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PubMed2002

[Image processing in radiology].

Medical imaging processing and analysis methods have significantly improved during recent years and are now being increasingly used in clinical applications. Preprocessing algorithms are used to influence image contrast and noise. Three-dimensional visualization techniques including volume rendering and virtual endoscopy are increasingly available to evaluate sectional imaging data sets. Registration techniques have been developed to merge different examination modalities. Structures of interest can be extracted from the image data sets by various segmentation methods. Segmented structures are used for automated quantification analysis as well as for three-dimensional therapy planning, simulation and intervention guidance, including medical modelling, virtual reality environments, surgical robots and navigation systems. These newly developed methods require specialized skills for the production and postprocessing of radiological imaging data as well as new definitions of the roles of the traditional specialties. The aim of this article is to give an overview of the state-of-the-art of medical imaging processing methods, practical implications for the radiologist's daily work and future aspects.

Computer Simulation↗

PubMed1977

The effects of family presence and brief family intervention on global outcome for hospitalized schizophrenic patients.

Virtually all modern inpatient psychiatric units operate on the assumptions that family presence, when the identified patient has schizophrenia, does affect outcome and that adding brief family intervention to the treatment prescription will enhance hospital and posthospital outcome. Often the family intervention is believed not adequate in terms of duration or frequency or quality (since trainees are the family therapists), given the standards of some experienced family clinicians. This report addresses these issues by comparing outcome measures for hospitalized patients with schizophrenia by (a) presence of a family and (b) amount and/or kind of family intervention. Most importantly, we wished to learn if global outcome would show change by virtue of family therapy (within the constraints imposed by the above limitations of family intervention).

Adolescent↗

PubMed1976

Psychodynamic and behavior modification approaches to the treatment of infantile autism empirical similarities.

In the treatment of infantile autism, behaviorists emphasize directed behavioral change while psychodynamic therapists tend to focus attention on the worker-child relationship. A review of the literature suggests that both of these aspects of intervention are important, and that both play a role in virtually all therapeutic efforts. The similarities in methods of intervention found in the work of investigators of very different theoretical persuasion raise the possibility that most treatment methods owe more to empirical clinical experience than to their presumed derivation from a theoretical model. This thesis is further examined with respect to a 50-year-old case history by Lightmer Witmer, and the work of the present writer with an 11-year-old autistic boy.

Autistic Disorder↗

PubMed2006

An experimental study on fear of public speaking using a virtual environment.

This paper examines a necessary condition for successful exploitation of a virtual environment (VE) in therapeutic intervention for fear of public speaking. The condition is that clients experience a degree of anxiety in the VE that is similar to what they would have been expected to experience in a similar real world setting. We refer to this as a "presence" response. The experimental study involved 20 people who were confident public speakers and 16 who were phobic, assessed on a standard psychological scale. Half of each group spoke within a VE depicting an empty seminar room, and the other half within the same room but populated by a neutrally behaving virtual audience of five people. Three responses were measured--a questionnaire-based measure of anxiety, a measure of self-focused attention on somatic responses, and actual heart rate. On all responses, the people with phobia showed a significant increase in signs of anxiety when speaking to the virtual audience compared to the empty room, whereas the confident people did not. The result was strong in spite of the relatively low representational and behavioral fidelity of the virtual characters.

Adult↗

PubMed2002

Anaemia: cardiovascular adaptations and maladaptive responses in chronic kidney disease.

Without intervention, premature cardiovascular disease is virtually certain in progressive chronic kidney disease (CKD). Whatever age the patient, the cardiovascular system in uraemia is senescent and poorly suited to dealing with supraphysiological haemodynamic demands. Anaemia and hypertension are the principal haemodynamic risk factors that can be treated. Many observational studies have shown that anaemia is a risk factor for haemodynamic overload, maladaptive left ventricular growth, left ventricular failure and death. The justification for normal target haemoglobin (Hb) in patients with CKD is still debated. Observational studies of left ventricular size, quality of life, functional status, hospital admission, and survival support higher Hb concentrations (> or =12 g/dl). Intervention trials to date suggest that a physiological approach to anaemia management benefits quality of life, and possibly left ventricular hypertrophy and dilatation. Obviously, avoiding anaemia is the only way to minimize time-averaged, anaemia-related haemodynamic load. Whether this strategy, involving efficient surveillance, early detection, early intervention, and high Hb targets that are independent of the phase of CKD, actually reduces cardiac failure or death remains to be seen.

