PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “virtual intervention”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources
PubMed1994

Prevention research and its interface with policy: defining the terms and challenges.

The United States has led the way in the development of new insights into the detection, treatment, and prevention of disease. Not only has the Nation's research community ushered in the virtual elimination of nutrient deficiency diseases, dramatic reductions in childhood vaccine-preventable diseases, and impressive gains against heart disease and stroke, it has also been at the forefront of basic research in genetics and molecular biology and the development of important diagnostic and therapeutic interventions. With health care reform comes an opportunity to build upon and strengthen the positive features of the Nation's health system, including health research--in particular, research that fosters the prevention of health problems and a better informed application of medical services.

Health Policy↗
PubMed1998

Preoperative planning and intraoperative navigation in skull base surgery.

Experience with the commercially available, 3-D navigation systems Viewing Wand (ISG, Mississauga, Ontario, Canada) and SPOCS (Aesculap, Germany) in skull base surgery is presented. Having meanwhile been tested in over 60 clinical trials, the systems achieved an accuracy of < or = 2.7 mm which, at the moment, we deem sufficiently acceptable to proceed with their clinical evaluation. There was no difference in intraoperative accuracy between the mechanical and the optical navigation systems. The systems proved to be very helpful in identifying the extent of the tumours and in visualizing the proximity of vital structures. 3-D-planning, simulation and intraoperative navigation especially facilitates surgery in anatomically complicated situations, without risk of damaging neighbouring structures. The SPOCS (Surgical Planning and Orientation Computer System) revealed a considerably improved flexibility in handling and a better integration into the surgical procedure in comparison with the relatively inflexible and space-demanding Viewing Wand arm. Especially, the 'offset' function of the SPOCS offers the possibility of a virtual elongation of the instrument and thus, in combination with the on-line visualization of the corresponding images, of a 'look ahead' operation. By using computer-assisted simulation and navigation systems, we can expect quality improvement and risk reduction. More extensive and radical interventions seem possible.

Computer Simulation↗
PubMed1994

Altered inflammatory responses in leukotriene-deficient mice.

Leukotrienes have been implicated in the regulation of immune responses, including inflammation and immediate hypersensitivity reactions. Here, we describe the phenotypic analysis of leukotriene-deficient mice generated by inactivation of the 5-lipoxygenase (5LO) gene. These 5LO(-/-) mice were unable to synthesize detectable levels of leukotrienes and were more resistant to lethal anaphylaxis induced by platelet-activating factor. The intensity of an acute inflammatory response induced by arachidonic acid was similar in 5LO(-/-) mice and controls. However, the response in 5LO(-/-) mice, but not in controls, could be virtually eliminated by a cyclooxygenase inhibitor. These data suggest that inflammatory responses are modulated by arachidonic acid metabolites through a variety of interconnected mechanisms. This has important implications for understanding the early events of an inflammatory response and for designing drugs for use in therapeutic intervention.

Anaphylaxis↗
PubMed1998

Virtual reality applied to hepatic surgery simulation: the next revolution.

OBJECTIVE: This article describes a preliminary work on virtual reality applied to liver surgery and discusses the repercussions of assisted surgical strategy and surgical simulation on tomorrow's surgery. SUMMARY BACKGROUND DATA: Liver surgery is considered difficult because of the complexity and variability of the organ. Common generic tools for presurgical medical image visualization do not fulfill the requirements for the liver, restricting comprehension of a patient's specific liver anatomy. METHODS: Using data from the National Library of Medicine, a realistic three-dimensional image was created, including the envelope and the four internal arborescences. A computer interface was developed to manipulate the organ and to define surgical resection planes according to internal anatomy. The first step of surgical simulation was implemented, providing the organ with real-time deformation computation. RESULTS: The three-dimensional anatomy of the liver could be clearly visualized. The virtual organ could be manipulated and a resection defined depending on the anatomic relations between the arborescences, the tumor, and the external envelope. The resulting parts could also be visualized and manipulated. The simulation allowed the deformation of a liver model in real time by means of a realistic laparoscopic tool. CONCLUSIONS: Three-dimensional visualization of the organ in relation to the pathology is of great help to appreciate the complex anatomy of the liver. Using virtual reality concepts (navigation, interaction, and immersion), surgical planning, training, and teaching for this complex surgical procedure may be possible. The ability to practice a given gesture repeatedly will revolutionize surgical training, and the combination of surgical planning and simulation will improve the efficiency of intervention, leading to optimal care delivery.

Computer Simulation↗
PubMed2004

Mitochondrial influence on aging rate in Caenorhabditis elegans.

