Observation Of Doctors Research Articles

A Robust Mutual-Reinforcing Framework for 3D Multi-Modal Medical Image Fusion Based on Visual-Semantic Consistency

This work proposes a robust 3D medical image fusion framework to establish a mutual-reinforcing mechanism between visual fusion and lesion segmentation, achieving their double improvement. Specifically, we explore the consistency between vision and semantics by sharing feature fusion modules. Through the coupled optimization of the visual fusion loss and the lesion segmentation loss, visual-related and semantic-related features will be pulled into the same domain, effectively promoting accuracy improvement in a mutual-reinforcing manner. Further, we establish the robustness guarantees by constructing a two-level refinement constraint in the process of feature extraction and reconstruction. Benefiting from full consideration for common degradations in medical images, our framework can not only provide clear visual fusion results for doctor's observation, but also enhance the defense ability of lesion segmentation against these negatives. Extensive evaluations of visual fusion and lesion segmentation scenarios demonstrate the advantages of our method in terms of accuracy and robustness. Moreover, our proposed framework is generic, which can be well-compatible with existing lesion segmentation algorithms and improve their performance. The code is publicly available at https://github.com/HaoZhang1018/RMR-Fusion.

Autism detection based on multiple time scale model

Objective. Current autism clinical detection relies on doctor observation and filling of clinical scales, which is subjective and prone to misdetection. Existing autism research of functional magnetic resonance imaging (fMRI) over-compresses the time-scale information and has poor generalization ability. This study extracts multiple time scale brain features of fMRI, providing objective detection. Approach. We first use least absolute shrinkage and selection operator to build a sparse network and extract features with a time scale of 1. Then, we use hidden markov model to extract features that describe the dynamic changes of the brain, with a time scale of 2. Additionally, to analyze the features of the potential network activity of autism from a higher time scale, we use long short-term memory to construct an auto-encoder to re-encode the original data and extract the features at a higher time scale, with a time scale of T, and T is the time length of fMRI. We use recursive feature elimination for feature selection for three different time scale features, merge them into multiple time scale features, and finally use one-dimensional convolution neural network for classification. Main results. Compared with well-established models, our method has achieved better results. The accuracy of our method is 76.0%, and the area under the roc curve is 0.83, tested on completely independent data, so our method has better generalization ability. Significance. This research analyzes fMRI sequences from multiple time scale to detect autism, and it also provides a new framework and research ideas for subsequent fMRI analysis.

БЕРЕМЕННОСТЬ И ЭПИЛЕПСИЯ: СОВРЕМЕННЫЙ МЕЖДИСЦИПЛИНАРНЫЙ ПОДХОД К НОЗОЛОГИИ

The article discusses the main approaches to the observation of women with epilepsy, focuses on the feasibility of planning pregnancy, the importance of pregravid preparation, including the comprehensive observation of doctors of related specialties, the competent choice of antiepileptic therapy and the selection of an effective dosage of the drug. According to modern studies, transferring women to monotherapy with the minimum effective dosage significantly reduces the risk of pregnancy complications and the occurrence of congenital malformations of the fetus. The article also indicates that with a comprehensive interdisciplinary approach and adherence to the recommendations of doctors, delivery of women with epilepsy through the vaginal birth canal is not contraindicated, given the compensated condition of the mother and fetus. In the postpartum period, this group of women is recommended to pay due attention to the sleep and wakefulness regimen in order to prevent the occurrence of epileptic seizures. In this connection, the issues of quality and hygiene of sleep in the postpartum period and the influence of sleep and wakefulness on the course of epilepsy remain controversial, therefore our research in these areas continues.

Biological Therapy During COVID-19

There is crucial question on further therapeutic tactics for the management of such patients (within the severe epidemiological situation caused by the pandemic of new coronavirus SARS-CoV-2) due to widespread application of genetically engineered biologic drugs (GEBD)in management of immune mediated inflammatory diseases. This review sums up current data on the pathogenesis of COVID-19 with the development of acute respiratory distress syndrome associated with cytokine release syndrome (cytokine storm). The effects of GEBD on COVID-19 pathogenesis and their role in management of COVID-19 severe forms of are considered. This review presents the latest guidelines of international associations/consensus and observations of doctors of various specialties on the issue of interruption/continuation of GEBD therapy and with further consequence evaluation in case of interruption of biological therapy.

