Early goal-directed therapy in severe sepsis and septic shock: converting science to reality.
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Clinical Protocols↗
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Results for “Reality Therapy”
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Current imaging paradigms in radiation oncology.
The technological revolution in imaging during recent decades has transformed the way image-guided radiation therapy is performed. Anatomical imaging (plain radiography, computed tomography, magnetic resonance imaging) greatly improved the accuracy of delineating target structures and has formed the foundation of 3D-based radiation treatment. However, the treatment planning paradigm in radiation oncology is beginning to shift toward a more biological and molecular approach as advances in biochemistry, molecular biology, and technology have made functional imaging (positron emission tomography, nuclear magnetic resonance spectroscopy, optical imaging) of physiological processes in tumors more feasible and practical. This review provides an overview of the role of current imaging strategies in radiation oncology, with a focus on functional imaging modalities, as it relates to staging and molecular profiling (cellular proliferation, apoptosis, angiogenesis, hypoxia, receptor status) of tumors, defining radiation target volumes, and assessing therapeutic response. In addition, obstacles such as imaging-pathological validation, optimal timing of post-therapy scans, spatial and temporal evolution of tumors, and lack of clinical outcome studies are discussed that must be overcome before a new era of functional imaging-guided therapy becomes a clinical reality.
Humans↗
Ultrasonographic contrast media: has the time come in obstetrics and gynecology?
OBJECTIVE: The aim of this work was to review the technical aspects and clinical applications of contrast media (microbubbles and nanomolecular agents) in obstetric and gynecologic ultrasonographic imaging. METHODS: With the use of a computerized database (MEDLINE) and several Web-based search engines (Google Scholar and Copernic), relevant articles on ultrasonographic contrast media were reviewed. References cited in these articles and not obtained via the search engines were also reviewed. RESULTS: Ultrasonographic contrast media constitute a new and expanding technology. They are frequently used, for example, in adult cardiology. Extensive research in laboratory setups, animals, and human subjects has shown their safety and huge potential as an adjunctive tool in clinical practice. They increase signals returning from insonated tissues and are particularly effective as intravascular agents, enhancing color and Doppler signals, for instance. Preliminary results in tumor imaging are encouraging. The ultrasonographic contrast media permit pharmacokinetic perfusion studies, which may be of enormous clinical importance in the study of early cancer development. Targeted imaging and therapies are becoming a reality. Microbubbles have already brought a new dimension to diagnostic ultrasonographic imaging. Many authors have described the clinical value of these agents in liver, prostate, and breast imaging, among others. Newer types of media, the nanomolecules, are now emerging as the latest in imaging enhancers as well as therapeutic agent carriers. CONCLUSIONS: Although showing potential in imaging of the uterus and fallopian tubes as well as some obstetric applications, the contrast media, in particular the nanomolecules, seem to be most promising in ovarian cancer.
Contrast Media↗
[Wish and reality. Comments on the current relation of psychoanalysis and behavior therapy].
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Behavior Therapy↗
[Practical social therapy in psychiatry (author's transl)].
For each person working in the psychiatric field, disease concerns predominantly the individual. This statement is true for both somatotherapeutically and psychotherapeutically emphasized therapy procedure. The social reality of the patient himself is not taken into consideration in this procedure. A sociotherapeutical approach is attempted in this present study complementing the interpretation and action models mentioned above. Basing on a case of a female patient suffering from paranoid changes, specific intervention possibilities are explained, and also which meaningfully applied solution strategies can be successful. In this connection sociotherapy is shown to be a therapeutic procedure in its own right which, while actually trying to normalize the patient's psychopathological abnormalities, does not overlook his real life situation (which can easily happen with somatic and psychotherapeutic processes) and expressly makes this the basis and subject of the "treatment".
Female↗
[Poor responders followed for 3 years in an IVF program].
Our study consisted of a population of 100 women who represented an insufficient response to the induction of ovulation. We researched to find out which therapeutic approach, of the subsequent attempts to IVF would give greater hope to a better response. Two groups were individualized: in the first group (62 women) we obtained at least once, 3 oocytes (288 attempts), in the second group (38 women) we always obtained less than 3 oocytes. In the first group, in order to raise the pregnancy rate it was necessary to raise the rate of E2/oocyte. There fore raising the duration of stimulation and the quantity of ampullage of hMG. The long protocol, hMG, produced the best results. In the second group, the results were always worse it was more than a problem of protocol, it was a problem of the patients. In reality, the future of therapy for lower responsive patients is probably biological with hatching today and the possibilities with oocytary maturation in vitro in the near future.
Adult↗
Using reality orientation on behavior problems in an adolescent girl.
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Adolescent↗
[Is there a rationale for pluralistic evaluation models? Limitations of randomized clinical trials].
