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PubMed1994

Testicular cancer health education: an integrative review.

Cancer of the testis is the most common malignancy in men between the ages of 15 and 35, yet it is one of the most curable cancers. The optimistic prognosis that results from early detection and treatment of testicular cancer underscores the critical need for teaching testicular self-examination (TSE). However, an integrative review of the health education literature suggests that the men most susceptible are virtually unaware of the symptoms of testicular cancer and how to detect them. Although educational materials have been available, very little intervention research has been published on testicular cancer. The literature to date has focused on the pyschosocial factors associated with the practice of TSE and increasing knowledge of testicular cancer. Although an important beginning step, knowledge of testicular cancer alone as a preventive health behaviour is not sufficient if young men either do not know how to do the examination on their own testicles or do not believe it is important to them. Nurses should incorporate health education for testicular cancer and TSE in the delivery of routine primary health care. Furthermore, future research should aim to (a) increase knowledge through the educational curricula of high schools and colleges by use of video presentations, (b) examine the efficacy of using silicone models to ensure that men can be trained to detect the symptoms of testicular cancer, and (c) study compliance with recommendations to perform TSE.

Adolescent↗

PubMed2004

Interactive virtual endoscopy in coronary arteries based on multimodality fusion.

A novel approach for platform-independent virtual endoscopy in human coronary arteries is presented in this paper. It incorporates previously developed and validated methodology for multimodality fusion of two X-ray angiographic images with pullback data from intravascular ultrasound (IVUS). These modalities pose inherently different challenges than those present in many tomographic modalities that provide parallel slices. The fusion process results in a three- or four-dimensional (3-D/4-D) model of a coronary artery, specifically of its lumen/plaque and media/adventitia surfaces. The model is used for comprehensive quantitative hemodynamic, morphologic, and functional analyses. The resulting quantitative indexes are then used to supplement the model. Platform-independent visualization is achieved through the use of the ISO/IEC-standardized Virtual Reality Modeling Language (VRML). The visualization includes an endoscopic fly-through animation that enables the user to interactively select vessel location and fly-through speed, as well as to display image pixel data or quantification results in 3-D. The presented VRML virtual-endoscopy system is used in research studies of coronary atherosclerosis development, quantitative assessment of coronary morphology and function, and vascular interventions.

Algorithms↗

PubMed1997

Summarizing clinical psychiatric data.

The authors propose a method of summarizing clinical data to serve patient care. The proposed one-page summary uses diverse visual presentations of data, including small graphs for ratings and drug dosages, time lines for clinic visits and hospital stays, and genograms for inherited illness, as well as a textual presentation of recent clinical notes. The summary depicts a patient's recent and lifetime clinical experience. It allows the viewer to assess relationships between interventions and outcomes for psychiatric and medical problems. Computerized patient information systems, which are increasingly being used, can present data in virtually any form. The authors hope to encourage mental health professionals to reshape psychiatric records.

Data Collection↗

PubMed2002

Stages of change. A critique.

The stages of change proposed by Prochaska and DiClemente have been applied to change efforts within and outside of formal treatment and in relation to virtually any problem behavior. This model has gained widespread popularity in health psychology and addictions and is being used to guide interventions and allocate treatment resources in several fields. In this article, the authors review 87 studies on the stages of change across problem behaviors. Research findings suggest that the proposed stages are not mutually exclusive and that there is scant evidence of sequential movement through discrete stages in studies of specific problem behaviors, such as smoking and substance abuse. Although the stage model may have considerable heuristic value, its practical utility is limited by concerns about the validity of stage assessments. The model's underlying concepts and alternative views of readiness for change are considered, along with directions for future research.

Adaptation, Psychological↗

PubMed2006

Highly-realistic, immersive training environment for hysteroscopy.

The primary driving application of our current research is the development of a generic surgical training simulator for hysteroscopy. A key target is to go beyond rehearsal of basic manipulative skills, and enable training of procedural skills like decision making and problem solving. In this respect, the sense of presence plays an important role in the achievable training effect. To enable user immersion into the training environment, the surrounding and interaction metaphors should be the same as during the real intervention. To this end, we replicated an OR in our lab, provided standard hysteroscopic tools for interaction, and generate a new virtual scene for every session. In this setting, the training starts, as soon as the trainees enter the OR, and ends when they leave the room.

Competency-Based Education↗

PubMed2006

Cognitive, emotional, and social processes in psychosis: refining cognitive behavioral therapy for persistent positive symptoms.

