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At least 883 records · Page 49Linked to original sources
PubMed1997

Human factors consideration in clinical applications of virtual reality.

Virtual reality environments have many potential applications in medicine, including surgical training, tele-operated robotic surgery, assessment and rehabilitation of behavioural and neurological disorders and diagnosis, therapy and rehabilitation of physical disabilities. Although there is much potential for the use of immersive virtual reality environments in clinical applications, there are problems which could limit their ultimate usability. Some users have experienced side-effects during and after exposure to virtual reality environments. The symptoms include ocular problems, disorientation and balance disturbances, and nausea. Susceptibility to side-effects can be affected by age, ethnicity, experience, gender and physical fitness, as well as the characteristics of the display, the virtual environment and the tasks. The characteristics of the virtual reality system have also been shown to affect the ability of users to perform tasks in a virtual environment. Many of these effects can be attributed to delays between the sampling of head and limb positions and the presentation of an appropriate image on the display. The introduction of patients to virtual reality environments, for assessment, therapy or rehabilitation, raises particular safety and ethical issues. Patients exposed to virtual reality environments for assessment and rehabilitation may have disabilities which increase their susceptibility to certain side-effects. Special precautions therefore need to be taken to ensure the safety and effectiveness of such virtual reality applications. These precautions include minimisation of possible side-effects at the design stage. Factors are identified which are likely to affect the incidence of side-effects during and after exposures, and which need to be understood in order to minimise undesirable consequences. There is also a need for the establishment of protocols for monitoring and controlling exposures of patients to virtual reality environments. Issues are identified which need to be included in such protocols.

Computer Graphics↗
PubMedDate not supplied

[Non-myeloablative transplant of hematopoietic precursor cells. Myth and reality].

The feasibility of applying allogeneic cell -mediated therapy in conjunction with allogeneic hematopoietic cell transplantation following reduced -intensity conditioning, with minimal toxicity and no serious transplant-related complications, makes it possible to perform such procedures on an outpatient basis as well to offer a valid option for cure to elderly individuals and patients with less than optimal performance status. Based on available experience, clinical application of this innovative therapy may open new horizons for the treatment of patients with leukemia, lymphoma, myeloma and other diseases. Many patients can now benefit from the advantages of immunotherapy mediated by alloreactive donor lymphocytes, while minimizing transplant-related toxicity and mortality. This kind of transplant is making real progress in the world of transplantation.

Adolescent↗
PubMed1991

[Erythrocyte viscosity-deformability-aggregation. A clinical reality].

Current clinical practice and indications for drug therapy for vascular pathologies of different etiology reveal the need to measure blood viscosity, either on the spot or at the site of greatest impact. The Authors propose as easily performed method of calculation using Reid's well-known technique, which, based on the measurement of hematic filterability using filters with different sized pores, gives the viscosity of the various fractions which make up overall viscosity but which have a different impact on areas of the circulation and their functions: total blood viscosity, corpuscolar viscosity, plasma-erythrocytic viscosity. These are quantified in cP as a values which is independent of the degree of sanguification and are markers of a functional flow datum. Erythrocytic deformability, expressed as a percentage of the inverse viscous impact of red cells on total blood viscosity, is restricted to a narrow range in the control population, and is therefore a very reliable parameter for the assessment of pathological and pharmacological changes. In addition to normal values, changes in subjects suffering from thalassemia are used as a paradigmatic example of structural and morphological erythrocytic changes without other associated diseases. A model table illustrates the methods of calculation used to obtain the degree of filtration in cP from filtration data.

Blood Viscosity↗
PubMed2001

Angiogenic gene therapy for heart disease: a review of animal studies and clinical trials.

The current published clinical literature on angiogenic gene therapy for the treatment of myocardial ischemia does not include a single randomized, placebo-controlled trial. Based on current clinical literature, it is an unproven therapy. Successful animal studies combined with published reports of good outcomes in patients enrolled in uncontrolled trials has led to the expectation that angiogenic gene therapy will ultimately become a clinical reality. The next important landmark in the field will be the publication of data showing a favorable effect of angiogenic gene transfer in placebo-controlled, blinded clinical trials.

