WorldWideScience

Sample records for tva based patient

  1. TVA GIS-based biomass resource assessment

    International Nuclear Information System (INIS)

    Noon, C.E.

    1993-01-01

    The focus of this paper is a computer-based system for estimating the costs of supplying wood fuel. The system is being developed for the Tennessee Valley Authority and is referred to as the Biomass Resource Assessment Version One (BRAVO) system. The main objective in developing the BRAVO system is to assist TVA in estimating the cost for supplying wood fuel to any one of its twelve coal-fired power plants. The BRAVO system is developed within a Geographic Information System (GIS) platform and is designed to allow a user to perform open-quotes what ifclose quotes analyses related to the costs of wood fuel supply. Three types of wood fuel are considered in the Bravo system: mill residues, logging residues and short-rotation woody crops (SRWC). Each type of wood fuel has unique economic and supply characteristics. The input data for the system includes the specific locations, amounts, and prices of the various types of wood fuel throughout the TVA region. The system input is completed by data on political boundaries, power plant locations, road networks and a model for estimating transportation costs as a function of distance. The result is a comprehensive system which includes information on all possible wood fuel supply points, demand points and product movement costs. In additions, the BRAVO system has been designed to allow a user to perform sensitivity analysis on a variety of supply system parameters. This will enable TVA to thoroughly investigate the financial impacts of issues such as increased competition for wood fuel, environmental policies, fuel taxes, and regional economic cycles

  2. TVA GIS-based biomass resource assessment

    Energy Technology Data Exchange (ETDEWEB)

    Noon, C.E. [Univ. of Tennessee, Knoxville, TN (United States)

    1993-12-31

    The focus of this paper is a computer-based system for estimating the costs of supplying wood fuel. The system is being developed for the Tennessee Valley Authority and is referred to as the Biomass Resource Assessment Version One (BRAVO) system. The main objective in developing the BRAVO system is to assist TVA in estimating the costs for supplying wood fuel to any one of its twelve coal-fired plants. The BRAVO system is developed within a Geographic Information System (GIS) platform and is designed to allow a user to perform {open_quotes}what if{close_quotes} analyses related to the costs of wood fuel supply. Three types of wood fuel are considered in the BRAVO system: mill residues, logging residues and short-rotation woody crops (SRWC). Each type of wood fuel has unique economic and supply characteristics. The input data for the system includes the specific locations, amount, and prices of the various types of wood fuel throughout the TVA region. The system input is completed by data on political boundaries, power plant locations, road networks and a model for estimating transportation costs as a function of distance. The result is a comprehensive system which includes information on all possible wood fuel supply joints, demand points and product movement costs. In addition, the BRAVO system has been designed to allow a user to perform sensitivity analysis on a variety of supply system parameters. This will enable TVA to thoroughly investigate the financial impacts of issues such as increased competition for wood fuel, environmental policies, fuel taxes, and regional economic cycles.

  3. TVA-Based Assessment of Visual Attention Using Line-Drawings of Fruits and Vegetables

    Directory of Open Access Journals (Sweden)

    Tianlu Wang

    2018-02-01

    Full Text Available Visuospatial attention and short-term memory allow us to prioritize, select, and briefly maintain part of the visual information that reaches our senses. These cognitive abilities are quantitatively accounted for by Bundesen’s theory of visual attention (TVA; Bundesen, 1990. Previous studies have suggested that TVA-based assessments are sensitive to inter-individual differences in spatial bias, visual short-term memory capacity, top-down control, and processing speed in healthy volunteers as well as in patients with various neurological and psychiatric conditions. However, most neuropsychological assessments of attention and executive functions, including TVA-based assessment, make use of alphanumeric stimuli and/or are performed verbally, which can pose difficulties for individuals who have troubles processing letters or numbers. Here we examined the reliability of TVA-based assessments when stimuli are used that are not alphanumeric, but instead based on line-drawings of fruits and vegetables. We compared five TVA parameters quantifying the aforementioned cognitive abilities, obtained by modeling accuracy data on a whole/partial report paradigm using conventional alphabet stimuli versus the food stimuli. Significant correlations were found for all TVA parameters, indicating a high parallel-form reliability. Split-half correlations assessing internal reliability, and correlations between predicted and observed data assessing goodness-of-fit were both significant. Our results provide an indication that line-drawings of fruits and vegetables can be used for a reliable assessment of attention and short-term memory.

  4. Clinical TVA-based studies: a general review

    Directory of Open Access Journals (Sweden)

    Thomas eHabekost

    2015-03-01

    Full Text Available In combination with whole report and partial report tasks, the Theory of Visual Attention (TVA can be used to estimate individual differences in five basic attentional parameters: The visual processing speed, the storage capacity of visual short-term memory, the perceptual threshold, the efficiency of top-down selectivity, and the spatial bias of attentional weighting. TVA-based assessment has been used in about 30 studies to investigate attentional deficits in a range of neurological and psychiatric conditions: (a neglect and simultanagnosia, (b reading disturbances, (c aging and neurodegenerative diseases, and most recently (d neurodevelopmental disorders. The article introduces TVA based assessment, discusses its methodology and psychometric properties, and reviews the progress made in each of the four research fields. The empirical results demonstrate the general usefulness of TVA-based assessment for many types of clinical neuropsychological research. The method’s most important qualities are cognitive specificity and theoretical grounding, but it is also characterized by good reliability and sensitivity to minor deficits. The review concludes by pointing to promising new areas for clinical TVA-based research.

  5. Usability of a theory of visual attention (TVA) for parameter-based measurement of attention II

    DEFF Research Database (Denmark)

    Bublak, Peter; Finke, Kathrin; Krummenacher, Joseph

    2005-01-01

    Based on a 'Theory of Visual Attention' (TVA), whole and partial report of brief letter arrays is presented as a diagnostic tool to estimate four clinically significant attentional components: perceptual processing speed, visual working memory storage capacity, efficiency of top-down control......, and spatial distribution of attention. The procedure used was short enough to be applicable within a standard clinical setting. Two brain-damaged patients, selected based on lesion location and neuropsychological test profile, were compared to a control group of 22 healthy subjects. One patient with a right...... dissociation supports the hypothesis that, even with a short version of whole and partial report, valid and meaningful results can be obtained in the neuropsychological assessment of attention deficits. The potential and constraints of TVA-based parameter estimation for the clinical application are discussed....

  6. Usability of a theory of visual attention (TVA) for parameter-based measurement of attention II

    DEFF Research Database (Denmark)

    Bublak, Peter; Finke, Kathrin; Krummenacher, Joseph

    2005-01-01

    inferior parietal lesion showed a pattern of non-spatially and spatially lateralized attention deficits that is typically found in neglect patients. Results from the second patient supported the decisive role of superior frontal brain structures for top-down control of visual attention. This double......Based on a 'Theory of Visual Attention' (TVA), whole and partial report of brief letter arrays is presented as a diagnostic tool to estimate four clinically significant attentional components: perceptual processing speed, visual working memory storage capacity, efficiency of top-down control...... dissociation supports the hypothesis that, even with a short version of whole and partial report, valid and meaningful results can be obtained in the neuropsychological assessment of attention deficits. The potential and constraints of TVA-based parameter estimation for the clinical application are discussed....

  7. Usability of a theory of visual attention (TVA) for parameter-based measurement of attention I

    DEFF Research Database (Denmark)

    Finke, Kathrin; Bublak, Peter; Krummenacher, Joseph

    2005-01-01

    The present study investigated the usability of whole and partial report of briefly displayed letter arrays as a diagnostic tool for the assessment of attentional functions. The tool is based on Bundesen’s (1990, 1998, 2002; Bundesen et al., 2005) theory of visual attention (TVA), which assumes...... four separable attentional components: processing speed, working memory storage capacity, spatial distribution of attention, and top-down control. A number of studies (Duncan et al., 1999; Habekost & Bundesen, 2003; Peers et al., 2005) have already demonstrated the clinical relevance...... clinical tests measuring similar constructs. The empirical independence of the four TVA parameters is suggested by nonsignificant or, in the case of processing speed and working memory storage capacity, only modest correlations between the parameter values....

  8. TVA coal-gasification commercial demonstration plant project. Volume 5. Plant based on Koppers-Totzek gasifier. Final report

    Energy Technology Data Exchange (ETDEWEB)

    1980-11-01

    This volume presents a technical description of a coal gasification plant, based on Koppers-Totzek gasifiers, producing a medium Btu fuel gas product. Foster Wheeler carried out a conceptual design and cost estimate of a nominal 20,000 TPSD plant based on TVA design criteria and information supplied by Krupp-Koppers concerning the Koppers-Totzek coal gasification process. Technical description of the design is given in this volume.

  9. TVA-based assessment of visual attentional functions in developmental dyslexia

    Directory of Open Access Journals (Sweden)

    Johanna eBogon

    2014-10-01

    Full Text Available There is an ongoing debate whether an impairment of visual attentional functions constitutes an additional or even an isolated deficit of developmental dyslexia (DD. Especially performance in tasks that require the processing of multiple visual elements in parallel has been reported to be impaired in DD. We review studies that used parameter-based assessment for identifying and quantifying impaired aspect(s of visual attention that underlie this multi-element-processing deficit in DD. These studies used the mathematical framework provided by the ‘theory of visual attention’ (TVA; Bundesen, 1990 to derive quantitative measures of general attentional resources and attentional weighting aspects on the basis of behavioral performance in whole- and partial-report tasks. Based on parameter estimates in children and adults with DD, the reviewed studies support a slowed perceptual processing speed as an underlying primary deficit in DD. Moreover, a reduction in visual short term memory storage capacity seems to present a modulating component, contributing to difficulties in written language processing. Furthermore, comparing the spatial distributions of attentional weights in children and adults suggest that having limited reading and writing skills might impair the development of a slight leftward bias, that is typical for unimpaired adult readers.

  10. Usability of a theory of visual attention (TVA) for parameter-based measurement of attention I: evidence from normal subjects

    DEFF Research Database (Denmark)

    Finke, Kathrin; Bublak, Peter; Krummenacher, Joseph

    2005-01-01

    The present study investigated the usability of whole and partial report of briefly displayed letter arrays as a diagnostic tool for the assessment of attentional functions. The tool is based on Bundesen's (1990, 1998, 2002; Bundesen et al., 2005) theory of visual attention (TVA), which assumes...... four separable attentional components: processing speed, working memory storage capacity, spatial distribution of attention, and top-down control. A number of studies (Duncan et al., 1999; Habekost & Bundesen, 2003; Peers et al., 2005) have already demonstrated the clinical relevance...... clinical tests measuring similar constructs. The empirical independence of the four TVA parameters is suggested by nonsignificant or, in the case of processing speed and working memory storage capacity, only modest correlations between the parameter values....

  11. Usability of a theory of visual attention (TVA) for parameter-based measurement of attention I: evidence from normal subjects

    DEFF Research Database (Denmark)

    Finke, Kathrin; Bublak, Peter; Krummenacher, Joseph

    2005-01-01

    The present study investigated the usability of whole and partial report of briefly displayed letter arrays as a diagnostic tool for the assessment of attentional functions. The tool is based on Bundesen's (1990, 1998, 2002; Bundesen et al., 2005) theory of visual attention (TVA), which assumes...... four separable attentional components: processing speed, working memory storage capacity, spatial distribution of attention, and top-down control. A number of studies (Duncan et al., 1999; Habekost & Bundesen, 2003; Peers et al., 2005) have already demonstrated the clinical relevance...... of these parameters. The present study was designed to examine whether (a) a shortened procedure bears sufficient accuracy and reliability, (b) whether the procedures reveal attentional constructs with clinical relevance, and (c) whether the mathematically independent parameters are also empirically independent...

  12. TVA and its rivals

    International Nuclear Information System (INIS)

    Feine, P.

    1997-01-01

    The long running opposition of a group of investor-owned electric utilities to the success of the federally-owned and subsidised Tennessee Valley Authority (TVA) is described. The TVA provides plentiful, affordable electric power to the many economically deprived residents of the southeastern United States, but there have been continued calls, most vocally by those electric utilities who would benefit financially from its demise, for reform of the power production giant, including withdrawal of its federal subsidies. In the manner of much US political manoevering claims and counter-claims are being pursued through the courts and via television advertising in an effort to sway public opinion against the publicly accountable TVA and towards privately owned utilities in the name of ''fair'' competition. (UK)

  13. Adapting the Theory of Visual Attention (TVA) to model auditory attention

    DEFF Research Database (Denmark)

    Roberts, Katherine L.; Andersen, Tobias; Kyllingsbæk, Søren

    Mathematical and computational models have provided useful insights into normal and impaired visual attention, but less progress has been made in modelling auditory attention. We are developing a Theory of Auditory Attention (TAA), based on an influential visual model, the Theory of Visual...... Attention (TVA). We report that TVA provides a good fit to auditory data when the stimuli are closely matched to those used in visual studies. In the basic visual TVA task, participants view a brief display of letters and are asked to report either all of the letters (whole report) or a subset of letters (e.......g., the red letters; partial report). For the auditory task, we used dichotic, concurrently-presented synthesised vowels. These auditory stimuli are closely-matched to the visual stimuli, in that they are simultaneous, separated in space, and unchanging over time. We found that TVA could successfully model...

  14. Theory of Visual Attention (TVA) applied to mice in the 5-choice serial reaction time task

    DEFF Research Database (Denmark)

    Fitzpatrick, C. M.; Caballero-Puntiverio, M.; Gether, U.

    2017-01-01

    modelled using a new three-parameter version of TVA to obtain estimates of visual processing speeds, visual thresholds and motor response baselines in each mouse. Results The parameter estimates for each animal were reliable across sessions, showing that the data were stable enough to support analysis......Rationale The 5-choice serial reaction time task (5-CSRTT) is widely used to measure rodent attentional functions. In humans, many attention studies in healthy and clinical populations have used testing based on Bundesen’s Theory of Visual Attention (TVA) to estimate visual processing speeds...... on an individual level. Scopolamine HBr dose-dependently reduced 5-CSRTT attentional performance while also increasing reward collection latency at the highest dose. Upon TVA modelling, scopolamine HBr significantly reduced visual processing speed at both doses, while having less pronounced effects on visual...

  15. Cirkulacija aktivnog stanovništva sela

    OpenAIRE

    Oliveira-Roca, Maria

    1988-01-01

    Cilj je ovog rada ukazati na neke od glavnih uzroka i posljedica redovite cirkulacije, odnosno komutiranja, aktivnog stanovništva sela u Jugoslaviji i svijetu. Uzroci komutiranja seoske radne snage mnogobrojni su i međusobno se isprepleću. To su, na primjer: privrženost zemlji i seoskoj zajednici, opredjeljenje za život u ruralnoj sredini i bavljenje poljoprivredom u slobodno vrijeme te osjećaj sigurnosti zbog dodatnih prihoda domaćinstvu (u zapadnoj Evropi i Jug...

  16. Copper-Silver Alloy Depositions Using Thermionic Vacuum ARC (TVA)

    International Nuclear Information System (INIS)

    Akan, T.

    2004-01-01

    TVA is a plasma source generating pure metal vapor plasma and consists of a heated cathode emitting thermo electrons and an anode containing material to be evaporated. We used Cu and Ag pieces as anode materials and produced their alloys by electron bombarding. Cu-Ag alloys in various mass ratios were prepared by using the TVA and the TVA discharges were generated in the vapors of these alloys. The volt-ampere characteristics of the TVA discharges generated in the vapors of these alloys were investigated with respect to the ratio of Ag in the Cu-Ag alloy. Cu-Ag alloy thin films with various mass ratios were deposited onto the glass substrates by using their TVA discharges. The ratios of Cu and Ag in the thin Cu-Ag alloy films were found using scanning electron microscope-energy dispersive xray (SEM-EDX) microanalyses

  17. Whistleblowers ask Congress to investigate TVA's nuclear power program

    International Nuclear Information System (INIS)

    Lane, E.

    1993-01-01

    Congress should investigate the Tennessee Valley Authority's nuclear power plant construction and operations programs as soon as possible, a coalition of Tennessee environmentalists and whistleblowers told reporters at a press conference in Washington, DC. The Foundation for Global Sustainability and four employees of TVA nuclear plants called for congressional action because they contend the Nuclear Regulatory Commission and the Department of Labor have failed to act to protect whistleblowers who report nuclear safety problems. The foundation contends the economics of nuclear plant construction by TVA do not make sense and in the rush to finish the Watts Bar nuclear plant, which has been under construction for 20 years, TVA has ignored safety issues

  18. Marker tiles coating by TVA method

    International Nuclear Information System (INIS)

    Lungu, C.P.; Mustata, I.; Zaroschi, V.; Anghel, A.; Lungu, A.M.; Chiru, P.; Pompilian, O.; Iacob, C.; Surdu-Bob, C.; Rubel, M.; Coad, J.P.; Matthews, G.; Pedricke, L.; Handley, R.

    2007-01-01

    Full text of publication follows: The JET main wall will be made of solid Be tiles. In order to assess the erosion rate of the thick Be wall tiles due to the plasma, an interlayer of Ni was used under a beryllium coating of a few microns. The 'marker' tiles will be placed in the areas of interest such as Outer Poloidal Limiters (OPL) and Inner Wall Guard Limiters (IWGL). The 'marker' is a Be tile with a stripe of an easily detected heavy metal (Ni) deposited on it as a thin interlayer, and with a few microns layer of the bulk-like Be on top of that. If the outer layer is eroded at the same rate as the bulk, then the erosion rate can be determined by measuring the distance of the interlayer from the final surface, for an eroded layer of a thickness that of the outer. An overview of the principles of manufacturing processes using plasma ignited in pure metal vapors by Thermionic Vacuum Arc (TVA) method [1] and the properties of the prepared coatings will be presented. The optimization of the manufacturing process (layer thickness, structure and purity) has been carried out on various substrates: glass, silicon, metals. The plasma diagnostic (the ion energy and electron temperature) during deposition and the results of the optimization process and analysis (SEM, TEM, XRD, Auger, RBS, AFM) of the coatings will be presented. Reference: [1] C. P. Lungu, I. Mustata, V. Zaroschi, A. M. Lungu, A. Anghel, P. Chiru, M. Rubel, P. Coad G. F. Matthews and JETEFDA contributors, Beryllium Coatings on Metals: Development of Process and Characterizations of Layers, Phys. Scr. T128 (2007) 157-161. (authors)

  19. Marker tiles coating by TVA method

    Energy Technology Data Exchange (ETDEWEB)

    Lungu, C.P.; Mustata, I.; Zaroschi, V.; Anghel, A.; Lungu, A.M.; Chiru, P.; Pompilian, O.; Iacob, C. [Association EURATOM-MEC Romania, National Institute of Laser, Plasma and Radiation Physics, Bucharest (Romania); Surdu-Bob, C. [Low Temperature Plasma Laboratory, NILPRP - National Institute for Lasers, Plasma and Radiation Physics, Bucharest (Romania); Rubel, M. [Alfven Laboratory, Royal Institute of Technology, Stockholm (Sweden); Coad, J.P. [Culham Science Centre, EURATOM-UKAEA Fusion Association, Abingdon, OX Oxon (United Kingdom); Matthews, G.; Pedricke, L.; Handley, R. [UKAEA Fusion, Association Euratom-UKAEA, Culham Science and Engineering Centre, OX, Abingdon, Oxon (United Kingdom)

    2007-07-01

    Full text of publication follows: The JET main wall will be made of solid Be tiles. In order to assess the erosion rate of the thick Be wall tiles due to the plasma, an interlayer of Ni was used under a beryllium coating of a few microns. The 'marker' tiles will be placed in the areas of interest such as Outer Poloidal Limiters (OPL) and Inner Wall Guard Limiters (IWGL). The 'marker' is a Be tile with a stripe of an easily detected heavy metal (Ni) deposited on it as a thin interlayer, and with a few microns layer of the bulk-like Be on top of that. If the outer layer is eroded at the same rate as the bulk, then the erosion rate can be determined by measuring the distance of the interlayer from the final surface, for an eroded layer of a thickness that of the outer. An overview of the principles of manufacturing processes using plasma ignited in pure metal vapors by Thermionic Vacuum Arc (TVA) method [1] and the properties of the prepared coatings will be presented. The optimization of the manufacturing process (layer thickness, structure and purity) has been carried out on various substrates: glass, silicon, metals. The plasma diagnostic (the ion energy and electron temperature) during deposition and the results of the optimization process and analysis (SEM, TEM, XRD, Auger, RBS, AFM) of the coatings will be presented. Reference: [1] C. P. Lungu, I. Mustata, V. Zaroschi, A. M. Lungu, A. Anghel, P. Chiru, M. Rubel, P. Coad G. F. Matthews and JETEFDA contributors, Beryllium Coatings on Metals: Development of Process and Characterizations of Layers, Phys. Scr. T128 (2007) 157-161. (authors)

  20. Is the adjustable TVA mesh effective for the long-term treatment of female stress incontinence?

    Science.gov (United States)

    Romero-Maroto, J; Pérez-Seoane, H; Gómez-Perez, L; Pérez-Tomás, C; Pacheco-Bru, J J; López-López, A

    To assess the long-term safety and efficacy of the adjustable TVA mesh in treating stress urinary incontinence. Pseudoexperimental study, before and after, conducted in a university urology department. Eighty-two patients were invited to participate from January 2002 to March 2005. Thirty-two patients agreed to participate and were implanted an adjustable TVA mesh. The preoperative study included a medical history review, physical examination with full bladder, flowmetry, residue study, complete urodynamic study and the self-administered questionnaires I-QoL and ICIQ-SF. In the postoperative assessment, the PGI-I questionnaire was added, but a complete urodynamic study was not performed. Twenty-nine (90.6%) and 28 (87.5%) patients were continent in the stress test at 1 and 10 years, respectively. Twenty (62.5%) and 16 (50%) patients had no urine escape at 1 and 10 years, respectively. Twenty-eight (87.5%) and 25 (78%) patients were satisfied 1 and 10 years after the surgery, respectively. Twenty-eight (87.5%) and 21 (62.5%) patients had a good quality of life at 1 year and at 10 years, respectively. There were no significant complications at the end of the study period. Treatment of stress urinary incontinence with the TVA mesh presented a high degree of objective healing and satisfaction at 10 years, with no severe adverse effects. The study showed that satisfaction does not always mean total continence but rather it reflects the improvement of symptoms and consequent quality of life. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. 18 CFR 1311.11 - What are TVA's obligations in interstate situations?

    Science.gov (United States)

    2010-04-01

    ... 18 Conservation of Power and Water Resources 2 2010-04-01 2010-04-01 false What are TVA's... ASSISTANCE AND DIRECT FEDERAL DEVELOPMENT PROGRAMS AND ACTIVITIES § 1311.11 What are TVA's obligations in... officials and entities in states which have adopted a process and which select TVA's program or activity; (3...

  2. 18 CFR 1304.407 - Development within flood control storage zones of TVA reservoirs.

    Science.gov (United States)

    2010-04-01

    ... zones of TVA reservoirs. (a) Activities involving development within the flood control storage zone on TVA reservoirs will be reviewed to determine if the proposed activity qualifies as a repetitive action. Under TVA's implementation of Executive Order 11988, Floodplain Management, repetitive actions are...

  3. O etici poslovanja i poduzetništva "business ethics"

    OpenAIRE

    Bozanić, Anton

    1998-01-01

    O etici poslovanja i poduzetništva ili gospodarstva i poduzetništva, opće poznatoj kao "business ethics", mnogo se danas raspravlja i piše, posebno u visoko razvijenijim zemljama, ali i svim ostalim koje žele uhvatiti korak sa svjetskim tržištem i vrlo dinamičnim izazovima konkurencije, ponude i potražnje. Sve više Jača svijest kako personalna etika - toliko važna u svakidašnjem ljudskom životu - nije sama po sebi dostatna kod donošenja etičkih odluka, Jer su u suvremenom gospodarskom...

  4. TVA experience in BWR reload design and licensing

    International Nuclear Information System (INIS)

    Robertson, J.D.

    1986-01-01

    TVA has developed and implemented the capability to perform BWR reload core design and licensing analyses. The advantages accruing from this capability include the tangible cost-savings from performing reload analyses in-house. Also, ''intangible'' benefits such as increased operating flexibility and the ability to accommodate multivendor fuel designs have been demonstrated. The major disadvantage with performing in-house analyses is the cost associated with development and maintenance of the analytical methods and staff expertise

  5. RAZVOJ BAZE PODATKOV ŠPORTNEGA DRUŠTVA

    OpenAIRE

    Kovačič, Nejc

    2016-01-01

    V rekreativnem Športnem društvu Izlake, ki se ukvarja z nogometom, tenisom, namiznim tenisom in tekom, imajo v pregled članov društva narejen v Excelovi tabeli. Težava je v tem, da Excel seznam ni vedno pri roki za razna tekmovanja. Društvo deluje na osnovi članstva, zato je kvalitetna urejenost nujno potrebna. Pri urejanju teh podatkov je verjetnost človeške napake zelo velika, saj ternutno ni nobenega varovala, ki bi napako preprečilo. V spletni aplikaciji na serverju lahko v vsakem trenutk...

  6. Exploring the word superiority effect using TVA

    DEFF Research Database (Denmark)

    Starrfelt, Randi

    for perception of words, or a higher speed of processing for words than letters. We have investigated the WSE using methods based on a Theory of Visual Attention. In an experiment using single stimuli (words or letters) presented centrally, we show that the classical WSE is specifically reflected in perceptual......Words are made of letters, and yet sometimes it is easier to identify a word than a single letter. This word superiority effect (WSE) has been observed when written stimuli are presented very briefly or degraded by visual noise. It is unclear, however, if this is due to a lower threshold...... simultaneously we find a different pattern: In a whole report experiment with six stimuli (letters or words), letters are perceived more easily than words, and this is reflected both in perceptual processing speed and short term memory capacity....

  7. Evaluation of NOX emissions from TVA coal-fired power plants

    International Nuclear Information System (INIS)

    Jones, J.W.; Stamey-Hall, S.

    1991-01-01

    The paper gives results of a preliminary evaluation of nitrogen oxide (NOx) emissions from 11 Tennessee Valley Authority (TVA) coal-fired power plants. Current EPA AP-42 emission factors for NOx from coal-fired utility boilers do not account for variations either in these emissions as a function of generating unit load, or in designs of boilers of the same general type, particularly wall-fired boilers. The TVA has compiled short-term NOx emissions data from 30 units at 11 TVA coal-fired plants. These units include cyclone, cell burner, single wall, opposed wall, single tangential, and twin tangential boiler firing designs. Tests were conducted on 29 of the 30 units at high load; 18 were also tested at reduced load. NOx emissions rates were calculated for each test and compared to the calculated rate for each boiler type using AP-42. Preliminary analysis indicates that: (1) TVA cyclone-fired units emit more NOx than estimated using AP-42; (2) TVA cell burner units emit considerably more NOx than estimated; (3) most TVA single-wall-fired units emit slightly more NOx than estimated; (4) most TVA single-furnace tangentially fired units emit less NOx than estimated at high load, but the same as (or more than) estimated at reduced load; and (5) most TVA twin-furnace tangentially fired units, at high load, emit slightly more NOx than estimated using AP-42

  8. Campbell Creek TVA 2010 First Year Performance Report July 1, 2009 August 31, 2010

    Energy Technology Data Exchange (ETDEWEB)

    Christian, Jeffrey E [ORNL; Gehl, Anthony C [ORNL; Boudreaux, Philip R [ORNL; New, Joshua Ryan [ORNL

    2010-10-01

    This research project was initiated by TVA in March 2008 and encompasses three houses that are of similar size, design and located within the same community - Campbell Creek, Farragut TN with simulated occupancy. This report covers the performance period from July 1, 2009 to August 31, 2010. It is the intent of TVA that this Valley Data will inform electric utilities future residential retrofit incentive program.

  9. TVA nuclear power: Management of the nuclear program through personal services contracts

    International Nuclear Information System (INIS)

    1987-01-01

    Mr. Steven White, a retired admiral, is serving as manager of the TVA Office of Nuclear Power. GAO previously concluded that Mr. White's retention under contractual arrangements constituted the improper use of a personal services contract and represented a circumvention of the statutory ceiling on salary payments to TVA employees. This report finds that Mr. White's rate of pay is within the range of the salaries paid by a sample of nonfederal utilities to their top executives and is over two and a half times the average salary paid to executives who hold positions which appear to have responsibility for managing the utilities' power or nuclear power operations. GAO also found that (1) TVA's Office of Nuclear Power has employed an additional 25 persons since 1986 under arrangements similar to the employing arrangements of Mr. White and (2) TVA's Nuclear Safety Review staff no longer reports directly to the TVA Board of Directors and General Manager. It has relocated from Knoxville, Tennessee to Chattanooga, Tennessee

  10. Modelling auditory attention: Insights from the Theory of Visual Attention (TVA)

    DEFF Research Database (Denmark)

    Roberts, K. L.; Andersen, Tobias; Kyllingsbæk, Søren

    We report initial progress towards creating an auditory analogue of a mathematical model of visual attention: the ‘Theory of Visual Attention’ (TVA; Bundesen, 1990). TVA is one of the best established models of visual attention. It assumes that visual stimuli are initially processed in parallel......, and that there is a ‘race’ for selection and representation in visual short term memory (VSTM). In the basic TVA task, participants view a brief display of letters and are asked to report either all of the letters (whole report) or a subset of the letters (e.g., the red letters; partial report). Fitting the model...... been used to model normal visual attention, as well as identifying how the different parameters are affected by changes across the lifespan (McAvinue et al., 2012) and by attentional deficits such as neglect (Duncan et al., 1999). An auditory analogue would allow these same parameters to be measured...

  11. 18 CFR 1304.208 - Shoreline stabilization on TVA-owned residential access shoreland.

    Science.gov (United States)

    2010-04-01

    ... Resources TENNESSEE VALLEY AUTHORITY APPROVAL OF CONSTRUCTION IN THE TENNESSEE RIVER SYSTEM AND REGULATION OF STRUCTURES AND OTHER ALTERATIONS TVA-Owned Residential Access Shoreland § 1304.208 Shoreline... retaining wall shall not be located more than an average of two horizontal feet lakeward of the existing...

  12. Production of avian retroviruses and tissue-specific somatic retroviral gene transfer in vivo using the RCAS/TVA system.

    Science.gov (United States)

    von Werder, Alexander; Seidler, Barbara; Schmid, Roland M; Schneider, Günter; Saur, Dieter

    2012-05-24

    Spatiotemporal retroviral gene transfer into specific somatic mammalian cells using the avian RCAS (replication-competent avian sarcoma-leukosis virus long terminal repeat with splice acceptor)/tumor virus A (TVA) system is a versatile tool for performing lineage tracing and gene function analysis in vivo. RCAS retroviruses carrying the subgroup A envelope transduce only genetically engineered mammalian cells that express the cognate avian retroviral receptor TVA. The RCAS/TVA gene delivery system has been successfully used in various different mouse TVA-expression models. This protocol contains a detailed description of the production of high-titer RCAS retroviruses in chicken fibroblasts and the transduction of proliferating TVA-positive somatic mammalian cells in vivo. By taking advantage of the combination of the RCAS/TVA with the 'universal' Cre/loxP system, the protocol can be used in nearly every proliferating cell type in vivo. The protocol takes 4 weeks from transfection of chicken fibroblasts, which act as the host cells for viral production, to the transduction of TVA-transgenic mice.

  13. Nitrogen doped silicon-carbon multilayer protective coatings on carbon obtained by TVA method

    Science.gov (United States)

    Ciupina, Victor; Vasile, Eugeniu; Porosnicu, Corneliu; Lungu, Cristian P.; Vladoiu, Rodica; Jepu, Ionut; Mandes, Aurelia; Dinca, Virginia; Caraiane, Aureliana; Nicolescu, Virginia; Cupsa, Ovidiu; Dinca, Paul; Zaharia, Agripina

    2017-08-01

    Protective nitrogen doped Si-C multilayer coatings on carbon, used to improve the oxidation resistance of carbon, were obtained by Thermionic Vacuum Arc (TVA) method. The initial carbon layer having a thickness of 100nm has been deposed on a silicon substrate in the absence of nitrogen, and then a 3nm Si thin film to cover carbon layer was deposed. Further, seven Si and C layers were alternatively deposed in the presence of nitrogen ions, each having a thickness of 40nm. In order to form silicon carbide at the interface between silicon and carbon layers, all carbon, silicon and nitrogen ions energy has increased up to 150eV . The characterization of microstructure and electrical properties of as-prepared N-Si-C multilayer structures were done using Transmission Electron Microscopy (TEM, STEM) techniques, Thermal Desorption Spectroscopy (TDS) and electrical measurements. Oxidation protection of carbon is based on the reaction between oxygen and silicon carbide, resulting in SiO2, SiO and CO2, and also by reaction involving N, O and Si, resulting in silicon oxynitride (SiNxOy) with a continuously variable composition, and on the other hand, since nitrogen acts as a trapping barrier for oxygen. To perform electrical measurements, 80% silver filled two-component epoxy-based glue ohmic contacts were attached on the N-Si-C samples. Electrical conductivity was measured in constant current mode. The experimental data show the increase of conductivity with the increase of the nitrogen content. To explain the temperature behavior of electrical conductivity we assumed a thermally activated electric transport mechanism.

  14. Design process and philosophy of TVA's latest advance control room complex

    International Nuclear Information System (INIS)

    Owens, G.R.; Masters, D.W.

    1979-01-01

    TVA's latest nuclear power plant control room design includes a greater emphasis on human factors as compared to their earlier plant designs. This emphasis has resulted in changes in the overall design philosophy and design process. This paper discusses some of the prominent design features of both the control room and the surrounding control room complex. In addition, it also presents some of the important activities involved in the process of developing the advanced control room design

  15. trans-11 18:1 Vaccenic Acid (TVA Has a Direct Anti-Carcinogenic Effect on MCF-7 Human Mammary Adenocarcinoma Cells

    Directory of Open Access Journals (Sweden)

    Ji-Na Lim

    2014-02-01

    Full Text Available Trans vaccenic acid (TVA; trans-11 18:1 is a positional and geometric isomer of oleic acid and it is the predominant trans isomer found in ruminant fats. TVA can be converted into cis-9, trans-11 conjugated linoleic acid (c9, t11-CLA, a CLA isomer that has many beneficial effects, by stearoyl CoA desaturase 1 (SCD1 in the mammary gland. The health benefits associated with CLA are well documented, but it is unclear whether trans fatty acids (TFAs from ruminant products have healthy effects. Therefore, the effects of TVA on the proliferation of MCF-7 human breast adenocarcinoma cells and MCF-10A human breast epithelial cells were investigated in the present study. Results showed that TVA inhibited the proliferation of MCF-7 cells but not MCF-10A cells by down-regulating the expression of Bcl-2 as well as procaspase-9. In addition, the suppressive effect of TVA was confirmed in SCD1-depleted MCF-7 cells. Our results suggested that TVA exerts a direct anti-carcinogenic effect on MCF-7 cells. These findings provided a better understanding of the research on the anti-carcinogenic effects of TVA and this may facilitate the manufacture of TVA/c9, t11-CLA fortified ruminant products.

  16. Vjera u narod bez vlasti i vlasništva: Crkvena šutnja 1961-1971. i glasnost 1990-

    OpenAIRE

    Padjen, Ivan

    2013-01-01

    Rad iznosi djelomične nalaze istraživanja hrvatskog narodnjaštva (etnonacionalizma) kao religije (u smislu ljudskog izmišljanja svetog). Praktični su problemi sljedeći: narodnjaštvo kao religija koja među ostalim uključuje da narod ima mogućnost i/ili sposobnost da se razvije u nositelja države i da to treba i postati; posljedice narodnjaštva, a to su nedostižnost narodne demokracije, narodne privrede i narodnog sazrijevanja; uvjeti vjere u narod, i to prvenstveno Katoličke ...

  17. Physical model of a floating trash boom to control aquatic weeds at the TVA Widows Creek Fossil Plant

    International Nuclear Information System (INIS)

    Hopping, P.N.

    1991-01-01

    This paper reports that the Tennessee Valley Authority (TVA) Widows Creek Fossil plant seasonally encounters adverse accumulations of aquatic weeds at the intakes of the condenser cooling water pumps. To reduce the accumulations, a floating trash boom has been proposed for the intakes. To evaluate the hydraulic feasibility of a boom, a physical model of the intakes has been built at the TVA Engineering Laboratory. The model was used to determine the boom alignment and depth of skimming needed to successfully deflect weeds away from the intakes and provide self-cleaning

  18. Evaluating a biomass resource: The TVA region-wide biomass resource assessment model

    International Nuclear Information System (INIS)

    Downing, M.; Graham, R.L.

    1993-01-01

    Wood is an alterative fuel for electric power generation at coal-fired plants in the Tennessee Valley Authority (TVA) region. Short rotation wood energy crops (SRWC) could provide a source of this woody biomass. However, the economic and supply structures of SRWC markets have not been established. Establishing the likely price and supply of SRWC biomass in a region is a complex task because biomass is not an established commodity as are oil, natural gas and coal. In this study we project the cost and supply of short-rotation woody biomass for the TVA region -- a 276 county area that includes all of Tennessee and portions of 10 contiguous states in the southeastern United States. Projected prices and quantities of SRWC are assumed to be a function of the amount and quality of crop and pasture land available in a region. expected SRWC yields and production costs on differing soils and land types, and the profit that could be obtained from current conventional crop production on these same lands. Results include the supply curve of SRWC biomass that is projected to be available from the entire region, the amount and location of crop and pasture land that would be used, and the conventional agricultural crops that would be displaced as a function of SRWC production. Finally, we show the results of sensitivity analysis on the projected cost and supply of SRWC biomass. In particular, we examine the separate impacts of varying SRWC production yields

  19. Bioluminescent Bioreporter Pseudomonas putida TVA8 as a Detector of Water Pollution. Operational Conditions and Selectivity of Free Cells Sensor

    Czech Academy of Sciences Publication Activity Database

    Kuncová, Gabriela; Pazlarová, J.; Hlavatá, Alena; Ripp, S.; Sayler, G.S.

    2011-01-01

    Roč. 11, č. 3 (2011), s. 882-887 ISSN 1470-160X R&D Projects: GA MŠk ME 893 Institutional research plan: CEZ:AV0Z40720504 Keywords : whole-cell biosensor * bioluminiscence * pseudomonas putida TVA8 Subject RIV: EI - Biotechnology ; Bionics Impact factor: 2.695, year: 2011

  20. Instrumentation and controls training in TVA: a story of large numbers

    International Nuclear Information System (INIS)

    Conner, D.L.

    1981-01-01

    The Tennessee Valley Authority currently has four nuclear units on line with seventeen units planned prior to the year 2000. Providing a permanent instrumentation and controls workforce, projected to be approximately 700 trades and labor craftsmen, is a formidable task requiring the cooperative efforts of many diverse groups: mangement and labor, engineers and craftsmen, students and instructors. In TVA, the primary source of skilled I and C craftsmen is through formal training programs conducted in cooperation with the craft bargaining unit, the International Brotherhood of Electrical Workers. The purpose of this paper is to describe and review the progress of two of these programs: the Instrument Mechanic Training Program and the Senior Instrument Mechanic Training Program

  1. GaN thin film deposition on glass and PET substrates by thermionic vacuum arc (TVA)

    Energy Technology Data Exchange (ETDEWEB)

    Pat, Suat, E-mail: suatpat@ogu.edu.tr [Eskisehir Osmangazi University, Physics Department, 26480 (Turkey); Korkmaz, Şadan; Özen, Soner [Eskisehir Osmangazi University, Physics Department, 26480 (Turkey); Şenay, Volkan [Bayburt University, Primary Science Education Department, 69000 (Turkey)

    2015-06-01

    In this paper, GaN thin film production was realized by thermionic vacuum arc (TVA), a plasma deposition technique, for the first time. We present a new deposition mechanism for GaN thin films with a very short production time. Microstructure properties of samples were analyzed by X-ray diffractometry. The peak at 2θ = 72.88° corresponding to GaN (0004) was detected in XRD spectra. The surface morphology of the deposited GaN films was analyzed using field emission scanning electron microscopy and atomic force microscopy. The surface properties of the produced samples are quite different. The average roughness values were determined to be 0.48 nm for GaN/PET and 1.17 nm for GaN/glass. The optical properties (i.e., refractive index and reflection) were determined using an interferometer. Moreover, the obtained optical data were compared with bulk GaN materials. The refractive indexes were measured as 2.2, 3,0 and 2,5 for the GaN/glass, GaN/PET and bulk GaN, respectively. The transparencies of the different GaN-coated substrates are nearly the same. The obtained band gap values were measured in the energy range of 3.3–3.5 eV. TVA is a novel non-reactive plasma technique for the generation of metal organic thin films. The main advantage of this method is its fast deposition rate without any loss in the quality of the films. - Highlights: • A new GaN thin film growth method is introduced. • Microstructure, surface and optical properties were characterized. • GaN/glass and GaN/PET were produced by a different plasma deposition method.

  2. GaN thin film deposition on glass and PET substrates by thermionic vacuum arc (TVA)

    International Nuclear Information System (INIS)

    Pat, Suat; Korkmaz, Şadan; Özen, Soner; Şenay, Volkan

    2015-01-01

    In this paper, GaN thin film production was realized by thermionic vacuum arc (TVA), a plasma deposition technique, for the first time. We present a new deposition mechanism for GaN thin films with a very short production time. Microstructure properties of samples were analyzed by X-ray diffractometry. The peak at 2θ = 72.88° corresponding to GaN (0004) was detected in XRD spectra. The surface morphology of the deposited GaN films was analyzed using field emission scanning electron microscopy and atomic force microscopy. The surface properties of the produced samples are quite different. The average roughness values were determined to be 0.48 nm for GaN/PET and 1.17 nm for GaN/glass. The optical properties (i.e., refractive index and reflection) were determined using an interferometer. Moreover, the obtained optical data were compared with bulk GaN materials. The refractive indexes were measured as 2.2, 3,0 and 2,5 for the GaN/glass, GaN/PET and bulk GaN, respectively. The transparencies of the different GaN-coated substrates are nearly the same. The obtained band gap values were measured in the energy range of 3.3–3.5 eV. TVA is a novel non-reactive plasma technique for the generation of metal organic thin films. The main advantage of this method is its fast deposition rate without any loss in the quality of the films. - Highlights: • A new GaN thin film growth method is introduced. • Microstructure, surface and optical properties were characterized. • GaN/glass and GaN/PET were produced by a different plasma deposition method

  3. Evaluating a biomass resource: The TVA region-wide biomass resource assessment model

    Energy Technology Data Exchange (ETDEWEB)

    Downing, M.; Graham, R.L. [Oak Ridge National Lab., TN (United States)

    1993-12-31

    The economic and supply structures of short rotation woody crop (SRWC) markets have not been established. Establishing the likely price and supply of SRWC biomass in a region is a complex task because biomass is not an established commodity as are oil, natural gas and coal. In this study we project the cost and supply of short-rotation woody biomass for the TVA region -- a 276 county area that includes all of Tennessee and portions of 10 contiguous states in the southeastern United States. Projected prices and quantities of SRWC are assumed to be a function of the amount and quality of crop and pasture land available in a region, expected SRWC yields and production costs on differing soils and land types, and the profit that could be obtained from current conventional crop production on these same lands. Results include the supply curve of SRWC biomass that is projected to be available from the entire region, the amount and location of crop and pasture land that would be used, and the conventional agricultural crops that would be displaced as a function of SRWC production. Finally, we show the results of sensitivity analysis on the projected cost and supply of SRWC biomass. In particular, we examine the separate impacts of varying SRWC production yields.

  4. Evaluation of TVA`s model site and individual technology pollution prevention demonstration programs and their impact on the agrichemical industry

    Energy Technology Data Exchange (ETDEWEB)

    Simpson, G.S.

    1995-06-01

    The high volume of fertilizer and pesticides funneled through a relatively small number of distribution outlets has made these agribusiness sites potential sources of surface/groundwater contamination in watersheds surrounding the agrichemical facilities. The agrichemical industry came under increased pressures in the mid-1980s to implement environmentally sound management practices and to install containment structures around fertilizer and chemical storage/handling areas to prevent future contamination of existing sites or the movement of contaminants offsite. TVA`s long and successful history of technology transfer to the retail fertilizer industry, as well as the technical expertise of the Agency`s staff, made TVA ideally suited to handle the new environmental challenge. It was during this time period that TVA`s Model Site Demonstration Program (MSD) and Individual Technology Demonstration Program (ITD) were conceived. Since inception, the pollution prevention program and the technologies advanced by it have made a very positive impact on the US agrichemical industry, as well as on other TVA programs. This paper is an attempt to document these impacts, with primary focus being placed on the program`s impact on the agribusiness dealer who implements the pollution prevention technologies/practices recommended by TVA.

  5. AlGaAs film growth using thermionic vacuum arc (TVA) and determination of its physical properties

    Science.gov (United States)

    Özen, Soner; Şenay, Volkan; Pat, Suat; Korkmaz, Şadan

    2015-06-01

    In this research, an AlGaAs film was deposited on a microscope slide by means of the thermionic vacuum arc (TVA) technique which is a novel plasma production technique. AlGaAs structures were grown by this deposition technique for the first time and this process occurred in a very short period of time. In order to characterize the produced film, nano-structural, nano-mechanical, optical, and surface properties were determined by field emission scanning electron microscope (FESEM), atomic force microscope (AFM), X-ray diffractometer (XRD) and interferometer. According to the results of the measurements, the mean thickness value of the produced film was obtained as 1.8 μm. The band gap value was determined as 2eV from the Kubelka-Munk plot. The refractive index value was obtained as approximately 3.4. Hardness value was determined as 2 GPa from the Oliver-Pharr method. All these values are consistent with the reported values in the literature for the AlGaAs films produced by different methods. TVA technique appeared as a suitable and promising technique for the production of AlGaAs films.

  6. Sudar vozila u vlasništvu istog leasing društva i problem treće osobe iz AO osiguranja

    OpenAIRE

    Radionov, Nikoleta; Padovan, Adriana Vincenca

    2012-01-01

    U radu se razmatraju pravni odnosi koji nastaju u slučaju sudara dvaju (ili više) vozila u vlasništvu istog leasing društva (slučaj leasing – leasing). Prema uvriježenoj praksi na domaćem tržištu osiguranja, u takvim slučajevima dolazi do isključenja iz osiguranja šteta na vozilu temeljem osiguranja automobilske odgovornosti (AO), s obzirom na to da su vozila u vlasništvu istog leasing društva koje je i jedini osiguranik po policama AO oba (ili više) vozila sudionika nezgode. Primatelj leasin...

  7. Reconstructed image of human heart for total artificial heart implantation, based on MR image and cast silicone model of heart

    International Nuclear Information System (INIS)

    Komoda, Takashi; Maeta, Hajime; Uyama, Chikao.

    1991-01-01

    Based on transverse (TRN) and LV long axis (LAX) MR images of two cadaver hearts, three-dimensional (3-D) computer models of the connecting interface between remaining heart and total artificial heart, i.e., mitral and tricuspid valvular annuli (MVA and TVA), ascending aorta (Ao) and pulmonary artery (PA), were reconstructed to compare the shape and the size of MVA and those of TVA, the distance between the center of MVA and TVA (D G ), the angle between the plane of MVA and that of TVA (R T ), and the angles of Ao and PA, respectively, to the plane of MVA (R A , R P ), with those obtained in cast silicone models. It was found that based on LAX rather than TRN MR image, MVA and TVA might be more precisely reconstructed. The data obtained in 3-D images of MVA, TVA, Ao and PA based on silicone models of 32 hearts were as follows: D G (cm): 4.17±0.43, R T (degrees): 22.1±11.3, R A (degrees): 54.9±15.3, R P (degrees): 30.8±17.1. (author)

  8. Growth and characterization of GaN thin film on Si substrate by thermionic vacuum arc (TVA)

    Science.gov (United States)

    Kundakçı, Mutlu; Mantarcı, Asim; Erdoğan, Erman

    2017-01-01

    Gallium nitride (GaN) is an attractive material with a wide-direct band gap (3.4 eV) and is one of the significant III-nitride materials, with many advantageous device applications such as high electron mobility transistors, lasers, sensors, LEDs, detectors, and solar cells, and has found applications in optoelectronic devices. GaN could also be useful for industrial research in the future. Chemical vapor deposition (CVD), molecular beam epitaxy (MBE), sputter, and pulsed laser deposition (PLD) are some of the methods used to fabricate GaN thin film. In this research, a GaN thin film grown on a silicon substrate using the thermionic vacuum arc (TVA) technique has been extensively studied. Fast deposition, short production time, homogeneity, and uniform nanostructure with low roughness can be seen as some of the merits of this method. The growth of the GaN was conducted at an operating pressure of 1× {{10}-6} \\text{Torr} , a plasma current 0.6 \\text{A} and for a very short period of time of 40 s. For the characterization process, scanning electron microscopy (SEM) was conducted to determine the structure and surface morphology of the material. Energy dispersive x-ray spectroscopy (EDX) was used to comprehend the elemental analysis characterization of the film. X-ray diffraction (XRD) was used to analyze the structure of the film. Raman measurements were taken to investigate the phonon modes of the material. The morphological properties of the material were analyzed in detail by atomic force microscopy (AFM).

  9. Karakteristike nupcijaliteta rumunskog stanovništva u Banatu na primeru sela Lokve

    Directory of Open Access Journals (Sweden)

    Ivkov Anđelija

    2007-01-01

    Full Text Available A series of data indicates characteristic traits of contracting marriages or nuptiality, based on which a situation in the village of Lokve can be reported as well as similarities and differences in relation to other settlements in Banat. In the first part of the paper an analysis of global indicators of Lokve nuptiality is made. The average age of men and women at the time of contracting their first marriage is analyzed and their place within HEINAL's typology of nuptiality has been set. The paper tries to define the position of this settlement within the widely accepted classification of nuptiality into the European and non-European model and indicates a great connection between demographic development of these areas and European demographic development, which emphasizes affiliation to the same cultural sphere. In addition to analysis of the first marriage average age, average age at the time of contracting higher order marriages has been analysed too, as well as relation between the first order marriages and higher order marriages, fluctuation of annual number of marriages, nuptiality rates, monthly fluctuation of number of marriages, phenomenon of isonomy and geographical origin of spouses.

  10. Video game experience and its influence on visual attention parameters: an investigation using the framework of the Theory of Visual Attention (TVA).

    Science.gov (United States)

    Schubert, Torsten; Finke, Kathrin; Redel, Petra; Kluckow, Steffen; Müller, Hermann; Strobach, Tilo

    2015-05-01

    Experts with video game experience, in contrast to non-experienced persons, are superior in multiple domains of visual attention. However, it is an open question which basic aspects of attention underlie this superiority. We approached this question using the framework of Theory of Visual Attention (TVA) with tools that allowed us to assess various parameters that are related to different visual attention aspects (e.g., perception threshold, processing speed, visual short-term memory storage capacity, top-down control, spatial distribution of attention) and that are measurable on the same experimental basis. In Experiment 1, we found advantages of video game experts in perception threshold and visual processing speed; the latter being restricted to the lower positions of the used computer display. The observed advantages were not significantly moderated by general person-related characteristics such as personality traits, sensation seeking, intelligence, social anxiety, or health status. Experiment 2 tested a potential causal link between the expert advantages and video game practice with an intervention protocol. It found no effects of action video gaming on perception threshold, visual short-term memory storage capacity, iconic memory storage, top-down control, and spatial distribution of attention after 15 days of training. However, observations of a selected improvement of processing speed at the lower positions of the computer screen after video game training and of retest effects are suggestive for limited possibilities to improve basic aspects of visual attention (TVA) with practice. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. The capacity of attention and simultaneous perception of objects: a group study of Huntington's disease patients.

    Science.gov (United States)

    Finke, Kathrin; Schneider, Werner X; Redel, Petra; Dose, Matthias; Kerkhoff, Georg; Müller, Hermann J; Bublak, Peter

    2007-11-05

    Using a whole report-paradigm based on [Bundesen, C. (1990). A theory of visual attention. Psychological Review, 97, 523-547; Bundesen, C. (1998). A computational theory of visual attention. Philosophical Transactions of the Royal Society of London B, Biological Sciences, 353, 1271-1281] theory of visual attention (TVA), [Finke, K., Bublak, P., Dose, M., Müller, H. J., & Schneider, W. X. (2006). Parameter-based assessment of spatial and non-spatial attentional deficits in Huntington's disease. Brain, 129, 1137-1151] demonstrated profound reductions in perceptual processing speed and visual working memory (WM) storage capacity in Huntington's disease (HD) patients. A comparably severe impairment of visual processing capacity has previously been reported for two simultanagnosia patients [Duncan, J., Bundesen, C., Olson, A., Humphreys, G., Ward, R., Kyllingsbaek, S., van Raamsdonk, M., Rorden, C., & Chavda, S. (2003). Attentional functions in dorsal and ventral simultanagnosia. Cognitive Neuropsychology, 20, 675-702]. To investigate whether such a deficit does also prevail in HD, the simultaneous perception of visual objects was tested in 10 HD patients under free viewing conditions and without time constraints. Objects were presented under four different conditions: (i) single, (ii) multiple adjacent, (iii) multiple embedded, and (iv) multiple overlapping. The dependent measure was the percentage of identification failures. Performance was compared to that of 15 healthy subjects matched for age, education, gender and general mental ability. For HD patients, the percentage of errors in the various testing conditions was examined for correlations with the TVA parameters of visuo-perceptual processing speed and WM storage capacity. These parameters were estimated using verbal whole report of briefly presented letters. TVA permits the two parameters to be estimated mathematically independently and relatively unaffected by any motor deficits present in HD. The

  12. TVA–based assessment of attentional capacities – associations with age and indices of brain white matter microstructure

    Directory of Open Access Journals (Sweden)

    Thomas eEspeseth

    2014-10-01

    Full Text Available In this study the primary aims were to characterize the effects of age on basic components of visual attention derived from assessments based on a theory of visual attention (TVA in 325 healthy volunteers covering the adult lifespan (19-81 years. Furthermore, we aimed to investigate how age-related differences on TVA parameters are associated with white matter (WM microstructure as indexed by diffusion tensor imaging (DTI. Finally, we explored how TVA parameter estimates were associated with complex, or multicomponent indices of processing speed (Digit-symbol substitution, DSS and fluid intelligence (gF. The results indicated that the TVA parameters for visual short-term memory capacity, K, and for attentional selectivity, α, were most strongly associated with age before the age of 50. However, in this age range, it was the parameter for processing speed, C, that was most clearly associated with DTI indices, in this case fractional anisotropy (FA, particularly in the genu and body of the corpus callosum. Furthermore, differences in the C parameter partially mediated differences in DSS within this age range. After the age of 50, the TVA parameter for the perceptual threshold, t0, as well as K, were most strongly related to participant age. Both parameters, but t0 more strongly so than K, were associated WM diffusivity, particularly in projection fibers such as the internal capsule, the sagittal stratum, and the corona radiata. Within this age range, t0 partially mediated age-related differences in gF. The results are consistent with, and provide novel empirical support for the neuroanatomical localization of TVA computations as outlined in the neuronal interpretation of TVA (NTVA. Furthermore, the results indicate that to understand the biological sources of age-related changes in processing speed and fluid cognition, it may be useful to employ methods that allow for computational fractionation of these multicomponent measures.

  13. Analysis of organizational options for the uranium enrichment enterprise in relation to asset divesture. [BPA; TVA; SYNFUELS; CONRAIL; British TELECOM; COMSTAT

    Energy Technology Data Exchange (ETDEWEB)

    Harrer, B.J.; Hattrup, M.P.; Dase, J.E.; Nicholls, A.K.

    1986-08-01

    This report presents a comparison of the characteristics of some prominent examples of independent government corporations and agencies with respect to the Department of Energy's (DOE) uranium enrichment enterprise. The six examples studied were: the Bonneville Power Administration (BPA); the Tennessee Valley Authority (TVA); the Synthetic Fuels Corporation (SYNFUELS); the Consolidated Rail Corporation (CONRAIL); the British Telecommunications Corporation (British TELECOM); and the Communications Satellite Organization (COMSAT), in order of decreasing levels of government ownership and control. They range from BPA, which is organized as an agency within DOE, to COMSAT, which is privately owned and free from almost all regulations common to government agencies. Differences in the degree of government involvement in these corporations and in many other characteristics serve to illustrate that there are no accepted standards for defining the characteristics of government corporations. Thus, historical precedent indicates considerable flexibility would be available in the development of enabling legislation to reorganize the enrichment enterprise as a government corporation or independent government agency.

  14. ZigBee-based remote patient monitoring.

    Science.gov (United States)

    Fernandez-Lopez, Helena; Afonso, José Augusto; Correia, José Higino; Simões, Ricardo

    2012-01-01

    This paper describes a developed continuous patient monitoring system based on the ZigBee protocol. The system was tested in the hospital environment using six sensor devices in two different modes. For electrocardiogram transmission and in the absence of hidden-nodes, the system achieved a mean delivery ratio of 100% and 98.56%, respectively for star and 2-hop tree network topologies. When sensor devices were arranged in a way that three of them were unable to hear the transmissions made by the other three, the mean delivery ratio dropped to 83.96%. However, when sensor devices were reprogrammed to transmit only heart rate values, the mean delivery ratio increased to 99.90%, despite the presence of hidden-nodes.

  15. PROCESNOPRAVNI RAZLOZI NIŠTETNOSTI ODLUKA SKUPŠTINE DRUŠTVA S OGRANIČENOM ODGOVORNOŠĆU - de lege lata vs. de lege ferenda

    Directory of Open Access Journals (Sweden)

    Lidija Šimunović

    2017-01-01

    Full Text Available Procesnopravni razlozi, za razliku od drugih razloga ništetnosti odluka skupštine društva s ograničenom odgovornošću (dalje: d.o.o., u sudskoj i poslovnoj praksi otvaraju najviše pravnih pitanja. Riječ je o „greškama u koracima“ koje dovode do ništetnosti odluka skupštine d.o.o.-a o kojima se u domaćoj pravnoj književnosti do sada nije sustavno raspravljalo. Ishodište za razradu ove problematike temelji se na okolnosti da je u odredbi članaka 448. ZTD-a propisano da se na ništetnost odluka skupštine d.o.o.-a na odgovarajući način primjenjuju odredbe o ništetnosti odluka glavne skupštine d.d.-a. Kako su procesnopravne razlike djelovanja glavne skupštine d.d.-a i skupštine d.o.o.-a jedna su od temeljnih razlika ova dva tipa društava kapitala spomenuto pozitivnopravno uređenje dovodi do pravne nesigurnosti i pogrešnih tumačenja. U prvom dijelu rada daje se kronološki pregled normativnog uređenja ništetnosti odluka skupštine d.o.o-a. Potom se doktrinarno razgraničavaju ništetne odluke od drugih odluka s nedostatkom. Zatim se svaka odredba o ništetnosti odluka glavne skupštine d.d.-a testira u kontekstu d.o.o.-a i potom izrijekom formulira odredba koja vrijedi samo za d.o.o. Osim domaćeg prava analiziraju se i rješenja iz poredbenog prava (osobito njemačkog jer se domaće pravo u velikoj mjeri preklapa s rješenjima iz poredbenih prava. U zaključku se daju smjernice za praktičnije de lege ferenda uređenje ZTD-a u pogledu ništetnosti odluka skupštine d.o.o.-a.

  16. Pitanje ilirske komponente stanovništva jugoistočnog dela Donje Panonije u savremenim istraživanjima

    Directory of Open Access Journals (Sweden)

    Milin Milena L.

    2002-01-01

    Full Text Available Following the Symposium on distribution of the Illyrians (4th to 2nd centuries B.C., Sarajevo, 1964, the view that the northern border of the Illyrians ran along the line even much southerner than the Sava (nn.2-8 has been firmly established in our archeology; this attitude has been extended to the Illyrian tribes in Roman times (n.7. At the same time, historians of the pre-Roman and Roman periods in the Balkans still hold the view of predominantly Illyrian origins of the tribes from Lower Pannonia, between the Danube and the lower course of the Sava river (n.9, based on contemporary historiographic epigraphic and linguistic evidence. Therefore, the author dwelled on the issue whether the Illyrian name, and in which meaning, may be applied to the inhabitants of Lower Pannonia in the Roman times as well. According to ancient literary sources (Strabo and Apian it follows that the Pannonian tribes in the ancient times were deemed to be Illyrian (pp. 2-3. Furthermore in mythology, the Pannonios was the descendant of Illyrians (App. Illyr. 2; cf. Papazoglu 1969, 265 n. 233, which points to the common awareness of being part of Lower Pannonia and other Illyrian tribes. Important evidence for this issue is deemed to be anthroponyms as well; Pannonian names in the research to date have shown to be different from Illyrian (p. 7 with note. The author gives the examples of names Dassius and Liccaius, epigraphically confirmed with Breuck and Amantino (6, note 30, and p. 7 with note, which she considers to have originated from Illyrian territory proper; that is proved by a wax tablet from Dacia, where the words Dassius Verzonis, Pirusta ex Kavieretio and Liccaius Epicadi were written (tab. cer. VI; cf. p. 8. As is well known, parts of the Illyrian population from southern Dalmatia were relocated to work in Dacia mines; that this is the case here as well is proved by referring to an Illyrian ethnic, Pirust, as well as the name of the village. On account of

  17. Patient and provider attitudes to emergency department-based HIV ...

    African Journals Online (AJOL)

    Patient and provider attitudes to emergency department-based HIV counselling and testing in South Africa. ... We also used two previously validated survey instruments to gather data on patients' HIV knowledge and providers' stigma against patients living with HIV, as we anticipated that these may have an impact on ...

  18. Acid-base disturbance in patients with cirrhosis

    DEFF Research Database (Denmark)

    Henriksen, Jens H; Bendtsen, Flemming; Møller, Søren

    2015-01-01

    PURPOSE: Acid-base disturbances were investigated in patients with cirrhosis in relation to hemodynamic derangement to analyze the hyperventilatory effects and the metabolic compensation. METHODS: A total of 66 patients with cirrhosis and 44 controls were investigated during a hemodynamic study......, and effects of unidentified ions (all Pacid-base disturbances could not be identified. CONCLUSION: Hypocapnic alkalosis is related to disease severity and hyperdynamic systemic circulation in patients with cirrhosis. The metabolic compensation includes...... alterations in serum albumin and water retention that may result in a delicate acid-base balance in these patients....

  19. Patient Posture Monitoring System Based on Flexible Sensors

    Directory of Open Access Journals (Sweden)

    Youngsu Cha

    2017-03-01

    Full Text Available Monitoring patients using vision cameras can cause privacy intrusion problems. In this paper, we propose a patient position monitoring system based on a patient cloth with unobtrusive sensors. We use flexible sensors based on polyvinylidene fluoride, which is a flexible piezoelectric material. Theflexiblesensorsareinsertedintopartsclosetothekneeandhipoftheloosepatientcloth. We measure electrical signals from the sensors caused by the piezoelectric effect when the knee and hip in the cloth are bent. The measured sensor outputs are transferred to a computer via Bluetooth. We use a custom-made program to detect the position of the patient through a rule-based algorithm and the sensor outputs. The detectable postures are based on six human motions in and around a bed. The proposed system can detect the patient positions with a success rate over 88 percent for three patients.

  20. Web-Based Patient Education in Orthopedics: Systematic Review.

    Science.gov (United States)

    Dekkers, Tessa; Melles, Marijke; Groeneveld, Bob Sander; de Ridder, Huib

    2018-04-23

    Patients with orthopedic conditions frequently use the internet to find health information. Patient education that is distributed online may form an easily accessible, time- and cost-effective alternative to education delivered through traditional channels such as one-on-one consultations or booklets. However, no systematic evidence for the comparative effectiveness of Web-based educational interventions exists. The objective of this systematic review was to examine the effects of Web-based patient education interventions for adult orthopedic patients and to compare its effectiveness with generic health information websites and traditional forms of patient education. CINAHL, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, PUBMED, ScienceDirect, Scopus, and Web of Science were searched covering the period from 1995 to 2016. Peer-reviewed English and Dutch studies were included if they delivered patient education via the internet to the adult orthopedic population and assessed its effects in a controlled or observational trial. A total of 10 trials reported in 14 studies involving 4172 patients were identified. Nine trials provided evidence for increased patients' knowledge after Web-based patient education. Seven trials reported increased satisfaction and good evaluations of Web-based patient education. No compelling evidence exists for an effect of Web-based patient education on anxiety, health attitudes and behavior, or clinical outcomes. Web-based patient education may be offered as a time- and cost-effective alternative to current educational interventions when the objective is to improve patients' knowledge and satisfaction. However, these findings may not be representative for the whole orthopedic patient population as most trials included considerably younger, higher-educated, and internet-savvy participants only. ©Tessa Dekkers, Marijke Melles, Bob Sander Groeneveld, Huib de Ridder. Originally published in the Journal of Medical Internet Research (http

  1. Web-Based Distress Management for Implantable Cardioverter Defibrillator Patients

    DEFF Research Database (Denmark)

    Habibović, Mirela; Denollet, Johan; Cuijpers, Pim

    2017-01-01

    distress post-ICD implantation. The WEB-based distress management program for ICD patients (WEBCARE) was developed to mitigate anxiety and depression and enhance health-related quality of life in ICD patients. This study investigates the 6- and 12-months outcomes. METHOD: A total of 289 consecutive ICD...... patients from 6 referral hospitals in the Netherlands were randomized to either the WEBCARE (n = 146) or usual care (n = 143) group. Patients in the WEBCARE group received an online, 12-weeks fixed, 6 lesson behavioral treatment based on problem solving therapy. Patients in the usual care group receive...... care as usual. RESULTS: Current findings show no significant difference on anxiety, depression or quality of life between the WEBCARE and Usual Care group at 6- and 12-months postimplantation. CONCLUSIONS: In this clinical trial of a Web-based behavioral intervention for ICD patients, the Web...

  2. Ambulatory orthopaedic surgery patients' knowledge with internet-based education.

    Science.gov (United States)

    Heikkinen, Katja; Leino-Kilpi, H; Salanterä, S

    2012-01-01

    There is a growing need for patient education and an evaluation of its outcomes. The aim of this study was to compare ambulatory orthopaedic surgery patients' knowledge with Internet-based education and face-to-face education with a nurse. The following hypothesis was proposed: Internet-based patient education (experiment) is as effective as face-to-face education with a nurse (control) in increasing patients' level of knowledge and sufficiency of knowledge. In addition, the correlations of demographic variables were tested. The patients were randomized to either an experiment group (n = 72) or a control group (n = 75). Empirical data were collected with two instruments. Patients in both groups showed improvement in their knowledge during their care. Patients in the experiment group improved their knowledge level significantly more in total than those patients in the control group. There were no differences in patients' sufficiency of knowledge between the groups. Knowledge was correlated especially with patients' age, gender and earlier ambulatory surgeries. As a conclusion, positive results concerning patients' knowledge could be achieved with the Internet-based education. The Internet is a viable method in ambulatory care.

  3. Agent-based intelligent medical diagnosis system for patients.

    Science.gov (United States)

    Zhang, Yingfeng; Liu, Sichao; Zhu, Zhenfei; Si, Shubin

    2015-01-01

    According to the analysis of the challenges faced by the current public health circumstances such as the sharp increase in elderly patients, limited medical personnel, resources and technology, the agent-based intelligent medical diagnosis system for patients (AIMDS) is proposed in this research. Based on advanced sensing technology and professional medical knowledge, the AIMDS can output the appropriate medical prescriptions and food prohibition when the physical signs and symptoms of the patient are inputted. Three core modules are designed include sensing module, intuition-based fuzzy set theory/medical diagnosis module, and medical knowledge module. The result shows that the optimized prescription can reach the desired level, with great curative effect for patient disease, through a case study simulation. The presented AIMDS can integrate sensor technique and intelligent medical diagnosis methods to make an accurate diagnosis, resulting in three-type of optimized descriptions for patient selection.

