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Results for “virtual intervention”

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PubMed2002

Six at six: interleukin-6 measured 6 h after the initiation of sepsis predicts mortality over 3 days.

Virtually of the all recent therapeutic interventions for treating sepsis have failed to improve survival. One potential explanation is that the heterogeneity of the immune response to the septic challenge is such that only a portion of the patients die as a result of excessive inflammation. The clinical trials lacked power because traditional measurements do not accurately identify these patients. Previous work has shown that higher levels of interleukin (IL)-6 are found in those mice that die from septic peritonitis; therefore, we sought to determine whether IL-6 measured 6 h after surgery could predict outcome. Adult, female BALB/c mice (n = 79) were subjected to cecal ligation and puncture with a 21-gauge needle and treated with imipenem in D5W every 12 h for 5 days, resulting in a homogenous population at the outset. Six hours after surgery, 20 microL of blood was obtained from the tail vein to measure IL-6. Mortality was followed for 21 days. Overall 3-day survival was 77%, and 21-day mortality was 56%. Plasma IL-6 levels >2,000 pg/mL were determined to predict mortality within the first 3 days with a sensitivity of 58% and specificity of 97%. To further refine the mortality prediction, body weight and a complete blood count were performed 24 hours after cecal ligation and puncture. Discriminate analysis indicated that a weighted formula combining body mass, lymphocyte, and platelet count would predict death with sensitivity of 83% and a specificity of 79%. We tested the value of the IL-6 prediction by surgically resecting the cecum in those animals with IL-6 > 2000 pg/mL, which resulted in a significant improvement in survival. These data demonstrate that IL-6 measured 6 h after injury accurately predicts mortality resulting from experimental sepsis. This measurement may be determined quickly so that therapy may be targeted only to those individuals at significant risk of dying and initiated within sufficient time to be effective.

Animals↗

PubMed2005

Cluster randomized controlled trials.

Cluster randomized controlled trial (RCT), in which groups or clusters of individuals rather than individuals themselves are randomized, are increasingly common. Indeed, for the evaluation of certain types of intervention (such as those used in health promotion and educational interventions) a cluster randomized trial is virtually the only valid approach. However, cluster trials are generally more difficult to design and execute than individually randomized studies, and some design features of a cluster trial may make it particularly vulnerable to a range of threats that can introduce bias. In this paper we discuss the issues that can lead to bias in cluster randomized trials and conclude with some suggestions for avoiding these problems.

Cluster Analysis↗

PubMed2006

Expanding the frame of understanding health disparities: from a focus on health systems to social and economic systems.

Policy makers are increasingly attending to the problem of racial and ethnic health disparities, but much of this focus has been on evidence of inequality in health care systems. This attention is important and laudable, but eliminating inequality in the health care system would be insufficient to eliminate racial and ethnic disparities and improve the health of all Americans. Social and economic factors, such as disadvantaged socioeconomic status, racism, discrimination, and geographic inequality shape virtually all risks for poor health. Interventions that focus solely on improving access to health care, or on reducing individual behavioral and psychosocial risks, therefore have limited potential to reduce racial and ethnic health disparities. The elimination of health disparities requires comprehensive, intensive strategies that address inequality in many sectors, including housing, education, employment, and health systems. These interventions must be targeted at many levels, including individuals and families, workplaces, schools, and communities.

Ethnicity↗

PubMed1987

Workplace health promotion: a commentary on the evolution of a paradigm.

Reports of workplace health promotion programs are reviewed in light of Kuhn's views on paradigmatic advances in science. Such reports fall into two categories: those which describe single health-habit interventions (e.g., smoking cessation, weight control, or stress management) and those which describe comprehensive efforts to incorporate many single health-habit interventions into integrated programs. Common to virtually all of these programs in their focus on the modification of the health behavior of individuals. Consideration of such organizational-level factors as work design or climate which are beyond the control of the individual, yet may contribute heavily to illness and absenteeism of employees, is typically omitted. It is concluded that workplace health promotion in the United States has achieved the status of a paradigm and that this paradigm is associated with several limitations and ethical problems in light of the programs' objectives: to reduce organizations' medical-care costs and improve productivity.

Environment↗

PubMed2005

Assay for evaluating ribonuclease H-mediated degradation of RNA-antisense oligonucleotide duplexes.