Adenoviridae↗
PubMed1999

Induction of immunologic tolerance for transplantation.

In the second half of the 20th century, the transplantation of replacement organs and tissues to cure disease has become a clinical reality. Success has been achieved as a direct result of progress in understanding the cellular and molecular biology of the immune system. This understanding has led to the development of immunosuppressive pharmaceuticals that are part of nearly every transplantation procedure. All such drugs are toxic to some degree, however, and their chronic use, mandatory in transplantation, predisposes the patient to the development of infection and cancer. In addition, many of them may have deleterious long-term effects on the function of grafts. New immunosuppressive agents are constantly under development, but organ transplantation remains a therapy that requires patients to choose between the risks of their primary illness and its treatment on the one hand, and the risks of life-long systemic immunosuppression on the other. Alternatives to immunosuppression include modulation of donor grafts to reduce immunogenicity, removal of passenger leukocytes, transplantation into immunologically privileged sites like the testis or thymus, encapsulation of tissue, and the induction of a state of immunologic tolerance. It is the last of these alternatives that has, perhaps, the most promise and most generic applicability as a future therapy. Recent reports documenting long-term graft survival in the absence of immunosuppression suggest that tolerance-based therapies may soon become a clinical reality. Of particular interest to our laboratory are transplantation strategies that focus on the induction of donor-specific T-cell unresponsiveness. The basic biology, protocols, experimental outcomes, and clinical implications of tolerance-based transplantation are the focus of this review.

Animals↗
PubMed1997

Blind persons navigate in virtual reality (VR); hearing and feeling communicates "reality".

Can Virtual Reality (VR) developments in audio navigation for blind persons support therapies for all? Working with Crystal River Engineering we are developing navigable Virtual Reality worlds for blind users, using spatialized audio [1], [2]. All persons, however, use specialized channels, such as: visual, aural, and kinetic learning senses. Predominantly visual VR worlds and health informatics models from World Wide Webs, may be downloaded, tailored, augmented, and delivered to each of these learning senses using VR. We are also testing a proof of concept system with Boston Dynamics which downloads 3-dimensional, satellite-derived map models from the World Wide Web, and makes them navigable by "feeling" the terrain using haptic (tactual or force feedback to your hand) robotic interfaces. Ultimately, these multi-sensory VR access methods: sight, localization by audio, and "feeling" of data sets could open up the World Wide Web to individuals with sight impairments. This could also, however, benefit government, businesses, universities, and (elementary) education. It could contribute more powerful communications, education, and medical simulation applications on the World Wide Web. This work is part of government technology transfer to telemedicine, (elementary) education, disabilities access to the Web, and new Internet access and productivity efforts under Vice President Gore's National Performance Review.

Adult↗
PubMed1989

Acute hypertensive crisis in pregnancy.

Severe pre-eclampsia is a state of acute afterload increase where compensation may be total by use of the Frank-Starling mechanism and/or increased adrenergic drive, or may be uncompensated in a patient with limited or exhausted preload reserve. As such, we are presented with a diverse group of patients and antihypertensive therapy ideally should be individualized. In reality we are dealing with a complex situation because of the presence of the fetus raising concerns about direct effects on the fetus as well as on uteroplacental blood flow. This limits our choice of agents to those with extensive use in pregnancy except in complicated or resistant cases. For these reasons, hydralazine is the antihypertensive agent of choice for treatment of acute hypertensive emergencies in pregnancy. In the complicated case other agents such as sodium nitroprusside or nitroglycerin may be more appropriate and, in these cases, hemodynamic monitoring should be performed to allow not only greater safety, but also to tailor therapy to the individual hemodynamic profile.

Acute Disease↗
PubMed1998

Haemophilia A gene therapy.

