Procedures In Clinical Medicine Research Articles

Submillimeter-scale multimaterial terrestrial robots.

Robots with submillimeter dimensions are of interest for applications that range from tools for minimally invasive surgical procedures in clinical medicine to vehicles for manipulating cells/tissues in biology research. The limited classes of structures and materials that can be used in such robots, however, create challenges in achieving desired performance parameters and modes of operation. Here, we introduce approaches in manufacturing and actuation that address these constraints to enable untethered, terrestrial robots with complex, three-dimensional (3D) geometries and heterogeneous material construction. The manufacturing procedure exploits controlled mechanical buckling to create 3D multimaterial structures in layouts that range from arrays of filaments and origami constructs to biomimetic configurations and others. A balance of forces associated with a one-way shape memory alloy and the elastic resilience of an encapsulating shell provides the basis for reversible deformations of these structures. Modes of locomotion and manipulation span from bending, twisting, and expansion upon global heating to linear/curvilinear crawling, walking, turning, and jumping upon laser-induced local thermal actuation. Photonic structures such as retroreflectors and colorimetric sensing materials support simple forms of wireless monitoring and localization. These collective advances in materials, manufacturing, actuation, and sensing add to a growing body of capabilities in this emerging field of technology.

Analysis of Medical School Term 1-2-3 Students' Communication and Empathy Skills

Giriş: Bir hekim, bir ömür boyu süren kariyeri süresince 160.000 ile 300.000 görüşme gerçekleştirmekte ve tıbbi görüşmeyi klinik tıpta en sık uygulanan prosedür haline getirmektedir. Bu nedenle iletişim ve empati, hastalarla görüşme yaparken istenilen ve geliştirilmesi gereken önemli bir klinik beceridir. Hekim adayları açısından düşünüldüğünde ise iletişim ve empati, öğretilip öğrenilebilen temel bir klinik beceridir. Bu çalışmada amacımız, hekim adaylarının klinik öncesi iletişim ve empati becerilerinin değerlendirilmesi ve demografik değişkenler açısından incelenmesidir. Bu anlamda elde edilen bulguların tıp eğitimi müfredatı açısından ihtiyaç analizi niteliğinde olabileceği düşünülmektedir.Gereç ve Yöntem: Bu araştırma, tanımlayıcı nitelikte olup, evrenini 2017-2018 öğretim yılında Ankara il merkezinde bulunan bir Vakıf Üniversitesinin Tıp Fakültesi Dönem 1, 2 ve 3 öğrencileri oluşturmuş ve çalışmaya katılmayı kabul eden 90 öğrenci ile tamamlanmıştır. Verilerin toplanmasında; Kişisel Bilgi Formu, Ersanlı ve Balcı tarafından geliştirilen İletişim Becerileri Envanteri ve Dökmen tarafından geliştirilen Empati Beceri Ölçeği B-Formu kullanılmıştır.Bulgular: Öğrencilerin % 61,1’i kadın, % 53,3’ü Anadolu Lisesi mezunu, % 93,3’ü çoğunlukla yaşamını il ortamında geçirmiş, % 70’i evde ailesi ile birlikte yaşamakta, % 86,7’si çekirdek aile yapısına sahiptir. Öğrencilerin iletişim beceri toplam puanı, orta düzeyin biraz üzerindeyken; empati beceri toplam puanı ise orta düzeyin altında kalmıştır. Ayrıca kadınların iletişim ve empati beceri puan ortalamasının erkeklere göre daha yüksek olduğu belirlenmiştir.Sonuç: Hekimlerin hastaları ile etkin iletişim kurabilmesi; hekimlerin daha erken ve daha doğru tanı koymasına yardımcı olacak, hastanın kaygısını azaltıp tedavi sürecinde uyumunu ve memnuniyetini artıracaktır. Bu noktada tıp eğitimi müfredatının, söz konusu etkileşimin hekim adaylarında erken dönemde fark edilmesini sağlayacak içerik ve nitelikte olması gerekmektedir.