Development of a New-type Nail-fold Microcirculation Imaging Device

At present, there are many problems in the nail-fold microcirculation detection devices, such as huge structure, inconvenience to carry. In addition, due to the patient's body shaking, the video is difficult to keep stable in collecting with the device, which brings great difficulties to the doctor's observation. We develop a small image acquisition device for nail-fold microcirculation based on the principle of SDF imaging principle and liquid lenses technology. An annular lighting device is fixed in front of the optical system, and the overall design of the system is based on the characteristics of human fingers. The device is small, easy to carry and conform to the fingertips. It can focus quickly through a controller. It can also achieve high quality images of the nail-fold microcirculation. This study can promote the usage of nail-fold microcirculation device at the bedside. It's an efficient tool for medical workers to observe the microcirculation of patients.

Group counseling as self-management intervention for former mental health patients: A case study

The aim of the study conducted in order to help and to give exposure for the group members on how to build self-confidence in facing society. Three objectives of the study are 1) to build self- confidence among group members on how to face society, 2) to encourage and to give support in self-motivation towards well-being among group members and 3) to give awareness for the group members that this life needs courage and positive thoughts which are more meaningful. The method of this study was conducted a group counselling session involving six mental health patients who are recovered and still under doctor observation at the Hospital Canselor Tuanku Mukhriz (HCTM), which is under the Day Care Community Psychiatry, Medical Centre and Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM). The findings show that the responsiveness of respondents’ self-management is still lacking as they are still in the process of recovering and monitoring from Psychiatrists and Counsellor Officers at HCTM for time to time.

"Combination Grafting" of Scalp and Body Hair to Enhance the Visual Density of Hair Transplant and Coverage of Higher Grade of Baldness.

Hair transplant is becoming the most common cosmetic procedure across the world with demand for higher density and coverage of baldness. This needs more number of donor hair follicles. Scalp donor has limitations to fulfill the required number of follicles for Norwood Grade VI and VII baldness. The body hair follicles can be used to cover up the deficit.The objective of this study was to observe the use of body hair follicles to increase the visual density and for better coverage for higher grades of baldness as an adjuvant to scalp hair follicles.Materials and Methods:A total of 16 patients were evaluated for the availability of body donor hair, and consent for body hair harvesting was obtained from them. The beard was the first preference and then chest and abdomen hair follicles were used in combination with scalp hair follicles to cover bald area of Norwood grade IV and above baldness. Body hairs were harvested using follicular unit extraction (FUE) technique. Postoperative pictures were taken, and patient satisfaction, doctor’s observation, and global photographic evaluation was carried out.Observations:The patient’s photographs were taken after 4, 8, and 12 months of hair transplant. The results were analyzed on the basis of global photography. The use of body hair with scalp has enhanced the visual density, leaving to better coverage in even higher grades of baldness.

Digital System for the Geriatric Somatic Function Assessment

At present, the somatic function assessment of the elderly mostly depends on the doctor's observation and the scale evaluation, and there isn't the objective and quantitative assessment criteria. In this paper, we design and construct a digital system for the geriatric somatic function assessment, which is based on digital ground, inertial unit, mobile terminal and PC terminal. The gait and balance parameters of the elderly were obtained by the Time Up and Go test and five postures test. Based on the linear regression model of gait and balance parameters, the system was used to evaluate the somatic function of the elderly. The experimental results show that the system not only can accurately distinguish elderly between fall and non-fall, but also has a high correlation between the score of the system and the score of clinical geriatric physical function scale.

Intentional burn injury: Assessment of allegations of self-infliction

This study investigates the question of whether there is evidence that suggests the possibility of self-infliction, or self-infliction by proxy, of burn injury among a group of asylum claimants in the UK who have attributed such injuries to torture, and how such evidence might be assessed. The question arose from the observations of doctors at the UK-based charity Freedom from Torture that increasing numbers of individuals from Sri Lanka who described a history of torture had suffered severe and disfiguring burn injuries from heated metal objects, and the suggestion from asylum decision-makers that in some cases such injuries could have been acquired deliberately by self-infliction or self-infliction by proxy rather than by torture as claimed. This suggestion has not been confined to Sri Lankan cases, but due to the large numbers of Sri Lankan asylum claimants referred to Freedom from Torture in recent years, including many with this type of injury, the case set for this study was drawn from this population. As many of these injuries are found to be on the back, where self-infliction would be extremely difficult, the possibility of self-infliction by proxy was specifically investigated.An observational data set was examined in detail, comprising medico-legal reports for Sri Lankans with heated metal object burn injuries documented in 2011–14 by the Medico-Legal Reports Service at Freedom from Torture. All had described detention in Sri Lanka since the end of the civil war in 2009. The study reviewed the documented evidence of these injuries alongside other physical and psychological evidence attributed to torture and relevant contextual factors documented in each case. Findings were compared with previous research on torture in Sri Lanka and patterns of injury identified in forensic medicine for both self-infliction and self-infliction by proxy. Thorough examination of the evidence found no indication in this data set to suggest the possibility of self-infliction or self-infliction by proxy and supported the view that, as indicated in the Istanbul Protocol, the overall conclusion on likelihood of torture should be made on evaluation of all the physical and psychological evidence over and above the scrutiny of an individual lesion.

