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Complementary and alternative groups contemplate the need for effectiveness, safety and cost-effectiveness research.

OBJECTIVE: To examine the views of complementary and alternative medicine (CAM) groups on the need to demonstrate the effectiveness, safety and cost-effectiveness of their therapies and practices. DESIGN: Qualitative interviews were conducted with 22 representatives of three CAM groups (chiropractic, homeopathy and Reiki). Qualitative content analysis was used to identify similarities and differences among and across groups. SETTING: Ontario, Canada. RESULTS: There were striking differences in the views of the three sets of respondents. The chiropractors agreed that it was essential for their group to provide scientific evidence that their interventions work, are safe and cost-effective. The leaders of the homeopathic group were divided on these points and the Reiki respondents showed virtually no interest in undertaking such research. CONCLUSIONS: CAM groups that are more formally organized are most likely to recognize the importance of scientific research on their practices and therapies.

Attitude of Health Personnel↗

Using immersive technology for postural research and rehabilitation.

Posture has traditionally been examined by isolating individual control pathways to determine their specific contributions. However, if these pathways are responsive to functional contexts, then their responses may differ when the system is receiving simultaneous inputs from multiple pathways. Thus, we may never fully understand how the central nervous system (CNS) organizes behaviors in the real world from studies conducted in the minimized environment of the laboratory. The consequence of this is that when findings from the laboratory are applied to therapeutic intervention, the intervention may not be appropriate for all circumstances and will not fully meet the needs of the patient. We have united an immersive dynamic virtual environment with motion of a posture platform to record the biomechanical and physiological responses to combined visual, vestibular, and proprioceptive inputs. The virtual environment possesses content, contrast, and texture so that we can examine postural responses as they might occur in a complex, real-world environment. In this paper we specifically describe the factors guiding our choices of virtual technology and present data from young adults, elderly adults, and an individual with bilateral labyrinthine loss to demonstrate how multimodal inputs influence their postural response organization. Significant implications for future experimental and rehabilitation protocols are also discussed.

Adult↗

Virtual reality and neuropsychology: upgrading the current tools.

BACKGROUND: Virtual reality (VR) is an evolving technology that has been applied in various aspects of medicine, including the treatment of phobia disorders, pain distraction interventions, surgical training, and medical education. These applications have served to demonstrate the various assets offered through the use of VR. OBJECTIVE: To provide a background and rationale for the application of VR to neuropsychological assessment. METHODS: A brief introduction to VR technology and a review of current ongoing neuropsychological research that integrates the use of this technology. CONCLUSIONS: VR offers numerous assets that may enhance current neuropsychological assessment protocols and address many of the limitations faced by our traditional methods.

Brain Injuries↗

Reversible renal failure caused by a microsporidian infection.

OBJECTIVE: To report a case of renal failure associated with microsporidian infection in an HIV-seropositive patient. DESIGN: Case report. SETTING: Chelsea and Westminster Hospital, London, England, UK. PATIENT: An HIV-seropositive patient presented febrile with abdominal pain who developed renal failure. Renal biopsy and urinalysis showed infection with a microsporidian of the genus Encephalitozoon. INTERVENTION: Treatment with albendazole (400 mg) twice daily was associated with disappearance of infection from the urine, clinical improvement and return of renal function virtually to normal. CONCLUSION: HIV-seropositive individuals with renal failure should have urine screened for microsporidia. The administration of albendazole in such cases may reverse renal failure.

AIDS-Related Opportunistic Infections↗

MR imaging of uterine inversion.

Inversion of the uterus is a postpartum complication that is an obstetric emergency. This report describes a case of inversion of the uterus in which clinical evaluation was inconclusive, and magnetic resonance (MR) of the pelvis revealed findings virtually pathognomonic of incomplete inversion of the uterus with far greater conspicuity than on corresponding ultrasound. The MR findings directly resulted in earlier therapeutic intervention with a possible decrease in morbidity.

Adult↗

Increasing the impact of European obesity research in preparation for the European research area: a report on the 2003 European Commission Obesity Workshop.