  4. Ensuring a proactive, evidence-based, patient safety approach to patient assessment.

    Science.gov (United States)

    Considine, Julie; Currey, Judy

    2015-01-01

    To argue that if all nurses were to adopt the primary survey approach (assessment of airway, breathing, circulation and disability) as the first element of patient assessment, they would be more focused on active detection of clinical deterioration rather than passive collection of patient data. Nurses are the professional group that carry the highest level of responsibility for patient assessment, accurate data collection and interpretation. The timely recognition of, and response to deteriorating patients, is dependent on the measurement and interpretation of pertinent physiological data by nurses. Discursive paper. Traditionally taught and commonly used approaches to patient assessment such as 'vital signs' and 'body systems' are not evidence-based nor framed in patient safety. The primary survey approach as the first element in patient assessment has three major advantages: (1) data are collected according to clinical importance; (2) data are collected using the same framework as most organisation's rapid response system activation criteria; and (3) the primary survey acts as a patient safety checklist, thereby decreasing the risk of failure to recognise, and therefore respond to, deteriorating patients. The vital signs and body systems approaches to patient assessment have significant limitations in identifying clinical deterioration. The primary survey approach provides nurses with a consistent, evidence-based and sequenced approach to patient assessment in every clinical setting. All nurses should use a primary survey approach as the first element of patient assessment in every patient encounter as a patient safety strategy. © 2014 John Wiley & Sons Ltd.

  5. Hospital based patient coordination for ethnic minority patients - a health technology assessment

    DEFF Research Database (Denmark)

    Sodemann, Morten

    A cross diciplinary, cross specialty, cross sectoral hospital based approach to cultural management of ethnic minority patients is effective in creating more approprite patient flows, better quality of care and increases functional level of patients. Surprisingly the aggregated effect saves...... especially on public medicine expenses and social services. Ethnic minority patients can achieve increased empowerment & Equity in type and quality of hospital care through cross dicplinary cross specialty cultural case management & support between hospital departments and primary sectors...

  6. Digital pen-based telemonitoring of elderly heart failure patients

    OpenAIRE

    Lind, Leili; Karlsson, Daniel

    2013-01-01

    Considering that a majority of elderlies are non-users of computers and Internet we developed a telemonitoring system for elderly heart failure (HF) home care patients based on digital pen technology - a technology never used before by this patient group. We implemented the system in clinical use in a 13 months long study. Fourteen patients (mean/median age 84 years) with severe HF participated. They accepted the technology and performed daily reports of their health state using the digital p...

  7. OASIS C Based Home Health Agency Patient Outcome, Process...

    Data.gov (United States)

    U.S. Department of Health & Human Services — OASIS C Based Home Health Agency Patient Outcome, Process and Potentially Avoidable Event Reports This report includes the state mean values for all measures...

  8. Exercise-based cardiac rehabilitation in patients with heart failure

    DEFF Research Database (Denmark)

    Lewinter, Christian; Doherty, Patrick; Gale, Christopher P

    2015-01-01

    BACKGROUND: Guidelines recommend exercise-based cardiac rehabilitation (EBCR) for patients with heart failure (HF). However, established research has not investigated the longer-term outcomes including mortality and hospitalisation in light of the contemporary management of HF. METHODS...

  9. Patient participation in general practice based undergraduate teaching: a focus group study of patient perspectives

    Science.gov (United States)

    Park, Sophie E; Allfrey, Caroline; Jones, Melvyn M; Chana, Jasprit; Abbott, Ciara; Faircloth, Sofia; Higgins, Nicola; Abdullah, Laila

    2017-01-01

    Background Patients make a crucial contribution to undergraduate medical education. Although a national resource is available for patients participating in research, none is as yet available for education. Aim This study aimed to explore what information patients would like about participation in general practice based undergraduate medical education, and how they would like to obtain this information. Design and setting Two focus groups were conducted in London-based practices involved in both undergraduate and postgraduate teaching. Method Patients both with and without teaching experience were recruited using leaflets, posters, and patient participation groups. An open-ended topic guide explored three areas: perceived barriers that participants anticipated or had experienced; patient roles in medical education; and what help would support participation. Focus groups were audiorecorded, transcribed, and analysed thematically. Results Patients suggested ways of professionalising the teaching process. These were: making information available to patients about confidentiality, iterative consent, and normalising teaching in the practice. Patients highlighted the importance of relationships, making information available about their GPs’ involvement in teaching, and initiating student–patient interactions. Participants emphasised educational principles to maximise exchange of information, including active participation of students, patient identification of student learner needs, and exchange of feedback. Conclusion This study will inform development of patient information resources to support their participation in teaching and access to information both before and during general practice based teaching encounters. PMID:28360073

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

    Science.gov (United States)

    Horwitz, Ralph I; Singer, Burton H

    2017-04-01

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

  11. Professional and patient-based evaluation of oral rehabilitation in patients with tooth agenesis

    DEFF Research Database (Denmark)

    Dueled, Erik; Gotfredsen, Klaus; Trab Damsgaard, Mogens

    2009-01-01

    : The study included 129 patients with tooth agenesis rehabilitated with implant- or tooth-supported reconstructions, and a control group of 58 patients. Professional assessments included biological, technical and aesthetic variables. An aesthetic index score included mucosal discoloration, crown morphology......, crown color match, occlusal harmony, and papilla level. The Oral Health Impact Profile (OHIP) questionnaire was used to evaluate the patient-based outcomes. Six OHIP questions were subtracted to evaluate the patient-based aesthetic outcomes. RESULTS: Severe root resorption was observed in 36...

  12. [QR-Code based patient tracking: a cost-effective option to improve patient safety].

    Science.gov (United States)

    Fischer, M; Rybitskiy, D; Strauß, G; Dietz, A; Dressler, C R

    2013-03-01

    Hospitals are implementing a risk management system to avoid patient or surgery mix-ups. The trend is to use preoperative checklists. This work deals specifically with a type of patient identification, which is realized by storing patient data on a patient-fixed medium. In 127 ENT surgeries data relevant for patient identification were encrypted in a 2D-QR-Code. The code, as a separate document coming with the patient chart or as a patient wristband, has been decrypted in the OR and the patient data were presented visible for all persons. The decoding time, the compliance of the patient data, as well as the duration of the patient identification was compared with the traditional patient identification by inspection of the patient chart. A total of 125 QR codes were read. The time for the decrypting of QR-Code was 5.6 s, the time for the screen view for patient identification was 7.9 s, and for a comparison group of 75 operations traditional patient identification was 27.3 s. Overall, there were 6 relevant information errors in the two parts of the experiment. This represents a ratio of 0.6% for 8 relevant classes per each encrypted QR code. This work allows a cost effective way to technically support patient identification based on electronic patient data. It was shown that the use in the clinical routine is possible. The disadvantage is a potential misinformation from incorrect or missing information in the HIS, or due to changes of the data after the code was created. The QR-code-based patient tracking is seen as a useful complement to the already widely used identification wristband. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Evidence-based Utilization of Noninvasive Ventilation and Patient Outcomes.

    Science.gov (United States)

    Mehta, Anuj B; Douglas, Ivor S; Walkey, Allan J

    2017-11-01

    Strong evidence supports use of noninvasive ventilation (NIV) for patients with respiratory distress from chronic obstructive pulmonary disease and heart failure (strong evidence conditions [SECs]). Despite unclear benefits of NIV for other causes of acute respiratory failure, utilization for conditions with weaker evidence is increasing, despite evidence demonstrating higher mortality for patients who suffer NIV failure (progression from NIV to invasive mechanical ventilation [IMV])) compared with being treated initially with IMV. To determine the association of hospital variation in evidence-based utilization of NIV with patient outcomes. Using the California State Inpatient Database 2011, we identified adult patients who received NIV. Patients were considered to have an SEC for NIV if they had an acute exacerbation of chronic obstructive pulmonary disease or heart failure. We used multivariable hierarchical logistic regression to determine the association between hospital rates of NIV use for SECs and patient risk of NIV failure (need for IMV after NIV). Among 22,706 hospitalizations with NIV as the initial ventilatory strategy, 6,820 (30.0%) had SECs. Patients with SECs had lower risk of NIV failure than patients with weak evidence conditions (8.1 vs. 18.2%, P benefited from admission to hospitals that used NIV more often for patients with SECs (Quartile 4 vs. Quartile 1 adjusted odds ratio for NIV failure = 0.68; 95% CI = 0.52-0.88). Most patients who received NIV did not have conditions with strong supporting evidence for its use with wide institutional variation in patient selection for NIV. Surprisingly, we found that all patients, even those without an SEC, benefited from admission to hospitals with greater evidence-based utilization of NIV, suggesting a "hospital effect" that is synergistic with patient selection.

  14. Multilevel model based glucose control for type-1 diabetes patients.

    Science.gov (United States)

    Garcia-Gabin, Winston; Jacobsen, Elling W

    2013-01-01

    Diabetes is a disease that involves alterations at multiple biological levels, ranging from intracellular signalling to organ processes. Since glucose homeostasis is the consequence of complex interactions that involve a number of factors, the control of diabetes should be based on a multilevel analysis. In this paper, a novel approach to design of closed-loop glucose controllers based on multilevel models is presented. A control scheme is proposed based on combining a pharmacokinetic/pharmacodynamic model with an insulin signal transduction model for type 1 diabetes mellitus patients. Based on this, an insulin feedback control schemes is designed. Two main advantages of explicitly utilizing information at the intracellular level were obtained. First, significant reduction of hypoglycaemic risk by reducing the undershoot in glucose levels in response to added insulin. Second, robust performance for inter-patient changes, demonstrated through application of the multilevel control strategy to a well established in silico population of diabetic patients.

  15. DIGITAL ONCOLOGY PATIENT RECORD - HETEROGENEOUS FILE BASED APPROACH

    Directory of Open Access Journals (Sweden)

    Nikolay Sapundzhiev

    2010-12-01

    Full Text Available Introduction: Oncology patients need extensive follow-up and meticulous documentation. The aim of this study was to introduce a simple, platform independent file based system for documentation of diagnostic and therapeutic procedures in oncology patients and test its function.Material and methods: A file-name based system of the type M1M2M3.F2 was introduced, where M1 is a unique identifier for the patient, M2 is the date of the clinical intervention/event, M3 is an identifier for the author of the medical record and F2 is the specific software generated file-name extension.Results: This system is in use at 5 institutions, where a total of 11 persons on 14 different workstations inputted 16591 entries (files for 2370. The merge process was tested on 2 operating systems - when copied together all files sort up as expected by patient, and for each patient in a chronological order, providing a digital cumulative patient record, which contains heterogeneous file formats.Conclusion: The file based approach for storing heterogeneous digital patient related information is an reliable system, which can handle open-source, proprietary, general and custom file formats and seems to be easily scalable. Further development of software for automatic checks of the integrity and searching and indexing of the files is expected to produce a more user-friendly environment

  16. The Palatability of Cereal Based Nutritional Supplements in Cancer Patients

    Science.gov (United States)

    Baik, Hyun Wook; Lee, Yu Sun; Song, Min-Kyung

    2014-01-01

    Recently, it is reported that intervention of oral nutritional supplement improves the nutritional status of cancer patients, and the effectiveness is affected by the sensory preference of cancer patients on the oral nutritional supplement. However, the variety of oral nutritional supplement is extremely limited and the number of patient's benefits from using the products are restricted mostly due to sensory dislikes. The objective of this study was to provide sensory preference score of trial manufactured products with different accessory ingredients to maximize the use of oral nutritional supplements. Cancer patients (n = 30) and age, sex-matched healthy volunteers (n = 30) participated in the sensory assessments (taste, flavor, viscosity, color and overall preference) of three types of oral supplements (cereal base, cereal base+herb and cereal base+fruit) and a control supplement product with scorched cereal flavor, a top seller in current Korean market. Results indicate that the cancer patients' overall preference was significantly higher for the control supplement, and fruit added supplement was preferred over plain cereal and herb added products, although the difference was insignificant. However, there was no significant preference difference for the supplements among the control group for all sensory factors. These results suggest that cancer patients are more sensitive to sensory preferences compared to the control group, and the patients prefer the flavor of cooked cereal which is a staple food in Korea. PMID:24527420

  17. The palatability of cereal based nutritional supplements in cancer patients.

    Science.gov (United States)

    Baik, Hyun Wook; Sung, Mi-Kyung; Lee, Yu Sun; Song, Min-Kyung; Bae, Yun Jung

    2014-01-01

    Recently, it is reported that intervention of oral nutritional supplement improves the nutritional status of cancer patients, and the effectiveness is affected by the sensory preference of cancer patients on the oral nutritional supplement. However, the variety of oral nutritional supplement is extremely limited and the number of patient's benefits from using the products are restricted mostly due to sensory dislikes. The objective of this study was to provide sensory preference score of trial manufactured products with different accessory ingredients to maximize the use of oral nutritional supplements. Cancer patients (n = 30) and age, sex-matched healthy volunteers (n = 30) participated in the sensory assessments (taste, flavor, viscosity, color and overall preference) of three types of oral supplements (cereal base, cereal base+herb and cereal base+fruit) and a control supplement product with scorched cereal flavor, a top seller in current Korean market. Results indicate that the cancer patients' overall preference was significantly higher for the control supplement, and fruit added supplement was preferred over plain cereal and herb added products, although the difference was insignificant. However, there was no significant preference difference for the supplements among the control group for all sensory factors. These results suggest that cancer patients are more sensitive to sensory preferences compared to the control group, and the patients prefer the flavor of cooked cereal which is a staple food in Korea.

  18. [Acid-base status in patients treated with peritoneal dialysis].

    Science.gov (United States)

    Katalinić, Lea; Blaslov, Kristina; Pasini, Eva; Kes, Petar; Bašić-Jukić, Nikolina

    2014-04-01

    When compared to hemodialysis, peritoneal dialysis is very simple yet low cost method of renal replacement therapy. Series of studies have shown its superiority in preserving residual renal function, postponing uremic complications, maintaining the acid-base balance and achieving better post-transplant outcome in patients treated with this method. Despite obvious advantages, its role in the treatment of chronic kidney disease is still not as important as it should be. Metabolic acidosis is an inevitable complication associated with progressive loss of kidney function. Its impact on mineral and muscle metabolism, residual renal function, allograft function and anemia is very complex but can be successfully managed. The aim of our study was to evaluate the efficiency in preserving the acid-base balance in patients undergoing peritoneal dialysis at Zagreb University Hospital Center. Twenty-eight patients were enrolled in the study. The mean time spent on the treatment was 32.39 ± 43.43 months. Only lactate-buffered peritoneal dialysis fluids were used in the treatment. Acid-base balance was completely maintained in 73.07% of patients; 11.54% of patients were found in the state of mild metabolic acidosis, and the same percentage of patients were in the state of mild metabolic alkalosis. In one patient, mixed alkalosis with respiratory and metabolic component was present. The results of this study showed that acid-base balance could be maintained successfully in patients undergoing peritoneal dialysis, even only with lactate-buffered solutions included in the treatment, although they were continuously proclaimed as inferior in comparison with bicarbonate-buffered ones. In well educated and informed patients who carefully use this method, accompanied by the attentive and thorough care of their physicians, this method can provide quality continuous replacement of lost renal function as well as better quality of life.

  19. Improving Patient Satisfaction Through Computer-Based Questionnaires.

    Science.gov (United States)

    Smith, Matthew J; Reiter, Michael J; Crist, Brett D; Schultz, Loren G; Choma, Theodore J

    2016-01-01

    Patient-reported outcome measures are helping clinicians to use evidence-based medicine in decision making. The use of computer-based questionnaires to gather such data may offer advantages over traditional paper-based methods. These advantages include consistent presentation, prompts for missed questions, reliable scoring, and simple and accurate transfer of information into databases without manual data entry. The authors enrolled 308 patients over a 16-month period from 3 orthopedic clinics: spine, upper extremity, and trauma. Patients were randomized to complete either electronic or paper validated outcome forms during their first visit, and they completed the opposite modality at their second visit, which was approximately 7 weeks later. For patients with upper-extremity injuries, the Penn Shoulder Score (PSS) was used. For patients with lower-extremity injuries, the Foot Function Index (FFI) was used. For patients with lumbar spine symptoms, the Oswestry Disability Index (ODI) was used. All patients also were asked to complete the 36-Item Short Form Health Survey (SF-36) Health Status Survey, version 1. The authors assessed patient satisfaction with each survey modality and determined potential advantages and disadvantages for each. No statistically significant differences were found between the paper and electronic versions for patient-reported outcome data. However, patients strongly preferred the electronic surveys. Additionally, the paper forms had significantly more missed questions for the FFI (P<.0001), ODI (P<.0001), and PSS (P=.008), and patents were significantly less likely to complete these forms (P<.0001). Future research should focus on limiting the burden on responders, individualizing forms and questions as much as possible, and offering alternative environments for completion (home or mobile platforms). Copyright 2016, SLACK Incorporated.

  20. Characterization of Cardiac Patients Based on the Synergy Model

    Directory of Open Access Journals (Sweden)

    Tavangar

    2014-10-01

    Full Text Available Background Cardiac patients need comprehensive support due to the adverse effects of this disease on different aspects of their lives. Synergy intervention is a model that focuses on patients' requirements. Objectives This study aimed to determine the eightfold characteristic of cardiac patients based on the synergy model that represent their clinical requirements. Materials and Methods In this descriptive cross-sectional study, 40 cardiac patients hospitalized at the cardiac care unit (CCU of Yazd Afshar Hospital were randomly selected. The data were collected by using a two-part check-list including demographic characteristics and also by studying eight characteristics of patients through interviewing and reviewing their records. The results were analyzed using descriptive statistics such as frequency (percentage and analytical statistics such as Spearman and Mann-Whitney test with the SPSS software, version 18. Results The results showed that among patients' internal characteristics, reversibility (70.6%, vulnerability (68.6%, and predictability (80.4% at level 1 (the minimum score had the highest frequency and stability (49% and complexity (54.9% were at level 3 (average score. Among external characteristics participation in decision-making (80.4% at level 1 had the highest frequency while care (62.7% and recourses (98% were at level 3. Conclusions Ignoring any of the eightfold characteristics based on the synergy model interferes with comprehensive support of cardiac patients. Therefore, it is necessary for professional health practitioners, especially nurses, to consider patients' eightfold characteristics in order to provide quality care.

  1. Implementing Electronic Tablet-Based Education of Acute Care Patients.

    Science.gov (United States)

    Sawyer, Tenita; Nelson, Monica J; McKee, Vickie; Bowers, Margaret T; Meggitt, Corilin; Baxt, Sarah K; Washington, Delphine; Saladino, Louise; Lehman, E Philip; Brewer, Cheryl; Locke, Susan C; Abernethy, Amy; Gilliss, Catherine L; Granger, Bradi B

    2016-02-01

    Poor education-related discharge preparedness for patients with heart failure is believed to be a major cause of avoidable rehospitalizations. Technology-based applications offer innovative educational approaches that may improve educational readiness for patients in both inpatient and outpatient settings; however, a number of challenges exist when implementing electronic devices in the clinical setting. Implementation challenges include processes for "on-boarding" staff, mediating risks of cross-contamination with patients' device use, and selling the value to staff and health system leaders to secure the investment in software, hardware, and system support infrastructure. Strategies to address these challenges are poorly described in the literature. The purpose of this article is to present a staff development program designed to overcome challenges in implementing an electronic, tablet-based education program for patients with heart failure. ©2016 American Association of Critical-Care Nurses.

  2. Empower the patients with a dialogue-based web application

    DEFF Research Database (Denmark)

    Bjørnes, Charlotte D.; Cummings, Elizabeth; Nøhr, Christian

    2012-01-01

    Based on a clinical intervention study this paper adds to the significance of users involvement in design processes and substantiate the potential of online, flexible health informatics tools as useful components to accommodate organizational changes that short stay treatment demands. A dialogue......-based web application was designed and implemented to accommodate patients' information and communication needs in short stay hospital settings. To ensure the system meet the patients' needs, both patients and healthcare professionals were involved in the design process by applying various participatory...... methods. Contextualization of the new application was also central in all phases to ensure a focus not only on the technology itself, but also the way it is used and in which relations and contexts. In evaluation of the tool, the patients' descriptions as user substantiate that the use of Internet...

  3. A Hospital Recommendation System Based on Patient Satisfaction Survey

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Khoie

    2017-09-01

    Full Text Available Surveys are used by hospitals to evaluate patient satisfaction and to improve general hospital operations. Collected satisfaction data is usually represented to the hospital administration by using statistical charts and graphs. Although such visualization is helpful, typically no deeper data analysis is performed to identify important factors which contribute to patient satisfaction. This work presents an unsupervised data-driven methodology for analyzing patient satisfaction survey data. The goal of the proposed exploratory data analysis is to identify patient communities with similar satisfaction levels and the major factors, which contribute to their satisfaction. This type of data analysis will help hospitals to pinpoint the prevalence of certain satisfaction factors in specific patient communities or clusters of individuals and to implement more proactive measures to improve patient experience and care. To this end, two layers of data analysis is performed. In the first layer, patients are clustered based on their responses to the survey questions. Each cluster is then labeled according to its salient features. In the second layer, the clusters of first layer are divided into sub-clusters based on patient demographic data. Associations are derived between the salient features of each cluster and its sub-clusters. Such associations are ranked and validated by using standard statistical tests. The associations derived by this methodology are turned into comments and recommendations for healthcare providers and patients. Having applied this method on patient and survey data of a hospital resulted in 19 recommendations where 10 of them were statistically significant with chi-square test’s p-value less than 0.5 and an odds ratio z-test’s p-value of more than 2 or less than −2. These associations not only are statistically significant but seems rational too.

  4. Empower the patients with a dialogue-based web application.

    Science.gov (United States)

    Bjørnes, Charlotte D; Cummings, Elizabeth; Nøhr, Christian

    2012-01-01

    Based on a clinical intervention study this paper adds to the significance of users involvement in design processes and substantiate the potential of online, flexible health informatics tools as useful components to accommodate organizational changes that short stay treatment demands. A dialogue-based web application was designed and implemented to accommodate patients' information and communication needs in short stay hospital settings. To ensure the system meet the patients' needs, both patients and healthcare professionals were involved in the design process by applying various participatory methods. Contextualization of the new application was also central in all phases to ensure a focus not only on the technology itself, but also the way it is used and in which relations and contexts. In evaluation of the tool, the patients' descriptions as user substantiate that the use of Internet applications can expand the time for dialogue between the individual patient and healthcare professionals. The patients experience being partners in an on going dialogue, and thereby are empowered, e.g. in managing their care even at home, as these dialogues generate individualized information.

  5. Video-based patient decision aids: A scoping review.

    Science.gov (United States)

    Winston, Karin; Grendarova, Petra; Rabi, Doreen

    2017-10-18

    This study reviews the published literature on the use of video-based decision aids (DA) for patients. The authors describe the areas of medicine in which video-based patient DA have been evaluated, the medical decisions targeted, their reported impact, in which countries studies are being conducted, and publication trends. The literature review was conducted systematically using Medline, Embase, CINAHL, PsychInfo, and Pubmed databases from inception to 2016. References of identified studies were reviewed, and hand-searches of relevant journals were conducted. 488 studies were included and organized based on predefined study characteristics. The most common decisions addressed were cancer screening, risk reduction, advance care planning, and adherence to provider recommendations. Most studies had sample sizes of fewer than 300, and most were performed in the United States. Outcomes were generally reported as positive. This field of study was relatively unknown before 1990s but the number of studies published annually continues to increase. Videos are largely positive interventions but there are significant remaining knowledge gaps including generalizability across populations. Clinicians should consider incorporating video-based DA in their patient interactions. Future research should focus on less studied areas and the mechanisms underlying effective patient decision aids. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Feasibility of web-based decision aids in neurological patients

    NARCIS (Netherlands)

    van Til, Janine Astrid; Drossaert, Constance H.C.; Renzenbrink, Gerbert J.; Snoek, Govert J.; Dijkstra, Evelien; Stiggelbout, Anne M.; IJzerman, Maarten Joost

    2010-01-01

    Decision aids (DAs) may be helpful in improving patients' participation in medical decision-making. We investigated the potential for web-based DAs in a rehabilitation population. Two self-administered DAs focused on the treatment of acquired ankle-foot impairment in stroke and the treatment of

  7. Digital pen-based telemonitoring of elderly heart failure patients.

    Science.gov (United States)

    Lind, Leili; Karlsson, Daniel

    2013-01-01

    Considering that a majority of elderlies are non-users of computers and Internet we developed a telemonitoring system for elderly heart failure (HF) home care patients based on digital pen technology - a technology never used before by this patient group. We implemented the system in clinical use in a 13 months long study. Fourteen patients (mean/median age 84 years) with severe HF participated. They accepted the technology and performed daily reports of their health state using the digital pen and a Health Diary form. Via the system the clinicians detected all HF-related deteriorations at an early stage and thereby prevented hospital re-admissions for all patients during the study, implying improved symptom control and large cost savings.

  8. The digital divide in Internet-based patient education materials.

    Science.gov (United States)

    Sun, Gordon H

    2012-11-01

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

  9. Lisfranc injuries: patient- and physician-based functional outcomes.

    LENUS (Irish Health Repository)

    O'Connor, P A

    2012-02-03

    The purpose of this study was to assess functional outcome of patients with a Lisfranc fracture dislocation of the foot by applying validated patient- and physician-based scoring systems and to compare these outcome tools. Of 25 injuries sustained by 24 patients treated in our institution between January 1995 and June 2001, 16 were available for review with a mean follow-up period of 36 (10-74) months. Injuries were classified according to Myerson. Outcome instruments used were: (a) Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), (b) Baltimore Painful Foot score (PFS) and (c) American Orthopedic Foot and Ankle Society (AOFAS) mid-foot scoring scale. Four patients had an excellent outcome on the PFS scale, seven were classified as good, three fair and two poor. There was a statistically significant correlation between the PFS and Role Physical (RP) element of the SF-36.

  10. Characterization and classification of lupus patients based on plasma thermograms.

    Directory of Open Access Journals (Sweden)

    Nichola C Garbett

    Full Text Available Plasma thermograms (thermal stability profiles of blood plasma are being utilized as a new diagnostic approach for clinical assessment. In this study, we investigated the ability of plasma thermograms to classify systemic lupus erythematosus (SLE patients versus non SLE controls using a sample of 300 SLE and 300 control subjects from the Lupus Family Registry and Repository. Additionally, we evaluated the heterogeneity of thermograms along age, sex, ethnicity, concurrent health conditions and SLE diagnostic criteria.Thermograms were visualized graphically for important differences between covariates and summarized using various measures. A modified linear discriminant analysis was used to segregate SLE versus control subjects on the basis of the thermograms. Classification accuracy was measured based on multiple training/test splits of the data and compared to classification based on SLE serological markers.Median sensitivity, specificity, and overall accuracy based on classification using plasma thermograms was 86%, 83%, and 84% compared to 78%, 95%, and 86% based on a combination of five antibody tests. Combining thermogram and serology information together improved sensitivity from 78% to 86% and overall accuracy from 86% to 89% relative to serology alone. Predictive accuracy of thermograms for distinguishing SLE and osteoarthritis / rheumatoid arthritis patients was comparable. Both gender and anemia significantly interacted with disease status for plasma thermograms (p<0.001, with greater separation between SLE and control thermograms for females relative to males and for patients with anemia relative to patients without anemia.Plasma thermograms constitute an additional biomarker which may help improve diagnosis of SLE patients, particularly when coupled with standard diagnostic testing. Differences in thermograms according to patient sex, ethnicity, clinical and environmental factors are important considerations for application of

  11. Education for arthritis patients: a community pharmacy based pilot project.

    Science.gov (United States)

    Petkova, Valentina B

    2009-04-01

    There are different kinds of arthritis, widely spread among the population, that make them a clinical problem with social, psychological and economic burden. Different education programs have been developed in order to improve patients' disease management, medication compliance and from there patients' quality of life. To develop and implement a community pharmacy-based educational program for patients with arthritis. Improvements in pain, medication compliance, decrease in general practitioner's visits and hospitalizations are expected. Prospective, randomized, controlled trial. The sample consisted of 43 individuals, with different stages of arthritis (aged 15 - 71), attending pharmacies - intervention group; and 43 individuals - control group. A 4-month education was conducted on the following topics: what causes arthritis and what are the factors that can intensify it; pain management and physical activities; self-management and prevention; pharmacotherapy and possible adverse drug reactions. Patient's health-related quality of life was assessed in the beginning and at the end of the survey. PARAMETERS ASSESSED DURING THE FOUR STAGES OF THE PROGRAM WERE: frequency of severe pain, frequency of general practitioner's visits, frequency of urgent medical aid calls, compliance with therapy, satisfaction with pharmacy services. Improvement in patients' health-related quality of life was observed and also: decrease in the severity of patients' pain, decrease in the physician's visits, and increase in satisfaction overall care. Positive results from the educational approach in pharmacy conditions were demonstrated. These consequences have a potential to increase arthritis patient's quality of life.

  12. Nickel allergy in interatrial shunt device-based closure patients.

    Science.gov (United States)

    Rigatelli, Gianluca; Cardaioli, Paolo; Giordan, Massimo; Aggio, Silvio; Chinaglia, Mauro; Braggion, Gabriele; Roncon, Loris

    2007-01-01

    The possibility of nickel toxicity has been raised with interatrial shunt closure devices constructed of nitinol. This study is aimed to assess the potential adverse symptoms in terms of incidence, duration, and significance, in patients with interatrial shunt and nickel allergy who underwent nitinol device-based closure. We prospectively enrolled 46 consecutive patients (mean age 35 +/- 28.8 years, 30 female) over a 12-month period referred to our center for catheter-based closure of interatrial shunts. Patients were investigated for previous hypersensivity to nickel and were required to test potential nickel allergy with cutaneous patch test (TRUE test) before device implantation. Routinely, clinical visit with laboratory examinations, and TTE were scheduled at 1, 6, and 12 months. Nine patients (19.5%, mean age 31.3 +/- 13.2 years) had proved symptomatic and instrumental nickel allergy as showed by cutaneous patch skin test but preferred to be implanted. All patients underwent successful transcatheter closure with an immediate occlusion rate of 100% without intraoperative complications. Between the 2nd and 3rd postoperative day, 8 out of 9 patients developed a sort of 'device syndrome' that included concurrent chest discomfort, exertional dyspnea and asthenia, and mild leukocytosis. The syndrome was treated with Prednison and Clopidogrel and in all was resolved after 1-week therapy. Interestingly, none of the patients without nickel allergy developed postclosure symptoms (P nickel allergy is still a problematic issue in patients scheduled for transcatheter closure of intracardiac shunts; however, our brief study suggests that nickel allergy is not per se a contraindication to nitinol device closure.

  13. Evidence-Based Treatment of Delirium in Patients With Cancer

    Science.gov (United States)

    Breitbart, William; Alici, Yesne

    2012-01-01

    Delirium is the most common neuropsychiatric complication seen in patients with cancer, and it is associated with significant morbidity and mortality. Increased health care costs, prolonged hospital stays, and long-term cognitive decline are other well-recognized adverse outcomes of delirium. Improved recognition of delirium and early treatment are important in diminishing such morbidity. There has been an increasing number of studies published in the literature over the last 10 years regarding delirium treatment as well as prevention. Antipsychotics, cholinesterase inhibitors, and alpha-2 agonists are the three groups of medications that have been studied in randomized controlled trials in different patient populations. In patients with cancer, the evidence is most clearly supportive of short-term, low-dose use of antipsychotics for controlling the symptoms of delirium, with close monitoring for possible adverse effects, especially in older patients with multiple medical comorbidities. Nonpharmacologic interventions also appear to have a beneficial role in the treatment of patients with cancer who have or are at risk for delirium. This article presents evidence-based recommendations based on the results of pharmacologic and nonpharmacologic studies of the treatment and prevention of delirium. PMID:22412123

  14. [Does simulator-based team training improve patient safety?].

    Science.gov (United States)

    Trentzsch, H; Urban, B; Sandmeyer, B; Hammer, T; Strohm, P C; Lazarovici, M

    2013-10-01

    Patient safety became paramount in medicine as well as in emergency medicine after it was recognized that preventable, adverse events significantly contributed to morbidity and mortality during hospital stay. The underlying errors cannot usually be explained by medical technical inadequacies only but are more due to difficulties in the transition of theoretical knowledge into tasks under the conditions of clinical reality. Crew Resource Management and Human Factors which determine safety and efficiency of humans in complex situations are suitable to control such sources of error. Simulation significantly improved safety in high reliability organizations, such as the aerospace industry.Thus, simulator-based team training has also been proposed for medical areas. As such training is consuming in cost, time and human resources, the question of the cost-benefit ratio obviously arises. This review outlines the effects of simulator-based team training on patient safety. Such course formats are not only capable of creating awareness and improvements in safety culture but also improve technical team performance and emphasize team performance as a clinical competence. A few studies even indicated improvement of patient-centered outcome, such as a reduced rate of adverse events but further studies are required in this respect. In summary, simulator-based team training should be accepted as a suitable strategy to improve patient safety.

  15. Patient Reported Outcomes in a New Home-Based Rehabilitation Programme for Prostate Cancer Patients

    DEFF Research Database (Denmark)

    Villumsen, Brigitta R.; Grønbech Jørgensen, Martin; Frystyk, Jan

    2015-01-01

    will explore the satisfaction and experience with the health game programme. To the best of our knowledge this is the first RCT study to investigate the effect of a home based health game programme on PC patients. No statistical analysis have been made thus far because inclusion is ongoing, however baseline...... observations show that most of the participants fulfil the criteria for being diagnosed with metabolic syndrome. Finally this study will assess the safety and efficacy of a novel exergaming modality for PC patients and the results are expected to influence recommendations on exercise given to this patient...

  16. A statistical analysis based recommender model for heart disease patients.

    Science.gov (United States)

    Mustaqeem, Anam; Anwar, Syed Muhammad; Khan, Abdul Rashid; Majid, Muhammad

    2017-12-01

    An intelligent information technology based system could have a positive impact on the life-style of patients suffering from chronic diseases by providing useful health recommendations. In this paper, we have proposed a hybrid model that provides disease prediction and medical recommendations to cardiac patients. The first part aims at implementing a prediction model, that can identify the disease of a patient and classify it into one of the four output classes i.e., non-cardiac chest pain, silent ischemia, angina, and myocardial infarction. Following the disease prediction, the second part of the model provides general medical recommendations to patients. The recommendations are generated by assessing the severity of clinical features of patients, estimating the risk associated with clinical features and disease, and calculating the probability of occurrence of disease. The purpose of this model is to build an intelligent and adaptive recommender system for heart disease patients. The experiments for the proposed recommender system are conducted on a clinical data set collected and labelled in consultation with medical experts from a known hospital. The performance of the proposed prediction model is evaluated using accuracy and kappa statistics as evaluation measures. The medical recommendations are generated based on information collected from a knowledge base created with the help of physicians. The results of the recommendation model are evaluated using confusion matrix and gives an accuracy of 97.8%. The proposed system exhibits good prediction and recommendation accuracies and promises to be a useful contribution in the field of e-health and medical informatics. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Preparation, validation and user-testing of pictogram-based patient information leaflets for hemodialysis patients.

    Science.gov (United States)

    Mateti, Uday Venkat; Nagappa, Anantha Naik; Attur, Ravindra Prabhu; Bairy, Manohar; Nagaraju, Shankar Prasad; Mallayasamy, Surulivelrajan; Vilakkathala, Rajesh; Guddattu, Vasudev; Balkrishnan, Rajesh

    2015-11-01

    Patient information leaflets are universally-accepted resources to educate the patients/users about their medications, disease and lifestyle modification. The objective of the study was to prepare, validate and perform user-testing of pictogram-based patient information leaflets (P-PILs) among hemodialysis (HD) patients. The P-PILs are prepared by referring to the primary, secondary and tertiary resources. The content and pictograms of the leaflet have been validated by an expert committee consisting of three nephrologists and two academic pharmacists. The Baker Able Leaflet Design has been applied to develop the layout and design of the P-PILs. Quasi-experimental pre- and post-test design without control group was conducted on 81 HD patients for user-testing of P-PILs. The mean Baker Able Leaflet Design assessment score for English version of the leaflet was 28, and 26 for Kannada version. The overall user-testing knowledge assessment mean scores were observed to have significantly improved from 44.25 to 69.62 with p value <0.001. The overall user opinion of content and legibility of the leaflets was good. Pictogram-based patient information leaflets can be considered an effective educational tool for HD patients.

  18. The patient with acute paraplegia: a problem-based review.

    Science.gov (United States)

    Elegbe, Oloruntoba; Wickremaratchi, Mirdhu; Hinchcliffe, Martyn

    2011-01-01

    Acute paraplegia is an emergency requiring immediate assessment by the acute medical team because of the need to rule out compressive lesions of the cord. Early intervention may preserve neurological spinal function and limit persistent disability. In addition, acute paraplegia may be complicated by life-threatening problems. These require prompt recognition and treatment. The following clinical scenario, based on a real case of acute paraplegia managed by the authors is aimed at providing a problem-based approach to the management of patients presenting with acute paraplegic weakness.

  19. Patient Reported Outcomes in a New Home-Based Rehabilitation Programme for Prostate Cancer Patients

    DEFF Research Database (Denmark)

    Villumsen, Brigitta R.; Grønbech Jørgensen, Martin; Frystyk, Jan

    2015-01-01

    will explore the satisfaction and experience with the health game programme. To the best of our knowledge this is the first RCT study to investigate the effect of a home based health game programme on PC patients. No statistical analysis have been made thus far because inclusion is ongoing, however baseline...

  20. Evidence-based nutritional support of the elderly cancer patient.

    Science.gov (United States)

    Bozzetti, Federico

    2015-04-01

    The papers included in this section represent the effort of the Task Force on Nutrition of the International Society of Geriatric Oncology to synthetize the evidence-based concepts on nutritional support of the elderly cancer patients. In the attempt of presenting a comprehensive overview of the topic, the panel included experts from different specialties: basic researchers, nutritionists, geriatricians, nurses, dieticians, gastroenterologists, oncologists. Cancer in elderly people is a growing problem. Not only in almost every country, the proportion of people aged over 60 years is growing faster than any other age group, but cancer per se is also a disease of old adult-elderly people, hence the oncologists face an increasing number of these patients both now and in the next years. The are several studies on nutrition of elderly subjects and many other on nutrition of cancer patients but relatively few specifically devoted to the nutritional support of the elderly cancer patients. However, the awareness that elderly subjects account for a high proportion of the mixed cancer patients population, in some way legitimates us to extend some conclusions of the literature also to the elderly cancer patients. Although the topics of this Experts' Consensus have been written by specialists in different areas of nutrition, the final message is addressed to the oncologists. Not only they should be more directly involved in the simplest steps of the nutritional care (recognition of the potential existence of a "nutritional risk" which can compromise the planned oncologic program, use of some oral supplements, etc.) but, as the true experts of the natural history of their cancer patient, they should also coordinate the process of the nutritional support, integrating this approach in the overall multidisciplinary cancer care. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Improving patient knowledge about sacral nerve stimulation using a patient based educational video.

    Science.gov (United States)

    Jeppson, Peter Clegg; Clark, Melissa A; Hampton, Brittany Star; Raker, Christina A; Sung, Vivian W

    2013-10-01

    We developed a patient based educational video to address the information needs of women considering sacral nerve stimulation for overactive bladder. Five semistructured focus groups were used to identify patient knowledge gaps, information needs, patient acceptable terminology and video content preferences for a patient based sacral nerve stimulation educational video. Each session was transcribed, independently coded by 2 coders and examined using an iterative method. A 16-minute educational video was created to address previously identified knowledge gaps and information needs using patient footage, 3-dimensional animation and peer reviewed literature. We developed a questionnaire to evaluate participant sacral nerve stimulation knowledge and therapy attitudes. We then performed a randomized trial to assess the effect of the educational video vs the manufacturer video on patient knowledge and attitudes using our questionnaire. We identified 10 patient important domains, including 1) anatomy, 2) expectations, 3) sacral nerve stimulation device efficacy, 4) surgical procedure, 5) surgical/device complications, 6) post-procedure recovery, 7) sacral nerve stimulation side effects, 8) postoperative restrictions, 9) device maintenance and 10) general sacral nerve stimulation information. A total of 40 women with overactive bladder were randomized to watch the educational (20) or manufacturer (20) video. Knowledge scores improved in each group but the educational video group had a greater score improvement (76.6 vs 24.2 points, p <0.0001). Women who watched the educational video reported more favorable attitudes and expectations about sacral nerve stimulation therapy. Women with overactive bladder considering sacral nerve stimulation therapy have specific information needs. The video that we developed to address these needs was associated with improved short-term patient knowledge. Copyright © 2013 American Urological Association Education and Research, Inc

  2. Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review.

    Science.gov (United States)

    Castro, Eva Marie; Van Regenmortel, Tine; Vanhaecht, Kris; Sermeus, Walter; Van Hecke, Ann

    2016-12-01

    The concepts of patient empowerment, patient participation and patient-centeredness have been introduced as part of the trend towards a more participatory health care and have largely been used interchangeably. Although these concepts have been discussed for a number of years, their exact meaning in hospital care remains somewhat unclear. This absence of theoretical and conceptual clarity has led to (1) poor understanding and communication among researchers, health practitioners and policy makers and (2) problems in measurement and comparison between studies across different hospitals. This paper examines all three concepts through a concept analysis based on the method of Avant and Walker (2005) [1] and the simultaneous concept analysis of Haase et al. (1992) [2]. Through these methods, the antecedents, attributes, consequences and empirical referents of each concept are determined. In addition, similarities and differences between the three concepts are identified and a definition offered for each concept. Furthermore, the interrelatedness between the key concepts is mapped, and definitions are proposed. It can be concluded that patient empowerment is a much broader concept than just patient participation and patient-centeredness. The present study may provide a useful framework that researchers, policy makers and health care providers can use to facilitate patient empowerment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Hospital‑based case management for migrant patients

    DEFF Research Database (Denmark)

    Ølholm, Anne Mette; Christensen, Janne B; Kamionka, Stine Lundstrøm

    2016-01-01

    management programme might include reducing inequality and improving clinical outcomes. No studies supporting the argument that specialized hospital care is stigmatizing or reduces quality of care were identified. Conclusion: The review highlights a fundamental lack of evidence against specialized care...... to patients with a refugee or immigrant background. Provision of specialized services for migrant patients, including case management with multidisciplinary physical, cognitive and social interventions, has been suggested as a way to tackle inequalities in response to a growing recognition of the complexity...... of both their health needs and the skills needed to meet these. However, categorical care is generally considered to be stigmatizing and to decrease care quality. The evidence base for both arguments is unclear. The aim of this review was therefore to investigate the effectiveness of specialized hospital...

  4. Acute gastroenteritis: evidence-based management of pediatric patients [digest].

    Science.gov (United States)

    Brady, KeriAnne; Pade, Kathryn H

    2018-02-01

    Although most cases of acute gastroenteritis require minimal medical intervention, severe dehydration and hypoglycemia may develop in cases of prolonged vomiting and diarrhea. The mainstay of treatment for mild-to-moderately dehydrated patients with acute gastroenteritis should be oral rehydration solution. Antiemetics allow for improved tolerance of oral rehydration solution, and, when used appropriately, can decrease the need for intravenous fluids and hospitalization. This issue reviews the common etiologies of acute gastroenteritis, discusses more-severe conditions that should be considered in the differential diagnosis, and provides evidence-based recommendations for management of acute gastroenteritis in patients with mild-to-moderate dehydration, severe dehydration, and hypoglycemia. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  5. Stratifying patients with peripheral neuropathic pain based on sensory profiles

    DEFF Research Database (Denmark)

    Vollert, Jan; Maier, Christoph; Attal, Nadine

    2017-01-01

    In a recent cluster analysis, it has been shown that patients with peripheral neuropathic pain can be grouped into 3 sensory phenotypes based on quantitative sensory testing profiles, which are mainly characterized by either sensory loss, intact sensory function and mild thermal hyperalgesia and...... populations that need to be screened to reach a subpopulation large enough to conduct a phenotype-stratified study. The most common phenotype in diabetic polyneuropathy was sensory loss (83%), followed by mechanical hyperalgesia (75%) and thermal hyperalgesia (34%, note that percentages are overlapping...

  6. Technology-based assessment in patients with disorders of consciousness

    Directory of Open Access Journals (Sweden)

    Carol Di Perri

    2014-09-01

    Full Text Available Introduction. A number of studies highlight the difficulty in forming a diagnosis for patients with disorders of consciousness when this is established merely on behavioral assessments. Background. Positron emission tomography (PET, functional magnetic resonance imaging (fMRI, diffusion tensor imaging (DTI, and electroencephalography combined with transcranial magnetic stimulation (TMS-EEG techniques are promoting the clinical characterization of this challenging population. With such technology-based "objective" tools, patients are also differentially able to follow simple commands and in some cases even communicate through modified brain activity. Consequently, the vegetative state and minimally conscious state have been revised and new nosologies have been proposed, namely the unresponsive wakefulness syndrome, the minimally conscious state plus and minus, and the functional locked-in syndrome. Aim. To our mind, an integration of different technical modalities is important to gain a holistic vision of the underlying pathophysiology of disorders of consciousness in general and to promote single-patient medical management in particular.

  7. An investigation of a video-based patient repositioning technique

    International Nuclear Information System (INIS)

    Yan Yulong; Song Yulin; Boyer, Arthur L.

    2002-01-01

    Purpose: We have investigated a video-based patient repositioning technique designed to use skin features for radiotherapy repositioning. We investigated the feasibility of the clinical application of this system by quantitative evaluation of performance characteristics of the methodology. Methods and Materials: Multiple regions of interest (ROI) were specified in the field of view of video cameras. We used a normalized correlation pattern-matching algorithm to compute the translations of each ROI pattern in a target image. These translations were compared against trial translations using a quadratic cost function for an optimization process in which the patient rotation and translational parameters were calculated. Results: A hierarchical search technique achieved high-speed (compute correlation for 128x128 ROI in 512x512 target image within 0.005 s) and subpixel spatial accuracy (as high as 0.2 pixel). By treating the observed translations as movements of points on the surfaces of a hypothetical cube, we were able to estimate accurately the actual translations and rotations of the test phantoms used in our experiments to less than 1 mm and 0.2 deg. with a standard deviation of 0.3 mm and 0.5 deg. respectively. For human volunteer cases, we estimated the translations and rotations to have an accuracy of 2 mm and 1.2 deg. Conclusion: A personal computer-based video system is suitable for routine patient setup of fractionated conformal radiotherapy. It is expected to achieve high-precision repositioning of the skin surface with high efficiency

  8. Labview Based ECG Patient Monitoring System for Cardiovascular Patient Using SMTP Technology.

    Science.gov (United States)

    Singh, Om Prakash; Mekonnen, Dawit; Malarvili, M B

    2015-01-01

    This paper leads to developing a Labview based ECG patient monitoring system for cardiovascular patient using Simple Mail Transfer Protocol technology. The designed device has been divided into three parts. First part is ECG amplifier circuit, built using instrumentation amplifier (AD620) followed by signal conditioning circuit with the operation amplifier (lm741). Secondly, the DAQ card is used to convert the analog signal into digital form for the further process. Furthermore, the data has been processed in Labview where the digital filter techniques have been implemented to remove the noise from the acquired signal. After processing, the algorithm was developed to calculate the heart rate and to analyze the arrhythmia condition. Finally, SMTP technology has been added in our work to make device more communicative and much more cost-effective solution in telemedicine technology which has been key-problem to realize the telediagnosis and monitoring of ECG signals. The technology also can be easily implemented over already existing Internet.

  9. Comparison of Physician-Based and Patient-Based Criteria for the Diagnosis of Fibromyalgia.

    Science.gov (United States)

    Wolfe, Frederick; Fitzcharles, Mary-Ann; Goldenberg, Don L; Häuser, Winfried; Katz, Robert L; Mease, Philip J; Russell, Anthony S; Jon Russell, I; Walitt, Brian

    2016-05-01

    The American College of Rheumatology (ACR) 2010 preliminary fibromyalgia diagnostic criteria require symptom ascertainment by physicians. The 2011 survey or research modified ACR criteria use only patient self-report. We compared physician-based (MD) (2010) and patient-based (PT) (2011) criteria and criteria components to determine the degree of agreement between criteria methodology. We studied prospectively collected, previously unreported rheumatology practice data from 514 patients and 30 physicians in the ACR 2010 study. We evaluated the widespread pain index, polysymptomatic distress (PSD) scale, tender point count (TPC), and fibromyalgia diagnosis using 2010 and 2011 rules. Bland-Altman 95% limits of agreement (LOA), kappa statistic, Lin's concordance coefficient, and the area under the receiver operating curve (ROC) were used to measure agreement and discrimination. MD and PT diagnostic agreement was substantial (83.4%, κ = 0.67). PSD scores differed slightly (12.3 MD, 12.8 PT; P = 0.213). LOA for PSD were -8.5 and 7.7, with bias of -0.42. The TPC was strongly associated with both the MD (r = 0.779) and PT PSD scales (r = 0.702). There was good agreement in MD and PT fibromyalgia diagnosis and other measures among rheumatology patients. Low bias scores indicate consistent results for physician and patient measures, but large values for LOA indicate many widely discordant pairs. There is acceptable agreement in diagnosis and PSD for research, but insufficient agreement for clinical decisions and diagnosis. We suggest adjudication of symptom data by patients and physicians, as recommended by the 2010 ACR criteria. © 2016, American College of Rheumatology.

  10. Congenital neutropenia: diagnosis, molecular bases and patient management

    Directory of Open Access Journals (Sweden)

    Chantelot Christine

    2011-05-01

    Full Text Available Abstract The term congenital neutropenia encompasses a family of neutropenic disorders, both permanent and intermittent, severe ( When neutropenia is detected, an attempt should be made to establish the etiology, distinguishing between acquired forms (the most frequent, including post viral neutropenia and auto immune neutropenia and congenital forms that may either be isolated or part of a complex genetic disease. Except for ethnic neutropenia, which is a frequent but mild congenital form, probably with polygenic inheritance, all other forms of congenital neutropenia are extremely rare and have monogenic inheritance, which may be X-linked or autosomal, recessive or dominant. About half the forms of congenital neutropenia with no extra-hematopoetic manifestations and normal adaptive immunity are due to neutrophil elastase (ELANE mutations. Some patients have severe permanent neutropenia and frequent infections early in life, while others have mild intermittent neutropenia. Congenital neutropenia may also be associated with a wide range of organ dysfunctions, as for example in Shwachman-Diamond syndrome (associated with pancreatic insufficiency and glycogen storage disease type Ib (associated with a glycogen storage syndrome. So far, the molecular bases of 12 neutropenic disorders have been identified. Treatment of severe chronic neutropenia should focus on prevention of infections. It includes antimicrobial prophylaxis, generally with trimethoprim-sulfamethoxazole, and also granulocyte-colony-stimulating factor (G-CSF. G-CSF has considerably improved these patients' outlook. It is usually well tolerated, but potential adverse effects include thrombocytopenia, glomerulonephritis, vasculitis and osteoporosis. Long-term treatment with G-CSF, especially at high doses, augments the spontaneous risk of leukemia in patients with congenital neutropenia.

  11. Simulation-based patient flow analysis in an endoscopy unit

    DEFF Research Database (Denmark)

    Koo, Pyung-Hoi; Nielsen, Karl Brian; Jang, Jaejin

    2010-01-01

    One of the major elements in improving efficiency of healthcare services is patient flow. Patients require a variety of healthcare resources as they receive healthcare services. Poor management of patient flow results in long waiting time of patients, under/over utilization of medical resources......, low quality of care and high healthcare cost. This article addresses patient flow problems at a Gastrointestinal endoscopy unit. We attempt to analyze the main factors that contribute to the inefficient patient flow and process bottlenecks and to propose efficient patient scheduling and staff...... allocation alternatives to increase the system efficiency. Simulation models are used to examine various healthcare operational strategies....

  12. Evidence-based guides in tracheostomy use in critical patients.

    Science.gov (United States)

    Raimondi, N; Vial, M R; Calleja, J; Quintero, A; Cortés Alban, A; Celis, E; Pacheco, C; Ugarte, S; Añón, J M; Hernández, G; Vidal, E; Chiappero, G; Ríos, F; Castilleja, F; Matos, A; Rodriguez, E; Antoniazzi, P; Teles, J M; Dueñas, C; Sinclair, J; Martínez, L; Von der Osten, I; Vergara, J; Jiménez, E; Arroyo, M; Rodriguez, C; Torres, J; Fernandez-Bussy, S; Nates, J L

    2017-03-01

    Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used. Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  13. Biological-based and physical-based optimization for biological evaluation of prostate patient's plans

    Science.gov (United States)

    Sukhikh, E.; Sheino, I.; Vertinsky, A.

    2017-09-01

    Modern modalities of radiation treatment therapy allow irradiation of the tumor to high dose values and irradiation of organs at risk (OARs) to low dose values at the same time. In this paper we study optimal radiation treatment plans made in Monaco system. The first aim of this study was to evaluate dosimetric features of Monaco treatment planning system using biological versus dose-based cost functions for the OARs and irradiation targets (namely tumors) when the full potential of built-in biological cost functions is utilized. The second aim was to develop criteria for the evaluation of radiation dosimetry plans for patients based on the macroscopic radiobiological criteria - TCP/NTCP. In the framework of the study four dosimetric plans were created utilizing the full extent of biological and physical cost functions using dose calculation-based treatment planning for IMRT Step-and-Shoot delivery of stereotactic body radiation therapy (SBRT) in prostate case (5 fractions per 7 Gy).

  14. Education for arthritis patients: a community pharmacy based pilot project.

    Directory of Open Access Journals (Sweden)

    Petkova VB

    2009-06-01

    Full Text Available There are different kinds of arthritis, widely spread among the population, that make them a clinical problem with social, psychological and economic burden. Different education programs have been developed in order to improve patients’ disease management, medication compliance and from there patients’ quality of life.Objective: To develop and implement a community pharmacy-based educational program for patients with arthritis. Improvements in pain, medication compliance, decrease in general practitioner’s visits and hospitalizations are expected.Methods: Prospective, randomized, controlled trial. The sample consisted of 43 individuals, with different stages of arthritis (aged 15 - 71, attending pharmacies – intervention group; and 43 individuals – control group. A 4-month education was conducted on the following topics: what causes arthritis and what are the factors that can intensify it; pain management and physical activities; self-management and prevention; pharmacotherapy and possible adverse drug reactions. Patient's health-related quality of life was assessed in the beginning and at the end of the survey. Results: Parameters assessed during the four stages of the program were: frequency of severe pain, frequency of general practitioner’s visits, frequency of urgent medical aid calls, compliance with therapy, satisfaction with pharmacy services. Improvement in patients’ health-related quality of life was observed and also: decrease in the severity of patients’ pain, decrease in the physician’s visits, and increase in satisfaction overall care.Conclusions: Positive results from the educational approach in pharmacy conditions were demonstrated. These consequences have a potential to increase arthritis patient’s quality of life.

  15. Smartphone-Based Patient Education in Plastic Surgery.

    Science.gov (United States)

    Noel, Warren; Bosc, Romain; Jabbour, Samer; Kechichian, Elio; Hersant, Barbara; Meningaud, Jean-Paul

    2017-12-01

    Internet use for health information has dramatically increased in the past decade. Mobile medical applications (MMAs) could be a useful tool to improve postoperative patient education and care. The objective of this study is to evaluate the impact of an MMA on patient care in plastic surgery. An MMA was developed to improve postoperative plastic surgery patients care. All patients who underwent surgery at our plastic surgery department between August and November 2014 and were willing to download the MMA were included. Two to 4 weeks after the procedure, the patients were asked to fill a questionnaire that assessed the content, design, and efficacy of the application. Sixty patients were included. The patients reported that their questions regarding the postoperative management were addressed by the application with a mean score of 4.1 over 5. Most patients would recommend the application to other plastic surgery patients with a mean score of 4.6 over 5. The application prevented 12 patients (20%) from calling the plastic surgeon or the emergency department. A smartphone application can optimize the plastic surgery patient care. It can provide additional information allowing the patients to get involved in their own medical care.

  16. Validation of phantom-based harmonization for patient harmonization.

    Science.gov (United States)

    Panetta, Joseph V; Daube-Witherspoon, Margaret E; Karp, Joel S

    2017-07-01

    To improve the precision of multicenter clinical trials, several efforts are underway to determine scanner-specific parameters for harmonization using standardized phantom measurements. The goal of this study was to test the correspondence between quantification in phantom and patient images and validate the use of phantoms for harmonization of patient images. The National Electrical Manufacturers' Association image quality phantom with hot spheres was scanned on two time-of-flight PET scanners. Whole-body [ 18 F]-fluorodeoxyglucose (FDG)-PET scans were acquired of subjects on the same systems. List-mode events from spheres (diam.: 10-28 mm) measured in air on each scanner were embedded into the phantom and subject list-mode data from each scanner to create lesions with known uptake with respect to the local background in the phantom and each subject's liver and lung regions, as a proxy to characterize true lesion quantification. Images were analyzed using the contrast recovery coefficient (CRC) typically used in phantom studies and serving as a surrogate for the standardized uptake value used clinically. Postreconstruction filtering (resolution recovery and Gaussian smoothing) was applied to determine if the effect on the phantom images translates equivalently to subject images. Three postfiltering strategies were selected to harmonize the CRC mean or CRC max values between the two scanners based on the phantom measurements and then applied to the subject images. Both the average CRC mean and CRC max values for lesions embedded in the lung and liver in four subjects (BMI range 25-38) agreed to within 5% with the CRC values for lesions embedded in the phantom for all lesion sizes. In addition, the relative changes in CRC mean and CRC max resulting from the application of the postfilters on the subject and phantom images were consistent within measurement uncertainty. Further, the root mean squared percent difference (RMS pd ) between CRC values on the two scanners

  17. What patients think about E-health: patients' perspective on internet-based cognitive behavioral treatment for patients with rheumatoid arthritis and psoriasis.

    Science.gov (United States)

    Ferwerda, Maaike; van Beugen, Sylvia; van Burik, Amanda; van Middendorp, Henriët; de Jong, Elke M G J; van de Kerkhof, Peter C M; van Riel, Piet L C M; Evers, Andrea W M

    2013-06-01

    In the past decade, the use of internet-based cognitive behavioral treatments (internet-based CBT) for a wide range of patients has grown intensively. Incorporating the patients' opinions and perspective into new health care innovations might improve the quality and applicability of these innovations, as high dropout rates and low attrition are the often-reported concerns in E-health research. Most studies to date have examined patient perspectives on specific internet-based interventions that patients had participated in, and not the views of the general public. The current paper explores the perspective of patients with rheumatoid arthritis and psoriasis on internet-based CBT for these patient groups. In total, 100 patients (55 % male) participated in a semi-structured telephone interview about internet-based CBT, including questions about possible advantages and disadvantages and the readiness to participate in this kind of treatment. Most patients (78 %) were prepared to participate in internet-based CBT. Patients endorsed the advantages (57 %) more often than the disadvantages (34 %). The ease of internet-based CBT and the time saved were especially appealing to patients. Main disadvantages according to patients are that not all patients will be reached due to computer illiteracy and the lack of face-to-face interaction with the therapist. The results suggest that, from the patients' perspective, internet-based CBT is a promising health care development. Further research into aspects such as therapist interaction and enhancing computer literacy might contribute to an effective way of E-health care delivery in the future.

  18. Labview Based ECG Patient Monitoring System for Cardiovascular Patient Using SMTP Technology

    Directory of Open Access Journals (Sweden)

    Om Prakash Singh

    2015-01-01

    Full Text Available This paper leads to developing a Labview based ECG patient monitoring system for cardiovascular patient using Simple Mail Transfer Protocol technology. The designed device has been divided into three parts. First part is ECG amplifier circuit, built using instrumentation amplifier (AD620 followed by signal conditioning circuit with the operation amplifier (lm741. Secondly, the DAQ card is used to convert the analog signal into digital form for the further process. Furthermore, the data has been processed in Labview where the digital filter techniques have been implemented to remove the noise from the acquired signal. After processing, the algorithm was developed to calculate the heart rate and to analyze the arrhythmia condition. Finally, SMTP technology has been added in our work to make device more communicative and much more cost-effective solution in telemedicine technology which has been key-problem to realize the telediagnosis and monitoring of ECG signals. The technology also can be easily implemented over already existing Internet.

  19. Web-based audiovisual patient information system--a study of preoperative patient information in a neurosurgical department.

    Science.gov (United States)

    Gautschi, Oliver P; Stienen, Martin N; Hermann, Christel; Cadosch, Dieter; Fournier, Jean-Yves; Hildebrandt, Gerhard

    2010-08-01

    In the current climate of increasing awareness, patients are demanding more knowledge about forthcoming operations. The patient information accounts for a considerable part of the physician's daily clinical routine. Unfortunately, only a small percentage of the information is understood by the patient after solely verbal elucidation. To optimise information delivery, different auxiliary materials are used. In a prospective study, 52 consecutive stationary patients, scheduled for an elective lumbar disc operation were asked to use a web-based audiovisual patient information system. A combination of pictures, text, tone and video about the planned surgical intervention is installed on a tablet personal computer presented the day before surgery. All patients were asked to complete a questionnaire. Eighty-four percent of all participants found that the audiovisual patient information system lead to a better understanding of the forthcoming operation. Eighty-two percent found that the information system was a very helpful preparation before the pre-surgical interview with the surgeon. Ninety percent of all participants considered it meaningful to provide this kind of preoperative education also to patients planned to undergo other surgical interventions. Eighty-four percent were altogether "very content" with the audiovisual patient information system and 86% would recommend the system to others. This new approach of patient information had a positive impact on patient education as is evident from high satisfaction scores. Because patient satisfaction with the informed consent process and understanding of the presented information improved substantially, the audiovisual patient information system clearly benefits both surgeons and patients.

  20. 77 FR 42317 - Establish a Patient-Based Registry To Evaluate the Association of Gadolinium Based Contrast...

    Science.gov (United States)

    2012-07-18

    ... Quality Assurance (QA) registry of patients with renal failure who received GBCAs as the basis for a... of the development of a patient-based registry to evaluate the association of gadolinium based..., and a copy to Ira Krefting, Center for Drug Evaluation and Research, Division of Medical Imaging...

  1. Exercise Training for Heart Failure Patients with and without Systolic Dysfunction: An Evidence-Based Analysis of How Patients Benefit

    Directory of Open Access Journals (Sweden)

    Neil Smart

    2011-01-01

    Full Text Available Significant benefits can be derived by heart failure patients from exercise training. This paper provides an evidence-based assessment of expected clinical benefits of exercise training for heart failure patients. Meta-analyses and randomized, controlled trials of exercise training in heart failure patients were reviewed from a search of PubMed, Cochrane Controlled Trial Registry (CCTR, CINAHL, and EMBASE. Exercise training improves functional capacity, quality of life, hospitalization, and systolic and diastolic function in heart failure patients. Heart failure patients with preserved systolic function (HFnEF participating in exercise training studies are more likely to be women and are 5–7 years older than their systolic heart failure (CHF counterparts. All patients exhibit low functional capacities, although in HFnEF patients this may be age related, therefore subtle differences in exercise prescriptions are required. Published works report that exercise training is beneficial for heart failure patients with and without systolic dysfunction.

  2. What patients think about E-health: patients' perspective on internet-based cognitive behavioral treatment for patients with rheumatoid arthritis and psoriasis

    NARCIS (Netherlands)

    Ferwerda, M.; Beugen, S. van; Burik, A. van; Middendorp, H. van; Jong, E.M.G.J. de; Kerkhof, P.C.M. van de; Riel, P.L.C.M. van; Evers, A.W.M.

    2013-01-01

    In the past decade, the use of internet-based cognitive behavioral treatments (internet-based CBT) for a wide range of patients has grown intensively. Incorporating the patients' opinions and perspective into new health care innovations might improve the quality and applicability of these

  3. Prognosis of uveal melanoma based on race in 8100 patients: The 2015 Doyne Lecture

    Science.gov (United States)

    Shields, C L; Kaliki, S; Cohen, M N; Shields, P W; Furuta, M; Shields, J A

    2015-01-01

    A retrospective, nonrandomized, interventional case series of 8100 patients with uveal melanoma were evaluated for melanoma-related metastasis based on patient race. The patient race was Caucasian (n=7918, 98%), Hispanic (n=105, 1%), Asian (n=44, melanoma based on race. In summary, uveal melanoma showed similar prognosis for all races. PMID:26248525

  4. A patient safety curriculum for medical residents based on the perspectives of residents and supervisors

    NARCIS (Netherlands)

    Jansma, J.D.; Wagner, C.; Bijnen, A.B.

    2011-01-01

    Objectives: To develop a patient safety course for medical residents based on the views of medical residents and their supervisors. Methods: In 2007, questionnaires were distributed to investigate residents' and supervisors' perspectives on the current patient safety performance and educational

  5. Losartan versus atenolol-based antihypertensive treatment reduces cardiovascular events especially well in elderly patients

    DEFF Research Database (Denmark)

    Ruwald, Anne Christine H; Westergaard, Bo; Sehestedt, Thomas

    2012-01-01

    The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study has previously demonstrated a beneficial effect of losartan compared to atenolol-based antihypertensive treatment in patients with essential hypertension and left-ventricular hypertrophy (LVH). However, patient age often...

  6. Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy

    Directory of Open Access Journals (Sweden)

    Yen-Hsuan Hsu

    2015-06-01

    Conclusion: Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state.

  7. Can face-to-face patient education be replaced by computer-based patient education? A randomised trial.

    NARCIS (Netherlands)

    Keulers, B.J.; Welters, C.F.; Spauwen, P.H.M.; Houpt, P.

    2007-01-01

    OBJECTIVE: Computer-based patient education is an effective (therapeutic) tool. More and more studies prove that it can be an effective additive for face-to-face education, but it is still unclear if it is possible to educate patients by only using a computer. Our objective was to compare knowledge

  8. Patient attitudes towards community-based tuberculosis DOT and ...

    African Journals Online (AJOL)

    Patient attitudes were measured using a 4-point Likert scale aggregated into a binary outcome with ''agree'' and ''disagree'' responses. Poisson regression model using a forward fitting approach in STATA v12 was used to determine the association between patient attitude towards CB-DOTs observers and adherence to TB ...

  9. Stability of parameters in repeated TVA measures

    DEFF Research Database (Denmark)

    Sørensen, Thomas Alrik

    Several recent studies have explored the limitations of human visual short-term memory or VSTM (e.g. Luck & Vogel, 1997; Wheeler & Treisman, 2002; Alvarez & Cavanagh, 2004). Usually researchers agree that VSTM is limited to a capacity of about 3 to 4 objects at any given moment (Cowan, 2001......). Capacity of short-term memory is measured in a range of studies often using the change detection paradigm (CD). However, the whole report paradigm (WR) may be a more reliable paradigm (Cusack, Lehmann, Veldsman, & Mitchell, 2009). Moreover, each individual WR trial yield more information compared to a CD...