SALIVARY THE LEVEL OF PROINFLAMMATORY CYTOKINES IN CHILDREN WITH AUTOIMMUNE DIABETES MELLITUS IN DIFFERENT PHASES OF COMPENSATION ENDOCRINOPATHY

Aim. To assess the dynamics of the level of proinflammatory cytokines and their receptors in mixed saliva in patients with autoimmune diabetes mellitus during the period of the occlusal occlusion at various stages of disease compensation and to determine the possibility of applying these values in the early diagnosis and control of the effectiveness of endocrinopathy. Materials and methods. The material of laboratory-diagnostic and clinical studies was the results of examination of 93 children during the period of the change of occlusion, which were divided into two groups. The comparison group consisted of children without endocrine pathology. The main group consisted of children diagnosed with type 1 diabetes mellitus, which were divided into two subgroups depending on the degree of endocrinopathy compensation. The level of pro-inflammatory cytokines and their receptors in the unstimulated oral liquid was carried out by the solid-phase enzyme-linked immunosorbent assay using the «Vector-Best»» and «Cytokine» reagent kits. Results. With the compensated form of autoimmune diabetes mellitus, there is an overregulation of regulatory mechanisms with an imbalance in the level of soluble receptors initiating the realization of the proinflammatory properties of these cytokines. The decompensated form of autoimmune diabetes is caused by an absolute increase in virtually all pro-inflammatory cytokines in the oral fluid, with an even more pronounced imbalance in their soluble receptors. Conclusion. In parallel with the therapeutic measures concerning the underlying disease in children with autoimmune diabetes mellitus the expediency of conducting a comprehensive dental examination with subsequent medical observation of doctors of a stomatology profile. In connection with a direct correlation be-tween the degree of activity of caries process and increase the severity of endocrinopathy, treatment and preventive measures in children with autoimmune diabetes should be regularly monitored and conducted with utmost care.

Impact of an education session on clinical handover between medical shifts in an emergency department: A pilot study.

To evaluate the impact of a medical education session on the implementation of a new change of shift medical clinical handover format in an urban hospital ED. This pilot study used a pre- and post-intervention design. The intervention consisted of a 1 h education session to teach a new handover format, SBARM (Situation, Background, Assessment, Recommendation, Medication). Data were collected through observations of doctors performing clinical handover and individual interviews with participants. The educational intervention led to an increased focus on checking medication charts, but had minimal effect on changing other aspects of clinical handover at doctors' change of shift times. Perceived increased time spent on handover using the new system was seen as a major barrier to the implementation of SBARM. The addition of 'M' to 'SBAR' heightened awareness of checking medication and fluid charts. Time pressures need to be taken into consideration when introducing changes to current processes. Also, it is recommended that, in addition to ongoing education, senior clinicians are engaged during the planning and execution stages of changes to practice.

A clínica do corpo sem boca

Resumo Este estudo buscou analisar a abordagem do território bucal feita por profissionais e estudantes da área médica durante consultas clínicas em uma Unidade Básica de Saúde, do município de São Paulo, e pode ser classificado como uma pesquisa de abordagem qualitativa, em que os dados foram derivados da observação participante das atividades clínicas de médicos e estudantes de medicina em uma Unidade Básica de Saúde do município de São Paulo. Os dados foram coletados por duas pesquisadoras, ao longo de quatro meses de imersão, e analisados por hermenêutica-dialética. Foi possível compreender a propedêutica clínica na área médica e perceber a centralidade de tecnologias-duras e ‘prescrições’ na abordagem clínica, em detrimento da centralidade do sujeito. Além disso, estudantes de medicina demonstraram desconhecimento da organização do serviço, revelando um descompasso entre formação e trabalho. Nas diferentes clínicas, mesmo quando havia inspeção da cavidade bucal, não houve o estabelecimento de conexões entre achados e sintomas apresentados pelos pacientes. A ‘experienciação’ das clínicas na Unidade Básica revelou a visão centrada no que “sobra do corpo” ao retirar a boca. Ou seja, a desconexão corpo-boca é reforçada também na área médica.

