Search results for: clinical depression

Authors: Ipsita Biswas, Arnab Sarkar, Ashikur Rahaman, Gopeswar Mukherjee, Subhrangsu Chatterjee, Shamee Bhattacharjee, Deba Prasad Mandal

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One of the major reasons for the high mortality rate of lung cancer is the substantial delays in disease detection at late metastatic stages. It is of utmost importance to understand the detailed molecular signaling and detect the molecular markers that can be used for the early diagnosis of cancer. Several studies explored the emerging roles of long noncoding RNAs (lncRNAs) in various cancers as well as lung cancer. A long non-coding RNA LINC00273 was recently discovered to promote cancer cell migration and invasion, and its positive correlation with the pathological stages of metastasis may prove it to be a potential target for inhibiting cancer cell metastasis. Comparing real-time expression of LINC00273 in various human clinical cancer tissue samples with normal tissue samples revealed significantly higher expression in cancer tissues. This long intergenic noncoding RNA was found to be highly expressed in human liver tumor-initiating cells, human gastric adenocarcinoma AGS cell line, as well as human non-small cell lung cancer A549 cell line. SiRNA and shRNA-induced knockdown of LINC00273 in both in vitro and in vivo nude mice significantly subsided AGS and A549 cancer cell migration and invasion. LINC00273 knockdown also reduced TGF-β induced SNAIL, SLUG, VIMENTIN, ZEB1 expression, and metastasis in A549 cells. Plenty of reports have suggested the role of microRNAs of the miR200 family in reversing epithelial to mesenchymal transition (EMT) by inhibiting ZEB transcription factors. In this study, hsa-miR-200a-3p was predicted via IntaRNA-Freiburg RNA tools to be a potential target of LINC00273 with a negative free binding energy of −8.793 kcal/mol, and this interaction was verified as a confirmed target of LINC00273 by RNA pulldown, real-time PCR and luciferase assay. Mechanistically, LINC00273 accelerated TGF-β induced EMT by sponging hsa-miR-200a-3p which in turn liberated ZEB1 and promoted prometastatic functions in A549 cells in vitro as verified by real-time PCR and western blotting. The similar expression patterns of these EMT regulatory pathway molecules, viz. LINC00273, hsa-miR-200a-3p, ZEB1 and TGF-β, were also detected in various clinical samples like breast cancer tissues, oral cancer tissues, lung cancer tissues, etc. Overall, this LINC00273 mediated EMT regulatory signaling can serve as a potential therapeutic target for the prevention of lung cancer metastasis.

Keywords: epithelial to mesenchymal transition, long noncoding RNA, microRNA, non-small-cell lung carcinoma

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Authors: Mohammad Alqattan, Tala Alkhunani, Reema Al, Aldawish, Felwa Almurshard, Abdullah Alzahrani

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: Poland’s Syndrome is a congenital anomaly with two clinical features : unilateral agenesis of the pectoralis major and ipsilateral hand symbrachydactyly. Case presentation: We report a rare case of bilateral Poland’s syndrome with several unique features. Discussion: Poland’s syndrome is thought to be due to a vascular insult to the subclavian axis around the 6th week of gestation. Our patient has multiple rare and unique features of Poland’s syndrome. Conclusion: To our best knowledge, for the first time in the literature we associate Poland’s syndrome with cone-shaped epiphysis of the metacarpals of all fingers. Bilaterality, cleft hand deformity, and dextrocardia, were also rare features in our patient.

Keywords: Poland's syndrome, cleft hand deformity, bilaterality, dextrocardia, cone-shaped epiphysis

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Authors: Jennifer Hunter, Francisco Ramirez, Neil A. Nedley, Thania Solorio, Christian Freed, Erica Kinjo

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People who have autoimmune disease are often at an increased risk for psychological disorders such as anxiety. Untreated psychological conditions can affect the development of disease and can affect one’s general quality of life. In this study, it was hypothesized that an educational community-based intervention would be useful in decreasing the anxiety levels of participants with autoimmune disease. Programs, 2-hours long each, were held weekly over a period of eight weeks. During every meeting, a 45-minute DVD presentation by a skilled physician was shown, a small group discussion was guided by trained facilitators, and weekly practical assignments were given to each participant. The focus of the program was to educate participants about healthy lifestyle behaviors such as exercise, nutrition, sleep hygiene, helpful thought patterns etc., and to provide a group environment in which each participant was supported. Participants were assessed pre-post program for anxiety using the Depression and Anxiety Assessment Test (registration TX 7-398-022), a validated mental health test based on DSM-5 criteria and demographics. Anxiety scores were classified according to the DSM-5 criteria into 4 categories: none (0-6), mild (7-10), moderate (11-19) or severe (20 or more). Out of the participants who participated in programs conducted in the manner explained above (n=431), the average age was 54.9 (SD 16.6) and 81.9% were female. At baseline, the mean group anxiety level was 9.4 (SD 5.4). Within the baseline group, anxiety levels were as follows: none (21.1%), mild (22.0%), moderate (27.1%) and severe (29.7%). After the program, mean group anxiety decreased to 4.7 (SD 4.0). Post-program anxiety levels were as follows: none (54.8%), mild (27.1%), moderate (12.5%), severe (5.6%). The decrease in overall anxiety levels was significant t(431)=19.3 p<.001, 95% CI [0.815, 1.041]. It was concluded that the eight-week intensive was beneficial in decreasing the anxiety levels of participants. A long-term follow-up study would be beneficial in determining how lasting such improvements are especially since autoimmune diseases are often chronic. Additionally, future studies that utilize a control group would aid in establishing whether the improvements seen are due to the use of this specific lifestyle-educational program.

