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At least 793 records · Page 44Linked to original sources
PubMed2001

Effectiveness of virtual reality-based pain control with multiple treatments.

OBJECTIVE: The current study explored whether immersive virtual reality continues to reduce pain (via distraction) with repeated use. SETTING: The study was conducted in a burn care unit at a regional trauma center. PATIENTS: Seven patients aged 9-32 years (mean age of 21.9 years; average of 23.7% total body surface area burned [range, 3-60%]) performed range-of-motion exercises of their injured extremity under an occupational therapist's direction on at least 3 separate days each. INTERVENTION: For each physical therapy session, each patient spent equal amounts of time in virtual reality and in the control condition (no distraction). The mean duration of physical therapy in virtual reality was 3.5, 4.9, and 6.4 minutes for the first, second, and third session, respectively. Condition order was randomized and counter-balanced. OUTCOME MEASURES: For each of the three physical therapy sessions, five visual analog pain scores for each treatment condition served as the dependent variables. RESULTS: Pain ratings were statistically lower when patients were in virtual reality, and the magnitude of pain reduction did not diminish with repeated use of virtual reality. The results of this study may be examined in more detail at www.vrpain.com. CONCLUSIONS: Although the small sample size limits generalizability. results provide converging preliminary evidence that virtual reality can function as a strong nonpharmacological pain reduction technique for burn patients during physical therapy. Results suggest that virtual reality does not diminish in analgesic effectiveness with three (and possibly more) uses. Virtual reality may also have analgesic potential for other painful procedures or pain populations. Practical implications are discussed.

Adolescent↗
PubMed1986

[Severe urge incontinence--therapeutic concept].

Basing on our experience with 39 patients with severe urge incontinence (in one-quarter of the cases pure urge incontinence, in one-half of the cases mixed incontinence and in a further quarter of the cases neurogenic bladder disorders) a supervised programme (mictiogram) and a well-tried therapy (especially in the Anglo-Saxon countries) consisting of the triad hospitalisation/bladder training/medication therapy are presented. After an average hospitalisation period of 14 days, we were able to achieve a symptom-free state in 94% of the patients. Cure was achieved on a long-term basis in 76%. Failure of conservative therapy was due especially to severe neurogenic bladder disorders, followed by urethral obstructive insufficiency that cannot be influenced. The superimposed psychic cause of urge incontinence that should not be underestimated and often presents as a transference of unresolved emotional needs (51% of our group are psychologically unstable), is discussed. With these facts in mind, our therapy concept is translated into reality. Hospitalisation brings about a change in surroundings, making the supervision of bladder training and adjustment to medication easier, thus supplying the basis for patient compliance and success of follow-up therapy subsequent to hospitalisation and discharge from hospital.

Adult↗
PubMed2005

Towards safe, non-viral therapeutic gene expression in humans.

The potential dangers of using viruses to deliver and integrate DNA into host cells in gene therapy have been poignantly highlighted in recent clinical trials. Safer, non-viral gene delivery approaches have been largely ignored in the past because of their inefficient delivery and the resulting transient transgene expression. However, recent advances indicate that efficient, long-term gene expression can be achieved by non-viral means. In particular, integration of DNA can be targeted to specific genomic sites without deleterious consequences and it is possible to maintain transgenes as small episomal plasmids or artificial chromosomes. The application of these approaches to human gene therapy is gradually becoming a reality.

Chromosomes, Artificial↗
PubMed1999

Advances in the diagnosis and treatment of malignant brain tumors.

Malignant brain tumors are tough to treat. The plethora of novel technological advances and the multitude of experimental therapies are indicative of this reality. However, it becomes clear that no magical panacea will provide the cure, and only step-wise progression of research and improved technological advances to enhance the efficacy of surgical and adjuvant therapies will eventually improve the outcome of brain tumor patients.

Antineoplastic Agents↗
PubMed1980

[Group psychotherapy in the treatment of cardiovascular diseases--health and disease education in inpatient rehabilitation (author's transl)].

