Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 695

Search results for: medical therapy

695 What Do Young People Seeking Professional Help Want and Expect From Therapy?

Authors: Clare Watsford, Debra Rickwood

Abstract:

Client expectations and preferences about therapy represent an important area of investigation as research shows they are linked to engagement in therapy and therapy outcomes. Studies examining young people-s expectations and preferences of therapy remain a neglected area of research. The present study explored what expectations and preferences young people seeking professional help held regarding: their role as a client, their therapist-s role, their therapeutic outcomes, and the processes of therapy. Gender and age differences were also examined. Participants included 188 young people aged 12-25 who completed a survey while attending their initial session at a youth mental health service. Data were analysed using quantitative methods. Results found the young people held significantly more pessimistic expectations around therapy when compared to what they had wanted therapy to be like. Few age and gender differences were found. Results highlight the importance of a collaborative therapy approach when working with young people.

Keywords: Client expectations, mental health services, preferences, young people

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694 Effect of Cold, Warm or Contrast Therapy on Controlling Knee Osteoarthritis Associated Problems

Authors: Amal E. Shehata, Manal E. Fareed

Abstract:

Osteoarthritis (OA) is the most prevalent and far common debilitating form of arthritis which can be defined as a degenerative condition affecting synovial joint. Patients suffering from osteoarthritis often complain of dull ache pain on movement. Physical agents can fight the painful process when correctly indicated and used such as heat or cold therapy Aim. This study was carried out to: Compare the effect of cold, warm and contrast therapy on controlling knee osteoarthritis associated problems. Setting: The study was carried out in orthopedic outpatient clinics of Menoufia University and teaching Hospitals, Egypt. Sample: A convenient sample of 60 adult patients with unilateral knee osteoarthritis. Tools: three tools were utilized to collect the data. Tool I : An interviewing questionnaire. It comprised of three parts covering  sociodemographic data, medical data and adverse effects of the treatment protocol. Tool II : Knee Injury and Osteoarthritis Outcome Score (KOOS) It consists of five main parts. Tool II1 : 0-10 Numeric pain rating scale. Results: reveled that the total knee symptoms score was decreased from moderate symptoms pre intervention to mild symptoms after warm and contrast method of therapy, but the contrast therapy had significant effect in reducing the knee symptoms and pain than the other symptoms. Conclusions: all of the three methods of therapy resulted in improvement in all knee symptoms and pain but the most appropriate protocol of treatment to relive symptoms and pain was contrast therapy.

Keywords: Knee Osteoarthritis, Cold, Warm and Contrast Therapy.

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693 The Effectiveness of Metaphor Therapy on Depression among Female Students

Authors: Marzieh Talebzadeh Shoushtari

Abstract:

The present study aimed to determine the effectiveness of Metaphor therapy on depression among female students. The sample included 60 female students with depression symptoms selected by simple sampling and randomly divided into two equal groups (experimental and control groups). Beck Depression Inventory was used to measure the variables. This was an experimental study with a pre-test/post-test design with control group. Eight metaphor therapy sessions were held for the experimental group. A post-test was administered to both groups. Data were analyzed using multivariate analysis of covariance (MANCOVA). Results showed that the Metaphor therapy decreased depression in the experimental group compared to the control group.

Keywords: Metaphor therapy, depression, female, students.

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692 A Tubular Electrode for Radiofrequency Ablation Therapy

Authors: Carlos L. Antunes, Tony R. Almeida, Nélia Raposeiro, Belarmino Gonçalves, Paulo Almeida, André Antunes

Abstract:

In the last two decades radiofrequency ablation (RFA) has been considered a promising medical procedure for the treatment of primary and secondary malignancies. However, the needle-based electrodes so far developed for this kind of treatment are not suitable for the thermal ablation of tumors located in hollow organs like esophagus, colon or bile duct. In this work a tubular electrode solution is presented. Numerical and experimental analyses were performed to characterize the volume of the lesion induced. Results show that this kind of electrode is a feasible solution and numerical simulation might provide a tool for planning RFA procedure with some accuracy.

Keywords: 3D modeling, cancer, medical therapy, radiofrequency ablation.

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691 The Effects of Extracorporeal Shockwave Therapy on Pain, Function, Range of Motion and Strength in Patients with Plantar Fasciitis

Authors: P. Sanzo

Abstract:

Ten percent of the population will develop plantar fasciitis (PF) during their lifetime. Two million people are treated yearly accounting for 11-15% of visits to medical professionals. Treatment ranges from conservative to surgical intervention. The purpose of this study was to assess the effects of extracorporeal shockwave therapy (ECSWT) on heel pain, function, range of motion (ROM), and strength in patients with PF. One hundred subjects were treated with ECSWT and measures were taken before and three months after treatment. There was significant differences in visual analog scale scores for pain at rest (p=0.0001); after activity (p= 0.0001) and; overall improvement (p=0.0001). There was also significant improvement in Lower Extremity Functional Scale scores (p=0.0001); ankle plantarflexion (p=0.0001), dorsiflexion (p=0.001), and eversion (p=0.017),and first metatarsophalangeal joint flexion (p=0.002) and extension (p=0.003) ROM. ECSWT is an effective treatment improving heel pain, function and ROM in patients with PF.