Keywords: anxiety, auto-immune disease, community-based educational program, lifestyle

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Authors: Michael Olson

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The Accreditation Council for Graduate Medical Education (ACGME) in the U.S. has established core competencies and milestones for family physicians in residency training programs. These competencies are intended to guide preceptors as they work with physician trainees toward independent practice. This conceptual paper describes a framework for coaching trainees toward these milestones using motivational interviewing as an evidence-based approach. The main objective of applying the motivational interviewing framework to the residency training setting is to facilitate clinical behavior change that meets higher level competencies/rubric. This is a work in progress and there is no manuscript/paper prepared to date. A conceptual paper/framework will be completed by the conference deadline. This is based on a separate but related development of work we have completed and published elsewhere.

Keywords: coaching, motivational interviewing, physicians, competencies

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Authors: Khabat Barkhordari

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Hepatitis delta virus (HDV) is a RNA virus that needs the function of hepatitis B virus (HBV) for its propagation and assembly. Infection by HDV can occur spontaneously with HBV infection and cause acute hepatitis or develop as secondary infection in HBV suffering patients. Based on genome sequence analysis, HDV has several genotypes which show broad geographic and diverse clinical features. The aim of current study is determine the molecular epidemiology of hepatitis delta virus genotype in patients with positive HBsAg among different ethnic groups of Iran. This systematic review study reviews the results of different studies which examined 2000 Iranian patients with HBV infection from 2010 to 2015. Among 2000 patients in this study, 16.75 % were containing anti-HDV antibody and HDV RNA was found in just 1.75% cases. All of positive cases also have genotype I.

Keywords: HDV, genotype, epidemiology, distribution

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Authors: Afaf Alharbi, Qianni Zhang

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The identification of malignant tissue in histopathological slides holds significant importance in both clinical settings and pathology research. This paper introduces a methodology aimed at automatically categorizing cancerous tissue through the utilization of a multiple-instance learning framework. This framework is specifically developed to acquire knowledge of the Bernoulli distribution of the bag label probability by employing neural networks. Furthermore, we put forward a neural network based permutation-invariant aggregation operator, equivalent to attention mechanisms, which is applied to the multi-instance learning network. Through empirical evaluation of an openly available colon cancer histopathology dataset, we provide evidence that our approach surpasses various conventional deep learning methods.

Keywords: attention multiple instance learning, MIL and transfer learning, histopathological slides, cancer tissue classification

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Authors: Harsh Thakkar, Ganesh Iyer

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In this paper, we survey various user-centered or context-based biomedical health information retrieval systems. We present and discuss the performance of systems submitted in CLEF eHealth 2014 Task 3 for this purpose. We classify and focus on comparing the two most prevalent retrieval models in biomedical information retrieval namely: Language Model (LM) and Vector Space Model (VSM). We also report on the effectiveness of using external medical resources and ontologies like MeSH, Metamap, UMLS, etc. We observed that the LM based retrieval systems outperform VSM based systems on various fronts. From the results we conclude that the state-of-art system scores for MAP was 0.4146, P@10 was 0.7560 and NDCG@10 was 0.7445, respectively. All of these score were reported by systems built on language modeling approaches.

Keywords: clinical document retrieval, concept-based information retrieval, query expansion, language models, vector space models

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Authors: Jacqueline Y. Thompson, Sam Watson, Lee Middleton, Karla Hemming

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Introduction: The odds ratio (estimated via logistic regression) is a well-established and common approach for estimating covariate-adjusted binary treatment effects when comparing a treatment and control group with dichotomous outcomes. Its popularity is primarily because of its stability and robustness to model misspecification. However, the situation is different for the relative risk and risk difference, which are arguably easier to interpret and better suited to specific designs such as non-inferiority studies. So far, there is no equivalent, widely acceptable approach to estimate an adjusted relative risk and risk difference when conducting clinical trials. This is partly due to the lack of a comprehensive evaluation of available candidate methods. Methods/Approach: A simulation study is designed to evaluate the performance of relevant candidate methods to estimate relative risks to represent conditional and marginal estimation approaches. We consider the log-binomial, generalised linear models (GLM) with iteratively weighted least-squares (IWLS) and model-based standard errors (SE); log-binomial GLM with convex optimisation and model-based SEs; log-binomial GLM with convex optimisation and permutation tests; modified-Poisson GLM IWLS and robust SEs; log-binomial generalised estimation equations (GEE) and robust SEs; marginal standardisation and delta method SEs; and marginal standardisation and permutation test SEs. Independent and identically distributed datasets are simulated from a randomised controlled trial to evaluate these candidate methods. Simulations are replicated 10000 times for each scenario across all possible combinations of sample sizes (200, 1000, and 5000), outcomes (10%, 50%, and 80%), and covariates (ranging from -0.05 to 0.7) representing weak, moderate or strong relationships. Treatment effects (ranging from 0, -0.5, 1; on the log-scale) will consider null (H0) and alternative (H1) hypotheses to evaluate coverage and power in realistic scenarios. Performance measures (bias, mean square error (MSE), relative efficiency, and convergence rates) are evaluated across scenarios covering a range of sample sizes, event rates, covariate prognostic strength, and model misspecifications. Potential Results, Relevance & Impact: There are several methods for estimating unadjusted and adjusted relative risks. However, it is unclear which method(s) is the most efficient, preserves type-I error rate, is robust to model misspecification, or is the most powerful when adjusting for non-prognostic and prognostic covariates. GEE estimations may be biased when the outcome distributions are not from marginal binary data. Also, it seems that marginal standardisation and convex optimisation may perform better than GLM IWLS log-binomial.

