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At least 613 records · Page 34Linked to original sources

PubMed1995

Quantitation of progressive muscle fatigue during dynamic leg exercise in humans.

There is virtually no published information on muscle fatigue, defined as a gradual decline in force-generating capacity, during conventional dynamic (D) leg exercise. To quantitate progression of fatigue, we developed 1) a model featuring integration of maximal voluntary static contraction (MVC) of knee extension (KE) muscles with ongoing DKE and 2) a device that allows frequent rapid transfer between DKE isolated to the quadriceps femoris muscles and measurement of KE MVC. Eight healthy men performed graded and submaximal constant work rate one-leg DKE to exhaustion while seated. Work rate, a product of a contraction rate (1 Hz), force measured at the ankle, and distance of ankle movement from 90 degrees to 150 degrees of KE, was precisely controlled. Lack of rise in myoelectric activity in biceps femoris of the active leg during DKE and MVC was consistent with restriction of muscle action to quadriceps femoris. The slope of the linear relationship between O2 uptake and work rate was 13.7 ml O2/W (r = 0.93). This slope and the increase of heart rate relative to increasing work intensity agreed with published values for D leg exercise. Test-retest values for O2 uptake were similar (P > 0.05) for matched DKE work rates. To track fatigue, MVC (90 degrees knee angle) was performed every 2 min of DKE. After 4 min of DKE at work rates corresponding to (mean +/- SE) 66 +/- 2, 78 +/- 2, and 100% of peak DKE O2 uptake, MVC fell to 95 +/- 3, 90 +/- 5, and 65 +/- 7%* of MVC of rested muscle, respectively (*P < 0.01 from previous work rates). Virtually identical declines in MVC were observed by the end of graded work rate DKE and submaximal constant work rate DKE tests. Quantitation of progressive muscle fatigue during D leg exercise provides a framework to study the effects of a variety of interventions on the fatigue process and may permit unique insights into the involved mechanisms.

Adolescent↗

PubMed2001

Zora: a pilot virtual community in the pediatric dialysis unit.

We describe a five-month pilot project conducted in the dialysis unit at Boston's Children's Hospital. Pediatric patients with renal disease used the Zora therapeutic community program while undergoing hemodialysis. Zora is a 3D multi-user computer environment designed at the MIT Media Laboratory to help young people explore issues of identity, while engaging in a virtual community. Users build "virtual rooms" and populate them with objects and characters, program them with storytelling behaviors, and converse with other young people in real-time through a virtual character representing themselves. It was specifically designed to help young people explore issues of identity, while engaging in a participatory virtual community. This paper presents the experience and evaluates the feasibility and safety of using Zora in a hospital setting. It describes how Zora facilitated explorations of identity and mutual patient support and interaction. Finally it also presents design recommendations for future interventions of this kind. More generally, this paper explores the potential of technology specifically designed with therapeutic purposes to help patients cope with their illness.

Attitude of Health Personnel↗

PubMed2004

Suicide prevention: a vital national public health issue.

Suicide continues to be a major public health problem in the United States, with 30,000 deaths per year. The suicide rate, which hovers around 10-12/100,000, has remained virtually unchanged over the past three decades. In 1999 the Surgeon General proposed a national plan to serve as a roadmap toward developing a comprehensive national suicide prevention strategy. The key features of this plan were encapsulated in the acronym AIM, Awareness, Intervention and Methodology, to define the relevant components of a national strategy. This refers to increasing public awareness of the problem of mental illness and suicide, providing increased access to treatment and prevention resources and developing improved research methodologies. Despite the overall numbers, suicide is a low base-rate event, which makes studying intervention and prevention strategies very difficult, as very large subject samples are required for meaningful outcome assessments. Suicide prevention and prevention research have received substantially fewer public resources than many other medical conditions, and apparent public health risks such as bioterrorism. It is for this reason that a comprehensive, national public health based suicide prevention program is required.

