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PubMed1990

[Jellinek's developmental stages and their reality under our sociocultural conditions].

In a group of 250 hospitalized male patients with the diagnosis 303 the author tested the aptness of Jellinek's developmental stages of alcoholism which are widely used in Czechoslovak alcohology. It was demonstrated that the developmental stages are not integrated developmental stages, that they lack the necessary compactness in the chronological sequence and in the frequency of individual phenomena. Loss of control (8) in the reported form is closer to the onset of development and the frequency of palimpsests (7) develops later, usually is overlaps with prolonged drunkedness (31). At the onset of development dominates "non-adaptive" drinking evaluated frequently as loss of control and in the more advanced stage the constant incidence of palimpsests causes frequent intoxication and declining tolerance. Among individual phenomena the following are important: in stage I regular contact with the drug (04) and increased tolerance (05), in stage II secret drinking (2) and frequency of palimpsests (7), in stage III signs derived mostly from rationalization and alcohol-centered behaviour and finally in stage IV impaired thinking (33), reduced tolerance (37) and possible ethic degradation (32). As to different developmental stages the chronic stage sounds most convincing.

Adult↗
PubMed2004

Comparing stress testing methods. Available techniques and their use in CAD evaluation.

Exercise stress testing remains one of the most widely used techniques in assessing functional capacity and in confirming a diagnosis of CAD. Its sensitivity and specificity are approximately 63% and 74%, respectively. The technique is safe when administered and supervised by qualified personnel who are trained to recognize contraindications and other reasons for termination of the test. More recently, echocardiography has been combined with exercise stress testing. It is a well-tolerated and valuable procedure for noninvasive evaluation of CAD. The sensitivity and specificity of stress echocardiography are higher than those of exercise stress testing and comparable to those of nuclear perfusion imaging. Continuing improvements in digital image analysis, cost, and the availability of contrast agents promise to make noninvasive stress testing even more useful in the years to come. Newer contrast and concomitant perfusion agents are on the horizon and may prove to be a reality in the echocardiographic laboratories of the future.

Clinical Protocols↗
PubMedDate not supplied

[FAB: a preliminar Spanish application of the frontal assessment battery to 11 groups of patients].

INTRODUCTION: We consider in this paper the applicability of the FAB in Spain, a battery at bedside devised to assess frontal lobe function and able to identify a dysexecutive syndrome, which takes few minutes to administer, and useful for neuropsychological diagnosis in diseases involving frontal lobe dysfunctions. PATIENTS AND METHODS: We study dual application of FAB and Folstein s MMSE to 195 subjects belonging to 11 subgroups (controls, neurodegenerative disorders and psychiatric conditions), and they were related to: cortical/subcortical normality, cortical/subcortical cognitive impairment, or cortical/subcortical dementia. STATISTICS: mean, standard deviation, U test (p< 0.05) and Pearson s correlation index. CONCLUSIONS: Data suggest FAB reflects in Spanish environment the reality of frontosubcortical deterioration in studied groups. FAB and MMSE showed a variable grade of positive lineal correlation in different diseases.

Adult↗
PubMed2006

Application of virtual reality graphics in assessment of concussion.

Abnormal balance in individuals suffering from traumatic brain injury (TBI) has been documented in numerous recent studies. However, specific mechanisms causing balance deficits have not been systematically examined. This paper demonstrated the destabilizing effect of visual field motion, induced by virtual reality graphics in concussed individuals but not in normal controls. Fifty five student-athletes at risk for concussion participated in this study prior to injury and 10 of these subjects who suffered MTBI were tested again on day 3, day 10, and day 30 after the incident. Postural responses to visual field motion were recorded using a virtual reality (VR) environment in conjunction with balance (AMTI force plate) and motion tracking (Flock of Birds) technologies. Two experimental conditions were introduced where subjects passively viewed VR scenes or actively manipulated the visual field motion. Long-lasting destabilizing effects of visual field motion were revealed, although subjects were asymptomatic when standard balance tests were introduced. The findings demonstrate that advanced VR technology may detect residual symptoms of concussion at least 30 days post-injury.