Virtually every model of mitochondrial involvement in aging shares the underlying proposition that mitochondrial dysfunction will accelerate the rate of aging. Caenorhabditis elegans is a post-mitotic organism with limited capacity for replacement and repair, and there is a great deal of evidence that interventions which decrease the induction of damage extend lifespan in this model. However, decreased availability of ubiquinone in adulthood has also been found to promote longevity and stress resistance, and evidence tentatively supports decreased mitochondrial function under these conditions. In addition, gene silencing experiments and mutations that target mitochondrial electron transport have also been found to increase lifespan and stress resistance in C. elegans, as has treatment with the mitochondrial inhibitor antimycin A. The involvement of damage by reactive oxygen species has been suggested, and yet many of these manipulations would be expected to increase the production of reactive oxygen species. The extension of lifespan by these interventions seems paradoxical and the mechanism, when it is elucidated, promises to have far-reaching significance.

Aging↗
PubMed1989

Infectious complications of modern cataract surgery and intraocular lens implantation.

Over one million intraocular lenses are implanted each year during cataract surgery in the United States alone. Despite an impressive overall success rate, infection remains an important postoperative complication. Virtually every microbial organism has the potential to be an intraocular pathogen, and this article addresses both generalized and localized forms of microbial endophthalmitis. Successful outcome requires prompt clinical recognition, appropriate laboratory evaluation, initiation of antimicrobial therapy, control of inflammatory sequelae, and when necessary, surgical intervention.

Bacterial Infections↗
PubMed1987

Pancreas transplant protocols at the University of Minnesota: recipient and donor selection, operative and postoperative management, and outcome.

In summary, at the University of Minnesota we perform pancreas transplants from both living-related and cadaver donors. Living-related donors must meet strict criteria indicating that they are not at risk for diabetes. Segmental grafts are procured from living-related donors. We currently procure whole pancreas grafts from most cadaver donors, including those in whom a liver is procured. We will accept preservation times up to 24 hours using hyperosmolar silica-gel-filtered plasma as the preservation solution. In regard to recipient selection, we have several categories of patients, including nonuremic individuals with early secondary lesions of diabetes affecting the eyes, nerves, and kidneys. Pancreas transplants are also performed in patients with end-stage diabetic nephropathy, either simultaneous with or after a kidney transplant. The potential benefit from pancreas transplantation is greatest in patients who have early diabetic complications which in the absence of this intervention would progress to a severity more serious than the possible side effects of chronic immunosuppression. A careful pretransplant evaluation is necessary in order to select nonuremic, nonkidney recipients in whom pancreas transplantation is appropriate. The selection process is much easier in kidney transplant recipients; virtually any person who can withstand the additional surgery is a candidate, the risks associated with immunosuppression having already been accepted in lieu of the unsatisfactory alternative of chronic dialysis. The results we have obtained in the 3 categories of recipients since November 1984 in patients managed by our currently preferred surgical techniques and immunosuppressive protocols are shown in Figure 6. One-year pancreas survival rates in nonuremic, nonkidney transplant recipients are 63%, in recipients of a previous kidney 46%, and in recipients of simultaneous kidneys 75%. With respect to surgical technique, our current preference is the bladder drainage method because the ability to monitor exocrine function leads to earlier diagnosis and treatment of rejection episodes. With related donor transplant, we have continued to use enteric drainage. Because the rejection rate is much lower than with cadaver donors, the one-year functional survival rate has been relatively high for technically successful enteric-drained related donor grafts. Nevertheless, rejection does occur, and related donor segmental grafts are being performed with bladder drainage. Our current immunosuppressive protocol of quadruple drug therapy has been associated with the highest graft survival rates, particularly in the bladder-drained group where early diagnosis and treatment of rejection has been facilitated. In our experience, UAA monitoring results have had a high correlation with rejection episodes, and we have never seen loss of endocrine function with retention of high UAA levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Clinical Protocols↗
PubMed1986

Birth weight, Apgar scores, labor and delivery complications and prenatal characteristics of Southeast Asian adolescents and older mothers.

The study population included 337 adolescents and 876 mothers who delivered live-born, singleton infants in the Maternity and Infant Care Program at the Minneapolis Health Department between 1980-1982. Whites and blacks on the average experienced menarche 1-2 years earlier than the Southeast Asians although age of first pregnancy was 2 years later for the Southeast Asians. In spite of the significantly later ages of entry into prenatal care, lower weight gains, and hematocrits among the Southeast Asians, compared to the white and black populations, overall height-weight status on admission compared favorably with whites and blacks. The virtual absence of alcohol and tobacco consumption among the Southeast Asians may in fact contribute to the generally favorable Apgar scores, length of gestation, and birth weights. The high frequencies of alcohol and tobacco consumption among white adolescents during pregnancy suggest the need for more intervention to discourage smoking in this population. Further, the potential adoption of these substances needs to be discouraged among the Southeast Asian adolescents. While 2-4% of the whites, blacks and Hmong adolescents experienced eclampsia, 1% of the older Hmong mothers and none of the other Southeast Asians experienced eclampsia. The most frequent complication for all groups was perineal laceration.

