Use of dexmedetomidine as a sedative and analgesic agent in critically ill adult patients: a meta-analysis

Purpose  

To assess the effects of using dexmedetomidine as a sedative and analgesic agent on length of intensive care unit (ICU) stay, duration of mechanical ventilation, risk of bradycardia, and hypotension in critically ill adult patients.     

Cisplatin incorporated in microspheres: development and fundamental studies for its clinical application.

A new drug delivery formulation, biodegradable glycolic acid-lactic acid copolymer (PGLA) microspheres incorporating cisplatin (CDDP-MS) has been developed for the treatment of peritoneal carcinomatosis. Scanning electron microscopy showed that CDDP-MS has a smooth surface and few cisplatin crystals in the hollow. An electron probe micro analyzer revealed that cisplatin was located mainly in the matrix in the state of a molecule. Release profile in vitro of CDDP from microspheres showed that the initial burst was 21.2% and the remaining CDDP was released slowly thenceforth over 14 days. Hydrolysis of CDDP-MS progresses very slowly during the 14 days, but there was no morphological change in the SEM views. The dimethylformamide content entrapped within CDDP-MS, determined by a gas chromatography, was 136 ppm at the evaporation temperature of 47 degrees C. The 50% lethal dose value of CDDP-MS, calculated by the Litchfield-Wilcoxon method, was reduced to 57% of the cisplatin solution. Therapeutic experiment on mice with peritoneal carcinomatosis showed that CDDP-MS did not enhance therapeutic effect as compared with the same dose dosage of a cisplatin aqueous solution but large quantities of cisplatin could be given in case of CDDP-MS owing to less toxicity.     

Practical clinical trials for translating research to practice: design and measurement recommendations

RATIONALE: There is a pressing need for practical clinical trials (PCTs) that are more relevant to clinicians and decision-makers, but many are unaware of these trials. Furthermore, such trials can be challenging to conduct and to report. OBJECTIVE: The objective of this study was to build on the seminal paper by Tunis et al (Practical clinical trials. Increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003;290:1624-1632.) and to provide recommendations and examples of how practical clinical trials can be conducted and the results reported to enhance external validity without sacrificing internal validity. KEY ISSUES: We discuss evaluating practical intervention options, alternative research designs, representativeness of samples participating at both the patient and the setting/clinician level, and the need for multiple outcomes to address clinical and policy implications. CONCLUSIONS: We provide a set of specific recommendations for issues to be reported in PCTs to increase their relevance to clinicians and policymakers, and to help reduce the gap between research and practice.     

Volume measurement using the Polhemus FastSCAN 3D laser scanning: a novel application for burns clinical research

The Polhemus FastSCAN system offers a noncontact method of quantifying limb edema volume by combining laser scanning with 3D spatial orientation. The aim of this study was to investigate the reliability, validity and clinical utility of this assessment technique in the burn environment. Pilot Studies: Completed in order to develop a standardised scanning procedure. Intertester Reliability: Two testers each scanned 30 uninjured upper limbs. Intratester Reliability: One tester conducted repeated scans for burn survivors (n = 6). Validity: The scan volumes were compared with water displacement measures for all volunteers (n = 36). Intertester reliability was moderate for whole arm scans (R = .59; 95% confidence intervals [CI] = 0.28-0.78) and excellent with hand truncated (R = .95; 95% CI = 0.90-0.98; minimum detectable difference = 242.1 cm3). Intratester reliability was inconclusive (R = .72; 95% CI = -0.07-0.96) but qualitative assessment confirmed poorer quality scans. The FastSCAN system overstated the arm volume by 49.3 cm3 on average, but 95% limits of agreement when compared with water displacement demonstrated the limitations as a clinical or research tool in the burn environment. The Polhemus FastSCAN system provides a noncontact method of limb volume measurement. The reliability was good only with the hand removed from calculations. The accuracy of the system compared poorly with water displacement measures in the burn clinical environment. Using the currently available software and method, the change detectable by this technique was too large for monitoring the efficacy of acute burn edema interventions.     