Awareness↗

PubMedDate not supplied

A case report of neuroleptic malignant syndrome without fever in a patient given aripiprazole.

Neuroleptic malignant syndrome (NMS) is a rare disorder seen most often in patients exposed to antipsychotic medications. This syndrome is generally manifested by hyperthermia, muscle rigidity, autonomic instability, altered mental status, tremors, elevated serum creatinine phosphokinase and leucocytosis. It was first described by Delay during the 1960s. It is considered a medical emergency and is fatal if not promptly addressed. It is clinically relevant not only to psychiatrists but all clinicians since patients taking neuroleptics are seen by physicians from virtually every specialty. Relevant studies report a mortality rate of 10-20%. Conditions that share some features of NMS but have different treatment regimens include serotonergic syndrome, lethal catatonia, malignant hyperthermia, infections and various heat disorders. The importance of recognition and prompt intervention can not be overemphasized. Fever is a predominant symptom in NMS. The authors present an unusual case of NMS in a schizophrenic patient without fever who had been on aripiprazole. To date, there are only three possible reported cases of NMS related to aripiprazole. This case report serves to remind clinicians of the essential features in the diagnosis and management of NMS.

Adult↗

PubMed1989

[Hydatid torsion as a cause of acute scrotum--clinical, sonographic and anatomic aspects].

Out of 82 patients with acute swelling of the scrotum, 25 (30.5%) had hydatid torsion. Hydatid torsion was the second most common cause of acute scrotal swelling in the entire patient group. In the group of patients up to 14 years of age (n = 36), hydatid torsion was found in 47.2% and was the most common cause of acute scrotal swelling, followed by torsion of the spermatic cord. Only 3 patients had torsion of an appendage of the epididymis. All other patients (n = 22) had torsion of the hydatid of Morgagni (appendage of the testicle). A difference in anatomical structure and vascularization during childhood seems to be the most important aspect regarding hydatid torsion and hemorrhagic infarction. Ultrasonographic examination of the scrotum and checking to see if the typical physical signs are present can help in making the exact diagnosis. In 13 patients with hydatid torsion, the scrotum was examined with ultrasound high-frequency transducers (7.5, 10 and 12 MHz). In 4 patients, the diagnosis was hydatid torsion, as determined by ultrasonography. Two patients were treated conservatively with a daily follow-up including a clinical examination and investigation of the scrotum with ultrasound. The patients recovered very quickly and the acute symptoms resolved within a few days in virtually all instances. Thus, in cases where the diagnosis is proven and the course of the disease is reasonably mild and painless, conservative management of intrascrotal hydatid torsion is possible and can be an effective means of treatment in lien of surgical intervention.

Acute Disease↗

PubMed1993

Ectopic pregnancy. Diagnostic and therapeutic algorithms minimizing surgical intervention.

Presented are the results of a diagnostic algorithm for ectopic pregnancy incorporating history, physical examination, quantitative human chorionic gonadotropin (hCG), serum progesterone, color-flow vaginal Doppler sonography and endometrial curettage as well as a treatment algorithm combining expectant, medical and surgical management. These algorithms resulted in: (1) earlier diagnosis of ectopic pregnancy, with fewer ruptured ectopic pregnancies; (2) virtual elimination of diagnostic laparoscopy; (3) elimination of culdocentesis; (4) greater use of methotrexate; and (5) increased use of expectant (i.e., nonsurgical and nonmedical) treatment. These algorithms are potentially applicable in other clinical settings and should be considered for use on at-risk populations or when the diagnosis of ectopic pregnancy is in question.

Algorithms↗

PubMed2006

Learning curves and reliability measures for virtual reality simulation in the performance assessment of carotid angiography.

