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Results for “virtual intervention”

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PubMed1991

Urine screening practices in methadone maintenance clinics. A survey of how the results are used.

The urinalysis practices of 324 methadone maintenance clinics were surveyed using a brief self-report questionnaire. Results indicate that there is wide variability in collection practices and clinic responses to positive findings. Virtually all clinics provide counseling and revocation of take-home methadone doses as a response to positive urinalysis results. However, increase in urine screening frequency, methadone dose adjustments, contingency contracting, group therapy, and eventual discharge are interventions also used. The implementation of different interventions varied as a function of clinic size, city size, region of the country, and program funding source.

Community Mental Health Centers↗

PubMedDate not supplied

Assistive technology and learning disabilities: today's realities and tomorrow's promises.

Many forms of technology, both "high" and "low," can help individuals with learning disabilities capitalize on their strengths and bypass, or compensate for, their disabilities. This article surveys the current status of assistive technology for this population and reflects on future promises and potential problems. In addition, a model is presented for conceptualizing assistive technology in terms of the types of barriers it helps persons with disabilities to surmount. Several current technologies are described and the research supporting their effectiveness reviewed: word processing, computer-based instruction in reading and other academic areas, interactive videodisc interventions for math, and technologies for daily life. In conclusion, three themes related to the future success of assistive technology applications are discussed: equity of access to technology; ease of technology, use; and emergent technologies, such as virtual reality.

Computer-Assisted Instruction↗

PubMed1982

Intraoperative monitoring of brain-stem auditory evoked potentials.

Brain-stem auditory evoked potentials (BAEP) were monitored during 545 neurosurgical operations in the cerebellopontine angle. The BAEP were irreversibly obliterated in five patients who required deliberate section of the auditory nerve. Technical difficulties interfered with monitoring in three cases, and three patients had deafness and absent BAEP preoperatively. Reversible alterations in BAEP were seen during 32 operations, with recovery after as long as 177 minutes of virtually complete obliteration. Changes in BAEP were associated with surgical retraction, operative manipulation, positioning of the head and neck for retromastoid craniectomy, and the combination of hypocarbia and moderate hypotension. In 19 cases, waveforms improved after specific interventions made by the surgeon or anesthesiologist because of deteriorating BAEP. In 13 other cases, BAEP recovered after maneuvers not specifically related to the electrophysiological monitoring, most often completion of operative manipulation. Whenever BAEP returned toward normal by the end of anesthesia, even after transient obliteration, hearing was preserved. Irreversible loss of BAEP occurred only when the auditory nerve was deliberately sacrificed. The authors conclude that monitoring of BAEP may help prevent injury to the auditory nerve and brain stem during operations in the cerebellopontine angle.

Adult↗

PubMed2000

Enteroscopy.

Enteroscopy in the new millennium will involve the development of instruments and accessories to allow deeper therapeutic intervention in the small bowel. There are also four new areas of development that involve the field of enteroscopy. These areas are the development of improved push enteroscopes, the development of laparoscopically assisted enteroscopy, the development of virtual enteroscopy, and gene research in the field of vascular anomalies of the gut.

Endoscopes, Gastrointestinal↗

PubMedDate not supplied

The value of virtual reality-simulator training in the development of laparoscopic surgical skills.

OBJECTIVE: To determine the effectiveness of virtual reality (VR) training in improving the surgical skills of medical students and gynecologic trainees. DESIGN: A prospective observational study to assess the changes observed in objectively measured surgical performance after VR training. SETTING AND POPULATION: University teaching hospital and the laboratories of the University of Western Australia. PARTICIPANTS: Fifteen 5th-year medical students, six junior-doctor trainees (years 1-3), and eight senior trainees (years 4-6). INTERVENTIONS: Standard gynecologic procedures before and after VR training were undertaken on sheep. The procedures were video-recorded and edited to blind the scorer as to identity and seniority of the operator. The procedures were scored using a combination of operative time and penalties for surgical errors. The surgical scores were correlated with the VR scores. MEASUREMENTS AND MAIN RESULTS: Operative skills were assessed using a combination score compiled from scores obtained while undertaking salpingectomy, salpingotomy, and tubal clipping. Virtual reality scores were also a combination score derived from summation of various computer-calculated measures of time and accuracy in undertaking two standardized exercises. RESULTS: The baseline VR scores were significantly related to the overall pre-training scores (salpingectomy p = .032). A better initial VR score was also predictive of better surgical performance. The initial VR score was also predictive of improvement observed between baseline and post-training (p = .004). CONCLUSION: Virtual reality training is of value in improving surgical skills in the clinical environment. It appears to be of most value in the earliest stages of training. These data suggest that serious consideration should be given to incorporating VR training into the training program of obstetricians and gynecologists at an early stage.