Adolescent↗
PubMed1983

Painful truths about depressives' cognitions.

Cognitive theories assert that depressed persons' cognitions are distorted. Most of the empirical literature directly contradicts this assertion. Using a wide variety of methods to study a wide variety of cognitive processes, experiments consistently find that depressed people suffer significantly less cognitive distortion than do both normals and nondepressed psychiatric patients. It was speculated that childhood traumas predispose depression by preventing the normal formation of a defensive screen against painful realities.

Cognition Disorders↗
PubMedDate not supplied

Realities of diagnosing Helicobacter pylori infection in clinical practice: a case for non-invasive indirect methodologies.

BACKGROUND: The current, arbitrarily defined gold standard for the diagnosis of H. pylori infection requires histologic examination of two specially stained antral biopsy specimens. However, routine histology is potentially limited in general clinical practice by both sampling and observer error. The current study was designed to examine the diagnostic performance of invasive and non-invasive H. pylori detection methods that would likely be available in general clinical practice. METHODS: The diagnostic performance of rotating clinical pathology faculty using thiazine staining was compared with that of an expert gastrointestinal pathologist in 38 patients. In situ hybridization stains of adjacent biopsy cuts were also examined by the expert pathologist for further comparison. Receiver operator characteristic (ROC) analysis was performed to evaluate whether the diagnostic performance of the expert pathologist differed depending upon the histologic method employed. A similar analysis was made to evaluate the diagnostic performance of pathology trainees relative to the expert. In the absence of an established invasive gold standard, non-invasive testing methods (rapid serum antibodies, formal Elisa antibodies and carbon-14 urea breath testing) were evaluated in 74 patients by comparison with a gold standard defined using a combination of diagnostic tests. RESULTS: Using either rapid urease testing of biopsy specimens or urea breath testing as the gold standard for comparison, the diagnostic performance of the rotating clinical pathology faculty was inferior to that of the expert gastrointestinal pathologist especially with regard to specificity (e.g., 69 percent for the former versus 88 percent, with the latter relative to rapid urease testing). Although interpretation of in situ hybridization staining by the expert appeared to have an even higher specificity, ROC analysis failed to show a difference. The mean ROC areas for thiazine and in situ hybridization staining for trainee pathologists relative to the expert were 0.88 and 0.94, respectively. In untreated patients, urea breath testing had a sensitivity and specificity of 100 percent as compared with thiazine staining with a sensitivity of 83 percent and a specificity of 97 percent. Post-therapy, breath testing had a sensitivity of 100 percent but a specificity of only 86 percent as compared with invasive testing with a sensitivity and specificity of 100 percent. Rapid serum antibody testing and formal Elisa antibody testing agreed in 93 percent of cases (Kappa 0.78) with the rapid test being correct in three of the four disagreements. CONCLUSIONS: The current study illustrates a number of realities regarding H. pylori diagnosis. There is no diagnostic gold standard in general clinical practice. Accurate interpretation of specially stained slides is a learned activity with a tendency towards overdiagnosis early on. Urea breath testing is likely to be the diagnostic method of choice for untreated patients in general clinical practice although antibody testing is almost as accurate. Rapid antibody tests are at least as accurate as formal Elisa antibody tests. Urea breath testing is useful for confirming cure after therapy, but false-positive results may occur in some patients.

Biopsy↗
PubMed1999

Virtual reality training in laparoscopic surgery: a preliminary assessment of minimally invasive surgical trainer virtual reality (MIST VR).

