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PubMed1980

Individual breathing reactions measured in hemoglobin by hydrogen exchange methods.

Protein hydrogen exchange is generally believed to register some aspects of internal protein dynamics, but the kind of motion at work is not clear. Experiments are being done to identify the determinants of protein hydrogen exchange and to distinguish between local unfolding and accessibility-penetration mechanisms. Results with small molecules, polynucleotides, and proteins demonstrate that solvent accessibility is by no means sufficient for fast exchange. H-exchange slowing is quite generally connected with intramolecular H-bonding, and the exchange process depends pivotally on transient H-bond cleavage. At least in alpha-helical structures, the cooperative aspect of H-bond cleavage must be expressed in local unfolding reactions. Results obtained by use of a difference hydrogen exchange method appear to provide a direct measurement of transient, cooperative, local unfolding reactions in hemoglobin. The reality of these supposed coherent breathing units is being tested by using the difference H-exchange approach to tritium label the units one at a time and then attempting to locate the tritium by fragmenting the protein, separating the fragments, and testing them for label. Early results demonstrate the feasibility of this approach.

Deuterium↗

PubMed2006

Muscular proprioception contributes to the control of interceptive actions.

The authors proposed a model of the control of interceptive action over a ground plane (Chardenon, Montagne, Laurent, & Bootsma, 2004). This model is based on the cancellation of the rate of change of the angle between the current position of the target and the direction of displacement (i.e., the bearing angle). While several sources of visual information specify this angle, the contribution of proprioceptive information has not been directly tested. In this study, the authors used a virtual reality setup to study the role of proprioception when intercepting a moving target. In a series of experiments, the authors manipulated proprioceptive information by using the tendon vibration paradigm. The results revealed that proprioception is crucial not only to locate a moving target with respect to the body but also, and more importantly, to produce online displacement velocity changes to intercept a moving target. These findings emphasize the importance of proprioception in the control of interceptive action and illustrate the relevance of our model to account for the regulations produced by the participants.

Adult↗

PubMed1993

The role of genetic screening in the management of hereditary malignancy.

The identification of closely linked markers for several genetic syndromes has resulted in the routine identification of gene carriers for these disorders before the development of disease manifestations. The experiences with the multiple endocrine neoplasia syndromes, multiple endocrine neoplasia type 2 in particular, provide one example of how genetic testing can be combined with ongoing screening, treatment and support mechanisms to help families cope with the treatment realities and the psychosocial aspects of genetic disease.

Genetic Testing↗

PubMed1999

The interactive surrogate travel system.

The Interactive Surrogate Travel (IST) system is based on the super-miniaturized system of virtual technology, Cave Automatic Virtual Environment (CAVE). Using bilateral virtual reality (VR-to-VR) communications, IST enables the testing of subjects via interactive communications. It appears that IST will find practical applications in the near future. We examined the utility of IST in medical treatment and psychiatric tests. Psychiatric symptoms reflect human pathos, which in turn are greatly influenced by culture. If these culture-bound symptoms can be adequately communicated between providers and clients of different cultures, we can develop effective telepsychiatric services across different societies and cultures. IST requires high-speed transmission and gigabyte circuits. A pilot project tested the utility of IST (through the use of optical fiber communications on earth) as a basis for experiments via the Gigabit satellite, to be launched in the year 2002.

Culture↗

PubMedDate not supplied

Computer-aided surgical planning for implantation of hearing aids based on CT data in a VR environment.

A study was undertaken to assess the feasibility of a preoperative fitting test for an implantable hearing aid in a virtual reality (VR) environment. High-resolution spiral computed tomography (CT) of the mastoid bone was performed, and the results of a mastoidectomy were simulated with manual segmentation on a standard medical workstation. CT was also performed on a temporal bone specimen obtained at real mastoidectomy, and the bone margins were segmented automatically with threshold-based techniques. A triangulated surface representation of the bone structures including the mastoid cavity was generated. These data as well as the computer-aided design (CAD) files of the medical devices were transferred into a VR environment. The CAD components of the hearing aid were manipulated to simulate the surgical implantation procedure. Merging CAD data of an implantable hearing aid with CT data of the temporal bone in a VR environment was shown to be a feasible method of providing three-dimensional information for the presurgical determination of fit and mountability. Advances in hardware and software are expected to improve the usability of this method. Although clinical studies are needed, these results may serve as an impetus for exploring the use of low-cost, widely available VR computer equipment in a potentially broad field of clinical applications.

Cochlear Implants↗

PubMedDate not supplied

Interventions to improve diabetes self-management: utility and relevance for practice.