Cell Free DNA Analysis for Chromosomal Abnormalities among Pregnant Females of Pakistan

The advancement of modern molecular biology techniques has made it possible to detect fetal anomalies beforehand in order to tackle the upcoming situation. However, the idea is to devise the most sensitive screening tools with fewer chances of errors as well as noninvasive methods to diagnose fetal abnormalities. Previously used methods amniocentesis and chorionic villus sampling possess risks for the fetus on the other hand cell free fetal DNA (cffDNA) method is less invasive and reduces the risk to fetus. However, currently most cffDNA screening tests routinely evaluate fetal sex and sex chromosomal aneuploidies while in developed countries analysis of cffDNA is incorporated in high-risk pregnancies to detect the defects and mutations. In Pakistan where the prevalence of birth defect is reported approximately 7% as well as increased consanguineous marriages increase the chance of such defects. Centers in Pakistan offer cffDNA testing but with a hefty cost on the pocket. This review highlights the importance and prospects of exploring the maternal plasma Cell-free DNA (cfDNA) screening in high risk mothers in Pakistan as well as the limitations and strengths of the technique. Since the cffDNA sequencing is a major advancement in genomic medicine that has reduced the invasive procedures in clinical medicine.

Effect of vibration frequency on biopsy needle insertion force

Needle insertion is critical in many clinical medicine procedures, such as biopsy, brachytherapy, and injection therapy. A platform with two degrees of freedom was set up to study the effect of vibration frequency on needle insertion force. The gel phantom deformation at the needle cutting edge and the Voigt model are utilized to develop a dynamic model to explain the relationship between the insertion force and needle-tip velocity. The accuracy of this model was verified by performing needle insertions into phantom gel. The effect of vibration on insertion force can be explained as the vibration increasing the needle-tip velocity and subsequently increasing the insertion force. In a series of needle insertion experiments with different vibration frequencies, the peak forces were selected for comparison to explore the effect of vibration frequency on needle insertion force. The experimental results indicate that the insertion force at 500Hz increases up to 17.9% compared with the force at 50Hz.

Defining a competency map for a practical skill.

In recent years there has been a move towards a competency-based model for assessing the performance of practical procedures in clinical medicine rather than the traditional assumption that competency is achieved with increasing experience. For such an assessment to be valid, the necessary competencies comprising that skill must be identified. Our aim was to map the individual competencies necessary to perform a given procedural skill using spinal anaesthesia as the example, and to explore the relationship of individual competencies with each other. In the first part of the study an extensive hierarchical task analysis (HTA) was undertaken to determine the competencies necessary for the performance of spinal anaesthesia. Secondly, the concept of competency-based knowledge space theory (CbKST) was applied to the map. CbKST is based on the principle that acquisition of a specific skill is usually preceded by a number of dependent or prerequisite skills. Our aim was tomap the individual competencies necessary to perform a given procedural skill The analysis yielded a comprehensive HTA of the skills necessary to perform spinal anaesthesia, comprising 509 individual competencies. Applying the concept of CbKST yielded 194 key competences with at least one dependent or prerequisite skill. We have defined a comprehensive HTA or competency map for use in the assessment of the performance of spinal anaesthesia. This CbKST approach will provide clinicians who undertake medical procedures to better understand their own performance, and to improve over time.

Pro forma: impact on communication skills?

A doctor performs 160 000-300 000 interviews during a lifetime career, thus making the medical interview the most common procedure in clinical medicine. It is reported that 60-80 per cent of diagnosis is based on history taking, yet there is little published data advising on the best method for medical students to initially attain and further refine these core skills during their medical degree. Medical students interviewed two patients: using an open interview first, based on the Calgary-Cambridge approach, and then using a structured pro forma. The students' medical data were assessed by a senior lecturer, and their communication skills were assessed by a behavioural scientist and by the patients. An exact Wilcoxon paired signed rank test was conducted to determine whether there was a difference between the open interview and pro forma methods for history taking and communication skills. The test yielded p-values of 0.0017 and 0.069, respectively, with the pro forma method providing a statistically significantly higher history-taking score and communication score than the open interview method. Subjectively, patients reported the pro forma method as being preferable. Medical students in the early years of training benefit from a structured history-taking pro forma to assist them gather an accurate data set without compromising their interpersonal and communication skills.