Electronic Health Records and Clinical Routines: Convergence and Divergence

The article is based on the preliminary results of author’s current study of the implementation of electronic health records in one of Russian outpatient clinics. Interviews with doctors, developers, managers of the State Department of Healthcare, IT-specialists, and clinic’s head, as well as observations of doctors’ everyday work, show that one of the key problems in the transition from paper to electronic record-keeping is how new information system transforms (or fails to transform) doctors’ routine, habitual activities. The article suggests that the widespread view of habitual action as an action in accordance with a preliminary scheme – a view that forms a basis for the majority of medical information systems – does not describe the actual structure of healthcare activities. The analysis of how doctors perceive and use electronic health records in their daily practice demonstrates that a situational approach to routine actions is more adequate. For example, the use of so-called “templates” that are created by doctors within the electronic health records cannot be understood without reference to the situational context of professional activities. Doctors, creating and using various “templates,” do this in such ways that allow them to make these health records circumstantially understandable. The view of routine activities as situated, concerted achievements not only proves the possibility of a new approach to the description of habitual actions’ role and place in the structure of social action, but can be important for the design and evaluation of professional information systems.

Developing ideas of professionalism

Professionalism is widely acknowledged as being central to medical practice, and is taught at most UK medical schools. The impact of this teaching in the context of competing influences on a student's developing view of themselves as professional is, however, unclear. We explored the understanding of professionalism in third-year medical students who have recently completed this element of their formal teaching, and related this understanding to previously unexplored wider influences placed upon them during their development. A questionnaire consisting of two closed questions and two open questions was distributed via e-mail to third-year students at Imperial College School of Medicine, London. The closed questions explored both beliefs about what constitutes medical professionalism and preferences for the teaching of professionalism. The open questions explored the contexts within which students believed their understanding of professionalism was derived. Content analysis of text-based questions was performed. The most commonly cited aspects of professionalism by students in this study were confidentiality, good medical knowledge and practical skill. Students also cited promptness, hygiene and appearance as being important, although these factors are rarely cited in the literature. Students cited role models, the media and parents as the three most important influences on their view of professionalism. These merit further consideration in future research and course design. Most students agreed that professionalism should be taught at medical school, but that this would be best achieved within a clinical setting. The favoured model for acquisition of views on professionalism was observation of doctors rather than formal teaching.

ÉTICA Y HUMANISMO EN LA FORMACIÓN MÉDICA

The claim to emphasize the ethic and humanistic axes of the medical education in the XXI st century leans not only on the repeated observation of doctors' professional misconducts, but also on the System of Health Care's inequities which often violate the patients' rights and arise society's complaints. A serious effort must be done to improve the ethic and humanistic medical training which must be inserted in an adequate theory of man's moral development, and start from a critical reflection about the requests that underlie that training, the professors and the procedures and sceneries that are employed to reach that aim.

Proposed mechanisms and treatment strategies for motion sickness disorder: a case series

Objective To present an overview of symptomatic motion sickness disorder and to propose allopathic and chiropractic approaches for treatment. Clinical Features Three representative cases are presented involving patients with motion sickness. All 3 patients had suffered from this condition throughout their lives. A discussion of the hypothesis of sensory conflict as a causative factor in cases of motion sickness is offered. Intervention and Outcome Following methods founded in applied kinesiology and using spinal and cranial manipulative treatment, the patients were able to travel long distances without nausea, sickness, or dizziness. The evaluation of these patients' responses to treatment was determined by the doctor's observation, the patients' subjective description of symptoms while riding in a motor vehicle, a visual analog scale for neck and associated pain, and applied kinesiology chiropractic physical assessment tools. Conclusion Further studies into chiropractic manipulative treatments for sensory conflict and proprioceptive dysfunctions associated with the problem of motion sickness are indicated. The hypothesis of sensory conflict as the cause of motion sickness should be explored more fully by other chiropractic physicians and researchers.