Evaluating research studies that address prognosis for patients receiving physical therapy care: a clinical update

A prognosis is a broad statement that predicts a patient's likely status, or degree of change, at some time in the future. Clinicians are likely to improve the accuracy of their judgments of prognosis by incorporating relevant research findings. In recent years, there has been substantial growth in the number of primary studies and systematic reviews addressing prognosis for people likely to receive physical therapy care. The purpose of this clinical update is to provide a framework for identifying, appraising, and utilizing these research findings to help make prognostic judgments.     

Initial development of a questionnaire evaluating perceived benefits and barriers to pediatric clinical trials participation

ObjectiveTo evaluate perceived benefits and barriers to pediatric clinical trials participation to improve decision-making and enhance recruitment and retention among minority youth with chronic health conditions (sickle cell disease, asthma) and their caregivers.MethodsA questionnaire was developed based on the social ecological model using input from medical experts and community-based public health organizations. Parallel caregiver, adolescent/young adult (AYA; 16–39 years old), and child (8–15 years old) versions were field tested. Patients and caregivers completed the questionnaire, which included demographic items, perceived life stress and social desirability measures.ResultsExploratory factor analysis rendered a four-factor solution for the caregiver version (direct treatment benefit, mistrust of research/researchers, trust in healthcare team to engage in safe research, and opportunity cost) and the AYA version (mistrust/no direct benefit, safety, direct treatment benefit/practical considerations, and social support for research). Factor structures differed for SCD and asthma caregivers; results were equivocal for the child version. Summated subscales were not significantly associated with patient demographics or social desirability, but significant correlations with perceived life stress and prior participation in research were identified.ConclusionsWhile the factor structure should be confirmed with larger samples, findings indicate potential benefit, perceived harm due to mistrust of researchers, and logistics are primary factors in decision-making about participation in pediatric clinical trials. By addressing these benefits/barriers through adjustments to recruitment and informed consent procedures, researchers may address misperceptions of research, improve decision-making, and increase recruitment and retention particularly for ethnic minority children with chronic health conditions.     

Proposal of a tool for providing patients with the main results of clinical research studies

CONTEXT: Clinical research regulations currently undergo major revisions mainly initiated by the European harmonization. Regulations must indeed all be adapted to the contents of directive 2001/20/CE applicable in France on 1 May 2004. One of the four principal modifications of the Huriet-Sérusclat law dating from 4 March 2002 relates to the transmission of the main results of research protocols to participating patients. However, no precise directives or information are provided to investigators and sponsors on how to implement this. OBJECTIVE: Our objective was to create a tool to assist investigators providing patients with the main results of clinical research studies. MATERIALS AND METHODS: We first consulted the various participants in biomedical research: ethics committee (CCPPRB), Clinical Investigation Centres (CIC), institutional sponsors, participating patients, plus research protocols and lawyers specialized in forensic medicine. CONCLUSION: After analysis of their answers, we worked out the bases of our tool. This tool is tested in an implementation phase.     

疑似埃博拉病毒感染患者血样采集流程的建立及应用

目的探讨疑似埃博拉病毒感染患者血样采集流程的应用效果。方法建立采集疑似埃博拉病毒感染患者血样的流程,并应用该流程完成112例患者的血样采集。结果成功完成经静脉采血278次,心脏采血3次,每次采血所需时间平均为13.5min,护理人员无一例感染。结论建立规范护理操作流程是护士能高效、安全地护理疑似埃博拉病毒患者的重要保证。     

Design and development of a web-based application for diabetes patient data management

A web-based database management system developed for collecting, managing and analysing information of diabetes patients is described here. It is a searchable, client-server, relational database application, developed on the Windows platform using Oracle, Active Server Pages (ASP), Visual Basic Script (VB Script) and Java Script. The software is menu-driven and allows authorized healthcare providers to access, enter, update and analyse patient information. Graphical representation of data can be generated by the system using bar charts and pie charts. An interactive web interface allows users to query the database and generate reports. Alpha- and beta-testing of the system was carried out and the system at present holds records of 500 diabetes patients and is found useful in diagnosis and treatment. In addition to providing patient data on a continuous basis in a simple format, the system is used in population and comparative analysis. It has proved to be of significant advantage to the healthcare provider as compared to the paper-based system.     