Keywords: binary outcomes, statistical methods, clinical trials, simulation study

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Authors: Gianna Zou

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Propensity score matching (PSM), introduced by Paul R. Rosenbaum and Donald Rubin in 1983, is a popular statistical matching technique which tries to estimate the treatment effects by taking into account covariates that could impact the efficacy of study medication in clinical trials. PSM can be used to reduce the bias due to confounding variables. However, PSM assumes that the response values are normally distributed. In some cases, this assumption may not be held. In this paper, a machine learning method - Bayesian Additive Regression Tree (BART), is used as a more robust method of matching. BART can work well when models are misspecified since it can be used to model heterogeneous treatment effects. Moreover, it has the capability to handle non-linear main effects and multiway interactions. In this research, a BART Matching Method (BMM) is proposed to provide a more reliable matching method over PSM. By comparing the analysis results from PSM and BMM, BMM can perform well and has better prediction capability when the response values are not normally distributed.

Keywords: BART, Bayesian, matching, regression

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Authors: Maftunakhon Latipova, Feruza Khaydarova

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Obesity is considered a chronic metabolic disease that occurs at any age. Regulation of body weight in the body is carried out through complex interaction of a complex of interrelated systems that control the body's energy system. Energy imbalance is the cause of obesity and overweight, in which the supply of energy from food exceeds the energy needs of the body. Obesity is closely related to impaired appetite regulation, and a hypothalamus is a key place for neural regulation of food consumption. The nucleus of the hypothalamus is connected and interdependent on receiving, integrating and sending hunger signals to regulate appetite. Purpose of the study: to identify markers of food behavior. Materials and methods: The screening was carried out to identify eating disorders in 200 men and women aged 18 to 35 years with overweight and obesity and to check the effects of Orexin A and Neuropeptide Y markers. A questionnaire and questionnaires were conducted with over 200 people aged 18 to 35 years. Questionnaires were for eating disorders and hidden depression (on the Zang scale). Anthropometry is measured by OT, OB, BMI, Weight, and Height. Based on the results of the collected data, 3 groups were divided: People with obesity, People with overweight, Control Group of Healthy People. Results: Of the 200 analysed persons, 86% had eating disorders. Of these, 60% of eating disorders were associated with childhood. According to the Zang test result: Normal condition was about 37%, mild depressive disorder 20%, moderate depressive disorder 25% and 18% of people suffered from severe depressive disorder without knowing it. One group of people with obesity had eating disorders and moderate and severe depressive disorder, and group 2 was overweight with mild depressive disorder. According to laboratory data, the first group had the lowest concentration of Orexin A and Neuropeptide U in blood serum. Conclusions: Being overweight and obese are the first signal of many diseases, and prevention and detection of these disorders will prevent various diseases, including type 2 diabetes. Obesity etiology is associated with eating disorders and signal transmission of the orexinorghetic system of the hypothalamus.

Keywords: obesity, endocrinology, hypothalamus, overweight

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Authors: Paulina Pergoł, Paulina Pergoł, Tomasz Kryczka

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Aging of societies is a phenomenon that is visible all over the world. The above has social, economic, and medical consequences. Many methods of pro-health stimulation of the elderly, improving cognitive functions and quality of life, are described in the world literature. The most frequently used method of activating the elderly is physical activity, in which, in addition to standard exercise programs, activities such as dance, tai chi, and yoga are often introduced. The introduction of physical activity may be limited due to the disability that often accompanies people aged 65+. Other activating methods mentioned in the literature are therapies with the participation of animals - animal therapy or plant therapy - hortitherapy, as well as music therapy, which is increasingly popular. All of the above-mentioned therapeutic methods require the involvement of a person who would conduct the so-called occupational therapist, which can be a financial barrier for many nursing homes. Researchers all over the world are trying to find solutions that can be applied in any care institution, even in those where financial support for running such centers is small. One of the forms of therapy that is recommended in the group of elderly people and which does not require large financial outlays is the so-called reminiscence therapy based on recalling personal experiences and experiences. Thanks to reminiscence therapy, seniors can return to happy moments in their lives. Research shows that reminiscence therapy increases self-esteem and reduces symptoms of depression. The method of activating older people with the use of correspondence can be an effective and low-cost form of therapy, as shown by the pilot study conducted in 2019 as part of the Queen Silvia Nursing Award competition, consisting in a systematic exchange of correspondence between volunteers and residents of the Nursing Home. This study was conducted with the participation of a small group of participants, therefore, in order to identify and prove the beneficial effect of this form of activation, it should be carried out on a larger group of respondents using standardized scales assessing various psychological parameters.

Keywords: nursing, elderly care, psychiatry, psychology

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Authors: Amar Ghelani

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People with auditory verbal hallucinations (AVH) who seek support from mental health services commonly report feeling unheard and invalidated in their interactions with social workers and psychiatric professionals. Current mental health training and clinical approaches have proven to be inadequate in addressing the complex nature of voice hearing. Childhood trauma is a key factor in the development of AVH and can render people more vulnerable to hearing both supportive and/or disturbing voices. Lived experiences of racism, poverty, and immigration are also associated with development of what is broadly classified as psychosis. Despite evidence affirming the influence of environmental factors on voice hearing, the Western biomedical system typically conceptualizes this experience as a symptom of genetically-based mental illnesses which requires diagnosis and treatment. Overemphasis on psychiatric medications, referrals, and directive approaches to people’s problems has shifted clinical interventions away from assessing and addressing problems directly related to AVH. The Maastricht approach offers voice hearers and mental health workers an alternative and respectful starting point for understanding and coping with voices. The approach was developed by voice hearers in partnership with mental health professionals and entails an innovative method to assess and create meaning from voice hearing and related life stressors. The objectives of the approach are to help people who hear voices: (1) understand the problems and/or people the voices may represent in their history, and (2) cope with distress and find solutions to related problems. The Maastricht approach has also been found to help voice hearers integrate emotional conflicts, reduce avoidance or fear associated with AVH, improve therapeutic relationships, and increase a sense of control over internal experiences. The proposed oral presentation will be guided by a recovery-oriented theoretical framework which suggests healing from psychological wounds occurs through social connections and community support systems. The presentation will start with a brainstorming exercise to identify participants pre-existing knowledge of the subject matter. This will lead into a literature review on the relations between trauma, intersectionality, and AVH. An overview of the Maastricht approach and review of research related to its therapeutic risks and benefits will follow. Participants will learn trauma-informed coping skills and questions which can help voice hearers make meaning from their experiences. The presentation will conclude with a review of resources and learning opportunities where participants can expand their knowledge of the Hearing Voices Movement and Maastricht approach.