Are we underestimating the frequency of malpositioned central venous catheters inserted via the left internal jugular vein? A case report and short review of literature

Abstract Central venous cannulation is a widely used procedure in clinical medicine. Central venous catheters are inserted most often via the internal jugular and subclavian veins. One of the complications is malpositioning of the catheter, and some insertion sites carry a higher risk for that occurrence. We report a case of a malpositioned central venous catheter inserted via the left internal jugular vein in a patient with a ruptured diaphragm. Our objectives were to review the venous anatomy of the chest and the literature reporting malpositioned central venous catheters and to discuss the approach through the left internal jugular vein. Left internal jugular cannulation could carry a higher rate of malposition than reported, and anatomy gives a possible, simple answer. Contrast enhancement, although central venous catheters are radiopaque, is helpful when an approach through the left internal jugular vein is used and difficulties are encountered during insertion.

Burn injury by nuclear magnetic resonance imaging

Nuclear magnetic resonance imaging has become a standard diagnostic procedure in clinical medicine and is well known to have hazards for patients with pacemaker or metallic foreign bodies. Compared to CT, the frequency of MRI examinations is increasing due to the missing exposure of the patients by X-rays. Furthermore, high-field magnetic resonance tomograph (MRT) with 3 T has entered clinical practice, and 7-T systems are installed in multiple scientific institutions. On the other hand, the possibility of burn injuries has been reported only in very few cases. Based on a clinical finding of a burn injury in a 31-year-old male patient during a routine MRI of the lumbar spine with standard protocol, the MR scanner was checked and the examination was simulated in an animal model. The patient received a third-degree burn injury of the skin of the right hand and pelvis in a small region of skin contact. The subsequent control of the MRI scanner indicated no abnormal values for radiofrequency (RF) and power. In the subsequent animal experiment, comparable injuries could only be obtained by high RF power in a microwave stove. It is concluded that ‘tissue loops’ resulting from a contact between hand and pelvis must be avoided. With regard to forensic aspects, the need to inform patients of such a minimal risk can be avoided if the patients are adequately positioned using an isolating material between the hands and pelvis. These facts must be emphasized more in the future, if high-field MRI with stronger RF gradients is available in routine imaging.

Blodtrykksapparater på legekontorer

Blood pressure monitoring is one of the most common procedures in clinical medicine. Evaluation and treatment of hypertension are costly and have considerable implications for the individuals involved. Mercury manometers have been dominant for a century, but are currently being replaced by other types of equipment. No national guidelines/recommendations exist on types of blood pressure monitors to be used. The aim of this study was to assess the types of blood pressure monitors used in Norwegian general practice, and to what extent routines have been established for control and calibration of the equipment. In 2007, a questionnaire was distributed to 65 university-affiliated primary healthcare centres in Mid-Norway. The questions included what type of blood pressure monitors are in use and whether routines exist for calibration of them. 45 healthcare centres with a total of 173 general practitioners (corresponding to 74 % of the doctors) responded. 18 (6 %) of the 320 monitors identified were of the mercury type, the rest were aneroid or oscillometric. Many centres had 24-hour monitors. Two healthcare centres (4 % of the doctors) had established routines for calibration of their blood pressure monitors. Routines should be established for quality assurance of blood pressure monitors in Norwegian primary healthcare services.

Human biome biotechnology and the personalization of odour profiles*

Human biome biotechnology and the personalization of odour profiles*

Development of an auxiliary system for the execution of vascular catheter interventions with a reduced radiological risk; system description and first experimental results

Vascular catheterization is a common procedure in clinical medicine. It is normally performed by a specialist using an X-ray fluoroscopic guide and contrast-media. In the present paper, an image-guided navigation system which indicates a path providing guidance to the desired target inside the vascular tree is described with the aim of reducing the exposure of personnel and patients to X-rays during the catheterization procedure. A 3D model of the patient vascular tree, reconstructed with data collected by an angiography before starting the intervention, is used as a guide map instead of fluoroscopic scans. An accurate spatial correspondence between the body of the patient and the 3D reconstructed vascular model is established and, by means of a position indicator installed over the catheter tip, the real-time position/orientation of the tip is indicated correctly. This paper describes the system and the operational procedures necessary to use the proposed method efficiently during a catheter intervention. Preliminary experimental results on a phantom are also reported.