Ribonucleases H are complex enzymes whose functions are not clearly understood, further compounded by the fact that multiple forms of the enzyme are present in various organisms. They are known to recognize and degrade the ribonucleic acid (RNA) strand of numerous deoxyribonucleic acid (DNA)-RNA duplex substrates, and so may provide a unique mode of therapeutic intervention at the genetic level of virtually any disease. We have therefore set out detailed procedures for conducting routine assays with almost any one of this family of enzymes by a straightforward assay aimed at identifying novel enzyme-activating antisense oligonucleotides (AONs). The procedures described herein should enable easy identification of potent AON molecules, provided that the RNA is appropriately labeled for subsequent visualization following the guidelines set forth in this protocol.

Base Sequence↗

PubMedDate not supplied

[Boerhaave's Syndrome. Case report and literature review].

OBJECTIVE: Report of a case of spontaneous perforation of esophagus in a 70-year-old patient. BACKGROUND: Boerhaave syndrome or spontaneous esophageal perforation is a life-threatening condition that demands early diagnosis and urgent management. Without surgical intervention, spontaneous perforation of esophagus is virtually incompatible with life. The classic history is of a patient who vomits and experiences epigastric or substernal pain. Diagnosis is often delayed because esophageal perforations can masquerade as many other clinical disorders. METHODS: Report of a case of a patient with Boerhaave syndrome referred to our institution. CONCLUSION: Boerhaave syndrome is suspected on a clinical basis and confirmed with radiologic studies. As gastric content passes to mediastinum and usually pleural space, a delay in diagnosis raises morbidity and mortality significantly. This pathology is best treated with definitive repair and mediastinal and/or pleural drainage procedures.

Aged↗

PubMedDate not supplied

[The indications and contraindications for emergency adenomectomy in patients with severe concomitant diseases].

The authors have performed 631 urgent suprapubic transvesical adenomectomies in patients with prostate adenoma complicated by acute urine retention or hemorrhage. Prearranged and urgent interventions had, by the authors' experience, virtually the same rate of postoperative complications and lethal outcomes. The risk in urgent adenomectomy performed in 294 patients was attributed to their concurrent affections: postinfarction cardiosclerosis, myocardial ischemia or hypertensive crisis, hemiparesis after brain apoplexy, bronchial asthma, diabetes mellitus, hepatic cirrhosis, chronic lymphoid leukemia, drug polyallergy, multiple tumors of the urinary bladder, stomach, etc., in stage T1-3NOMO. 80 patients had intermittent chronic renal failure. In compensation of severe concurrent diseases and satisfactory condition of the patients urgent adenomectomy was conducted within 24 hours since hospitalization. Longer interval (within 24-72 hours) was necessary in subcompensation of the concurrent diseases, intermittent chronic renal failure which were intensively treated. The authors achieved uneventful postoperative course for 272 (92.5%) high-risk patients. Postoperative lethality made up 3.06%. According to 1-11-year follow-up 7 patients died, for the most part of blood and respiratory diseases. Functional long-term outcomes were good in 83.5% of the patients. Basing on their experience, the authors specify indications to urgent adenomectomy and optimal time of its conduction. Contraindications to urgent adenomectomy were revised and narrowed.

Acute Disease↗

PubMedDate not supplied

[The use of a Russian software-hardware package for the quantitative analysis of coronary angiograms].

The software and hardware complex developed by the Cardiology Research Center, Russian Academy of Medical Sciences, jointly with the Technomash Research Production Association on the basis of a IBM 386DX personal computer equipped with a VS-100 video controller and a DS P31 VS signal processor board. Testing has indicated that it provides a qualitative image and a quantitative analysis both of phantoms and real images of coronarograms, but more accurately in the analysis of the image obtained from a film projector. Valid results are yielded when lenses more than 1 mm in diameter are used. Clinical tests have shown that the software and hardware complex may yield a rather qualitative image and calculate the required diameter of a vessel, virtually without prolonging the time of intervention, which is particularly important while making intervention procedures and implementing research programmes.

Analog-Digital Conversion↗

PubMed1999

Three-year maintenance of improved diet and physical activity: the CATCH cohort. Child and Adolescent Trial for Cardiovascular Health.