  10. Seroepidemiololgy of rickettsioses in Sri Lanka: a patient based study

    Directory of Open Access Journals (Sweden)

    Liyanapathirana Veranja

    2011-11-01

    Full Text Available Abstract Background Rickettsioses are emerging infections in Sri Lanka as shown by the increase in the number of clinically diagnosed rickettsial patients being reported to the Epidemiology Unit, Sri Lanka. However, mapping the disease for the whole island with laboratory confirmed cases has not been previously carried out. Methods 615 samples received from 23 hospital representing 8 provinces were tested using ELISA or IFA methods and clinical data was collected using a validated questionnaire. Results Rash was found among more spotted fever seropositive patients than scrub typhus seropositive patients while the opposite was true for the presence of eschar. Spotted fever and scrub typhus was found in a geographically restricted manner. Consistent temporal patterns were seen for the presentation of patients with rickettsioses in Kandy and Kurunegala districts for 2009 and 2010. Conclusions This study expanded knowledge on the distribution of rickettsioses in Sri Lanka and their clinical profiles which in turn helps in the clinical diagnosis of these infections.

  11. Patient Preference for Dosing Frequency Based on Prior Biologic Experience.

    Science.gov (United States)

    Zhang, Mingliang; Carter, Chureen; Olson, William H; Johnson, Michael P; Brennem, Susan K; Lee, Seina; Farahi, Kamyar

    2017-03-01

    There is limited research exploring patient preferences regarding dosing frequency of biologic treatment of psoriasis. Patients with moderate-to-severe plaque psoriasis identified in a healthcare claims database completed a survey regarding experience with psoriasis treatments and preferred dosing frequency. Survey questions regarding preferences were posed in two ways: (1) by likelihood of choosing once per week or 2 weeks, or 12 weeks; and (2) by choosing one option among once every 1-2 or 3-4 weeks or 1-2 or 2-3 months. Data were analyzed by prior biologic history (biologic-experienced vs biologic-naïve, and with one or two specific biologics). Overall, 426 patients completed the survey: 163 biologic-naïve patients and 263 biologic-experienced patients (159 had some experience with etanercept, 105 with adalimumab, and 49 with ustekinumab). Among patients who indicated experience with one or two biologics, data were available for 219 (30 with three biologics and 14 did not specify which biologic experience). The majority of biologic-naïve (68.8%) and overall biologic-experienced (69.4%) patients indicated that they were very likely to choose the least frequent dosing option of once every 12 weeks (Table 1). In contrast, fewer biologic-naïve (9.1% and 16.7%) and biologic-experienced (22.5% and 25.3%) patients indicated that they were very likely to choose the 1-week and 2-week dosing interval options, respectively. In each cohort grouped by experience with specific biologics, among those with no experience with ustekinumab, the most chosen option was 1-2 weeks. The most frequently chosen option was every 2-3 months, among patients with any experience with ustekinumab, regardless of their experience with other biologics. The least frequent dosing interval was preferred among biologic naïve patients and patients who had any experience with ustekinumab. Dosing interval may influence the shared decision-making process for psoriasis treatment with biologics. J

  12. Evaluating the Patient With Diarrhea: A Case-Based Approach

    OpenAIRE

    Sweetser, Seth

    2012-01-01

    The evaluation of the patient with diarrhea can be complex and the treatment challenging. In this article, the definition of diarrhea and the pathophysiologic mechanisms that lead to diarrhea are reviewed. A simplified 5-step approach to the patient with diarrhea is provided and applied in a case-oriented manner applicable to everyday clinical practice. On completion of this article, you should be able to (1) define diarrhea, (2) outline various pathophysiologic mechanisms of diarrhea, and (3...

  13. Patient empowerment, patient participation and patient-centeredness in hospital care : A concept analysis based on a literature review

    NARCIS (Netherlands)

    Castro, E.M.; van Regenmortel, T.; Vanhaecht, K.; Sermeus, W.; van Hecke, A.

    2016-01-01

    Objectives The concepts of patient empowerment, patient participation and patient-centeredness have been introduced as part of the trend towards a more participatory health care and have largely been used interchangeably. Although these concepts have been discussed for a number of years, their exact

  14. GPS and GPRS Based Telemonitoring System for Emergency Patient Transportation

    Science.gov (United States)

    Satyanarayana, K.; Sarma, A. D.; Sravan, J.; Malini, M.; Venkateswarlu, G.

    2013-01-01

    Telemonitoring during the golden hour of patient transportation helps to improve medical care. Presently there are different physiological data acquisition and transmission systems using cellular network and radio communication links. Location monitoring systems and video transmission systems are also commercially available. The emergency patient transportation systems uniquely require transmission of data pertaining to the patient, vehicle, time of the call, physiological signals (like ECG, blood pressure, a body temperature, and blood oxygen saturation), location information, a snap shot of the patient, and voice. These requirements are presently met by using separate communication systems for voice, physiological data, and location that result in a lot of inconvenience to the technicians, maintenance related issues, in addition to being expensive. This paper presents design, development, and implementation of such a telemonitoring system for emergency patient transportation employing ARM 9 processor module. This system is found to be very useful for the emergency patient transportation being undertaken by organizations like the Emergency Management Research Institute (EMRI). PMID:27019844

  15. A phantom based method for deriving typical patient doses from measurements of dose-area product on populations of patients

    International Nuclear Information System (INIS)

    Chapple, C.-L.; Broadhead, D.A.

    1995-01-01

    One of the chief sources of uncertainty in the comparison of patient dosimetry data is the influence of patient size on dose. Dose has been shown to relate closely to the equivalent diameter of the patient. This concept has been used to derive a prospective, phantom based method for determining size correction factors for measurements of dose-area product. The derivation of the size correction factor has been demonstrated mathematically, and the appropriate factor determined for a number of different X-ray sets. The use of phantom measurements enables the effect of patient size to be isolated from other factors influencing patient dose. The derived factors agree well with those determined retrospectively from patient dose survey data. Size correction factors have been applied to the results of a large scale patient dose survey, and this approach has been compared with the method of selecting patients according to their weight. For large samples of data, mean dose-area product values are independent of the analysis method used. The chief advantage of using size correction factors is that it allows all patient data to be included in a survey, whereas patient selection has been shown to exclude approximately half of all patients. (author)

  16. Patient satisfaction with a hospital-based neuropsychology service.

    Science.gov (United States)

    Foran, Amie; Millar, Elisa; Dorstyn, Diana

    2016-09-01

    Objective The aim of the present study was to develop and pilot a measure of patient satisfaction that encompasses themes, activities, settings and interactions specific to the neuropsychological assessment process. Methods A focus group of out-patients (n=15) was surveyed to identify the factors commonly associated with a satisfactory neuropsychological experience. Responses informed a purposely designed 14-item patient satisfaction scale (α=0.88) that was completed by 66 hospital out-patients with mild to moderate cognitive impairment. Results Satisfaction with the neuropsychological assessment process was generally reported, with the testing phase (85%) rated significantly more favourably than the pre-assessment (79%) and feedback (70%) phases. Commentaries provided by 32 respondents identified interpersonal facilitators to a satisfactory neuropsychological assessment experience, but also dissatisfaction with physical aspects of the testing environment in addition to service availability. Conclusions The patient satisfaction scale can be used as a quality assurance tool to evaluate neuropsychological service delivery. Large-scale research is needed to confirm the scale's psychometric properties. Further research may also include a broader perspective on the consumers' experience of neuropsychological services.

  17. Evaluating the Patient With Diarrhea: A Case-Based Approach

    Science.gov (United States)

    Sweetser, Seth

    2012-01-01

    The evaluation of the patient with diarrhea can be complex and the treatment challenging. In this article, the definition of diarrhea and the pathophysiologic mechanisms that lead to diarrhea are reviewed. A simplified 5-step approach to the patient with diarrhea is provided and applied in a case-oriented manner applicable to everyday clinical practice. On completion of this article, you should be able to (1) define diarrhea, (2) outline various pathophysiologic mechanisms of diarrhea, and (3) describe a simplified 5-step approach to facilitate the evaluation of diarrhea. PMID:22677080

  18. Purine Bases in Blood Plasma of Patients with Chronic Pulmonary Diseases

    Directory of Open Access Journals (Sweden)

    Larissa E. Muravluyova

    2012-09-01

    Full Text Available The article is focused on the study of purine bases and intermediates of purine catabolism in plasma of patients with chronic obstructive bronchitis and idiopathic interstitial pneumonia. Decrease of adenine and hypoxantine in plasma of patients with idiopathic interstitial pneumonia was registered. Increase of guanine in plasma of patients with chronic obstructive pulmonary disease was established.

  19. Implant-based overdenture: A review in patient perspective.

    Science.gov (United States)

    Krishnaraj, R; Murugan, R; Meera, N Krishna; Laksmipathy, P; Krishnan, C S; Packiaraj, I

    2016-10-01

    A review in affected person's attitude in abstract care of edentulous patients has to be a priority in elderly individuals. The development of complete dentures (CDs) has been the selection of remedy retaining in mind the socioeconomic popularity, age, and nutritional elements. However, most of the patients complain of loss of retention in mandibular implant-supported overdentures (ODs), which compensated the downside of the loss of retention in complete dentures (CDs). Moreover, implant supported over dentures (ISOVDs) supplied accurate exceptional of lifestyles, esthetics, progressed nutritional deficiencies, and provided good patient satisfaction. The place of dental implants and desire of retentive attachments for implant supported mandibular over dentures (ISOVD) are selected on clinician preference and professional opinion. This text offers a fundamental statistics regarding implant placement, mode of treatment to be selected, and patient care. Two implants provide extraordinary long-term achievement and survival with improved oral capabilities. Single midline implant OD is costly, powerful, and may be a promising alternative. In maxilla, 4-6 implants splinted with bar have located to give true results.

  20. Implant-based overdenture: A review in patient perspective

    Directory of Open Access Journals (Sweden)

    R Krishnaraj

    2016-01-01

    Full Text Available A review in affected person's attitude in abstract care of edentulous patients has to be a priority in elderly individuals. The development of complete dentures (CDs has been the selection of remedy retaining in mind the socioeconomic popularity, age, and nutritional elements. However, most of the patients complain of loss of retention in mandibular implant-supported overdentures (ODs, which compensated the downside of the loss of retention in complete dentures (CDs. Moreover, implant supported over dentures (ISOVDs supplied accurate exceptional of lifestyles, esthetics, progressed nutritional deficiencies, and provided good patient satisfaction. The place of dental implants and desire of retentive attachments for implant supported mandibular over dentures (ISOVD are selected on clinician preference and professional opinion. This text offers a fundamental statistics regarding implant placement, mode of treatment to be selected, and patient care. Two implants provide extraordinary long-term achievement and survival with improved oral capabilities. Single midline implant OD is costly, powerful, and may be a promising alternative. In maxilla, 4–6 implants splinted with bar have located to give true results.

  1. Home based rehabilitation for patients with COPD : an attractive alternative

    NARCIS (Netherlands)

    Wijkstra, Peter

    2007-01-01

    Pulmonary rehabilitation programs are well established to provide a multidisciplinary approach to control and alleviate symptoms and to optimise functional capacity in patients with chronic obstructive pulmonary disease (COPD). In the last decade a large number of studies have investigated the

  2. Diabetic foot disease in Ethiopian patients: A hospital based study ...

    African Journals Online (AJOL)

    Background: Ulcers of the foot are one of the most feared and common complications of diabetes. It is a major cause of disability, morbidity and mortality among diabetic patients and about 15% develop foot ulcers in their lifetime. So far, there are few published data in relation to the high-risk diabetic foot in Ethiopian ...

  3. Diabetic foot disease in Ethiopian patients: A hospital based study

    African Journals Online (AJOL)

    Bernt Lindtjørn

    Abstract. Background: Ulcers of the foot are one of the most feared and common complications of diabetes. It is a major cause of disability, morbidity and mortality among diabetic patients and about 15% develop foot ulcers in their lifetime. So far, there are few published data in relation to the high-risk diabetic foot in ...

  4. Patient-based radiographic exposure factor selection: a systematic review

    International Nuclear Information System (INIS)

    Ching, William; Robinson, John; McEntee, Mark

    2014-01-01

    Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system

  5. Patient-based radiographic exposure factor selection: a systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Ching, William; Robinson, John; McEntee, Mark, E-mail: mark.mcentee@sydney.edu.au [Discipline of Medical Radiation Sciences, University of Sydney, Lidcombe, New South Wales (Australia)

    2014-09-15

    Digital technology has wider exposure latitude and post-processing algorithms which can mask the evidence of underexposure and overexposure. Underexposure produces noisy, grainy images which can impede diagnosis and overexposure results in a greater radiation dose to the patient. These exposure errors can result from inaccurate adjustment of exposure factors in response to changes in patient thickness. This study aims to identify all published radiographic exposure adaptation systems which have been, or are being, used in general radiography and discuss their applicability to digital systems. Studies in EMBASE, MEDLINE, CINAHL and SCOPUS were systematically reviewed. Some of the search terms used were exposure adaptation, exposure selection, exposure technique, 25% rule, 15% rule, DuPont™ Bit System and radiography. A manual journal-specific search was also conducted in The Radiographer and Radiologic Technology. Studies were included if they demonstrated a system of altering exposure factors to compensate for variations in patients for general radiography. Studies were excluded if they focused on finding optimal exposures for an ‘average’ patient or focused on the relationship between exposure factors and dose. The database search uncovered 11 articles and the journal-specific search uncovered 13 articles discussing systems of exposure adaptation. They can be categorised as simple one-step guidelines, comprehensive charts and computer programs. Only two papers assessed the efficacy of exposure adjustment systems. No literature compares the efficacy of exposure adaptations system for film/screen radiography with digital radiography technology nor is there literature on a digital specific exposure adaptation system.

  6. Epileptic seizures in patients with glioma: A single centre- based ...

    African Journals Online (AJOL)

    3Department of Radiology, Yichang Central People's Hospital, Yichang, Hubei 443003, China ... INTRODUCTION. Epilepsy is typical in brain tumour patients, and its control plays imperative part in clinical management. Convulsions add up considerable morbidity in brain tumour ..... influence the action of that enzyme.

  7. Simulation-based Advance Patient Scheduling of Operating Theatres

    DEFF Research Database (Denmark)

    Andersen, Anders Reenberg; Stidsen, Thomas Jacob Riis; Nielsen, Bo Friis

    2017-01-01

    is a Markov decision process, where patients are allocated to a date and room on a daily basis. By assuming that both state and action space is only partially observable, we apply our model in an on-line scheme known as rollout, where actions are constructed using a heuristic search method. Our objective...

  8. Towards evidence-based physiotherapy for patients with stroke

    NARCIS (Netherlands)

    van Peppen, R.P.S.

    2008-01-01

    The first aim of the thesis was to collect and review systematically, and to appraise critically the available evidence stemming from physiotherapy and physiotherapy-related studies in patients with stroke. It can be concluded that the application of physiotherapy improves performance to execute

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  10. Informing cancer patient based on his type of personality: the arrogant (narcissistic) patient.

    Science.gov (United States)

    Kallergis, G

    2012-01-01

    The task of informing the cancer patient is considered an arduous one as it typically involves breaking bad news to the patient. It appears that the adoption of an empathic approach is vital within a therapeutic relationship. This applies to every character or personality type, perhaps more so to the arrogant patient with a feeling of superiority. The question "Is it possible to determine who should be told what, when and how" basically implies the adoption of an empathic approach and the tailoring of information to each cancer patient. The use of character traits contributes to managing the physically ill patient in the best possible way. Therefore, follows the question: in what way does a character or personality type affect cancer patient informing? The aim of this article was to describe the arrogant (narcissistic) character or type of personality in an analytic way so that any therapist can make a diagnosis and tailor the information strategy to the patient's needs. As method of research was used the qualitative method research through groups with doctors and nurses, while research within groups lasted for 5 years. The degree of informing the arrogant personality in the range "minimal - small - medium - large - very large" is: The degree of denial varies between "large" and "very large" while the degree of informing varies between "medium" and "small". Informing the family: The patient objects to a common approach with the family as he is concerned about inflicting a blow to his image.

  11. Relationship between Nursing Students' Views about Web-Based Patient Education Course and Anxiety in Turkey

    Science.gov (United States)

    Tasocak, Gülsün; Kaya, Hülya; Senyuva, Emine; Isik, Burçin; Bodur, Gönül

    2014-01-01

    The study was designed as descriptive and cross-sectional to determine the relation between students' views about web-based Patient Education course and anxiety. The study group consisted of all students registered the web-based Patient Education course (N: 148) at 2010-2011 semester at a nursing school. Data were collected using "Information…

  12. Evidence-Based Chiropractic Education: Are We Equipping Graduates for Clinical Practice with Improved Patient Outcomes?

    OpenAIRE

    Shreeve, Michael W.

    2012-01-01

    Evidence-based practice has emerged as a driving factor in current curriculum development in chiropractic education. This commentary discusses educational strategies incorporating evidence-based practices in the doctor of chiropractic curriculum and explores whether all five steps of the evidence-based process and patient outcomes from evidence-based practice are being assessed.

  13. The effect of mindfulness-based therapy for cancer patients

    DEFF Research Database (Denmark)

    Piet, Jacob

    of anxiety and depression in adult cancer patients and survivors. Method: Electronic databases were searched, and researchers were contacted for further relevant studies. Twenty-two independent studies with a total of 1,403 participants were included. Studies were coded for quality (range: 0–4), and overall...... relatively high-quality RCTs to support the use of MBT for cancer patients and survivors with symptoms of anxiety and depression....... was associated with significantly reduced symptoms of anxiety and depression from pre- to posttreatment corresponding to moderate effect sizes (Hedges’s g) of 0.60 and 0.42, respectively. The pooled controlled effect sizes (Hedges’s g) of RCTs (average quality score: 2.9) were 0.37 for anxiety symptoms (p .001...

  14. Automated Verification of IGRT-based Patient Positioning.

    Science.gov (United States)

    Jiang, Xiaojun; Fox, Tim; Cordova, James S; Schreibmann, Eduard

    2015-11-08

    A system for automated quality assurance in radiotherapy of a therapist's registration was designed and tested in clinical practice. The approach compliments the clinical software's automated registration in terms of algorithm configuration and performance, and constitutes a practical approach for ensuring safe patient setups. Per our convergence analysis, evolutionary algorithms perform better in finding the global optima of the cost function with discrepancies from a deterministic optimizer seen sporadically.

  15. Erectile dysfunction among diabetic patients in Saudi Arabia: A hospital-based primary care study

    Directory of Open Access Journals (Sweden)

    Yousef A Al-Turki

    2007-01-01

    Conclusions: Complete (severe and partial erectile dysfunction was quite common among adult diabetic patients in a hospital-based primary care setting in Saudi Arabia. It is important for primary care physicians to diagnose erectile dysfunction in diabetic patients, and to counsel them early, as most patients are hesitant to discuss their concern during a consultation. Further studies are recommended to evaluate the effect of other risk factors on erectile dysfunction in diabetic patients.

  16. Patients reject the concept of fragility fracture--a new understanding based on fracture patients' communication.

    Science.gov (United States)

    Sale, J E M; Gignac, M A; Frankel, L; Hawker, G; Beaton, D; Elliot-Gibson, V; Bogoch, E

    2012-12-01

    We examined patients' communication about fragility fractures to gain insight into why patients do not connect fractures to bone health. The term "fragility" fracture was a misnomer to patients who perceived the event as physically and emotionally traumatic. Improved communication about such fractures could facilitate awareness of bone health. We examined patients' communication about fragility fractures to gain insight into why patients do not perceive the connection between their fracture and low bone mass. A descriptive phenomenological (qualitative) study was conducted. During face-to-face interviews, the participants described the experience of their fracture in detail and the circumstances surrounding the fracture. Data analysis was guided by Giorgi's methodology. English-speaking male and female patients aged 65+ years and "high" risk for future fracture were eligible and screened for osteoporosis through an established screening program at an urban teaching hospital. We recruited 30 participants (9 males, 21 females), aged 65-88, who presented with a hip (n = 11), wrist (n = 11), shoulder (n = 6), or other (n = 2) fracture. Ten of the 30 fractures occurred inside the home and the remaining fractures occurred outside the home. Sustaining a fragility fracture was perceived as a traumatic event, both physically and emotionally. In general, participants used forceful, action-oriented words and referred to hard surfaces to describe the experience. Explanations for the fracture, other than bone quality, were often reported, especially that falls were "freak" or "fluke" events. Patients who sustained a fracture under more mundane circumstances seemed more likely to perceive a connection between the fracture and their bone health. The term fragility fracture was a misnomer for many older adults. By reexamining how this term is communicated to fracture patients, health care providers may better facilitate patients' awareness of bone health.

  17. Implementing evidence-based patient and family education on oral anticoagulation therapy: a community-based participatory project.

    Science.gov (United States)

    Shaha, Maya; Wüthrich, Erika; Stauffer, Yvonne; Herczeg, Franziska; Fattinger, Karin; Hirter, Kathrin; Papalini, Marianne; Herrmann, Luzia

    2015-06-01

    This study aimed at developing and implementing evidence-based patient and family education on oral anticoagulation therapy. The number of persons with chronic diseases who live at home is increasing. They have to manage multiple diseases and complex treatments. One such treatment is oral anticoagulation therapy, a high risk variable dose medication. Adherence to oral anticoagulation therapy is jeopardised by limited information about the medications, their risk and complications, the impact of individual daily routine and the limited inclusion of family members in education. Hence, improved and tailored education is essential for patients and families to manage oral anticoagulation therapy at home. A community-based participatory research design combined with the Precede-Proceed model was used including a systematic literature review, posteducation analysis, an online nurse survey, a documentation analysis and patient/family interviews. The study was conducted between April 2010-December 2012 at a department of general internal medicine in a teaching hospital in Switzerland. Participants were the department's nursing and medical professionals including the patients and their families. The evidence-based patient and family education on oral anticoagulation therapy emerged comprising a learning assessment, teaching units, clarification of responsibilities of nurse professionals and documentation guidelines. The inclusion of the whole department has contributed to the development and implementation of this evidence-based patient family education on oral anticoagulation therapy, which encompasses local characteristics and patient preferences. This education is now being used throughout the department. © 2015 John Wiley & Sons Ltd.

  18. Risk of Pathologic Upgrading or Locally Advanced Disease in Early Prostate Cancer Patients Based on Biopsy Gleason Score and PSA: A Population-Based Study of Modern Patients

    Energy Technology Data Exchange (ETDEWEB)

    Caster, Joseph M.; Falchook, Aaron D. [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Hendrix, Laura H. [Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Chen, Ronald C., E-mail: Ronald_chen@med.unc.edu [Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States); Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (United States)

    2015-06-01

    Purpose: Radiation oncologists rely on available clinical information (biopsy Gleason score and prostate-specific antigen [PSA]) to determine the optimal treatment regimen for each prostate cancer patient. Existing published nomograms correlating clinical to pathologic extent of disease were based on patients treated in the 1980s and 1990s at select academic institutions. We used the Surveillance, Epidemiology, and End Results (SEER) database to examine pathologic outcomes (Gleason score and cancer stage) in early prostate cancer patients based on biopsy Gleason score and PSA concentration. Methods and Materials: This analysis included 25,858 patients whose cancer was diagnosed between 2010 and 2011, with biopsy Gleason scores of 6 to 7 and clinical stage T1 to T2 disease, who underwent radical prostatectomy. In subgroups based on biopsy Gleason score and PSA level, we report the proportion of patients with pathologically advanced disease (positive surgical margin or pT3-T4 disease) or whose Gleason score was upgraded. Logistic regression was used to examine factors associated with pathologic outcomes. Results: For patients with biopsy Gleason score 6 cancers, 84% of those with PSA <10 ng/mL had surgical T2 disease with negative margins; this decreased to 61% in patients with PSA of 20 to 29.9 ng/mL. Gleason score upgrading was seen in 43% (PSA: <10 ng/mL) to 61% (PSA: 20-29.9 ng/mL) of biopsy Gleason 6 patients. Patients with biopsy Gleason 7 cancers had a one-third (Gleason 3 + 4; PSA: <10 ng/mL) to two-thirds (Gleason 4 + 3; PSA: 20-29.9 ng/mL) probability of having pathologically advanced disease. Gleason score upgrading was seen in 11% to 19% of patients with biopsy Gleason 4 + 3 cancers. Multivariable analysis showed that higher PSA and older age were associated with Gleason score upgrading and pathologically advanced disease. Conclusions: This is the first population-based study to examine pathologic extent of disease and pathologic Gleason score

  19. A web-based patient education system and self-help group in Persian language for inflammatory bowel disease patients.

    Science.gov (United States)

    Rezailashkajani, Mohammadreza; Roshandel, Delnaz; Ansari, Shahin; Zali, Mohammad Reza

    2008-02-01

    To study the use patterns of a Persian web-based patient education system for inflammatory bowel disease (IBD) patients in Iran. A web-based patient education system was developed with Persian content in three sections: general, ulcerative colitis (UC), and Crohn's disease (CD). The website included a forum for patients to communicate as a self-help group. A customized web tracking system recorded web use statistics. Polls at the bottom of each page collected the visitors' opinion on the extent of helpfulness and readability of page contents. Web use data were analyzed for an 18-month period from October 2004 to April 2006. Having excluded page visits from search engine robots, the website's homepage was visited 4452 times (mean of monthly visits: 234, range: 102-330). The web pages titled Anatomy of gastrointestinal system, Nutrition in IBD, Diagnostic tests, How to cope with IBD, and IBD in women were the most favorite in general section. The web page titled IBD treatment was the most visited in both CD and UC sections followed by the web pages on cause of disease, diagnostic procedures and complications in CD section; and those titled symptoms, cause of disease and risk factors in the UC section. Overall, the content evaluation polls received 294 hits (from 186 unique visitors) of which, 196 (67%) were from patients, 30 (10%) from patients' relatives/friends, 21 (7%) from doctors, and 47 (16%) from other groups. During the 18-month period, 47 patients registered in the self-help forum, 24 threads were opened, and 97 posts (33 in CD and 64 in UC section) were sent. Considering the increasing trend of Internet use in developing countries like Iran, and the consequent increase in the proportion of Internet-using patients, and finally the time constraints gastroenterologists face answering patients' questions; similar websites seem to be effective ways of patient education in close future.

  20. Patient satisfaction with primary care office-based buprenorphine/naloxone treatment.

    Science.gov (United States)

    Barry, Declan T; Moore, Brent A; Pantalon, Michael V; Chawarski, Marek C; Sullivan, Lynn E; O'Connor, Patrick G; Schottenfeld, Richard S; Fiellin, David A

    2007-02-01

    Factors associated with satisfaction among patients receiving primary care-based buprenorphine/naloxone are unknown. To identify factors related to patient satisfaction in patients receiving primary care-based buprenorphine/naloxone that varied in counseling intensity (20 vs 45 minutes) and office visit frequency (weekly vs thrice weekly). One hundred and forty-two opioid-dependent subjects. Demographics, drug treatment history, and substance use status at baseline and during treatment were collected. The primary outcome was patient satisfaction at 12 weeks. Patients' mean overall satisfaction score was 4.4 (out of 5). Patients were most satisfied with the medication and ancillary services and indicated strong willingness to refer a substance-abusing friend for the same treatment. Patients were least satisfied with their interactions with other opioid-dependent patients, referrals to Narcotics Anonymous, and the inconvenience of the treatment location. Female gender (beta = .17, P = .04) and non-White ethnicity/race (beta = .17, P = .04) independently predicted patient satisfaction. Patients who received briefer counseling and buprenorphine/naloxone dispensed weekly had greater satisfaction than those whose medication was dispensed thrice weekly (mean difference 4.9, 95% confidence interval 0.08 to 9.80, P = .03). Patients are satisfied with primary care office-based buprenorphine/naloxone. Providers should consider the identified barriers to patient satisfaction.

  1. A region-based two-step P300-based brain-computer interface for patients with amyotrophic lateral sclerosis.

    Science.gov (United States)

    Ikegami, Shiro; Takano, Kouji; Kondo, Kiyohiko; Saeki, Naokatsu; Kansaku, Kenji

    2014-11-01

    The P300-based brain-computer interface (BCI) is designed to help patients with motor disabilities to control their environment, and it has been used successfully in patients with amyotrophic lateral sclerosis (ALS). However, some ALS patients were unable to use the visual P300-BCI with the conventional row/column presentation. In this study, we evaluated the effect of a newly developed region-based two-step P300 speller, which has a larger flashing area than the conventional visual array. Seven ALS patients and seven age- and sex-matched able-bodied control subjects were required to input hiragana characters using our P300 BCI system. We prepared two types of input procedures, the conventional row/column (RC) speller and the two-step speller, and evaluated their online performance. The mean online accuracy of the ALS patients was 24% for the RC condition and 55% for the two-step condition. The accuracy of the control subjects was 71% and 83% for the RC and two-step condition, respectively. Accuracy in ALS patients was significantly lower than that in the control subjects, and the new visual stimuli significantly increased accuracy of ALS patients. Using the new speller, two ALS patients showed an initial accuracy sufficient for practical use (>70%). The other two ALS patients, who performed better in the first trial using the new speller, continued to experience the BCI system, and their mean accuracy increased to 92%. The two-step procedure for the visual P300 BCI system provided significantly increased accuracy for ALS patients compared with a conventional RC speller. The new region-based two-step P300 speller was effective in ALS patients, and the system may be beneficial to expand their range of activities. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  2. Exploring the efficacy of replacing linear paper-based patient cases in problem-based learning with dynamic Web-based virtual patients: randomized controlled trial.

    Science.gov (United States)

    Poulton, Terry; Ellaway, Rachel H; Round, Jonathan; Jivram, Trupti; Kavia, Sheetal; Hilton, Sean

    2014-11-05

    Problem-based learning (PBL) is well established in medical education and beyond, and continues to be developed and explored. Challenges include how to connect the somewhat abstract nature of classroom-based PBL with clinical practice and how to maintain learner engagement in the process of PBL over time. A study was conducted to investigate the efficacy of decision-PBL (D-PBL), a variant form of PBL that replaces linear PBL cases with virtual patients. These Web-based interactive cases provided learners with a series of patient management pathways. Learners were encouraged to consider and discuss courses of action, take their chosen management pathway, and experience the consequences of their decisions. A Web-based application was essential to allow scenarios to respond dynamically to learners' decisions, to deliver the scenarios to multiple PBL classrooms in the same timeframe, and to record centrally the paths taken by the PBL groups. A randomized controlled trial in crossover design was run involving all learners (N=81) in the second year of the graduate entry stream for the undergraduate medicine program at St George's University of London. Learners were randomized to study groups; half engaged in a D-PBL activity whereas the other half had a traditional linear PBL activity on the same subject material. Groups alternated D-PBL and linear PBL over the semester. The measure was mean cohort performance on specific face-to-face exam questions at the end of the semester. D-PBL groups performed better than linear PBL groups on questions related to D-PBL with the difference being statistically significant for all questions. Differences between the exam performances of the 2 groups were not statistically significant for the questions not related to D-PBL. The effect sizes for D-PBL-related questions were large and positive (>0.6) except for 1 question that showed a medium positive effect size. The effect sizes for questions not related to D-PBL were all small (≤0

  3. Patient perceptions regarding the use of smart devices for medical photography: results of a patient-based survey.

    Science.gov (United States)

    Nair, Akshay Gopinathan; Potdar, Nayana A; Dadia, Suchit; Aulakh, Simranjeet; Ali, Mohammad Javed; Shinde, Chhaya A

    2018-03-06

    To assess patient perceptions regarding medical photography and the use of smart devices, namely mobile phones and tablets for medical photography. A questionnaire-based survey was conducted among 280 consecutive adult patients who presented to the oculoplastics clinic at a tertiary eye care centre. The responses were tabulated and analysed. Of the 280 patients surveyed, 68% felt that medical photography had a positive impact on their understanding of their illnesses and 72% felt that the use of smartphones for medical photography was acceptable. Respondents below the age of 40 years were more likely to approve of the use of mobile phones for photography as compared to those over 40. Most patients (74%) preferred a doctor to be the person photographing them. While a majority approved of doctors and trainee physicians having access to their photographs, they felt non-physician healthcare personnel should not have access to clinical photographs. Also, 72% of the respondents felt that the patient's consent should be taken before using their photographs. It was noted that patient identification and breach of confidentiality could be some of the potential issues with using smart devices as cameras in the clinic. Clinical photography in general and, specifically, using smart devices for clinical photographs have gained acceptance among patients. The outcomes of this study may be utilized to create policy guidelines for the use of smart devices as photography tools in the clinics. The findings of this survey can also help to create standardized, uniform patient consent forms for clinical photography.

  4. Listening to patients with cancer: using a literary-based research method to understand patient-focused care.

    Science.gov (United States)

    Begley, Amanda; Pritchard-Jones, Kathy; Biriotti, Maurice; Kydd, Anna; Burdsey, Tim; Townsley, Emma

    2014-10-16

    In spite of considerable attention, patients diagnosed with cancer continue to report poor experiences of care. The root causes of this remain unclear. This exploratory study aimed to investigate new ways of understanding the experience of patients with cancer, using a literary-based research approach. Interviews were undertaken with four patients diagnosed with high-grade brain cancers at least 6 months from diagnosis and with people (n=5) identified by the patients as important in their care pathway. Interview transcripts were analysed by humanities academics as pieces of literature, where each patient's story was told from more than one person's perspective. The academics then came together in a facilitated workshop to agree major themes within the patient experiences. The themes were presented at a patient and carer event involving 70 participants to test the validity of the insights. Insights into the key issues for patients with cancer could be grouped into six themes: accountability; identity; life context; time; language; rigour and emotion. Patients often held a different perspective to the traditionally held medical views of what constitutes good care. For example, patients did not see any conflict between a doctor having scientific rigour and portraying emotion. One key feature of the approach was its comparative nature: patients often held different views from those traditionally held by physicians of what constitutes health and good outcomes. This revealed aspects that may be considered by healthcare professionals when designing improvements. Proposals for further testing are discussed, with a particular emphasis on the need for sensitivity to individual differences in experiences. 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.

  5. Patient education based on principles of cognitive behavioral therapy for a patient with persistent low back pain: a case report.

    Science.gov (United States)

    Rundell, Sean D; Davenport, Todd E

    2010-08-01

    Case report. Cognitive behavioral therapy (CBT) is an effective intervention for patients with persistent pain. Recent research indicates that physical therapists self-perceive a lack of knowledge, skills, and time to provide this intervention. The purpose of this case report is to describe how specific CBT strategies can be integrated with multimodal physical therapist management of a patient with persistent low back pain. The patient was a 70-year-old female with activity limitations of walking, standing, and forward bending. Oswestry Disability Questionnaire score was 19/50 and Fear-Avoidance Belief Questionnaire physical activity subscale was 23/24. The Low Back Activity Confidence Scale revealed 19%, 100%, and 84% for function, symptom self-regulation, and exercise, respectively. CBT-based patient education was provided in combination with manual therapy and exercise. CBT techniques included cognitive restructuring, goal setting, activity pacing, problem-solving strategies, graded exposure, encouraging exposure to pleasant experiences, and maintenance strategies. The patient was discharged after 7 visits distributed over 21 weeks. Her Oswestry Disability Questionnaire score was reduced 10% and Fear-Avoidance Belief Questionnaire physical activity subscale score reduced 48%. On the Low Back Activity Confidence Scale the patient's scores were 19%, 87%, and 94% for function, symptom self-regulation, and exercise, respectively. This case report describes the use of CBT techniques during patient education by a physical therapist. The patient demonstrated clinically measurable and significant improvements in disability. Improvements in both self-efficacy beliefs related to exercise and activity avoidance beliefs were associated with improvement in disability. Additional research is needed to determine best practices for CBT-based patient education by physical therapists. Therapy, level 4.

  6. Electronic-Based Patient-Reported Outcomes: Willingness, Needs, and Barriers in Adjuvant and Metastatic Breast Cancer Patients.

    Science.gov (United States)

    Hartkopf, Andreas D; Graf, Joachim; Simoes, Elisabeth; Keilmann, Lucia; Sickenberger, Nina; Gass, Paul; Wallwiener, Diethelm; Matthies, Lina; Taran, Florin-Andrei; Lux, Michael P; Wallwiener, Stephanie; Belleville, Eric; Sohn, Christof; Fasching, Peter A; Schneeweiss, Andreas; Brucker, Sara Y; Wallwiener, Markus

    2017-08-07

    Patient-reported outcomes (PROs) play an increasingly important role as an adjunct to clinical outcome parameters in measuring health-related quality of life (HRQoL). In fact, PROs are already the accepted gold standard for collecting data about patients' subjective perception of their own state of health. Currently, paper-based surveys of PRO still predominate; however, knowledge regarding the feasibility of and barriers to electronic-based PRO (ePRO) acceptance remains limited. The objective of this trial was to analyze the willingness, specific needs, and barriers of adjuvant breast cancer (aBC) and metastatic breast cancer (mBC) patients in nonexposed (no exposure to electronic assessment) and exposed (after exposure to electronic assessment decision, whether a tablet-based questionnaire is favored) settings before implementing digital ePRO assessment in relation to health status. We also investigated whether providing support can increase the patients' willingness to participate in such programs. The nonexposed patients only answered a paper-based questionnaire, whereas the exposed patients filled out both paper- and tablet-based questionnaires. The assessment comprised socioeconomic variables, HRQoL, preexisting technical skills, general attitude toward electronic-based surveys, and potential barriers in relation to health status. Furthermore, nonexposed patients were asked about the existing need for technological support structures. In the course of data evaluation, we performed a frequency analysis as well as chi-square tests and Wilcoxon signed-rank tests. Subsequently, relative risks analysis, univariate categorical regression (CATREG), and mediation analyses (Hayes' bias-corrected bootstrap) were performed. A total of 202 female breast cancer patients completed the PRO assessment (nonexposed group: n=96 patients; exposed group: n=106 patients). Self-reported technical skills were higher in exposed patients (2.79 vs 2.33, P ≤.001). Significant

  7. A Secure ECC-based RFID Mutual Authentication Protocol to Enhance Patient Medication Safety.

    Science.gov (United States)

    Jin, Chunhua; Xu, Chunxiang; Zhang, Xiaojun; Li, Fagen

    2016-01-01

    Patient medication safety is an important issue in patient medication systems. In order to prevent medication errors, integrating Radio Frequency Identification (RFID) technology into automated patient medication systems is required in hospitals. Based on RFID technology, such systems can provide medical evidence for patients' prescriptions and medicine doses, etc. Due to the mutual authentication between the medication server and the tag, RFID authentication scheme is the best choice for automated patient medication systems. In this paper, we present a RFID mutual authentication scheme based on elliptic curve cryptography (ECC) to enhance patient medication safety. Our scheme can achieve security requirements and overcome various attacks existing in other schemes. In addition, our scheme has better performance in terms of computational cost and communication overhead. Therefore, the proposed scheme is well suitable for patient medication systems.

  8. Community Based Organizations in HIV/AIDS Prevention, Patient ...

    African Journals Online (AJOL)

    The main objective of this review is to provide a preliminary evaluation of the suitability of community-based organizations (CBOs) to contribute to HIV/AIDS prevention, care/support and control programs in Ethiopia. In order to put CBOs and programs in the context of HIV transmission and spread, the role of the Multisectoral ...

  9. PCR-based clonality assessment in patients with lymphocytic ...

    Indian Academy of Sciences (India)

    lymphocytic leukaemia; immunoglobulin; T-cell receptor; gene rearrangements; polymerase chain reaction; clonality; human genetics. Abstract. PCR-based clonality testing can be performed in all lymphoproliferations by analysing gene rearrangements of antigen receptors, rearrangements that are unique for each kind of ...

  10. Smoking habits in lung cancer patients: a hospital based case ...

    African Journals Online (AJOL)

    This retrospective, hospital based case-control study was designed to investigate the cigarette smoking history, the relationship between cigarette smoking and the risk of lung cancer in KHMC-Jordan. Six hundred cases with lung cancer (576 males, 24 females) and 600 controls were included in the study. The majority of ...

  11. Implementation of an evidence-based education practice change for patients with cancer.

    Science.gov (United States)

    Portz, Denise; Johnston, Mary Pat

    2014-01-01

    As oncology care continues to move toward delivery in the outpatient setting, oncology nurses must find ways to effectively educate patients about diagnosis, treatment, and symptom management. A cancer diagnosis induces high levels of anxiety, often affecting a patient's ability to retain information about his or her disease, treatment, and symptom management. Based on results from the ONS Foundation-supported Breast Cancer Care Quality Measures Set and Breast Cancer Survivorship Quality Measures Set, a community-based, multisite cancer center located in the midwestern United States embarked on a quality project in patient education. The purpose of this article is to describe a quality project that evolved from a review of the patient education process for patients with cancer in three medical oncology clinics to a pilot of a new model for patient education. The pilot identified gaps, developed and implemented evidence-based improvement strategies, and planned for evaluation of process and patient outcomes of this practice change. A pilot study to assess processes and workflows associated with a one-hour separate patient education visit was designed and initiated. Patients and oncology nurses have expressed satisfaction with standardized patient education. Although processes and workflows continue to be evaluated, a proposal was developed, submitted, and accepted by the institutional review board to evaluate patient-centered outcomes.

  12. Informing cancer patient based on his type of personality: the uninvolved - aloof patient.

    Science.gov (United States)

    Kallergis, George

    2014-01-01

    Communicating bad news is often part of a doctor's task. By bad news we mean information which is received as unpleasant by the patient who feels that it can have an unwanted effect in his life. It appears that the way each patient assesses bad news is associated with his personality type, his individual character traits and the adoption of an empathic approach is vital within a therapeutic relationship. The aim of this article was to describe the uninvolved-aloof character or type of personality thoroughly so that any therapist can make a diagnosis and tailor the information strategy to the patient's needs. As method of research was used the qualitative method through groups with doctors and nurses, while research within groups lasted for 5 years. Assessing the denial mechanism may present the hardest task since the patient does not give any hint to the doctor as to how he feels. The degree of informing should be not as much as for the controlling-orderly person but more than the dependent person's, about "average" to "small". Informing Family: He accepts the family's involvement. Relatives need to be alerted about the patient's fragility.

  13. Informing cancer patient based on his type of personality:The self-sacrificing patient.

    Science.gov (United States)

    Kallergis, George

    2015-01-01

    Imparting the bad news has become a hard task for the doctor, and is usually perceived as unpleasant by the patient to whom the bad news is revealed. It is vital that the physician's approach be tailored to the cancer patient's personality. Gathering by the informing process protocols already suggested the hardest step for the doctors to take is empathic understanding which, presupposes tailoring to the individual's needs. The aim of this article was to describe the self-sacrificing type of personality thoroughly, so that any physician can make a diagnosis and tailor the information strategy to their needs. As method of research was used the qualitative method through groups with doctors and nurses, while research within groups lasted for 5 years. Assessing the denial mechanism is hard for a person that regards disease as punishment and propitiation. The physician must mobilize his countertransference, the sense he gets from the discussions with the patient and their overall communication. If he finds that the patient has self-control, then the approach of imparting the news resembles that of the controlling-orderly personality. If he ascertains that the patient has a lasting embarrassment, he should be more careful and impart the news gradually, his approach resembling that of the dependent person.

  14. Implementing health information technology in a patient-centered manner: patient experiences with an online evidence-based lifestyle intervention.

    Science.gov (United States)

    Lyden, Jennifer R; Zickmund, Susan L; Bhargava, Tina D; Bryce, Cindy L; Conroy, Molly B; Fischer, Gary S; Hess, Rachel; Simkin-Silverman, Laurey R; McTigue, Kathleen M

    2013-01-01

    The patient-centered care (PCC) model and the use of health information technology (HIT) are major initiatives for improving U.S. healthcare quality and delivery. A lack of published data on patient perceptions of Internet-based care makes patient-centered implementation of HIT challenging. To help ascertain patients' perceptions of an online intervention, patients completing a 1-year web-based lifestyle intervention were asked to complete a semistructured interview. We used qualitative methodology to determine frequency and types of interview responses. Overall satisfaction with program features was coded on a Likert-type scale. High levels of satisfaction were seen with the online lifestyle coaching (80%), self-monitoring tools (57%), and structured lesson features (54%). Moderated chat sessions and online resources were rarely used. Frequently identified helpful aspects were those that allowed for customized care and shared decision-making consistent with the tenets of PCC. Unhelpful program aspects were reported less often. Findings suggest that despite challenges for communicating effectively in an online forum, the personalized support, high-tech data management capabilities, and easily followed evidence-based curricula afforded by HIT may be a means of providing PCC and improving healthcare delivery and quality. © 2013 National Association for Healthcare Quality.

  15. Mobile-based patient-provider communication in cancer survivors: The roles of health literacy and patient activation.

    Science.gov (United States)

    Jiang, Shaohai; Hong, Y Alicia

    2018-03-01

    Thanks to rapid penetration of mobile tools, more and more cancer survivors have adopted mobile-based patient-provider communication (MBPPC). The relationship between MBPPC and patients' health outcomes, however, remains unclear; how health literacy and patient activation interact with such relationship is unexplored. Data were drawn from National Cancer Institute's Health Information National Trends Survey 4 Cycle 3. A sample of 459 cancer survivors were included in the analysis. Based on the 3-stage model of health promotion using interactive media, this study empirically tested a moderated mediation model. MBPPC (eg, patient use of email, text message, mobile app, and social media to communicate with providers) had no direct effect on cancer survivors' emotional health. Instead, health literacy completely mediated this path. Patient activation positively moderated the effect of health literacy on emotional health and further increased the indirect effect of MBPPC on emotional health. MBPPC alone does not directly result in better emotional health outcomes; health literacy is the key to realize its health benefits; patient activation significantly strengthens the effects of MBPPC. As we embrace the mHealth movement, innovative programs are needed to promote MBPPC, and improve health literacy and activation of cancer survivors, particularly in underserved communities, to reduce health disparities. Copyright © 2017 John Wiley & Sons, Ltd.

  16. Focusing Feedback on Interpersonal Skills: Practice Makes Perfect. A Web-based Tutorial for Standardized Patients

    Science.gov (United States)

    Owens, Tamara; Xie, Zhong; Gregg, Peggy; Phelps, Cynthia; Johnson, Craig W.

    2002-01-01

    Focusing Feedback on Interpersonal Skills: Practice Makes Perfect is a Web-Based learning environment enabling standardized patients (SPs) to develop, practice and enhance constructive feedback skills. The Web-based training environment for SPs features realistic professional healthcare provider/patient video scenarios, graphics, audio and immediate feedback in a student-centered self-instructional environment. SPs, who are trained to simulate an illness and portray a patient in a realistic and consistent way, subsequently provide feedback from a patient's perspective to students undergoing communication and interpersonal skills training in health science fields like medicine and nursing.

  17. Classifying Normal and Abnormal Status Based on Video Recordings of Epileptic Patients

    Directory of Open Access Journals (Sweden)

    Jing Li

    2014-01-01

    Full Text Available Based on video recordings of the movement of the patients with epilepsy, this paper proposed a human action recognition scheme to detect distinct motion patterns and to distinguish the normal status from the abnormal status of epileptic patients. The scheme first extracts local features and holistic features, which are complementary to each other. Afterwards, a support vector machine is applied to classification. Based on the experimental results, this scheme obtains a satisfactory classification result and provides a fundamental analysis towards the human-robot interaction with socially assistive robots in caring the patients with epilepsy (or other patients with brain disorders in order to protect them from injury.

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

    Science.gov (United States)

    Kaufman, Gerri; Bellerby, Ann; Kitching, Mike

    2017-06-14

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

  19. How do online sports gambling disorder patients compare with land-based patients?

    Science.gov (United States)

    Estévez, Ana; Rodríguez, Raquel; Díaz, Noelia; Granero, Roser; Mestre-Bach, Gemma; Steward, Trevor; Fernández-Aranda, Fernando; Aymamí, Neus; Gómez-Peña, Mónica; Pino-Gutiérrez, Amparo Del; Baño, Marta; Moragas, Laura; Mallorquí-Bagué, Núria; López-González, Hibai; Jauregui, Paula; Onaindia, Jaione; Martín-Romera, Virginia; Menchón, José M; Jiménez-Murcia, Susana

    2017-12-01

    Background and aims Recent technological developments have brought about notable changes in the way people gamble. The widespread use of mobile Internet devices and gambling websites has led to a significant leap in the number of people who recreationally gamble. However, for some, gambling can turn into a psychiatric disorder resembling substance addiction. At present, there is a shortage of studies examining differences between adults with gambling disorder (GD) who exclusively make sports bets online, GD patients that are non-sports Internet gamblers, and offline gamblers. Therefore, this study was undertaken to determine the differences between these three groups, considering sociodemographic, personality, and clinical characteristics. Methods The sample consisted of 2,743 treatment-seeking male patients from the Pathological Gambling Unit at a university hospital. All patients met DSM-5 criteria for GD. Results We found that gamblers who exclusively engaged in non-sports Internet gambling activities were younger than offline gamblers and online sports gamblers. Non-sports Internet gamblers were also more likely to have greater levels of debt compared with offline gamblers. In terms of personality characteristics, our sample displayed low levels of self-directedness and cooperativeness and high levels of novelty seeking. In addition, online sports gamblers obtained higher scores in persistence than non-sports Internet gamblers and offline gamblers. Discussion and conclusion Although differences if terms of gambling severity were not identified between groups, GD patients who exclusively bet online appear to possess distinct personality characteristics and higher debt levels compared with offline gamblers.

  20. Reanimating patients: cardio-respiratory CT and MR motion phantoms based on clinical CT patient data

    Science.gov (United States)

    Mayer, Johannes; Sauppe, Sebastian; Rank, Christopher M.; Sawall, Stefan; Kachelrieß, Marc

    2017-03-01

    Until today several algorithms have been developed that reduce or avoid artifacts caused by cardiac and respiratory motion in computed tomography (CT). The motion information is converted into so-called motion vector fields (MVFs) and used for motion compensation (MoCo) during the image reconstruction. To analyze these algorithms quantitatively there is the need for ground truth patient data displaying realistic motion. We developed a method to generate a digital ground truth displaying realistic cardiac and respiratory motion that can be used as a tool to assess MoCo algorithms. By the use of available MoCo methods we measured the motion in CT scans with high spatial and temporal resolution and transferred the motion information onto patient data with different anatomy or imaging modality, thereby reanimating the patient virtually. In addition to these images the ground truth motion information in the form of MVFs is available and can be used to benchmark the MVF estimation of MoCo algorithms. We here applied the method to generate 20 CT volumes displaying detailed cardiac motion that can be used for cone-beam CT (CBCT) simulations and a set of 8 MR volumes displaying respiratory motion. Our method is able to reanimate patient data virtually. In combination with the MVFs it serves as a digital ground truth and provides an improved framework to assess MoCo algorithms.

  1. [Assisted peritoneal dialysis: home-based renal replacement therapy for the elderly patient].

    Science.gov (United States)

    Wiesholzer, Martin

    2013-06-01

    The number of elderly patients with end stage renal disease is constantly increasing. Conventional hämodiaylsis as the mainstay of renal replacement therapy is often poorly tolerated by frail eldery patients with multiple comorbidities. Although many of these patients would prefer a home based dialysis treatment, the number of elderly patients using peritoneal dialysis (PD) is still low. Impaired physical and cognitive function often generates insurmountable barriers for self care peritoneal dialysis. Assisted peritoneal dialysis can overcome many of these barriers and give elderly patients the ability of a renal replacement therapy in their own homes respecting their needs.

  2. Evidence-based Dentistry and Its Role in Caring for Special Needs Patients.

    Science.gov (United States)

    Queen, Alan N

    2016-07-01

    Evidence-based dentistry is a concept ideally suited and applicable to special needs dentistry. As the special needs of patients varies according to the individual, so should the way we evaluate our patient, prescribe a course of treatment, and implement that treatment plan. Future generations of dental students and residents should be trained in these concepts not just for patients with special needs, but also for the general patient population. It is imperative that the dental community not retreat in the face of what many deem to be "difficult" patients with special needs. Knowledge and training can overcome many barriers to treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Patient positioning based on a radioactive tracer implanted in patients with localized prostate cancer: a performance and safety evaluation.

    Science.gov (United States)

    de Kruijf, Willy J M; Verstraete, Jan; Neustadter, David; Corn, Benjamin W; Hol, Sandra; Venselaar, Jack L M; Davits, Rob J; Wijsman, Bart P; Van den Bergh, Laura; Budiharto, Tom; Oyen, Raymond; Haustermans, Karin; Poortmans, Philip M P

    2013-02-01

    To evaluate the performance and safety of a radiation therapy positioning system (RealEye) based on tracking a radioactive marker (Tracer) implanted in patients with localized prostate cancer. We performed a single-arm multi-institutional trial in 20 patients. The iridium-192 ((192)Ir)-containing Tracer was implanted in the patient together with 4 standard gold seed fiducials. Patient prostate-related symptoms were evaluated with the International Prostate Symptom Score (IPSS) questionnaire. Computed tomography (CT) was performed for treatment planning, during treatment, and after treatment to evaluate the migration stability of the Tracer. At 5 treatment sessions, cone beam CT was performed to test the positioning accuracy of the RealEye. The Tracer was successfully implanted in all patients. No device or procedure-related adverse events occurred. Changes in IPSS scores were limited. The difference between the mean change in Tracer-fiducial distance and the mean change in fiducial-fiducial distance was -0.39 mm (95% confidence interval [CI] upper boundary, -0.22 mm). The adjusted mean difference between Tracer position according to RealEye and the Tracer position on the CBCT for all patients was 1.34 mm (95% CI upper boundary, 1.41 mm). Implantation of the Tracer is feasible and safe. Migration stability of the Tracer is good. Prostate patients can be positioned and monitored accurately by using RealEye. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Furthering patient adherence: a position paper of the international expert forum on patient adherence based on an internet forum discussion.

    Science.gov (United States)

    van Dulmen, Sandra; Sluijs, Emmy; van Dijk, Liset; de Ridder, Denise; Heerdink, Rob; Bensing, Jozien

    2008-02-27

    As the problem of patient non-adherence persists and a solution appears hard to be found, it continues to be important to look for new ways to further the issue. We recently conducted a meta-review of adherence intervention studies which yielded a preliminary agenda for future research, practice and theory development in patient adherence. The objective of the present project was to find out to what extent adherence experts consider this agenda relevant and feasible. The thirty-five corresponding authors of the review studies included in the meta-review were invited to join the International Expert Forum on Patient Adherence and to participate in a four-week web-based focus group discussion. The discussion was triggered by the points on the preliminary agenda presented as propositions to which forum members could react. Two researchers analysed the transcripts and selected relevant phrases. Twenty adherence experts participated. Various ideas and viewpoints were raised. After the closure of the web-site, the expert forum was asked to authorize the synthesis of the discussion, to list the propositions in order of priority and to answer a few questions on the use of the web-based focus group as a tool to obtain expert opinions. Their ranking showed that the development of simple interventions is the most promising step to take in fostering patient adherence, preferably within a multidisciplinary setting of medical, pharmaceutical, social and technical science and, not in the least, by incorporating patients' perspectives. For enhancing adherence, the development of simple interventions originating from a multidisciplinary perspective including patients' input, appears most promising. Disclosing patients' perspectives requires open communication about patients' expectations, needs and experiences in taking medication and about what might help them to become and remain adherent.

  5. Furthering patient adherence: A position paper of the international expert forum on patient adherence based on an internet forum discussion

    Directory of Open Access Journals (Sweden)

    Heerdink Rob

    2008-02-01

    Full Text Available Abstract Background As the problem of patient non-adherence persists and a solution appears hard to be found, it continues to be important to look for new ways to further the issue. We recently conducted a meta-review of adherence intervention studies which yielded a preliminary agenda for future research, practice and theory development in patient adherence. The objective of the present project was to find out to what extent adherence experts consider this agenda relevant and feasible. Methods The thirty-five corresponding authors of the review studies included in the meta-review were invited to join the International Expert Forum on Patient Adherence and to participate in a four-week web-based focus group discussion. The discussion was triggered by the points on the preliminary agenda presented as propositions to which forum members could react. Two researchers analysed the transcripts and selected relevant phrases. Results Twenty adherence experts participated. Various ideas and viewpoints were raised. After the closure of the web-site, the expert forum was asked to authorize the synthesis of the discussion, to list the propositions in order of priority and to answer a few questions on the use of the web-based focus group as a tool to obtain expert opinions. Their ranking showed that the development of simple interventions is the most promising step to take in fostering patient adherence, preferably within a multidisciplinary setting of medical, pharmaceutical, social and technical science and, not in the least, by incorporating patients' perspectives. Conclusion For enhancing adherence, the development of simple interventions originating from a multidisciplinary perspective including patients' input, appears most promising. Disclosing patients' perspectives requires open communication about patients' expectations, needs and experiences in taking medication and about what might help them to become and remain adherent.

  6. Increasing patient engagement during virtual reality-based motor rehabilitation.

    Science.gov (United States)

    Zimmerli, Lukas; Jacky, Mario; Lünenburger, Lars; Riener, Robert; Bolliger, Marc

    2013-09-01

    To investigate the influence of different design characteristics of virtual reality exercises on engagement during lower extremity motor rehabilitation. Correlational study. Spinal cord injury (SCI) rehabilitation center. Subjects with SCI (n=12) and control subjects (n=10). Not applicable. Heart rate and electromyographic activity from both legs at the tibialis anterior, the gastrocnemius medialis, the rectus femoris, and the biceps femoris were recorded. Interactivity (ie, functionally meaningful reactions to motor performance) was crucial for the engagement of subjects. No significant differences in engagement were found between exercises that differed in feedback frequency, explicit task goals, or aspects of competition. Functional feedback is highly important for the active participation of patients during robotic-assisted rehabilitation. Further investigations on the design characteristics of virtual reality exercises are of great importance. Exercises should thoroughly be analyzed regarding their effectiveness, while user preferences and expectations should be considered when designing virtual reality exercises for everyday clinical motor rehabilitation. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  7. A Novel Inflammation-Based Stage (I Stage in Patients with Resectable Esophageal Squamous Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Peng-Cheng Chen

    2016-01-01

    Full Text Available Background. Inflammation plays a key role in cancer. In the current study, we proposed a novel inflammation-based stage, named I stage, for patients with resectable esophageal squamous cell carcinoma (ESCC. Methods. Three hundred and twenty-three patients with resectable ESCC were enrolled in the current study. The I stage was calculated as follows: patients with high levels of C-reactive protein (CRP (>10 mg/L, neutrophil-to-lymphocyte ratio (NLR (>3.5, and platelet-count-to-lymphocyte ratio (PLR (>150 were defined as I3. Patients with two, one, or no abnormal value were defined as I2, I1, or I0, respectively. The prognostic factors were evaluated by univariate and multivariate analyses. Results. There were 112 patients for I0, 97 patients for I1, 66 patients for I2, and 48 patients for I3, respectively. The 5-year cancer-specific survival (CSS in patients with I0, I1, I2, and I3 was 50.0%, 30.9%, 18.2%, and 8.3%, respectively (I0 versus I1, P=0.002; I1 versus I2, P=0.012; I2 versus I3, P=0.020. Multivariate analyses revealed that I stage was an independent prognostic factor in patients with resectable ESCC (P<0.001. Conclusion. The inflammation-based stage (I stage is a novel and useful predictive factor for CSS in patients with resectable ESCC.

  8. Interleukin-2 based immunotherapy in patients with metastatic renal cell carcinoma

    DEFF Research Database (Denmark)

    Donskov, Frede

    2007-01-01

    The present thesis consists of 8 published articles focusing on interleukin-2 based immunotherapy in metastatic renal cell carcinoma (mRCC). This disease represents a significant challenge, as the tumor is resistant to current chemotherapy, hormonal therapy and radiation therapy. However, IL-2...... based immunotherapy may induce dramatic durable tumor regression by manipulating the immune system, however, only in a minority of patients. Two critical questions have driven the present thesis. First, which properties of the immune system are responsible for the dramatic tumor regression seen in some...... patients with mRCC following IL-2 administration? And second, can histamine increase the efficacy of IL-2 based immunotherapy by ending the immune suppression induced by phagocyte-generation of reactive oxygen species? 120 Danish patients, 41 UK patients and 20 Swedish patients were treated with low...

  9. Medical Assistant-based care management for high risk patients in small primary care practices

    DEFF Research Database (Denmark)

    Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.

    2016-01-01

    Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2...... diabetes, chronic obstructive pulmonary disease, or chronic heart failure and a likelihood of hospitalization in the upper quartile of the population, as predicted by insurance data analysis. Intervention: We compared protocol-based care management including structured assessment, action planning...

  10. Patient Similarity in Prediction Models Based on Health Data: A Scoping Review

    Science.gov (United States)

    Sharafoddini, Anis; Dubin, Joel A

    2017-01-01

    Background Physicians and health policy makers are required to make predictions during their decision making in various medical problems. Many advances have been made in predictive modeling toward outcome prediction, but these innovations target an average patient and are insufficiently adjustable for individual patients. One developing idea in this field is individualized predictive analytics based on patient similarity. The goal of this approach is to identify patients who are similar to an index patient and derive insights from the records of similar patients to provide personalized predictions.. Objective The aim is to summarize and review published studies describing computer-based approaches for predicting patients’ future health status based on health data and patient similarity, identify gaps, and provide a starting point for related future research. Methods The method involved (1) conducting the review by performing automated searches in Scopus, PubMed, and ISI Web of Science, selecting relevant studies by first screening titles and abstracts then analyzing full-texts, and (2) documenting by extracting publication details and information on context, predictors, missing data, modeling algorithm, outcome, and evaluation methods into a matrix table, synthesizing data, and reporting results. Results After duplicate removal, 1339 articles were screened in abstracts and titles and 67 were selected for full-text review. In total, 22 articles met the inclusion criteria. Within included articles, hospitals were the main source of data (n=10). Cardiovascular disease (n=7) and diabetes (n=4) were the dominant patient diseases. Most studies (n=18) used neighborhood-based approaches in devising prediction models. Two studies showed that patient similarity-based modeling outperformed population-based predictive methods. Conclusions Interest in patient similarity-based predictive modeling for diagnosis and prognosis has been growing. In addition to raw/coded health

  11. Fatigue and Mood States in Nursing Home and Nonambulatory Home-Based Patients with Multiple Sclerosis.

    Science.gov (United States)

    Younus, Zilfah; Vaughn, Caila B; Sanai, Shaik Ahmed; Kavak, Katelyn S; Gupta, Sahil; Nadeem, Muhammad; Teter, Barbara E; Noyes, Katia; Zivadinov, Robert; Edwards, Keith; Coyle, Patricia K; Goodman, Andrew; Weinstock-Guttman, Bianca

    2017-01-01

    Multiple sclerosis (MS) is a chronic, progressively disabling condition of the central nervous system. We sought to evaluate and compare mood states in patients with MS with increased disability residing in nursing homes and those receiving home-based care. We conducted a cross-sectional analysis of the New York State Multiple Sclerosis Consortium to identify patients with MS using a Kurtzke Expanded Disability Status Scale (EDSS) score of 7.0 or greater. The nursing home group was compared with home-based care patients regarding self-reported levels of loneliness, pessimism, tension, panic, irritation, morbid thoughts, feelings of guilt, and fatigue using independent-samples t tests and χ 2 tests. Multivariate logistic regression analyses were used to investigate risk-adjusted differences in mood states. Ninety-four of 924 patients with EDSS scores of at least 7.0 lived in a nursing home (10.2%). Nursing home patients were less likely to use disease-modifying therapy and had higher mean EDSS scores compared with home-based patients. However, nursing home patients were less likely than home-based patients to report fatigue (odds ratio [OR] for no fatigue, 3.8; 95% CI, 2.1-7.2), feeling tense (OR for no tension, 1.7; 95% CI, 1.1-2.7), and having feelings of pessimism (OR for no pessimism, 1.8; 95% CI, 1.2-2.8). The nursing home patients with MS were less likely to report fatigue, pessimism, and tension than those receiving home-based care. Further studies should examine ways of facilitating a greater degree of autonomy and decision-making control in MS patients receiving home-based care.

  12. Lean body mass-based levothyroxine replacement in young athyrotic patients with differentiated carcinoma of thyroid

    Directory of Open Access Journals (Sweden)

    Fatima Begum

    2013-01-01

    Full Text Available Objective: The objective of this study was to optimize dose of levothyroxine (LT4 based on lean body mass (LBM in young athyrotic patients with differentiated carcinoma of thyroid (DCT which has not been properly addressed in Bangladesh before. Materials and Methods: Sixty patients with DCT (age, range: 20-39 years having total thyroidectomy followed by radioiodine ablative therapy (RIT and 23 euthyroid volunteers were recruited. Clinical, biochemical parameters were obtained from all patients after 2 months of RIT and on LT4 replacement at a dose of 200 μg/day as first follow up visit and also from control subjects. Then 60 patients were divided into two groups consisting of 30 patients each. Patients of Group-I received LT4 replacement based on LBM measured by dual energy X-ray absorptiometry (DXA and Group-II continued LT4 replacement in conventional dose. Patients of both groups were assessed again for same parameters at 6 to 12 months at the second visit. Results: Optimized dose of LT4 based on LBM by DXA (131 ±23 μg/day significantly reduced thyroid hormones and kept thyroid stimulating hormone (TSH in expected levels in patients of Group-I at the second visit compared to patients of Group-II who continued conventional LT4 dose (200 μg/day. Hyperthyroid symptom scale (HSS was significantly reduced to 2 ± 1 in patients of Group-I but not in patients of Group-II, HSS, 8 ±1 ( P < 0.001. Conclusion: Optimization of LT4 dose based on LBM can avoid chronic exposure of mild excess of thyroid hormone in young patients with low risk DCT.

  13. Mindfulness-Based Cognitive Behavior Therapy in Patients with Anxiety Disorders: A Case Series

    OpenAIRE

    Sharma, Mahendra P.; Mao, Angelina; Sudhir, Paulomi M.

    2012-01-01

    The present study is aimed at evaluating the effectiveness of a Mindfulness-Based Cognitive Behavior Therapy (MBCBT) for reducing cognitive and somatic anxiety and modifying dysfunctional cognitions in patients with anxiety disorders. A single case design with pre- and post-assessment was adopted. Four patients meeting the specified inclusion and exclusion criteria were recruited for the study. Three patients received a primary diagnosis of generalized anxiety disorder (GAD), while the fourth...

  14. Lean body mass-based levothyroxine replacement in young athyrotic patients with differentiated carcinoma of thyroid

    Science.gov (United States)

    Begum, Fatima; Ahmed, Chaudhury M.; Afroz, Shahana; Kabir, Enamul; Alam, Faridul; Banerjee, Sajal; Zaman, Nazma

    2013-01-01

    Objective: The objective of this study was to optimize dose of levothyroxine (LT4) based on lean body mass (LBM) in young athyrotic patients with differentiated carcinoma of thyroid (DCT) which has not been properly addressed in Bangladesh before. Materials and Methods: Sixty patients with DCT (age, range: 20-39 years) having total thyroidectomy followed by radioiodine ablative therapy (RIT) and 23 euthyroid volunteers were recruited. Clinical, biochemical parameters were obtained from all patients after 2 months of RIT and on LT4 replacement at a dose of 200 μg/day as first follow up visit and also from control subjects. Then 60 patients were divided into two groups consisting of 30 patients each. Patients of Group-I received LT4 replacement based on LBM measured by dual energy X-ray absorptiometry (DXA) and Group-II continued LT4 replacement in conventional dose. Patients of both groups were assessed again for same parameters at 6 to 12 months at the second visit. Results: Optimized dose of LT4 based on LBM by DXA (131 ±23 μg/day) significantly reduced thyroid hormones and kept thyroid stimulating hormone (TSH) in expected levels in patients of Group-I at the second visit compared to patients of Group-II who continued conventional LT4 dose (200 μg/day). Hyperthyroid symptom scale (HSS) was significantly reduced to 2 ± 1 in patients of Group-I but not in patients of Group-II, HSS, 8 ±1 (P > 0.001). Conclusion: Optimization of LT4 dose based on LBM can avoid chronic exposure of mild excess of thyroid hormone in young patients with low risk DCT. PMID:23776898

  15. Retro-pharyngeal lymphadenopathy in patients with nasopharyngeal carcinoma. A computed tomography-based study

    Energy Technology Data Exchange (ETDEWEB)

    Chua, D.; Sham, J.; Kwong, D.; Au, G.; Choy, D. [Hong Kong Univ. (Hong Kong)

    1998-02-01

    The purpose of this study was to investigate the incidence and the prognostic value of retro-pharyngeal lymphadenopathy in nasopharyngeal carcinoma patients using contrast enhanced computed tomography (CT). In conclusion, using CT imaging, the presence of retro-pharyngeal lymphadenopathy in patients with nasopharyngeal carcinoma does not appear to affect the prognosis. In patients with clinical NO disease, the identification of retro-pharyngeal lymphadenopathy based only on CT imaging is not sufficient evidence for an N1 classification. (N.C.)