Cardiovascular Diseases↗

PubMedDate not supplied

Porcine transfer study: virtual reality simulator training compared with porcine training in endovascular novices.

PURPOSE: To compare the learning of endovascular interventional skills by training on pig models versus virtual reality simulators. METHODS: Twelve endovascular novices participated in a study consisting of a pig laboratory (P-Lab) and a virtual reality laboratory (VR-Lab). Subjects were stratified by experience and randomized into four training groups. Following 1 hr of didactic instruction, all attempted an iliac artery stenosis (IAS) revascularization in both laboratories. Onsite proctors evaluated performances using task-specific checklists and global rating scales, yielding a Total Score. Participants completed two training sessions of 3 hr each, using their group's assigned method (P-Lab x 2, P-Lab + VR-Lab, VR-Lab + P-Lab, or VR-Lab x 2) and were re-evaluated in both laboratories. A panel of two highly experienced interventional radiologists performed assessments from video recordings. ANCOVA analysis of Total Score against years of surgical, interventional radiology (IR) experience and cumulative number of P-Lab or VR-Lab sessions was conducted. Inter-rater reliability (IRR) was determined by comparing proctored scores with the video assessors in only the VR-Lab. RESULTS: VR-Lab sessions improved the VR-Lab Total Score (beta = 3.029, p = 0.0015) and P-Lab Total Score (beta = 1.814, p = 0.0452). P-Lab sessions increased the P-Lab Total Score (beta = 4.074, p < 0.0001) but had no effect on the VR-Lab Total Score. In the general statistical model, both P-Lab sessions (beta = 2.552, p = 0.0010) and VR-Lab sessions (beta = 2.435, p = 0.0032) significantly improved Total Score. Neither previous surgical experience nor IR experience predicted Total Score. VR-Lab scores were consistently higher than the P-Lab scores (Delta = 6.659, p < 0.0001). VR-Lab IRR was substantial (r = 0.649, p < 0.0008). CONCLUSIONS: Endovascular skills learned in the virtual environment may be transferable to the real catheterization laboratory as modeled in the P-Lab.

Adult↗

PubMed2004

JUST in time health emergency interventions: an innovative approach to training the citizen for emergency situations using virtual reality techniques and advanced IT tools (the Web-CD).

This paper reports the results of the first of the two systems developed by JUST, a collaborative project supported by the European Union under the Information Society Technologies (IST) Programme. The most innovative content of the project has been the design and development of a complementary training course for non-professional health emergency operators, which supports the traditional learning phase, and which purports to improve the retention capability of the trainees. This was achieved with the use of advanced information technology techniques, which provide adequate support and can help to overcome the present weaknesses of the existing training mechanisms.

Adolescent↗

PubMed2004

JUST in time health emergency interventions: an innovative approach to training the citizen for emergency situations using virtual reality techniques and advanced IT tools (the VR Tool).

This paper reports the results of the second of the two systems developed by JUST, a collaborative project supported by the European Union under the Information Society Technologies (IST) Programme. The most innovative content of the project has been the design and development of a complementary training course for non-professional health emergency operators, which supports the traditional learning phase, and which purports to improve the retention capability of the trainees. This was achieved with the use of advanced information technology techniques, which provide adequate support and can help to overcome the present weaknesses of the existing training mechanisms.

Clinical Competence↗

PubMed2004

The minimally invasive sinus technique: theory and practice.

Minimally invasive sinus technique (MIST) is a targeted endoscopic intervention, introduced in 1994, with goals virtually identical to those originally reported for FESS but with distinct differences. The procedure, as outlined in the following section, is the only stepwise intranasal intervention with a defined beginning and end for all patients regardless of disease severity, thereby standardizing the procedure for surgeons and patients alike. This elegant, reproducible method avoids unnecessary disruption of normal mucosa while restoring mucociliary clearance through the primary birth ostia and reduces operative morbidity.

Endoscopy↗

PubMed2005

Universal newborn hearing screening: are we achieving the Joint Committee on Infant Hearing (JCIH) objectives?