Keywords: Extracorporeal shockwave therapy, shockwave therapy, plantar fasciitis, heel pain, function, range of motion, strength.

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690 Pilot Trial of Evidence-Based Integrative Group Therapy to Improve Executive Functioning among Adults: Implications for Community Mental Health and Training Clinics

Authors: B. Parchem, M. Watanabe, D. Modrakovic, L. Mathew, A. Franklin, M. Cao, R. E. Broudy

Abstract:

Objective: Executive functioning (EF) deficits underlie several mental health diagnoses including ADHD, anxiety, and depression. Community mental health clinics face extensive waitlists for services with many referrals involving EF deficits. A pilot trial of a four-week group therapy was developed using key components from Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and mindfulness with an aim to improve EF skills and offer low-fee services. Method: Eight adults (M = 34.5) waiting for services at a community clinic were enrolled in a four-week group therapy at an in-house training clinic for doctoral trainees. Baseline EF, pre-/post-intervention ADHD and distress symptoms, group satisfaction, and curriculum helpfulness were assessed. Results: Downward trends in ADHD and distress symptoms pre/post-intervention were not significant. Favorable responses on group satisfaction and helpfulness suggest clinical utility. Conclusion: Preliminary pilot data from a brief group therapy to improve EF may be an efficacious, acceptable, and feasible intervention for adults waiting for services at community mental health and training clinics where there are high demands and limits to services and staffs.

Keywords: Executive functioning, cognitive-behavioral therapy, dialectical behavior therapy, mindfulness, adult group therapy.

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689 Cognitive Behaviour Therapy to Treat Social Anxiety Disorder: A Psychology Case

Authors: Yasmin Binti Othman Mydin, Mohd. Fadzillah Abdul Razak

Abstract:

Rational Emotive Behaviour Therapy is the first cognitive behavior therapy which was introduced by Albert Ellis. This is a systematic and structured psychotherapy which is effective in treating various psychological problems. A patient, 25 years old male, experienced intense fear and situational panic attack to return to his faculty and to face his class-mates after a long absence (2 years). This social anxiety disorder was a major factor that impeded the progress of his study. He was treated with the use of behavioural technique such as relaxation breathing technique and cognitive techniques such as imagery, cognitive restructuring, rationalization technique and systematic desensitization. The patient reported positive improvement in the anxiety disorder, able to progress well in studies and lead a better quality of life as a student.

Keywords: Anxiety, behaviour, cognitive, therapy

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688 A Heat-Inducible Transgene Expression System for Gene Therapy

Authors: Masaki Yamaguchi, Akira Ito, Noriaki Okamoto, Yoshinori Kawabe, Masamichi Kamihira

Abstract:

Heat-inducible gene expression vectors are useful for hyperthermia-induced cancer gene therapy, because the combination of hyperthermia and gene therapy can considerably improve the therapeutic effects. In the present study, we developed an enhanced heat-inducible transgene expression system in which a heat-shock protein (HSP) promoter and tetracycline-responsive transactivator were combined. When the transactivator plasmid containing the tetracycline-responsive transactivator gene was co-transfected with the reporter gene expression plasmid, a high level of heat-induced gene expression was observed compared with that using the HSP promoter without the transactivator. In vitro evaluation of the therapeutic effect using HeLa cells showed that heat-induced therapeutic gene expression caused cell death in a high percentage of these cells, indicating that this strategy is promising for cancer gene therapy.

Keywords: Inducible gene expression, Gene therapy, Hyperthermia, Heat shock protein, Tetracycline transactivator.

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687 The Impact of Solution-Focused Brief Therapy on the Improvement of the Psychological Wellbeing of Family Supervisor Women

Authors: Kaveh Qaderi Bagajan, Osman Khanahmadi, Ziba Mamaghani Chaharborj, Majid Chenaparchi

Abstract:

The purpose of this study is to investigate the efficacy of the solution-focused brief therapy on improving the psychological wellbeing of family supervisor woman. This study has been carried out by semi-experimental method and in the form of pre-test, post-test performance on two groups (experimental and control), so that one sample group of 30 individuals was randomly achieved and were randomly divided in two groups of experimental (n=15) and control (n=15). To collect data, Ryff scale psychological wellbeing was used. After conducting pre-test (RSPWB) for two experimental and control groups, Solution-focused brief therapy interference was conducted on the experimental group during five two-hour sessions. Finally, Ryff scale psychological wellbeing was reused for the two groups as post-test and achieved outcomes that were analyzed using covariance. The results indicated that the significant increase of average marks of the experimental group in psychological wellbeing had better function than that of the control group. Finally, solution-focused brief therapy for improving psychological well-being of family supervisor women has a suitable capability and could be used in this way.