BACKGROUND: The "fulcrum effect" of the body wall on surgical instrument manipulation is a major hurdle for novice endoscopic surgeons. Virtual reality training has not previously been evaluated as a means to overcome this problem. MATERIALS AND METHODS: 16 participants with no experience of endoscopy were required to make multiple defined incisions under laparoscopic laboratory conditions within 2-minute periods. Half of the subjects were randomized to receive initial training on the Minimally Invasive Surgical Trainer, Virtual Reality (MIST VR) computer programme. RESULTS: Participants with MIST VR training made significantly more correct incisions (P = 0.0001) than the control group on test trial 1, and even after extended practice by both groups (P = 0.0001). They were also significantly more likely to actively use both hands to perform the endoscopic evaluation task (P = 0.01). CONCLUSIONS: Virtual reality training represents a potential, viable solution for junior endoscopists, for overcoming the "fulcrum effect", in a replicable, safe learning environment which allows objective and reliable quantification of skill levels by trainers.

Adult↗
PubMed1979

[Frequency of bacteriuria in the aged (author's transl)].

1125 inhabitants of 2 homes for aged people were tested for bacteriuria by dip slides. Increasing of age did not lead to higher frequency of bacteriuria, neither in women (n = 869), nor in men (n = 256). The persons were divided in the 4 decades of being 61--70, 71--80, 81--90, and 91--99 years old. The corresponding rates of bacteriuria (greater than or equal to 10(5) germs/ml) were 14.0, 15.0, 12.4, and 9.1%, respectively. The rate of reproducibility was 75.4%, indicating still smaller values in reality. The discrepancies to the much higher values reported in the literature may depend on the people tested: "normal persons" instead of hospital patients or patients' specimens having been sent to a microbiological laboratory.

Age Factors↗
PubMed2003

Immunoinformatics in personalized medicine.

Diagnosis of human disease has been undergoing steady improvement over the past few centuries. Many ailments that were once considered a single entity have been classified into finer categories on the basis of response to therapy (e.g. type I and type II diabetes), inheritance (e.g. familial and non-familial polyposis coli), histology (e.g. small cell and adenocarcinoma of lung) and most recently transcriptional profiling (e.g. leukaemia, lymphoma). The next dimension in this finer categorization appears to be the typing of the patient rather than the disease i.e. disease X in person of type Y. The problem of personalized medicine is to devise tests which predict the type of individual, especially where the type is correlated with response to therapy. Immunology has been at the forefront of personalized medicine for quite a while, even though the term is not often used in this connection. Blood grouping and cross-matching (for blood transfusion), and anaphylaxis test (for penicillin) are just two examples. In this paper I will argue that immunological tests have an important place in the future of personalized medicine. I will describe methods we developed for personalizing vaccines based on MHC allele frequencies in human populations and methods for predicting peptide binding to class I MHC molecules. In conclusion, I will argue that immunological tests, and consequently immunoinformatics, will play a big role in making personalized medicine a reality.

Alleles↗
PubMed2006

The human embryonic stem cell-derived cardiomyocyte as a pharmacological model.

Embryonic stem (ES) cells are specialised cells derived from the early embryo, which are capable of both sustained propagation in the undifferentiated state as well as subsequent differentiation into the majority of cell lineages. Human ES cells are being developed for clinical tissue repair, but a number of problems must be addressed before this becomes a reality. However, they also have potential for translational benefit through its use as a test system for screening pharmaceutical compounds. In the cardiac field, present model systems are not ideal for either screening or basic pharmacological/physiological studies. Cardiomyocytes produced from human ES differentiation have advantages for these purposes over the primary isolated cells or the small number of cell lines available. This review describes the methodology for obtaining cardiomyocytes from human embryonic stem cell-derived cardiomyocyte (hESCM), for increasing the proportion of cardiomyocytes in the preparation and for isolating single embryonic stem cell-derived cardiomyocyte (ESCM) from clusters. Their morphological, contractile and electrophysiological characteristics are compared to mature and immature primary cardiomyocytes. The advantages and disadvantages of the hESCM preparation for long term culture and genetic manipulation are described. Basic pharmacological studies on adrenoceptors and muscarinic receptors in hESCM have been performed, and have given stable and reproducible responses. Prolongation of repolarisation can be detected using hESCM cultured on multielectrode arrays (MEA). Human ESCM have a clear potential to improve model systems available for both basic scientific studies and pharmaceutical screening of cardiac target compounds.