  16. Evaluating the Feasibility of Developing National Outcomes Data Bases to Assist Patients with Marking Treatment Decisions

    National Research Council Canada - National Science Library

    Damberg, Cheryl

    2003-01-01

    This report examines the potential for, and range of issues associated with, establishing national health outcomes data bases to help patients and their physicians evaluate tradeoffs among various treatment options...

  17. Moving from gamma passing rates to patient DVH-based QA metrics in pretreatment dose QA

    Energy Technology Data Exchange (ETDEWEB)

    Zhen, Heming; Nelms, Benjamin E.; Tome, Wolfgang A. [Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53705 (United States); Department of Human Oncology, University of Wisconsin, Madison, Wisconsin 53792 and Canis Lupus LLC, Merrimac, Wisconsin 53561 (United States); Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53705 and Department of Human Oncology, University of Wisconsin, Madison, Wisconsin 53792 (United States)

    2011-10-15

    Purpose: The purpose of this work is to explore the usefulness of the gamma passing rate metric for per-patient, pretreatment dose QA and to validate a novel patient-dose/DVH-based method and its accuracy and correlation. Specifically, correlations between: (1) gamma passing rates for three 3D dosimeter detector geometries vs clinically relevant patient DVH-based metrics; (2) Gamma passing rates of whole patient dose grids vs DVH-based metrics, (3) gamma passing rates filtered by region of interest (ROI) vs DVH-based metrics, and (4) the capability of a novel software algorithm that estimates corrected patient Dose-DVH based on conventional phan-tom QA data are analyzed. Methods: Ninety six unique ''imperfect'' step-and-shoot IMRT plans were generated by applying four different types of errors on 24 clinical Head/Neck patients. The 3D patient doses as well as the dose to a cylindrical QA phantom were then recalculated using an error-free beam model to serve as a simulated measurement for comparison. Resulting deviations to the planned vs simulated measured DVH-based metrics were generated, as were gamma passing rates for a variety of difference/distance criteria covering: dose-in-phantom comparisons and dose-in-patient comparisons, with the in-patient results calculated both over the whole grid and per-ROI volume. Finally, patient dose and DVH were predicted using the conventional per-beam planar data as input into a commercial ''planned dose perturbation'' (PDP) algorithm, and the results of these predicted DVH-based metrics were compared to the known values. Results: A range of weak to moderate correlations were found between clinically relevant patient DVH metrics (CTV-D95, parotid D{sub mean}, spinal cord D1cc, and larynx D{sub mean}) and both 3D detector and 3D patient gamma passing rate (3%/3 mm, 2%/2 mm) for dose-in-phantom along with dose-in-patient for both whole patient volume and filtered per-ROI. There was

  18. Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Samoocha, David; Bruinvels, David J.; Elbers, Nieke A.; Anema, Johannes R.; van der Beek, Allard J.

    2010-01-01

    Patient empowerment is growing in popularity and application. Due to the increasing possibilities of the Internet and eHealth, many initiatives that are aimed at empowering patients are delivered online. Our objective was to evaluate whether Web-based interventions are effective in increasing

  19. Computer Self-Efficacy of Patients in Urban Health Centers for Web-Based Health Education

    Science.gov (United States)

    Leung, Margaret P.

    2014-01-01

    Internet-based health information has become increasingly important for ensuring health equity for all populations. The lack of studies reporting on Internet use among patients of public health clinics has obscured the needs of diverse patient groups. Guided by social cognitive theory, this quantitative cross-sectional study used a 30-question…

  20. A Community-Based Family/Patient Group Program for Alzheimer's Disease.

    Science.gov (United States)

    Aronson, Miriam K.; And Others

    1984-01-01

    Describes a support program for community-based Alzheimer's patients and their caregivers. In addition to joint activities, the family group focuses on the family organization, support networks, feelings, new activities, and making decisions. The patient group provides social and awareness activities. (JAC)

  1. Mindfulness-based cognitive therapy for recurrent depression: Do we need to exclude currently depressed patients?

    NARCIS (Netherlands)

    Aalderen, J.R. van

    2016-01-01

    For many patients, major depression is a recurrent disorder and a potential chronic disease causing significant levels of distress. Mindfulness-based cognitive therapy (MBCT) is an 8-week training combining meditation exercises and cognitive therapy aimed at preventing relapse in patients with

  2. Risk of Clostridium difficile Infection in Patients With Celiac Disease: A Population-Based Study.

    Science.gov (United States)

    Lebwohl, Benjamin; Nobel, Yael R; Green, Peter H R; Blaser, Martin J; Ludvigsson, Jonas F

    2017-12-01

    Patients with celiac disease are at increased risk for infections such as tuberculosis, influenza, and pneumococcal pneumonia. However, little is known about the incidence of Clostridium difficile infection (CDI) in patients with celiac disease. We identified patients with celiac disease based on intestinal biopsies submitted to all pathology departments in Sweden over a 39-year period (from July 1969 through February 2008). We compared risk of CDI (based on stratified Cox proportional hazards models) among patients with celiac disease vs. without celiac disease (controls) matched by age, sex, and calendar period. We identified 28,339 patients with celiac disease and 141,588 controls; neither group had a history of CDI. The incidence of CDI was 56/100,000 person-years among patients with celiac disease and 26/100,000 person-years among controls, yielding an overall hazard ratio (HR) of 2.01 (95% confidence interval (CI), 1.64-2.47; Pceliac disease (HR, 5.20; 95% CI, 2.81-9.62; Pceliac disease and controls. In a large population-based cohort study, patients with celiac disease had significantly higher incidence of CDI than controls. This finding is consistent with prior findings of higher rates of other infections in patients with celiac disease, and suggests the possibility of altered gut immunity and/or microbial composition in patients with celiac disease.

  3. [Development of integrated clinical abilities by simulated patient assisted problem-based learning tutorial].

    Science.gov (United States)

    Norose, Takahiko

    2013-01-01

    In Hokkaido Pharmaceutical University, problem-based learning (PBL) has been introduced as a part of the laboratory and practice curriculum for all school years to promote active learning skills and enhance students' problem-solving ability. The PBL program at our school has been developed using a tutorial study based on scenarios and learning strategies, such as experiments and/or standardized patients (SPs) and role-playing, according to students' developmental stage and learning objectives. The course "Practice VIII/Principles of Clinical Communication" for the fifth-grade students is an example of the new PBL program to improve students' clinical communication skills and ability to design a care plan for patients. We divided 196 students into 49 groups (each group had 4 members). We used the large-class PBL model, in which the students had discussions with several facilitators. The students were presented with a patient-case scenario, in which they were first provided with a brief background of the patient. Afterward, students interviewed SPs to obtain detailed information, based on which a care plan was designed for each patient. Students role-played with SPs as a part of patient support, consulted using the patient care plan, and made Subjective information, Objective information, Assessment, and Plan (SOAP) notes at the end. Some students commented that the PBL program was very helpful in understanding how to design a patient care plan and that they understood the importance of communication in obtaining information for designing a patient care plan.

  4. Impact of community based nurse-led clinics on patient outcomes, patient satisfaction, patient access and cost effectiveness: A systematic review.

    Science.gov (United States)

    Randall, Sue; Crawford, Tonia; Currie, Jane; River, Jo; Betihavas, Vasiliki

    2017-08-01

    The role and scope of nursing practice has evolved in response to the dynamic needs of individuals, communities, and healthcare services. Health services are now focused on maintaining people in their communities, and keeping them out of hospital where possible. Community based nurse-led clinics are ideally placed to work towards this goal. The initial impetus for these services was to increase patient access to care, to provide a cost-effective and high quality streamlined service. This systematic review aimed to identify the impact of nurse-led clinics in relation to patient outcomes, patient satisfaction, impact on patient access to services, and cost effectiveness. A review of community based nurse-led clinic research in Medline, CINAHL and Embase was undertaken using MeSH terms: Nurse-managed centres, Practice, Patterns, Nurse, Ambulatory Care, keywords: nurse-led clinic, nurse led clinic, community and phrases primary health care and primary care. Papers were appraised using the Joanna Briggs Appraisal criteria. The final review comprised 15 studies with 3965 participants. Most studies explored patient satisfaction which was largely positive towards nurse-led clinics. Patient outcomes reported were typically from self-report, although some papers addressed objective clinical measures; again positive. Access was reported as being increased. Cost-effectiveness was the least reported impact measure with mixed results. Nurse-led clinics have largely shown positive impact on patient outcomes, patient satisfaction, access to care and mixed results on cost-effectiveness. Future research evaluating NLCs needs to adopt a standardised structure to provide rigorous evaluations that can rationalise further efforts to set up community based nurse-led clinical services. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Efficacy of peg-interferon based treatment in patients with hepatitis C refractory to previous conventional interferon-based treatment

    International Nuclear Information System (INIS)

    Shaikh, S.; Devrajani, B.R.; Kalhoro, M.

    2012-01-01

    Objective: To determine the efficacy of peg-interferon-based therapy in patients refractory to previous conventional interferon-based treatment and factors predicting sustained viral response (SVR). Study Design: Analytical study. Place and Duration of Study: Medical Unit IV, Liaquat University Hospital, Jamshoro, from July 2009 to June 2011. Methodology: This study included consecutive patients of hepatitis C who were previously treated with conventional interferon-based treatment for 6 months but were either non-responders, relapsed or had virologic breakthrough and stage = 2 with fibrosis on liver biopsy. All eligible patients were provided peg-interferon at the dosage of 180 mu g weekly with ribavirin thrice a day for 6 months. Sustained Viral Response (SVR) was defined as absence of HCV RNA at twenty four week after treatment. All data was processed on SPSS version 16. Results: Out of 450 patients enrolled in the study, 192 were excluded from the study on the basis of minimal fibrosis (stage 0 and 1). Two hundred and fifty eight patients fulfilled the inclusion criteria and 247 completed the course of peg-interferon treatment. One hundred and sixty one (62.4%) were males and 97 (37.6%) were females. The mean age was 39.9 +- 6.1 years, haemoglobin was 11.49 +- 2.45 g/dl, platelet count was 127.2 +- 50.6 10/sup 3/ /mm/sup 3/, ALT was 99 +- 65 IU/L. SVR was achieved in 84 (32.6%). The strong association was found between SVR and the pattern of response (p = 0. 001), degree of fibrosis and early viral response (p = 0.001). Conclusion: Peg-interferon based treatment is an effective and safe treatment option for patients refractory to conventional interferon-based treatment. (author)

  6. Effect of an Office-Based Surgical Safety System on Patient Outcomes

    OpenAIRE

    Rosenberg, Noah M.; Urman, Richard Dennis; Gallagher, Sean; Stenglein, John Joseph; Liu, Xiaoxia; Shapiro, Fred E.

    2012-01-01

    Objective: To implement a customizable checklist in an interdisciplinary, team-based plastic surgery setting to reduce surgical complications. Methods: We examined the effects on patient outcomes and documentation of a customizable, office-based surgical safety checklist. On the basis of the World Health Organization Surgical Safety Checklist, we developed a 28-element, perioperative checklist for use in the office-based surgical setting. The checklist was implemented in an office-based plast...

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

    Science.gov (United States)

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

    2018-03-08

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

  8. A comparison of two methods of partner notification for sexually transmitted infections in South Africa: patient-delivered partner medication and patient-based partner referral

    NARCIS (Netherlands)

    Young, T.; de Kock, A.; Jones, H.; Altini, L.; Ferguson, T.; van de Wijgert, J.

    2007-01-01

    The objective of this study was to determine acceptability and feasibility of patient-based partner referral (PBPR) and patient-delivered partner medication (PDPM) among female sexually transmitted infection (STI) patients in a community-based STI screening study. Women were randomized to STI

  9. Model-based optimal PEEP in mechanically ventilated ARDS patients in the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Sundaresan Ashwath

    2011-07-01

    Full Text Available Abstract Background The optimal level of positive end-expiratory pressure (PEEP is still widely debated in treating acute respiratory distress syndrome (ARDS patients. Current methods of selecting PEEP only provide a range of values and do not provide unique patient-specific solutions. Model-based methods offer a novel way of using non-invasive pressure-volume (PV measurements to estimate patient recruitability. This paper examines the clinical viability of such models in pilot clinical trials to assist therapy, optimise patient-specific PEEP, assess the disease state and response over time. Methods Ten patients with acute lung injury or ARDS underwent incremental PEEP recruitment manoeuvres. PV data was measured at increments of 5 cmH2O and fitted to the recruitment model. Inspiratory and expiratory breath holds were performed to measure airway resistance and auto-PEEP. Three model-based metrics are used to optimise PEEP based on opening pressures, closing pressures and net recruitment. ARDS status was assessed by model parameters capturing recruitment and compliance. Results Median model fitting error across all patients for inflation and deflation was 2.8% and 1.02% respectively with all patients experiencing auto-PEEP. In all three metrics' cases, model-based optimal PEEP was higher than clinically selected PEEP. Two patients underwent multiple recruitment manoeuvres over time and model metrics reflected and tracked the state or their ARDS. Conclusions For ARDS patients, the model-based method presented in this paper provides a unique, non-invasive method to select optimal patient-specific PEEP. In addition, the model has the capability to assess disease state over time using these same models and methods.

  10. For the Love of the Game: Game- Versus Lecture-Based Learning With Generation Z Patients.

    Science.gov (United States)

    Adamson, Mary A; Chen, Hengyi; Kackley, Russell; Micheal, Alicia

    2018-02-01

    The current study evaluated adolescent patients' enjoyment of and knowledge gained from game-based learning compared with an interactive lecture format on the topic of mood disorders. It was hypothesized that game-based learning would be statistically more effective than a lecture in knowledge acquisition and satisfaction scores. A pre-post design was implemented in which a convenience sample of 160 adolescent patients were randomized to either a lecture (n = 80) or game-based (n = 80) group. Both groups completed a pretest/posttest and satisfaction survey. Results showed that both groups had significant improvement in knowledge from pretest compared to posttest. Game-based learning was statistically more effective than the interactive lecture in knowledge achievement and satisfaction scores. This finding supports the contention that game-based learning is an active technique that may be used with patient education. [Journal of Psychosocial Nursing and Mental Health Services, 56(2), 29-36.]. Copyright 2018, SLACK Incorporated.

  11. Cranial base pathology in pediatric osteogenesis imperfecta patients treated with bisphosphonates.

    Science.gov (United States)

    Arponen, Heidi; Vuorimies, Ilkka; Haukka, Jari; Valta, Helena; Waltimo-Sirén, Janna; Mäkitie, Outi

    2015-03-01

    Cranial base pathology is a serious complication of osteogenesis imperfecta (OI). Our aim was to analyze whether bisphosphonate treatment, used to improve bone strength, could also prevent the development of craniocervical junction pathology (basilar impression, basilar invagination, or platybasia) in children with OI. In this single-center retrospective study the authors analyzed the skull base morphology from lateral skull radiographs and midsagittal MR images (total of 94 images), obtained between the ages of 0 and 25 years in 39 bisphosphonate-treated OI patients. The results were compared with age-matched normative values and with findings in 70 OI patients who were not treated with bisphosphonates. In addition to cross-sectional data, longitudinal data were available from 22 patients with an average follow-up period of 7.6 years. The patients, who had OI types I, III, IV, VI, and VII, had been treated with zoledronic acid, pamidronate, or risedronate for 3.2 years on average. Altogether 33% of the 39 bisphosphonate-treated patients had at least 1 cranial base anomaly, platybasia being the most prevalent diagnosis (28%). Logistic regression analysis suggested a higher risk of basilar impression or invagination in patients with severe OI (OR 22.04) and/or older age at initiation of bisphosphonate treatment (OR 1.45), whereas a decreased risk was associated with longer duration of treatment (OR 0.28). No significant associations between age, height, or cumulative bisphosphonate dose and the risk for cranial base anomaly were detected. In longitudinal evaluation, Kaplan-Meier curves suggested delayed development of cranial base pathology in patients treated with bisphosphonates but the differences from the untreated group were not statistically significant. These findings indicate that cranial base pathology may develop despite bisphosphonate treatment. Early initiation of bisphosphonate treatment may delay development of craniocervical junction pathology

  12. Motivational interviewing: an evidence-based approach to counseling helps patients follow treatment recommendations.

    Science.gov (United States)

    Levensky, Eric Ross; Forcehimes, Alyssa; O'Donohue, William T; Beitz, Kendra

    2007-10-01

    Motivational interviewing is an evidenced-based counseling approach that health care providers can use to help patients adhere to treatment recommendations. It emphasizes using a directive, patient-centered style of interaction to promote behavioral change by helping patients explore and resolve ambivalence. This article will help nurses learn how to use motivational interviewing to encourage patients to adhere to treatment recommendations. The basic theoretical underpinnings, principles, and methods of motivational interviewing are discussed, with an emphasis on acting in accordance with the "spirit" of the approach.

  13. Control of Nausea Based on Risk Analysis in Patients with Esophageal and Gastric Cancer Who Received Cisplatin-based Chemotherapy.

    Science.gov (United States)

    Fujii, Hironori; Iihara, Hirotoshi; Kajikawa, Noriko; Kobayashi, Ryo; Suzuki, Akio; Tanaka, Yoshihiro; Yamaguchi, Kazuya; Yoshida, Kazuhiro; Itoh, Yoshinori

    2017-12-01

    Cisplatin is commonly used for esophageal and gastric cancer, but has a high emetic risk. Although the control of vomiting is favorable, nausea is still poorly controlled in patients receiving cisplatin-based regimens. The present study was designed to determine the risks for cisplatin-induced nausea. The effect of olanzapine, an antipsychotic drug, as an antiemetic for patients with risk of poor control of nausea was subsequently examined. The prevalence of antiemetic medication and the control of nausea and vomiting were retrospectively examined in patients with esophageal or gastric cancer receiving the first cycle of cisplatin-based chemotherapy. Risks for nausea were analyzed by multivariate logistic regression analysis, in which threshold for age and cisplatin dose wer assessed by receiver operating characteristic curve analysis. A total of 186 patients received cisplatin-based regimens during January 2011 and December 2016. Guideline-consistent antiemetic medication was administered to all patients. Although the rate of no vomiting was high (93%), the rate of non-significant (grade 2 or more) nausea was insufficient (64%) during the overall period. Risk analysis showed that cisplatin dose of 50 mg/m 2 or more and female gender were significant risks for nausea. Addition of olanzapine, but not of prochlorperazine, to the standard antiemetic medication was effective in suppressing nausea in patients who experienced nausea in the first cycle. Being female and cisplatin doses at 50 mg/m 2 or more were demonstrated to increase risk for nausea. Addition of olanzapine to the standard medication was effective in preventing nausea in high-risk patients with esophageal and gastric cancer. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  14. Educational benefits of Internet and computer-based programmes for prostate cancer patients: a systematic review.

    Science.gov (United States)

    Salonen, Anne; Ryhänen, Anne M; Leino-Kilpi, Helena

    2014-01-01

    This study aims to review systematically the available literature on Internet and computer-based patient education programmes, assess the quality of these studies and analyze the benefit of these programmes for prostate cancer patients. Complete databases were searched. Studies were included if they concerned patient education of prostate cancer patients, were qualitative or quantitative and examined Internet or interactive CD-ROM use. Eighteen studies met the inclusion criteria. The majority of the studies reported a significant increase in the knowledge of the disease, satisfaction with treatment options and support for men. The benefit of the programmes was that the patients felt more empowered and obtained a heightened sense of control over their disease. The Internet or computer-based programmes had a positive impact on prostate cancer patient education. Most papers reported that the programmes were beneficial, but few presented data from studies with rigorous research methodologies to support these claims. Internet and computer-based programmes can be useful tools in prostate cancer patient education. In order to improve the benefits of the programmes, more Internet and computer-based programmes need to be developed and studied. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

  15. The Future of Graduate Medical Education: A Systems-Based Approach to Ensure Patient Safety.

    Science.gov (United States)

    Bagian, James P

    2015-09-01

    In the past 15 years, there has been growing recognition that improving patient safety must be more systems based and sophisticated than the traditional approach of simply telling health care providers to "be more careful." Drawing from his own experience, the author discusses barriers to systems-based patient safety initiatives and emphasizes the importance of overcoming those barriers. Physicians may be slow to adopt standardized patient safety initiatives because of a resistance to standardization, but faculty in training institutions have a responsibility to model safe, effective, systems-based approaches to patient care in order to instill these values in the residents they teach. Importantly, graduate medical education (GME) is well positioned to influence not only how future physicians provide care to patients but also how today's physicians and health care systems improve patient safety and care. The necessary systems-based knowledge and skills are rooted in both understanding and proficiently identifying threats to patient safety, their underlying causes, the development and implementation of effective countermeasures, and the measurement of whether the threat has been successfully addressed. This knowledge and its application is notably absent in the operation of most institutions that sponsor GME training programs in terms of didactic instruction and everyday demonstrated proficiency. Most important of all, faculty must model the behavior and competencies that are desirable in future physicians and not fall into the trap of the "do as I say, not as I do" mentality, which can have a corrosive deleterious effect on the next generation of physicians.

  16. [Web-based for preanesthesia evaluation record: a structured, evidence-based patient interview to assess the anesthesiological risk profile].

    Science.gov (United States)

    Kramer, Sylvia; Lau, Alexandra; Krämer, Michael; Wendler, Olafur Gunnarsson; Müller-Lobeck, Lutz; Scheding, Christoph; Klarhöfer, Manja; Schaffartzik, Walter; Neumann, Tim; Krampe, Henning; Spies, Claudia

    2011-10-01

    At present, providers at an Anesthesia Preoperative Evaluation Clinic (APEC) may have difficulties in gaining access to relevant clinical information, including external medical records, surgical dictations etc. This common occurence makes obtaining an informed consent by the patient after a complete pre-anesthetic assessment difficult. This form of patient information is subject to wide interindividual variations and, thus, represents a challenge for quality assurance. Insufficient or not completed pre-anesthetic assessments can lead to an untimely termination of an elective procedure.A web-based pre-anesthetic evaluation record moves the time point of the first contact to well before the day of admission. The current pre-anesthesia evaluation record is replaced by a structured interview in the form of a complex of questions in a specific hierarchy taking guidelines, standard operating procedures (SOP) and evidence-based medicine (EBM) into consideration. The answers to the complex of questions are then classified according to agreed criteria and possible scoring systems of relevant classifications. The endpoints result in procedural recommendations not only for the informing anesthesiologist but also for the patient. The standardized risk criteria can be used as core process indicators to check the process quality of the anesthesiological risk evaluation. Short-notice cancellations of elective operations due to incomplete premedication procedures will then be avoided with the help of such structured and evidence-based patient interviews with detailed assessment of the anesthesiological risk profile.The web-based anesthesia evaluation record (WAR) corresponds with the recommendations of the DGAI to carry out the staged information in analogy to the staged information of Weissauer. The basic practice is not changed by WACH. By means of WACH, the time point of the first contact with anesthesia is moved forward and occurs within a different framework. WACH has

  17. Development of Evidence-Based Disease Education Literature for Pakistani Rheumatoid Arthritis Patients

    Directory of Open Access Journals (Sweden)

    Atta Abbas Naqvi

    2017-11-01

    Full Text Available Rheumatoid arthritis affects 0.5% to 1% of the population globally and is one of the most common causes of disability. Patient education plays a key role in improving treatment outcomes. The purpose of this study was to discuss the process involved in designing an evidence-based disease education literature for rheumatoid arthritis patients of Pakistan in Urdu language with culturally relevant illustrations. A study was conducted to develop disease education literature using Delphi consensus, content validity, and patient feedback. A panel of experts comprised of university professors and health care experts, including health practitioners and pharmacists as well as a social scientist, was set up to assess the need. Eight patients were randomly selected and were asked to give their feedback. Their feedback was incorporated in the development process. The entire process was carried out in eight steps. A disease education literature for patients of rheumatoid arthritis was developed and edited in the form of a booklet. The booklet contained evidence-based information that must be provided to patients in both Urdu and English languages with culturally relevant illustrations. The availability of such literature is significant, as it enables the patients to seek knowledge at home at their convenience. This home-based knowledge support is as helpful as any other means of medical care. The developed literature is planned to be used in further studies which will evaluate its impact in improving knowledge of RA patients.

  18. Case Study: Evidence-Based Interventions Enhancing Diabetic Foot Care Behaviors among Hospitalized DM Patients

    Directory of Open Access Journals (Sweden)

    Titis Kurniawan

    2011-01-01

    Full Text Available Background: Improving diabetic patients’ foot care behaviors is one of the most effective strategies in minimizing diabetic foot ulceration and its further negative impacts, either in diabetic hospitalized patients or outpatients.Purpose: To describe foot care knowledge and behaviors among hospitalized diabetic patients, to apply selected foot care knowledge and behaviors improvement evidence, and to evaluate its effectiveness.Method: Four diabetic patients who were under our care for at least three days and could communicate in Thai language were selected from a surgical ward in a university hospital. The authors applied educational program based on patients’ learning needs, provided diabetic foot care leaflet, and assisted patients to set their goal and action plans. In the third day of treatment, we evaluated patients’ foot care knowledge and their goal and action plan statements in improving foot care behaviors.Result: Based on the data collected among four hospitalized diabetic patients, it was shown that all patients needed foot care behaviors improvement and the educational program improved hospitalized patients’ foot care knowledge and their perceived foot care behaviors. The educational program that combined with goal setting and action plans method was easy, safe, and seemed feasibly applicable for diabetic hospitalized patients.Conclusion: The results of this study provide valuable information for improvement of hospitalized diabetic patients’ foot care knowledge and behaviors. The authors recommend nurses to use this evidence-based practice to contribute in improving the quality of diabetic care.Keywords: Intervention, diabetic foot care, hospitalized diabetic patients

  19. Outlier-based detection of unusual patient-management actions: An ICU study.

    Science.gov (United States)

    Hauskrecht, Milos; Batal, Iyad; Hong, Charmgil; Nguyen, Quang; Cooper, Gregory F; Visweswaran, Shyam; Clermont, Gilles

    2016-12-01

    Medical errors remain a significant problem in healthcare. This paper investigates a data-driven outlier-based monitoring and alerting framework that uses data in the Electronic Medical Records (EMRs) repositories of past patient cases to identify any unusual clinical actions in the EMR of a current patient. Our conjecture is that these unusual clinical actions correspond to medical errors often enough to justify their detection and alerting. Our approach works by using EMR repositories to learn statistical models that relate patient states to patient-management actions. We evaluated this approach on the EMR data for 24,658 intensive care unit (ICU) patient cases. A total of 16,500 cases were used to train statistical models for ordering medications and laboratory tests given the patient state summarizing the patient's clinical history. The models were applied to a separate test set of 8158 ICU patient cases and used to generate alerts. A subset of 240 alerts generated by the models were evaluated and assessed by eighteen ICU clinicians. The overall true positive rates for the alerts (TPARs) ranged from 0.44 to 0.71. The TPAR for medication order alerts specifically ranged from 0.31 to 0.61 and for laboratory order alerts from 0.44 to 0.75. These results support outlier-based alerting as a promising new approach to data-driven clinical alerting that is generated automatically based on past EMR data. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Can Team-Based Care Improve Patient Satisfaction? A Systematic Review of Randomized Controlled Trials

    Science.gov (United States)

    Wen, Jin; Schulman, Kevin A.

    2014-01-01

    Background Team-based approaches to patient care are a relatively recent innovation in health care delivery. The effectiveness of these approaches on patient outcomes has not been well documented. This paper reports a systematic review of the relationship between team-based care and patient satisfaction. Methods We searched MEDLINE, EMBASE, Cochrane Library, CINAHL, and PSYCHOINFO for eligible studies dating from inception to October 8, 2012. Eligible studies reported (1) a randomized controlled trial, (2) interventions including both team-based care and non-team-based care (or usual care), and (3) outcomes including an assessment of patient satisfaction. Articles with different settings between intervention and control were excluded, as were trial protocols. The reference lists of retrieved papers were also evaluated for inclusion. Results The literature search yielded 319 citations, of which 77 were screened for further full-text evaluation. Of these, 27 articles were included in the systematic review. The 26 trials with a total of 15,526 participants were included in this systematic review. The pooling result of dichotomous data (number of studies: 10) showed that team-based care had a positive effect on patient satisfaction compared with usual care (odds ratio, 2.09; 95% confidence interval, 1.54 to 2.84); however, combined continuous data (number of studies: 7) demonstrated that there was no significant difference in patient satisfaction between team-based care and usual care (standardized mean difference, −0.02; 95% confidence interval, −0.40 to 0.36). Conclusions Some evidence showed that team-based care is better than usual care in improving patient satisfaction. However, considering the pooling result of continuous data, along with the suboptimal quality of included trials, further large-scale and high-quality randomized controlled trials comparing team-based care and usual care are needed. PMID:25014674

  1. Utilitarian prioritization of radiation oncology patients based on maximization of population tumour control

    International Nuclear Information System (INIS)

    Ebert, M A; Li, W; Kearvell, R; Bydder, S; Jennings, L

    2013-01-01

    An objective method for establishing patient prioritization in the context of a radiotherapy waiting list is investigated. This is based on a utilitarian objective, being the greatest probability of local tumour control in the population of patients. A numerical simulation is developed and a clinical patient case-mix is used to determine the influence of the characteristics of the patient population on resulting optimal patient scheduling. With the utilitarian objective, large gains in tumour control probability (TCP) can be achieved for individuals or cohorts by prioritizing patients for that fraction of the patient population with relatively small sacrifices in TCP for a smaller fraction of the population. For a waiting list in steady state with five patients per day commencing treatment and leaving the list (and so with five patients per day entering the list), and a mean wait time of 35 days and a maximum of 90 days, optimized wait times ranged from a mean of one day for patients with tumour types with short effective doubling times to a mean of 66.9 days for prostate cancer patients. It is found that, when seeking the optimal daily order of patients on the waiting list in a constrained simulation, the relative rather than absolute value of TCP is the determinant of the resulting optimal waiting times. An increase in the mean waiting time mostly influences (increases) the optimal waiting times of patients with fast-growing tumours. The proportional representation of groups (separated by tumour type) in the patient population has an influence on the resulting distribution of optimal waiting times for patients in those groups, though has only a minor influence on the optimal mean waiting time for each group. (paper)

  2. Utilitarian prioritization of radiation oncology patients based on maximization of population tumour control

    Science.gov (United States)

    Ebert, M. A.; Li, W.; Jennings, L.; Kearvell, R.; Bydder, S.

    2013-06-01

    An objective method for establishing patient prioritization in the context of a radiotherapy waiting list is investigated. This is based on a utilitarian objective, being the greatest probability of local tumour control in the population of patients. A numerical simulation is developed and a clinical patient case-mix is used to determine the influence of the characteristics of the patient population on resulting optimal patient scheduling. With the utilitarian objective, large gains in tumour control probability (TCP) can be achieved for individuals or cohorts by prioritizing patients for that fraction of the patient population with relatively small sacrifices in TCP for a smaller fraction of the population. For a waiting list in steady state with five patients per day commencing treatment and leaving the list (and so with five patients per day entering the list), and a mean wait time of 35 days and a maximum of 90 days, optimized wait times ranged from a mean of one day for patients with tumour types with short effective doubling times to a mean of 66.9 days for prostate cancer patients. It is found that, when seeking the optimal daily order of patients on the waiting list in a constrained simulation, the relative rather than absolute value of TCP is the determinant of the resulting optimal waiting times. An increase in the mean waiting time mostly influences (increases) the optimal waiting times of patients with fast-growing tumours. The proportional representation of groups (separated by tumour type) in the patient population has an influence on the resulting distribution of optimal waiting times for patients in those groups, though has only a minor influence on the optimal mean waiting time for each group.

  3. Embedding Patient Education in Mobile Platform for Patients With Heart Failure: Theory-Based Development and Beta Testing.

    Science.gov (United States)

    Athilingam, Ponrathi; Osorio, Richard E; Kaplan, Howard; Oliver, Drew; O'neachtain, Tara; Rogal, Philip J

    2016-02-01

    Health education is an important component of multidisciplinary disease management of heart failure. The educational information given at the time of discharge after hospitalization or at initial diagnosis is often overwhelming to patients and is often lost or never consulted again. Therefore, the aim of this developmental project was to embed interactive heart failure education in a mobile platform. A patient-centered approach, grounded on several learning theories including Mayer's Cognitive Theory of Multimedia Learning, Sweller's Cognitive Load, Instructional Design Approach, and Problem-Based Learning, was utilized to develop and test the mobile app. Ten heart failure patients, who attended an outpatient heart failure clinic, completed beta testing. A validated self-confidence questionnaire was utilized to assess patients' confidence in using the mobile app. All participants (100%) reported moderate to extreme confidence in using the app, 95% were very likely to use the app, 100% reported the design was easy to navigate, and content on heart failure was appropriate. Having the information accessible on their mobile phone was reported as a positive, like a health coach by all patients. Clinicians and nurses validated the content. Thus, embedding health education in a mobile app is proposed in promoting persistent engagement to improve health outcomes.

  4. The effect of performance-based financial incentives on improving patient care experiences: a statewide evaluation.

    Science.gov (United States)

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

    2009-12-01

    Patient experience measures are central to many pay-for-performance (P4P) programs nationally, but the effect of performance-based financial incentives on improving patient care experiences has not been assessed. The study uses Clinician & Group CAHPS data from commercially insured adult patients (n = 124,021) who had visits with 1,444 primary care physicians from 25 California medical groups between 2003 and 2006. Medical directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the patient experience improvement activities adopted by groups. Multilevel regression models were used to assess the relationship between performance change on patient care experience measures and medical group characteristics, financial incentives, and performance improvement activities. Over the course of the study period, physicians improved performance on the physician-patient communication (0.62 point annual increase, p performance on patient experience measures experienced larger improvements (p performance on the physician communication (p performance-based financial incentives, patient care experiences significantly improved. In order to promote patient-centered care in pay for performance and public reporting programs, the mechanisms by which program features influence performance improvement should be clarified.

  5. [Treatment by panel physicians of patients in protective institutions and homes : Analysis based on secondary data].

    Science.gov (United States)

    Kurch-Bek, Diana; Sundmacher, Leonie; Gallowitz, Christian; Tenckhoff, Bernhard

    2018-02-01

    According to the nursing statistics from 2014 a total of 2.6 million patients in Germany required nursing care of which 1.86 million received care at home and approximately 29 % (764,000 patients) received inpatient treatment exclusively in a nursing home. Reports on the number of long-term nursing care patients usually only include patients with a need of long-term care (according to § 14 German Social Code XI) confirmed by the statutory healthcare insurance. Currently, in Germany there is no nationwide report based on routine (billing) data estimating the number of patients in protective residential homes or institutions, nursing homes or homes for the elderly with nursing personnel (private institutions) based on routine data. This needs to be clarified. The present analysis was based on the nationwide ambulatory statutory healthcare insurance physician (ASHIP) authorized billing data from 2014. An estimation of the number of patients in nursing and retirement homes was made based on the medical services data. Morbidity and outpatient medical healthcare details were analyzed using methods for descriptive analyses. In 2014 a total of 525,863 patients in private nursing homes received ASHIP-authorized treatment, of which 173,233 were treated exclusively in nursing homes by ASHIP-authorized physicians and 352,630 patients were treated in nursing homes as well as in ASHIP-authorized practices. In the year under investigation approximately two thirds of the patients in nursing homes consulted ambulatory practices in addition to care in the nursing home. Nationwide ambulatory ASHIP billing data can substantially contribute to assessment of multimorbidities and provision of long-term healthcare by panel physicians for patients in nursing homes.

  6. A Varian DynaLog file-based procedure for patient dose-volume histogram-based IMRT QA.

    Science.gov (United States)

    Calvo-Ortega, Juan F; Teke, Tony; Moragues, Sandra; Pozo, Miquel; Casals-Farran, Joan

    2014-03-06

    In the present study, we describe a method based on the analysis of the dynamic MLC log files (DynaLog) generated by the controller of a Varian linear accelerator in order to perform patient-specific IMRT QA. The DynaLog files of a Varian Millennium MLC, recorded during an IMRT treatment, can be processed using a MATLAB-based code in order to generate the actual fluence for each beam and so recalculate the actual patient dose distribution using the Eclipse treatment planning system. The accuracy of the DynaLog-based dose reconstruction procedure was assessed by introducing ten intended errors to perturb the fluence of the beams of a reference plan such that ten subsequent erroneous plans were generated. In-phantom measurements with an ionization chamber (ion chamber) and planar dose measurements using an EPID system were performed to investigate the correlation between the measured dose changes and the expected ones detected by the reconstructed plans for the ten intended erroneous cases. Moreover, the method was applied to 20 cases of clinical plans for different locations (prostate, lung, breast, and head and neck). A dose-volume histogram (DVH) metric was used to evaluate the impact of the delivery errors in terms of dose to the patient. The ionometric measurements revealed a significant positive correlation (R² = 0.9993) between the variations of the dose induced in the erroneous plans with respect to the reference plan and the corresponding changes indicated by the DynaLog-based reconstructed plans. The EPID measurements showed that the accuracy of the DynaLog-based method to reconstruct the beam fluence was comparable with the dosimetric resolution of the portal dosimetry used in this work (3%/3 mm). The DynaLog-based reconstruction method described in this study is a suitable tool to perform a patient-specific IMRT QA. This method allows us to perform patient-specific IMRT QA by evaluating the result based on the DVH metric of the planning CT image (patient

  7. Meta-analysis of meditative/relaxation-based interventions for cognitive impairment in cancer patient

    Directory of Open Access Journals (Sweden)

    Yang Zhang

    2017-07-01

    Conclusion: Mediation-based interventions had statistically significant difference in improve subjective cognitive function and mental QOL in cancer patients. However, since the conclusion of this meta-analysis was drawn based on limited number of RCTs, future research should be conducted to confirm its positive intervention effects.

  8. Using the Java language to develop computer based patient records for use on the Internet.

    OpenAIRE

    Zuckerman, A. E.

    1996-01-01

    The development of the Java Programming Language by Sun Microsystems has provided a new tool for the development of Internet based applications. Our preliminary work has shown how Java can be used to program an Internet based CBPR. Java is well suited to the needs of patient records and can interface with clinical data repositories written in MUMPS or SQL.

  9. Internet-Based Early Intervention to Prevent Posttraumatic Stress Disorder in Injury Patients: Randomized Controlled Trial

    NARCIS (Netherlands)

    Mouthaan, Joanne; Sijbrandij, Marit; de Vries, Giel-Jan; Reitsma, Johannes B.; van de Schoot, Rens; Goslings, J. Carel; Luitse, Jan S. K.; Bakker, Fred C.; Gersons, Berthold P. R.; Olff, Miranda

    2013-01-01

    Background: Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms. Objective: To determine

  10. Internet-based early intervention to prevent poststraumatic stress disorder in injury patients: Randomized controlled trial.

    NARCIS (Netherlands)

    Mouthaan, J.; Sijbrandij, M.; de Vries, G.J.; Reitsma, J.B.; van de Schoot, R.; Goslings, J.C.; Luitse, J.S.K.; Bakker, F.C.; Gersons, B.P.R.; Olff, M.

    2013-01-01

    Background: Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms. Objective: To determine

  11. A deformation-based morphometry study of patients with early-stage Parkinson's disease

    DEFF Research Database (Denmark)

    Borghammer, P; Østergaard, Karen; Cumming, P

    2010-01-01

    BACKGROUND AND PURPOSE: Previous volumetric magnetic resonance imaging (MRI) studies of Parkinson's disease (PD) utilized primarily voxel-based morphometry (VBM), and investigated mostly patients with moderate- to late-stage disease. We now use deformation-based morphometry (DBM), a method...

  12. Using the Java language to develop computer based patient records for use on the Internet.

    Science.gov (United States)

    Zuckerman, A. E.

    1996-01-01

    The development of the Java Programming Language by Sun Microsystems has provided a new tool for the development of Internet based applications. Our preliminary work has shown how Java can be used to program an Internet based CBPR. Java is well suited to the needs of patient records and can interface with clinical data repositories written in MUMPS or SQL. PMID:8947770

  13. Health-related quality of life in patients with skull base tumours.

    LENUS (Irish Health Repository)

    Kelleher, M O

    2012-02-03

    The objective of the investigation was to report on the health-related quality of life (HRQoL) of patients diagnosed with skull base tumours using the Short Form Health Survey questionnaire (SF-36). Those patients suffering with vestibular schwannoma were examined to determine the effect facial nerve function had on their quality of life. It took place at the tertiary referral centre at the Department of Clinical Neurosciences, Western General Hospital, Edinburgh. A prospective study of 70 consecutive patients was taken, who harboured the following tumours: 54 vestibular schwannomas, 13 meningiomas, two haemangioblastomas and one hypoglossal schwannoma. Patients were interviewed using the short form 36 (SF-36) questionnaire. Facial nerve function was assessed in those patients who had vestibular schwannomas. The entire cohort of live skull base patients were assessed after a median follow-up time of 38.4 months. Patients with vestibular schwannoma treated conservatively with interval MRI had a quality of life similar to t he normal population. Those who underwent surgery had a significant difference in two of the SF-36 domains. No statistically significant correlation was found at final assessment between the degree of facial nerve functioning and any of the domains of SF-36. Patients with non-vestibular tumours had an impaired HRQoL in seven of the eight domains. Patients with skull base tumours have a significant impairment of their HRQoL. A conservative policy of follow up with interval MRI for patients with small vestibular schwannomas may therefore be more appropriate to preserve their HRQoL. Facial nerve outcome has little influence on quality of life in vestibular schwannoma patients.

  14. Operation of a P300-based brain-computer interface by patients with spinocerebellar ataxia

    Directory of Open Access Journals (Sweden)

    Yoji Okahara

    Full Text Available Objective: We investigated the efficacy of a P300-based brain-computer interface (BCI for patients with spinocerebellar ataxia (SCA, which is often accompanied by cerebellar impairment. Methods: Eight patients with SCA and eight age- and gender-matched healthy controls were instructed to input Japanese hiragana characters using the P300-based BCI with green/blue flicker. All patients depended on some assistance in their daily lives (modified Rankin scale: mean 3.5. The chief symptom was cerebellar ataxia; no cognitive deterioration was present. A region-based, two-step P300-based BCI was used. During the P300 task, eight-channel EEG data were recorded, and a linear discriminant analysis distinguished the target from other nontarget regions of the matrix. Results: The mean online accuracy in BCI operation was 82.9% for patients with SCA and 83.2% for controls; no significant difference was detected. Conclusion: The P300-based BCI was operated successfully not only by healthy controls but also by individuals with SCA. Significance: These results suggest that the P300-based BCI may be applicable for patients with SCA. Keywords: BCI, BMI, P300, Visual stimuli, Spinocerebellar ataxia

  15. Impact of Community-Based Clinical Training on Dental Students' Confidence in Treating Pediatric Patients.

    Science.gov (United States)

    Coe, Julie M; Brickhouse, Tegwyn H; Bhatti, Bushra A; Best, Al M

    2018-01-01

    With a significant need for more general dentists to provide care for pediatric patients, previous studies have found that community-based clinical training experience with children increased dental students' willingness to provide care to pediatric patients after graduation. The aim of our study was to determine the impact of community-based clinical training with pediatric patients on dental students' self-perceived confidence in treating pediatric patients, both overall and related to specific procedures. Of the total 105 fourth-year dental students at one U.S. dental school invited to participate in the study in academic year 2011-12, 76 completed the survey about their community-based dental education (CBDE), for a 72% response rate. Over half of the respondents (55%) reported feeling more confident in treating pediatric patients after their rotations. The increase in confidence was not associated with demographics. The placement of sealants (p=0.0022) and experience in giving local anesthesia (p=0.0008) were the two procedures most strongly associated with the increase in confidence. Also, these students received more experience in pulp therapy, extractions, and treating children up to three years of age during their community-based rotations than in the school-based clinic. In this study, greater exposure to pediatric dental clinical experiences during CBDE increased the students' confidence in treating pediatric patients. These results suggest that community-based experiences are useful in supplementing the school-based pediatric clinical experience, including increasing entry-level dentists' confidence in treating pediatric patients.

  16. A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis

    DEFF Research Database (Denmark)

    Lund, H.; Weile, U.; Christensen, R.

    2008-01-01

    patients reported adverse events (i.e. discomfort) in land-based exercise, while only 3 reported adverse events in the aquatic exercise. Conclusion: Only land-based exercise showed some improvement in pain and muscle strength compared with the control group, while no clinical benefits were detectable after......Objective: To compare the efficacy of aquatic exercise and a land-based exercise programme vs control in patients with knee osteoarthritis. Methods: Primary outcome was change in pain, and in addition Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS). Standing balance and strength...... was also measured after and at 3-month follow-up. Seventy-nine patients (62 women), with a mean age of 68 years (age range 40-89 years) were randomized to aquatic exercise (n = 27), land-based exercise (n = 25) or control (n = 27). Results: No effect was observed immediately after exercise cessation (8...

  17. Patient-centred hand hygiene information in orthopaedics units: an evidence-based implementation project.

    Science.gov (United States)

    Ong, Arielle Yi Jia; Tan, Joanne; Yeo, Hui Ling; Goh, Mien Li

    2017-03-01

    This project aimed to improve patients' knowledge on the importance of hand hygiene. It involved providing patients with a patient and family education on the importance of hand hygiene using a patient information leaflet that introduces the rationale of hand hygiene, possible consequences of poor hand hygiene, and the seven steps of hand hygiene. This projected used a preimplementation and postimplementation audit strategy using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research Into Practice programs. The implementation occurred in three phases over a period of 6 months from January 2014 to June 2014. The audits took place in two orthopaedic wards in a large acute care setting tertiary hospital in Singapore and involved a sample size of 54 patients. It involved going through the medical records of the cases, assessment of patient knowledge based on the audit criteria, and checking if the patients received the patient information leaflet on hand hygiene. The postimplementation audit found significant improvements in all three audit criteria. The percentage of patients who demonstrated knowledge in the importance of hand hygiene saw an improvement of 48.1%. There was an improvement of 44.5% in nurses' compliance to the documentation of patient education being carried out. The percentage of patients who received a patient information leaflet on hand hygiene saw an increase of 36.1%. This project demonstrated that a preimplementation and postimplementation audit is a viable method to implement change and translate evidence into practice. Through this project, patients gained an understanding on the importance of hand hygiene and could take better ownership of their well being. This may potentially improve hospitalization experience and benefit health outcomes. The positive results of this project are contributed by the enthusiastic involvement of all the stakeholders, from patients and their caregivers to the bedside

  18. The patient is the teacher: ambulatory patient-centred student-based interprofessional education where the patient is the teacher who improves patient care outcomes.

    Science.gov (United States)

    Fiddes, P J; Brooks, P M; Komesaroff, P

    2013-07-01

    The patient's role as the key to medical student education was enunciated by Osler in 1903 and remains central to the broader imperative of interprofessional education. Interprofessional education needs to progress from the patient's passive bedside or office role to assume a more active and primary role by his/her participation as the teacher, immersed in student education. To date, the achievements in interprofessional education have been limited, but ambulatory patient-centred learning opportunities involving direct student to patient dialogues and mixed health professional student engagement with patients as teachers are emerging within various interprofessional student clinic formats. There is good evidence that such approaches lead to actual improvements in patient outcomes. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

  19. Using Experience-Based Design to Improve the Care Experience for Patients With Pancreatic Cancer.

    Science.gov (United States)

    Hagensen, Ann; London, Amy E; Phillips, Jennifer J; Helton, W Scott; Picozzi, Vincent J; Blackmore, C Craig

    2016-12-01

    Despite the importance of the patient care experience to quality and outcome, the literature detailing the care experience in patients with pancreatic cancer is limited. To elicit the experience of patients with pancreatic cancer for care redesign, we deployed experience-based design, an emerging methodology based on identification of events of high emotional content, known as touch points, to delineate qualitatively what matters most to patients and families. We defined touch points through direct observations, interviews, and a focus group. We then used experience questionnaires to measure emotional content and develop an experience map to graphically display the fluctuating emotional journey through the care processes. Study subjects were patients with pancreatic cancer who were cared for at Virginia Mason Medical Center, family caregivers, and staff. Redesign was initiated through an all-day improvement event in September 2013. During 2013 and 2014, we cared for 485 new patients with pancreatic cancer, the majority of whom had local disease at diagnosis. The response rate for the experience questionnaire was 23% (117 of 500 questionnaires distributed). The experience-based design results were often contrary to staff preconceptions of the care experience for patients with pancreatic cancer, and contributed to redesign in three key areas: understanding and documenting patient goals and values, providing better resources for caregivers/families, and improving care coordination and support services. Experience-based design enabled us to understand the care experience and associated emotional content for patients with pancreatic cancer and their caregivers. This knowledge then supported care redesign targeted at areas of high negative emotional content.

  20. Patient and provider attitudes to emergency department-based HIV counselling and testing in South Africa.

    Science.gov (United States)

    Hansoti, Bhakti; Hill, Sarah E; Whalen, Madeleine; Stead, David; Parrish, Andy; Rothman, Richard; Hsieh, Yu-Hsiang; Quinn, Thomas C

    2017-01-01

    The national South African HIV Counselling and Testing (HCT) guidelines mandate that voluntary counselling and testing (VCT) should be offered in all healthcare facilities. Emergency departments (EDs) are at the forefront of many healthcare facilities, yet VCT is not routinely implemented in this setting. We conducted a cross-sectional study that surveyed patients and healthcare providers at a tertiary care ED in the spring and summer of 2016 to ascertain their attitudes to VCT in the ED. We also used two previously validated survey instruments to gather data on patients' HIV knowledge and providers' stigma against patients living with HIV, as we anticipated that these may have an impact on providers' and patients' attitudes to the provision of HIV testing within the ED, and may offer insights for future intervention development. A total of 104 patients and 26 providers were enrolled in the study. Overall, patients responded more favourably to ED-based HIV testing (92.3%) compared to providers (only 40% responded favourably). When asked about potential barriers to receiving or providing HIV testing, 16.4% of patients and 24% of providers felt that the subject of HIV was too sensitive and 58.7% of patients and 80% of providers indicated that privacy and confidentiality issues would pose major barriers to implementing ED-based HIV testing. This study shows that while ED-based HIV testing is overall highly acceptable to patients, providers seem less willing to provide this service. The survey data also suggest that future development of ED-based testing strategies should take into consideration privacy and confidentiality concerns that may arise within a busy emergency care setting. Furthermore, every effort should be made to tackle HIV stigma among providers to improve overall attitudes towards HIV-positive individuals that present for care in the ED.

  1. Single-Dose Lignocaine-Based Blood Cardioplegia in Single Valve Replacement Patients

    Directory of Open Access Journals (Sweden)

    Jaydip Ramani

    Full Text Available Abstract OBJECTIVE: Myocardial protection is the most important in cardiac surgery. We compared our modified single-dose long-acting lignocaine-based blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in patients undergoing single valve replacement. METHODS: A total of 110 patients who underwent single (aortic or mitral valve replacement surgery were enrolled. Patients were divided in two groups based on the cardioplegia solution used. In group 1 (56 patients, long-acting lignocaine based-blood cardioplegia solution was administered as a single dose while in group 2 (54 patients, standard St Thomas IB (short-acting blood-based cardioplegia solution was administered and repeated every 20 minutes. All the patients were compared for preoperative baseline parameters, intraoperative and all the postoperative parameters. RESULTS: We did not find any statistically significant difference in preoperative baseline parameters. Cardiopulmonary bypass time were 73.8±16.5 and 76.4±16.9 minutes (P=0.43 and cross clamp time were 58.9±10.3 and 66.3±11.2 minutes (P=0.23 in group 1 and group 2, respectively. Mean of maximum inotrope score was 6.3±2.52 and 6.1±2.13 (P=0.65 in group 1 and group 2, respectively. We also did not find any statistically significant difference in creatine-phosphokinase-MB (CPK-MB, Troponin-I levels, lactate level and cardiac functions postoperatively. CONCLUSION: This study proves the safety and efficacy of long-acting lignocaine-based single-dose blood cardioplegia compared to the standard short-acting multi-dose blood cardioplegia in patients requiring the single valve replacement. Further studies need to be undertaken to establish this non-inferiority in situations of complex cardiac procedures especially in compromised patients.

  2. Patient-based estimation of organ dose for a population of 58 adult patients across 13 protocol categories

    International Nuclear Information System (INIS)

    Sahbaee, Pooyan; Segars, W. Paul; Samei, Ehsan

    2014-01-01

    Purpose: This study aimed to provide a comprehensive patient-specific organ dose estimation across a multiplicity of computed tomography (CT) examination protocols. Methods: A validated Monte Carlo program was employed to model a common CT system (LightSpeed VCT, GE Healthcare). The organ and effective doses were estimated from 13 commonly used body and neurological CT examination. The dose estimation was performed on 58 adult computational extended cardiac-torso phantoms (35 male, 23 female, mean age 51.5 years, mean weight 80.2 kg). The organ dose normalized by CTDI vol (h factor) and effective dose normalized by the dose length product (DLP) (k factor) were calculated from the results. A mathematical model was derived for the correlation between the h and k factors with the patient size across the protocols. Based on this mathematical model, a dose estimation iPhone operating system application was designed and developed to be used as a tool to estimate dose to the patients for a variety of routinely used CT examinations. Results: The organ dose results across all the protocols showed an exponential decrease with patient body size. The correlation was generally strong for the organs which were fully or partially located inside the scan coverage (Pearson sample correlation coefficient (r) of 0.49). The correlation was weaker for organs outside the scan coverage for which distance between the organ and the irradiation area was a stronger predictor of dose to the organ. For body protocols, the effective dose before and after normalization by DLP decreased exponentially with increasing patient's body diameter (r > 0.85). The exponential relationship between effective dose and patient's body diameter was significantly weaker for neurological protocols (r < 0.41), where the trunk length was a slightly stronger predictor of effective dose (0.15 < r < 0.46). Conclusions: While the most accurate estimation of a patient dose requires specific modeling of the

  3. A technology-based quality innovation to identify undiagnosed hypertension among active primary care patients.

    Science.gov (United States)

    Rakotz, Michael K; Ewigman, Bernard G; Sarav, Menaka; Ross, Ruth E; Robicsek, Ari; Konchak, Chad W; Gavagan, Thomas F; Baker, David W; Hyman, David J; Anderson, Kenneth P; Masi, Christopher M

    2014-07-01

    The goal of this study was to develop a technology-based strategy to identify patients with undiagnosed hypertension in 23 primary care practices and integrate this innovation into a continuous quality improvement initiative in a large, integrated health system. In phase 1, we reviewed electronic health records (EHRs) using algorithms designed to identify patients at risk for undiagnosed hypertension. We then invited each at-risk patient to complete an automated office blood pressure (AOBP) protocol. In phase 2, we instituted a quality improvement process that included regular physician feedback and office-based computer alerts to evaluate at-risk patients not screened in phase 1. Study patients were observed for 24 additional months to determine rates of diagnostic resolution. Of the 1,432 patients targeted for inclusion in the study, 475 completed the AOBP protocol during the 6 months of phase 1. Of the 1,033 at-risk patients who remained active during phase 2, 740 (72%) were classified by the end of the follow-up period: 361 had hypertension diagnosed, 290 had either white-coat hypertension, prehypertension, or elevated blood pressure diagnosed, and 89 had normal blood pressure. By the end of the follow-up period, 293 patients (28%) had not been classified and remained at risk for undiagnosed hypertension. Our technology-based innovation identified a large number of patients at risk for undiagnosed hypertension and successfully classified the majority, including many with hypertension. This innovation has been implemented as an ongoing quality improvement initiative in our medical group and continues to improve the accuracy of diagnosis of hypertension among primary care patients. © 2014 Annals of Family Medicine, Inc.

  4. Multi-criterial patient positioning based on dose recalculation on scatter-corrected CBCT images.

    Science.gov (United States)

    Hofmaier, Jan; Haehnle, Jonas; Kurz, Christopher; Landry, Guillaume; Maihoefer, Cornelius; Schüttrumpf, Lars; Süss, Philipp; Teichert, Katrin; Söhn, Matthias; Spahr, Nadine; Brachmann, Christoph; Weiler, Florian; Thieke, Christian; Küfer, Karl-Heinz; Belka, Claus; Parodi, Katia; Kamp, Florian

    2017-12-01

    Our aim was to evaluate the feasibility and potential advantages of dose guided patient positioning based on dose recalculation on scatter corrected cone beam computed tomography (CBCT) image data. A scatter correction approach has been employed to enable dose calculations on CBCT images. A recently proposed tool for interactive multicriterial dose-guided patient positioning which uses interpolation between pre-calculated sample doses has been utilized. The workflow was retrospectively evaluated for two head and neck patients with a total of 39 CBCTs. Dose-volume histogram (DVH) parameters were compared to rigid image registration based isocenter corrections (clinical scenario). The accuracy of the dose interpolation was found sufficient, facilitating the implementation of dose guided patient positioning. Compared to the clinical scenario, the mean dose to the parotid glands could be improved for 2 out of 5 fractions for the first patient while other parameters were preserved. For the second patient, the mean coverage over all fractions of the high dose PTV could be improved by 4%. For this patient, coverage improvements had to be traded against organ at risk (OAR) doses within their clinical tolerance limits. Dose guided patient positioning using in-room CBCT data is feasible and offers increased control over target coverage and doses to OARs. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Feasibility and impact of telemonitor-based depression care management for geriatric homecare patients.

    Science.gov (United States)

    Sheeran, Thomas; Rabinowitz, Terry; Lotterman, Jennifer; Reilly, Catherine F; Brown, Suzanne; Donehower, Patricia; Ellsworth, Elizabeth; Amour, Judith L; Bruce, Martha L

    2011-10-01

    The objective of this study was to test the feasibility, acceptability, and preliminary clinical outcomes of a method to leverage existing home healthcare telemonitoring technology to deliver depression care management (DCM) to both Spanish- and English-speaking elderly homebound recipients of homecare services. Three stand-alone, nonprofit community homecare agencies located in New York, Vermont, and Miami participated in this study. Evidence-based DCM was adapted to the telemonitor platform by programming questions and educational information on depression symptoms, antidepressant adherence, and side effects. Recruited patients participated for a minimum of 3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. On-site trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol. An ethnically diverse sample of 48 English- and Spanish-only-speaking patients participated, along with seven telehealth nurses. Both patients and telehealth nurses reported high levels of protocol acceptance. Among 19 patients meeting diagnostic criteria for major depression, the mean depression severity was in the "markedly severe" range at baseline and in the "mild" range at follow-up. Results of this pilot support the feasibility of using homecare's existing telemonitoring technology to deliver DCM to their elderly homebound patients. This was true for both English- and Spanish-speaking patients. Preliminary clinical outcomes suggest improvement in depression severity, although these findings require testing in a randomized clinical trial. Implications for the science and service of telehealth-based depression care for elderly patients are discussed.

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

    Directory of Open Access Journals (Sweden)

    Abdul Muhith

    2017-04-01

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

  7. Advances in Audio-Based Systems to Monitor Patient Adherence and Inhaler Drug Delivery.

    Science.gov (United States)

    Taylor, Terence E; Zigel, Yaniv; De Looze, Céline; Sulaiman, Imran; Costello, Richard W; Reilly, Richard B

    2018-03-01

    Hundreds of millions of people worldwide have asthma and COPD. Current medications to control these chronic respiratory diseases can be administered using inhaler devices, such as the pressurized metered dose inhaler and the dry powder inhaler. Provided that they are used as prescribed, inhalers can improve patient clinical outcomes and quality of life. Poor patient inhaler adherence (both time of use and user technique) is, however, a major clinical concern and is associated with poor disease control, increased hospital admissions, and increased mortality rates, particularly in low- and middle-income countries. There are currently limited methods available to health-care professionals to objectively and remotely monitor patient inhaler adherence. This review describes recent sensor-based technologies that use audio-based approaches that show promising opportunities for monitoring inhaler adherence in clinical practice. This review discusses how one form of sensor-based technology, audio-based monitoring systems, can provide clinically pertinent information regarding patient inhaler use over the course of treatment. Audio-based monitoring can provide health-care professionals with quantitative measurements of the drug delivery of inhalers, signifying a clear clinical advantage over other methods of assessment. Furthermore, objective audio-based adherence measures can improve the predictability of patient outcomes to treatment compared with current standard methods of adherence assessment used in clinical practice. Objective feedback on patient inhaler adherence can be used to personalize treatment to the patient, which may enhance precision medicine in the treatment of chronic respiratory diseases. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  8. Patient Satisfaction With an Early Smartphone-Based Cosmetic Surgery Postoperative Follow-Up.

    Science.gov (United States)

    Pozza, Edoardo Dalla; D'Souza, Gehaan F; DeLeonibus, Anthony; Fabiani, Brianna; Gharb, Bahar Bassiri; Zins, James E

    2017-12-13

    While prevalent in everyday life, smartphones are also finding increasing use as a medical care adjunct. The use of smartphone technology as a postoperative cosmetic surgery adjunct for care has received little attention in the literature. The purpose of this effort was to assess the potential efficacy of a smartphone-based cosmetic surgery early postoperative follow-up program. Specifically, could smartphone photography provided by the patient to the plastic surgeon in the first few days after surgery allay patient's concerns, improve the postoperative experience and, possibly, detect early complications? From August 2015 to March 2016 a smartphone-based postoperative protocol was established for patients undergoing cosmetic procedures. At the time of discharge, the plastic surgeon sent a text to the patient with instructions for the patient to forward a postoperative photograph of the operated area within 48 to 72 hours. The plastic surgeon then made a return call/text that same day to review the patient's progress. A postoperative questionnaire evaluated the patients' postoperative experience and satisfaction with the program. A total of 57 patients were included in the study. Fifty-two patients responded to the survey. A total of 50 (96.2%) patients reported that the process improved the quality of their postoperative experience. The protocol allowed to detect early complications in 3 cases. The physician was able to address and treat the complications the following day prior to the scheduled clinic follow up. The smartphone can be effectively utilized by the surgeon to both enhance the patient's postoperative experience and alert the surgeon to early postoperative problems. 4. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  9. Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters.

    Science.gov (United States)

    Chang, Ching-Sheng; Chen, Su-Yueh; Lan, Yi-Ting

    2013-01-16

    Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling) statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients' perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients' overall satisfaction in two ways: (A) interpersonal-based medical service encounter directly affects patient satisfaction, which represents a

  10. Dyadic psychological intervention for patients with cancer and caregivers in home-based specialized palliative care

    DEFF Research Database (Denmark)

    von Heymann-Horan, Annika Berglind; Puggaard, Louise B; Nissen, Kathrine G

    2018-01-01

    and psychological interventions offered according to need. Its main limitation was a lack of an intervention for other family members. SIGNIFICANCE OF RESULTS: Our results show that psychological intervention can be systematically integrated into SPC and that it appears feasible to provide dyadic needs......OBJECTIVE: Patients with incurable cancer and their informal caregivers have numerous psychological and psychosocial needs. Many of these patients wish to receive their care and die at home. Few home-based specialized palliative care (SPC) interventions systematically integrate psychological...... support. We present a psychological intervention for patient-caregiver dyads developed for an ongoing randomized controlled trial (RCT) of home-based SPC, known as Domus, as well as the results of an assessment of its acceptability and feasibility. METHOD: The Domus model of SPC for patients...

  11. Classification of iRBD and Parkinson's disease patients based on eye movements during sleep

    DEFF Research Database (Denmark)

    Christensen, Julie Anja Engelhard; Koch, Henriette; Frandsen, Rune

    2013-01-01

    suffering from iRBD or PD based on features reflecting eye movements (EMs) during sleep. A Latent Dirichlet Allocation (LDA) topic model was developed based on features extracted from two electrooculographic (EOG) signals measured as parts in full night polysomnographic (PSG) recordings from ten control......Patients suffering from the sleep disorder idiopathic rapid-eye-movement sleep behavior disorder (iRBD) have been observed to be in high risk of developing Parkinson's disease (PD). This makes it essential to analyze them in the search for PD biomarkers. This study aims at classifying patients...... subjects. The trained model was tested on ten other control subjects, ten iRBD patients and ten PD patients, obtaining a EM topic mixture diagram for each subject in the test dataset. Three features were extracted from the topic mixture diagrams, reflecting “certainty”, “fragmentation” and “stability...

  12. [Efficacy of health education on patients with hip replacement based on the Internet].

    Science.gov (United States)

    Zhou, Yang; Yang, Tubao; Li, Yinglan; Yu, Jie; Zeng, Biyun

    2015-03-01

    To evaluate the efficacy of health education on patients with hip replacement based on the Internet, and to establish a new health education model through modern technology. A total of 300 patients with hip replacement from March to August, 2015 were enrolled in this study. The participants were divided into a control group and an experimental group according to months surgeries performed. Traditional education was applied in the control group while the multimedia source material plus the Internet platform of Joint Registration System were applied in the experimental group. Levels of anxiety, degree of satisfaction, and postoperative complications were analyzed. The levels of knowledge, attitude and behavior compliance in the patients of the experimental group were significantly improved, while the levels of postoperative anxiety were decreased compared with those in the control group (PEducation based on the Internet platform of Joint Registration System and the computer video could improve patients' knowledge, attitude, and behavior, which is worthy of clinical spread.