Adult↗

PubMed2001

Percutaneous coronary intervention in st-elevation myocardial infarction.

This review traces the development of coronary angioplasty as a direct, primary means of establishing reperfusion in an acutely occluded infarct-related artery. As a therapeutic strategy for the early management of patients with ST-elevated acute myocardial infarction, this mechanical-invasive procedure arose virtually simultaneously with the demonstration that intravenous administration of fibrinolytic agents to such patients results in a relative reduction in early mortality by as much as 25% to 30%. Over the past 15 years, more than a dozen randomized, controlled trials have investigated the question, "Which is the better means of administrating reperfusion therapy?" The recent demonstration that the combination of coronary stenting plus glycoprotein IIb/IIIa inhibitors used in the early stages of ST-elevation acute myocardial infarction salvages more myocardium than the administration of front-loaded tissue plasminogen activator offers a convincing answer. This is further supported by the evidence that clinical outcomes also improved in these patients, with the greater improvement in ventricular function. It is likely, however, that the development of newer pharmacologic agents plus the combination of both strategies will keep this a hotly debated issue for some time to come.

Angioplasty, Balloon, Coronary↗

PubMedDate not supplied

Interventional radiologic placement of peripherally inserted central catheters.

PURPOSE: This study examines the difference in success between bedside insertions of peripherally inserted central catheters (PICCs) performed by clinicians and fluoroscopically assisted insertions by cardiovascular/interventional (CV/I) radiologists. PATIENTS AND MATERIALS: Four hundred four PICCs were inserted in 305 patients, with a mean age of 48 years (range, 8-78 years), who required intermediate and long-term central venous access. One hundred fifty patients underwent bedside insertion, and 155 patients underwent fluoroscopically assisted insertion. Dual- and single-lumen PICC devices were used depending on venous access needs. RESULTS: Central venous access with the PICC device was achieved in 111 (74%) of 150 bedside insertions and in 153 (98.7%) of 155 fluoroscopic insertions. Average PICC dwell time was 72.7 days (range, 2-307 days). Of the 305 patients, 244 (73.4%) completed planned therapy with a single catheter, 54 patients (17.7%) required two PICCs at the same site, 15 patients (4.9%) required three or more PICCs at the same site, and 12 patients (4.0%) required PICC replacement to a different site to complete therapy. Complications with bedside insertions included upper extremity thrombophlebitis (n = 4), entry site infection (n = 6), and PICC shear with migration (n = 2), while complications with fluoroscopic insertions included entry site infection (n = 2). CONCLUSION: Because of the far greater placement success achieved by CV/I radiologists, all PICCs are now inserted fluoroscopically. The devices complete favorably with surgically placed central catheters with regard to service interval, morbidity, and cost. Use of fluoroscopic techniques enables placement of these devices in virtually all patients, even those with seemingly no peripheral veins.

Adolescent↗

PubMed1990

Cornelia de Lange syndrome. Otolaryngologic manifestations.

Cornelia de Lange syndrome (CDLS) is characterized by multiple congenital malformations and mental retardation. New studies have documented otolaryngologic abnormalities. We examined 45 patients with CDLS. Virtually all had hearing loss, and most had impaired language development. Other otolaryngologic abnormalities, including external auditory canal stenosis and cleft palate, were also common. Because of the high incidence of otolaryngologic abnormalities, and the need for early intervention, it is important for otolaryngologists to recognize CDLS manifestations in the head and neck.

Adolescent↗

PubMed1993

Beta-carotene and vitamin E in oral cancer prevention.