Keywords: Solution-Focused Brief Therapy, Short-term Therapy, Family Supervisor Women, Psychological Wellbeing.

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686 The Efficacy of Self-Administered Danger Ideation Reduction Therapy for a 50-year Old Woman with a 20 Year History of Obsessive- Compulsive Disorder: A Case Study

Authors: Mairwen K. Jones, Lynne Harris, Lisa D. Vaccaro

Abstract:

Obsessive-Compulsive Disorder (OCD) is a common and disabling condition. Therapist-delivered treatments that use exposure and response prevention have been found to be very effective in treating OCD, although they are costly and associated with high rates of attrition. Effective treatments that can be made widely available without the need for therapist contact are urgently needed. This case study represents the first published investigation of a self-administered cognitive treatment for OCD in a 50-year old female with a 20 year history of OCD. The treatment evaluation occurred over 27 weeks, including 12 weeks of self-administration of the Danger Ideation Reduction Therapy (DIRT) program. Decreases of between 23% to 33% on measures from pre-treatment to follow-up were observed. Bearing in mind the methodological limitations associated with a case study, we conclude that the results reported here are encouraging and indicate that further research effort evaluating the effectiveness of self-administered DIRT is warranted.

Keywords: Anxiety Treatment, Cognitive Therapy, Danger Ideation Reduction Therapy, Obsessive–Compulsive Disorder, Self- Administered Danger Ideation Reduction Therapy.

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685 The Effects of Mirror Therapy on Clinical Improvement in Hemiplegic Lower Extremity Rehabilitation in Subjects with Chronic Stroke

Authors: Hassan M. Abo Salem, Xiaolin Huang

Abstract:

Background: The effectiveness of mirror therapy (MT) has been investigated in acute hemiplegia. The present study examines whether MT, given during chronic stroke, was more effective in promoting motor recovery of the lower extremity and walking speed than standard rehabilitation alone. Methods: The study enrolled 30 patients with chronic stroke. Fifteen patients each were assigned to the treatment group and the control group. All patients received a conventional rehabilitation program for a 4-week period. In addition to this rehabilitation program, patients in the treatment group received mirror therapy for 4 weeks, 5 days a week. Main measures: Passive ankle joint dorsiflexion range of motion, gait speed, Brunnstrom stages of motor recovery, plantar flexor muscle tone by Modified Ashworth Scale. Results: No significant difference was found in the outcome measures among groups before treatment. When compared with standard rehabilitation, mirror therapy improved Ankle ROM, Brunnstrom stages and waking speed (p < 0.05). However, there were no significant differences between two groups on MAS (P > 0.05).Conclusion: Mirror therapy combined with a conventional stroke rehabilitation program enhances lowerextremity motor recovery and walking speed in chronic stroke patients.

Keywords: Mirror therapy, stroke, MAS, walking speed.

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684 The Efficacy of Danger Ideation Reduction Therapy for an 86-Year Old Man with a 63-Year History of Obsessive-Compulsive Disorder: A Case Study

Authors: Mairwen K. Jones, Bethany M. Wootton, Lisa D. Vaccaro

Abstract:

While OCD is one of the most commonly occurring psychiatric conditions experienced by older adults, there is a paucity of research conducted into the treatment of older adults with OCD. This case study represents the first published investigation of a cognitive treatment for geriatric OCD. It describes the successful treatment of an 86-year old man with a 63-year history of OCD using Danger Ideation Reduction Therapy (DIRT). The client received 14 individual, 50-minute treatment sessions of DIRT over 13 weeks. Clinician-based Y-BOCS scores reduced 84% from 25 (severe) at pre-treatment, to 4 (subclinical) at 6-month post-treatment follow-up interview, demonstrating the efficacy of DIRT for this client. DIRT may have particular advantages over ERP and pharmacological approaches, however further research is required in older adults with OCD.