Psychosis used to be thought of as essentially a biological condition unamenable to psychological interventions. However, more recent research has shown that positive symptoms such as delusions and hallucinations are on a continuum with normality and therefore might also be susceptible to adaptations of the cognitive behavioral therapies found useful for anxiety and depression. In the context of a model of cognitive, emotional, and social processes in psychosis, the latest evidence for the putative psychological mechanisms that elicit and maintain symptoms is reviewed. There is now good support for emotional processes in psychosis, for the role of cognitive processes including reasoning biases, for the central role of appraisal, and for the effects of the social environment, including stress and trauma. We have also used virtual environments to test our hypotheses. These developments have improved our understanding of symptom dimensions such as distress and conviction and also provide a rationale for interventions, which have some evidence of efficacy. Therapeutic approaches are described as follows: a collaborative therapeutic relationship, managing dysphoria, helping service users reappraise their beliefs to reduce distress, working on negative schemas, managing and reducing stressful environments if possible, compensating for reasoning biases by using disconfirmation strategies, and considering the full range of evidence in order to reduce high conviction. Theoretical ideas supported by experimental evidence can inform the development of cognitive behavior therapy for persistent positive symptoms of psychosis.

Affect↗

PubMed2006

Cluster randomized controlled trials in primary care: an introduction.

BACKGROUND: Cluster randomized trials occur when groups or clusters of individuals, rather than the individuals themselves, are randomized to intervention and control groups and outcomes are measured on individuals within those clusters. Within primary care, between 1997 and 2000, there has been a virtual doubling in the number of published cluster randomized trials. A recent systematic review, specifically within primary care, found study quality to be both generally lower than that reported elsewhere and not to have shown any recent quality improvement. OBJECTIVE: To discuss the design, conduct and analysis of cluster randomized trials within primary care in terms of the appropriate expertise required, potential bias, ethical considerations and expense. DISCUSSION: Compared with trials that involve the randomization of individual participants, cluster randomized trials are more complex to design and analyse and, for a given sample size, have decreased power and a broadening of confidence intervals. Cluster randomized trials are specifically prone to potential bias at two levels-the cluster and individual. Regarding the former, it is recommended that cluster allocation be undertaken by a party independent to the research team and careful consideration be given to ensure minimal cluster attrition. Bias at the individual level can be overcome by identifying trial participants before randomization and at this time obtaining consent for intervention, data collection or both. A unique ethical aspect to cluster randomized trials is that cluster leaders may consent to the trial on behalf of potential cluster members. Additional costs of cluster randomized trials include the increased number of patients required, the complexity in their design and conduct and, usually, the need to recruit clusters de novo. CONCLUSION: Cluster randomized trials are a powerful and increasingly popular research tool. They are uniquely placed for the conduct of research within primary-care clusters where intracluster contamination can occur. Associated methodological issues are straightforward and surmountable and just need careful consideration and management.

Bias↗

PubMedDate not supplied

Oral administration of a nitric oxide synthase inhibitor enhances de novo mammalian angiogenesis mediated by TNF-alpha, saline and mast-cell secretion.

In healthy adult rats, the test tissue that is used in the mesenteric-window angiogenesis assay is natively vascularized, lacks physiological angiogenesis, and is unperturbed by surgical intervention. Using the rat MWAA oral treatment with the nitric oxide (NO) synthase inhibitor Nw-nitro-L-arginine methyl ester (L-NAME) enhanced the angiogenic response (compared with controls receiving the inactive enantiomer D-NAME) following i.p. injections of (i) TNF-alpha at an approximate physiological dose, (ii) Compound 48/80, which is a highly selective secretagogue causing mast-cell secretion in situ and a very strong angiogenic response, and (iii) saline of a grade not made for infusion, causing a weak angiogenic response. Angiogenesis was assessed quantitatively using microscopic morphometry and image analysis in terms of objective variables recording the microvascular spatial extension, microvascular density, number and length of microvessel segments (extending between two successive branching points) and the degree of microvessel tortuosity. The data strongly suggest that endogenous NO inhibits all three mammalian angiogenesis reactions, although to a markedly different extent. Notably, the present data are virtually the opposite of those that have been reported from other mammalian angiogenesis models, the test tissues of which display deranged homeostasis, such as surgical intervention and/or ischemia.

Administration, Oral↗

PubMed2001

A Green's function approach to local rf heating in interventional MRI.