Psychotherapy, beside kinesitherapy, pharmacotherapy and the use of appropriate devices in cardiology, are an important and integral part of therapeutic efforts in inpatient rehabilitation of cardiovascular diseases. A working pattern is suggested for the major part of psychological treatment, namely, group therapy, devised and translated into reality by a clinical psychologist for a specialised rehabilitation center. The therapeutical aims of group psychotherapy include adequate control of disease of anxiety after myocardial infarction and subsequent health training based on behaviour therapy. The different types of group therapies are described and assessed.

Adaptation, Psychological↗
PubMed1997

Molecular advances in pancreatic cancer.

Our understanding of the molecular genetics of pancreatic cancer has advanced spectacularly over the last 5 years so that this tumour type is now one of the best characterised of all malignancies. A small proportion of cases results from inherited predisposition due to germline transmission of a mutated CDKN2 or BRCA2 gene, while patients with familial pancreatitis due to a mutated cationic trypsinogen gene have a greatly increased risk of developing pancreatic cancer. The majority of cases are sporadic and are characterised at the molecular level by several key genetic abnormalities. The most frequent of these is point mutation of the dominant oncogene KRAS, a lesion which occurs as an early and possibly initiating event in tumourigenesis. Inactivating mutations of the tumour suppressor genes TP53, CDKN2 and SMAD4 are also frequently observed and this constellation of genetic defects sets pancreatic cancer apart from other types of cancer, a feature which could have important implications for molecular diagnosis. Genetic intervention for cancer prevention and therapy is becoming a clinical reality and several approaches are being pursued for pancreatic cancer. As well as tumour suppressor gene replacement and oncogene blockade, strategies with a potential bystander effect are showing promise. These include genetic prodrug activation therapy using selective expression of suicide genes and genetic immunomodulation with cytokines and tumour-associated antigens.

Genes, Tumor Suppressor↗
PubMed1997

Gene therapy for atherosclerosis.

Although considerable progress has been made in the prevention and treatment of atherosclerotic cardiovascular disease, new therapeutic strategies are still needed. Atherosclerosis is a systemic disease and represents an attractive target for the development of somatic gene transfer intended to modulate systemic factors with the goal of inhibiting disease progression. This approach should be differentiated from localized vascular gene delivery to isolated atherosclerotic lesions such as that intended to prevent restenosis. Systemic gene therapy for atherosclerosis can involve either: 1) gene replacement therapy in patients with defined genetic disorder causing premature atherosclerosis, or 2) overexpression of proteins which directly or indirectly inhibit atherosclerosis or stabilize vulnerable lesions. The former is conceptually straightforward, and a pilot clinical gene therapy trial for one of these diseases, homozygous familial hypercholesterolemia, has already been reported. The latter has significant potential for eventual application to a large number of patients at risk for progressive atherosclerosis, independent of the specific cause. However, substantial progress in vector development and the demonstration of efficacy in relevant animal models will be required before gene therapy for atherosclerosis becomes a clinical reality.

Apolipoproteins E↗
PubMed1992

Future prospects for treatment of hemoglobinopathies.

Strategies for the treatment of sickle cell anemia and beta-thalassemia are founded on the knowledge that these disorders result from structural or functional defects in an adult gene for which an intact fetal counterpart exists. During the past decade, several pharmacologic agents have been investigated for their potential to ameliorate sickle cell anemia and beta-thalassemia by increasing the synthesis of fetal hemoglobin in adults. Progress in understanding globin gene regulation is now being combined with advances in retrovirus-mediated gene transfer, and the once-distant goal of providing gene therapy for hemoglobinopathies is rapidly approaching reality.

Adult↗
PubMed2000

[Molecular biology and medicine at the end of the 20th Century].

This paper reviews basic concepts of modern molecular biology with the premise that its influence in today's medicine is so important that its knowledge cannot remain limited to a few experts. I first analyze the overall structure and organization of human genes, their split nature and the flow of genetic information from DNA to protein. The role of transcriptional control in the regulation of gene expression and cell differentiation is described by introducing experimental examples that define the importance of "master" genes. Basic concepts of genetic engineering, the generation of transgenic and knock out animals and the uses of molecular biology in clinical diagnosis, paternity tests and forensic medicine are presented. Finally, I discuss the possibilities of gene therapy and the fantasies and realities of transgenesis and cloning by nuclear transplant in humans.