Deep brain stimulation: a review of basic research and clinical studies

Deep brain stimulation for pain control in humans was first used almost 30 years ago and has continued to receive considerable attention. Despite the large number of clinical reports describing pain relief, numerous studies have indicated that the results of these procedures vary considerably. In addition, many neurosurgeons find the procedures unpredictable, and considerable disagreement still exists regarding important issues related to the technique itself. This review gives an historical overview of the relevant basic and clinical literature and provides a critical examination of the clinical efficacy, choice of stimulation sites, parameters of stimulation, and effects on experimental pain. Finally, we give suggestions for future research that could more definitively determine the usefulness of deep brain stimulation for pain control.     

Accounting for nonlinear BOLD effects in fMRI: parameter estimates and a model for prediction in rapid event-related studies

Nonlinear effects in fMRI BOLD data may substantially influence estimates of task-related activations, particularly in rapid event-related designs. If the BOLD response to each stimulus is assumed to be independent of the stimulation history, nonlinear interactions create a prediction error that may reduce sensitivity. When stimulus density differs among conditions, nonlinear effects can cause artifactual differences in activation. This situation can occur in rapid event-related designs or when comparing blocks of unequal lengths. We present data showing substantial nonlinear history effects for stimuli 1 s apart and use estimates of nonlinearities in response magnitude, onset time, and time to peak to form a low-dimensional parameterization of these nonlinear effects. Our estimates of nonlinearity appear relatively consistent throughout the brain, and these estimates can be used to form adjusted linear predictors for future rapid event-related fMRI studies. Adjusting the linear model for these known nonlinear effects results in a substantially better model fit. The biggest advantages to using predictors adjusted for known nonlinear effects are (1) higher sensitivity at the individual subject level of analysis, (2) better control of confounds related to nonlinear effects, and (3) more accurate estimates of design efficiency in experimental fMRI design.     

Measuring free-living physical activity in COPD patients: Deriving methodology standards for clinical trials through a review of research studies

This article presents a review of the research literature to identify the methodology used and outcome measures derived in the use of accelerometers to measure free-living activity in patients with COPD. Using this and existing empirical validity evidence we further identify standards for use, and recommended clinical outcome measures from continuous accelerometer data to describe pertinent measures of sedentary behaviour and physical activity in this and similar patient populations. We provide measures of the strength of evidence to support our recommendations and identify areas requiring continued research. Our findings support the use of accelerometry in clinical trials to understand and measure treatment-related changes in free-living physical activity and sedentary behaviour in patient populations with limited activity.     

Bridging the healthcare divide with patient navigation: development of a research program to address disparities

Americans who live in poverty as well as certain ethnic and racial groups have higher cancer death rates than other populations. Patient navigators have been identified as an important weapon against these disparities. Navigators can address insurance, financial, and logistical issues (e.g., transportation, appointment scheduling, child or elder care). They can provide understandable health education that may lessen fears of cancer diagnosis and treatment. This article describes the development and implementation of a multisite patient navigator program involving five cancer institutions in Western Pennsylvania. Navigator programs have great potential to enhance cancer care by reaching underserved populations and opening the door for future research.     

The meaning of patient participation for patients and nurses at a nurse-led clinic for chronic heart failure.

BACKGROUND: The legislation of many Western countries emphasizes active patient participation. Patients with chronic heart failure (CHF), however, have experienced participation differently from the general interpretation of legal definitions. Education improves uptake of self-management strategies yet knowledge is lacking about support of patients' own resources in CHF. AIM: To explore the phenomena of patient participation and non-participation as shown in patient visits to a nurse-led clinic for CHF and as experienced by the patients and nurses. METHODS: Data triangulation of field notes from participatory observations and texts from narrative interviews with the patients and assigned nurse specialists. Data were analyzed according to the phenomenological hermeneutic tradition. FINDINGS: Patients' experience of participation and non-participation was interpreted as "Being responsible and accepting responsibility" and "Lacking an equal relationship while being controlled", respectively. Nurses experienced patient participation as "Getting information and security to act" and patient non-participation as "Not accepting". CONCLUSION: Conflicting values of patients and nurses, which were interpreted with respect to participation and non-participation, presumably might influence patient information and education negatively. The issue of participation should be raised as a means of attaining concordance and to facilitate patient participation with education specifically tailored to the individual patient's needs.