  13. Morphometric changes of whole brain in patients with alcohol addiction: a voxel-based morphometry study

    International Nuclear Information System (INIS)

    Li Jinfeng; Chen Zhiye; Ma Lin

    2011-01-01

    Objective: To evaluate morphometric changes of brain in patients with alcohol addiction by voxel-based morphometry. Methods: Fifteen patients with alcohol addiction and 15 health controls were recruited and underwent fluid attenuated inversion recovery (FLAIR) and 3D fast spoiled gradient echo (FSPGR) T 1 -weighted sequences on a 3.0 T MRI system. 3D FSPGR T 1 structure images were normalized, segmented and smoothed, and then underwent voxel-based morphometry. An ANCOVA was applied with age, body mass index (BMI), and education years as covariates because of exact sex match. A statistical threshold of P 0.05). Conclusions: Regional gray and white matter atrophy can be the initial changes in patients with alcohol addiction and the frontal region is a relative specific damaged brain region. VBM has a potential value for the detection of subtle brain atrophy in patients with alcohol addiction. (authors)

  14. An empirically based conceptual framework for fostering meaningful patient engagement in research.

    Science.gov (United States)

    Hamilton, Clayon B; Hoens, Alison M; Backman, Catherine L; McKinnon, Annette M; McQuitty, Shanon; English, Kelly; Li, Linda C

    2018-02-01

    Patient engagement in research (PEIR) is promoted to improve the relevance and quality of health research, but has little conceptualization derived from empirical data. To address this issue, we sought to develop an empirically based conceptual framework for meaningful PEIR founded on a patient perspective. We conducted a qualitative secondary analysis of in-depth interviews with 18 patient research partners from a research centre-affiliated patient advisory board. Data analysis involved three phases: identifying the themes, developing a framework and confirming the framework. We coded and organized the data, and abstracted, illustrated, described and explored the emergent themes using thematic analysis. Directed content analysis was conducted to derive concepts from 18 publications related to PEIR to supplement, confirm or refute, and extend the emergent conceptual framework. The framework was reviewed by four patient research partners on our research team. Participants' experiences of working with researchers were generally positive. Eight themes emerged: procedural requirements, convenience, contributions, support, team interaction, research environment, feel valued and benefits. These themes were interconnected and formed a conceptual framework to explain the phenomenon of meaningful PEIR from a patient perspective. This framework, the PEIR Framework, was endorsed by the patient research partners on our team. The PEIR Framework provides guidance on aspects of PEIR to address for meaningful PEIR. It could be particularly useful when patient-researcher partnerships are led by researchers with little experience of engaging patients in research. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  15. Assessing Motor Fluctuations in Parkinson's Disease Patients Based on a Single Inertial Sensor.

    Science.gov (United States)

    Pérez-López, Carlos; Samà, Albert; Rodríguez-Martín, Daniel; Català, Andreu; Cabestany, Joan; Moreno-Arostegui, Juan Manuel; de Mingo, Eva; Rodríguez-Molinero, Alejandro

    2016-12-15

    Altered movement control is typically the first noticeable symptom manifested by Parkinson's disease (PD) patients. Once under treatment, the effect of the medication is very patent and patients often recover correct movement control over several hours. Nonetheless, as the disease advances, patients present motor complications. Obtaining precise information on the long-term evolution of these motor complications and their short-term fluctuations is crucial to provide optimal therapy to PD patients and to properly measure the outcome of clinical trials. This paper presents an algorithm based on the accelerometer signals provided by a waist sensor that has been validated in the automatic assessment of patient's motor fluctuations (ON and OFF motor states) during their activities of daily living. A total of 15 patients have participated in the experiments in ambulatory conditions during 1 to 3 days. The state recognised by the algorithm and the motor state annotated by patients in standard diaries are contrasted. Results show that the average specificity and sensitivity are higher than 90%, while their values are higher than 80% of all patients, thereby showing that PD motor status is able to be monitored through a single sensor during daily life of patients in a precise and objective way.

  16. Web-Based Predictive Analytics to Improve Patient Flow in the Emergency Department

    Science.gov (United States)

    Buckler, David L.

    2012-01-01

    The Emergency Department (ED) simulation project was established to demonstrate how requirements-driven analysis and process simulation can help improve the quality of patient care for the Veterans Health Administration's (VHA) Veterans Affairs Medical Centers (VAMC). This project developed a web-based simulation prototype of patient flow in EDs, validated the performance of the simulation against operational data, and documented IT requirements for the ED simulation.

  17. Randomized clinical trial of Appendicitis Inflammatory Response score-based management of patients with suspected appendicitis.

    Science.gov (United States)

    Andersson, M; Kolodziej, B; Andersson, R E

    2017-10-01

    The role of imaging in the diagnosis of appendicitis is controversial. This prospective interventional study and nested randomized trial analysed the impact of implementing a risk stratification algorithm based on the Appendicitis Inflammatory Response (AIR) score, and compared routine imaging with selective imaging after clinical reassessment. Patients presenting with suspicion of appendicitis between September 2009 and January 2012 from age 10 years were included at 21 emergency surgical centres and from age 5 years at three university paediatric centres. Registration of clinical characteristics, treatments and outcomes started during the baseline period. The AIR score-based algorithm was implemented during the intervention period. Intermediate-risk patients were randomized to routine imaging or selective imaging after clinical reassessment. The baseline period included 1152 patients, and the intervention period 2639, of whom 1068 intermediate-risk patients were randomized. In low-risk patients, use of the AIR score-based algorithm resulted in less imaging (19·2 versus 34·5 per cent; P appendicitis (6·8 versus 9·7 per cent; P = 0·034). Intermediate-risk patients randomized to the imaging and observation groups had the same proportion of negative appendicectomies (6·4 versus 6·7 per cent respectively; P = 0·884), number of admissions, number of perforations and length of hospital stay, but routine imaging was associated with an increased proportion of patients treated for appendicitis (53·4 versus 46·3 per cent; P = 0·020). AIR score-based risk classification can safely reduce the use of diagnostic imaging and hospital admissions in patients with suspicion of appendicitis. Registration number: NCT00971438 ( http://www.clinicaltrials.gov). © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  18. Patient Safety in Guideline-Based Decision Support for Hypertension Management: ATHENA DSS

    OpenAIRE

    Goldstein, M. K.; Hoffman, B. B.; Coleman, R. W.; Tu, S. W.; Shankar, R. D.; O’Connor, M.; Martins, S.; Advani, A.; Musen, M. A.

    2002-01-01

    The Institute of Medicine recently issued a landmark report on medical error.1 In the penumbra of this report, every aspect of health care is subject to new scrutiny regarding patient safety. Informatics technology can support patient safety by correcting problems inherent in older technology; however, new information technology can also contribute to new sources of error. We report here a categorization of possible errors that may arise in deploying a system designed to give guideline-based ...

  19. Patient safety in guideline-based decision support for hypertension management: ATHENA DSS.

    OpenAIRE

    Goldstein, M. K.; Hoffman, B. B.; Coleman, R. W.; Tu, S. W.; Shankar, R. D.; O'Connor, M.; Martins, S.; Martins, S.; Advani, A.; Musen, M. A.

    2001-01-01

    The Institute of Medicine recently issued a landmark report on medical error.1 In the penumbra of this report, every aspect of health care is subject to new scrutiny regarding patient safety. Informatics technology can support patient safety by correcting problems inherent in older technology; however, new information technology can also contribute to new sources of error. We report here a categorization of possible errors that may arise in deploying a system designed to give guideline-based ...

  20. Web-Based Cognitive Behavioral Therapy for Female Patients With Eating Disorders: Randomized Controlled Trial

    OpenAIRE

    ter Huurne, E.D.; de Haan, H.A.; Postel, Marloes Gerda; van der Palen, Jacobus Adrianus Maria; VanDerNagel, Joanneke E.L.; de Jong, Cor A.J.

    2015-01-01

    Background Many patients with eating disorders do not receive help for their symptoms, even though these disorders have severe morbidity. The Internet may offer alternative low-threshold treatment interventions. Objective This study evaluated the effects of a Web-based cognitive behavioral therapy (CBT) intervention using intensive asynchronous therapeutic support to improve eating disorder psychopathology, and to reduce body dissatisfaction and related health problems among patients with eat...

  1. What Do Stroke Patients Look for in Game-Based Rehabilitation: A Survey Study.

    Science.gov (United States)

    Hung, Ya-Xuan; Huang, Pei-Chen; Chen, Kuan-Ta; Chu, Woei-Chyn

    2016-03-01

    Stroke is one of the most common causes of physical disability, and early, intensive, and repetitive rehabilitation exercises are crucial to the recovery of stroke survivors. Unfortunately, research shows that only one third of stroke patients actually perform recommended exercises at home, because of the repetitive and mundane nature of conventional rehabilitation exercises. Thus, to motivate stroke survivors to engage in monotonous rehabilitation is a significant issue in the therapy process. Game-based rehabilitation systems have the potential to encourage patients continuing rehabilitation exercises at home. However, these systems are still rarely adopted at patients' places. Discovering and eliminating the obstacles in promoting game-based rehabilitation at home is therefore essential. For this purpose, we conducted a study to collect and analyze the opinions and expectations of stroke patients and clinical therapists. The study is composed of 2 parts: Rehab-preference survey - interviews to both patients and therapists to understand the current practices, challenges, and expectations on game-based rehabilitation systems; and Rehab-compatibility survey - a gaming experiment with therapists to elaborate what commercial games are compatible with rehabilitation. The study is conducted with 30 outpatients with stroke and 19 occupational therapists from 2 rehabilitation centers in Taiwan. Our surveys show that game-based rehabilitation systems can turn the rehabilitation exercises more appealing and provide personalized motivation for various stroke patients. Patients prefer to perform rehabilitation exercises with more diverse and fun games, and need cost-effective rehabilitation systems, which are often built on commodity hardware. Our study also sheds light on incorporating the existing design-for-fun games into rehabilitation system. We envision the results are helpful in developing a platform which enables rehab-compatible (i.e., existing, appropriately

  2. Effectiveness of antihypertensive therapy based on arresting of specific features in psychosomatic patients

    Directory of Open Access Journals (Sweden)

    G. A. Usenko

    2013-01-01

    Full Text Available In contrast to the empirical therapy, 18month antihypertensive therapy based on administration of adrenoblockers to the patients with the sympathetic division activity (cholerics and sanguinics, and the angiotensinconverting enzyme activity in the patients with renninangiotensinaldosterone system due parasimpatikotonii (phlegmatics and melancholics combined with the alignment of values of the studied parameters with those in healthy individuals of the same temperament.

  3. Comparative economic evaluation of home-based and hospital-based palliative care for terminal cancer patients.

    Science.gov (United States)

    Kato, Koki; Fukuda, Haruhisa

    2017-11-01

    To quantify the difference between adjusted costs for home-based palliative care and hospital-based palliative care in terminally ill cancer patients. We carried out a case-control study of home-care patients (cases) who had died at home between January 2009 and December 2013, and hospital-care patients (controls) who had died at a hospital between April 2008 and December 2013. Data on patient characteristics were obtained from insurance claims data and medical records. We identified the determinants of home care using a multivariate logistic regression analysis. Cox proportional hazards analysis was used to examine treatment duration in both types of care, and a generalized linear model was used to estimate the reduction in treatment costs associated with home care. The case and control groups comprised 48 and 99 patients, respectively. Home care was associated with one or more person(s) living with the patient (adjusted OR 6.54, 95% CI 1.18-36.05), required assistance for activities of daily living (adjusted OR 3.61, 95% CI 1.12-10.51), non-use of oxygen inhalation therapy (adjusted OR 12.75, 95% CI 3.53-46.02), oral or suppository opioid use (adjusted OR 5.74, 95% CI 1.11-29.54) and transdermal patch opioid use (adjusted OR 8.30, 95% CI 1.97-34.93). The adjusted hazard ratio of home care for treatment duration was not significant (adjusted OR 0.95, 95% CI 0.59-1.53). However, home care was significantly associated with a reduction of $7523 (95% CI $7093-7991, P = 0.015) in treatment costs. Despite similar treatment durations between the groups, treatment costs were substantially lower in the home-care group. These findings might inform the policymaking process for improving the home-care support system. Geriatr Gerontol Int 2017; 17: 2247-2254. © 2017 Japan Geriatrics Society.

  4. 3D fluoroscopic image estimation using patient-specific 4DCBCT-based motion models

    International Nuclear Information System (INIS)

    Dhou, S; Hurwitz, M; Cai, W; Rottmann, J; Williams, C; Wagar, M; Berbeco, R; Lewis, J H; Mishra, P; Li, R; Ionascu, D

    2015-01-01

    3D fluoroscopic images represent volumetric patient anatomy during treatment with high spatial and temporal resolution. 3D fluoroscopic images estimated using motion models built using 4DCT images, taken days or weeks prior to treatment, do not reliably represent patient anatomy during treatment. In this study we developed and performed initial evaluation of techniques to develop patient-specific motion models from 4D cone-beam CT (4DCBCT) images, taken immediately before treatment, and used these models to estimate 3D fluoroscopic images based on 2D kV projections captured during treatment. We evaluate the accuracy of 3D fluoroscopic images by comparison to ground truth digital and physical phantom images. The performance of 4DCBCT-based and 4DCT-based motion models are compared in simulated clinical situations representing tumor baseline shift or initial patient positioning errors. The results of this study demonstrate the ability for 4DCBCT imaging to generate motion models that can account for changes that cannot be accounted for with 4DCT-based motion models. When simulating tumor baseline shift and patient positioning errors of up to 5 mm, the average tumor localization error and the 95th percentile error in six datasets were 1.20 and 2.2 mm, respectively, for 4DCBCT-based motion models. 4DCT-based motion models applied to the same six datasets resulted in average tumor localization error and the 95th percentile error of 4.18 and 5.4 mm, respectively. Analysis of voxel-wise intensity differences was also conducted for all experiments. In summary, this study demonstrates the feasibility of 4DCBCT-based 3D fluoroscopic image generation in digital and physical phantoms and shows the potential advantage of 4DCBCT-based 3D fluoroscopic image estimation when there are changes in anatomy between the time of 4DCT imaging and the time of treatment delivery. (paper)

  5. Prevention of blood transfusion with intravenous iron in gynecologic cancer patients receiving platinum-based chemotherapy.

    Science.gov (United States)

    Athibovonsuk, Punnada; Manchana, Tarinee; Sirisabya, Nakarin

    2013-12-01

    To compare the efficacy of intravenous iron and oral iron for prevention of blood transfusions in gynecologic cancer patients receiving platinum-based chemotherapy. Sixty-four non anemic gynecologic cancer patients receiving adjuvant platinum-based chemotherapy were stratified and randomized according to baseline hemoglobin levels and chemotherapy regimen. The study group received 200mg of intravenous iron sucrose immediately after each chemotherapy infusion. The control group received oral ferrous fumarate at a dose of 200mg three times a day. Complete blood count was monitored before each chemotherapy infusion. Blood transfusions were given if hemoglobin level was below 10mg/dl. There were 32 patients in each group. No significant differences in baseline hemoglobin levels and baseline characteristics were demonstrated between both groups. Nine patients (28.1%) in the study group and 18 patients (56.3%) in the control group required blood transfusion through 6 cycles of chemotherapy (p=0.02). Fewer median number of total packed red cell units were required in the study group compared to the control group (0 and 0.5 unit, respectively, p=0.04). Serious adverse events and hypersensitivity reactions were not reported. However, constipation was significantly higher in the control group (3.1% and 40.6%, p=gynecologic cancer patients receiving platinum-based chemotherapy, associated with less constipation than the oral formulation. © 2013 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    En-Chi Chiu

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

  7. A target based approach identifies genomic predictors of breast cancer patient response to chemotherapy

    Directory of Open Access Journals (Sweden)

    Hallett Robin M

    2012-05-01

    Full Text Available Abstract Background The efficacy of chemotherapy regimens in breast cancer patients is variable and unpredictable. Whether individual patients either achieve long-term remission or suffer recurrence after therapy may be dictated by intrinsic properties of their breast tumors including genetic lesions and consequent aberrant transcriptional programs. Global gene expression profiling provides a powerful tool to identify such tumor-intrinsic transcriptional programs, whose analyses provide insight into the underlying biology of individual patient tumors. For example, multi-gene expression signatures have been identified that can predict the likelihood of disease reccurrence, and thus guide patient prognosis. Whereas such prognostic signatures are being introduced in the clinical setting, similar signatures that predict sensitivity or resistance to chemotherapy are not currently clinically available. Methods We used gene expression profiling to identify genes that were co-expressed with genes whose transcripts encode the protein targets of commonly used chemotherapeutic agents. Results Here, we present target based expression indices that predict breast tumor response to anthracycline and taxane based chemotherapy. Indeed, these signatures were independently predictive of chemotherapy response after adjusting for standard clinic-pathological variables such as age, grade, and estrogen receptor status in a cohort of 488 breast cancer patients treated with adriamycin and taxotere/taxol. Conclusions Importantly, our findings suggest the practicality of developing target based indices that predict response to therapeutics, as well as highlight the possibility of using gene signatures to guide the use of chemotherapy during treatment of breast cancer patients.

  8. What's in a Name? Health Care Providers' Perceptions of Pediatric Pain Patients Based on Diagnostic Labels.

    Science.gov (United States)

    Betsch, Taylor A; Gorodzinsky, Ayala Y; Finley, G A; Sangster, Michael; Chorney, Jill

    2017-08-01

    Diagnostic labels can help patients better understand their symptoms and can influence providers' treatment planning and patient interactions. Recurrent pain is common in childhood; however, there are various diagnostic labels used. The objective of this study was to evaluate the influence of diagnostic labels on pediatric health care providers' perceptions of pediatric chronic pain patients. Using an online survey, providers were randomly assigned to 1 of 2 vignette conditions (differing only in diagnostic label provided) and completed questionnaires about their perceptions of the vignette patient. Responses from 58 participants were analyzed. The 2 groups, based on diagnostic conditions used (fibromyalgia and chronic widespread pain) did not differ significantly on general demographics and health care providers' perceptions of the patient. Perceived origin of the pain influenced providers' perceptions; pain of a perceived medical origin was negatively correlated with stigmatization and positively correlated with sympathy. Perceived psychological origin was positively correlated with stigmatization and providers' age. Health care providers' perceptions of children's pain are more likely influenced by the presumed etiology rather than the diagnostic label used. Pain believed to be more medically based was associated with more positive reactions from providers (ie, less stigmatization). Older providers in particular perceived the patient more negatively if they believe the pain to be psychologically based. The findings of this pediatric study replicated findings from adult literature on chronic pain, suggesting that children and adults are subject to negative perceptions from health care providers when the providers believe the pain to be psychological in origin.

  9. Effect of behavioral stage-based nutrition education on management of osteodystrophy among hemodialysis patients, Lebanon.

    Science.gov (United States)

    Karavetian, Mirey; de Vries, Nanne; Elzein, Hafez; Rizk, Rana; Bechwaty, Fida

    2015-09-01

    Assess the effect of intensive nutrition education by trained dedicated dietitians on osteodystrophy management among hemodialysis patients. Randomized controlled trial in 12 hospital-based hemodialysis units equally distributed over clusters 1 and 2. Cluster 1 patients were either assigned to usual care (n=96) or to individualized intensive staged-based nutrition education by a dedicated renal dietitian (n=88). Cluster 2 patients (n=210) received nutrition education from general hospital dietitians, educating their patients at their spare time from hospital duties. Main outcomes were: (1) dietary knowledge(%), (2) behavioral change, (3) serum phosphorus (mmol/L), each measured at T0 (baseline), T1 (post 6 month intervention) and T2 (post 6 month follow up). Significant improvement was found only among patients receiving intensive education from a dedicated dietitian at T1; the change regressed at T2 without statistical significance: knowledge (T0: 40.3; T1: 64; T2: 63) and serum phosphorus (T0: 1.79; T1: 1.65; T2: 1.70); behavioral stages changed significantly throughout the study (T0: Preparation, T1: Action, T2: Preparation). The intensive protocol showed to be the most effective. Integrating dedicated dietitians and stage-based education in hemodialysis units may improve the nutritional management of patients in Lebanon and countries with similar health care systems. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Primary care office-based buprenorphine treatment: comparison of heroin and prescription opioid dependent patients.

    Science.gov (United States)

    Moore, Brent A; Fiellin, David A; Barry, Declan T; Sullivan, Lynn E; Chawarski, Marek C; O'Connor, Patrick G; Schottenfeld, Richard S

    2007-04-01

    Prescription opioid dependence is increasing, but treatment outcomes with office-based buprenorphine/naloxone among these patients have not been described. We compared demographic, clinical characteristics and treatment outcomes among 200 patients evaluated for entry into a trial of primary care office-based buprenorphine/naloxone treatment stratifying on those who reported exclusive heroin use (n = 124), heroin and prescription opioid use (n = 47), or only prescription opioid use (n = 29). Compared to heroin-only patients, prescription-opioid-only patients were younger, had fewer years of opioid use, and less drug treatment history. They were also more likely to be white, earned more income, and were less likely to have Hepatitis C antibodies. Prescription-opioid-only patients were more likely to complete treatment (59% vs. 30%), remained in treatment longer (21.0 vs. 14.2 weeks), and had a higher percent of opioid-negative urine samples than heroin only patients (56.3% vs. 39.8%), all p values buprenorphine/naloxone maintenance in an office-based setting compared to those who exclusively or episodically use heroin.

  11. Missed strokes using computed tomography imaging in patients with vertigo: population-based cohort study.

    Science.gov (United States)

    Grewal, Keerat; Austin, Peter C; Kapral, Moira K; Lu, Hong; Atzema, Clare L

    2015-01-01

    The purpose of this study was to determine the proportion of emergency department (ED) patients with a diagnosis of peripheral vertigo who received computed tomography (CT) head imaging in the ED and to examine whether strokes were missed using CT imaging. This population-based retrospective cohort study assessed patients who were discharged from an ED in Ontario, Canada, with a diagnosis of peripheral vertigo, April 2006 to March 2011. Patients who received CT imaging (exposed) were matched by propensity score methods to patients who did not (unexposed). If performed, CT imaging was presumed to be negative for stroke because brain stem/cerebellar stroke would result in hospitalization. We compared the incidence of stroke within 30, 90, and 365 days subsequent to ED discharge between groups, to determine whether the exposed group had a higher frequency of early strokes than the matched unexposed group. Among 41 794 qualifying patients, 8596 (20.6%) received ED head CT imaging, and 99.8% of these patients were able to be matched to a control. Among exposed patients, 25 (0.29%) were hospitalized for stroke within 30 days when compared with 11 (0.13%) among matched nonexposed patients. The relative risk of a 30- and 90-day stroke among exposed versus unexposed patients was 2.27 (95% confidence interval, 1.12-4.62) and 1.94 (95% confidence interval, 1.10-3.43), respectively. There was no difference between groups at 1 year. Strokes occurred at a median of 32.0 days (interquartile range, 4.0-33.0 days) in exposed patients, compared with 105 days (interquartile range, 11.5-204.5) in unexposed patients. One fifth of patients diagnosed with peripheral vertigo in Ontario received imaging that is not recommended in guidelines, and that imaging was associated with missed strokes. © 2014 American Heart Association, Inc.

  12. Autoimmune and immunogenetic profile of patients with optic neuritis in a population-based cohort

    DEFF Research Database (Denmark)

    Soelberg, K.; Nilsson, A. C.; Nielsen, C.

    2018-01-01

    Background: Optic neuritis (ON) is an inflammatory optic neuropathy, where the genetic and autoimmune dependency remains poorly characterized. Objective: To investigate autoimmune and immunogenetic aspects of ON. Method: In a prospective population-based cohort 51 patients with ON were included....... At follow up 20 patients had progressed to multiple sclerosis (MS-ON). All patients were screened for neuronal and systemic autoantibodies. HLA genotypes and allele and genotype frequencies of the PTPN22 C1858T and the PD-1.3 single-nucleotide polymorphisms (SNPs) were determined and compared to a cohort...

  13. Attitudes of heart failure patients and health care providers towards mobile phone-based remote monitoring.

    Science.gov (United States)

    Seto, Emily; Leonard, Kevin J; Masino, Caterina; Cafazzo, Joseph A; Barnsley, Jan; Ross, Heather J

    2010-11-29

    Mobile phone-based remote patient monitoring systems have been proposed for heart failure management because they are relatively inexpensive and enable patients to be monitored anywhere. However, little is known about whether patients and their health care providers are willing and able to use this technology. The objective of our study was to assess the attitudes of heart failure patients and their health care providers from a heart function clinic in a large urban teaching hospital toward the use of mobile phone-based remote monitoring. A questionnaire regarding attitudes toward home monitoring and technology was administered to 100 heart failure patients (94/100 returned a completed questionnaire). Semi-structured interviews were also conducted with 20 heart failure patients and 16 clinicians to determine the perceived benefits and barriers to using mobile phone-based remote monitoring, as well as their willingness and ability to use the technology. The survey results indicated that the patients were very comfortable using mobile phones (mean rating 4.5, SD 0.6, on a five-point Likert scale), even more so than with using computers (mean 4.1, SD 1.1). The difference in comfort level between mobile phones and computers was statistically significant (Pmobile phones to view health information (mean 4.4, SD 0.9). Patients and clinicians were willing to use the system as long as several conditions were met, including providing a system that was easy to use with clear tangible benefits, maintaining good patient-provider communication, and not increasing clinical workload. Clinicians cited several barriers to implementation of such a system, including lack of remuneration for telephone interactions with patients and medicolegal implications. Patients and clinicians want to use mobile phone-based remote monitoring and believe that they would be able to use the technology. However, they have several reservations, such as potential increased clinical workload, medicolegal

  14. Celiac Disease and Drug-Based Therapies: Inquiry into Patients Demands.

    Science.gov (United States)

    Branchi, Federica; Tomba, Carolina; Ferretti, Francesca; Norsa, Lorenzo; Roncoroni, Leda; Bardella, Maria Teresa; Conte, Dario; Elli, Luca

    2016-01-01

    Medical research is looking for alternative drug-based options to the gluten-free diet (GFD) for celiac disease. We aimed at evaluating the need for alternative therapies perceived by celiac patients. During the 2013 meeting of the Lombardy section of the Italian Celiac Patients Association, adult subjects were invited to fill in a questionnaire investigating their clinical profile in relation to compliance to the diet, quality of life (QOL) as well as their opinion on alternative therapies. Three hundred and seventy two patients (76 m, mean age 41.7 ± 13.9 years) completed the questionnaire. Patients reported a significant improvement in health status (HS) and QOL after the diet was started (p < 0.001). The GFD was accepted by 88% patients, but the need for alternative therapies was reported by 65%. Subjects expressing the need for a drug-based therapy showed a lower increase in QOL (p = 0.003) and HS (p = 0.005) on GFD. The preferred option for an alternative therapy was the use of enzymes (145 subjects), followed by a vaccine (111 subjects). The GFD is favorably accepted by most celiac patients. Nevertheless, a proportion of patients pronounce themselves in favor of the development of alternative drugs. © 2016 S. Karger AG, Basel.

  15. The effect of weight-based chemotherapy dosing in a cohort of gynecologic oncology patients.

    Science.gov (United States)

    Hansen, Jean; Stephan, Jean-Marie; Freesmeier, Michele; Bender, David; Button, Anna; Goodheart, Michael J

    2015-07-01

    Many clinicians limit chemotherapy doses based on a maximum body surface area (BSA) of 2m(2). We sought to determine how chemotherapy-related toxicities compared between groups of patients that varied with respect to BSA. We hypothesized that obese patients receiving weight-based (WB) dosing would not have significantly higher chemotherapy-related toxicities than control groups. We performed a retrospective review of patients with BSA≥2m(2) who received WB chemotherapy for a gynecologic cancer between January and August 2013. Subjects were matched with two controls: patients with BSAGynecologic cancer patients with BSA≥2m(2) treated with WB chemotherapy had no increase in hematologic or non-hematologic toxicities when compared to controls. Consideration should be given to using WB dosing in obese patients with gynecologic malignancies. Further investigation is required to determine the effect of WB dosing on progression-free and overall survival in obese gynecologic cancer patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Doctors' recognition and management of melanoma patients' risk: An Australian population-based study.

    Science.gov (United States)

    Madronio, C M; Armstrong, B K; Watts, C G; Goumas, C; Morton, R L; Curtin, A; Menzies, S W; Mann, G J; Thompson, J F; Cust, A E

    2016-12-01

    Guidelines recommend that health professionals identify and manage individuals at high risk of developing melanoma, but there is limited population-based evidence demonstrating real-world practices. A population-based, observational study was conducted in the state of New South Wales, Australia to determine doctors' knowledge of melanoma patients' risk and to identify factors associated with better identification and clinical management. Data were analysed for 1889 patients with invasive, localised melanoma in the Melanoma Patterns of Care study. This study collected data on all melanoma diagnoses notified to the state's cancer registry during a 12-month period from 2006 to 2007, as well as questionnaire data from the doctors involved in their care. Three-quarters (74%) of patients had doctors who were aware of their risk factor status with respect to personal and family history of melanoma and the presence of many moles. Doctors working in general practice, skin cancer clinics and dermatology settings had better knowledge of patients' risk factors than plastic surgeons. Doctors were 15% more likely to know the family history of younger melanoma patients (risk status, by doctors practising in plastic surgery, dermatology and skin cancer clinic settings, and by female doctors. Both patient-related and doctor-related factors were associated with doctors' recognition and management of melanoma patients' risk and could be the focus of strategies for improving care. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. iPad-based patient briefing for radiological examinations-a clinical trial.

    Science.gov (United States)

    Schlechtweg, Philipp M; Hammon, Matthias; Giese, David; Heberlein, Christian; Uder, Michael; Schwab, Siegfried A

    2014-08-01

    To analyze if an iPad-based patient briefing can serve as a digital alternative to conventional documentations prior to radiological examinations. One hundred one patients referred for routine MRI were randomized into two groups, who underwent iPad-based and classic written briefing in opposite order. For each briefing completion time, completeness and correctness were noted. Patient's knowledge about the content of either briefing modality was subsequently tested. The influence of patient-related factors on the performance of the electronic briefing (EB) was analyzed. Finally, the patient's subjective impression of the EB was assessed. The mean durations were 4.4 ± 2.2 min for EB and 1.7 ± 1.3 min for the classic briefing (p iPad briefings were returned entirely filled out, whereas 11 % of the classic forms were returned with missing data. No significant differences in memorization of the briefing's information were objectified. There was a positive correlation between the duration of EB and age (r = 0.53; p iPads transfers the information for the patients equally well compared to the classic written approach. Although iPad briefing took patients longer to perform, the majority would prefer it to written consent briefings in the future. Nevertheless, measures have to be undertaken to improve the overall acceptance and performance.

  18. Patient-specific port placement for laparoscopic surgery using atlas-based registration

    Science.gov (United States)

    Enquobahrie, Andinet; Shivaprabhu, Vikas; Aylward, Stephen; Finet, Julien; Cleary, Kevin; Alterovitz, Ron

    2013-03-01

    Laparoscopic surgery is a minimally invasive surgical approach, in which abdominal surgical procedures are performed through trocars via small incisions. Patients benefit by reduced postoperative pain, shortened hospital stays, improved cosmetic results, and faster recovery times. Optimal port placement can improve surgeon dexterity and avoid the need to move the trocars, which would cause unnecessary trauma to the patient. We are building an intuitive open source visualization system to help surgeons identify ports. Our methodology is based on an intuitive port placement visualization module and atlas-based registration algorithm to transfer port locations to individual patients. The methodology follows three steps:1) Use a port placement visualization module to manually place ports in an abdominal organ atlas. This step generates port-augmented abdominal atlas. This is done only once for a given patient population. 2) Register the atlas data with the patient CT data, to transfer the prescribed ports to the individual patient 3) Review and adjust the transferred port locations using the port placement visualization module. Tool maneuverability and target reachability can be tested using the visualization system. Our methodology would decrease the amount of physician input necessary to optimize port placement for each patient case. In a follow up work, we plan to use the transferred ports as starting point for further optimization of the port locations by formulating a cost function that will take into account factors such as tool dexterity and likelihood of collision between instruments.

  19. A pharmacy-based medication reconciliation and review program in hemodialysis patients: a prospective study

    Directory of Open Access Journals (Sweden)

    Patricia NJ

    2016-09-01

    Full Text Available Background: Hemodialysis (HD patients are on multiple medications, see many prescribers and have many hospitalizations which put them at risk for medication record discrepancies and medication related problems (MRP. Being able to effectively identify and reconcile these medication issues is crucial in reducing hospitalizations, morbidities, and mortalities. The care of the hemodialysis patients can be enhanced by incorporating a pharmacist into the interprofessional team. There is little data in the literature on medication record discrepancies and MRP’s in dialysis patients. Objective: The objectives of this research were to determine the types of medication discrepancies and MRPs in dialysis patients and if recommendations for changes based on these findings were accepted by providers. Methods: Patients were asked to bring medications to the dialysis unit for review. Discrepancy and MRP recommendations were communicated to the unit staff via written progress notes. A follow-up was performed an average of 33 days later to determine if the recommendations were accepted. Results: Overall, in 93 unique patients, 376 discrepancies (3.1 per patient and 64 MRPs (0.5 per patient were identified. The most common type of discrepancy and MRP was drug omission and indication without drug, respectively. Of the total 440 interventions, 77% were ultimately accepted. Discrepancies were more likely to be accepted as compared to MRPs (85% vs. 27%, respectively. Conclusion: Medication record discrepancies and MRPs are common in dialysis patients. Recommendations related to discrepancies were more likely to be accepted by the providers as compared to MRPs. Medication records became inaccurate within 12 months. A pharmacy-based medication reconciliation and review program may have an important impact on the care of hemodialysis patients.

  20. Treating homeless opioid dependent patients with buprenorphine in an office-based setting.

    Science.gov (United States)

    Alford, Daniel P; LaBelle, Colleen T; Richardson, Jessica M; O'Connell, James J; Hohl, Carole A; Cheng, Debbie M; Samet, Jeffrey H

    2007-02-01

    Although office-based opioid treatment with buprenorphine (OBOT-B) has been successfully implemented in primary care settings in the US, its use has not been reported in homeless patients. To characterize the feasibility of OBOT-B in homeless relative to housed patients. A retrospective record review examining treatment failure, drug use, utilization of substance abuse treatment services, and intensity of clinical support by a nurse care manager (NCM) among homeless and housed patients in an OBOT-B program between August 2003 and October 2004. Treatment failure was defined as elopement before completing medication induction, discharge after medication induction due to ongoing drug use with concurrent nonadherence with intensified treatment, or discharge due to disruptive behavior. Of 44 homeless and 41 housed patients enrolled over 12 months, homeless patients were more likely to be older, nonwhite, unemployed, infected with HIV and hepatitis C, and report a psychiatric illness. Homeless patients had fewer social supports and more chronic substance abuse histories with a 3- to 6-fold greater number of years of drug use, number of detoxification attempts and percentage with a history of methadone maintenance treatment. The proportion of subjects with treatment failure for the homeless (21%) and housed (22%) did not differ (P = .94). At 12 months, both groups had similar proportions with illicit opioid use [Odds ratio (OR), 0.9 (95% CI, 0.5-1.7) P = .8], utilization of counseling (homeless, 46%; housed, 49%; P = .95), and participation in mutual-help groups (homeless, 25%; housed, 29%; P = .96). At 12 months, 36% of the homeless group was no longer homeless. During the first month of treatment, homeless patients required more clinical support from the NCM than housed patients. Despite homeless opioid dependent patients' social instability, greater comorbidities, and more chronic drug use, office-based opioid treatment with buprenorphine was effectively implemented in

  1. Optimizing psychosocial support during office-based buprenorphine treatment in primary care: Patients' experiences and preferences.

    Science.gov (United States)

    Fox, Aaron D; Masyukova, Mariya; Cunningham, Chinazo O

    2016-01-01

    Buprenorphine maintenance treatment is effective and has been successfully integrated into human immunodeficiency virus (HIV) and primary care settings. However, one key barrier to providers prescribing buprenorphine is their perception that they are unable to provide adequate counseling or psychosocial support to patients with opioid addiction. This qualitative study investigated supportive elements of office-based buprenorphine treatment that patients perceived to be most valuable. The authors conducted five focus groups with 33 buprenorphine treatment-experienced participants. Focus groups were audio-recorded and transcribed. Iterative readings of transcripts and grounded theory analysis revealed common themes. Overall, participants perceived that buprenorphine treatment helped them to achieve their treatment goals and valued the flexibility, accessibility, and privacy of treatment. Participants identified interpersonal and structural elements of buprenorphine treatment that provided psychosocial support. Participants desired good physician-patient relationships, but also valued care delivery models that were patient-centered, created a safe place for self-disclosure, and utilized coordinated team-based care. Participants derived psychosocial support from their prescribing physician, but were also open to collaborative or team-based models of care, as long as they were voluntary and confidential. Buprenorphine-prescribing physicians without access to referral options for psychosocial counseling could focus on maintaining nonjudgmental attitudes and shared decision-making during patient encounters. Adding structure and psychosocial support to buprenorphine treatment through coordinated team-based care also seems to have great promise.

  2. NURSING CARE KNOWLEDGE MANAGEMENT BASED TRAINING DECREASE NOSOCOMIAL INFECTION INCIDEN IN POST SECTIO CESAREA PATIENTS

    Directory of Open Access Journals (Sweden)

    Ahsan Ahsan

    2017-04-01

    Full Text Available Introduction: Model of nursing care based on knowledge management can reduce the incidence of nosocomial infections through the performance of nurses in the prevention of infection. Nursing care based on knowledge management is established from identi fi cation knowledge which is required, prevention performance of nosocomial infections post caesarean section. Nosocomial infections component consists of wound culture result. Method: This study was an observational study with a quasy experimental design. The population were all of nursing staff who working in obstetrics installation and a number of patients who is treated in hospitals A and B post sectio caesarea. Sample is comparised a total population all the nursing staff who worked in obstetrics installation according to criteria of the sample, and most of patients were taken care by nursing staff post caesarean section which is taken by random sampling 15 patients. Data was collected through observation sheets and examination of the wound culture. Data analysis which is used the t test. Result: The result was showed that there was signi fi cant difference in the incidence of nosocomial infection in patients with post sesctio caesarea in hospital before and after nursing care training based on knowledge management (tvalue = 2.316 and p = 0.028 < α = 0.05 level, and the incidence of nosocomial infection was lower after training than before training. Discussion: It can be concluded that training knowledge management based on nursing care effectives to reduce Incidence of Nosocomial Infections in Patients after Sectio Caesarea.

  3. Comparison of cardiovascular risk factors in maintenance hemodialysis patients based on phase angle of bioimpedance analysis

    Science.gov (United States)

    Muzasti, R. A.; Lubis, H. R.

    2018-03-01

    Mortality and morbidity rate, especially from cardiovascular disease in hemodialysis patients in Indonesia is still quite high. One of indicator to assess the predictive value of mortality is the phase angle (PhA) of bioimpedance analysis (BIA) scan examination. Determining the comparison of BMI and laboratory data as cardiovascular risk factors in hemodialysis patients based on PhA.A cross-sectional analytical study was done on 155 outpatientsin RasyidaRenal Hospital, Medan in 2016. Patients were two groups, namely PhAgroup and ≥ 4 group. The comparison of BMI and laboratory data based on PhA were by analyzingthe independent T-test. A P-value age 40-59 years (56.1%). Based on PhA, 56.7% patients have PhA ≥4. There are differences in the profile of age (p: 0.01), BMI (p: 0.028) and hemoglobin (p: 0.00) between two groups, but not in the profile of albumin (p: 0.071), total cholesterol (p: 0.65), HDL (p: 0.06), LDL (p: 0.07), triglyceride (p: 0.87), calcium (p: 0.59) and phosphorus (p: 0.17).Based onPhA, the cardiovascular risk factors of hemodialysis patients were determined by age, BMI, and hemoglobin.

  4. Knowledge-based immunosuppressive therapy for kidney transplant patients--from theoretical model to clinical integration.

    Science.gov (United States)

    Seeling, Walter; Plischke, Max; de Bruin, Jeroen S; Schuh, Christian

    2015-01-01

    Immunosuppressive therapy is a risky necessity after a patient received a kidney transplant. To reduce risks, a knowledge-based system was developed that determines the right dosage of the immunosuppresive agent Tacrolimus. A theoretical model, to classify medication blood levels as well as medication adaptions, was created using data from almost 500 patients, and over 13.000 examinations. This model was then translated into an Arden Syntax knowledge base, and integrated directly into the hospital information system of the Vienna General Hospital. In this paper we give an overview of the construction and integration of such a system.

  5. Web-Based Tools for Text-Based Patient-Provider Communication in Chronic Conditions: Scoping Review.

    Science.gov (United States)

    Voruganti, Teja; Grunfeld, Eva; Makuwaza, Tutsirai; Bender, Jacqueline L

    2017-10-27

    Patients with chronic conditions require ongoing care which not only necessitates support from health care providers outside appointments but also self-management. Web-based tools for text-based patient-provider communication, such as secure messaging, allow for sharing of contextual information and personal narrative in a simple accessible medium, empowering patients and enabling their providers to address emerging care needs. The objectives of this study were to (1) conduct a systematic search of the published literature and the Internet for Web-based tools for text-based communication between patients and providers; (2) map tool characteristics, their intended use, contexts in which they were used, and by whom; (3) describe the nature of their evaluation; and (4) understand the terminology used to describe the tools. We conducted a scoping review using the MEDLINE (Medical Literature Analysis and Retrieval System Online) and EMBASE (Excerpta Medica Database) databases. We summarized information on the characteristics of the tools (structure, functions, and communication paradigm), intended use, context and users, evaluation (study design and outcomes), and terminology. We performed a parallel search of the Internet to compare with tools identified in the published literature. We identified 54 papers describing 47 unique tools from 13 countries studied in the context of 68 chronic health conditions. The majority of tools (77%, 36/47) had functions in addition to communication (eg, viewable care plan, symptom diary, or tracker). Eight tools (17%, 8/47) were described as allowing patients to communicate with the team or multiple health care providers. Most of the tools were intended to support communication regarding symptom reporting (49%, 23/47), and lifestyle or behavior modification (36%, 17/47). The type of health care providers who used tools to communicate with patients were predominantly allied health professionals of various disciplines (30%, 14

  6. Meta-analysis of cell-based CaRdiac stUdiEs (ACCRUE) in patients with acute myocardial infarction based on individual patient data

    DEFF Research Database (Denmark)

    Gyöngyösi, Mariann; Wojakowski, Wojciech; Lemarchand, Patricia

    2015-01-01

    RATIONALE: The meta-Analysis of Cell-based CaRdiac study is the first prospectively declared collaborative multinational database, including individual data of patients with ischemic heart disease treated with cell therapy. OBJECTIVE: We analyzed the safety and efficacy of intracoronary cell...... therapy after acute myocardial infarction (AMI), including individual patient data from 12 randomized trials (ASTAMI, Aalst, BOOST, BONAMI, CADUCEUS, FINCELL, REGENT, REPAIR-AMI, SCAMI, SWISS-AMI, TIME, LATE-TIME; n=1252). METHODS AND RESULTS: The primary end point was freedom from combined major adverse...... cardiac and cerebrovascular events (including all-cause death, AMI recurrance, stroke, and target vessel revascularization). The secondary end point was freedom from hard clinical end points (death, AMI recurrence, or stroke), assessed with random-effects meta-analyses and Cox regressions for interactions...

  7. 3D fluoroscopic image estimation using patient-specific 4DCBCT-based motion models

    Science.gov (United States)

    Dhou, Salam; Hurwitz, Martina; Mishra, Pankaj; Cai, Weixing; Rottmann, Joerg; Li, Ruijiang; Williams, Christopher; Wagar, Matthew; Berbeco, Ross; Ionascu, Dan; Lewis, John H.

    2015-01-01

    3D fluoroscopic images represent volumetric patient anatomy during treatment with high spatial and temporal resolution. 3D fluoroscopic images estimated using motion models built using 4DCT images, taken days or weeks prior to treatment, do not reliably represent patient anatomy during treatment. In this study we develop and perform initial evaluation of techniques to develop patient-specific motion models from 4D cone-beam CT (4DCBCT) images, taken immediately before treatment, and use these models to estimate 3D fluoroscopic images based on 2D kV projections captured during treatment. We evaluate the accuracy of 3D fluoroscopic images by comparing to ground truth digital and physical phantom images. The performance of 4DCBCT- and 4DCT- based motion models are compared in simulated clinical situations representing tumor baseline shift or initial patient positioning errors. The results of this study demonstrate the ability for 4DCBCT imaging to generate motion models that can account for changes that cannot be accounted for with 4DCT-based motion models. When simulating tumor baseline shift and patient positioning errors of up to 5 mm, the average tumor localization error and the 95th percentile error in six datasets were 1.20 and 2.2 mm, respectively, for 4DCBCT-based motion models. 4DCT-based motion models applied to the same six datasets resulted in average tumor localization error and the 95th percentile error of 4.18 and 5.4 mm, respectively. Analysis of voxel-wise intensity differences was also conducted for all experiments. In summary, this study demonstrates the feasibility of 4DCBCT-based 3D fluoroscopic image generation in digital and physical phantoms, and shows the potential advantage of 4DCBCT-based 3D fluoroscopic image estimation when there are changes in anatomy between the time of 4DCT imaging and the time of treatment delivery. PMID:25905722

  8. Impact of gender on patient preferences for technology-based behavioral interventions.

    Science.gov (United States)

    Kim, David J; Choo, Esther K; Ranney, Megan L

    2014-08-01

    Technology-based interventions offer an opportunity to address high-risk behaviors in the emergency department (ED). Prior studies suggest behavioral health strategies are more effective when gender differences are considered. However, the role of gender in ED patient preferences for technology-based interventions has not been examined. The objective was to assess whether patient preferences for technology-based interventions varies by gender. This was a secondary analysis of data from a systematic survey of adult (≥18 years of age), English-speaking patients in a large urban academic ED. Subjects were randomly selected during a purposive sample of shifts. The iPad survey included questions on access to technology, preferences for receiving health information, and demographics. We defined "technology-based" as web, text message, e-mail, social networking, or DVD; "non-technology-based" was defined as in-person, written materials, or landline. We calculated descriptive statistics and used univariate tests to compare men and women. Gender-stratified multivariable logistic regression models were used to examine associations between other demographic factors (age, race, ethnicity, income) and technology-based preferences for information on specific risky behaviors. Of 417 participants, 45.1% were male. There were no significant demographic differences between men and women. Women were more likely to use computers (90.8% versus 81.9%; p=0.03), Internet (66.8% versus 59.0%; p=0.03), and social networks (53.3% versus 42.6%; p=0.01). 89% of men and 90% of women preferred technology-based formats for at least type of health information; interest in technology-based for individual health topics did not vary by gender. Concern about confidentiality was the most common barrier to technology-based use for both genders. Multivariate analysis showed that for smoking, depression, drug/alcohol use, and injury prevention, gender modified the relationship between other demographic

  9. Clinical Pathways and the Patient Perspective in the Pursuit of Value-Based Oncology Care.

    Science.gov (United States)

    Ersek, Jennifer L; Nadler, Eric; Freeman-Daily, Janet; Mazharuddin, Samir; Kim, Edward S

    2017-01-01

    The art of practicing oncology has evolved substantially in the past 5 years. As more and more diagnostic tests, biomarker-directed therapies, and immunotherapies make their way to the oncology marketplace, oncologists will find it increasingly difficult to keep up with the many therapeutic options. Additionally, the cost of cancer care seems to be increasing. Clinical pathways are a systematic way to organize and display detailed, evidence-based treatment options and assist the practitioner with best practice. When selecting which treatment regimens to include on a clinical pathway, considerations must include the efficacy and safety, as well as costs, of the therapy. Pathway treatment regimens must be continually assessed and modified to ensure that the most up-to-date, high-quality options are incorporated. Value-based models, such as the ASCO Value Framework, can assist providers in presenting economic evaluations of clinical pathway treatment options to patients, thus allowing the patient to decide the overall value of each treatment regimen. Although oncologists and pathway developers can decide which treatment regimens to include on a clinical pathway based on the efficacy of the treatment, assessment of the value of that treatment regimen ultimately lies with the patient. Patient definitions of value will be an important component to enhancing current value-based oncology care models and incorporating new, high-quality, value-based therapeutics into oncology clinical pathways.

  10. Teamwork in skull base surgery: An avenue for improvement in patient care.

    Science.gov (United States)

    McLaughlin, Nancy; Carrau, Ricardo L; Kelly, Daniel F; Prevedello, Daniel M; Kassam, Amin B

    2013-01-01

    During the past several decades, numerous centers have acquired significant expertise in the treatment of skull base pathologies. Favorable outcomes are not only due to meticulous surgical planning and execution, but they are also related to the collaborative efforts of multiple disciplines. We review the impact of teamwork on patient care, elaborate on the key processes for successful teamwork, and discuss its challenges. Pubmed and Medline databases were searched for publications from 1970 to 2012 using the following keywords: "teamwork", "multidisciplinary", "interdisciplinary", "surgery", "skull base", "neurosurgery", "tumor", and "outcome". Current literature testifies to the complexity of establishing and maintaining teamwork. To date, few reports on the impact of teamwork in the management of skull base pathologies have been published. This lack of literature is somewhat surprising given that most patients with skull base pathology receive care from multiple specialists. Common factors for success include a cohesive and well-integrated team structure with well-defined procedural organization. Although a multidisciplinary work force has clear advantages for improving today's quality of care and propelling research efforts for tomorrow's cure, teamwork is not intuitive and requires training, guidance, and executive support. Teamwork is recommended to improve quality over the full cycle of care and consequently patient outcomes. Increased recognition of the value of an integrated team approach for skull base pathologies will hopefully encourage centers, physicians, allied health caregivers, and scientists devoted to treating these patients and advancing the field of knowledge to invest the time, effort, and resources to optimize and organize their collective expertise.

  11. Effect of a Website That Presents Patients' Experiences on Self-Efficacy and Patient Competence of Colorectal Cancer Patients: Web-Based Randomized Controlled Trial.

    Science.gov (United States)

    Giesler, Jürgen M; Keller, Bettina; Repke, Tim; Leonhart, Rainer; Weis, Joachim; Muckelbauer, Rebecca; Rieckmann, Nina; Müller-Nordhorn, Jacqueline; Lucius-Hoene, Gabriele; Holmberg, Christine

    2017-10-13

    Patients often seek other patients' experiences with the disease. The Internet provides a wide range of opportunities to share and learn about other people's health and illness experiences via blogs or patient-initiated online discussion groups. There also exists a range of medical information devices that include experiential patient information. However, there are serious concerns about the use of such experiential information because narratives of others may be powerful and pervasive tools that may hinder informed decision making. The international research network DIPEx (Database of Individual Patients' Experiences) aims to provide scientifically based online information on people's experiences with health and illness to fulfill patients' needs for experiential information, while ensuring that the presented information includes a wide variety of possible experiences. The aim is to evaluate the colorectal cancer module of the German DIPEx website krankheitserfahrungen.de with regard to self-efficacy for coping with cancer and patient competence. In 2015, a Web-based randomized controlled trial was conducted using a two-group between-subjects design and repeated measures. The study sample consisted of individuals who had been diagnosed with colorectal cancer within the past 3 years or who had metastasis or recurrent disease. Outcome measures included self-efficacy for coping with cancer and patient competence. Participants were randomly assigned to either an intervention group that had immediate access to the colorectal cancer module for 2 weeks or to a waiting list control group. Outcome criteria were measured at baseline before randomization and at 2 weeks and 6 weeks. The study randomized 212 persons. On average, participants were 54 (SD 11.1) years old, 58.8% (124/211) were female, and 73.6% (156/212) had read or heard stories of other patients online before entering the study, thus excluding any influence of the colorectal cancer module on

  12. [Development and evaluation of a dance-based exercise therapy for patients with haemophilia].

    Science.gov (United States)

    Czepa, D; van Ravenstein, S; Stäuber, F; Hilberg, T

    2013-01-01

    So far, the use of methods derived from creative arts has not been considered in the haemophilia treatment. The AIM was to investigate the expectations for a dance-based exercise therapy for patients with haemophilia and the extent of its acceptance. The one-hour dance-based exercise therapy was offered to 30 haemophilia patients (HI30) (49 ± 11, 30-67 years). For the evaluation of expectations, questionnaires were created and filled out by participants before and after the intervention. Additionally, 19 haemophilia patients (HF) and 20 controls without haemophilia (KF) who did not participate in the intervention were also questioned. The RESULTS show that haemophilia patients have more experience in dance than controls (HI30:62%, HF:74%, KF:45%). In contrast, the proportion of those who are currently dancing is higher in controls without haemophilia (HI30: 17%, HF: 10%, KF:26%). The termination of dance activity in patients with haemophilia who were part of the intervention was mainly due to pain (HI30: 40%, HF: 29%, KF: 0%), whereby controls without intervention terminated the dance activity mainly due to lack of time (HI30: 30%, HF: 57%, KF: 56%). Ultimately, 24 out of 30 patients with haemophilia (HI24) completed the intervention. All HI24 met their expectations. 38% felt limited by haemophilia while carrying out the exercises. The majority of the participants were able to follow the exercises well (96%) and were did not overstrain physically (92%) nor mentally (87%), also 79% did not have pain. 23 of HI24 (96%) can envision a continuation of the dance-based exercise therapy. The experience with the dance-based exercise therapy was predominantly positive. It represents an alternative sports therapy programme for patients with haemophilia. Further studies are needed in order to make statements concerning the long-term use of such training.

  13. Patient and provider attitudes to emergency department-based HIV counselling and testing in South Africa

    Directory of Open Access Journals (Sweden)

    Bhakti Hansoti

    2017-05-01

    Full Text Available Background: The national South African HIV Counselling and Testing (HCT guidelines mandate that voluntary counselling and testing (VCT should be offered in all healthcare facilities. Emergency departments (EDs are at the forefront of many healthcare facilities, yet VCT is not routinely implemented in this setting. Methods: We conducted a cross-sectional study that surveyed patients and healthcare providers at a tertiary care ED in the spring and summer of 2016 to ascertain their attitudes to VCT in the ED. We also used two previously validated survey instruments to gather data on patients’ HIV knowledge and providers’ stigma against patients living with HIV, as we anticipated that these may have an impact on providers’ and patients’ attitudes to the provision of HIV testing within the ED, and may offer insights for future intervention development. Results: A total of 104 patients and 26 providers were enrolled in the study. Overall, patients responded more favourably to ED-based HIV testing (92.3% compared to providers (only 40% responded favourably. When asked about potential barriers to receiving or providing HIV testing, 16.4% of patients and 24% of providers felt that the subject of HIV was too sensitive and 58.7% of patients and 80% of providers indicated that privacy and confidentiality issues would pose major barriers to implementing ED-based HIV testing. Conclusion: This study shows that while ED-based HIV testing is overall highly acceptable to patients, providers seem less willing to provide this service. The survey data also suggest that future development of ED-based testing strategies should take into consideration privacy and confidentiality concerns that may arise within a busy emergency care setting. Furthermore, every effort should be made to tackle HIV stigma among providers to improve overall attitudes towards HIV-positive individuals that present for care in the ED.

  14. An Outcome-Based Approach to Assign MELD Exception Points for Patients With Hepatocellular Cancer.

    Science.gov (United States)

    Kensinger, Clark D; Feurer, Irene D; Karp, Seth J

    2017-09-01

    Current Model for End-Stage Liver Disease (MELD) exception points provided to patients with hepatocellular cancer (HCC) are not based on outcome data and advantage these patients compared to those listed based on laboratory values (LABMELD). We sought to develop a data-based assignment for exception points for patients with HCC that equalizes outcomes among HCC and LABMELD patients. We used Scientific Registry of Transplant Recipients data to compare patients listed with HCC who received exception points versus patients listed with LABMELD. Nation- and region-specific data were examined for (1) a composite outcome for adverse events of death, delisting, or becoming ineligible for transplant; and (2) transplant rate. We also determined MELD progression rates for LABMELD patients. Candidates listed with LABMELD scores were compared with those listed with 22 exception points for HCC (HCC22) to determine the LABMELD for which statistical parity was achieved for our composite outcome. HCC22 candidates time to adverse event were comparable to LABMELD scores of 16 (LABMELD16) candidates (range, 15-19), whereas time to transplant was comparable to LABMELD22 candidates (range, 21-23). LABMELD22 candidates had 2.1 times greater risk of adverse event compared with HCC22 (95% confidence interval, 1.9-2.4; range, 1.5-2.4). Progression among LABMELD16 candidates whose scores did not improve was similar across regions and averaged 0.94 points/month (95% confidence interval, 0.88-0.99, range 0.80-1.04). To equalize the occurrence of an adverse outcome, the proper listing MELD for patients with HCC is 16, with approximately 1 additional point/month. These results provide a data-driven algorithm to increase fairness in listing priority.

  15. Atrial Fibrillation in Patients with Transient Ischemic Attack in Accordance with the Tissue-Based Definition.

    Science.gov (United States)

    Scheef, Björn; Al-Khaled, Mohamed

    2016-06-01

    Transient ischemic attack (TIA) management requires a cardiac evaluation with a Holter electrocardiogram (ECG), preferably a long-term (24 h) electrocardiogram (LT-ECG), to detect atrial fibrillation (AF), which places patients at higher risk of cerebrovascular events. The aim of this study was to determine the frequency of AF using ECG and LT-ECG in patients with tissue-based TIA. During a three-year period (starting in 2011), all consecutive patients with tissue-based TIA (no evidence of infarction by brain imaging) were included and prospectively evaluated. Of 861 patients (mean age, 70 ± 13 years; 49.7% women), 854 patients (99.2%) had an ECG at admission, and 338 patients (39.3%) underwent 24-h LT-ECG monitoring during hospitalization. Patients who underwent LT-ECG monitoring were significantly younger (68 vs. 71 years; P=0.001) and experienced longer symptom duration (143 vs. 79 minutes; P=0.024) compared with those who did not. Furthermore, they had lower rates of unilateral weakness (32% vs. 39%; P=0.034) and previous strokes (18% vs. 26%; P=0.007). The LT-ECG investigation was also associated with longer hospitalization (7.9 vs. 5.7 days; Phypertension (OR, 3.1; 95% CI: 1-8.9; P=0.041) and increased glucose level >6.05 mmol/L) on admission (OR, 1.9; 95% CI: 1-3.5; P=0.036). Cardiac evaluation with LT-ECG appears to increase the rate of detected AF and may lead to a change in secondary prophylaxis in patients with tissue-based TIA.

  16. Effectiveness of a home-based physical therapy program in patients with chronic low back pain

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    Elena SÎRBU

    2017-03-01

    Full Text Available Aim: To demonstrate the effectiveness of a home-based physical therapy program on pain, spine mobility and quality of daily activities in patients with chronic low back pain (CLBP. We also want to show that patients who undergo this program decreased their intake in analgesic and anti-inflammatory drugs. Methods: 18 patients with chronic low back pain were assessed with the following tests: VAS pain scale, Schober’s test and Rolland-Morris questionnaire. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAID consumption was recorded. Over a period of six months all subjects participated in a 45 minutes home-based physical therapy program, three times per week. Before starting this intervention all patients were instructed and exercises were demonstrated in front of them by a physical therapist. Moreover, they received written brochures in order to exercise correctly at home. Follow-up examinations took place at baseline and six months later. Results: We obtained significant differences between pre- and post-intervention assessments of pain (p=0.001, lumbar flexion (p=0.0001 and functional status (p=0.0005 in our group. Moreover, the number of patients who were taken analgesics decreased from 7 (39% to 5 patients (28%. Likewise the number of patients who were taken anti-inflammatory drugs decreased from 11 (61% to 8 (44%. Conclusion: The home-based rehabilitation program was effective in improving the ranges of active lumbar flexion and in decreasing the physical disability caused by low back pain, as well as in reducing the levels of pain. We note that a larger number of patients have given up to the intake of NSAIDs comparative to those who have given up to analgesics.

  17. Can a multimedia educational computer-based program on genital herpes teach patients about their disease?

    Science.gov (United States)

    Wald; Stern; Skinner; Beutner; Conant; Tyring; Reitano; Davis

    1998-07-01

    Objective: Education of patients with genital herpes about their disease is time consuming. To evaluate the effectiveness of an educational computer program, we developed a multimedia interactive presentation to teach patients about genital herpes. Such programs can supplement clinician visits for patients with genital herpes, or those at risk for HSV acquisition.Methods: Patients seeking care for genital herpes, or those at risk for HSV acquisition, were asked to participate in the program during routine clinic visits at 5 physician's offices nationwide. A self-administered 7 item herpes knowledge questionnaire was given before and after participation. An additional questionnaire evaluating the satisfaction with the program was also self-administered at completion.Results: 428 patients were enrolled and completed the pre- and post-knowledge questionnaire and 332 patients completed the satisfaction survey. On the pre-test, 20.1% of patients answered all questions correctly, 65.4% answered correctly 4 to 6 questions, and 14.5% 3 or less. On the post-test, 32.9% of patients answered all questions correctly, 61.5% answered correctly 4 to 6 questions, and 5.6% 3 or less (P poor) to 7 (excellent).Conclusion: Computer-based education programs about genital herpes may provide a useful adjunct to teaching in physician offices and result in knowledge gain about the disease, at least short-term. Such programs may assist in management of chronic sexually transmitted infections.

  18. Long-term survival among Hodgkin's lymphoma patients with gastrointestinal cancer: a population-based study

    Science.gov (United States)

    Youn, P.; Li, H.; Milano, M. T.; Stovall, M.; Constine, L. S.; Travis, L. B.

    2013-01-01

    Background The increased risk of gastrointestinal (GI) cancers after Hodgkin's lymphoma (HL) is well established. However, no large population-based study has described the actuarial survival after subsequent GI cancers in HL survivors (HL-GI). Patients and methods For 209 patients with HL-GI cancers (105 colon, 35 stomach, 30 pancreas, 21 rectum, and 18 esophagus) and 484 165 patients with first primary GI cancers (GI-1), actuarial survival was compared, accounting for age, gender, race, GI cancer stage, radiation for HL, and other variables. Results Though survival of HL patients who developed localized stage colon cancer was similar to that of the GI-1 group, overall survival (OS) of HL patients with regional or distant stage colon cancer was reduced [hazard ratio, (HR) = 1.46, P = 0.01]. The HL survivors with regional or distant stage colon cancer in the transverse segment had an especially high risk of mortality (HR: 2.7, P = 0.001 for OS). For localized stomach cancer, OS was inferior among HL survivors (HR = 3.46, P = 0.006). Conclusions The HL patients who develop GI cancer experience significantly reduced survival compared with patients with a first primary GI cancer. Further research is needed to explain the inferior survival of HL patients and to define selection criteria for cancer screening in HL survivors. PMID:22855552

  19. HEAR MAPS a classification for congenital microtia/atresia based on the evaluation of 742 patients.

    Science.gov (United States)

    Roberson, Joseph B; Goldsztein, Hernan; Balaker, Ashley; Schendel, Stephen A; Reinisch, John F

    2013-09-01

    Describe anatomical and radiological findings in 742 patients evaluated for congenital aural atresia and microtia by a multidisciplinary team. Develop a new classification method to enhance multidisciplinary communication regarding patients with congenital aural atresia and microtia. Retrospective chart review with descriptive analysis of findings arising from the evaluation of patients with congenital atresia and microtia between January 2008 and January 2012 at a multidisciplinary tertiary referral center. We developed a classification method based on the acronym HEAR MAPS (Hearing, Ear [microtia], Atresia grade, Remnant earlobe, Mandible development, Asymmetry of soft tissue, Paralysis of the facial nerve and Syndromes). We used this method to evaluate 742 consecutive congenital atresia and microtia patients between 2008 and January of 2012. Grade 3 microtia was the most common external ear malformation (76%). Pre-operative Jahrsdoerfer scale was 9 (19%), 8 (39%), 7 (19%), and 6 or less (22%). Twenty three percent of patients had varying degrees of hypoplasia of the mandible. Less than 10% of patients had an identified associated syndrome. Patients with congenital aural atresia and microtia often require the intervention of audiology, otology, plastic surgery, craniofacial surgery and speech and language professionals to achieve optimal functional and esthetic reconstruction. Good communication between these disciplines is essential for coordination of care. We describe our use of a new classification method that efficiently describes the physical and radiologic findings in microtia/atresia patients to improve communication amongst care providers. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. The design of a theory-based intervention to improve medication adherence in chronic pain patients.

    Science.gov (United States)

    Timmerman, Leon; Stronks, Dirk L; Huygen, Frank J P M

    2017-07-01

    Non-adherence to pain medication is common in chronic pain patients and may result in unfavorable treatment outcomes. Interventions to improve adherence behavior often fail to significantly change medication use. In this report, we describe the application of a theoretical psychological model of behavior change in order to design an intervention to improve medication adherence in chronic pain patients. This study applies the Behavior Change Wheel framework and the Behavior Change Techniques Taxonomy to design a theory-based intervention to improve pain medication use. Available literature was used to extract determinants of adherence in chronic pain patients. Selected target behaviors to improve medication adherence are: share agreement on follow up policy, monitor medication adherence, provide patient education routinely, discuss attitudes and concerns towards pain medication, develop medication taking habits and use medication reminders. The intervention consists of three components in which relevant behavior change techniques are applied: (1) changes in the electronic patient data management systems to enable medical staff to apply target behaviors; (2) bi-annual education of medical staff to commit the team to the proposed intervention and provide feedback; (3) routine and mandatory education of chronic pain patients following prescription of pain medication. To improve medication adherence in chronic pain patients, most interventions should be focused on providers of pain therapy. Prescribing chronic pain medication should be seen as part of a larger treatment regimen including adequate follow-up, adherence monitoring and patient education during the course of treatment.

  1. An Investigation of an RFID-based Patient-tracking and Mobile Alert System

    Directory of Open Access Journals (Sweden)

    C.L. Yeung

    2011-02-01

    Full Text Available In the modern era, patient health is no longer the only concern for hospitals. Hospitals have to bear the responsibility of the patient safety and the patient comfort. However, due to the overcrowded and understaffed clinical areas with complex workflow patterns, there are different forms of medical care errors arisen in the healthcare system. According to recent statistic from World Health Organization, ten of milions of patient around the world are injured or dead every yearas a result of incorrect medical care. Rroughly 10% patients admitted to hospital in developed countries suffered some forms of medical care errors or medical adverse events. It is about 1.4 million of world population.In order to enhance the patient safety and patient comfort in the current medical service system, an RFID‐based Patient Tracking and Mobile Alert System integrated with information communications technology was designed and developed. Apart from identifying different patient’s whereabouts, instant alerts are generated through mobile devices so as to enhance patients’ safety and comfort. With a view of investigating the feasibility of RFID and mobile technology in the healthcare environment, a pilot study was conducted in Mindset Club in the Castle Peak Hospital in Hong Kong.

  2. Wavelet-Based ECG Steganography for Protecting Patient Confidential Information in Point-of-Care Systems.

    Science.gov (United States)

    Ibaida, Ayman; Khalil, Ibrahim

    2013-12-01

    With the growing number of aging population and a significant portion of that suffering from cardiac diseases, it is conceivable that remote ECG patient monitoring systems are expected to be widely used as point-of-care (PoC) applications in hospitals around the world. Therefore, huge amount of ECG signal collected by body sensor networks from remote patients at homes will be transmitted along with other physiological readings such as blood pressure, temperature, glucose level, etc., and diagnosed by those remote patient monitoring systems. It is utterly important that patient confidentiality is protected while data are being transmitted over the public network as well as when they are stored in hospital servers used by remote monitoring systems. In this paper, a wavelet-based steganography technique has been introduced which combines encryption and scrambling technique to protect patient confidential data. The proposed method allows ECG signal to hide its corresponding patient confidential data and other physiological information thus guaranteeing the integration between ECG and the rest. To evaluate the effectiveness of the proposed technique on the ECG signal, two distortion measurement metrics have been used: the percentage residual difference and the wavelet weighted PRD. It is found that the proposed technique provides high-security protection for patients data with low (less than 1%) distortion and ECG data remain diagnosable after watermarking (i.e., hiding patient confidential data) and as well as after watermarks (i.e., hidden data) are removed from the watermarked data.

  3. [Development of Internet-based system to collect and provide drug information for patients/consumers].