Animals↗
PubMed1992

The revolution in clinical genetics. Practical applications.

Recent advances in genetics directly affect family physicians. Many diagnostic tests are currently available to screen the fetus for malformations and genetic diseases, and gene therapy is slowly becoming a reality. This article discusses some of the screening techniques available, including chromosome analysis, ultrasound, and DNA studies.

DNA Probes↗
PubMed1993

[Problems and strategies of qualitative psychotherapy research in clinical institutions].

The neglect of institutional codetermination in therapeutic decisions is exposed as a desiderative in research. Qualitative approaches as developed in the social sciences must come to grips with the social unconscious institutional procedures; therapy is proposed to be considered as a social event. Thus Reality Work is viewed as field and object of qualitative research in clinical institutions, a concept close to ethnographic and social constructionist approaches. The generative techniques (as dissonance reduction, narrative transformations and selection of rules of discourse) institutions use for the establishment of their social-emotional integration are illustrated by examples; they are instruments to produce a processible image of the patient. Images thus generated rule treatment, they can be formulated as metaphors und looked for at different levels.

Hospitalization↗
PubMed2006

Pharmacogenetics, drug-metabolizing enzymes, and clinical practice.

The application of pharmacogenetics holds great promise for individualized therapy. However, it has little clinical reality at present, despite many claims. The main problem is that the evidence base supporting genetic testing before therapy is weak. The pharmacology of the drugs subject to inherited variability in metabolism is often complex. Few have simple or single pathways of elimination. Some have active metabolites or enantiomers with different activities and pathways of elimination. Drug dosing is likely to be influenced only if the aggregate molar activity of all active moieties at the site of action is predictably affected by genotype or phenotype. Variation in drug concentration must be significant enough to provide "signal" over and above normal variation, and there must be a genuine concentration-effect relationship. The therapeutic index of the drug will also influence test utility. After considering all of these factors, the benefits of prospective testing need to be weighed against the costs and against other endpoints of effect. It is not surprising that few drugs satisfy these requirements. Drugs (and enzymes) for which there is a reasonable evidence base supporting genotyping or phenotyping include suxamethonium/mivacurium (butyrylcholinesterase), and azathioprine/6-mercaptopurine (thiopurine methyltransferase). Drugs for which there is a potential case for prospective testing include warfarin (CYP2C9), perhexiline (CYP2D6), and perhaps the proton pump inhibitors (CYP2C19). No other drugs have an evidence base that is sufficient to justify prospective testing at present, although some warrant further evaluation. In this review we summarize the current evidence base for pharmacogenetics in relation to drug-metabolizing enzymes.

Animals↗
PubMed2005

Vascular-targeting agents and radiation therapy in lung cancer: where do we stand in 2005?

With recent Food and Drug Administration approval of the anti-vascular endothelial growth factor (VEGF) antibody for the treatment of colon cancer, it may be possible to achieve similar progress in the treatment of locally advanced lung cancer. Antiangiogenic therapies in the clinic are a reality, and it is important to demonstrate that they can be used safely with conventional modalities, including radiation therapy (RT). Strategies under scrutiny in preclinical and clinical studies include the use of endogenous inhibitors of angiogenesis, use of agents that target VEGF and VEGF receptor signaling, targeting endothelial-related integrins during angiogenesis, and targeting the preexisting immature vessels growing within tumors (ie, vascular targeting). Regardless of the approach, it is necessary to address whether angiogenesis is a consistent phenomenon within the lung parenchyma around a cancer and a relevant target and whether inhibiting angiogenesis will improve current lung cancer therapies without increasing toxicity. Vascular-targeting agents (VTAs) are an interesting class of agents that have the potential to enhance RT, but their clinical promise has yet to be realized. In preclinical models, these agents selectively destroy the tumor vasculature, initiating a rapid centralized necrosis within established tumors. Characteristically, after treatment with VTAs, a rim of viable tumor cells remains at the periphery of the tumor, which remains well perfused and should therefore be relatively sensitive to radiation-induced cytotoxicity. This review will focus on VTAs in the treatment of lung cancer and includes a discussion of combination studies with RT in the laboratory and some of the hurdles in the clinical application of these agents.