Adolescent↗
PubMed1996

Prevention of gastrointestinal cancer--the potential role of NSAIDs in colorectal cancer.

Gastrointestinal cancers are among the leading sites of cancer and leading causes of cancer-related deaths. Gastrointestinal cancers are often at an advanced stage at the time of diagnosis, and are highly resistant to non-surgical therapy. Thus early diagnosis and prevention are approaches that are under active investigation. Screening and surveillance are considered secondary prevention. Primary prevention is the use of dietary or environmental modification or chemopreventive agents. This written review will emphasize the potential role of acetylsalicylic acid and other non-steroidal anti-inflammatory drugs (NSAIDs) in the prevention of gastrointestinal cancer, and specifically colorectal cancer. Cell culture and animal studies have shown that NSAIDs possess anti-proliferative and anti-neoplastic effects. Recent epidemiologic surveys also suggest that individuals who regularly take NSAIDs, particularly acetylsalicylic acid, have about a 50% decrease in colorectal cancer incidence and mortality. However, in the only interventional trial of aspirin (and beta-carotene), a retrospective analysis had inadequate statistical power to demonstrate any protective effect against colorectal cancer. About a dozen small prospective intervention studies have been done in a total of about a hundred patients with familial adenomatous polyposis to test the efficacy of NSAIDs, particularly sulindac. All human trials have shown substantial partial and some complete regression of colorectal and perhaps also duodenal adenomatous polyps. But virtually all patients had regrowth of adenomatous polyps after sulindac was stopped. In addition, sulindac and other NSAIDs result in occasional adverse events such as gastrointestinal bleeding. Thus sulindac cannot be recommended for routine use outside of a study setting. One valid current approach to the prevention of gastrointestinal cancer, and colorectal cancer in particular, is the adoption of a healthy lifestyle and appropriate screening and surveillance. Screening and surveillance guidelines have been developed by several public agencies and their recommendations should be adopted. In addition, we should adopt a healthy lifestyle and diet, which consists of low fat ( < 30% to total calories), and high fiber (> 3 daily servings of fruits/vegetables), with the avoidance of red meats ( < 3 weekly servings) and alcohol ( < 2 drinks daily), and the absolute avoidance of tobacco smoking.

Adenomatous Polyposis Coli↗
PubMed2006

Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education.

BACKGROUND: We have witnessed a rapid increase in the use of Web-based 'collaborationware' in recent years. These Web 2.0 applications, particularly wikis, blogs and podcasts, have been increasingly adopted by many online health-related professional and educational services. Because of their ease of use and rapidity of deployment, they offer the opportunity for powerful information sharing and ease of collaboration. Wikis are Web sites that can be edited by anyone who has access to them. The word 'blog' is a contraction of 'Web Log' - an online Web journal that can offer a resource rich multimedia environment. Podcasts are repositories of audio and video materials that can be "pushed" to subscribers, even without user intervention. These audio and video files can be downloaded to portable media players that can be taken anywhere, providing the potential for "anytime, anywhere" learning experiences (mobile learning). DISCUSSION: Wikis, blogs and podcasts are all relatively easy to use, which partly accounts for their proliferation. The fact that there are many free and Open Source versions of these tools may also be responsible for their explosive growth. Thus it would be relatively easy to implement any or all within a Health Professions' Educational Environment. Paradoxically, some of their disadvantages also relate to their openness and ease of use. With virtually anybody able to alter, edit or otherwise contribute to the collaborative Web pages, it can be problematic to gauge the reliability and accuracy of such resources. While arguably, the very process of collaboration leads to a Darwinian type 'survival of the fittest' content within a Web page, the veracity of these resources can be assured through careful monitoring, moderation, and operation of the collaborationware in a closed and secure digital environment. Empirical research is still needed to build our pedagogic evidence base about the different aspects of these tools in the context of medical/health education. SUMMARY AND CONCLUSION: If effectively deployed, wikis, blogs and podcasts could offer a way to enhance students', clinicians' and patients' learning experiences, and deepen levels of learners' engagement and collaboration within digital learning environments. Therefore, research should be conducted to determine the best ways to integrate these tools into existing e-Learning programmes for students, health professionals and patients, taking into account the different, but also overlapping, needs of these three audience classes and the opportunities of virtual collaboration between them. Of particular importance is research into novel integrative applications, to serve as the "glue" to bind the different forms of Web-based collaborationware synergistically in order to provide a coherent wholesome learning experience.