Leading obesity researchers from across Europe assembled in Aberdeen, Scotland, in January 2003 to consider how to increase the impact of European obesity research. The workshop was funded by the European Commission and hosted by the Rowett Research Institute, Aberdeen. The delegates identified the need to (i) develop a portfolio of studies that integrate genetics and mechanisms through parallel study of humans and animal models and (ii) establish major intervention studies in weight management and early life nutrition. It was recommended that these goals would be best achieved under the umbrella of a virtual European Obesity Research Institute, or Network of Excellence in Obesity Research under Framework Programme 6, that would facilitate harmonization of methodology, manage centralized standardized resources, coordinate training initiatives, workshops and working groups, and increase focus.

Diet↗

Hospitals and academic health sciences centres: leaders or followers in health globalization?

The overall impact of globalization on health outcomes is contentious, but there is no doubt that knowledge transfer and the extension of specific health interventions to developing countries promise extraordinary benefits. It has been suggested that improved information/communications technology and the creation of distributed hospital systems leading a virtual healthcare web will permit realization of the promise of globalization. It is argued in this commentary that such evolution will require a new model of shared governance in the healthcare system. The leading vision is most likely to come from academic institutions, researchers, health professionals and governments. The "super-hospital" of the future should be expected to play a key role as service provider and partner.

Academic Medical Centers↗

[Cardiovascular therapy problems in the elderly patient].

The therapeutic management of elderly patients should be extremely careful, particularly in those over 75 years of age. As a matter of fact, in such patients a steep increase of the risk of comorbidity and of dependence has been evidenced. This implies a more complex therapeutic management, that must be oriented to the amelioration of quality of life more than to the resolution of the single pathologies. However, all the intervention trials so far conducted excluded such patients. Therefore, they cannot be considered representative of the geriatric epidemiological reality. As a result, there is virtually no useful information on the efficacy and safety of cardiovascular drugs in patients over 75 years of age. However, the following items should be pointed out: only drugs whose efficacy has been proved should be used, and only after a thorough diagnosis; a multidimensional evaluation should be performed, also addressing psychological, social, environmental and economical factors that could affect the clinical course; the risks and benefits of any therapy should be considered, particularly in the presence of comorbidity, as the number of assumed drugs directly correlates with the risk of developing adverse reactions; drugs should be dosed according to renal function and body weight, possibly starting with half the dosage of younger patients; after starting the therapy, patients should be kept under strict clinical control, and every new symptom should be considered an adverse reaction, unless it will not disappear after withdrawal of the drug; serum drug concentration should be monitored whenever possible, given its larger variability in advanced age.

Aged↗

Pharmacologic considerations in the geriatric patient.

A physician has the primary responsibility of first causing no harm. Unfortunately, the myriad of pharmacologic agents available to the clinician at times may make this directive difficult. When the variable of age-related changes is introduced, the clinician's task may seem almost impossible. The most important aspect of gerontology is that there are no constants. Age-related changes are inconsistent. Although liver function may vary little among the general population, virtually every other system is affected by the aging process. Additional factors that complicate treatment of the geriatric patient are multiple organ diseases, the intervention of multiple practitioners, and nutritional variation. Multiple diseases require polypharmacy with its greater tendency for drug-drug interaction and iatrogenic disease exacerbation. Multiple clinician involvement frequently lacks appropriate communication between the various specialties. Aging is commonly associated with drastic changes in dietary habits. An older person living alone may tend to miss more meals than other groups. Meals that are consumed may be inadequate and lack proper balance, especially adequate amounts of protein. Mineral and vitamin depletion are additional problems, especially with patients on diuretics and chronic anti-infective therapy. In this article an attempt has been made to stimulate thought and generate an awareness in the podiatric practitioner of the considerations necessary when contemplating drug therapy in the geriatric population. Long lists of specific agents and recommended dosages, which quickly become outdated as newer drugs are introduced into the clinical arena, were intentionally not presented in this article. The author hopes that this article will generate interest in conducting additional research in podiatric applications of drugs.

Aged↗

Rational antibiotic use in China: lessons learnt through introducing surgeons to Australian guidelines.