OBJECTIVE: To assess differences through grade 8 in diet, physical activity, and related health indicators of students who participated in the Child and Adolescent Trial for Cardiovascular Health (CATCH) school and family intervention from grades 3 through 5. DESIGN: Follow-up of the 4-center, randomized, controlled field trial with 56 intervention and 40 control elementary schools. PARTICIPANTS: We studied 3714 (73%) of the initial CATCH cohort of 5106 students from ethnically diverse backgrounds in California, Louisiana, Minnesota, and Texas at grades 6, 7, and 8. RESULTS: Self-reported daily energy intake from fat at baseline was virtually identical in the control (32.7%) and intervention (32.6%) groups. At grade 5, the intake for controls remained at 32.2%, while the intake for the intervention group declined to 30.3% (P<.001). At grade 8, the between-group differential was maintained (31.6% vs 30.6%, P = .01). Intervention students maintained significantly higher self-reported daily vigorous activity than control students (P = .001), although the difference declined from 13.6 minutes in grade 5 to 11.2, 10.8, and 8.8 minutes in grades 6, 7, and 8, respectively. Significant differences in favor of the intervention students also persisted at grade 8 for dietary knowledge and dietary intentions, but not for social support for physical activity. No impact on smoking behavior or stages of contemplating smoking was detected at grade 8. No significant differences were noted among physiologic indicators of body mass index, blood pressure, or serum lipid and cholesterol levels. CONCLUSION: The original CATCH results demonstrated that school-level interventions could modify school lunch and school physical education programs as well as influence student behaviors. This 3-year follow-up without further intervention suggests that the behavioral changes initiated during the elementary school years persisted to early adolescence for self-reported dietary and physical activity behaviors.

Adolescent↗

PubMed2025

The effects of haptonomy and virtual reality, anxiety, prenatal attachment and acceptance of pregnancy in unplanned pregnancy.

AIM: Unplanned pregnancies are an important public health problem that negatively affects the health of women and babies. This study aimed to determine the effects of haptonomy and virtual reality on anxiety, prenatal attachment and acceptance of pregnancy in unplanned pregnancies. Haptonomy, a touch-based bonding technique, and virtual reality, an immersive fetal visualisation tool, were used as interventions. METHODS: The sample of this randomised controlled study consisted of 217 pregnant women (haptonomy: 73, virtual reality: 72 and control: 72) who applied to the Obstetrics and Gynaecology outpatient clinics of a public hospital in eastern Turkey between July 2020 and April 2021. For both experimental groups, four interviews were conducted with the pregnant women between the 24thand32nd gestational weeks at intervals of 7-10 days. Data were collected on pregnancy-related anxiety, prenatal attachment and pregnancy acceptance. Group differences were analysed using appropriate statistical comparisons. RESULTS: Pregnancy-related anxiety was lower, and acceptance of pregnancy was higher in the experimental groups compared to the control group (p < .001). Prenatal attachment level was higher in the haptonomy and virtual reality groups compared to the control group (p < .001). Notably, prenatal attachment scores were significantly higher in the haptonomy group compared to the virtual reality group (p < .001). CONCLUSION: In unplanned pregnancies, imagining the baby through haptonomy and imagining the baby through virtual reality are techniques that reduce the level of anxiety related to pregnancy and increase the level of prenatal attachment and acceptance of pregnancy. Especially haptonomy showed a higher effect on prenatal attachment.

Humans↗

PubMed2005

Motion compensated coronary interventional navigation by means of diaphragm tracking and elastic motion models.

Current catheter tracking in the x-ray catheter laboratory during coronary interventions is performed using 2D fluoroscopy. Although this features real-time navigation on high-resolution images, drawbacks such as overlap and foreshortening exist and hamper the diagnosis and treatment process. An alternative to fluoroscopy-based tracking is device tracking by means of a magnetic tracking system (MTS). Having measured the 3D location of the interventional device, its position can be reconstructed on 3D images or virtual roadmaps of the organ or vessel structure under examination. In this paper, a method is presented which compensates the interventional device location measured by the MTS for organ motion and thus registers it dynamically to a 3D virtual roadmap. The motion compensation is accomplished by using an elastic motion model which is driven by the ECG signal and a respiratory sensor signal derived from ultrasonic diaphragm tracking. The model is updated during the intervention itself, thus allowing for a local refinement in regions which bear a complex geometric structure, such as stenoses and bifurcations. The evaluation is done by means of a phantom-based study using a dynamic heart-phantom. The mean displacement caused by the overall motion of the heart is improved from 10.4+/-4.8 mm in the uncompensated case to 2.1+/-1.2 mm in the motion compensated case.

Algorithms↗

PubMed2001

[Virtual bronchoscopy].

