Lung recruitment also improved gas exchange: with PEEP=1.2±0.4 kPa, static tho-racopulmonary compliance (Cst elevated from 0.18±0.02 l/kPa to 0.3±0.02 l/kPa and then to 0.38±0.05 l/kPa. Airways resistance (Raw decreased by more than 30%. Improved lung aeration was also estimated as a manifestation of

  2. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON TESTING FOR AUTONOMIC AND SOMATIC NERVE DYSFUNCTION.

    Science.gov (United States)

    Vinik, Aaron I; Camacho, Pauline M; Davidson, Jaime A; Handelsman, Yehuda; Lando, Howard M; Leddy, Anne L; Reddy, Sethu K; Cook, Richard; Spallone, Vicenza; Tesfaye, Solomon; Ziegler, Dan

    2017-12-01

    This document represents the official position of the American Association of Clinical Endocrinologists and the American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

  3. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON THE ASSOCIATION OF TESTOSTERONE AND CARDIOVASCULAR RISK.

    Science.gov (United States)

    Goodman, Neil; Guay, Andre; Dandona, Paresh; Dhindsa, Sandeep; Faiman, Charles; Cunningham, Glenn R

    2015-09-01

    This document represents the official position of the American Association of Clinical Endocrinologists and the American College of Endocrinology. Where there were no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician.

  4. Dengue fever outbreak: a clinical management experience

    International Nuclear Information System (INIS)

    Ahmed, S.; Illyas, M.

    2008-01-01

    To determine the frequency of dengue as a cause of fever and compare the clinical and haematological characteristics of Dengue-probable and Dengue-proven cases. All patients with age above 14 years, who were either hospitalized or treated in medical outdoor clinic due to acute febrile illness, were evaluated for clinical features of Dengue Fever (DF), Dengue haemorrhagic fever (DHF) and Dengue Shock Syndrome (DSS). Patients showing typical clinical features and haematological findings suggestive of Dengue fever (As per WHO criteria) were evaluated in detail for comparison of probable and confirmed cases of Dengue fever. All other cases of acute febrile illness, not showing clinical features or haematological abnormalities of Dengue fever, were excluded. The clinical and laboratory features were recorded on SPSS 11.0 programme and graded where required, for descriptive and statistical analysis. Out of 5200 patients with febrile illness, 107 (2%) presented with typical features of DF, 40/107 (37%) were Dengue-proven while 67/107 (63%) were Dengue-probable. Out of Dengue-proven cases, 38 were of DF and 2 were of DHF. Day 1 temperature ranged from 99-105 degreeC (mean 101 degree C). Chills and rigors were noticed in 86 (80%), myalgia in 67%, headache in 54%, pharyngitis in 35%, rash in 28%, and bleeding manifestations in 2% cases. Hepatomegaly in 1(0.5%), lymphadenopathy in 1 (0.5%) and splenomegaly in 12 (11.2%) cases. Leucopoenia (count 40 U/L in 57% cases. Frequency of clinically suspected dengue virus infection was 107 (2%), while confirmed dengue fever cases were 40 (0.8%) out of 5200 fever cases. Fever with chills and rigors, body aches, headache, myalgia, rash, haemorrhagic manifestations, platelet count, total leukocyte count, and ALT, are parameters to screen the cases of suspected dengue virus infection, the diagnosis cannot be confirmed unless supported by molecular studies or dengue specific IgM. (author)

  5. Clinical Education Environment Experiences of Operating Room Students

    Directory of Open Access Journals (Sweden)

    Tahereh khazaei

    2016-01-01

    Full Text Available Background and purpose: The objective of medical education is to train competent and qualified workforce in order to provide services in various health environments. One of the important objectives of Operating Room students is to train workforce who can involve in patient’s health and recovery. Training these students should cause clinical ability and independent decision making during surgery. Since students during internship face with many problems, this study has been conducted to explore and describe the challenges and experiences.Methods: This qualitative study is a phenomenology that was conducted based on 20 students in the last semester of Operating Room associate’s degree with purposive sampling. Deep and semi-structured interviews were used to collect data and data were analyzed by content analysis method.Results: The findings in 5 main themes: (1 Physical space and equipment in the operating room, (2 The student’s position in operating room, (3 Integrating knowledge and action, (4 Managing education environment and 5- Student’s viewpoint about operating room and working in it.Conclusions: Interviews with students revealed the educational environment challenges with which they are faced during their study. Teachers can provide solutions to overcome the challenges and create a positive atmosphere for students' learning using results of this study and students may continue their interest in education and improve the quality of their education.Keywords: CLINICAL EDUCATION, OPERATING ROOM STUDENTS, CHALLENGE

  6. Influence of depressive symptoms on distress related to positive psychotic-like experiences in women.

    Science.gov (United States)

    Brañas, Antía; Barrigón, María Luisa; Lahera, Guillermo; Canal-Rivero, Manuel; Ruiz-Veguilla, Miguel

    2017-12-01

    The Community Assessment of Psychic Experiences (CAPE) is an effective instrument for detection of the presence of psychotic symptoms and associated distress in the general population. However, little research has studied distress associated with positive psychotic-like experiences (PLEs). Our aim is to study PLE-related distress using the CAPE. In this study we analysed factors associated with differences in PLE-related distress in a sample of 200 non-clinical participants recruited by snowball sampling. Presence of PLEs and related psychological distress was measured using the CAPE questionnaire. The influence of age, gender, educational level and drug use was studied. In univariate analysis we found that gender and CAPE positive, depressive and negative scores, were associated with CAPE positive distress. Using multiple linear regression, we found that only the effect of gender, and the interaction between frequency of depression and gender, remained statistically significant. In our sample interaction between gender and depressive symptoms is a determining factor in distress associated with positive PLEs. The results of this study may be useful for the implementation of prevention programs. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Clinical and immunological status of a newly diagnosed HIV positive ...

    African Journals Online (AJOL)

    Objective: To evaluate the clinical and the immune status of newly HIV diagnosed patients, in Marrakech city and its neighboring area, in Morocco. Methods: We performed a retrospective study on 235 patients who have been previously confirmed for HIV infection, and underwent a CD4 T cells using flow cytometry ...

  8. Positioning for vertical integration through clinics "without walls".

    Science.gov (United States)

    Johnson, B A; Schryver, D L

    1994-01-01

    Authors Bruce A. Johnson, J.D., M.P.A., and Darrell Schryver, D.P.A., offer the clinic without walls model as a transitory step to full vertical integration. They write that this model "may enable physicians to address the key issues associated with managed care and integration in a more gradual, controlled fashion.

  9. Upright or dorsal? childbirth positions among antenatal clinic ...

    African Journals Online (AJOL)

    clinic attendees of two tertiary healthcare institutions located in the semi‑urban areas of .... Television. 33 (16.4). 4 (3.8). 37 (12.1) 0.002. Internet. 4 (2.0). 3 (2.9). 7 (2.3). 0.82. Mother. 49 (24.4) .... attitudes to things. Some earlier studies in ...

  10. Prevalence and clinical presentation of HIV positive female ...

    African Journals Online (AJOL)

    Nine of the 19 HIV positive patients (47%) had a pre-existing primary psychiatric diagnosis, most commonly Bipolar Disorder, recent episode mania with psychotic symptoms. The most common psychotic symptoms were grandiose delusions followed by auditory hallucinations, paranoid delusions and visual hallucinations.

  11. Positive clinical interventions : Why are they important and how do they work?

    NARCIS (Netherlands)

    Bohlmeijer, E. T.; Bolier, L.; Lamers, S. M.A.; Westerhof, G. J.

    2017-01-01

    In this paper we discuss positive clinical psychology as an emerging field within clinical psychology. Positive clinical psychology is based on research demonstrating that mental health is more than the absence of mental illness, on research showing that well-being has buffering effects on the

  12. Dengue fever outbreak: a clinical management experience.

    Science.gov (United States)

    Ahmed, Shahid; Ali, Nadir; Ashraf, Shahzad; Ilyas, Mohammad; Tariq, Waheed-Uz-Zaman; Chotani, Rashid A

    2008-01-01

    To determine the frequency of dengue as a cause of fever and compare the clinical and haematological characteristics of Dengue-probable and Dengue-proven cases. An observational study. The Combined Military Hospital, Malir Cantt., Karachi, from August 2005 to December 2006. All patients with age above 14 years, who were either hospitalized or treated in medical outdoor clinic due to acute febrile illness, were evaluated for clinical features of Dengue Fever (DF), Dengue haemorrhagic fever (DHF) and Dengue Shock Syndrome (DSS). Patients showing typical clinical features and haematological findings suggestive of Dengue fever (As per WHO criteria) were evaluated in detail for comparison of probable and confirmed cases of Dengue fever. All other cases of acute febrile illness, not showing clinical features or haematological abnormalities of Dengue fever, were excluded. The clinical and laboratory features were recorded on SPSS 11.0 programme and graded where required, for descriptive and statistical analysis. Out of 5200 patients with febrile illness, 107(2%) presented with typical features of DF, 40/107(37%) were Dengue-proven while 67/107(63%) were Dengue-probable. Out of Dengue-proven cases, 38 were of DF and 2 were of DHF. Day 1 temperature ranged from 99-1050C (mean 1010C). Chills and rigors were noticed in 86 (80%), myalgia in 67%, headache in 54%, pharyngitis in 35%, rash in 28%, and bleeding manifestations in 2% cases. Hepatomegaly in 1(0.5%), lymphadenopathy in 1(0.5%) and splenomegaly in 12 (11.2%) cases. Leucopoenia (count40 U/L in 57% cases. Frequency of clinically suspected dengue virus infection was 107 (2%), while confirmed dengue fever cases were 40 (0.8%) out of 5200 fever cases. Fever with chills and rigors, body aches, headache, myalgia, rash, haemorrhagic manifestations, platelet count, total leukocyte count, and ALT, are parameters to screen the cases of suspected dengue virus infection; the diagnosis cannot be confirmed unless supported by

  13. 9592 THE EXPERIENCES OF HIV-POSITIVE MOTHERS ...

    African Journals Online (AJOL)

    Mimi

    exclusive breastfeeding, HIV-positive mothers, aged 21-41 years, married and unemployed, participated during two visits to the study site. Responses to semi- ... Five major themes emerged: (i) benefits of breast milk to the mother and the baby ...

  14. Emotional Intelligence in Intensive Clinical Experiences for Nursing Students

    Science.gov (United States)

    Zoromski, Lorraine M.

    2017-01-01

    This study looked for associations between measures of emotional intelligence in an intensive clinical experience for nursing students in their final semester of an associate's degree program. The theory of emotional labor was used to make connections between nursing clinical experience and emotional intelligence. Twenty nursing students from a…

  15. Nursing students’ perception of clinical learning experiences as provided by the nursing staff in the wards

    Directory of Open Access Journals (Sweden)

    N. R. C. TIakula

    1993-03-01

    Full Text Available A descriptive survey was carried out, using convenience and systematic sampling in order to better understand the manner in which student nurses perceive their clinical experience in the hospital. Data were collected from 80 subjects in 4 nursing colleges using a critical incident technique. Positive and negative experiences are described,

  16. Correlative Studies in Clinical Trials: A Position Statement From the International Thyroid Oncology Group.

    Science.gov (United States)

    Bible, Keith C; Cote, Gilbert J; Demeure, Michael J; Elisei, Rossella; Jhiang, Sissy; Ringel, Matthew D

    2015-12-01

    Patients with progressive thyroid cancer in distant metastatic sites represent a population with a need for new therapeutic options. Aspiring to improve the treatment of such patients, the objective of this position statement from the International Thyroid Oncology Group (ITOG) is to clarify the importance of incorporating high-quality correlative studies into clinical trials. ITOG was formed to develop and support high-quality multicenter and multidisciplinary clinical trials for patients with aggressive forms of thyroid cancer. The Correlative Sciences Committee of the ITOG focuses on the quality and types of correlative studies included in ITOG-associated clinical trials. This document represents expert consensus from ITOG regarding this issue based on extensive collective experience in clinical and translational trials informed by basic science. The Correlative Studies Committee identified an international writing group representative of diverse specialties, including basic sciences. Drafts were reviewed by all members of the writing group, the larger committee, and the ITOG board. After consideration of all comments by the writing group and modification of the document, the final document was then approved by the authors and the ITOG board. High-quality correlative studies, which include variety in the types of correlates, should be intrinsic to the design of thyroid cancer clinical trials to offer the best opportunity for each study to advance treatment for patients with advanced and progressive thyroid cancer.

  17. Planning for positive clinical & financial returns with telemonitoring.

    Science.gov (United States)

    Wright, Kristy

    2003-10-01

    Telemonitoring is a burgeoning market in the home care industry. Making the decision to invest in telemonitoring technology can be difficult in the best situations. The financial investment is significant, the risks can be high, and the need to achieve a positive return is critical to future success. In spite of the risks, this relatively new technology in home care holds the promise for the redefinition of the industry.

  18. Clinical Perspective An adolescent's subjective experiences of ...

    African Journals Online (AJOL)

    An adolescent's subjective experiences of mindfulness were explored in a single case study of a 17-yearold female. Data were created by means of 'mindfulness sessions', unstructured interviews, creative expression, journals and field notes. The data were analysed and interpreted using a combination of typological and ...

  19. Students' Positive and Negative Experiences in Hybrid and Online Classes

    Science.gov (United States)

    El Mansour, Bassou; Mupinga, Davison M.

    2007-01-01

    As higher education institutions struggle to meet the growing demand for education from non-traditional students, many are turning to hybrid and online courses. These courses, free up classroom space, allow faculty to reach a wider audience using technology; and are therefore cost effective. But, what learning experiences do these courses provide…

  20. An evaluation of the Positive Emotional Experiences Scale: A preliminary analysis

    Directory of Open Access Journals (Sweden)

    Rene van Wyk

    2016-11-01

    Full Text Available Orientation: The positive organisational behaviour movement emphasises the advantages of psychological strengths in business. The psychological virtues of positive emotional experiences can potentially promote human strengths to the advantages of business functioning and the management of work conditions. This is supported by Fredrickson’s broaden-and-build theory that emphasises the broadening of reactive thought patterns through experiences of positive emotions. Research purpose: A preliminary psychometric evaluation of a positive measurement of dimensions of emotional experiences in the workplace, by rephrasing the Kiefer and Barclay Toxic Emotional Experiences Scale. Motivation for the study: This quantitative Exploratory Factor Analysis investigates the factorial structure and reliability of the Positive Emotional Experiences Scale, a positive rephrased version of the Toxic Emotional Experiences Scale. Research approach, design and method: This Exploratory Factor Analysis indicates an acceptable three-factor model for the Positive Emotional Experiences Scale. These three factors are: (1 psychological recurrent positive state, (2 social connectedness and (3 physical refreshed energy, with strong Cronbach’s alphas of 0.91, 0.91 and 0.94, respectively. Main findings: The three-factor model of the Positive Emotional Experiences Scale provides a valid measure in support of Fredrickson’s theory of social, physical and psychological endured personal resources that build positive emotions. Practical/Managerial implications: Knowledge gained on positive versus negative emotional experiences could be applied by management to promote endured personal resources that strengthen positive emotional experiences. Contribution/value-add: The contribution of this rephrased Positive Emotional Experiences Scale provides a reliable measure of assessment of the social, physical and endured psychological and personal resources identified in Fredrickson

  1. Discriminating between true-positive and false-positive clinical mastitis alerts from automatic milking systems

    NARCIS (Netherlands)

    Steeneveld, W.; Gaag, van der L.C.; Ouweltjes, W.; Mollenhorst, H.; Hogeveen, H.

    2010-01-01

    Automatic milking systems (AMS) generate alert lists reporting cows likely to have clinical mastitis (CM). Dutch farmers indicated that they use non-AMS cow information or the detailed alert information from the AMS to decide whether to check an alerted cow for CM. However, it is not yet known to

  2. Intraoperative radiotherapy. Clinical experiences and results

    Energy Technology Data Exchange (ETDEWEB)

    Calvo, F.A.; Santos, M. (Clinica Universitaria, Dept. of Oncology, Service of Radiotherapy, Pamplona (Spain)); Brady, L.W. (Hahnemann Univ., Dept. of Radiation Oncology, Philadelphia, PA (United States)) (eds.)

    1992-01-01

    This monograph reports on the largest clinical series to date in which intraoperative radiation therapy (IORT) has been used in mulitdisciplinary treatment programs for tumors of various sites and differing histological sybtype. It represents the product of 5 years' intensive work by physicians active at a leading European institution. The findings are supplemented by a thorough review of the data presented worldwide during the last two decades. The results in this book are meticulously presented and focus on the most important features of clinical research reports based on phase I-II studies (toxicity, local tumor control, and survival data). The tumor sites and histologies analyzed are: head and neck cancer, lung cancer, gastric cancer, pancreatic cancer, colorectal cancer, bladder cancer, gynecologic cancer, soft tissue sarcomas of the extremities, retroperitoneal and other central soft issue sarcomas, Ewing's sarcoma, osteosarcoma, and intracranial tumors. (orig./MG) With 60 figs.

  3. Clinical Engineering: Experiences of assisted professional practices

    International Nuclear Information System (INIS)

    Langone, Luis; Vanetta, Marcos; Vazquez, Marcelo; Rotger, Viviana I; Olivera, Juan Manuel

    2007-01-01

    In the curricula of the Biomedical Engineering career of the Facultad de Ciencias Exactas y TecnologIa of the Universidad Nacional de Tucuman, Argenitna, there are the Assisted Professional Practices. Within this framework, the students have the possibility of performing practices in the clinic Sanatorio 9 de Julio. One of the objectives of these practices is to apply the concepts, methods and procedures studied along the career in the field work under real work conditions. From the point of view of the host institution, the objective is to improve the performance of the different services and areas applying the tools of Biomedical Engineering. The present work shows an example of such practices where an equipment preliminary analysis was made, its use and maintenance corresponding to the surgical unit of the clinic

  4. Clinical experience with the radiosensitizer misonidazole

    International Nuclear Information System (INIS)

    Kogelnik, D.; Szepesi, T.; Kaercher, K.H.; Seitz, W.

    1979-01-01

    From April 1976 to June 1978, 74 cancer patients were treated with multiple doses of misonidazole at the University Clinic for Radiotherapy and Radiobiology of Vienna. Thirtyone patients had inoperable brain tumors or high-grade astrocytomas, the remaining patients suffered from late stages of various extracerebral malignancies. All patients were hospitalized and thoroughly examined for possible side-effects of this currently most promising hypoxic cell radiosensitizer. Neurotoxicity, principally the development of peripheral neuropathies, is the most important limiting factor in the clinical application of misonidazole. With total doses of 12 g/m 2 of surface area a low and acceptable incidence of neuropathies is seen. By extension of the over-all treatment time to 6-8 weeks the total dose may be increased to 15 g/m 2 . (orig.) 891 MG/orig. 892 RDG [de

  5. Broadband Laser Ranging for Position Measurements in Shock Physics Experiments

    Science.gov (United States)

    Rhodes, Michelle; Bennett, Corey; Daykin, Edward; Younk, Patrick; Lalone, Brandon; Kostinski, Natalie

    2017-06-01

    Broadband laser ranging (BLR) is a recently developed measurement system that provides an attractive option for determining the position of shock-driven surfaces. This system uses broadband, picosecond (or femtosecond) laser pulses and a fiber interferometer to measure relative travel time to a target and to a reference mirror. The difference in travel time produces a delay difference between pulse replicas that creates a spectral beat frequency. The spectral beating is recorded in real time using a dispersive Fourier transform and an oscilloscope. BLR systems have been designed that measure position at 12.5-40 MHz with better than 100 micron accuracy over ranges greater than 10 cm. We will give an overview of the basic operating principles of these systems. Prepared by LLNL under Contract DE-AC52-07NA27344, by LANL under Contract DE-AC52-06NA25396, and by NSTec Contract DE-AC52-06NA25946.

  6. Uncovering Clinical Features of De Novo Philadelphia Positive Myelodysplasia.

    Science.gov (United States)

    Armas, Aristides; Chen, Chen; Mims, Martha; Rivero, Gustavo

    2017-01-01

    Myelodysplastic syndrome (MDS) is cytogenetically heterogeneous and retains variable risk for acute myeloid leukemia transformation. Though not yet fully understood, there is an association between genetic abnormalities and defects in gene expression. The functional role for infrequent cytogenetic alteration remains unclear. An uncommon chromosomic abnormality is the presence of the Philadelphia (Ph) chromosome. Here, we report a patient with Ph+ MDS treated with low dose Dasatinib who achieved hematologic response for 7 months. In addition, we also examined the English literature on all de novo Ph + MDS cases between 1996 and 2015 to gain insight into clinical features and outcome.

  7. Replacing stressful challenges with positive coping strategies: a resilience program for clinical placement learning.

    Science.gov (United States)

    Delany, C; Miller, K J; El-Ansary, D; Remedios, L; Hosseini, A; McLeod, S

    2015-12-01

    Clinical education is foundational to health professional training. However, it is also a time of increased stress for students. A student's perception of stressors and their capacity to effectively manage them is a legitimate concern for educators, because anxiety and decreased coping strategies can interfere with effective learning, clinical performance and capacity to care for patients. Resilience is emerging as a valuable construct to underpin positive coping strategies for learning and professional practice. We report the development and evaluation of a psycho-education resilience program designed to build practical skills-based resilience capacities in health science (physiotherapy) students. Six final year undergraduate physiotherapy students attended four action research sessions led by a clinical health psychologist. Resilience strategies drawn from cognitive behavioural therapy, and positive and performance psychology were introduced. Students identified personal learning stressors and their beliefs and responses. They chose specific resilience-based strategies to address them, and then reported their impact on learning performance and experiences. Thematic analysis of the audio-recorded and transcribed action research sessions, and students' de identified notes was conducted. Students' initial descriptions of stressors as 'problems' outside their control resulting in poor thinking and communication, low confidence and frustration, changed to a focus on how they managed and recognized learning challenges as normal or at least expected elements of the clinical learning environment. The research suggests that replacing stressful challenges with positive coping strategies offers a potentially powerful tool to build self-efficacy and cognitive control as well as greater self-awareness as a learner and future health practitioner.

  8. Silicon position sensitive detectors for the Helios (NA 34) experiment

    Energy Technology Data Exchange (ETDEWEB)

    Engels, E Jr; Mani, S; Manns, T; Plants, D; Shepard, P F; Thompson, J A; Tosh, R; Chand, T; Shivpuri, R; Baker, W

    1987-01-15

    The design construction and testing of X-Y tracking modules for a silicon microstrip vertex detector for use in Fermilab experiment E706 is discussed. A successful adaptation of various technologies, essential for instrumenting this class of detectors at a university laboratory is described. Emphasis is placed on considerable cost reduction, design flexibiity and more rapid turnover with a view toward large detectors for the future.

  9. Antiretroviral Therapy Helps HIV-Positive Women Navigate Social Expectations for and Clinical Recommendations against Childbearing in Uganda

    Directory of Open Access Journals (Sweden)

    Jasmine Kastner

    2014-01-01

    Full Text Available Understanding factors that influence pregnancy decision-making and experiences among HIV-positive women is important for developing integrated reproductive health and HIV services. Few studies have examined HIV-positive women’s navigation through the social and clinical factors that shape experiences of pregnancy in the context of access to antiretroviral therapy (ART. We conducted 25 semistructured interviews with HIV-positive, pregnant women receiving ART in Mbarara, Uganda in 2011 to explore how access to ART shapes pregnancy experiences. Main themes included: (1 clinical counselling about pregnancy is often dissuasive but focuses on the importance of ART adherence once pregnant; (2 accordingly, women demonstrate knowledge about the role of ART adherence in maintaining maternal health and reducing risks of perinatal HIV transmission; (3 this knowledge contributes to personal optimism about pregnancy and childbearing in the context of HIV; and (4 knowledge about and adherence to ART creates opportunities for HIV-positive women to manage normative community and social expectations of childbearing. Access to ART and knowledge of the accompanying lowered risks of mortality, morbidity, and HIV transmission improved experiences of pregnancy and empowered HIV-positive women to discretely manage conflicting social expectations and clinical recommendations regarding childbearing.

  10. Positive results of clinical educational support in situations of psychological distress.

    Science.gov (United States)

    Tavormina, Dominique

    2014-11-01

    Education is a complex process that involves the individual in the course of his entire life and leads to the maturation and the overall development of his personality. The educational process involves the complete growth of each and completes the infinite possibilities that every child has potential since birth. Education also is a necessity for the human being, as only adequate environmental stimulation causes the mental processes to begin. In fact, the higher intellectual functions, such as language, thought, memory, emerge only from social and educational experiences of the child. The educational surgery creates experiences and learning that allow the person to change by improving the efficiency of synaptic connections. Clinical pedagogy has developed in Italy in the last decades of the twentieth century with the aim of research and experimenting educational purposes suitable for different situations in order to provide each subject with appropriate development opportunities. Clinical pedagogical support is offered in the form of artistic or bodily activities and represents for the individual a positive environment that allows the development of different brain areas and the potential inherent in them. The various methods are suitable for any situation of existential discomfort, which are understood as moments of personal growth.

  11. Endogenous T-Cell Therapy: Clinical Experience.

    Science.gov (United States)

    Yee, Cassian; Lizee, Greg; Schueneman, Aaron J

    2015-01-01

    Adoptive cellular therapy represents a robust means of augmenting the tumor-reactive effector population in patients with cancer by adoptive transfer of ex vivo expanded T cells. Three approaches have been developed to achieve this goal: the use of tumor-infiltrating lymphocytes or tumor-infiltrating lymphocytess extracted from patient biopsy material; the redirected engineering of lymphocytes using vectors expressing a chimeric antigen receptor and T-cell receptor; and third, the isolation and expansion of often low-frequency endogenous T cells (ETCs) reactive to tumor antigens from the peripheral blood of patients. This last form of adoptive transfer of T cells, known as ETC therapy, requires specialized methods to isolate and expand from peripheral blood the very low-frequency tumor-reactive T cells, methods that have been developed over the last 2 decades, to the point where such an approach may be broadly applicable not only for the treatment of melanoma but also for that of other solid tumor malignancies. One compelling feature of ETC is the ability to rapidly deploy clinical trials following identification of a tumor-associated target epitope, a feature that may be exploited to develop personalized antigen-specific T-cell therapy for patients with almost any solid tumor. With a well-validated antigen discovery pipeline in place, clinical studies combining ETC with agents that modulate the immune microenvironment can be developed that will transform ETC into a feasible treatment modality.

  12. Multigenerational Challenges: Team-Building for Positive Clinical Workforce Outcomes

    Science.gov (United States)

    Moore, Jill M; Everly, Marcee; Bauer, Renee

    2016-05-31

    Patient acuity in hospital settings continues to increase, and there is greater emphasis on patient outcomes. The current nursing workforce is comprised of four distinct generational cohorts that include veterans, baby boomers, millennials, and generation Xers. Each group has unique characteristics that add complexity to the workforce and this can add challenges to providing optimal patient care. Team building is one strategy to increase mutual understanding, communication, and respect, and thus potentially improve patient outcomes. In this article, we first briefly define generational cohorts by characteristics, and discuss differing expectations for work/life balance and potential negative outcomes. Our discussion offers team building strategies for positive outcomes, a case scenario, and concludes with resources for team building and organizational opportunities.

  13. Instant messaging and nursing students' clinical learning experience.

    Science.gov (United States)

    Pimmer, Christoph; Brühlmann, Florian; Odetola, Titilayo Dorothy; Dipeolu, Oluwafemi; Gröhbiel, Urs; Ajuwon, Ademola J

    2018-05-01

    Although learning in clinical settings is a key element of nursing education, for many learners these are challenging developmental contexts often marked by isolation and a lack of belongingness. Despite the massive appropriation of mobile instant messaging (MIM) platforms and the connective properties attendant to them, very little is known about their role in and impact on nursing students' clinical learning experiences. To address this gap, the study, which was part of a multinational research project on the use of mobile social media in health professions education in developing countries, examined the use of the instant messaging platform WhatsApp by nursing students during placements and potential associations with socio-professional indicators. The survey involved a total number of 196 nursing students from 5 schools in Oyo State, Nigeria. The findings suggest that students used WhatsApp relatively frequently and they perceived that this platform strongly enhanced their communication with other students and nurses. WhatsApp use during placements was positively associated with students' maintained social capital with peer students, the development of a professional identity, placement satisfaction and with reduced feelings of isolation from professional communities. The determinants that influenced WhatsApp use during placements were perceived usefulness and perceived ease of use. No associations were found between WhatsApp use during placement and age, attitude, subjective norms and placement duration. This study is one of the first of its kind that points to the relevance of mobile instant messaging as part of nursing students' (inter)personal learning environments in clinical settings and, particularly, in the development setting under investigation. Further research is needed to corroborate these findings, to enhance the understanding of the impact mechanisms, and to evaluate a more systematic use of MIM in clinical learning contexts. Copyright © 2018

  14. The Upward Spiral of Adolescents' Positive School Experiences and Happiness: Investigating Reciprocal Effects over Time

    Science.gov (United States)

    Stiglbauer, Barbara; Gnambs, Timo; Gamsjager, Manuela; Batinic, Bernad

    2013-01-01

    In line with self-determination theory and Fredrickson's (2001) broaden-and-build theory of positive emotions, this study adopts a positive perspective on students' school experiences and their general psychological functioning. The reciprocal effects of positive school experiences and happiness, a dimension of affective well-being, are examined…

  15. Pharmacology and clinical experience with risperidone.

    Science.gov (United States)

    Love, R C; Nelson, M W

    2000-12-01

    Risperidone (Risperdal, Janssen Pharmaceutica) is a second generation antipsychotic (SGA) for the treatment of schizophrenia and other psychotic disorders. It is a potent antagonist of serotonin-2 (5-HT2) and dopamine-2 (D2) receptors in the brain. In comparison to conventional antipsychotics, risperidone demonstrates superior efficacy against the positive and negative symptoms of schizophrenia and a decreased occurrence of extrapyramidal side effects (EPS). Risperidone causes less weight gain than other marketed SGAs, but can increase prolactin levels and cause EPS in a dose-related manner. In a variety of pharmacoeconomic analyses, it has proven to be a cost-effective addition to the antipsychotic armamentarium. As the first SGA available for front line use, risperidone has established a new standard of care for the treatment of individuals with psychotic disorders.

  16. Clinical experiences with the radiosensitizer Misonidazol

    International Nuclear Information System (INIS)

    Bamberg, M.; Scherer, C.; Tamulevicius, P.; Streffer, C.

    1981-01-01

    The principle of action of sensitizers with electron affinity is explained and the development of these radiosensitizing substances up to the clinical of Misonidazol (MIS; Ro-07-0582) is shown. With special regard to the pharmacokinetic action of this substance, the therapeutic effects of MIS were examined in ten patients with brain tumors of high malignancy (400 mg/m 2 ) and four patients with oesophageal carcinomas (1 g/m 2 ), all these patients having reached the clinical phase III. Four other patients with recurrent brain tumors received a dose of 1 g/m 2 of MIS before each irradiation. Apart from slight neurotoxic and gastrointestinal side effects, the applicated doses of MIS were generally well tolerated. Only in one case a generalized maculopapular exanthema developed which regressed completely within few days. No correlation could be found between the subjective side effects and the plasma values determined by means of high pressure liquid chromatography (HPLC). After one to four hours following oral application, the maximum plasma concentrations were measured, the half-life (T 1/2) varying in all patients between five and ten hours. It was not possible to demonstrate an influence of dexamethasone on the plasma concentration of half-life of MIS in the brain tumor patients. The cerebrospinal fluid concentrations of MIS which may be used as an index for the concentrations in brain tumors, are closely correlated with the corresponding plasma values. There was no correlation between MIS concentrations in plasma and saliva, so that the determination of MIS in the saliva cannot be recommended as a routine method for control examinations. (orig.) [de

  17. Cognitive development, clinical knowledge, and clinical experience related to diagnostic ability.

    Science.gov (United States)

    Aquilino, M L

    1997-01-01

    To examine the relationship among cognitive development, clinical knowledge, and clinical experience in nursing students. A survey of junior and senior baccalaureate nursing students from three Midwestern colleges (N = 55). Students' diagnostic ability increased as they gained clinical experience and clinical knowledge. However, students failed to identify many nursing diagnoses and demonstrated only moderate levels of cognitive development. Nurse educators and nursing students need to change their approaches to teaching and learning to enhance students' diagnostic ability and cognitive development.

  18. Cartap hydrochloride poisoning: A clinical experience.

    Science.gov (United States)

    Boorugu, Hari K; Chrispal, Anugrah

    2012-01-01

    Cartap hydrochloride, a nereistoxin analog, is a commonly used low toxicity insecticide. We describe a patient who presented to the emergency department with alleged history of ingestion of Cartap hydrochloride as an act of deliberate self-harm. The patient was managed conservatively. To our knowledge this is the first case report of Cartap hydrochloride suicidal poisoning. Cartap toxicity has been considered to be minimal, but a number of animal models have shown significant neuromuscular toxicity resulting in respiratory failure. It is hypothesized that the primary effect of Cartap hydrochloride is through inhibition of the [(3)H]-ryanodine binding to the Ca(2+) release channel in the sarcoplasmic reticulum in a dose-dependent manner and promotion of extracellular Ca(2+) influx and induction of internal Ca(2+) release. This results in tonic diaphragmatic contraction rather than paralysis. This is the basis of the clinical presentation of acute Cartap poisoning as well as the treatment with chelators namely British Anti Lewisite and sodium dimercaptopropane sulfonate.

  19. Treatment of impalpable testis - one clinic's experience.

    Science.gov (United States)

    Osemlak, Paweł; Żądkowski, Tomasz; Rogowski, Błażej; Cielecki, Czesław; Wieczorek, Andrzej; Woźniak, Magdalena; Jędrzejewski, Grzegorz; Beń-Skowronek, Iwona; Nachulewicz, Paweł

    2017-06-01

    Undescended testes are recognised in 1% to 2% of boys during the first year of life, and about 20% of them are impalpable. Ultrasonography (US) may establish the localisation of the testis but the final diagnosis is usually determined laparoscopically. To evaluate long-term results of laparoscopic treatment of boys with impalpable testes and sensitivity of preoperative ultrasound. Between 2011 and 2015, we operated on 545 boys with undescended testes. Sixty-two of them with 65 impalpable testes were treated laparoscopically - the study group. Mean age was 3.5 years. The study group was divided into 5 groups according to type of treatment. The volume and position of the operated gonad were assessed manually and by ultrasound. In group 1 testicular agenesis was observed in 19 patients. In group 2 revision of the inguinal canal revealed testicular agenesis in 7 and atrophy in 4 patients. In group 3 conversion to classic orchiopexy was performed in 10 patients. In group 4 one-stage orchiopexy was performed in 9 patients on 12 testes. In group 5 a two-stage F-S procedure was performed in 13 patients. Ten testes in group 4 had a volume in the normal range (84%) and also 10 testes in group 5 (77%). Laparoscopy in impalpable testes is the procedure of choice and allows definitive management, even when conversion to open procedure is necessary. Sensitivity of preoperative ultrasound is generally about 60% for true intra-abdominal testes, so diagnostic laparoscopy is necessary.

  20. Ameloblastoma: Our clinical experience with 68 cases

    Directory of Open Access Journals (Sweden)

    Benjamin Fomete

    2014-01-01

    Full Text Available Introduction: In this environment, previous workers have reported on the challenges of managing large sized ameloblastoma of the jaws with less than adequate facilities. The aim of this review is to present the management of 68 cases of ameloblastoma with emphasis on surgical care. Materials and Methods: Retrospective survey of case notes of patients with histopathologic diagnosis of ameloblastoma (using the criteria of Barnes et al., 2005 seen between January 2006 and August 2010 at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria was undertaken. Data collected includes histopathological diagnosis, age, gender, clinical information on site of lesion, form of intubation and surgical procedure performed. Results: Out of 94 patients, 68 with histological diagnosis of ameloblastoma (59 mandibular and 9 maxillary were operated within the study period. The remainder (26 was not treated in hospital. Among 68 patients treated, more were males (38 than females (30, giving a male to female ratio of 1.3:1. The age range was between 14 and 74 years (mean-standard deviation. The duration of the symptoms ranged from 7 months to 24 years, most were follicular ameloblastoma (n = 13 followed by acanthomatous type (n = 7. Endotracheal intubation was the most common (n = 55 followed by fiber optic laryngoscopy (n = 8. The surgical approach most used was extended Risdon with intraoral (n = 24 followed by extended Risdon with lip split and intraoral (n = 17. Segmental resection (en block formed the bulk of our procedures (n = 22 followed by subtotal mandibulectomy (n = 16. Conclusion: The treatment of ameloblastoma remains controversial. Its destructive nature has left patients with wide defects difficult to reconstruct.

  1. Digital breast tomosynthesis (DBT): initial experience in a clinical setting

    International Nuclear Information System (INIS)

    Skaane, Per; Gullien, Randi; Eben, Ellen B.; Haakenaasen, Unni; Naess Jebsen, Ingvild; Krager, Mona; Bjoerndal, Hilde; Ekseth, Ulrika; Jahr, Gunnar

    2012-01-01

    false-positive findings. The side-by-side feature analysis showed higher conspicuity scores for tomosynthesis compared to conventional 2D for cancers presenting as spiculated masses and distortions. Conclusion: Tomosynthesis is a promising new technique. Our preliminary clinical experience shows that there is a potential for increasing the sensitivity using this new technique, especially for cancers manifesting as spiculated masses and distortions

  2. Clinical surgical Experiences with 51-ileal pouches

    International Nuclear Information System (INIS)

    Puerta, Juan D; Castano, Rodrigo; Arismendi, Ivan R

    2004-01-01

    Restorative proctocolectomy and ileal pouch (IP) has become an established surgery for patients with chronic ulcerative colitis and poliposis syndromes. The authors report the results of 8-year experience of restorative proctocolectomy and IP. Chart review was performed for 51 patients undergoing IP from 1994 through 2002. Preoperative histopathologic diagnoses were ulcerative colitis (n=39), poliposis syndromes (n=10), 2 Crohn diseases and 1 patient with colorectal cancer and extended resection. Information was obtained regarding patient demographics, type and duration of diseases, previous operations, and indications for surgery. Early (within 30 days after surgery) and late complications were noted. Follow-up included an annual function, physical examination, and biopsies of the pouch and anal transitional zone when were indicated. Of the 51 patients (24 women) with mean follow-up time of 44,5 months (range 12 -108 months), histopathologic diagnoses of ulcerative colitis were changed for Crohn's disease in 2 patients. The overall mortality rate was 2% (1 patient) one death was related to perineal sepsis 45 months after ileal pouch. The overall morbidity rate was 65% (73 complications in 33 patients; early 39%; late 49%) the mean hospitalary stance was 8, 9 days (range 6-25 days). Small bowel obstruction, septic complication and reoperation rates were 36%, 22% and 26%, respectively. The most frequent late complication was pouchitis (31,8%). The ileal pouch was removed in 1 patient, and it is functional in 50 (98%). There was a satisfactory index with 82% with excellent-good results, and 16% and 2% with regular and bad results. Restorative proctocolectomy with an IP is a safe procedure, with low mortality and major morbidity rates. Although total morbidity rate is appreciable, functional results generally are good and patient satisfaction is acceptable

  3. Differences in clinical experiences of ADN and BSN students.

    Science.gov (United States)

    Oermann, M H

    1998-05-01

    Prior research has suggested that clinical experience for nursing students is stressful. Concern about making an error and harming the patient, limited knowledge and skills for practice, and difficulties in interacting with the teacher and others in the clinical setting are some of the stressors reported by students. Few studies have compared these stresses and the clinical experiences in general between students in associate degree (ADN) and baccalaureate (BSN) nursing programs. The purposes of this research were to compare the clinical experiences of ADN and BSN students at different levels in the programs and describe these experiences from the students' perspectives. As such, both quantitative and qualitative data were collected from 415 students in ADN and BSN programs in the Midwest. The ADN students reported significantly higher stress in clinical practice than BSN students (t = 2.16, p ADN and BSN students in clinical practice increased as they progressed through the programs. The semester prior to graduation was the most stressful time in terms of clinical practice for both ADN and BSN students. The instructor was the predominant stressor reported by students in ADN programs across all levels of the curriculum. Among BSN students, the most prevalent stresses were coping with demands associated with patient care and the clinical teacher. The findings highlight the important role of the clinical faculty in both types of nursing programs.

  4. Updated clinical guidelines experience major reporting limitations

    Directory of Open Access Journals (Sweden)

    Robin W.M. Vernooij

    2017-10-01

    Full Text Available Abstract Background The Checklist for the Reporting of Updated Guidelines (CheckUp was recently developed. However, so far, no systematic assessment of the reporting of updated clinical guidelines (CGs exists. We aimed to examine (1 the completeness of reporting the updating process in CGs and (2 the inter-observer reliability of CheckUp. Methods We conducted a systematic assessment of the reporting of the updating process in a sample of updated CGs using CheckUp. We performed a systematic search to identify updated CGs published in 2015, developed by a professional society, reporting a systematic review of the evidence, and containing at least one recommendation. Three reviewers independently assessed the CGs with CheckUp (16 items. We calculated the median score per item, per domain, and overall, converting scores to a 10-point scale. Multiple linear regression analyses were used to identify differences according to country, type of organisation, scope, and health topic of updated CGs. We calculated the intraclass coefficient (ICC and 95% confidence interval (95% CI for domains and overall score. Results We included in total 60 updated CGs. The median domain score on a 10-point scale for presentation was 5.8 (range 1.7 to 10, for editorial independence 8.3 (range 3.3 to 10, and for methodology 5.7 (range 0 to 10. The median overall score on a 10-point scale was 6.3 (range 3.1 to 10. Presentation and justification items at recommendation level (respectively reported by 27 and 38% of the CGs and the methods used for the external review and implementing changes in practice were particularly poorly reported (both reported by 38% of the CGs. CGs developed by a European or international institution obtained a statistically significant higher overall score compared to North American or Asian institutions (p = 0.014. Finally, the agreement among the reviewers on the overall score was excellent (ICC 0.88, 95% CI 0.75 to 0.95. Conclusions The

  5. POSITIVE CLINICAL INTERVENTIONS: WHY ARE THEY IMPORTANT AND HOW DO THEY WORK?

    Directory of Open Access Journals (Sweden)

    E.T. Bohlmeijer

    2017-01-01

    Full Text Available In this paper we discuss positive clinical psychology as an emerging field within clinical psychology. Positive clinical psychology is based on research demonstrating that mental health is more than the absence of mental illness, on research showing that wellbeing has buffering effects on the incidence of psychopathology and mental illnesses and on studies demonstrating that positive characteristics, such as positive emotions and gratitude, can predict pathology beyond the predictive power of negative characteristics. In this paper we present three distinct forms of well-being: emotional, psychological and social. In addition we review three types of positive clinical interventions: well-being therapy, positive psychotherapy and acceptance and commitment therapy. The paper ends with a call for a transformation of mental health care in which illness oriented treatments are complemented with well-being oriented treatments.

  6. Entering the Field: Beginning Teachers' Positioning Experiences of the Staffroom

    Science.gov (United States)

    Christensen, Erin; Rossi, Tony; lisahunter; Tinning, Richard

    2018-01-01

    Little is known about beginning teachers' political positioning experiences of the staffroom. This paper employs Bourdieu's conceptual tools of field, habitus and capital to explore beginning health and physical education teachers' positioning experiences and learning in staffrooms, the place in which teachers spend the majority of their…

  7. Analisis Hotel Experience Dalam Hubungan Terhadap Positive Ewom Motivation Di Surabaya

    OpenAIRE

    Wibisana, Kharisadi; Handojono, Vincentius Kusuma

    2016-01-01

    : This study was conducted to analyze the positive motivation that drives people of Surabaya to share their experience at hotel online review website based on hotel experience. Variables used are price fairness, service quality and atmosphere which are three main variables of hotel experience.The method used is Linear Multiple Regression with SPSS program. The results showed that the variables that have the most influence toward customer's positive motivation to do the online review is price...

  8. Evidence That a Psychopathology Interactome Has Diagnostic Value, Predicting Clinical Needs: An Experience Sampling Study

    Science.gov (United States)

    van Os, Jim; Lataster, Tineke; Delespaul, Philippe; Wichers, Marieke; Myin-Germeys, Inez

    2014-01-01

    Background For the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level. Method Fifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN). Results Psychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS

  9. Clinical Engeneering Experience at the Hospital of the State University of Londrina

    OpenAIRE

    Ernesto Fernando Ferreyra Ramírez

    2002-01-01

    This paper describes the four-year experience of implementation of Clinical Engineering services at the Hospital of the State University of Londrina (HURNP/UEL). It was performed by the Electrical Engineering Department (DEEL), through a project involving lecturers and students from the Electrical and Civil Engineering Courses of the same university. The main objectives were the formation of human resources in the Clinical Engineering area and a positive contribution to the healthcare service...

  10. Hard-Earned Wisdom: Exploratory Processing of Difficult Life Experience Is Positively Associated with Wisdom

    Science.gov (United States)

    Weststrate, Nic M.; Glück, Judith

    2017-01-01

    Laypersons and experts believe that wisdom is cultivated through a diverse range of positive and negative life experiences. Yet, not all individuals with life experience are wise. We propose that one possible determinant of growth in wisdom from life experience is self-reflection. In a life span sample of adults (N = 94) ranging from 26 to 92…

  11. Pre-clinical medical student experience in a pediatric pulmonary clinic

    Directory of Open Access Journals (Sweden)

    Thomas G. Saba

    2015-11-01

    Full Text Available Objective: Our objective was to evaluate the educational value of introducing pre-clinical medical students to pediatric patients and their families in a subspecialty clinic setting. Methods: First- and second-year medical students at the University of Michigan seeking clinical experience outside of the classroom attended an outpatient pediatric pulmonary clinic. Evaluation of the experience consisted of pre- and post-clinic student surveys and post-clinic parent surveys with statements employing a four-point Likert scale as well as open-ended questions. Results: Twenty-eight first-year students, 6 second-year students, and 33 parents participated in the study. Post-clinic statement scores significantly increased for statements addressing empathic attitudes, confidence communicating with children and families, comfort in the clinical environment, and social awareness. Scores did not change for statements addressing motivation, a sense of team membership, or confidence with career goals. Students achieved their goals of gaining experience interacting with patients, learning about pulmonary diseases, and observing clinic workflow. Parents felt that they contributed to student education and were not inconvenienced. Conclusions: Students identified several educational benefits of exposure to a single pediatric pulmonary clinic. Patients and families were not inconvenienced by the participation of a student. Additional studies are warranted to further investigate the value of this model of pre-clinical medical student exposure to subspecialty pediatrics.

  12. Opportunity to discuss ethical issues during clinical learning experience.

    Science.gov (United States)

    Palese, Alvisa; Gonella, Silvia; Destrebecq, Anne; Mansutti, Irene; Terzoni, Stefano; Morsanutto, Michela; Altini, Pietro; Bevilacqua, Anita; Brugnolli, Anna; Canzan, Federica; Ponte, Adriana Dal; De Biasio, Laura; Fascì, Adriana; Grosso, Silvia; Mantovan, Franco; Marognolli, Oliva; Nicotera, Raffaela; Randon, Giulia; Tollini, Morena; Saiani, Luisa; Grassetti, Luca; Dimonte, Valerio

    2018-01-01

    Undergraduate nursing students have been documented to experience ethical distress during their clinical training and felt poorly supported in discussing the ethical issues they encountered. Research aims: This study was aimed at exploring nursing students' perceived opportunity to discuss ethical issues that emerged during their clinical learning experience and associated factors. An Italian national cross-sectional study design was performed in 2015-2016. Participants were invited to answer a questionnaire composed of four sections regarding: (1) socio-demographic data, (2) previous clinical learning experiences, (3) current clinical learning experience quality and outcomes, and (4) the opportunity to discuss ethical issues with nurses in the last clinical learning experience (from 0 - 'never' to 3 - 'very much'). Participants and research context: Participants were 9607 undergraduate nursing students who were attending 95 different three-year Italian baccalaureate nursing programmes, located at 27 universities in 15 Italian regions. Ethical considerations: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after the research protocol was approved by an ethics committee. Overall, 4707 (49%) perceived to have discussed ethical issues 'much' or 'very much'; among the remaining, 3683 (38.3%) and 1217 (12.7%) students reported the perception of having discussed, respectively, 'enough' or 'never' ethical issues emerged in the clinical practice. At the multivariate logistic regression analysis explaining 38.1% of the overall variance, the factors promoting ethical discussion were mainly set at the clinical learning environment levels (i.e. increased learning opportunities, self-directed learning, safety and nursing care quality, quality of the tutorial strategies, competences learned and supervision by a clinical nurse). In contrast, being male was associated with a perception of less opportunity to discuss ethical issues

  13. Morgellons disease: experiences of an integrated multidisciplinary dermatology team to achieve positive outcomes.

    Science.gov (United States)

    Mohandas, Padma; Bewley, Anthony; Taylor, Ruth

    2018-03-01

    In recent years, there has been a reported increase in affliction of the skin with small fibres or other particles. The condition has been referred to as Morgellons disease. Patients present with stinging, burning or crawling sensations of the skin, with perceived extrusion of inanimate material alongside fatigue and other systemic symptoms. Sufferers often experience significant morbidity and reduction in quality of life. We aimed to explore the various clinical presentations, management strategies and outcomes employed to treat this condition in our patients. We conducted a retrospective case notes review of 35 patients referred to our multidisciplinary psycho-dermatology clinic at the Royal London Hospital between January 2004 and January 2017. The majority of patients were women (25) 71.4%, with a mean age of 54.6 years (26-80 years). Most (26) 74.2% were living alone. The average duration of illness prior to presentation was 3.8 years (4 months-20 years). Many patients had perceived precipitating factors (54.2%) and often self-diagnosed (28.5%). Psychiatric co-morbidities included 42.8% with depressive symptoms and 25.7% with anxiety. Substance misuse was elicited in five patients (14%). Management of patients included both the treatment of skin disease and psychosocial co-morbidities. Out of the 35 patients who attended (14) 40% cleared or showed significant improvement. Sixteen (45.7%) patients were stable and under review. One patient declined treatment and three did not attend review. One patient died from disease unrelated to her skin condition. Morgellons disease is a condition, which is widely discussed on the internet and patients often self-diagnose. The course of the disease can be chronic and debilitating. For a positive outcome, it is important that a strong physican-patient relationship is cultivated. As demonstrated in this case series, managing patients holistically in an integrated multidisciplinary dermatology setting helps achieve

  14. Understanding HIV-positive patients' preferences for healthcare services: a protocol for a discrete choice experiment

    Science.gov (United States)

    Youssef, Elaney; Cooper, Vanessa; Miners, Alec; Llewellyn, Carrie; Pollard, Alex; Lagarde, Mylene; Sachikonye, Memory; Sabin, Caroline; Foreman, Claire; Perry, Nicky; Nixon, Eileen; Fisher, Martin

    2016-01-01

    Introduction While the care of HIV-positive patients, including the detection and management of comorbidities, has historically been provided in HIV specialist outpatient clinics, recent years have seen a greater involvement of non-HIV specialists and general practitioners (GPs). The aim of this study is to determine whether patients would prefer to see their GP or HIV physician given general symptoms, and to understand what aspects of care influence their preferences. Methods/analysis We have developed and piloted a discrete choice experiment (DCE) to better understand patients' preferences for care of non-HIV-related acute symptoms. The design of the DCE was informed by our exploratory research, including the findings of a systematic literature review and a qualitative study. Additional questionnaire items have been included to measure demographics, service use and experience of non-HIV illnesses and quality of life (EQ5D). We plan to recruit 1000 patients from 14 HIV clinics across South East England. Data will be analysed using random-effects logistic regression and latent class analysis. ORs and 95% CIs will be used to estimate the relative importance of each of the attribute levels. Latent class analysis will identify whether particular groups of people value the service attribute levels differently. Ethics/dissemination Ethical approval for this study was obtained from the Newcastle and North Tyneside Research Ethics Committee (reference number 14/NE/1193). The results will be disseminated at national and international conferences and peer-reviewed publications. A study report, written in plain English, will be made available to all participants. The Patient Advisory Group will develop a strategy for wider dissemination of the findings to patients and the public. PMID:27431895

  15. Physiotherapy students' perceptions and experiences of clinical prediction rules.

    Science.gov (United States)

    Knox, Grahame M; Snodgrass, Suzanne J; Stanton, Tasha R; Kelly, David H; Vicenzino, Bill; Wand, Benedict M; Rivett, Darren A

    2017-09-01

    Clinical reasoning can be difficult to teach to pre-professional physiotherapy students due to their lack of clinical experience. It may be that tools such as clinical prediction rules (CPRs) could aid the process, but there has been little investigation into their use in physiotherapy clinical education. This study aimed to determine the perceptions and experiences of physiotherapy students regarding CPRs, and whether they are learning about CPRs on clinical placement. Cross-sectional survey using a paper-based questionnaire. Final year pre-professional physiotherapy students (n=371, response rate 77%) from five universities across five states of Australia. Sixty percent of respondents had not heard of CPRs, and a further 19% had not clinically used CPRs. Only 21% reported using CPRs, and of these nearly three-quarters were rarely, if ever, learning about CPRs in the clinical setting. However most of those who used CPRs (78%) believed CPRs assisted in the development of clinical reasoning skills and none (0%) was opposed to the teaching of CPRs to students. The CPRs most commonly recognised and used by students were those for determining the need for an X-ray following injuries to the ankle and foot (67%), and for identifying deep venous thrombosis (63%). The large majority of students in this sample knew little, if anything, about CPRs and few had learned about, experienced or practiced them on clinical placement. However, students who were aware of CPRs found them helpful for their clinical reasoning and were in favour of learning more about them. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  16. Altered Positive Affect in Clinically Anxious Youth: the Role of Social Context and Anxiety Subtype

    OpenAIRE

    Morgan, JK; Lee, GE; Wright, AGC; Gilchrist, DE; Forbes, EE; McMakin, DL; Dahl, RE; Ladouceur, CD; Ryan, ND; Silk, JS

    2017-01-01

    © 2016, Springer Science+Business Media New York. Anxious youth may experience altered positive affect (PA) relative to healthy youth, perhaps because of greater sensitivity to social experiences. Altered PA may be especially evident during the transition to adolescence, a period in which positive social events increase in salience and value. The current study evaluated whether anxious youth show differences in baseline PA, rate of return to baseline, and variability around baseline PA and te...

  17. [Clinical features and therapeutic response of our anti-SRP positive patients with myositis].

    Science.gov (United States)

    Botos, Balázs; Nagy-Vincze, Melinda; Dankó, Katalin

    2017-09-01

    Idiopathic inflammatory myopathies are a group of clinically heterogeneous diseases, which have been classified by myositis specific antibodies recently. The anti-SRP positive subset of this group is characterized by more severe clinical prognosis than other myositis specific antibody positive types. Our goal was to compare 16 anti-SRP positive patients in the Division of Clinical Immunology, Department of Internal Medicine, University of Debrecen with 16 antibody negative ones. Muscle strength validated in both groups by the manual muscle test proved to be significantly decreased both before and after therapy (χ 2 = 0.006 and 0.019) in the anti-SRP positive group. Muscle-specific inflammatory laboratory parameters showed significant difference only in case of LDH-levels after therapy. Both groups showed good clinical response to first line steroid treatment, yet the significantly higher rate of second line administration suggests worse therapeutic response of the antibody positive group. Based on these facts we determined poor clinical prognosis and therapeutic response of the anti-SRP positive group. Orv Hetil. 2017; 158(35): 1382-1389.

  18. Swedish fathers' experiences of childbirth in relation to maternal birth position: a mixed method study.

    Science.gov (United States)

    Johansson, Margareta; Thies-Lagergren, Li

    2015-12-01

    Fathers often want to be involved in labour and birth. To investigate how maternal birth position during second stage of labour may influence fathers' experience of childbirth. Mixed method study with 221 Swedish fathers completing an on-line questionnaire. Descriptive statistics and qualitative content analysis were used. In total 174 (78.7%) had a positive overall birth experience. The theme An emotional life-changing event influenced by the birth process and the structure of obstetrical care was revealed and included the categories; Midwives ability to be professional, The birth process' impact, and Being prepared to participate. The most frequently utilised birth position during a spontaneous vaginal birth was birth seat (n=83; 45.1%), and the fathers in this group were more likely to assess the birth position as very positive (n=40; 54.8%) compared to other upright and horizontal birth positions. Fathers with a partner having an upright birth position were more likely to have had a positive birth experience (p=0.048), to have felt comfortable (p=0.003) and powerful (p=0.019) compared to women adopting a horizontal birth position during a spontaneous vaginal birth. When the women had an upright birth position the fathers deemed the second stage of labour to have been more rapid (mean VAS 7.01 vs. 4.53) compared to women in a horizontal birth position. An upright birth position enhances fathers' experience of having been positively and actively engaged in the birth process. Midwives can enhance fathers' feelings of involvement and participation by attentiveness through interaction and communicating skills. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  19. Early clinical experience: do students learn what we expect?

    NARCIS (Netherlands)

    Helmich, E.; Bolhuis, S.; Laan, R.F.J.M.; Koopmans, R.T.C.M.

    2011-01-01

    CONTEXT: Early clinical experience is thought to contribute to the professional development of medical students, but little is known about the kind of learning processes that actually take place. Learning in practice is highly informal and may be difficult to direct by predefined learning outcomes.

  20. Early clinical experience : do students learn what we expect?

    NARCIS (Netherlands)

    Helmich, Esther; Bolhuis, Sanneke; Laan, Roland; Koopmans, Raymond

    CONTEXT Early clinical experience is thought to contribute to the professional development of medical students, but little is known about the kind of learning processes that actually take place. Learning in practice is highly informal and may be difficult to direct by predefined learning outcomes.

  1. Clinical and laboratory experience of chorionic villous sampling in ...

    African Journals Online (AJOL)

    Background: Chorionic villous sampling is a first trimester invasive diagnosis procedure that was introduced in Nigeria <2 decades ago. Objective: The objective of the following study is to review experience with chorionic villous sampling in relation to clinical and laboratory procedures, including general characteristics of ...

  2. Clinical evaluation of the use of an intracardiac electrocardiogram to guide the tip positioning of peripherally inserted central catheters.

    Science.gov (United States)

    Zhao, Ruiyi; Chen, Chunfang; Jin, Jingfen; Sharma, Komal; Jiang, Nan; Shentu, Yingqin; Wang, Xingang

    2016-06-01

    The use of peripherally inserted central catheters (PICCs) provides important central venous accesses for clinical treatments, tests and monitoring. Compared with the traditional methods, intracardiac electrocardiogram (ECG)-guided method has the potential to guide more accurate tip positioning of PICCs. This study aimed to clinically evaluate the effectiveness of an intracardiac ECG to guide the tip positioning by monitoring characteristic P-wave changes. In this study, eligible patients enrolled September 2011 to May 2012 according to the inclusion and exclusion criteria received the catheterization monitored by intracardiac ECG. Then chest radiography was performed to check the catheter position. The results revealed that, with 117 eligible patients, all bar one patient who died (n = 116) completed the study, including 60 males and 56 females aged 51.2 ± 15.1 years. Most (n = 113, > 97%) had characteristic P-wave changes. The intracardiac ECG-guided positioning procedure achieved correct placement for 112 patients (96.56%), demonstrating 99.12% sensitivity and 100% specificity. In conclusion, the intracardiac ECG can be a promising technique to guide tip positioning of PICCs. However, since the sample size in this study is limited, more experience and further study during clinical practice are needed to demonstrate achievement of optimal catheterization outcomes. © 2015 John Wiley & Sons Australia, Ltd.

  3. Trait and State Positive Emotional Experience in Schizophrenia: A Meta-Analysis

    Science.gov (United States)

    Yan, Chao; Cao, Yuan; Zhang, Yang; Song, Li-Ling; Cheung, Eric F. C.; Chan, Raymond C. K.