Randomized clinical trials (RCTs) are believed to deliver the highest level of clinical evidence, and other types of evidence are rarely integrated in therapy assessments. Under ideal circumstances, RCTs are perfect tools of therapy evaluation; however, in clinical reality they suffer from a variety of limitations. Their prioritization can distort public health regulation because of commercial bias, career bias, bias of large numbers, mediocrity bias, and bias of therapy preferences; also, they can lead to discrepancies between clinical research and routine medical practice, to ethical problems, and to divergent and asymmetrical results. Moreover, the seemingly simple therapy assessment based on RCT results bears the danger of their endorsement and misuse by non-medical personnel, especially bureaucrats. To meet the demands of the complex reality of medical care, the physician's judgment should be methodologically professionalized and re-integrated into the process of generating medical knowledge; fixed hierarchies of medical evidence should be de-emphasized in favor of information syntheses from different types of (quality assessed) evidence.
Clinical Medicine↗
Thinking about thinking in family therapy.
Epistemological comparison reveals congruence between the reality-defusing though rules of new science, Batesonian evolution, and ecosystemic thinking with families and family therapy. These rules provide a base for a technology of therapy in which the therapist functions as a benign detective, seeking out with the family and others the event-shape in time-space (the Storey) that contains the reported distress. Intervention consists of action that adds to the Storey in a manner designed to alleviate the distress. A Storey is presented that illustrates the difference between medical, paradoxical, and ecosystemic interventions.
Adult↗
Interventions for confusion and dementia. 4: Alternative approaches.
While reality orientation and reminiscence are useful therapies, recent years have been a growing awareness of other approaches to caring for people with dementia. This article discusses some of the less established, but potentially valuable, approaches--validation therapy, resolution therapy and multisensory environments. Validation therapy seeks to help care givers understand the thoughts and feelings of care receivers. In contrast to the confrontational approach of reality orientation, it encourages empathy between giver and receiver. Resolution therapy develops aspects of validation therapy, adopting a less structured, more psychodynamic and individualistic approach. Multisensory environments use sensory stimulation to achieve pleasure for the individual. All three approaches have a limited knowledge base, but share a humanistic philosophy that enables them to contribute to a person's quality of life.
Confusion↗
Interferon in cancer: Faith, hope and reality.
Patients that have received interferon therapy for tumor diseases to date do not total more than a few hundred. Remissions have been reported in some patients with various types of malignant tumors. This is interesting, as interferon therapy represents a new principle in the treatment of tumor diseases. However, prolonged and complete remissions have been rare, and we are not yet in a position to say whether interferon therapy is superior to other treatment methods in current use for any type of malignant tumor. If this proves to be the case for some such diseases, we would still be faced with the tasks of identifying patients that may benefit from the interferon treatment, and of establishing the best procedure for its application. Research toward these ends would be greatly facilitated by the development of methods for producing interferon.
Clinical Trials as Topic↗
Viral vector-mediated gene therapy for hemophilia.
Hemophilia A and B are hereditary coagulation disorders that result from functional deficiencies of factor VIII (FVIII) or factor IX (FIX), respectively. Current treatment consists of injections with plasma-derived or recombinant clotting factors. Despite the significant clinical benefits of protein replacement therapies, these do not constitute a cure and patients are still at risk of bleeding. Significant progress has been made recently in the development of gene therapy for hemophilia. This has been primarily due to the technical improvements of existing vector systems and the development of new gene delivery methods. Therapeutic and sometimes physiologic levels of FVIII and FIX could be achieved in FVIII- and FIX-deficient mice and hemophilic dogs using different types of viral vectors. In these preclinical studies, long-term correction of the bleeding disorders and in some cases a permanent cure has been realized. However, complications related to the induction of neutralizing antibodies or viral promoter inactivation often precludes stable phenotypic correction. Several gene therapy phase I clinical trials have been initiated in patients suffering from severe hemophilia A or B. The results from the extensive pre-clinical studies and the preliminary clinical data are encouraging. It is likely that successful gene therapy for hemophilia will become a reality at the beginning of this new millennium, serving as the trailblazer for gene therapy of other diseases.
Adenoviridae↗
Getting evidence to prescribers and patients or how to make EBM a reality.
Bringing all available evidence on therapy efficacy to users is a necessary step in the evidence-based medicine paradigm. Today, the needs of physicians in medical information, including therapeutic information, are not met. Further, the information reaching the doctors is rarely consistent with the available evidence. The growth rate of emerging evidence and its increasing complexity make the doctors unable to cope with it within the current medical information system. So, there is a real need to sort out a new way for transferring therapeutic information to doctors and patients. We conceived a new paradigm and designed an Internet process based on it by which unbiased evidence is brought to doctors in such a format that it can be accessed and used during the visit.
Decision Support Systems, Clinical↗
[Spermatogenesis protection: myth or reality?].