OBJECTIVE: To determine whether a two-stage auditory brainstem response (ABR) Universal Newborn Hearing Screening (UNHS) protocol at an academic medical center has been achieving the Joint Committee on Infant Hearing (JCIH) recommendations for screening all infants, diagnosing hearing loss (HL) within 3 months, and instituting intervention within 6 months. STUDY DESIGN: Retrospective database and chart review in an academic tertiary care hospital. METHODS: A 5-year retrospective review of all newborns screened at our medical center between 1997 to 2001 was performed. Screening was performed by multiple in-hospital postnatal sequential ABR with follow-up outpatient ABR for failures. The protocol called for each newborn to receive at least two separate ABR in-hospital screenings before discharge if the newborn failed the initial screening. For those newborns with extended hospital courses, additional ABR screening were performed randomly in attempt to decrease referral rates at time of discharge. Overall screening population capture rate, referral rate, and false-positive rate were calculated. In addition, HL risk factors, age at diagnosis of HL, and age of onset of intervention were obtained. Cost per diagnosis of HL was calculated as well. RESULTS: The total number screened was 17,602. Seventy-eight (0.44%) were diagnosed with HL, with 62 (79%) in the high-risk population. The frequency of HL was 1 per 811 low-risk neonates versus 1 in 75 meeting high-risk criteria. Overall population capture rate was greater than 99%, referral rate 4.1%, and false-positive rate 3.6%. Mean age at diagnosis was 3.9 months, with mean age at intervention 6.1 months. Cost per diagnosis was estimated at US 5,074 dollars. CONCLUSIONS: Our current UNHS protocol using sequential ABR has been successful in screening virtually all neonates and providing timely intervention. This retrospective review has shown one HL diagnosis for every 811 babies screened without high-risk factors.

Academic Medical Centers↗

PubMedDate not supplied

The afferent circulation of the liver in patients with primary hepatocellular carcinoma.

BACKGROUND/AIMS: The data on the afferent circulation of the liver, in patients with primary hepatocellular carcinoma, are controversial or non-existent. MATERIALS AND METHODS: The authors measured hepatic arterial and portal venous flow intra-operatively by transit time ultrasonic volume flowmetry. RESULTS: In patients with primary hepatocellular carcinoma, the hepatic artery flow increased to 0.55 +/- 0.21 l, as compared with the control value of 0.37 +/- 102 l/min (p < 0.01). The portal venous flow decreased from 0.61 +/- 0.212 l/min to 0.47 +/- 0.203 l/min p < 0.01). Owing to the opposite changes in the afferent circulation, the total hepatic blood flow did not change significantly. The ratio of hepatic arterial flow to portal vein flow increased to 1.239 +/- 0.246 in patients with hepatocellular carcinoma, which is twice the basic control value (0.66 +/- 0.259 l/min). After resection, this ratio showed virtually no change. The surgical intervention, that is resection of the liver, did not significantly alter hepatic artery and portal venous flow, although total hepatic blood flow decreased significantly (p < 0.01). The pronounced increase in the ratio of hepatic arterial flow may be attributed to the decrease in portal venous flow caused by the primary hepatocellular carcinoma. The decrease in venous flow can most probably be explained by compression and infiltration of the intrahepatic branches of the portal vein. As we pointed out, the decrease in portal venous circulation leads to an increase in hepatic arterial flow. CONCLUSIONS: On the basis of our initial results, it seems probable that the ratio of the two circulations represents a diagnostic tool for the altered circulation in patients with hepatocellular carcinoma. The significance of this phenomena is not yet quite clear, but a review of the literature shows that similar observations have not been reported. In practical terms this phenomenon may be useful from the point of view of US and Doppler US diagnosis, e.g. in the case of a hypo-echoic or hyperechoir, mass in the liver, increased blood flow in the hepatic, artery, and decreased portal venous flow, a malignant liver tumor is virtually certain. The authors hypothesise that any pathology in the liver may lead to a primary decrease in PVF and a subsequent increase in HAF.

Adult↗

PubMed2000

3D norm data: the first step towards semiautomatic virtual craniofacial surgery.