Keywords: Maastricht interview, recovery, therapeutic assessment, voice hearing

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Authors: M. A. I Perera, C. R. Wijesinghe, A. R. Weerasinghe

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his study was conducted to review and identify the unsupervised techniques that can be employed to analyze gene expression data in order to identify better subtypes of tumors. Identifying subtypes of cancer help in improving the efficacy and reducing the toxicity of the treatments by identifying clues to find target therapeutics. Process of gene expression data analysis described under three steps as preprocessing, clustering, and cluster validation. Feature selection is important since the genomic data are high dimensional with a large number of features compared to samples. Hierarchical clustering and K Means are often used in the analysis of gene expression data. There are several cluster validation techniques used in validating the clusters. Heatmaps are an effective external validation method that allows comparing the identified classes with clinical variables and visual analysis of the classes.

Keywords: cancer subtypes, gene expression data analysis, clustering, cluster validation

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Authors: Pedro Gomes, Luís Sá Castelo, António Lopes, Marta Maio, Pedro Mota, Adélia Avelar, António Marques Dias

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Introduction: Total Knee Arthroplasty (TKA) has contributed to improvement of patient`s quality of life, although it has been associated with some complications including component loosening and polyethylene wear. To prevent these complications various fixation techniques have been employed. Hybrid TKA with cemented tibial and cementless femoral components have shown favourable outcomes, although it still lack of consensus in the literature. Objectives: To evaluate the clinical and radiographic results of hybrid versus cemented TKA with an average 5 years follow-up and analyse the survival rates. Methods: A retrospective study of 125 TKAs performed in 92 patients at our institution, between 2006 to 2008, with a minimum follow-up of 2 years. The same prosthesis was used in all knees. Hybrid TKA fixation was performed in 96 knees, with a mean follow-up of 4,8±1,7 years (range, 2–8,3 years) and 29 TKAs received fully cemented fixation with a mean follow-up of 4,9±1,9 years (range, 2-8,3 years). Selection for hybrid fixation was nonrandomized and based on femoral component fit. The Oxford Knee Score (OKS 0-48) was evaluated for clinical assessment and Knee Society Roentgenographic Evaluation Scoring System was used for radiographic outcome. The survival rate was calculated using the Kaplan-Meier method, with failures defined as revision of either the tibial or femoral component for aseptic failures and all-causes (aseptic and infection). Analysis of survivorship data was performed using the log-rank test. SPSS (v22) was the computer program used for statistical analysis. Results: The hybrid group consisted of 72 females (75%) and 24 males (25%), with mean age 64±7 years (range, 50-78 years). The preoperative diagnosis was osteoarthritis (OA) in 94 knees (98%), rheumatoid arthritis (RA) in 1 knee (1%) and Posttraumatic arthritis (PTA) in 1 Knee (1%). The fully cemented group consisted of 23 females (79%) and 6 males (21%), with mean age 65±7 years (range, 47-78 years). The preoperative diagnosis was OA in 27 knees (93%), PTA in 2 knees (7%). The Oxford Knee Scores were similar between the 2 groups (hybrid 40,3±2,8 versus cemented 40,2±3). The percentage of radiolucencies seen on the femoral side was slightly higher in the cemented group 20,7% than the hybrid group 11,5% p0.223. In the cemented group there were significantly more Zone 4 radiolucencies compared to the hybrid group (13,8% versus 2,1% p0,026). Revisions for all causes were performed in 4 of the 96 hybrid TKAs (4,2%) and 1 of the 29 cemented TKAs (3,5%). The reason for revision was aseptic loosening in 3 hybrid TKAs and 1 of the cemented TKAs. Revision was performed for infection in 1 hybrid TKA. The hybrid group demonstrated a 7 years survival rate of 93% for all-cause failures and 94% for aseptic loosening. No significant difference in survivorship was seen between the groups for all-cause failures or aseptic failures. Conclusions: Hybrid TKA yields similar intermediate-term results and survival rates as fully cemented total knee arthroplasty and remains a viable option in knee joint replacement surgery.

Keywords: hybrid, survival rate, total knee arthroplasty, orthopaedic surgery

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Authors: Anna Jeon, Seung-Ho Han, Je-Hun Lee

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The aim of this study was to determine the location and distribution pattern of neurovascular structures superior and inferior to the clavicle by detailed dissection. Fifteen adult non-embalmed cadavers with a mean age of 71.5 years were studied. For measurements, the most prominent point of the sternal end of the clavicle (SEC) on anterior view and the most prominent point of the acromial end of the clavicle (AEC) were identified before dissection. A line connecting the SEC and AEC was used as a reference line. The surrounding neurovascular structures were investigated. The supraclavicular nerve was densely distributed at 71.73% on the reference line. Branches of the thoracoacromial artery were located at 76.92%. Branches of subclavian vein were evenly distributed at all sections. The subclavian vein and artery and brachial plexus were located from 31.3% to 57.5%. That area needs caution because major neurovascular structures run underneath the clavicle.