PURPOSE: The purpose of this study was to review publications of research on diabetes self-management interventions and assess whether the interventions are relevant for practice. METHODS: A content analysis was performed on research reports published between 1993 and 2004 of interventions designed to improve patients' diabetes self-management. Information was abstracted relevant to the intervention's generalizability to other settings and its compatibility and feasibility in practice. RESULTS: Publications included only limited information relevant to an intervention's generalizability across populations and settings. Many of the interventions tested were not designed to be compatible with the realities of current practice or to be delivered in the settings in which most diabetes care is provided. Many of the interventions were very complex, requiring multiple delivery modes and contacts, proactive scheduling, and coordination across disciplines. CONCLUSIONS: In view of the prevalence of diabetes, it is critical that effective self-management interventions be adopted and implemented. Interventions need to be designed so that their findings have greater relevance and utility for practice and can be generalized across practice settings.

Diabetes Mellitus↗

PubMed1989

Learning from the past, improving upon the present: traditional and western medical systems at the juncture.

Each cultural group has a reality which consists of a formal multi-centuried tested system of beliefs and practices. That system potentially inhibits or facilitate the acceptance of newly introduced technology and ideas. Among the critical beliefs and practices are those related to health and well-being. This article compares and contrasts "western" and "traditional" medical systems located both in the United States and other parts of the world. It discusses health and policy related postures concerning the "traditional medical system" taken by several countries and organizations. It, further, provides an overview of some current trends related to the recognition and acknowledged value of traditional medicine world-wide.

Attitude to Health↗

PubMed2005

The VREST learning environment.

The VREST learning environment is an integrated architecture to improve the education of health care professionals. It is a combination of a learning, content and assessment management system based on virtual reality. The generic architecture is now being build and tested around the Lichtenstein protocol for hernia inguinalis repair.

Computer Simulation↗

PubMed2006

[Those who cannot remember the past are condemned to repeat it].

To the casual observer, the history of medicine seems one of continuous progress. In reality, for every therapeutic accomplishment that has withstood the test of time there have been several ineffective or even harmful treatments that are now forgotten; yet they were based on theories regarded as plausible at the time. Examples abound, also in the archives of the Dutch Journal of Medicine: treatments for poliomyelitis and sciatica provide striking illustrations. Even in the current era of controlled trials and meta-analyses, physicians need to be reminded that a logical theory in itself does not justify treatment decisions unless it is supported by experimental evidence. The essential difference between mainstream medicine and complementary medicine is not the plausibility of the underlying theories but the rigour in testing hypotheses. On the other hand, many decisions in medicine must be made without sufficient evidence. Logic is indispensable but should be part of an empirical cycle in which new thoughts lead to new experiments and vice versa.

Evidence-Based Medicine↗

PubMed1989

Use of the concept of subjective probability in undergraduate training in differential diagnosing.

In teaching clinical problem solving the probabilistic component should be emphasized. In the domain of empirical medical knowledge to be utilized in diagnostic strategies the prediction according to clinicians' subjective probabilities is used in medical decision making concerning patient problem definition and diagnosis. Two approaches in teaching differential diagnosing by decision models using short case studies are compared. The first is traditional one with the concept of one "true" diagnosis selected from proposed diagnoses group in a MCQ-test. The second approach reflects more the medical practice reality: the students have to predict quantified subjective probabilities of each diagnosis in a suggested diagnoses group considering all the diagnoses probable and not excluding each other. The advantages of the second procedure are evaluated.

Cohort Studies↗

PubMed1983

Pain relief associated with a religious visitation: a case report.

A 68-year-old black woman tolerated partial colectomy for resection of a carcinoma with minimal postoperative discomfort and without the need of any analgesia. She attributed her positive experience to the presence of protective angels. Psychologic interviews and testing revealed her to be fully in touch with reality. Her experience, as well as those of similar patients reported in the medical literature, has biological, sociocultural, and psychological components. The role of religious belief in the pain experience has received scant attention, but it constitutes a challenging area for future research.

Adenocarcinoma↗

PubMed1997

A method for representing search results in three dimensions.

This paper presents a new method for representing results of an information retrieval search in a three dimensional environment. Aside from the fact that users find 3-D interfaces visually appealing, there are strong practical reasons for developing 3-D representations of search results. Traditional information retrieval systems present results in ordered lists which are difficult to browse, and exclude useful information. The current method employs a multivariate statistical method called Local Latent Semantic Indexing (LLSI) to create meaningful local dimensions in which to view search results. A prototype Internet-ready system is described which utilizes Virtual Reality Modeling Language (VRML) to display search results. Preliminary tests of this system with a small collection of MEDLINE articles are very encouraging.

Computer Graphics↗

PubMed2006

The American Board of Dental Examiners clinical dental licensure examination: a strategy for evidence-based testing.

The evolution and implementation of a uniform national clinical examination has become a reality under the guidance of the American Board of Dental Examiners (ADEX). The defined purpose of this examination is to provide a defensible construct that assesses the critical clinical competencies of dental and dental hygiene candidates that will differentiate between competent and incompetent entry-level practitioners. The author includes a discussion of validity evidence that will be gathered by ADEX in order to support the decisions and interpretations made concerning competency and the agency's claim for validity. Included is a brief discussion of some controversial opinions regarding general validity concerns involving clinical dental licensure exam constructs. The author intends for this manuscript to provide a better appreciation for the science of psychometrics as it is applied to evidence-based testing for entry-level dental and dental hygiene candidates.