The ultimate proof that a putative chemopreventive agent does prevent cancer is a demonstration of reduced cancer incidence in a targeted population. However, because of practical and logistical considerations, such trials are virtually impossible to conduct for the majority of cancers. Therefore, a conclusion regarding the efficacy of chemopreventive activity is based on consideration of a variety of indirect lines of evidence, including laboratory studies, animal model systems, epidemiologic surveys, intervention trials involving reversal of premalignant changes, and the prevention of malignancies in particularly high risk subjects. Furthermore, the only agents worth testing are those with limited, or preferably, no toxicity, since the final use will be prevention in a generally healthy population. Beta-carotene and vitamin E both fulfill all the criteria for suitable chemopreventive agents; several lines of evidence point toward preventive roles for them in oral cancer. In numerous epidemiologic studies, low intake of beta-carotene has been associated with higher cancer risk. Both intake and supplemental use of vitamin E have been associated with a lowered risk of cancer. Smokers, whose habit is a major risk factor, have lower beta-carotene levels in oral mucosal cells when compared with non-smokers. In several laboratory and animal model systems, including the very relevant hamster cheek pouch model, these agents strongly inhibit oral cavity carcinogenesis. Beta-carotene and vitamin E produce regression of oral leukoplakia, a premalignant lesion for oral cancer. This has now been shown in seven clinical trials: five with beta-carotene alone, one with vitamin E, and one with a combination of both.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1986

Corrosive burns of the esophagus and stomach: a recommendation for an aggressive surgical approach.

During a six-year period ending in December, 1980, 62 patients with a history or clinical evidence of corrosive ingestion were admitted into our institutions. The majority were adults who had attempted suicide. Strong alkali (lye), the most common corrosive agent involved, was ingested by more than half of the patients (39). The remaining 23 patients had ingested weak alkali or nonalkali corrosive agents. Of the 27 patients with severe esophagogastric burns (second- and third-degree), a 43.5% incidence overall, liquid lye was responsible in 21, including 7 of 8 patients with extensive full-thickness esophagogastric necrosis. In sharp contrast, only 1 of the 23 patients who had ingested weak alkali or nonalkali corrosive agents had serious esophagogastric injury. In the first two years of this review, the management approach was the so-called standard one (esophagoscopy, steroids, antibiotics, and dilation) (Group 1). The results were disappointing. In 5 of 9 patients with endoscopic findings of second-degree burns, stricture requiring dilation developed, and all 4 with extensive full-thickness esophagogastric necrosis died. In contrast, during the last four years, with the adoption of a more aggressive surgical approach, that is, early surgical intervention including the use of an intraluminal esophageal stent and radical resection as indicated, missed or delayed diagnosis of full-thickness esophagogastric necrosis with its prohibitive mortality was avoided and the complication of severe esophageal stricture was virtually eliminated (Group 2).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2002

Visualization and simulation techniques for surgical simulators using actual patient's data.

Because of the increasing complexity of surgical interventions research in surgical simulation became more and more important over the last years. However, the simulation of tissue deformation is still a challenging problem, mainly due to the short response times that are required for real-time interaction. The demands to hard and software are even larger if not only the modeled human anatomy is used but the anatomy of actual patients. This is required if the surgical simulator should be used as training medium for expert surgeons rather than students. In this article, suitable visualization and simulation methods for surgical simulation utilizing actual patient's datasets are described. Therefore, the advantages and disadvantages of direct and indirect volume rendering for the visualization are discussed and a neuro-fuzzy system is described, which can be used for the simulation of interactive tissue deformations. The neuro-fuzzy system makes it possible to define the deformation behavior based on a linguistic description of the tissue characteristics or to learn the dynamics by using measured data of real tissue. Furthermore, a simulator for minimally-invasive neurosurgical interventions is presented that utilizes the described visualization and simulation methods. The structure of the simulator is described in detail and the results of a system evaluation by an experienced neurosurgeon--a quantitative comparison between different methods of virtual endoscopy as well as a comparison between real brain images and virtual endoscopies--are given. The evaluation proved that the simulator provides a higher realism of the visualization and simulation then other currently available simulators.

Artificial Intelligence↗

PubMed1997

Modeling valuations for EuroQol health states.