    2012-01-01

    Background Prior meta-analyses indicated that people with schizophrenia show impairment in trait hedonic capacity but retain their state hedonic experience (valence) in laboratory-based assessments. Little is known about what is the extent of differences for state positive emotional experience (especially arousal) between people with schizophrenia and healthy controls. It is also not clear whether negative symptoms and gender effect contribute to the variance of positive affect. Methods and Findings The current meta-analysis examined 21 studies assessing state arousal experience, 40 studies measuring state valence experience, and 47studies assessing trait hedonic capacity in schizophrenia. Patients with schizophrenia demonstrated significant impairment in trait hedonic capacity (Cohen’s d = 0.81). However, patients and controls did not statistically differ in state hedonic (valence) as well as exciting (arousal) experience to positive stimuli (Cohen’s d = −0.24 to 0.06). They also reported experiencing relatively robust state aversion and calmness to positive stimuli compared with controls (Cohen’s d = 0.75, 0.56, respectively). Negative symptoms and gender contributed to the variance of findings in positive affect, especially trait hedonic capacity in schizophrenia. Conclusions Our findings suggest that schizophrenia patients have no deficit in state positive emotional experience but impairment in “noncurrent” hedonic capacity, which may be mediated by negative symptoms and gender effect. PMID:22815785

  4. Management Control Systems and Clinical Experience of Managers in Public Hospitals

    Directory of Open Access Journals (Sweden)

    Rogério Joao Lunkes

    2018-04-01

    Full Text Available Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector.

  5. Management Control Systems and Clinical Experience of Managers in Public Hospitals

    Science.gov (United States)

    Naranjo-Gil, David

    2018-01-01

    Healthcare authorities are encouraging managers in hospitals to acquire clinical experience and knowledge in order to better carry out and coordinate healthcare service delivery. The main objective of this paper is to analyse how the clinical experience of hospital managers is related to public health institutions’ performance. It is proposed that the effect of the clinical experience on operative and financial organizational performance is indirect through the mediating variables of perceived utility of management information and horizontal management control system. This paper analyses how these variables impact hospital performance through the data from a survey sent to 364 hospital managers in Brazil. The results show that managers’ clinical experience is related to higher perceived utility of historical, financial, short-term, and internal information, but not with horizontal control adoption in hospitals. Furthermore, our results show that, in hospitals, perceived utility of forecasted, non-financial, long-term, and external managerial information positively affects hospitals’ financial performance, while adoption of horizontal control management positively affects operational performance. Through showing evidence that clinical background could explain the differences not only in hospital service management but also in information capabilities and management control processes, this study offer meaningful implications for healthcare authorities and hospital managers involved in the development and implementation of strategies in the health sector. PMID:29673192

  6. Fostering new relational experience: clinical process in couple psychotherapy.

    Science.gov (United States)

    Marmarosh, Cheri L

    2014-03-01

    One of the most critical goals for couple psychotherapy is to foster a new relational experience in the session where the couple feels safe enough to reveal more vulnerable emotions and to explore their defensive withdrawal, aggressive attacking, or blaming. The lived intimate experience in the session offers the couple an opportunity to gain integrative insight into their feelings, expectations, and behaviors that ultimately hinder intimacy. The clinical processes that are necessary include empathizing with the couple and facilitating safety within the session, looking for opportunities to explore emotions, ruptures, and unconscious motivations that maintain distance in the relationship, and creating a new relational experience in the session that has the potential to engender integrative insight. These clinical processes will be presented with empirical support. Experts from a session will be used to highlight how these processes influence the couple and promote increased intimacy. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

  7. Using clinical caring journaling: nursing student and instructor experiences.

    Science.gov (United States)

    Kuo, Chien-Lin; Turton, Michael; Cheng, Su-Fen; Lee-Hsieh, Jane

    2011-06-01

    Journaling has been incorporated into many nursing courses as an active reflective teaching strategy that can facilitate the learning process, personal growth, and professional development of students. There is limited research support of journaling as an appropriate tool to promote reflection for the purpose of learning caring in nursing education. The aim of this study was to explore the experiences and perceptions of student nurses and instructors who use clinical caring journaling (CCJ) in their clinical practicum. Researchers used a descriptive qualitative research design. The study population was 880 senior student nurses and 90 clinical instructors from a nursing program at a university in Taiwan who used CCJ. After completion of 1 year of clinical practicum, 16 students and 7 instructors participated voluntarily in focus group interviews. Researchers used content analysis to sort interview data into themes. Six themes were categorized that encapsulated student and instructor experiences and perceptions regarding using CCJ in their clinical practicum. These themes were guiding caring behavior toward patients, enabling students' reflective caring abilities, building up students' self-confidence, increasing interaction between students and instructors, enhancing students' self-development, and overcoming writing difficulty. Research findings may serve as a reference for nursing educators to use CCJ strategy in student nurses' clinical practicum.

  8. Betwixt and Between: The Social Position and Stress Experiences of Graduate Students

    Science.gov (United States)

    Grady, Rebecca K.; La Touche, Rachel; Oslawski-Lopez, Jamie; Powers, Alyssa; Simacek, Kristina

    2014-01-01

    Graduate students occupy social positions within institutions of higher education that are rife with role strain and, relative to broader power relations within these institutions, are marginalized. In this study, we inquire how the social positions and concomitant roles of graduate students shape their mental health experiences, investigating…

  9. Facilitative and obstructive factors in the clinical learning environment: Experiences of pupil enrolled nurses

    Directory of Open Access Journals (Sweden)

    Eucebious Lekalakala-Mokgele

    2015-03-01

    Full Text Available Background: The clinical learning environment is a complex social entity that influences student learning outcomes in the clinical setting. Students can experience the clinical learning environment as being both facilitative and obstructive to their learning. The clinical environment may be a source of stress, creating feelings of fear and anxiety which in turn affect the students’ responses to learning. Equally, the environment can enhance learning if experienced positively. Objectives: This study described pupil enrolled nurses’ experiences of facilitative and obstructive factors in military and public health clinical learning settings. Method: Using a qualitative, contextual, exploratory descriptive design, three focus group interviews were conducted until data saturation was reached amongst pupil enrolled nurses in a military School of Nursing. Results: Data analysed provided evidence that acceptance by clinical staff and affordance of self-directed learning facilitated learning. Students felt safe to practise when they were supported by the clinical staff. They felt a sense of belonging when the staff showed an interest in and welcomed them. Learning was obstructed when students were met with condescending comments. Wearing of a military uniform in the public hospital and horizontal violence obstructed learning in the clinical learning environment. Conclusion: Students cannot have effective clinical preparation if the environment is not conducive to and supportive of clinical learning, The study shows that military nursing students experience unique challenges as they are trained in two professions that are hierarchical in nature. The students experienced both facilitating and obstructing factors to their learning during their clinical practice. Clinical staff should be made aware of factors which can impact on students’ learning. Policies need to be developed for supporting students in the clinical learning

  10. Facilitative and obstructive factors in the clinical learning environment: Experiences of pupil enrolled nurses.

    Science.gov (United States)

    Lekalakala-Mokgele, Eucebious; Caka, Ernestine M

    2015-03-31

    The clinical learning environment is a complex social entity that influences student learning outcomes in the clinical setting. Students can experience the clinical learning environment as being both facilitative and obstructive to their learning. The clinical environment may be a source of stress, creating feelings of fear and anxiety which in turn affect the students' responses to learning. Equally, the environment can enhance learning if experienced positively. This study described pupil enrolled nurses' experiences of facilitative and obstructive factors in military and public health clinical learning settings. Using a qualitative, contextual, exploratory descriptive design, three focus group interviews were conducted until data saturation was reached amongst pupil enrolled nurses in a military School of Nursing. Data analysed provided evidence that acceptance by clinical staff and affordance of self-directed learning facilitated learning. Students felt safe to practise when they were supported by the clinical staff. They felt a sense of belonging when the staff showed an interest in and welcomed them. Learning was obstructed when students were met with condescending comments. Wearing of a military uniform in the public hospital and horizontal violence obstructed learning in the clinical learning environment. Students cannot have effective clinical preparation if the environment is not conducive to and supportive of clinical learning, The study shows that military nursing students experience unique challenges as they are trained in two professions that are hierarchical in nature. The students experienced both facilitating and obstructing factors to their learning during their clinical practice. Clinical staff should be made aware of factors which can impact on students' learning. Policies need to be developed for supporting students in the clinical learning environment.

  11. Direct detection of Trichomonas vaginalis virus in Trichomonas vaginalis positive clinical samples from the Netherlands.

    Science.gov (United States)

    Jehee, Ivo; van der Veer, Charlotte; Himschoot, Michelle; Hermans, Mirjam; Bruisten, Sylvia

    2017-12-01

    Trichomonas vaginalis is the most common sexually transmitted parasitical infection worldwide. T. vaginalis can carry a virus: Trichomonas vaginalis virus (TVV). To date, four TVV species have been described. Few studies have investigated TVV prevalence and its clinical importance. We have developed a nested reverse-transcriptase PCR, with novel, type specific primers to directly detect TVV RNA in T. vaginalis positive clinical samples. A total of 119T. vaginalis positive clinical samples were collected in Amsterdam and "s-Hertogenbosch, the Netherlands, from 2012 to 2016. For all samples T. vaginalis was genotyped using multi-locus sequence typing. The T. vaginalis positive samples segregated into a two-genotype population: type I (n=64) and type II (n=55). All were tested for TVV with the new TVV PCR. We detected 3 of the 4 TVV species. Sequencing of the amplified products showed high homology with published TVV genomes (82-100%). Half of the T. vaginalis clinical samples (n=60, 50.4%) were infected with one or more TVV species, with a preponderance for TVV infections in T. vaginalis type I (n=44, 73.3%). Clinical data was available for a subset of samples (n=34) and we observed an association between testing positive for (any) TVV and reporting urogenital symptoms (p=0.023). The nested RT-PCR allowed for direct detection of TVV in T. vaginalis positive clinical samples. This may be helpful in studies and clinical settings, since T. vaginalis disease and/or treatment outcome may be influenced by the protozoa"s virus. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Clinical Characteristics of MuSK Antibody-positive Myasthenia Gravis in Taiwan

    Directory of Open Access Journals (Sweden)

    Yung-Chuan Huang

    2008-07-01

    Full Text Available Circulating antibodies of the acetylcholine receptor (AchRAb are detectable in most patients with generalized myasthenia gravis (MG. A newly discovered antibody against muscle-specific kinase (MuSKAb has been detected in 40–70% of AchRAb-negative MG patients. We report a series of Taiwanese MuSKAb-positive patients, and compare their clinical features with MuSKAb-negative patients and also with MuSKAb-positive Caucasians. Five out of 44 seronegative generalized MG patients (11.4% were positive for MuSKAb. Patients with MuSKAb tended to have severe disability and bulbar involvement, and more often experienced crisis or impending crisis. Although all of these patients showed an initial response to immunosuppressant therapy, they had greater disability at follow-up. The clinical features of Taiwanese MuSKAb-positive patients were not different from those of Caucasians, except for a lower prevalence.

  13. Clinical characteristics differentiating bacteriologically positive pulmonary tuberculosis patients from negative ones in Mongolia.

    Science.gov (United States)

    Toyota, M; Yasuda, N; Koda, S; Ohara, H; Enkhbat, S; Tsogt, G

    1998-06-01

    The objective of this study is to clarify clinical characteristics which differentiate bacteriologically positive pulmonary tuberculosis patients from negative ones in Mongolia. The subjects include 338 patients aged 16 years and older who had undergone bacteriological examinations. Of them, 107 patients (31.7%) were confirmed bacteriologically. The proportion of bacteriological positive results increased significantly among patients who had cavities in the roentgenographic examination, cough at diagnosis and the family history of tuberculosis. Addressing these clinical characteristics will contribute to raising not only the sensitivity of the sputum examination, but also the specificity of the roentgenographic examination in the diagnostic process of tuberculosis.

  14. HIV positive refugees/asylum seekers and clinical trials: some ethical issues

    OpenAIRE

    McDonald, Linda

    2014-01-01

    The aim of this thesis was to identify some of the ethical issues of HIV positive asylum seekers and refugees participating in clinical trials in Britain. While all individuals are to some degree vulnerable in clinical trials, I have shown in this thesis that this group is particularly vulnerable in a number of areas. Many will not have English as a first language and while they may be able to understand everyday language, the participant information sheet (PIS) may be difficult to comprehend...

  15. Aerobic training in aquatic environment improves the position sense of stroke patients: A randomized clinical trial

    OpenAIRE

    Flávia de Andrade e Souza Mazuchi; Aline Bigongiari; Juliana Valente Francica; Patricia Martins Franciulli; Luis Mochizuki; Joseph Hamill; Ulysses Fernandes Ervilha

    2018-01-01

    Abstract AIMS (Stroke patients often present sensory-motor alterations and less aerobic capacity. Joint position sense, which is crucial for balance and gait control, is also affected in stroke patients). To compare the effect of two exercise training protocols (walking in deep water and on a treadmill) on the knee position sense of stroke patients. METHODS This study was designed as a randomized controlled clinical trial. Twelve adults, who suffered a stroke at least one year prior to the ...

  16. Performance of high-resolution position-sensitive detectors developed for storage-ring decay experiments

    International Nuclear Information System (INIS)

    Yamaguchi, T.; Suzaki, F.; Izumikawa, T.; Miyazawa, S.; Morimoto, K.; Suzuki, T.; Tokanai, F.; Furuki, H.; Ichihashi, N.; Ichikawa, C.; Kitagawa, A.; Kuboki, T.; Momota, S.; Nagae, D.; Nagashima, M.; Nakamura, Y.; Nishikiori, R.; Niwa, T.; Ohtsubo, T.; Ozawa, A.

    2013-01-01

    Highlights: • Position-sensitive detectors were developed for storage-ring decay spectroscopy. • Fiber scintillation and silicon strip detectors were tested with heavy ion beams. • A new fiber scintillation detector showed an excellent position resolution. • Position and energy detection by silicon strip detectors enable full identification. -- Abstract: As next generation spectroscopic tools, heavy-ion cooler storage rings will be a unique application of highly charged RI beam experiments. Decay spectroscopy of highly charged rare isotopes provides us important information relevant to the stellar conditions, such as for the s- and r-process nucleosynthesis. In-ring decay products of highly charged RI will be momentum-analyzed and reach a position-sensitive detector set-up located outside of the storage orbit. To realize such in-ring decay experiments, we have developed and tested two types of high-resolution position-sensitive detectors: silicon strips and scintillating fibers. The beam test experiments resulted in excellent position resolutions for both detectors, which will be available for future storage-ring experiments

  17. Hospice clinical experiences for nursing students: living to the fullest.

    Science.gov (United States)

    Spicer, Sherri; Heller, Rebecca; Troth, Sarah

    2015-01-01

    Preparing future nurses to provide appropriate care for patients and their families at the end of life can be a formidable challenge for nurse educators. Most nursing schools thread end-of-life concepts throughout the curriculum. Grand Canyon University includes a 40-hour hospice clinical as a component of a home healthcare practicum. Students' weekly written reflections reveal the depth of affective learning that occurs during this experience. Article includes hospice materials and resources.

  18. HIV-positive patients’ perceptions of care received at a selected antiretroviral therapy clinic in Vhembe district, South Africa

    Directory of Open Access Journals (Sweden)

    Tshifhiwa V. Ndou

    2016-04-01

    Full Text Available Background: Patients’ experiences are a reflection of what has happened during the care process and, therefore, provide information about the performance of health care professional workers. They refer to the process of care provision at the antiretroviral therapy (ART sites. Aim and setting: This article explored the perceptions of HIV-positive patients of care received at the Gateway Clinic of the regional hospital that provides antiretroviral treatment in the Vhembe district. Methods: A qualitative, explorative and descriptive design was used. A non-probability, convenient sampling method was used to select 20 HIV-positive patients who were above 18 years of age. In-depth individual interviews were used to collect data. Data were analysed through Tech’s open coding method. Results: One theme and two sub-themes emerged, namely positive experiences related to the environment and attitudes of health professionals, and negative experiences concerning the practices by health care providers. Conclusion: Patients’ perceptions of quality of, and satisfaction with, health care may affect health outcomes. Recommendations are made to consider, practice and strengthen the protocols, the standard operating procedures and the principles of infection control in the health facilities. Keywords: Human Immunodeficiecy Virus, Antiretroviral Treatment, HIV positive, Limpopo

  19. DNA-abzymes in autoimmune diseases in clinic and experiment

    Directory of Open Access Journals (Sweden)

    T E Naumova

    2003-01-01

    Full Text Available DNA-abzymes enzymes in autoimmune diseases in clinic and experiment T.E. Naumova, O.M. Durova, A.G. Gabibov, Z.S. Alekberova, S. V. Suchkov DNA-hydrolyzing autoantibodies (AAB or DNA-abzymes can be found in autoimmune diseases in clinic and experiment. Technology of serum express screening for presence of DNA abzymes is described. Comparative study of DNA-hydrolising activity in patients with different forms of systemic and organ-specific autoimmune diseases was performed. Blood of clinically healthy donors was usually free of IgG DNA-abzymes. DNA-abzymes were most often revealed in patients with systemic lupus erythematosus (SLE and rheumatoid arthritis (RA less often in patients with organ-specific forms of autoimmune disturbances. The results of the study confirm the hypothesis of autoimmune origin of IgG DNA abzymes and demonstrate the possibility to use them in clinical practice for monitoring to disease activity in SLE and RA.

  20. Clinical decision-making: physicians' preferences and experiences

    Directory of Open Access Journals (Sweden)

    White Martha

    2007-03-01

    Full Text Available Abstract Background Shared decision-making has been advocated; however there are relatively few studies on physician preferences for, and experiences of, different styles of clinical decision-making as most research has focused on patient preferences and experiences. The objectives of this study were to determine 1 physician preferences for different styles of clinical decision-making; 2 styles of clinical decision-making physicians perceive themselves as practicing; and 3 the congruence between preferred and perceived style. In addition we sought to determine physician perceptions of the availability of time in visits, and their role in encouraging patients to look for health information. Methods Cross-sectional survey of a nationally representative sample of U.S. physicians. Results 1,050 (53% response rate physicians responded to the survey. Of these, 780 (75% preferred to share decision-making with their patients, 142 (14% preferred paternalism, and 118 (11% preferred consumerism. 87% of physicians perceived themselves as practicing their preferred style. Physicians who preferred their patients to play an active role in decision-making were more likely to report encouraging patients to look for information, and to report having enough time in visits. Conclusion Physicians tend to perceive themselves as practicing their preferred role in clinical decision-making. The direction of the association cannot be inferred from these data; however, we suggest that interventions aimed at promoting shared decision-making need to target physicians as well as patients.

  1. Challenges (Obstacles in Reaching Leadership PositionsExperiences of Women Professors at Novi Sad University Serbia

    Directory of Open Access Journals (Sweden)

    Andrić Marijana Mišić

    2017-12-01

    Full Text Available Underrepresentation of women in leadership positions in universities is a phenomenon present in most countries of the world, with some significant differences. In our work we focused on obstacles that women professors in Novi Sad University (Serbia faced in reaching leadership positions. Analysis is based on qualitative research using a semi structured interview, statistical data and selected secondary sources. Obstacles, mentorship and networking have been researched from an idiographic perspective (reflection and the personal experience of the women at Novi Sad University. Results indicate a significant underrepresentation of women in leadership positions at Novi Sad University. Findings point to a general pattern: the more power and authority the leadership position holds, the scarcer the number of women participating in it. According to interviewees’ statements the patriarchal value system makes the leadership positions difficult to attain for women. Interview analysis also suggests additional limiting factors, such as lack of mentorship and inadequate networking, acting as inhibitors in reaching leadership positions.

  2. Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties.

    Science.gov (United States)

    Li, Tse Yan; Gao, Xiaoli; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

    2015-04-14

    Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students' acquisition of clinical competence. This study aimed to understand the experience of undergraduate students across clinical disciplines-medicine, dentistry, and nursing-in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong-Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both Plearning in the planned curriculum. This trend calls for a transformation of the educator's role from dispensing knowledge to guidance and support.

  3. Positive Family Intervention for Severe Challenging Behavior I: A Multisite Randomized Clinical Trial

    Science.gov (United States)

    Durand, V. Mark; Hieneman, Meme; Clarke, Shelley; Wang, Mo; Rinaldi, Melissa L.

    2013-01-01

    The present study was a multisite randomized clinical trial assessing the effects of adding a cognitive-behavioral intervention to positive behavior support (PBS). Fifty-four families who met the criteria of (a) having a child with a developmental disability, (b) whose child displayed serious challenging behavior (e.g., aggression, self-injury,…

  4. The dimensions of the tarsal sinus and canal in different foot positions and its clinical implications

    NARCIS (Netherlands)

    Kleipool, R. P.; Blankevoort, L.; Ruijter, J. M.; Kerkhoffs, G. M. M. J.; Oostra, R. J.

    2017-01-01

    This study presents a reference for the dimensions of the tarsal sinus and canal in healthy adults in different foot positions to facilitate understanding of the kinematics of the subtalar joint, the effect of an implant, and other clinical issues. In a 3D CT stress test on 20 subjects, the right

  5. A comparison of the clinical features of depression in hiv-positive ...

    African Journals Online (AJOL)

    by far the worst affected region in the world with a continental prevalence of around ... This study compared the clinical features of major depression between .... programme Statistical Package for Social Scientists (SPSS), version 11.5. ... HIV-Positive N=64 n(%) HIV-Negative N=66 n(%) X2. OR (95%CI). P-Value. Gender.

  6. The clinical nurse leader in the perioperative setting: a preceptor experience.

    Science.gov (United States)

    Wesolowski, Michael S; Casey, Gwendolyn L; Berry, Shirley J; Gannon, Jane

    2014-07-01

    The U.S. Veterans Administration (VA) has implemented the clinical nurse leader (CNL) role nationwide. Nursing leaders at the Malcolm Randall VA Medical Center in Gainesville, Florida, implemented the development of the CNL role in the perioperative setting during the summer of 2012. The perioperative department developed the position in partnership with the University of Florida College of Nursing, Gainesville, Florida. The team developed a description of the roles and experiences of the preceptors, the clinical nurse leader resident, and the University of Florida faculty member. The clinical nurse leader resident's successes and the positive outcomes, such as improved patient outcomes, experienced by the perioperative department demonstrated the importance of the CNL role. Published by Elsevier Inc.

  7. Exploration of life experiences of positive growth in long-term childhood cancer survivors.

    Science.gov (United States)

    Kim, Yoonjung

    2017-10-01

    The aim of this study was to explore experiences of positive growth in long-term childhood cancer survivors, from their perspective. Fifteen long-term survivors of childhood cancer provided descriptions of their experiences. Data were collected through face-to-face interviews and the analysis was based on Giorgi's phenomenological research method. The analysis of positive growth experienced by long-term childhood cancer survivors revealed three themes: self-directed life, normalcy in life, and inner maturity. Long-term survivors defined positive growth as a successful transition to a self-satisfactory life based on motivation acquired through their cancer experience and on subjective goal-setting, as well as becoming cancer-free and living a normal life within society. They seemed to have acquired optimistic, flexible, active attitudes toward life while demonstrating profound gratefulness and consideration of people around them, as well as prudent approaches to health. The findings of this study verified that long-term survivors of childhood cancer have grown positively due to their negative past experience. We expect these findings to contribute to the development of programs that promote positive growth in long-term childhood cancer survivors. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Explaining effervescence: Investigating the relationship between shared social identity and positive experience in crowds.

    Science.gov (United States)

    Hopkins, Nick; Reicher, Stephen D; Khan, Sammyh S; Tewari, Shruti; Srinivasan, Narayanan; Stevenson, Clifford

    2016-01-01

    We investigated the intensely positive emotional experiences arising from participation in a large-scale collective event. We predicted such experiences arise when those attending a collective event are (1) able to enact their valued collective identity and (2) experience close relations with other participants. In turn, we predicted both of these to be more likely when participants perceived crowd members to share a common collective identity. We investigated these predictions in a survey of pilgrims (N = 416) attending a month-long Hindu pilgrimage festival in north India. We found participants' perceptions of a shared identity amongst crowd members had an indirect effect on their positive experience at the event through (1) increasing participants' sense that they were able to enact their collective identity and (2) increasing the sense of intimacy with other crowd members. We discuss the implications of these data for how crowd emotion should be conceptualised.

  9. Clinical experience with routine diode dosimetry for electron beam radiotherapy

    International Nuclear Information System (INIS)

    Yaparpalvi, Ravindra; Fontenla, Doracy P.; Vikram, Bhadrasain

    2000-01-01

    Purpose: Electron beam radiotherapy is frequently administered based on clinical setups without formal treatment planning. We felt, therefore, that it was important to monitor electron beam treatments by in vivo dosimetry to prevent errors in treatment delivery. In this study, we present our clinical experience with patient dose verification using electron diodes and quantitatively assess the dose perturbations caused by the diodes during electron beam radiotherapy. Methods and Materials: A commercial diode dosimeter was used for the in vivo dose measurements. During patient dosimetry, the patients were set up as usual by the therapists. Before treatment, a diode was placed on the patient's skin surface and secured with hypoallergenic tape. The patient was then treated and the diode response registered and stored in the patient radiotherapy system database via our in-house software. A customized patient in vivo dosimetry report showing patient details, expected and measured dose, and percent difference was then generated and printed for analysis and record keeping. We studied the perturbation of electron beams by diodes using film dosimetry. Beam profiles at the 90% prescription isodose depths were obtained with and without the diode on the beam central axis, for 6-20 MeV electron beams and applicator/insert sizes ranging from a 3-cm diameter circular field to a 25 x 25 cm open field. Results: In vivo dose measurements on 360 patients resulted in the following ranges of deviations from the expected dose at the various anatomic sites: Breast (222 patients) -20.3 to +23.5% (median deviation 0%); Head and Neck (63 patients) -21.5 to +14.8% (median -0.7%); Other sites (75 patients) -17.6 to +18.8% (median +0.5%). Routine diode dosimetry during the first treatment on 360 patients (460 treatment sites) resulted in 11.5% of the measurements outside our acceptable ±6% dose deviation window. Only 3.7% of the total measurements were outside ±10% dose deviation. Detailed

  10. Pre-Hospital Fast Positive Cases Identified by DFB Ambulance Paramedics – Final Clinical Diagnosis

    LENUS (Irish Health Repository)

    Feeney, A

    2016-04-01

    Ischaemic stroke clinical outcomes are improved by earlier treatment with intravenous thrombolysis. An existing pathway at the Mater University Hospital for assessment of suspected acute stroke in the Emergency Department was updated, aiming to shorten ‘door to needle time’. This study examines the final clinical diagnosis of Dublin Fire Brigade Ambulance Paramedic identified Face Arm Speech Test (FAST) positive patients presenting to the Emergency Department over a 7 month period. A retrospective analysis was carried out of 177 consecutive FAST positive patients presenting between March and November 2014. The final clinical diagnosis was acute stroke in 57.1% (n=101) of patients. Of these, 76 were ischaemic strokes of whom 56.5% (n=43) were thrombolysed. In the pre-hospital setting Ambulance Paramedics can identify, with reasonable accuracy, acute stroke using the FAST test. Over half of the ischaemic stroke patients presenting via this pathway can be treated with intravenous thrombolysis

  11. Positive and Negative Affect in Clinic-Referred Youth With ADHD.

    Science.gov (United States)

    Okado, Izumi; Mueller, Charles W; Nakamura, Brad J

    2016-01-01

    To examine self-reported positive affect (PA) and negative affect (NA) among youth with ADHD (only and comorbid) and other non-ADHD-referred youth in an ethnically diverse clinical sample. Semi-structured interviews identified 80 pure ADHD, 284 ADHD plus one or more comorbidities, and 730 non-ADHD youth (e.g., other diagnoses or no diagnosis). The Positive and Negative Affect Scale-Children (PANAS-C) was used to assess affective states. Even after controlling for the influence of potential confounds, youth with only ADHD reported higher PA and lower NA than other clinic-referred youth. The ADHD-comorbid group reported higher PA than the "non-ADHD" group, but these groups did not differ on level of NA. ADHD subtype did not influence results. Among clinic-referred youth, ADHD is associated with higher levels of PA and when there are no comorbid disorders, lower levels of NA. © The Author(s) 2013.

  12. Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Juul-Kristensen, Birgit; Lund, Hans

    %), with only one study rated as ‘good’. The reliability domain was most often investigated. Fewof the assessment methods in the included studies that had ‘fair’ or ‘good’ measurement properties demonstrated acceptable results for both reliability and validity.ConclusionWe found a substantially larger number......ABSTRACT OARSI Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review Larsen CM1, Juul-Kristensen B1,2 Lund H1,2, Søgaard K11University of Southern Denmark, Institute of Sports Science and Clinical Biomechanics2Institute...... assessment methods have measured the degree of scapular dyskinesis, subjectively by visual evaluation and objectively by measurements of static and dynamic scapular positioning, by either a 3-dimensional electromagnetic device or 2-dimensional clinically applicable methods. Since advanced equipment (i.e. 3D...

  13. Measurement properties of exsisting clinical assessment methods evaluating scapular positioning and function. A systematic review

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Juul-Kristensen, B; Lund, H

    (COSMIN checklist), the methodological quality in the reliability and validity domains was ‘fair’ (57%) to ‘poor’ (43%), with only one study rated as ‘good’. The reliability domain was most often investigated. Fewof the assessment methods in the included studies that had ‘fair’ or ‘good’ measurement......MEASUREMENT PROPERTIES OF EXISTING CLINICAL ASSESSMENT METHODS EVALUATING SCAPULAR POSITIONING AND FUNCTION. A SYSTEMATIC REVIEW1,2Camilla Marie Larsen, 1,3Birgit Juul-Kristensen, 1,3Hans Lund, 1Karen Søgaard1Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark2......,2]. Rehabilitation exercises are aiming at altering abnormal/asymmetric scapular positioning and/or function. Numerous assessment methods have measured the degree of scapular dyskinesis, subjectively by visual evaluation and objectively by measurements of static and dynamic scapular positioning, by either a 3...

  14. Autistic traits and positive psychotic experiences modulate the association of psychopathic tendencies with theory of mind in opposite directions.

    Science.gov (United States)

    Gillespie, Steven M; Mitchell, Ian J; Abu-Akel, Ahmad M

    2017-07-25

    Various clinical disorders, including psychopathy, and autism and schizophrenia spectrum disorders, have been linked with impairments in Theory of Mind (ToM). However, although these conditions can co-occur in the same individual, the effect of their inter-play on ToM abilities has not been investigated. Here we assessed ToM abilities in 55 healthy adults while performing a naturalistic ToM task, requiring participants to watch a short film and judge the actors' mental states. The results reveal for the first time that autistic traits and positive psychotic experiences interact with psychopathic tendencies in opposite directions to predict ToM performance-the interaction of psychopathic tendencies with autism traits was associated with a decrement in performance, whereas the interaction of psychopathic tendencies and positive psychotic experiences was associated with improved performance. These effects were specific to cognitive rather than affective ToM. These results underscore the importance of the simultaneous assessment of these dimensions within clinical settings. Future research in these clinical populations may benefit by taking into account such individual differences.

  15. [Clinical manifestation of Lyme borreliosis in children with positive and negatiwe western blot results].

    Science.gov (United States)

    Ołdak, Elzbieta; Rozkiewicz, Doroto; Sulik, Artur

    2008-01-01

    In the afforested area of North-Eastern Poland the risk of Borrelia burgdorferi infection seems to be higher compared to the other regions. Because of unspecific clinical manifestation of Lyme borreliosis in children the positive ELISA IgM results should be confirmed with Western blot IgM tests. Retrospective analysis of clinical signs and symptoms of Lyme borreliosis in children with positive ELISA IgM and positive Western blot IgM results and in children with positive ELISA IgM and negative Western blot IgM results. The study included 20 children reactive with ELISA IgM (Bellco Biomedica, Austria), hospitalized in Pediatric Infectious Diseases Clinic in 2007 due to probable diagnosis of Lyme disease. All children were tested with B. burgdorferi Western blot IgM and/or IgG assay (DRG, Diagnostics, Germany) as a second-step diagnosis. In 10 (50% females, 50% males) out of 20 children the results were positive (borreliosis) and in other 10 (80% females, 20% males) the results were negative (controls). In both groups of patients the retrospective analysis of signs and symptoms was done. The most often clinical manifestation of Lyme borreliosis in children was neuroborreliosis. Children presented Lyme meningitis (30%), facial nerve palsy (10%) and chronic or recurrent headaches (40%), associated with vertigo (20%), weakness (30%), fever (40%), and fatigue syndrome (30%). One patient presented Lyme arthritis. Children of control group presented with unspecific symptoms like isolated headaches (40%), arthralgias (70%), myalgias (10%) and abdomen pain (20%) (1) The most frequent clinical presentation of Lyme borreliosis in analyzed children was neuroborreliosis; (2) Isolated arthralgias in children reactive with B. burgdorferi ELISA IgM need to be confirmed with Western blot assay before implementing the antibiotic therapy.

  16. Clinical Engeneering Experience at the Hospital of the State University of Londrina

    Directory of Open Access Journals (Sweden)

    Ernesto Fernando Ferreyra Ramírez

    2002-01-01

    Full Text Available This paper describes the four-year experience of implementation of Clinical Engineering services at the Hospital of the State University of Londrina (HURNP/UEL. It was performed by the Electrical Engineering Department (DEEL, through a project involving lecturers and students from the Electrical and Civil Engineering Courses of the same university. The main objectives were the formation of human resources in the Clinical Engineering area and a positive contribution to the healthcare services offered by the HURNP for the community in the surroundings of Londrina – Paraná State – Brazil.

  17. Changes in patient satisfaction related to hospital renovation: experience with a new clinical building.

    Science.gov (United States)

    Siddiqui, Zishan K; Zuccarelli, Rebecca; Durkin, Nowella; Wu, Albert W; Brotman, Daniel J

    2015-03-01

    There is an increasing trend toward designing hospitals with patient-centered features like reduced noise, improved natural light, visitor friendly facilities, well-decorated rooms, and hotel-like amenities. It has also been suggested that because patients cannot reliably distinguish positive experiences with the physical environment from positive experience with care, an improved hospital environment leads to higher satisfaction with physicians, nursing, food service, housekeeping, and higher overall satisfaction. To characterize changes in patient satisfaction that occurred when clinical services (comprised of stable nursing, physician, and unit teams) were relocated to a new clinical building with patient-centered features. We hypothesized that new building features would positively impact provider, ancillary staff, and overall satisfaction, as well as improved satisfaction with the facility. Natural experiment utilizing a pre-post design with concurrent controls. Academic tertiary care hospital. We included all patients discharged from 12 clinical units that relocated to the new clinical building who returned surveys in the 7.5-month period following the move. Premove baseline data were captured from the year prior to the move. Patients on unmoved clinical units who returned satisfaction surveys served as concurrent controls. Patient-centered design features incorporated into the new clinical building. All patients during the baseline period and control patients during the study period were located in usual patient rooms with standard hospital amenities. The primary outcome was satisfaction scores on the Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems survey, dichotomized at highest category versus lower categories. We performed logistic regression to identify predictors of "top-box" scores. The move was associated with improved room- and visitor-related satisfaction without significant improvement in satisfaction with clinical

  18. [Leadership Experience of Clinical Nurses: Applying Focus Group Interviews].

    Science.gov (United States)

    Lee, Byoung Sook; Eo, Yong Sook; Lee, Mi Aie

    2015-10-01

    The purpose of this study was to understand and describe the leadership experience of clinical nurses. During 2014, data were collected using focus group interviews. Three focus group interviews were held with a total of 20 clinical nurses participating. All interviews were recorded as they were spoken and transcribed and data were analyzed using qualitative content analysis. Fifteen categories emerged from the five main themes. 1) Thoughts on the leadership category: to lead others, to cope with problem situations adequately and to serve as a shield against difficulties. 2) Situations requiring leadership: situation that requires correct judgement, coping and situations that need coordination and cooperation. 3-1) Leadership behaviors: other-oriented approach and self-oriented approach. 3-2) Leadership behavior consequences: relevant compensation and unfair termination. 4-1) Facilitators of leadership: confidence and passion for nursing and external support and resources. 4-2) Barriers to leadership: non-supportive organization culture and deficiency in own leadership competencies. 5) Strategies of leadership development: strengthen leadership through self-development and organizational leadership development. In conclusion, the results indicate that it is necessary to enhance clinical nurses' leadership role in healthcare. Enhancement can be achieved through leadership programs focused on enlarging leadership experience, constant self-development, leadership training, and development of leadership competencies suited to the nursing environment.

  19. Clinical and Laboratory Potential Predictors of Blood Culture Positivity in Under Five Children with Clinically Severe Pneumonia - Khartoum -Sudan.

    Science.gov (United States)

    Salih, Karimeldin Mohamed Ali; El-Samani, El-Fatih; Bilal, Jalal Ali; Eldouch, Widad; Ibrahim, Salah Ahmed

    2015-08-01

    Blood culture is necessary for appropriate management of clinically severe pneumonia in children under five years of age. However, in limited resource countries it might be unduly costly and waste of valuable time because of the high negative culture rate. This study aims to identify clinical and laboratory parameters that potentially predict a positive blood culture in cases of severe pneumonia. A hospital based study, enrolled 189 cases satisfying the WHO definition of severe pneumonia. Age, gender, clinical history, physical examination, temperature, complete blood count, C-reactive protein, blood culture and Chest X Ray for all the patients were recorded. Forty one patients had positive blood culture giving a prevalence of 21.7%. All variables were used in a dichotomous manner. White Blood Count (WBC) more than 20 000, very high C-reactive protein (C-RP ≥8mg/L) and Temperature more than 40(o)C, had a positive predictive value of 46.1%, 44.3% and 40.0% respectively for a positive culture as well as a Negative Predictive Value of 91.1%, 91.6% and 91.7% respectively. The WBC more than 20 000 and temperature above 40(o)C had a significant association with a positive blood culture. Their adjusted Odds Ratios were 3.9 (95% CI: 1.4-10.90) and 3.1 (95% CI: 1.2-8.4) respectively. This was not the case for C-RP (Odds Ratio=2.2, 95% CI: 0.7-2.2) or positive Chest X Ray (Odds Ratio=1.5, 95% CI: 0.6-3.6). Temperature of more than 40(o)C, Very high C-RP and WBC of more than 20 000 are good indicators of a potential positive blood culture. It is therefore recommended that further research be undertaken to refine these predictors as screening tools before resorting to blood culture. It is also recommended that antibiotic treatment may be initiated on the basis of the high temperature and WBC, while waiting for the culture results.

  20. Exploring nursing students’ experience of peer learning in clinical practice

    Science.gov (United States)

    Ravanipour, Maryam; Bahreini, Masoud; Ravanipour, Masoumeh

    2015-01-01

    Background: Peer learning is an educational process wherein someone of the same age or level of experience level interacts with other students interested in the same topic. There is limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of this study was to explore nursing students’ experiences of peer learning in clinical practice. Materials and Methods: A qualitative content analysis was conducted. Focus groups were used to find the students’ experiences about peerlearning. Twenty-eight baccalaureate nursing students at Bushehr University of Medical Sciences were selected purposively, and were arranged in four groups of seven students each. The focus group interviews were conducted using a semi-structured interview schedule. All interviews were tape-recorded, transcribed verbatim, and analyzed using conventional content analysis method. Results: The analysis identified four themes: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice. Gained advantages and perceived disadvantages created paradoxical dualism, and peer exploitation resulted from peer selection and peer training. Conclusion: Nursing students reported general satisfaction concerning peer learning due to much more in-depth learning with little stress than conventional learning methods. Peer learning is a useful method for nursing students for practicing educational leadership and learning the clinical skills before they get a job. PMID:26097860

  1. Gay men's experiences of surrogacy clinics in India.

    Science.gov (United States)

    Riggs, Damien W; Due, Clemence; Power, Jennifer

    2015-01-01

    While growing numbers of Australian gay men are entering into 'offshore' surrogacy arrangements in order to become parents, little empirical research has been conducted with this population. This article reports on a qualitative analysis of interviews with 12 gay men who had entered into surrogacy arrangements in India. The findings outline both positive and negative experiences in terms of support pre-conception, during the birth and post-birth. Changes to legislation in India mean that gay men can no longer access surrogacy services there, but it is important to understand the experiences of men who had previously accessed those services. The article concludes by highlighting aspects of the data that demonstrate the particular experiences of gay men who undertake offshore surrogacy arrangements, especially with regard to their need for support and involvement in all aspects of the process. A more thoroughly developed network of care may help to facilitate such support and this may further increase the positive outcomes reported by gay men who form families through surrogacy arrangements. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Clinical accompaniment: the critical care nursing students’ experiences in a private hospital

    Directory of Open Access Journals (Sweden)

    N. Tsele

    2000-09-01

    Full Text Available The quality of clinical accompaniment of the student enrolled for the post-basic diploma in Medical and Surgical Nursing Science: Critical Care Nursing (General is an important dimension of the educational/learning programme. The clinical accompanist/mentor is responsible for ensuring the student’s compliance with the clinical outcomes of the programme in accordance with the requirements laid down by the Nursing Education Institution and the South African Nursing Council. The purpose of this study was to explore and describe the experiences of the students enrolled for a post-basic diploma in Medical and Surgical Nursing Science: Critical Care Nursing (General, in relation to the clinical accompaniment in a private hospital in Gauteng. An exploratory, descriptive and phenomenological research design was utilised and individual interviews were conducted with the ten students in the research hospital. A content analysis was conducted and the results revealed both positive and negative experiences by the students in the internal and external worlds. The recommendations include the formulation of standards for clinical accompaniment of students. the evaluation of the quality of clinical accompaniment of students and empowerment of the organisation, clinical accompanists/mentors and clinicians.

  3. Positioning Learning Design: Learner Experience and the challenges of transforming teaching practice

    NARCIS (Netherlands)

    Johnson, Mark; Griffiths, Dai; Hanslot, Zubair

    2010-01-01

    Johnson, M., Griffiths, D., & Hanslot, Z. (2010). Positioning Learning Design: Learner Experience and the challenges of transforming teaching practice. In D. Griffiths, & R. Koper (Eds.), Rethinking Learning and Employment at a Time of Economic Uncertainty. Proceedings of the 6th TENCompetence Open

  4. Fostering Inclusion and Positive Physical Education Experiences for Overweight and Obese Students

    Science.gov (United States)

    Rukavina, Paul B.; Doolittle, Sarah A.

    2016-01-01

    Overweight and obese students are often socially and instructionally excluded from physical education and school physical activity opportunities. This article describes teaching strategies from a study of middle school physical education teachers who are committed to providing effective teaching and positive experiences for overweight and obese…

  5. Positive Childhood Experiences: Resilience and Recovery from Personality Disorder in Early Adulthood

    Science.gov (United States)

    Skodol, Andrew E.; Bender, Donna S.; Pagano, Maria E.; Shea, M. Tracie; Yen, Shirley; Sanislow, Charles A.; Grilo, Carlos M.; Daversa, Maria T.; Stout, Robert L.; Zanarini, Mary C.; McGlashan, Thomas H.; Gunderson, John G.

    2009-01-01

    Objective--Recent follow-along studies of personality disorders have shown significant improvement in psychopathology over time. The purpose of this study was to prospectively investigate the association between positive childhood experiences related to resiliency and remission from personality disorder. Method--Five hundred twenty patients with…

  6. Positional stability experiment and analysis of elongated plasmas in Doublet III

    International Nuclear Information System (INIS)

    Yokomizo, Hideaki

    1984-04-01

    Control systems of the plasma position and shape on Doublet III are explained and experimental results of vertical stability of elongated plasmas are reviewed. Observed results of the vertical instability are qualitatively compared with the predictions from the simplified model and quantitatively compared with the numerical calculations based on a more realistic model. Experiments are in reasonable agreement with the theoretical analyses. (author)

  7. Creating a Positive PLA Experience: A Step-by-Step Look at University PLA

    Science.gov (United States)

    Leiste, Sara M.; Jensen, Kathryn

    2011-01-01

    A prior learning assessment (PLA) can be an intimidating process for adult learners. Capella University's PLA team has developed best practices, resources, and tools to foster a positive experience and to remove barriers in PLA and uses three criteria to determine how to best administer the assessment. First, a PLA must be motivating, as described…

  8. Clinical training of medical physicists. IAEA experience in Asia

    International Nuclear Information System (INIS)

    McLean, D.

    2013-01-01

    Medical physicists make a major contribution to the safe and effective diagnosis and treatment of patients with cancer and other illnesses. The medical physicist's responsibilities include the major areas of dosimetry, treatment planning, quality assurance, image quality, optimization, equipment management, research, teaching, and radiation safety. With the increasing complexity of technological application to medicine the competence of trained physicists is critical to good patient care, with counter examples, sadly evident in the literature. The International Atomic Energy Agency (IAEA), in conjunction with international experts, including from Japan, has developed clinical training programmes that have been successfully implemented on a pilot basis in a number of countries in Asia. A new project is to begin in 2014 which will focus increasingly on the use of electronic teaching material and experiences, to assist medical physicists in clinical training increasingly in more remote locations in Asia. (author)

  9. The problem of false positives and false negatives in violent video game experiments.

    Science.gov (United States)

    Ferguson, Christopher J

    The problem of false positives and negatives has received considerable attention in behavioral research in recent years. The current paper uses video game violence research as an example of how such issues may develop in a field. Despite decades of research, evidence on whether violent video games (VVGs) contribute to aggression in players has remained mixed. Concerns have been raised in recent years that experiments regarding VVGs may suffer from both "false positives" and "false negatives." The current paper examines this issue in three sets of video game experiments, two sets of video game experiments on aggression and prosocial behaviors identified in meta-analysis, and a third group of recent null studies. Results indicated that studies of VVGs and aggression appear to be particularly prone to false positive results. Studies of VVGs and prosocial behavior, by contrast are heterogeneous and did not demonstrate any indication of false positive results. However, their heterogeneous nature made it difficult to base solid conclusions on them. By contrast, evidence for false negatives in null studies was limited, and little evidence emerged that null studies lacked power in comparison those highlighted in past meta-analyses as evidence for effects. These results are considered in light of issues related to false positives and negatives in behavioral science more broadly. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Beam position reconstruction for the g2p experiment in Hall A at Jefferson lab

    International Nuclear Information System (INIS)

    Zhu, Pengjia; Allada, Kalyan; Allison, Trent; Badman, Toby; Camsonne, Alexandre; Chen, Jian-ping; Cummings, Melissa; Gu, Chao; Huang, Min; Liu, Jie; Musson, John; Slifer, Karl; Sulkosky, Vincent; Ye, Yunxiu; Zhang, Jixie; Zielinski, Ryan

    2016-01-01

    Beam-line equipment was upgraded for experiment E08-027 (g2p) in Hall A at Jefferson Lab. Two beam position monitors (BPMs) were necessary to measure the beam position and angle at the target. A new BPM receiver was designed and built to handle the low beam currents (50–100 nA) used for this experiment. Two new super-harps were installed for calibrating the BPMs. In addition to the existing fast raster system, a slow raster system was installed. Before and during the experiment, these new devices were tested and debugged, and their performance was also evaluated. In order to achieve the required accuracy (1–2 mm in position and 1–2 mrad in angle at the target location), the data of the BPMs and harps were carefully analyzed, as well as reconstructing the beam position and angle event by event at the target location. The calculated beam position will be used in the data analysis to accurately determine the kinematics for each event.

  11. Beam position reconstruction for the g2p experiment in Hall A at Jefferson lab

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Pengjia, E-mail: pzhu@jlab.org [University of Science and Technology of China, Hefei, Anhui 230026 (China); Allada, Kalyan [Thomas Jefferson National Accelerator Facility, Newport News, VA 23606 (United States); Massachusetts Institute of Technology, MA 02139 (United States); Allison, Trent [Thomas Jefferson National Accelerator Facility, Newport News, VA 23606 (United States); Badman, Toby [University of New Hampshire, Durham, NH 03824 (United States); Camsonne, Alexandre; Chen, Jian-ping [Thomas Jefferson National Accelerator Facility, Newport News, VA 23606 (United States); Cummings, Melissa [College of William & Mary, Williamsburg, VA 23187 (United States); Gu, Chao [University of Virginia, Charlottesville, VA 22904 (United States); Huang, Min [Duke University, Durham, NC 27708 (United States); Liu, Jie [University of Virginia, Charlottesville, VA 22904 (United States); Musson, John [Thomas Jefferson National Accelerator Facility, Newport News, VA 23606 (United States); Slifer, Karl [University of New Hampshire, Durham, NH 03824 (United States); Sulkosky, Vincent [University of Virginia, Charlottesville, VA 22904 (United States); Massachusetts Institute of Technology, MA 02139 (United States); Ye, Yunxiu [University of Science and Technology of China, Hefei, Anhui 230026 (China); Zhang, Jixie [Thomas Jefferson National Accelerator Facility, Newport News, VA 23606 (United States); University of Virginia, Charlottesville, VA 22904 (United States); Zielinski, Ryan [University of New Hampshire, Durham, NH 03824 (United States)

    2016-02-01

    Beam-line equipment was upgraded for experiment E08-027 (g2p) in Hall A at Jefferson Lab. Two beam position monitors (BPMs) were necessary to measure the beam position and angle at the target. A new BPM receiver was designed and built to handle the low beam currents (50–100 nA) used for this experiment. Two new super-harps were installed for calibrating the BPMs. In addition to the existing fast raster system, a slow raster system was installed. Before and during the experiment, these new devices were tested and debugged, and their performance was also evaluated. In order to achieve the required accuracy (1–2 mm in position and 1–2 mrad in angle at the target location), the data of the BPMs and harps were carefully analyzed, as well as reconstructing the beam position and angle event by event at the target location. The calculated beam position will be used in the data analysis to accurately determine the kinematics for each event.

  12. Experiences of internationally educated nurses holding management positions in the United States: Descriptive phenomenological study.

    Science.gov (United States)

    Allen, Lilian A

    2018-02-12

    The purpose of this study was to explore the experiences of internationally educated nurses in management positions in United States health care organisations to understand the obstacles and support these individuals' experience when pursuing and working in managerial roles. Although internationally educated nurses are an integral part of the US health care industry, few work in managerial roles. Little is known about the experiences of internationally educated nurses who do obtain management positions. In this qualitative, phenomenological study, seven internationally educated nurses who were managers in Chicago, Illinois, responded to open-ended interview questions. Supervisors contributed to the participants' acceptance of management positions. The participants experienced challenges such as cultural differences, language, and communication. Despite these challenges, the participants had positive working relationships with staff and supervisors. Further, the participants had opportunities for education and professional growth. Internationally educated nurses benefit from participating in organisational committees. They face challenges related to work responsibilities, cultural differences and communication but can succeed in management roles through developing strategies to overcome the challenges and through receiving support from staff, colleagues and supervisors. More internationally educated nurses may obtain managerial positions if supervisors provide encouragement and support. © 2018 John Wiley & Sons Ltd.

  13. Beam position reconstruction for the g2p experiment in Hall A at Jefferson lab

    Science.gov (United States)

    Zhu, Pengjia; Allada, Kalyan; Allison, Trent; Badman, Toby; Camsonne, Alexandre; Chen, Jian-ping; Cummings, Melissa; Gu, Chao; Huang, Min; Liu, Jie; Musson, John; Slifer, Karl; Sulkosky, Vincent; Ye, Yunxiu; Zhang, Jixie; Zielinski, Ryan

    2016-02-01

    Beam-line equipment was upgraded for experiment E08-027 (g2p) in Hall A at Jefferson Lab. Two beam position monitors (BPMs) were necessary to measure the beam position and angle at the target. A new BPM receiver was designed and built to handle the low beam currents (50-100 nA) used for this experiment. Two new super-harps were installed for calibrating the BPMs. In addition to the existing fast raster system, a slow raster system was installed. Before and during the experiment, these new devices were tested and debugged, and their performance was also evaluated. In order to achieve the required accuracy (1-2 mm in position and 1-2 mrad in angle at the target location), the data of the BPMs and harps were carefully analyzed, as well as reconstructing the beam position and angle event by event at the target location. The calculated beam position will be used in the data analysis to accurately determine the kinematics for each event.

  14. Healthcare students' experiences of an interprofessional, student-led neuro-rehabilitation community-based clinic.

    Science.gov (United States)

    Gustafsson, Louise; Hutchinson, Laura; Theodoros, Deborah; Williams, Katrina; Copley, Anna; Fagan, Amy; Desha, Laura

    2016-01-01

    Student-led clinics are becoming more prominent as educators seek alternate models of clinical education for health professionals. The purpose of this study was to evaluate healthcare students' experiences of an interprofessional student-led clinic for clients with neurological conditions. Thirteen students representing occupational therapy, physiotherapy, and speech pathology were recruited for the study. A sequential mixed-methods evaluation was employed and the results from the Interprofessional Education Scale and focus group revealed that the students experienced positive perceptions of working collaboratively with other professions, forming good relationships with others, as well as an increased respect for the roles of other professions. The findings suggest that providing a capstone opportunity, where students can work as part of an interprofessional team with a real client, in a format they may come across in future clinical practice, may be beneficial in providing them with essential interprofessional skills as new graduate health professionals.

  15. Urban ministry workers' positive experiences of interpersonal and religious support during crisis.

    Science.gov (United States)

    Wilkins, Ashley; Eriksson, Cynthia; Gottuso, Ann; Fort, Christin

    2017-01-01

    Research on faith-based urban workers is limited despite the chronic and traumatic exposure inherent in their work. This study details the perception of positive interpersonal relationships during a time of trauma or crisis as described in semistructured 2- to 3-hour interviews with 13 faith-based urban workers in Los Angeles, California. Using strategies consistent with Consensual Qualitative Research, categories and subcategories defining positive interpersonal relationships were identified. Resulting categories suggested that there are specific characteristics, products, and types of relationships that urban workers experience as important during the time of trauma or crisis. Positive experiences were often religious in nature and included feeling supported, feeling connected, relationship growth, sharing and listening, authenticity, and feeling as through relationships facilitated personal growth or coping. The findings highlight participants' need for both practical support and relational support which reflects and enhances their spiritual commitment.

  16. Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth.

    Science.gov (United States)

    Joseph, K S; Fahey, John; Shankardass, Ketan; Allen, Victoria M; O'Campo, Patricia; Dodds, Linda; Liston, Robert M; Allen, Alexander C

    2014-03-27

    The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency. We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003. Data were obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax T1 Family Files. Separate logistic models were used to quantify the association between socioeconomic position, clinical risk factors and spontaneous preterm birth and iatrogenic preterm birth. The study population included 132,714 singleton deliveries and the rate of preterm birth was 5.5%. Preterm birth rates were significantly higher among the women in the lowest (versus the highest) family income group for spontaneous (rate ratio 1.14, 95% confidence interval (CI) 1.03, 1.25) but not iatrogenic preterm birth (rate ratio 0.95, 95% CI 0.75, 1.19). Adjustment for maternal characteristics attenuated the family income-spontaneous preterm birth relationship but strengthened the relationship with iatrogenic preterm birth. Clinical risk factors such as hypertension were differentially associated with spontaneous (rate ratio 3.92, 95% CI 3.47, 4.44) and iatrogenic preterm (rate ratio 14.1, 95% CI 11.4, 17.4) but factors such as diabetes mellitus were not (rate ratio 4.38, 95% CI 3.21, 5.99 for spontaneous and 4.02, 95% CI 2.07, 7.80 for iatrogenic preterm birth). Socioeconomic position and clinical risk factors have different effects on spontaneous and iatrogenic preterm. Recent temporal increases in iatrogenic preterm birth appear to be responsible for the inconsistent relationship between socioeconomic position and preterm birth.

  17. Characterizing Clinical Genetic Counselors' Countertransference Experiences: an Exploratory Study.

    Science.gov (United States)

    Reeder, Rebecca; Veach, Patricia McCarthy; MacFarlane, Ian M; LeRoy, Bonnie S

    2017-10-01

    Countertransference (CT) refers to conscious and unconscious emotions, fantasies, behaviors, perceptions, and psychological defenses genetic counselors experience in response to any aspect of genetic counseling situations (Weil 2010). Some authors theorize about the importance of recognizing and managing CT, but no studies solely aim to explore genetic counselors' experiences of the phenomenon. This study examined the extent to which clinical genetic counselors' perceive themselves as inclined to experience CT, gathered examples of CT encountered in clinical situations, and assessed their CT management strategies. An anonymous online survey, sent to NSGC members, yielded 127 usable responses. Participants completed Likert-type items rating their CT propensities; 57 of these individuals also provided examples of CT they experienced in their practice. Factor analysis of CT propensities tentatively suggested four factors: Control, Conflict Avoidance, Directiveness, and Self-Regulation, accounting for 38.5% of response variance. Thematic analysis of CT examples yielded five common triggers: general similarity to patient, medical/genetic similarity, angry patients, patient behaves differently from counselor expectations, and disclosing bad news; six common manifestations: being self-focused, projecting feelings onto the patient, intense emotional reaction to patient, being overly invested, disengagement, and physical reaction; five CT effects: disruption in rapport building, repaired empathy, over-identification, conversation does not reach fullest potential, and counselor is drained emotionally; and three management strategies: recognizing CT as it occurs, self-reflection, and consultation. Results suggest CT is a common experience, occurring in both "routine" and emotionally complex cases. Training programs, continuing education, and peer supervision might include discussion of CT, informed by examples from the present study, to increase genetic counselor awareness

  18. American Clinical Neurophysiology Society Guideline 2: Guidelines for Standard Electrode Position Nomenclature.

    Science.gov (United States)

    Acharya, Jayant N; Hani, Abeer; Cheek, Janna; Thirumala, Partha; Tsuchida, Tammy N

    2016-08-01

    This revision to the EEG Guidelines is an update incorporating current electroencephalography technology and practice and was previously published as Guideline 5. While the 10-10 system of electrode position nomenclature has been accepted internationally for almost two decades, it has not been used universally. The reasons for this and clinical scenarios when the 10-10 system provides additional localizing information are discussed in this revision. In addition, situations in which AF1/2, AF5/6, PO1/2 and PO5/6 electrode positions may be utilized for EEG recording are discussed.

  19. Survey study of challenging experiences after ingesting psilocybin mushrooms: Acute and enduring positive and negative consequences.

    Science.gov (United States)

    Carbonaro, Theresa M; Bradstreet, Matthew P; Barrett, Frederick S; MacLean, Katherine A; Jesse, Robert; Johnson, Matthew W; Griffiths, Roland R

    2016-12-01

    Acute and enduring adverse effects of psilocybin have been reported anecdotally, but have not been well characterized. For this study, 1993 individuals (mean age 30 yrs; 78% male) completed an online survey about their single most psychologically difficult or challenging experience (worst "bad trip") after consuming psilocybin mushrooms. Thirty-nine percent rated it among the top five most challenging experiences of his/her lifetime. Eleven percent put self or others at risk of physical harm; factors increasing the likelihood of risk included estimated dose, duration and difficulty of the experience, and absence of physical comfort and social support. Of the respondents, 2.6% behaved in a physically aggressive or violent manner and 2.7% received medical help. Of those whose experience occurred >1 year before, 7.6% sought treatment for enduring psychological symptoms. Three cases appeared associated with onset of enduring psychotic symptoms and three cases with attempted suicide. Multiple regression analysis showed degree of difficulty was positively associated, and duration was negatively associated, with enduring increases in well-being. Difficulty of experience was positively associated with dose. Despite difficulties, 84% endorsed benefiting from the experience. The incidence of risky behavior or enduring psychological distress is extremely low when psilocybin is given in laboratory studies to screened, prepared, and supported participants. © The Author(s) 2016.