When planning craniofacial surgical interventions, the ideal appearance of the patient is very important. The final appearance should be as close as possible to that which the patient would have if he/she were without defects. Our first step towards achieving this is to build a database containing sets of three-dimensional CT images that allows for comparison of the shape of a patient with defects to the typical shape of an age- and sex-matched "average" person without defects. We started to collect CT data from patients without pathologies and, in co-operation with two radiology institutes (in Mannheim and Heidelberg), over 100 CT data sets have now been collected and classified according to age and sex. It is necessary to choose an appropriate statistical method to calculate the norm data from the different data sets. Based on the statistical method, an age- and sex-matched "average" model of the anatomy will be created.

Adolescent↗

PubMed1995

Trial of Nonpharmacologic Intervention in the Elderly (TONE). Design and rationale of a blood pressure control trial.

National and international policy-making organizations advocate nonpharmacologic therapies to reduce blood pressure (BP). However, data to support such recommendations in older persons are virtually nonexistent. The Trials of Nonpharmacologic Intervention in the Elderly (TONE) is a randomized, controlled trial that will test whether weight loss or a reduced sodium (Na) intake or both can maintain satisfactory BP control, without unacceptable side effects, after withdrawal of antihypertensive drug therapy. Medication-treated hypertensives (aged 60 to 80 years) with a systolic BP less than 145 mm Hg and a diastolic BP less than 85 mm Hg who are taking one antihypertensive medication are randomly assigned to one of four groups: (1) weight loss alone, (2) reduced Na intake alone, (3) combined weight loss and reduced Na intake, or (4) usual life-style (control group). Overweight participants are randomized to one of these four groups, while nonoverweight individuals are assigned to either the reduced Na intake or the usual life-style group. The interventions, tailored to the needs of older persons, use behavioral approaches to accomplish intervention-specific goals (weight loss > or = 10 lb, daily Na intake < or = 80 mEqa). Three months after the start of intervention, antihypertensive drug therapy is withdrawn. The primary trial end point is a BP of 150/90 mm Hg or higher, resumption of antihypertensive drug therapy, or the occurrence of a BP-related clinical complication during 2 to 3 years of follow-up. It is anticipated that TONE findings may identify an effective and acceptable nonpharmacologic approach to control hypertension in the increasingly large number of older persons treated with antihypertensive drug therapy.

Aged↗

PubMed2005

Reducing discriminatory attitudes toward people living with HIV/AIDS (PLWHA) in Hong Kong: an intervention study using an integrated knowledge-based PLWHA participation and cognitive approach.

The present paper describes the development and evaluation of an intervention programme aiming to reduce adolescents' discriminatory attitudes toward people living with HIV/AIDS (PLWHA). The intervention programme integrates components of 'virtual interaction' with PLWHA (watching a documentary), knowledge enhancement and a simple cognitive exercise. To evaluate its effectiveness, the programme was implemented to about 600 form 3-4 (grade 9-10) students of three secondary schools in Hong Kong. Using a structured questionnaire, the level of discriminatory attitudes toward PLWHA, knowledge about HIV/AIDS and perceptions about PLWHA, etc. were measured before and after the implementation of the programme. A notable improvement on the level of acceptance of PLWHA and knowledge about HIV/AIDS was found after the implementation of the programme. Negative perceptions about PLWHA also reduced substantially. For instance, before the programme, over one-third (35.7%) of all respondents believed that the majority of PLWHA were promiscuous; the figure dropped to 15.8% after exposure to the programme (adjusted odds ratio = 0.35, p < 0.001). Further, some gender differences were observed. Female respondents tended to be less discriminatory toward PLWHA and responded more favourably to the programme than their male counterparts.

Acquired Immunodeficiency Syndrome↗

PubMed1999

Prevention agenda for genital herpes.

Few meeting participants envisioned a prevention and control program on the scale or scope of CDC's programs to prevent HIV infection, syphilis, gonorrhea, and chlamydial infection, but all agreed that the virtual absence of public health interventions to prevent genital herpes is no longer appropriate in light of evolving epidemiologic knowledge and other research advances. The ultimate scope of a national genital herpes prevention effort will depend in part on the results of the recommended research agenda, which probably will evolve over the better part of a decade. Numerous other STD prevention partners will also need to contribute to this effort and help to determine the makeup of future programs. Substantial new fiscal resources will be required both to implement the proposed research agenda and, depending on the results, to undertake the prevention efforts indicated by those studies. Competing STD prevention priorities and other national health needs will influence the availability of those resources. The consultants' meeting and the research and program activities summarized above are described in more detail in the full meeting report, which is posted on the Division's web site (www.cdc.gov/nchstp/dstd/dstdp.html) or may be requested directly from the Division. DSTDP is interested in receiving comments and suggestions about herpes prevention.