OBJECTIVES: Improvement in performance as measured by metric-based procedural errors must be demonstrated if virtual reality (VR) simulation is to be used as a valid means of proficiency assessment and improvement in procedural-based medical skills. BACKGROUND: The Food and Drug Administration requires completion of VR simulation training for physicians learning to perform carotid stenting. METHODS: Interventional cardiologists (n = 20) participating in the Emory NeuroAnatomy Carotid Training program underwent an instructional course on carotid angiography and then performed five serial simulated carotid angiograms on the Vascular Interventional System Trainer (VIST) VR simulator (Mentice AB, Gothenburg, Sweden). Of the subjects, 90% completed the full assessment. Procedure time (PT), fluoroscopy time (FT), contrast volume, and composite catheter handling errors (CE) were recorded by the simulator. RESULTS: An improvement was noted in PT, contrast volume, FT, and CE when comparing the subjects' first and last simulations (all p < 0.05). The internal consistency of the VIST VR simulator as assessed with standardized coefficient alpha was high (range 0.81 to 0.93), except for FT (alpha = 0.36). Test-retest reliability was high for CE (r = 0.9, p = 0.0001). CONCLUSIONS: A learning curve with improved performance was demonstrated on the VIST simulator. This study represents the largest collection of such data to date in carotid VR simulation and is the first report to establish the internal consistency of the VIST simulator and its test-retest reliability across several metrics. These metrics are fundamental benchmarks in the validation of any measurement device. Composite catheter handling errors represent measurable dynamic metrics with high test-retest reliability that are required for the high-stakes assessment of procedural skills.

Cardiology↗

PubMed2004

Aging, anti-aging, and hormesis.

As a result of almost 50 years of efforts in collecting descriptive data, biogerontologists are now able to construct general principles of aging and to explore possibilities of gerontomodulation. Most of the data indicate that aging is characterized by a stochastic accumulation of molecular damage and a progressive failure of maintenance and repair, and the genes involved in homeodynamic pathways are the most likely candidate virtual gerontogenes. Several approaches are being tried and tested to modulate aging in a wide variety of organisms, but with the ultimate aim of improving the quality of human life in old age. These approaches include gene therapy, hormonal supplementation, nutritional modulation, and intervention by antioxidants and other molecules. A recent approach is that of applying hormesis in aging research and therapy, which is based on the principle of stimulation of maintenance and repair pathways by repeated exposure to mild stress.

Aging↗

PubMed2005

Role of the microbiology laboratory in infectious disease surveillance, alert and response.

Surveillance is usually defined as the ongoing and systematic collection, analysis and interpretation of health data essential to the planning, implementation and evaluation of public health practice. During recent years, most of these programmes have been developed in the field of antimicrobial resistance and nosocomial infections, but efforts have also been made in other areas. Recent experiences of emerging microbial threats, including severe acute respiratory syndrome and new influenza variants affecting humans, the re-emergence of infectious disease problems and the possibility of bioterrorism have evidenced the need for implementation of infectious disease surveillance programmes. clinical microbiology laboratories play a pivotal role in these programmes. They have the first opportunity to detect these problems and should participate in the design of reporting strategies and dissemination of this information. Policies for the flow of data to national and international authorities should be established using passive surveillance strategies. However, active surveillance programmes taking advantage of new methodologies, including virtual tools and mathematical programs, should be the goal for early detection of unusual patterns of microbial pathogens, outbreaks and healthcare-associated infections. In addition, early implementation of response strategies should be designed and performed with the cooperation of microbiology laboratories, and intervention and response protocols should be defined with the participation of clinical microbiologists.

Communicable Disease Control↗

PubMed2001

Developing regional workplace health and hazard surveillance in the Americas.