OBJECTIVES: It has become increasingly common for preference-based measures of health-related quality of life to be used in the evaluation of different health-care interventions. For one such measure, The EuroQol, designed to be used for these purposes, it was necessary to derive a single index value for each of the 243 health states it generates. The problem was that it was virtually impossible to generate direct valuations for all of these states, and thus it was necessary to find a procedure that allows the valuations of all EuroQol states to be interpolated from direct valuations on a subset of these. METHODS: In a recent study, direct valuations were elicited for 42 EuroQol health states (using the time trade-off method) from a representative sample of the UK population. This article reports on the methodology that was adopted to build up a "tariff" of EuroQol values from this data. RESULTS: A parsimonious model that fits the data well was defined as one in which valuations were explained in terms of the level of severity associated with each dimension, an intercept associated with any move away from full health, and a term that picked up whether any dimension in the state was at its most severe level. CONCLUSIONS: The model presented in this article appears to predict the values of the states for which there are direct observations and, thus, can be used to interpolate values for the states for which no direct observations exist.

Activities of Daily Living↗

PubMed2004

MRI/TRUS data fusion for prostate brachytherapy. Preliminary results.

Prostate brachytherapy involves implanting radioactive seeds (I125 for instance) permanently in the gland for the treatment of localized prostate cancers, e.g., cT1c-T2a N0 M0 with good prognostic factors. Treatment planning and seed implanting are most often based on the intensive use of transrectal ultrasound (TRUS) imaging. This is not easy because prostate visualization is difficult in this imaging modality particularly as regards the apex of the gland and from an intra- and interobserver variability standpoint. Radioactive seeds are implanted inside open interventional MR machines in some centers. Since MRI was shown to be sensitive and specific for prostate imaging whilst open MR is prohibitive for most centers and makes surgical procedures very complex, this work suggests bringing the MR virtually in the operating room with MRI/TRUS data fusion. This involves providing the physician with bi-modality images (TRUS plus MRI) intended to improve treatment planning from the data registration stage. The paper describes the method developed and implemented in the PROCUR system. Results are reported for a phantom and first series of patients. Phantom experiments helped characterize the accuracy of the process. Patient experiments have shown that using MRI data linked with TRUS data improves TRUS image segmentation especially regarding the apex and base of the prostate. This may significantly modify prostate volume definition and have an impact on treatment planning.

Biophysical Phenomena↗

PubMed1994

Family grief.

As grief is both an individual and shared experience, adopting a systemic perspective is most appropriate for health-care professionals seeking to assist the bereaved. Within this framework, the family virtually always constitutes the most significant social group in which grief is experienced. In this paper we review the literature on family grief, covering clinical case reports, the observations of family therapists, systematic family bereavement research and family intervention studies. An understanding of patterns of family grief and vulnerability factors for morbid grief is pivotal to both preventive intervention and treatment of an established disorder.

Adaptation, Psychological↗

PubMedDate not supplied

[Comparative evaluation of the efficiency of transscleral diode laser cyclophotocoagulation during contact and contactless procedures: experimental morphological study].

To elucidate the extent to which contact and contactless procedures of diode laser transscleral cyclophotocoagulation (CPC) has a antihypertensive effect and a ocular tissue damaging effect, the authors have made a comparative assessment of the procedures to determine their preference. The study was conducted on an experimental material (5 Chinchilla rabbits (10 eyes)). The follow-up was 1 day to 6 months after laser interventions. The authors estimated the parameters of ocular hydrodynamics before and laser intervtntion throughout the follow-up and analyzed them with morphological changes kept in mind. The final antihypertensive effect of both contact and contactless procedures was virtually equal. However, less inflammatory changes and lower ocular damaging effect, and no additional medical manipulations for contactless diode laser CPC make it more preferable to contact CPC for clinical use.

Animals↗

PubMed2005

Decreased red meat fat consumption in New Zealand: 1995-2002.