  20. The South African Military Nursing College Pupil Enrolled Nurses’ experiences of the clinical learning environment

    Directory of Open Access Journals (Sweden)

    Ernestina M. Caka

    2013-06-01

    Full Text Available The study focused on the clinical learning experiences of Pupil Enrolled Nurses (PENs within the military health service. The purpose of the research was to explore and describe the learning experiences of PENs within the Military health clinical learning environment. An explorative, descriptive, contextual design which is qualitative in nature was used to guide the study. The military as a training institution prides itself on preparing nurses both as soldiers and nurses, this could be both challenging and exasperating for students, as the scopes are diverse. Being notably very hierarchical, the military’s rules constantly take precedence over nursing rules. For the duration of nursing training, students are allocated in the clinical learning area to acquire competencies such as problem solving, cognitive and psychomotor skills (Kuiper & Pesut 2003:383. Students learn how to merge theory and practice and apply theories in the practical sense. This is however, not done in isolation from the military codes, as they are intertwined. Attendance of military parades and drills are incorporated during this phase. This could create missed opportunities from the clinical learning as students are expected to leave the clinical setting for this purpose. Three focus group sessions were conducted and the experiences of the students, as narrated by themselves, yielded valuable insights. The researcher wrote field notes and assisted with the management of the audio tapes for easy retrieval of information. Data was analysed by the researcher, independent of the cocoder. Two themes relating to the PENs’ learning experiences emerged from the data analysed: (1 facilitators of clinical learning, (2 and barriers to clinical learning. The findings obtained depicted those factors which facilitated and obstructed student learning. These findings made it possible for the researcher to make recommendations concerning positive interventions which could be taken to

  1. Sample positioning in neutron diffraction experiments using a multi-material fiducial marker

    Energy Technology Data Exchange (ETDEWEB)

    Marais, D., E-mail: Deon.Marais@necsa.co.za [Research and Development Division, South African Nuclear Energy Corporation (Necsa) SOC Limited, PO Box 582, Pretoria 0001 (South Africa); School of Mechanical and Nuclear Engineering, North-West University, Potchefstroom 2520 (South Africa); Venter, A.M., E-mail: Andrew.Venter@necsa.co.za [Research and Development Division, South African Nuclear Energy Corporation (Necsa) SOC Limited, PO Box 582, Pretoria 0001 (South Africa); Faculty of Agriculture Science and Technology, North-West University, Mahikeng 2790 (South Africa); Markgraaff, J., E-mail: Johan.Markgraaff@nwu.ac.za [School of Mechanical and Nuclear Engineering, North-West University, Potchefstroom 2520 (South Africa); James, J., E-mail: Jon.James@open.ac.uk [Faculty of Mathematics, Computing and Technology, The Open University, Milton Keynes, MK76AA England (United Kingdom)

    2017-01-01

    An alternative sample positioning method is reported for use in conjunction with sample positioning and experiment planning software systems deployed on some neutron diffraction strain scanners. In this approach, the spherical fiducial markers and location trackers used with optical metrology hardware are replaced with a specifically designed multi-material fiducial marker that requires one diffraction measurement. In a blind setting, the marker position can be determined within an accuracy of ±164 µm with respect to the instrument gauge volume. The scheme is based on a pre-determined relationship that links the diffracted peak intensity to the absolute positioning of the fiducial marker with respect to the instrument gauge volume. Two methods for establishing the linking relationship are presented, respectively based on fitting multi-dimensional quadratic functions and a cross-correlation artificial neural network.

  2. Precision positioning of SuperKamiokande with GPS for a long-baseline neutrino oscillation experiment

    International Nuclear Information System (INIS)

    Noumi, H.; Ieiri, M.; Ishii, H.; Katoh, Y.; Minakawa, M.; Nakamura, K.; Nishikawa, K.; Suzuki, Y.; Takasaki, M.; Tanaka, K.H.; Yamanoi, Y.; Kurodai, M.; Kasa, H.; Yoshimura, K.

    1997-01-01

    A positioning of the neutrino detector superkamiokande (SK) was made for a long-baseline neutrino oscillation experiment planned at KEK. For positioning, global positioning system (GPS) was employed. It has been demonstrated that GPS is of practical use for measuring the positions of SK and KEK, being 250 km distance from each other, to a better resolution. The geodetic coordinates at the SK center were obtained to be Lat. 36 25'32.5862'' N., Long. 137 18'37.1241'' E., H. 371.839 m in the global ellipsoidal coordinate system, WGS-84. The obtained coordinates are based on the coordinates given at a triangulation point at the KEK site. The present work will be fed back for constructing the neutrino beam line. (orig.)

  3. Clinical predictors of central sleep apnea evoked by positive airway pressure titration

    OpenAIRE

    Bianchi, Matt; Gannon,Karen; Lovell,Kathy; Merlino,Margaret; Mojica,James; Moro,Marilyn

    2016-01-01

    Marilyn Moro,1 Karen Gannon,1 Kathy Lovell,1 Margaret Merlino,1 James Mojica,2 Matt T Bianchi,1,3 1Neurology Department, 2Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA; 3Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA Purpose: Treatment-emergent central sleep apnea (TECSA), also called complex apnea, occurs in 5%–15% of sleep apnea patients during positive airway pressure (PAP) therapy, but the clinical predictors are not w...

  4. Clinical predictors of central sleep apnea evoked by positive airway pressure titration.

    Science.gov (United States)

    Moro, Marilyn; Gannon, Karen; Lovell, Kathy; Merlino, Margaret; Mojica, James; Bianchi, Matt T

    2016-01-01

    Treatment-emergent central sleep apnea (TECSA), also called complex apnea, occurs in 5%-15% of sleep apnea patients during positive airway pressure (PAP) therapy, but the clinical predictors are not well understood. The goal of this study was to explore possible predictors in a clinical sleep laboratory cohort, which may highlight those at risk during clinical management. We retrospectively analyzed 728 patients who underwent PAP titration (n=422 split-night; n=306 two-night). Demographics and self-reported medical comorbidities, medications, and behaviors as well as standard physiological parameters from the polysomnography (PSG) data were analyzed. We used regression analysis to assess predictors of binary presence or absence of central apnea index (CAI) ≥5 during split-night PSG (SN-PSG) versus full-night PSG (FN-PSG) titrations. CAI ≥5 was present in 24.2% of SN-PSG and 11.4% of FN-PSG patients during titration. Male sex, maximum continuous positive airway pressure, and use of bilevel positive airway pressure were predictors of TECSA, and rapid eye movement dominance was a negative predictor, for both SN-PSG and FN-PSG patients. Self-reported narcotics were a positive predictor of TECSA, and the time spent in stage N2 sleep was a negative predictor only for SN-PSG patients. Self-reported history of stroke and the CAI during the diagnostic recording predicted TECSA only for FN-PSG patients. Clinical predictors of treatment-evoked central apnea spanned demographic, medical history, sleep physiology, and titration factors. Improved predictive models may be increasingly important as diagnostic and therapeutic modalities move away from the laboratory setting, even as PSG remains the gold standard for characterizing primary central apnea and TECSA.

  5. Women's Management of Recurrent Bacterial Vaginosis and Experiences of Clinical Care: A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Jade Bilardi

    Full Text Available Few data are available on how women manage recurring bacterial vaginosis (BV and their experiences of the clinical care of this condition. This study aimed to explore women's recurrent BV management approaches and clinical care experiences, with a view to informing and improving the clinical management of BV.A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews.The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and inappropriate diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers. Women's frustrations led most to try their own self-help remedies and lifestyle modifications in an attempt to treat symptoms and prevent recurrences, including well-known risk practices such as douching.In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.

  6. Running a postmortem service - a business case and clinical experience

    International Nuclear Information System (INIS)

    Cohen, Marta C.; Whitby, Elspeth; Fink, Michelle A.; Collett, Jacquelene M.; Offiah, Amaka C.

    2015-01-01

    The purpose of the postmortem examination is to offer answers to explain the cause and manner of death. In the case of perinatal, infant and paediatric postmortem examinations, the goal is to identify unsuspected associated features, to describe pathogenic mechanisms and new conditions, and to evaluate the clinical management and diagnosis. Additionally, the postmortem examination is useful to counsel families regarding the probability of recurrence in future pregnancies and to inform family planning. Worldwide the rate of paediatric autopsy examinations has significantly declined during the last few decades. Religious objections to postmortem dissection and organ retention scandals in the United Kingdom provided some of the impetus for a search for non-invasive alternatives to the traditional autopsy; however, until recently, imaging studies remained an adjunct to, rather than a replacement for, the traditional autopsy. In 2012, Sheffield Children's Hospital National Health Service Foundation Trust set up the service provision of minimally invasive fetal, perinatal and neonatal autopsy, while a postmortem imaging service has been running in Melbourne, Australia, since 2008. Here we summarise the essentials of a business case and practical British and Australian experiences in terms of the pathological and radiologic aspects of setting up a minimally invasive clinical service in the United Kingdom and of developing a clinical postmortem imaging service as a complementary tool to the traditional autopsy in Australia. (orig.)

  7. Running a postmortem service - a business case and clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, Marta C.; Whitby, Elspeth; Fink, Michelle A.; Collett, Jacquelene M.; Offiah, Amaka C. [Western Bank, Academic Unit of Child Health, Sheffield Children' s NHS Foundation Trust, University of Sheffield, Sheffield (United Kingdom)

    2015-04-01

    The purpose of the postmortem examination is to offer answers to explain the cause and manner of death. In the case of perinatal, infant and paediatric postmortem examinations, the goal is to identify unsuspected associated features, to describe pathogenic mechanisms and new conditions, and to evaluate the clinical management and diagnosis. Additionally, the postmortem examination is useful to counsel families regarding the probability of recurrence in future pregnancies and to inform family planning. Worldwide the rate of paediatric autopsy examinations has significantly declined during the last few decades. Religious objections to postmortem dissection and organ retention scandals in the United Kingdom provided some of the impetus for a search for non-invasive alternatives to the traditional autopsy; however, until recently, imaging studies remained an adjunct to, rather than a replacement for, the traditional autopsy. In 2012, Sheffield Children's Hospital National Health Service Foundation Trust set up the service provision of minimally invasive fetal, perinatal and neonatal autopsy, while a postmortem imaging service has been running in Melbourne, Australia, since 2008. Here we summarise the essentials of a business case and practical British and Australian experiences in terms of the pathological and radiologic aspects of setting up a minimally invasive clinical service in the United Kingdom and of developing a clinical postmortem imaging service as a complementary tool to the traditional autopsy in Australia. (orig.)

  8. Doctors' experience with handheld computers in clinical practice: qualitative study.

    Science.gov (United States)

    McAlearney, Ann Scheck; Schweikhart, Sharon B; Medow, Mitchell A

    2004-05-15

    To examine doctors' perspectives about their experiences with handheld computers in clinical practice. Qualitative study of eight focus groups consisting of doctors with diverse training and practice patterns. Six practice settings across the United States and two additional focus group sessions held at a national meeting of general internists. 54 doctors who did or did not use handheld computers. Doctors who used handheld computers in clinical practice seemed generally satisfied with them and reported diverse patterns of use. Users perceived that the devices helped them increase productivity and improve patient care. Barriers to use concerned the device itself and personal and perceptual constraints, with perceptual factors such as comfort with technology, preference for paper, and the impression that the devices are not easy to use somewhat difficult to overcome. Participants suggested that organisations can help promote handheld computers by providing advice on purchase, usage, training, and user support. Participants expressed concern about reliability and security of the device but were particularly concerned about dependency on the device and over-reliance as a substitute for clinical thinking. Doctors expect handheld computers to become more useful, and most seem interested in leveraging (getting the most value from) their use. Key opportunities with handheld computers included their use as a stepping stone to build doctors' comfort with other information technology and ehealth initiatives and providing point of care support that helps improve patient care.

  9. Dental Student Hand Hygiene Decreased With Increased Clinical Experience.

    Science.gov (United States)

    Yaembut, Nanmanas; Ampornaramveth, Ruchanee S; Pisarnturakit, Pagaporn P; Subbalekha, Keskanya

    2016-01-01

    To investigate the effectiveness, related knowledge, attitudes, and practices of hand hygiene (HH) among dental students with different levels of clinical experience. This was a cross-sectional analytical study. Bacterial samples on the participants' hands were obtained using a swab technique before and after handwashing, for oral surgical procedures. After culturing, the colony-forming units were counted. Self-reported questionnaires reflecting the knowledge, attitudes, and practices related to HH were completed by the participants. This study was performed in a primary oral health care institution, Faculty of Dentistry, Chulalongkorn University (Bangkok, Thailand). Bacterial samples and self-reported questionnaires were collected in the Department of Oral and Maxillofacial Surgery. Bacterial culture was performed in the Department of Microbiology. The 120 participants comprised first, second, third-year clinical training students (CTs), and postgraduate dental students (PGs) (32, 34, 30, and 24 participants, respectively). More than 99% of the bacteria were eliminated from the participants' hands after handwashing. Significantly higher numbers of bacteria were recovered from the hands of the PGs compared with those of the CTs, and the hands of the third-year CTs compared with those of the first-year CTs (p < 0.001), after HH. The first-year CTs had the highest attitude scores, whereas the PGs had the lowest practice scores. The knowledge scores were similar in all groups. HH effectiveness, attitudes, and practices of dental students decreased as students gained more clinical experience, whereas knowledge did not. Our results suggest that HH instruction should be given throughout the duration of dental students' education. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  10. Testing HIV positive in pregnancy: A phenomenological study of women's experiences.

    Science.gov (United States)

    Lingen-Stallard, Andrew; Furber, Christine; Lavender, Tina

    2016-04-01

    globally women receive HIV testing in pregnancy; however, limited information is available on their experiences of this potentially life-changing event. This study aims to explore women's experiences of receiving a positive HIV test result following antenatal screening. a qualitative, phenomenological approach. two public National Health Service (NHS) hospitals and HIV support organisations. a purposive sampling strategy was used. Thirteen black African women with a positive HIV result, in England, participated. data were collected using in-depth semi-structured interviews. An interpretive phenomenological approach to data analysis was used. the emergent phenomenon was transition and transformation of 'being,' as women accepted HIV as part of their lives. Paired themes support the phenomenon: shock and disbelief; anger and turmoil; stigma and confidentiality issues; acceptance and resilience. Women had extreme reactions to their positive HIV diagnosis, compounded by the cultural belief that they would die. Initial disbelief of the unexpected result developed into sadness at the loss of their old self. Turmoil was evident, as women considered termination of pregnancy, self-harm and suicide. Women felt isolated from others and relationship breakdowns often occurred. Most reported the pervasiveness of stigma, and how this was managed alongside living with HIV. Coping strategies included keeping HIV 'secret' and making their child(ren) the prime focus of life. Growing resilience was apparent with time. this study gives midwives unique understanding of the complexities and major implications for women who tested positive for HIV. Women's experiences resonated with processes of bereavement, providing useful insight into a transitional and transformational period, during which appropriate support can be targeted. midwives are crucial in improving the experience of women when they test HIV positive and to do this they need to be appropriately trained. Midwives need to

  11. Study on reactor power transient characteristics (reactor training experiments). Control rod reactivity calibration by positive period method and other experiment

    International Nuclear Information System (INIS)

    Ozaki, Yoshihiko; Sunagawa, Takeyoshi

    2014-01-01

    In this paper, it is reported about some experiments that have been carried out in the reactor training that targets sophomore of the department of applied nuclear engineering, FUT. Reactor of Kinki University Atomic Energy Research Institute (UTR-KINKI) was used for reactor training. When each critical state was achieved at different reactor output respectively in reactor operating, it was confirmed that the control rod position at that time does not change. Further, control rod reactivity calibration experiments using positive Period method were carried out for shim safety rod and regulating rod, respectively. The results were obtained as reasonable values in comparison with the nominal value of the UTR-KINKI. The measurement of reactor power change after reactor scram was performed, and the presence of the delayed neutron precursor was confirmed by calculating the half-life. The spatial dose rate measurement experiment of neutrons and γ-rays in the reactor room in a reactor power 1W operating conditions were also performed. (author)

  12. [Management Competence in Leading Positions in Clinical Surgery - What Does a Surgeon Need to Know?

    Science.gov (United States)

    Hellmann, W; Meyer, F

    2016-12-01

    Background: Surgeons, more than other specialists, are required to combine high medical expertise with management competence. This is due to changing environments, new demands with respect to quality, the ongoing discussion on increased performance in the context of questionable target agreements, an increasing tendency of university hospitals and other departments and clinics to recruit leading personnel in medicine with management competence, but also to the understanding of one's own role and surgeons' distinguished public reputation. Aim: This narrative review describes the changing environments for surgeons in leading positions in hospitals and provides an overview on the practical use of management skills in surgery. In addition, it advises on how to acquire management competence and presents an educational concept appropriate for surgeons in leading positions. Key points: 1. The management of new challenges in the healthcare system - also in clinical surgery - requires management skills, which are indispensable for a surgeon in a leading position. 2. Management skills in surgery comprise aspects such as communication ability, social competence, cooperation and leadership skills, knowledge on business administration aspects and legal certainty. 3. The necessary knowledge can be acquired in courses leading to a certificate (e.g. "MHM® Medical Hospital Manager") or by earning a "Master of Business Administration" (MBA). Conclusion: Management competence is essential in leading positions in clinical surgery today. The use of these skills is challenging in daily practice. Successfully applied, management competence not only guarantees comprehensive patient care and leadership of employees, but also provides satisfaction in leading positions of a surgical department. Georg Thieme Verlag KG Stuttgart · New York.

  13. Comparing the acceptability of a positive psychology intervention versus a cognitive behavioural therapy for clinical depression.

    Science.gov (United States)

    Lopez-Gomez, Irene; Chaves, Covadonga; Hervas, Gonzalo; Vazquez, Carmelo

    2017-09-01

    There is growing evidence on the efficacy of positive psychology interventions (PPI) to treat clinical disorders. However, very few studies have addressed their acceptability. The present study aimed to analyse 2 key components of acceptability (i.e., client satisfaction and adherence to treatment) of a new PPI programme, the Integrative Positive Psychological Intervention for Depression (IPPI-D), in comparison to a standard cognitive behavioural therapy (CBT) programme in the treatment of clinical depression. One hundred twenty-eight women with a DSM-IV diagnosis of major depression or dysthymia were allocated to a 10-session IPPI-D or CBT group intervention condition. Results showed that both interventions were highly acceptable for participants. Attendance rates were high, and there were no significant differences between conditions. However, the IPPI-D condition showed significantly higher client satisfaction than the CBT condition. Moreover, acceptability did not differ based on participants' severity of symptoms, regardless of condition. These findings encourage further investigations of the applicability of PPI in clinical settings in order to broaden the range of acceptable and suitable therapies for depressed patients. Key Practitioner Message This study sheds light on the client satisfaction and adherence to a positive intervention. For participants, positive psychology interventions (PPI) may be more satisfactory than CBT as PPI are framed within a positive mental health model and, consequently, may reduce the risk of stigmatization Because acceptability of treatments and preferences may affect the efficacy of treatments, this study provides an excellent opportunity to offer professionals more therapeutic options to tailor treatments to clients' needs and expectations. Copyright © 2017 John Wiley & Sons, Ltd.

  14. [Ankylosing spondylitis in Shantou: clinical experience in fifteen years].

    Science.gov (United States)

    Zeng, Q; Chen, S; Xu, J; Xiao, Z; Lin, L; Liu, Y; Huang, S; Xie, S

    1999-07-01

    To evaluate the clinical features of ankylosing spondylitis (AS) in Shantou area and improve the diagnostic level and therapeutic effect. Clinical and laboratory data, and the methods and effects of therapy were analyzed. Some patients were followed up. 94% of the cases had an insidious onset. Low back pain or discomfort, peripheral arthritis, positive "4" test and pressing tenderness over the sacroiliac joints and lumbar spine were the frequent symptoms and signs. The degree of sacroiliitis and involvement of hip and spine were related to the disease duration. However, hip joint involvement in juvenile onset AS did not relate to the disease duration. Some cases with disease duration as long as 16 years still remained at II of degree sacroiliitis. Clinical improvement was more obvious in the first two years of treatment. Although some patients came to a standstill condition after this period, yet the disease activity might still relapse with withdrawal of the treatment. The rate of adhering to the treatment for 1, 2, and over 5 years was 34.6%, 28.4%, and 10.3% respectively. The radiological changes frequently did not parallel with the clinical manifestations. Early diagnosis is of importance in improving the prognosis of AS and adherence to slow-acting anti-rheumatic drug therapy is beneficial in disease controlling. A follow up of more than 3 years is necessary to estimate the therapeutic efficacy, and the radiological change is the key indicator. AS is a heterogenic disease and the risk factors for prognosis should be further studied.

  15. Concept-Based Learning in Clinical Experiences: Bringing Theory to Clinical Education for Deep Learning.

    Science.gov (United States)

    Nielsen, Ann

    2016-07-01

    Concept-based learning is used increasingly in nursing education to support the organization, transfer, and retention of knowledge. Concept-based learning activities (CBLAs) have been used in clinical education to explore key aspects of the patient situation and principles of nursing care, without responsibility for total patient care. The nature of best practices in teaching and the resultant learning are not well understood. The purpose of this multiple-case study research was to explore and describe concept-based learning in the context of clinical education in inpatient settings. Four clinical groups (each a case) were observed while they used CBLAs in the clinical setting. Major findings include that concept-based learning fosters deep learning, connection of theory with practice, and clinical judgment. Strategies used to support learning, major teaching-learning foci, and preconditions for concept-based teaching and learning will be described. Concept-based learning is promising to support integration of theory with practice and clinical judgment through application experiences with patients. [J Nurs Educ. 2016;55(7):365-371.]. Copyright 2016, SLACK Incorporated.

  16. Transitioning HIV-Positive Adolescents to Adult Care: Lessons Learned From Twelve Adolescent Medicine Clinics.

    Science.gov (United States)

    Tanner, Amanda E; Philbin, Morgan M; DuVal, Anna; Ellen, Jonathan; Kapogiannis, Bill; Fortenberry, J Dennis

    2016-01-01

    To maximize positive health outcomes for youth with HIV as they transition from youth to adult care, clinical staff need strategies and protocols to help youth maintain clinic engagement and medication adherence. Accordingly, this paper describe transition processes across twelve clinics within the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) to provide lessons learned and inform the development of transition protocols to improve health outcomes as youth shift from adolescent to adult HIV care. During a large multi-method Care Initiative program evaluation, three annual visits were completed at each site from 2010-2012 and conducted 174 semi-structured interviews with clinical and program staff (baseline n=64, year 1 n=56, year 2=54). The results underscore the value of adhering to recent American Academy of Pediatrics (AAP) transition recommendations, including: developing formal transition protocols, preparing youth for transition, facilitating youth's connection to the adult clinic, and identifying necessary strategies for transition evaluation. Transitioning youth with HIV involves targeting individual-, provider-, and system-level factors. Acknowledging and addressing key barriers is essential for developing streamlined, comprehensive, and context-specific transition protocols. Adolescent and adult clinic involvement in transition is essential to reduce service fragmentation, provide coordinated and continuous care, and support individual and community level health. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Effect of Positioning and Early Ambulation on Coronary Angiography Complications: a Randomized Clinical Trial.

    Science.gov (United States)

    Abdollahi, Ali Akbar; Mehranfard, Shahzad; Behnampour, Nasser; Kordnejad, Abdol Mohamad

    2015-06-01

    After coronary angiography to prevent potential complications, patients are restricted to 4-24 hours bed rest in the supine position due to the complications. This study was designed to assess the effect of changing position and early ambulation on low back pain, urinary retention, bleeding and hematoma after cardiac catheterization. In this clinical trial, 140 patients by using a convenience sampling randomly divided into four 35-individual groups. The patients in the control group were in the supine position for 6 hours without a movement. Change position was applied to the second group (based on a specific protocol), early ambulation was applied to the third group and both early ambulation and change position were applied to the fourth group. Then, severity of bleeding, hematoma, back pain and urinary retention were measured at zero, 1, 2, 4, 6, and 24 hours after angiography. The data was collected through an individual data questionnaire, Numerical Rating Scale (NRS) of pain and Kristin Swain's check list was applied to evaluate the severity of bleeding and hematoma. None of patients developed vascular complications. Incidence of urinary retention was higher in the control group, although this difference was not significant. The mean of pain intensity in the fourth and sixth hours showed a significant difference. Based on the findings of this study, changing patients' position can be safe and they can be ambulated early after angiography.

  18. Effect of Positioning and Early Ambulation on Coronary Angiography Complications: a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Ali Akbar Abdollahi

    2015-06-01

    Full Text Available Introduction: After coronary angiography to prevent potential complications, patients are restricted to 4-24 hours bed rest in the supine position due to the complications. This study was designed to assess the effect of changing position and early ambulation on low back pain, urinary retention, bleeding and hematoma after cardiac catheterization. Methods: In this clinical trial, 140 patients by using a convenience sampling randomly divided into four 35-individual groups. The patients in the control group were in the supine position for 6 hours without a movement. Change position was applied to the second group (based on a specific protocol, early ambulation was applied to the third group and both early ambulation and change position were applied to the fourth group. Then, severity of bleeding, hematoma, back pain and urinary retention were measured at zero, 1, 2, 4, 6, and 24 hours after angiography. The data was collected through an individual data questionnaire, Numerical Rating Scale (NRS of pain and Kristin Swain’s check list was applied to evaluate the severity of bleeding and hematoma. Results: None of patients developed vascular complications. Incidence of urinary retention was higher in the control group, although this difference was not significant. The mean of pain intensity in the fourth and sixth hours showed a significant difference.Conclusion: Based on the findings of this study, changing patients’ position can be safe and they can be ambulated early after angiography.

  19. The clinical trial of TOMOTRON - a new electronic device - and eight months' clinical experience

    International Nuclear Information System (INIS)

    Kroepelin, T.; Billmann, P.; Wenz, W.; Baumann, H.

    1985-01-01

    We have been using digital tomography (TOMOTRON) clinically for eight months. Its advantages include savings in both time and dose, good image quality throug increased contrast, and improved magnification and image postprocessing compared with conventional tomography. However, lower image resolution and small image sections are the disadvantages of digital tomography. Weighing these advantages and disadvantages by our experience, the diagnostic accuracy of digital tomography is higher than conventional tomography, particularly in skeletal studies. (author)

  20. Design and experiments with scale model of a ship with dynamic positioning system

    Energy Technology Data Exchange (ETDEWEB)

    Souza, Carlos Eduardo S.; Morishita, Helio M.; Moratelli Junior, Lazaro; Lago, Glenan A.; Tannuri, Eduardo A. [Universidade de Sao Paulo (USP), SP (Brazil)

    2008-07-01

    Dynamic Positioning Systems (DPS) are used to keep a floating vessel on a specific position or follow pre-defined path through the action of controlled propellers. This paper describes a facility used to experimentally analyze DPS and to validate a numerical simulator. It is composed by a scale model of a DP tanker with 3 thrusters, a measurement system based on computational vision and a control software with the same DP algorithms used in industrial systems. Simple wind and current generators were also implemented. This work shows preliminary results of experiments, which has been useful to calibrate the simulator and to validate the mathematical model. (author)

  1. 'False-positive' and 'false-negative' test results in clinical urine drug testing.

    Science.gov (United States)

    Reisfield, Gary M; Goldberger, Bruce A; Bertholf, Roger L

    2009-08-01

    The terms 'false-positive' and 'false-negative' are widely used in discussions of urine drug test (UDT) results. These terms are inadequate because they are used in different ways by physicians and laboratory professionals and they are too narrow to encompass the larger universe of potentially misleading, inappropriate and unexpected drug test results. This larger universe, while not solely comprised of technically 'true' or 'false' positive or negative test results, presents comparable interpretive challenges with corresponding clinical implications. In this review, we propose the terms 'potentially inappropriate' positive or negative test results in reference to UDT results that are ambiguous or unexpected and subject to misinterpretation. Causes of potentially inappropriate positive UDT results include in vivo metabolic conversions of a drug, exposure to nonillicit sources of a drug and laboratory error. Causes of potentially inappropriate negative UDT results include limited assay specificity, absence of drug in the urine, presence of drug in the urine, but below established assay cutoff, specimen manipulation and laboratory error. Clinical UDT interpretation is a complicated task requiring knowledge of recent prescription, over-the-counter and herbal drug administration, drug metabolism and analytical sensitivities and specificities.

  2. Densitometria clínica: posições oficiais 2006 Clinical densitometry: official positions 2006

    Directory of Open Access Journals (Sweden)

    Cristiano A. F. Zerbini

    2007-02-01

    Full Text Available Descrevemos as posições oficiais da Sociedade Brasileira de Densitometria Clínica (SBDens para a realização e o relato do exame de densitometria óssea. Essas posições foram obtidas por consenso em encontro realizado em São Paulo no ano de 2006. A SBDens contou com o apoio de várias sociedades científicas descritas no texto.We describe the official positions of the Brazilian Society for Clinical Densitometry (SBDens for the performance and report of the bone mineral density testing. These positions were obtained by consensus in a meeting at São Paulo in 2006. SBDens positions were supported by other scientific societies described in the text.

  3. In vitro activity of daptomycin against clinical isolates of Gram-positive bacteria.

    Science.gov (United States)

    Piper, Kerryl E; Steckelberg, James M; Patel, Robin

    2005-08-01

    We determined the activity of daptomycin, a recently FDA-approved antimicrobial agent, against clinical isolates of Gram-positive bacteria, including viridans group streptococci (16 Streptococcus mitis species group, 12 S. mutans species group, 9 S. anginosus species group, 8 S. sanguinis species group, 5 S. salivarius species group) from patients with infective endocarditis, 32 methicillin-resistant Staphylococcus aureus, 32 high-level penicillin-resistant Streptococcus pneumoniae, 38 vancomycin-resistant enterococci (including 1 linezolid-resistant isolate), and the following unusual Gram-positive bacteria: 3 Listeria monocytogenes, 4 Erysipelothrix rhusiopathiae, 9 Corynebacterium species, 10 Abiotrophia/Granulicatella species, 2 Rothia (Stomatococcus) mucilaginosus, and 4 Gemella morbillorum. Daptomycin minimum inhibitory concentration (MIC)(90) values for the viridans group streptococci, methicillin-resistant S. aureus, penicillin-resistant S. pneumoniae, and Enterococcus species were 0.5, 0.5, endocarditis as well as against several types of unusual Gram-positive bacteria that can cause endocarditis.

  4. LH2 Target Design & Position Survey Techniques for the MUSE experiment for Precise Proton Radius Measurement

    Science.gov (United States)

    Le Pottier, Luc; Roy, Pryiashee; Lorenzon, Wolfgang; Raymond, Richard; Steinberg, Noah; Rossi de La Fuente, Erick; MUSE (MUon proton Scattering Experiment) Collaboration

    2017-09-01

    The proton radius puzzle is a currently unresolved problem which has intrigued the scientific community, dealing with a 7 σ discrepancy between the proton radii determined from muonic hydrogen spectroscopy and electron scattering measurements. The MUon Scattering Experiment (MUSE) aims to resolve this puzzle by performing the first simultaneous elastic scattering measurements of both electrons and muons on the proton, which will allow the comparison of the radii from the two interactions with reduced systematic uncertainties. The data from this experiment is expected to provide the best test of lepton universality to date. The experiment will take place at the Paul Scherrer Institute in Switzerland in 2018. An essential component of the experiment is a liquid hydrogen (LH2) cryotarget system. Our group at the University of Michigan is responsible for the design, fabrication and installation of this system. Here we present our LH2 target cell design and fabrication techniques for successful operation at 20 K and 1 atm, and our computer vision-based target position survey system which will determine the position of the target, installed inside a vacuum chamber, with 0.01 mm or better precision at the height of the liquid hydrogen target and along the beam direction during the experiment.

  5. Clinical assessment of scapular positioning in musicians: an intertester reliability study.

    Science.gov (United States)

    Struyf, Filip; Nijs, Jo; De Coninck, Kris; Giunta, Marco; Mottram, Sarah; Meeusen, Romain

    2009-01-01

    The reliability of the measurement of the distance between the posterior border of the acromion and the wall and the reliability of the modified lateral scapular slide test have not been studied. Overall, the reliability of the clinical tools used to assess scapular positioning has not been studied in musicians. To examine the intertester reliability of scapular observation and 2 clinical tests for the assessment of scapular positioning in musicians. Intertester reliability study. University research laboratory. Thirty healthy student musicians at a single university. Two assessors performed a standardized observation protocol, the measurement of the distance between the posterior border of the acromion and the wall, and the modified lateral scapular slide test. Each assessor was blinded to the other's findings. The intertester reliability coefficients (kappa) for the observation in relaxed position, during unloaded movement, and during loaded movement were 0.41, 0.63, and 0.36, respectively. The kappa values for the observation of tilting and winging at rest were 0.48 and 0.42, respectively; during unloaded movement, the kappa values were 0.52 and 0.78, respectively; and with a 1-kg load, the kappa values were 0.24 and 0.50, respectively. The intraclass correlation coefficient (ICC) of the measurement of the acromial distance was 0.72 in relaxed position and 0.75 with the participant actively retracting both shoulders. The ICCs for the modified lateral scapular slide test varied between 0.63 and 0.58. Our results demonstrated that the modified lateral scapular slide test was not a reliable tool to assess scapular positioning in these participants. Our data indicated that scapular observation in the relaxed position and during unloaded abduction in the frontal plane was a reliable assessment tool. The reliability of the measurement of the distance between the posterior border of the acromion and the wall in healthy musicians was moderate.

  6. Evaluation of undergraduate clinical learning experiences in the subject of pediatric dentistry using critical incident technique

    Directory of Open Access Journals (Sweden)

    S Vyawahare

    2013-01-01

    Full Text Available Introduction: In pediatric dentistry, the experiences of dental students may help dental educators better prepare graduates to treat the children. Research suggests that student′s perceptions should be considered in any discussion of their education, but there has been no systematic examination of India′s undergraduate dental students learning experiences. Aim: This qualitative investigation aimed to gather and analyze information about experiences in pediatric dentistry from the students′ viewpoint using critical incident technique (CIT. Study Design: The sample group for this investigation came from all 240 3 rd and 4 th year dental students from all the four dental colleges in Indore. Using CIT, participants were asked to describe at least one positive and one negative experience in detail. Results: They described 308 positive and 359 negative experiences related to the pediatric dentistry clinic. Analysis of the data resulted in the identification of four key factors related to their experiences: 1 The instructor; 2 the patient; 3 the learning process; and 4 the learning environment. Conclusion: The CIT is a useful data collection and analysis technique that provides rich, useful data and has many potential uses in dental education.

  7. Evaluation of undergraduate clinical learning experiences in the subject of pediatric dentistry using critical incident technique.

    Science.gov (United States)

    Vyawahare, S; Banda, N R; Choubey, S; Parvekar, P; Barodiya, A; Dutta, S

    2013-01-01

    In pediatric dentistry, the experiences of dental students may help dental educators better prepare graduates to treat the children. Research suggests that student's perceptions should be considered in any discussion of their education, but there has been no systematic examination of India's undergraduate dental students learning experiences. This qualitative investigation aimed to gather and analyze information about experiences in pediatric dentistry from the students' viewpoint using critical incident technique (CIT). The sample group for this investigation came from all 240 3rd and 4th year dental students from all the four dental colleges in Indore. Using CIT, participants were asked to describe at least one positive and one negative experience in detail. They described 308 positive and 359 negative experiences related to the pediatric dentistry clinic. Analysis of the data resulted in the identification of four key factors related to their experiences: 1) The instructor; 2) the patient; 3) the learning process; and 4) the learning environment. The CIT is a useful data collection and analysis technique that provides rich, useful data and has many potential uses in dental education.

  8. Experiment of Laser Pointing Stability on Different Surfaces to validate Micrometric Positioning Sensor

    CERN Document Server

    AUTHOR|(SzGeCERN)721924; Mainaud Durand, Helene; Piedigrossi, Didier; Sandomierski, Jacek; Sosin, Mateusz; Geiger, Alain; Guillaume, Sebastien

    2014-01-01

    CLIC requires 10 μm precision and accuracy over 200m for the pre-alignment of beam related components. A solution based on laser beam as straight line reference is being studied at CERN. It involves camera/shutter assemblies as micrometric positioning sensors. To validate the sensors, it is necessary to determine an appropriate material for the shutter in terms of laser pointing stability. Experiments are carried out with paper, metal and ceramic surfaces. This paper presents the standard deviations of the laser spot coordinates obtained on the different surfaces, as well as the measurement error. Our experiments validate the choice of paper and ceramic for the shutter of the micrometric positioning sensor. It also provides an estimate of the achievable precision and accuracy of the determination of the laser spot centre with respect to the shutter coordinate system defined by reference targets.

  9. Experiment study on four button electrode used to monitor position of high current electron-beam

    International Nuclear Information System (INIS)

    Xu Tiezheng; Wang Huacen; Xie Yutong; Zhang Wenwei

    2004-01-01

    The button electrode is one that widely used in high energy accelerators, such as storage ring, and the button electrode has many merit like high accuracy, high resolution, resisting magnetic field, simple machinery, without magnetic core and low cost, etc. It's helpful that the button electrode is used as the beam position monitor in the linear induction accelerator. The experimental facilities have been designed and set up and it can simulate the beam of linear induction accelerator. The button electrode beam position monitor experiment have been done on the experimental facilities. The result of the experiment prove that the button electrode has an accuracy of 0.5 mm, and can reflect the wave of electron-beam accurately

  10. Prescribing exercise training in pulmonary rehabilitation: A clinical experience

    Directory of Open Access Journals (Sweden)

    S. Bernard

    2014-03-01

    Full Text Available Built around exercise training, pulmonary rehabilitation (PR is a multidisciplinary, evidence‐based, comprehensive approach to working with the patient as a whole and not just the pulmonary component of the disease. Integrated into the individualized treatment, this intervention aims to reduce symptoms, optimize functional status, increase participation in daily life, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease. Although there are many other components that should be considered to manage the impairment and symptom burden, supervised exercise training is considered the cornerstone of effective pulmonary rehabilitation. This paper addresses our clinical experience at Institut universitaire de cardiologie et de pneumologie de Québec to assess and manage exercise training in line with the current recommendations and guidelines surrounding PR. Resumo: Construída com base no exercício físico, a reabilitação pulmonar (RP é uma abordagem multidisciplinar, fundamentada e abrangente para trabalhar com o doente como um todo, e não apenas com a componente pulmonar da doença. Integrado no tratamento individual, esta intervenção visa reduzir os sintomas, optimizar o estado funcional, aumentar a participação na vida diária e reduzir os custos do tratamento de saúde, através da estabilização ou inversão das manifestações sistémicas da doença. Embora existam muitos outros componentes que devem ser tidos em consideração para gerir o peso da incapacidade e dos sintomas, o exercício físico supervisionado é considerado o fundamento da reabilitação pulmonar eficiente. Este documento trata da nossa experiência clínica no Institut universitaire de cardiologie et de pneumologie de Québec para avaliar e gerir o exercício físico em linha com as recomendações e orientações actuais envolvendo a RP

  11. Nurses' Lived Experience of Working with Nursing Students in Clinical Wards: a Phenomenological Study

    Directory of Open Access Journals (Sweden)

    Kobra Parvan

    2018-03-01

    Full Text Available Introduction: Despite being aware of the importance of nurses’ role in providing clinical training to nursing students, studies show that sufficient research has not yet been conducted on the experience of clinical nurses who are engaged in training nursing students outside their normal working hours. The present study aim to describe the experience of these nurses who are training outside their routine working hours. Methods: This study was conducted using descriptive-phenomenology method. Twelve nurses was participated in this research. Data were collected using purposive sampling method and face to face interviews based on nurses’ real life experience of students’ learning in clinical settings through answering open-ended questions. Spiegel burg analysis method was used to analyze the data. Results: The result of data analysis was the derivation of four themes and eight sub-themes. Themes included "nurses as teaching sources", "changes in the balance of doing routine tasks", "professional enthusiasm", and "nurses as students' professional socialization source of inspiration". Sub-themes included "efficient education", "poor education", "support", "interference in the role," "self-efficacy development", "inner satisfaction", "positive imaging" and "being a model". Conclusion: It is necessary that academic centers plan for teaching nurses working on a contractual basis in the field of the evaluation method and various methods of teaching. The findings also suggested the development of individual self-efficacy in clinical nurses who train students.

  12. Scale for positive aspects of caregiving experience: development, reliability, and factor structure.

    Science.gov (United States)

    Kate, N; Grover, S; Kulhara, P; Nehra, R

    2012-06-01

    OBJECTIVE. To develop an instrument (Scale for Positive Aspects of Caregiving Experience [SPACE]) that evaluates positive caregiving experience and assess its psychometric properties. METHODS. Available scales which assess some aspects of positive caregiving experience were reviewed and a 50-item questionnaire with a 5-point rating was constructed. In all, 203 primary caregivers of patients with severe mental disorders were asked to complete the questionnaire. Internal consistency, test-retest reliability, cross-language reliability, split-half reliability, and face validity were evaluated. Principal component factor analysis was run to assess the factorial validity of the scale. RESULTS. The scale developed as part of the study was found to have good internal consistency, test-retest reliability, cross-language reliability, split-half reliability, and face validity. Principal component factor analysis yielded a 4-factor structure, which also had good test-retest reliability and cross-language reliability. There was a strong correlation between the 4 factors obtained. CONCLUSION. The SPACE developed as part of this study has good psychometric properties.

  13. [Stigma and discrimination: the experiences of HIV-positive women in poor neighborhoods of Maputo, Mozambique].

    Science.gov (United States)

    Andrade, Rosário Gregório; Iriart, Jorge Alberto Bernstein

    2015-03-01

    The HIV/AIDS epidemic is a serious public health problem in Mozambique. The country has high prevalence rates, and the epidemic's impact is aggravated by the stigma affecting HIV-positive persons. This study takes a socio-anthropological perspective to analyze the experience of HIV-positive women in poor neighborhoods of Maputo and the ways they cope with stigma and discrimination. Semi-structured interviews were conducted with 10 HIV-positive women. The results show how gender inequalities increase women's vulnerability to HIV and contribute to their stigmatization and discrimination. In dealing with stigma, women try to keep their diagnosis confidential, seeking support in group meetings with others living with HIV. Public policies should focus on women's empowerment and the reduction of HIV/AIDS-related stigma.

  14. Positive caregiving experiences are associated with life satisfaction in spouses of stroke survivors.

    Science.gov (United States)

    Kruithof, Willeke J; Visser-Meily, Johanna M A; Post, Marcel W M

    2012-11-01

    Studies into caregivers usually have been focused on negative caregiving experiences. This study is based on the hypotheses that positive caregiving experiences (i.e., self-esteem derived from caregiving) of spouses of stroke patients also need to be taken into account, and that these are related to life satisfaction in 2 ways: first, by a direct association with life satisfaction, and second, indirectly by way of a buffer effect (i.e., by compensating for the impact of negative caregiving experiences on life satisfaction). In this cross-sectional study (n = 121) 3 years poststroke, the Caregiver Reaction Assessment was used to assess caregiver burden (Burden) and self-esteem derived from caregiving (Self-esteem scale). Life satisfaction was measured with the Life Satisfaction Questionnaire (LiSat-9). Spearman correlations and regression analyses were performed. Both Self-esteem and Burden scores were associated with life satisfaction (correlation coefficients 0.35 and -0.74, respectively). An interaction effect was also found (P = .006); spouses who perceived both high Burden and high Self-esteem reported significantly higher life satisfaction scores (mean 4.2, standard deviation [SD] 0.5) than spouses who perceived high Burden but low Self-esteem (mean 3.6, SD 0.7). Positive caregiving experiences are related to spouses' life satisfaction 3 years poststroke and mediate the impact of burden on life satisfaction. Positive caregiving experiences should get more attention in rehabilitation research and practice. Copyright © 2012 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. Junior nursing students' experiences of vertical violence during clinical rotations.

    Science.gov (United States)

    Thomas, Sandra P; Burk, Renee

    2009-01-01

    Horizontal violence is a form of workplace violence, a phenomenon that is prevalent in the nursing profession. Research has revealed a variety of negative peer-to-peer behaviors that lower morale and lead to turnover. However, little research has been conducted on "eating our young" (violence occurring between individuals with unequal power, such as staff nurse and student). We propose "vertical violence" as the appropriate term when abusive registered nurse (RN) behavior is directed towards students. We report a content analysis of stories written by junior nursing students about incidents of injustice perpetrated by staff RNs during their clinical experiences. Four levels of injustice were described. Nursing leadership, both in hospitals and educational institutions, must become engaged in efforts to eradicate vertical violence towards students.

  16. Clinical update on linezolid in the treatment of Gram-positive bacterial infections

    Science.gov (United States)

    Ager, Sally; Gould, Kate

    2012-01-01

    Gram-positive pathogens are a significant cause of morbidity and mortality in both community and health care settings. Glycopeptides have traditionally been the antibiotics of choice for multiresistant Gram-positive pathogens but there are problems with their use, including the emergence of glycopeptide-resistant strains, tissue penetration, and achieving and monitoring adequate serum levels. Newer antibiotics such as linezolid, a synthetic oxazolidinone, are available for the treatment of resistant Gram-positive bacteria. Linezolid is active against a wide range of Gram-positive bacteria and has been generally available for the treatment of Gram-positive infections since 2000. There are potential problems with linezolid use, including its bacteriostatic action and the relatively high incidence of reported adverse effects, particularly with long-term use. Long-term use may also be complicated by the development of resistance. However, linezolid has been shown to be clinically useful in the treatment of several serious infections where traditionally bacteriocidal agents have been required and many of its adverse effects are reversible on cessation. It has also been shown to be a cost-effective treatment option in several studies, with its high oral bioavailability allowing an early change from intravenous to oral formulations with consequent earlier patient discharge and lower inpatient costs. PMID:22787406

  17. [Threats to Identity: A Grounded Theory Approach on Student Nurses' Experience of Incivility during Clinical Placement].

    Science.gov (United States)

    Kang, Jiyeon; Jeong, Yeon Jin; Kong, Kyoung Ran

    2018-02-01

    This qualitative study aimed to explore the experience of incivility among nursing students. Sixteen nursing students who had experienced incivility during their clinical placement were invited for one-on-one interviews until the point of theoretical saturation. The grounded theory approach of Corbin and Strauss was adopted to analyze transcribed interview contents. Incivility occurred in the context of a hierarchical organizational culture, due to nursing students' position as outsiders, non-systematic clinical education, and poor nursing work environment. The experience of incivility was identified as "being mistreated as a marginal person," and nursing students responded to this phenomenon in the following three steps: reality shock, passive action, and submissive acceptance. This process caused students to lose self-esteem and undergo role conflict. Furthermore, nursing students' experience of incivility could eventually lead to workplace bullying in nurses. The results of this study suggest that nursing students' experience of incivility can be a process that threatens their identity. It is necessary to develop educational programs and provide appropriate counseling services so that nursing students can actively cope with the incivility. In addition, institutional plans are needed to ensure safe and supportive clinical learning environments. © 2018 Korean Society of Nursing Science.

  18. Scapular positioning and motor control in children and adults: a laboratory study using clinical measures.

    Science.gov (United States)

    Struyf, Filip; Nijs, Jo; Horsten, Stijn; Mottram, Sarah; Truijen, Steven; Meeusen, Romain

    2011-04-01

    The scapular muscular system is the major determinant of scapular positioning. In addition, strength and muscular endurance develops from childhood through adolescence. It is not known whether differences in scapular positioning and motor control between adults and children may exist. Ninety-two shoulders of 46 adults (mean = 39.4; 18-86 years; SD = 22.5), and 116 shoulders of 59 children (mean = 11.6; 6-17 years; SD = 3.5), were included in the study. Scapular positioning data were collected using a clinical assessment protocol including visual observation of titling and winging, measurement of forward shoulder posture, measurement of scapular upward rotation, and the Kinetic Medial Rotation Test (KMRT). The observation protocol for scapular winging and tilting did not show significant differences between adults and children. After controlling for height, forward shoulder posture (relaxed (0.28 cm/cm (0.06) vs. 0.31 cm/cm (0.07) and retracted (0.15 cm/cm (0.05) vs. 0.20 cm/cm (0.06)) were significantly smaller in children than in adults (P < 0.01). In addition, children showed greater scapular upward rotation (18.6°; SD 9.6°) than adults (14.5°; SD 10.9°) at 90° shoulder abduction. No significant differences were seen between children (19% positive test) and adults (24% positive test) using the KMRT. Children and adults show significant but small differences in scapular upward rotation and forward shoulder posture. These data provide useful reference values using a clinical protocol. Copyright © 2010 Elsevier Ltd. All rights reserved.

  19. Learning Clinical Procedures Through Internet Digital Objects: Experience of Undergraduate Students Across Clinical Faculties

    Science.gov (United States)

    Li, Tse Yan; Wong, Kin; Tse, Christine Shuk Kwan; Chan, Ying Yee

    2015-01-01

    Background Various digital learning objects (DLOs) are available via the World Wide Web, showing the flow of clinical procedures. It is unclear to what extent these freely accessible Internet DLOs facilitate or hamper students’ acquisition of clinical competence. Objective This study aimed to understand the experience of undergraduate students across clinical disciplines—medicine, dentistry, and nursing—in using openly accessible Internet DLOs, and to investigate the role of Internet DLOs in facilitating their clinical learning. Methods Mid-year and final-year groups were selected from each undergraduate clinical degree program of the University of Hong Kong—Bachelor of Medicine and Bachelor of Surgery (MBBS), Bachelor of Dental Surgery (BDS), and Bachelor of Nursing (BNurs). All students were invited to complete a questionnaire on their personal and educational backgrounds, and their experiences and views on using Internet DLOs in learning clinical procedures. The questionnaire design was informed by the findings of six focus groups. Results Among 439 respondents, 97.5% (428/439) learned a variety of clinical procedures through Internet DLOs. Most nursing students (107/122, 87.7%) learned preventive measures through Internet DLOs, with a lower percentage of medical students (99/215, 46.0%) and dental students (43/96, 45%) having learned them this way (both Pstudents accessed DLOs through public search engines, whereas 93.2% (409/439) accessed them by watching YouTube videos. Students often shared DLOs with classmates (277/435, 63.7%), but rarely discussed them with teachers (54/436, 12.4%). The accuracy, usefulness, and importance of Internet DLOs were rated as 6.85 (SD 1.48), 7.27 (SD 1.53), and 7.13 (SD 1.72), respectively, out of a high score of 10. Conclusions Self-exploration of DLOs in the unrestricted Internet environment is extremely common among current e-generation learners and was regarded by students across clinical faculties as an important

  20. Epidemiological and clinical features of hepatitis delta in HBsAg-positive patients by HIV status.

    Science.gov (United States)

    Nicolini, Laura A; Taramasso, Lucia; Schiavetti, Irene; Giannini, Edoardo G; Beltrame, Andrea; Feasi, Marcello; Cassola, Giovanni; Grasso, Alessandro; Bartolacci, Valentina; Sticchi, Laura; Picciotto, Antonino; Viscoli, Claudio

    2015-01-01

    The epidemiology of HBV-associated hepatitis has changed in recent years, especially after the introduction of anti-HBV vaccination, with a consequent decrease in the incidence of HDV-associated hepatitis. However, HDV remains of concern in non-vaccinated people and in immigrants. The aim of this retrospective survey has been to assess prevalence and clinical characteristics of HDV infection in Liguria, a region in Northern Italy, in both HIV-positive and negative patients. During the year 2010, 641 patients chronically infected with HBV entered an observational study of HBV infection conducted in eight tertiary care centres belonging to the 'Ligurian HBV Study Group'. Of 641 patients, 454 (70.8%) were evaluated for HDV serology and 26 (5.7%) were found positive. Among them, 16 were also HIV-positive and 10 were not. Of the 428 HDV-negative patients, only 313 were tested for HIV and 33 (10.5%) were positive. At the time point of study entry there was no age difference between HIV-positive or negative patients, but HIV-positive patients were 10 years younger than HIV-negative (mean age 34.25 ±6.16 versus 41.50 ±8.89 years; P=0.021) at the time point of their first visit in each centre and they were also more frequently intravenous drug users (P=0.009). Despite a similar rate of cirrhosis in the two groups, no HIV-positive patient received an HDV-active therapy (that is, interferon), versus 4 of 10 HIV-negative patients (P=0.014). HDV infection is still a problem in patients not covered by HBV vaccination. Both HDV and HIV testing were frequently overlooked in our setting.

  1. Medical academia clinical experiences of Ward Round Teaching curriculum.

    Science.gov (United States)

    Haghani, Fariba; Arabshahi, Seyed Kamran Soltani; Bigdeli, Shoaleh; Alavi, Mousa; Omid, Athar

    2014-01-01

    Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members' experience on Ward Round Teaching content. This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9). Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation. Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability) were employed (Guba and Lincoln). Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1) tangible teachings (analytic intelligence, technical intelligence, legal duties) and (2) implied teachings (professionalism, professional discipline, professional difficulties). Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

  2. Medical academia clinical experiences of Ward Round Teaching curriculum

    Directory of Open Access Journals (Sweden)

    Fariba Haghani

    2014-01-01

    Full Text Available Background: Medical students spend most of their time in hospital wards and it is necessary to study clinical educational opportunities. This study was aimed to explore faculty members′ experience on Ward Round Teaching content. Methods and Materials: This qualitative study was conducted by purposive sampling with the maximum variation of major clinical departments faculty members in Isfahan University of Medical Sciences (n = 9. Data gathering was based on deep and semi-structured interviews. Data gathering continued till data saturation.Data was analyzed through the Collaizzi method and validated. Strategies to ensure trustworthiness of data (credibility, dependability, conformability, transferability were employed (Guba and Lincoln. Results: Basic codes extracted from the analyzed data were categorized into two main themes and related subthemes, including (1 tangible teachings (analytic intelligence, technical intelligence, legal duties and (2 implied teachings (professionalism, professional discipline, professional difficulties. Conclusion: Ward round teaching is a valuable opportunity for learners to learn not only patient care aspects but also ethical values. By appropriate planning, opportunities can be used to teach capabilities that are expected of general practitioners.

  3. A position sensitive silicon detector for AEgIS (Antimatter Experiment: Gravity, Interferometry, Spectroscopy)

    CERN Multimedia

    Gligorova, A

    2014-01-01

    The AEḡIS experiment (Antimatter Experiment: Gravity, Interferometry, Spectroscopy) is located at the Antiproton Decelerator (AD) at CERN and studies antimatter. The main goal of the AEḡIS experiment is to carry out the first measurement of the gravitational acceleration for antimatter in Earth’s gravitational field to a 1% relative precision. Such a measurement would test the Weak Equivalence Principle (WEP) of Einstein’s General Relativity. The gravitational acceleration for antihydrogen will be determined using a set of gravity measurement gratings (Moiré deflectometer) and a position sensitive detector. The vertical shift due to gravity of the falling antihydrogen atoms will be detected with a silicon strip detector, where the annihilation of antihydrogen will take place. This poster presents part of the development process of this detector.

  4. Dasatinib first-line: Multicentric Italian experience outside clinical trials.

    Science.gov (United States)

    Breccia, Massimo; Stagno, Fabio; Luciano, Luigiana; Abruzzese, Elisabetta; Annunziata, Mario; D'Adda, Mariella; Maggi, Alessandro; Sgherza, Nicola; Russo-Rossi, Antonella; Pregno, Patrizia; Castagnetti, Fausto; Iurlo, Alessandra; Latagliata, Roberto; Cedrone, Michele; Di Renzo, Nicola; Sorà, Federica; Rege-Cambrin, Giovanna; La Nasa, Giorgio; Scortechini, Anna Rita; Greco, Giovanna; Franceschini, Luca; Sica, Simona; Bocchia, Monica; Crugnola, Monica; Orlandi, Esther; Guarini, Attilio; Specchia, Giorgina; Rosti, Gianantonio; Saglio, Giuseppe; Alimena, Giuliana

    2016-01-01

    Dasatinib was approved for the treatment of chronic phase (CP) chronic myeloid leukemia (CML) patients in first line therapy based on the demonstration of efficacy and safety reported in patients enrolled in clinical trials. We describe a multicentric Italian "real-life" experience of dasatinib used as frontline treatment outside clinical trials. One hundred and nine patients (median age 54 years) were treated from January 2012 to December 2013. Increased incidence of high risk patients were detected according to stratification (26% according to Sokal score, 19% according to Euro score and 16% according to EUTOS) when compared to company sponsored studies. Median time from diagnosis to start of dasatinib was 18 days. Ten patients received unscheduled starting dose (6 patients 50mg and 4 patients 80 mg QD), whereas 99 patients started with 100mg QD. At 3 months, 92% of patients achieved a BCR-ABL ratio less than 10%. At 6 months, the rate of CCyR was 91% and the rate of MR3 was 40%, with 8% of the patients reaching MR4.5. Ninety-three patients were evaluable at 12 months: the rate of MR3 was 62%, with MR4.5 being achieved by 19% of the patients. At a median follow-up of 12 months, 27 patients (24.7%) were receiving the drug at reduced dose. Two patients (1.8%) experienced a lymphoid blast crisis and the overall incidence of resistance was 8%. As regards safety, the major side effects recorded were thrombocytopenia, neutropenia and pleural effusions, which occurred in 22%, 10% and 8% of patients, respectively. Present results, achieved in a large cohort of patients treated outside clinical trials, further confirm the efficacy and safety of dasatinib as firstline treatment in CML. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Laparoscopic adrenalectomy: Our clinical experiences with the first 10 patients

    Directory of Open Access Journals (Sweden)

    Alparslan Kemal Tuzcu

    2012-12-01

    Full Text Available Objectives: The aim of this study is to present the resultsof our first ten laparoscopic adrenalectomy cases whichwere performed in our clinic.Materials and methods: Between December 2010 andSeptember 2012 the standard transperitoneal laparoscopicadrenalectomy was performed on 10 patients.Data of patients such as age, weight, height, operationtime, hospitalization time, complications, size of adrenalmass and pathological diagnosis were retrospectively reviewedand recorded from the hospital records.Results: Three of ten patients were male and seven ofthem were female. The mean age of the patients was42.12±11.4 (21-55 years. Mean operation time was recordedas 136±23.6 (100-190 min. Mean tumor size was7.1±2.7 (5-12 cm. None of the patients required bloodtransfusion. Mean hospital stay was 2.3±1.2 (2-6 days.Pathological diagnoses of masses were pheocromacytomain two patients, adrenal adenoma in six, myelolipomain one and pseudocist in one.Conclusions: According to our experience with the limitednumber of the first ten cases, transperitoneal laparoscopicadrenalectomy is a safe and effective treatmentmodality, associated with minimal morbidity. To obtainmore reliable information larger series with long-term resultsof laparoscopic adrenalectomy is needed.Key words: Laparoscopy, adrenalectomy, experience,transperitoneal

  6. [Ethic review on clinical experiments of medical devices in medical institutions].

    Science.gov (United States)

    Shuai, Wanjun; Chao, Yong; Wang, Ning; Xu, Shining

    2011-07-01

    Clinical experiments are always used to evaluate the safety and validity of medical devices. The experiments have two types of clinical trying and testing. Ethic review must be done by the ethics committee of the medical department with the qualification of clinical research, and the approval must be made before the experiments. In order to ensure the safety and validity of clinical experiments of medical devices in medical institutions, the contents, process and approval criterions of the ethic review were analyzed and discussed.