An objective of the Workers' Health Program at the Pan American Health Organization (PAHO) is to strengthen surveillance in workers' health in the Region of the Americas in order to implement prevention and control strategies. To date, four phases of projects have been organized to develop multinational workplace health and hazard surveillance in the Region. Phase 1 was a workshop held in 1999 in Washington, D.C., for the purpose of developing a methodology for identifying and prioritizing the top three occupational sentinel health events to be incorporated into the surveillance systems in the Region. Three surveillance protocols were developed, one each for fatal occupational injuries, pesticide poisoning, and low back pain, which were identified in the workshop as the most important occupational health problems. Phase 2 comprised projects to disseminate the findings and recommendations of the Washington Workshop, including publications, pilot projects, software development, electronic communication, and meetings. Phase 3 was a sub-regional meeting in 2000 in Rosario, Argentina, to follow up on the progress in carrying out the recommendations of the Washington workshop and to create a Virtual Regional Center for Latin America that could coordinate the efforts of member countries. Currently phase 4 includes a number of projects to achieve the objectives of this Center, such as pilot projects, capacity building, editing a compact disk, analyzing legal systems and intervention strategies, software training, and developing an internet course on surveillance. By documenting the joint efforts made to initiate and develop Regional multinational surveillance of occupational injuries and diseases in the Americas, this paper aims to provide experience and guidance for others wishing to initiate and develop regional multinational surveillance for other diseases or in other regions.

Accidents, Occupational↗

PubMed2002

Delirium. Pragmatic guidance for managing a common, confounding, and sometimes lethal condition.

Virtually any medical illness, intoxication, or medication can precipitate delirium, an acute confusional state common among older persons. Delirium is associated with a high risk of morbidity and mortality, thus management requires thorough assessment and swift but careful action. A range of nonpharmacologic interventions can aid management of delirium, but in general, emergent, empiric pharmacotherapy is indicated for acute cases. Key to assessment and diagnosis is ruling out dementia and depression, determining the presence of delirium, and establishing an underlying cause. Several screening tools are available to aid this effort. Vigilance can help reduce the high number of patients discharged with unresolved symptoms.

Aged↗

PubMedDate not supplied

Evaluation of neck muscle strength with a modified sphygmomanometer dynamometer: reliability and validity.

OBJECTIVE: Determine test-retest reliability, normative data and clinical validity of isometric muscle strength testing in the neck with a modified sphygmomanometer dynamometer (MSD). DESIGN: Analytic survey. Paired trials of various muscle strength tests were conducted on convenience samples of normal subjects and consecutive samples of symptomatic subjects. SETTING: Outpatient chiropractic research clinic. PATIENTS/SUBJECTS: For study 2, 40 normal male subjects, average age 25 +/- 2 yr, were studied for reliability and normative data. For study 3, 24 symptomatic patients, 12 males and 12 females, average age 39 +/- 7 yr, were studied, 8 with "whiplash"-type injuries (average duration 22.5 wk) and 16 with nontraumatic chronic neck pain (average duration 110 wk). INTERVENTION: No therapeutic intervention is reported. MAIN OUTCOME MEASURE: Pressure levels generated by subjects against a modified sphygmomanometer-type dynamometer as measured in kilopascals. RESULTS: Study 1. Repeated paired trials of a standardized weight column (20 lbs) produced a coefficient of variation of 0.84% and virtually no difference between the means of the first vs. second trials. Study 2. High test-retest correlation coefficients were found for all ranges of motion (.79-.97). Right-to-left asymmetry in rotation and lateral flexion was within 6-8%. The flexion/extension ratio was .57:1, indicating that in normal subjects, flexion was approximately 40% lower than extension. Lower cutoffs were established as the mean--1 SD as follows (in kPa): flexion--3300, extension--5800, rotation--5200 and lateral flexion--6200. Coefficients of variation ranged from 25 to 29%. Study 3. Differences between paired trials were analyzed by intraclass coefficients, which were very high (.95-.99), and by percentages, which ranged from 4 to 10.4%, with an average of 7%, indicating a high degree of test-retest consistency. The mean values for all symptomatic subjects for flexion, extension, right rotation and right lateral bending were all well below the normal cutoff values as found in study 2. The flexion/extension ratio for whiplash subjects was 0.25:1.00, which is half of that of normal subjects. CONCLUSIONS: The MSD has been found to be a reliable instrument for the evaluation of isometric muscle strength in the neck in normal and symptomatic subjects. Normative values for absolute test levels, bilateral symmetry and flexion/extension ratios have been determined. A symptomatic group demonstrated significant deviations from these norms in the form of reduced strength levels and reduced flexion/extension ratios, while still maintaining very high levels of test-retest consistency and bilateral symmetry. The MSD appears very promising in the evaluation of neck-injured patients.