Keywords: Cognitive Therapy, Danger Ideation Reduction Therapy, Obsessive-Compulsive Disorder, Older adults, Psychogeriatrics

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683 The Use of Music Therapy to Improve Non-Verbal Communication Skills for Children with Autism

Authors: Maria Vinca Novenia

Abstract:

The number of school-aged children with autism in Indonesia has been increasing each year. Autism is a developmental disorder which can be diagnosed in childhood. One of the symptoms is the lack of communication skills. Music therapy is known as an effective treatment for children with autism. Music elements and structures create a good space for children with autism to express their feelings and communicate their thoughts. School-aged children are expected to be able to communicate non-verbally very well, but children with autism experience the difficulties of communicating non-verbally. The aim of this research is to analyze the significance of music therapy treatment to improve non-verbal communication tools for children with autism. This research informs teachers and parents on how music can be used as a media to communicate with children with autism. The qualitative method is used to analyze this research, while the result is described with the microanalysis technique. The result is measured specifically from the whole experiment, hours of every week, minutes of every session, and second of every moment. The samples taken are four school-aged children with autism in the age range of six to 11 years old. This research is conducted within four months started with observation, interview, literature research, and direct experiment. The result demonstrates that music therapy could be effectively used as a non-verbal communication tool for children with autism, such as changes of body gesture, eye contact, and facial expression.

Keywords: Autism, non-verbal communication, microanalysis, music therapy, school-aged children.

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682 The Effectiveness of Solution-Focused Group Therapy on Improving Depressed Mothers of Child Abuser Families

Authors: Roya Maqami, Kaveh Qaderi Bagajan, Mohammad Mahdi Yousefi, Saeed Moradi

Abstract:

The purpose of this study is to investigate the efficacy of solution-focused group therapy on improving the depressed mothers of child abuser families. This study was carried out in the form of a semi-pilot, pre-test and post-test on two groups (experimental and control). Subjects include all mothers and their children that are the members of Shush and Naser Khosro child home. Beck Depression Inventory and Child Trauma Questionnaire were used to collect data. First, child abuse questionnaire was completed by children, Then Beck Depression Inventory was completed by their mothers that 22 of them were recognized as depressed and randomly divided in two groups of experimental and control. After applying pre-test for both of these groups, the intervention of solution- focused group therapy was performed in five sessions on experimental group. Finally, post-test was applied on both groups and subsequently in a month, follow-up test was performed. T-test, multivariate variance, and repeated measurement analysis of variance were used to analyze the data. According to the findings, it can be concluded that this therapy leads to the improvement of depressed mother's mood. As a result, the intervention of solution-focused group therapy is useful in order to improve the depressing mood of mothers of child abuser families.

Keywords: Child Abuse, Depressed Mothers, Child Abuser Families, Solution-focused Group Therapy.

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681 Similarity Based Retrieval in Case Based Reasoning for Analysis of Medical Images

Authors: M. Das Gupta, S. Banerjee

Abstract:

Content Based Image Retrieval (CBIR) coupled with Case Based Reasoning (CBR) is a paradigm that is becoming increasingly popular in the diagnosis and therapy planning of medical ailments utilizing the digital content of medical images. This paper presents a survey of some of the promising approaches used in the detection of abnormalities in retina images as well in mammographic screening and detection of regions of interest in MRI scans of the brain. We also describe our proposed algorithm to detect hard exudates in fundus images of the retina of Diabetic Retinopathy patients.

Keywords: Case based reasoning, Exudates, Retina image, Similarity based retrieval.

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680 Acceptance and Commitment Therapy for Work Stress: Variation in Perceived Group Process and Outcomes

Authors: William H. O'Brien, Erin Bannon, M.A., Heather McCarren, Eileen Delaney

Abstract:

Employees commonly encounter unpredictable and unavoidable work related stressors. Exposure to such stressors can evoke negative appraisals and associated adverse mental, physical, and behavioral responses. Because Acceptance and Commitment Therapy (ACT) emphasizes acceptance of unavoidable stressors and diffusion from negative appraisals, it may be particularly beneficial for work stress. Forty-five workers were randomly assigned to an ACT intervention for work stress (n = 21) or a waitlist control group (n = 24). The intervention consisted of two 3-hour sessions spaced one week apart. An examination of group process and outcomes was conducted using the Revised Sessions Rating Scale. Results indicated that the ACT participants reported that they perceived the intervention to be supportive, task focused, and without adverse therapist behaviors (e.g., feelings of being criticized or discounted). Additionally, the second session (values clarification and commitment to action) was perceived to be more supportive and task focused than the first session (mindfulness, defusion). Process ratings were correlated with outcomes. Results indicated that perceptions of therapy supportiveness and task focus were associated with reduced psychological distress and improved perceived physical health.

Keywords: Work stress, Acceptance and Commitment Therapy, therapy process.