  7. Patient experience of source isolation: lessons for clinical practice.

    Science.gov (United States)

    Barratt, Ruth Linda; Shaban, Ramon; Moyle, Wendy

    2011-10-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is now the leading antimicrobial-resistant organism of concern to clinicians worldwide. Preventing and controlling the increase and spread of MRSA within the health-care environment is therefore an important function of the infection control team. The prevention and control of MRSA requires strict use of both Standard and Additional Precautions, which include good hand hygiene practices, judicious antimicrobial prescribing, and source isolation. While few would dispute the need for these precautions for preventing the spread of MRSA and other infections, their use may result in adverse physical and psychological effects for the patient. In an age of quality and safety of health care, ensuring infection control practice such as source isolation and contact precautions adhere to fundamental human rights is paramount. This paper presents a review of the literature on the patient experience of source isolation for MRSA or other infectious diseases. The review yielded five major interconnected themes: (1) psychological effects of isolation; (2) coping with isolation; (3) social isolation; (4) communication and information provision; and (5) physical environment and quality of care. It found that the experience of isolation by patients has both negative and positive elements. Isolation may result in detrimental psychological effects including anxiety, stress and depression, but may also result in the patient receiving less or substandard care. However, patients may also benefit from the quietness and privacy of single rooms. Nurses and other healthcare workers must look for ways to improve the experience of isolation and contact precautions of patients in source isolation. Opportunities exist in particular in improving the environment and the patient's self-control of the situation and in providing adequate information.

  8. 42 CFR 482.80 - Condition of participation: Data submission, clinical experience, and outcome requirements for...

    Science.gov (United States)

    2010-10-01

    ..., clinical experience, and outcome requirements for initial approval of transplant centers. 482.80 Section... Hospitals Transplant Center Data Submission, Clinical Experience, and Outcome Requirements § 482.80 Condition of participation: Data submission, clinical experience, and outcome requirements for initial...

  9. Applying extracellular vesicles based therapeutics in clinical trials – an ISEV position paper

    Directory of Open Access Journals (Sweden)

    Thomas Lener

    2015-12-01

    Full Text Available Extracellular vesicles (EVs, such as exosomes and microvesicles, are released by different cell types and participate in physiological and pathophysiological processes. EVs mediate intercellular communication as cell-derived extracellular signalling organelles that transmit specific information from their cell of origin to their target cells. As a result of these properties, EVs of defined cell types may serve as novel tools for various therapeutic approaches, including (a anti-tumour therapy, (b pathogen vaccination, (c immune-modulatory and regenerative therapies and (d drug delivery. The translation of EVs into clinical therapies requires the categorization of EV-based therapeutics in compliance with existing regulatory frameworks. As the classification defines subsequent requirements for manufacturing, quality control and clinical investigation, it is of major importance to define whether EVs are considered the active drug components or primarily serve as drug delivery vehicles. For an effective and particularly safe translation of EV-based therapies into clinical practice, a high level of cooperation between researchers, clinicians and competent authorities is essential. In this position statement, basic and clinical scientists, as members of the International Society for Extracellular Vesicles (ISEV and of the European Cooperation in Science and Technology (COST program of the European Union, namely European Network on Microvesicles and Exosomes in Health and Disease (ME-HaD, summarize recent developments and the current knowledge of EV-based therapies. Aspects of safety and regulatory requirements that must be considered for pharmaceutical manufacturing and clinical application are highlighted. Production and quality control processes are discussed. Strategies to promote the therapeutic application of EVs in future clinical studies are addressed.

  10. Applying extracellular vesicles based therapeutics in clinical trials – an ISEV position paper

    Science.gov (United States)

    Lener, Thomas; Gimona, Mario; Aigner, Ludwig; Börger, Verena; Buzas, Edit; Camussi, Giovanni; Chaput, Nathalie; Chatterjee, Devasis; Court, Felipe A.; del Portillo, Hernando A.; O'Driscoll, Lorraine; Fais, Stefano; Falcon-Perez, Juan M.; Felderhoff-Mueser, Ursula; Fraile, Lorenzo; Gho, Yong Song; Görgens, André; Gupta, Ramesh C.; Hendrix, An; Hermann, Dirk M.; Hill, Andrew F.; Hochberg, Fred; Horn, Peter A.; de Kleijn, Dominique; Kordelas, Lambros; Kramer, Boris W.; Krämer-Albers, Eva-Maria; Laner-Plamberger, Sandra; Laitinen, Saara; Leonardi, Tommaso; Lorenowicz, Magdalena J.; Lim, Sai Kiang; Lötvall, Jan; Maguire, Casey A.; Marcilla, Antonio; Nazarenko, Irina; Ochiya, Takahiro; Patel, Tushar; Pedersen, Shona; Pocsfalvi, Gabriella; Pluchino, Stefano; Quesenberry, Peter; Reischl, Ilona G.; Rivera, Francisco J.; Sanzenbacher, Ralf; Schallmoser, Katharina; Slaper-Cortenbach, Ineke; Strunk, Dirk; Tonn, Torsten; Vader, Pieter; van Balkom, Bas W. M.; Wauben, Marca; Andaloussi, Samir El; Théry, Clotilde; Rohde, Eva; Giebel, Bernd

    2015-01-01

    Extracellular vesicles (EVs), such as exosomes and microvesicles, are released by different cell types and participate in physiological and pathophysiological processes. EVs mediate intercellular communication as cell-derived extracellular signalling organelles that transmit specific information from their cell of origin to their target cells. As a result of these properties, EVs of defined cell types may serve as novel tools for various therapeutic approaches, including (a) anti-tumour therapy, (b) pathogen vaccination, (c) immune-modulatory and regenerative therapies and (d) drug delivery. The translation of EVs into clinical therapies requires the categorization of EV-based therapeutics in compliance with existing regulatory frameworks. As the classification defines subsequent requirements for manufacturing, quality control and clinical investigation, it is of major importance to define whether EVs are considered the active drug components or primarily serve as drug delivery vehicles. For an effective and particularly safe translation of EV-based therapies into clinical practice, a high level of cooperation between researchers, clinicians and competent authorities is essential. In this position statement, basic and clinical scientists, as members of the International Society for Extracellular Vesicles (ISEV) and of the European Cooperation in Science and Technology (COST) program of the European Union, namely European Network on Microvesicles and Exosomes in Health and Disease (ME-HaD), summarize recent developments and the current knowledge of EV-based therapies. Aspects of safety and regulatory requirements that must be considered for pharmaceutical manufacturing and clinical application are highlighted. Production and quality control processes are discussed. Strategies to promote the therapeutic application of EVs in future clinical studies are addressed. PMID:26725829

  11. Positive and negative affect dimensions in chronic knee osteoarthritis: effects on clinical and laboratory pain.

    Science.gov (United States)

    Finan, Patrick H; Quartana, Phillip J; Smith, Michael T

    2013-06-01

    This study investigated whether daily and laboratory assessed pain differs as a function of the temporal stability and valence of affect in individuals with chronic knee osteoarthritis (KOA). One hundred fifty-one men and women with KOA completed 14 days of electronic diaries assessing positive affect (PA), negative affect (NA), and clinical pain. A subset of participants (n =79) engaged in quantitative sensory testing (QST). State PA and NA were assessed prior to administration of stimuli that induced suprathreshold pain and temporal summation. Multilevel modeling and multiple regression evaluated associations of affect and pain as a function of valence (i.e., positive versus negative) and stability (i.e., stable versus state). In the diary, stable NA (B = -.63, standard error [SE] = .13, p affect-pain processes in the field may reflect individual differences in central pain facilitation.

  12. Clinical measuring system for the form and position errors of circular workpieces using optical fiber sensors

    Science.gov (United States)

    Tan, Jiubin; Qiang, Xifu; Ding, Xuemei

    1991-08-01

    Optical sensors have two notable advantages in modern precision measurement. One is that they can be used in nondestructive measurement because the sensors need not touch the surfaces of workpieces in measuring. The other one is that they can strongly resist electromagnetic interferences, vibrations, and noises, so they are suitable to be used in machining sites. But the drift of light intensity and the changing of the reflection coefficient at different measuring positions of a workpiece may have great influence on measured results. To solve the problem, a spectroscopic differential characteristic compensating method is put forward. The method can be used effectively not only in compensating the measuring errors resulted from the drift of light intensity but also in eliminating the influence to measured results caused by the changing of the reflection coefficient. Also, the article analyzes the possibility of and the means of separating data errors of a clinical measuring system for form and position errors of circular workpieces.

  13. Traumatic stress and psychopathology: experiences of a trauma clinic

    African Journals Online (AJOL)

    Adele

    The trauma clinic, now known as the Victim Empowerment. Programme (VEP) ... psychological services had outstripped the need for mere social support, and the ... clinical profile of individuals who presented to the trauma clinic, in particular ...

  14. Clinical predictors of central sleep apnea evoked by positive airway pressure titration

    Directory of Open Access Journals (Sweden)

    Moro M

    2016-07-01

    Full Text Available Marilyn Moro,1 Karen Gannon,1 Kathy Lovell,1 Margaret Merlino,1 James Mojica,2 Matt T Bianchi,1,3 1Neurology Department, 2Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA; 3Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA Purpose: Treatment-emergent central sleep apnea (TECSA, also called complex apnea, occurs in 5%–15% of sleep apnea patients during positive airway pressure (PAP therapy, but the clinical predictors are not well understood. The goal of this study was to explore possible predictors in a clinical sleep laboratory cohort, which may highlight those at risk during clinical management.Methods: We retrospectively analyzed 728 patients who underwent PAP titration (n=422 split night; n=306 two-night. Demographics and self-reported medical comorbidities, medications, and behaviors as well as standard physiological parameters from the polysomnography (PSG data were analyzed. We used regression analysis to assess predictors of binary presence or absence of central apnea index (CAI ≥5 during split PSG (SN-PSG versus full-night PSG (FN-PSG titrations.Results: CAI ≥5 was present in 24.2% of SN-PSG and 11.4% of FN-PSG patients during titration. Male sex, maximum continuous positive airway pressure, and use of bilevel positive airway pressure were predictors of TECSA, and rapid eye movement dominance was a negative predictor, for both SN-PSG and FN-PSG patients. Self-reported narcotics were a positive predictor of TECSA, and the time spent in stage N2 sleep was a negative predictor only for SN-PSG patients. Self-reported history of stroke and the CAI during the diagnostic recording predicted TECSA only for FN-PSG patients.Conclusion: Clinical predictors of treatment-evoked central apnea spanned demographic, medical history, sleep physiology, and titration factors. Improved predictive models may be increasingly important as diagnostic and therapeutic modalities move away from the

  15. Aerobic training in aquatic environment improves the position sense of stroke patients: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Flávia de Andrade e Souza Mazuchi

    2018-03-01

    Full Text Available Abstract AIMS (Stroke patients often present sensory-motor alterations and less aerobic capacity. Joint position sense, which is crucial for balance and gait control, is also affected in stroke patients. To compare the effect of two exercise training protocols (walking in deep water and on a treadmill on the knee position sense of stroke patients. METHODS This study was designed as a randomized controlled clinical trial. Twelve adults, who suffered a stroke at least one year prior to the start of the study, were randomly assigned to one of two groups: 1 pool group submitted to aerobic deep water walking training; and 2 the treadmill group which was submitted to aerobic walk on a treadmill. Measurements: The position sense, absolute error and variable error, of the knee joint was evaluated prior to and after nine weeks of aerobic training. RESULTS The pool group presented smaller absolute (13.9o versus 6.1o; p < 0.05 and variable (9.2o versus 3.9o; p < 0.05 errors after nine-weeks gait training than the treadmill group. CONCLUSIONS Nine-week aerobic exercise intervention in aquatic environment improved precision in the position sense of the knee joint of stroke patients, suggesting a possible application in a rehabilitation program.

  16. [The positive psychological impact of rich childbirth experiences on child-rearing].

    Science.gov (United States)

    Takehara, Kenji; Noguchi, Makiko; Shimane, Takuya; Misago, Chizuru

    2009-05-01

    The purpose of this study was to investigate the psychological implications of emotionally enriching childbirth experiences for problems such as awareness of motherhood, postnatal depression, and parenting stress among women after childbirth. All women who gave birth at five study centers (four birthing homes and one maternity hospital) during May 2002 and August 2003 were asked to participate in the cohort study. All 2314 women were approached and 1004 eligible women agreed to take part. Analyses were conducted using a baseline survey and four follow-up surveys conducted at 4 months, 9 months, 2 and a half years, and 3 years after childbirth. The questionnaire included four scales to evaluate the subjects' childbirth experiences, awareness of motherhood, postnatal depression, and parenting stress and difficulties. Data were collected via structured interviews and transcription from medical records. Bivariate and multivariate analysis indicated that women who had good childbirth experiences had positive feelings concerning motherhood and parenting stress and anxiety were lower. Bivariate analysis also indicated that childbirth experience had an inverse relationship with postnatal depression. This study revealed that having good childbirth experiences inhibits negative awareness of motherhood and abusive behavior towards children. These results show that it is important for mothers to be provided with appropriate care during pregnancy and labor for preventing child abuse and parenting stress and anxiety. More research is needed to identify the determinants of childbirth

  17. Clinical spectrum and outcome of pulmonary nocardiosis: 5-year experience

    Directory of Open Access Journals (Sweden)

    Akashdeep Singh

    2016-01-01

    Full Text Available Background: Pulmonary nocardiosis is a rare but a life-threatening infection caused by Nocardia spp. The diagnosis is often missed and delayed resulting in delay in appropriate treatment and thus higher mortality. Aim: In this study, we aim to evaluate the clinical spectrum and outcome of patients with pulmonary nocardiosis. Methods: A retrospective, 5-year (2009-2014 review of demographic profile, risk factors, clinical manifestations, imaging findings, treatment, and outcome of patients with pulmonary nocardiosis admitted to a tertiary care hospital. Results: The median age of the study subjects was 54 years (range, 16-76 and majority of them (75% were males. The risk factors for pulmonary nocardiosis identified in our study were long-term steroid use (55.6%, chronic lung disease (52.8%, diabetes (27.8%, and solid-organ transplantation (22.2%. All the patients were symptomatic, and the most common symptoms were cough (91.7%, fever (78%, and expectoration (72%. Almost two-third of the patients were initially misdiagnosed and the alternative diagnosis included pulmonary tuberculosis (n = 7, community-acquired pneumonia (n = 5, lung abscess (n = 4, invasive fungal infection (n = 3, lung cancer (n = 2, and Wegener′s granulomatosis (n = 2. The most common radiographic features were consolidation (77.8% and nodules (56%. The mortality rate for indoor patients was 33% despite treatment. Higher mortality rate was observed among those who had brain abscess (100.0%, HIV positivity (100%, need for mechanical ventilation (87.5%, solid-organ transplantation (50%, and elderly (age > 60 years patients (43%. Conclusion: The diagnosis of pulmonary nocardiosis is often missed and delayed resulting in delay in appropriate treatment and thus high mortality. A lower threshold for diagnosing pulmonary nocardiosis needs to be exercised, in chest symptomatic patients with underlying chronic lung diseases or systemic immunosuppression, for the early diagnosis, and

  18. Toward Reducing Ageism: PEACE (Positive Education about Aging and Contact Experiences) Model.

    Science.gov (United States)

    Levy, Sheri R

    2018-03-19

    The population of older adults is growing worldwide. Negative ageism (negative attitudes and behavior toward older adults) is a serious international concern that negatively influences not only older adults but also individuals across the age continuum. This article proposes and examines the application of an integrative theoretical model across empirical evidence in the literature on ageism in psychology, medicine, social work, and sociology. The proposed Positive Education about Aging and Contact Experiences (PEACE) model focuses on 2 key contributing factors expected to reduce negative ageism: (a) education about aging including facts on aging along with positive older role models that dispel negative and inaccurate images of older adulthood; and (b) positive contact experiences with older adults that are individualized, provide or promote equal status, are cooperative, involve sharing of personal information, and are sanctioned within the setting. These 2 key contributing factors have the potential to be interconnected and work together to reduce negative stereotypes, aging anxiety, prejudice, and discrimination associated with older adults and aging. This model has implications for policies and programs that can improve the health and well-being of individuals, as well as expand the residential, educational, and career options of individuals across the age continuum.

  19. Mentor experiences of international healthcare students' learning in a clinical environment: A systematic review.

    Science.gov (United States)

    Mikkonen, Kristina; Elo, Satu; Tuomikoski, Anna-Maria; Kääriäinen, Maria

    2016-05-01

    Globalisation has brought new possibilities for international growth in education and professional mobility among healthcare professionals. There has been a noticeable increase of international degree programmes in non-English speaking countries in Europe, creating clinical learning challenges for healthcare students. The aim of this systematic review was to describe mentors' experiences of international healthcare students' learning in a clinical environment. The objective of the review was to identify what influences the success or failure of mentoring international healthcare students when learning in the clinical environment, with the ultimate aim being to promote optimal mentoring practice. A systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination. Seven electronic databases were used to search for the published results of previous research: CINAHL, Medline Ovid, Scopus, the Web of Science, Academic Search Premiere, Eric, and the Cochrane Library. Search inclusion criteria were planned in the PICOS review format by including peer-reviewed articles published in any language between 2000 and 2014. Five peer-reviewed articles remained after the screening process. The results of the original studies were analysed using a thematic synthesis. The results indicate that a positive intercultural mentor enhanced reciprocal learning by improving the experience of international healthcare students and reducing stress in the clinical environment. Integrating international healthcare students into work with domestic students was seen to be important for reciprocal learning and the avoidance of discrimination. Many healthcare students were found to share similar experiences of mentoring and learning irrespective of their cultural background. However, the role of a positive intercultural mentor was found to make a significant difference for international students: such mentors advocated and mediated cultural differences and

  20. Experiments of Laser Pointing Stability in Air and in Vacuum to Validate Micrometric Positioning Sensor

    CERN Document Server

    Stern, G; Piedigrossi, D; Sandomierski, J; Sosin, M; Geiger, A; Guillaume, S

    2014-01-01

    Aligning accelerator components over 200m with 10 μm accuracy is a challenging task within the Compact Linear Collider (CLIC) study. A solution based on laser beam in vacuum as straight line reference is proposed. The positions of the accelerator’s components are measured with respect to the laser beam by sensors made of camera/shutter assemblies. To validate these sensors, laser pointing stability has to be studied over 200m. We perform experiments in air and in vacuum in order to know how laser pointing stability varies with the distance of propagation and with the environment. The experiments show that the standard deviations of the laser spot coordinates increase with the distance of propagation. They also show that the standard deviations are much smaller in vacuum (8 μm at 35m) than in air (2000 μm at 200m). Our experiment validates the concept of laser beam in vacuum with camera/shutter assembly for micrometric positioning over 35m. It also gives an estimation of the achievable precision.

  1. A cfr-positive clinical staphylococcal isolate from India with multiple mechanisms of linezolid-resistance

    Directory of Open Access Journals (Sweden)

    Vineeth Rajan

    2014-01-01

    Full Text Available Background & objectives: Linezolid, a member of the oxazolidinone class of antibiotics, has been an effective therapeutic option to treat severe infections caused by multidrug resistant Gram positive bacteria. Emergence of linezolid resistant clinical strains is a serious issue in the healthcare settings worldwide. We report here the molecular characterization of a linezolid resistant clinical isolate of Staphylococcus haemolyticus from India. Methods: The species of the clinical isolate was identified by 16S rRNA gene sequencing. The minimum inhibitory concentrations (MICs of linezolid, clindamycin, chloramphenicol and oxacillin were determined by E-test method. To elucidate the mechanism of linezolid-resistance, presence of cfr gene (chloramphenicol florfenicol resistance and mutations in 23S rRNA and ribosomal proteins (L3, L4 and L22 were investigated. Staphylococcal Cassette Chromosome mec (SCCmec typing was performed by multiplex PCR. Results: The study documented a rare clinical S. haemolyticus strain with three independent mechanisms of linezolid-resistance. The strain carried cfr gene, the only known transmissible mechanism of linezolid-resistance. The strain also possessed resistance-conferring mutations such as G 2576 T in domain V of 23S rRNA gene and Met 156 Thr in L3 ribosomal protein. The other ribosomal proteins (L4 and L22 did not exhibit mutations accountable for linezolid-resistance. Restriction digestion by NheI revealed that all the alleles of 23S rRNA gene were mutated. The isolate showed elevated MIC values (>256 ΅g ml -[1] of linezolid, clindamycin, chloramphenicol and oxacillin. Methicillin resistance was conferred by type I SCCmec element. The strain also harboured lsa(B gene which encodes an ABC transporter that can efflux clindamycin. Interpretation & conclusions: The present study reports the first clinical strain from India with transmissible and multiple mechanisms of linezolid-resistance. Judicious use of

  2. Short-term clinical experience with hip resurfacing arthroplasty.

    Science.gov (United States)

    Cieliński, Łukasz; Kusz, Damian; Wojciechowski, Piotr; Dziuba, Anna

    2007-01-01

    This paper discusses the authors' experience with hip resurfacing arthroplasty. Although introduced many years ago, the method did not gain wide popularity because of poor long-term outcomes. At present, owing to the introduction of metal-on-metal bearings and hybrid fixation techniques, short- and mid-term results are very good and encourage wider use of this technique, especially in the younger and more active patients whose results with standard total hip replacements would be unsatisfactory. We performed 13 hip resurfacing arthroplasties at our institution between August 1, 2005, and May 1, 2006. Twelve patients reported for the scheduled follow-up and were included in the study. Treatment outcomes were assessed according to the Harris Hip Score. The short-term outcomes of hip resurfacing arthroplasties are encouraging. In the study group there were no intraoperative complications, infections, peripheral nerve palsy, hip dislocations or clinically overt vein thrombosis. All of the patients reported complete or major pain relief. Clinical assessment according to the Harris Hip Score revealed improvement from an average of 57.7 (20.1) points preoperatively to an average of 87.7 (12) points after the surgery. Crutches were used for a maximum of 6 weeks postoperatively. All of the patients are currently able to walk without crutches with full weight-bearing. 1) Hip resurfacing arthroplasty seems to be an advisable method of operative management of younger, active patients, in whom standard THR would be associated with a high risk of failure; it allows THR to be postponed and carried out as a revision surgery with the acetabular component already in place. 2) Despite the good short- and mid-term results, the utility of this method should be evaluated with caution due to the lack of adequate long-term follow-up data.

  3. Centralization of a Regional Clinical Microbiology Service: The Calgary Experience

    Directory of Open Access Journals (Sweden)

    Deirdre L Church

    1999-01-01

    Full Text Available Diagnostic laboratory services in Alberta have been dramatically restructured over the past five years. In 1994, Alberta Health embarked on an aggressive laboratory restructuring that cut back approximately 30% of the overall monies previously paid to the laboratory service sector in Calgary. A unique service delivery model consolidated all institutional and community-based diagnostic testing in a company called Calgary Laboratory Services (CLS in late 1996. CLS was formed by a public/private partnership between the Calgary Regional Health Care Authority (CRHA and MDS-Kasper Laboratories. By virtue of its customer service base and scope of testing, CLS provides comprehensive regional laboratory services to the entire populace. Regional microbiology services within CLS have been successfully consolidated over the past three years into a centralized high volume laboratory (HVL. Because the HVL is not located in a hospital, rapid response laboratories (RRLs are operated at each acute care site. Although the initial principle behind the proposed test menus for the RRLs was that only procedures requiring a clinical turnaround time of more than 2 h stay on-site, many other principles had to be used to develop and implement an efficient and clinically relevant RRL model for microbiology. From these guiding principles, a detailed assessment of the needs of each institution and extensive networking with user groups, the functions of the microbiology RRLs were established and a detailed implementation plan drawn up. The experience at CLS with regards to restructuring a regional microbiology service is described herein. A post-hoc analysis provides the pros and cons of directing and operating a regionalized microbiology service.

  4. NBME subject examination in surgery scores correlate with surgery clerkship clinical experience.

    Science.gov (United States)

    Myers, Jonathan A; Vigneswaran, Yalini; Gabryszak, Beth; Fogg, Louis F; Francescatti, Amanda B; Golner, Christine; Bines, Steven D

    2014-01-01

    Most medical schools in the United States use the National Board of Medical Examiners Subject Examinations as a method of at least partial assessment of student performance, yet there is still uncertainty of how well these examination scores correlate with clinical proficiency. Thus, we investigated which factors in a surgery clerkship curriculum have a positive effect on academic achievement on the National Board of Medical Examiners Subject Examination in Surgery. A retrospective analysis of 83 third-year medical students at our institution with 4 unique clinical experiences on the general surgery clerkship for the 2007-2008 academic year was conducted. Records of the United States Medical Licensing Examination Step 1 scores, National Board of Medical Examiners Subject Examination in Surgery scores, and essay examination scores for the groups were compared using 1-way analysis of variance testing. Rush University Medical Center, Chicago IL, an academic institution and tertiary care center. Our data demonstrated National Board of Medical Examiners Subject Examination in Surgery scores from the group with the heavier clinical loads and least time for self-study were statistically higher than the group with lighter clinical services and higher rated self-study time (p = 0.036). However, there was no statistical difference of National Board of Medical Examiners Subject Examination in Surgery scores between the groups with equal clinical loads (p = 0.751). Students experiencing higher clinical volumes on surgical services, but less self-study time demonstrated statistically higher academic performance on objective evaluation, suggesting clinical experience may be of higher value than self-study and reading. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  5. First operational experience with the positive-ion injector of ATLAS

    Energy Technology Data Exchange (ETDEWEB)

    Bollinger, L M; Pardo, R C; Shepard, K W; Bogaty, J M; Clifft, B E; Munson, F H; Zinkann, G [Argonne National Lab., IL (United States)

    1993-04-15

    The recently completed positive-ion injector for the heavy-ion accelerator ATLAS was designed as a replacement for the tandem injector of the present tandem-linac system and, unlike the tandem, the positive-ion injector is required to provide ions from the full range of the periodic table. The concept for the new injector, which consists of an ECR ion source on a voltage platform coupled to a very-low-velocity superconducting linac, introduces technical problems and uncertainties that are well beyond those encountered previously for superconducting linacs. The solution to these problems and their relationship to performance are outlined, and initial experience in the acceleration of heavy-ion beams through the entire ATLAS system is discussed. The unusually good longitudinal beam quality of ATLAS with its new injector is emphasized. (orig.).

  6. First operational experience with the positive-ion injector of ATLAS

    International Nuclear Information System (INIS)

    Bollinger, L.M.; Pardo, R.C.; Shepard, K.W.; Bogaty, J.M.; Clifft, B.E.; Munson, F.H.; Zinkann, G.

    1992-01-01

    The recently completed positive-ion injector for the heavy-ion accelerator ATLAS was designed as a replacement for the tandem injector of the present tandem-linac system and, unlike the tandem, the positive-ion injector is required to provide ions from the full range of the periodic table. The concept for the new injector, which consists of an ECR ion source on a voltage platform coupled to a very-low-velocity superconducting linac, introduces technical problems and uncertainties that are well beyond those encountered previously for superconducting linacs. The solution to these problems and their relationship to performance are outlined, and initial experience in the acceleration of heavy-ion beams through the entire ATLAS system is discussed. The unusually good longitudinal beam quality of ATLAS with its new injector is emphasized

  7. Using Labeled Choice Experiments to Analyze Demand Structure and Market Position among Seafood Products

    DEFF Research Database (Denmark)

    Nguyen, Thong Tien; Solgaard, Hans Stubbe; Haider, Wolfgang

    2018-01-01

    Understanding market competition and consumer preferences are important first steps in developing a business. In a competitive market, effectiveness of the various elements of a firm’s marketing mix depends not only on the absolute value of each element but also on the relative values......-employed consumers are the most sensitive to price. Four segments are identified and described in terms of both consumer characteristics and preferences. Our results are meaningful for producers and retailers to develop marketing strategies and production plan....... of the elements with respect to the firm’s position in the market. In this paper we analyze the demand structure and market positions for a variety of seafood products in the French retail market. We use a labeled choice experiment (LCE) to analyze twelve seafood species. The choice options are labeled...

  8. The error model and experiment of measuring angular position error based on laser collimation

    Science.gov (United States)

    Cai, Yangyang; Yang, Jing; Li, Jiakun; Feng, Qibo

    2018-01-01

    Rotary axis is the reference component of rotation motion. Angular position error is the most critical factor which impair the machining precision among the six degree-of-freedom (DOF) geometric errors of rotary axis. In this paper, the measuring method of angular position error of rotary axis based on laser collimation is thoroughly researched, the error model is established and 360 ° full range measurement is realized by using the high precision servo turntable. The change of space attitude of each moving part is described accurately by the 3×3 transformation matrices and the influences of various factors on the measurement results is analyzed in detail. Experiments results show that the measurement method can achieve high measurement accuracy and large measurement range.

  9. Job stress, occupational position and gender as factors differentiating workplace bullying experience.

    Science.gov (United States)

    Drabek, Marcin; Merecz, Dorota

    2013-01-01

    The results of our research broaden the knowledge concerning the correlates of mobbing. The study is aimed at finding out whether an employee's gender, his/her occupational position and level of occupational stress are related to bullying experience. 1313 employees of a transport company participated in the study. The relationships between gender, occupational position, the level of stress and bullying were analysed. Bullying was measured by the use of the MD)M Questionnaire, while work environment was assessed using the Subjective Assessment of Work Questionnaire. It was found that women were generally more exposed to bullying than men (Z = -1.999; p company, its organisational culture as well as its situation. Therefore it's difficult to talk about irrefutable individual correlates of bullying at work.

  10. Exceptional suffering? Enumeration and vernacular accounting in the HIV-positive experience.

    Science.gov (United States)

    Benton, Adia

    2012-01-01

    Drawing on 17 months of ethnographic fieldwork in Freetown, Sierra Leone, I highlight the recursive relationship between Sierra Leone as an exemplary setting and HIV as an exceptional disease. Through this relationship, I examine how HIV-positive individuals rely on both enumerative knowledge (seroprevalence rates) and vernacular accounting (NGO narratives of vulnerability) to communicate the uniqueness of their experience as HIV sufferers and to demarcate the boundaries of their status. Various observers' enumerative and vernacular accounts of Sierra Leone's decade-long civil conflict, coupled with global health accounts of HIV as exceptional, reveal the calculus of power through which global health projects operate. The contradictions between the exemplary and the exceptional-and the accompanying tension between quantitative and qualitative facts-are mutually constituted in performances and claims made by HIV-positive individuals themselves.

  11. First operational experience with the positive-ion injector of ATLAS

    Energy Technology Data Exchange (ETDEWEB)

    Bollinger, L.M.; Pardo, R.C.; Shepard, K.W.; Bogaty, J.M.; Clifft, B.E.; Munson, F.H.; Zinkann, G.

    1992-08-01

    The recently completed positive-ion injector for the heavy-ion accelerator ATLAS was designed as a replacement for the tandem injector of the present tandem-linac system and, unlike the tandem, the positive-ion injector is required to provide ions from the full range of the periodic table. The concept for the new injector, which consists of an ECR ion source on a voltage platform coupled to a very-low-velocity superconducting linac, introduces technical problems and uncertainties that are well beyond those encountered previously for superconducting linacs. The solution to these problems and their relationship to performance are outlined, and initial experience in the acceleration of heavy-ion beams through the entire ATLAS system is discussed. The unusually good longitudinal beam quality of ATLAS with its new injector is emphasized.

  12. First operational experience with the positive-ion injector of ATLAS

    Energy Technology Data Exchange (ETDEWEB)

    Bollinger, L.M.; Pardo, R.C.; Shepard, K.W.; Bogaty, J.M.; Clifft, B.E.; Munson, F.H.; Zinkann, G.

    1992-01-01

    The recently completed positive-ion injector for the heavy-ion accelerator ATLAS was designed as a replacement for the tandem injector of the present tandem-linac system and, unlike the tandem, the positive-ion injector is required to provide ions from the full range of the periodic table. The concept for the new injector, which consists of an ECR ion source on a voltage platform coupled to a very-low-velocity superconducting linac, introduces technical problems and uncertainties that are well beyond those encountered previously for superconducting linacs. The solution to these problems and their relationship to performance are outlined, and initial experience in the acceleration of heavy-ion beams through the entire ATLAS system is discussed. The unusually good longitudinal beam quality of ATLAS with its new injector is emphasized.

  13. Initial Clinical Experience Using the Amplatzer Vascular Plug

    International Nuclear Information System (INIS)

    Tuite, David J.; Kessel, David O.; Nicholson, Anthony A.; Patel, Jai V.; McPherson, Simon J.; Shaw, David R.

    2007-01-01

    Background and purpose. The Amplatzer Vascular Plug (AVP) is a self-expanding nitinol wire mesh vascular embolization device derived from the Amplatz septal occluder. We assessed the results of vascular embolization obtained using the AVP. Methods. A retrospective review was carried out of 23 consecutive cases of vascular embolization using the AVP in a variety of different clinical settings. The AVP was chosen to have a diameter approximately 30-50% greater than the target vessel. The device was delivered via an appropriately sized guide catheter and was released when satisfactorily positioned. Additional embolic agents were used in some cases. Results. All target vessels were successfully occluded with no device malpositioning or malfunction. In 14 (61%) patients the AVP was the sole embolic material. In the remaining patients additional agents were used, particularly in preoperative embolization of highly vascular renal tumors. The AVP does not cause instantaneous thrombosis and in high-flow situations thrombosis typically takes up to 15 min. Conclusion. The AVP is a safe, effective embolization device that provides a useful adjunct to the therapeutic armamentarium. It is particularly suited to the treatment of short high-flow vessels where coil migration and catheter dislodgment might occur. In the majority of cases no additional embolic agents are necessary but it may take up to 15 min for complete thrombosis to occur

  14. Positive experiences of volunteers working in deployable laboratories in West Africa during the Ebola outbreak.

    Science.gov (United States)

    Belfroid, Evelien; Mollers, Madelief; Smit, Pieter W; Hulscher, Marlies; Koopmans, Marion; Reusken, Chantal; Timen, Aura

    2018-01-01

    The largest outbreak of Ebola virus disease ever started in West Africa in December 2013; it created a pressing need to expand the workforce dealing with it. The aim of this study was to gain insight into the experiences of volunteers from the European Union who worked in deployable laboratories in West Africa during the outbreak. This study is part of the EMERGE project. We assessed the experiences of 251 volunteers with a 19-item online questionnaire. The questions asked about positive aspects of volunteering such as learning new skills, establishing a new path in life, and changing life values. Other questionnaire subjects were the compliance to follow-up measures, the extent to which volunteers felt these measures restricted their daily activities, the fear of stigmatization, and worries about becoming infected or infecting their families. The volunteers reported positive effects that reached far beyond their daily work, such as changes in life priorities and a greater appreciation of the value of their own lives. Although the volunteers did not feel that temperature monitoring restricted their daily activities, full compliance to temperature monitoring and reporting it to the authorities was low. The volunteers did not fear Ebola infection for themselves or their families and were not afraid of stigmatization. With respect to the burden on the families, 50% reported that their family members were worried that the volunteer would be infected with Ebola virus. Altogether, the positive experiences of the volunteers in this study far outweigh the negative implications and constitute an important argument for inspiring people who intend to join such missions and for motivating the hesitant ones.

  15. Positive experiences of volunteers working in deployable laboratories in West Africa during the Ebola outbreak.

    Directory of Open Access Journals (Sweden)

    Evelien Belfroid

    Full Text Available The largest outbreak of Ebola virus disease ever started in West Africa in December 2013; it created a pressing need to expand the workforce dealing with it. The aim of this study was to gain insight into the experiences of volunteers from the European Union who worked in deployable laboratories in West Africa during the outbreak. This study is part of the EMERGE project. We assessed the experiences of 251 volunteers with a 19-item online questionnaire. The questions asked about positive aspects of volunteering such as learning new skills, establishing a new path in life, and changing life values. Other questionnaire subjects were the compliance to follow-up measures, the extent to which volunteers felt these measures restricted their daily activities, the fear of stigmatization, and worries about becoming infected or infecting their families. The volunteers reported positive effects that reached far beyond their daily work, such as changes in life priorities and a greater appreciation of the value of their own lives. Although the volunteers did not feel that temperature monitoring restricted their daily activities, full compliance to temperature monitoring and reporting it to the authorities was low. The volunteers did not fear Ebola infection for themselves or their families and were not afraid of stigmatization. With respect to the burden on the families, 50% reported that their family members were worried that the volunteer would be infected with Ebola virus. Altogether, the positive experiences of the volunteers in this study far outweigh the negative implications and constitute an important argument for inspiring people who intend to join such missions and for motivating the hesitant ones.

  16. The Effect of Body Position on Pain Due to Nasal Continuous Positive Airway Pressure (CPAP in Premature Neonates: A Cross-Over Clinical Trial Study

    Directory of Open Access Journals (Sweden)

    Mahnaz Jabraeili

    2018-01-01

    Full Text Available Background The most common cause of admission to neonatal intensive care units (NICU is respiratory distress syndrome. One of the respiratory assistance methods is using nasal continuous positive airway pressure (CPAP. Regarding the importance of pain control which is one of the major priorities in neonatal nursing care, this study aimed to evaluate the effect of body position on pain due to nasal CPAP in premature neonates. Materials and Methods In this cross-over clinical trial, 50 premature neonates who were receiving nasal CPAP admitted to the NICU of Imam Reza Hospital, Kermanshah, Iran, were included. The neonates were randomly placed at three body positions (fetal, supine, and prone positions. Pain was measured by Astrid Lindgren Children’s Hospital Pain Scale Neonates (ALPS-Neo pain assessment scale. The collected data were analyzed using the SPSS software (Version 22.0. Results Significant difference existed regarding pain of nasal CPAP among body positions (p< 0.001. Mean (SD pain was 5.15 (0.822 in fetal position, 6.260 (0.747 in prone position and 7.326 (0.792 in supine position. Conclusion Body positioning in premature neonates under nasal CPAP in NICU can be effective as a non-pharmacologic method in alleviating pain due to nasal CPAP. Among the studied positions, the lowest pain score was seen in fetal position.

  17. Distribution and clinical determinants of time-to-positivity of blood cultures in patients with neutropenia.

    Science.gov (United States)

    Lambregts, Merel M C; Warreman, Eva B; Bernards, Alexandra T; Veelken, Hendrik; von dem Borne, Peter A; Dekkers, Olaf M; Visser, Leo G; de Boer, Mark G

    2018-02-01

    Blood cultures (BCs) are essential in the evaluation of neutropenic fever. Modern BC systems have significantly reduced the time-to-positivity (TTP) of BC. This study explores the probability of bacteraemia when BCs have remained negative for different periods of time. All adult patients with neutropenia and bacteraemia were included (January 2012-February 2016). Predictive clinical factors for short (≤16 hours) and long (>24 hours) TTP were determined. The residual probability of bacteraemia was estimated for the scenario of negative BC 24 hours after collection. The cohort consisted of 154 patients, accounting for 190 episodes of bacteraemia. Median age of 61 years, 60.5% were male. In 123 (64.7%) episodes, BC yielded a single Gram-positive micro-organism and in 49 (25.8%) a Gram-negative micro-organism (median TTP 16.7, 14.5 hours respectively, P hours in 91.6% of episodes. Central line-associated bacteraemia was associated with long TTP. The probability of bacteraemia if BC had remained negative for 24 hours was 1%-3%. The expected TTP offers guidance in the management of patients with neutropenia and suspected bacteraemia. The knowledge of negative BC can support a change in working diagnosis, and impact clinical decisions as soon as 24 hours after BC collection. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. [Clinical relevance of ESR1 circulating mutations detection in hormone receptor positive metastatic breast cancer].

    Science.gov (United States)

    Clatot, Florian; Perdrix, Anne; Sefrioui, David; Sarafan-Vasseur, Nasrin; Di Fiore, Frédéric

    2018-01-01

    If hormone therapy is a key treatment for hormone receptor positive advanced breast cancers, secondary resistance occurs as a rule. Recently, acquired alterations of the ESR1 gene have been identified as a mechanism of resistance on aromatase inhibitor (AI) treatment. The selective pressure by AI exposure during the metastatic setting triggers the emergence of ESR1 activating mutations. In that context, the "liquid biopsy" concept has been used to detect this molecular resistance before progression. Thus, the ESR1 circulating mutation detection will soon be used in daily practice to help monitoring patients on AI treatment and provide an early change for specific therapies that still have to be determined in prospective clinical trials. This review will present the acquired ESR1 mutations, as well as the methods used for their detection in blood and the potential clinical impact of this approach for hormone receptor positive breast cancer management. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  19. Funding source, conflict of interest and positive conclusions in neuro-oncology clinical trials.

    Science.gov (United States)

    Moraes, Fabio Y; Mendez, Lucas C; Taunk, Neil K; Raman, Srinivas; Suh, John H; Souhami, Luis; Slotman, Ben; Weltman, Eduardo; Spratt, Daniel E; Berlin, Alejandro; Marta, Gustavo N

    2018-02-01

    We aimed to test any association between authors' conclusions and self-reported COI or funding sources in central nervous system (CNS) studies. A review was performed for CNS malignancy clinical trials published in the last 5 years. Two investigators independently classified study conclusions according to authors' endorsement of the experimental therapy. Statistical models were used to test for associations between positive conclusions and trials characteristics. From February 2010 to February 2015, 1256 articles were retrieved; 319 were considered eligible trials. Positive conclusions were reported in 56.8% of trials with industry-only, 55.6% with academia-only, 44.1% with academia and industry, 77.8% with none, and 76.4% with not described funding source (p = 0.011). Positive conclusions were reported in 60.4% of trials with unrelated COI, 60% with related COI, and 60% with no COI reported (p = 0.997). Factors that were significantly associated with the presence of positive conclusion included trials design (phase 1) [OR 11.64 (95 CI 4.66-29.09), p source [OR 2.45 (95 CI 1.22-5.22), p = 0.011]. In a multivariable regression model, all these factors remained significantly associated with trial's positive conclusion. Funding source and self-reported COI did not appear to influence the CNS trials conclusion. Funding source information and COI disclosure were under-reported in 14.1 and 17.2% of the CNS trials. Continued efforts are needed to increase rates of both COI and funding source reporting.

  20. Is there a relationship between the diversity characteristics of nursing students and their clinical placement experiences? A literature review.

    Science.gov (United States)

    Koch, Jane; Everett, Bronwyn; Phillips, Jane; Davidson, Patricia M

    2015-01-01

    There has been an increase in ethno-cultural, linguistic, and socio-demographical diversity in students enrolling in undergraduate nursing programs. Diversity also involves other characteristics, but little is known about how diversity impacts on the clinical experiences of nursing students. The aim of this review is to identify studies which describe the clinical placement experiences of nursing students who have a broad range of diversity characteristics. Major databases were searched and original studies published from 2003 to 30 June 2013 were eligible for inclusion. An expanded definition of diversity was used to include characteristics such as ethnicity, language, age, religion, gender, socioeconomic status, carer responsibilities, sexual orientation and special needs/disability. Male gender and speaking English as a second language are diversity characteristics associated with a less positive clinical experience. These students are also more likely to leave their nursing program. Mature-aged students and those from ethnic minority groups were also noted to have a less positive clinical experience and in some cases, this also increased attrition. However, it was difficult to determine the impact of these characteristics alone as they appeared to be linked with other characteristics such as financial difficulties and carer responsibilities in the case of mature-aged students, and language and international student status in the case of ethnicity. Given the significant benefits associated with preparing a diverse nursing workforce, it is an imperative to better understand the impact of diversity on nursing students to ensure that every placement becomes a positive and valuable learning experience.

  1. The positive-ion injector of ATLAS: design and operating experience

    Energy Technology Data Exchange (ETDEWEB)

    Bollinger, L M [Physics Div., Argonne National Lab., IL (United States); Pardo, R C [Physics Div., Argonne National Lab., IL (United States); Shepard, K W [Physics Div., Argonne National Lab., IL (United States); Billquist, P J [Physics Div., Argonne National Lab., IL (United States); Bogaty, J M [Physics Div., Argonne National Lab., IL (United States); Clifft, B E [Physics Div., Argonne National Lab., IL (United States); Harkewicz, R [Physics Div., Argonne National Lab., IL (United States); Munson, F H [Physics Div., Argonne National Lab., IL (United States); Nolen, J A [Physics Div., Argonne National Lab., IL (United States); Zinkann, G P [Physics Div., Argonne National Lab., IL (United States)

    1993-06-01

    The recently completed positive-ion injector for the heavy-ion accelerator ATLAS is a replacement for the tandem injector of the present tandem-linac system. Unlike the tandem, the new injector provides ions from the full range of the periodic table. The concept for the new injector, which consists of an ECR ion source on a voltage platform coupled to a very-low-velocity superconducting linac, introduces technical problems and uncertainties that are well beyond those encountered previously for superconducting linacs. The solution to these problems and their relationship to performance are outlined, and experience in the operation of ATLAS with its new injector is discussed. (orig.)

  2. The positive-ion injector of ATLAS: Design and operating experience

    International Nuclear Information System (INIS)

    Bollinger, L.M.; Pardo, R.C.; Shepard, K.W.; Billquist, P.J.; Bogaty, J.M.; Clifft, B.E.; Harkewicz, R.; Munson, F.H.; Nolen, J.A.; Zinkann, G.P.

    1992-01-01

    The recently completed Positive-Ion Injector for the heavy-ion accelerator ATLAS is a replacement for the tandem injector of the present tandem-linac system. Unlike the tandem, the new injector provides ions from the full range of the periodic table. The concept for the new injector, which consists of an ECR ion source on a voltage platform coupled to a very-low-velocity superconducting linac, introduces technical problems and uncertainties that are well beyond those encountered previously for superconducting linacs. The solution to these problems and their relationship to performance are outlined, and experience in the operation of ATLAS with its new injector is discussed

  3. Some tests of wet tropospheric calibration for the CASA Uno Global Positioning System experiment

    Science.gov (United States)

    Dixon, T. H.; Wolf, S. Kornreich

    1990-01-01

    Wet tropospheric path delay can be a major error source for Global Positioning System (GPS) geodetic experiments. Strategies for minimizing this error are investigted using data from CASA Uno, the first major GPS experiment in Central and South America, where wet path delays may be both high and variable. Wet path delay calibration using water vapor radiometers (WVRs) and residual delay estimation is compared with strategies where the entire wet path delay is estimated stochastically without prior calibration, using data from a 270-km test baseline in Costa Rica. Both approaches yield centimeter-level baseline repeatability and similar tropospheric estimates, suggesting that WVR calibration is not critical for obtaining high precision results with GPS in the CASA region.

  4. Potential clinical applications of {sup 18}F-fluorodeoxyglucose position emission tomography/magnetic resonance mammography in breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Ihn Ho; Kong, Eun Jung [Dept. of Nuclear Medicine, Yeugnam University Hospital, Daegu (Korea, Republic of)

    2017-09-15

    The whole-body positron emission tomography (PET)/magnetic resonance (MR) scan is a cutting edge technology providing comprehensive structural information from MR imaging and functional features from PET in a single session. Recent research findings and clinical experience have shown that 18F-fluorodeoxyglucose (FDG) whole-body PET/MR imaging has a diagnostic performance comparable with or superior to that of PET/CT in the field of oncology, including for breast cancer. In particular, FDG PET/MR mammography in the prone position with the breast hanging in a pendant manner can provide more comprehensive information about the metabolism, anatomy, and functional features of a breast lesion than a whole-body PET/MR scan. This article reports on current state-of-the-art PET/MR mammography in patients with breast cancer and the prospects for potential application in the future.

  5. A cross-sectional examination of psychological distress, positive mental health and their predictors in medical students in their clinical clerkships

    Directory of Open Access Journals (Sweden)

    Inge van Dijk

    2017-11-01

    Full Text Available Abstract Background Medical students can experience the transition from theory to clinical clerkships as stressful. Scientific literature on the mental health of clinical clerkship students is scarce and mental health is usually defined as absence of psychological distress without assessing psychological, emotional and social wellbeing, together called ‘positive mental health’. This cross-sectional study examines the prevalence of psychological distress and positive mental health and explores possible predictors in a Dutch sample of clinical clerkship students. Methods Fourth-year medical students in their first year of clinical clerkships were invited to complete an online questionnaire assessing demographics, psychological distress (Brief Symptom Inventory, positive mental health (Mental Health Continuum- SF, dysfunctional cognitions (Irrational Beliefs Inventory and dispositional mindfulness skills (Five Facet Mindfulness Questionnaire. Multiple linear regression analysis was used to explore relationships between psychological distress, positive mental health (dependent variables and demographics, dysfunctional cognitions and dispositional mindfulness skills (predictors. Results Of 454 eligible students, 406 (89% completed the assessment of whom 21% scored in the clinical range of psychological distress and 41% reported a flourishing mental health. These proportions partially overlap each other. Female students reported a significantly higher mean level of psychological distress than males. In the regression analysis the strongest predictors of psychological distress were ‘acting with awareness’ (negative and ‘worrying’ (positive. Strongest predictors of positive mental health were ‘problem avoidance’ (negative and ‘emotional irresponsibility’ (negative. Conclusions The prevalence of psychopathology in our sample of Dutch clinical clerkship students is slightly higher than in the general population. Our results support

  6. A cross-sectional examination of psychological distress, positive mental health and their predictors in medical students in their clinical clerkships.

    Science.gov (United States)

    van Dijk, Inge; Lucassen, Peter L B J; van Weel, Chris; Speckens, Anne E M

    2017-11-17

    Medical students can experience the transition from theory to clinical clerkships as stressful. Scientific literature on the mental health of clinical clerkship students is scarce and mental health is usually defined as absence of psychological distress without assessing psychological, emotional and social wellbeing, together called 'positive mental health'. This cross-sectional study examines the prevalence of psychological distress and positive mental health and explores possible predictors in a Dutch sample of clinical clerkship students. Fourth-year medical students in their first year of clinical clerkships were invited to complete an online questionnaire assessing demographics, psychological distress (Brief Symptom Inventory), positive mental health (Mental Health Continuum- SF), dysfunctional cognitions (Irrational Beliefs Inventory) and dispositional mindfulness skills (Five Facet Mindfulness Questionnaire). Multiple linear regression analysis was used to explore relationships between psychological distress, positive mental health (dependent variables) and demographics, dysfunctional cognitions and dispositional mindfulness skills (predictors). Of 454 eligible students, 406 (89%) completed the assessment of whom 21% scored in the clinical range of psychological distress and 41% reported a flourishing mental health. These proportions partially overlap each other. Female students reported a significantly higher mean level of psychological distress than males. In the regression analysis the strongest predictors of psychological distress were 'acting with awareness' (negative) and 'worrying' (positive). Strongest predictors of positive mental health were 'problem avoidance' (negative) and 'emotional irresponsibility' (negative). The prevalence of psychopathology in our sample of Dutch clinical clerkship students is slightly higher than in the general population. Our results support conclusions of previous research that psychological distress and positive mental

  7. Art promoting mental health literacy and a positive attitude towards people with experience of mental illness.

    Science.gov (United States)

    Koh, Eugen; Shrimpton, Bradley

    2014-03-01

    Exhibitions of art by people with experience of mental illness are increasingly being staged to improve awareness of mental health issues in the general community and to counter the stigma of mental illness. However, few exhibitions have incorporated research to ascertain their actual effectiveness. This paper reports the results of a study that considered the responses of 10,000 people after they viewed exhibitions of art produced by people with experience of mental illness. These works were selected from the Cunningham Dax Collection, one of the world's most extensive collection of artworks by people with experience of mental illness and/or psychological trauma. More than 90% of respondents agreed with three propositions that the exhibitions helped them: (1) gain a better understanding of mental illness; (2) gain a more sympathetic understanding of the suffering of people with mental illness; and (3) appreciate the ability and creativity of people with mental illness. The results suggest that exhibitions can successfully promote mental health literacy and contribute to positive attitudes towards people with experience of mental illness. This paper explores these findings and raises questions about how the presentation of artworks in an exhibition influences their effectiveness in mental health promotion.

  8. Biological wound dressings sterilized with gamma radiation: Mexican clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Martinez-Pardo, M.E. [Instituto Nacional de Investigaciones Nucleares, Apdo. postal 18-1027, Col. Escandon 11801 Mexico DF (Mexico)], E-mail: memp@nuclear.inin.mx; Ley-Chavez, E. [ISSEMYM Toluca, Mexico DF (Mexico); Reyes-Frias, M.L. [Instituto Nacional de Investigaciones Nucleares, Apdo. postal 18-1027, Col. Escandon 11801 Mexico DF (Mexico); Rodriguez-Ferreyra, P. [Hospital ' Dr. Nicolas San Juan' , Toluca, Mexico DF (Mexico); Vazquez-Maya, L.; Salazar, M.A. [Hospital General de Mexico, Mexico DF (Mexico)

    2007-11-15

    Biological wound dressings sterilized with gamma radiation, such as amnion and pig skin, are a reality in Mexico. These tissues are currently processed in the tissue bank and sterilized in the Gamma Industrial Irradiation Plant; both facilities belong to the Instituto Nacional de Investigaciones Nucleares (ININ) (National Institute of Nuclear Research). With the strong support of the International Atomic Energy Agency, the bank was established at the ININ and the Mexican Ministry of Health issued its sanitary license on July 7, 1999. The Quality Management System of the bank was certified by ISO 9001:2000 on August 1, 2003; the scope of the system is 'Research, Development and Processing of Biological Tissues Sterilized with Gamma Radiation'. At present, more than 150 patients from 16 hospitals have been successfully treated with these tissues. This paper presents a brief description of the tissue processing, as well as the present Mexican clinical experience with children and adult patients who underwent medical treatment with radiosterilized amnion and pig skin, used as biological wound dressings on burns and ocular surface disorders.

  9. Biological wound dressings sterilized with gamma radiation: Mexican clinical experience

    Science.gov (United States)

    Martínez-Pardo, M. E.; Ley-Chávez, E.; Reyes-Frías, M. L.; Rodríguez-Ferreyra, P.; Vázquez-Maya, L.; Salazar, M. A.

    2007-11-01

    Biological wound dressings sterilized with gamma radiation, such as amnion and pig skin, are a reality in Mexico. These tissues are currently processed in the tissue bank and sterilized in the Gamma Industrial Irradiation Plant; both facilities belong to the Instituto Nacional de Investigaciones Nucleares (ININ) (National Institute of Nuclear Research). With the strong support of the International Atomic Energy Agency, the bank was established at the ININ and the Mexican Ministry of Health issued its sanitary license on July 7, 1999. The Quality Management System of the bank was certified by ISO 9001:2000 on August 1, 2003; the scope of the system is "Research, Development and Processing of Biological Tissues Sterilized with Gamma Radiation". At present, more than 150 patients from 16 hospitals have been successfully treated with these tissues. This paper presents a brief description of the tissue processing, as well as the present Mexican clinical experience with children and adult patients who underwent medical treatment with radiosterilized amnion and pig skin, used as biological wound dressings on burns and ocular surface disorders.

  10. Radiofrequency Ablation Treatment for Renal Cell Carcinoma: Early Clinical Experience

    Energy Technology Data Exchange (ETDEWEB)

    Park, Seong Hoon; Yoon, Seong Kuk; Cho, Jin Han; Oh, Jong Young; Nam, Kyung Jin; Kwon, Hee Jin; Kim, Su Yeon; Kang, Myong Jin; Choi, Sun Seob; Sung, Gyung Tak [Dong-A University College of Medicine, Busan (Korea, Republic of)

    2008-08-15

    To evaluate the early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC). The RF ablation treatment was performed on 17 tumors from 16 patients (mean age, 60.5 years; range, 43 73 years) with RCC. The treatment indications were localized, solid renal mass, comorbidities, high operation risk, and refusal to perform surgery. All tumors were treated by a percutaneous CT (n = 10), followed by an US-guided (n = 2), laparoscopy-assisted US (n = 2), and an open (n = 2) RF ablation. Furthermore, patients underwent a follow- up CT at one day, one week, one month, three and six months, and then every six months from the onset of treatment. We evaluated the technical success, technical effectiveness, ablation zone, benign periablation enhancement, irregular peripheral enhancement, and complications. All 17 exophytic tumors (mean size, 2.2 cm; range, 1.1 5.0 cm) were completely ablated. Technical success and effectiveness was achieved in all cases and the mean follow-up period was 23.8 months (range, 17 33 months). A local recurrence was not detected in any of the cases; however, five patients developed complications as a result of treatment, including hematuria (n = 2), mild thermal injury of the psoas muscle (n = 1), mild hydronephrosis (n = 1), and fistula formation (n = 1). The RF ablation is an alternative treatment for exophytic RCCs and represents a promising treatment for some patients with small RCCs.

  11. Effect of Physical Therapy Students' Clinical Experiences on Clinician Productivity.

    Science.gov (United States)

    Pivko, Susan E; Abbruzzese, Laurel D; Duttaroy, Pragati; Hansen, Ruth L; Ryans, Kathryn

    2016-01-01

    Physical therapy clinical education experiences (CEEs) are difficult to secure, particularly first-level CEEs. Our purpose was to determine 1) what impact student full-time CEEs have on PT clinician productivity and 2) whether there is a productivity difference between first vs final CEEs. Productivity logs, including possible factors impacting productivity, were distributed to clinician-student pairings on first and final CEEs. Two-week baseline data (without a student) were compared to weeks 1 and 6 (with a student) for 31 logs using a 2x4 repeated-measures ANOVA. In a subset of 17 logs for CEEs 8 weeks or longer, a 2x5 repeated-measures ANOVA was performed. There was a significant increase in the number of patients seen and CPT units billed by both levels of CEEs comparing weeks 1 and 6. In the subset of CEEs, 8 weeks or longer, there was a significant increase in the number of patients treated per hour at week 6 and a trend toward a change at week 8 when compared to baseline week A. The factors selected as impacting productivity were census (59%) and staffing (32%). Physical therapy clinician-student pairings showed an overall increase in productivity during both full-time first and final level CEEs.

  12. Radiofrequency Ablation Treatment for Renal Cell Carcinoma: Early Clinical Experience

    International Nuclear Information System (INIS)

    Park, Seong Hoon; Yoon, Seong Kuk; Cho, Jin Han; Oh, Jong Young; Nam, Kyung Jin; Kwon, Hee Jin; Kim, Su Yeon; Kang, Myong Jin; Choi, Sun Seob; Sung, Gyung Tak

    2008-01-01

    To evaluate the early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC). The RF ablation treatment was performed on 17 tumors from 16 patients (mean age, 60.5 years; range, 43 73 years) with RCC. The treatment indications were localized, solid renal mass, comorbidities, high operation risk, and refusal to perform surgery. All tumors were treated by a percutaneous CT (n = 10), followed by an US-guided (n = 2), laparoscopy-assisted US (n = 2), and an open (n = 2) RF ablation. Furthermore, patients underwent a follow- up CT at one day, one week, one month, three and six months, and then every six months from the onset of treatment. We evaluated the technical success, technical effectiveness, ablation zone, benign periablation enhancement, irregular peripheral enhancement, and complications. All 17 exophytic tumors (mean size, 2.2 cm; range, 1.1 5.0 cm) were completely ablated. Technical success and effectiveness was achieved in all cases and the mean follow-up period was 23.8 months (range, 17 33 months). A local recurrence was not detected in any of the cases; however, five patients developed complications as a result of treatment, including hematuria (n = 2), mild thermal injury of the psoas muscle (n = 1), mild hydronephrosis (n = 1), and fistula formation (n = 1). The RF ablation is an alternative treatment for exophytic RCCs and represents a promising treatment for some patients with small RCCs

  13. Radiochemotherapy of malignant glioma in adults. Clinical experiences

    Energy Technology Data Exchange (ETDEWEB)

    Kortmann, R.D.; Jeremic, B.; Plasswilm, L.; Bamberg, M. [Dept. for Radiation Oncology, Univ. of Tuebingen (Germany); Weller, M. [Dept. of Neurology, Univ. of Tuebingen (Germany)

    2003-04-01

    Background: Standard treatment in patients with malignant glioma consists of surgery and postoperative radiotherapy. A high early recurrence rate, particularly in glioblastoma, has led to the investigation of additional chemotherapy. Material and Methods: Recent results of radiochemotherapy published in the literature were reviewed with respect to outcome in phase II and III trials. Based on these experiences, aspects of future strategies were discussed. Results: 3 decades of intensive research had, unfortunately, little impact on the overall results. While early prospective studies established adjuvant nitrosoureas, particularly BCNU, as suitable adjuvant to surgery and postoperative radiotherapy, further studies largely concentrated on combined chemotherapeutic protocols, mostly procarbazine, CCNU and vincristine (PCV), which was shown to prolong survival in anaplastic astrocytoma. The recent MRC study, however, showed no effect for adjuvant PCV in grade III and IV malignant glioma. Only in high-grade glioma with an oligodendroglial component, additional chemotherapy may be of a decisive benefit. The introduction of newer drugs such as paclitaxel, temozolomide, or gemcitabine demonstrated no decisive advantage. Different modes of application and sequencing of radiotherapy and chemotherapy are presently actively investigated, but failed to substantially improve outcome. Conclusions: Therefore, search for newer and more effective drugs continues, as well as for ''optimal'' administration and sequencing, especially from the standpoint of accompanying acute and late toxicity. Finally, recent endeavors focused on basic research such as angiogenesis, migration and invasion, or induction of cell differentiation, but these strategies are still away from broader clinical investigation. (orig.)