Gene therapy for haemophilia A would represent a significant improvement over the current treatment by providing prophylactic expression of FVIII and correction of the coagulation defect. Furthermore, a gene therapy protocol allowing simple, infrequent vector administration may extend haemophilia treatment to remote locations world-wide that currently lack access to FVIII replacement therapy. Within the last half decade, significant progress has been made on the development of gene therapy for the treatment of haemophilia A. Recent achievements include high level clotting factor expression in mice, dogs, and monkeys as well as phenotypic correction in haemophiliac mice and dogs. With the efforts that are currently directed toward the improvement of gene transfer vectors and the development of technologies to enable sustained clotting factor expression, gene therapy for haemophilia A will ultimately become a reality.

Animals↗
PubMed1986

Twenty-four hour reality orientation: changes for staff and patients.

A 24-hour reality orientation programme was initiated in a long-stay geriatric ward. Nursing and occupational therapy routines were changed specifically to meet the needs of the 20 patients participating in the programme. The assessments included the Clifton Assessment Procedures for the Elderly, the Holden Communication Scale, the Holden Orientation Facilities Scale, and the Oberleder Scale (adapted by Holden et al.). These scales were administered before, during and after completion of a study lasting 4 months. The CAPE scales showed no significant results. However, the Holden Communication Scale indicated that there were significant differences for certain groups of patients. Those patients with high scores initially tended to continue to have high scores and showed no real change. However, patients who had scores in the medium range initially, showed improvement. This finding indicated that severity at onset of the experiment was an important variable when considering outcome of treatment. Expectations regarding the future of the very elderly must be realistic, and to anticipate a return to previous vitality and total independence should not be expected. However, to find a means by which functional levels can be maintained, and even slightly improved, is desirable. It would seem that the 24-hour reality orientation programme achieved this goal.

Aged↗
PubMed1990

Potential space and the Rorschach: an application of object relations theory.

This article examines the concept of potential space, developed by Winnicott (1971), and its relevance for Rorschach assessment. I propose that the response process can be viewed as occurring in the potential space between reality and fantasy and that various forms of psychopathology can be conceptualized as forms of the collapse of potential space. I suggest that this model can be of utility in interpreting the Rorschach protocols of a variety of difficult-to-diagnose patients. Examples from the Rorschach of a patient diagnosed with a dissociative disorder are presented to illustrate these points.

Arousal↗
PubMed1993

Motor skill learning in cerebral palsy: movement, action and computer-enhanced therapy.

This chapter discusses the extent to which previous research into movement control can provide key principles on which to model therapy for individuals with severe cerebral palsy. It is suggested that the movement perspective has traditionally stressed the role of implicit knowledge of the dynamic characteristics of the body and that this provides support for the principles of biofeedback training. From a more ecological 'action' perspective, however, it is concluded that previous approaches to biofeedback have been too constrained and do not translate well to functional tasks. A variation of biofeedback training is proposed that provides real-time feedback to shape the subject's action, thereby guiding them through learning contexts that are moulded to fit the individual's capabilities. A pilot study of the efficacy of such an approach in adolescents with cerebral palsy is then presented. The potential of extending computer-enhanced therapy into speculative areas such as virtual reality is also discussed.

Adolescent↗
PubMed1995

Inference processes in obsessive-compulsive disorder: some clinical observations.

In this paper we outline a cognitive model of Obsessive-Compulsive Disorder (OCD) which proposes that the core belief of OCD evolves through a series of illogical inferences. These faulty inference processes involve inferring the plausibility of events on the basis of irrelevant associations, dismissing actual evidence on the grounds of going beyond surface reality to a deeper reality, and finally inferring that a completely fictional narrative is a remote probability. A therapy aimed specifically at changing these inference processes is illustrated with case examples of OCD clients who had not benefited from conventional behavior therapy. The inference based approach (IBA) complements existing cognitive-behavioral therapy but suggests that in certain cases, the conventional cognitive therapy view of OCD beliefs as exaggerated fears of remote possibilities may actually reinforce the obsessional belief since even remote events are real. The IBA on the contrary suggests that an important goal in therapy is to highlight this confusion found in OCD between imagination and reality and illuminate for the OCD client how their compulsions, far from reassuring them about a remote possibility, actually take them further away from reality and reinforce their imaginary doubt.