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679 A Retrospective Study of Vaginal Stenosis Following Treatment of Cervical Cancers and the Effectiveness of Rehabilitation Interventions

Authors: Manjusha R. Vagal, Shyam K. Shrivastava, Umesh Mahantshetty, Sudeep Gupta, Supriya Chopra, Reena Engineer, Amita Maheshwari, Atul Buduk

Abstract:

Vaginal stenosis is a common side effect associated with pelvic radiotherapy in cervical cancer patients which contributes negatively to woman’s health and prevents adequate vaginal/cervical examination. Vaginal dilation with a dilator is routine practice and is internationally advocated as a prophylactic measure to preserve vaginal patency. This retrospective study was carried out with the aim to know the usefulness of vaginal dilation following pelvic radiation therapy in cervical cancer patients in India. Data from medical records of 183 cervical cancer patients, which met the study criteria, were collected related to the stage of the disease, treatment received, commencement period of dilation post radiation therapy, sexual status and side effects associated to dilation practice. Data related to vaginal dimensions as per the length of insertion of a small, medium and large dilator were collected on regular follow-ups until 36 months and/or more. Vaginal dimensions as measured with the length of medium dilator insertion were used for analysis of dilation therapy results using paired t-test. Patients who underwent vaginal dilation with dilator maintained vaginal patency, also the mean vaginal length significantly increased, from 8.02 cm ± 2.69 to 9.96 ± 2.89 cm with a p value <0.001. There was no significant difference found on vaginal patency with different intervals of initiation of dilation therapy. At the third year and more following dilation therapy, significant increase in vaginal length observed with a p value of 0.0001 in both sexually active and inactive patients. Compilation of vaginal dosage during brachytherapy was inadequate, and hence, the secondary objective of the study to determine the effect of radiotherapy on the outcome of rehabilitation intervention was not studied in detail. This retrospective study has found that dilation therapy with vaginal dilators post pelvic radiotherapy is effective in preventing vaginal stenosis and improving vaginal patency and cannot be substituted with vaginal intercourse. Sexual quality of life assessment in the Indian population needs much attention.

Keywords: Dilator, sexually active, vaginal dilation, vaginal stenosis.

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678 Ozone Therapy and Pulsed Electromagnetic Fields Interplay in Controlling Tumor Growth, Symptom and Pain Management: A Case Report

Authors: J. F. Pollo Gaspary, F. Peron Gaspary, E. M. Simão, R. Concatto Beltrame, G. Orengo de Oliveira, M. S. Ristow Ferreira, F. Sartori Thies, I. F. Minello, F. dos Santos de Oliveira

Abstract:

Background: The immune system has evolved several mechanisms to protect the host against cancer, and it has now been suggested that the expansion of its functions may prevent tumor growth and control the symptoms of cancer patients. Two techniques, ozone therapy and pulsed electromagnetic fields (PEMF), are independently associated with an increase in the immune system functions and they maybe help palliative care of patients in these conditions. Case Report: A patient with rectal adenocarcinoma with metastases decides to interrupt the clinical chemotherapy protocol due to refractoriness and side effects. As a palliative care alternative treatment it is suggested to the patient the use of ozone therapy associated with PEMF techniques. Results: The patient reports an improvement in well-being, in autonomy and in pain control. Imaging tests confirm a pause in tumor growth despite more than 60 days without using classic treatment. These results associated with palliative care alternative treatment stimulate the return to the chemotherapy protocol. Discussion: This case illustrates that these two techniques can contribute to the control of tumor growth and refractory symptoms, such as pain, probably by enhancing the immune system. Conclusions: The potential use of the combination of these two therapies, ozone therapy and PEMF therapy, can contribute to palliation of cancer patients, alone or in combination with pharmacological therapies. The conduct of future investigations on this paradigm can elucidate how much these techniques contribute to the survival and well-being of these patients.

Keywords: Cancer, complementary and alternative medicine, ozone therapy, palliative care, PEMF Therapy.

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677 TeleMe Speech Booster: Web-Based Speech Therapy and Training Program for Children with Articulation Disorders

Authors: C. Treerattanaphan, P. Boonpramuk, P. Singla

Abstract:

Frequent, continuous speech training has proven to be a necessary part of a successful speech therapy process, but constraints of traveling time and employment dispensation become key obstacles especially for individuals living in remote areas or for dependent children who have working parents. In order to ameliorate speech difficulties with ample guidance from speech therapists, a website has been developed that supports speech therapy and training for people with articulation disorders in the standard Thai language. This web-based program has the ability to record speech training exercises for each speech trainee. The records will be stored in a database for the speech therapist to investigate, evaluate, compare and keep track of all trainees’ progress in detail. Speech trainees can request live discussions via video conference call when needed. Communication through this web-based program facilitates and reduces training time in comparison to walk-in training or appointments. This type of training also allows people with articulation disorders to practice speech lessons whenever or wherever is convenient for them, which can lead to a more regular training processes.