AIM: To review New Zealand red meat and meat fat supply trends before and after the introduction of the Quality Mark standard. METHODS: Review of trends in: per capita meat fat supply estimates from the Food and Agriculture Organization (FAO); carcase and meat cut composition reports of knife dissection and chemical analyses; the fate of fat trim; and a Lincoln College study of home-cooked and trimmed beef. Intervention From September 1997, the red meat industry's Quality Mark required trimming of beef and lamb cuts to no more than 5 mm external fat. RESULTS: (1) Trimming of fat from red meat before sale (supported by virtually all butchers) decreased the fat and saturated fat content of a red meat carcase by 30% (beef, -27%; lamb, -30%; tallow unchanged); by -8% in the total food supply; and by -17% across all meat. In 2002, fat comprised 7.4% of trimmed beef cuts, and 11.2% of all beef sold: cuts, mince, or sausages. In 2002, fat comprised 15.3% of lamb cuts; and 15.5% with mince included. (2) From 1995 to 2002, total saturated fat availability per capita in the food supply decreased by 19% (from 65 g to 53 g per day), mostly due to 7 g less saturated fat daily from red meat. (3) When combining effects (1) and (2), saturated fat per capita decreased: -27% in total food supply; -65% in red meat excluding tallow; -48% in red meat including tallow. In 1995 (without trimming), red meat contributed 25% of saturated fat in the total food supply whereas in 2002, red meat contributed 19% before (and 13% after) trimming. (4) Home trimming may remove an additional 27% of fat from beef steaks. CONCLUSION: Centralised meat processing, and Quality Mark labelling since 1997, ensured fat was trimmed from beef and lamb cuts, and reduced saturated fat in red meats by 30%. In 2002, mince and sausages accounted for nearly half of beef fat sold as red meat.

Animals↗

PubMed1994

The virtual absence of stress-ulceration related bleeding in ICU patients receiving prolonged mechanical ventilation without any prophylaxis. A prospective cohort study.

OBJECTIVE: To study the incidence of stress-ulcer related bleeding in ICU patients receiving prolonged (> 2 days) mechanical ventilation without any stress ulceration prophylaxis. DESIGN: A prospective cohort study in 183 patients. INTERVENTIONS: All patients received clinical treatment including maintenance of adequate tissue perfusion (with low dose inotropes and vasodilators), infection prevention (by selective decontamination of the digestive tract) throughout ICU stay and suppression of generalized inflammatory reaction (by steroids). SETTING: Medical/surgical ICU of a major teaching hospital in Amsterdam (Onze Lieve Vrouwe Gasthuis). MEASUREMENTS AND RESULTS: 167 patients were evaluated during 2182 treatment days in the ICU and during 1753 days on mechanical ventilation without stress ulceration prophylaxis. The mean total risk score for stress ulceration related bleeding was 38 (Tryba score). Stress ulceration related bleeding developed in 1 patient (0.6%). CONCLUSIONS: The incidence of SURB was less then 1% in this cohort of ICU patients receiving longterm mechanical ventilation with a high risk for SURB (mean total risk score 38). All patients received agressive shock resuscitation, infection prevention with selective decontamination of the digestive tract (SDD) and suppression of inflammatory response with steroids. Further studies are needed to evaluate the contribution of each of these elements of the integral approach.

Aged↗

PubMed1987

Pharmacologic management of asthma.

Obstructive airway disease from asthma needs to be distinguished from other causes, classified with regard to clinical pattern, and assessed to identify severity and precipitating factors. Intervention of acute symptoms is most effective with inhaled sympathomimetic bronchodilators backed up with short courses of high-dose oral corticosteroids for symptoms that are suboptimally responsive to bronchodilation alone, especially for those patients with a history of emergency care requirements and/or hospitalization. Maintenance therapy with scheduled daily use of inhaled beta2 agonists, cromolyn, and slow-release theophylline can be used prophylactically for patients with chronic disease. The inhaled beta2 agonists are the most effective therapeutic agents for relieving acute bronchospasm and for decreasing responsiveness of the airways to specific stimuli such as exercise; however, even the newer agents have sufficiently short duration of effect to limit efficacy for maintenance therapy. Cromolyn and slow-release theophylline are commonly used for chronic therapy; cromolyn has the merit of virtually no toxic potential but is less convenient and less likely to be effective, at least for more severe asthma, than theophylline. Corticosteroids uniquely decrease the inflammatory component of asthma, thereby decreasing or preventing airway obstruction from mucosal edema and secretions. Short courses of high-dose oral steroids without tapering provide useful and safe intervention for acute symptoms, whereas alternate-morning oral use and the new generation of topical inhaled agents provide acceptably safe alternatives for managing chronic disease not controlled with other measures. Nonpharmacological factors that require therapeutic consideration include environmental factors such as cigarette smoke and aeroallergens, and general physical conditioning. Compliance with the medical recommendations requires dealing with dysfunctional attitudes and beliefs held by the patient and/or family and the fostering of an internal locus of control by including the patient in the decision-making process.

Adolescent↗