Current safety regulations for local radiofrequency (rf) heating, developed for externally positioned rf coils, may not be suitable for internal rf coils that are being increasingly used in interventional MRI. This work presents a two-step model for rf heating in an interventional MRI setting: (1) the spatial distribution of power in the sample from the rf pulse (Maxwell's equations); and (2) the transformation of that power to temperature change according to thermal conduction and tissue perfusion (tissue bioheat equation). The tissue bioheat equation is approximated as a linear, shift-invariant system in the case of local rf heating and is fully characterized by its Green's function. Expected temperature distributions are calculated by convolving (averaging) transmit coil specific absorption rate (SAR) distributions with the Green's function. When the input SAR distribution is relatively slowly varying in space, as is the case with excitation by external rf coils, the choice of averaging methods makes virtually no difference on the expected heating as measured by temperature change (deltaT). However, for highly localized SAR distributions, such as those encountered with internal coils in interventional MRI, the Green's function method predicts heating that is significantly different from the averaging method in current regulations. In our opinion, the Green's function method is a better predictor since it is based on a physiological model. The Green's function also elicits a time constant and scaling factor between SAR and deltaT that are both functions of the tissue perfusion rate. This emphasizes the critical importance of perfusion in the heating model. The assumptions made in this model are only valid for local rf heating and should not be applied to whole body heating.

Biophysical Phenomena↗

PubMed2000

Functional characterization of Jurkat T cells rescued from CD95/Fas-induced apoptosis through the inhibition of caspases.

The caspases are known to play a pivotal role in the triggering and execution of apoptosis in virtually all cell types. Because inappropriate apoptosis is a prominent feature of many human diseases, the caspases are attractive targets for therapeutic intervention. In the present study we investigated whether Jurkat T lymphocytes rescued from Fas-induced cell death through the inhibition of caspases are functional. Here we show that the pan-caspase, tripeptide inhibitor, benzyloxycarbonyl-Val-Ala-Asp (Ome) fluoromethylketone (z-VAD-FMK), inhibited the activation of caspase-2, -3, -7, and -8, and subsequently apoptosis in Jurkat T lymphocytes induced by agonistic anti-Fas. The apoptotic signals induced by the cross-linking of the Fas antigen have a relatively long half-life, as z-VAD-FMK had to be continuously present in the culture medium for 72 h after Fas stimulation in order to maintain cell survival. After 72 h, the z-VAD-FMK-rescued cells proliferate normally and responded to activation induced cell death after phytohaemaglutinin treatment, and readily undergo apoptosis when restimulated with agonistic Fas antibodies. Taken together, our results demonstrate that Jurkat T cells rescued from Fas-mediated cell death through the inhibition of caspases are functional.

Amino Acid Chloromethyl Ketones↗

PubMed1988

Cranial burr hole decompression in the emergency department.

Presently virtually all patients with acute head trauma are computed tomography (CT) scanned and transferred to a neurosurgical operating room before any surgical intervention. The time required for this, especially if the patient is transferred to another institution, may lead to a significant delay in treatment. In a patient with an expanding intracranial hematoma and evidence of brainstem compromise this delay may produce a worse outcome. Cranial burr hole placement can rapidly, safely, and accurately find and partially decompress most extracerebral intracranial hematomas. A burr hole placed rapidly before CT and transfer could prevent further damage to the brain by an expanding hematoma. The case of a child with a preterminal epidural hematoma whose outcome was excellent because of a burr hole placed in the emergency department (ED) is presented. In light of this case and a complete literature review, it is suggested that more frequent attempts to decompress intracranial hematomas in the ED may be warranted.

Child, Preschool↗

PubMed2006

Impact of routine angiographic follow-up on the clinical benefits of paclitaxel-eluting stents: results from the TAXUS-IV trial.

OBJECTIVES: The objectives of the study were to evaluate the effect of angiographic follow-up on revascularization rates in the TAXUS-IV trial and to determine whether the relative benefit of paclitaxel-eluting stent implantation compared with bare metal stent implantation was modified by angiographic follow-up. BACKGROUND: Although several clinical trials have demonstrated that drug-eluting stents (DES) reduce restenosis compared with bare-metal stents (BMS), virtually all of these studies have incorporated angiographic follow-up. METHODS: In the TAXUS-IV trial, 1,314 percutaneous coronary intervention patients were randomized to receive paclitaxel-eluting stents (PES) (n = 662) or identical-appearing BMS (n = 652). Clinical outcomes were compared, stratified by assignment to angiographic follow-up or clinical follow-up alone. RESULTS: Compared with clinical follow-up alone, angiographic follow-up patients had a significantly higher rate of target vessel revascularization (TVR) at 1 year (adjusted hazard ratio [HR] 1.46; p = 0.04), with similar relative increases in PES and BMS patients. Because PES reduced TVR by approximately 60% regardless of type of follow-up, assignment to angiographic follow-up tended to overestimate the absolute benefit of PES relative to clinical follow-up alone. In contrast, assessment of end points immediately before the time of follow-up angiography led to substantial underestimation of the absolute benefit of PES implantation. CONCLUSIONS: Performance of mandatory angiographic follow-up increases rates of TVR among patients receiving both BMS and PES and overestimates the absolute clinical benefits of PES relative to clinical follow-up alone. Nonetheless, PES substantially reduces TVR regardless of assignment to mandatory angiographic follow-up or not. Future studies designed to determine the true clinical benefits of DES should either forgo routine angiographic follow-up or separate the time of repeat angiography from the primary clinical end point by as long as possible.