Angiogenesis Inhibitors↗
PubMed1997

[Surgical treatment and research of esophageal cancer in the past and the present era in our department--for the view point of the future].

We describe the result of esophageal cancer treatment in the past era of the Department of Surgery, Chiba University School of Medicine directed by Professor Seo, Nakayama and Sato and the improved results of the treatment at the present time from the view point of diagnosis (early superficial cancer, lymph node metastasis and adjacent organ invasion) and treatment (three-field lymph node dissection, improved result of operative mortality and morbidity, improvement of long-term survival rate). In addition, we prospect the future through the present study such as mutation of P53 gene and malignancy, immunotherapy using cytokine gene transfer, cancer inhibition therapy by induction of cancer suppressor gene, prodrug therapy, heavy particle iron therapy, and clinical application of virtual reality to the surgical field.

Esophageal Neoplasms↗
PubMed2006

Same bridge, new destinations rethinking paradigms for mechanical cardiac support in heart failure.

Mechanical cardiac support with ventricular assist devices is an established therapy for a variety of clinical scenarios, including postcardiotomy shock, "bridge to transplant," and "destination therapy." At present, device development, clinical trial design, regulatory approval, and reimbursement decisions for the clinical application of mechanical cardiac support devices continue to be considered in the context of these clinical indications. Although understandable from a historical perspective, these arbitrary divisions are inconsistent with the clinical realities of advanced heart failure therapy. By narrowly focusing on transplant eligibility at a static point in the clinical course, current guidelines impede the broader application of ventricular assist device technology to the growing population of patients who may benefit from this therapy.

Heart Failure↗
PubMed1999

[Not Available].

Though the use of elaborated and standardized behavioral therapy strategies has been successful in treatment evaluation and in areas of neurobiological research, numerous psychoanalytically orientated therapists will exhibit fear and avoidance behavior while facing terms like "standardization", "treatment evaluation studies" and "neurobiology". In our comment, we aim to initiate a successful therapeutic process by intensified reality testing and repeated exposure therapy.

Neurobiology↗
PubMed2006

Toward a standard definition and measurement of persistence with drug therapy: Examples from research on statin and antihypertensive utilization.

BACKGROUND: Long-term utilization of prescription drugs for chronic conditions such as hypertension and/or hypercholesterolemia is a reality for millions of individuals, yet therapies may be discontinued before they can exert their beneficial effect. Several studies have measured the mean duration of therapy (ie, persistence) using administrative health databases. However, the terminology and methodology used for measuring persistence varied across studies, making it difficult to compare persistence rates. OBJECTIVES: The objectives of this study were to identify currently used measures of persistence and to propose a standard operational definition for use in administrative database analyses of drug utilization. METHODS: MEDLINE was searched for English-language articles published between January 1997 and June 2005 that quantified the concepts of persistence, adherence, compliance, or continuity with statin or antihypertensive therapy using administrative prescription claims databases. The conceptual and operational definitions of persistence used in the identified studies were categorized and applied to prescription-refill data for a hypothetical patient to compare the durations of persistence resulting from each method. RESULTS: Thirty-one articles were identified and reviewed. Few of the studies explicitly stated the conceptual definition of persistence used. Five methods of measuring persistence were identified: anniversary models, minimum-refills models, refill-sequence models, proportion-of-days-covered models, and hybrid models. When these models were applied to data for the hypothetical patient, total persistence with drug therapy ranged from 7 days to >1 year. CONCLUSIONS: There continue to be inconsistencies in the definition of persistence and the methods by which it is measured. A standard operational definition of persistence should be 2-dimensional, quantifying not only the total duration of therapy, but also the intensity of medication-taking within this interval.

Antihypertensive Agents↗