Adrenergic Agonists↗
PubMed2000

The control of human locomotor pointing under restricted informational conditions.

Since a perception-action coupling type of control (Kugler, P.N. and Turvey, M.T., Information, Natural Law, and Self-Assembly of Rhythmic Movements, Erlbaum, Hillsdale, 1987, 481 pp.) continuously operates during locomotor pointing tasks (e.g. long jumping) (Montagne, G., Cornus, S., Glize, D., Quaine, F. and Laurent, M., A 'perception-action coupling' type of control in long-jumping. J. Motor Behav., (2000) in press), the information sources underlying this control have to be dealt with. Under the assumption that subjects use information about the first-order time remaining before they pass the target, we identify in the literature four different sources of information that specify this physical property. Only one of these sources is inevitably present under all possible environmental conditions containing at least a continuously visible target on the floor. This study aimed to test its sufficiency to perform a locomotor pointing task. The use of a virtual reality set-up permitted us to compare locomotor pointing executed with all four information sources or only with the aforementioned one. The likeness found between those two conditions, as far as the pointing performance and the mode of control are concerned, expresses the evoked sufficiency.

Biomechanical Phenomena↗
PubMed1981

Castration fantasies and assertiveness in father-absent males.

In a previous report (Shill 1981), father-absence was linked to insecurity in core male gender identity in a nonclinical sample of college males. The present paper describes further aspects of the experimental use of projective techniques, based on psychoanalytic theory and clinical discussions, to assess the effect of father-absence on male personality development. Castration fantasies and sense of competence in the mastery of external reality as an index of masculine self-representation were coded from the projective test responses of 103 father-present and 28 father-absent college males. When given a choice of castrating figure at the human or animal level, all subjects identified the human mother rather than the father as the more frightening castrating figure. Father-absent subjects, however, identified the animal mother as the more frightening castrating figure, compared to the animal father, more frequently than the father-present subjects, suggesting a denial and displacement of castration fear toward the human mother onto the animal substitute. The father-absent subjects also evidence significantly less sense of mastery, suggesting less self-assertiveness and sense of competence than the father-present controls. The importance of identification with the father as the basis for a masculine ego style and of father absence as a developmental interference affecting the appropriate management of aggression in males is discussed.

Adult↗
PubMed2004

Assessing stroke patients' prospective memory using virtual reality.

There is a dearth of empirical evidence about prospective memory (remembering to perform actions in the future) in stroke patients. A probable reason for this is that it is difficult to perform a realistic and controlled assessment of prospective memory ability in a rehabilitation setting. Virtual reality may provide a solution to this difficulty by allowing prospective memory to be tested in a simulation of a real-life situation whilst retaining a laboratory level of scientific control. This exploratory study assessed the performance of stroke patients and age-matched control participants on event-, time- and activity-based prospective memory retrieval tasks in a personal computer-based virtual environment. Stroke patients were severely impaired at the event- and activity-based tasks compared with age-matched controls, but only marginally impaired at the time-based task. The additional knowledge gained from this form of assessment could direct rehabilitation more effectively towards specific impairments of individual patients.

Aged↗
PubMedDate not supplied

Women as body parts in the era of reproductive and genetic engineering.

Reproductive and genetic engineering are presented by their promoters as miracle cures for people with infertility problems or who are at genetic risk in having their desired healthy child. Focusing on the test-tube baby method (in vitro fertilization), in this article I investigate the medical reality of these technologies and their impact on women's lives as individuals and as members of a social group, women. Specifically, I discuss these developments in a global context and suggest that, in connection with fertility-control methods, they could be used as the ultimate means of population control. I contend that reproductive and genetic engineering dismember, fragment, and dissect women into their body parts and that, in the interests of women with a right to bodily integrity and dignity, they need to be stopped.