Upper cervical chiropractic management of a patient with Parkinson's disease: A case report

Objective: To discuss the use of upper cervical chiropractic management in managing a single patient with Parkinson's disease and to describe the clinical picture of the disease. Clinical Features: A 60-year-old man was diagnosed with Parkinson's disease at age 53 after a twitch developed in his left fifth finger. He later developed rigidity in his left leg, body tremor, slurring of speech, and memory loss among other findings. Intervention and Outcome: This subject was managed with upper cervical chiropractic care for 9 months. Analysis of precision upper cervical radiographs determined upper cervical mis-alignment. Neurophysiology was monitored with paraspinal digital infrared imaging. This patient was placed on a specially designed knee-chest table for adjustment, which was delivered by hand to the first cervical vertebrae, according to radiographic findings. Evaluation of Parkinson's symptoms occurred by doctor's observation, the patient's subjective description of symptoms, and use of the Unified Parkinson's Disease Rating Scale. Reevaluations demonstrated a marked improvement in both subjective and objective findings. Conclusion: Upper cervical chiropractic care aided by cervical radiographs and thermal imaging had a successful outcome for a patient with Parkinson's disease. Further investigation into upper cervical injury as a contributing factor to Parkinson's disease should be considered. (J Manipulative Physiol Ther 2000;23:573-7)

Johnny Ransom's Imagination

Johnny Ransom's Imagination William Marvel In 188 1, when John Ransom released the first edition ofwhat he claimed was his diary ofprisonlifeintheConfederacy, heinsisted thathehadbeen"induced" to do so, both by his friends and by his own impulse. He devoted two of the four paragraphs in his introduction to assurances of the book's truthfulness, while a third paragraph explained that the original volumes of his journal had been consumed in a fire after the war: he had previously serialized the diary in his hometown newspaper, he told his readers, and through that extraordinary good fortune he was able to present his daily entries with "little change."1 About the time that Ransom would have started putting his manuscript together, John McElroy's memoir ofprison Ufe had begun to find an enthusiastic and lucrative market, and McElroy's success may have been what caused Ransom's friends to advise the publication ofhis own book, if, indeed, any such friends so advised him. At least one historian and one bibliographer have deduced that Ransom's own motive may have been to aid the cause of former prisoners who sought pensions for their suffering—a fairly simple deduction, considering that the first edition ofhis book carried the text of a congressional bill intended to provide pensions for ex-prisoners. What no one seems to have recognized is that such altruism may have had a more mercenary touch. Ransom produced the book in the middle of his own search for a pension, which dragged along without resolution for an unusual twenty-nine months: he filed his claim in the autumn of 1879 and published his book himself in the summer of 1881. Only in March of 1882—after both his and McElroy's books had rekindled public sympathy for the survivors of Andersonville—did the commissioner ofpensions grant Ransom a certificate, largely because he was losing his teeth.2 1 John L. Ransom,AndersonvilleDiary, Escape, andListofthe Dead, withName, Co., Regiment, Date ofDeath, andNo. ofGrave in Cemetery (Auburn, N.Y, 1881), 7. 2 Ibid., 303-4; John McElroy, Andersonville, A Story ofRebel Military Prisons (Toledo: D. R. Locke, 1879); Ovid L. Futch, History ofAndersonville Prison (Gainesville: Univ. ofFlorida Press, 1968). 137; Allan Nevins, James I. Robertson, Jr., and Bell I. Wiley, eds., Civil War Books: A Critical Bibliography, 2 vols. (Baton Rouge: Louisiana State Univ. Press, 1967), 1:200; original application and pension certificate #203948, John L. Ransom pension file, RG 15, National Civil War History, Vol. xu. No. 3 O 1995 by The Kent State University Press l82CIVIL WAR HISTORY The surgeon who examined the former Michigan cavalryman on February 8, 1882, attributed the loss of Ransom's six upper teeth to scurvy, which the applicant had suffered seventeen years before. Despite one doctor's observation that Ransom's health had suffered so that he was beyond hope of full recovery, the missing teeth formed the foundation ofhis claim; as his other teeth fell out, or were pulled out, he applied for increases to his pension, which were all granted on the same assumption that scurvy still affected him. Felicitously, Ransom's published diary offers much confirmation of his bout with the disease , starting with his first recognition ofthe symptoms on April 14, 1864.3 At that point Ransom had been a prisoner for five months. It was physically possible that he suffered early signs ofscurvy, but ifhe did so he was one ofthe first prisoners at Andersonville to come down with it, not to mention one of the first to diagnose the disease correctly. Even among the longest-held prisoners, scurvy did not begin to take firm hold until July, yet Ransom complained of swollen legs and sore gums as early as May 29, and he mentioned the worsening symptoms frequently thereafter.4 It is difficult to ignore the suspicion that he doctored his diary entries to satisfy the demands of the pension department, especially in light ofthe diary's other inconsistencies. Notwithstanding the author's protests of his own veracity and his assertion that the published diary closely paralleled the alleged original, the verifiable elements of Ransom's book demonstrate that it was not the product of an 1864 journal at...