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Michelle J Wilkinson, Henry G Smith, Gráinne McEntee, Joan Kyula-Currie, Tim D Pencavel, David C Mansfield, Aadil A Khan, Victoria Roulstone, Andrew J Hayes, Kevin J Harrington
Advanced extremity melanoma and sarcoma present a significant therapeutic challenge, requiring multimodality therapy to treat or even palliate disease. These aggressive tumours are relatively chemo-resistant, therefore new treatment approaches are urgently required. We have previously reported on the efficacy of oncolytic virotherapy (OV) delivered by isolated limb perfusion. In this report, we have improved therapeutic outcomes by combining OV with radiotherapy. In vitro, the combination of oncolytic vaccinia virus (GLV-1h68) and radiotherapy demonstrated synergistic cytotoxicity...
October 22, 2016: Oncotarget
Sarah E Baum, Kari White, Kristine Hopkins, Joseph E Potter, Daniel Grossman
BACKGROUND: In November 2013, Texas implemented three abortion restrictions included in House Bill 2 (HB 2). Within six months, the number of facilities providing abortion decreased by almost half, and the remaining facilities were concentrated in large urban centers. The number of medication abortions decreased by 70% compared to the same period one year prior due to restrictions on this method imposed by HB 2. The purpose of this study was to explore qualitatively the experiences of women who were most affected by the law: those who had to travel farther to reach a facility and those desiring medication abortion...
2016: PloS One
Andrea T Kozak, Joanna Buscemi, Misty A W Hawkins, Monica L Wang, Jessica Y Breland, Kathryn M Ross, Anupama Kommu
Obesity is a prevalent health care issue associated with disability, premature morality, and high costs. Behavioral weight management interventions lead to clinically significant weight losses in overweight and obese individuals; however, many individuals are not able to participate in these face-to-face treatments due to limited access, cost, and/or time constraints. Technological advances such as widespread access to the Internet, increased use of smartphones, and newer behavioral self-monitoring tools have resulted in the development of a variety of eHealth weight management programs...
October 25, 2016: Journal of Behavioral Medicine
Lauren A Maggio
INTRODUCTION: Evidence-based medicine (EBM) is an expectation of professional healthcare and a requisite component of medical school curricula. However, upon graduation medical students' EBM skills have been found lacking suggesting a need to examine EBM training. METHODS: This PhD report presents two studies on EBM education. The first study is a literature review that describes and attempts to assess educational interventions for teaching medical students EBM...
October 25, 2016: Perspectives on Medical Education
Michael C O'Donovan, Michael J Owen
Recent genomic studies have revealed the highly polygenic nature of psychiatric disorders, including schizophrenia, bipolar disorder and major depressive disorder. Many of the individual genetic associations are shared across multiple disorders in a way that points to extensive biological pleiotropy and further challenges the biological validity of existing diagnostic approaches. Here we argue that the existence of risk alleles specific to a single diagnostic category is unlikely. We also highlight some of the important clinical repercussions of pleiotropy...
October 26, 2016: Nature Medicine
Aliza B Solomon, Rachel Reed, Keith Benkov, Joseph Kingsbery, Sarah S Lusman, Lisa B Malter, Jeremiah Levine, Simon Rabinowitz, Martin Wolff, Sondra Zabar, Elizabeth Weinshel
BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) has described six core competencies with which trainees should demonstrate proficiency. Using the Objective Structured Clinical Exam (OSCE), we aimed to assess four of these competencies among Pediatric GI fellows (PG). METHODS: Eight first-year PG's from six medical centers in the New York area participated in a four-station OSCE with trained standardized patient (SP) actors. The cases included an "ED Consult" for lower GI bleeding; "Breaking Bad News" focusing on CF nutritional complications; "Second Opinion" for abdominal pain; "Transition of Care" for inflammatory bowel disease...