BACKGROUND: World-wide concern about increasing antibiotic resistance has focused attention on strategies to improve antibiotic use. This research adapted Australian best-practice guidelines on the prophylactic use of antibiotics in surgery to a Beijing teaching hospital and then used them as a quality assessment and improvement tool, supplemented by educational interventions. Qualitative data about factors influencing antibiotic use was also obtained. METHODS: Australian and international guideline materials were amalgamated with the help of Chinese experts. Antibiotics prescribed for surgical prophylaxis in 60 consecutive patients undergoing clean or clean-contaminated surgery (120 total) were then compared with guideline recommendations in three phases; a pre-intervention period from June to August, 2002, an intervention period from June to August 2003 and post-intervention period from September to November 2003. During the intervention phase, feedback about prescriptions not in accord with the guideline was discussed with around 25 prescribers every two weeks. In addition, local factors influencing antibiotic use were explored with 13 junior surgeons and 8 high level informants. RESULTS: While agreement was reached on the principles of antibiotic surgical prophylaxis there was no consensus on detail. Of 180 patients undergoing clean surgery throughout all phases of the study, antibiotic prophylaxis was administered to 78% compared to 98% of the 180 patients undergoing clean-contaminated surgery. Second and third generation cephalosporin antibiotics predominated in both low-risk clean and clean-contaminated operations. The timing of prophylaxis was correct in virtually all patients. The duration of prophylaxis was less than 24 hours in 96% of patients undergoing clean surgery compared to only 62% of patients undergoing clean-contaminated surgery. The intervention produced no improvement in the duration of prophylaxis nor the overuse and inappropriate choice of unnecessary broad-spectrum and expensive drugs. Interviews and focus groups revealed that an important explanation for the latter problem was Chinese government policy which expected hospitals to support themselves largely through the sale of drugs. CONCLUSION: Improving antibiotic use in China will require hospital funding reform, more authoritative best-practice guidelines, and hospital authorities embracing quality improvement.

Journal Article↗

Active surveillance with selective delayed intervention for favorable risk prostate cancer: clinical experience and a 'number needed to treat' analysis.

This is a summary of the case for active surveillance for 'favorable-risk' prostate cancer with selective delayed intervention for rapid biochemical progression, assessed by rising prostate-specific antigen (PSA) levels, or grade progression. The results of a large phase II trial using this approach are reviewed. To date, this study has shown that virtually all men with 'favorable-risk' prostate cancer managed in this fashion will die of unrelated causes. Based on the Swedish randomized trial of radical prostatectomy versus watchful waiting, the Connecticut observation series, and the Toronto active surveillance experience, a number needed to treat analysis of the benefit of radical treatment of all newly diagnosed favorable risk prostate cancer patients, compared to a strategy of active surveillance with selective delayed intervention, is presented. This suggests that approximately 100 patients will require radical treatment for each prostate cancer death averted. This translates into a 2-3 week survival benefit, unadjusted for quality of life. This figure is confirmed based on an analysis of the D'Amico PSA velocity data in favorable risk disease. The approach of active surveillance with selective delayed intervention based on PSADT and repeat biopsy represents a practical compromise between radical therapy for all patients, (which results in overtreatment for patients with indolent disease), and watchful waiting with palliative therapy only, (which results in undertreatment for those with aggressive disease).

Disease Progression↗

Application of keyhole imaging to interventional MRI: a simulation study to predict sequence requirements.

A wide variety of techniques have been proposed recently to improve the temporal resolution of MRI. These include echo-planar imaging methods, wavelet encoding, singular value decomposition encoding, and k-space sharing methods known as "keyhole" imaging. In this work, we use a simulation study to investigate the phase-encoding ordering and data-sharing methods required for the application of keyhole imaging to interventional MRI (I-MRI). The advantages of keyhole imaging over other methods are its simplicity and the use of conventional phase encoding and Fourier transform reconstruction found on virtually all modern MR imagers. Our analysis has predicted that conventional keyhole methods that repeatedly acquire only the center portion of k space, and those that sequentially progress from the center of k space outward, will not meet the combination of temporal and spatial resolution required for tip localization during I-MRI needle insertion. Instead, acquisitions that acquire both high and low k-space data, in ranked order, should provide acceptable tip position and needle width accuracy in both temporal and spatial domains for use in I-MRI.

Artifacts↗

A trial of the effect of a standardized psychiatric consultation on health outcomes and costs in somatizing patients.