Keywords: clavicle, ORIF, neurovascular structure, anatomical study

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Authors: Sandra Landy

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Traumatic experiences in youth are a major risk factor for future suicidality. With suicide steadily increasing over the last 20 years as one of the top three leading causes of death in children and adolescents, it is essential to examine the aspects of trauma that contribute to suicidality. A quantitative secondary data analysis of a prospective, multicenter 24-month observational study of youth who have experienced traumatic experiences was utilized to determine the relationship between bullying and suicide attempts, cyberbullying and suicide attempts, and number of traumas and suicide attempts. Data was analyzed with the Spearman-rank correlation test to determine the relationships. Findings supported past research establishing a relationship between bulling, including cyberbullying, and suicide attempts, as well as increasing number of traumatic experiences and suicide attempts. Further large scale studies may be beneficial to support these findings.

Keywords: adolescent(s), suicide, trauma, bullying, cyberbullying

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Authors: Annunziata Albano

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Intimate Partner Violence (IPV) and Non-Partner Sexual Violence (NPSV) are still the most common forms of interpersonal violence against women today, and numerous studies have shown how they can affect women's physical and psychological well-being, frequently leading to depression, posttraumatic stress disorder (PTSD), and substance abuse. The primary goal of Italian Anti-Violence Centres (AVCs) is to provide an appropriate context for women to embark on a personalised path out of violence by providing various services such as listening groups, psychological and legal support, housing support in collaboration with shelters, work orientation, and specific support in the case of minor children. However, their physical environment is frequently overlooked, partly because these centres are typically established in pre-existing buildings and have a limited budget. Several studies on healthcare design and mental health, on the other hand, emphasise the potential of the built environment to facilitate healing by providing a restorative setting that aids in coping with stress and traumatic experiences, investigating the positive role of natural features and sensorial qualities such as light, colours, sound, and smell. This research aims to collect and summarise the key evidence-based principles derived from a multidisciplinary literature review about interior design elements that can help women recover after their traumatic experience. Furthermore, the study examines multiple case studies of Italian AVCs through the lens of previously determined principles, to understand how and whether these guidelines have been applied and which outcomes can provide relevant insights for design practice, with an emphasis on sensory qualities, usually overlooked in favour of other requirements. The outlined guidelines may serve as a framework for various typologies of services provided to women who are the victims of interpersonal violence, such as women's crisis centres and shelters.

Keywords: anti-violence centres, environmental psychology, interior design, interpersonal violence, restorative environments

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Authors: Nassim Salmi

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Postoperative mobilization is an important part of fundamental care. Increased mobilization has a positive effect on recovery, but immobilization is still a challenge in postoperative care. Aims: To report how the establishment of a national nursing database was used to measure postoperative mobilization in patients undergoing surgery for ovarian cancer. Mobilization was defined as at least 3 hours out of bed on postoperative day 1, with the goal set at achieving this in 60% of patients. Clinical nurses on 4400 patients with ovarian cancer performed data entry. Findings: 46.7% of patients met the goal for mobilization on the first postoperative day, but variations in duration and type of mobilization were observed. Of those mobilized, 51.8% had been walking in the hallway. A national nursing database creates opportunities to optimize fundamental care. By comparing nursing data with oncological, surgical, and pathology data, it became possible to study mobilization in relation to cancer stage, comorbidity, treatment, and extent of surgery.

Keywords: postoperative care, gynecology, nursing documentation, database

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Authors: Genziana Lay

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A wide majority of older children and adolescents who enter the juvenile court system present with an array of problematic symptoms and behaviors including anxiety, depression, aggressive acting out, detachment, and substance abuse. Attachment theory offers a framework for understanding normative and pathological functioning, which during development is influenced by emotional, social and cognitive elements. There is clear evidence that children and adolescents with the highest risk of developing adaptation problems present an insecure attachment profile. Most offending minors have experienced dysfunctional family relationships as well as social and/or economic deprivation. Their maladaptive attachment develops not only through their relationship with caregivers but with the environment at large. Activation of their faulty attachment system leads them to feel emotionally overwhelmed and engage in destructive behaviors and decision-making. A psycho-social intervention with this population conceptualized as attachment therapy is a multi-faceted, practical approach that has shown excellent results in terms of increased psychological well-being and drastically reduced rates of re-offense/ destructive behavior. Through several; components including psychotherapy, monitoring, volunteering, meditation and socialization, the program focuses on seven dimensions: self-efficacy, responsibility, empathy/reparation, autonomy/security, containment/structure, insight building, and relational health. This paper presents the program and illustrates how the framework of attachment theory practically applied to psycho-social intervention has great therapeutic and social reparation potential. Preliminary evidence drawn from the Sassari Juvenile Court is very promising; this paper will illustrate these results and propose an even more comprehensive, applicable approach to psycho-social reparative intervention that leads to greater psychological health and reduced recidivism in the child and adolescent population.

Keywords: attachment, child, adolescent, crime, juvenile, psychosocial

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Authors: Eryati Darwin, Arina Widya Murni, Adnil Edwin Nurdin