October 25, 2016: Journal of Pediatric Gastroenterology and Nutrition
Muhammad Afzal, Maqbool Hussain, Wajahat Ali Khan, Taqdir Ali, Arif Jamshed, Sungyoung Lee
BACKGROUND: With the increasing use of electronic health records (EHRs), there is a growing need to expand the utilization of EHR data to support clinical research. The key challenge in achieving this goal is the unavailability of smart systems and methods to overcome the issue of data preparation, structuring, and sharing for smooth clinical research. MATERIALS AND METHODS: We developed a robust analysis system called the smart extraction and analysis system (SEAS) that consists of two subsystems: (1) the information extraction system (IES), for extracting information from clinical documents, and (2) the survival analysis system (SAS), for a descriptive and predictive analysis to compile the survival statistics and predict the future chance of survivability...
October 26, 2016: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
A Neubert, Z Yang, C Engstrom, Y Xia, M W Strudwick, S S Chandra, J Fripp, S Crozier
PURPOSE: Magnetic resonance (MR) imaging plays a key role in investigating early degenerative disorders and traumatic injuries of the glenohumeral cartilages. Subtle morphometric and biochemical changes of potential relevance to clinical diagnosis, treatment planning, and evaluation can be assessed from measurements derived from in vivo MR segmentation of the cartilages. However, segmentation of the glenohumeral cartilages, using approaches spanning manual to automated methods, is technically challenging, due to their thin, curved structure and overlapping intensities of surrounding tissues...
October 2016: Medical Physics
Jeppe Brage Christensen, Heikki Tölli, Niels Bassler
PURPOSE: Dosimetry with ionization chambers in clinical ion beams for radiation therapy requires correction for recombination effects. However, common radiation protocols discriminate between initial and general recombination and provide no universal correction method for the presence of both recombination types in ion beams of charged particles heavier than protons. The advent of multiple field optimization in ion beams, allowing for complex patterns of dose delivery in both temporal and spatial domains, results in new challenges for recombination correction where the resulting recombination depends on the plan delivered...
October 2016: Medical Physics
Humberto Rocha, Joana Dias, Tiago Ventura, Brígida Ferreira, Maria do Carmo Lopes
PURPOSE: The inverse planning of an intensity-modulated radiation therapy (IMRT) treatment requires decisions regarding the angles used for radiation incidence, even when arcs are used. The possibility of improving the quality of treatment plans by an optimized selection of the beam angle incidences-beam angle optimization (BAO)-is seldom done in clinical practice. The inclusion of noncoplanar beam incidences in an automated optimization routine is even more unusual. However, for some tumor sites, the advantage of considering noncoplanar beam incidences is well known...
October 2016: Medical Physics
Qiang Liu, Jian Liang, Carl W Stanhope, Di Yan
PURPOSE: Inaccurate density information may introduce dose calculation errors when inhomogeneity correction is applied. The aim of the present study was to examine the effect of density variation on photon dose calculation accuracy using the convolution/superposition (CS) algorithm with the focus on newer treatment technologies including intensity modulated radiotherapy, volumetric modulated arc radiotherapy, and stereotactic body radiotherapy (SBRT). METHODS: Calculations were first performed using simple inhomogeneity phantoms in order to determine clinically relevant tolerance levels for different tissue types...
October 2016: Medical Physics
Enrico Franco, Mike Ristic, Marc Rea, Wladyslaw M W Gedroyc
PURPOSE: Percutaneous ablation under MRI-guidance allows treating otherwise inoperable liver tumors locally using a catheter probe. However, manually placing the probe is an error-prone and time consuming task that requires a considerable amount of training. The aim of this paper was to present a pneumatically actuated robotic instrument that can assist clinicians in MRI-guided percutaneous intervention of the liver and to assess its functionality in a clinical setting. The robot positions a needle-guide inside the MRI scanner bore and assists manual needle insertions outside the bore...
October 2016: Medical Physics
Lynda C Ikejimba, Stephen J Glick, Kingshuk Roy Choudhury, Ehsan Samei, Joseph Y Lo
PURPOSE: The purpose of this study is to quantify the differences in detectability between full field digital mammography (FFDM), digital breast tomosynthesis (DBT), and synthetic mammography (SM) for challenging, low contrast signals, in the context of both a uniform and an anthropomorphic, textured phantom. METHODS: Images of the phantoms were acquired using a Hologic Selenia Dimensions system. Images were taken at 50%, 100%, and 200% of the dose delivered under automatic exposure control (AEC)...