Angioplasty, Balloon, Coronary↗

PubMed1976

The cardiologist's responsibility for preventing coronary heart disease.

The recent increase in coronary heart disease is real and the causes must mainly be environmental. Consequently the condition should largely be preventable. The application of what is already known is likely to be a far more effective way of reducing the mortality rate than all attempts at palliative treatment, but vigorous action will be necessary. Much greater sums are being expended on coronary-care units and cardiac surgery than in preventing the need for them, although there is little evidence that they have significantly lowered the over-all mortality rate. Conventional treatment is immensely expensive. Prevention could in the long run be much cheaper. Cardiologists on their own are unlikely to succeed in a program of prevention. They need the help of many others, including community nurses, nutritionists, public health workers, sociologists, and of course general practitioners, but they have responsibility for leadership and for providing background knowledge. For the detection of certain risk factors, health examinations are necessary and should be part of general practice. Also, advice is best given on an individual basis. The chief-known risk factors (hyperlipidemia, hypertension, smoking, physical inactivity) could be controlled. CHD occurs in adults but atherosclerosis starts many years before. Prevention should begin with appropriate infant feeding, whenever possible with breast milk, and continue into childhood, when habits are formed and attitudes to life can best be influenced. It should be possible to bring up children virtually free from risk factors. It may never be possible to prove the effectiveness of such a multifactorial program by prospective controlled intervention studies, but the evidence indicates strong probability. The stakes are too high to delay action any longer. Physicians daily give advice in areas where the evidence is much less certain. Such a program for the control of coronary artery disease is urgently needed and could become one of the most rewarding activities for the medical profession.

Adult↗

PubMed2000

Colon polyps and cancer.

Several important studies on screening for colorectal neoplasia were published in 1998-99, including average-risk as well as high-risk groups, and different strategies such as endoscopy, fecal occult blood tests, and other more specific markers of neoplasia. Some of these studies included the use of interventions other than initial screening and polypectomy; a few dealt with diagnostic methods in symptomatic patients, and the new diagnostic tool of virtual colonoscopy was highlighted by several authors. Endoscopic treatment for large adenomas and early colorectal cancer has become more widespread, but clearly it has limitations. Current discussion of the topic of colorectal polyps and cancer is largely based on the concept of the adenoma-carcinoma sequence, which is thought to be the most probable pathogenesis for colorectal cancer.

Adenomatous Polyps↗

PubMed2006

Treatment of chemotherapy-induced oral mucositis with light-emitting diode.

OBJECTIVE: The aim of this study was to assess the clinical effectiveness of phototherapy with noncoherent light in the alleviation of chemotherapy-induced mucositis in patients with metastatic cancer. BACKGROUND DATA: Mucositis occurs in more than 40% of chemotherapy-treated patients, significantly reducing the quality of their lives. Many different interventions have been evaluated to reduce oral mucositis. Recently, good results have been achieved by phototherapy with photoradiation, a technique which has virtually no side effects. Some clinical results seem to indicate that also phototherapy through noncoherent light emissions which can be produced by less expensive light sources such as light-emitting diodes (LEDs) may be effective. However, until now, no studies have been available on this subject. METHODS: Twelve patients, aged from 34 to 82, selected on the basis of a diagnosis of chemotherapy-induced oral mucositis, were treated intra-orally through a noncoherent LED emission, wavelength 645 +/- 15 nm, 7.8 mW, fluence 0.99 J/cm(2), three times a day for 1 week. Mucositis was scored daily using the Daily Mucositis Index (DMI), a scale that evaluates the disease evolution through 16 different items. The primary end-point assessed was the time to recovery, from the start of LED treatment, compared to a nonrandomized control group of 12 patients with comparable stomatitis. RESULTS: The median healing time, expressed as the DMI decrease, was 1.7 (range 1-2.8) and, in seven LED-treated patients, was shorter than in the control group. The healing rate (measured as the ratio of the DMIs) increased from 117% to 164%. CONCLUSION: This pilot study shows that LED treatment is safe and capable of reducing the duration of chemotherapy-induced mucositis. This result needs to be confirmed in an adequate phase III study.