Clinical Competence↗

PubMed1981

Impact of sex education on medical students' projections of patients' attitudes.

Although previous studies have indicated that sex education courses in medical school improved students' sexual knowledge and personal sexual attitudes, response bias and lack of control groups led to erroneous interpretations of course effectiveness. Using a modified form of the Sex Knowledge and Attitude Test (SKAT), the sexual attitudes and knowledge of sophomores were tested before and after a medical school sex education course, with a group of senior students who had not had the course as a control group. The students were asked not only to give their own personal responses to the questions, but to project how they thought a "typical patient" might respond. A group of patients were also given the SKAT test. Postcourse sophomores responded much as the seniors did, and pre-and postcourse sophomores and seniors all erroneously perceived patients as highly conservative sexually. In reality, although patients were somewhat more conservative than students on several dimensions of the test, their conservativeness was neither as pervasive nor as profound as the students anticipated. Medical students' stereotypes of patients' sexual attitudes were also highly resistant to change.

Adult↗

PubMed1995

Assessing biological age: reality?

This paper is a short critical essay about the value of 'battery tests', to predict the longevity of groups and individuals. It takes a standpoint that there is a long history behind efforts to define the concepts of 'physiological age', and 'chronological age', and their relationships with 'lifespan'. The conclusion is that clinical measurements have little value in defining biological age and lifespan. These latter are the outcomes of uncorrected molecular errors which are far removed in time and place from their clinical expressions.

Aging↗

PubMed2001

[In-hospital accidental falls: a reality].

OBJECTIVE: To describe the patients who suffer falls in our center and test the sensibility of risk factors currently defined in order to correctly identify them and apply corrective measures. MATERIALS AND METHODS: We studied the falls which occurred between March 1996and May 1998. The authors analyze the circumstances of the fall as well as the characteristics of those patients who suffered these falls. In the case of patients who suffered more than one fall, we analyzed just the first one. RESULTS: The 12,894 patients registered in this hospital during that time period suffered 192 falls, involving 171 patients. The risk increases with age. The majority occurred in patients who are registered for rehabilitation after having a vascular cerebral acccident. CONCLUSIONS: the defined risk factors are sufficient enough to identify patients at risk, but we should include rehabilitation patients as such. The quantity of countermeasures installed to prevent falls and their high degree of announcement contrasts with the poor identification of those patients considered at risk; we should modify this system of identification. It is necessary to include relatives in the prevention of falls. This information shall be divulged to the all other hospital sections.

Accident Prevention↗

PubMed1983

[Serotoninergic depression--hypothesis or reality?].

Could we use the term "serotoninergic depression"? To answer this question various tests that seem to confirm the serotoninergic hypothesis of depression are described and their respective value ascertained. The measure of 5 HIAA (5 hydroxy indole acetic acid) in the cerebrospinal fluid has made it possible to isolate a population of depressed people with a low rate of this main metabolite of serotonin. This test seems to be linked with the frequency and the severity of attempts to commit suicide. The tryptophane, the direct serotonin's precursor, is reduced among some depressed people, for whom it could be used as a therapy. Blood platelet is used as a peripheral model of serotoninergic neuron; present research highlight among depressed people, decrease of serotonin uptake, of binding of tritiated imipramine, of monoamine oxidase, and of serum serotonin levels. Results analysis has been made difficult because of a lack of homogeneous methodologies: classification systems of depressions differ and the composition of test groups do not take into account physiological factors. In spite of these difficulties, we can try to describe the "serotoninergic depression" and consider this notion as a model for research.

Blood Platelets↗

PubMed2004

Virtual reality neurosurgery: a simulator blueprint.

OBJECTIVE: This article details preliminary studies undertaken to integrate the most relevant advancements across multiple disciplines in an effort to construct a highly realistic neurosurgical simulator based on a distributed computer architecture. Techniques based on modified computational modeling paradigms incorporating finite element analysis are presented, as are current and projected efforts directed toward the implementation of a novel bidirectional haptic device. METHODS: Patient-specific data derived from noninvasive magnetic resonance imaging sequences are used to construct a computational model of the surgical region of interest. Magnetic resonance images of the brain may be coregistered with those obtained from magnetic resonance angiography, magnetic resonance venography, and diffusion tensor imaging to formulate models of varying anatomic complexity. RESULTS: The majority of the computational burden is encountered in the presimulation reduction of the computational model and allows realization of the required threshold rates for the accurate and realistic representation of real-time visual animations. CONCLUSION: Intracranial neurosurgical procedures offer an ideal testing site for the development of a totally immersive virtual reality surgical simulator when compared with the simulations required in other surgical subspecialties. The material properties of the brain as well as the typically small volumes of tissue exposed in the surgical field, coupled with techniques and strategies to minimize computational demands, provide unique opportunities for the development of such a simulator. Incorporation of real-time haptic and visual feedback is approached here and likely will be accomplished soon.

Computer Simulation↗