T regulatory cells as an immunotherapy for transplantation

Advances in immunosuppressive therapies have made tissue and organ transplantation a common procedure in clinical medicine. However, true donor and recipient tolerance is not regularly achieved and almost all transplant recipients continue to require immunosuppressants throughout life, which is associated with side effects of the drugs. The identification and characterisation of regulatory T cells (Tregs) has recently opened up exciting opportunities for new ways of adoptive immunotherapy in transplantation. CD4+CD25+ Tregs of thymic origin have been shown to be key regulators of unseasoned immune responses in mice and in humans, preventing graft-versus-host disease and organ graft rejection in the transplantation setting. Although these cells can be found in the peripheral blood of healthy individuals, their isolation to a satisfying degree of purity is time-consuming and ineffective. Therefore, a variety of different methods to expand or induce regulatory T cells ex vivo have been advocated. Antigen-specific activation of Tregs is a prerequisite for their optimal function, making the design of new strategies to create and expand antigen-specific Tregs highly desirable. This review will focus on recent advances achieved in the field of transplantation tolerance using naturally occurring Tregs (CD4+CD25+), as well as other Tregs, and will discuss future applications of these cells in immunotherapy.

Biopsy procedures in clinical medicine. Edited by A. E. Read, M.D., F.R.C.P., Reader in Medicine, University of Bristol. 8×5½ in. Pp. 196+xii, with 45 illustrations. 1968. Bristol: John Wright & Sons Ltd. 40s

Biopsy procedures in clinical medicine. Edited by A. E. Read, M.D., F.R.C.P., Reader in Medicine, University of Bristol. 8×5½ in. Pp. 196+xii, with 45 illustrations. 1968. Bristol: John Wright & Sons Ltd. 40s

Benefit and risk perceptions in transfusion medicine: blood and blood substitutes.

Blood transfusion is a remarkably safe, routine procedure in clinical medicine. However, little attention has focused on the perceptions of risk associated with the receipt of blood, blood products or 'blood substitutes'. It is pertinent to ask (i) what key stakeholder groups know about transfusion, (ii) how safe they perceive blood/blood products to be, (iii) how the latter information might influence their own and others' perceptions of risk linked to transfusion, and (iv) the extent to which approved blood substitutes might be preferred over autologous or donor blood. An appreciation of what stakeholders perceive to be the benefits and risks of the receipt of blood and blood substitutes will inform future transfusion strategies. To obtain such information, a programme of research has been initiated at Nottingham. Surveys have targeted key stakeholder groups, namely, UK adult blood donors and nondonors, anaesthetists, general practitioners and health care journalists. Experimental studies examining message framing and cueing have also been conducted with undergraduate students. Such research will improve misunderstandings about current issues associated with blood donation and transfusion against the backdrop of changing public trust of health care professionals and attitudes and expectations on blood safety and benefits of blood substitutes.

Indirect calorimetry in malnutrition: nutritional assessment or therapeutic reference?

The measurement of gas exchange for use in indirect calorimetry is a clinical research tool struggling to find its proper place in the care of acutely ill and nutritionally depleted patients. Some investigators have proposed that it should be used as part of the nutritional assessment. Unfortunately, in common with many other measurements for nutritional assessment, the information provided must be integrated with other information. It is recognized that factors other than malnutrition may influence the level of the metabolic rate. Despite the lack of precision and specificity, the measurement of energy expenditure provides an important reference for determining patients' requirements for energy intake. As with many other procedures in clinical medicine, the more severely ill the patient, the less the accuracy of standard formulas for estimating energy expenditure. Thus, actual measurements of energy expenditure assume special value.

Technology and the undergraduate medical curriculum.