Audiovisual Aids↗
PubMed2004

Navigation systems based on registration of endoscopic and CT-derived virtual images for bronchofiberoscopic procedures.

Bronchofiberoscopy is an essential diagnostic procedure in patients with lung cancer. Sampling methods employed during endoscopy of the respiratory tract are performed with the aim of diagnosis confirmation and staging. Transbronchial needle aspiration may be used for evaluation of lymph nodes neighbouring with trachea and bronchi. Many efforts have been undertaken to increase the sensitivity of this procedure including the application of endobronchial ultrasonography. In recent years several research groups have proposed models of navigating systems to provide computer assistance during bronchoscopic interventions. Although they have used different techniques, their objective was the same - enabling tracking location and movement of bronchofiberoscope tip with reference to previously-acquired computed tomography (CT) images. Since a fiber-optic bronchoscope is a rather long and flexible device, determination of its tip location is not an easy task. The adoption of optical tracking methods used in neurosurgery or laparoscopic surgery to endoscopy of the tracheobronchial tree is usually not possible. Another obstacle is related to the fact that bronchofiberoscopes usually have only one operational channel. This feature considerably limits the feasibility of navigation systems based on the use of small electromagnetic sensing devices or USG probes. The sources of positioning errors in such systems are respiratory movements and the lack of external referential coordinate system associated with the tracheobronchial tree.A promising option for development of a bronchoscopic guidance system is the application of image registration algorithms. Such an approach encompasses registration of endoscopic images to views derived from advanced imaging methods, e.g. CT. In the first step, reconstruction of a three-dimensional, endoluminal views is performed. Next, the position of the virtual camera in a CT-derived virtual model is determined using a complex multi-level image registering algorithm. This stage is the source of the greatest differences between proposed methods and a potential field for considerable improvements.This paper presents a review of recent as well as classical image registering methods used in navigation systems for bronchofiberoscopy. Details related to the selection of crucial elements of navigation systems based on image registering techniques, such as transformation, similarity criteria, matching and global optimization, are specified.

Algorithms↗
PubMed2006

Effective and safe pediatric oral conscious sedation: philosophy and practical considerations.

Because dental treatment can represent a threatening event for some children, need exists to include sedation within our management arsenal. By definition, pre-cooperative children and those lacking in cooperative ability have immature cognitive skills, a highly restricted range of coping abilities, brief or negligible attention spans, and virtually no experience coping with stress. As result, they can be especially prone to maladaptive responses to anxiety provoking situations. For many of these, traditional non-pharmacologic behavior management strategies may often prove inadequate or inappropriate to overcome resistive or uncooperative behaviors. The importance of intervention with non-aversive techniques that provide a safe, child-oriented environment and timely opportunity in which to encounter and cope with fear-producing situations cannot be dismissed. The use of sedation techniques can frequently serve to obtund interfering and potentially harmful behaviors to safely permit quality care, minimize or eliminate the need for aversive measures, and help bridge the transition for a child lacking cooperative ability to the time when cooperation potential develops.

Administration, Oral↗
PubMed2004

Microbial contamination of drinking water and disease outcomes in developing regions.

Drinking water is a major source of microbial pathogens in developing regions, although poor sanitation and food sources are integral to enteric pathogen exposure. Gastrointestinal disease outcomes are also more severe, due to under-nutrition and lack of intervention strategies in these regions. Poor water quality, sanitation and hygiene account for some 1.7 million deaths a year world-wide (3.1% of all deaths and 3.7% of all DALY's), mainly through infectious diarrhoea. Nine out of 10 such deaths are in children and virtually all of the deaths are in developing countries. Major enteric pathogens in these children include: rotavirus, Campylobacter jejuni, enterotoxigenic Escherichia coli, Shigella spp. and Vibrio cholerae O1, and possibly enteropathogenic E. coli, Aeromonas spp. V. cholerae O139, enterotoxigenic Bacteroides fragilis, Clostridium difficile and Cryptosporidium parvum. All except the latter are easily control by chlorination of water, but recontamination of treated water is a huge problem. Emerging environmental pathogens, such as Helicobacter pylori and Burkholderia pseudomallei, may well be of significance in some regions. In adults, much less is understood of various sequellae such as myocarditis, diabetes, reactive arthritis and cancers some months-years after initial infections. So in addition to the traditional pathogens (helminths, Entamoeba histolytica, Giardia lamblia hepatitis A and E) various enteroviruses, C. jejuni and H. pylori are emerging issues in adults.