  14. Fournier's Gangrene: A Summary of 10 Years of Clinical Experience

    Science.gov (United States)

    Oguz, Abdullah; Gümüş, Metehan; Turkoglu, Ahmet; Bozdağ, Zübeyir; Ülger, Burak Veli; Agaçayak, Elif; Böyük, Abdullah

    2015-01-01

    We aimed to present our clinical experience with FG treatment. Fournier's gangrene (FG) is a rare but serious disease characterized by progressive necrosis in the genitourinary and perineal region. The retrospective study included 43 patients. Patients were divided into 2 groups as survivors and nonsurvivors. Included in the analysis were data pertaining to demographics, predisposing factors, comorbidities, results of bacteriologic analyses, number of debridements, duration of treatment, FG Severity Index (FGSI) score, fecal diversion methods (trephine ostomy or Flexi-Seal Fecal Management System-FMS), and dressing methods (wet or negative aspiration system). In the nonsurvivor group, urea, WBC, and age were significantly higher, whereas albumin, hematocrit, platelet count, and length of hospital stay (LOHS) were significantly lower compared to the survivor group. Mean FGSI was lower in survivors in comparison with nonsurvivors (5.00 ± 1.86 and 10.00 ± 1.27, respectively; P < 0.001). We conclude that FGSI is an important predictor in the prognosis of FG. Vacuum-assisted closure (VAC) should be performed in compliant patients in order to enhance patient comfort by reducing pain and the number of dressings. Fecal diversion should be performed as needed, preferably by using FMS. The trephine ostomy should be the method of choice in cases where an ostomy is necessary. PMID:25859652

  15. Biological wound dressings sterilized with gamma radiation: Mexican clinical experience

    International Nuclear Information System (INIS)

    Martinez-Pardo, M.E.; Ley-Chavez, E.; Reyes-Frias, M.L.; Rodriguez-Ferreyra, P.; Vazquez-Maya, L.; Salazar, M.A.

    2007-01-01

    Biological wound dressings sterilized with gamma radiation, such as amnion and pig skin, are a reality in Mexico. These tissues are currently processed in the tissue bank and sterilized in the Gamma Industrial Irradiation Plant; both facilities belong to the Instituto Nacional de Investigaciones Nucleares (ININ) (National Institute of Nuclear Research). With the strong support of the International Atomic Energy Agency, the bank was established at the ININ and the Mexican Ministry of Health issued its sanitary license on July 7, 1999. The Quality Management System of the bank was certified by ISO 9001:2000 on August 1, 2003; the scope of the system is 'Research, Development and Processing of Biological Tissues Sterilized with Gamma Radiation'. At present, more than 150 patients from 16 hospitals have been successfully treated with these tissues. This paper presents a brief description of the tissue processing, as well as the present Mexican clinical experience with children and adult patients who underwent medical treatment with radiosterilized amnion and pig skin, used as biological wound dressings on burns and ocular surface disorders

  16. Radiochemotherapy of malignant glioma in adults. Clinical experiences

    International Nuclear Information System (INIS)

    Kortmann, R.D.; Jeremic, B.; Plasswilm, L.; Bamberg, M.; Weller, M.

    2003-01-01

    Background: Standard treatment in patients with malignant glioma consists of surgery and postoperative radiotherapy. A high early recurrence rate, particularly in glioblastoma, has led to the investigation of additional chemotherapy. Material and Methods: Recent results of radiochemotherapy published in the literature were reviewed with respect to outcome in phase II and III trials. Based on these experiences, aspects of future strategies were discussed. Results: 3 decades of intensive research had, unfortunately, little impact on the overall results. While early prospective studies established adjuvant nitrosoureas, particularly BCNU, as suitable adjuvant to surgery and postoperative radiotherapy, further studies largely concentrated on combined chemotherapeutic protocols, mostly procarbazine, CCNU and vincristine (PCV), which was shown to prolong survival in anaplastic astrocytoma. The recent MRC study, however, showed no effect for adjuvant PCV in grade III and IV malignant glioma. Only in high-grade glioma with an oligodendroglial component, additional chemotherapy may be of a decisive benefit. The introduction of newer drugs such as paclitaxel, temozolomide, or gemcitabine demonstrated no decisive advantage. Different modes of application and sequencing of radiotherapy and chemotherapy are presently actively investigated, but failed to substantially improve outcome. Conclusions: Therefore, search for newer and more effective drugs continues, as well as for ''optimal'' administration and sequencing, especially from the standpoint of accompanying acute and late toxicity. Finally, recent endeavors focused on basic research such as angiogenesis, migration and invasion, or induction of cell differentiation, but these strategies are still away from broader clinical investigation. (orig.)

  17. Clinical significance of orthostatic dizziness in the diagnosis of benign paroxysmal positional vertigo and orthostatic intolerance.

    Science.gov (United States)

    Jeon, Eun-Ju; Park, Yong-Soo; Park, Shi-Nae; Park, Kyoung-Ho; Kim, Dong-Hyun; Nam, In-Chul; Chang, Ki-Hong

    2013-01-01

    Orthostatic dizziness (OD) and positional dizziness (PD) are considerably common conditions in dizziness clinic, whereas those two conditions are not clearly separated. We aimed to evaluate the clinical significance of simple OD and OD combined with PD for the diagnosis of benign paroxysmal positional vertigo (BPPV) and orthostatic intolerance (OI). Patients presenting with OD (n=102) were divided into two groups according to their symptoms: group PO, presenting with PD as well as OD; group O, presenting with OD. A thorough medical history, physical examination, and vestibular function tests were performed to identify the etiology of the dizziness. Orthostatic vital sign measurement (OVSM) was used to diagnose OI. The majority of patients were in group PO (87.3%). BPPV was the most common cause of OD for entire patients (36.3%) and group PO (37.1%), while OI was most common etiology for group O (38.5%). Total of 17 (16.7%) OI patients were identified by OVSM test. Orthostatic hypotension (n=10) was most frequently found, followed by orthostatic hypertension (n=5), and orthostatic tachycardia (n=2). Group O showed significantly higher percentage (38.5%) of OI than group PO (13.5%) (P=0.039). It is suggested that orthostatic testing such as OVSM or head-up tilt table test should be performed as an initial work up for the patients with simple OD. Positional tests for BPPV should be considered as an essential diagnostic test for patients with OD, even though their dizziness is not associated with PD. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Environmental factors that distinguish between clinical and healthy samples with childhood experiences of abuse and neglect.

    Science.gov (United States)

    Infurna, Maria Rita; Giannone, Francesca; Guarnaccia, Cinzia; Lo Cascio, Maria; Parzer, Peter; Kaess, Michael

    2015-01-01

    Childhood maltreatment is associated with a wide range of problems in adulthood. However, specific environmental factors (either positive or negative) influence mental health outcomes in maltreated children. The present study investigated the effect of environmental factors by comparing a group of clinical participants with experiences of abuse/neglect with a healthy group with similar patterns of experiences. Environmental factors selected were: separation from parents, financial hardship, parental psychiatric disorders, and low social involvement. The study included 55 mixed clinical participants and 23 healthy participants. All participants were investigated using the Childhood Experience of Care and Abuse (CECA) interview. The two groups were specifically matched with regard to patterns of childhood maltreatment. The findings indicated that psychopathological outcome was associated with a greater presence of negative environmental factors (p < 0.001). In particular, lack of social support seemed to be the only one predictor (OR = 27.86). This study is the first to investigate the influence of specific environmental factors in two groups with similar childhood experiences of abuse/neglect but different mental health outcomes. These findings suggest that efforts should be made to incorporate both familial and external sources of social support in promoting mental health for maltreated children. © 2015 S. Karger AG, Basel.

  19. The Positive and Negative Experiences of Caregiving for Siblings of Young People with First Episode Psychosis

    Science.gov (United States)

    Bowman, Siann; Alvarez-Jimenez, Mario; Wade, Darryl; Howie, Linsey; McGorry, Patrick

    2017-01-01

    Background: The impact of first episode psychosis (FEP) upon parents’ experience of caregiving has been well-documented. However, the determinants and nature of this remain poorly understood in siblings. It is hypothesized that siblings of young people with FEP are also impacted by caregiving and burden. This study aimed to characterize the experience of caregiving for siblings of young people with FEP. Method: Survey methodology was used to explore the experience of 157 siblings in the first 18 months of their brother or sister’s treatment for FEP. Participants reported on their appraisal of the negative and positive aspects of caregiving as measured by the Experience of Caregiving Inventory (ECI). Descriptive statistics were used to establish the results for the total sample as well as for gender and birth order differences. A series of multivariate regression analyses were conducted to determine the relationships between illness characteristics and siblings’ experience of caregiving. Results: Older brothers reported the lowest scores for negative experiences in caregiving and younger sisters reported the highest. Negative experiences in caregiving resulted in less warmth within the sibling relationship and impacted negatively upon quality of life. When the young person with FEP had attempted suicide and/or been physically violent, siblings experienced more caregiver burden. Multivariate analysis showed that female gender was a significant factor in explaining the impact of illness related variables on the experience of caregiving. Conclusion: Suicide attempts and a history of violence resulted in higher caregiving burden for siblings regardless of whether they lived with the young person experiencing FEP or not. Female siblings are at higher risk of negative experiences from caregiving resulting in a reduced quality of life and a changed sibling relationship. Suicide attempts and violence are indicators for intensive case management to improve outcomes for

  20. The Positive and Negative Experiences of Caregiving for Siblings of Young People with First Episode Psychosis

    Directory of Open Access Journals (Sweden)

    Siann Bowman

    2017-05-01

    Full Text Available Background: The impact of first episode psychosis (FEP upon parents’ experience of caregiving has been well-documented. However, the determinants and nature of this remain poorly understood in siblings. It is hypothesized that siblings of young people with FEP are also impacted by caregiving and burden. This study aimed to characterize the experience of caregiving for siblings of young people with FEP.Method: Survey methodology was used to explore the experience of 157 siblings in the first 18 months of their brother or sister’s treatment for FEP. Participants reported on their appraisal of the negative and positive aspects of caregiving as measured by the Experience of Caregiving Inventory (ECI. Descriptive statistics were used to establish the results for the total sample as well as for gender and birth order differences. A series of multivariate regression analyses were conducted to determine the relationships between illness characteristics and siblings’ experience of caregiving.Results: Older brothers reported the lowest scores for negative experiences in caregiving and younger sisters reported the highest. Negative experiences in caregiving resulted in less warmth within the sibling relationship and impacted negatively upon quality of life. When the young person with FEP had attempted suicide and/or been physically violent, siblings experienced more caregiver burden. Multivariate analysis showed that female gender was a significant factor in explaining the impact of illness related variables on the experience of caregiving.Conclusion: Suicide attempts and a history of violence resulted in higher caregiving burden for siblings regardless of whether they lived with the young person experiencing FEP or not. Female siblings are at higher risk of negative experiences from caregiving resulting in a reduced quality of life and a changed sibling relationship. Suicide attempts and violence are indicators for intensive case management to

  1. Patient obesity and the practical experience of the plain radiography professional: On everyday ethics, patient positioning and infelicitous equipment

    International Nuclear Information System (INIS)

    Woods, A.L.; Miller, P.K.; Sloane, C.

    2016-01-01

    Patient obesity is increasingly placing significant and multifaceted strain upon medical imaging departments, and professionals, in (particularly Western) healthcare systems. The majority of obesity-related studies in radiology are, however, primarily focused only upon the technical business of collecting diagnostically-efficacious images. This study, using Interpretative Phenomenological Analysis (IPA), qualitatively explores the everyday clinical experiences of eight expert UK diagnosticians working in plain radiography. Focus herein falls particularly upon (a) problems with patient positioning during examination, and (b) challenges arising around available equipment. In line with extant research, participants reported that difficulties with positioning obese patients could have negative impacts on image quality, and that insufficient table weight limits and widths, and inadequate detector sizes, can adversely affect examination. They also raised some more novel issues, such as how the impact of available gown sizes upon a patient's sense of dignity can cause practical and ethical dilemmas for a clinician in situ. The issue of how one might ‘train’ experience in positioning patients without bony landmarks as a reference point was also made salient, with strong implications for undergraduate radiography curricula. It is finally highlighted how the participating radiographers themselves seldom conceptualised any given problem as a purely ‘technical’ one, instead recurrently recognising the interlinking of material, socio-economic and moral matters in real healthcare contexts. By better understanding such nuance and complexity as lived by real radiographers, it is contended, a more context-sensitive and flexible path to effective training and guideline-production can be mapped. - Highlights: • Difficulties with positioning obese patients can have negative impacts on image quality. • Positioning patients without bony landmarks as a reference point is

  2. Efficiency of the modified Sims maternal position in the rotation of persistent occiput posterior position during labor: A randomized clinical trial.

    Science.gov (United States)

    Bueno-Lopez, Vanessa; Fuentelsaz-Gallego, Carmen; Casellas-Caro, Manel; Falgueras-Serrano, Ana Maria; Crespo-Berros, Silvia; Silvano-Cocinero, Ana Maria; Alcaine-Guisado, Carolina; Zamoro Fuentes, Manuela; Carreras, Elena; Terré-Rull, Carmen

    2018-03-14

    Fetal occiput posterior position in labor is associated with more painful and prolonged labor, and an increase in both maternal and fetal morbidity. The aim of this study is to assess whether the modified Sims position on the side of the fetal spine increases the rotation to occiput anterior position in women with epidural analgesia and a fetus in persistent occiput posterior (POP) position. This is an open, randomized controlled, clinical trial. One hundred and twenty women in labor with fetuses in POP position were included. The diagnosis was performed through digital vaginal examination and confirmed with an ultrasound scan. Women were randomized into the free position group or the modified Sims on the side of the fetal spine. The primary outcome was rotation to occiput anterior, and secondary outcomes were type of delivery, postpartum perineal condition, perinatal results, and maternal satisfaction. In pregnant women undergoing labor in the Sims position, fetuses in POP rotated to occiput anterior in 50.8% of cases, whilst in the free position group, the rotation occurred in 21.7% (P = .001). The rate of vaginal deliveries was higher in the Sims group compared with the free position group (84.7% vs 68.3%, P = .035). The modified Sims position is a maternal posture intervention efficient in POP rotation, which decreases cesarean delivery rate. It is a simple and noninvasive intervention, reproducible, and well tolerated by pregnant women. © 2018 Wiley Periodicals, Inc.

  3. Experience of Early Childhood Caries May Positively Correlate with Psychomotor Development.

    Science.gov (United States)

    Liang, Chen-Yi; Liu, Yen-Chun; Shieh, Tien-Yu; Lin, Jia-Rong; Tseng, Yi-Chun; Teng, Andy Yen-Tung

    2015-01-01

    To examine the as yet unknown relationship between dental caries and the child's psychomotor development. A cross-sectional study was designed by screening the kindergartens from urban areas of two cities in southern Taiwan. Besides the personal, demographic and dietary information, the common measures for caries (dmft) and the amended comprehensive scales (CCDI) for psychomotor development were used to assess their relationship(s). A power analysis showed that 334 subjects would be required. One-way ANOVA vs multiple linear regression analysis were used to compare the differences of variables between gender, age and dmft scales, vs the relationship among all variables tested, respectively. A total of 433 children completed the study. The results demonstrated that there was a positive relationship between higher (i.e. dmft≥4 and 5) but not lower or extremely high caries experience and aspects of psychomotor development (i.e. personal-social and expressive language) in children aged 4 to 6 years. The present results are important for paediatric dentists, as they suggest a positive correlation between caries experience (dmft 3 to 6) and psychomotor development in pre-school children and that such a correlation may occur more significantly as an attribute of the most affected teeth (incisors and molars) during the critical stage of personal-social and expressive language development (speech-communication).

  4. A comparison of memory for homicide, non-homicidal violence, and positive life experiences.

    Science.gov (United States)

    Woodworth, Michael; Porter, Stephen; Ten Brinke, Leanne; Doucette, Naomi L; Peace, Kristine; Campbell, Mary Ann

    2009-01-01

    Defendants commonly claim amnesia for their criminal actions especially in cases involving extreme violence. While some claims are malingered or result from physiological factors, other cases may represent genuine partial or complete amnesia resulting from the psychological distress and/or extreme emotion associated with the perpetration of the crime. Fifty Canadian homicide offenders described their memories of their homicide, a non-homicide violent offense, and their most positive adulthood life experience. Self-reported and objective measures of memories for these events revealed that homicides were recalled with the greatest level of detail and sensory information. Although dissociative tendencies were associated with a self-reported memory loss, objective measures of memory quality did not reflect this perceived impairment, suggesting a failure of meta-memory. Recollections of positive life events were superior to those of non-homicidal violence, possibly due to greater impact and meaning attached to such experiences. Findings suggest that memory for homicide typically is enhanced by the powerful emotion associated with its perpetration.

  5. ATX-101 (Deoxycholic Acid Injection) Treatment in Men: Insights From Our Clinical Experience.

    Science.gov (United States)

    Shridharani, Sachin M; Behr, Kathleen L

    2017-11-01

    Excess submental fat (SMF), also called a double chin, is an area of concern for men that can be addressed clinically. ATX-101 (deoxycholic acid injection; Kybella in the United States and Belkyra in Canada, Australia, and various European countries) is the first injectable approved for reduction of SMF. To share the authors' clinical experience using ATX-101 in men with submental fullness and offer insights regarding how this treatment may be presented to men as an option to improve their submental profile. Retrospective review of the authors' medical records for male patients treated with ATX-101. To allow for fewer ATX-101 treatments, it is recommended that a large surface area be treated at the first session. The positive changes and outcomes achieved with ATX-101 build confidence between the physician and patient, which often leads to male patients seeking other aesthetic treatments to improve their overall appearance. ATX-101 treatment is often an effective introduction to aesthetic medicine for men.

  6. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY POSITION STATEMENT ON MENOPAUSE-2017 UPDATE.

    Science.gov (United States)

    Cobin, Rhoda H; Goodman, Neil F

    2017-07-01

    EXECUTIVE SUMMARY This American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE) Position Statement is designed to update the previous menopause clinical practice guidelines published in 2011 but does not replace them. The current document reviews new clinical trials published since then as well as new information regarding possible risks and benefits of therapies available for the treatment of menopausal symptoms. AACE reinforces the recommendations made in its previous guidelines and provides additional recommendations on the basis of new data. A summary regarding this position statement is listed below: New information available from randomized clinical trials and epidemiologic studies reported after 2011 was critically reviewed. No previous recommendations from the 2011 menopause clinical practice guidelines have been reversed or changed. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, selective estrogen-receptor modulators (SERMs), and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. Newer information enhances AACE's guidance for the use of hormone therapy in different subsets of women. Newer information helps to support the use of various types of estrogens, SERMs, and progesterone, as well as the route of delivery. Newer information supports the previous recommendation against the use of bioidentical hormones. The use of nonhormonal therapies for the symptomatic relief of menopausal symptoms is supported. New recommendations in this position statement include: 1. the use of menopausal hormone therapy in symptomatic postmenopausal women should be based on consideration of all risk factors for

  7. Positive and negative experiences of breast pumping during the first 6 months.

    Science.gov (United States)

    Flaherman, Valerie J; Hicks, Katherine G; Huynh, Justine; Cabana, Michael D; Lee, Kathryn A

    2016-04-01

    For mothers with breastfeeding difficulties, pumping can be recommended to help establish milk production. However, pumping may present some barriers to successful breastfeeding. Mothers with milk supply concern may be at higher risk of barriers to successful breastfeeding. No previous studies have described experiences of pumping among mothers with milk supply concern. We conducted 10 focus groups of 56 mothers who had milk supply concern in the first month after birth. A paid, trained facilitator led groups in a semi-structured approach. Sessions were audiorecorded and transcribed verbatim. The transcripts were coded independently by two investigators and analysed using grounded theory. We identified five themes related to the experience of pumping among mothers with milk supply concern: (1) additional control over breastfeeding from pumping: 'I would feed and then give him … whatever I could manage to pump to him'. (2) Painful experience: 'The first time I pumped my boobs hurt so bad'. (3) Pumped volume affected milk supply concern: 'Pump and there was hardly anything coming out that's when I started to worry'. (4) Pumping interfered with other nurturing activities: 'While you're pumping, you can't touch the baby'. (5) Frustration from inconsistent provider advice: 'They told me to pump … and then said, "That's going to cause your milk to increase too much" '. Mothers had positive and negative experiences with pumping. Clinicians should assess a mother's experience shortly after she initiates pumping, as further management and counselling may be necessary to avoid barriers to successful breastfeeding. © 2014 John Wiley & Sons Ltd.

  8. Methyldibromo glutaronitrile: clinical experience and exposure-based risk assessment.

    Science.gov (United States)

    Zachariae, Claus; Rastogi, Suresh; Devantier, Charlotte; Menné, Torkil; Johansen, Jeanne Duus

    2003-03-01

    In the year 2000, the level of methyldibromo glutaronitrile (MDGN) allergy in dermatology clinics in Europe exceeded the level of allergies to all other preservatives, with a prevalence of 3.5%. In the present study, cases of primary sensitization and elicitation to MDGN due to cosmetic products were collected over an 8-month period at the Department of Dermatology, Gentofte University Hospital. The aim was to identify the products related to hand eczema, assess exposure to MDGN in these products and relate the findings to results from a newly developed updated risk assessment model for contact allergy. Out of 24 patients with a positive patch test to MDGN, 17 patients with hand eczema were identified. In 11 of these patients, cosmetic products used in relation to the onset of the disease were shown to contain MDGN (65%). In 8 of these 11 cases, primary sensitization was probable, 5 due to hand/body lotions and 3 due to lotions and/or liquid hand soap. Chemical analysis of 12 products showed that lotions contained 149-390 ppm of MDGN, liquid hand soap 144-399 ppm, a rinsing cream 293 ppm and shampoos 78-79 ppm. The shampoo exposure was not of certain relevance to the eczema. Applying the newly developed updated risk assessment model showed that the concentrations of MDGN in lotions of 149-390 ppm exceeded the calculated maximum acceptable exposure level for MDGN, which would be expected to lead to sensitization in consumers using such products, as seen in the current study. The present cases and updated exposure-based risk assessment process add to the evidence and need for re-defining safe-use concentrations of MDGN in cosmetic products.

  9. Experiences of work among people with disabilities who are HIV-positive in Zambia.

    Science.gov (United States)

    Njelesani, Janet; Nixon, Stephanie; Cameron, Deb; Parsons, Janet; Menon, Anitha

    2015-01-01

    This paper focuses on accounts of how having a disability and being HIV-positive influences experiences of work among 21 people (12 women, 9 men) in Lusaka, Zambia. In-depth semi-structured interviews were conducted in English, Bemba, Nyanja, or Zambian sign language. Descriptive and thematic analyses were conducted. Three major themes were generated. The first, a triple burden, describes the burden of having a disability, being HIV-positive, and being unemployed. The second theme, disability and HIV is not inability, describes participants' desire for work and their resistance to being regarded as objects of charity. Finally, how work influences HIV management, describes the practicalities of working and living with HIV. Together these themes highlight the limited options available to persons with disabilities with HIV in Lusaka, not only secondary to the effects of HIV influencing their physical capacity to work, but also because of the attendant social stigma of being a person with a disability and HIV-positive.

  10. Position dependent mismatch discrimination on DNA microarrays – experiments and model

    Directory of Open Access Journals (Sweden)

    Michel Wolfgang

    2008-12-01

    Full Text Available Abstract Background The propensity of oligonucleotide strands to form stable duplexes with complementary sequences is fundamental to a variety of biological and biotechnological processes as various as microRNA signalling, microarray hybridization and PCR. Yet our understanding of oligonucleotide hybridization, in particular in presence of surfaces, is rather limited. Here we use oligonucleotide microarrays made in-house by optically controlled DNA synthesis to produce probe sets comprising all possible single base mismatches and base bulges for each of 20 sequence motifs under study. Results We observe that mismatch discrimination is mostly determined by the defect position (relative to the duplex ends as well as by the sequence context. We investigate the thermodynamics of the oligonucleotide duplexes on the basis of double-ended molecular zipper. Theoretical predictions of defect positional influence as well as long range sequence influence agree well with the experimental results. Conclusion Molecular zipping at thermodynamic equilibrium explains the binding affinity of mismatched DNA duplexes on microarrays well. The position dependent nearest neighbor model (PDNN can be inferred from it. Quantitative understanding of microarray experiments from first principles is in reach.

  11. Italian Association of Clinical Endocrinologists (AME) & Italian Association of Clinical Diabetologists (AMD) Position Statement : Diabetes mellitus and thyroid disorders: recommendations for clinical practice.

    Science.gov (United States)

    Guastamacchia, Edoardo; Triggiani, Vincenzo; Aglialoro, Alberto; Aiello, Antimo; Ianni, Lucia; Maccario, Mauro; Zini, Michele; Giorda, Carlo; Guglielmi, Rinaldo; Betterle, Corrado; Attanasio, Roberto; Borretta, Giorgio; Garofalo, Piernicola; Papini, Enrico; Castello, Roberto; Ceriello, Antonio

    2015-06-01

    Thyroid disease and diabetes mellitus, the most common disorders in endocrine practice, are not infrequently associated in the same subject. An altered thyroid function may affect glucose tolerance and worsen metabolic control in patients with diabetes. Thyrotoxicosis increases the risk of hyperglycemic emergencies, while a clinically relevant hypothyroidism may have a detrimental effect on glycemic control in diabetic patients. The association of alterations in thyroid function with diabetes mellitus may adversely affect the risk of cardiovascular and microvascular complications resulting from diabetes. Moreover, the treatments used for both diabetes and thyroid disease, respectively, can impact one other. Finally, multinodular goiter, but not thyroid carcinoma, was shown to be more prevalent in type 2 diabetes mellitus. Aim of the present Position Statement is to focus on the evidence concerning the association of thyroid disease and diabetes mellitus and to provide some practical suggestions for an updated clinical management.

  12. Examining the Experiences of Athletic Trainers as they transition into their First Full-Time Position

    Directory of Open Access Journals (Sweden)

    Stephanie M. Mazerolle

    2017-04-01

    Full Text Available Transition to clinical practice is an important topic in athletic training, as it can be a period of time that presents challenges for the athletic trainer. Most of the research pertaining to transition to practice focuses on the skills and knowledge necessary for clinical practice, yet we know that stress can manifest from not only being an independent practitioner but also from learning how to balance one’s roles. We wanted to understand the perspective of today’s novice athletic trainers and how they feel in their first full-time position, specifically relating to their professional development and establishment or maintenance of work-life balance (WLB. Using a qualitative paradigm, we phone interviewed athletic trainers who were categorized as career starters by the National Athletic Trainers’ Association. Using a purposive recruitment strategy we were able to recruit 20 (12 female, 8 male athletic trainers meeting this classification. General inductive analyses were used to code the data from our interviews, and we satisfied credibility though saturation of the data, peer review, and researcher triangulations during the coding process. Our findings suggest that while confidence in clinical skills is apparent, some of the more administrative aspects of clinical practice present challenges. We found that various employment settings offered various expectations or challenges that had the potential to impact WLB. A blend of professional and organizational processes helped transition the athletic trainer, and although both were helpful each also could be bolstered to improve transitioning for the newly credentialed athletic trainer. Employers of early career starters should be aware of the stress related to transition to practice, and the time it can take to acclimate.

  13. HIV-positive patients in Pusan servitude : clinical and chest radiographic findings

    International Nuclear Information System (INIS)

    Son, Young Keun; Kim, Kun Il

    2001-01-01

    To analyze the clinical and chest radiolographic findings of HIV-positive in Pusan survitude. We reviewed the medical records of 74 admission cases of 41 HIV-positive patients (38 mem and 3 women), confirmed in NIH and admitted to our hospital between May 1990 and September 1997. We evaluated the clinical findings including the pulmonary disease diagnosed at each admission, and using the pattern approach assessed the radiographic findings in 63 cases available among 74 admission cases. For statistical analysis the Pearson Chi-Square test was used, and the chest CT findings available in 19 cases among 17 patients were also evaluated. In all cases the mode of transmission was sexual contact, and they were more frequently contacted with foreigners (73%) than koreans (27%). During the follow-up period, pulmonary diseases were diagnosed in 52 (70%) of 74 admission cases. The diagnoses were pneumocystis cabrini pneumonia (PCP, n=15), pneumonia(n=15), pulmonary tuberculosis(n=15), combined infection with PCP and pulmonary tuberculosis(n=5), and combined infection with PCP and bacterial pneumonia(n=1). The count of CD4+ lymphocyte in 33 of 55 available admissions cases was less than 50 cells/mm?. In 28 patients(68%) who died, the time between confirmation of HIV-positive status to death ranged from 2 to 81 (mean, 39) months. Chest radiographs of 46 available admission cases (73%) showed the followingabnormal findings: interstitial opacities(n=26), consolidation(n=17), single or multiple nodules (n=9), hilar or mediastinal lymph node enlargement(n=10), pleural effusion(n=8), cyst(n=2), mass(n=1), and pericardial effusion(n=1). Diffuse ground glass opacity was observed in eight (89%) of nine PCP cases (p<0.05), and in cases of pulmonary tubercolosis, hilar or mediastinal lymph node enlargement was frequent (p<0.05). Pulmonary diseases in HIV-positive patients in Pusan servitude were diagnosed during follow-up in 70% of cases. The majority of these diseases were infectious

  14. HIV-positive patients in Pusan servitude : clinical and chest radiographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Son, Young Keun; Kim, Kun Il [Pusan National Univ. College of Medicine, Pusan (Korea, Republic of)

    2001-04-01

    To analyze the clinical and chest radiolographic findings of HIV-positive in Pusan survitude. We reviewed the medical records of 74 admission cases of 41 HIV-positive patients (38 mem and 3 women), confirmed in NIH and admitted to our hospital between May 1990 and September 1997. We evaluated the clinical findings including the pulmonary disease diagnosed at each admission, and using the pattern approach assessed the radiographic findings in 63 cases available among 74 admission cases. For statistical analysis the Pearson Chi-Square test was used, and the chest CT findings available in 19 cases among 17 patients were also evaluated. In all cases the mode of transmission was sexual contact, and they were more frequently contacted with foreigners (73%) than koreans (27%). During the follow-up period, pulmonary diseases were diagnosed in 52 (70%) of 74 admission cases. The diagnoses were pneumocystis cabrini pneumonia (PCP, n=15), pneumonia(n=15), pulmonary tuberculosis(n=15), combined infection with PCP and pulmonary tuberculosis(n=5), and combined infection with PCP and bacterial pneumonia(n=1). The count of CD4+ lymphocyte in 33 of 55 available admissions cases was less than 50 cells/mm?. In 28 patients(68%) who died, the time between confirmation of HIV-positive status to death ranged from 2 to 81 (mean, 39) months. Chest radiographs of 46 available admission cases (73%) showed the followingabnormal findings: interstitial opacities(n=26), consolidation(n=17), single or multiple nodules (n=9), hilar or mediastinal lymph node enlargement(n=10), pleural effusion(n=8), cyst(n=2), mass(n=1), and pericardial effusion(n=1). Diffuse ground glass opacity was observed in eight (89%) of nine PCP cases (p<0.05), and in cases of pulmonary tubercolosis, hilar or mediastinal lymph node enlargement was frequent (p<0.05). Pulmonary diseases in HIV-positive patients in Pusan servitude were diagnosed during follow-up in 70% of cases. The majority of these diseases were infectious

  15. Encountering aged care: a mixed methods investigation of medical students' clinical placement experiences.

    Science.gov (United States)

    Annear, Michael J; Lea, Emma; Lo, Amanda; Tierney, Laura; Robinson, Andrew

    2016-02-04

    Residential aged care is an increasingly important health setting due to population ageing and the increase in age-related conditions, such as dementia. However, medical education has limited engagement with this fast-growing sector and undergraduate training remains primarily focussed on acute presentations in hospital settings. Additionally, concerns have been raised about the adequacy of dementia-related content in undergraduate medical curricula, while research has found mixed attitudes among students towards the care of older people. This study explores how medical students engage with the learning experiences accessible in clinical placements in residential aged care facilities (RACFs), particularly exposure to multiple comorbidity, cognitive impairment, and palliative care. Fifth-year medical students (N = 61) completed five-day clinical placements at two Australian aged care facilities in 2013 and 2014. The placements were supported by an iterative yet structured program and academic teaching staff to ensure appropriate educational experiences and oversight. Mixed methods data were collected before and after the clinical placement. Quantitative data included surveys of dementia knowledge and questions about attitudes to the aged care sector and working with older adults. Qualitative data were collected from focus group discussions concerning medical student expectations, learning opportunities, and challenges to engagement. Pre-placement surveys identified good dementia knowledge, but poor attitudes towards aged care and older adults. Negative placement experiences were associated with a struggle to discern case complexity and a perception of an aged care placement as an opportunity cost associated with reduced hospital training time. Irrespective of negative sentiment, post-placement survey data showed significant improvements in attitudes to working with older people and dementia knowledge. Positive student experiences were explained by in

  16. Brazilian experience in EU-CORE: daptomycin registry and treatment of serious Gram-positive infections

    Directory of Open Access Journals (Sweden)

    Artur Timerman

    Full Text Available OBJECTIVES: To collect data about non-controlled prescribing use of daptomycin and its impact among Brazilian patients with serious Gram positive bacterial infection, as well as the efficacy and safety outcomes. MATERIALS AND METHODS: This is a multi-center, retrospective, non-interventional registry (August 01, 2009 to June 30, 2011 to collect data on 120 patients (44 patients in the first year and 76 patients in the second year who had received at least one dose of commercial daptomycin in Brazil for the treatment of serious Gram-positive bacterial infection. RESULTS: Right-sided endocarditis (15.8%, complicated skin and soft tissue infections (cSSTIwound (15.0% and bacteremia-catheter-related (14.2% were the most frequent primary infections; lung (21.7% was the most common site for infection. Daptomycin was used empirically in 76 (63.3% patients, and methicillin-resistant Staphylococcus aureus (MRSA was the most common suspected pathogen (86.1%. 82.5% of the cultures were obtained prior to or shortly after initiation of daptomycin therapy. Staphylococcus spp. - coagulase negative, MRSA, and methicillin-susceptible S. aureus were the most frequently identified pathogens (23.8%, 23.8% and 12.5%, respectively. The most common daptomycin dose administered for bacteremia and cSSTI was 6 mg/kg (30.6% and 4 mg/kg (51.7%, respectively. The median duration of inpatient daptomycin therapy was 14 days. Most patients (57.1% did not receive daptomycin while in intensive care unit. Carbapenem (22.5% was the most commonly used antibiotic concomitantly. The patients showed clinical improvement after two days (median following the start of daptomycin therapy. The clinical success rate was 80.8% and the overall rate of treatment failure was 10.8%. The main reasons for daptomycin discontinuation were successful end of therapy (75.8%, switched therapy (11.7%, and treatment failure (4.2%. Daptomycin demonstrated a favorable safety and tolerability profile

  17. Early clinical experience: do students learn what we expect?

    Science.gov (United States)

    Helmich, Esther; Bolhuis, Sanneke; Laan, Roland; Koopmans, Raymond

    2011-07-01

    Early clinical experience is thought to contribute to the professional development of medical students, but little is known about the kind of learning processes that actually take place. Learning in practice is highly informal and may be difficult to direct by predefined learning outcomes. Learning in medical practice includes a socialisation process in which some learning outcomes may be valued, but others neglected or discouraged. This study describes students' learning goals (prior to a Year 1 nursing attachment) and learning outcomes (after the attachment) in relation to institutional educational goals, and evaluates associations between learning outcomes, student characteristics and place of attachment. A questionnaire containing open-ended questions about learning goals and learning outcomes was administered to all Year 1 medical students (n = 347) before and directly after a 4-week nursing attachment in either a hospital or a nursing home. Two confirmatory focus group interviews were conducted and data were analysed using qualitative and quantitative content analyses. Students' learning goals corresponded with educational goals with a main emphasis on communication and empathy. Other learning goals included gaining insight into the organisation of health care and learning to deal with emotions. Self-reported learning outcomes were the same, but students additionally mentioned reflection on professional behaviour and their own future development. Women and younger students mentioned communication and empathy more often than men and older students. Individual learning goals, with the exception of communicating and empathising with patients, did not predict learning outcomes. Students' learning goals closely match educational goals, which are adequately met in early nursing attachments in both hospitals and nursing homes. Learning to deal with emotions was under-represented as a learning goal and learning outcome, which may indicate that emotional aspects

  18. Reversibility of ventricular dysfunction: clinical experience in a medical office

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Pereira Barretto

    2001-12-01

    Full Text Available OBJECTIVE - To describe clinical observations of marked improvement in ventricular dysfunction in a medical office environment under circumstances differing from those in study protocols and multicenter studies performed in hospital or with outpatient cohorts. METHODS - Eleven cardiac failure patients with marked ventricular dysfunction receiving treatment at a doctors office between 1994 and 1999 were studied. Their ages ranged from 20 and 66 years (mean 39.42±14.05 years; 7 patients were men, 4 were women. Cardiopathic etiologies were arterial hypertension in 5 patients, peripartum cardiomyopathy in 2, nondefined myocarditis in 2, and alcoholic cardiomyopathy in 4. Initial echocardiograms revealed left ventricular dilatation (average diastolic diameter, 69.45±8.15mm, reduced left ventricular ejection fraction (0.38±0.08 and left atrial dilatation (43.36±5.16mm. The therapeutic approach followed consisted of patient orientation, elimination of etiological or causal factors of cardiac failure, and prescription of digitalis, diuretics, and angiotensinconverting enzyme inhibitors. RESULTS - Following treatment, left ventricular ejection fraction changed to 0.63±0.09; left ventricular diameters changed to 57.18±8.13mm, and left atrium diameters changed to 37.27±8.05mm. Maximum improvement was noted after 16.9±8.63 (6 to 36 months. CONCLUSION - Patients with serious cardiac failure and ventricular dysfunction caused by hypertension, alcoholism, or myocarditis can experience marked improvement in ventricular dysfunction after undergoing appropriate therapy within the venue of the doctor's office.

  19. Neratinib in HER-2-positive breast cancer: results to date and clinical usefulness.

    Science.gov (United States)

    Chan, Arlene

    2016-09-01

    The management of HER-2-positive breast cancer has improved significantly with the use of targeted agents to the HER-2 signaling pathway. Despite the improved survival achieved with the use of trastuzumab and chemotherapy in both the adjuvant and metastatic setting, patients may still recur or progress; whilst preclinical data demonstrate that these cancer cells remain addicted to the HER-2 oncogene. Neratinib, an oral small molecule tyrosine-kinase inhibitor has efficacy in the metastatic and adjuvant setting of patients who have previously received trastuzumab-based treatment. Diarrhea, being a class effect of tyrosine-kinase inhibitor, is the most common side effect seen following neratinib administration, but recent data suggests that a prophylactic loperamide regimen can reduce the incidence of grade 3 diarrhea. Phase I through to III clinical trials of neratinib will be reviewed, with discussion of the postulated mechanism underlying diarrheal events and its management.

  20. Essential UX metrics to be considered when designing m-health applications in order to provide positive user experiences

    CSIR Research Space (South Africa)

    Ouma, S

    2010-07-01

    Full Text Available into positive user experiences. More complications arise in that there is no agreed standard of measuring the user experience of a particular product. In this working paper, the authors propose core user experience metrics that are essential and should...

  1. Web-based objective structured clinical examination with remote standardized patients and Skype: resident experience.

    Science.gov (United States)

    Langenau, Erik; Kachur, Elizabeth; Horber, Dot

    2014-07-01

    Using Skype and remote standardized patients (RSPs), investigators sought to evaluate user acceptance of a web-based objective structured clinical examination (OSCE) among resident physicians. After participating in four web-based clinical encounters addressing pain with RSPs, 59 residents from different training programs, disciplines and geographic locations completed a 52-item questionnaire regarding their experience with Skype and RSPs. Open-ended responses were solicited as well. The majority of participants (97%) agreed or strongly agreed the web-based format was convenient and a practical learning exercise, and 90% agreed or strongly agreed the format was effective in teaching communication skills. Although 93% agreed or strongly agreed they could communicate easily with RSPs using Skype, 80% preferred traditional face-to-face clinical encounters, and 58% reported technical difficulties during the encounters. Open-ended written responses supported survey results. Findings from this study expose challenges with technology and human factors, but positive experiences support the continued investigation of web-based OSCEs as a synchronous e-learning initiative for teaching and assessing doctor-patient communication. Such educational programs are valuable but unlikely to replace face-to-face encounters with patients. This web-based OSCE program provides physician learners with additional opportunity to improve doctor-patient communication. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Mirror neurons, procedural learning, and the positive new experience: a developmental systems self psychology approach.

    Science.gov (United States)

    Wolf, N S; Gales, M; Shane, E; Shane, M

    2000-01-01

    In summary, we are impressed with the existence of a mirror neuron system in the prefrontal cortex that serves as part of a complex neural network, including afferent and efferent connections to the limbic system, in particular the amygdala, in addition to the premotor and motor cortex. We think it is possible to arrive at an integration that postulates the mirror neuron system and its many types of associated multimodal neurons as contributing significantly to implicit procedural learning, a process that underlies a range of complex nonconscious, unconscious, preconscious and conscious cognitive activities, from playing musical instruments to character formation and traumatic configurations. This type of brain circuitry may establish an external coherence with developmental systems self psychology which implies that positive new experience is meliorative and that the intentional revival of old-old traumatic relational configurations might enhance maladaptive procedural patterns that would lead to the opposite of the intended beneficial change. When analysts revive traumatic transference patterns for the purpose of clarification and interpretation, they may fail to appreciate that such traumatic transference patterns make interpretation ineffective because, as we have stated above, the patient lacks self-reflection under such traumatic conditions. The continued plasticity and immediacy of the mirror neuron system can contribute to positive new experiences that promote the formation of new, adaptive, implicit-procedural patterns. Perhaps this broadened repertoire in the patient of ways of understanding interrelational events through the psychoanalytic process allows the less adaptive patterns ultimately to become vestigial and the newer, more adaptive patterns to emerge as dominant. Finally, as we have stated, we believe that the intentional transferential revival of trauma (i.e., the old-old relational configuration) may not contribute to therapeutic benefit. In

  3. Non-allergic rhinitis: Position paper of the European Academy of Allergy and Clinical Immunology.

    Science.gov (United States)

    Hellings, P W; Klimek, L; Cingi, C; Agache, I; Akdis, C; Bachert, C; Bousquet, J; Demoly, P; Gevaert, P; Hox, V; Hupin, C; Kalogjera, L; Manole, F; Mösges, R; Mullol, J; Muluk, N B; Muraro, A; Papadopoulos, N; Pawankar, R; Rondon, C; Rundenko, M; Seys, S F; Toskala, E; Van Gerven, L; Zhang, L; Zhang, N; Fokkens, W J

    2017-11-01

    This EAACI position paper aims at providing a state-of-the-art overview on nonallergic rhinitis (NAR). A significant number of patients suffering from persistent rhinitis are defined as nonallergic noninfectious rhinitis (NANIR) patients, often denominated in short as having NAR. NAR is defined as a symptomatic inflammation of the nasal mucosa with the presence of a minimum of two nasal symptoms such as nasal obstruction, rhinorrhea, sneezing, and/or itchy nose, without clinical evidence of endonasal infection and without systemic signs of sensitization to inhalant allergens. Symptoms of NAR may have a wide range of severity and be either continuously present and/or induced by exposure to unspecific triggers, also called nasal hyperresponsiveness (NHR). NHR represents a clinical feature of both AR and NAR patients. NAR involves different subgroups: drug-induced rhinitis, (nonallergic) occupational rhinitis, hormonal rhinitis (including pregnancy rhinitis), gustatory rhinitis, senile rhinitis, and idiopathic rhinitis (IR). NAR should be distinguished from those rhinitis patients with an allergic reaction confined to the nasal mucosa, also called "entopy" or local allergic rhinitis (LAR). We here provide an overview of the current consensus on phenotypes of NAR, recommendations for diagnosis, a treatment algorithm, and defining the unmet needs in this neglected area of research. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

  4. Clinical characteristics and treatment outcomes for benign paroxysmal positional vertigo comorbid with hypertension.

    Science.gov (United States)

    Tan, Jun; Deng, Yuxiao; Zhang, Tianyu; Wang, Menghong

    2017-05-01

    Patients with BPPV comorbid with hypertension (h-BPPV) tend to receive a delayed diagnosis of BPPV. Comorbidity with hypertension did not influence the efficacy of the repositioning maneuver; however, comorbidity with hypertension was associated with an increased recurrence rate of BPPV. To determine the clinical characteristics and outcomes of h-BPPV, as well as the clinical differences between h-BPPV and idiopathic BPPV (i-BPPV). The authors reviewed the medical records of 41 consecutive patients with h-BPPV (the h-BPPV group) from March to December 2014 and 47 patients with i-BPPV (the i-BPPV group) during the same period. There were no significant differences in age, sex ratio, or the affected side between the h-BPPV and i-BPPV groups. The proportion of patients reporting an initial episode of positional vertigo was significantly lower in the h-BPPV group (51.22% vs 74.47%; p = .024). Patients in the h-BPPV group reported a longer median episode duration than did those in the i-BPPV group (60 days vs 15 days; p = .017). The results of treatment using repositioning maneuvers were similar between the two groups. At follow-up, 13 patients in the h-BPPV group were diagnosed with recurrent BPPV compared with six in the i-BPPV group (p = .031).

  5. Lipid-lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel.

    Science.gov (United States)

    Cicero, Arrigo F G; Colletti, Alessandro; Bajraktari, Gani; Descamps, Olivier; Djuric, Dragan M; Ezhov, Marat; Fras, Zlatko; Katsiki, Niki; Langlois, Michel; Latkovskis, Gustavs; Panagiotakos, Demosthenes B; Paragh, Gyorgy; Mikhailidis, Dimitri P; Mitchenko, Olena; Paulweber, Bernhard; Pella, Daniel; Pitsavos, Christos; Reiner, Željko; Ray, Kausik K; Rizzo, Manfredi; Sahebkar, Amirhossein; Serban, Maria-Corina; Sperling, Laurence S; Toth, Peter P; Vinereanu, Dragos; Vrablík, Michal; Wong, Nathan D; Banach, Maciej

    2017-09-01

    In recent years, there has been growing interest in the possible use of nutraceuticals to improve and optimize dyslipidemia control and therapy. Based on the data from available studies, nutraceuticals might help patients obtain theraputic lipid goals and reduce cardiovascular residual risk. Some nutraceuticals have essential lipid-lowering properties confirmed in studies; some might also have possible positive effects on nonlipid cardiovascular risk factors and have been shown to improve early markers of vascular health such as endothelial function and pulse wave velocity. However, the clinical evidence supporting the use of a single lipid-lowering nutraceutical or a combination of them is largely variable and, for many of the nutraceuticals, the evidence is very limited and, therefore, often debatable. The purpose of this position paper is to provide consensus-based recommendations for the optimal use of lipid-lowering nutraceuticals to manage dyslipidemia in patients who are still not on statin therapy, patients who are on statin or combination therapy but have not achieved lipid goals, and patients with statin intolerance. This statement is intended for physicians and other healthcare professionals engaged in the diagnosis and management of patients with lipid disorders, especially in the primary care setting. © The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  6. Clinical Utility of Circulating Tumor Cells in ALK-Positive Non-Small-Cell Lung Cancer.

    Science.gov (United States)

    Faugeroux, Vincent; Pailler, Emma; Auger, Nathalie; Taylor, Melissa; Farace, Françoise

    2014-01-01

    The advent of rationally targeted therapies such as small-molecule tyrosine kinase inhibitors (TKIs) has considerably transformed the therapeutic management of a subset of patients with non-small-cell lung cancer (NSCLC) harboring defined molecular abnormalities. When such genetic molecular alterations are detected the use of specific TKI has demonstrated better results (overall response rate, progression free survival) compared to systemic therapy. However, the detection of such molecular abnormalities is complicated by the difficulty in obtaining sufficient tumor material, in terms of quantity and quality, from a biopsy. Here, we described how circulating tumor cells (CTCs) can have a clinical utility in anaplastic lymphoma kinase (ALK) positive NSCLC patients to diagnose ALK-EML4 gene rearrangement and to guide therapeutic management of these patients. The ability to detect genetic abnormalities such ALK rearrangement in CTCs shows that these cells could offer new perspectives both for the diagnosis and the monitoring of ALK-positive patients eligible for treatment with ALK inhibitors.

  7. Clinical comparative study of efficacy of epley manoeuvre and semont manoeuvre in benign paroxysmal positional vertigo

    International Nuclear Information System (INIS)

    Majeed, M.A.; Haq, A.U.

    2015-01-01

    To compare the efficacy of Epley manoeuvre and Semont manoeuvre in the management of benign paroxysmal positional vertigo. Study Design: Randomized controlled trials. Place and Duration of Study: ENT Department Combined Military Hospital (CMH) Kharian and Gilgit from March 2005 to February 2010. Material and Methods: Hundred cases of benign paroxysmal positional vertigo (BPPV) were selected on Dix-Hallpike test by non probability convenient sampling technique and randomly divided into two groups of 50 cases each. Patients in group-1 were treated by Epley manoeuvre and patients in group-2 were treated by Semont manoeuvre. The patients were examined on first day, 3rd day, 7th day and after 01 month and clinical results were observed. Results: In group-1, 68% cases showed immediate resolution of symptoms, 74% cases on 3rd day, 80% cases on 7th day and total 82% cases recovered completely after one month. In group-2, 62% cases showed immediate resolution of symptoms, 68% cases on 3rd day, 74% cases on 7th day and total 78% cases showed complete recovery after 1 month. There was insignificant difference between the two groups regarding recovery at different follow ups. Conclusion: It was concluded that Epley and Semont manoeuvres are equally effective in the management of BPPV. (author)

  8. Presenting symptoms and clinical findings in HPV-positive and HPV-negative oropharyngeal cancer patients.

    Science.gov (United States)

    Carpén, Timo; Sjöblom, Anni; Lundberg, Marie; Haglund, Caj; Markkola, Antti; Syrjänen, Stina; Tarkkanen, Jussi; Mäkitie, Antti; Hagström, Jaana; Mattila, Petri

    2018-05-01

    Oropharyngeal squamous cell carcinoma (OPSCC) is divided in two different disease entities depending on HPV involvement. We investigated differences in presenting symptoms and clinical findings in patients with HPV-positive and -negative OPSCC tumors. Altogether 118 consecutive patients diagnosed with primary OPSCC between 2012 and 2014 at the Helsinki University Hospital were included. HPV-status of the tumors was assessed by PCR detection of HPV DNA and immunostaining with p16-INK4a antibody. Fifty-one (47.7%) of the patients had HPV-positive and 56 (52.3%) HPV-negative tumors. Forty-nine (49/51, 96.1%) of the HPV+ tumors were also p16+ showing high concordance. The most common presenting symptom among HPV+/p16+ patients was a neck mass (53.1%), whereas any sort of pain in the head and neck area was more frequently related to the HPV-/p16- (60.0%) group. HPV+/p16+ tumors had a tendency to locate in the tonsillar complex and more likely had already spread into regional lymph nodes compared with HPV-/p16- tumors. Smoking and heavy alcohol consumption were significantly more common among HPV-/p16- patients but also rather common among HPV+/p16+ patients. This analysis of symptoms and signs confirm that OPSCC can be dichotomized in two distinct disease entities as defined by HPV status.

  9. Case series of fertility treatment in HIV-discordant couples (male positive, female negative: the Ontario experience.

    Directory of Open Access Journals (Sweden)

    Trent Newmeyer

    Full Text Available The success of combination antiretroviral therapies for the treatment of human immunodeficiency virus (HIV has resulted in prolonged life expectancy (over 40 years from diagnosis and an improved quality of life for people living with HIV. The risk of vertical HIV transmission during pregnancy has been reduced to less than 1%. As a result of these breakthroughs and as many of these individuals are of reproductive age, fertility issues are becoming increasingly important for this population. One population in which conception planning and reduction of horizontal HIV transmission warrants further research is HIV-discordant couples where the male partner is HIV-positive and the female partner is HIV-negative. Sperm washing is a technique carried out in a fertility clinic that separates HIV from the seminal fluid. Although sperm washing followed by intrauterine insemination significantly reduces the risk of horizontal HIV transmission, there has been limited access to the procedure in North America. Furthermore, little is known about the conception decision-making experiences of HIV-discordant couples who might benefit from sperm washing. Chart reviews and semi-structured interviews were completed with 12 HIV-discordant couples in Ontario, Canada. Couples were recruited through HIV clinics and one fertility clinic that offered sperm washing. Participants identified a number of factors that affected their decision-making around pregnancy planning. Access to sperm washing and other fertility services was an issue (cost, travel and few clinics. Participants identified a lack of information on the procedure (availability, safety. Sources of support (social networks, healthcare providers were unevenly distributed, especially among those who did not disclose their HIV status to friends and family. Finally, the stigmatisation of HIV continues to have a negative affect on HIV-discordant couples and their intentions to conceive. Access to sperm washing and

  10. Continuous positive airway pressure (CPAP after lung resection: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Ligia dos Santos Roceto

    Full Text Available CONTEXT AND OBJECTIVE: Noninvasive mechanical ventilation during the postoperative period (PO following lung resection can restore residual functional capacity, improve oxygenation and spare the inspiratory muscles. The objective of this study was to assess the efficacy of continuous positive airway pressure (CPAP associated with physiotherapy, compared with physiotherapy alone after lung resection. DESIGN AND SETTING: Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas. METHOD: Sessions were held in the immediate postoperative period (POi and on the first and second postoperative days (PO1 and PO2, and the patients were reassessed on the discharge day. CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O. The oxygenation index (OI, Borg scale, pain scale and presence of thoracic drains and air losses were evaluated. RESULTS : There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy (CP group, P = 0.024. In the CP group the OI was significantly lower on PO1 (P = 0,042, than CPAP group. The air losses were significantly greater in the CPAP group in the POi and on PO1 (P = 0.001, P = 0.028, but there was no significant difference between the groups on PO2 and PO3. There was a statistically significant difference between the groups regarding the Borg scale in the POi (P < 0.001, but there were no statistically significant differences between the groups regarding the pain score. CONCLUSION: CPAP after lung resection is safe and improves oxygenation, without increasing the air losses through the drains. CLINICAL TRIAL REGISTRATION: NCT01285648

  11. Long-term Clinical Outcomes of Whole-Breast Irradiation Delivered in the Prone Position

    International Nuclear Information System (INIS)

    Stegman, Lauren D.; Beal, Katherine P.; Hunt, Margie A.; Fornier, Monica N.; McCormick, Beryl

    2007-01-01

    Purpose: The aim of this study was to evaluate retrospectively the effectiveness and toxicity of post-lumpectomy whole-breast radiation therapy delivered with prone positioning. Methods and Materials: Between September 1992 and August 2004, 245 women with 248 early-stage invasive or in situ breast cancers were treated using a prone breast board. Photon fields treated the whole breast to 46 to 50.4 Gy with standard fractionation. The target volume was clinically palpable breast tissue; no attempt was made to irradiate chest wall lymphatics. Tumor bed boosts were delivered in 85% of cases. Adjuvant chemotherapy and hormonal therapy were administered to 42% and 62% of patients, respectively. Results: After a median follow-up of 4.9 years, the 5 year actuarial true local and elsewhere ipsilateral breast tumor recurrence rates were 4.8% and 1.3%, respectively. The 5-year actuarial rates of regional nodal recurrence and distant metastases were 1.6% and 7.4%. Actuarial disease-free, disease-specific, and overall survival rates at 5 years were 89.4%, 97.3%, and 93%, respectively. Treatment breaks were required by 2.4% of patients. Grade 3 acute dermatitis and edema were each limited to 2% of patients. Only 4.9% of patients complained of acute chest wall discomfort. Chronic Grade 2 to 3 skin and subcutaneous tissue toxicities were reported in 4.4% and 13.7% of patients, respectively. Conclusions: Prone position breast radiation results in similar long-term disease control with a favorable toxicity profile compared with standard supine tangents. The anatomic advantages of prone positioning may contribute to improving the therapeutic ratio of post-lumpectomy radiation by improving dose homogeneity and minimizing incidental cardiac and lung dose

  12. Impact of positive and negative lesion site remodeling on clinical outcomes: insights from PROSPECT.

    Science.gov (United States)

    Inaba, Shinji; Mintz, Gary S; Farhat, Naim Z; Fajadet, Jean; Dudek, Dariusz; Marzocchi, Antonio; Templin, Barry; Weisz, Giora; Xu, Ke; de Bruyne, Bernard; Serruys, Patrick W; Stone, Gregg W; Maehara, Akiko

    2014-01-01

    This study investigated coronary artery remodeling patterns associated with clinical outcomes. In the prospective, multicenter PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree: An Imaging Study in Patients With Unstable Atherosclerotic Lesions) study, reported predictors of nonculprit lesion (NCL) major adverse cardiac events (MACE) were an intravascular ultrasound (IVUS) minimal lumen area (MLA) ≤4 mm(2), a plaque burden ≥70%, and a IVUS-virtual histology (VH) thin-cap fibroatheroma (TCFA), but not lesion site remodeling. Overall, 697 consecutive patients with an acute coronary syndrome were enrolled and underwent 3-vessel gray-scale and IVUS-VH; 3,223 NCLs were identified by IVUS. The remodeling index (RI) was calculated as the external elastic membrane area at the MLA site divided by the average of the proximal and distal reference external elastic membrane areas. First, one third of the patients were randomly selected to determine RI cutoffs related to NCL MACE (development cohort). Receiver-operating characteristic analysis showed that there were 2 separate cut points that predicted NCL MACE: RI = 0.8789 and RI = 1.0046 (area under the curve = 0.663). These cut points were used to define negative remodeling as an RI 1.00. Second, we used the remaining two-thirds of patients to validate these cut points with respect to lesion morphology and clinical outcomes (validation cohort). Kaplan-Meier curve analysis in the validation cohort showed that NCL MACE occurred more frequent (and equally) in negative and positive remodeling lesions compared with intermediate remodeling lesions. In this cohort, negative remodeling lesions had the smallest MLA, positive remodeling lesions had the largest plaque burden, and VH TCFA, especially VH TCFA with multiple necrotic cores, was most common in negatively remodeling lesions. The present study showed the novel concept that positive and negative lesion site remodeling was

  13. Young Investigator Perspectives. Teaching and the postdoctoral experience: impact on transition to faculty positions.

    Science.gov (United States)

    Uno, Jennifer; Walton, Kristen L W

    2014-05-01

    This editorial continues with our Young Investigator Perspectives series. Drs. Uno and Walton are young investigators who hold faculty positions. They completed a K12 postdoctoral program through the IRACDA (Individual Research and Career Development Award) program sponsored through the NIGMS institute at NIH. IRACDA programs exist at multiple institutions in the USA to combine postdoctoral training with formal training in academic skills and teaching at partner institutions. I thank Drs. Walton and Uno for a thoughtful perspective on how this experience shaped their career goals to combine teaching and research and inspire undergraduates to science careers. Given the current national dialog on broadening career paths and outcomes for PhD scientists, this is a timely perspective. -P. Kay Lund.