Instruction of medical students in the use of technologic procedures in clinical medicine has emerged in recent years on a more or less piecemeal basis. Individual technologies are introduced as the teaching hospital acquires the requisite equipment and personnel; as experience is gained by faculty and attending staff some sense emerges of the indications, contraindications, risks, accuracy, and usefulness of a procedure, which then is transmitted to housestaff and students. Instruction is likely to occur on a case-by-case basis, supplemented occasionally by conferences or formal presentations, generally oriented around major innovations, such as computerized transaxial tomography or magnetic resonance imaging. As relevant clinical literature appears, it is used to reiterate and expand the available information base of trainees, but to a considerably greater extent for housestaff than for students. Ultimately what emerges is a pattern of use, a gestalt, for each technology, reflecting the synthesis of the available information and clinical experience with the procedure in the particular institution. In view of the enormous number and variety of technologies available, the task of the student or house officer in acquiring even basic familiarity with those in common use is formidable. A coherent approach to instruction in the use of technologic procedures is required. Students need, and medical faculties must find, a way to provide intellectual systems for incorporating technologies into the clinical armamentarium in a manner that permits them to be maximally useful.

Randomized Clinical Trials Need to Be More Clinical

It is tempting to despair that scientific conditions can ever be substituted for clinical circumstances. Randomized trials were first developed for agricultural research in an attempt to account for the natural variability in plots of ground and species. The results of those trials have been used to produce consistent increases in crop yields. 1 While random allocation of treatments and isolation of variables appear natural in agriculture, it can be an invasive procedure in clinical medicine. The randomized clinical trial requires clinicians to set aside their own judgments, asks patients to accept a treatment that may be substandard, introduces arbitrary definitions of disease, encourages recruitment of patients, and requires aggressive follow-up and unusual efforts to ensure compliance. But the clinical milieu is complex and refractory; seldom does the randomized clinical trial succeed in eliminating or bypassing extraneous clinical variables. More than two years after the publication of the β-blocker heart

9] The kinetics of immobilized enzyme systems

Publisher Summary This chapter reviews that most kinetic studies on enzyme-catalyzed reactions are made with both the enzyme and the substrate in free solution. It discusses the kinetic principles that apply to immobilized enzymes and some of the applications of these principles to the systems that have been investigated experimentally. There are several reasons to investigate the kinetics of immobilized enzymes. In the first place, enzymes in nature are frequently immobilized in cells or tissues and kinetic studies in free solution, although providing an important basis for understanding do not give the entire answer, as to how the enzymes function in the living organism. Second, chemical engineers are becoming increasingly interested in the use of enzymes as catalysts for industrial processes. Third, immobilized enzymes lead to important procedures in clinical medicine. Another important clinical application is the automated analysis of important metabolities, biological fluid being pumped into one end of a tube and an analysis made of the effluent. The chapter explains the kinetic behavior observed when an enzyme is included within a solid matrix that is in contact with a solution, containing the substrate and, also, with the situation, in which the enzyme is attached to the interior surface of a tube, through which substrate solution is flowing.

June 4–8, 1973, Istanbyk (Turkey) IAEA symposium on radioimmunoassay and related procedures in clinical medicine and research info: International Atomic Energy Agency, Kärtner Ring 11–13, A-1010 Vienna, Austria

June 4–8, 1973, Istanbyk (Turkey) IAEA symposium on radioimmunoassay and related procedures in clinical medicine and research info: International Atomic Energy Agency, Kärtner Ring 11–13, A-1010 Vienna, Austria

Biopsy Procedures In Clinical Medicine.

Editor Read and 12 collaborators have assembled a comprehensive review of biopsy procedures that are currently most valuable in the practice of medicine. Each section of the book is written by an expert in the relevant field. Attention is focused on indications, methods, precautions, and complications. The apparatus needed for each procedure is described and illustrated by clear line drawings. The subjects of exfoliative cytology and cytogenetics are covered in reference to techniques of specimen collection and preparation. Proper emphasis is given to collaboration between clinician and pathologist. The first chapter is devoted to general laboratory methods used in the handling of biopsy material; the second chapter is concerned with cytological methods. Subsequent chapters deal with biopsy procedures as they apply to 13 different organ systems. The discussion of each method is followed by an ample reference list. The book is short, concise, and clear. It will fulfill its purpose