Antibodies, Viral↗

PubMed2005

Locomotor training and virtual reality-based balance training for an individual with multiple sclerosis: a case report.

BACKGROUND AND PURPOSE: Impaired walking ability, balance, and fatigue are common problems for people with multiple sclerosis (MS). The purpose of this case report is to describe the use of plan of care that included locomotor training using both a body weight support (BWS) with a treadmill (TM) and overground walking as well as a virtual reality (VR)-based balance intervention to improve walking ability, balance, and endurance for an individual with MS. CASE DESCRIPTION: The client was a 48-year-old female with a 10-year history of MS. Her main goals were to improve walking ability, balance, and endurance. She presented with impaired gait, balance, motor function, and increased fatigue. Locomotor training using a BWS/TM system and overground and VR-based balance interventions were implemented 2 days a week for 12 weeks. OUTCOMES: The client demonstrated improvements in gait speed, gait endurance, and balance postintervention and maintained the improvements at a 2-month follow up. DISCUSSION: This case report is the first to report on the use of locomotor training with BWS/TM system and overground and VR-based balance interventions for a client with MS. The plan of care was formulated based on the patient's goals and the available literature on the use of the interventions with other patients with neurologic conditions to provide an intervention that was task-oriented, skilled, and intensive.

Female↗

PubMed2005

De novo calcium/sulfur SAD phasing of the human formylglycine-generating enzyme using in-house data.

Sulfatases are a family of enzymes essential for the degradation of sulfate esters. Formylglycine is the key catalytic residue in the active site of sulfatases and is generated from a cysteine residue by FGE, the formylglycine-generating enzyme. Inactivity of FGE owing to inherited mutations in the FGE gene results in multiple sulfatase deficiency (MSD), which leads to early death in infants. Human FGE was crystallized in the presence of traces of the protease elastase, which was absolutely essential for crystal growth, and the structure of FGE was determined by molecular replacement. Before this model was completed, the FGE structure was re-determined by SAD phasing using in-house data based on the anomalous signal of two calcium ions bound to the native enzyme and intrinsic S atoms. A 14-atom substructure was determined at 1.8 A resolution by SHELXD; SHELXE was used for density modification and phase extension to 1.54 A resolution. Automated model building with ARP/wARP and refinement with REFMAC5 yielded a virtually complete model without manual intervention. The minimal data requirements for successful phasing and the relative contributions of the Ca and S atoms are discussed and compared with the related FGE paralogue, pFGE. This work emphasizes the usefulness of de novo phasing using weak anomalous scatterers and in-house data.

Calcium↗

PubMed2005

Just-in-time evidence-based e-mail "reminders" in home health care: impact on nurse practices.

OBJECTIVE: To test the effectiveness of two interventions designed to improve the adoption of evidence-based practices by home health nurses caring for heart failure (HF) patients. DATA SOURCES/STUDY SETTING: Information on nurse practices was abstracted from the clinical records of patients admitted between June 2000 and November 2001 to the care of 354 study nurses at a large, urban, nonprofit home care agency. STUDY DESIGN: The study employed a randomized design with nurses assigned to usual care or one of two intervention groups upon identification of an eligible patient. The basic intervention was a one-time e-mail reminder highlighting six HF-specific clinical recommendations. The augmented intervention consisted of the initial e-mail reminder supplemented by provider prompts, patient education material, and clinical nurse specialist outreach. DATA COLLECTION: At each home health visit provided by a study nurse to an eligible HF patient during the 45-day follow-up period, a structured chart abstraction tool was used to collect information on whether the nurse provided the care practices highlighted in the e-mail reminder. PRINCIPAL FINDINGS: Both the basic and the augmented interventions greatly increased the practice of evidence-based care, according to patient records, in the areas of patient assessment and instructions about HF disease management. While not all results were statistically significant at conventional levels, intervention effects were positive in virtually all cases and effect magnitudes frequently were large. CONCLUSIONS: The results of this randomized trial strongly support the efficacy of just-in-time evidence-based reminders as a means of changing clinical practice among home health nurses who are geographically dispersed and spend much of their time in the field.

Adult↗