    Science.gov (United States)

    Kurimoto, Fuki; Hori, Satoko; Satoh, Hiroki; Miki, Akiko; Sawada, Yasufumi

    2013-01-01

    For drug fostering and evolution, it is important to collect information directly from patients on the efficacy and safety of drugs as well as patient needs. At present, however, information gathered by healthcare professionals, pharmaceutical companies, or governments is not sufficient. There is concern that patients may fail to recognize the importance of providing information voluntarily. The present study was conducted to provide drug information to patients/consumers, to enlighten them on the importance of providing drug information by themselves, and to develop an Internet website, called "Minkusu," for collecting drug information from patients. This website is based on a registration system (free of charge). It is designed to provide information on proper drug use, and to collect opinions about drugs. As of May 31, 2012, a total of 1149 people had been registered. The male/female ratio of registered members was approximately 1:1, and patients/consumers accounted for 23%. According to the results of a questionnaire survey, several patient/consumer members appreciated the usefulness of the information service, and they took an opportunity to know of the concepts of drug development and evolution (Ikuyaku, in Japanese) through the information services provided by this site. In conclusion, the developed information system would contribute to the proper use of drugs by patients/consumers and to the promotion of drug development and evolution.

  4. Delayed diagnosis of aneurysmal subarachnoid hemorrhage in patients: a community-based study.

    Science.gov (United States)

    Inagawa, Tetsuji

    2011-10-01

    A community-based study was conducted to estimate the frequency of and evaluate the clinical features related to delayed diagnosis of aneurysmal subarachnoid hemorrhage (SAH). Between 1980 and 1998, 358 patients with aneurysmal SAH underwent treatment in Izumo, Japan. The diagnosis of SAH was delayed in 76 patients (21%) and was early in 282 (79%). Among the 76 patients whose diagnosis was delayed, the condition was misdiagnosed by clinicians in 46 cases (Subgroup A), and in the remaining 30 the patients were unaware that SAH had occurred and failed to seek prompt treatment (Subgroup B). The proportion of Subgroup A patients decreased significantly from 18% (30 of 170 patients) between 1980 and 1989 to 9% (16 of 188 patients) between 1990 and 1998 (p = 0.0098), whereas the proportion of Subgroup B patients during the same periods was 8% (13 of 170 patients) and 9% (17 of 188 patients), respectively (p = 0.6341). With regard to Subgroup A, the misdiagnosis rate in private clinics decreased from 14% (23 of 170 patients) between 1980 and 1989 to 5% (10 of 188 patients) between 1990 and 1998 (p = 0.0073), whereas the misdiagnosis rate in hospitals during the same periods was 4% (7 of 170 patients) and 3% (6 of 188 patients), respectively (p = 0.6399). Multivariate analysis revealed that World Federation of Neurosurgical Societies Grade I or II was the main risk factor for delayed diagnosis of SAH (OR 3.97 [95% CI 1.69-10.37]), and that the timing of SAH onset, that is, between 12:00 a.m. and 6:00 a.m., was an important reason for the condition in Subgroup B patients (OR 9.29 [95% CI 2.66-33.93]). Rebleeding before admission occurred in 26% of the patients in whom diagnosis was delayed, and in 3% of those who were diagnosed early (p better educated about SAH and the importance of getting prompt medical attention, even in the middle of the night.

  5. Dendritic cell-based immunotherapy targeting Wilms' tumor 1 in patients with recurrent malignant glioma.

    Science.gov (United States)

    Sakai, Keiichi; Shimodaira, Shigetaka; Maejima, Shinya; Udagawa, Nobuyuki; Sano, Kenji; Higuchi, Yumiko; Koya, Terutsugu; Ochiai, Takanaga; Koide, Masanori; Uehara, Shunsuke; Nakamura, Midori; Sugiyama, Haruo; Yonemitsu, Yoshikazu; Okamoto, Masato; Hongo, Kazuhiro

    2015-10-01

    Dendritic cell (DC)-based vaccination is considered a potentially effective therapy against advanced cancer. The authors conducted a Phase I study to investigate the safety and immunomonitoring of Wilms' tumor 1 (WT1)-pulsed DC vaccination therapy for patients with relapsed malignant glioma. WT1-pulsed and/or autologous tumor lysate-pulsed DC vaccination therapy was performed in patients with relapsed malignant gliomas. Approximately 1 × 10(7) to 2 × 10(7) pulsed DCs loaded with WT1 peptide antigen and/or tumor lysate were intradermally injected into the axillary areas with OK-432, a streptococcal preparation, at 2-week intervals for at least 5-7 sessions (1 course) during an individual chemotherapy regimen. Ten patients (3 men, 7 women; age range 24-64 years [median 39 years]) with the following tumors were enrolled: glioblastoma (6), anaplastic astrocytoma (2), anaplastic oligoastrocytoma (1), and anaplastic oligodendroglioma (1). Modified WT1 peptide-pulsed DC vaccine was administered to 7 patients, tumor lysate-pulsed DC vaccine to 2 patients, and both tumor lysate-pulsed and WT1-pulsed DC vaccine to 1 patient. The clinical response was stable disease in 5 patients with WT1-pulsed DC vaccination. In 2 of 5 patients with stable disease, neurological findings improved, and MR images showed tumor shrinkage. No serious adverse events occurred except Grade 1-2 erythema at the injection sites. WT1 tetramer analysis detected WT1-reactive cytotoxic T cells after vaccination in patients treated with WT1-pulsed therapy. Positivity for skin reaction at the injection sites was 80% (8 of 10 patients) after the first session, and positivity remained for these 8 patients after the final session. This study of WT1-pulsed DC vaccination therapy demonstrated safety, immunogenicity, and feasibility in the management of relapsed malignant gliomas.

  6. Uptake of tenofovir-based antiretroviral therapy among HIV-HBV-coinfected patients in the EuroSIDA study

    DEFF Research Database (Denmark)

    Peters, Lars; Mocroft, Amanda; Grint, Daniel

    2018-01-01

    BACKGROUND: According to guidelines all HIV/HBV co-infected patients should receive tenofovir-based combination antiretroviral therapy (cART). We aimed to investigate uptake and outcomes of tenofovir-based cART among HIV/HBV patients in the EuroSIDA study. METHODS: All HBsAg+ patients followed up...

  7. An emergency department patient flow model based on queueing theory principles.

    Science.gov (United States)

    Wiler, Jennifer L; Bolandifar, Ehsan; Griffey, Richard T; Poirier, Robert F; Olsen, Tava

    2013-09-01

    The objective was to derive and validate a novel queuing theory-based model that predicts the effect of various patient crowding scenarios on patient left without being seen (LWBS) rates. Retrospective data were collected from all patient presentations to triage at an urban, academic, adult-only emergency department (ED) with 87,705 visits in calendar year 2008. Data from specific time windows during the day were divided into derivation and validation sets based on odd or even days. Patient records with incomplete time data were excluded. With an established call center queueing model, input variables were modified to adapt this model to the ED setting, while satisfying the underlying assumptions of queueing theory. The primary aim was the derivation and validation of an ED flow model. Chi-square and Student's t-tests were used for model derivation and validation. The secondary aim was estimating the effect of varying ED patient arrival and boarding scenarios on LWBS rates using this model. The assumption of stationarity of the model was validated for three time periods (peak arrival rate = 10:00 a.m. to 12:00 p.m.; a moderate arrival rate = 8:00 a.m. to 10:00 a.m.; and lowest arrival rate = 4:00 a.m. to 6:00 a.m.) and for different days of the week and month. Between 10:00 a.m. and 12:00 p.m., defined as the primary study period representing peak arrivals, 3.9% (n = 4,038) of patients LWBS. Using the derived model, the predicted LWBS rate was 4%. LWBS rates increased as the rate of ED patient arrivals, treatment times, and ED boarding times increased. A 10% increase in hourly ED patient arrivals from the observed average arrival rate increased the predicted LWBS rate to 10.8%; a 10% decrease in hourly ED patient arrivals from the observed average arrival rate predicted a 1.6% LWBS rate. A 30-minute decrease in treatment time from the observed average treatment time predicted a 1.4% LWBS. A 1% increase in patient arrivals has the same effect on LWBS rates as a 1

  8. Initial test of a T9-like P300-based speller by an ALS patient

    Science.gov (United States)

    Ron-Angevin, R.; Varona-Moya, S.; da Silva-Sauer, L.

    2015-08-01

    Objective. Visual P300-based brain-computer interface spellers offer a useful communication channel for locked-in patients, who are completely dependent in their daily lives. One of the research goals for these systems is to achieve greater communication rates by means of modifying some features of their interfaces, e.g., reducing the matrix size. However, such modifications may not work well with disabled end-users, such as patients of amyotrophic lateral sclerosis (ALS), due to a supposed reduction of their cognitive resources. The purpose of the present study was to provide a proof of concept that ALS patients could efficiently use a P300-based speller with a 4 × 3 symbol matrix based on the T9 interface developed for mobile phones. Approach. We conducted an experiment with a sample of 11 able-bodied participants and one locked-in patient with ALS. All participants tested our T9-like visual P300-based speller and also two different 7 × 6 matrix spellers based on Farwell and Donchin’s classic proposal—one of them included a word predictor system like the T9-like speller did. Main results. The performance analyses indicated that the locked-in patient benefited from using a reduced matrix size as much as healthy users did, spelling words almost 1.6 times faster and equally accurately when using the T9-like speller than when using the alternative spellers. Significance. Due to counting on only one locked-in patient, the current work constitutes a feasibility study. The actual usability of systems such as the one proposed in this paper should be determined by means of studies with a greater number of end-users in real-life conditions.

  9. A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis

    DEFF Research Database (Denmark)

    Lund, Hans; Weile, Ulla; Christensen, Robin

    2008-01-01

    reported adverse events (i.e. discomfort) in land-based exercise, while only 3 reported adverse events in the aquatic exercise. CONCLUSION: Only land-based exercise showed some improvement in pain and muscle strength compared with the control group, while no clinical benefits were detectable after aquatic......OBJECTIVE: To compare the efficacy of aquatic exercise and a land-based exercise programme vs control in patients with knee osteoarthritis. METHODS: Primary outcome was change in pain, and in addition Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS). Standing balance and strength...... was also measured after and at 3-month follow-up. Seventy-nine patients (62 women), with a mean age of 68 years (age range 40-89 years) were randomized to aquatic exercise (n = 27), land-based exercise (n = 25) or control (n = 27). RESULTS: No effect was observed immediately after exercise cessation (8...

  10. Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters

    Directory of Open Access Journals (Sweden)

    Chang Ching-Sheng

    2013-01-01

    Full Text Available Abstract Background Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. Methods We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Results Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. Conclusions According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients’ perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients’ overall satisfaction in two ways: (A interpersonal-based medical

  11. Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters

    Science.gov (United States)

    2013-01-01

    Background Interaction between service provider and customer is the primary core of service businesses of different natures, and the influence of trust on service quality and customer satisfaction could not be ignored in interpersonal-based service encounters. However, lack of existing literature on the correlation between service quality, patient trust, and satisfaction from the prospect of interpersonal-based medical service encounters has created a research gap in previous studies. Therefore, this study attempts to bridge such a gap with an evidence-based practice study. Methods We adopted a cross-sectional design using a questionnaire survey of outpatients in seven medical centers of Taiwan. Three hundred and fifty copies of questionnaire were distributed, and 285 valid copies were retrieved, with a valid response rate of 81.43%. The SPSS 14.0 and AMOS 14.0 (structural equation modeling) statistical software packages were used for analysis. Structural equation modeling clarifies the extent of relationships between variables as well as the chain of cause and effect. Restated, SEM results do not merely show empirical relationships between variables when defining the practical situation. For this reason, SEM was used to test the hypotheses. Results Perception of interpersonal-based medical service encounters positively influences service quality and patient satisfaction. Perception of service quality among patients positively influences their trust. Perception of trust among patients positively influences their satisfaction. Conclusions According to the findings, as interpersonal-based medical service encounters will positively influence service quality and patient satisfaction, and the differences for patients’ perceptions of the professional skill and communication attitude of personnel in interpersonal-based medical service encounters will influence patients’ overall satisfaction in two ways: (A) interpersonal-based medical service encounter directly

  12. Unsupervised ensemble ranking of terms in electronic health record notes based on their importance to patients.

    Science.gov (United States)

    Chen, Jinying; Yu, Hong

    2017-04-01

    Allowing patients to access their own electronic health record (EHR) notes through online patient portals has the potential to improve patient-centered care. However, EHR notes contain abundant medical jargon that can be difficult for patients to comprehend. One way to help patients is to reduce information overload and help them focus on medical terms that matter most to them. Targeted education can then be developed to improve patient EHR comprehension and the quality of care. The aim of this work was to develop FIT (Finding Important Terms for patients), an unsupervised natural language processing (NLP) system that ranks medical terms in EHR notes based on their importance to patients. We built FIT on a new unsupervised ensemble ranking model derived from the biased random walk algorithm to combine heterogeneous information resources for ranking candidate terms from each EHR note. Specifically, FIT integrates four single views (rankers) for term importance: patient use of medical concepts, document-level term salience, word co-occurrence based term relatedness, and topic coherence. It also incorporates partial information of term importance as conveyed by terms' unfamiliarity levels and semantic types. We evaluated FIT on 90 expert-annotated EHR notes and used the four single-view rankers as baselines. In addition, we implemented three benchmark unsupervised ensemble ranking methods as strong baselines. FIT achieved 0.885 AUC-ROC for ranking candidate terms from EHR notes to identify important terms. When including term identification, the performance of FIT for identifying important terms from EHR notes was 0.813 AUC-ROC. Both performance scores significantly exceeded the corresponding scores from the four single rankers (Ppatients. It may help develop future interventions to improve quality of care. By using unsupervised learning as well as a robust and flexible framework for information fusion, FIT can be readily applied to other domains and applications

  13. [Soy-based food in a complex treatment of patients with tuberculosis].

    Science.gov (United States)

    Mel'nyk, V P; Anisimova, Iu M; Borovs'kyĭ, V R; Stadnyk, L V; Svitlychna, T H

    2006-12-01

    Results of clinical and laboratoty studies on efficiency and safety of upplied soya-based food during intensive antimicobacterial treatment of patients with tuberculosis are presented in the article. Obtained results showed the necessity of introduction soya-based food in a complex treatment of this infection as it enhances processes of detoxication, positevely influences on functional and structural state of the liver, reduces cytolysis, cholestasis symptomes, mesenchymal and inflamation reactions thus increases the tolerance of antimicobacterial agents.

  14. Mass Spectrometry-Based Quantitative Metabolomics Revealed a Distinct Lipid Profile in Breast Cancer Patients

    Directory of Open Access Journals (Sweden)

    Yun Yen

    2013-04-01

    Full Text Available Breast cancer accounts for the largest number of newly diagnosed cases in female cancer patients. Although mammography is a powerful screening tool, about 20% of breast cancer cases cannot be detected by this method. New diagnostic biomarkers for breast cancer are necessary. Here, we used a mass spectrometry-based quantitative metabolomics method to analyze plasma samples from 55 breast cancer patients and 25 healthy controls. A number of 30 patients and 20 age-matched healthy controls were used as a training dataset to establish a diagnostic model and to identify potential biomarkers. The remaining samples were used as a validation dataset to evaluate the predictive accuracy for the established model. Distinct separation was obtained from an orthogonal partial least squares-discriminant analysis (OPLS-DA model with good prediction accuracy. Based on this analysis, 39 differentiating metabolites were identified, including significantly lower levels of lysophosphatidylcholines and higher levels of sphingomyelins in the plasma samples obtained from breast cancer patients compared with healthy controls. Using logical regression, a diagnostic equation based on three metabolites (lysoPC a C16:0, PC ae C42:5 and PC aa C34:2 successfully differentiated breast cancer patients from healthy controls, with a sensitivity of 98.1% and a specificity of 96.0%.

  15. Objective Assessment of Patient Inhaler User Technique Using an Audio-Based Classification Approach.

    Science.gov (United States)

    Taylor, Terence E; Zigel, Yaniv; Egan, Clarice; Hughes, Fintan; Costello, Richard W; Reilly, Richard B

    2018-02-01

    Many patients make critical user technique errors when using pressurised metered dose inhalers (pMDIs) which reduce the clinical efficacy of respiratory medication. Such critical errors include poor actuation coordination (poor timing of medication release during inhalation) and inhaling too fast (peak inspiratory flow rate over 90 L/min). Here, we present a novel audio-based method that objectively assesses patient pMDI user technique. The Inhaler Compliance Assessment device was employed to record inhaler audio signals from 62 respiratory patients as they used a pMDI with an In-Check Flo-Tone device attached to the inhaler mouthpiece. Using a quadratic discriminant analysis approach, the audio-based method generated a total frame-by-frame accuracy of 88.2% in classifying sound events (actuation, inhalation and exhalation). The audio-based method estimated the peak inspiratory flow rate and volume of inhalations with an accuracy of 88.2% and 83.94% respectively. It was detected that 89% of patients made at least one critical user technique error even after tuition from an expert clinical reviewer. This method provides a more clinically accurate assessment of patient inhaler user technique than standard checklist methods.

  16. Development of a Nursing Handoff Tool: A Web-Based Application to Enhance Patient Safety

    Science.gov (United States)

    Goldsmith, Denise; Boomhower, Marc; Lancaster, Diane R.; Antonelli, Mary; Kenyon, Mary Anne Murphy; Benoit, Angela; Chang, Frank; Dykes, Patricia C.

    2010-01-01

    Dynamic and complex clinical environments present many challenges for effective communication among health care providers. The omission of accurate, timely, easily accessible vital information by health care providers significantly increases risk of patient harm and can have devastating consequences for patient care. An effective nursing handoff supports the standardized transfer of accurate, timely, critical patient information, as well as continuity of care and treatment, resulting in enhanced patient safety. The Brigham and Women’s/Faulkner Hospital Healthcare Information Technology Innovation Program (HIP) is supporting the development of a web based nursing handoff tool (NHT). The goal of this project is to develop a “proof of concept” handoff application to be evaluated by nurses on the inpatient intermediate care units. The handoff tool would enable nurses to use existing knowledge of evidence-based handoff methodology in their everyday practice to improve patient care and safety. In this paper, we discuss the results of nursing focus groups designed to identify the current state of handoff practice as well as the functional and data element requirements of a web based Nursing Handoff Tool (NHT). PMID:21346980

  17. An information entropy model on clinical assessment of patients based on the holographic field of meridian

    Science.gov (United States)

    Wu, Jingjing; Wu, Xinming; Li, Pengfei; Li, Nan; Mao, Xiaomei; Chai, Lihe

    2017-04-01

    Meridian system is not only the basis of traditional Chinese medicine (TCM) method (e.g. acupuncture, massage), but also the core of TCM's basic theory. This paper has introduced a new informational perspective to understand the reality and the holographic field of meridian. Based on maximum information entropy principle (MIEP), a dynamic equation for the holographic field has been deduced, which reflects the evolutionary characteristics of meridian. By using self-organizing artificial neural network as algorithm, the evolutionary dynamic equation of the holographic field can be resolved to assess properties of meridians and clinically diagnose the health characteristics of patients. Finally, through some cases from clinical patients (e.g. a 30-year-old male patient, an apoplectic patient, an epilepsy patient), we use this model to assess the evolutionary properties of meridians. It is proved that this model not only has significant implications in revealing the essence of meridian in TCM, but also may play a guiding role in clinical assessment of patients based on the holographic field of meridians.

  18. An evidence-based patient-centered method makes the biopsychosocial model scientific.

    Science.gov (United States)

    Smith, Robert C; Fortin, Auguste H; Dwamena, Francesca; Frankel, Richard M

    2013-06-01

    To review the scientific status of the biopsychosocial (BPS) model and to propose a way to improve it. Engel's BPS model added patients' psychological and social health concerns to the highly successful biomedical model. He proposed that the BPS model could make medicine more scientific, but its use in education, clinical care, and, especially, research remains minimal. Many aver correctly that the present model cannot be defined in a consistent way for the individual patient, making it untestable and non-scientific. This stems from not obtaining relevant BPS data systematically, where one interviewer obtains the same information another would. Recent research by two of the authors has produced similar patient-centered interviewing methods that are repeatable and elicit just the relevant patient information needed to define the model at each visit. We propose that the field adopt these evidence-based methods as the standard for identifying the BPS model. Identifying a scientific BPS model in each patient with an agreed-upon, evidence-based patient-centered interviewing method can produce a quantum leap ahead in both research and teaching. A scientific BPS model can give us more confidence in being humanistic. In research, we can conduct more rigorous studies to inform better practices. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  19. KERMA-based radiation dose management system for real-time patient dose measurement

    Science.gov (United States)

    Kim, Kyo-Tae; Heo, Ye-Ji; Oh, Kyung-Min; Nam, Sang-Hee; Kang, Sang-Sik; Park, Ji-Koon; Song, Yong-Keun; Park, Sung-Kwang

    2016-07-01

    Because systems that reduce radiation exposure during diagnostic procedures must be developed, significant time and financial resources have been invested in constructing radiation dose management systems. In the present study, the characteristics of an existing ionization-based system were compared to those of a system based on the kinetic energy released per unit mass (KERMA). Furthermore, the feasibility of using the KERMA-based system for patient radiation dose management was verified. The ionization-based system corrected the effects resulting from radiation parameter perturbations in general radiography whereas the KERMA-based system did not. Because of this difference, the KERMA-based radiation dose management system might overestimate the patient's radiation dose due to changes in the radiation conditions. Therefore, if a correction factor describing the correlation between the systems is applied to resolve this issue, then a radiation dose management system can be developed that will enable real-time measurement of the patient's radiation exposure and acquisition of diagnostic images.

  20. Engaging the Voice of Patients Affected by Gender-Based Violence: Informing Practice and Policy.

    Science.gov (United States)

    Lewis-O'Connor, Annie; Chadwick, Mardi

    2015-01-01

    Evidence regarding the benefits, opportunities, and risks associated with providing health care to patients experiencing gender-based violence (GBV) and, moreover, their satisfaction with health care services is sparse. Using a patient- and trauma-informed relationship-based framework, survivors of GBV who were referred for follow-up care were asked to participate in a quality improvement (QI) initiative in an effort to understand their perspectives of receiving healthcare services. Patients were asked to answer three open-ended questions in regard to their healthcare experience. Individuals who were eligible for evidence collection after sexual assault (sexually assaulted should have evidence collected. More extensive research and program evaluation including outcomes research are warranted.

  1. Web-based cognitive behavioral therapy for female patients with eating disorders: Randomized controlled trial

    NARCIS (Netherlands)

    Huurne, E.D. ter; Haan, H.A. de; Postel, M.G.; Palen, J.A.M. van der; Nagel, J.E.L. van der; Jong, C.A.J. de

    2015-01-01

    Background: Many patients with eating disorders do not receive help for their symptoms, even though these disorders have severe morbidity. The Internet may offer alternative low-threshold treatment interventions. Objective: This study evaluated the effects of a Web-based cognitive behavioral therapy

  2. Web-Based Cognitive Behavioral Therapy for Female Patients With Eating Disorders: Randomized Controlled Trial

    NARCIS (Netherlands)

    ter Huurne, E.D.; de Haan, H.A.; Postel, Marloes Gerda; van der Palen, Jacobus Adrianus Maria; VanDerNagel, Joanneke E.L.; de Jong, Cor A.J.

    2015-01-01

    Background: Many patients with eating disorders do not receive help for their symptoms, even though these disorders have severe morbidity. The Internet may offer alternative low-threshold treatment interventions. Objective: This study evaluated the effects of a Web-based cognitive behavioral therapy

  3. Is Bobath-based therapy used by physiotherapists in the care of stroke patients?

    NARCIS (Netherlands)

    Nico L.U. Meeteren; Maria H.F. Grypdonck; Thóra Hafsteinsdóttir

    2005-01-01

    The aim of this study was to investigate if physiotherapists had knowledge and skills in applying Bobath-based therapy (BB), also referred to as Neurodevelopmental Treatment, in the care of stroke patients and if they generally used the therapy in daily practice. This is because of the important

  4. Risk of infections in patients with gout : a population-based cohort study

    NARCIS (Netherlands)

    Spaetgens, B; de Vries, F; Driessen, J H M; Leufkens, H G; Souverein, P C; Boonen, A; van der Meer, J W M; Joosten, L A B

    2017-01-01

    To investigate the risk of various types of infections (pneumonia and urinary tract infection (UTI)), and infection-related mortality in patients with gout compared with population-based controls. A retrospective cohort study was conducted using data from the UK Clinical Practice Research Datalink

  5. Treatment of xerostomia with polymer-based saliva substitutes in patients with Sjogren's syndrome

    NARCIS (Netherlands)

    vanderReijden, WA; vanderKwaak, H; Vissink, A; Veerman, ECI; Amerongen, AVN

    Objective. To determine the efficacy of 3 types of polymer-based saliva substitutes in reducing oral dryness in patients with Sjogren's syndrome (SS). Methods. Subjective efficacy of 3 different saliva substitutes (determined by self-administered questionnaire) was evaluated in a double-blind,

  6. Computer-Based Education for Patients with Hypertension: A Systematic Review

    Science.gov (United States)

    Saksena, Anuraag

    2010-01-01

    Objective: To evaluate the benefits of using computer-based interventions to provide patient education to individuals with hypertension. Methods: MEDLINE, Web of Knowledge, CINAHL, ERIC, EMBASE, and PsychINFO were searched from 1995 to April 2009 using keywords related to "computers," "hypertension," "education," and "clinical trial." Additional…

  7. Improving patient safety in image-based procedures : Bridging the gap between preferred and actual proficiency

    NARCIS (Netherlands)

    Buzink, S.N.

    2010-01-01

    For patients less invasive image-based procedures (IBP) such as laparoscopy have many benefits in comparison to traditional open surgery, such as less pain, faster recovery, and fewer scars. However, to perform IBP effectively, efficiently, and above all safely, the surgical team is highly dependent

  8. Home-based specialized palliative care in patients with advanced cancer

    DEFF Research Database (Denmark)

    Nordly, Mie; Vadstrup, Eva Soelberg; Sjøgren, Per

    2016-01-01

    OBJECTIVE: Due to an urgent need for specialized palliative care (SPC) for patients with advanced cancer, an overview of available information on organization and outcomes of home-based SPC would be valuable. Our systematic review aims to give an overview of available information on the organizat...... for patients with advanced cancer, resulting in poor information and a lack of evidence. Generally, home-based SPC seems to have some positive effect on pain and dyspnea, but more high-quality studies are required.......OBJECTIVE: Due to an urgent need for specialized palliative care (SPC) for patients with advanced cancer, an overview of available information on organization and outcomes of home-based SPC would be valuable. Our systematic review aims to give an overview of available information...... on the organization and outcomes of home-based SPC for patients with advanced cancer. Outcomes related to place of death, survival time, quality of life, performance status, and symptom management are included. METHOD: A PICO process search strategy consisting of terms related to cancer, palliation, and home care...

  9. Diabetic patients detected by population-based stepwise screening already have a diabetic cardiovascular risk profile

    NARCIS (Netherlands)

    Spijkerman, Annemieke M W; Adriaanse, Marcel C; Dekker, Jacqueline M; Nijpels, Giel; Stehouwer, Coen D A; Bouter, Lex M; Heine, Robert J

    2002-01-01

    OBJECTIVE: To describe a population-based two-step screening procedure for type 2 diabetes and to study the cardiovascular risk profile of the patients identified by the screening. RESEARCH DESIGN AND METHODS: The first step of the screening procedure consisted of the Symptom Risk Questionnaire

  10. Treatment dropout in web-based cognitive behavioral therapy for patients with eating disorders

    NARCIS (Netherlands)

    Huurne, E.D. ter; Postel, M.G.; Haan, H.A. de; Palen, J.A.M. van der; Jong, C.A.J. de

    2017-01-01

    Treatment dropout is an important concern in eating disorder treatments as it has negative implications for patients' outcome, clinicians’ motivation, and research studies. Our main objective was to conduct an exploratory study on treatment dropout in a two-part web-based cognitive behavioral

  11. Patient preparation for intravenous urography: are we practising evidence-based medicine?

    International Nuclear Information System (INIS)

    Singh, S.; Reddicliffe, N.; Parker, D.A.

    2008-01-01

    Aim: To identify the current practice of patient preparation prior to intravenous urography (IVU) in England and Wales. Methods: Seventy-two hospitals were contacted to request details regarding the duration of fluid restriction, adherence to a low-residue diet, or use of laxatives for patient preparation before IVU examinations. Results: Results showed that out of 45 hospitals that still use IVU, only six (13.3%) did not follow a patient-preparation regime. The vast majority of the hospitals contacted (87.6%), implemented either fluid and/or food restriction, or prescribed laxatives. The duration of fluid and food restriction varied from 2-12 h duration, and some departments advocated 48 h of laxatives. Conclusion: A large proportion of hospitals are not practising evidence-based medicine in relation to IVU, and we suggest that the practice of patient preparation should be abandoned

  12. Corneal-Based Surgical Presbyopic Therapies and Their Application in Pseudophakic Patients

    Science.gov (United States)

    Paley, Grace L.; Chuck, Roy S.

    2016-01-01

    Purpose. The purpose of this review is to provide a summary of laser refractive surgery and corneal inlay approaches to treat presbyopia in patients after cataract surgery. Summary. The presbyopic population is growing rapidly along with increasing demands for spectacle independence. This review will focus on the corneal-based surgical options to address presbyopia including various types of corneal intrastromal inlays and laser ablation techniques to generate either a multifocal cornea (“PresbyLASIK”) or monovision. The natural history of presbyopia develops prior to cataracts, and these presbyopic surgeries have been largely studied in phakic patients. Nevertheless, pseudophakic patients may also undergo these presbyopia-compensating procedures for enhanced quality of life. This review examines the published reports that apply these technologies to patients after cataract surgery and discusses unique considerations for this population. PMID:27051527

  13. Corneal-Based Surgical Presbyopic Therapies and Their Application in Pseudophakic Patients

    Directory of Open Access Journals (Sweden)

    Grace L. Paley

    2016-01-01

    Full Text Available Purpose. The purpose of this review is to provide a summary of laser refractive surgery and corneal inlay approaches to treat presbyopia in patients after cataract surgery. Summary. The presbyopic population is growing rapidly along with increasing demands for spectacle independence. This review will focus on the corneal-based surgical options to address presbyopia including various types of corneal intrastromal inlays and laser ablation techniques to generate either a multifocal cornea (“PresbyLASIK” or monovision. The natural history of presbyopia develops prior to cataracts, and these presbyopic surgeries have been largely studied in phakic patients. Nevertheless, pseudophakic patients may also undergo these presbyopia-compensating procedures for enhanced quality of life. This review examines the published reports that apply these technologies to patients after cataract surgery and discusses unique considerations for this population.

  14. Patient preparation for intravenous urography: are we practising evidence-based medicine?

    Science.gov (United States)

    Singh, S; Reddicliffe, N; Parker, D A

    2008-02-01

    To identify the current practice of patient preparation prior to intravenous urography (IVU) in England and Wales. Seventy-two hospitals were contacted to request details regarding the duration of fluid restriction, adherence to a low-residue diet, or use of laxatives for patient preparation before IVU examinations. Results showed that out of 45 hospitals that still use IVU, only six (13.3%) did not follow a patient-preparation regime. The vast majority of the hospitals contacted (87.6%), implemented either fluid and/or food restriction, or prescribed laxatives. The duration of fluid and food restriction varied from 2-12 h duration, and some departments advocated 48 h of laxatives. A large proportion of hospitals are not practising evidence-based medicine in relation to IVU, and we suggest that the practice of patient preparation should be abandoned.

  15. A manual-based vocational rehabilitation program for patients with an acquired brain injury

    DEFF Research Database (Denmark)

    Høffding, Louise.K.Enggaard; Nielsen, Maria Haahr; Rasmussen, Morten Arendt

    2017-01-01

    % of the patients with ABI are of working age. Thus, standardized clinically effective and cost-effective methodologies regarding VR for patients with ABI are highly needed. Therefore, the aim of this study is to evaluate the effect of an individually targeted manual-based VR for patient with ABI compared...... will be included in the study. The patients will randomly be allocated in a 1:1 ratio to the VR intervention provided by a specialized Brain Injury Centre or the conventional VR provided by the municipalities (usual care). The six- to nine-month intervention will consist of individual and group therapies as well...... as a work placement program including supported employment. Furthermore, the intervention will include a family intervention program followed up by support to one individual family caregiver. The primary outcomes are increased work or study rate at six-month follow-up. Moreover, a budget impact analysis...

  16. Feasibility of nonradiation EUS-based ERCP in patients with uncomplicated choledocholithiasis (with video).

    Science.gov (United States)

    Shah, Janak N; Bhat, Yasser M; Hamerski, Chris M; Kane, Steve D; Binmoeller, Kenneth F

    2016-11-01

    ERCP inherently involves radiation exposure. Nonradiation ERCP has been described in pregnancy. Theoretically, the same techniques could be applied to the general population. We prospectively assessed the feasibility of nonradiation, EUS-based ERCP in nonpregnant patients with choledocholithiasis. Consecutive patients referred for ERCP for choledocholithiasis were recruited over a 1-year period. Patients providing study consent underwent the following procedural protocol. First, EUS was performed to verify the presence, size, and number of stones. Second, biliary cannulation was attempted without fluoroscopy for a maximum of 10 minutes. Selective cannulation was based on deep insertion with visible bile in the catheter on aspiration. Third, for stone removal, sphincterotomy was performed and stones were removed using a basket or balloon. The number of stones exiting the papilla was matched to the number seen on EUS. Finally, once the duct was deemed clear by the endoscopist, a final occlusion cholangiogram and ductal sweep served as the reference standard for confirmation of stone clearance. Nonradiation ERCP was attempted in 31 patients. Cannulation without fluoroscopy was successful in 26 patients (84%). Complete stone removal without fluoroscopy was achieved in all 26 of these cases. The 5 patients with failed nonfluoroscopic cannulation required double guidewire (n = 2) or precut papillotomy (n = 3) for deep biliary access and subsequent stone clearance. One patient who required precut papillotomy for access developed moderate post-ERCP pancreatitis (3%). Nonradiation, EUS-based ERCP for uncomplicated choledocholithiasis appears to be successful and safe. (Clinical trial registration number: NCT01678391.). Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  17. Internet-based technologies to improve cancer care coordination: current use and attitudes among cancer patients.

    Science.gov (United States)

    Girault, Anne; Ferrua, Marie; Lalloué, Benoît; Sicotte, Claude; Fourcade, Aude; Yatim, Fatima; Hébert, Guillaume; Di Palma, Mario; Minvielle, Etienne

    2015-03-01

    The uses of internet-based technologies (e.g. patient portals, websites and applications) by cancer patients could be strong drive for change in cancer care coordination practices. The goal of this study was to assess the current utilisation of internet-based technologies (IBT) among cancer patients, and their willingness to use them for their health, as well as analyse the influence of socio-demographics on both aspects. A questionnaire-based survey was conducted in June 2013, over seven non-consecutive days within seven outpatient departments of Gustave Roussy, a comprehensive cancer centre (≈160,000 consultations yearly), located just outside Paris. We computed descriptive statistics and performed correlation analysis to investigate patients' usage and attitudes in correspondence with age, gender, socioeconomic status, social isolation, and place of living. We then conducted multinomial logistic regressions using R. The participation level was 85% (n=1371). The median age was 53.4. 71% used a mobile phone everyday and 93% had access to Internet from home. Age and socioeconomic status were negatively associated with the use of IBT (puse in health care, and especially, the possibility to enhance communication with providers. 84% of patients reported feeling comfortable with the use of such technologies but age and socioeconomic status had a significant influence. Most patients used IBTs every day. Overall, patients advocated for an extended use of IBT in oncology. Differences in perceived ease of use corresponding to age and socioeconomic status have to be addressed. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Maxillary Complete Denture Outcomes: A Systematic Review of Patient-Based Outcomes.

    Science.gov (United States)

    Thalji, Ghadeer; McGraw, Kate; Cooper, Lyndon F

    2016-01-01

    The aim of this systematic review is to report on the current knowledge regarding patient satisfaction as a primary outcome for maxillary complete denture therapy. We asked, "For the maxillary edentulous patient treated using maxillary dentures, what are the patient-based outcomes regarding quality of life and treatment satisfaction." An electronic search of publications up to March 2014 was established using four databases: PubMed, Web of Science, Scopus, and Embase. To meet the ultimate goal of establishing clinical guidelines based on available information, prospective comparative studies, cohort prospective studies, and retrospective studies on more than 10 subjects were included. The electronic search identified 4,530 articles that were evaluated at the title, abstract, and article level to include 31 articles of interest. The patient-based outcomes and satisfaction data included were examined and reported. The studies included 5,485 participants. Of these, 2,685 were identified as wearing maxillary complete dentures. Reported mean ages ranged from 59.7 to 73.6 years. A systematic review indicated that the provision of new maxillary complete dentures for edentulous patients results in improved self-reported satisfaction and oral health-related quality of life. The included reports, while providing evidence that complete denture satisfaction of participants and new dentures improve self-reported outcomes, did not include variables that influence these positive outcomes. A broad range of evidence supports the use of complete dentures for rehabilitation of the edentulous maxilla. When considering treatment of the edentulous maxilla, the expectations of patients for esthetic and phonetic (social) rehabilitation are high and can be met using maxillary complete dentures as the mode of prosthetic rehabilitation. Patients dissatisfied with new complete dentures may be referred for dental implant therapies involving fixed or removable prostheses.

  19. What Do Stroke Patients Look for in Game-Based Rehabilitation

    Science.gov (United States)

    Hung, Ya-Xuan; Huang, Pei-Chen; Chen, Kuan-Ta; Chu, Woei-Chyn

    2016-01-01

    Abstract Stroke is one of the most common causes of physical disability, and early, intensive, and repetitive rehabilitation exercises are crucial to the recovery of stroke survivors. Unfortunately, research shows that only one third of stroke patients actually perform recommended exercises at home, because of the repetitive and mundane nature of conventional rehabilitation exercises. Thus, to motivate stroke survivors to engage in monotonous rehabilitation is a significant issue in the therapy process. Game-based rehabilitation systems have the potential to encourage patients continuing rehabilitation exercises at home. However, these systems are still rarely adopted at patients’ places. Discovering and eliminating the obstacles in promoting game-based rehabilitation at home is therefore essential. For this purpose, we conducted a study to collect and analyze the opinions and expectations of stroke patients and clinical therapists. The study is composed of 2 parts: Rehab-preference survey – interviews to both patients and therapists to understand the current practices, challenges, and expectations on game-based rehabilitation systems; and Rehab-compatibility survey – a gaming experiment with therapists to elaborate what commercial games are compatible with rehabilitation. The study is conducted with 30 outpatients with stroke and 19 occupational therapists from 2 rehabilitation centers in Taiwan. Our surveys show that game-based rehabilitation systems can turn the rehabilitation exercises more appealing and provide personalized motivation for various stroke patients. Patients prefer to perform rehabilitation exercises with more diverse and fun games, and need cost-effective rehabilitation systems, which are often built on commodity hardware. Our study also sheds light on incorporating the existing design-for-fun games into rehabilitation system. We envision the results are helpful in developing a platform which enables rehab-compatible (i.e., existing

  20. The evidence-based evaluation of the safety of contrast media in patients with diabetes mellitus

    International Nuclear Information System (INIS)

    Li Jixia; Huang Baosheng

    2009-01-01

    Contrast-induced nephropathy (CIN) has now been the third most common cause of acquired renal failure. Diabetes mellitus (DM), the type of contrast agent used and the intra-arterial route of administration are three important risk factors inducing CIN. The incidence rate of CIN is very high in patients with DM or renal insufficiency after iodinated contrast was administered. Unfortunately, it has not yet attracted physicians'and radiologists'sufficient attention. This paper aims to make an evidence-based evaluation of the safety and rephrotoxicity of various contrast agents when they are used in patients with DM. Usually, intravenous administration of contrast media will not cause permanent damage to the kidney in highrisk patients. Low-osmolarity contrast media is relatively safe for patients with DM only, while it takes much risk of CIN when low-osmolarity contrast media is used in patients with diabetic nephropathy or in patients of DM accompanied with renal insufficiency, for such patients, the iso-osmolarity contrast media, iodixanol, can be used. (authors)

  1. Calculating radiotherapy margins based on Bayesian modelling of patient specific random errors

    Science.gov (United States)

    Herschtal, A.; te Marvelde, L.; Mengersen, K.; Hosseinifard, Z.; Foroudi, F.; Devereux, T.; Pham, D.; Ball, D.; Greer, P. B.; Pichler, P.; Eade, T.; Kneebone, A.; Bell, L.; Caine, H.; Hindson, B.; Kron, T.

    2015-02-01

    Collected real-life clinical target volume (CTV) displacement data show that some patients undergoing external beam radiotherapy (EBRT) demonstrate significantly more fraction-to-fraction variability in their displacement (‘random error’) than others. This contrasts with the common assumption made by historical recipes for margin estimation for EBRT, that the random error is constant across patients. In this work we present statistical models of CTV displacements in which random errors are characterised by an inverse gamma (IG) distribution in order to assess the impact of random error variability on CTV-to-PTV margin widths, for eight real world patient cohorts from four institutions, and for different sites of malignancy. We considered a variety of clinical treatment requirements and penumbral widths. The eight cohorts consisted of a total of 874 patients and 27 391 treatment sessions. Compared to a traditional margin recipe that assumes constant random errors across patients, for a typical 4 mm penumbral width, the IG based margin model mandates that in order to satisfy the common clinical requirement that 90% of patients receive at least 95% of prescribed RT dose to the entire CTV, margins be increased by a median of 10% (range over the eight cohorts -19% to +35%). This substantially reduces the proportion of patients for whom margins are too small to satisfy clinical requirements.

  2. Learning safe patient handling skills: student nurse experiences of university and practice based education.

    Science.gov (United States)

    Kneafsey, Rosie; Haigh, Carol

    2007-11-01

    Poor patient handling practices increase nurse injuries and reduce patients' safety and comfort. UK Universities have a duty to prepare student nurses for patient handling activities occurring during clinical placements. This study examines students' experiences of moving and handling education in academic and clinical settings. A 34 item questionnaire was distributed to student nurses at one School of Nursing (n=432, response rate of 75%). Many students undertook unsafe patient handling practices and provided reasons for this. There was a medium statistically significant correlation between the variables 'provision of supervision' and 'awareness of patient handling needs' (r(s)=.390, p=.000). 40% of students stated that their M&H competency was assessed through direct observation. Twenty six percent of the total sample (n=110), said they had begun to develop musculo-skeletal pain since becoming a student nurse. Forty-eight stated that this was caused by an incident whilst on placement. Inadequate patient handling practices threaten student nurse safety in clinical settings. Although some students may be overly confident, they should be supervised when undertaking M&H activities. Though important, University based M&H education will only be beneficial if students learn in clinical settings that take safe patient handling seriously.

  3. Systematic suicide risk assessment for patients with schizophrenia: a national population-based study.

    Science.gov (United States)

    Pedersen, Charlotte Gjørup; Jensen, Signe Olrik Wallenstein; Gradus, Jaimie; Johnsen, Søren Paaske; Mainz, Jan

    2014-02-01

    Systematic suicide risk assessment is recommended for patients with schizophrenia; however, little is known about the implementation of suicide risk assessment in routine clinical practice. The study aimed to determine the use of systematic suicide risk assessment at discharge and predictors of suicide attempt among hospitalized patients with schizophrenia in Denmark. A one-year follow-up study was conducted of 9,745 patients with schizophrenia who were discharged from psychiatric wards and registered in a national population-based schizophrenia registry between 2005 and 2009. The proportion of patients receiving suicide risk assessment at discharge from a psychiatric ward increased from 72% (95% confidence interval [CI]=71%-74%) in 2005, when the national monitoring began, to 89% (CI=89%-90%) in 2009. Within one year after discharge, 1% of all registered patients had died by suicide and 8% had attempted suicide. One out of three patients who died by suicide had no documented suicide risk assessment before discharge. The use of systematic suicide risk assessment at discharge among patients with schizophrenia increased in Denmark between 2005 and 2009, in accordance with recommendations in national clinical guidelines and monitoring in a national clinical registry. Additional efforts are warranted to ensure a lower risk of suicidal behavior after hospital discharge.

  4. Misclassification of Patients with Spinocerebellar Ataxia as having Psychogenic Postural Instability based on Computerized Dynamic Posturography

    Directory of Open Access Journals (Sweden)

    Susan J Herdman

    2011-04-01

    Full Text Available Specific criteria have been developed based on computerized dynamic posturography (CDP to assist clinicians in identifying patients with psychogenic balance problems1-4. Patients with known Spinocerebellar Ataxia (SCA meet several of the criteria for psychogenic balance problem and risk being misclassified as having imbalance of psychogenic origin. However, our research shows that patients with SCA may be distinguished from patients with psychogenic balance problems in several ways. We compared test performance on CDP and the observation of specific behaviors that are associated with psychogenic balance problems in patients with SCA (n = 43 and patients with known psychogenic balance problems (n = 40. Chi square analysis was used to determine if there were significant differences between the groups for the frequency of each criterion for psychogenic CDP and Observed Behaviors. Level of significance was Bonferroni corrected for multiple comparisons. Sensitivity, specificity, and positive likelihood ratios were calculated for each criterion. Hierarchical cluster analysis was used to examine whether the two patient groups demonstrated similar groupings of criteria. Comparison of the results of these analyses identified two criteria that were significantly more frequent in the Psychogenic group than in the SCA group: Regular Periodicity of sway and Circular Sway. Sensitivity, specificity and positive likelihood ratios identified two additional criteria, Inconsistent Motor Responses and Large lateral Sway that also seem to suggest a psychogenic component to a person’s imbalance. Prospective studies are needed to validate the usefulness of these findings.

  5. Enhancing electronic health record usability in pediatric patient care: a scenario-based approach.

    Science.gov (United States)

    Patterson, Emily S; Zhang, Jiajie; Abbott, Patricia; Gibbons, Michael C; Lowry, Svetlana Z; Quinn, Matthew T; Ramaiah, Mala; Brick, David

    2013-03-01

    Usability of electronic health records (EHRs) is an important factor affecting patient safety and the EHR adoption rate for both adult and pediatric care providers. A panel of interdisciplinary experts (the authors) was convened by the National Institute of Standards and Technology to generate consensus recommendations to improve EHR usefulness, usability, and patient safety when supporting pediatric care, with a focus on critical user interactions. The panel members represented expertise in the disciplines of human factors engineering (HFE), usability, informatics, and pediatrics in ambulatory care and pediatric intensive care. An iterative, scenario-based approach was used to identify unique considerations in pediatric care and relevant human factors concepts. A draft of the recommendations were reviewed by invited experts in pediatric informatics, emergency medicine, neonatology, pediatrics, HFE, nursing, usability engineering, and software development and implementation. Recommendations for EHR developers, small-group pediatric medical practices, and children's hospitals were identified out of the original 54 recommendations, in terms of nine critical user interaction categories: patient identification, medications, alerts, growth chart, vaccinations, labs, newborn care, privacy, and radiology. Pediatric patient care has unique dimensions, with great complexity and high stakes for adverse events. The recommendations are anticipated to increase the rate of EHR adoption by pediatric care providers and improve patient safety for pediatric patients. The described methodology might be useful for accelerating adoption and increasing safety in a variety of clinical areas where the adoption of EHRs is lagging or usability issues are believed to reduce potential patient safety, efficiency, and quality benefits.

  6. Depression among patients with diabetes: A community-based study in South India

    Directory of Open Access Journals (Sweden)

    Abdullahi S Aminu

    2017-01-01

    Full Text Available Background: Depression is one of the more common mental health conditions found among people suffering from chronic diseases. Its presence in patients with type 2 diabetes could hinder the adherence to and effectiveness of treatment. Most studies on depression among patients with diabetes are hospital-based suggesting the need for a community-based study to assess the correlates of depression among patients with diabetes. Aim: This study aimed to estimate the prevalence and to identify the factors influencing depression among patients with type 2 diabetes in Udupi taluk situated in southern India. Subjects and Methods: This study recruited 200 patients with type 2 diabetes from both rural and urban areas. Demographic, clinical, and diabetes-related information were collected using a semi-structured questionnaire. Depression was assessed using Patient Health Questionnaire-9; a standardized questionnaire developed in the United States of America and validated in the Indian population. Results: The prevalence of depression among patients with diabetes in the community was found to be 37.5%. Most frequently, depression was mild (42, 21% in nature with severe depression (9, 4.5% seen the least. Several factors were found to be positively associated with depression including female gender, rural residence, unemployment, and the status of being unmarried. The presence of diabetic complications and other chronic diseases such as hypertension and obesity also were found to be associated with depression. Conclusion: Depression was found to be particularly high among the study population. Since depression could significantly hinder patient's adherence to treatment, there is an urgent need for early diagnosis and treatment. This calls for the integration of mental health care into the management of diabetes.

  7. The direct health care costs of eating disorders among hospitalized patients: A population-based study.

    Science.gov (United States)

    de Oliveira, Claire; Colton, Patricia; Cheng, Joyce; Olmsted, Marion; Kurdyak, Paul

    2017-12-01

    To estimate the direct health care costs of eating disorders in Ontario, Canada, in 2012, using a prevalence-based cost-of-illness approach. We selected a population-based sample of all patients eligible for public health care insurance over the age of 4 with a hospitalization for an eating disorder at any point since 1988. We estimated total and mean direct net costs per patient in 2012, from the third public payer perspective, by sex, age group, and health service type. In 2012, there were 6,326 patients ever hospitalized for an eating disorder. They had a mean age of 31 at hospitalization, were mostly female (93%), and generally from high-income, urban neighborhoods. Direct total costs were just under $63 million CAD; direct net costs were roughly $48 million CAD. Mean net costs per patient were higher for females than males ($7,743.40 and $6,340.50, respectively), and higher for patients under 20 and patients 65+ ($17,961.50 and $14,953.90, respectively). The main cost drivers were psychiatric hospitalizations and physician visits, although this varied by age group. For younger patients, net costs were mainly because of psychiatric hospitalizations, while for older patients net costs were mainly because of psychiatric and nonpsychiatric hospitalizations, and other care. The cost of eating disorders is substantial and varies by sex and age group. Our findings suggest that, from a health care utilization/cost perspective, the effect of eating disorders is likely to persist over the lifespan. © 2017 Wiley Periodicals, Inc.

  8. Which Dimensions of Patient-Centeredness Matter? - Results of a Web-Based Expert Delphi Survey.

    Directory of Open Access Journals (Sweden)

    Jördis M Zill

    Full Text Available Present models and definitions of patient-centeredness revealed a lack of conceptual clarity. Based on a prior systematic literature review, we developed an integrative model with 15 dimensions of patient-centeredness. The aims of this study were to 1 validate, and 2 prioritize these dimensions.A two-round web-based Delphi study was conducted. 297 international experts were invited to participate. In round one they were asked to 1 give an individual rating on a nine-point-scale on relevance and clarity of the dimensions, 2 add missing dimensions, and 3 prioritize the dimensions. In round two, experts received feedback about the results of round one and were asked to reflect and re-rate their own results. The cut-off for the validation of a dimension was a median < 7 on one of the criteria.105 experts participated in round one and 71 in round two. In round one, one new dimension was suggested and included for discussion in round two. In round two, this dimension did not reach sufficient ratings to be included in the model. Eleven dimensions reached a median ≥ 7 on both criteria (relevance and clarity. Four dimensions had a median < 7 on one or both criteria. The five dimensions rated as most important were: patient as a unique person, patient involvement in care, patient information, clinician-patient communication and patient empowerment.11 out of the 15 dimensions have been validated through experts' ratings. Further research on the four dimensions that received insufficient ratings is recommended. The priority order of the dimensions can help researchers and clinicians to focus on the most important dimensions of patient-centeredness. Overall, the model provides a useful framework that can be used in the development of measures, interventions, and medical education curricula, as well as the adoption of a new perspective in health policy.

  9. Retinal toxicity after cisplatin-based chemotherapy in patients with germ cell cancer.

    Science.gov (United States)

    Dulz, Simon; Asselborn, Niels H; Dieckmann, Klaus-Peter; Matthies, Cord; Wagner, Walter; Weidmann, Jens; Seidel, Christoph; Oing, Christoph; Berger, Lars A; Alsdorf, Winfried; Mankichian, Blanche; Meyer, Christian; Vetterlein, Malte W; Gild, Philipp; Ludwig, Tim A; Soave, Armin; Schriefer, Philipp; Becker, Andreas; Ahyai, Sascha A; Oechsle, Karin; Bokemeyer, Carsten; Wagenfeld, Lars; Fisch, Margit; Hartmann, Michael; Chun, Felix K-H; Kluth, Luis A

    2017-07-01

    Visual impairment represents an infrequent form of cisplatin-induced neurotoxicity; however, visual deterioration has been reported in several studies. To evaluate potential morphological and functional retinal alterations in patients with germ cell cancer (GCC) treated with cisplatin-based chemotherapy (CBC). Multi-disciplinary and multi-institutional study design. Examination of 28 eyes of 14 male GCC patients, who had received at least one cycle of CBC. A matched control group of healthy, untreated patients were included in this study. Subjects underwent a retinal nerve fiber thickness (RNFL) measurement, color vision, visual acuity testing, full-field electroretinograms (ff-ERG). To assess a correlation between cumulative cisplatin dose and measured RNFL and ff-ERG Pearson correlation coefficient analysis was performed. Both study groups (CBC recipients vs. healthy controls) consisted each of 14 participants with a median patient age of 30 years (interquartile range (IQR) 26-37 years). Tumor histology was seminoma in 6 of 14 patients (43%), and non-seminomatous GCC in 8 of 14 patients (57%). Median cumulative cisplatin dosis at examination was 627 mg/m 2 (IQR 413-1013 mg/m 2 ). Morphological assessment revealed reduced RNFL in 11 of 14 patients (78.6%). Reduction in RNFL was significantly correlated to the cumulative CBC dose received (rho = + 0.70; p = 0.004). ff-ERG showed significant differences between CBC recipients and the control group in 2 of 5 tested categories (all p values cisplatin-based chemotherapy in patients with GCC. The reduction of RNFL might become clinically relevant in upcoming age-related chronic degenerative disorders such as glaucoma.

  10. Feasibility and Impact of Telemonitor-Based Depression Care Management for Geriatric Homecare Patients

    Science.gov (United States)

    Rabinowitz, Terry; Lotterman, Jennifer; Reilly, Catherine F.; Brown, Suzanne; Donehower, Patricia; Ellsworth, Elizabeth; Amour, Judith L.; Bruce, Martha L.

    2011-01-01

    Abstract Objective The objective of this study was to test the feasibility, acceptability, and preliminary clinical outcomes of a method to leverage existing home healthcare telemonitoring technology to deliver depression care management (DCM) to both Spanish- and English-speaking elderly homebound recipients of homecare services. Materials and Methods Three stand-alone, nonprofit community homecare agencies located in New York, Vermont, and Miami participated in this study. Evidence-based DCM was adapted to the telemonitor platform by programming questions and educational information on depression symptoms, antidepressant adherence, and side effects. Recruited patients participated for a minimum of 3 weeks. Telehealth nurses were trained on DCM and received biweekly supervision. On-site trained research assistants conducted in-home research interviews on depression diagnosis and severity and patient satisfaction with the protocol. Results An ethnically diverse sample of 48 English- and Spanish-only–speaking patients participated, along with seven telehealth nurses. Both patients and telehealth nurses reported high levels of protocol acceptance. Among 19 patients meeting diagnostic criteria for major depression, the mean depression severity was in the “markedly severe” range at baseline and in the “mild” range at follow-up. Conclusions Results of this pilot support the feasibility of using homecare's existing telemonitoring technology to deliver DCM to their elderly homebound patients. This was true for both English- and Spanish-speaking patients. Preliminary clinical outcomes suggest improvement in depression severity, although these findings require testing in a randomized clinical trial. Implications for the science and service of telehealth-based depression care for elderly patients are discussed. PMID:21780942

  11. Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept.

    Science.gov (United States)

    Smedal, Tori; Lygren, Hildegunn; Myhr, Kjell-Morten; Moe-Nilssen, Rolf; Gjelsvik, Bente; Gjelsvik, Olav; Strand, Liv Inger; Inger, Liv

    2006-06-01

    Patients with multiple sclerosis (MS) tend to have movement difficulties, and the effect of physiotherapy for this group of patients has been subjected to limited systematic research. In the present study physiotherapy based on the Bobath concept, applied to MS patients with balance and gait problems, was evaluated. The ability of different functional tests to demonstrate change was evaluated. A single-subject experimental study design with ABAA phases was used, and two patients with relapsing-remitting MS in stable phase were treated. Tests were performed 12 times, three at each phase: A (at baseline); B (during treatment); A (immediately after treatment); and A (after two months). The key feature of treatment was facilitation of postural activity and selective control of movement. Several performance and self report measures and interviews were used. After intervention, improved balance was shown by the Berg Balance Scale (BBS) in both patients, and improved quality of gait was indicated by the Rivermead Visual Gait Assessment (RVGA). The patients also reported improved balance and gait function in the interviews and scored their condition as 'much improved'. Gait parameters, recorded by an electronic walkway, changed, but differently in the two patients. Among the physical performance tests the BBS and the RVGA demonstrated the highest change, while no or minimal change was demonstrated by the Rivermead Mobility Index (RMI) and Ratings of Perceived Exertion (RPE). The findings indicate that balance and gait can be improved after physiotherapy based on the Bobath concept, but this should be further evaluated in larger controlled trials of patients with MS.

  12. Demographic Factors and Hospital Size Predict Patient Satisfaction Variance- Implications for Hospital Value-Based Purchasing

    Science.gov (United States)

    McFarland, Daniel C.; Ornstein, Katherine; Holcombe, Randall F.

    2016-01-01

    Background Hospital Value-Based Purchasing (HVBP) incentivizes quality performance based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population dense areas and could bias CMS reimbursement. Objective Assess nonrandom variation in patient satisfaction as determined by HCAHPS. Design Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized four highly predictive variables and hospitals were re-ranked accordingly. Setting 3,907 HVBP-participating hospitals. Patients 934,800 patient surveys, by most conservative estimate. Measurements 3,144 county demographics (U.S. Census), and HCAHPS. Results Hospital size and primary language (‘non-English speaking’) most strongly predicted unfavorable HCAHPS scores while education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals’ locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. Conclusions Demographic and structural factors (e.g., hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct. PMID:25940305

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

    Science.gov (United States)

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

    2015-08-01

    The main objective of the current investigation was to assess the readability of Internet-based patient education materials related to the field of anesthesiology. We hypothesized that the majority of patient education materials would not be written according to current recommended readability grade level. Online patient education materials describing procedures, risks, and management of anesthesia-related topics were identified using the search engine Google (available at www.google.com) using the terms anesthesia, anesthesiology, anesthesia risks, and anesthesia care. Cross-sectional evaluation. None. Assessments of content readability were performed using validated instruments (Flesch-Kincaid Grade Formulae, the Gunning Frequency of Gobbledygook, the New Dale-Chall Test, the Fry graph, and the Flesch Reading Ease score). Ninety-six Web sites containing Internet patient education materials (IPEMs) were evaluated. The median (interquartile range) readability grade level for all evaluated IPEMs was 13.5 (12.0-14.6). All the evaluated documents were classified at a greater readability level than the current recommended readability grade, P < .001. Readability grades were not significantly different among different IPEM sources. Assessment by the Flesch Reading Ease test classified all but 4 IPEMs as at least fairly difficult to read. Internet-based patient education materials related to the field of anesthesiology are currently written far above the recommended readability grade level. High complexity of written education materials likely limits access of information to millions of American patients. Redesign of online content of Web sites that provide patient education material regarding anesthesia could be an important step in improving access to information for patients with poor health literacy. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  15. Web-Based Treatment Program Using Intensive Therapeutic Contact for Patients With Eating Disorders: Before-After Study

    OpenAIRE

    ter Huurne, Elke D; Postel, Marloes G; de Haan, Hein A; Drossaert, Constance H.C; DeJong, Cor A.J

    2013-01-01

    Background: Although eating disorders are common in the Netherlands, only a few patients are treated by mental health care professionals. To reach and treat more patients with eating disorders, Tactus Addiction Treatment developed a web-based treatment program with asynchronous and intensive personalized communication between the patient and the therapist. Objective: This pilot study evaluated the web-based treatment program using intensive therapeutic contact in a population of 165 patients ...

  16. PATIENTS OVERCOME ANXIETY AND ARE ENCOURAGED TO BE PHYSICAL ACTIVE THROUGH EXERCISE-BASED CARDIAC REHABILITATION

    DEFF Research Database (Denmark)

    Simonÿ, Charlotte; Dreyer, Pia; Pedersen, Birthe D.

    into that the heart endures physical activity. In addition to serving as physical guidance, exercise-based cardiac rehabilitation offers valuable mental support. The patients find help to overcome an initial anxiety and move forward towards a physically active life featuring a feeling of improved health and new......, and it seems to be crucial to further emphasise the individuals lived experiences when exercise-based cardiac rehabilitation is followed. Hence this study aims to investigate how patients experience exercise-based cardiac rehabilitation in a hospital setting. Methods. This study, which included nine men...... interviews were performed 1-2 months later. A phenomenological hermeneutic interpretation was conducted, comprising three methodological steps: naïve reading, structural analysis and comprehensive interpretation. Results. The preliminary findings are that although physically and especially mentally...

  17. PATIENTS OVERCOME ANXIETY AND ARE ENCOURAGED TO BE PHYSICAL ACTIVETHROUGH EXERCISE-BASED CARDIAC REHABILITATION

    DEFF Research Database (Denmark)

    Simonÿ, Charlotte; Dreyer, Pia; Pedersen, Birthe D.

    2015-01-01

    into that the heart endures physical activity. In addition to serving as physical guidance, exercise-based cardiac rehabilitation offers valuable mental support. The patients find help to overcome an initial anxiety and move forward towards a physically active life featuring a feeling of improved health and new......, and it seems to be crucial to further emphasise the individuals lived experiences when exercise-based cardiac rehabilitation is followed. Hence this study aims to investigate how patients experience exercise-based cardiac rehabilitation in a hospital setting. Methods. This study, which included nine men...... interviews were performed 1-2 months later. A phenomenological hermeneutic interpretation was conducted, comprising three methodological steps: naïve reading, structural analysis and comprehensive interpretation. Results. The preliminary findings are that although physically and especially mentally...

  18. Approaches based on behavioral economics could help nudge patients and providers toward lower health spending growth.

    Science.gov (United States)

    King, Dominic; Greaves, Felix; Vlaev, Ivo; Darzi, Ara

    2013-04-01

    Policies that change the environment or context in which decisions are made and "nudge" people toward particular choices have been relatively ignored in health care. This article examines the role that approaches based on behavioral economics could play in "nudging" providers and patients in ways that could slow health care spending growth. The basic insight of behavioral economics is that behavior is guided by the very fallible human brain and greatly influenced by the environment or context in which choices are made. In policy arenas such as pensions and personal savings, approaches based on behavioral economics have provided notable results. In health care, such approaches have been used successfully but in limited ways, as in the use of surgical checklists that have increased patient safety and reduced costs. With health care spending climbing at unsustainable rates, we review the role that approaches based on behavioral economics could play in offering policy makers a potential set of new tools to slow spending growth.

  19. A randomized controlled trial of aquatic and land-based exercise in patients with knee osteoarthritis

    DEFF Research Database (Denmark)

    Lund, H.; Weile, U.; Christensen, R.

    2008-01-01

    Objective: To compare the efficacy of aquatic exercise and a land-based exercise programme vs control in patients with knee osteoarthritis. Methods: Primary outcome was change in pain, and in addition Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS). Standing balance and strength...... was also measured after and at 3-month follow-up. Seventy-nine patients (62 women), with a mean age of 68 years (age range 40-89 years) were randomized to aquatic exercise (n = 27), land-based exercise (n = 25) or control (n = 27). Results: No effect was observed immediately after exercise cessation (8...... weeks). At 3-month follow-up a reduction in pain was observed only in the land-based exercise group compared with control (-8.1 mm, (95% confidence interval -15.4 to -0.4; p = 0. 039), but no differences between groups were observed for KOOS; and no improvement following aquatic exercise. Eleven...

  20. Telephone-based health coaching for chronically ill patients: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Dwinger, Sarah; Dirmaier, Jörg; Herbarth, Lutz; König, Hans-Helmut; Eckardt, Matthias; Kriston, Levente; Bermejo, Isaac; Härter, Martin

    2013-10-17

    The rising prevalence of chronic conditions constitutes a major burden for patients and healthcare systems and is predicted to increase in the upcoming decades. Improving the self-management skills of patients is a strategy to steer against this burden. This could lead to better outcomes and lower healthcare costs. Health coaching is one method for enhancing the self-management of patients and can be delivered by phone. The effects of telephone-based health coaching are promising, but still inconclusive. Economic evaluations and studies examining the transferability of effects to different healthcare systems are still rare. Aim of this study is to evaluate telephone-based health coaching for chronically ill patients in Germany. The study is a prospective randomized controlled trial comparing the effects of telephone-based health coaching with usual care during a 4-year time period. Data are collected at baseline and after 12, 24 and 36 months. Patients are selected based on one of the following chronic conditions: diabetes, coronary artery disease, asthma, hypertension, heart failure, COPD, chronic depression or schizophrenia. The health coaching intervention is carried out by trained nurses employed by a German statutory health insurance. The frequency and the topics of the health coaching are manual-based but tailored to the patients' needs and medical condition, following the concepts of motivational interviewing, shared decision-making and evidence-based-medicine. Approximately 12,000 insurants will be enrolled and randomized into intervention and control groups. Primary outcome is the time until hospital readmission within two years after enrolling in the health coaching, assessed by routine data. Secondary outcomes are patient-reported outcomes like changes in quality of life, depression and anxiety and clinical values assessed with questionnaires. Additional secondary outcomes are further economic evaluations like health service use as well as costs and

  1. Nomogram-based Prediction of Overall Survival in Patients with Metastatic Urothelial Carcinoma Receiving First-line Platinum-based Chemotherapy

    DEFF Research Database (Denmark)

    Necchi, Andrea; Sonpavde, Guru; Lo Vullo, Salvatore

    2017-01-01

    BACKGROUND: The available prognostic models for overall survival (OS) in patients with metastatic urothelial carcinoma (UC) have been derived from clinical trial populations of cisplatin-treated patients. OBJECTIVE: To develop a new model based on real-world patients. DESIGN, SETTING, AND PARTICI...

  2. [Breast cancer patient satisfaction with immediate two-stage implant-based breast reconstruction].

    Science.gov (United States)

    Coufal, O; Gabrielová, L; Justan, I; Zapletal, O; Selingerová, I; Krsička, P

    2014-01-01

    For most breast cancer patients in the Czech Republic, breast reconstruction is available only in a delayed manner. In the Masaryk Memorial Cancer Institute (MMCI), suitable candidates are offered immediate breast reconstruction using tissue expander with later exchange to a permanent silicone implant. The aim of this study was to assess patient satisfaction with this type of reconstruction. Sixty-two women who had undergone surgery at the MMCI from 2007 through 2013 were sent a simple questionnaire developed by our working team. Fifty-seven patients completed the questionnaire. The data were evaluated by description methods and statistical tests. Patient response was 92%. The absolute majority of patients (56/57) would opt for this method again. The vast majority of patients (48/57) are generally satisfied with their reconstruction. Most women (8/14) younger than 50 years after the unilateral surgery would prefer synchronous contralateral prophylactic mastectomy and bilateral reconstruction if they could choose again. After bilateral surgery, reconstructed breasts are more often regarded as a part of the patients body. Dressed women rate their look substantially better than when they are undressed. As for self-esteem, these women are feeling excellent or good. Their psychosocial well-being in common situations is predominantly excellent. Their sexual well-being is significantly worse, and almost half of these women indicate occasional pain in their reconstructed breasts. The patients emphasize the need for appropriate information before the surgery. Immediate two-stage implant-based breast reconstruction is a suitable option for some breast cancer patients. With regard to the less natural cosmetic result and feeling of the implant-reconstructed breast, appropriate selection of women for this type of surgery is necessary and potential candidates must be thoroughly informed in the preoperative setting.