  14. Clinical condition and comorbidity as determinants for blood culture positivity in patients with skin and soft-tissue infections

    NARCIS (Netherlands)

    van Daalen, F. V.; Kallen, M. C.; van den Bosch, C. M. A.; Hulscher, M. E. J. L.; Geerlings, S. E.; Prins, J. M.

    2017-01-01

    The utility of performing blood cultures in patients with a suspected skin infection is debated. We investigated the association between blood culture positivity rates and patients' clinical condition, including acute disease severity and comorbidity. We performed a retrospective study, including

  15. Position Statement on the management of continuous subcutaneous insulin infusion (CSII): The Italian Lazio experience.

    Science.gov (United States)

    Maurizi, Anna R; Suraci, Concetta; Pitocco, Dario; Schiaffini, Riccardo; Tubili, Claudio; Morviducci, Lelio; Giordano, Renato; Manfrini, Silvia; Lauro, Davide; Frontoni, Simona; Pozzilli, Paolo; Buzzetti, Raffaella

    2016-01-01

    This document has been developed by a group of Italian diabetologists with extensive experience in continuous subcutaneous insulin infusion (CSII) therapy to provide indications for the clinical management of CSII in diabetic patients (both type 1 and type 2) based on delivery mode operating in Italy. Although the potential benefits of pump therapy in achieving glycemic goals is now accepted, such results cannot be obtained without specific knowledge and skills being conveyed to patients during ad hoc educational training. To ensure that these new technologies reach their full effectiveness, as demonstrated theoretically and clinically, a careful assessment of the overall therapeutic and educational process is required, in both qualitative and quantitative terms. Therefore, to ensure the cost-effectiveness of insulin pump therapy and to justify reimbursement of therapy costs by the National Health System in Italy, in this article we present a model for diabetes and healthcare centers to follow that provides for different levels of expertise in the field of CSII therapy. This model will guarantee the provision of excellent care during insulin pump therapies, thus representing the basis for a successful outcome and expansion of this form of insulin treatment in patients with diabetes while also keeping costs under control. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  16. Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant.

    Science.gov (United States)

    Sluch, Ilya; Gudgel, Brett; Dvorak, Justin; Anne Ahluwalia, Mary; Ding, Kai; Vold, Steve; Sarkisian, Steven

    2017-01-01

    To evaluate the safety and efficacy of the M4 (porous polyethylene plate) Ahmed Glaucoma Valve (AGV) drainage implant in a multicenter retrospective study. A retrospective chart review of medical records of patients who had undergone the M4 Ahmed valve was performed from January 2013 to April 2015. The primary outcome measure was surgical failure defined as: Less than a 20% reduction in baseline intraocular pressure (IOP) to last follow-up visit, final IOP less than 5 mm Hg or greater than 18 mm Hg, reoperation for glaucoma, or loss of light perception vision. All eyes not meeting the above criteria were defined as success. A total of 291 eyes met all study inclusion criteria. The average follow-up in the study was 6 months (±7.6 months) with 112 patients achieving 12-month follow-up (38.5%). 208 eyes (71.5%) met the study success criteria at final follow-up. No statistically significant spikes in postoperative IOP at 1 and 4 months were detected. The average preoperative IOP was 26.0 on an average of 2.8 medications. At 6 months, the average IOP dropped to 16.7 on 0.9 medications and stayed relatively stable at 15.8 on 1.2 medications at 12-month follow-up. The M4 valve appears to have less of a hypertensive phase compared with the other Ahmed class valves with a similar safety profile. While 71.5% success rate was achieved at final follow-up, the failure rate steadily increased over time. While the M4 production has been discontinued, the porous design of the M4 may avoid a pressure spike in the Ahmed valve class and warrants future investigation for valve design. How to cite this article: Sluch I, Gudgel B, Dvorak J, Ahluwalia MA, Ding K, Vold S, Sarkisian S. Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant. J Curr Glaucoma Pract 2017;11(3):92-96.

  17. Aggressiveness, social support and school experiences as dimensions differentiating negative and positive adaptation among adolescents

    Directory of Open Access Journals (Sweden)

    Marzanna Agnieszka Farnicka

    2017-10-01

    Full Text Available Background The study results presented below lie within a field of study which seeks to identify appropriate risk indicators for risky behaviours in the group of adolescents. The study drew on the tenets of developmental psychopathology. Adaptation assessment was performed on the basis of an objective indicator which comprised adolescents’ problems with social functioning. Participants and procedure The main determinants of the observed changes in behaviour and the development of adaptation pathways during the period of adolescence were considered to include bio-psycho-social temperamental factors (Buss & Plomin, 1984, attachment patterns (Armsden & Greenberg, 1987, trait of aggressiveness (Buss & Perry, 1992, conditions created by the environment (support of family members, peers and teachers [Malecki & Demaray, 2002] as well as previous experiences such as being a victim of violence (Osterman & Bjorqvist, 2008 or the level of school success. The final study group comprised a total of 140 positively and 140 negatively adapted teenagers (N = 280 between the ages of 12 and 19. The study was carried out in Poland. Results The study confirmed the gender effect, demonstrating a higher frequency of involvement in risky behaviours among boys. The results from searching for differences between positively and negatively adapted teens showed that in the negatively adapted group there were lower grades at school and more frequent aggressive behaviour. Conclusions The main conclusion that can be drawn from the study is that the potential prophylactic and therapeutic interventions require consideration of factors such as age, educational success, aggressiveness and social support.

  18. Hierarchy and health: Physiological effects of interpersonal experiences associated with socioeconomic position.

    Science.gov (United States)

    Cundiff, Jenny M; Smith, Timothy W; Baron, Carolynne E; Uchino, Bert N

    2016-04-01

    The inverse association between socioeconomic position (SEP) and cardiovascular disease may involve social psychophysiological processes. To test effects of aspects of SEP on physiological reactivity, we experimentally manipulated 3 features of social context related to social hierarchy-social rank or status relative to an interaction partner, the partner's degree of dominant behavior, and the presence of social-evaluative threat. The study design was a 2 × 2 × 2 × 2 (Participant Relative Status [high vs. low] × Partner Dominance [high vs. low] × Evaluative Threat [high vs. low] × Sex [male vs. female]) factorial, and 180 undergraduates participated. Cardiovascular and salivary cortisol responses were measured while participants engaged in a controlled interaction task with a prerecorded confederate partner. Lower participant relative status resulted in greater increases in systolic (SBP) and diastolic blood pressure (DBP). Interacting with a more dominant partner resulted in greater increases in SBP and heart rate (HR), and larger changes in cardiac sympathetic and parasympathetic activation. Higher levels of social-evaluative threat evoked larger increases in HR and SBP. In some cases, these effects were stronger in men than in women, and aspects of the low status social context had synergistic effects on some physiological outcomes. Interpersonal interactions and experiences may contribute to the association between SEP and cardiovascular health through the mechanism of physiological activation. Recurring patterns of everyday social experiences and their physiological effects may be a pathway linking the broader social context to cardiovascular disease. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  19. Vantage Sensitivity: Environmental Sensitivity to Positive Experiences as a Function of Genetic Differences.

    Science.gov (United States)

    Pluess, Michael

    2017-02-01

    A large number of gene-environment interaction studies provide evidence that some people are more likely to be negatively affected by adverse experiences as a function of specific genetic variants. However, such "risk" variants are surprisingly frequent in the population. Evolutionary analysis suggests that genetic variants associated with increased risk for maladaptive development under adverse environmental conditions are maintained in the population because they are also associated with advantages in response to different contextual conditions. These advantages may include (a) coexisting genetic resilience pertaining to other adverse influences, (b) a general genetic susceptibility to both low and high environmental quality, and (c) a coexisting propensity to benefit disproportionately from positive and supportive exposures, as reflected in the recent framework of vantage sensitivity. After introducing the basic properties of vantage sensitivity and highlighting conceptual similarities and differences with diathesis-stress and differential susceptibility patterns of gene-environment interaction, selected and recent empirical evidence for the notion of vantage sensitivity as a function of genetic differences is reviewed. The unique contribution that the new perspective of vantage sensitivity may make to our understanding of social inequality will be discussed after suggesting neurocognitive and molecular mechanisms hypothesized to underlie the propensity to benefit disproportionately from benevolent experiences. © 2015 Wiley Periodicals, Inc.

  20. Effect of radiologist experience on the risk of false-positive results in breast cancer screening programs

    International Nuclear Information System (INIS)

    Zubizarreta Alberdi, Raquel; Llanes, Ana B.F.; Ortega, Raquel Almazan; Exposito, Ruben Roman; Collado, Jose M.V.; Oliveres, Xavier Castells; Queiro Verdes, Teresa; Natal Ramos, Carmen; Sanz, Maria Ederra; Salas Trejo, Dolores

    2011-01-01

    To evaluate the effect of radiologist experience on the risk of false-positive results in population-based breast cancer screening programmes. We evaluated 1,440,384 single-read screening mammograms, corresponding to 471,112 women aged 45-69 years participating in four Spanish programmes between 1990 and 2006. The mammograms were interpreted by 72 radiologists. The overall percentage of false-positive results was 5.85% and that for false-positives resulting in an invasive procedure was 0.38%. Both the risk of false-positives overall and of false-positives leading to an invasive procedure significantly decreased (p 14,999 mammograms with respect to the reference category (<500). The risk of both categories of false-positives was also significantly reduced (p < 0.001) as radiologists' years of experience increased: OR 0.96 and OR 0.84, respectively, for 1 year's experience and OR 0.72 and OR 0.73, respectively, for more than 4 years' experience with regard to the category of <1 year's experience. Radiologist experience is a determining factor in the risk of a false-positive result in breast cancer screening. (orig.)

  1. How to Conduct Clinical Qualitative Research on the Patient's Experience

    Science.gov (United States)

    Chenail, Ronald J.

    2011-01-01

    From a perspective of patient-centered healthcare, exploring patients' (a) preconceptions, (b) treatment experiences, (c) quality of life, (d) satisfaction, (e) illness understandings, and (f) design are all critical components in improving primary health care and research. Utilizing qualitative approaches to discover patients' experiences can…

  2. [Clinical research of using optimal compliance to determine positive end-expiratory pressure].

    Science.gov (United States)

    Xu, Lei; Feng, Quan-sheng; Lian, Fu; Shao, Xin-hua; Li, Zhi-bo; Wang, Zhi-yong; Li, Jun

    2012-07-01

    To observe the availability and security of optimal compliance strategy to titrate the optimal positive end-expiratory pressure (PEEP), compared with quasi-static pressure-volume curve (P-V curve) traced by low-flow method. Fourteen patients received mechanical ventilation with acute respiratory distress syndrome (ARDS) admitted in intensive care unit (ICU) of Tianjin Third Central Hospital from November 2009 to December 2010 were divided into two groups(n = 7). The quasi-static P-V curve method and the optimal compliance titration were used to set the optimal PEEP respectively, repeated 3 times in a row. The optimal PEEP and the consistency of repeated experiments were compared between groups. The hemodynamic parameters, oxygenation index (OI), lung compliance (C), cytokines and pulmonary surfactant-associated protein D (SP-D) concentration in plasma before and 2, 4, and 6 hours after the experiment were observed in each group. (1) There were no significant differences in gender, age and severity of disease between two groups. (2)The optimal PEEP [cm H(2)O, 1 cm H(2)O=0.098 kPa] had no significant difference between quasi-static P-V curve method group and the optimal compliance titration group (11.53 ± 2.07 vs. 10.57 ± 0.87, P>0.05). The consistency of repeated experiments in quasi-static P-V curve method group was poor, the slope of the quasi-static P-V curve in repeated experiments showed downward tendency. The optimal PEEP was increasing in each measure. There was significant difference between the first and the third time (10.00 ± 1.58 vs. 12.80 ± 1.92, P vs. 93.71 ± 5.38, temperature: 38.05 ± 0.73 vs. 36.99 ± 1.02, IL-6: 144.84 ± 23.89 vs. 94.73 ± 5.91, TNF-α: 151.46 ± 46.00 vs. 89.86 ± 13.13, SP-D: 33.65 ± 8.66 vs. 16.63 ± 5.61, MAP: 85.47 ± 9.24 vs. 102.43 ± 8.38, CCI: 3.00 ± 0.48 vs. 3.81 ± 0.81, OI: 62.00 ± 21.45 vs. 103.40 ± 37.27, C: 32.10 ± 2.92 vs. 49.57 ± 7.18, all P safety and usability.

  3. The contribution of Multi-GNSS Experiment (MGEX) to precise point positioning

    Science.gov (United States)

    Guo, Fei; Li, Xingxing; Zhang, Xiaohong; Wang, Jinling

    2017-06-01

    In response to the changing world of GNSS, the International GNSS Service (IGS) has initiated the Multi-GNSS Experiment (MGEX). As part of the MGEX project, initial precise orbit and clock products have been released for public use, which are the key prerequisites for multi-GNSS precise point positioning (PPP). In particular, precise orbits and clocks at intervals of 5 min and 30 s are presently available for the new emerging systems. This paper investigates the benefits of multi-GNSS for PPP. Firstly, orbit and clock consistency tests (between different providers) were performed for GPS, GLONASS, Galileo and BeiDou. In general, the differences of GPS are, respectively, 1.0-1.5 cm for orbit and 0.1 ns for clock. The consistency of GLONASS is worse than GPS by a factor of 2-3, i.e. 2-4 cm for orbit and 0.2 ns for clock. However, the corresponding differences of Galileo and BeiDou are significantly larger than those of GPS and GLONASS, particularly for the BeiDou GEO satellites. Galileo as well as BeiDou IGSO/MEO products have a consistency of 0.1-0.2 m for orbit, and 0.2-0.3 ns for clock. As to BeiDou GEO satellites, the difference of their orbits reaches 3-4 m in along-track, 0.5-0.6 m in cross-track, and 0.2-0.3 m in the radial directions, together with an average RMS of 0.6 ns for clock. Furthermore, the short-term stability of multi-GNSS clocks was analyzed by Allan deviation. Results show that clock stability of the onboard GNSS is highly dependent on the satellites generations, operational lifetime, orbit types, and frequency standards. Finally, kinematic PPP tests were conducted to investigate the contribution of multi-GNSS and higher rate clock corrections. As expected, the positioning accuracy as well as convergence speed benefit from the fusion of multi-GNSS and higher rate of precise clock corrections. The multi-GNSS PPP improves the positioning accuracy by 10-20%, 40-60%, and 60-80% relative to the GPS-, GLONASS-, and BeiDou-only PPP. The usage of 30 s

  4. American Society of Clinical Oncology position statement on obesity and cancer.

    Science.gov (United States)

    Ligibel, Jennifer A; Alfano, Catherine M; Courneya, Kerry S; Demark-Wahnefried, Wendy; Burger, Robert A; Chlebowski, Rowan T; Fabian, Carol J; Gucalp, Ayca; Hershman, Dawn L; Hudson, Melissa M; Jones, Lee W; Kakarala, Madhuri; Ness, Kirsten K; Merrill, Janette K; Wollins, Dana S; Hudis, Clifford A

    2014-11-01

    Rates of obesity have increased significantly over the last three decades in the United States and globally. In addition to contributing to heart disease and diabetes, obesity is a major unrecognized risk factor for cancer. Obesity is associated with worsened prognosis after cancer diagnosis and also negatively affects the delivery of systemic therapy, contributes to morbidity of cancer treatment, and may raise the risk of second malignancies and comorbidities. Research shows that the time after a cancer diagnosis can serve as a teachable moment to motivate individuals to adopt risk-reducing behaviors. For this reason, the oncology care team--the providers with whom a patient has the closest relationships in the critical period after a cancer diagnosis--is in a unique position to help patients lose weight and make other healthy lifestyle changes. The American Society of Clinical Oncology is committed to reducing the impact of obesity on cancer and has established a multipronged initiative to accomplish this goal by 1) increasing education and awareness of the evidence linking obesity and cancer; 2) providing tools and resources to help oncology providers address obesity with their patients; 3) building and fostering a robust research agenda to better understand the pathophysiology of energy balance alterations, evaluate the impact of behavior change on cancer outcomes, and determine the best methods to help cancer survivors make effective and useful changes in lifestyle behaviors; and 4) advocating for policy and systems change to address societal factors contributing to obesity and improve access to weight management services for patients with cancer. © 2014 by American Society of Clinical Oncology.

  5. Position paper for health authorities: archived clinical pathology data-treasure to revalue and appropriate.

    Science.gov (United States)

    Nwose, E U; Richards, R S; Butkowski, E; Cann, Nathan

    2010-12-01

    Archived clinical pathology data (ACPD) is recognized as useful for research. Given our privileged de-identified ACPD from South West Pathology Service (SWPS), attempt is made to estimate what it would cost any researcher without such privilege to generate the same data. The Ethics Committee of the Area Health Service approved a request for Dr. Uba Nwose to use de-identified ACPD acquired by the SWPS for clinical laboratory-based translational biomedical science research. 10-years (1999-2008) have been pooled to constitute the database. Data include blood sugar, cholesterol, D-dime, ESR, glucose tolerance, haematocrit, HbA 1 c, homocysteine, serum creatinine, total protein and vitamins [C & E] amongst others. For this report, the bulk-billed-cost of tests were estimated based on number and unit price of each test performed. AU$ 17,507,136.85 is the cost paid by Medicare in the period. This amount is a conservative estimate that could be spent to generate such 10-years data in the absence of ACPD. The health/pathology service has not given any financial research grant. However, the support-in-kind is worth more than celebrated competitive research grants. It calls for revaluatrion by academic, research and scientific institutions the use ofACPD. For the countries where such provision is non-existent, this report provides a 'Position Paper' to present to the directorates or institutes of health authorities to appropriate the value of ACPD and approve of their use as a research treasure and resource management tool.

  6. H. Pylori Positivity and Various Pathological, Endoscopic and Clinical Features Correlated with Each Other

    International Nuclear Information System (INIS)

    Coskun, A.; Yukselen, V.; Yasa, M. H.; Karaoglu, A. O.; Meteoglu, I.; Ergin, F.; Kadikoylu, G.

    2015-01-01

    Objective: To investigate the relationship between dyspepsia symptom scores and endoscopic appearances, and histopathological findings and helicobacter pylori positivity in patients having dyspepsia symptom. Methods: The study was conducted at the gastroenterology outpatient clinic of Adnan Menderes University, School of Medicine, Aydin, Turkey from April 2012 to July 2012 and comprised patients between 18-65 years of age who were admitted with dyspepsia. Glasgow dyspepsia severity scoring was done with questions posed orally to the patients. In histopathological evaluation of biopsy specimens according to Sydney criteria, chronic inflammation, activity, atrophy, intestinal metaplasia and helicobacter pylori parameters were used. Total number of eosinophils and number of mast cells were recorded. Results: Of the 60 patients with dyspepsia, 38(63.3 percent) were female and 22(36.7 percent) were male. The degree of activation and severity of inflammation increased significantly with increasing helicobacter pylori positivity(r=0.459'p<0.0001; r=0.475'p<0.0001). A significant relationship was found between inflammation, activation and the number of mast cells (p<0.05).There was no relationship between helicobacter pylori intensity and the eosinophil count (r=0.171; p=0.093). There was also a statistically significant correlation between severity of inflammation and activation and the number of eosinophils (r=0.313;p=0.002;r=0.245;p=0.016). Conclusion: Mast cell density was seen to have a role in the inflammatory processes of helicobacter pylori infection. (author)

  7. The experience of clinical supervision for nurses and healthcare assistants in a secure adolescent service: Affecting service improvement.

    Science.gov (United States)

    McCarron, R H; Eade, J; Delmage, E

    2018-04-01

    2013, HCAs and nurses in a secure adolescent service were surveyed about clinical supervision. Forty-nine HCAs and 20 nurses responded. In 2014, interventions to facilitate supervision were introduced. In 2016, the study was repeated. Forty HCAs and 30 nurses responded. Responses were analysed using a mixed methods approach. Results Significantly more HCAs found supervision to be a positive experience in 2016, and both nurses and HCAs reported significantly fewer challenges in accessing supervision. HCAs and nurses understood the value of clinical supervision. Discussion Significant improvements in the experience of clinical supervision were achieved following increased staff awareness, multidisciplinary and group supervision, and recording supervision rates. HCAs and nurses understood the consequences of inadequate supervision. Implications for practice Organizations could adopt the interventions to facilitate clinical supervision. Supervision should not be overlooked for HCAs. © 2017 John Wiley & Sons Ltd.

  8. Clinical and laboratory experience of chorionic villous sampling in ...

    African Journals Online (AJOL)

    2013-12-14

    Dec 14, 2013 ... clinical and laboratory procedures, including general characteristics of women, indications and outcome, .... quality assurance, accuracy and reliability of results. ... controls for confirmation of results, while negative control.

  9. TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

    Directory of Open Access Journals (Sweden)

    O. V. Gaisenok

    2014-01-01

    Full Text Available Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

  10. Clinical-radiological experiences in patients with hypertrophic cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Hofmann, A; Bonse, G; Beck, B; Sauter, E; Sundermeyer, R; Gunkel, L V

    1986-09-01

    The hypertrophic cardiomyopathy shows a series of interesting clinical and radiological problems, discussed in case of selected patients. A special difficult problem arises in the differential diagnosis of hypertrophic cardiomyopathy and cardiac disease secondary to systemic hypertension.

  11. Perampanel for focal epilepsy: insights from early clinical experience

    OpenAIRE

    Trinka, E.; Steinhoff, B. J.; Nikanorova, M.; Brodie, M. J.

    2015-01-01

    Perampanel is approved for adjunctive therapy of focal epilepsy with or without secondarily generalized seizures in patients aged >12 years. This narrative review uses real-world and clinical trial data to elucidate perampanel's role in the clinic. Audit data show good tolerability with perampanel and higher freedom-from-seizure rates in elderly vs younger patients. When using perampanel in elderly patients, special attention should be given to comorbidities and co-medication to avoid potenti...

  12. Developing a leadership pipeline: the Cleveland Clinic experience

    OpenAIRE

    Hess, Caryl A.; Barss, Christina; Stoller, James K.

    2014-01-01

    The complexity of health care requires excellent leadership to address the challenges of access, quality, and cost of care. Because competencies to lead differ from clinical or research skills, there is a compelling need to develop leaders and create a talent pipeline, perhaps especially in physician-led organizations like Cleveland Clinic. In this context, we previously reported on a cohort-based physician leadership development course called Leading in Health Care and, in the current report...

  13. [Clinical study of aged patients with secondary benign paroxysmal positional vertigo].

    Science.gov (United States)

    Zhu, Z J; Wei, L P; Xu, Z X; Xu, H J; Liu, Q; Luo, N

    2017-09-07

    Objective: To investigate the clinical features and evaluate the efficacy of manual reduction in treatment of age patients with secondary benign paroxysmal positional vertigo (s-BPPV). Methods: Thirty-two cases of aged patients ( the s-BPPV group: including 19 cases of female and 13 males, age from 60 to 86 years old)with secondary benign paroxysmal positional vertigo from Jul. 2013 to Sep. 2015 in our hospital were retrospectively analyzed. The results were compared with 121 patients( the primary group: including 82 cases of female and 39males, aged from 60 to 86 years old)with aged primary benign paroxysmal positional vertigo(p -BPPV). All the patients were followed up for 12 months. Statistical data analysis was carried out with SPSS 19.0. Results: 20.92%(32/153)of all the observed elderly patients with BPPV was the aged s-BPPV. The sex ratio and onset age had no significant difference between the two groups(χ(2)=0.79, P >0.05; t =0.37, P >0.05). The rate of two or more semicircular canal involvement in the secondary group(21.88%) was higher than that in primary group(6.61%)(χ(2)=6.67, P manual reduction was 57.50%(23/40)in secondary group and 82.31%(107/130)in primary group, the difference was significant(χ(2)=10.46, P manual reduction in secondary group and 91.54%(119/130) in primary group, the difference was not significant(χ(2)= 0.59, P >0.05). The numbers of circulation of the first successful manual reduction management were (3.9±1.3)times in secondary group and (2.1±1.1)times in primary group, the difference was significant( t =3.15, P manual reduction of secondary BPPV is lower than primary BPPV, it's needed more circulation of first success in manual reduction management. The total effective rates are not significant in two groups and recurrence rate is relatively high in secondary group.

  14. Small bowel lymphangiectasia and angiodysplasia: a positive association; novel clinical marker or shared pathophysiology?

    Science.gov (United States)

    Macdonald, Jonathan; Porter, Victoria; Scott, Neil W; McNamara, Deirdre

    2010-10-01

    Small bowel angiodysplasia accounts for 30 to 40% of cases of obscure gastrointestinal bleeding and is associated with significant morbidity and mortality. Identifying lesions can be difficult. Small bowel capsule endoscopy (SBCE) is a significant advance on earlier diagnostic techniques. The cause of angiodysplasia is unknown and the natural history poorly understood. Many lesions are thought to arise from a degenerative process associated with ageing, local vascular anomalies, and tissue hypoxia. Nonpathologic lymphangiectasias are commonly seen throughout the small bowel and are considered a normal finding. To determine whether there is an association between lymphangiectasias, angiodysplasia, and atherosclerosis related conditions. Relevant information was collected from a dedicated SBCE database. Logistic regression analysis was used to examine associations between angiodysplasia, lymphangiectasia, patient demographics, and comorbidity. In all, 180 patients underwent SBCE during the study period, 46 (25%) had angiodysplasia and 47 (26%) lymphangiectasia. Lymphangiectasia were seen in 24 (52%) of 46 with angiodysplasia, in 16 (19%) of 84 with obscure gastrointestinal bleeding without angiodysplasia and in 7 (14%) of 50 without gastrointestinal bleeding. Logistic regression analysis confirmed a strong positive association between angiodysplasia and lymphangiectasia; odds ratio 4.42, PLymphangiectasia are strongly associated with the presence of small intestinal angiodysplasia and may represent a useful clinical marker for this condition. Angiodysplasia are also associated with increasing age. Conditions associated with systemic atherosclerosis did not increase the risk of angiodysplasia.

  15. Surgical templates for dental implant positioning; current knowledge and clinical perspectives

    Directory of Open Access Journals (Sweden)

    Mohammed Zaheer Kola

    2015-01-01

    Full Text Available Dental implants have been used in a variety of different forms for many years. Since the mid-20 th century, there has been an increase in interest in the implant process for the replacement of missing teeth. Branemark was one of the initial pioneers who applied scientifically based research techniques to develop an endosseous implant that forms an immobile connection with bone. The need for a dental implant to completely address multiple physical and biological factors imposes tremendous constraints on the surgical and handling protocol. Metallic dental implants have been successfully used for decades, but they have serious shortcomings related to their bony union and the fact that their mechanical properties do not match those of bone. However, anatomic limitation and restorative demands encourage the surgeon to gain precision in planning and surgical positioning of dental implants. Ideal placement of the implant facilitates the establishment of favorable forces on the implants and the prosthetic component as well as ensures an aesthetic outcome. Therefore, it is advisable to establish a logical continuity between the planned restoration and the surgical phases, it is essential to use a transfer device that for sure increases the predictability of success. The surgical guide template is fabricated by a dental technician after the presurgical restorative appointments that primarily include determination of occlusal scheme and implant angulations. Here, authors genuinely attempted to review the evolution and clinical applicability of surgical templates used in the placement of dental implants.

  16. Undergraduate nursing students' experience related to their clinical learning environment and factors affecting to their clinical learning process.

    Science.gov (United States)

    Arkan, Burcu; Ordin, Yaprak; Yılmaz, Dilek

    2018-03-01

    Clinical education is an essential part of nursing education. The purpose of this study was to explore nurse students' experiences related to cinical learning environments, factors effecting to clinical learning process. Descriptive qualitative design was used in this study, and data were collected from 2nd class nursing student (n = 14). The study took the form of in-depth interviews between August-October 2015. The qualitative interviews were analyzed by using simple content analysis. Data were analyzed manually. Experiences nurse students are described five themes. The themes of the study are (1) effecting persons to clinical learning, (2) educational atmosphere, (3) students' personal charactering, (4) the impact of education in school, and (5) students' perceptions related to clinical learning. Participants stated that they experienced many difficulties during clinical learning process. All students importantly stated that nurse teacher is very effecting to clinical learning. This study contributes to the literature by providing data on beginner nursing student' experiences about clinical learning process. The data of this present study show to Turkish nursing student is affecting mostly from persons in clinical learning. The data of this present study will guide nurse teacher when they plan to interventions to be performed to support student during clinical learning process. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Junior physicians' workplace experiences in clinical fields in German-speaking Switzerland.

    Science.gov (United States)

    Buddeberg-Fischer, Barbara; Klaghofer, Richard; Abel, Thomas; Buddeberg, Claus

    2005-01-08

    To date, there have been several prospective cohort studies investigating the workplace experiences of junior physicians, but with limited focus on gender issues. The objective of the present study is to explore the workplace experiences of first-year residents according to gender, type of training hospital, and clinical field. Data reported are from the second assessment of the longitudinal Swiss physicians' career development study, begun in 2001. In 2003, 497 residents (54.7% females, 45.3% males) assessed their workplace conditions, social support at work, and effort-reward imbalance. There are few, but relevant, gender related differences in workplace experiences, with female physicians experiencing less mentoring and higher over-commitment, yet more positive social relationships at work. In a multivariate model, significant differences in some workplace variables with regard to type of training hospital and/or clinical field are found: workplace conditions are rated worse in type "A" hospitals (university and cantonal hospitals) than in type "B"/"C"/"D" hospitals (regional hospitals and highly specialised units), and in surgical fields than in internal medicine. In "A" hospitals mentoring is assessed as better, but positive social relationships as worse. Both scales are rated worse in surgical fields than in internal medicine. The effort-reward imbalance (ERI) is rated significantly higher (unfavourable) in "A" hospitals than in "B"/"C"/"D" hospitals, regardless of gender and clinical field. Significantly more subjects with an ERI quotient above 1 (which is unfavourable) work in "A" hospitals, and in surgical fields regardless of hospital type. Of the total sample, 81 subjects (16.3%), 41 males and 40 females, show an ERI quotient above 1. The greater the workload, the worse the rating of workplace conditions, effort-reward imbalance, and over-commitment. Institutional determinants are crucial factors for the workplace experiences and first career steps of

  18. Predictors of experiences of discrimination and positive treatment in people with mental health problems: findings from an Australian national survey.

    Science.gov (United States)

    Reavley, Nicola J; Morgan, Amy J; Jorm, Anthony F

    2017-03-01

    The aim of the study was to assess the factors predicting experiences of avoidance, discrimination and positive treatment in people with mental health problems. In 2014, telephone interviews were carried out with 5220 Australians aged 18+, 1381 of whom reported a mental health problem or scored highly on a symptom screening questionnaire. Questions covered experiences of avoidance, discrimination and positive treatment by friends, spouse, other family, workplace, educational institution and others in the community; as well as disclosure of mental health problems. Avoidance, discrimination and positive treatment scores were calculated by counting the number of domains in which each occurred. Predictors of avoidance, discrimination and positive treatment were modelled with negative binomial regression analyses. After adjusting for the effects of other predictors in multivariate analyses, symptom severity and a diagnosis of 'any other disorder' (most commonly psychotic disorders or eating disorders) predicted experiences of both avoidance and discrimination but not positive treatment. Disclosing a mental health problem in more settings was also associated with higher rates of avoidance and discrimination, but also with positive treatment. Disclosure of mental health problems to others may increases experiences of discrimination, but may also increase experiences of positive treatment. These findings can help to inform decision making by people with mental health problems about disclosure, particularly in the case of more severe or low-prevalence disorders.

  19. Clinical interdisciplinary health team care: an educational experiment.

    Science.gov (United States)

    Mazur, H; Beeston, J J; Yerxa, E J

    1979-09-01

    With increasing concern for teamwork in clinical practice in health care settings, the need to identify the concepts, methods, and learning processes for improving interdisciplinary team skills is apparent. This paper describes patient-centered, clinical-research-demonstration programs for teams of students, preceptors, and faculty members from six disciplines who provided patient care in a long-term rehabilitation setting. The teams were involved in the theory and practice of team-building, including weekly sessions on leadership styles, communication, group decision-making, and team effectiveness assessment. Objective and subjective measurements were administered throughout the program. The results indicate that task-oriented patient care favors the learning of team skills, especially when all levels of administration support and participate in the processes. Question are raised concerning the effect of clinical teams on the quality of patient care, their cost-effectiveness, and the low priority given to teaching interdisciplinary team skills in professional education.

  20. Job stress, occupational position and gender as factors differentiating workplace bullying experience

    Directory of Open Access Journals (Sweden)

    Marcin Drabek

    2013-06-01

    Full Text Available Background: The results of our research broaden the knowledge concerning the correlates of mobbing. The study is aimed at finding out whether an employee's gender, his/her occupational position and level of occupational stress are related to bullying experience. Material and Methods: 1313 employees of a transport company participated in the study. The relationships between gender, occupational position, the level of stress and bullying were analysed. Bullying was measured by the use of the MDM Questionnaire, while work environment was assessed using the Subjective Assessment of Work Questionnaire. Results: It was found that women were generally more exposed to bullying than men (Z = –1.999; p < 0.05. Women experienced more bullying by their colleagues than men did (Z = –2.712; p < 0.01, in particular: bullying by colleagues that destroys the worker's image (Z = –2.922; p < 0.01 and bullying by colleagues that destroys social relations (Z = –3.004; p < 0.01. Individuals with managerial jobs experienced overall bullying (Z = –2.762; p < 0.01, bullying by colleagues (Z = –0.014; p < 0.05 and bullying by colleagues that destroys social relations (Z = –2.260; p < 0.05 more often than the individuals with non-management positions. The results of the study also indicated that employees with higher level of stress in comparison with less stressed co-workers reported more incidents of bullying behaviour (overall bullying – Z = –8.171; p < 0.001, bullying by colleagues – Z = –7.114; p < 0.001, bullying by supervisors – Z = –6.716; p < 0.001, all types of behaviour – p < 0.001. Conclusions: Comparing the results of our study to the previous research, it seems that the pattern of relationships between individual characteristics and bullying is rooted in the wider cultural context, the specificity of the company, its organisational culture as well as its situation. Therefore it's difficult to talk about irrefutable individual

  1. Clinical Experience of the Klippel-Trenaunay Syndrome

    Directory of Open Access Journals (Sweden)

    Hyung Min Sung

    2015-09-01

    Full Text Available BackgroundThe Klippel-Trenaunay syndrome (KTS is characterized by three clinical features, namely cutaneous capillary malformations, venous malformations, and soft tissue and/or bony hypertrophy of the extremities. The varied manifestations are attributed to the unpredictable clinical nature and prognosis of the syndrome. To elucidate the clinical characteristics of this disease, we reviewed a relatively large number of KTS patients who presented to our vascular anomalies center.MethodsWe conducted a retrospective study with 19 patients who were diagnosed with KTS and treated in our vascular anomalies clinic between 2003 and 2014, and examined their demographic characteristics, their clinical features, and the treatments administered.ResultsThe sex distribution was balanced, with 9 (47% males and 10 (53% females. The mean follow-up period was 4.1 years (range, 7 months-9 years. Most of the patients received conservative treatments such as medication or physiotherapy. Compression therapies such as wearing of elastic garments/bandages were also administered, and surgical interventions were considered only when the patients became excessively symptomatic. Other treatments included laser therapy and sclerotherapy, and all the treatments were adjusted according to each case, tailored to the conditions of the individual patients.ConclusionsKTS is an extremely rare, multifactorial disorder that induces widely varied symptoms. Because of this unique feature, plastic surgeons, when not careful, tend to attach a one-sided importance to typical symptoms such as limb hypertrophy or capillary malformation and thus overlook other symptoms and clinical features. KTS can be suspected in all infants who show capillary malformations or limb hypertrophy and require a multi-disciplinary approach for comprehensive management.

  2. [Clinical and monitoring experience of isotretinoin in Italy].

    Science.gov (United States)

    Cavicchini, S; Bottoni, A; Caputo, R

    1989-01-01

    We report the results of a multicentric evaluation on effectiveness and safety of isotretinoin in severe acne, recalcitrant to traditional treatments. 208 patients, suffering especially from cystic acne, have been enrolled in a post-marketing clinical trial in 11 Dermatological Italian Departments. The clinical effectiveness of isotretinoin has been very good in 77% of patients, good in 16% and sufficient in 4%. The tolerability of the drug was considered good in 90% of patients. Finally, isotretinoin might be considered as one of the most effective drugs in the therapy of severe forms of acne, resistant to usual treatment, and often affecting patients on the physical and psychological side.

  3. Laboratory and Clinical features of EIA Toxin-positive and EIA Toxin-negative Community-acquired Clostridium difficile Infection.

    Science.gov (United States)

    Patel, Hiren; Randhawa, Jeewanjot; Nanavati, Sushant; Marton, L Randy; Baddoura, Walid J; DeBari, Vincent A

    2015-01-01

    Studies have described the clinical course of patients with Clostridium difficile infection (CDI) with positive enzyme immunoassay (EIA) for toxins A and B. Limited information is available for the patients with negative EIA but positive for the toxin B gene (TcdB) by the PCR. The aim of our study is to determine if there are any differences that exist among the clinical and laboratory parameters in the patients tested to be positive by EIA for toxin and those who were negative. This is a retrospective cohort study conducted in a 700-bed teaching hospital. We reviewed charts of the patients with presumptive CDI between January 2006 and July 2013. We divided these patients into two groups, EIA-positive and EIA-negative, based on result of EIA for toxins A and B and the requirement for a positive PCR analysis of the TcdB gene. The EIA-positive group had significantly higher white blood cell counts (p<0.001), with a significantly greater percentage of bands (p<0.0001). Albumin and total protein both exhibit significantly (p<0.0001, both comparisons) lower values in the EIA-positive group. Among clinical findings, the EIA-positive group had significantly longer length of hospital stay (p=0.010). These data suggest that an infection with an EIA-negative strain of C. difficile presents laboratory markers closer to those of healthy subjects and clinical features suggesting considerably less severe than infection with EIA-positive C. difficile. © 2015 by the Association of Clinical Scientists, Inc.

  4. Innovation in retail: impact on creating a positive experience when buying fashion products

    Directory of Open Access Journals (Sweden)

    Cristinel Vasiliu

    2015-05-01

    Full Text Available Innovation in fashion retail is critical in order to ensure competitive advantage in a constantly evolving market, in terms of consumer expectations. The modern customer is mobile, permanently connected to the Internet, well-informed about international trends, mindful of the quality of products, but more price sensitive and less loyal to a brand. The shopping experience provided by retailers is a crucial factor in purchase decision, encompassing all these variables in a complex concept of exogenous variable. As retailers’ efforts to provide excellence in shopping experience are focused on operating costs and thus on the profit margins, it is important to consider and identify which are the most relevant variables that form the perception of excellence for Romanian customers, so that retailers can innovate according to their expectations. The purpose of this article was to highlight the role of innovation in creating a positive experience for consumers buying clothes, shoes and accessories. The approach was based on the conduct of exploratory research. The research ? represented by five original objectives and as many different working scenarios ? resulted in the identification of thematic outlined exploratory opinions, exploiting a first investigation of its kind in Romania, less Pearson coefficients used in the analysis of ordinal variables or hierarchical, but quickly assessed using SPSS, version 21. As a pioneering research emphasis was on identifying potential associations and quantified correlations and less on rigorous delimitation of exogenous or endogenous quality in general, leaving room for future studies, sharper and with a higher degree of representation. Thus, we could highlight some useful aspects of the investigated retailers, by the dominant character of interested customers’ opinions according to their volunteer responses. Consumers are accustomed to using the Internet to obtain information; they rarely express opinions on

  5. Learning from clinical placement experience: Analysing nursing students' final reflections in a digital storytelling activity.

    Science.gov (United States)

    Paliadelis, Penny; Wood, Pamela

    2016-09-01

    This paper reports on the learning potential of a reflective activity undertaken by final year nursing students, in which they were asked to recount two meaningful events that occurred during their clinical placements over the duration of their 3-year nursing degree program and reflect on how these events contributed to their learning to become beginning level Registered Nurses (RNs). This descriptive qualitative study gathered narratives from 92 students as individual postings in an online forum created within the University's learning management system. An analysis of the students' reflections are the focus of this paper particularly in relation to the value of reflecting on the identified events. Four themes emerged that clearly highlight the way in which these students interpreted and learned from both positive and negative clinical experiences, their strong desire to fit into their new role and their ability to re-imagine how they might respond to clinical events when they become Registered Nurses. The findings of this study may contribute to developing nursing curricula that better prepares final year students for the realities of practice. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Stressor experience negatively affects life satisfaction in adolescents: the positive role of sense of coherence.

    Science.gov (United States)

    Moksnes, Unni K; Haugan, G

    2015-10-01

    The aim of the present study was to investigate the association between different normative stressors, sense of coherence and life satisfaction separately for gender in Norwegian adolescents. The interaction effect of stress by sense of coherence in relation to life satisfaction was also investigated. The data are based on a cross-sectional sample of 1239 adolescents (13-18 years) from public elementary and secondary schools in Central Norway. Hierarchical multiple regression analysis was used to evaluate the association between stressors, sense of coherence and life satisfaction, separately for gender. The results showed significant differences between genders, where boys reported higher scores than girls on sense of coherence and life satisfaction, whereas girls scored higher than boys on five of seven stressor domains. All stressors were significantly and inversely associated with life satisfaction in both genders; however, all associations were stronger for girls compared to boys. Sense of coherence showed a significant strong and positive association with life satisfaction, controlled for age and each individual stressor. A significant although weak interaction effect of stress related to romantic relationships by sense of coherence was found in association with life satisfaction for boys; the other interaction effects were nonsignificant in both genders. The results give support for a significant unique role of stressor experience and sense of coherence in relation to life satisfaction in both genders during adolescence, where the associations were especially strong in girls.

  7. High-accuracy local positioning network for the alignment of the Mu2e experiment.

    Energy Technology Data Exchange (ETDEWEB)

    Hejdukova, Jana B. [Czech Technical Univ., Prague (Czech Republic)

    2017-06-01

    This Diploma thesis describes the establishment of a high-precision local positioning network and accelerator alignment for the Mu2e physics experiment. The process of establishing new network consists of few steps: design of the network, pre-analysis, installation works, measurements of the network and making adjustments. Adjustments were performed using two approaches. First is a geodetic approach of taking into account the Earth’s curvature and the metrological approach of a pure 3D Cartesian system on the other side. The comparison of those two approaches is performed and evaluated in the results and compared with expected differences. The effect of the Earth’s curvature was found to be significant for this kind of network and should not be neglected. The measurements were obtained with Absolute Tracker AT401, leveling instrument Leica DNA03 and gyrotheodolite DMT Gyromat 2000. The coordinates of the points of the reference network were determined by the Least Square Meth od and the overall view is attached as Annexes.

  8. Sportmen's experiences at a somatology clinic receiving a sport ...

    African Journals Online (AJOL)

    Sportsmen are increasingly visiting somatology clinics for massages prior to an aerobic sports event. Massage is frequently utilised prior to an athletic activity, as a means of enhancing performance. Massage is known to have both calming and stimulating properties, thereby possessing the potential to benefit performance ...

  9. Informed consent in clinical trials: Perceptions and experiences of a ...

    African Journals Online (AJOL)

    It is recommended that more recognition be given to the important role of trial counsellors in clinical trials, and that they be given more formal training, support and ... Daar word aanbeveel dat meer erkenning gegee word aan die rol van proefvoorligters in kliniese proewe, dat hulle meer formele opleiding ondergaan, dat ...

  10. Experiences of health science students during clinical placements at ...

    African Journals Online (AJOL)

    Inadequate supervision and inappropriate behaviours by supervisors were some of the challenges faced. Almost 89% used stress-relieving strategies such as focusing on why they were doing the clinical placement and the importance of successful completion. Ninety-one per cent had never used cannabis/mbanje but 41% ...

  11. Clinical outcome of parotidectomy with reconstruction: Experience of ...

    African Journals Online (AJOL)

    The comprehensive clinical outcome of the malignant cases could not be objectively assessed, as the OS and DFS were 50% at 2-years follow-up. It is our submission that a larger sample size is utilized in subsequent studies and quality of life evaluation is included in the methodology. Keywords: Facial re-animation, neural ...

  12. Managing University Clinical Partnership: Learning from International Experience

    Science.gov (United States)

    Davies, Stephen; Smith, Tom

    2004-01-01

    Dialogue between the leaders of academic clinical organisations in different countries has revealed that the core elements of the partnership between universities and health care systems are remarkably consistent across national boundaries. There is now an impetus to move beyond analysis of common challenges and towards strategies for success that…

  13. Clinical practice experience with testosterone treatment in men with testosterone deficiency syndrome.

    Science.gov (United States)

    McLaren, Drew; Siemens, D Robert; Izard, Jason; Black, Angela; Morales, Alvaro

    2008-11-01

    To report on a clinical practice series of testosterone-replacement therapy (TRT) in men with testosterone deficiency syndrome (TDS), examining clinical efficacy, biochemical parameters and effects on prostate health over a 2-year period. A retrospective review of 85 patients with symptoms of TDS and at least a 3-month trial of TRT was performed in this single-centre, clinical practice setting. Three domains of symptomatology were evaluated: libido, erectile function and energy levels. Symptoms were assessed by a combination of patient reporting, physician's assessment and validated symptom assessment scores. Total testosterone (TT), calculated bio-available testosterone (BT) and prostate-specific antigen (PSA) levels were continuously measured and effects on prostate health were examined. Only 38 (45%) patients in this cohort remained on TRT for >2 years. The most common reason for discontinuing treatment was lack of clinical response but those remaining on TRT had continued improvement in libido, erectile function and energy levels. During treatment, the average TT and calculated BT values significantly increased compared with the baseline values at most of the evaluated time points, with no significant change in average PSA values. In all, 15% of this cohort had some degree of progression of lower urinary tract symptoms. Seven patients had eight 'for-cause' prostate biopsies either during supplementation or at any date after completion, with an only three positive for cancer. Only 45% of men on TRT remained on treatment for >2 years in this clinical practice experience of men with TDS. Those remaining showed persistent improvement in their symptoms. The average TT and BT values increased significantly with no significant change in PSA levels.

  14. Clinical profile of parkinson's disease: Experience of niger

    Directory of Open Access Journals (Sweden)

    Hamid Assadeck

    2018-01-01

    Full Text Available Background: Parkinson's disease (PD is a chronic neurodegenerative pathology with unknown etiology. It is characterized clinically by the classic triad that associated tremors, bradykinesia, and rigidity. In Niger, there are no data on PD. Aims: We aimed to provide the demographic and clinical profile of PD in patients from Niger to create a database on PD in Niger. Patients and Methods: We conducted a retrospective study at the Neurology Outpatient Clinic of the Hôpital National de Niamey (HNN, Niger over a period of 4.42 years from February 2009 to July 2013 collecting all cases of PD. The demographic and clinical features of all patients were collected and analyzed. Results: During the period of the study, 1695 patients consulted at the Neurology Outpatient Clinic of the HNN, among which 76 patients (4.48% had secondary parkinsonism and 25 patients (1.47% had features compatible with PD. Only patients with PD were included in this study. The mean age at onset of symptoms was 58 years (range: 42–74 years. The male sex was predominant (60% with a sex ratio of 1.5. The mean time interval from the onset of symptoms to diagnosis of PD was 1.8 years (range: 1–5 years. The tremor was the most common symptom (84%. Bradykinesia represented 64% of the symptoms and rigidity 20%. At the time of the diagnosis of PD, 8 patients (32% were in Stage I of the classification of Hoehn and Yahr, 16 patients (64% in Stage II, and 1 patient (4% in Stage III. The levodopa/carbidopa combination was the most used antiparkinsonian drug in our patients (88%. The mean time of follow-up of the patients was 2.5 years (range: 1–4.42 years. During the course of the disease, 9 patients (36% were in Stage II of the classification of Hoehn and Yahr, 13 patients (52% in Stage III, and 3 patients (12% in Stage IV. Conclusion: Our study provides demographic and clinical data of PD in patients from Niger and shows that the hospital frequency of this disease is low (1

  15. Rectocele repair using biomaterial augmentation: current documentation and clinical experience.

    Science.gov (United States)

    Altman, Daniel; Mellgren, Anders; Zetterström, Jan

    2005-11-01

    Although the etiology of rectocele remains debated, surgical innovations are currently promoted to improve anatomic outcome while avoiding dyspareunia and alleviating rectal emptying difficulties following rectocele surgery. Use of biomaterials in rectocele repair has become widespread in a short time, but the clinical documentation of their effectiveness and complications is limited. Medline and the Cochrane database were searched electronically from 1964 to May 2005 using the Pubmed and Ovid search engines. All English language publications including any of the search terms "rectocele," "implant," "mesh," "biomaterial," "prolapse," "synthetical," "pelvic floor," "biological," and "compatibility" were reviewed. This review outlines the basic principles for use of biomaterials in pelvic reconstructive surgery and provides a condensation of peer-reviewed articles describing clinical use of biomaterials in rectocele surgery. Historical and new concepts in rectocele surgery are discussed. Factors of importance for human in vivo biomaterial compatibility are presented together with current knowledge from clinical studies. Potential risks and problems associated with the use of biomaterials in rectocele and pelvic reconstructive surgery in general are described. Although use of biomaterials in rectocele and other pelvic organ prolapse surgery offers exciting possibilities, it raises treatment costs and may be associated with unknown and potentially severe complications at short and long term. Clinical benefits are currently unknown and need to be proven in clinical studies. Obstetricians & Gynecologists, Family Physicians After completion of this article, the reader should be able to explain that the objective of surgical treatment is to improve anatomic outcome and alleviate rectal emptying difficulties, describe the efficacy of biomaterials in rectocele repair, and summarize the potential risks and problems associated with use of biomaterials in rectocele and pelvic

  16. Clinical validation of synthetic brain MRI in children: initial experience

    International Nuclear Information System (INIS)

    West, Hollie; Leach, James L.; Jones, Blaise V.; Care, Marguerite; Radhakrishnan, Rupa; Merrow, Arnold C.; Alvarado, Enrique; Serai, Suraj D.

    2017-01-01

    The purpose of this study was to determine the diagnostic accuracy of synthetic MR sequences generated through post-acquisition processing of a single sequence measuring inherent R1, R2, and PD tissue properties compared with sequences acquired conventionally as part of a routine clinical pediatric brain MR exam. Thirty-two patients underwent routine clinical brain MRI with conventional and synthetic sequences acquired (22 abnormal). Synthetic axial T1, T2, and T2 fluid attenuation inversion recovery or proton density-weighted sequences were made to match the comparable clinical sequences. Two exams for each patient were de-identified. Four blinded reviewers reviewed eight patients and were asked to generate clinical reports on each exam (synthetic or conventional) at two different time points separated by a mean of 33 days. Exams were rated for overall and specific finding agreement (synthetic/conventional and compared to gold standard consensus review by two senior reviewers with knowledge of clinical report), quality, and diagnostic confidence. Overall agreement between conventional and synthetic exams was 97%. Agreement with consensus readings was 84% (conventional) and 81% (synthetic), p = 0.61. There were no significant differences in sensitivity, specificity, or accuracy for specific imaging findings involving the ventricles, CSF, brain parenchyma, or vasculature between synthetic or conventional exams (p > 0.05). No significant difference in exam quality, diagnostic confidence, or noise/artifacts was noted comparing studies with synthetic or conventional sequences. Diagnostic accuracy and quality of synthetically generated sequences are comparable to conventionally acquired sequences as part of a standard pediatric brain exam. Further confirmation in a larger study is warranted. (orig.)

  17. Clinical validation of synthetic brain MRI in children: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    West, Hollie; Leach, James L.; Jones, Blaise V.; Care, Marguerite; Radhakrishnan, Rupa; Merrow, Arnold C.; Alvarado, Enrique; Serai, Suraj D. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2017-01-15

    The purpose of this study was to determine the diagnostic accuracy of synthetic MR sequences generated through post-acquisition processing of a single sequence measuring inherent R1, R2, and PD tissue properties compared with sequences acquired conventionally as part of a routine clinical pediatric brain MR exam. Thirty-two patients underwent routine clinical brain MRI with conventional and synthetic sequences acquired (22 abnormal). Synthetic axial T1, T2, and T2 fluid attenuation inversion recovery or proton density-weighted sequences were made to match the comparable clinical sequences. Two exams for each patient were de-identified. Four blinded reviewers reviewed eight patients and were asked to generate clinical reports on each exam (synthetic or conventional) at two different time points separated by a mean of 33 days. Exams were rated for overall and specific finding agreement (synthetic/conventional and compared to gold standard consensus review by two senior reviewers with knowledge of clinical report), quality, and diagnostic confidence. Overall agreement between conventional and synthetic exams was 97%. Agreement with consensus readings was 84% (conventional) and 81% (synthetic), p = 0.61. There were no significant differences in sensitivity, specificity, or accuracy for specific imaging findings involving the ventricles, CSF, brain parenchyma, or vasculature between synthetic or conventional exams (p > 0.05). No significant difference in exam quality, diagnostic confidence, or noise/artifacts was noted comparing studies with synthetic or conventional sequences. Diagnostic accuracy and quality of synthetically generated sequences are comparable to conventionally acquired sequences as part of a standard pediatric brain exam. Further confirmation in a larger study is warranted. (orig.)

  18. An Enzymatic Clinical Chemistry Laboratory Experiment Incorporating an Introduction to Mathematical Method Comparison Techniques

    Science.gov (United States)

    Duxbury, Mark

    2004-01-01

    An enzymatic laboratory experiment based on the analysis of serum is described that is suitable for students of clinical chemistry. The experiment incorporates an introduction to mathematical method-comparison techniques in which three different clinical glucose analysis methods are compared using linear regression and Bland-Altman difference…

  19. Using lean manufacturing principles to evaluate wait times for HIV-positive patients in an urban clinic in Kenya.

    Science.gov (United States)

    Monroe-Wise, Aliza; Reisner, Elizabeth; Sherr, Kenneth; Ojakaa, David; Mbau, Lilian; Kisia, Paul; Muhula, Samuel; Farquhar, Carey

    2017-12-01

    As human immunodeficiency virus (HIV) treatment programs expand in Africa, delivery systems must be strengthened to support patient retention. Clinic characteristics may affect retention, but a relationship between clinic flow and attrition is not established. This project characterized HIV patient experience and flow in an urban Kenyan clinic to understand how these may affect retention. We used Toyota's lean manufacturing principles to guide data collection and analysis. Clinic flow was evaluated using value stream mapping and time and motion techniques. Clinic register data were analyzed. Two focus group discussions were held to characterize HIV patient experience. Results were shared with clinic staff. Wait times in the clinic were highly variable. We identified four main barriers to patient flow: inconsistent patient arrivals, inconsistent staffing, filing system defects, and serving patients out of order. Focus group participants explained how clinic operations affected their ability to engage in care. Clinic staff were eager to discuss the problems identified and identified numerous low-cost potential solutions. Lean manufacturing methodologies can guide efficiency interventions in low-resource healthcare settings. Using lean techniques, we identified bottlenecks to clinic flow and low-cost solutions to improve wait times. Improving flow may result in increased patient satisfaction and retention.

  20. Position sensitive detection coupled to high-resolution time-of-flight mass spectrometry: Imaging for molecular beam deflection experiments

    International Nuclear Information System (INIS)

    Abd El Rahim, M.; Antoine, R.; Arnaud, L.; Barbaire, M.; Broyer, M.; Clavier, Ch.; Compagnon, I.; Dugourd, Ph.; Maurelli, J.; Rayane, D.

    2004-01-01

    We have developed and tested a high-resolution time-of-flight mass spectrometer coupled to a position sensitive detector for molecular beam deflection experiments. The major achievement of this new spectrometer is to provide a three-dimensional imaging (X and Y positions and time-of-flight) of the ion packet on the detector, with a high acquisition rate and a high resolution on both the mass and the position. The calibration of the experimental setup and its application to molecular beam deflection experiments are discussed

  1. Development of Methods for Obtaining Position Image and Chemical Binding Information from Flow Experiments of Porous Media

    Energy Technology Data Exchange (ETDEWEB)

    Haugan, Are

    1998-12-01

    Existing oil reservoirs might be more fully exploited if the properties of the flow of oil and water in porous media were better known. In laboratory experiments it is important to collect as much information as possible to make a descriptive model of the system, including position imaging and chemical binding information. This thesis develops nuclear methods for obtaining position image and chemical binding information from flow experiments of porous media. A combined positron emission tomography and single photon emission computed tomography system to obtain position images, and a time-differential perturbed angular correlation system to obtain chemical binding information, have been built and thoroughly tested. 68 refs., 123 figs., 14 tabs.

  2. Adaptive digital image processing in real time: First clinical experiences

    International Nuclear Information System (INIS)

    Andre, M.P.; Baily, N.A.; Hier, R.G.; Edwards, D.K.; Tainer, L.B.; Sartoris, D.J.

    1986-01-01

    The promise of computer image processing has generally not been realized in radiology, partly because the methods advanced to date have been expensive, time-consuming, or inconvenient for clinical use. The authors describe a low-cost system which performs complex image processing operations on-line at video rates. The method uses a combination of unsharp mask subtraction (for low-frequency suppression) and statistical differencing (which adjusts the gain at each point of the image on the basis of its variation from a local mean). The operator interactively adjusts aperture size, contrast gain, background subtraction, and spatial noise reduction. The system is being evaluated for on-line fluoroscopic enhancement, for which phantom measurements and clinical results, including lithotripsy, are presented. When used with a video camera, postprocessing of radiographs was advantageous in a variety of studies, including neonatal chest studies. Real-time speed allows use of the system in the reading room as a ''variable view box.''

  3. Experience of targeted Usher exome sequencing as a clinical test

    Science.gov (United States)

    Besnard, Thomas; García-García, Gema; Baux, David; Vaché, Christel; Faugère, Valérie; Larrieu, Lise; Léonard, Susana; Millan, Jose M; Malcolm, Sue; Claustres, Mireille; Roux, Anne-Françoise

    2014-01-01

    We show that massively parallel targeted sequencing of 19 genes provides a new and reliable strategy for molecular diagnosis of Usher syndrome (USH) and nonsyndromic deafness, particularly appropriate for these disorders characterized by a high clinical and genetic heterogeneity and a complex structure of several of the genes involved. A series of 71 patients including Usher patients previously screened by Sanger sequencing plus newly referred patients was studied. Ninety-eight percent of the variants previously identified by Sanger sequencing were found by next-generation sequencing (NGS). NGS proved to be efficient as it offers analysis of all relevant genes which is laborious to reach with Sanger sequencing. Among the 13 newly referred Usher patients, both mutations in the same gene were identified in 77% of cases (10 patients) and one candidate pathogenic variant in two additional patients. This work can be considered as pilot for implementing NGS for genetically heterogeneous diseases in clinical service. PMID:24498627

  4. Limb anomaly and associated conditions: our clinical experience

    Directory of Open Access Journals (Sweden)

    Ragavan M

    2011-03-01

    Full Text Available Munisamy Ragavan1, Uppalu Haripriya1, Janarthanam Sarvavinothini2, Nagaraja Rao3, Ramamoorthy Gokulkrishnan31Department of Pediatric Surgery, 2Department of Anesthesia, 3Department of Pediatrics, Narayana Medical College and Superspeciality Hospital, Nellore, Andhra Pradesh, IndiaAbstract: Limb anomalies are a common clinical problem with a various spectrum of involvement. There are many conditions associated with these anomalies. There is a variable extent of involvement in the form of agenesis, overgrowth, and duplication, and there is no standard classification to describe all these lesions. Studying limb anomalies provides insights into limb development which may be useful for etiologic studies and public health monitoring. We pooled our data for 12 limb anomaly cases presenting from January 2008 to May 2009 and investigated their associated conditions. A descriptive system for the nomenclature and classification of congenital limb malformations suitable for clinical, epidemiological, and experimental use is discussed.Keywords: limb anomaly, phocomelia, amelia 

  5. Juvenile nasopharyngeal angiofibroma: Clinical diagnosis and treatment experience

    Directory of Open Access Journals (Sweden)

    Sladoje Radmila

    2002-01-01

    Full Text Available Juvenile nasopharyngeal angiofibroma is an infrequent epi-pharyngeal tumor necessitating particular diagnostic and therapeutic procedures in comparison to other benign epipharyngeal tumors due to its expansive growth tendency. Our retrospective study is aimed at presenting clinical casuistry of the tumor in order to evaluate modern diagnostic and therapeutic possibilities. The study included 13 male patients, aged 13-24 years, who were hospitalized, diagnostically assessed and surgically treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia over the period 1990 - June 2001. The following parameters were analyzed: sex, age groups, preoperative symptoms of the disease, diagnostic methods, embolization, local tumor spreading, number and time of tumor relapses and surgical approach.