BACKGROUND: Patients who somatize but who do not meet criteria for somatization disorder are common in the community. Virtually no research has been conducted to determine how to treat these patients. METHODS: We conducted a randomized controlled clinical trial of a psychiatric consultation intervention we had previously shown to improve the management of somatization disorder. The study population included 51 physicians treating 56 somatizing patients who had a history of seeking help for six to 12 lifetime unexplained physical symptoms. At the onset of the experiment, physicians randomized to the treatment condition received a consultation letter recommending a specific management approach; physicians randomized to the control/crossover condition received the consultation letter after 12 months. Data on health outcomes and charges were collected every 4 months for 2 years after randomization for 96% of subjects who entered the study. RESULTS: Patients of physicians who received the intervention reported significantly increased physical functioning, an improvement that remained stable during the year after the intervention. The intervention reduced annual medical care charges by $289 (95% confidence interval, $40 to $464) in 1990 constant dollars, which equates to a 32.9% reduction in the annual median cost of their medical care. CONCLUSIONS: Somatizing patients with a lifetime history of six to 12 unexplained physical symptoms reported better physical functioning after their primary care physician was provided appropriate treatment recommendations via a psychiatric consultation. Such a consultation is cost-effective because it reduces subsequent charges for medical care, while improving health outcomes in a chronically impaired population.

Adult↗

Improving alertness and performance in emergency department physicians and nurses: the use of planned naps.

STUDY OBJECTIVE: We examine whether a 40-minute nap opportunity at 3 AM can improve cognitive and psychomotor performance in physicians and nurses working 12-hour night shifts. METHODS: This is a randomized controlled trial of 49 physicians and nurses working 3 consecutive night shifts in an academic emergency department. Subjects were randomized to a control group (no-nap condition=NONE) or nap intervention group (40-minute nap opportunity at 3 AM=NAP). The main outcome measures were Psychomotor Vigilance Task, Probe Recall Memory Task, CathSim intravenous insertion virtual reality simulation, and Profile of Mood States, which were administered before (6:30 PM), during (4 AM), and after (7:30 AM) night shifts. A 40-minute driving simulation was administered at 8 AM and videotaped for behavioral signs of sleepiness and driving accuracy. During the nap period, standard polysomnographic data were recorded. RESULTS: Polysomnographic data revealed that 90% of nap subjects were able to sleep for an average of 24.8 minutes (SD 11.1). At 7:30 AM, the nap group had fewer performance lapses (NAP 3.13, NONE 4.12; p<0.03; mean difference 0.99; 95% CI: -0.1-2.08), reported more vigor (NAP 4.44, NONE 2.39; p<0.03; mean difference 2.05; 95% CI: 0.63-3.47), less fatigue (NAP 7.4, NONE 10.43; p<0.05; mean difference 3.03; 95% CI: 1.11-4.95), and less sleepiness (NAP 5.36, NONE 6.48; p<0.03; mean difference 1.12; 95% CI: 0.41-1.83). They tended to more quickly complete the intravenous insertion (NAP 66.40 sec, NONE 86.48 sec; p=0.10; mean difference 20.08; 95% CI: 4.64-35.52), exhibit less dangerous driving and display fewer behavioral signs of sleepiness during the driving simulation. Immediately after the nap (4 AM), the subjects scored more poorly on Probed Recall Memory (NAP 2.76, NONE 3.7; p<0.05; mean difference 0.94; 95% CI: 0.20-1.68). CONCLUSION: A nap at 3 AM improved performance and subjective report in physicians and nurses at 7:30 AM compared to a no-nap condition. Immediately after the nap, memory temporarily worsened. The nap group did not perform any better than the no-nap group during a simulated drive home after the night shift.

Automobile Driving↗

Multi-omics reveals that burdock seed aglycone alleviates renal fibrosis by restoring mitochondrial oxidative phosphorylation function.