Female↗
PubMed2006

The sliced bomab phantom: a new variant for intercomparison.

Previously, this laboratory conceptualized a new phantom for calibration or performance testing of whole body counters using Monte Carlo simulations. This paper describes the physical reality that was created from the Monte Carlo design project and compares its counting efficiency to that of a conventional BOMAB phantom using two whole body counters. In one counter (NaI based) the agreement between the two phantoms was +/-8% and in the second counter (Ge based) the agreement was +/-5% at all the energies measured (126 keV, 661 keV, 1172 keV, 1330 keV). The advantage of the sliced phantom is that the sources are solid, sealed, and cannot leak activity thereby simplifying packing for shipment if the phantom is classified as a Dangerous Good. The new phantom is, therefore, ideal for uses that involve shipment, such as an intercomparison exercise. The phantom is also re-usable as the sources can be changed.

Female↗
PubMed2005

Disease progression: identification of high-risk groups and individuals for periodontitis.

AIMS: While the role of bacteria in the initiation of periodontitis is primary, a range of host-related factors influence the onset, clinical presentation and rate of progression of disease. The objectives of this review are (1) to present evidence for individual predictive factors associated with a patient's susceptibility to progression of periodontitis and (2) to describe the use of prognostic models aimed at identifying high-risk groups and individuals in a clinical setting. METHODS: Relevant publications in the English language were identified after Medline and PubMed database searches. Because of a paucity of longitudinal studies investigating factors including clinical, demographic, environmental, behavioural, psychosocial, genetic, systemic and microbiologic parameters to identify individuals at risk for disease progression, some association studies were also included in this review. FINDINGS AND CONCLUSIONS: Cigarette smoking is a strong predictor of progressive periodontitis, the effect of which is dose related. High levels of specific bacteria have been predictive of progressive periodontitis in some studies but not all. Diabetics with poor glycaemic control have an increased risk for progression of periodontitis. The evidence for the effect of a number of putative factors including interleukin-1 genotype, osteoporosis and psychosocial factors is inconclusive and requires further investigation in prospective longitudinal studies. Specific and sensitive diagnostic tests for the identification of individuals susceptible to disease progression are not yet a reality. While factors assessed independently may not be valuable in predicting risk of future attachment loss, the combination of factors in a multifactorial model may be useful in identifying individuals at risk for disease progression. A number of multifactorial models for risk assessment, at a subject level have been developed but require validation in prospective longitudinal studies.

Alcohol Drinking↗
PubMed1985

The predictive value of diagnostic procedures.

Nurses are in an ideal position to answer clients' questions regarding the necessity of diagnostic tests and clarification of test results. A perfect test would always be positive in the presence of disease and negative in the absence of disease. However, false-negative or false-positive results are a reality and must be considered as the clinician strives for accuracy in diagnostic procedures. Understanding predictive value enables the nurse to discuss the rationale, usefulness and limitations of tests currently used to assess disease, disease activity and to guide therapy.

Clinical Laboratory Techniques↗
PubMed1993

A review of constructivism: understanding and using a relatively new theory.

The purpose of this review paper is to familiarize family medicine educators with a relatively new educational theory, "constructivism." This theory is derived from the philosophical proposition that reality is constructed by the individual. According to the more traditional theory of "objectivism," knowledge exists in the world external to personal experience. Constructivist theory postulates that personal experience cannot be separated from knowledge. In analyzing the literature, the author found that constructivism can be viewed at the cognitive (individual) and social (community) levels. Cognitive constructivism maintains that individuals develop their own models of reality using personal experience and research-based data. Two key elements of cognitive constructivism with implications for family medicine educators are promoting student independence and active learning. Social constructivism maintains that individuals use their membership in a community to continually refine and shape their models of reality. By communicating with each other (for physicians, in the "conversation of medicine"), we test our constructs. Two key elements of social constructivism with implications for application by family medicine educators are promoting collaboration and peer teaching.

Cognition↗