  6. Cardiac dysfunction in the trastuzumab clinical trials experience.

    Science.gov (United States)

    Seidman, Andrew; Hudis, Clifford; Pierri, Mary Kathryn; Shak, Steven; Paton, Virginia; Ashby, Mark; Murphy, Maureen; Stewart, Stanford J; Keefe, Deborah

    2002-03-01

    This study sought to estimate cardiac dysfunction (CD) risk for patients receiving trastuzumab; to characterize observed CD by severity, treatment, and clinical outcome; to assess effects of baseline clinical risk factors on CD; and to assess effects of cumulative doses of anthracyclines and trastuzumab on CD. A retrospective review of records for patients enrolled onto any of seven phase II and III trastuzumab clinical trials was performed. Predefined criteria were used for the diagnosis, and the New York Heart Association functional classification system was used to document CD severity. Product-limit estimates were used to summarize the cumulative anthracycline and trastuzumab doses at the time of CD onset. Patients treated with trastuzumab were found to be at an increased risk for CD. The incidence was greatest in patients receiving concomitant trastuzumab and anthracycline plus cyclophosphamide (27%). The risk was substantially lower in patients receiving paclitaxel and trastuzumab (13%) or trastuzumab alone (3% to 7%); however, most of these patients had received prior anthracycline therapy. CD was noted in 8% of patients receiving anthracycline plus cyclophosphamide and 1% receiving paclitaxel alone. Most trastuzumab-treated patients developing CD were symptomatic (75%), and most improved with standard treatment for congestive heart failure (79%). Trastuzumab is associated with an increased risk of CD, which is greatest in patients receiving concurrent anthracyclines. In most patients with metastatic breast cancer, the risk of CD can be justified given the improvement in overall survival previously reported with trastuzumab.

  7. Clinical experience of integrative cancer immunotherapy with GcMAF.

    Science.gov (United States)

    Inui, Toshio; Kuchiike, Daisuke; Kubo, Kentaro; Mette, Martin; Uto, Yoshihiro; Hori, Hitoshi; Sakamoto, Norihiro

    2013-07-01

    Immunotherapy has become an attractive new strategy in the treatment of cancer. The laboratory and clinical study of cancer immunotherapy is rapidly advancing. However, in the clinical setting, the results of cancer immunotherapy are mixed. We therefore contend that cancer immunotherapy should be customized to each patient individually based on their immune status and propose an integrative immunotherapy approach with second-generation group-specific component macrophage activating factor (GcMAF)-containing human serum. The standard protocol of our integrative cancer immunotherapy is as follows: i) 0.5 ml GcMAF-containing human serum is administered intramuscularly or subcutaneously once or twice per week for the duration of cancer therapy until all cancer cells are eradicated; ii) hyper T/natural killer (NK) cell therapy is given once per week for six weeks; iii) high-dose vitamin C is administered intravenously twice per week; iv) alpha lipoic acid (600 mg) is administered orally daily; v) vitamin D3 (5,000-10,000 IU) is administered orally daily. By March 2013, Saisei Mirai have treated over 345 patients with GcMAF. Among them we here present the cases of three patients for whom our integrative immunotherapy was remarkably effective. The results of our integrative immunotherapy seem hopeful. We also plan to conduct a comparative clinical study.>

  8. Adjuvant therapy for ampullary carcinomas: The Mayo Clinic experience

    International Nuclear Information System (INIS)

    Bhatia, Sumita; Miller, Robert C.; Haddock, Michael G.; Donohue, John H.; Krishnan, Sunil

    2006-01-01

    Purpose: To determine the effects of adjuvant radiotherapy and chemotherapy for carcinoma of the ampulla of Vater. Methods and Materials: We retrospectively reviewed the records of 125 patients who underwent definitive surgery for carcinomas involving the ampulla of Vater between April 1977 and February 2005 and who survived more than 50 days after surgery. Twenty-nine of the patients also received adjuvant radiotherapy (median dose, 50.4 Gy in 28 fractions) with concurrent 5-fluorouracil chemotherapy. Adverse prognostic factors were investigated, and overall survival (OS) and local and distant failure were estimated. Results: Adverse prognostic factors for decreased OS by univariate analysis included lymph node (LN) involvement, locally advanced tumors (T3/T4), and poor histologic grade. By multivariate analysis, positive LN status (p = 0.02) alone was associated with decreased OS. The addition of adjuvant radiotherapy and chemotherapy improved OS for patients with positive LN (p = 0.01). Median survival for positive LN patients receiving adjuvant therapy was 3.4 years, vs. 1.6 years for those with surgery alone. Conclusions: The addition of adjuvant radiotherapy and 5-fluorouracil chemotherapy may improve OS in patients with LN involvement. The effect of adjuvant therapy on outcomes for patients with poor histologic grade or T3/T4 tumors without LN involvement could not be assessed

  9. Position-specific 13C distributions within propane from experiments and natural gas samples

    Science.gov (United States)

    Piasecki, Alison; Sessions, Alex; Lawson, Michael; Ferreira, A. A.; Santos Neto, E. V.; Ellis, Geoffrey S.; Lewan, Michael D.; Eiler, John M.

    2018-01-01

    Site-specific carbon isotope measurements of organic compounds potentially recover information that is lost in a conventional, 'bulk' isotopic analysis. Such measurements are useful because isotopically fractionating processes may have distinct effects at different molecular sites, and thermodynamically equilibrated populations of molecules tend to concentrate heavy isotopes in one molecular site versus another. Most recent studies of site-specific 13C in organics use specialized Nuclear Magnetic Resonance (NMR) techniques or complex chemical degradations prior to mass spectrometric measurements. Herein we present the first application of a new mass spectrometric technique that reconstructs the site-specific carbon isotope composition of propane based on measurements of the 13C/12C ratios of two or more fragment ions that sample different proportions of the terminal and central carbon sites. We apply this method to propane from laboratory experiments and natural gas samples to explore the relationships between site-specific carbon isotope composition, full-molecular δ13C, thermal maturity, and variation in organic matter precursors. Our goal is to advance the understanding of the sources and histories of short-chain alkanes within geologic systems. Our findings suggest that propane varies in its site-specific carbon isotope structure, which is correlated with increasing thermal maturity, first increasing in terminal position δ13C and then increasing in both center and terminal position δ13C. This pattern is observed in both experimental and natural samples, and is plausibly explained by a combination of site-specific, temperature-dependent isotope effects associated with conversion of different precursor molecules (kerogen, bitumen, and/or oil) to propane, differences in site-specific isotopic contents of those precursors, and possibly distillation of reactive components of those precursors with increasing maturity. We hypothesize that the largest changes in

  10. Position-specific 13C distributions within propane from experiments and natural gas samples

    Science.gov (United States)

    Piasecki, Alison; Sessions, Alex L.; Lawson, Michael; Ferreira, A.A.; Santos Neto, E. V.; Ellis, Geoffrey S.; Lewan, Michael; Eilers, J.M.

    2018-01-01

    Site-specific carbon isotope measurements of organic compounds potentially recover information that is lost in a conventional, ‘bulk’ isotopic analysis. Such measurements are useful because isotopically fractionating processes may have distinct effects at different molecular sites, and thermodynamically equilibrated populations of molecules tend to concentrate heavy isotopes in one molecular site versus another. Most recent studies of site-specific 13C in organics use specialized Nuclear Magnetic Resonance (NMR) techniques or complex chemical degradations prior to mass spectrometric measurements. Herein we present the first application of a new mass spectrometric technique that reconstructs the site-specific carbon isotope composition of propane based on measurements of the 13C/12C ratios of two or more fragment ions that sample different proportions of the terminal and central carbon sites. We apply this method to propane from laboratory experiments and natural gas samples to explore the relationships between site-specific carbon isotope composition, full-molecular δ13C, thermal maturity, and variation in organic matter precursors. Our goal is to advance the understanding of the sources and histories of short-chain alkanes within geologic systems. Our findings suggest that propane varies in its site-specific carbon isotope structure, which is correlated with increasing thermal maturity, first increasing in terminal position δ13C and then increasing in both center and terminal position δ13C. This pattern is observed in both experimental and natural samples, and is plausibly explained by a combination of site-specific, temperature-dependent isotope effects associated with conversion of different precursor molecules (kerogen, bitumen, and/or oil) to propane, differences in site-specific isotopic contents of those precursors, and possibly distillation of reactive components of those precursors with increasing maturity. We hypothesize that the largest changes in

  11. Clinical spectrum of hypopituitarism in India: A single center experience

    Science.gov (United States)

    Gundgurthi, Abhay; Garg, M. K.; Bhardwaj, Reena; Brar, Karninder S.; Kharb, Sandeep; Pandit, Aditi

    2012-01-01

    Objectives: There is paucity of information regarding clinical profile of hypopituitarism from India. We report the clinical profile of hypopituitarism from a tertiary center in North India. Materials and Methods: This study was carried out in patients attending our endocrine center between January 2010 and December 2011. All new patients were studied prospectively and those registered before January 2010 retrospectively. Relevant clinical, hormonal, and imaging data were collected. Dynamic testing for pituitary functions was carried out as necessary. Hormonal deficiencies were defined as per prevailing recommendations. Results: This study included 113 subjects. The mean age was 38.6 ± 17.8 years (range, 4 – 76 years). There were 78 (69%) males and 35 females (31%). There were 22 subjects aged ≤18 years (childhood and adolescence) and 91 adults (>18 years). Visual disturbances were the most common presenting complaint (33%), though headache was the most common symptom (81%). Fifteen percent presented with pituitary apoplexy. Tumors comprised of 84% of cases. Hypogonadism (97%) was the most common abnormality seen followed by hypothyroidism (83.2%), hypoadrenalism (79.6%), growth hormone deficiency (88.1% of the 42 patients tested), and diabetes insipidus (13.3%). Panhypopituitarism was seen in 104 (92%) patients. There were no cases of hypopituitarism secondary to traumatic brain injury, subarachnoid hemorrhage, central nervous system infections, or cranial irradiation to extrasellar tumors. Conclusion: The most common cause of hypopituitarism at tertiary care center is pituitary tumors and the commonest presenting complaint is visual symptoms. Panhypopituitarism is present in 92% cases. PMID:23087868

  12. Clinical spectrum of hypopituitarism in India: A single center experience

    Directory of Open Access Journals (Sweden)

    Abhay Gundgurthi

    2012-01-01

    Full Text Available Objectives: There is paucity of information regarding clinical profile of hypopituitarism from India. We report the clinical profile of hypopituitarism from a tertiary center in North India. Materials and Methods: This study was carried out in patients attending our endocrine center between January 2010 and December 2011. All new patients were studied prospectively and those registered before January 2010 retrospectively. Relevant clinical, hormonal, and imaging data were collected. Dynamic testing for pituitary functions was carried out as necessary. Hormonal deficiencies were defined as per prevailing recommendations. Results: This study included 113 subjects. The mean age was 38.6 ± 17.8 years (range, 4 - 76 years. There were 78 (69% males and 35 females (31%. There were 22 subjects aged ≤18 years (childhood and adolescence and 91 adults (>18 years. Visual disturbances were the most common presenting complaint (33%, though headache was the most common symptom (81%. Fifteen percent presented with pituitary apoplexy. Tumors comprised of 84% of cases. Hypogonadism (97% was the most common abnormality seen followed by hypothyroidism (83.2%, hypoadrenalism (79.6%, growth hormone deficiency (88.1% of the 42 patients tested, and diabetes insipidus (13.3%. Panhypopituitarism was seen in 104 (92% patients. There were no cases of hypopituitarism secondary to traumatic brain injury, subarachnoid hemorrhage, central nervous system infections, or cranial irradiation to extrasellar tumors. Conclusion: The most common cause of hypopituitarism at tertiary care center is pituitary tumors and the commonest presenting complaint is visual symptoms. Panhypopituitarism is present in 92% cases.

  13. Perampanel for focal epilepsy: insights from early clinical experience.

    Science.gov (United States)

    Trinka, E; Steinhoff, B J; Nikanorova, M; Brodie, M J

    2016-03-01

    Perampanel is approved for adjunctive therapy of focal epilepsy with or without secondarily generalized seizures in patients aged >12 years. This narrative review uses real-world and clinical trial data to elucidate perampanel's role in the clinic. Audit data show good tolerability with perampanel and higher freedom-from-seizure rates in elderly vs younger patients. When using perampanel in elderly patients, special attention should be given to comorbidities and co-medication to avoid potential interactions or adverse events. Slower titration is generally recommended, and seizure control should be reassessed at a dose of 4 mg before further dose increases. Perampanel efficacy is similar in adolescents and adults; however, somnolence, nasopharyngitis, and aggression are more frequent in adolescents vs the overall population. Individualized and slow-dose titration can minimize adverse events. Low serum concentrations of perampanel may occur in patients also receiving some enzyme-inducing anti-epileptic drugs; a perampanel dose increase may be required. Adverse events of importance with perampanel include dizziness; anger, aggression, and hostile behavior (particularly in adolescents); and falls (particularly in patients >65 years). An individualized approach to dosing, including slower up-titration and bedtime dosing, reduces dizziness risk. Other drugs may cause or aggravate dizziness; reducing concomitant drugs may be necessary when up-titrating perampanel. It would seem clinically appropriate to give due consideration to avoiding use in patients with a history of anger or hostile/aggressive behavior. The possibility of such behaviors should be discussed with patients before starting perampanel, with monitoring during up-titration. Slower up-titration of perampanel in older patients helps reduce fall risk. © 2015 The Authors. Acta Neurologica Scandinavica Published by John Wiley & Sons Ltd.

  14. Clinical experience with the objective symmetry detector method for gammaencephalography

    International Nuclear Information System (INIS)

    Sachs, C.; Ericson, K.; Lind, M.

    1982-01-01

    The objective symmetry detector method for gammaencephalography previously described has been further developed. A rapid micro-computerized automatic measuring device has been constructed and the method used in screening of neurologic patients. The previously chosen classification boundaries between normal and pathologic isotope distributions were not entirely satisfactory for clinical screening of patients with neurologic symptoms. By use of new classification boundaries, 87 per cent of patients with brain tumours could be separated from patients with neurologic symptoms but without gross brain lesions and from neurologically healthy subjects. (Auth.)

  15. Antiarrhythmic treatment with flecainide (Tambocor). Clinical experience from 107 patients

    DEFF Research Database (Denmark)

    Frandsen, F; Pless, P; Mickley, H

    1990-01-01

    The long-term clinical effect of oral flecainide treatment was evaluated in 107 pts (10-82 yrs). Indications for treatment were: atrial fibrillation 38%, atrial flutter 16%, ventricular tachycardia 24%, ventricular ectopic beats 10% and supraventricular tachycardia 12%. Daily flecainide dosage...... was 200 (100-400) mg. Follow-up period 3 mths (15 days-15 mths). Based on the history and ECG flecainide had been effective in 51 pts. The improvement was most pronounced in pts suffering from supraventricular tachycardia involving an accessory bypass tract (84-92%). Flecainide had been discontinued in 50...

  16. [Animal experimental and clinical experiences with carbon polymer stomas].

    Science.gov (United States)

    Harzmann, R; Bichler, K H; Kieninger, G; Haumer, M; Ideler, V

    1978-07-01

    Biocarbon implants consist of 99.9% pure carbon and are characterized by chemical inactivity and good tissue compatibility. Biocarbon was used for subfascial implantations, as well as coecostomies, ileostomies and cystostomie on mongrel dogs. The most important clinical results was the good healing over of the material without adverse reaction. The cystostomies showed only a very slight tendency to form incrustations. Drainage was watertight without signs of leakage. The satisfying results with two patients who were provided with a cystostoma are reported and further uses of the procedure, such as ureterocutaneostomy, iliac and colonic conduit, are discussed.

  17. SU-F-T-469: A Clinically Observed Discrepancy Between Image-Based and Log- Based MLC Position

    Energy Technology Data Exchange (ETDEWEB)

    Neal, B; Ahmed, M; Siebers, J [University of Virginia Health System, Charlottesville, VA (United States)

    2016-06-15

    Purpose: To present a clinical case which challenges the base assumption of log-file based QA, by showing that the actual position of a MLC leaf can suddenly deviate from its programmed and logged position by >1 mm as observed with real-time imaging. Methods: An EPID-based exit-fluence dosimetry system designed to prevent gross delivery errors was used in cine mode to capture portal images during treatment. Visual monitoring identified an anomalous MLC leaf pair gap not otherwise detected by the automatic position verification. The position of the erred leaf was measured on EPID images and log files were analyzed for the treatment in question, the prior day’s treatment, and for daily MLC test patterns acquired on those treatment days. Additional standard test patterns were used to quantify the leaf position. Results: Whereas the log file reported no difference between planned and recorded positions, image-based measurements showed the leaf to be 1.3±0.1 mm medial from the planned position. This offset was confirmed with the test pattern irradiations. Conclusion: It has been clinically observed that log-file derived leaf positions can differ from their actual positions by >1 mm, and therefore cannot be considered to be the actual leaf positions. This cautions the use of log-based methods for MLC or patient quality assurance without independent confirmation of log integrity. Frequent verification of MLC positions through independent means is a necessary precondition to trusting log file records. Intra-treatment EPID imaging provides a method to capture departures from MLC planned positions. Work was supported in part by Varian Medical Systems.

  18. Association Between Medicare Summary Star Ratings for Patient Experience and Clinical Outcomes in US Hospitals

    Directory of Open Access Journals (Sweden)

    Stephen Trzeciak MD, MPH

    2016-03-01

    Full Text Available Objective: In 2015, the Centers for Medicare and Medicaid Services (CMS released new summary star ratings for US hospitals based on patient experience. We aimed to test the association between CMS patient experience star ratings and clinical outcomes. Methods: We analyzed risk-adjusted data for more than 3000 US hospitals from CMS Hospital Compare using linear regression. Results: We found that better patient experience was associated with favorable clinical outcomes. Specifically, a higher number of stars for patient experience had a statistically significant association with lower rates of many in-hospital complications. A higher patient experience star rating also had a statistically significant association with lower rates of unplanned readmissions to the hospital within 30 days. Conclusion: Better patient experience according to the CMS star ratings is associated with favorable clinical outcomes. These results support the inclusion of patient experience data in the framework of how hospitals are paid for services.

  19. Hypnosis Training and Education: Experiences with a Norwegian One-Year Education Course in Clinical Hypnosis for Children and Adolescents.

    Science.gov (United States)

    Lindheim, Maren Ø; Helgeland, Helene

    2017-01-01

    Although the efficacy of clinical hypnosis is well documented, its implementation in clinical practice is far from completed and there are few reports of systematic, professional training. This article gives a historical overview and description of a 1-year training program in clinical hypnosis which started in Norway in 2008 and has been held yearly since then. We describe the present education course with respect to aims, conceptual framework, structure, target groups, teaching themes, and experiences. The following factors have been considered of importance for the success of this program: The extent and duration of the course, the focus on demonstrations, experiential skill-building and exercises, and that the education is rooted in acknowledged clinical, academic, and educational environments. The participants' evaluations tell stories of mastery and positive experiences with hypnosis as a therapeutic tool in their clinical practice. However, many struggle to understand the various concepts of hypnosis, trance, and suggestions. Some find it hard to get started and challenging to integrate hypnosis in their clinical practice. Finally, some report scarce opportunities to apply their newly acquired skills at their work places and limited support by their leaders. The development of systematic, professional training programs as described in this article may be of importance for further implementation. However, this will also require that clinicians and leaders in universities and professional environments, and policymakers at higher levels, recognize clinical hypnosis as a valid and efficient choice of treatment. This must be reflected in dedicated efforts to ensure successful implementation in practice.

  20. Review of the Clinical and Biologic Aspects of Human Papillomavirus-Positive Squamous Cell Carcinomas of the Head and Neck

    International Nuclear Information System (INIS)

    Blitzer, Grace C.; Smith, Molly A.; Harris, Stephen L.; Kimple, Randall J.

    2014-01-01

    Human papillomavirus (HPV), a known etiology of a subset of head-and-neck squamous cell carcinomas (HNCs), causes numerous alterations in normal cellular functions. This article reviews the biology, detection, and treatment of HPV-positive HNC. The role of HPV oncoproteins in tumor development, the natural history of HPV infection, and risk factors for and prevention of transmission of oral HPV are considered. Commonly used methods for detecting HPV infection, including limitations of these methods, are discussed to aid the practicing clinician in using these tests in their clinical practice. Clinical characteristics of HPV-positive HNC, including potential explanations for the improved outcomes seen in patients with HPV-positive HNC, are assessed. Ongoing clinical trials specific for patients with HPV-positive HNC are described, and areas in need of additional research are summarized. Until the results of ongoing trials are known, treatment of HPV-positive HNC should not differ in clinical practice from treatment of similar non-HPV related cancers

  1. Review of the Clinical and Biologic Aspects of Human Papillomavirus-Positive Squamous Cell Carcinomas of the Head and Neck

    Energy Technology Data Exchange (ETDEWEB)

    Blitzer, Grace C.; Smith, Molly A. [Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin (United States); Harris, Stephen L. [Radiation Oncology Associates, Manchester, New Hampshire (United States); Kimple, Randall J., E-mail: rkimple@humonc.wisc.edu [Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin (United States); University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin (United States)

    2014-03-15

    Human papillomavirus (HPV), a known etiology of a subset of head-and-neck squamous cell carcinomas (HNCs), causes numerous alterations in normal cellular functions. This article reviews the biology, detection, and treatment of HPV-positive HNC. The role of HPV oncoproteins in tumor development, the natural history of HPV infection, and risk factors for and prevention of transmission of oral HPV are considered. Commonly used methods for detecting HPV infection, including limitations of these methods, are discussed to aid the practicing clinician in using these tests in their clinical practice. Clinical characteristics of HPV-positive HNC, including potential explanations for the improved outcomes seen in patients with HPV-positive HNC, are assessed. Ongoing clinical trials specific for patients with HPV-positive HNC are described, and areas in need of additional research are summarized. Until the results of ongoing trials are known, treatment of HPV-positive HNC should not differ in clinical practice from treatment of similar non-HPV related cancers.

  2. Evaluation of concordance between CAD/CAM and clinical positions of abutment shoulder against mucosal margin: an observational study.

    Science.gov (United States)

    Pietruski, Jan K; Skurska, Anna; Bernaczyk, Anna; Milewski, Robert; Pietruska, Maria Julia; Gehrke, Peter; Pietruska, Małgorzata D

    2018-05-02

    While working on CAD/CAM-customized abutments, the use of standard impression copings with a circular diameter produces inconsistency within the emergence profile. It may begin with a collapse of the supra-implant mucosa during impression taking, then lead to a computer-generated mismatch of the position and outline of the abutment shoulder, and consequently result in a compromised outcome of anticipated treatment. The aim of the study was to compare the virtual and clinical positions of the abutment shoulder in relation to the mucosal margin after the abutment delivery. Conventional open-tray impression takings followed uncovering surgery. Master casts were scanned with a desktop scanner. Clinical examinations took place after abutment's insertion and temporization (T1) and prior to cementation of the definitive crown (T2). The distances between the abutment shoulder and marginal soft tissue were measured intraorally in four aspects and juxtaposed with those on the virtual model. The study evaluated 257 dental implants and CAD/CAM-customized abutments. As T1 and T2 showed, there was a positive correlation between the virtually designed abutment shoulder position and matching clinical location relative to the mucosal margin. In 42.1% of cases, the distance between the mucosal margin and the abutment shoulder did not change. It increased in 36.3% of cases while a decrease occurred in 21.6% of them. Computer-set position of the abutment shoulder in relation to the mucosal margin can be predictably implemented in clinical practice.

  3. Rheumatoid disease without arthritis; clinical case of pulmonary fibrosis, rheumatoid nodulosis and positive rheumatoid factor without arthritis

    International Nuclear Information System (INIS)

    Ochoa Franco, Julian Andres; Canas Davila, Carlos Alberto

    2003-01-01

    We reported a case of a patient suffering pulmonary fibrosis rapidly progressive and a positive rheumatoid factor test with the presence of HLA DR11 y HLADR17, without arthritis, We discuss how rare is this clinical appearance, and remark the concept that rheumatoid arthritis is a systemic disease, with a wide clinical presentation, that some authors with a right criteria have called rheumatoid disease

  4. Caring touch--patients' experiences in an anthroposophic clinical context.

    Science.gov (United States)

    Ozolins, Lise-Lotte; Hörberg, Ulrica; Dahlberg, Karin

    2015-12-01

    This study describes the phenomenon of caring touch from the patients' perspective in an anthroposophic clinical context where caring touch is often used to promote health and alleviate suffering. The aim of the study was to explore and phenomenologically describe the phenomenon of caring touch from the patients' perspectives. The study has been carried out with a Reflective Lifeworld Research approach in order to understand and describe human existential phenomena. Ten female patients were interviewed in an anthroposophic clinic in Sweden. The findings show how caring touch has multifaceted meanings and makes the patients' feel present and anchored in a meaningful context. The patients' feel that they are seen, accepted and confirmed. Furthermore, touch creates a caring space where the patients become receptive for care and has the power to alleviate the patients' suffering, as well as to frighten and cause or worsen the suffering. In order to take advantage of the caring potential, the patient needs to be invited to a respectful and sensitive form of touch. An interpersonal flexible space is necessary where the touch can be effective, and where a dynamic interplay can develop. In conclusion, caring touch is an opportunity for carers to support well-being and health. The carers need to approach their patients in both a sensitive and reflective way. A caring science perspective can serve as a help to further understand touch as a unique caring act. © 2015 Nordic College of Caring Science.

  5. Clinical Experiences in the Surgical Treatment of Accessory Tragus

    Directory of Open Access Journals (Sweden)

    Uğur Horoz

    2016-09-01

    Full Text Available Objective: Tragus is a part of the external ear that develops from the first branchial arch. Accessory ear is a congenital external ear anomaly and has skin elevation containing remnant cartilage. The auricle develops between the 4th and 12th week of the embryonic stage, which groove the tissue from the 1st and 2nd branchial arches. Histologically, the lesions include a rugated epidermis with a thin layer stratum corneum, tiny mature hair follicles, fat lobules, and connective tissue framework that may include a central cartilage core. The aim of this study was to evaluate the accessory tragus lesions with our clinical surgical treatment results. Material and Methods: Lesions usually located anterior to the tragus and along an imaginary line drawn from the tragus to the angle of the mouth. Twelve patients admitted to our clinic between October 2011 and November 2014 were included in this study. Results: Seven boys and five girls between two–13 years old underwent operation. In total, 28 accessory ears were excised. No complications were observed during the procedure, and no complaints were noted in the postoperative period. Conclusion: Generally, limited anomaly is associated with the first and second branchial arch anomalies. Surgical excision is the standard treatment for the lesions which usually due to the esthetic concerns.

  6. Initial experience with golimumab in clinical practice for ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Luisa Castro-Laria

    Full Text Available Background: Golimumab is a TNF-blocking agent indicated as a second-line therapy in ulcerative colitis. Purpose: To research the effectiveness and safety of golimumab in patients with ulcerative colitis in clinical practice. Methods: Retrospective study of the effectiveness and safety of golimumab in patients with ulcerative colitis. All patients received golimumab 200 mg subcutaneously at week 0, and golimumab 100 mg subcutaneously at week 2. After the induction treatment, each patient received 50 mg sc. every 4 weeks in patients with body weight less than 80 kg, and 100 mg every 4 weeks in patients with body weight greater than or equal to 80 kg. Results: Study of a group of 23 ulcerative colitis patients, 7 of whom were naive to any anti-TNF therapy, and 16 patients who had previously been treated with an anti-TNF agent other than golimumab (non-naive patients. The average treatment time with golimumab was 14.3 weeks. Globally, withdrawal of corticosteroids was observed in 74% of cases. Clinical response was observed in 85.5% of patients who had not received biological treatment previously, and in patients who had previously received biological treatment the response rate was 75%. Conclusions: In this short study, golimumab seems to be an alternative treatment in naive and non-naive anti-TNF ulcerative colitis patients. It is also a safe therapy, given that there were no adverse effects in the patients studied.

  7. Nursing experience in clinical endovascular treatment for renal artery aneurysms

    International Nuclear Information System (INIS)

    Dong Yanfen; Pan Xiaoxia; Luan Shaoliang; Wei Ren

    2012-01-01

    Objective: To discuss the standardized clinical nursing measures for patients receiving endovascular treatment of renal artery aneurysms. Methods: The clinical data of 9 patients with renal artery aneurysm, who were admitted to authors' hospital during the period from Jan. 2010 to Aug. 2011 and received endovascular treatment, were retrospectively analyzed. The related nursing points as well as the received endovascular. Results: A total of 9 cases with renal artery aneurysm were treated nursing measures were summarized. Results: A total of 9 cases with renal artery aneurysm were with interventional management, including embolization (n = 6), stent implantation (n = 2) and stent implantation together with coil embolization (n = 1). The mean hospitalization time was (10±2) days. Postoperative retention of urine was observed in one patient and postoperative retroperitoneal hemorrhage occurred in another patient. Neither nursing-related nor operation-related complications occurred. Conclusion: Standardized perioperative nursing care for patients with renal artery aneurysm can surely help enhance the patient's tolerance to the surgery, and effectively prevent the complications. (authors)

  8. Clinical experience with intravenous radiosensitizers in unresectable sarcomas

    International Nuclear Information System (INIS)

    Kinsella, T.J.; Glatstein, E.

    1987-01-01

    Traditionally, adult bone and soft tissue sarcomas have been considered to be ''radioresistant.'' Because of this philosophy, patients who present with locally advanced, unresectable sarcomas often are treated in a palliative fashion, usually with low-dose radiotherapy. Over the last 6 years, 29 patients with unresectable primary or metastatic sarcomas were treated using a combination of intravenous chemical radiosensitizers and high-dose irradiation. Twenty-two of 29 patients achieved clinical local control, with six patients having a complete clinical response. The time to tumor response is often several months or longer, which is in contrast to other tumor histologies (carcinomas, lymphomas), where tumor response usually occurs over several weeks. Several large tumors have shown only a minimal tumor response, yet were found to be sterilized in posttreatment biopsy or autopsy examination. Of 15 patients with primary sarcomas without metastases, 11 patients (73%) remain free of local tumor progression from 12 to 83 months. Adult high-grade sarcomas can be controlled with high-dose radiotherapy and intravenous radiosensitizers, although the precise role of these agents is unclear

  9. Effect of radiologist experience on the risk of false-positive results in breast cancer screening programs

    Energy Technology Data Exchange (ETDEWEB)

    Zubizarreta Alberdi, Raquel [Galician Breast Cancer Screening Programme, Public Health and Planning Directorate, Health Office, Galicia (Spain); Edificio Administrativo da Conselleria de Sanidade, Servicio de Programas Poboacionais de Cribado, Direccion Xeral de Saude Publica e Planificacion, Santiago de Compostela, Galicia (Spain); Llanes, Ana B.F.; Ortega, Raquel Almazan [Galician Breast Cancer Screening Programme, Public Health and Planning Directorate, Health Office, Galicia (Spain); Exposito, Ruben Roman; Collado, Jose M.V.; Oliveres, Xavier Castells [Department of Epidemiology and Evaluation, Institut Municipal d' Investigacio Medica-Parc de Salut Mar. CIBERESP, Barcelona (Spain); Queiro Verdes, Teresa [Galician Agency for Health Technology Assessment, Public Health and Planning Directorate, Health Office, Galicia (Spain); Natal Ramos, Carmen [Principality of Asturias Breast Cancer Screening Programme, Principality of Asturias (Spain); Sanz, Maria Ederra [Public Health Institute, Navarra Breast Cancer Screening Programme, Pamplona (Spain); Salas Trejo, Dolores [General Directorate Public Health and Centre for Public Health Research (CSISP), Valencia Breast Cancer Screening Programme, Valencia (Spain)

    2011-10-15

    To evaluate the effect of radiologist experience on the risk of false-positive results in population-based breast cancer screening programmes. We evaluated 1,440,384 single-read screening mammograms, corresponding to 471,112 women aged 45-69 years participating in four Spanish programmes between 1990 and 2006. The mammograms were interpreted by 72 radiologists. The overall percentage of false-positive results was 5.85% and that for false-positives resulting in an invasive procedure was 0.38%. Both the risk of false-positives overall and of false-positives leading to an invasive procedure significantly decreased (p < 0.001) with greater reading volume in the previous year: OR 0.77 and OR 0.78, respectively, for a reading volume 500-1,999 mammograms and OR 0.59 and OR 0.60 for a reading volume of >14,999 mammograms with respect to the reference category (<500). The risk of both categories of false-positives was also significantly reduced (p < 0.001) as radiologists' years of experience increased: OR 0.96 and OR 0.84, respectively, for 1 year's experience and OR 0.72 and OR 0.73, respectively, for more than 4 years' experience with regard to the category of <1 year's experience. Radiologist experience is a determining factor in the risk of a false-positive result in breast cancer screening. (orig.)

  10. Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates

    Directory of Open Access Journals (Sweden)

    Sharon Fonn

    2013-01-01

    Full Text Available Background: Mid-level medical workers play an important role in health systems and hold great potential for addressing the human resource shortage, especially in low- and middle-income countries. South Africa began the production of its first mid-level medical workers – known as clinical associates – in small numbers in 2008. Objective: We describe the way in which scopes of practice and course design were negotiated and assess progress during the early years. We derive lessons for other countries wishing to introduce new types of mid-level worker. Methods: We conducted a rapid assessment in 2010 consisting of a review of 19 documents and 11 semi-structured interviews with a variety of stakeholders. A thematic analysis was performed. Results: Central to the success of the clinical associate training programme was a clear definition and understanding of the interests of various stakeholders. Stakeholder sensitivities were taken into account in the conceptualisation of the role and scope of practice of the clinical associate. This was achieved by dealing with quality of care concerns through service-based training and doctor supervision, and using a national curriculum framework to set uniform standards. Conclusions: This new mid-level medical worker can contribute to the quality of district hospital care and address human resource shortages. However, a number of significant challenges lie ahead. To sustain and expand on early achievements, clinical associates must be produced in greater numbers and the required funding, training capacity, public sector posts, and supervision must be made available. Retaining the new cadre will depend on the public system becoming an employer of choice. Nonetheless, the South African experience yields positive lessons that could be of use to other countries contemplating similar initiatives.

  11. Conducting Family Nursing in Heart Failure outpatient clinics: Nurses experiences

    DEFF Research Database (Denmark)

    Voltelen, Barbara; Konradsen, Hanne; Østergaard, Birte

    Aim: This study aimed to explore what was documented during structured Family Nursing (FN) conversations with patients diagnosed with Heart Failure and their families, and to gain knowledge about the nurses’ experiences conducting FN. Background: Patients with HF face many challenges, and so do...... throughout the FN intervention and a Focus group interview with 6 nurses who were conducting the conversations. Content analyses of all text material dealt with both manifest and latent content, and were analyzed through a deductive and inductive process. Results: Enabling bonding emerged as the overall...

  12. Clinical experience with the Bentall procedure: 28 years.

    Science.gov (United States)

    Joo, Hyun-Chel; Chang, Byung-Chul; Youn, Young-Nam; Yoo, Kyung-Jong; Lee, Sak

    2012-09-01

    We retrospectively analyzed 28 years of experience with the Bentall procedure in patients with aortic valve, aortic root, and ascending aortic disease. Between March 1982 and December 2010, a total of 218 patients underwent the Bentall procedure using a composite valved conduit. The "inclusion technique" was used in 30 patients (13.8%), the "open-button technique" in 181 patients (83.0%), and the Cabrol technique in 7 patients (3.2%). The early mortality rate was 5.5% (12/218). The mean follow-up duration was 108.0±81.0 months (range: 1-329 months). Seven patients required re-operation, and 1 patient required stent graft insertion at the descending thoracic aorta for progression of aortic arch or descending thoracic aortic dissection or aneurysm after the first operation, and 5 of them had Marfan syndrome. Kaplan-Meier estimated survival rates at 1, 5, 10, 20, and 25 years were 90.4%, 82.7%, 77.6%, 65.3%, and 60.3%, respectively. Freedom from reoperation rates at 1, 5, 10, 20, and 25 years were 99.0%, 98.3%, 95.5%, 90.8%, and 90.8%, respectively. In our experience, the Bentall procedure provided optimal survival with improved functional status. The disease of the aorta may progress, especially in patients with Marfan syndrome. Therefore, careful follow-up with regular computed tomography angiograms should be performed in these patients.

  13. Biocarbon urinary conduit: laboratory experience and clinical applications.

    Science.gov (United States)

    Kobashi, L I; Raible, D A

    1980-07-01

    A new urinary conduit utilizing pure vitreous carbon has been used successfully in dogs. Pure carbon appears to be inert with respect to urine and urothelium. Lack of urinary salt encrustation on the exposed surface provides a well-functioning urinary conduit for vesical drainage. Twenty-one vesicostomies were performed in dogs. Careful follow-up and histologic studies of removed specimens were done to establish the biocompatibility of pure carbon. All vesicostomies functioned well. A description of the device, protocol, and results of laboratory experimentation are outlined. The surgical procedure is explained in detail. Results encourage the clinical trial of these devices in humans. Indications include patients with neurogenic vesicla dysfunction and those with total urinary incontinence, both of which require permanent indwelling catheters.

  14. Clinical experience of radiation therapy for Graves` ophthalmopathy

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Takeo; Mitsuhashi, Norio; Nagashima, Hisako; Sakurai, Hideyuki; Murata, Osamu; Ishizeki, Kei; Shimaya, Sanae; Hayakawa, Kazushige; Niibe, Hideo [Gunma Univ., Maebashi (Japan). School of Medicine

    1996-11-01

    The effect of radiation therapy for Graves` ophthalmopathy was evaluated. Ten patients with Graves` ophthalmopathy were treated with radiation therapy between 1992 and 1993 in Gunma University Hospital. All patients had a past history of hyperthyroidism and received 2,000 cGy to the retrobulbar tissues in 20 fractions. Nine of ten patients were treated with radiation therapy after the failure of corticosteroids. Six patients (60%) showed good or excellent responses. The exophthalmos type was more responsive to radiation therapy than the double vision type in this series. Two of five patients with the exophthalmos type demonstrated excellent responses, and their symptoms disappeared almost completely. The improvement of symptoms appeared within 3-6 months, and obvious clinical effects were demonstrated after 6 months of radiotherapy. Radiation therapy was well tolerated, and we have not observed any side effects of radiation therapy. In conclusion, radiation therapy is effective treatment for Graves` ophthalmopathy. (author)

  15. Clinical experience of radiation therapy for Graves' ophthalmopathy

    International Nuclear Information System (INIS)

    Takahashi, Takeo; Mitsuhashi, Norio; Nagashima, Hisako; Sakurai, Hideyuki; Murata, Osamu; Ishizeki, Kei; Shimaya, Sanae; Hayakawa, Kazushige; Niibe, Hideo

    1996-01-01

    The effect of radiation therapy for Graves' ophthalmopathy was evaluated. Ten patients with Graves' ophthalmopathy were treated with radiation therapy between 1992 and 1993 in Gunma University Hospital. All patients had a past history of hyperthyroidism and received 2,000 cGy to the retrobulbar tissues in 20 fractions. Nine of ten patients were treated with radiation therapy after the failure of corticosteroids. Six patients (60%) showed good or excellent responses. The exophthalmos type was more responsive to radiation therapy than the double vision type in this series. Two of five patients with the exophthalmos type demonstrated excellent responses, and their symptoms disappeared almost completely. The improvement of symptoms appeared within 3-6 months, and obvious clinical effects were demonstrated after 6 months of radiotherapy. Radiation therapy was well tolerated, and we have not observed any side effects of radiation therapy. In conclusion, radiation therapy is effective treatment for Graves' ophthalmopathy. (author)

  16. Lokomat: Clinical training and experience in a neurorehabilitation hospital

    DEFF Research Database (Denmark)

    Riberholt, Christian Gunge

    2014-01-01

    This presentation aims to give insight into the daily work of walking rehabilitation of patients with severe acquired brain injury (ABI) using the Lokomat© system. The lokomat system offers a high number of repetitions (steps) pr. training session with less physical stress on therapists compared...... to conventional gait training. The effect of a high number of repetitions for functional recovery after brain injury has become evident in studies performed during the last decade within the field of neurorehabilitation. Yet robotic treatment for rehabilitation of gait function is still rather new and the current...... literature lack randomized controlled trials in ABI. Furthermore few trials have specifically investigated the most optimal training strategy for different groups of neurological patients This presentation aims at highlighting some of the strategies and clinical challenges using an evidence-based approach...

  17. Japanese experience with clinical trails of fast neutrons

    International Nuclear Information System (INIS)

    Tsunemoto, H.; Arai, T.; Morita, S.; Ishikawa, T.; Aoki, Y.; Takada, N.; Kamata, S.

    1982-01-01

    Between November, 1975 and November, 1981, 825 patients were treated with 30 MeV (d-Be) neutrons at the National Institute of Radiological Sciences, Chiba. At the Institute of Medical Science, Tokyo, 302 patients were referred to the Radiation Therapy department and were treated with 16 MeV (d-Be) neutrons. The emphasis of these clinical trials with fast neutrons was placed on the estimation of the effect of fast neutrons for locally advanced cancers or radioresistant cancers, and on evaluation of the rate of complication of normal tissues following irradiaton with fast neutrons. Results were evaluated for patients with previously untreated cancer; local control of the tumor was observed in 59.1%. Complications requiring medical care developed in only 32 patients. Patients who had received pre- or postoperative irradiation were excluded from this evaluation. Late reaction of soft tissue seemed to be more severe than that observed with photon beams. The results also suggest that for carcinoma of the larynx, esophagus, uterine cervix, Pancoasts's tumor of the lung and osteosarcoma, fast neutrons were considered to be effectively applied in this randomized clinical trial. For carcinoma of the larynx, a fast nuetron boost was effectively delivered, although an interstitial implant was necessarily combined with fast neutrons for carcinoma of the tongue. The cumulative survival rate of the patients with carcinoma of the esophagus treated with fast neutrons was 26% compared to the survival rate of 10.5% obtained using photons. This was supported by evidence from the pathological studies that showed that the tumor cells which had deeply invaded into the esophagus were effectively destroyed when fast neutrons were applied

  18. Japanese experience with clinical trials of fast neutrons

    International Nuclear Information System (INIS)

    Tsunemoto, H.; Arai, T.; Morita, S.; Ishikawa, T.; Aoki, Y.; Takada, N.; Kamata, S.

    1982-01-01

    Between November, 1975 and November, 1981, 825 patients were treated with 30 MeV (d-Be) neutrons at the National Institute of Radiological Sciences, Chiba. At the Institute of Medical Science, Tokyo, 302 patients were referred to the Radiation Therapy department and were treated with 16 MeV (d-Be) neutrons. The emphasis of these clinical trials with fast neutrons was placed on the estimation of the effect of fast neutrons for locally advanced cancers or radioresistant cancers, and on evaluation of the rate of complication of normal tissues following irradiation with fast neutrons. Results were evaluated for patients with previously untreated cancer; local control of the tumor was observed in 59.1%. Complications requiring medical care developed in only 32 patients. Late reaction of soft tissue seemed to be more severe than that observed with photon beams. The results also suggest that for carcinoma of the larynx, esophagus, uterine cervix, Pancoast's tumor of the lung and osteosarcoma, fast neutrons were considered to be effectively applied in this randomized clinical trial. For carcinoma of the larynx, a fast neutron boost was effectively delivered, although an interstitial implant was necessarily combined with fast neutrons for carcinoma of the tongue. The cumulative survival rate of the patients with carcinoma of the esophagus treated with fast neutrons of 26% compared to the survival rate of 10.5% obtained using photons. The results also indicate that local control and relief of the symptom related to Pancoast's tumor of the lung seemed to be better with neutrons than with photons. For patients suffering from osteosarcoma, the surgical procedures preserving the function of the leg and arm were studied according to the better local control rate of the tumor following fast neutron beam therapy

  19. The 'positive' magnetic islands conception and its applications to T-11M experiments

    International Nuclear Information System (INIS)

    Mirnov, S.V.; Semenov, I.B.; Belov, A.M.; Azizov, E.A.

    1999-01-01

    A situation in tokamaks is analyzed in which the development of strong plasma current filamentation leads to nonlinear magnetic islands formation near resonant magnetic surfaces. It is shown that, along with the usual 'negative' magnetic islands, in which the modulation of the perturbation currents is negative, 'positive' islands can form in local regions with the positive current modulation. The 'positive' magnetic islands can be a reason of the 'hot spot' in plasma center during sawtooth crash. Also the 'positive' islands, probably, plays the important role in m=2 development during the major disruption and in the locked modes dynamics. (author)

  20. The ''positive'' magnetic islands conception and its applications to T-11M experiments

    International Nuclear Information System (INIS)

    Mirnov, S.V.; Semenov, I.; Belov, A.M.; Azizov, E.A.

    2001-01-01

    A situation in tokamaks is analyzed in which the development of strong plasma current filamentation leads to nonlinear magnetic islands formation near resonant magnetic surfaces. It is shown that, along with the usual ''negative'' magnetic islands, in which the modulation of the perturbation currents is negative, ''positive'' islands can form in local regions with the positive current modulation. The ''positive'' magnetic islands can be a reason of the ''hot spot'' in plasma center during sawtooth crash. Also the ''positive'' islands, probably, plays the important role in m=2 development during the major disruption and in the locked modes dynamics. (author)

  1. The clinical impact of a positive family history of psychosis or mental ...

    African Journals Online (AJOL)

    Background: A family history of psychosis is associated with negative clinical characteristics of psychosis. Aim: We aimed to determine the relationship between a family history (in first-degree relatives) of psychosis (FHP) or of any mental illness (FHM), and the clinical features (including cannabis use) of first episode early ...

  2. Comparison of the clinical and cognitive features of genetically positive ALS patients from the largest tertiary center in Serbia.

    Science.gov (United States)

    Marjanović, Ivan V; Selak-Djokić, Biljana; Perić, Stojan; Janković, Milena; Arsenijević, Vladimir; Basta, Ivana; Lavrnić, Dragana; Stefanova, Elka; Stević, Zorica

    2017-06-01

    Discovering novel mutations in C9orf72, FUS, ANG, and TDP-43 genes in ALS patients arises necessities for better clinical characterizations of these subjects. The aim is to determine clinical and cognitive profile of genetically positive Serbian ALS patients. 241 ALS patients were included in the study (17 familiar and 224 apparently sporadic). The following genes were analyzed: SOD1, C9orf72, ANG, FUS, and TDP-43. An extensive battery of classic neuropsychological tests was used in 27 ALS patients (22 SOD1 positive and 5 SOD1 negative) and 82 healthy controls (HCs). Overall 37 (15.4%) of 241 ALS patients carried mutations in tested genes-among 17 familiar ALS patients 16 (94.1%) were positive and among 224 apparently sporadic 21 (9.4%) had causative mutation. Mutations in SOD1 gene were the most common, representing 27 (73.0%) of all genetically positive ALS patients. The main clinical characteristics of SOD1 positive patients were: spinal onset in lower extremities, common sphincter and sensitive disturbances, and dysexecutive syndrome. Within SOD1 positive patients, we noticed somewhat earlier onset in patients with A145G, sensory and sphincter disturbances were dominant in patients with L144F, while D90A patients had significant sensory involvement. SOD1 negative group consisted of ten (27.0%) patients (six C9orf72, two ANG, one TDP-43, and one patient baring triple FUS, C9orf72 expansion, and ANG variants). Bulbar involvement and more extensive neuropsychological impairment (including executive, visuospatial, and memory difficulties) were the main features of SOD1 negative cohort. Our results suggest that meaningful clinical suspicion of certain ALS genotype might be made based on thorough clinical evaluation of patients.

  3. Harmonizing and consolidating the measurement of patient-reported information at health care institutions: a position statement of the Mayo Clinic

    Directory of Open Access Journals (Sweden)

    Eton DT

    2014-02-01

    Full Text Available David T Eton,1,2 Timothy J Beebe,1,2 Philip T Hagen,3 Michele Y Halyard,4 Victor M Montori,1,5 James M Naessens,1,2 Jeff A Sloan,6 Carrie A Thompson,7 Douglas L Wood1,81Division of Heath Care Policy and Research, Department of Health Sciences Research, 2Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 3Department of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN, 4Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, 5Knowledge and Evaluation Research Unit, 6Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, 7Division of Hematology, Department of Medicine, 8Center for Innovation, Mayo Clinic, Rochester, MN, USAAbstract: Patient-reported outcomes (PROs capture how patients perceive their health and their health care; their use in clinical research is longstanding. Today, however, PROs increasingly are being used to inform the care of individual patients, and document the performance of health care entities. We recently wrote and internally distributed an institutional position statement titled "Harmonizing and Consolidating the Measurement of Patient-Reported Outcomes at Mayo Clinic: A Position Statement for the Center for the Science of Health Care Delivery". The statement is meant to educate clinicians, clinical teams, and institutional administrators about the merits of using PROs in a systematic manner for clinical care and quality measurement throughout the institution. The present article summarizes the most important messages from the statement, describing PROs and their use, identifying practical considerations for implementing them in routine practice, elucidating potential barriers to their use, and formulating strategies to overcome these barriers. The lessons learned from our experience – including pitfalls, challenges, and successes – may inform other health care institutions that are interested in

  4. Wanting to Maximize the Positive and Minimize the Negative: Implications for Mixed Affective Experience in American and Chinese Contexts

    Science.gov (United States)

    Sims, Tamara; Tsai, Jeanne L.; Jiang, Da; Wang, Yaheng; Fung, Helene H.; Zhang, Xiulan

    2016-01-01

    Previous studies have demonstrated that European Americans have fewer mixed affective experiences (i.e., are less likely to experience the bad with the good) compared to Chinese. In this paper, we argue that these cultural differences are due to “ideal affect,” or how people ideally want to feel. Specifically, we predict that people from individualistic cultures want to maximize positive and minimize negative affect more than people from collectivistic cultures, and as a result, they are less likely to actually experience mixed emotions (reflected by a more negative within-person correlation between actual positive and negative affect). We find support for this prediction in two experience sampling studies conducted in the U.S. and China (Studies 1 and 2). In addition, we demonstrate that ideal affect is a distinct construct from dialectical view of the self, which has also been related to mixed affective experience (Study 3). Finally, in Study 4, we demonstrate that experimentally manipulating the desire to maximize the positive and minimize the negative alters participants' actual experience of mixed emotions during a pleasant (but not unpleasant or combined pleasant and unpleasant) television clip in the U.S. and Hong Kong. Together, these findings suggest that across cultures, how people want to feel shapes how they actually feel, particularly people's mixed affective experience. PMID:26121525

  5. Wanting to maximize the positive and minimize the negative: implications for mixed affective experience in American and Chinese contexts.

    Science.gov (United States)

    Sims, Tamara; Tsai, Jeanne L; Jiang, Da; Wang, Yaheng; Fung, Helene H; Zhang, Xiulan

    2015-08-01

    Previous studies have demonstrated that European Americans have fewer mixed affective experiences (i.e., are less likely to experience the bad with the good) compared with Chinese. In this article, we argue that these cultural differences are due to "ideal affect," or how people ideally want to feel. Specifically, we predict that people from individualistic cultures want to maximize positive and minimize negative affect more than people from collectivistic cultures, and as a result, they are less likely to actually experience mixed emotions (reflected by a more negative within-person correlation between actual positive and negative affect). We find support for this prediction in 2 experience sampling studies conducted in the United States and China (Studies 1 and 2). In addition, we demonstrate that ideal affect is a distinct construct from dialectical view of the self, which has also been related to mixed affective experience (Study 3). Finally, in Study 4, we demonstrate that experimentally manipulating the desire to maximize the positive and minimize the negative alters participants' actual experience of mixed emotions during a pleasant (but not unpleasant or combined pleasant and unpleasant) TV clip in the United States and Hong Kong. Together, these findings suggest that across cultures, how people want to feel shapes how they actually feel, particularly people's experiences of mixed affect. (c) 2015 APA, all rights reserved.

  6. Incidence of positive surgical margins after robotic assisted radical prostatectomy: Does the surgeon's experience have an influence on all pathological stages?

    Science.gov (United States)

    Villamil, A W; Costabel, J I; Billordo Peres, N; Martínez, P F; Giudice, C R; Damia, O H

    2014-03-01

    The aim of this study is to analyze the clinical and surgical features of patients who underwent robotic-assisted radical prostatectomy (RARP) at our institution, and the impact of the surgeon's experience in the oncological results related to pathological stage. An analysis of 300 RARP consecutively performed by the same urologist was conducted. Patients were divided into 3 groups of 100 patients in chronological order, according to surgery date. All patients had organ-confined clinical stage. Variables which could impact in positive margins rates were analyzed. Finally, positive surgical margins (PSM) in regard to pathological stage and surgeon's experience were compared and analyzed. No significant differences were found in variables which could impact in PSM rates. The overall PSM rate was 21%, with 28% in the first group, 20% in the second, and 16% in the third (P = .108). Significant lineal decreasing tendency was observed (P = .024). In pT2 patients, the overall PSM rate was 16.6%, with 27%, 13.8%, and 7.3% in each group respectively (P = .009). A significant difference was found between group 1 and group 3 (P = .004). In pT3 patients, the surgeon's experience was not significantly associated with margin reductions with an overall PSM rate of 27.7% (28.2%, 28.6%, and 26.7% in each group respectively). Clinical and surgical features in our patients did not vary over time. We found a significant reduction of PSM related to surgeon's experience in pT2 patients. Contrariwise, the margin status remained stable despite increasing experience in pT3 patients. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  7. Experiences of discrimination and positive treatment in people with mental health problems: Findings from an Australian national survey.

    Science.gov (United States)

    Reavley, Nicola J; Jorm, Anthony F

    2015-10-01

    Stigma and discrimination are central concerns for people with mental health problems. The aim of the study was to carry out a national survey in order to assess experiences of avoidance, discrimination and positive treatment in people with mental health problems. In 2014, telephone interviews were carried out with 5220 Australians aged 18+, 1381 of whom reported a mental health problem or scored highly on a symptom screening questionnaire. Questions covered experiences of avoidance, discrimination and positive treatment by friends, spouse, other family, workplace, educational institution and others in the community. In most domains, respondents reported more positive treatment experiences than avoidance or discrimination. Friends and family were more likely to avoid the person than to discriminate. The results can provide input into the design of anti-discrimination interventions and further empower people with mental health problems as they advocate for change in the area of discrimination. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  8. The Depressive Experiences Questionnaire: validity and psychological correlates in a clinical sample.

    Science.gov (United States)

    Riley, W T; McCranie, E W

    1990-01-01

    This study sought to compare the original and revised scoring systems of the Depressive Experiences Questionnaire (DEQ) and to assess the construct validity of the Dependent and Self-Critical subscales of the DEQ in a clinically depressed sample. Subjects were 103 depressed inpatients who completed the DEQ, the Beck Depression Inventory (BDI), the Hopelessness Scale, the Automatic Thoughts Questionnaire (ATQ), the Rathus Assertiveness Schedule (RAS), and the Minnesota Multiphasic Personality Inventory (MMPI). The original and revised scoring systems of the DEQ evidenced good concurrent validity for each factor scale, but the revised system did not sufficiently discriminate dependent and self-critical dimensions. Using the original scoring system, self-criticism was significantly and positively related to severity of depression, whereas dependency was not, particularly for males. Factor analysis of the DEQ scales and the other scales used in this study supported the dependent and self-critical dimensions. For men, the correlation of the DEQ with the MMPI scales indicated that self-criticism was associated with psychotic symptoms, hostility/conflict, and a distress/exaggerated response set, whereas dependency did not correlate significantly with any MMPI scales. Females, however, did not exhibit a differential pattern of correlations between either the Dependency or the Self-Criticism scales and the MMPI. These findings suggest possible gender differences in the clinical characteristics of male and female dependent and self-critical depressive subtypes.

  9. Psychological experiences in South African society before the 2010 FIFA World Cup from the systems psychodynamic and positive psychology perspectives

    Directory of Open Access Journals (Sweden)

    Pieter Koortzen

    2012-05-01

    Research purpose: The objective of this study was to analyse and describe the psychological experiences of South Africans before the 2010 FIFA World Cup. Research design, approach and method: The researchers conducted the study from the systems psychodynamic and positive psychology perspectives. The study comprised a qualitative, explorative and social phenomenological study. The researchers conducted interviews with a wide range of their colleagues and clients. Main findings: The results seemed to indicate that South Africans had had a number of positive and negative experiences before the 2010 FIFA World Cup. Practical/managerial implications: The researchers presented the findings as a number of systems psychodynamic and positive psychology themes. Contribution/value-add: This study presents original research that contributes valuable new knowledge to the positive psychology and systems psychodynamic perspectives.

  10. Clinical experience in coronary stenting with the Vivant Z Stent.

    Science.gov (United States)

    Chee, K H; Siaw, F S; Chan, C G; Chong, W P; Imran, Z A; Haizal, H K; Azman, W; Tan, K H

    2005-06-01

    This single centre study was designed to demonstrate feasibility, safety and efficacy of the Vivant Z stent (PFM AG, Cologne, Germany). Patients with de novo lesion were recruited. Coronary angioplasty was performed with either direct stenting or after balloon predilatation. Repeated angiogram was performed 6 months later or earlier if clinically indicated. Between January to June 2003, a total of 50 patients were recruited (mean age 55.8 +/- 9 years). A total of 52 lesions were stented successfully. Mean reference diameter was 2.77 mm (+/-0.59 SD, range 2.05-4.39 mm) with mean target lesion stenosis of 65.5% (+/-11.6 SD, range 50.1-93.3%). Forty-six lesions (88.5%) were American College of Cardiologist/American Heart Association class B/C types. Direct stenting was performed in 18 (34.6%) lesions. Mean stent diameter was 3.18 mm (+/-0.41 SD, range 2.5-4 mm), and mean stent length was 14.86 mm (+/-2.72 SD, range 9-18 mm). The procedure was complicated in only one case which involved the loss of side branch with no clinical sequelae. All treated lesions achieved Thrombolysis In Myocardial Infarction 3 flow. Mean residual diameter stenosis was 12.2% (+/-7.55 SD, range 0-22.6%) with acute gain of 1.72 mm (+/-0.50 SD, range 0.5-2.8). At 6 months, there was no major adverse cardiovascular event. Repeated angiography after 6 months showed a restenosis rate of 17% (defined as >50% diameter restenosis). Mean late loss was 0.96 mm (+/-0.48 SD) with loss index of 0.61 (+/-0.38 SD). The restenosis rate of those lesions less than 3.0 mm in diameter was 22.2% compared with 6.25% in those lesions more than 3.0 mm in diameter. The Vivant Z stent was shown to be safe and efficacious with low restenosis rate in de novo coronary artery lesion.

  11. The role of religiosity, coping strategies, self-efficacy and personality dimensions in the prediction of Iranian undergraduate rehabilitation interns' satisfaction with their clinical experience.