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Background: Functional dyspepsia (FD) is a highly prevalent and heterogeneous disorder. Most patients with FD complain of symptoms related to the intake of meals. Psychological stress may promote peptic ulcer and had an effect on ulcers associated Hp, and may also trigger worsen symptoms in inflammatory disorders of the gastrointestinal. Cells in mucosal gastric stimulate the production of several cytokines, which might associated with Helicobacter pylori infection. The cascade of biological events leading to stress-induced FD remains poorly understood. Aim of Study: To determine the prion-flammatory cytokine IL-6, and Helicobacter pylori activity on mucosal gastric of FD and their association with psychological stress. Methods: The subjects of this study were dyspeptic patients who visited M. Djamil General Hospital and in two Community Health Centers in Padang. On the basis of the stress index scale to identify psychological stress by using Depression Anxiety and Stress Scale (DASS 42), subjects were divided into two groups of 20 each, stress groups and non-stress groups. All diagnoses were confirmed by review of cortisol and esophagogastroduodenoscopy reports. Gastric biopsy samples and peripheral blood were taken during diagnostic procedures. Immunohistochemistry methods were used to determine the expression of IL-6 and Hp in gastric mucosal. The data were statistically analyzed by univariate and bivariate analysis. All procedures of this study were approved by Research Ethics Committee of Medical Faculty Andalas University. Results: In this study, we enrolled 40 FD patients (26 woman and 14 men) in range between 35-56 years old. Cortisol level of blood FD patients as parameter of stress hormone which taken in the morning was significantly higher in stress group than non-stress group. The expression of IL-6 in gastric mucosa was significantly higher in stress group in compared to non-stress group (p<0,05). Helicobacter pylori activity in gastric mucosal in stress group were significantly higher than non-stress group. Conclusion: The present study showed that psychological stress can induce gastric mucosal inflammation and increase of Helicobacter pylori activity.

Keywords: functional dyspepsia, Helicobacter pylori, interleukin-6, psychological stress

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Authors: Khairi El Battawy, Monika Skalicki

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The present investigation has been done on pure Egyptian Arabian mares that reared in private horse studs. Fifty non-pregnant mares were selected and examined to classify them as either being reproductively healthy or subfertile mares including clinical endometritis, early embryonic death, granulosa cell tumor, repeat breeder (post-breeding endometritis), and anoestrus mares. The purpose of the study was to assess oxidative/antioxidant biochemical metabolites, lipogram, trace elements and reproductive hormones throughout reproductive conditions in mares during regular estrous, anestrum, early pregnancy, granulose cell tumor, ovulation failure, and endometritis. Results showed intensification of the free radical-dependent process in the blood of infertile mare, especially mares with endometritis. Ultrasonography as a diagnostic tool diagnosis of endometritis in mares was an important step as it revealed much information concerning infertility problem.

Keywords: endometritis, ovulation, oxidative, mare

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Authors: Dereje Ferede, Solomon Negash

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Artificial Intelligence (AI) is a key enabler and driver to transform and revolutionize the healthcare industries. However, utilizing AI and achieving these benefits is challenging for different sectors in wide-ranging, more difficult for developing economy healthcare. Due to this, real-world clinical execution and implementation of AI have not yet aged. We believe that examining the determinants is key to addressing these challenges. Furthermore, the literature does not yet particularize determinants of AI capabilities and ways of empowering the healthcare ecosystem to develop AI capabilities in a developing economy. Thus, this study aims to position AI as a digital transformation weapon for the healthcare ecosystem by examining AI capability determinants and providing insights on better empowering the healthcare industry to develop AI capabilities. To do so, we base on the technology-organization-environment (TOE) model and will apply a mixed research approach. We will conclude with recommendations based on findings for future practitioners and researchers.

Keywords: artificial intelligence, capability, digital transformation, developing economies, healthcare

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Authors: Soheila Zhaeentan, Anders Von Heijne, Elisabet Hagert, André Stark, Björn Salomonsson

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Recommended treatment for traumatic rotator cuff tear (TRCT) is surgery within a few weeks after injury if the diagnosis is made early, especially if a functional impairment of the shoulder exists. This may lead to the assumption that a poor outcome then can be expected in delayed surgical treatment, when the patient is diagnosed at a later stage. The aim of this study was to investigate if a surgical repair later than three months after injury may result in successful outcomes and patient satisfaction. There is evidence in literature that good results of treatment can be expected up to three months after the injury, but little is known of later treatment with cuff repair. 73 patients (75 shoulders), 58 males/17 females, mean age 59 (range 34-­‐72), who had undergone surgical intervention for TRCT between January 1999 to December 2011 at our clinic, were included in this study. Patients were assessed by MRI investigation, clinical examination, Western Ontario Rotator Cuff index (WORC), Oxford Shoulder Score, Constant-­‐Murley Score, EQ-­‐5D and patient subjective satisfaction at follow-­‐up. The patients treated surgically within three months ( < 12 weeks) after injury (39 cases) were compared with patients treated more than three months ( ≥ 12 weeks) after injury (36 cases). WORC was used as the primary outcome measure and the other variables as secondary. A senior consultant radiologist, blinded to patient category and clinical outcome, evaluated all MRI-­‐images. Rotator cuff integrity, presence of arthritis, fatty degeneration and muscle atrophy was evaluated in all cases. The average follow-­‐up time was 56 months (range 14-­‐149) and the average time from injury to repair was 16 weeks (range 3-­‐104). No statistically significant differences were found for any of the assessed parameters or scores between the two groups. The mean WORC score was 77 (early group, range 25-­‐ 100 and late group, range 27-­‐100) for both groups (p= 0.86), Constant-­‐Murley Score (p= 0.91), Oxford Shoulder Score (p= 0.79), EQ-­‐5D index (p= 0.86). Re-­‐tear frequency was 24% for both groups, and the patients with re-­‐tear reported less satisfaction with outcome. Discussion and conclusion: This study shows that surgical repair of TRCT performed later than three months after injury may result in good functional outcomes and patient satisfaction. However, this does not motivate an intentional delay in surgery when there is an indication for surgical repair as that delay may adversely affect the possibility to perform a repair. Our results show that surgeons may safely consider surgical repair even if a delay in diagnosis has occurred. A retrospective cohort study on 75 shoulders shows good functional result after traumatic rotator cuff tear (TRCT) treated surgically up to one year after the injury.