Adult↗
PubMed2001

Gene therapy for familial hypercholesterolemia.

Current approaches to the treatment of homozygous familial hypercholesterolemia (FH) are not optimal and this disorder remains an excellent candidate for the development of clinical gene therapy. Preclinical proof of principle studies of long-term expression of both the low density lipoprotein (LDL) receptor and the very low density lipoprotein (VLDL) receptor in relevant animal models of homozygous FH demonstrating reduction in both LDL cholesterol and atherosclerosis have been performed. The major rate-limiting step in the development of clinical trials is the development of safe vectors that provide long term expression. Once these vectors are available, effective clinical gene therapy for homozygous FH is likely to become a clinical reality.

Animals↗
PubMed1996

The status of psychic reality in adolescence. An adult female patient's quasi-adolescent material and the analyst's counter transference response.

The author holds that the crisis of adolescence is in fact one of psychic reality, its elements being loss of boundaries, externalisation and the involvement of a third party. In this view, it is essential to conceive of adolescence differently from adulthood, in that, for example, an adolescent's acting out may not be solely a matter of regression but to a considerable extent a consequence of his or her physical development. It is noted that the boundaries between psychic and material reality are fluid throughout life and that adolescents crave identificatory models. The author stresses the importance of the psychic reality of the other in the adolescent's crisis. After considering various views, including those of Freud, on psychic reality and the crises of adolescence, he illustrates his thesis by the clinical example of two adolescent episodes of perversion forming part of an adult female patient's material. In the author's view, these instances of acting out had helped the patient to regain her auto-erotic capacity in the pleasure of fantasy life. He considers that a mutative interpretation must touch upon the primal fantasy and therefore involve the entire person of the analyst in the transference.

Acting Out↗
PubMed1998

Psychopathology and primitive mental states.

The author discusses the psychoanalytic concept of primitive mental states, arguing that normal primitive mental states contain omnipotent fantasies that in an adult would be classified as delusions and hallucinations, but also contain sufficient reality sense to allow the infant to learn through experience that its omnipotent unconscious fantasies are not real, but only ordinary unconscious fantasies. Psychopathology of the type requiring psychoanalytic treatment is connected to persistent unconscious omnipotent fantasies (delusions). It is not the result of a regression to a normal primitive mental state, since in a normal primitive mental state, such delusions and their resultant inhibitions, symptoms and anxieties are gradually and spontaneously overcome through learning from experience. The unconscious delusions related to psychopathology persist because they are insulated from the effects of the learning from experience that would ordinarily convert them into unconscious fantasies by the use of transformations in hallucinosis, reversal of perspective and realistic projective identification by the psychotic part of the personality. Together, these mechanisms distort experience in such a way that reality appears to confirm, not challenge, the delusions, making learning impossible. The theory that psychopathology is due to a regression or fixation to a normal primitive mental state acts as a defence against the awareness that the mental states associated with current psychopathology are not like normal primitive ones, and that they differ from normal primitive mental states by containing forces that are sufficiently destructive of learning from experience to have prevented the patient's mental state from evolving in a normal fashion.

Adult↗
PubMed1995

The loss of the sense of reality in incest and child sexual abuse: a psychoanalytic perspective.

This article takes a psychoanalytic perspective on incest and child sexual abuse. It concentrates on what could be called "the loss of the sense of reality" that is experienced by the victim of incest. The position in which a child of five is placed when she is sexually abused by her father is considered; this is followed by detailed material from the analysis of a woman who had an incestuous relationship with her brother. Transference and counter-transference difficulties that arise in work with abused patients are explored. A theoretical explanation of the damaging effects of an incestuous relationship is outlined.

Adolescent↗