Keywords: Web-Based Remote Training Program, Thai Speech Therapy, Articulation Disorders.

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676 Two Cases of VACTERL Association in Pregnancy with Lymphocyte Therapy

Authors: Seyed Mazyar Mortazavi, Masod Memari, Hasan Ali Ahmadi, Zhaleh Abed

Abstract:

VACTERL association is a rare disorder with various congenital malformations. The aetiology remains unknown. Combination of at least three congenital anomalies of the following criteria is required for diagnosis: vertebral defects, anal atresia, cardiac anomalies, tracheo-esophageal fistula, renal anomalies, and limb defects. The first case was 1-day old male neonate with multiple congenital anomalies was bore from 28 years old mother. The mother had history of pregnancy with lymphocyte therapy. His anomalies included: defects in thoracic and lumbar vertebral, anal atresia, bilateral hydronephrosis, atrial septal defect, and lower limb abnormality. Other anomalies were cryptorchidism and nasal canal narrowing. The second case was born with 32 weeks gestational age from mother with history of pregnancy with lymphocyte therapy. He had thoracic vertebral defect, cardiac anomalies and renal defect. diagnosis based on clinical finding is VACTERL association. Early diagnosis is very important to investigation and treatment of other coexistence anomalies. VACTERL association in mothers with history of pregnancy with lymphocyte therapy has suggested possibly of relationship between VACTERL association and this method of pregnancy.

Keywords: Anal atresia, tracheo-esophageal fistula, atrial septal defect, lymphocyte therapy.

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675 Education and Research in Physical Therapy and Rehabilitation in Libya

Authors: W. Astiata, A. Wasif

Abstract:

In this paper, an overview is made on the educational and research activities in the field of physical medicine and rehabilitation in Libya, including development in rehabilitation science, research, training, occupational therapy, physiotherapy and physiatrist, which are mainly concerned with the patients in Libya[3] [13].

Keywords: Physiotherapy, Rehabilitation, Libya, Graduates, Institutions, Universities, Research, Education, Courses.

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674 Marital Interactions in Predicting Treatment Outcome in Panic Disorder with Agoraphobia

Authors: Ghassan El-Baalbaki, Claude Bélanger, Michel Perreault, Steffany J. Fredman, Donald H. Baucom

Abstract:

This study had two goals. First, it investigated marital interaction variables as predictors of treatment outcome in panic disorder with agoraphobia (PDA) in sixty-five couples with one spouse suffering from PDA. Second, it analyzed the impact of PDA improvement, following therapy, on marital interaction patterns of both spouses. The partners were observed during a problem-solving task, before and after treatment. Negative behaviors at the outset of therapy, both in the PDA and the NPDA partners, predicted less improvement at post-test. It also appears that improvement in some PDA symptoms following therapy is linked to increase in the dominant behavior of the NPDA spouse and to an improvement in terms of his intrusiveness.

Keywords: Communication and problem-solving skills, Emotional overinvolvement, Marital relationship, Panic disorder withagoraphobia, Treatment outcome.

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673 The Effects of Extracorporeal Shockwave Therapy on Pain, Function, Range of Motion, and Strength in Patients with Insertional Achilles Tendinosis

Authors: P. Sanzo

Abstract:

Increased physical fitness participation has been paralleled by increasedoveruse injuries such as insertional Achilles tendinosis (AT). Treatment has provided inconsistentresults. The use of extracorporeal shockwave therapy (ECSWT) offers a new treatment consideration.The purpose of this study was to assess the effects of ECSWTon pain, function, range of motion (ROM), joint mobility and strength in patients with AT. Thirty subjects were treated with ECSWT and measures were takenbefore and three months after treatment. There was significant differences in visual analog scale (VAS) scores for pain at rest (p=0.002); after activity (p= 0.0001); overall improvement(p=0.0001); Lower Extremity Functional Scale (LEFS) scores (p=0.002); dorsiflexion range of motion (ROM) (p=0.0001); plantarflexion strength (p=0.025); talocrural joint anterior glide (p=0.046); and subtalar joint medial and lateral glide (p=0.025).ECSWT offers a new intervention that may limit the progression of the disorder and the long term healthcare costs associated with AT.