Keywords: traumatic rotator cuff injury, time to surgery, surgical outcome, retrospective cohort study

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Authors: Cailyn Green

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Substance use counselors have a variety of fast-paced tasks and responsibilities. Professional resources are designed to support professionals in making their job duties easier and less stressful. The purpose of this research was to identify what types of resources would support addiction counselors in performing their job duties. Counselors often must jump in and facilitate a group counseling session with little to no time for prep. This causes stress and creates pressure to come up with a clinical group activity in little time. The researcher utilized qualitative interviews focused on identifying what types of resources would support addiction counselors in doing their jobs easier and effectively. The researcher visited 23 different addiction counseling facilities seeking participants for the interviews. Altogether 15 interviews were collected across six different substance-use counseling facilities. The interviews guided the researcher toward creating an open education resource (OER) of group activities for addiction counselors to utilize.

Keywords: addiction, counseling, resources, OER, treatment

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Authors: Alinka Molnár-Tóth, Tímea Tánczos, Regina Barna, Katalin Jakab, Péter Klivényi

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Supported by neuroscientific findings, the so-called Hub-and-Spoke model of the human semantic system is based on two subcomponents of semantic cognition, namely the semantic control process and semantic representation. Our semantic knowledge is multimodal in nature, as the knowledge system stored in relation to a conception is extensive and broad, while different aspects of the conception may be relevant depending on the purpose. The motivation of our research is to develop a new diagnostic measurement procedure based on the preservation of semantic representation, which is appropriate to the specificities of the Hungarian language and which can be used to compare the non-verbal semantic knowledge of healthy and aphasic persons. The development of the test will broaden the Hungarian clinical diagnostic toolkit, which will allow for more specific therapy planning. The sample of healthy persons (n=480) was determined by the last census data for the representativeness of the sample. Based on the concept of the Pyramids and Palm Tree Test, and according to the characteristics of the Hungarian language, we have elaborated a test based on different types of semantic information, in which the subjects are presented with three pictures: they have to choose the one that best fits the target word above from the two lower options, based on the semantic relation defined. We have measured 5 types of semantic knowledge representations: associative relations, taxonomy, motional representations, concrete as well as abstract verbs. As the first step in our data analysis, we examined the normal distribution of our results, and since it was not normally distributed (p < 0.05), we used nonparametric statistics further into the analysis. Using descriptive statistics, we could determine the frequency of the correct and incorrect responses, and with this knowledge, we could later adjust and remove the items of questionable reliability. The reliability was tested using Cronbach’s α, and it can be safely said that all the results were in an acceptable range of reliability (α = 0.6-0.8). We then tested for the potential gender differences using the Mann Whitney-U test, however, we found no difference between the two (p < 0.05). Likewise, we didn’t see that the age had any effect on the results using one-way ANOVA (p < 0.05), however, the level of education did influence the results (p > 0.05). The relationships between the subtests were observed by the nonparametric Spearman’s rho correlation matrix, showing statistically significant correlation between the subtests (p > 0.05), signifying a linear relationship between the measured semantic functions. A margin of error of 5% was used in all cases. The research will contribute to the expansion of the clinical diagnostic toolkit and will be relevant for the individualised therapeutic design of treatment procedures. The use of a non-verbal test procedure will allow an early assessment of the most severe language conditions, which is a priority in the differential diagnosis. The measurement of reaction time is expected to advance prodrome research, as the tests can be easily conducted in the subclinical phase.

Keywords: communication disorders, diagnostic toolkit, neurorehabilitation, semantic knowlegde

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Authors: Sara Grazhdani, Alma Cili, Arben Ivanaj

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Immune Thrombocytopenic Purpura is an autoimmune disease characterized by the destruction of platelets by immune mediators, their deficient production in the red bone marrow and increased splenic sequestration, leading to the appearance of thrombocytopenia and increased risk of hemorrhage. Treatment is indicated in patients with low platelet counts (<30 x 10 9 /L) who present clinically with hemorrhagic events or are at increased risk for hemorrhage. The goal of the treatment remains (I) prevention of hemorrhagic events and deaths resulting from them, (II) reaching an adequate level of the number of platelets, (III) treatment of patients with as few toxic effects as possible. Corticosteroid therapy remains the first choice in the treatment of patients with Primary Immune Thrombocytopenic Purpura. Rituximab (Mabthera) remains the first choice in the second line in the treatment of patients with Immune Thrombocytopenic Purpura, refractory to the use of cortisones.

Keywords: ITP, rituximab, prednisolone, relapse

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Authors: Kamini Kaushal

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Medicinal plants of Ayurveda are effective in the treatment of cervical cancer. The aim of this paper is to assess anti cancerous activities of these medicinal plants against cancer. Most of the medicinal plants in Ayurveda are using to treat cervical cancer as name of disease as treatment of YONI VYAPADA. The selected plants has been studied scientifically in India and evidence based written since Vedic era. The compilation results showed potential anti cervical cancer activity of the tested plants. There plants are remaining under the dark due to lack of awareness, lack of popularity and barrier of language. Now this is the time to eye opener regarding the classical text and clinical evidences, so that we can give the hope to world's affected women from this disease. World is waiting for such type of remedy which is having zero side effects, low cost and effective.