Adult↗

PubMed2000

[Ciaglia blue rhino: a modified technique for percutaneous dilatation tracheostomy. Technique and early clinical results].

OBJECTIVE: Elective tracheostomy has become an established treatment modality in modern intensive care medicine, and the number of percutaneously performed tracheostomies is steadily increasing. The Ciaglia Blue Rhino (CBR) represents another percutaneous technique in which the tracheostoma is formed by one-step dilation. Our study presents the technique itself and the early clinical experiences. METHODS: In 20 adult patients on long-term ventilation, CBR was done. After puncture of the trachea in typical manner, dilation of the tracheostoma was achieved in one single step by means of a curved dilator with a special hydrophilic coating. Then, the tracheostomy tube was inserted over a curved loading dilator. Practicability and safety were determined as well as gas exchange during the procedure by means of arterial blood gas samples. RESULTS: As a result of the dilator's hydrophilic coating, dilation of the tracheostoma was rapidly achieved within 152 +/- 22 s, virtually free from resistance of the trachea or the cervical tissues. Complications such as bleeding, aspiration or postoperative infection of the stoma were not noted in any of our patients. Fractures of isolated tracheal cartilage rings were seen in 5 patients, however, no therapeutic intervention was necessary. In terms of perioperative gas exchange, pre- and postoperative levels of FiO2, PaO2, PaCO2 and the oxygenation index (PaO2/FiO2) did not change significantly. CONCLUSIONS: Based on our early clinical experience, Ciaglia Blue Rhino represents a new method that may combine the typical advantages of each of the other techniques for percutaneous tracheostomy (i.e. Ciaglia, Griggs, Fantoni) in one single technique. This method is distinguished by a high level of safety and practicability. However, further comparative trials need to be done before a definitive judgement can be made.

Adult↗

PubMed2001

Preoperative planning with magnetic resonance imaging and computerized volume rendering in twin-to-twin transfusion syndrome.

Our purpose was to illustrate the feasibility of preoperative planning with magnetic resonance imaging, 3-dimensional reconstruction, and volume-rendering techniques in twin-to-twin transfusion syndrome treated by endoscopic laser ablation of communicating vessels. After ultrasonographic determination of the syndrome and the indications for intervention, 2 patients with an anterior placenta underwent magnetic resonance imaging without the need for maternal or fetal sedation. Raw image data were downloaded into a desktop computer and manipulated with 3-dimensional reconstruction, volume rendering, and surgical navigation software. In both patients a virtual rendering of the fetuses, placenta, and uterus could be manipulated to expose all sides, demonstrate the location of the intertwin membrane, and plan the point of entry and curve of the endoscopic instruments. Preoperative planning and virtual surgical navigation in fetal surgery are now possible, as a result of shorter magnetic resonance imaging acquisition times and volume-rendering software. In this manner an entire virtual endoscopic fetal operation can be performed and fine-tuned before the actual procedure is to take place.

Endoscopy↗

PubMed1992

Psychosurgery in the modern era: therapeutic and ethical aspects.

Brain operations for psychiatric illness were in the past the centre of public controversy. Fear of untoward side-effects and an exaggerated use of the procedure including treatment of societal aspects of the disease process caused a virtual cessation of psychosurgical operations. With the introduction of techniques that could accurately lesion specific areas in the brain, especially in the limbic system, psychosurgical procedures were revived. Psychiatric syndromes, such as obsessive-compulsive affective disorders, were shown to have benefited from such intervention, without giving rise to untoward side-effects. Given societal supervision it is appropriate to reconsider the use of psychosurgery in well-defined clinical entities of mental disease that do not respond to alternative therapy.