Keywords: Extracorporeal shockwave therapy, shockwave therapy, Achilles tendinosis, range of motion, strength, joint mobility

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672 Neurological Manifestations in Patients with HIV Infection in the Era of Combined Antiretroviral Therapy

Authors: Sharan Badiger, Prema T. Akkasaligar, Deepak Kadeli, M. Vishok

Abstract:

Neurological disorders are the most debilitating of manifestations seen in patients infected with HIV. The clinical profile of neurological manifestations in HIV patients has undergone a shift in recent years with opportunistic infections being controlled with combination anti-retroviral therapy and the advent of drugs which have higher central nervous system penetrability. The aim of this paper is to study the clinical, investigation profile and various neurological disorders in HIV patients on anti‐retroviral therapy. Fifty HIV patients with neurological manifestations were studied. A complete neurological examination including neurocognitive functioning using Montreal Cognitive Assessment and HIV Dementia scale were assessed. Apart from relevant investigations, CD4 count, cerebrovascular fluid analysis, computed tomography (CT) and magnetic resonance imaging (MRI) of brain were done whenever required. Neurocognitive disorders formed the largest group with 42% suffering from HIV associated Neurocognitive Disorders. Among them, asymptomatic neurocognitive impairment was seen in 28%; mild neurocognitive disorder in 12%, and 2% had HIV‐associated dementia. Opportunistic infections of the nervous system accounted for 32%, with meningitis being the most common. Four patients had space occupying lesions of central nervous system; four tuberculomas, and one toxoplasmosis. With the advent of highly active retroviral therapy, HIV patients have longer life spans with suppression of viral load leading to decrease in opportunistic infections of the nervous system. Neurocognitive disorders are now the most common neurological dysfunction seen and thus neurocognitive assessment must be done in all patients with HIV.

Keywords: Anti retroviral therapy, cognitive dysfunction, dementia, neurological manifestations, opportunistic infections.

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671 Controllability of Efficiency of Antiviral Therapy in Hepatitis B Virus Infections

Authors: Shyam S.N. Perera

Abstract:

An optimal control problem for a mathematical model of efficiency of antiviral therapy in hepatitis B virus infections is considered. The aim of the study is to control the new viral production, block the new infection cells and maintain the number of uninfected cells in the given range. The optimal controls represent the efficiency of antiviral therapy in inhibiting viral production and preventing new infections. Defining the cost functional, the optimal control problem is converted into the constrained optimization problem and the first order optimality system is derived. For the numerical simulation, we propose the steepest descent algorithm based on the adjoint variable method. A computer program in MATLAB is developed for the numerical simulations.

Keywords: Virus infection model, Optimal control, Adjoint system, Steepest descent

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670 Automatic 2D/2D Registration using Multiresolution Pyramid based Mutual Information in Image Guided Radiation Therapy

Authors: Jing Jia, Shanqing Huang, Fang Liu, Qiang Ren, Gui Li, Mengyun Cheng, Chufeng Jin, Yican Wu

Abstract:

Medical image registration is the key technology in image guided radiation therapy (IGRT) systems. On the basis of the previous work on our IGRT prototype with a biorthogonal x-ray imaging system, we described a method focused on the 2D/2D rigid-body registration using multiresolution pyramid based mutual information in this paper. Three key steps were involved in the method : firstly, four 2D images were obtained including two x-ray projection images and two digital reconstructed radiographies(DRRs ) as the input for the registration ; Secondly, each pair of the corresponding x-ray image and DRR image were matched using multiresolution pyramid based mutual information under the ITK registration framework ; Thirdly, we got the final couch offset through a coordinate transformation by calculating the translations acquired from the two pairs of the images. A simulation example of a parotid gland tumor case and a clinical example of an anthropomorphic head phantom were employed in the verification tests. In addition, the influence of different CT slice thickness were tested. The simulation results showed that the positioning errors were 0.068±0.070, 0.072±0.098, 0.154±0.176mm along three axes which were lateral, longitudinal and vertical. The clinical test indicated that the positioning errors of the planned isocenter were 0.066, 0.07, 2.06mm on average with a CT slice thickness of 2.5mm. It can be concluded that our method with its verified accuracy and robustness can be effectively used in IGRT systems for patient setup.

Keywords: 2D/2D registration, image guided radiation therapy, multi resolution pyramid, mutual information.

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669 Medical Knowledge Management in Healthcare Industry

Authors: B. Stroetmann, A. Aisenbrey

Abstract:

The Siemens Healthcare Sector is one of the world's largest suppliers to the healthcare industry and a trendsetter in medical imaging and therapy, laboratory diagnostics, medical information technology, and hearing aids. Siemens offers its customers products and solutions for the entire range of patient care from a single source – from prevention and early detection to diagnosis, and on to treatment and aftercare. By optimizing clinical workflows for the most common diseases, Siemens also makes healthcare faster, better, and more cost effective. The optimization of clinical workflows requires a multidisciplinary focus and a collaborative approach of e.g. medical advisors, researchers and scientists as well as healthcare economists. This new form of collaboration brings together experts with deep technical experience, physicians with specialized medical knowledge as well as people with comprehensive knowledge about health economics. As Charles Darwin is often quoted as saying, “It is neither the strongest of the species that survive, nor the most intelligent, but the one most responsive to change," We believe that those who can successfully manage this change will emerge as winners, with valuable competitive advantage. Current medical information and knowledge are some of the core assets in the healthcare industry. The main issue is to connect knowledge holders and knowledge recipients from various disciplines efficiently in order to spread and distribute knowledge.