October 2016: Medical Physics
Letitia H Burridge, Michele M Foster, Maria Donald, Jianzhen Zhang, Anthony W Russell, Claire L Jackson
As the prevalence of type 2 diabetes continues to escalate, health system reform is seeking better patient outcomes through new models of care that aim to provide the most appropriate care when needed. Patients' experiences of service innovations can shed light on the successes and challenges of implementing change. This paper explores patients' views of a new model of integrated care for patients with type 2 diabetes. A mixed-methods, randomised control trial evaluated a beacon clinic model of care for complex type 2 diabetes led by specialist general practitioners (GPs) in primary care settings in Brisbane, Australia...
October 26, 2016: Health & Social Care in the Community
Daniel Ricklin, Edimara S Reis, Dimitrios C Mastellos, Piet Gros, John D Lambris
As a preformed defense system, complement faces a delicate challenge in providing an immediate, forceful response to pathogens even at first encounter, while sparing host cells in the process. For this purpose, it engages a tightly regulated network of plasma proteins, cell surface receptors, and regulators. Complement component C3 plays a particularly versatile role in this process by keeping the cascade alert, acting as a point of convergence of activation pathways, fueling the amplification of the complement response, exerting direct effector functions, and helping to coordinate downstream immune responses...
November 2016: Immunological Reviews
Yu-Ming Shen, Lien D Le, Rory Wilson, Ulrich Mansmann
BACKGROUND: Biomarkers providing evidence for patient-treatment interaction are key in the development and practice of personalized medicine. Knowledge that a patient with a specific feature - as demonstrated through a biomarker - would have an advantage under a given treatment vs. a competing treatment can aid immensely in medical decision-making. Statistical strategies to establish evidence of continuous biomarkers are complex and their formal results are thus not easy to communicate...
October 26, 2016: Methods of Information in Medicine
Valerio Dimonte, Alvisa Palese, Paolo Chiari, Dario Laquintana, Gianni Tognoni, Paola Di Giulio
. The debate on the development of advanced nursing competences. The dossier aims to describe and disentagle the present Italian and international debate on the development and recognition of advanced nursing competences. Following a general brief description of the legislative national background, the attention is first of all focused on the lack of clarity on the definition of advanced competence, which is further complicated by the issue of their formal, contractual and economic recognition. To explore these issues a list of contributions is presented and some proposals are formulated to favor a better oriented development of the debate: a...
July 2016: Assistenza Infermieristica e Ricerca: AIR
R Claeys, M Walsdorff, S Pargov, R Matasa, R Duttmann, M Cannie
Non-traumatic wrist pain remains a diagnostic challenge. An accurate diagnosis is crucial in order to choose the appropriate treatment. We report the case of a 23-year-old female with a four-month history of mainly nocturnal wrist pain. There was no history of trauma or prior surgery. Radiographs and CT scans showed a lytic lesion with central nidus and sclerotic margins in the pisiform bone. Bone scan showed increased uptake in the pisiform bone. The diagnosis of osteoid osteoma was confirmed by histopathological analysis after complete surgical resection...
September 2016: Hand Surgery and Rehabilitation
J-N Goubier, F Teboul
Recovery of shoulder function is a real challenge in cases of partial brachial plexus palsy. Currently, in C5-C6 root injuries, transfer of the long head of the triceps brachii branch is done to revive the deltoid muscle. Spinal accessory nerve transfer is typically used for reanimation of the suprascapular nerve. We propose an alternative technique in which the nerve of the rhomboid muscles is transferred to the suprascapular nerve. A 33-year-old male patient with a C5-C6 brachial plexus injury with shoulder and elbow flexion palsy underwent surgery 7 months after the injury...
October 2016: Hand Surgery and Rehabilitation
Justin Arcaro, Carolyn Summerhurst, Evelyn Vingilis, Michael Wammes, Elizabeth Osuch
This study examined presenting concerns and characteristics of emerging adults (EAs) seeking treatment at an early intervention program for mood and anxiety disorders to better understand presenting concerns when treatment is needed. During an intake assessment conducted by a social worker or clinical psychologist, participants (N = 548; 62% female, 38% male) reported their top three current life concerns, which were analyzed qualitatively using thematic analysis. Participants completed a battery of questionnaires assessing demographic information, symptomatology, and daily functioning...
October 26, 2016: Psychology, Health & Medicine
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