Flexible bronchoscopy represents a clinically well-established invasive diagnostic tool. Virtual bronchoscopies, calculated from thin-slice CT sections, allow astonishing immitations of reality although principal differences exist between both technologies: the fact that colour representation is artificial and concommitant interventions are impossible limits the clinical use of virtual bronchoscopy. However, its value increases when calculations can be attained within minutes due to technological advancements, and when virtually any chest CT is suitable for further postprocessing. Indications, findings and the clinical role of virtual bronchoscopy are discussed.

Bronchoscopy↗

PubMed2002

Effectiveness of virtual reality for teaching pedestrian safety.

Sixty percent to 70% of pedestrian injuries in children under the age of 10 years are the result of the child either improperly crossing intersections or dashing out in the street between intersections. The purpose of this injury prevention research study was to evaluate a desktop virtual reality (VR) program that was designed to educate and train children to safely cross intersections. Specifically, the objectives were to determine whether children can learn pedestrian safety skills while working in a virtual environment and whether pedestrian safety learning in VR transfers to real world behavior. Following focus groups with a number of key experts, a virtual city with eight interactive intersections was developed. Ninety-five children participated in a community trial from two schools (urban and suburban). Approximately half were assigned to a control group who received an unrelated VR program, and half received the pedestrian safety VR intervention. Children were identified by group and grade by colored tags on their backpacks, and actual street crossing behavior of all children was observed 1 week before and 1 week after the interventions. There was a significant change in performance after three trials with the VR intervention. Children learned safe street crossing within the virtual environment. Learning, identified as improved street-crossing behavior, transferred to real world behavior in the suburban school children but not in the urban school. The results are discussed in relation to possibilities for future VR interventions for injury prevention.

Accidents, Traffic↗

PubMed1997

The effect of behavioral intervention on the psychological distress of Holocaust survivors with cancer.

METHODS: This study describes a particular psychological intervention offered to a unique self-selected population of cancer patients who, 50 years earlier, had experienced the extreme trauma of the Holocaust. A total of 45 patients in follow-up at the Outpatient Clinic of the Oncology Department at the Hadassah University Hospital were approached. Two self-reports were administered: the Brief Symptom Inventory to assess psychological distress, and the Impact of Events Scale to assess intrusion and avoidance. RESULTS: There was a significant decrease in distress by the specific short-term psychological intervention used in this traumatized population. However, 3 months later the improvement virtually disappeared. CONCLUSION: This study failed to demonstrate a long-lasting effect of behavioral intervention upon Holocaust survivors with cancer.

Adaptation, Psychological↗

PubMed1998

Antithrombotics in interventional cardiology: optimizing treatment and strategies.

Although the use of coronary stents has virtually abolished the threat of periprocedural obstructive dissection, subacute and acute intracoronary thrombosis and late restenosis remain a major problem with catheter-guided transluminal coronary interventions, despite significant technical advances over the last 10 years. Acute stent thrombosis emerged as a new problem with the introduction of metallic coronary prostheses (stents), which unfortunately represent an ideal stimulus for platelet deposition. Recently, dramatic progress has been achieved by focusing on the inhibition of thrombin and platelets, before and during interventional procedures. This has stimulated the search for powerful and well-tolerated antithrombotic agents-platelet inhibitors and antithrombins-so that long-term (oral) administration may become possible, if necessary. The current roles of unfractionated and low-molecular-weight heparins (LMWHs), direct thrombin inhibitors (such as hirulog and hirudin), antiplatelet agents (such as aspirin, clopidogrel, and ticlopidine) and the potential of the glycoprotein IIb/IIa receptor blockers are reviewed and put into perspective with respect to their acute and long-term clinical value.

Angioplasty, Balloon, Coronary↗

PubMed2003

Psychological adjustment among African American breast cancer patients: one-year follow-up results of a randomized psychoeducational group intervention.

The effectiveness of support group interventions for cancer patients has been established among White patients but has been virtually unstudied among minority patients. The current study represents the 1st randomized support group intervention targeted to African American women with breast cancer. Participants (N = 73) with nonmetastatic breast cancer were randomly assigned to an 8-week group intervention or an assessment-only control condition At 12 months, the intervention resulted in improved mood as well as improved general and cancer-specific psychological functioning among women with greater baseline distress or lower income. Subsequent research is needed to address effective methods of enrolling and following women with fewer psychosocial and financial resources, as they were the most likely to benefit from this particular intervention.

Adaptation, Psychological↗

PubMed2004

Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions.