Keywords: Business Excellence, Clinical Knowledge, Knowledge Management, Knowledge Services, Learning Organizations, Trust.

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668 Pre-Malignant Breast Lesions, Methods of Treatment and Outcome

Authors: Ahmed Mostafa, Mohamed Mahmoud, Nesreen H. Hafez, Mohamed Fahim

Abstract:

This retrospective study includes 60 patients with pre-invasive breast cancer. Aim of the study: Evaluation of premalignant lesions of the breast (DCIS), different treatment methods and outcome. Patients and methods: 60 patients with DCIS were studied from the period between 2005 to 2012, for 38 patients the primary surgical method was wide local resection (WLE) (63.3%) and the other cases (22 patients, 36.7%) had mastectomy, fourteen cases from those who underwent local excision received radiotherapy, while no adjuvant radiotherapy was given for those who underwent mastectomy. In case of hormonal receptor positive DCIS lesions hormonal treatment (Tamoxifen) was given after local control. Results: No difference in overall survival between mastectomy & breast conserving therapy (wide local excision and adjuvant radiotherapy), however local recurrence rate is higher in case of breast conserving therapy, also no role of Axillary evacuation in case of DCIS. The use of hormonal therapy decreases the incidence of local recurrence by about 98%. Conclusion: The main management of DCIS is local treatment (wide local excision and radiotherapy) with hormonal treatment in case of hormone receptor positive lesions.

Keywords: Ductal carcinoma in situ, surgical treatment, radiotherapy, breast conserving therapy, hormonal treatment.

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667 Optimal Temperature and Duration for Dabbing Customers with the Massage Compressed Packs Reported from Customers’ Perception

Authors: Wichan Lertlop, Boonyarat Chaleephay

Abstract:

The objective of this research was to study the appropriate thermal level and time for dabbing customers with the massage compressed pack reported from their perception. The investigation was conducted by comparing different angles of tilted heads done by the customers together with their perception before and after the dabbing. The variables included different temperature of the compressed packs and different dabbing duration. Samples in this study included volunteers who got massage therapy and dabbing with hot compressed packs by traditional Thai medical students. The experiment was conducted during January to June 2013. The research tool consisted of angle meters, stop watches, thermometers, and massage compressed packs. The customers were interviewed for their perceptions before and after the dabbing. The results showed that:

  1. There was a difference of the average angles of tilted heads before and after the dabbing.
  2. There was no difference of the average angles at different temperatures but constant duration.
  3. There was no difference of the average angles at different durations.
  4. The customers reported relaxation no matter what the various temperatures and various dabbing durations were. However, they reported too hot at the temperature 70oC and over.

Keywords: Massage, Therapy, Therapeutic Systems and Technologies.

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666 The Impact of Regulatory Changes on the Development of Mobile Medical Apps

Authors: M. McHugh, D. Lillis

Abstract:

Mobile applications are being used to perform a wide variety of tasks in day-to-day life, ranging from checking email to controlling your home heating. Application developers have recognized the potential to transform a smart device into a medical device, by using a mobile medical application i.e. a mobile phone or a tablet. When initially conceived these mobile medical applications performed basic functions e.g. BMI calculator, accessing reference material etc.; however, increasing complexity offers clinicians and patients a range of functionality. As this complexity and functionality increases, so too does the potential risk associated with using such an application. Examples include any applications that provide the ability to inflate and deflate blood pressure cuffs, as well as applications that use patient-specific parameters and calculate dosage or create a dosage plan for radiation therapy. If an unapproved mobile medical application is marketed by a medical device organization, then they face significant penalties such as receiving an FDA warning letter to cease the prohibited activity, fines and possibility of facing a criminal conviction. Regulatory bodies have finalized guidance intended for mobile application developers to establish if their applications are subject to regulatory scrutiny. However, regulatory controls appear contradictory with the approaches taken by mobile application developers who generally work with short development cycles and very little documentation and as such, there is the potential to stifle further improvements due to these regulations. The research presented as part of this paper details how by adopting development techniques, such as agile software development, mobile medical application developers can meet regulatory requirements whilst still fostering innovation.

Keywords: Medical, mobile, applications, software Engineering, FDA, standards, regulations, agile.

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