Adult↗

PubMed2005

The fully automatic external cardioverter defibrillator: reality of a new meaningful scenario for in-hospital cardiac arrests.

Sudden cardiac death is an unresolved problem which causes significant mortality and morbidity in both the community and in-hospital setting. Cardiac arrest is often caused by ventricular tachyarrhythmias which may be mostly interrupted by cardioversion or defibrillation. The single most critical factor for survival is the response time. Over the last 30 years, there have been virtually no procedural changes in the way hospitals address in-hospital resuscitation. A unique device has been developed that eliminates human intervention and assures defibrillation therapy is administered in seconds. This is accomplished with a fully automatic, external bedside monitor defibrillator designed to be prophylactically attached to hospitalized patients at risk of ventricular tachyarrhythmia. The safety and efficacy of the device has been demonstrated in multicenter US and European trials. Thus, this device allows a new scenario which may increase survival and enables meaningful redistribution of health resources.

Clinical Trials as Topic↗

PubMed1999

Penetrating cardiac trauma at an urban trauma center: a 22-year perspective.

This is a report of a 22-year experience with penetrating cardiac trauma at a single urban Level I trauma center. We conducted a retrospective chart review supplemented by computerized patient log. Comparisons of mortality between Period 1 (1975-1985; 113 patients) and Period 2 (1986-1996; 79 patients) were by chi2 or Fisher's exact tests. Statistical significance was defined as P < or = 0.05. From 1975 to 1996, 192 patients (mean age, 32 years; 88% male) with penetrating cardiac stab wounds (68%) or gunshot wounds (32%) were treated. The most common initial clinical presentation was cardiac tamponade, and most patients (54%) were hypotensive (systolic blood pressure 30-90 mm Hg). The most common initial intervention in the emergency center was tube thoracostomy. The use of pericardiocentesis as a diagnostic and therapeutic modality in the emergency center virtually disappeared in Period 2, as compared with Period 1. Since 1994, surgeon-performed cardiac ultrasound has been performed and has correctly diagnosed hemopericardium in 12 patients (100% survival). The overall mortality for all patients during the 22-year study interval was 25 per cent and was not significantly different between Period 1 (27%) and Period 2 (22%). The mortality associated with gunshot wounds was increased compared with that of stab wounds. Similarly, mortality for patients who arrested in the emergency center was increased compared with those patients who did not arrest. We conclude: 1) cardiac tamponade is the most common presentation in patients with cardiac wounds; 2) pericardiocentesis in the emergency center has essentially disappeared; 3) surgeon-performed ultrasound of the pericardium should improve survival of future patients who are normotensive or mildly hypotensive; 4) over the last 11 years, there has been a substantial decrease in mortality in patients with stab wounds and a statistically significant decrease in arrested patients; and 5) overall mortality for penetrating cardiac trauma has not changed during the 22-year interval.

Adolescent↗

PubMed1995

Diagnosis and therapy of hereditary polyposis syndromes.

The hereditary polyposis syndromes include the adenomatous polyposis syndromes (familial adenomatous polyposis and Gardner syndrome, and Turcot syndrome) and the hamartomatous polyposis syndromes (Peutz-Jeghers syndrome, juvenile polyposis, and Cowden's disease). The adenomatous polyposis syndromes are characterized by numerous adenomatous polyps throughout the entire colon and a spectrum of extracolonic manifestations; they invariably progress to colorectal cancer without appropriate intervention. The hamartomatous polyposis syndromes are characterized by diffuse intestinal or colonic hamartomatous polyps, such as juvenile polyps. Although hamartomatous polyps have virtually no malignant potential, the hamartomatous polyposis syndromes are associated with increased risk of cancer, both within and outside the small intestine and the colon. Diagnosis of symptomatic polyposis is by colonoscopy, but in presymptomatic screening of familial adenomatous polyposis, genetic testing can be effective, and it is becoming increasingly available though research laboratories. Management involves treatment of affected individuals, counseling of patients and their families, screening of at-risk individuals, and surveillance of affected patients for extracolonic cancers. Treatment of adenomatous polyposis is primarily colectomy during the second or third decade. For the hamartomatous polyposis syndromes, surveillance for early cancers and their excision remain the only practical, although not totally satisfactory, approaches.

Adenomatous Polyposis Coli↗