    Science.gov (United States)

    Mirsaleh, Y R; Rezai, H; Kivi, S R; Ghorbani, R

    2010-12-01

    to investigate the relationship between religiosity, coping styles, self-efficacy and personality dimensions as predictors of satisfaction with clinical experience in rehabilitation interns during transition from academic study to clinical internship. a cross-sectional survey design. five rehabilitation faculties. three hundred and eighteen undergraduate rehabilitation interns, including physical therapy, occupational therapy and speech and language pathology students. Islamic Religiosity Scale, Ways of Coping Questionnaire, General Self-efficacy Scale, NEO Five Factor Inventory, and Satisfaction with Clinical Experiences Questionnaire. religiosity, problem-focused coping and general self-efficacy had significant positive correlation with satisfaction with clinical internship in rehabilitation students. Among personality dimensions, openness, agreement and consciousness had significant positive correlation with satisfaction with clinical experience and neuroticism had significant negative correlation with satisfaction with clinical experience. The results of regression analysis demonstrated that religiosity and self-efficacy had important roles in the prediction of satisfaction with clinical experience in all the rehabilitation intern students of three disciplines (physical therapy, occupational therapy, and speech and language pathology). religiosity, problem-focused coping and general self-efficacy seem to be good predictors of satisfaction with clinical internship in rehabilitation students.

  12. Sex moderates the effects of positive and negative affect on clinical pain in patients with knee osteoarthritis.

    Science.gov (United States)

    Speed, Traci J; Richards, Jessica M; Finan, Patrick H; Smith, Michael T

    2017-07-01

    Sex differences in clinical pain severity and response to experimental pain are commonly reported, with women generally showing greater vulnerability. Affect, including state (a single rating) and stable (average daily ratings over two weeks) positive affect and negative affect has also been found to impact pain sensitivity and severity, and research suggests that affect may modulate pain differentially as a function of sex. The current study aimed to examine sex as a moderator of the relationships between affect and pain-related outcomes among participants with knee osteoarthritis (KOA). One hundred and seventy-nine participants (59 men) with KOA completed electronic diaries assessing clinical pain, positive affect, and negative affect. A subset of participants (n=120) underwent quantitative sensory testing, from which a single index of central sensitization to pain was derived. We used multiple regression models to test for the interactive effects of sex and affect (positive versus negative and stable versus state) on pain-related outcomes. We used mixed effects models to test for the moderating effects of sex on the relationships between state affect and pain over time. Sex differences in affect and pain were identified, with men reporting significantly higher stable positive affect and lower central sensitization to pain indexed by quantitative sensory testing, as well as marginally lower KOA-specific clinical pain compared to women. Moreover, there was an interaction between stable positive affect and sex on KOA-specific clinical pain and average daily non-specific pain ratings. Post hoc analyses revealed that men showed trends towards an inverse relationship between stable positive affect and pain outcomes, while women showed no relationship between positive affect and pain. There was also a significant interaction between sex and stable negative affect and sex on KOA-specific pain such that men showed a significantly stronger positive relationship between

  13. Dismissing Children's Perceptions of Their Emotional Experience and Parental Care: Preliminary Evidence of Positive Bias

    Science.gov (United States)

    Borelli, Jessica L.; David, Daryn H.; Crowley, Michael J.; Snavely, Jonathan E.; Mayes, Linda C.

    2013-01-01

    The tendency to perceive caregivers in highly positive terms and to perceive the self as strong and problem-free are two facets of the positive bias characteristic of a dismissing attachment classification in adulthood. However, this link has not yet been examined in children. We evaluated the association between dismissing attachment and positive…

  14. High Hopes: Organizational Position, Employment Experiences, and Women's and Men's Promotion Aspirations.

    Science.gov (United States)

    Cassirer, Naomi; Reskin, Barbara

    2000-01-01

    Analysis of General Social Survey data (n=733) indicated that men attached greater importance to promotion than women because they were more likely in positions with promotion potential. Results support Kanter's thesis that men's and women's positions in the workplace opportunity structure, not gender, shape career attitudes. (Contains 66…

  15. Surface protection of inner shells of cooling towers. Positive long-term experience with coating systems.; Oberflaechenschutz von Kuehlturminnenschalen. Positive Langzeiterfahrungen mit Beschichtungssystemen

    Energy Technology Data Exchange (ETDEWEB)

    Heine, Peer [MC-Bauchemie Mueller GmbH und Co.KG, Bottrop (Germany)

    2010-07-15

    Natural-draught cooling tower are modern power plant components with great importance for safe and reliable power supply. Due to the complex effects of operating and environmental conditions especially on the inner shell, the concrete must be protected by special resin-based surface coating systems. Parallel to the development of the power plant technology, also the coating systems are under constant improvement in order to ensure reliable and permanent protection. The positive long-term experience suggests that power plant operators may rely on a high level of safety here. (orig.)

  16. Demographic, clinical and radiological characteristics of seronegative spondyloarthritis Egyptian patients: A rheumatology clinic experience in Mansoura

    Directory of Open Access Journals (Sweden)

    Adel Abdelsalam

    2017-04-01

    Conclusion: The demographic, clinical and radiological characteristics of Egyptian SpA patients are comparable to those from other countries except for the lower prevalence of extra-articular manifestations.

  17. [Brain-Computer Interface: the First Clinical Experience in Russia].

    Science.gov (United States)

    Mokienko, O A; Lyukmanov, R Kh; Chernikova, L A; Suponeva, N A; Piradov, M A; Frolov, A A

    2016-01-01

    Motor imagery is suggested to stimulate the same plastic mechanisms in the brain as a real movement. The brain-computer interface (BCI) controls motor imagery by converting EEG during this process into the commands for an external device. This article presents the results of two-stage study of the clinical use of non-invasive BCI in the rehabilitation of patients with severe hemiparesis caused by focal brain damage. It was found that the ability to control BCI did not depend on the duration of a disease, brain lesion localization and the degree of neurological deficit. The first step of the study involved 36 patients; it showed that the efficacy of rehabilitation was higher in the group with the use of BCI (the score on the Action Research Arm Test (ARAT) improved from 1 [0; 2] to 5 [0; 16] points, p = 0.012; no significant improvement was observed in control group). The second step of the study involved 19 patients; the complex BCI-exoskeleton (i.e. with the kinesthetic feedback) was used for motor imagery trainings. The improvement of the motor function of hands was proved by ARAT (the score improved from 2 [0; 37] to 4 [1; 45:5] points, p = 0.005) and Fugl-Meyer scale (from 72 [63; 110 ] to 79 [68; 115] points, p = 0.005).

  18. Pattern and presentation of odontogenic jaw cysts: a clinical experience

    International Nuclear Information System (INIS)

    Awan, M.U.A.; Ibrahim, M.W.

    2017-01-01

    Objective: To determine the pattern and presentations of odontogenic jaw cysts in patients reporting at the Armed Forces Institute of Dentistry. Study Design: Descriptive study. Place and Duration of Study: Armed Forces Institute of Dentistry, from Jan to Dec 2007. Material and Methods: Hundred patients including 70 males and 30 females with the age range 5-65 years were included in the study. History, clinical examination, radiographic examination and histopathologic examination of lesion were carried out for each patient. A proforma was filled for each patient for all relevant information, presentation and pattern. Diagnosis was confirmed by histopathology. Data were analyzed using SPSS version 10. Results: Out of total 100 patients, 58 percent were diagnosed with radicular cysts, 25 percent with dentigerous cysts, 15 percent with odontogenic keratocyst, 1 percent patient with calcifying epithelial odontogenic cyst and 1 percent patient was diagnosed with eruption cyst. Conclusion: The study demonstrates that radicular cyst was the most common odontogenic cysts followed by dentigerous and odontogenic keratocysts respectively in our study sample. (author)

  19. Clinical experiences of NBI laryngoscope in diagnosis of laryngeal lesions

    Science.gov (United States)

    Qi, Xinmeng; Yu, Dan; Zhao, Xue; Jin, Chunshun; Sun, Changling; Liu, Xueshibojie; Cheng, Jinzhang; Zhang, Dejun

    2014-01-01

    Endoscopy is essential for the diagnosis and treatment of cancers derived from the larynx. However, a laryngoscope with conventional white light (CWL) has technical limitations in detecting small or superficial lesions on the mucosa. Narrow band imaging especially combined with magnifying endoscopy (ME) is useful for the detection of superficial squamous cell carcinoma (SCC) within the oropharynx, hypopharynx, and oral cavity. A total of 3675 patients who have come to the outpatient clinic and complained of inspiratory stridor, dyspnea, phonation problems or foreign body sensation, were enrolled in this study. We describe the glottic conditions of the patients. All 3675 patients underwent laryngoscopy equipped with conventional white light (CWL) and NBI system. 1149 patients received a biopsy process. And 1153 lesions were classified into different groups according to their histopathological results. Among all the 1149 patients, 346 patients (312 males, 34 females; mean age 62.2±10.5 years) were suspected of having a total of 347 precancerous or cancerous (T1 or T2 without lymphnode involvement) lesions of the larynx under the CWL. Thus, we expected to attain a complete vision of what laryngeal lesions look like under the NBI view of a laryngoscope. The aim was to develop a complete description list of each laryngeal conditions (e.g. polyps, papilloma, leukoplakia, etc.), which can serve as a criteria for further laryngoscopic examinations and diagnosis. PMID:25419362

  20. Clinical experience of magnetic resonance angiography in hand surgery

    International Nuclear Information System (INIS)

    Kawabata, Hidehiko; Yasui, Natsuo; Kitano, Motohiro; Sai, Eikoh

    1996-01-01

    Magnetic resonance angiography was performed in fourteen patients with congenital hand abnormalities. A two-dimentional time-of-flight imaging clearly demonstrated presence or absence of the radial, ulnar, and anterior interosseous arteires at forearm. However, smaller arteries such as digital arteries were depressed sometimes. This fact makes clinical application of the method somewhat limited. At present. appropriate applications in orthopaedic fields are evaluation of run-off of the major vessels after trauma or atherosclerotic diseases, venous vascular problems such as thrombophlebitis and aneurysm, and preoperative and post operative evaluation in microsurgery. If more detailed information is required, for example, in differential diagnosis of tumors conventional angiography or digital subtraction angiography is recommended. Because magnetic resonance angiography is non-invasive and does not need anesthesia, it is suitable especially for children. No requirement of contrast medium makes it easy to apply angiography to high risk patients and allergic patients to iodine. Technical advancement in near future will rise up magnetic resonance angiography to a standard evaluation method for vascular problems in orthopaedic fields very soon. (author)

  1. The First Experience of Clinical Practice on Psychology Students’ Imaginary

    Directory of Open Access Journals (Sweden)

    Sueli Regina Gallo-Belluzzo

    2013-09-01

    Full Text Available Considering the academic development of the psychologist as a complex process which articulates the transmission of scientific knowledge and changes in imaginative activity, we psychoanalytically investigate the collective imaginary of Psychology students regarding the first clinical consultation. We conducted a group interview with 52 undergraduate students, using the Thematic Story-Drawing Procedure as a way to open a dialogical field. The material obtained, through the psychoanalytical method, resulted in the creation/gathering of four affective-emotional meaning fields: “I came, I saw and I conquered”, “I know that I (do not know”, “I survived and I will save” and “I am and I do”, from which we see an emotionally immature imaginary about the meeting with the patient, since students are more self-centered than concerned with the patient. The overall situation indicates the need for care regarding student academic development, in order to encourage a more mature approach toward the suffering of the other.

  2. Transumbilical breast augmentation (TUBA): patient selection, technique, and clinical experience.

    Science.gov (United States)

    Pound, E C; Pound, E C

    2001-07-01

    The TUBA procedure offers another approach to placing inflatable breast implants in the subglandular or submuscular position. It is an easy procedure to learn and to perform, using only a few relatively inexpensive specialized instruments. It also can be modified to use preexisting scars on the abdomen as the access point. The authors believe that complications seem to occur less with TUBA patients than with patients having breast augmentation by other approaches, an observation shared by other plastic surgeons offering the TUBA procedure. Limitations include the fact that only inflatable implants can be used. Also, with increasing distance from the breast, there is less control over manipulation of the pocket. Fortunately, the authors have not found this to be a problem in achieving symmetry. Furthermore, bleeding tends to be minimal with this approach. Nevertheless, should technical difficulties arise, conversion to a standard breast incision is an easy back-up option and should be discussed with the patient before surgery. Interest in the TUBA approach to breast augmentation continues to grow. Patients appreciate the lack of scarring on the breast and the short recovery that allows them to resume their normal lifestyle quickly. The authors' caseload has increased considerably over the past 8 years through word-of-mouth advertising from satisfied patients. Other plastic surgeons who offer this approach agree that patient demand for this operation continues to grow dramatically in their practices.

  3. Four-year clinical experience in photodynamic therapy

    Science.gov (United States)

    Stranadko, Eugeny P.; Skobelkin, Oleg K.; Vorozhtsov, Georgy N.; Mironov, Andrei F.; Markichev, Nikolai A.; Riabov, Michail V.

    1996-12-01

    The analysis of the results of photodynamic therapy (PDT) for treating malignant neoplasms of skin, breasts, tongue, oral mucose, lower lip, larynx, stomach, bladder, rectum and other locations has been made. During 1992 - 1996 867 tumoral foci in 222 patients have been treated with PDT. All patients were previously treated with conventional techniques or they were not treated due to contraindications either because of severe accompanying diseases or because of old age. A part of the patients had PDT because of recurrences or intradermal metastases in 1 - 2 years after surgical, radial or combined treatment. Up to now we have follow-up control data within 2 months and 4 years. Positive effect of PDT was seen in 93.7% of patients including complete regression of tumors in 64.9% and partial in 28.8%. Currently this new perspective technique of treating malignant neoplasms is successfully being used in Russia; new photosensitizers and light sources for PDT and fluorescent tumor diagnostics are being developed as well.

  4. A decade of experience with a clinical pharmacokinetics service.

    Science.gov (United States)

    Ambrose, P J; Smith, W E; Palarea, E R

    1988-09-01

    The development, operation, and functions of the pharmacokinetics service at Memorial Medical Center of Long Beach (MMCLB) are described, and the data used to determine the quality and cost-effectiveness of the service are presented. Current functions of the pharmacokinetics service at MMCLB include making brief written comments about the interpretations of serum drug concentrations (SDCs) and oral recommendations to physicians on dosage adjustment; provision of written consultations with dosage recommendations; provision of drug information, education, and research; and development of drug dosing guidelines for the pharmacy and medical staff. During the 10-year existence of this service, costs have been justified on the basis of not only revenue generated by the service (in the form of "drug concentration scheduling" and "drug concentration evaluation" fees charged to patients) but also by cost savings resulting from the prevention of inappropriate, misleading, and potentially dangerous SDCs. An audit conducted in 1986 showed that the policy of having pharmacists schedule the sampling times for SDCs saves about $500,000 annually. Quality assurance has been documented by auditing compliance with and therapeutic effectiveness of dosing guidelines and by working with laboratory personnel to identify and prevent spurious SDC results and assay errors. The methods used by the pharmacokinetics service at MMCLB to document the benefits of the service have been vital in proving both its cost-effectiveness and its positive effect on patient care.

  5. Learning by playing: A cross-sectional descriptive study of nursing students' experiences of learning clinical reasoning.

    Science.gov (United States)

    Koivisto, Jaana-Maija; Multisilta, Jari; Niemi, Hannele; Katajisto, Jouko; Eriksson, Elina

    2016-10-01

    Clinical reasoning is viewed as a problem-solving activity; in games, players solve problems. To provide excellent patient care, nursing students must gain competence in clinical reasoning. Utilising gaming elements and virtual simulations may enhance learning of clinical reasoning. To investigate nursing students' experiences of learning clinical reasoning process by playing a 3D simulation game. Cross-sectional descriptive study. Thirteen gaming sessions at two universities of applied sciences in Finland. The prototype of the simulation game used in this study was single-player in format. The game mechanics were built around the clinical reasoning process. Nursing students from the surgical nursing course of autumn 2014 (N=166). Data were collected by means of an online questionnaire. In terms of the clinical reasoning process, students learned how to take action and collect information but were less successful in learning to establish goals for patient care or to evaluate the effectiveness of interventions. Learning of the different phases of clinical reasoning process was strongly positively correlated. The students described that they learned mainly to apply theoretical knowledge while playing. The results show that those who played digital games daily or occasionally felt that they learned clinical reasoning by playing the game more than those who did not play at all. Nursing students' experiences of learning the clinical reasoning process by playing a 3D simulation game showed that such games can be used successfully for learning. To ensure that students follow a systematic approach, the game mechanics need to be built around the clinical reasoning process. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

    NARCIS (Netherlands)

    Ryom, L.; Boesecke, C.; Gisler, V.; Manzardo, C.; Rockstroh, J. K.; Puoti, M.; Furrer, H.; Miro, J. M.; Gatell, J. M.; Pozniak, A.; Behrens, G.; Battegay, M.; Lundgren, J. D.; Lundgren, Jens D.; Ryom, Lene; Gatell, José M.; Pozniak, Anton; Manzardo, Christian; Monforte, Antonella d'Arminio; Arribas, José; Battegay, Manuel; Clumeck, Nathan; Dedes, Nikos; Geretti, Anna Maria; Horban, Andrzej; Katlama, Christina; McCormack, Sheena; Molina, Jean-Michel; Mussini, Cristina; Raffi, François; Reiss, Peter; Stellbrink, Hans-Jürgen; Behrens, Georg; Bower, Mark; Cinque, Paola; Collins, Simon; Compston, Juliet; Deray, Gilbert; de Wit, Stéphane; Fux, Christoph A.; Guraldi, Giovanni; Mallon, Patrick; Martinez, Esteban; Marzolini, Catia; Papapoulos, Socrates; Du Pasquier, Renaud; Poulter, Neil; Williams, Ian; Winston, Alan; Rockstroh, Jürgen K.

    2016-01-01

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

  7. Implant-supported mandibular removable partial dentures : Functional, clinical and radiographical parameters in relation to implant position

    NARCIS (Netherlands)

    Jensen, Charlotte; Speksnijder, Caroline M.; Raghoebar, Gerry M.; Kerdijk, Wouter; Meijer, Henny J A; Cune, Marco S.

    Background: Patients with a Kennedy class I situation often encounter problems with their removable partial denture (RPD). Purpose: To assess the functional benefits of implant support to RPDs, the clinical performance of the implants and teeth and to determine the most favorable implant position:

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  9. The overtime effect of social position on dental caries experience in a group of old-aged Danes born in 1914

    DEFF Research Database (Denmark)

    Krustrup, Ulla; Holm-Pedersen, Poul; Petersen, Poul Erik

    2008-01-01

    OBJECTIVES: The purpose of this study was to analyze the life-course effects of education, occupation, and income at ages 70, 75, 80, and 85 years, respectively, on dental caries experience of 85-year-olds. METHODS: The present study includes follow-up data from a population-based study, which...... comprised a sample of 176 individuals aged 85 years. Data on social position were collected at ages 70, 75, 80, and 85 years by means of structured personal interviews. Clinical oral health examinations were conducted to obtain data on dental caries at age 85. Dental caries was recorded at tooth surface...... level and caries experience was expressed by the DMF Index: the decayed tooth surfaces (D component), missing tooth surfaces (M component), and filled tooth surfaces (F component). RESULTS: The participants in the present study demonstrated a high level of dental caries experience; the prevalence rate...

  10. Effect of video-game experience and position of flight stick controller on simulated-flight performance.

    Science.gov (United States)

    Cho, Bo-Keun; Aghazadeh, Fereydoun; Al-Qaisi, Saif

    2012-01-01

    The purpose of this study was to determine the effects of video-game experience and flight-stick position on flying performance. The study divided participants into 2 groups; center- and side-stick groups, which were further divided into high and low level of video-game experience subgroups. The experiment consisted of 7 sessions of simulated flying, and in the last session, the flight stick controller was switched to the other position. Flight performance was measured in terms of the deviation of heading, altitude, and airspeed from their respective requirements. Participants with high experience in video games performed significantly better (p increase (0.78 %). However, after switching from a center- to a side-stick controller, performance scores decreased (4.8%).

  11. The importance of clinical monitoring for compliance with Continuous Positive Airway Pressure.

    Science.gov (United States)

    Pelosi, Lucas B; Silveira, Mariana L C; Eckeli, Alan L; Chayamiti, Emilia M P C; Almeida, Leila A; Sander, Heidi H; Küpper, Daniel S; Valera, Fabiana C P

    Obstructive sleep apnea syndrome is currently a public health problem of great importance. When misdiagnosed or improperly treated, it can lead to serious consequences on patients' quality of life. The gold standard treatment for cases of obstructive sleep apnea syndrome, especially in mild to severe and symptomatic cases, is continuous positive airway pressure therapy. Compliance with continuous positive airway pressure therapy is directly dependent on the active participation of the patient, which can be influenced by several factors. The objective of this study is to describe the factors related to compliance with continuous positive airway pressure therapy, and to analyze which associated factors directly influence the efficiency of the treatment. Patients who received continuous positive airway pressure therapy through the Municipal Health Department of the city of Ribeirão Preto were recruited. A structured questionnaire was administered to the patients. Compliance with continuous positive airway pressure therapy was assessed by average hours of continuous positive airway pressure therapy usage per night. Patients with good compliance (patients using continuous positive airway pressure therapy ≥4h/night) were compared to those with poor compliance (patients using <4h/night). 138 patients were analyzed: 77 (55.8%) were considered compliant while 61 (44.2%) were non-compliant. The comparison between the two groups showed that regular monitoring by a specialist considerably improved compliance with continuous positive airway pressure therapy (odds ratio, OR=2.62). Compliance with continuous positive airway pressure therapy is related to educational components, which can be enhanced with continuous and individualized care to patients with obstructive sleep apnea syndrome. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  12. Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review

    DEFF Research Database (Denmark)

    Larsen, Camilla Marie; Juul-Kristensen, Birgit; Lund, Hans

    2014-01-01

    a substantially larger number of clinical scapular assessment methods than previously reported. Using the COSMIN checklist the methodological quality of the included measurement properties in the reliability and validity domains were in general ‘‘fair’’ to ‘‘poor’’. None were examined for all three domains: (1...... utility for clinical practice.......The aims were to compile a schematic overview of clinical scapular assessment methods and critically appraise the methodological quality of the involved studies. A systematic, computerassisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to October...

  13. Stapes surgery in residency: the UFPR clinical hospital experience.

    Science.gov (United States)

    Caldart, Adriano Ulisses; Terruel, Igor; Enge, Dair Jocely; Kurogi, Adriana Sayuri; Buschle, Maurício; Mocellin, Marcos

    2007-01-01

    Surgery of the stapedius remains the established treatment for otosclerosis. Recent publications have showed that success in surgeries done by residents have decreased and hearing results are worse than those obtained by experienced otologic surgeons. To evaluate the experience of the otorhinolaryngology unit, Parana University, relative to stapes surgery done in the residency training program. A retrospective study of 114 stapes surgeries done in the past 9 years in 96 patients. Audiometric results were analysed according to the Committee on Hearing and Equilibrium guidelines and the Amsterdam Hearing Evaluation Plots. The improvement of the airway postoperative gap and thresholds were taken into account. 96 patients were included, most of them female adults (67.7%) and white (93.7%). Stapedectomy was done in 50.9% of cases, mostly under local anesthesia and sedation (96.5%), using mostly the Teflon prosthesis (37.7%). The surgical success rate was 50.88%, there was an 11.4% complication rate. Postoperative hearing gains considered as surgical success were inferior to published results in the literature, done by experienced surgeons.

  14. Initial experience of the medical clinic of the education Casmu

    International Nuclear Information System (INIS)

    Musé, M.; Laureiro, E.; Musetti, C.

    2010-01-01

    Full text: What happens when a patient (p te) is faced once treatment Q T? We know that for p te involves both how their family; face a charge of myths and half-truths; causing the treatment is so vivid apprehension as the disease itself. In this context the concern of the Department of Oncology Casmu arises; of give patients an area where the p te to receive information contribute to reaching the treatment of Q T in better condition. All patients will start treatment Q T for the first time; are cited for an interview at the Polyclinic of Education. It is coordinated delayed with respect to the talks with the Treating oncologist, in order to allow the patient to develop their doubts and to raise them. In the interview also involved the p te and his family, Oncology Residents Department, and a member of Campus Nursing thereof. the interview is divided into five modules: 1) Administrative Aspects 2) Nursing Care 3) Potential side effects. 4) Social Benefits 5) Resources Information. Between January 2003 and August 2004, 70 interviews were conducted education. the average length thereof was 30 minutes. Is in progress writing a brochure based on the questions most frequently asked by patients and their families; well as an evaluation of the experience

  15. Clinical course of ectopic pregnancy: A single-center experience

    Directory of Open Access Journals (Sweden)

    Aqueela Ayaz

    2013-01-01

    Full Text Available Objectives: The objective was to highlight the frequency, clinical profile, and predisposing factors of ectopic pregnancy (EP in a general hospital. Materials and Methods: This descriptive study was conducted at the Obstetrics and Gynaecology department of Hera General hospital, Makkah, Saudi Arabia, from July 1, 2009 to December 29, 2010. Data were collected on chief medical complaints, sociodemographic characteristics, past obstetrics and gynecological history, management done, and outcome of management. Data were analyzed using Microsoft Office Excel (version 2007. Results: Out of total 7564 pregnancies, 44 (0.58% patients were diagnosed as EP. Out of 44, 22 (50% patients presented within 24 h of onset of symptoms. Mean age was 28 ± 7 years. Multigravida were predominant in 25 (57%, and 21 (48% had gestational age of 6-8 weeks at the time of presentation; the common presenting features were amenorrhea (41, 93.2%, abdominal pain (39, 88.6%, and tenderness (38, 86%. Previous pelvic surgery (13, 29.5%, infertility treatment (11, 25%, and pelvic inflammatory disease (10, 22.7% were the common predisposing factors. Twenty-five (57% presented with ruptured EP and were operated within 24 h, and the remaining were kept under observation till further diagnosis. After confirming the diagnosis, 12/19 underwent laparoscopy, whereas 7/19 received medical treatment. Surgery confirmed fallopian tube pregnancies in 35 (94.5%. No mortality was observed. Conclusion: Previous pelvic surgeries were the major etiological factor for EP. Other factors were infertility treatment and pelvic inflammatory disease. The most common site of EP was fallopian tubes.

  16. A CLINICAL STUDY AND MANAGEMENT OF PAEDIATRIC CATARACT, OUR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Satish D. Shet

    2017-09-01

    Full Text Available BACKGROUND Control of childhood blindness is one of the priorities identified for achieving the goals of Vision-2020 by WHO. This is considered a priority because blind-years (number of years that a blind person lives after going blind due to childhood blindness are second only to cataract and half of childhood blindness is avoidable (treatable/preventable. Paediatric cataract accounts for 12% of the 1.4 million blind children globally. The prevalence of childhood cataract has been reported as 1 to 15 cases in 10,000 children in developing countries. Compared to industrialised countries, this figure is 10 times higher. Early detection and timely treatment of various childhood disorders such as congenital cataract are the most crucial factors for successful outcome. A suitable measure to address amblyopia and posterior capsule opacification post operatively is imperative for successful visual rehabilitation of such children. The objectives of this study were- 1 To study the clinical profile of paediatric cataract. 2 To evaluate the visual outcome after cataract surgery in these patients. 3 To evaluate different causes of visual impairment following management. MATERIALS AND METHODS A prospective study conducted at Karnataka institute of medical sciences department of ophthalmology from October 2015 to September 2016. All children below 14 years of age presenting with cataract will undergo thorough ophthalmologic examination and cataract surgery. RESULTS The results of the present study with 25 paediatric patients (36 eyes indicates that excellent vision can be expected after cataract surgery and posterior chamber IOL implantation coupled with appropriate amblyopia therapy. CONCLUSION The paediatric cataract patients are referred from primary health centers, and district hospital from north Karnataka to KIMS Hubli. All paediatric patients are from lower socio economic status. Early detection of cataracts and referrals to the ophthalmologist can

  17. Clinical experiences with cannabinoids in spasticity management in multiple sclerosis.

    Science.gov (United States)

    Lorente Fernández, L; Monte Boquet, E; Pérez-Miralles, F; Gil Gómez, I; Escutia Roig, M; Boscá Blasco, I; Poveda Andrés, J L; Casanova-Estruch, B

    2014-06-01

    Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS. Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor's analysis and overall impression. Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data. We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of the study. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1). THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  18. Clinical experience of infective endocarditis complicated by acute cerebrovascular accidents.

    Science.gov (United States)

    Hsu, Chan-Yang; Chi, Nai-Hsin; Wang, Shoei-Shen; Chen, Yih-Sharng; Yu, Hsi-Yu

    2017-04-01

    To evaluate the clinical results of patients with infective endocarditis (IE) complicated by acute cerebrovascular accidents (CVAs). A total of 44 patients with IE complicated by CVA at admission were retrospectively analyzed in a single medical institute from 2005 to 2011. At the time of admission, 18 patients were diagnosed with hemorrhagic stroke, and 26 patients were diagnosed with ischemic stroke. Fifteen patients received surgical intervention during hospitalization. The hospital mortality rate was 38.9% for the hemorrhagic stroke group and 42.3% for the ischemic stroke group (p = 0.821). The mortality rate was 33.3% for the surgical group and 44.8% for the nonsurgical group (p = 0.531). At 30 days of hospitalization, 45.8% of the patients experienced an adverse event (defined as death due to organ failure, restroke, cardiogenic shock, or septic shock during the treatment period), and the attrition rate was 1.5% per day. Surgery performed after the adverse events increased mortality (80.0%) compared with surgery performed on patients with no adverse events (10.0%; p = 0.017). A Cox regression analysis revealed that creatinine > 2 mg/dL, diabetes, and staphylococcal infection were the risk factors of the adverse events. Early surgical intervention for IE with ischemic stroke may prevent adverse events, particularly in patients with impaired renal function, diabetes, or staphylococcal infection. A delay in operation of > 30 days is recommended after hemorrhagic stroke. Copyright © 2017. Published by Elsevier Taiwan.

  19. Effects of positive electrical feedback in the oscillating Belousov-Zhabotinsky reaction: Experiments and simulations

    International Nuclear Information System (INIS)

    Sriram, K.

    2006-01-01

    This paper describes both the experimental and numerical investigations on the effect of positive electrical feedback in the oscillating Belovsou-Zhabotinsky (BZ) reaction under batch conditions. Positive electrical feedback causes an increase in the amplitude and period of the oscillations with the corresponding increase of the feedback strength. Oregonator model with a positive feedback term suitably incorporated in one of the dynamical variables is used to account for these experimental observations. Further, the effect of positive feedback on the Hopf points are investigated numerically by constructing the bifurcation diagrams. In the absence of feedback, for a particular stoichiometric parameter, the model exhibits both supercritical and subcritical Hopf bifurcations with canard existing near the former Hopf point. In the presence of positive feedback it is observed that (i) both the Hopf points advances, (ii) the distance between the two Hopf points decreases linearly, while the period increases exponentially with the increase of feedback strength near the Hopf points, (iii) only supercritical Hopf point without canard survives for a very strong positive feedback strength and (iv) moderate feedback strength takes the system away from limit cycle to the canard regime. These observations are explained in terms of Field-Koeroes-Noyes mechanism of the Belousov-Zhabotinsky reaction. This may be the first instance where the advancement of Hopf points due to positive feedback is clearly shown

  20. The Mayo Clinic Arizona Spasmodic Dysphonia Experience: A Demographic Analysis of 718 Patients.

    Science.gov (United States)

    Patel, Alpen B; Bansberg, Stephen F; Adler, Charles H; Lott, David G; Crujido, Lisa

    2015-11-01

    Analyze demographic data collected over a 25-year experience of 718 patients with spasmodic dysphonia (SD) who have been treated with botulinum toxin-A (BoNT-A) and compare our data with previously published studies. Seven hundred eighteen patients with SD were treated with 6621 BoNT-A injections at Mayo Clinic Arizona between 1989 and 2014. All patients were treated by the same physician team. Background demographic data for each patient were recorded. Of 718 patients, 557 patients were female (77.6%). Six hundred sixty of 718 (91.8%) patients had adductor SD (AdSD), and 58 of 718 (8.1%) patients had abductor SD (AbSD). Average age of onset was 51 years. Of 718 patients, 378 (52.6%) had vocal tremor (VT); VT was present in 54.4% of AdSD patients and 32.1% of AbSD patients. Thirty-seven of 718 (5.2%) patients had other dystonias, including cervical dystonia (2.3%), blepharospasm (1.4%), limb dystonia (1.1%), and oromandibular dystonia (0.3%). A positive family history of SD was present in only 6 of 718 patients (0.8%) and of other dystonias in 11 of 718 patients (1.5%). Spasmodic dysphonia is a chronic and potentially disabling focal laryngeal dystonia. The Mayo Clinic Arizona SD experience compares to prior reports and reveals a female preponderance, onset in middle age, infrequent hereditary pattern, high co-occurrence of VT, and low co-occurrence of other dystonias. © The Author(s) 2015.

  1. Psychiatric Consultation in Community Clinics: A Decade of Experience in the Community Clinics in Jerusalem.

    Science.gov (United States)

    Avny, Ohad; Teitelbaum, Tatiana; Simon, Moshe; Michnick, Tatiana; Siman-Tov, Maya

    2016-01-01

    A consultation model between primary care physicians and psychiatrists that has been in operation for 12 years in the Jerusalem district of the Clalit Health Services in Israel is evaluated. In this model psychiatrists provide consultations twice a month at the primary care clinic. All patients are referred by their family physicians. Communication between the psychiatric consultant and the referring physician is carried out by telephone, correspondence and staff meetings. Evaluation of the psychiatric care consultation model in which a psychiatrist consults at the primary care clinic. A questionnaire-based survey distributed to 17 primary care physicians in primary care clinics in Jerusalem in which a psychiatric consultant is present. Almost all of the doctors (93%) responded that the consultation model was superior to the existing model of referral to a secondary psychiatric clinic alone and reduced the workload in caring for the referred patients. The quality of psychiatric care was correlated with the depression prevalence among patients referred for consultation at their clinic (r=0.530, p=0.035). In addition, correlation was demonstrated between primary care physicians impression of alleviation of care of patients and their impression of extent of the patients' cooperation with the consulting psychiatrist (r=0.679, p = 0.015) Conclusions: Very limited conclusions may be drawn from this questionnaire distributed to primary care physicians who were asked to assess psychiatric consultation in their clinic. Our conclusion could be influenced by the design and the actual distribution of the questionnaires by the consulting psychiatrist. Nevertheless answers to the questionnaire might imply that the consultation model of care between a psychiatric consultant and the primary care physician, where the patient's primary care physician takes a leading role in his psychiatric care, is perceived by family physicians as a good alternative to referral to a psychiatric

  2. Understanding Positive Play: An Exploration of Playing Experiences and Responsible Gambling Practices.

    Science.gov (United States)

    Wood, Richard T A; Griffiths, Mark D

    2015-12-01

    This study is one of the first to explore in detail the behaviors, attitudes and motivations of players that show no signs of at-risk or problem gambling behavior (so-called 'positive players'). Via an online survey, 1484 positive players were compared with 209 problem players identified using the Lie/Bet screen. The study identified two distinct groups of positive players defined according to their motivations to play and their engagement with responsible gambling (RG) practices. Those positive players that played most frequently employed the most personal RG strategies. Reasons that positive players gave for gambling were focused on leisure (e.g., playing for fun, being entertained, and/or winning a prize). By contrast, problem gamblers were much more focused upon modifying mood states (e.g., excitement, relaxation, depression and playing when bored or upset). The present study also suggests that online gambling is not, by default, inherently riskier than gambling in more traditional ways, as online gambling was the most popular media by which positive players gambled. Furthermore, most positive players reported that it was easier to stick to their limits when playing the National Lottery online compared to traditional retail purchasing of tickets. Problem players were significantly more likely than positive players to gamble with family and friends, suggesting that, contrary to a popular RG message, social play may not be inherently safer than gambling alone. It is proposed that players (generally) may identify more with the term 'positive play' than the term 'RG' which is frequently interpreted as being aimed at people with gambling problems, rather than all players.

  3. Thoracoscopic part of minimal invasive oesophagectomy in semiprone position: our initial experience.

    Science.gov (United States)

    Thakkar, Chirag M; Kumar, Alankar V; Soni, Harshad N; Shah, Atul J; Patel, Kantilal S; Haribhakti, Sanjiv P

    2014-08-01

    Surgical resection with curative intent is till the mainstay of treatment for resectable esophageal cancer. Minimal invasive oesophagectomy has the potential to lower morbidity and mortality. In all likelihood, thoracoscopic oesophagectomy in semiprone position gives all the benefits of prone position and can be converted to thoracotomy without change in patient position if needed. The aim of this study is to analyze the feasibility of thoracoscopic oesophagectomy in semiprone position. This is a retrospective analysis of the data of thoracoscopic oesophgeactomy in semiprone position at Kaizen Hospital, a tertiary care center for gastroenterology during the period of December 2011 to December 2012. All surgeries were performed under general anesthesia with a single-lumen endotracheal tube. Esophageal mobilization was done by thoracoscopic approach in a semiprone position and an end-to-end hand-sewn cervical anastomosis was done. Abdominal part was performed by laparoscopic method in 3 patients and by laparotomy in rest of the patients. Total of 12 patients were included in this study. There was 1 conversion to thoracotomy and 1 surgical mortality. Mean operating time for the thoracoscopic part was 103 minutes, mean estimated blood loss for the thoracoscopic part was 110 mL, mean maximum end-tidal CO2 38.5 mm Hg, mean lymph nodes retrieved 14, and all patients had R0 resection. The median intensive care unit stay was 1 day and hospital stay was 8 days. Thoracoscopic part of thoracolaparoscopic oesophagectomy in semiprone position is a feasible option. It gives all advantages of prone position and thoracotomy is possible without change in patient position. However, further large-scale studies are required.

  4. Initial clinical experience with a sac-anchoring endoprosthesis for aortic aneurysm repair.

    Science.gov (United States)

    Donayre, Carlos E; Zarins, Christopher K; Krievins, Dainis K; Holden, Andrew; Hill, Andrew; Calderas, Carlos; Velez, Jaime; White, Rodney A

    2011-03-01

    All current aortic endografts depend on proximal and distal fixation to prevent migration. However, migration and rupture can occur, particularly in patients with aortic necks that are short or angulated, or both. We present our initial clinical experience with a new sac-anchoring endoprosthesis designed to anchor and seal the device within the aneurysm sac. The initial worldwide experience using a new endoprosthesis for the treatment of aortic aneurysms (Nellix Endovascular, Palo Alto, Calif) was reviewed. The endoprosthesis consists of dual balloon-expandable endoframes surrounded by polymer-filled endobags designed to obliterate the aneurysm sac and maintain endograft position. Clinical results and follow-up contrast computed tomography (CT) scans at 30 days and 6 and 12 months were reviewed. The endograft was successfully deployed in 21 patients with infrarenal aortic aneurysms measuring 5.7 ± 0.7 cm (range, 4.3-7.4 cm). Two patients with common iliac aneurysms were treated with sac-anchoring extenders that maintained patency of the internal iliac artery. Infusion of 71 ± 37 mL of polymer (range, 19-158 mL) into the aortic endobags resulted in complete aneurysm exclusion in all patients. Mean implant time was 76 ± 35 minutes, with 33 ± 17 minutes of fluoroscopy time and 180 ± 81 mL of contrast; estimated blood loss was 174 ± 116 mL. One patient died during the postoperative period (30-day mortality, 4.8%), and one died at 10 months from non-device-related causes. During a mean follow-up of 8.7 ± 3.1 months and a median of 6.3 months, there were no late aneurysm- or device-related adverse events and no secondary procedures. CT imaging studies at 6 months and 1 year revealed no increase in aneurysm size, no device migration, and no new endoleaks. One patient had a limited proximal type I endoleak at 30 days that resolved at 60 days and remained sealed. One patient has an ongoing distal type I endoleak near the iliac bifurcation, with no change in aneurysm

  5. The electromagnetic bio-field: clinical experiments and interferences.

    Science.gov (United States)

    Burnei, G; Hodorogea, D; Georgescu, I; Gavriliu, Ş; Drăghici, I; Dan, D; Vlad, C; Drăghici, L

    2012-06-12

    One of the most important factors is the technical and scientifically rapid development that is continually modifying the world we live in and polluting it with electromagnetic radiations. A functional and structural influence of magnetic and electromagnetic field on living organisms is presented in the literature by many performed experiments. The notion of bio-field represents the electromagnetic field generated by the bio-structures, not only in their normal physiological activities but also in their pathological states. There is a tight interdependency between the bio-field and the bio-structure, which respects the primary notion of an electromagnetic field given by the Maxwell-Faraday laws, in which, the electromagnetic phenomena are simplified to the field variations. These variations can be expressed in a coherent differential equation system that bounds the field vectors to different space points at different time moments. The living organisms cannot contain electrostatic and magneto-static fields due to the intense activity of the bio-structures. The biochemical reactions that have high rhythms and speeds always impose the electrodynamics character of the biologic field that also corresponds to the stability of the protein molecule that can be explained only through a dynamic way. The existent energy is not considered an exciting agent, and it does not lead to any effects. The parameters of these elementary bio-fields cannot yet be fully known due to technical reasons. The biological structures are very complex ones and undergo continuous dynamical activity. That is why the calculus model should be related to the constant dynamics, nowadays being very difficult to express.

  6. Surgical treatment of pancreatic pseudocysts – clinical experience

    Directory of Open Access Journals (Sweden)

    Artur Zakościelny

    2014-06-01

    Full Text Available Introduction: Pancreatic pseudocysts are frequent complications after acute and chronic pancreatitis. They are diagnosed in 6–18% of patients with the history of acute pancreatitis and in 20–40% cases with chronic pancreatitis. The aim of the study was to analyse early results of surgical treatment of pancreatic acute and chronic pseudocysts based on our experience. Material and methods: The retrospective analysis was based on early results of surgical treatment of 46 patients aged between 20 and 78 (33 males and 13 females who underwent treatment of acute (n = 26 and chronic (n = 20 pancreatic pseudocysts from November 2005 to July 2011 at the Second Department of General and Gastrointestinal Surgery and Surgical Oncology of the Alimentary Tract in Lublin. Results: The choice of a surgical method of treatment depended on the size, localisation, thickness of pseudocystic wall and changes in the main pancreatic duct. We used the following surgical methods: cystogastrostomy (Jurasz procedure was conducted in 22 patients (47.8%, Roux-en-Y cystojejunostomy was performed in 19 cases (41.3%, complete excision of the pseudocyst was possible in two patients (4.3% and cystoduodenostomy – in one case (2.1%. Also, in single cases external drainage (2.1% and cystopancreaticojejunostomy of Puestow (2.1% were applied. Forty-four patients (95.6% were cured. Early postoperative complications were observed in 2 patients (4.4%. Two reoperations (4.4% were required. Early postoperative mortality was 0%. Conclusions: Classic internal drainage procedures, known since the 19th century, are still effective methods of treatment in acute and chronic pancreatic pseudocysts.

  7. Detecting and staging podoconiosis cases in North West Cameroon: positive predictive value of clinical screening of patients by community health workers and researchers

    Directory of Open Access Journals (Sweden)

    Samuel Wanji

    2016-09-01

    Full Text Available Abstract Background The suitability of using clinical assessment to identify patients with podoconiosis in endemic communities has previously been demonstrated. In this study, we explored the feasibility and accuracy of using Community Health Implementers (CHIs for the large scale clinical screening of the population for podoconiosis in North-west Cameroon. Methods Before a regional podoconiosis mapping, 193 CHIs and 50 health personnel selected from 6 health districts were trained in the clinical diagnosis of the disease. After training, CHIs undertook community screening for podoconiosis patients under health personnel supervision. Identified cases were later re-examined by a research team with experience in the clinical identification of podoconiosis. Results Cases were identified by CHIs with an overall positive predictive value (PPV of 48.5% [34.1–70%]. They were more accurate in detecting advanced stages of the disease compared to early stages; OR 2.07, 95% CI = 1.15–3.73, p = 0.015 for all advanced stages. Accuracy of detecting cases showed statistically significant differences among health districts (χ2 = 25.30, p = 0.0001. Conclusion Podoconiosis being a stigmatized disease, the use of CHIs who are familiar to the community appears appropriate for identifying cases through clinical diagnosis. However, to improve their effectiveness and accuracy, more training, supervision and support are required. More emphasis must be given in identifying early clinical stages and in health districts with relatively lower PPVs.

  8. The management of isolated positive syphilis enzyme immunoassay results in HIV-negative patients attending a sexual health clinic.

    Science.gov (United States)

    Thorley, Nicola; Adebayo, Michael; Smit, Erasmus; Radcliffe, Keith

    2016-08-01

    An unconfirmed positive treponemal enzyme immunoassay (enzyme immunoassay positive, Treponema pallidum particle agglutination negative and rapid plasma reagin negative) presents a clinical challenge to distinguish early syphilis infection from false-positive results. These cases are referred for syphilis line assay (INNO-LIA) and recalled for repeat syphilis serology. We performed a retrospective audit to establish the proportion of HIV-negative cases with unconfirmed positive enzyme immunoassay results, the proportion of these cases that received an INNO-LIA test and repeat syphilis serology testing and reviewed the clinical outcomes; 0.35% (80/22687) cases had an unconfirmed positive treponemal enzyme immunoassay result. Repeat syphilis serology was performed in 80% (64/80) cases, but no additional cases of syphilis were identified. Eighty-eight per cent (70/80) received an INNO-LIA test; 14% (5/37) unconfirmed enzyme immunoassay-positive cases with no prior history of syphilis were confirmed on INNO-LIA assay, supporting a diagnosis of latent syphilis. As a confirmatory treponemal test, the INNO-LIA assay may be more useful than repeat syphilis serological testing. © The Author(s) 2016.

  9. Barriers and challenges in clinical ethics consultations: the experiences of nine clinical ethics committees.

    Science.gov (United States)

    Pedersen, Reidar; Akre, Victoria; Førde, Reidun

    2009-10-01

    Clinical ethics committees have recently been established in nearly all Norwegian hospital trusts. One important task for these committees is clinical ethics consultations. This qualitative study explores significant barriers confronting the ethics committees in providing such consultation services. The interviews with the committees indicate that there is a substantial need for clinical ethics support services and, in general, the committee members expressed a great deal of enthusiasm for the committee work. They also reported, however, that tendencies to evade moral disagreement, conflict, and 'outsiders' are common in the hospitals. Sometimes even the committees comply with some of these tendencies. The committees agree that there is a need to improve their routines and procedures, clarify the committees' profile and field of responsibility, to make the committees well-known, to secure adequate operating conditions, and to develop organizational integration and support. Various strategies to meet these challenges on a local, regional or national level are also explored in this paper.

  10. Heidelberg Ion Therapy Center (HIT): Initial clinical experience in the first 80 patients

    Energy Technology Data Exchange (ETDEWEB)

    Combs, Stephanie E. (Univ. Hospital of Heidelberg, Dept. of Radiation Oncology, Heidelberg (Germany)), E-mail: Stephanie.Combs@med.uni-heidelberg.de; Ellerbrock, Malte; Haberer, Thomas (Heidelberger Ionenstrahl Therapiezentrum (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg (Germany)) (and others)

    2010-10-15

    The Heidelberg Ion Therapy Center (HIT) started clinical operation in November 2009. In this report we present the first 80 patients treated with proton and carbon ion radiotherapy and describe patient selection, treatment planning and daily treatment for different indications. Patients and methods. Between November 15, 2009 and April 15, 2010, 80 patients were treated at the Heidelberg Ion Therapy Center (HIT) with carbon ion and proton radiotherapy. Main treated indications consisted of skull base chordoma (n = 9) and chondrosarcoma (n = 18), malignant salivary gland tumors (n=29), chordomas of the sacrum (n = 5), low grade glioma (n=3), primary and recurrent malignant astrocytoma and glioblastoma (n=7) and well as osteosarcoma (n = 3). Of these patients, four pediatric patients aged under 18 years were treated. Results. All patients were treated using the intensity-modulated rasterscanning technique. Seventy-six patients were treated with carbon ions (95%), and four patients were treated with protons. In all patients x-ray imaging was performed prior to each fraction. Treatment concepts were based on the initial experiences with carbon ion therapy at the Gesellschaft fuer Schwerionenforschung (GSI) including carbon-only treatments and carbon-boost treatments with photon-IMRT. The average time per fraction in the treatment room per patient was 29 minutes; for irradiation only, the mean time including all patients was 16 minutes. Position verification was performed prior to every treatment fraction with orthogonal x-ray imaging. Conclusion. Particle therapy could be included successfully into the clinical routine at the Dept. of Radiation Oncology in Heidelberg. Numerous clinical trials will subsequently be initiated to precisely define the role of proton and carbon ion radiotherapy in radiation oncology.

  11. Challenges (Obstacles) in Reaching Leadership PositionsExperiences of Women Professors at Novi Sad University Serbia

    OpenAIRE

    Andrić Marijana Mišić; Markov Slobodanka

    2017-01-01

    Underrepresentation of women in leadership positions in universities is a phenomenon present in most countries of the world, with some significant differences. In our work we focused on obstacles that women professors in Novi Sad University (Serbia) faced in reaching leadership positions. Analysis is based on qualitative research using a semi structured interview, statistical data and selected secondary sources. Obstacles, mentorship and networking have been researched from an idiographic per...

  12. Dosimetric evaluation of whole-breast radiation therapy: Clinical experience

    International Nuclear Information System (INIS)

    Osei, Ernest; Darko, Johnson; Fleck, Andre; White, Jana; Kiciak, Alexander; Redekop, Rachel; Gopaul, Darin

    2015-01-01

    Radiation therapy of the intact breast is the standard therapy for preventing local recurrence of early-stage breast cancer following breast conservation surgery. To improve patient standard of care, there is a need to define a consistent and transparent treatment path for all patients that reduces significance variations in the acceptability of treatment plans. There is lack of consistency among institutions or individuals about what is considered an acceptable treatment plan: target coverage vis-à-vis dose to organs at risk (OAR). Clinical trials usually resolve these issues, as the criteria for an acceptable plan within the trial (target coverage and doses to OAR) are well defined. We developed an institutional criterion for accepting breast treatment plans in 2006 after analyzing treatment data of approximately 200 patients. The purpose of this article is to report on the dosimetric review of 623 patients treated in the last 18 months to evaluate the effectiveness of the previously developed plan acceptability criteria and any possible changes necessary to further improve patient care. The mean patient age is 61.6 years (range: 25.2 to 93.0 years). The mean breast separation for all the patients is 21.0 cm (range: 12.4 to 34.9 cm), and the mean planning target volume (PTV-eval) (breast volume for evaluation) is 884.0 cm"3 (range: 73.6 to 3684.6 cm"3). Overall, 314 (50.4%) patients had the disease in the left breast and 309 (49.6%) had it in the right breast. A total of 147 (23.6%) patients were treated using the deep inspiration breath-hold (DIBH) technique. The mean normalized PTV-eval receiving at least 92% (V_9_2_% _P_D) and 95% (V_9_5_% _P_D) of the prescribed dose (PD) are more than 99% and 97%, respectively, for all patients. The mean normalized PTV-eval receiving at least 105% (V_1_0_5_% _P_D) of the PD is less than 1% for all groups. The mean homogeneity index (HI), uniformity index (UI), and conformity index (CI) for the PTV-eval are 0.09 (range: 0

  13. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY 2018 POSITION STATEMENT ON INTEGRATION OF INSULIN PUMPS AND CONTINUOUS GLUCOSE MONITORING IN PATIENTS WITH DIABETES MELLITUS.

    Science.gov (United States)

    Grunberger, George; Handelsman, Yehuda; Bloomgarden, Zachary T; Fonseca, Vivian A; Garber, Alan J; Haas, Richard A; Roberts, Victor L; Umpierrez, Guillermo E

    2018-03-01

    This document represents the official position of the American Association of Clinical Endocrinologists and American College of Endocrinology. Where there are no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician. AACE/ACE Task Force on Integration of Insulin Pumps and Continuous Glucose Monitoring in the Management of Patients With Diabetes Mellitus Chair George Grunberger, MD, FACP, FACE Task Force Members Yehuda Handelsman, MD, FACP, FNLA, MACE Zachary T. Bloomgarden, MD, MACE Vivian A. Fonseca, MD, FACE Alan J. Garber, MD, PhD, FACE Richard A. Haas, MD, FACE Victor L. Roberts, MD, MBA, FACP, FACE Guillermo E. Umpierrez, MD, CDE, FACP, FACE Abbreviations: AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology A1C = glycated hemoglobin BGM = blood glucose monitoring CGM = continuous glucose monitoring CSII = continuous subcutaneous insulin infusion DM = diabetes mellitus FDA = Food & Drug Administration MDI = multiple daily injections T1DM = type 1 diabetes mellitus T2DM = type 2 diabetes mellitus SAP = sensor-augmented pump SMBG = self-monitoring of blood glucose STAR 3 = Sensor-Augmented Pump Therapy for A1C Reduction phase 3 trial.

  14. Memory binding in clinical and non-clinical psychotic experiences: how does the continuum model fare?

    Science.gov (United States)

    Chhabra, S; Badcock, J C; Maybery, M T

    2013-07-01

    Both clinical and non-clinical auditory hallucinations (AH) have been associated with source memory deficits, supporting a continuum of underlying cognitive mechanisms, though few studies have employed the same task in patient and nonpatient samples. Recent commentators have called for more debate on the continuum model of psychosis. Consequently, the current study investigated the continuity model of AH with reference to memory binding. We used an identical voice and word recognition memory task to assess binding in two separate studies of: (1) healthy hallucination-prone individuals and controls (30 high and 30 low scorers on the Launay-Slade Hallucination Scale-Revised) and (2) schizophrenia patient samples (32 with AH, 32 without AH) and 32 healthy controls. There was no evidence of impaired binding in high hallucination-prone, compared to low hallucination-prone individuals. In contrast, individuals with schizophrenia (both with and without AH) had difficulties binding (remembering "who said what"), alongside difficulties remembering individual words and voices. Binding ability and memory for voices were also negatively linked to the loudness of hallucinated voices reported by patients with AH. These findings suggest that different mechanisms may exist in clinical and non-clinical hallucinators, adding to the growing debate on the continuum model of psychotic symptoms.

  15. Young Women's Lived Experience of Participating in a Positive Youth Development Programme: The "Teens & Toddlers" Pregnancy Prevention Intervention

    Science.gov (United States)

    Sorhaindo, Annik; Mitchell, Kirstin; Fletcher, Adam; Jessiman, Patricia; Keogh, Peter; Bonell, Chris

    2016-01-01

    Purpose: Evaluation of the Teens & Toddlers (T&T) positive youth development (PYD) and teenage pregnancy prevention programme suggested that the intervention had minimal effectiveness partly due to its unclear theory of change. The purpose of this paper is to examine the lived experiences of young women participating in the programme to…

  16. Linguistic Identity Positioning in Facebook Posts during Second Language Study Abroad: One Teen's Language Use, Experience, and Awareness

    Science.gov (United States)

    Dressler, Roswita; Dressler, Anja

    2016-01-01

    Teens who post on the popular social networking site Facebook in their home environment often continue to do so on second language study abroad sojourns. These sojourners use Facebook to document and make sense of their experiences in the host culture and position themselves with respect to language(s) and culture(s). This study examined one…

  17. Re-Forming the Boundaries: A Trans-Cultural Comparison of Positive Experiences among Adolescent Males and Females.

    Science.gov (United States)

    Magen, Zipora

    1983-01-01

    Presents a cross-cultural study of positive experiences among males and females from Israeli-Arab, Israeli-Jewish, and American samples (N=1094), which revealed that differences between the sexes were in the same direction across the three cultures. The one exception is the life aspiration of Israeli boys, markedly more self-transcending than…

  18. Mammography with and without radiolucent positioning sheets : Comparison of projected breast area, pain experience, radiation dose and technical image quality

    NARCIS (Netherlands)

    Timmers, Janine; ten Voorde, Marloes; van Engen, Ruben E.; van Landsveld-Verhoeven, Cary; Pijnappel, Ruud; Droogh-de Greve, Kitty; den Heeten, Gerard J.; Broeders, Mireille J. M.

    2015-01-01

    Purpose: To compare projected breast area, image quality, pain experience and radiation dose between mammography performed with and without radiolucent positioning sheets. Methods: 184 women screened in the Dutch breast screening programme (May-June 2012) provided written informed consent to have

  19. Mammography with and without radiolucent positioning sheets: Comparison of projected breast area, pain experience, radiation dose and technical image quality

    NARCIS (Netherlands)

    Timmers, Janine; ten Voorde, Marloes; van Engen, Ruben E.; van Landsveld-Verhoeven, Cary; Pijnappel, Ruud; Droogh-de Greve, Kitty; den Heeten, Gerard J.; Broeders, Mireille J. M.

    2015-01-01

    To compare projected breast area, image quality, pain experience and radiation dose between mammography performed with and without radiolucent positioning sheets. 184 women screened in the Dutch breast screening programme (May-June 2012) provided written informed consent to have one additional image

  20. Clinical experience with Omalizumab in a Portuguese severe asthma unit

    Directory of Open Access Journals (Sweden)

    S. Alfarroba

    2014-03-01

    Full Text Available Background: It is widely recognized that asthma control is not always possible in patients with very severe asthma despite available treatment. The aim of this study was to evaluate the efficacy of Omalizumab on asthma control as an add‐on therapy in patients from the “Severe Asthma Outpatient Service” of Pulido Valente Hospital in Lisbon, Portugal. Methods: A retrospective study was conducted to assess asthma control by the ACT score and by GINA classification, frequency and severity of exacerbations, medication use and pulmonary function in patients treated with Omalizumab. Clinical information was collected from medical records from the start of treatment and at 6‐, 12‐ and 24‐month follow‐ups. Results: 26 patients started the treatment with Omalizumab, and all (100% were classified by GINA with uncontrolled asthma prior to treatment. Mean ACT score was 11.5. All the patients had treatment with fixed‐dose ICS and LABA and 34.6% also had an anti‐cholinergic inhaler. 42.3% of patients were also treated with oral glucocorticosteroids for control. Patients reported an average of 1.8 moderate and 3.1 severe exacerbations/year. Statistical differences were found at 6‐month follow‐up in most end‐points: GINA score improved: 60.9% of patients with partially controlled asthma and only 39.1% with uncontrolled asthma (Wilcoxon 0.00; ACT score improved to 19.52 (Wilcoxon 0.00; mean FEV1 improved to 76.7% (Wilcoxon 0.025; the proportion of patients requiring oral glucocorticosteroid therapy reduced to 17.4% (Wilcoxon 0.014; and the number of moderate and severe exacerbations also decreased to 1.04 and 1.83 respectively (Wilcoxon 0.007; Wilcoxon 0.002 respectively. Conclusions: The current analysis shows evidence that omalizumab is successful in improving asthma control as an add‐on therapy GINA step 5 treatment. Resumo: Introdução: Está bem documentado que o controlo de asma nem

  1. Experience with the Implementation of Clinical Pharmacy Services and Processes in a University Hospital in Belgium.

    Science.gov (United States)

    Somers, Annemie; Claus, Barbara; Vandewoude, Koen; Petrovic, Mirko

    2016-03-01

    This article summarizes the experience with the development of clinical pharmacy services in the Ghent University Hospital in Belgium. Implementation of clinical pharmacy services in Belgian hospitals has not been evident because these activities were initially not structurally financed. The aim is to describe the strengths and weaknesses of the clinical pharmacy development process, and the milestones that enhanced the progress. Furthermore, the organisation of clinical pharmacy in the Ghent University Hospital is explained, including back- and front-office activities, seamless pharmaceutical care and medication safety improvement. Some working methods, procedures and tools are explained for different clinical pharmacy services. In particular, the clinical pharmacy projects for geriatric patients as well as the preparation of clinical pharmacy services for the accreditation process are explained. We also reflect on the organisation model and the future development of clinical pharmacy, taking into consideration facilitators and potential barriers.

  2. Towards understanding experiences of women aspiring to senior management