Behavior Control↗

PubMed1993

Clinical and biochemical phenotype in 11 patients with mevalonic aciduria.

OBJECTIVE: Mevalonic aciduria is a consequence of the deficiency of mevalonate kinase, the first enzyme after 3-hydroxy-3-methylglutaryl-coenzyme A reductase in the biosynthesis of cholesterol and nonsterol isoprenes. To establish the clinical and biochemical phenotype of mevalonic aciduria, the authors assembled their experience with 11 patients including attempts at therapeutic interventions. METHODS: Mevalonic acid in body fluids was determined by stable isotope dilution gas chromatography/mass spectroscopy with selected ion monitoring, ubiquinone-10 concentrations by reversed-phase high-pressure liquid chromatography. RESULTS: Varying degrees of severity of clinical illness were observed despite uniform, virtual absence of residual activity of the enzyme. The most severely affected patients have had profound developmental delay, dysmorphic features, cataracts, hepatosplenomegaly, lymphadenopathy, and anemia, as well as diarrhea and malabsorption, and have died in infancy. Less severely affected patients have had psychomotor retardation, hypotonia, myopathy, and ataxia. All patients have had recurrent crises in which there was fever, lymphadenopathy, increase in size of liver and spleen, arthralgia, edema, and a morbilliform rash. Neuroimaging studies revealed selective and progressive atrophy of the cerebellum. Mevalonic acid concentrations were found to be grossly elevated in body fluids of all patients. Concentrations of plasma cholesterol were normal or only slightly reduced. Concentrations of ubiquinone-10 in plasma were found to be decreased in most patients. Abnormalities such as hypoglycemia, metabolic acidosis, or lactic acidemia, the usual concomitants of disorders of organic acid metabolism, were conspicuously absent. CONCLUSIONS: These observations establish the broad range of clinical symptoms and biochemical findings in mevalonic aciduria. It is concluded that although patients with mevalonic aciduria have a recognizable phenotype of serious clinical manifestations, some patients are likely to remain undiagnosed and may be found in a variety of subspecialty clinics, including neurology, gastroenterology, cardiology, and genetics.

Abnormalities, Multiple↗

PubMed2006

A haptic device for guide wire in interventional radiology procedures.

Interventional Radiology (IR) is a minimally invasive procedure where thin tubular instruments, guide wires and catheters, are steered through the patient's vascular system under X-ray imaging. In order to perform these procedures, a radiologist has to be trained to master hand-eye coordination, instrument manipulation and procedure protocols. The existing simulation systems all have major drawbacks: the use of modified instruments, unrealistic insertion lengths, high inertia of the haptic device that creates a noticeably degraded dynamic behavior or excessive friction that is not properly compensated for. In this paper we propose a quality training environment dedicated to IR. The system is composed of a virtual reality (VR) simulation of the patient's anatomy linked to a robotic interface providing haptic force feedback. This paper focuses on the requirements, design and prototyping of a specific haptic interface for guide wires.

Catheterization↗

PubMed1985

Occupational medicine. A new focus for general internal medicine.

In the past two decades, occupational medicine has advanced from a formerly clinical discipline to one focused on epidemiology and toxicology. However, because efforts to prevent occupational disease by concerted application of industrial hygiene have not eliminated the problem, there remains a strong need for clinical interventions. Appropriate interventions could result in a further substantial reduction in the morbidity and mortality of work-connected illness. Unfortunately, neither adequate training nor the necessary scientific foundation for clinical decision making presently exist. Studies are needed to characterize the modern spectra and natural histories of virtually all recognized occupational diseases and to evaluate the efficacy of available therapeutic strategies. Sections of general internal medicine potentially offer an ideal academic setting to address these educational and scientific deficiencies.

Female↗