OBJECTIVE: To compile and evaluate the evidence on the effects on health and social outcomes of computer based peer to peer communities and electronic self support groups, used by people to discuss health related issues remotely. DESIGN AND DATA SOURCES: Analysis of studies identified from Medline, Embase, CINAHL, PsycINFO, Evidence Based Medicine Reviews, Electronics and Communications Abstracts, Computer and Information Systems Abstracts, ERIC, LISA, ProQuest Digital Dissertations, Web of Science. SELECTION OF STUDIES: We searched for before and after studies, interrupted time series, cohort studies, or studies with control groups; evaluating health or social outcomes of virtual peer to peer communities, either as stand alone interventions or in the context of more complex systems with peer to peer components. MAIN OUTCOME MEASURES: Peer to peer interventions and co-interventions studied, general characteristics of studies, outcome measures used, and study results. RESULTS: 45 publications describing 38 distinct studies met our inclusion criteria: 20 randomised trials, three meta-analyses of n of 1 trials, three non-randomised controlled trials, one cohort study, and 11 before and after studies. Only six of these evaluated "pure" peer to peer communities, and one had a factorial design with a "peer to peer only" arm, whereas 31 studies evaluated complex interventions, which often included psychoeducational programmes or one to one communication with healthcare professionals, making it impossible to attribute intervention effects to the peer to peer community component. The outcomes measured most often were depression and social support measures; most studies did not show an effect. We found no evidence to support concerns over virtual communities harming people. CONCLUSIONS: No robust evidence exists of consumer led peer to peer communities, partly because most peer to peer communities have been evaluated only in conjunction with more complex interventions or involvement with health professionals. Given the abundance of unmoderated peer to peer groups on the internet, research is required to evaluate under which conditions and for whom electronic support groups are effective and how effectiveness in delivering social support electronically can be maximised.

Clinical Trials as Topic↗

PubMed2002

Perspectives of drug-eluting stents: the next revolution.

Coronary stent implantation has become a well established therapy in the management of coronary artery disease (CAD). Although the Stent Restenosis Study (STRESS) and Belgium-Netherlands Stent (BENESTENT) trials demonstrated convincingly that stenting is superior to percutaneous transluminal coronary angioplasty with respect to restenosis in de novo lesions, there is, however, still a high incidence (10 to 50%) of restenosis following stent implantation. Improvements in stent design and implantation techniques resulted in an increase in the use of coronary stents and today, in most centers in the US and Europe, stenting has become the predominant form of nonsurgical revascularization accounting for about 80% of all percutaneous coronary intervention procedures. Coronary stents provide luminal scaffolding that virtually eliminates elastic recoil and remodelling. Stents, however, do not decrease neointimal hyperplasia and in fact lead to an increase in the proliferative comportment of restenosis. Agents that inhibit cell-cycle progression indirectly have also been tested as inhibitors of vascular proliferation. When coated onto stents, sirolimus, a macrolide antibiotic with immunosuppressive properties, and paclitaxel and dactinomycin, both chemotherapeutic agents, induced cell-cycle arrest in smooth muscle cells (SMC) and inhibited neointimal formation in animal models. Preliminary clinical studies with drug-eluting stents produced dramatic results eliminating restenosis in large and mid-size arteries. Quantitative coronary angiography and intravascular ultrasound demonstrated virtually complete inhibition of tissue growth at 6 and 12 months after sirolimus-eluting stent implantation. Results are also very encouraging with paclitaxel-coated stents. However, it needs to be proven that current drug-eluting stents will produce similar results in 'real life' interventional practice (long lesions, lesions in small vessels, in vein grafts, chronic total occlusions, and bifurcated and ostial lesions). The ongoing randomized, double-blind sirolimus-coated Bx Velocity trade mark balloon expandable stent in the treatment of patients with de novo coronary artery lesions (SIRIUS) trial may answer some of these concerns. With further improvements, including the expansion of drug-loading capacity, double coatings and coatings with programmable pharmacokinetic capacity using advances in nanotechnology (which may allow for more precise and controlled release of less toxic and improved molecules), we think that in the next few years the practice of interventional cardiology may undergo major changes. A new era of dramatic improvements in the treatment of CAD may have dawned. The prospect of approval of this technology should herald a host of clinical trials to revisit basic assumptions about the place of coronary stenting in the contemporary care of obstructive (and nonobstructive) CAD.

Angioplasty, Balloon, Coronary↗