Keywords: anti cancerous, cervical cancer, ayurveda, medicinal plants, scientific study, classical text

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Authors: Shiva Naidoo, Kristena Yossef, Grimm Jimm, Mirza Wasique, Eric Kemmerer, Joshua Obuch, Anand Mahadevan

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Background: Fiducial markers effectively enhance tumor target visibility prior to Stereotactic Body Radiation Therapy or Proton therapy. To streamline clinical practice, fiducial placement guidelines from a robotic radiosurgery vendor were examined with the goals of optimizing and standardizing feasible geometries for each treatment indication. Clinical examples of prostate, renal, and pancreatic cases are presented. Methods: Vendor guidelines (Accuray, Sunnyvale, Ca) suggest implantation of 4–6 fiducials at least 20 mm apart, with at least a 15-degree angular difference between fiducials, within 50 mm or less from the target centroid, to ensure that any potential fiducial motion (e.g., from respiration or abdominal/pelvic pressures) will mimic target motion. Also recommended is that all fiducials can be seen in 45-degree oblique views with no overlap to coincide with the robotic radiosurgery imaging planes. For the prostate, a standardized geometry that meets all these objectives is a 2 cm-by-2 cm square in the coronal plane. The transperineal implant of two pairs of preloaded tandem fiducials makes the 2 cm-by-2 cm square geometry clinically feasible. This technique may be applied for renal cancer, except repositioned in a sagittal plane, with the retroperitoneal placement of the fiducials into the tumor. Pancreatic fiducial placement via endoscopic ultrasound (EUS) is technically more challenging, as fiducial placement is operator-dependent, and lesion access may be limited by adjacent vasculature, tumor location, or restricted mobility of the EUS probe in the duodenum. Fluoroscopically assisted fiducial placement during EUS can help ensure fiducial markers are deployed with optimal geometry and visualization. Results: Among the first 22 fiducial cases on a newly installed robotic radiosurgery system, live x-ray images for all nine prostatic cases had excellent fiducial visualization at the treatment console. Renal and pancreatic fiducials were not as clearly visible due to difficult target access and smaller caliber insertion needle/fiducial usage. The geometry of the first prostate case was used to ensure accurate geometric marker placement for the remaining 8 cases. Initially, some of the renal and pancreatic fiducials were closer than the 20 mm recommendation, and interactive feedback with the proceduralists led to subsequent fiducials being too far to the edge of the tumor. Further feedback and discussion of all cases are being used to help guide standardized geometries and achieve ideal fiducial placement. Conclusion: The ideal tradeoffs of fiducial visibility versus the thinnest possible gauge needle to avoid complications needs to be systematically optimized among all patients, particularly in regards to body habitus. Multidisciplinary collaboration among proceduralists and radiation oncologists can lead to improved outcomes.

Keywords: fiducial, prostate cancer, renal cancer, pancreatic cancer, radiotherapy

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Authors: Mohammed A. Abutalib

Abstract:

Papillary thyroid carcinoma (PTC) accounts for the most common type of thyroid cancer, a well-differentiated type. PTC is featured by biologically low-grade and less aggressive tumors with a survival rate of 10 years in most of the diagnosed cases. PTC can be presented with the involvement of cervical lymph nodes in about 50% of the patients, yet the distant spread is very uncommon. Herein, we discussed an early 50-year-old male patient with a history of PTC that presented to the emergency department complaining of shortness of breath and a radiological finding of hydrothorax. Cytologic examination, together with immune-histochemical staining and molecular studies of pleural effusion aspiration, concluded the definitive diagnosis of metastatic papillary thyroid carcinoma in the pleural space. PTC seldom causes metastatic niches in the pleural space, and this is a rare clinical presentation; nevertheless, a differential diagnosis of thyroid metastasis needs to be excluded.

Keywords: thyroid cancer, malignant pleural effusion, cytology aspiration, papillary thyroid carcinoma

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Authors: Nurgul A. Abenova, Gaukhar S. Dilmagambetova, Lazzat M. Zhamaliyeva

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Professionalism is a core competency that all medical students must achieve throughout their studies. Clinical knowledge, good communication skills and an understanding of ethics form the basis of professionalism. Patients, medical societies and accrediting organizations expect future specialists to be professionals in their field, which in turn leads to the best clinical results. Currently, there are no studies devoted to the study of medical professionalism in the Republic of Kazakhstan. As a result, medical education in the Kazakhstani system has a limited perception of the concept of professionalism compared to many Western medical schools. Thus, the primary purpose of this study is to analyze the perception of medical professionalism among residents and teachers of family medicine at the West Kazakhstan Marat Ospanov Medical University. А qualitative research method was used based on the content analysis methodology. A focus group discussion was held with 60 residents and 12 family medicine teachers to gather participants' views and experiences in the field of medical professionalism. The received information was processed using the MAXQDA-2020 software package. Respondents were selected for the study based on their age, gender, and educational level. The results of the conducted survey confirmed the respondents’ acknowledgment of the basic attributes of professionalism, such as medical knowledge and skills (more than 40% of the answers), personal and moral qualities of the doctor (more than 25% of the answers), respect for the interests of the patient (15% of the answers), the relationship between the doctor and the patient and among professionals themselves (15% of responses). Another important discovery of the survey was that residents are five times more likely to define the relationship between a doctor and a patient in a model “respect for the interests of the patient” in comparison with teachers of family medicine, who primarily reported responsibility and collegiality to be the basis for the development of professionalism and traditionally view doctor-patient relationship to be formed on the basis of paternalism defined by a high degree of control over patients. This significant difference demonstrates a rift among specialists in the field of family medicine, which causes a lot of problems. For example, nowadays, professional family doctors regularly face burnout problem due to many reasons and factors that force them to abandon their jobs. In addition to that, elements of professionalism such as reflective skills, time management and feedback collection were presented to the least extent (less than 1%) by both groups, which differs from the perception of the Western medical school and is a significant issue that needs to be solved. The qualitative nature of our study provides a detailed understanding of medical professionalism in the context of the Central Asian healthcare system, revealing many aspects that are inferior to the Western medical school counterparts and provides a solution, which is to teach the attributes and skills required for medical professionalism at all stages of medical education of family doctors.

Keywords: family medicine, family doctors, medical professionalism, medical education

Procedia PDF Downloads 141