Adult↗
PubMed1988

Divorce and children.

The divorce rate in the United States is currently half the rate of marriages. Whether this rate will continue is not known. Millions of American children have already experienced their parents' divorce and millions more are likely to share the experience in the future. This makes divorce a problem that frequently appears in a pediatrician's patient population. Most children of divorce will experience it at the least as a potent transient stress that disrupts virtually all aspects of their lives. Many will accommodate to their new life circumstances successfully, but a substantial percentage will suffer long-term negative effects. Many of the problems of these children and their families can be anticipated, prevented, or alleviated by thoughtful and timely intervention. The pediatrician can be helpful by serving as the child's advocate, offering anticipatory guidance, helping the family weather the turmoil of the acute stage, screening for maladjustment or maladaptive behavior of children and parents, providing counseling, and referring the children and family for more specialized mental health input when indicated.

Adaptation, Psychological↗
PubMed2000

Disease recurrence following liver transplantation.

Virtually all liver diseases that necessitate orthotopic liver transplantation (OLT) can recur, and recurrent disease has the potential to become the most serious problem facing transplantation in the future. In addition, recurrence following transplantation provides a model to study pathogenic mechanisms of these diseases. While some interventions (e.g., HBIG) have been shown to alter the natural history of recurrent disease, most of these disease processes are not modified by our currently available therapies. In addition, the role of different immunosuppressive protocols on disease recurrence requires further definition. As a varying proportion of the first generation of liver transplant patients develop severe recurrence and graft failure, policies of organ allocation for retransplantation will be challenged.

Hepatitis B, Chronic↗
PubMedDate not supplied

Parents with psychosis.

This study examined the prevalence of parenthood in a community-based sample of first-admission patients with DSM-IV diagnoses of Schizophrenia/Schizoaffective Disorder, Bipolar Disorder with psychotic features and Major Depressive Disorder with psychosis. A total of 130 (28.7%) of 453 patients were parents at the time of first admission. Women were twice as likely as men to be parents in all diagnostic groups. Patients with mood disorder with psychosis were twice as likely to be parents as those with Schizophrenia/Schizoaffective Disorder. Substance Use Disorder was a common comorbidity among fathers and to a somewhat lesser extent among mothers as well. At the time of admission, over three-quarters of mothers were living with their children, as were half or more of the fathers with mood disorder. Most continued to live with their children after discharge. Almost 40% of mothers with mood disorders were living as single parents both before and after admission. Almost three-quarters of the children were under 16 years of age. Over 40% of mothers in all diagnostic categories had at least one child under 5 years of age. About 20% of mothers in all 3 diagnoses experienced the onset of psychosis within 6 months of childbirth. Over half of these experienced psychotic symptoms related to the child or had neglected the child prior to admission. Our findings contrast with earlier studies from more chronic patient samples in documenting that first-admission patients with psychosis are generally intimately involved in their children's lives both before and after admission. Despite the fact that over three-quarters of these parents were still in treatment at 6-month follow-up, there was virtually no evidence that any form of educational or family-oriented treatment was offered to these parents. These results, coupled with earlier reports of highly disrupted family lives and serious adverse outcomes among the children of chronically ill parents, underscore the need for early family intervention programs. In addition, there is a need for systematic research to identify effective treatment interventions for this population.

Adolescent↗
PubMed2002

Brief virtual reality therapy for public speaking anxiety.

The primary goal of this research program was to investigate the effectiveness of virtual reality therapy (VRT) in reducing public speaking anxiety of university students. The prevalence and impact of public speaking anxiety as a type of Social Phobia are discussed. Studies of VRT as an emerging treatment for psychological problems are reviewed. In the present study, eight students completed VRT individual treatment and post-testing, and six students in a Wait-List control group completed post-testing. Assessment measures included four self-report inventories, self-report of Subjective Units of Discomfort during exposure to VRT and physiological measurements of heart rate during speaking tasks. Four weekly individual exposure treatment sessions of approximately 15 min each were conducted by the author serving as therapist. Results on self-report and physiological measures appear to indicate that four virtual reality treatment sessions were effective in reducing public speaking anxiety in university students, corroborating earlier studies of VRT's effectiveness as a psychotherapeutic modality. Future research directions are discussed, primarily the need for research on younger populations, to assess the effectiveness of VRT for earlier intervention with public speaking anxiety.

Anxiety↗