  3. Postoperative adverse outcomes in intellectually disabled surgical patients: a nationwide population-based study.

    Directory of Open Access Journals (Sweden)

    Jui-An Lin

    Full Text Available BACKGROUND: Intellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients. METHODS: A nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact. RESULTS: Controls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37, pneumonia (odds ratio 2.01, 1.61 to 2.49, postoperative bleeding (odds ratio 1.35, 1.09 to 1.68 and septicemia (odds ratio 2.43, 1.85 to 3.21 without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability. CONCLUSION: Intellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients.

  4. Cherenkoscopy based patient positioning validation and movement tracking during post-lumpectomy whole breast radiation therapy.

    Science.gov (United States)

    Zhang, Rongxiao; Andreozzi, Jacqueline M; Gladstone, David J; Hitchcock, Whitney L; Glaser, Adam K; Jiang, Shudong; Pogue, Brian W; Jarvis, Lesley A

    2015-01-07

    To investigate Cherenkov imaging (Cherenkoscopy) based patient positioning and movement tracking during external beam radiation therapy (EBRT). In a phase 1 clinical trial, including 12 patients undergoing post-lumpectomy whole breast irradiation, Cherenkov emission was imaged with a time-gated ICCD camera synchronized to the LINAC pulse output, during different fractions of the treatment. Patients were positioned with the aid of the AlignRT system in the beginning of each treatment session. Inter-fraction setup variation was studied by rigid image registrations between images acquired at individual treatments to the average image from all imaged treatment fractions. The amplitude of respiratory motion was calculated from the registration of each frame of Cherenkov images to the reference. A Canny edge detection algorithm was utilized to highlight the beam field edges and biological features provided by major blood vessels apparent in the images. Real-time Cherenkoscopy can monitor the treatment delivery, patient motion and alignment of the beam edge to the treatment region simultaneously. For all the imaged fractions, the patient positioning discrepancies were within our clinical tolerances (3 mm in shifts and 3 degree in pitch angle rotation), with 4.6% exceeding 3 mm but still within 4 mm in shifts. The average discrepancy of repetitive patient positioning was 1.22 mm in linear shift and 0.34 degrees in rotational pitch, consistent with the accuracy reported by the AlignRT system. The edge detection algorithm enhanced features such as field edges and blood vessels. Patient positioning discrepancies and respiratory motion retrieved from rigid image registration were consistent with the edge enhanced images. Besides positioning discrepancies caused by globally inaccurate setups, edge enhanced blood vessels indicate the existence of deformations within the treatment region, especially for large patients. Real-time Cherenkoscopy imaging during EBRT is a

  5. Patient and practitioner perspectives on reducing sedentary behavior at an exercise-based cardiac rehabilitation program.

    Science.gov (United States)

    Biswas, Aviroop; Faulkner, Guy E; Oh, Paul I; Alter, David A

    2017-06-06

    To understand the awareness of sedentary behavior, as well as the perceived facilitators and barriers to reducing sedentary behaviors from the perspectives of patients undertaking an exercise-based cardiac rehabilitation program, and from staff involved in supporting patient self-management. A qualitative study was conducted at a large cardiac rehabilitation program in a metropolitan city in Canada. Guided by an ecological framework, semi-structured interviews were conducted individually with 15 patients, and in two focus groups with six staff. Transcribed interviews were analyzed by thematic analysis. Patients placed little importance on reducing sedentary behavior as they were unconvinced of the health benefits, did not perceive themselves to be sedentary, or associated such behaviors with enjoyment and relaxation. While staff were aware of the risks, they saw them as less critical than other health behaviors. Intrapersonal factors (physical and psychosocial health) and environment factors (the information environment, socio-cultural factors) within leisure time, the home, and work, influenced sedentary behavior. While these findings require further testing, future interventions may be effective if aimed at increasing awareness of the health benefits of reducing sedentary behavior, utilizing existing behavior change strategies, and using a participatory approach to tailor strategies to patients. Implications for rehabilitation Cardiac rehabilitation programs effectively use exercise promotion to improve the health of people with established cardiovascular disease. As sedentary lifestyles become more prevalent, recommendations to reduce the health risks of prolonged sedentary behavior that are specific to the characteristics and prognostic profiles of cardiac rehabilitation patients are needed. Cardiac rehabilitation programs must consider extending existing behavior change strategies utilized for exercise promotion towards addressing sedentary behaviors in order

  6. Hypnosis-based psychodynamic treatment in ALS: a longitudinal study on patients and their caregivers

    Science.gov (United States)

    Kleinbub, Johann R.; Palmieri, Arianna; Broggio, Alice; Pagnini, Francesco; Benelli, Enrico; Sambin, Marco; Sorarù, Gianni

    2015-01-01

    Background: Evidence of psychological treatment efficacy is strongly needed in ALS, particularly regarding long-term effects. Methods: Fifteen patients participated in a hypnosis treatment and self-hypnosis training protocol after an in-depth psychological and neurological evaluation. Patients' primary caregivers and 15 one-by-one matched control patients were considered in the study. Measurements of anxiety, depression and quality of life (QoL) were collected at the baseline, post-treatment, and after 3 and 6 months from the intervention. Bayesian linear mixed-models were used to evaluate the impact of treatment and defense style on patients' anxiety, depression, QoL, and functional impairment (ALSFRS-r), as well as on caregivers' anxiety and depression. Results: The statistical analyses revealed an improvement in psychological variables' scores immediately after the treatment. Amelioration in patients' and caregivers' anxiety as well as caregivers' depression, were found to persist at 3 and 6 months follow-ups. The observed massive use of primitive defense mechanisms was found to have a reliable and constant buffer effect on psychopathological symptoms in both patients and caregivers. Notably, treated patients decline in ALSFRS-r score was observed to be slower than that of control group's patients. Discussion: Our brief psychodynamic hypnosis-based treatment showed efficacy both at psychological and physical levels in patients with ALS, and was indirectly associated to long-lasting benefits in caregivers. The implications of peculiar psychodynamic factors and mind-body techniques are discussed. Future directions should be oriented toward a convergence of our results and further psychological interventions, in order to delineate clinical best practices for ALS. PMID:26136710

  7. Biomarker-Based Phase II Trial of Savolitinib in Patients With Advanced Papillary Renal Cell Cancer.

    Science.gov (United States)

    Choueiri, Toni K; Plimack, Elizabeth; Arkenau, Hendrik-Tobias; Jonasch, Eric; Heng, Daniel Y C; Powles, Thomas; Frigault, Melanie M; Clark, Edwin A; Handzel, Amir A; Gardner, Humphrey; Morgan, Shethah; Albiges, Laurence; Pal, Sumanta Kumar

    2017-09-10

    Purpose Patients with advanced papillary renal cell carcinoma (PRCC) have limited therapeutic options. PRCC may involve activation of the MET pathway, for example, through gene amplification or mutations. Savolitinib (AZD6094, HMPL-504, volitinib) is a highly selective MET tyrosine kinase inhibitor. We report results of a single-arm, multicenter, phase II study evaluating the safety and efficacy of savolitinib in patients with PRCC according to MET status. Patients and Methods Patients with histologically confirmed locally advanced or metastatic PRCC were enrolled and received savolitinib 600 mg orally once daily. MET-driven PRCC was defined as any of the following: chromosome 7 copy gain, focal MET or HGF gene amplification, or MET kinase domain mutations. Efficacy was assessed according to MET status. Safety, toxicity, and patient-reported health-related quality-of-life outcomes were assessed in all patients. Results Of 109 patients treated, PRCC was MET driven in 44 (40%) and MET independent in 46 (42%); MET status was unknown in 19 (17%). MET-driven PRCC was strongly associated with response; there were eight confirmed partial responders with MET-driven disease (18%), but none with MET-independent disease ( P = .002). Median progression-free survival for patients with MET-driven and MET-independent PRCC was 6.2 months (95% CI, 4.1 to 7.0 months) and 1.4 months (95% CI, 1.4 to 2.7 months), respectively (hazard ratio, 0.33; 95% CI, 0.20 to 0.52; log-rank P < .001). The most frequent adverse events associated with savolitinib were nausea, fatigue, vomiting, and peripheral edema. Conclusion These data show activity and tolerability of savolitinib in the subgroup of patients with MET-driven PRCC. Furthermore, molecular characterization of MET status was more predictive of response to savolitinib than a classification based on pathology. These findings justify investigating savolitinib in MET-driven PRCC.

  8. The effect of the Movie- Based Education on Sleep Quality in Patients with Bronchial Asthma

    Directory of Open Access Journals (Sweden)

    E Elahiyan Borojeni

    2017-05-01

    Full Text Available Background & aim: In recent decades, the use of media education to control the problems of patients with chronic diseases has been taken into consideration by medical staff, but few studies have been done on their effectiveness in improving the quality of sleep in patients with bronchial asthma. The aim of this study was to determine the effect of film-based education on sleep quality in patients with bronchial asthma.   Methods: The present study was a quasi-experimental study and all of the patients with bronchial asthma referred to the Asthma clinic of Boroujen were included in this study. Fifty one patients who were eligible for inclusion in the study were selected by non probability sampling method. The samples were assigned to randomly assigned blocks between the two test and control groups. For patients in the test group, patient education was performed through a 15-minute video clip by computer, DVD player and mobile phone, but patients in the control group only received routine care. The Pittsburgh Sleep Quality Index questionnaire was used to collect data one week before intervention and one month after intervention. The collected data were analyzed by descriptive statistics and t-test, Chi-square, Mann-Whitney and Wilcoxon tests.   Results: There was no significant difference before the intervention, in the overall score of sleep quality and its dimensions in the two groups (p = 0.66. There was a significant difference between the two groups after the intervention in the general score of sleep quality and the dimensions of sleep quality, sleep disturbances and sleep latency (p = 0.001 However, there was no significant difference in the use of sleep apnea, sleep duration, adequacy of sleep and daily dysfunction in the test and control groups.   Conclusion: The movie-based instruction has been able to improve the quality of sleep in patients with bronchial asthma. Considering the ease of implementation of this educational method

  9. Impact of Gender on Patient Preferences for Technology-Based Behavioral Interventions

    Directory of Open Access Journals (Sweden)

    David J. Kim

    2014-08-01

    Full Text Available Introduction: Technology-based interventions offer an opportunity to address high-risk behaviors in the emergency department (ED. Prior studies suggest behavioral health strategies are more effective when gender differences are considered. However, the role of gender in ED patient preferences for technology-based interventions has not been examined. The objective was to assess whether patient preferences for technology-based interventions varies by gender. Methods: This was a secondary analysis of data from a systematic survey of adult (18 years of age, English-speaking patients in a large urban academic ED. Subjects were randomly selected during a purposive sample of shifts. The iPad survey included questions on access to technology, preferences for receiving health information, and demographics. We defined ‘‘technology-based’’ as web, text message, e-mail, social networking, or DVD; ‘‘non-technology-based’’ was defined as in-person, written materials, or landline. We calculated descriptive statistics and used univariate tests to compare men and women. Gender-stratified multivariable logistic regression models were used to examine associations between other demographic factors (age, race, ethnicity, income and technology-based preferences for information on specific risky behaviors. Results: Of 417 participants, 45.1% were male. There were no significant demographic differences between men and women. Women were more likely to use computers (90.8% versus 81.9%; p¼0.03, Internet (66.8% versus 59.0%; p¼0.03, and social networks (53.3% versus 42.6%; p¼0.01. 89% of men and 90% of women preferred technology-based formats for at least type of health information; interest in technology-based for individual health topics did not vary by gender. Concern about confidentiality was the most common barrier to technology-based use for both genders. Multivariate analysis showed that for smoking, depression, drug/alcohol use, and injury

  10. In search of patient characteristics that may guide empirically based treatment selection for personality disorder patients - a concept map approach

    NARCIS (Netherlands)

    van Manen, J.G.; Kamphuis, J.H.; Goossensen, A.; Timman, R.; Busschbach, J.J.V.; Verheul, R.

    2012-01-01

    Using the concept map method, this study aimed to summarize and describe patient characteristics pertinent to treatment selection for patients with personality disorders (PDs). Initial patient characteristics were derived from the research literature and a survey among Dutch expert clinicians.

  11. Development of the internet based psychoeducation for patients with bipolar affective disorder.

    Science.gov (United States)

    Prasko, Jan; Kamaradova, Dana; Jelenova, Daniela; Ociskova, Marie; Sedlackova, Zuzana

    2013-01-01

    Despite pharmacological treatment of bipolar affective disorder has many advantages; only drug treatment remains insufficiently beneficial to many patients. The combination of pharmacotherapy and internet psychoeducation seems to be the effective way how to improve remission. Internet-based therapy programs offer an exclusive chance for large underserved parts of the population to make evidence-based treatment without the need of full-time therapist. Our goal was to create a psychoeducational program for patients suffering from bipolar disorder that can be used in Czech Republic. There were identified studies through Web of Science, PUBMED, and Scopus databases as well as existing reviews were used in development of comprehensive internet psychoeducational program for patients with bipolar disorder. The search terms included "bipolar disorder", "psychoeducation", and "internet psychoeducation". The search was performed with no language or time restrictions. The internet psychoeducational program was developed in accordance to the data from the literature review. The aim of the Internet psychoeducational program of the Department of Psychiatry University Hospital in Olomouc is to familiarize patients with the fundamental nature of bipolar affective disorder, the character and principles of pharmacotherapy, the recognition of the warning signs of relapse, inappropriate and stressful stereotypes in communication within families, and finally the practice of social skills. Information from studies can help to prepare comprehensive psychoeducational program for bipolar patients.

  12. Direct estimation of patient attributes from anatomical MRI based on multi-atlas voting.

    Science.gov (United States)

    Wu, Dan; Ceritoglu, Can; Miller, Michael I; Mori, Susumu

    MRI brain atlases are widely used for automated image segmentation, and in particular, recent developments in multi-atlas techniques have shown highly accurate segmentation results. In this study, we extended the role of the atlas library from mere anatomical reference to a comprehensive knowledge database with various patient attributes, such as demographic, functional, and diagnostic information. In addition to using the selected (heavily-weighted) atlases to achieve high segmentation accuracy, we tested whether the non-anatomical attributes of the selected atlases could be used to estimate patient attributes. This can be considered a context-based image retrieval (CBIR) approach, embedded in the multi-atlas framework. We first developed an image similarity measurement to weigh the atlases on a structure-by-structure basis, and then, the attributes of the multiple atlases were weighted to estimate the patient attributes. We tested this concept first by estimating age in a normal population; we then performed functional and diagnostic estimations in Alzheimer's disease patients. The accuracy of the estimated patient attributes was measured against the actual clinical data, and the performance was compared to conventional volumetric analysis. The proposed CBIR framework by multi-atlas voting would be the first step toward a knowledge-based support system for quantitative radiological image reading and diagnosis.

  13. Direct estimation of patient attributes from anatomical MRI based on multi-atlas voting

    Directory of Open Access Journals (Sweden)

    Dan Wu

    2016-01-01

    Full Text Available MRI brain atlases are widely used for automated image segmentation, and in particular, recent developments in multi-atlas techniques have shown highly accurate segmentation results. In this study, we extended the role of the atlas library from mere anatomical reference to a comprehensive knowledge database with various patient attributes, such as demographic, functional, and diagnostic information. In addition to using the selected (heavily-weighted atlases to achieve high segmentation accuracy, we tested whether the non-anatomical attributes of the selected atlases could be used to estimate patient attributes. This can be considered a context-based image retrieval (CBIR approach, embedded in the multi-atlas framework. We first developed an image similarity measurement to weigh the atlases on a structure-by-structure basis, and then, the attributes of the multiple atlases were weighted to estimate the patient attributes. We tested this concept first by estimating age in a normal population; we then performed functional and diagnostic estimations in Alzheimer's disease patients. The accuracy of the estimated patient attributes was measured against the actual clinical data, and the performance was compared to conventional volumetric analysis. The proposed CBIR framework by multi-atlas voting would be the first step toward a knowledge-based support system for quantitative radiological image reading and diagnosis.

  14. Hospital-based special needs patient decontamination: lessons from the shower.

    Science.gov (United States)

    Bulson, Julie; Bulson, Timothy C; Vande Guchte, Kathi S

    2010-01-01

    A hospital-based decontamination team tested whether it could (1) perform effective technical decontamination while maintaining safety of staff and patients; (2) safely accommodate unique needs in the showers, including guide dogs and motorized wheelchairs; (3) identify needs of special needs populations by patient type, including blindness, hearing loss, and cognitive learning disabilities; (4) outline effective use of federal preparedness funds to support planning and execution of tabletop and mock victim drills; and (5) demonstrate the ability of a community hospital to act as a catalyst for community-wide disaster response improvements. A series of five disaster exercises were used to test hypotheses and to generate quality improvement results. Fixed emergency department decontamination facilities. A total of 39 hospital-based decontamination team members, 40 other drill staff and 35 mock victims were included. Three priority decontamination operations changes resulted from each of the five completed drills. Formulated prioritized list of decontamination team procedural changes to improve patient safety and technical decontamination and to generate a table of best practices to share. With enhanced training, disaster drills participation of community response agencies and special needs patients, community hospitals can improve safety while accommodating unique patient needs.

  15. Patient-Centered Specialty Practice: Defining the Role of Specialists in Value-Based Health Care.

    Science.gov (United States)

    Ward, Lawrence; Powell, Rhea E; Scharf, Michael L; Chapman, Andrew; Kavuru, Mani

    2017-04-01

    Health care is at a crossroads and under pressure to add value by improving patient experience and health outcomes and reducing costs to the system. Efforts to improve the care model in primary care, such as the patient-centered medical home, have enjoyed some success. However, primary care accounts for only a small portion of total health-care spending, and there is a need for policies and frameworks to support high-quality, cost-efficient care in specialty practices of the medical neighborhood. The Patient-Centered Specialty Practice (PCSP) model offers ambulatory-based specialty practices one such framework, supported by a formal recognition program through the National Committee for Quality Assurance. The key elements of the PCSP model include processes to support timely access to referral requests, improved communication and coordination with patients and referring clinicians, reduced unnecessary and duplicative testing, and an emphasis on continuous measurement of quality, safety, and performance improvement for a population of patients. Evidence to support the model remains limited, and estimates of net costs and value to practices are not fully understood. The PCSP model holds promise for promoting value-based health care in specialty practices. The continued development of appropriate incentives is required to ensure widespread adoption. Copyright © 2017. Published by Elsevier Inc.

  16. Increasing patient engagement in rehabilitation exercises using computer-based citizen science.

    Science.gov (United States)

    Laut, Jeffrey; Cappa, Francesco; Nov, Oded; Porfiri, Maurizio

    2015-01-01

    Patient motivation is an important factor to consider when developing rehabilitation programs. Here, we explore the effectiveness of active participation in web-based citizen science activities as a means of increasing participant engagement in rehabilitation exercises, through the use of a low-cost haptic joystick interfaced with a laptop computer. Using the joystick, patients navigate a virtual environment representing the site of a citizen science project situated in a polluted canal. Participants are tasked with following a path on a laptop screen representing the canal. The experiment consists of two conditions: in one condition, a citizen science component where participants classify images from the canal is included; and in the other, the citizen science component is absent. Both conditions are tested on a group of young patients undergoing rehabilitation treatments and a group of healthy subjects. A survey administered at the end of both tasks reveals that participants prefer performing the scientific task, and are more likely to choose to repeat it, even at the cost of increasing the time of their rehabilitation exercise. Furthermore, performance indices based on data collected from the joystick indicate significant differences in the trajectories created by patients and healthy subjects, suggesting that the low-cost device can be used in a rehabilitation setting for gauging patient recovery.

  17. Epileptic seizure predictors based on computational intelligence techniques: a comparative study with 278 patients.

    Science.gov (United States)

    Alexandre Teixeira, César; Direito, Bruno; Bandarabadi, Mojtaba; Le Van Quyen, Michel; Valderrama, Mario; Schelter, Bjoern; Schulze-Bonhage, Andreas; Navarro, Vincent; Sales, Francisco; Dourado, António

    2014-05-01

    The ability of computational intelligence methods to predict epileptic seizures is evaluated in long-term EEG recordings of 278 patients suffering from pharmaco-resistant partial epilepsy, also known as refractory epilepsy. This extensive study in seizure prediction considers the 278 patients from the European Epilepsy Database, collected in three epilepsy centres: Hôpital Pitié-là-Salpêtrière, Paris, France; Universitätsklinikum Freiburg, Germany; Centro Hospitalar e Universitário de Coimbra, Portugal. For a considerable number of patients it was possible to find a patient specific predictor with an acceptable performance, as for example predictors that anticipate at least half of the seizures with a rate of false alarms of no more than 1 in 6 h (0.15 h⁻¹). We observed that the epileptic focus localization, data sampling frequency, testing duration, number of seizures in testing, type of machine learning, and preictal time influence significantly the prediction performance. The results allow to face optimistically the feasibility of a patient specific prospective alarming system, based on machine learning techniques by considering the combination of several univariate (single-channel) electroencephalogram features. We envisage that this work will serve as benchmark data that will be of valuable importance for future studies based on the European Epilepsy Database. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. Regional gray matter abnormalities in patients with schizophrenia determined with optimized voxel-based morphometry

    Science.gov (United States)

    Guo, XiaoJuan; Yao, Li; Jin, Zhen; Chen, Kewei

    2006-03-01

    This study examined regional gray matter abnormalities across the whole brain in 19 patients with schizophrenia (12 males and 7 females), comparing with 11 normal volunteers (7 males and 4 females). The customized brain templates were created in order to improve spatial normalization and segmentation. Then automated preprocessing of magnetic resonance imaging (MRI) data was conducted using optimized voxel-based morphometry (VBM). The statistical voxel based analysis was implemented in terms of two-sample t-test model. Compared with normal controls, regional gray matter concentration in patients with schizophrenia was significantly reduced in the bilateral superior temporal gyrus, bilateral middle frontal and inferior frontal gyrus, right insula, precentral and parahippocampal areas, left thalamus and hypothalamus as well as, however, significant increases in gray matter concentration were not observed across the whole brain in the patients. This study confirms and extends some earlier findings on gray matter abnormalities in schizophrenic patients. Previous behavior and fMRI researches on schizophrenia have suggested that cognitive capacity decreased and self-conscious weakened in schizophrenic patients. These regional gray matter abnormalities determined through structural MRI with optimized VBM may be potential anatomic underpinnings of schizophrenia.

  19. Audit of a ward-based patient-controlled epidural analgesia service in Ireland.

    LENUS (Irish Health Repository)

    Tan, T

    2012-02-01

    BACKGROUND: Ward-based patient-controlled epidural analgesia (PCEA) for postoperative pain control was introduced at our institution in 2006. We audited the efficacy and safety of ward-based PCEA from January 2006 to December 2008. METHOD: Data were collected from 928 patients who received PCEA in general surgical wards for postoperative analgesia using bupivacaine 0.125% with fentanyl 2 mug\\/mL. RESULTS: On the first postoperative day, the median visual analogue pain score was 2 at rest and 4 on activity. Hypotension occurred in 21 (2.2%) patients, excessive motor blockade in 16 (1.7%), high block in 5 (0.5%), nausea in 5 (0.5%) and pruritus in only 1 patient. Excessive sedation occurred in two (0.2%) patients but no intervention was required. There were no serious complications such as epidural abscess, infection or haematoma. CONCLUSION: Effective and safe postoperative analgesia can be provided with PCEA in a general surgical ward without recourse to high-dependency supervision.

  20. Dose optimization in radiotherapy patients for IMRT based on 4D-CBCT

    International Nuclear Information System (INIS)

    Alfonso, R.; Castillo, D.; Ascensión, Y.; Linares, H.; García, F.; Argota, R.

    2015-01-01

    The use of tomographic systems based on conical photon beams kVp (kV-CBCT) to verify the accuracy of the positioning of patients in external radiotherapy treatments has expanded in recent years, with increasing availability of linear accelerators systems for image guided radiation therapy (IGRT) based kV-CBCT systems, incorporated into the gantry of the equipment. Several studies have evaluated the collateral doses received by patients using these positioning systems for radiotherapy (RT). Recently, the firm Elekta has developed a solution to manage the effects of respiratory movements and reduce internal margins that affect the planning target volume (Symmetry TM ), which is based on the acquisition of dynamic tomographic studies (4D- CBCT), making it possible to estimate the average white temporal position in each treatment, without using methods triggered or ‘tracking’. These 4D studies however require a greater number of images per gantry angle, potentially involves a higher dose administered to patients, besides the actual dose treatment beam. The present study investigated a methodology to assess dose rates 4DCBCT (4D-CBDI) using dosimetric instrumentation and phantoms as those typically available in radiotherapy departments. The doses received by different techniques are compared using as criteria of merit image quality and overall geometric accuracy achieved in positioning and internal margins. The results show that it is possible to reduce the administered to patients in studies of CBCT static and dynamic, without significantly affecting the objectives of the same in terms of geometric accuracy dose. [es

  1. Detection method of flexion relaxation phenomenon based on wavelets for patients with low back pain

    Science.gov (United States)

    Nougarou, François; Massicotte, Daniel; Descarreaux, Martin

    2012-12-01

    The flexion relaxation phenomenon (FRP) can be defined as a reduction or silence of myoelectric activity of the lumbar erector spinae muscle during full trunk flexion. It is typically absent in patients with chronic low back pain (LBP). Before any broad clinical utilization of this neuromuscular response can be made, effective, standardized, and accurate methods of identifying FRP limits are needed. However, this phenomenon is clearly more difficult to detect for LBP patients than for healthy patients. The main goal of this study is to develop an automated method based on wavelet transformation that would improve time point limits detection of surface electromyography signals of the FRP in case of LBP patients. Conventional visual identification and proposed automated methods of time point limits detection of relaxation phase were compared on experimental data using criteria of accuracy and repeatability based on physiological properties. The evaluation demonstrates that the use of wavelet transform (WT) yields better results than methods without wavelet decomposition. Furthermore, methods based on wavelet per packet transform are more effective than algorithms employing discrete WT. Compared to visual detection, in addition to demonstrating an obvious saving of time, the use of wavelet per packet transform improves the accuracy and repeatability in the detection of the FRP limits. These results clearly highlight the value of the proposed technique in identifying onset and offset of the flexion relaxation response in LBP subjects.

  2. Correlation of Serum Cystatin C with Glomerular Filtration Rate in Patients Receiving Platinum-Based Chemotherapy.

    Science.gov (United States)

    Cavalcanti, Ernesta; Barchiesi, Vittoria; Cerasuolo, Dionigio; Di Paola, Flaviano; Cantile, Monica; Cecere, Sabrina Chiara; Pignata, Sandro; Morabito, Alessandro; Costanzo, Raffaele; Di Maio, Massimo; Perrone, Francesco

    2016-01-01

    Objectives . Serum cystatin C seems to be an accurate marker of glomerular filtration rate (GFR) compared to serum creatinine. The aim of this work was to explore the possibility of using serum cystatin C instead of serum creatinine to early predict renal failure in cancer patients who received platinum based chemotherapy. Design and Methods . Serum creatinine, serum cystatin C concentrations, and GFR were determined simultaneously in 52 cancer patients received carboplatin-based or cisplatin-based chemotherapy. Serum creatinine was assayed on Cobas C6000-Roche, serum cystatin C assay was performed on AIA 360-Tosoh, and GFR was determined in all patients, before the first cycle of chemotherapy and before the subsequent administrations. Results . In the overall series, for the prediction of a fall of GFR cystatin C was 0,667 and the best threshold was 1.135 mg/L (sensitivity 90.5%, specificity 61.1%). For a GFR fall cystatin C was 74.3% and the best threshold was 1.415 mg/L (sensitivity 66.7%, specificity 73.2%). Conclusions . Baseline cystatin C values were not able to predict renal failure during subsequent treatment. In conclusion, serum cystatin C is not a reliable early marker to efficiently predict renal failure in patients receiving chemotherapy.

  3. [Effect of video-based education on anxiety and satisfaction of patients undergoing spinal anesthesia].

    Science.gov (United States)

    Cakmak, Meltem; Kose, Isil; Zinzircioglu, Ciler; Karaman, Yucel; Tekgul, Zeki Tuncel; Pektas, Sinan; Balik, Yelda; Gonullu, Mustafa; Bozkurt, Pervin Sutas

    2018-04-07

    Providing sufficient information during a preanesthetic interview may help improve patient understanding and decrease anxiety related to spinal anesthesia. We investigated the effect of video-based education on anxiety and satisfaction in patients about to undergo spinal anesthesia. A total of 198 patients scheduled for minor elective surgery under spinal anesthesia were prospectively enrolled. The State-Trait Anxiety Inventory (State-Trait Anxiety Inventory/State and State-Trait Anxiety Inventory/Trait) questionnaires and visual analog scale were used to measure anxiety levels before the standard anesthesia evaluation was initiated. Then, 100 patients in Group 1 received written, verbal, and video-based education, whereas 98 patients in Group 2 received only written and verbal instructions regarding spinal anesthesia. Then all participants completed the State-Trait Anxiety Inventory/State and visual analog scale to evaluate anxiety. Finally, a 5-point Likert scale was used to measure satisfaction during postoperative period. No differences were found in the State-Trait Anxiety Inventory/State, State-Trait Anxiety Inventory/Trait, or visual analog scale scores between the two groups before the information period. The State-Trait Anxiety Inventory/State scores evaluating anxiety during the post-information period were differed in both groups and they found as 36.5±10.0 in Group 1 and 39.6±8.6 in Group 2 (p=0.033). The 5-point Likert scale scores to measure satisfaction were stated as 4.5±0.6 in Group 1 and 3.5±1.2 in Group 2 (p<0.001). Providing video-based information during the preanesthetic interview alleviated anxiety and increased satisfaction in patients undergoing spinal anesthesia. Copyright © 2018. Publicado por Elsevier Editora Ltda.

  4. Randomized controlled trial of family-based education for patients with heart failure and their carers.

    Science.gov (United States)

    Srisuk, Nittaya; Cameron, Jan; Ski, Chantal F; Thompson, David R

    2017-04-01

    The aim of this study was to evaluate a heart failure education programme developed for patients and carers in Thailand. Heart failure is major health problem. This is the first trial of a family-based education programme for heart failure patients and carers residing in rural Thailand. Randomized controlled trial. One hundred patient-carer dyads attending cardiac clinics in southern Thailand from April 2014 - March 2015 were randomized to usual care (n = 50) or a family-based education programme (n = 50) comprising face-to-face counselling, a heart failure manual and DVD and telephone support. Assessments of heart failure knowledge, health-related quality of life, self-care behaviours and perceived control were conducted at baseline, three and six months. Linear mixed-effects model revealed that patients and carers who received the education programme had higher knowledge scores at three and six months than those who received usual care. Among those who received the education programme, when compared with those who received usual care, patients had better self-care maintenance and confidence, and health-related quality of life scores at three and six months, and better self-care management scores at six months, whereas carers had higher perceived control scores at three months. Addressing a significant service gap in rural Thailand, this family-based heart failure programme improved patient knowledge, self-care behaviours and health-related quality of life and carer knowledge and perceived control. © 2016 John Wiley & Sons Ltd.

  5. Dicer and Drosha expression and response to Bevacizumab-based therapy in advanced colorectal cancer patients.

    Science.gov (United States)

    Vincenzi, Bruno; Zoccoli, Alice; Schiavon, Gaia; Iuliani, Michele; Pantano, Francesco; Dell'aquila, Emanuela; Ratta, Raffaele; Muda, Andrea Onetti; Perrone, Giuseppe; Brunelli, Chiara; Correale, Pierpaolo; Riva, Elisabetta; Russo, Antonio; Loupakis, Fotios; Falcone, Alfredo; Santini, Daniele; Tonini, Giuseppe

    2013-04-01

    The miRNA-regulating enzymes Dicer and Drosha exhibit aberrant expression in several cancer types. Dicer and Drosha play a crucial role during the angiogenetic process in vitro and, for Dicer, in vivo. We aimed to investigate the potential role of Dicer and Drosha in predicting response to Bevacizumab-based therapy in advanced colorectal cancer (CRC) patients. Dicer and Drosha mRNA levels were analysed in formalin-fixed paraffin-embedded specimens from patients affected by advanced CRC treated with or without Bevacizumab-containing regimens (n=116 and n=50, respectively) and from patients with diverticulosis as control group (n=20). The experimental data were obtained using qRT-PCR, analysed comparing Dicer and Drosha expression levels in tumour samples versus normal mucosa and then compared to clinical outcome. The tumour samples from Bevacizumab-treated patients showed a significantly higher Drosha expression (P<.001) versus normal mucosa, while Dicer levels did not differ. Intriguingly, we found that low Dicer levels predicted a longer progression-free survival (PFS) (P<.0001) and overall survival (OS) (P=.009). In addition, low Dicer levels were associated with better response to Bevacizumab-based treatments versus high Dicer levels (1.7% complete responses and 53.4% partial responses versus 0% and 32.7%, respectively; P=.0067). Multivariate analysis identified three independent predictors of improved OS: high performance status (PS) (relative risk (RR) 1.45; P=.011), lower organs involvement (RR 0.79; P=.034) and low Dicer expression (RR 0.71; P=.008). Conversely, Drosha levels were not associated with prognosis and outcome associated with treatment. In non-Bevacizumab-treated patients, Dicer and Drosha expression did not correlate with outcome. These findings suggest that low Dicer mRNA levels seem to be independent predictors of favourable outcome and response in patients affected by advanced CRCs treated with Bevacizumab-based therapy. Copyright © 2012

  6. Patient outcomes in simulation-based medical education: a systematic review.

    Science.gov (United States)

    Zendejas, Benjamin; Brydges, Ryan; Wang, Amy T; Cook, David A

    2013-08-01

    Evaluating the patient impact of health professions education is a societal priority with many challenges. Researchers would benefit from a summary of topics studied and potential methodological problems. We sought to summarize key information on patient outcomes identified in a comprehensive systematic review of simulation-based instruction. Systematic search of MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus, key journals, and bibliographies of previous reviews through May 2011. Original research in any language measuring the direct effects on patients of simulation-based instruction for health professionals, in comparison with no intervention or other instruction. Two reviewers independently abstracted information on learners, topics, study quality including unit of analysis, and validity evidence. We pooled outcomes using random effects. From 10,903 articles screened, we identified 50 studies reporting patient outcomes for at least 3,221 trainees and 16,742 patients. Clinical topics included airway management (14 studies), gastrointestinal endoscopy (12), and central venous catheter insertion (8). There were 31 studies involving postgraduate physicians and seven studies each involving practicing physicians, nurses, and emergency medicine technicians. Fourteen studies (28 %) used an appropriate unit of analysis. Measurement validity was supported in seven studies reporting content evidence, three reporting internal structure, and three reporting relations with other variables. The pooled Hedges' g effect size for 33 comparisons with no intervention was 0.47 (95 % confidence interval [CI], 0.31-0.63); and for nine comparisons with non-simulation instruction, it was 0.36 (95 % CI, -0.06 to 0.78). Focused field in education; high inconsistency (I(2) > 50 % in most analyses). Simulation-based education was associated with small-moderate patient benefits in comparison with no intervention and non-simulation instruction, although the latter did not reach statistical

  7. Paclitaxel-Based Chemoradiotherapy in the Treatment of Patients With Operable Esophageal Cancer

    International Nuclear Information System (INIS)

    Kelsey, Chris R.; Chino, Junzo P.; Willett, Christopher G.; Clough, Robert W.; Hurwitz, Herbert I.; Morse, Michael A.; Bendell, Johanna C.; D'Amico, Thomas A.; Czito, Brian G.

    2007-01-01

    Purpose: To compare a neoadjuvant regimen of cisplatin/5-fluorouracil (5-FU) and concurrent radiation therapy (RT) with paclitaxel-based regimens and RT in the management of operable esophageal (EC)/gastroesophageal junction (GEJ) cancer. Methods and Materials: All patients receiving neoadjuvant chemotherapy (CT) and RT for EC/GEJ cancer at Duke University between January 1995 and December 2004 were included. Clinical end points were compared for patients receiving paclitaxel-based regimens (TAX) vs. alternative regimens (non-TAX). Local control (LC), disease-free survival (DFS), and overall survival (OS) were estimated using the Kaplan-Meier method. Chi-square analysis was performed to test the effect of TAX on pathologic complete response (pCR) rates and toxicity. Results: A total of 109 patients received CT-RT followed by esophagectomy (95 M; 14 F). Median RT dose was 45 Gy (range, 36-66 Gy). The TAX and non-TAX groups comprised 47% and 53% of patients, respectively. Most (83%) TAX patients received three drug regimens including platinum and a fluoropyrimidine. In the non-TAX group, 89% of the patients received cisplatin and 5-FU. The remainder received 5-FU or capecitabine alone. Grade 3-4 toxicity occurred in 41% of patients receiving TAX vs. 24% of those receiving non-TAX (p = 0.19). Overall pCR rate was 39% (39% with TAX vs. 40% with non-TAX, p = 0.9). Overall LC, DFS, and OS at 3 years were 80%, 34%, and 37%, respectively. At 3 years, there were no differences in LC (75% vs. 85%, p = 0.33) or OS (37% vs. 37%, p = 0.32) between TAX and non-TAX groups. Conclusions: In this large experience, paclitaxel-containing regimens did not improve pCR rates or clinical end points compared to non-paclitaxel-containing regimens

  8. Systematic Review of Data Mining Applications in Patient-Centered Mobile-Based Information Systems.

    Science.gov (United States)

    Fallah, Mina; Niakan Kalhori, Sharareh R

    2017-10-01

    Smartphones represent a promising technology for patient-centered healthcare. It is claimed that data mining techniques have improved mobile apps to address patients' needs at subgroup and individual levels. This study reviewed the current literature regarding data mining applications in patient-centered mobile-based information systems. We systematically searched PubMed, Scopus, and Web of Science for original studies reported from 2014 to 2016. After screening 226 records at the title/abstract level, the full texts of 92 relevant papers were retrieved and checked against inclusion criteria. Finally, 30 papers were included in this study and reviewed. Data mining techniques have been reported in development of mobile health apps for three main purposes: data analysis for follow-up and monitoring, early diagnosis and detection for screening purpose, classification/prediction of outcomes, and risk calculation (n = 27); data collection (n = 3); and provision of recommendations (n = 2). The most accurate and frequently applied data mining method was support vector machine; however, decision tree has shown superior performance to enhance mobile apps applied for patients' self-management. Embedded data-mining-based feature in mobile apps, such as case detection, prediction/classification, risk estimation, or collection of patient data, particularly during self-management, would save, apply, and analyze patient data during and after care. More intelligent methods, such as artificial neural networks, fuzzy logic, and genetic algorithms, and even the hybrid methods may result in more patients-centered recommendations, providing education, guidance, alerts, and awareness of personalized output.

  9. ICF-based approach to evaluating functionality in cardiac rehabilitation patients after heart surgery.

    Science.gov (United States)

    Racca, V; Di Rienzo, M; Mazzini, P; Ripamonti, V; Gasti, G; Spezzaferri, R; Modica, M; Ferratini, M

    2015-08-01

    Heart surgery is a frequent reason for admission to in-patient cardiac rehabilitation programmes. ICF approach has never been used to evaluate cardiac patients after major heart surgery. The aim was to evaluate and measure functionality in cardiac patients who have undergone heart surgery, using for the first time the ICF-based approach and to assess whether such approach can be feasible and useful in cardiac rehabilitation. Observational study. In-patients cardiac Rehabilitation Unit in Milan. Fifty consecutively admitted patients who had undergone heart surgery (34 males, 16 females; mean age 65.7±12.5 years). We prepared a ICF-core set short enough to be feasible and practical. Patients were individually interviewed by different healthcare professionals (randomly selected from a group of two physicians, two physiotherapists and two psychologists) at the beginning (T1) and end of cardiac rehabilitation (T2) RESULTS: The sum of the scores of each ICF body function, body structure, activity and participation code significantly decreased between T1 and T2 (PICF body function scores and Barthel's index (ρ=0.381; P=0.006), NYHA class (ρ=0.404; P=0.004) and plasma Cr-P levels (r=0.31; P=0.03), between the ICF body structure codes and the Conley scale (ρ=0.306; P=0.02), and between the activity/participation codes and SpO2 (ρ=0.319; P=0.04). There were no correlations between the ICF environmental codes and clinical parameters. The ICF-based data provided functional information that was consistent with the patients' clinical course. The core set used allowed to quantify important body functions and activities, including some areas that are generally insufficiently considered by healthcare professionals during cardiac rehabilitation, and document their improvement.

  10. Selecting the patients for morning report sessions: case-based vs. conventional method.

    Science.gov (United States)

    Rabiei, Mehdi; Saeidi, Masumeh; Kiani, Mohammad Ali; Amin, Sakineh Mohebi; Ahanchian, Hamid; Jafari, Seyed Ali; Kianifar, Hamidreza

    2015-08-01

    One of the most important issues in morning report sessions is the number of patients. The aim of this study was to investigate and compare the number of cases reported in the morning report sessions in terms of case-based and conventional methods from the perspective of pediatric residents of Mashhad University of Medical Sciences. The present study was conducted on 24 pediatric residents of Mashhad University of Medical Sciences in the academic year 2014-2015. In this survey, the residents replied to a 20-question researcher-made questionnaire that had been designed to measure the views of residents regarding the number of patients in the morning report sessions using case-based and conventional methods. The validity of the questionnaire was confirmed by experts' views and its reliability by calculating Cronbach's alpha coefficients. Data were analyzed by t-test analysis. The mean age of the residents was 30.852 ± 2.506, and 66.6% of them were female. The results showed that there was no significant relationship among the variables of academic year, gender, and residents' perspective to choosing the number of patients in the morning report sessions (P > 0.05). T-test analysis showed a significant relationship among the average scores of residents in the selection of the case-based method in comparison to the conventional method (P case-based morning report was preferred compared to the conventional method. This method makes residents pay more attention to the details of patients' issues and therefore helps them to better plan how to address patient problems and improve their differential diagnosis skills.

  11. A network-based gene expression signature informs prognosis and treatment for colorectal cancer patients.

    Directory of Open Access Journals (Sweden)

    Mingguang Shi

    Full Text Available Several studies have reported gene expression signatures that predict recurrence risk in stage II and III colorectal cancer (CRC patients with minimal gene membership overlap and undefined biological relevance. The goal of this study was to investigate biological themes underlying these signatures, to infer genes of potential mechanistic importance to the CRC recurrence phenotype and to test whether accurate prognostic models can be developed using mechanistically important genes.We investigated eight published CRC gene expression signatures and found no functional convergence in Gene Ontology enrichment analysis. Using a random walk-based approach, we integrated these signatures and publicly available somatic mutation data on a protein-protein interaction network and inferred 487 genes that were plausible candidate molecular underpinnings for the CRC recurrence phenotype. We named the list of 487 genes a NEM signature because it integrated information from Network, Expression, and Mutation. The signature showed significant enrichment in four biological processes closely related to cancer pathophysiology and provided good coverage of known oncogenes, tumor suppressors, and CRC-related signaling pathways. A NEM signature-based Survival Support Vector Machine prognostic model was trained using a microarray gene expression dataset and tested on an independent dataset. The model-based scores showed a 75.7% concordance with the real survival data and separated patients into two groups with significantly different relapse-free survival (p = 0.002. Similar results were obtained with reversed training and testing datasets (p = 0.007. Furthermore, adjuvant chemotherapy was significantly associated with prolonged survival of the high-risk patients (p = 0.006, but not beneficial to the low-risk patients (p = 0.491.The NEM signature not only reflects CRC biology but also informs patient prognosis and treatment response. Thus, the network-based

  12. Community-based interventions in hypertensive patients: a comparison of three health education strategies.

    Science.gov (United States)

    Lu, Chu-Hong; Tang, Song-Tao; Lei, Yi-Xiong; Zhang, Mian-Qiu; Lin, Wei-Quan; Ding, Sen-Hua; Wang, Pei-Xi

    2015-01-29

    Community-based health education programs may be helpful in improving health outcomes in patients with chronic illnesses. This study aimed to evaluate community-based health education strategies in the management of hypertensive patients with low socioeconomic status in Dongguan City, China. This was a randomized, non-blinded trial involving 360 hypertensive patients enrolled in the community health service centre of Liaobu Town, Dongguan City, China. Participants were randomized to receive one of the three community-based health education programs over 2 years: self-learning reading (Group 1), monthly regular didactic lecture (Group 2), monthly interactive education workshop (Group 3). Outcomes included the changes in the proportion of subjects with normalized blood pressure (BP), hypertension-related knowledge score, adherence to antihypertensive treatment, lifestyle, body mass index and serum lipids. After the 2-y intervention, the proportion of subjects with normalized BP increased significantly in Group 2 (from 41.2% to 63.2%, p<0.001), and increased more substantially in Group 3 (from 40.2% to 86.3%, p<0.001), but did not change significantly in Group 1. Improvements in hypertension-related knowledge score, adherence to regular use of medications, appropriate salt intake and regular physical activity were progressively greater from group 1 to group 2 to group 3. Group 3 had the largest reductions in body mass index and serum LDL cholesterol levels. Interactive education workshops may be the most effective strategy in community-based health promotion education programs for hypertensive patients in improving patients' knowledge on hypertension and alleviating clinical risk factors for preventing hypertension-related complications.

  13. SU-F-R-14: PET Based Radiomics to Predict Outcomes in Patients with Hodgkin Lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, J; Aristophanous, M; Akhtari, M; Milgrom, S; Bouthaina, D; Pinnix, C; Narang, S; Rao, A; Court, L; Smith, G [The University of Texas MD Anderson Cancer Center, Houston, TX (United States)

    2016-06-15

    Purpose: To identify PET-based radiomics features associated with high refractory/relapsed disease risk for Hodgkin lymphoma patients. Methods: A total of 251 Hodgkin lymphoma patients including 19 primary refractory and 9 relapsed patients were investigated. All patients underwent an initial pre-treatment diagnostic FDG PET/CT scan. All cancerous lymph node regions (ROIs) were delineated by an experienced physician based on thresholding each volume of disease in the anatomical regions to SUV>2.5. We extracted 122 image features and evaluated the effect of ROI selection (the largest ROI, the ROI with highest mean SUV, merged ROI, and a single anatomic region [e.g. mediastinum]) on classification accuracy. Random forest was used as a classifier and ROC analysis was used to assess the relationship between selected features and patient’s outcome status. Results: Each patient had between 1 and 9 separate ROIs, with much intra-patient variability in PET features. The best model, which used features from a single anatomic region (the mediastinal ROI, only volumes>5cc: 169 patients with 12 primary refractory) had a classification accuracy of 80.5% for primary refractory disease. The top five features, based on Gini index, consist of shape features (max 3D-diameter and volume) and texture features (correlation and information measure of correlation1&2). In the ROC analysis, sensitivity and specificity of the best model were 0.92 and 0.80, respectively. The area under the ROC (AUC) and the accuracy were 0.86 and 0.86, respectively. The classification accuracy was less than 60% for other ROI models or when ROIs less than 5cc were included. Conclusion: This study showed that PET-based radiomics features from the mediastinal lymph region are associated with primary refractory disease and therefore may play an important role in predicting outcomes in Hodgkin lymphoma patients. These features could be additive beyond baseline tumor and clinical characteristics, and may warrant

  14. SU-F-R-14: PET Based Radiomics to Predict Outcomes in Patients with Hodgkin Lymphoma

    International Nuclear Information System (INIS)

    Lee, J; Aristophanous, M; Akhtari, M; Milgrom, S; Bouthaina, D; Pinnix, C; Narang, S; Rao, A; Court, L; Smith, G

    2016-01-01

    Purpose: To identify PET-based radiomics features associated with high refractory/relapsed disease risk for Hodgkin lymphoma patients. Methods: A total of 251 Hodgkin lymphoma patients including 19 primary refractory and 9 relapsed patients were investigated. All patients underwent an initial pre-treatment diagnostic FDG PET/CT scan. All cancerous lymph node regions (ROIs) were delineated by an experienced physician based on thresholding each volume of disease in the anatomical regions to SUV>2.5. We extracted 122 image features and evaluated the effect of ROI selection (the largest ROI, the ROI with highest mean SUV, merged ROI, and a single anatomic region [e.g. mediastinum]) on classification accuracy. Random forest was used as a classifier and ROC analysis was used to assess the relationship between selected features and patient’s outcome status. Results: Each patient had between 1 and 9 separate ROIs, with much intra-patient variability in PET features. The best model, which used features from a single anatomic region (the mediastinal ROI, only volumes>5cc: 169 patients with 12 primary refractory) had a classification accuracy of 80.5% for primary refractory disease. The top five features, based on Gini index, consist of shape features (max 3D-diameter and volume) and texture features (correlation and information measure of correlation1&2). In the ROC analysis, sensitivity and specificity of the best model were 0.92 and 0.80, respectively. The area under the ROC (AUC) and the accuracy were 0.86 and 0.86, respectively. The classification accuracy was less than 60% for other ROI models or when ROIs less than 5cc were included. Conclusion: This study showed that PET-based radiomics features from the mediastinal lymph region are associated with primary refractory disease and therefore may play an important role in predicting outcomes in Hodgkin lymphoma patients. These features could be additive beyond baseline tumor and clinical characteristics, and may warrant

  15. A Novel Inflammation-Based Stage (I Stage Predicts Overall Survival of Patients with Nasopharyngeal Carcinoma

    Directory of Open Access Journals (Sweden)

    Jian-Pei Li

    2016-11-01

    Full Text Available Recent studies have indicated that inflammation-based prognostic scores, such as the Glasgow Prognostic Score (GPS, modified GPS (mGPS and C-reactive protein/Albumin (CRP/Alb ratio, platelet–lymphocyte ratio (PLR, and neutrophil–lymphocyte ratio (NLR, have been reported to have prognostic value in patients with many types of cancer, including nasopharyngeal carcinoma (NPC. In this study, we proposed a novel inflammation-based stage, named I stage, for patients with NPC. A retrospective study of 409 newly-diagnosed cases of NPC was conducted. The prognostic factors (GPS, mGPS, CRP/Alb ratios, PLR, and NLR were evaluated using univariate and multivariate analyses. Then, according to the results of the multivariate analyses, we proposed a I stage combination of independent risk factors (CRP/Alb ratio and PLR. The I stage was calculated as follows: patients with high levels of CRP/Alb ratio (>0.03 and PLR (>146.2 were defined as I2; patients with one or no abnormal values were defined as I1 or I0, respectively. The relationships between the I stage and clinicopathological variables and overall survival (OS were evaluated. In addition, the discriminatory ability of the I stage with other inflammation-based prognostic scores was assessed using the AUCs (areas under the curves analyzed by receiver operating characteristics (ROC curves. The p value of <0.05 was considered to be significant. A total of 409 patients with NPC were enrolled in this study. Multivariate analyses revealed that only the CRP/Alb ratio (Hazard ratio (HR = 2.093; 95% Confidence interval (CI: 1.222–3.587; p = 0.007 and PLR (HR: 2.003; 95% CI: 1.177–3.410; p = 0.010 were independent prognostic factors in patients with NPC. The five-year overall survival rates for patients with I0, I1, and I2 were 92.1% ± 2.9%, 83.3% ± 2.6%, and 63.1% ± 4.6%, respectively (p < 0.001. The I stage had a higher area under the curve value (0.670 compared with other systemic inflammation-based

  16. Exploring change in a group-based psychological intervention for multiple sclerosis patients.

    Science.gov (United States)

    Borghi, Martina; Bonino, Silvia; Graziano, Federica; Calandri, Emanuela

    2018-07-01

    The study is focused on a group-based cognitive behavioral intervention aimed at promoting the quality of life and psychological well-being of multiple sclerosis patients. The study investigates how the group intervention promoted change among participants and fostered their adjustment to the illness. The intervention involved six groups of patients (a total of 41 patients) and included four consecutive sessions and a 6-month follow-up. To explore change, verbatim transcripts of the intervention sessions were analyzed using a mixed-methods content analysis with qualitative data combined with descriptive statistics. The categories of resistance and openness to change were used to describe the process of change. Resistance and openness to change coexisted during the intervention. Only in the first session did resistance prevail over openness to change; thereafter, openness to change gradually increased and stabilized over time, and openness to change was then always stronger than resistance. The study builds on previous research on the effectiveness of group-based psychological interventions for multiple sclerosis patients and gives methodological and clinical suggestions to health care professionals working with multiple sclerosis patients. Implications for rehabilitation The study suggests that a group-based cognitive behavioral intervention for multiple sclerosis patients focused on the promotion of identity redefinition, a sense of coherence and self-efficacy in dealing with multiple sclerosis fosters the process of change and may be effective in promoting patients' adjustment to their illness. Health care professionals leading group-based psychological interventions for multiple sclerosis patients should be aware that resistance and openness to change coexist in the process of change. The study suggests that the duration of the intervention is a crucial factor: a minimum of three sessions appears to be necessary for group participants to develop greater openness

  17. Medical costs for Korean patients with rheumatoid arthritis based on the national claims database.

    Science.gov (United States)

    Kwon, Jeong-Mi; Cho, Soo-Kyung; Kim, Jin-Hee; Lee, Eui-Kyung

    2012-09-01

    The purposes of this study are to investigate medical resource utilization and medical costs of Korean rheumatoid arthritis (RA) patients and to analyze predictors in relation to medical costs. National claims data on medical treatment were analyzed for the 151,472 RA patients in 2009. For outpatients, the mean annual number of visits was 32.5, and the mean annual total outpatient care costs were 2.0 million KRW (US$1,594) per patient. On the other hand, the mean annual length of stay of inpatients was 22.2 days, and the mean annual total inpatient care costs were 3.8 million KRW (US$3,013). Average annual total medical costs per patient for all of the RA patients were 2.9 million KRW (US$2,310). Total medical costs consisted of 26.1% outpatients' costs, 25.4% inpatient, and 48.6% medication costs, making medication costs a predominant cost driver. In the multiple regression analysis, biologic use was an important cost factor in relation to the annual total medical costs. This study provides information on the cost of illness of RA with the population-based representative RA patients in Korea, which had not been reported until now.

  18. Schizophrenia patients differentiation based on MR vascular perfusion and volumetric imaging

    Science.gov (United States)

    Spanier, A. B.; Joskowicz, L.; Moshel, S.; Israeli, D.

    2015-03-01

    Candecomp/Parafac Decomposition (CPD) has emerged as a framework for modeling N-way arrays (higher-order matrices). CPD is naturally well suited for the analysis of data sets comprised of observations of a function of multiple discrete indices. In this study we evaluate the prospects of using CPD for modeling MRI brain properties (i.e. brain volume and gray-level) for schizophrenia diagnosis. Taking into account that 3D imaging data consists of millions of pixels per patient, the diagnosis of a schizophrenia patient based on pixel analysis constitutes a methodological challenge (e.g. multiple comparison problem). We show that the CPD could potentially be used as a dimensionality redaction method and as a discriminator between schizophrenia patients and match control, using the gradient of pre- and post Gd-T1-weighted MRI data, which is strongly correlated with cerebral blood perfusion. Our approach was tested on 68 MRI scans: 40 first-episode schizophrenia patients and 28 matched controls. The CPD subject's scores exhibit statistically significant result (P schizophrenia with MRI, the results suggest that the CPD could potentially be used to discriminate between schizophrenia patients and matched control. In addition, the CPD model suggests for brain regions that might exhibit abnormalities in schizophrenia patients for future research.

  19. Evaluating Infection Prevention Strategies in Out-Patient Dialysis Units Using Agent-Based Modeling.

    Directory of Open Access Journals (Sweden)

    Joanna R Wares

    Full Text Available Patients receiving chronic hemodialysis (CHD are among the most vulnerable to infections caused by multidrug-resistant organisms (MDRO, which are associated with high rates of morbidity and mortality. Current guidelines to reduce transmission of MDRO in the out-patient dialysis unit are targeted at patients considered to be high-risk for transmitting these organisms: those with infected skin wounds not contained by a dressing, or those with fecal incontinence or uncontrolled diarrhea. Here, we hypothesize that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of MDRO. We also hypothesize that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. To address our hypotheses, we built an agent-based model to simulate different treatment strategies in a dialysis unit. Our results suggest that reducing antimicrobial treatment, either by reducing the number of patients receiving treatment or by reducing the duration of the treatment, markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. Our results also suggest that improving the environmental decontamination efficacy between patient dialysis treatments is an effective method for reducing colonization and contamination rates. These findings have important implications for the development and implementation of future infection prevention strategies.

  20. Developing a Virtual Reality-Based Vocational Rehabilitation Training Program for Patients with Schizophrenia.

    Science.gov (United States)

    Sohn, Bo Kyung; Hwang, Jae Yeon; Park, Su Mi; Choi, Jung-Seok; Lee, Jun-Young; Lee, Ji Yeuon; Jung, Hee-Yeon

    2016-11-01

    Maintaining employment is difficult for patients with schizophrenia because of deterioration of psychosocial and cognitive functions. Such patients usually require vocational rehabilitation training, which is both demanding and costly. In this study, we developed a virtual reality-based vocational rehabilitation training program (VR-VRTP) for such patients and evaluated its feasibility as an alternative to traditional rehabilitation programs. We developed the VR-VRTP to include various situations commonly encountered in two types of occupations: convenience store employee and supermarket clerk. We developed practical situations, as well as a system for providing feedback, to ensure patients would not lose interest during training. Nine participants each performed the VR-VRTP repeatedly per week for a total of 8 weeks. At baseline and after training, all participants were evaluated using the following clinical and neuropsychological tests: Manchester Scale, Clinical Global Impression, Personal and Social Performance Scale (PSP), Hamilton Depression Rating Scale, Zung Depression Rating Scale, Beck Anxiety Inventory, Wisconsin Card Sorting Test, Stroop Test, Rey-Osterrieth Complex Figure Test (RCFT), and Auditory Verbal Learning Test (AVLT). After training, patient scores improved on the PSP, general symptoms on the Manchester Scale, AVLT, and delayed recall on the RCFT. The Manchester positive symptom score showed a trend of improvement. No significant changes were observed for other measures. The VR-VRTP may improve general psychosocial function and memory, potentially influencing real-world vocational performance. These findings provide preliminary evidence regarding the utility of the VR-VRTP in patients with schizophrenia.

  1. Mindfulness-based cognitive behavior therapy in patients with anxiety disorders: a case series.

    Science.gov (United States)

    Sharma, Mahendra P; Mao, Angelina; Sudhir, Paulomi M

    2012-07-01

    The present study is aimed at evaluating the effectiveness of a Mindfulness-Based Cognitive Behavior Therapy (MBCBT) for reducing cognitive and somatic anxiety and modifying dysfunctional cognitions in patients with anxiety disorders. A single case design with pre- and post-assessment was adopted. Four patients meeting the specified inclusion and exclusion criteria were recruited for the study. Three patients received a primary diagnosis of generalized anxiety disorder (GAD), while the fourth patient was diagnosed with Panic Disorder. Patients were assessed on the Cognitive and Somatic Anxiety Questionnaire (CSAQ), Penn State Worry Questionnaire (PSWQ), Hamilton's Anxiety Inventory (HAM-A), and Dysfunctional Attitudes Scale. The therapeutic program consisted of education regarding nature of anxiety, training in different versions of mindfulness meditation, cognitive restructuring, and strategies to handle worry, such as, worry postponement, worry exposure, and problem solving. A total of 23 sessions over four to six weeks were conducted for each patient. The findings of the study are discussed in light of the available research, and implications and limitations are highlighted along with suggestions for future research.

  2. A robust gene expression-based prognostic risk score predicts overall survival of lung adenocarcinoma patients.

    Science.gov (United States)

    Chen, En-Guo; Wang, Pin; Lou, Haizhou; Wang, Yunshan; Yan, Hong; Bi, Lei; Liu, Liang; Li, Bin; Snijders, Antoine M; Mao, Jian-Hua; Hang, Bo

    2018-01-23

    Identification of reliable predictive biomarkers and new therapeutic targets is a critical step for significant improvement in patient outcomes. Here, we developed a multi-step bioinformatics analytic strategy to mine large omics and clinical data to build a prognostic scoring system for predicting the overall survival (OS) of lung adenocarcinoma (LuADC) patients. In latter we first identified 1327 significantly and robustly deregulated genes, 600 of which were significantly associated with the OS of LuADC patients. Gene co-expression network analysis revealed the biological functions of these 600 genes in normal lung and LuADCs, which were found to be enriched for cell cycle-related processes, blood vessel development, cell-matrix adhesion and metabolic processes. Finally, we implemented a multiple resampling method combined with Cox regression analysis to identify a 27-gene signature associated with OS, and then created a prognostic scoring system based on this signature. This scoring system robustly predicted OS of LuADC patients in 100 sampling test sets and was further validated in four independent LuADC cohorts. In addition, in comparison to other existing prognostic gene signatures published in the literature, our signature was significantly superior in predicting OS of LuADC patients. In summary, our multi-omics and clinical data integration study created a 27-gene prognostic risk score that can predict OS of LuADC patients independent of age, gender and clinical stage. This score could guide therapeutic selection and allow stratification in clinical trials.

  3. Patient-specific dosimetric endpoints based treatment plan quality control in radiotherapy

    International Nuclear Information System (INIS)

    Song, Ting; Zhou, Linghong; Staub, David; Chen, Mingli; Lu, Weiguo; Tian, Zhen; Jia, Xun; Li, Yongbao; Jiang, Steve B; Gu, Xuejun

    2015-01-01

    In intensity modulated radiotherapy (IMRT), the optimal plan for each patient is specific due to unique patient anatomy. To achieve such a plan, patient-specific dosimetric goals reflecting each patient’s unique anatomy should be defined and adopted in the treatment planning procedure for plan quality control. This study is to develop such a personalized treatment plan quality control tool by predicting patient-specific dosimetric endpoints (DEs). The incorporation of patient specific DEs is realized by a multi-OAR geometry-dosimetry model, capable of predicting optimal DEs based on the individual patient’s geometry. The overall quality of a treatment plan is then judged with a numerical treatment plan quality indicator and characterized as optimal or suboptimal. Taking advantage of clinically available prostate volumetric modulated arc therapy (VMAT) treatment plans, we built and evaluated our proposed plan quality control tool. Using our developed tool, six of twenty evaluated plans were identified as sub-optimal plans. After plan re-optimization, these suboptimal plans achieved better OAR dose sparing without sacrificing the PTV coverage, and the dosimetric endpoints of the re-optimized plans agreed well with the model predicted values, which validate the predictability of the proposed tool. In conclusion, the developed tool is able to accurately predict optimally achievable DEs of multiple OARs, identify suboptimal plans, and guide plan optimization. It is a useful tool for achieving patient-specific treatment plan quality control. (paper)

  4. Voxel-based analysis of diffusion tensor indices in the brain in patients with Parkinson's disease

    International Nuclear Information System (INIS)

    Zhang Kaiyuan; Yu Chunshui; Zhang Yujin; Wu Xiaoli; Zhu Chaozhe; Chan Piu; Li Kuncheng

    2011-01-01

    Purpose: To investigate the abnormal diffusion in cerebral white matter and its relationship with the olfactory dysfunction in patients with Parkinson's disease (PD) through diffusion tensor imaging (DTI). Materials and methods: Diffusion tensor imaging of the cerebrum was performed in 25 patients with Parkinson's disease and 25 control subjects matched for age and sex. Differences in fractional anisotropy (FA) and mean diffusivity (MD) between these two groups were studied by voxel-based analysis of the DTI data. Correlations between diffusion indices and the olfactory function in PD patients were evaluated using the multiple regression model after controlling for the duration of the disease, Unified Parkinson's Disease Rating Sale (UPDRS), and age. Results: The damaged white and gray matter showed decreased FA or increased MD, localized bilaterally in the cerebellar and orbitofrontal cortex. In addition, in PD patients there was a positive correlation between FA values in the white matter of the left cerebellum and the thresholds of olfactory identification (TOI) and a negative correlation between MD values in the white matter of right cerebellum and the TOI. Conclusion: In patients with PD, there was disruption in the cerebellar white matter which may play an important role in the olfactory dysfunction in patients with Parkinson's disease.

  5. Survival of patients with mixed phenotype acute leukemias: A large population-based study.

    Science.gov (United States)

    Shi, Runhua; Munker, Reinhold

    2015-06-01

    Little is known about the incidence and treatment outcome of patients with acute biphenotypic leukemias. The World Health Organization (WHO) established the term of acute leukemia of ambiguous phenotype in 2001 (revised in 2008) introducing the term of mixed phenotype acute leukemias. Using the database of the Surveillance, Epidemiology, and End Results registry (SEER), we identified 313 patients with mixed phenotype acute leukemias and compared them with 14,739 patients with acute lymphoblastic leukemia and 34,326 patients with acute myelogenous leukemias diagnosed between 2001 and 2011. As a further control group, 1777 patients were included who were not classified as myeloid, lymphoid or biphenotypic (other acute leukemias). The incidence of mixed phenotype acute leukemias is 0.35 cases/1,000,000 person-years. In a multivariate analysis, the prognosis depends strongly on age (as with other leukemias) and it has the worst outcome of all four types of leukemia. However, the prognosis has improved, comparing 2001-2005 with 2006-2011. We present the first comprehensive, population-based study of acute biphenotypic or mixed phenotype acute leukemias according to the WHO classification. Especially in older patients, the prognosis is unfavorable and new treatments should be investigated. Published by Elsevier Ltd.

  6. A web-based, patient driven registry for Angelman syndrome: the global Angelman syndrome registry.

    Science.gov (United States)

    Napier, Kathryn R; Tones, Megan; Simons, Chloe; Heussler, Helen; Hunter, Adam A; Cross, Meagan; Bellgard, Matthew I

    2017-08-01

    Angelman syndrome (AS) is a rare neurodevelopmental disorder that is characterised by severe global developmental delays, ataxia, loss of speech, epilepsy, sleep disorders, and a happy disposition. There is currently no cure for AS, though several pharmaceutical companies are anticipating drug trials for new therapies to treat AS. The Foundation for Angelman Therapeutics (FAST) Australia therefore identified a need for a global AS patient registry to identify patients for recruitment for clinical trials.The Global AS Registry was deployed in September 2016 utilising the Rare Disease Registry Framework, an open-source tool that enables the efficient creation and management of patient registries. The Global AS Registry is web-based and allows parents and guardians worldwide to register, provide informed consent, and enter data on individuals with AS. 286 patients have registered in the first 8 months since deployment.We demonstrate the successful deployment of the first patient-driven global registry for AS. The data generated from the Global AS Registry will be crucial in identifying patients suitable for clinical trials and in informing research that will identify treatments for AS, and ultimately improve the lives of individuals and their families living with AS.