Cytotoxic agents used in various therapies (anticancer treatments in particular) are known to be very deleterious to male fertility. In these situations, both quantitative (oligo and azoospermia) and qualitative alterations of the male reproductive system occur. What are the various possibilities to protect male reproduction? Sperm cryo-storage, prior to the beginning of chemotherapy and/or radiotherapy, is one possibility. However this possibility can only be offered to a relatively limited number of patients, due to the fact that the disease itself often causes gonadal abnormalities. Another possibility is the substitution of the most cytotoxic drugs by less deleterious agents, as well as, the reduction of the doses used in the therapeutic regimens. Progress in this field however remains very slow. Therefore, the use of various protective agents appears to be necessary. Of all the agents so far tested (anti-oxidants, GnRH analogs, FSH, steroids), the combination of medroxyprogesterone acetate and testosterone (MPA+T) is the one which has been the most studied both in men (contraception) and in rodents (contraception and protection). From a series of experiments using MPA+T in male rats, it appears that both qualitative and quantitative protection of fertility can be achieved against chemo- and radiotherapy. Progress in this field should be the prelude of clinical trials. This transfer from animals to men, should result as one of the activities of a pluri-disciplinary group supported by INSERM and entitled "Prosperm". The dialogue established in this group between researchers and physicians offers new perspectives in the domain of protection of spermatogenesis, at a time when this is most needed.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Gene therapy for prostate cancer. New perspectives on an old problem.
Recent advances in molecular biology have made the prospect of gene therapy for prostate cancer a reality. A wide variety of genetic strategies, vector designs, and delivery modalities are currently in use. This article examines the state of the art prostate cancer gene therapy and details the various options available to clinicians.
Cancer Vaccines↗
Clinical gene transfer studies for hemophilia A.
The recent advances in gene transfer technology have expedited the development of gene therapy for the treatment of hemophilia A. Three different U.S. Food and Drug Administration-approved phase I clinical trials had been initiated using different gene therapy approaches each with their own advantages and limitations. In the first gene therapy trial for hemophilia A, a non-viral approach was being explored for patients with severe hemophilia A using ex vivo transfected dermal fibroblast expressing B-domain-deleted factor VIII ( BDD-FVIII). There were no serious adverse events and some patients appeared to have experienced fewer bleeding episodes with very low levels of FVIII near baseline. In the second trial, onco-retroviral vectors expressing BDD-FVIII were injected by peripheral intravenous infusion in adult patients suffering from severe hemophilia A. The procedure was safe and in some patients FVIII-transduced cells were detectable in the peripheral blood for more than a year. Although no sustained FVIII expression was detectable, occasional modest changes in FVIII levels were apparent, and in some cases a reduced bleeding frequency occurred compared with historical rates. In another trial, one patient suffering from severe hemophilia A has been treated with a high-capacity (or gutless) adenoviral vector expressing full-length FVIII, which appeared to have resulted in 1% of normal FVIII levels for several months. However, a transient inflammatory response with hematologic and liver abnormalities was observed. In conclusion, although modest improvements in clinical end points have been detected in some patients in these early phase I trials, further improvements in gene delivery technologies are warranted to bring hemophilia A gene therapy one step closer to reality.
Clinical Trials as Topic↗
Angiogenesis in brain tumors; pathobiological and clinical aspects.
Angiogenesis is the outgrowth of new blood vessels from the preexistent vasculature. In 1971, Folkman hypothesized that solid tumors are dependent on angiogenesis for sustained growth and that anti-angiogenic treatment is a potential antineoplastic therapy. Because glioblastoma multiforma (GBM) frequently shows florid microvascular proliferation (MVP), this tumor has been considered since then as a suitable candidate for such treatment that attempts to eradicate or control a neoplasm by interfering with its blood supply. Indeed, in animal models the growth of glioma xenografts can be inhibited by targeting the angiogenic process. However, unlike many glioma xenografts, human infiltrating gliomas such as GBMs have a diffuse infiltrative growth pattern, and preexistent vessels may suffice to provide many tumor cells with much of their blood supply, particularly in the critical peripheral infiltrative margins. Thus, while attractive in concept, anti-angiogenic therapy of GBM must address the anatomic vascular realities of this neoplasm. Even if anti-angiogenic therapy ultimately has a role in infiltrative neoplasms, there are a host of other intracranial neoplasms whose discrete architecture might make them attractive candidates for anti-angiogenic therapy. This review summarizes the angiogenic process in GBM and suggests other types of tumors for which the efficacy of anti-angiogenic therapy might be studied.
Brain Neoplasms↗
[Psychological technics and meditation--reflections on some aspects of a borderline treatment area].
The pretentious propagation of psycho-techniques and psychotherapies that claim to be doctrines of salvation has resulted in a continually increasing number of persons who are cheated of their basic wish for meditation by their being led away under false pretences from the initial signs of meditation to merely suggestive or analytical procedures. While psychotechniques are useful and even mandatory for achieving prophylactic and therapeutic goals, they do not help the patient to step out of the self. The need for meditation, however, stems from his encounter with reality. Nevertheless, psychotechnique can support or promote meditation provided one is basically ready to transcend therapy. This would be an important contribution to psychohygiene.
Adaptation, Psychological↗