Renal fibrosis (RF), a common pathological process driving chronic kidney disease (CKD) progression to end-stage renal failure, is closely associated with oxidative phosphorylation (OXPHOS). Arctigenin (ATG), the main active component of burdock seed, exhibits anti-inflammatory and anti-fibrotic activities, but its mechanisms in RF treatment remain unclear. Here, we performed integrated transcriptomic and proteomic analyses to identify key targets and pathways of ATG in a unilateral ureteral obstruction-induced rat RF model. Multi-omics enrichment analysis revealed that NDUFS8 and NDUFS2 were the core targets of ATG, with the OXPHOS pathway as the central intersecting pathway. Our results suggest that ATG exerts anti-renal fibrosis effects by targeting the OXPHOS pathway to inhibit excessive reactive oxygen species production and oxidative stress. SIGNIFICANCE: Chronic kidney disease (CKD) continues to impose an escalating global health and socioeconomic burden, while renal fibrosis (RF), as the convergent pathological endpoint of virtually all progressive nephropathies, remains the principal determinant of irreversible renal failure and adverse clinical outcomes. Despite extensive efforts to develop antifibrotic therapies, effective clinical interventions remain elusive, largely due to the complex and multifactorial nature of RF pathogenesis. In this study, we employed an integrated multi-omics framework encompassing transcriptomics, proteomics, and metabolomics to systematically decipher the antifibrotic mechanism of arctigenin (ATG), a bioactive natural compound derived from traditional Chinese medicine. Our findings identify mitochondrial oxidative phosphorylation as the pivotal regulatory axis underlying the renoprotective effects of ATG and further establish key catalytic subunits of mitochondrial complex I as its direct molecular targets. Mechanistically, ATG not only restores complex I activity and reprograms mitochondrial energy metabolism but also preserves the intracellular stability and localization of these subunits, thereby preventing their aberrant release-mediated inflammatory activation and disrupting the self-perpetuating cycle linking metabolic dysfunction, inflammation, and fibrosis progression. Beyond revealing a previously unrecognized dual mechanism integrating metabolic and inflammatory regulation, this study provides compelling evidence that mitochondrial dysfunction is not merely a secondary consequence of tissue injury but a fundamental driver of fibrotic remodeling. Importantly, our work highlights the translational potential of natural product-based mitochondrial interventions for CKD treatment and supports a broader conceptual shift toward metabolism-centered therapeutic strategies for chronic fibrotic diseases. Given the central role of mitochondrial dysfunction across multiple organs, these findings may also have far-reaching implications for the treatment of systemic fibrosis-related disorders beyond the kidney.

Animals↗

Unilateral transpedicular course of an ascending lumbar vein through a pedicular foramen mimicking a lytic lesion: an anatomic variant.

An ascending lumbar vein passing through a foramen on the right pedicle of the third lumbar vertebra unilaterally, which was diagnosed incidentally during virtual CT colonoscopy of a patient with a rectal tumor, is described. Recognition of this anatomic variation is important to avoid diagnostic misinterpretations and transpedicular interventions such as percutaneous vertebroplasty or surgical instrumentation that may result in excessive hemorrhage and inadvertent leak of cement when it is present.

Colonography, Computed Tomographic↗

[Study of pressor drops during continuous peridural analgesia in gerontologic surgery].

A statistical study bearing upon othe fall of blood pressure concomitant with the setting of peridural anaesthesia was carried out upon an homogeneous series of patients over 75 belonging to groups III and IV of the A S A classification for interventions seating below the IXth metamere. From this study, it seems to follow that: - for starting maximum arterial tensions over 180 mm/Hg, pressure falls are virtually constant in absolute value; - the most important variations in pressure falls are to be found in abdominal surgery; - the lowest figure in blood pressure which accompanies the achievement of surgical analgesia takes place about the 24 th minute whatever the type of surgery can be; - no significant link can be evidence between the importance of the fall in blood pressure and the consumption of the mixture required for surgical analgesia.

Abdomen↗

A randomized, controlled, prospective study validating the acquisition of percutaneous renal collecting system access skills using a computer based hybrid virtual reality surgical simulator: phase I.

PURPOSE: The need to develop new methods of surgical training combined with advances in computing has led to the development of sophisticated virtual reality surgical simulators. The PERC Mentortrade mark is designed to train the user in percutaneous renal collecting system access puncture. We evaluated and established face, content and construct validation of the simulator in this task. MATERIALS AND METHODS: A total of 63 trainees underwent baseline testing on the simulator, consisting of percutaneous renal puncture followed by the introduction of a guidewire into the collecting system. Subjects were then randomized to an intervention arm, in which they underwent 2, 30-minute training sessions on the simulator, and a control arm, in which no further training was given, followed by repeat testing. Performance was assessed using a global rating scale and by virtual reality derived parameters. RESULTS: There were no significant differences between the 2 groups with respect to baseline measures. Subjects who underwent training with the simulator demonstrated significant improvement in objective and subjective parameters compared to their baseline performance and compared to the untrained control group. Spearman rank correlations demonstrated a significant relationship between multiple parameters of the objective and subjective data. CONCLUSIONS: Training on the simulator improves virtual reality skills. It may allow trainees to develop the basic skills necessary to perform percutaneous renal collecting system access. Face and content validity were demonstrated and construct validity was supported by establishing convergent validity.

Computer Simulation↗