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

    Directory of Open Access Journals (Sweden)

    Bo Young Yoon

    2016-06-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

  9. Cancer Patients' Recommendations for Nature-Based Design and Engagement in Oncology Contexts: Qualitative Research.

    Science.gov (United States)

    Blaschke, Sarah; O'Callaghan, Clare C; Schofield, Penelope

    2017-01-01

    To explore cancer patients' recommendations for nature engagement based on their subjective nature experiences and observations in the cancer setting. The rationale was to gain practical insight for delineating relevant and translatable nature-based care and design opportunities in oncology contexts. Innovative cancer care services are needed to respond to growing demand and shifting healthcare needs. Engagement with nature has shown multiple health benefits and presents a promising opportunity for application in healthcare to improve outcomes. Qualitative research design using content analysis was used. Eligible adults with any cancer diagnosis participated in semistructured and audio-recorded interviews. Transcribed textual data included responses to two open-ended questions querying about participants' recommendations related to nature-based opportunities in the cancer setting. Deductive analysis used three predetermined categories: "recommendation: features," "recommendation: functions," and "cautions." Twenty patients with cancer (nine female) participated. Broad recommendations incorporated (1) using nature for vital sensory stimulation and engagement, (2) using nature for personal space and freedom to enable private and social exploration, (3) using views to nature for distraction and comfort, and (4) accessing nature for physical activity and movement. Three critical factors were determined for avoiding adverse experiences: determining appropriate expenditure and resourcing, selection of appropriate nature-based design materials, and exercising caution around demanding nature engagement and harsh weather conditions. Cancer patients' recommendations reveal the importance of engaging with nature in their experiences of health and recovery. The findings can inform planning appropriate and safe integration of beneficial nature engagement in cancer settings and support services.

  10. Heart rate variability analysis based on time–frequency representation and entropies in hypertrophic cardiomyopathy patients

    International Nuclear Information System (INIS)

    Clariá, F; Vallverdú, M; Caminal, P; Baranowski, R; Chojnowska, L

    2008-01-01

    In hypertrophic cardiomyopathy (HCM) patients there is an increased risk of premature death, which can occur with little or no warning. Furthermore, classification for sudden cardiac death on patients with HCM is very difficult. The aim of our study was to improve the prognostic value of heart rate variability (HRV) in HCM patients, giving insight into changes of the autonomic nervous system. In this way, the suitability of linear and nonlinear measures was studied to assess the HRV. These measures were based on time–frequency representation (TFR) and on Shannon and Rényi entropies, and compared with traditional HRV measures. Holter recordings of 64 patients with HCM and 55 healthy subjects were analyzed. The HCM patients consisted of two groups: 13 high risk patients, after aborted sudden cardiac death (SCD); 51 low risk patients, without SCD. Five-hour RR signals, corresponding to the sleep period of the subjects, were considered for the analysis as a comparable standard situation. These RR signals were filtered in the three frequency bands: very low frequency band (VLF, 0–0.04 Hz), low frequency band (LF, 0.04–0.15 Hz) and high frequency band (HF, 0.15–0.45 Hz). TFR variables based on instantaneous frequency and energy functions were able to classify HCM patients and healthy subjects (control group). Results revealed that measures obtained from TFR analysis of the HRV better classified the groups of subjects than traditional HRV parameters. However, results showed that nonlinear measures improved group classification. It was observed that entropies calculated in the HF band showed the highest statistically significant levels comparing the HCM group and the control group, p-value < 0.0005. The values of entropy measures calculated in the HCM group presented lower values, indicating a decreasing of complexity, than those calculated from the control group. Moreover, similar behavior was observed comparing high and low risk of premature death, the values of

  11. Accuracy of UTE-MRI-based patient setup for brain cancer radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Yingli; Cao, Minsong; Kaprealian, Tania; Sheng, Ke; Gao, Yu; Gomez, Caitlin; Santhanam, Anand; Tenn, Stephen; Agazaryan, Nzhde; Low, Daniel A. [Department of Radiation Oncology, University of California, Los Angeles, California 90095 (United States); Han, Fei; Hu, Peng, E-mail: penghu@mednet.ucla.edu [Department of Radiological Sciences, University of California, Los Angeles, California 90095 (United States)

    2016-01-15

    Purpose: Radiation therapy simulations solely based on MRI have advantages compared to CT-based approaches. One feature readily available from computed tomography (CT) that would need to be reproduced with MR is the ability to compute digitally reconstructed radiographs (DRRs) for comparison against on-board radiographs commonly used for patient positioning. In this study, the authors generate MR-based bone images using a single ultrashort echo time (UTE) pulse sequence and quantify their 3D and 2D image registration accuracy to CT and radiographic images for treatments in the cranium. Methods: Seven brain cancer patients were scanned at 1.5 T using a radial UTE sequence. The sequence acquired two images at two different echo times. The two images were processed using an in-house software to generate the UTE bone images. The resultant bone images were rigidly registered to simulation CT data and the registration error was determined using manually annotated landmarks as references. DRRs were created based on UTE-MRI and registered to simulated on-board images (OBIs) and actual clinical 2D oblique images from ExacTrac™. Results: UTE-MRI resulted in well visualized cranial, facial, and vertebral bones that quantitatively matched the bones in the CT images with geometric measurement errors of less than 1 mm. The registration error between DRRs generated from 3D UTE-MRI and the simulated 2D OBIs or the clinical oblique x-ray images was also less than 1 mm for all patients. Conclusions: UTE-MRI-based DRRs appear to be promising for daily patient setup of brain cancer radiotherapy with kV on-board imaging.

  12. Enhancing requirements engineering for patient registry software systems with evidence-based components.

    Science.gov (United States)

    Lindoerfer, Doris; Mansmann, Ulrich

    2017-07-01

    Patient registries are instrumental for medical research. Often their structures are complex and their implementations use composite software systems to meet the wide spectrum of challenges. Commercial and open-source systems are available for registry implementation, but many research groups develop their own systems. Methodological approaches in the selection of software as well as the construction of proprietary systems are needed. We propose an evidence-based checklist, summarizing essential items for patient registry software systems (CIPROS), to accelerate the requirements engineering process. Requirements engineering activities for software systems follow traditional software requirements elicitation methods, general software requirements specification (SRS) templates, and standards. We performed a multistep procedure to develop a specific evidence-based CIPROS checklist: (1) A systematic literature review to build a comprehensive collection of technical concepts, (2) a qualitative content analysis to define a catalogue of relevant criteria, and (3) a checklist to construct a minimal appraisal standard. CIPROS is based on 64 publications and covers twelve sections with a total of 72 items. CIPROS also defines software requirements. Comparing CIPROS with traditional software requirements elicitation methods, SRS templates and standards show a broad consensus but differences in issues regarding registry-specific aspects. Using an evidence-based approach to requirements engineering for registry software adds aspects to the traditional methods and accelerates the software engineering process for registry software. The method we used to construct CIPROS serves as a potential template for creating evidence-based checklists in other fields. The CIPROS list supports developers in assessing requirements for existing systems and formulating requirements for their own systems, while strengthening the reporting of patient registry software system descriptions. It may be

  13. Patients, evidence and genes: an exploration of GPs' perspectives on gene-based personalized nutrition advice.

    Science.gov (United States)

    Bouwman, Laura; Te Molder, Hedwig; Hiddink, Gerrit

    2008-12-01

    Nutrigenomics science examines the response of individuals to food compounds using post-genomics technology. It is expected that in the future, personalized nutrition advice can be provided based on information about genetic make-up. Gene-based personalized nutrition advice emerges at the junction of different disciplines and technologies and may directly influence people's lives. Therefore, public concern is to be expected. Because GPs are gatekeepers of health care, their involvement in early stages of the development process is desirable. In 2006, 15 GPs were interviewed to collect their perceived barriers and opportunities towards involvement in gene-based nutrition advice. The interviews were qualitatively analysed with use of Atlas.ti, a qualitative analysis programme. The participants held a mostly critical view towards such personalized nutrition advice. They argued that findings of nutritional studies lacked robustness, were not based on patients' needs and were often equivocal. And that a patient central perspective urges them to question consequences for patients. Participants argued that GPs should be involved in selecting and monitoring patients in nutrigenomics studies. Early involvement of GPs in the development process is needed to allow for the integration of their practical, social and ethical considerations in the technical and scientific agendas. However, the background of their critical attitude towards nutrigenomics-based personalized nutrition, and nutrition advice more generally, has to be explored further. To facilitate a joint learning process and to improve socio-technical decision making with respect to this innovation, initiatives that allow different stakeholders to exchange their perspectives should be organized.

  14. Levetiracetam (Keppra: Evidence-Based Polypharmacy in Two Patients With Epilepsy

    Directory of Open Access Journals (Sweden)

    Tolou-Ghamari

    2016-04-01

    Full Text Available Introduction Epilepsy is a prolonged disorder characterized by repeated violent epileptic seizures. Its managements depend on proper classification of the seizure category and the epileptic pattern. Levetiracetam (Keppra® has been approved as monotherapy or for adjunctive management of partial onset seizures, juvenile myoclonic epilepsy, and idiopathic generalized epilepsy. Case reporting of levetiracetam polypharmacy shows adverse effects linked to evidence-based clinical and laboratory data in two patients with epilepsy. Case reporting of levetiracetam polypharmacy, based on evidence-based clinical and laboratory data was of interest that investigated. Case Presentation Two cases were studied, one patient was a 32-year-old male and the other was a 14-year-old female. The key words relevant to search topics were surveyed using PubMed (United States national library of medicine. Articles related to the levetiracetam prescription in epileptic patients were selected and considered separately. Pharmacotherapy based on levetiracetam, primidone, phenytoin, and topiramate in a 32-year-old epileptic male showed a decrease in white blood cell count (3400 cells/mcL, red blood cell count (4.4 mil/mm3 hemoglobin (11.8 g/dL and hematocrit (36.7%. The drug regimen for the 14-year-old epileptic female was a levetiracetam polypharmacy in combination with primidone and sodium-valproate simultaneously. In this patient, there was a decrease in hemoglobin (10.4 g/dL and hematocrit (34%. An increase in lymphocyte (84% was also observed. Conclusions Administration of AEDs in general and levetiracetam in particular should be based on attention to pharmacokinetic behavior in terms of monotherapy or polypharmacy.

  15. Sevoflurane-Based Inhalation Induction in High-Risk Elderly Patients During Noncardiac Surgery

    Directory of Open Access Journals (Sweden)

    O. A. Grebenchikov

    2011-01-01

    Full Text Available Objective: to study the hemodynamic effects of sevoflurane during the induction of anesthesia in elderly patients at high risk for cardiac events. Subjects and methods. This study enrolled 32 patients who had a left ventricular ejection fraction of <30% during preoperative examination. According to the presumptive type of anesthesia, the patients were randomized to one of the study groups: In the sevoflurane group receiving infusion of fentanyl (1 ig^kg”‘^hr”‘, anesthesia was induced by sevoflurane at the maximum concentration of 8 vol% at first inspiration, without the respiratory circuit being prefilled. After loss of consciousness, further saturation was carried out using Fianesth, 5 vol%. Combination anesthesia (CA was that which was induced by successive administration of dormicum, ketamine, propo-fol, and fentanyl. The trachea was intubated during total myoplegia under the control of TOF (TOF-Watch, Organon, the Netherlands. Results. In all the patients under CA, its induction was made during infusion of dopamine (5 lg^kg”‘^min”‘, the dose of which had to be increased up to 10 ig • kg-1 • min-1 in 6 (75% patients. Nevertheless, there were decreases in mean blood pressure (BPmean to 46±6 mm Hg and in cardiac index (CI to 1.5±0.3 fig • kg-1 • min-1 (by 32% of the outcome value. In the sevoflurane inhalation induction group, only 3 (12.5% patients needed dopamine. Its dose producing a cardiotonic effect was near-minimal; its average maintenance infusion rate was 5.3±0.3 ig^kg”‘^min”‘. The reduction in CI was statistically insignificant; despite a 9% decrease in BPmean, this indicator in the sevoflurane group remained within acceptable ranges. Conclusion. The use of a sevoflurane-based inhalation induction technique permits higher hemodynamic stability in patients at high risk for cardiac events. Key words: inhalation induction, sevoflurane, ketamine, elderly patients.

  16. Tomato-based randomized controlled trial in prostate cancer patients: Effect on PSA.

    Science.gov (United States)

    Paur, Ingvild; Lilleby, Wolfgang; Bøhn, Siv Kjølsrud; Hulander, Erik; Klein, Willibrord; Vlatkovic, Ljiljana; Axcrona, Karol; Bolstad, Nils; Bjøro, Trine; Laake, Petter; Taskén, Kristin A; Svindland, Aud; Eri, Lars Magne; Brennhovd, Bjørn; Carlsen, Monica H; Fosså, Sophie D; Smeland, Sigbjørn S; Karlsen, Anette S; Blomhoff, Rune

    2017-06-01

    The effect of lycopene-containing foods in prostate cancer development remains undetermined. We tested whether a lycopene-rich tomato intervention could reduce the levels of prostate specific antigen (PSA) in prostate cancer patients. Prior to their curative treatment, 79 patients with prostate cancer were randomized to a nutritional intervention with either 1) tomato products containing 30 mg lycopene per day; 2) tomato products plus selenium, omega-3 fatty acids, soy isoflavones, grape/pomegranate juice, and green/black tea (tomato-plus); or 3) control diet for 3 weeks. The main analysis, which included patients in all risk categories, did not reveal differences in changes of PSA-values between the intervention and control groups. Post-hoc, exploratory analyses within intermediate risk (n = 41) patients based on tumor classification and Gleason score post-surgery, revealed that median PSA decreased significantly in the tomato group as compared to controls (-2.9% and +6.5% respectively, p = 0.016). In separate post-hoc analyses, we observed that median PSA-values decreased by 1% in patients with the highest increases in plasma lycopene, selenium and C20:5 n-3 fatty acid, compared to an 8.5% increase in the patients with the lowest increase in lycopene, selenium and C20:5 n-3 fatty acid (p = 0.003). Also, PSA decreased in patients with the highest increase in lycopene alone (p = 0.009). Three week nutritional interventions with tomato-products alone or in combination with selenium and n-3 fatty acids lower PSA in patients with non-metastatic prostate cancer. Our observation suggests that the effect may depend on both aggressiveness of the disease and the blood levels of lycopene, selenium and omega-3 fatty acids. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  17. Internet and social media usage of orthopaedic patients: A questionnaire-based survey.

    Science.gov (United States)

    Duymus, Tahir Mutlu; Karadeniz, Hilmi; Çaçan, Mehmet Akif; Kömür, Baran; Demirtaş, Abdullah; Zehir, Sinan; Azboy, İbrahim

    2017-02-18

    To evaluate social media usage of orthopaedic patients to search for solutions to their health problems. The study data were collected using face-to-face questionnaire with randomly selected 1890 patients aged over 18 years who had been admitted to the orthopaedic clinics in different cities and provinces across Turkey. The questionnaire consists of a total of 16 questions pertaining to internet and social media usage and demographics of patients, patients' choice of institution for treatment, patient complaints on admission, online hospital and physician ratings, communication between the patient and the physician and its effects. It was found that 34.2% ( n = 647) of the participants consulted with an orthopaedist using the internet and 48.7% ( n = 315) of them preferred websites that allow users to ask questions to a physician. Of all question-askers, 48.5% ( n = 314) reported having found the answers helpful. Based on the educational level of the participants, there was a highly significant difference between the rates of asking questions to an orthopaedist using the internet ( P = 0.001). The rate of question-asking was significantly lower in patients with an elementary education than that in those with secondary, high school and undergraduate education ( P = 0.001) The rate of reporting that the answers given was helpful was significantly higher in participants with an undergraduate degree compared to those who were illiterate, those with primary, elementary or high school education ( P = 0.001). It was also found that the usage of the internet for health problems was higher among managers-qualified participants than unemployed-housewives, officers, workers-intermediate staff ( P social media to select a specific physician or to seek solution to their health problems in an effective way. Even though the internet and social media offer beneficial effects for physicians or patients, there is still much obscurity regarding their harms and further studies are

  18. A Population-Based Assessment of Mortality and Morbidity Patterns among Patients with Thymoma

    Science.gov (United States)

    Gadalla, Shahinaz M; Rajan, Arun; Pfeiffer, Ruth; Kristinsson, Sigurdur Y; Björkholm, Magnus; Landgren, Ola; Giaccone, Giuseppe

    2010-01-01

    Thymomas are rare tumors of the mediastinum; a limited number of small studies have evaluated the outcomes in these patients. We identified 668 patients with thymoma from the Swedish Cancer Registry, and 2,719 population-based matched controls. We obtained information on autoimmunity from the nationwide inpatient/outpatient hospital discharge Registry. We constructed Kaplan-Meier curves for survival analysis, conditional regression and Cox proportional hazards models to evaluate the association between thymoma and autoimmune diseases, and standardized incidence ratios (SIRs) to evaluate the risk for second cancers following thymoma. Compared with controls, patients with benign or malignant thymoma had a poorer (p thymoma patients, younger age at diagnosis and being diagnosed in recent years were associated with a better survival. Compared with controls, thymoma patients were more likely to have an autoimmune disease at some point during their lives (32.7% vs. 2.4%, respectively, pThymoma patients had 2-fold excess risk for second cancers compared with the general population, most notably: non-melanoma skin cancer (SIR=10.6, 95% confidence intervals (CI)=6.0–17.3), non-Hodgkin lymphoma (SIR=6.8, 95% CI=3.00–13.0), and cervical (SIR=6.9, 95% CI=1.4–20.1), endocrine (SIR=4.7, 95% CI=1.3–12.0), and prostate cancer (SIR=3.0, 95% CI=1.7–4.8). Despite the improved survival for thymoma patients over time, they have worse survival than controls. Thymoma patients are in need for follow-up to detect and manage autoimmune diseases and cancer. PMID:20669226

  19. Effects of a team-based assessment and intervention on patient safety culture in general practice

    DEFF Research Database (Denmark)

    Hoffmann, B; Müller, V; Rochon, J

    2014-01-01

    Background: The measurement of safety culture in healthcare is generally regarded as a first step towards improvement. Based on a self-assessment of safety culture, the Frankfurt Patient Safety Matrix (FraTrix) aims to enable healthcare teams to improve safety culture in their organisations...... months, scores were allocated for safety culture as expressed in practice structure and processes (indicators), in safety climate and in patient safety incident reporting. The primary outcome was the indicator error management. Results: During the team sessions, practice teams reflected on their safety...... culture and decided on about 10 actions per practice to improve it. After 12 months, no significant differences were found between intervention and control groups in terms of error management (competing probability = 0.48, 95% CI 0.34 to 0.63, p = 0.823), 11 further patient safety culture indicators...

  20. Evidence-based guidelines for supportive care of patients with Ebola virus disease.

    Science.gov (United States)

    Lamontagne, François; Fowler, Robert A; Adhikari, Neill K; Murthy, Srinivas; Brett-Major, David M; Jacobs, Michael; Uyeki, Timothy M; Vallenas, Constanza; Norris, Susan L; Fischer, William A; Fletcher, Thomas E; Levine, Adam C; Reed, Paul; Bausch, Daniel G; Gove, Sandy; Hall, Andrew; Shepherd, Susan; Siemieniuk, Reed A; Lamah, Marie-Claude; Kamara, Rashida; Nakyeyune, Phiona; Soka, Moses J; Edwin, Ama; Hazzan, Afeez A; Jacob, Shevin T; Elkarsany, Mubarak Mustafa; Adachi, Takuya; Benhadj, Lynda; Clément, Christophe; Crozier, Ian; Garcia, Armando; Hoffman, Steven J; Guyatt, Gordon H

    2017-10-17

    The 2013-16 Ebola virus disease outbreak in west Africa was associated with unprecedented challenges in the provision of care to patients with Ebola virus disease, including absence of pre-existing isolation and treatment facilities, patients' reluctance to present for medical care, and limitations in the provision of supportive medical care. Case fatality rates in west Africa were initially greater than 70%, but decreased with improvements in supportive care. To inform optimal care in a future outbreak of Ebola virus disease, we employed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to develop evidence-based guidelines for the delivery of supportive care to patients admitted to Ebola treatment units. Key recommendations include administration of oral and, as necessary, intravenous hydration; systematic monitoring of vital signs and volume status; availability of key biochemical testing; adequate staffing ratios; and availability of analgesics, including opioids, for pain relief. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Youngsu Cha; Kihyuk Nam; Doik Kim

    2017-07-01

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

  2. Guiding Ebola patients to suitable health facilities: an SMS-based approach.

    Science.gov (United States)

    Trad, Mohamad-Ali; Jurdak, Raja; Rana, Rajib

    2015-01-01

    Access to appropriate health services is a fundamental problem in developing countries, where patients do not have access to information and to the nearest health service facility. We propose building a recommendation system based on simple SMS text messaging to help Ebola patients readily find the closest health service with available and appropriate resources. The system will map people's reported symptoms to likely Ebola case definitions and suitable health service locations. In addition to providing a valuable individual service to people with curable diseases, the proposed system will also predict population-level disease spread risk for infectious diseases using crowd-sourced symptoms from the population. Health workers will be able to better plan and anticipate responses to the current Ebola outbreak in West Africa. Patients will have improved access to appropriate health care. This system could also be applied in other resource poor or rich settings.

  3. EEG-Based Asynchronous BCI Controls Functional Electrical Stimulation in a Tetraplegic Patient

    Directory of Open Access Journals (Sweden)

    Müller-Putz Gernot R

    2005-01-01

    Full Text Available The present study reports on the use of an EEG-based asynchronous (uncued, user-driven brain-computer interface (BCI for the control of functional electrical stimulation (FES. By the application of FES, noninvasive restoration of hand grasp function in a tetraplegic patient was achieved. The patient was able to induce bursts of beta oscillations by imagination of foot movement. These beta oscillations were recorded in a one EEG-channel configuration, bandpass filtered and squared. When this beta activity exceeded a predefined threshold, a trigger for the FES was generated. Whenever the trigger was detected, a subsequent switching of a grasp sequence composed of 4 phases occurred. The patient was able to grasp a glass with the paralyzed hand completely on his own without additional help or other technical aids.

  4. Trends and variation in the management of oesophagogastric cancer patients: a population-based survey

    Directory of Open Access Journals (Sweden)

    Greenberg David C

    2009-12-01

    Full Text Available Abstract Background Previous evidence indicates potential variation in the quality of care of cancer patients. We aimed to examine whether recent changes in the treatment of oesophagogastric cancers have been distributed equally among different patient subgroups. Methods We analysed population-based cancer registry data about the treatment patterning of oesophagogastric cancer (other than oesophageal squamous cell carcinoma during 1995-2006. Results There were 14,077 patients aged ≥40 years (69% men. There was only limited information on stage, and no information on co-morbidity status. During successive triennia, curative surgery use decreased from 28% to 20% (p Conclusions During the study period, curative surgery decreased by a third and chemotherapy use increased by more than three-fold, reflecting improvements in the appropriateness and quality of management, but chemotherapy use, in particular, was unequal, both by socioeconomic status and gender.

  5. Heart valve disease among patients with hyperprolactinemia: a nationwide population-based cohort study.

    Science.gov (United States)

    Steffensen, Charlotte; Maegbaek, Merete Lund; Laurberg, Peter; Andersen, Marianne; Kistorp, Caroline Micheala Nervil; Norrelund, Helene; Sørensen, Henrik Toft; Jorgensen, Jens Otto Lunde

    2012-05-01

    Increased risk of heart valve disease during treatment with certain dopamine agonists, such as cabergoline, has been observed in patients with Parkinson's disease. The same compound is used to treat hyperprolactinemia, but it is unknown whether this also associates with heart valve disease. The objective of the study was to assess the incidence of diagnosed heart valve disease and cardiac valve surgery among patients with hyperprolactinemia, compared with a general population cohort in Denmark. This was a nationwide, population-based, cohort study based on a nationwide hospital registry. We identified 2381 hyperprolactinemia patients with a first-time diagnosis recorded from 1994 through 2010 in the registry, with no previous hospital diagnosis of heart valve disease. Each patient was compared with 10 age- and gender-matched comparison cohort members from the general population. The association between hyperprolactinemia and heart valve disease was analyzed with Cox's proportional hazards regression, controlling for potential confounding factors. To assess the risk of cardiac valve surgery and avoid ascertainment bias, a subanalysis was made in a cohort of 2,387 hyperprolactinemia patients with no previous cardiac valve surgery and 23,870 comparison cohort members. Nineteen hyperprolactinemic patients (0.80%) were diagnosed with heart valve disease during a total of 17,759.8 yr of follow-up, compared with 75 persons (0.31%) in the comparison cohort during 179,940.6 yr of follow-up [adjusted hazard ratio 2.27 (95% confidence interval 1.35-3.82)]. Seven of the 10 patients treated with cabergoline and diagnosed with heart valve disease were asymptomatic and diagnosed on the basis of an echocardiography performed as a safety measure. However, only two patients with hyperprolactinemia (0.08%) underwent surgery, compared with 28 persons in the general population cohort (0.12%) [adjusted hazard ratio 0.55 (95% confidence interval 0.13-2.42)]. Data from the present

  6. Clinical benefits of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    de Sousa Pinto, Juliana M; Martín-Nogueras, Ana M; Calvo-Arenillas, José I; Ramos-González, Jacinto

    2014-01-01

    To evaluate the benefits of home-based pulmonary rehabilitation (PR) in patients with severe and very severe chronic obstructive pulmonary disease (COPD). Randomized clinical trial involving 58 patients. Pulmonary function, quality of life evaluated by the Saint George Respiratory Questionnaire, breathlessness evaluated by the London Chest Activity of Daily Living Scale, and exercise tolerance evaluated by 6-minute walk distance were assessed at baseline and at 12 weeks. The program consisted of 2 weekly visits by a physiotherapist in the first 2 weeks, followed by visits twice a month, as well as weekly telephone calls. Training included breathing and stretching exercises and strength exercises (upper and lower limbs), along with endurance training, including walking, stair climbing, cycling, and treadmill walking, depending on available patient resources. The treatment group (TG; n = 23) and control group (CG; n = 18) completed the study. Following the intervention, no statistically significant differences were found in pulmonary function in the TG and CG. The TG exhibited statistically significant differences in the activity domain (P = .008), impact domain (P Saint George Respiratory Questionnaire (P < .001). In addition, the TG demonstrated statistically significant differences in all domains of the London Chest Activity of Daily Living Scale and no differences were observed in the CG after 12 weeks. There was a statistically significant difference in the 6-Minute Walk Distance in the TG after rehabilitation (P = .008). This study offers evidence that home-based PR promotes benefits in the quality of life, breathlessness in activities of daily living, and exercise capacity in patients with severe and very severe COPD. Home-based PR must be considered as part of the treatment for patients who live far from hospitals even in severe COPD.

  7. EEG-Based Analysis of the Emotional Effect of Music Therapy on Palliative Care Cancer Patients.

    Science.gov (United States)

    Ramirez, Rafael; Planas, Josep; Escude, Nuria; Mercade, Jordi; Farriols, Cristina

    2018-01-01

    Music is known to have the power to induce strong emotions. The present study assessed, based on Electroencephalography (EEG) data, the emotional response of terminally ill cancer patients to a music therapy intervention in a randomized controlled trial. A sample of 40 participants from the palliative care unit in the Hospital del Mar in Barcelona was randomly assigned to two groups of 20. The first group [experimental group (EG)] participated in a session of music therapy (MT), and the second group [control group (CG)] was provided with company. Based on our previous work on EEG-based emotion detection, instantaneous emotional indicators in the form of a coordinate in the arousal-valence plane were extracted from the participants' EEG data. The emotional indicators were analyzed in order to quantify (1) the overall emotional effect of MT on the patients compared to controls, and (2) the relative effect of the different MT techniques applied during each session. During each MT session, five conditions were considered: I (initial patient's state before MT starts), C1 (passive listening), C2 (active listening), R (relaxation), and F (final patient's state). EEG data analysis showed a significant increase in valence ( p = 0.0004) and arousal ( p = 0.003) between I and F in the EG. No significant changes were found in the CG. This results can be interpreted as a positive emotional effect of MT in advanced cancer patients. In addition, according to pre- and post-intervention questionnaire responses, participants in the EG also showed a significant decrease in tiredness, anxiety and breathing difficulties, as well as an increase in levels of well-being. No equivalent changes were observed in the CG.

  8. A Comparison of Systemic Inflammation-Based Prognostic Scores in Patients on Regular Hemodialysis

    Directory of Open Access Journals (Sweden)

    Akihiko Kato

    2013-10-01

    Full Text Available Background/Aims: Systemic inflammation-based prognostic scores have prognostic power in patients with cancer, independently of tumor stage and site. Although inflammatory status is associated with mortality in hemodialysis (HD patients, it remains to be determined as to whether these composite scores are useful in predicting clinical outcomes. Methods: We calculated the 6 prognostic scores [Glasgow prognostic score (GPS, modified GPS (mGPS, neutrophil-lymphocyte ratio (NLR, platelet lymphocyte ratio (PLR, prognostic index (PI and prognostic nutritional index (PNI], which have been established as a useful scoring system in cancer patients. We enrolled 339 patients on regular HD (age: 64 ± 13 years; time on HD: 129 ± 114 months; males/females = 253/85 and followed them for 42 months. The area under the receiver-operating characteristics curve was used to determine which scoring system was more predictive of mortality. Results: Elevated GPS, mGPS, NLR, PLR, PI and PNI were all associated with total mortality, independent of covariates. If GPS was raised, mGPS, NLR, PLR and PI were also predictive of all-cause mortality and/or hospitalization. GPS and PNI were associated with poor nutritional status. Using overall mortality as an endpoint, the area under the curve (AUC was significant for a GPS of 0.701 (95% CI: 0.637-0.765; p Conclusion: GPS, based on serum albumin and highly sensitive C-reactive protein, has the most prognostic power for mortality prediction among the prognostic scores in HD patients. However, as the determination of serum albumin reflects mortality similarly to GPS, other composite combinations are needed to provide additional clinical utility beyond that of albumin alone in HD patients.

  9. Web-based depression treatment for type 1 and type 2 diabetic patients

    DEFF Research Database (Denmark)

    van Bastelaar, Kim M P; Pouwer, Francois; Cuijpers, Pim

    2011-01-01

    intervention on a large scale at relatively low costs. This study evaluated the effectiveness of Web-based CBT for depression treatment in adults with type 1 or type 2 diabetes, with minimal guidance. RESEARCH DESIGN AND METHODS: A randomized controlled trial was conducted in the Netherlands in 255 adult...... no beneficial effect on glycemic control (P > 0.05). CONCLUSIONS: Web-based CBT depression treatment is effective in reducing depressive symptoms in adults with type 1 and type 2 diabetes. In addition, the intervention reduces diabetes-specific emotional distress in depressed patients.......OBJECTIVE: Comorbid depression is common in patients with type 1 and type 2 diabetes, adversely affecting quality of life, diabetes outcomes, and mortality. Depression can be effectively treated with cognitive behavior therapy (CBT). The Internet is a new and attractive method for delivering CBT...

  10. Hemodynamic behavior modeling of a Virtual Surgical Patient based on a Fuzzy Expert System.

    Directory of Open Access Journals (Sweden)

    Paulo Farias Paiva

    2016-07-01

    Full Text Available The Virtual Reality (VR allows its users to experience a sense of being immersed in synthetic 3D scenarios generated by computer graphics. The so-called Virtual Environments (VEs based on RV can be applied to medical education, enabling: repetitive training and the development of psychomotor skills in surgical procedures without compromising real patients. Surgical simulators that feature Dynamic Virtual Patients (VPs, that is, reacts physiologically to interventions and medical decisions made during the training. These systems present more realism while it offers the possibility of varying clinical cases. This work has as main objective to discuss important issues of modeling the hemodynamic performance of a VP, specifically to simulate blood pressure values (both sistolic and diastolic variables. The model of a VP is presented as result as well as is presented an architecture for its integration to simulators based on VR.

  11. PATIENTS OVERCOME ANXIETY AND ARE ENCOURAGED TO BE PHYSICAL ACTIVETHROUGH EXERCISE-BASED CARDIAC REHABILITATION

    DEFF Research Database (Denmark)

    Simonÿ, Charlotte; Dreyer, Pia; Pedersen, Birthe D.

    2015-01-01

    into that the heart endures physical activity. In addition to serving as physical guidance, exercise-based cardiac rehabilitation offers valuable mental support. The patients find help to overcome an initial anxiety and move forward towards a physically active life featuring a feeling of improved health and new...... interviews were performed 1-2 months later. A phenomenological hermeneutic interpretation was conducted, comprising three methodological steps: naïve reading, structural analysis and comprehensive interpretation. Results. The preliminary findings are that although physically and especially mentally...... other to begin exercising; and growing confidence in the heart, whereby the patients overcome anxiety and dare to be physically active. Conclusions. Exercise-based cardiac rehabilitation provides a comfort-giving setting that offers peer support and a positive physical perception leading to confidence...

  12. Health Care Use by Patients with Somatoform Disorders A Register-Based Follow-Up Study*

    DEFF Research Database (Denmark)

    Andersen, Nadia Lyhne Trærup; Eplov, Lene Falgaard; Andersen, Jon Trærup

    2012-01-01

    the background population. Data from the Danish National Registers were used to assess health care use in both primary and secondary care. RESULTS: Somatoform patients incurred 2.11 (2.09-2.12) times the primary care visits of controls. They had 3.12 (3.08-3.16) times as many somatic bed-days than controls and 3...... of somatic health care was independent of psychiatric comorbidity. Primary care use and disability pension award were not influenced by proper diagnosing of somatoform disorders whereas number of somatic admissions were halved.......OBJECTIVE: Studies have shown a greater use of medical than mental health services in patients with somatoform disorders. However, not many studies are based on structured interviews and include the entire somatoform spectrum of diagnoses. We conducted a register-based case-control study...

  13. Cognitive training on stroke patients via virtual reality-based serious games.

    Science.gov (United States)

    Gamito, Pedro; Oliveira, Jorge; Coelho, Carla; Morais, Diogo; Lopes, Paulo; Pacheco, José; Brito, Rodrigo; Soares, Fabio; Santos, Nuno; Barata, Ana Filipa

    2017-02-01

    Use of virtual reality environments in cognitive rehabilitation offers cost benefits and other advantages. In order to test the effectiveness of a virtual reality application for neuropsychological rehabilitation, a cognitive training program using virtual reality was applied to stroke patients. A virtual reality-based serious games application for cognitive training was developed, with attention and memory tasks consisting of daily life activities. Twenty stroke patients were randomly assigned to two conditions: exposure to the intervention, and waiting list control. The results showed significant improvements in attention and memory functions in the intervention group, but not in the controls. Overall findings provide further support for the use of VR cognitive training applications in neuropsychological rehabilitation. Implications for Rehabilitation Improvements in memory and attention functions following a virtual reality-based serious games intervention. Training of daily-life activities using a virtual reality application. Accessibility to training contents.

  14. Atrial fibrillation in patients with ischemic stroke: A population-based study

    Directory of Open Access Journals (Sweden)

    Sandra Kruchov Thygesen

    2009-05-01

    Full Text Available Sandra Kruchov Thygesen1, Lars Frost2, Kim A Eagle3, Søren Paaske Johnsen11Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; 2Silkeborg Hospital and Clinical Institute, Aarhus University Hospital, Denmark; 3The Michigan Cardiovascular Research and Reporting Program, University of Michigan, Ann Arbor, MI, USABackground: Atrial fibrillation is a major risk factor for ischemic stroke. However, the prognostic impact of atrial fibrillation among patients with stroke is not fully clarified. We compared patient characteristics, including severity of stroke and comorbidity, quality of in-hospital care and outcomes in a cohort of first-time ischemic stroke patients with and without atrial fibrillation.Methods: Based on linkage of public medical databases, we did a population-based follow-up study among 3,849 stroke patients from the County of Aarhus, Denmark admitted in the period of 2003–2007 and prospectively registered in the Danish National Indicator Project.Results: Atrial fibrillation was associated with an adverse prognostic profile but not with an overall poorer quality of in-hospital care. Patients with atrial fibrillation had a longer total length of stay (median: 15 vs 9 days, and were at increased risk of in-hospital medical complications (adjusted relative risk = 1.48, 95% CI: 1.23–1.79 and recurrent stroke (adjusted hazard ratio = 1.30, 95% CI: 0.93–1.82 when compared with patients without atrial fibrillation. The adjusted hazard ratios for 30 days and one year mortality were 1.55 (95% CI: 1.20–2.01 and 1.55 (95% CI: 1.30–1.85, respectively. Patients not eligible to oral anticoagulant treatment had an increased risk of recurrent stroke (adjusted hazard ratio = 1.92, 95% CI: 1.19–3.11.Conclusion: Atrial fibrillation is associated with a poor outcome among patients with ischemic stroke particularly among patients, who are not eligible to oral anticoagulant treatment. Keywords: atrial fibrillation, stroke

  15. Using A Web-Based Nutrition Algorithm In Hemodialysis (Hd Patients

    Directory of Open Access Journals (Sweden)

    Alison Steiber

    2012-06-01

    Full Text Available Nutrition care is complex and encompasses evaluation and correction of protein-energy wasting plus many nutrition abnormalities such as hyperphosphatemia, abdominal obesity, and risk factors of cardiovascular disease. The purpose of this study was to test a nutritionally comprehensive algorithm for feasibility and functionality in a diverse group of HD patients. This was a prospective, observational study designed to test a nutrition algorithm for 1 clinical feasibility; 2 logical progression; 3 ability to collect data; and 4 effectiveness in improving outcomes. Patients included in this study were enrolled by renal dietitians (RD working in HD units based in five different countries. To select study subjects, RD were asked to screen and consent patients in their facilities until 4 patients were identified as at nutrition risk per the algorithm’s screening tool. All data were collected via the algorithm including screening, assessment, nutrition related diagnosis, etiology of the nutrition diagnosis, nutrition related barriers, nutrition focused interventions, and outcome parameters. Statistics were performed using SPSS vs 20.0 and significance set at p<0.05. One hundred patients, enrolled by 29 RD, were included in this analysis. The screening parameters that triggered an “at risk flag” for more than 50% of the patients were: PTH, serum cholesterol and unintentional weight loss. Of the patients with an albumin of <3.8 mg/dl (37% of sample, 73% were given a nutritional diagnosis of insufficient protein intake. Overall, patients with insufficient intake had significantly lower serum albumin concentrations at baseline than those who did not have this (3.7±0.4 vs. 4.0±0.4, p<0.05. Patients with a diagnosis of “high phosphorus” had decreases in serum PTH (349.5±184.5 to 201.7±113.6, p=0.06 and phosphorus (from 6.5±1.0–5.3±1.9 mg/dl, p=0.04 at the three month data collection. This study is the first of its kind to show that a web-based

  16. Survey of a community-based infusion program for Australian patients with rheumatoid arthritis requiring treatment with tocilizumab: patient characteristics and drivers of patient satisfaction and patient-perceived benefits and concerns

    Directory of Open Access Journals (Sweden)

    Voight L

    2012-04-01

    Full Text Available Louisa VoightCoast Joint Care, Maroochydore, Queensland, AustraliaBackground: Tocilizumab is an effective therapy for patients with moderate to severe rheumatoid arthritis that is administered by infusion over one hour every 4 weeks. The community-based infusion (ACTiv program was introduced to Australia in August 2010 to provide accessible and convenient treatment for patients with rheumatoid arthritis who require tocilizumab. The primary objectives of this study were to determine the characteristics of patients in the ACTiv program, patient satisfaction, and patient-perceived benefits and concerns with the ACTiv program, and drivers of patient satisfaction and patient-perceived benefits and concerns.Methods: A voluntary self-administered survey was given to all 608 patients in the ACTiv program between January 27, 2011 and March 31, 2011.Results: A total of 351 surveys were returned completed, giving a response rate of 58% (351/608. Most patients in the ACTiv program were women aged 40–64 years, with a mean disease duration of 13.7 years and moderate disability, who had been in the ACTiv program for ≥5 months. Most patients (88%, 302/342 were either very satisfied or satisfied with the ACTiv program and believed that they were very unlikely or somewhat unlikely to switch from the ACTiv program (64%, 214/335. The most important benefit was the reassurance of receiving treatment from a trained nurse in a professional medical environment (33%, 102/309. The most important concern was the fear of side effects (48%, 134/280. The main drivers of patient satisfaction and patient-perceived benefits and concerns of patients were health profile, previous medication experience, and length of treatment time in the program.Conclusion: The ACTiv program is used by patients of various ages, family life situations, and locations. Patient satisfaction with the program is high, which enables patients to benefit from long-term use of tocilizumab

  17. Smart home-based health platform for behavioral monitoring and alteration of diabetes patients.

    Science.gov (United States)

    Helal, Abdelsalam; Cook, Diane J; Schmalz, Mark

    2009-01-01

    Researchers and medical practitioners have long sought the ability to continuously and automatically monitor patients beyond the confines of a doctor's office. We describe a smart home monitoring and analysis platform that facilitates the automatic gathering of rich databases of behavioral information in a manner that is transparent to the patient. Collected information will be automatically or manually analyzed and reported to the caregivers and may be interpreted for behavioral modification in the patient. Our health platform consists of five technology layers. The architecture is designed to be flexible, extensible, and transparent, to support plug-and-play operation of new devices and components, and to provide remote monitoring and programming opportunities. The smart home-based health platform technologies have been tested in two physical smart environments. Data that are collected in these implemented physical layers are processed and analyzed by our activity recognition and chewing classification algorithms. All of these components have yielded accurate analyses for subjects in the smart environment test beds. This work represents an important first step in the field of smart environment-based health monitoring and assistance. The architecture can be used to monitor the activity, diet, and exercise compliance of diabetes patients and evaluate the effects of alternative medicine and behavior regimens. We believe these technologies are essential for providing accessible, low-cost health assistance in an individual's own home and for providing the best possible quality of life for individuals with diabetes. © Diabetes Technology Society

  18. Evaluating a community-based stroke nursing education and rehabilitation programme for patients with mild stroke.

    Science.gov (United States)

    Wang, Lee; Chen, Chiu-Mei; Liao, Wen-Chun; Hsiao, Chun-Yin

    2013-06-01

    This study evaluated whether mild stroke patients who received a community-based stroke nursing intervention had better stroke knowledge, behaviour and self-efficacy than those who were exposed to traditional education programmes. The intervention group consisted of sixty five stroke patients randomly selected from seven communities who received three 2-hour stroke interventions per week for 8 weeks. The normal care group consisted of sixty two stroke patients randomly selected from a medical centre who received a general stroke education programme. The stroke patients in two groups were assessed at baseline, after intervention and at the 6-month follow-up. At the 6-month follow-up, the intervention group demonstrated an improvement in the knowledge of stroke risk factors compared with the normal care group. Three months after education, the intervention group exhibited changes in the knowledge of stroke, social participation and self-efficacy compared with those at baseline. Also, self-efficacy was correlated with the knowledge of stroke risk factors after intervention and at the 6-month follow-up; self-efficacy was correlated with social participation after the 6-month follow-up. A community-based stroke nursing intervention might have effects on changes in the knowledge of stroke risk factors, social participation and self-efficacy. © 2013 Wiley Publishing Asia Pty Ltd.

  19. Correntropy-based analysis of respiratory patterns in patients with chronic heart failure.

    Science.gov (United States)

    Garde, Ainara; Sörnmo, Leif; Jané, Raimon; Giraldo, Beatriz F

    2009-01-01

    A correntropy-based technique is proposed for the analysis and characterization of respiratory flow signals in chronic heart failure (CHF) patients with both periodic and nonperiodic breathing (PB and nPB), and healthy subjects. Correntropy is a novel similarity measure which provides information on temporal structure and statistical distribution simultaneously. Its properties lend itself to the definition of the correntropy spectral density (CSD). An interesting result from CSD-based spectral analysis is that both the respiratory frequency and modulation frequency can be detected at their original positions in the spectrum without prior demodulation of the flow signal. The respiratory pattern is characterized by a number of spectral parameters extracted from the respiratory and modulation frequency bands. The results show that the power of the modulation frequency band offers excellent performance when classifying CHF patients versus healthy subjects, with an accuracy of 95.3%, and nPB patients versus healthy subjects with 90.7%. The ratio between the power in the modulation and respiration frequency bands provides the best results classifying CHF patients into PB and nPB, with an accuracy of 88.9%.

  20. Correntropy-based spectral characterization of respiratory patterns in patients with chronic heart failure.

    Science.gov (United States)

    Garde, Ainara; Sörnmo, Leif; Jané, Raimon; Giraldo, Beatriz F

    2010-08-01

    A correntropy-based technique is proposed for the characterization and classification of respiratory flow signals in chronic heart failure (CHF) patients with periodic or nonperiodic breathing (PB or nPB, respectively) and healthy subjects. The correntropy is a recently introduced, generalized correlation measure whose properties lend themselves to the definition of a correntropy-based spectral density (CSD). Using this technique, both respiratory and modulation frequencies can be reliably detected at their original positions in the spectrum without prior demodulation of the flow signal. Single-parameter classification of respiratory patterns is investigated for three different parameters extracted from the respiratory and modulation frequency bands of the CSD, and one parameter defined by the correntropy mean. The results show that the ratio between the powers in the modulation and respiratory frequency bands provides the best result when classifying CHF patients with either PB or nPB, yielding an accuracy of 88.9%. The correntropy mean offers excellent performance when classifying CHF patients versus healthy subjects, yielding an accuracy of 95.2% and discriminating nPB patients from healthy subjects with an accuracy of 94.4%.

  1. Patient-completed or symptom-based screening tools for endometriosis: a scoping review.

    Science.gov (United States)

    Surrey, Eric; Carter, Cathryn M; Soliman, Ahmed M; Khan, Shahnaz; DiBenedetti, Dana B; Snabes, Michael C

    2017-08-01

    The objective of this review was to evaluate existing patient-completed screening questionnaires and/or symptom-based predictive models with respect to their potential for use as screening tools for endometriosis in adult women. Validated instruments were of particular interest. We conducted structured searches of PubMed and targeted searches of the gray literature to identify studies reporting on screening instruments used in endometriosis. Studies were screened according to inclusion and exclusion criteria that followed the PICOS (population, intervention, comparison, outcomes, study design) framework. A total of 16 studies were identified, of which 10 described measures for endometriosis in general, 2 described measures for endometriosis at specific sites, and 4 described measures for deep-infiltrating endometriosis. Only 1 study evaluated a questionnaire that was solely patient-completed. Most measures required physician, imaging, or laboratory assessments in addition to patient-completed questionnaires, and several measures relied on complex scoring. Validation for use as a screening tool in adult women with potential endometriosis was lacking in all studies, as most studies focused on diagnosis versus screening. This literature review did not identify any fully validated, symptom-based, patient-reported questionnaires for endometriosis screening in adult women.

  2. [Upgrading of complete removable prosthetic appliance of stomatological patients by the use of new base materials].

    Science.gov (United States)

    Кузь, Виталий С; Дворник, Валентин Н; Тесленко, Александра И; Кузь, Гельфира М; Мартыненко, Игорь Н

    2016-01-01

    The effectiveness of orthopedic treatment of edentulous patients depends on the properties of the basic materials. The main group of materials for manufacturing of such structures are acrylic plastics of thermal polymerization. However, many years of experience in the use of plastics has revealed a number of shortcomings. One of the main is insufficient functional durability of prostheses, and as a consequence - the fragility of acrylic constructions. At present, more and more dentists use nonacrylic thermoplastics, which can improve the functional quality of full removable dentures, as well as, avoid the above disadvantages of acrylic basic plastic. The work is devoted to the study of comparative clinical effectiveness of dental prosthetic in edentulous patients using a variety of basic materials for the production of removable dentures. In this work we used the following materials - "Ftorax" - acrylic plastic of hot polymerization and «Vertex Thermosense» - nonacrylic thermoplastic plastic. As a result of the performed work it can be concluded that the use of the basic thermoplastic materials, namely «Vertex Thermosense», allows to get more rapid adaptation of the patient to full removable dentures due to better fixation and stabilization. Based on the results of our comparative clinical study it can be recommended using of base material «Vertex Thermosense» in the clinic of prosthetic dentistry in treatment of edentulous patients.

  3. Surface electromyography based muscle fatigue analysis for stroke patients at different Brunnstrom stages.

    Science.gov (United States)

    Yinjun Tu; Zhe Zhang; Xudong Gu; Qiang Fang

    2016-08-01

    Muscle fatigue analysis has been an important topic in sport and rehabilitation medicine due to its role in muscle performance evaluation and pathology investigation. This paper proposes a surface electromyography (sEMG) based muscle fatigue analysis approach which was specifically designed for stroke rehabilitation applications. 14 stroke patients from 5 different Brunnstrom recovery stage groups were involved in the experiment and features including median frequency and mean power frequency were extracted from the collected sEMG samples for investigation. After signal decomposition, the decline of motor unit firing rate of patients from different groups had also been studied. Statistically significant presence of fatigue had been observed in deltoideus medius and extensor digitorum communis of patients at early recovery stages (P0.01). It had also been discovered that the motor unit firing frequency declines with a range positively correlated to the recovery stage during repetitive movements. Based on the experiment result, it can be verified that as the recovery stage increases, the central nervous system's control ability strengthens and the patient motion becomes more stable and resistive to fatigue.

  4. Bone Health in Patients with Breast Cancer: Recommendations from an Evidence-Based Canadian Guideline

    Directory of Open Access Journals (Sweden)

    Alexander H. G. Paterson

    2013-12-01

    Full Text Available Bone loss is common in patients with breast cancer. Bone modifying agents (BMAs, such as bisphosphonates and denosumab, have been shown to reverse or stabilize bone loss and may be useful in the primary and metastatic settings. The purpose of this review is to provide clear evidence-based strategies for the management of bone loss and its symptoms in breast cancer. A systematic review of clinical trials and meta-analyses published between 1996 and 2012 was conducted of MEDLINE and EMBASE. Reference lists were hand-searched for additional publications. Recommendations were developed based on the best available evidence. Zoledronate, pamidronate, clodronate, and denosumab are recommended for metastatic breast cancer patients; however, no one agent can be recommended over another. Zoledronate or any oral bisphosphonate and denosumab should be considered in primary breast cancer patients who are postmenopausal on aromatase inhibitor therapy and have a high risk of fracture and/or a low bone mineral density and in premenopausal primary breast cancer patients who become amenorrheic after therapy. No one agent can be recommended over another. BMAs are not currently recommended as adjuvant therapy in primary breast cancer for the purpose of improving survival, although a major Early Breast Cancer Cooperative Trialists’ Group meta-analysis is underway which may impact future practice. Adverse events can be managed with appropriate supportive care.

  5. The Balloon-Based Manometry Evaluation of Swallowing in Patients with Amyotrophic Lateral Sclerosis

    Directory of Open Access Journals (Sweden)

    Jerzy Tomik

    2017-03-01

    Full Text Available The aim of the study was to analyse the disturbances of the oro-pharyngeal swallowing phase of dysphagia in amyotrophic lateral sclerosis (ALS patients with the use of specific manometric measurements and to evaluate their plausible association with the duration of the disease. Seventeen patients with ALS were evaluated with manometric examinations of the oral and pharyngeal part of the gastrointestinal tract. Tests were carried out by using the oesophageal balloon-based method with four balloon transducers located 5 cm away from each other. The following manometric parameters were analysed: the base of tongue contraction (BTC and the upper oesophageal sphincter pressure (UESP, and the hypopharyngeal suction pump (HSP as well as the oro-pharyngeal, pharyngeal and hypopharyngeal transit time and average pharyngeal bolus velocity (oropharyngeal transit time (OTT, pharyngeal transit time (PTT, hypopharyngeal transit time (HTT and average pharyngeal bolus velocity (APBV, respectively. Manomatric examinations during swallowing in patients with ALS showed significant weakness of BTC, a decrease of HSP and a decrease of the velocity of bolus transit inside the pharynx which were particularly marked between the first and the third examination. Manometric examinations of the oro-pharyngeal part of the gastrointestinal tract are useful and supportive methods in the analysis of swallowing disturbances in ALS patients.

  6. Gait re-education based on the Bobath concept in two patients with hemiplegia following stroke.

    Science.gov (United States)

    Lennon, S

    2001-03-01

    This case report describes the use of gait re-education based on the Bobath concept to measure the changes that occurred in the gait of 2 patients with hemiplegia who were undergoing outpatient physical therapy. One patient ("NM"), a 65-year-old woman, was referred for physical therapy 6 weeks following a right cerebrovascular accident. She attended 30 therapy sessions over a 15-week period. The other patient ("SA"), a 71-year-old woman, was referred for physical therapy 7 weeks following a left cerebrovascular accident. She attended 28 therapy sessions over a 19-week period. Clinical indexes of impairment and disability and 3-dimensional gait data were obtained at the start of treatment and at discharge. Therapy was based on the Bobath concept. At discharge, NM demonstrated improvements in her hip and knee movements, reduced tone, and improved mobility. At discharge, SA demonstrated improved mobility. During gait, both patients demonstrated more normal movement patterns at the level of the pelvis, the knee, and the ankle in the sagittal plane. SA also demonstrated an improvement in hip extension. These cases demonstrate that recovery of more normal movement patterns and functional ability can be achieved following a cardiovascular accident and provide insight into the clinical decision making of experienced practitioners using Bobath's concept.

  7. Antidepressants and risk of dementia in migraine patients: A population-based case-control study.

    Science.gov (United States)

    Lee, Cynthia Wei-Sheng; Lin, Cheng-Li; Lin, Pan-Yen; Thielke, Stephen; Su, Kuan-Pin; Kao, Chia-Hung

    2017-07-03

    To ascertain the relationship between receipt of antidepressant agents and the risk of subsequent dementia in migraine patients. A population-based case-control analysis, using the Taiwan National Health Insurance Research Database. We identified 1774 patients with dementia and 1774 matched nondementia controls from migraine patients enrolled in the Taiwan National Health Insurance program between 2005 and 2011. The proportional distributions of exposure to three classes of antidepressant were compared between dementia and nondementia groups. Univariable and multivariable logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of dementia based on antidepressant exposure. The proportions of subjects taking tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and new-generation antidepressants (NGAs) in dementia versus nondementia groups are 52.3 vs 51.2%, 25.5 vs 30.7%, and 18.8 vs 6.26%, respectively. The adjusted ORs of dementia were 1.02 (95% CI=0.89, 1.17; P=0.56) for TCAs, 0.58 (95% CI=0.50, 0.69; Pdementia in migraine patients. TCAs showed no association with dementia risk, and NGAs showed increased risk. Given the possibility of confounding by indication, additional prospective trials and basic research are needed before drawing conclusions about the population-level risks for dementia onset conferred by antidepressant medications. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. A Pilot Study of an Exercise-Based Patient Education Program in People with Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Stephanie Kersten

    2014-01-01

    Full Text Available There is increasing evidence that physical exercise leads to numerous positive effects in PwMS. However, long-term effects of exercise may only be achievable if training is implemented in daily routine. Enabling patients to exercise regularly, we developed a patient education program focused on evidence-based information of training. PwMS were educated in neurophysiological effects of physical exercise, exercise-induced benefits for PwMS, and risk factors (e.g., weather. Fifteen PwMS were analyzed before (T0 and after (T1 a 12-week patient education. Afterwards, participants performed their exercises autonomously for 32 weeks and were tested in sustainability tests (T2. Guided interviews were carried out, additionally. Significant improvements from T0 to T1 were found in 6MWT, gait velocity, TUG, fatigue, and quality of life. Significant results of TUG and gait velocity from T1 to T2 demonstrated that participants kept few effects after the 32-week training phase. Qualitative analyses showed improved self-confidence and identified training strategies and barriers. This pilot study provides evidence that PwMS are able to acquire good knowledge about physical exercise and apply this knowledge successfully in training management. One might conclude that this exercise-based patient education seems to be a feasible option to maintain or improve patients’ integral constitution concerning physical and mental health.

  9. Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy.

    Science.gov (United States)

    Hsu, Yen-Hsuan; Lin, Feng-Sheng; Yang, Chi-Cheng; Lin, Chih-Peng; Hua, Mau-Sun; Sun, Wei-Zen

    2015-06-01

    Midazolam is a widely used sedative agent during colonoscopy, with cognitive toxicity. However, the potential cognitive hazard of midazolam-based light sedation has not been sufficiently examined. We aimed to examine the cognitive safety and vulnerability profile under midazolam light sedation, with a particular focus on individual variations. We conducted a prospective case-controlled study in an academic hospital. In total, 30 patients undergoing sedative colonoscopy as part of a health check-up were recruited. Neuropsychological testing on the full cognitive spectrum was evaluated at 15 minutes and 120 minutes after low-dose midazolam administration. The modified reliable change index (RCI) was used for intrapersonal comparisons and controlling for practice effects. Midazolam affected psychomotor speed (48%), memory (40%), learning (32%), working memory (17%), and sustained attention (11%), while sparing orientation and the fluency aspect of executive function at the acute stage. Residual memory (10%) and learning (10%) impairments at 2 hours after administration were evidenced in some patients. The three object recall and digit symbol coding tests can serve as useful screening tools. Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state. Copyright © 2013. Published by Elsevier B.V.

  10. The prognostic role of MAC30 in advanced gastric cancer patients receiving platinum-based chemotherapy.

    Science.gov (United States)

    Wu, Xiaohong; Zhou, Feiqing; Ji, Xiuhai; Ren, Kewei; Shan, Ye; Mao, Xuhua; Fen, Yan; Chen, Ruhua; Ding, Hui; Fu, Xingli

    2017-12-01

    We aimed to investigate a practical profile of MAC30 on chemotherapeutic response in gastric cancer (GC). We elected 87 GC patients receiving platinum-based chemotherapy in this study. MAC30 levels in tumor and adjuvant nontumor tissues were confirmed via reverse transcription-PCR to identify the clinical profile in GC and the correlation with therapeutic response. We found elevated MAC30 in GC compared with the matched adjacent nontumor tissues. GC with enhanced MAC30 exhibited poorer survival by Kaplan-Meier analysis and poor response to adjuvant platinum-based chemotherapy. A multivariate analysis showed that MAC30 was an independent prognostic factor of overall survival in GC receiving platinum-based chemotherapy. MAC30 could play as a potential biomarker for prognosis of GC with platinum-based chemotherapy.

  11. Correntropy-based spectral characterization of respiratory Patterns in patients with chronic heart failure

    OpenAIRE

    Garde Martínez, Ainara; Sörnmo, Leif; Jané Campos, Raimon; Giraldo Giraldo, Beatriz

    2010-01-01

    A correntropy-based technique is proposed for the characterization and classification of respiratory flow signals in chronic heart failure (CHF) patients with periodic or nonperiodic breathing (PB or nPB, respectively) and healthy subjects. The correntropy is a recently introduced, generalized correlation measure whose properties lend themselves to the definition of a correntropybased spectral density (CSD). Using this technique, both respiratory and modulation frequencies can be reliably ...

  12. Comparison of the prognostic values of preoperative inflammation-based parameters in patients with breast cancer.

    Directory of Open Access Journals (Sweden)

    Hideya Takeuchi

    Full Text Available Peripheral blood-derived inflammation-based markers, including C-reactive protein (CRP, neutrophil-to-lymphocyte ratio (NLR, lymphocyte-to-monocyte ratio (LMR, and platelet-to-lymphocyte ratio (PLR are indicators of prognosis in various malignant tumors. The present study aimed to identify the inflammation-based parameters that are most suitable for predicting outcomes in patients with breast cancer. Two hundred ninety-six patients who underwent surgery for localized breast cancer were reviewed retrospectively. The association between clinicopathological factors and inflammation-based parameters were investigated. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic indicators associated with disease-free survival (DFS. The NLR level correlated significantly with tumor size (P<0.05. The PLR level correlated with the expression of estrogen receptor and lymph node involvement (P<0.05. Univariate analysis revealed that lower CRP and PLR values as well as tumor size, lymph node involvement, and nuclear grade were significantly associated with superior DFS (CRP: P<0.01; PLR, tumor size, lymph node involvement, and nuclear grade: P<0.05. On multivariate analysis, CRP (hazard ratio [HR]: 2.85, 95% confidence interval [CI]: 1.03-7.88, P<0.05, PLR (HR: 2.61, 95% CI: 1.07-6.36, P<0.05 and nuclear grade (HR: 3.066, 95% CI: 1.26-7.49, P<0.05 were significant prognostic indicators of DFS in patients with breast cancer. Neither LMR nor NLR significantly predicted DFS. Both preoperative CRP and PLR values were independently associated with poor prognosis in patients with breast carcinoma; these were superior to other inflammation-based scores in terms of prognostic ability.

  13. Evidence-Based Indicators of Neuropsychological Change in the Individual Patient: Relevant Concepts and Methods

    Science.gov (United States)

    Duff, Kevin

    2012-01-01

    Repeated assessments are a relatively common occurrence in clinical neuropsychology. The current paper will review some of the relevant concepts (e.g., reliability, practice effects, alternate forms) and methods (e.g., reliable change index, standardized based regression) that are used in repeated neuropsychological evaluations. The focus will be on the understanding and application of these concepts and methods in the evaluation of the individual patient through examples. Finally, some future directions for assessing change will be described. PMID:22382384

  14. Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy

    OpenAIRE

    Yen-Hsuan Hsu; Feng-Sheng Lin; Chi-Cheng Yang; Chih-Peng Lin; Mau-Sun Hua; Wei-Zen Sun

    2015-01-01

    Midazolam is a widely used sedative agent during colonoscopy, with cognitive toxicity. However, the potential cognitive hazard of midazolam-based light sedation has not been sufficiently examined. We aimed to examine the cognitive safety and vulnerability profile under midazolam light sedation, with a particular focus on individual variations. Methods: We conducted a prospective case-controlled study in an academic hospital. In total, 30 patients undergoing sedative colonoscopy as part of ...

  15. Renal versus splenic maximum slope based perfusion CT modelling in patients with portal-hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Michael A. [University Hospital Zurich, Department of Diagnostic and Interventional Radiology, Zurich (Switzerland); Karolinska Institutet, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden); Brehmer, Katharina [Karolinska University Hospital Huddinge, Department of Radiology, Stockholm (Sweden); Svensson, Anders; Aspelin, Peter; Brismar, Torkel B. [Karolinska Institutet, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Stockholm (Sweden); Karolinska University Hospital Huddinge, Department of Radiology, Stockholm (Sweden)

    2016-11-15

    To assess liver perfusion-CT (P-CT) parameters derived from peak-splenic (PSE) versus peak-renal enhancement (PRE) maximum slope-based modelling in different levels of portal-venous hypertension (PVH). Twenty-four patients (16 men; mean age 68 ± 10 years) who underwent dynamic P-CT for detection of hepatocellular carcinoma (HCC) were retrospectively divided into three groups: (1) without PVH (n = 8), (2) with PVH (n = 8), (3) with PVH and thrombosis (n = 8). Time to PSE and PRE and arterial liver perfusion (ALP), portal-venous liver perfusion (PLP) and hepatic perfusion-index (HPI) of the liver and HCC derived from PSE- versus PRE-based modelling were compared between the groups. Time to PSE was significantly longer in PVH groups 2 and 3 (P = 0.02), whereas PRE was similar in groups 1, 2 and 3 (P > 0.05). In group 1, liver and HCC perfusion parameters were similar for PSE- and PRE-based modelling (all P > 0.05), whereas significant differences were seen for PLP and HPI (liver only) in group 2 and ALP in group 3 (all P < 0.05). PSE is delayed in patients with PVH, resulting in a miscalculation of PSE-based P-CT parameters. Maximum slope-based P-CT might be improved by replacing PSE with PRE-modelling, whereas the difference between PSE and PRE might serve as a non-invasive biomarker of PVH. (orig.)

  16. Cannabis as a Substitute for Opioid-Based Pain Medication: Patient Self-Report.

    Science.gov (United States)

    Reiman, Amanda; Welty, Mark; Solomon, Perry

    2017-01-01

    Introduction: Prescription drug overdoses are the leading cause of accidental death in the United States. Alternatives to opioids for the treatment of pain are necessary to address this issue. Cannabis can be an effective treatment for pain, greatly reduces the chance of dependence, and eliminates the risk of fatal overdose compared to opioid-based medications. Medical cannabis patients report that cannabis is just as effective, if not more, than opioid-based medications for pain. Materials and Methods: The current study examined the use of cannabis as a substitute for opioid-based pain medication by collecting survey data from 2897 medical cannabis patients. Discussion : Thirty-four percent of the sample reported using opioid-based pain medication in the past 6 months. Respondents overwhelmingly reported that cannabis provided relief on par with their other medications, but without the unwanted side effects. Ninety-seven percent of the sample "strongly agreed/agreed" that they are able to decrease the amount of opiates they consume when they also use cannabis, and 81% "strongly agreed/agreed" that taking cannabis by itself was more effective at treating their condition than taking cannabis with opioids. Results were similar for those using cannabis with nonopioid-based pain medications. Conclusion: Future research should track clinical outcomes where cannabis is offered as a viable substitute for pain treatment and examine the outcomes of using cannabis as a medication assisted treatment for opioid dependence.

  17. Effect of an office-based surgical safety system on patient outcomes.

    Science.gov (United States)

    Rosenberg, Noah M; Urman, Richard D; Gallagher, Sean; Stenglein, John; Liu, Xiaoxia; Shapiro, Fred E

    2012-01-01

    To implement a customizable checklist in an interdisciplinary, team-based plastic surgery setting to reduce surgical complications. We examined the effects on patient outcomes and documentation of a customizable, office-based surgical safety checklist. On the basis of the World Health Organization Surgical Safety Checklist, we developed a 28-element, perioperative checklist for use in the office-based surgical setting. The checklist was implemented in an office-based plastic surgery practice with an already high standard of care. We recorded baseline, prechecklist rates for each checklist item and postoperative adverse outcomes via a retrospective chart review of 219 cases. After an education program and 30-day run-in period, a prospective, post-checklist implementation chart review was initiated (n = 184), with outcome data compared to the baseline. The total number of complications per 100 patients decreased from 15.1 to 2.72 after checklist implementation (P checklist was associated with a reduction in surgical complications in an office-based plastic surgery practice with an already high standard of care.

  18. Supervised and home-based exercise training for patients with intermittent claudication

    Science.gov (United States)

    Wang, Jianxiong; Zhou, Shi; Bronks, Roger; Graham, John; Myers, Stephen

    2008-01-01

    Home-based exercise training, applied as the primary treatment in patients with intermittent claudication, has produced inconsistent effects on walking capacity in previous published studies. The aim of the present study was to evaluate whether a home-based exercise training program could maintain improved walking capacity and other functional variables achieved through a supervised exercise training program. The present design was a 48-week self-controlled study. The first 12-week period was a control stage in which no prescribed exercise program was provided, the second 12-week period was a supervised treadmill-walking training program and the following 24-week period was a home-based exercise program. Twenty-two subjects with intermittent claudication were recruited initially; 15 of them (14 men and one woman) completed the whole program. Walking capacity, peak oxygen uptake, walking economy and ankle-brachial index were measured at baseline and at 12, 24 and 48 weeks. There was no significant change in the measured variables after the control stage. The 12-week supervised treadmill-walking training program significantly increased pain-free walking time, maximal walking time and peak oxygen uptake. Walking economy was also significantly improved. These improvements were successfully maintained after 24 weeks of home-based training. The results indicated that 12 weeks of supervised treadmill-walking training followed by a home-based training program is an effective model of exercise rehabilitation for patients with intermittent claudication. PMID:22477417

  19. Mindfulness-Based Stress Reduction for lung cancer patients and their partners: Results of a mixed methods pilot study

    NARCIS (Netherlands)

    Hurk, D.G.M. van den; Schellekens, M.P.J.; Molema, J.; Speckens, A.E.M.; Drift, M.A. van der

    2015-01-01

    BACKGROUND: Lung cancer patients and partners show high rates of impaired quality of life and heightened distress levels. Mindfulness-Based Stress Reduction has proven to be effective in reducing psychological distress in cancer patients. However, studies barely included lung cancer patients. AIM:

  20. Art therapy