Facilitating narrative medical discussions of type 1 diabetes with computer visualizations and photography

OBJECTIVE: Patient-centered approaches to medicine suggest the need for physicians to become more aware of concerns and needs expressed in patient narratives. However, patients and physicians have different goals and discourse styles during consultations. We attempt to bridge these differences by providing patients with ways to collect, visualize, and describe behavioral and biomedical data. METHODS: We describe an intervention where individuals with type 1 diabetes photograph health-related behaviors. These images and blood glucose records are displayed in computer visualizations and used during patient-physician interviews. RESULTS: Qualitative analyses of interview data with patients who photographed their lives suggest the range of difficulties associated with diabetes self-management. The visualizations helped them articulate concerns about stress, peer relations, and unhealthy routines. CONCLUSION: Interventions that combine biomedical and biopsychosocial data during patient-physician consultations may be beneficial for patients, helping them reflect on correlations between behaviors and health. Physicians are provided with contextual evidence to better understand patient issues around diabetes management. PRACTICE IMPLICATIONS: We suggest that this and similar interventions could be used as an occasional diagnostic to help patients articulate stories of their health-related practices. Annotated archives of photographs and glucose data may also be useful tools for sharing diabetes experiences with newly diagnosed patients.     

A Randomized,Crossover, Single-Dose Bioequivalence Study of Two Extended-Release Tablets of Donepezil 23 mg in Healthy Human Volunteers under Fasting and Fed States

To assess the bioequivalence of two extended-release tablets of donepezil 23 mg, open label, randomized, single-dose, two-sequence, two-period crossover studies under fasting (n=74) and fed (n=94) conditions in healthy adult human volunteers were conducted. Subjects were randomized to either of the two treatment arms (test or reference) separated by a washout period of 28 days. Blood samples were collected up to 72 h post-dose and plasma samples were analyzed for donepezil using a validated LC-MS/MS method. Pharmacokinetic parameters were derived using a non-compartmental approach. Bioequivalence was evaluated in 69 subjects in the fasting study, and 71 subjects in the fed study. In the fasting study, the 90% CI of C_max and AUC_0-72 were 82.50–90.10 and 92.38–98.60, respectively. Corresponding values in the fed study were 91.82–98.05 and 97.27–100.27. Based on the results, the test product (donepezil) met the US regulatory criteria of bioequivalence relative to the reference product (Aricept^®) under both fasting and fed conditions.     

Quantification of ligand PET studies using a reference region with a displaceable fraction: application to occupancy studies with [11C]-DASB as an example

This paper aims to build novel methodology for the use of a reference region with specific binding for the quantification of brain studies with radioligands and positron emission tomography (PET). In particular: (1) we introduce a definition of binding potential BP_D=DVR−1 where DVR is the volume of distribution relative to a reference tissue that contains ligand in specifically bound form, (2) we validate a numerical methodology, rank-shaping regularization of exponential spectral analysis (RS-ESA), for the calculation of BP_D that can cope with a reference region with specific bound ligand, (3) we demonstrate the use of RS-ESA for the accurate estimation of drug occupancies with the use of correction factors to account for the specific binding in the reference. [¹¹C]-DASB with cerebellum as a reference was chosen as an example to validate the methodology. Two data sets were used; four normal subjects scanned after infusion of citalopram or placebo and further six test–retest data sets. In the drug occupancy study, the use of RS-ESA with cerebellar input plus corrections produced estimates of occupancy very close the ones obtained with plasma input. Test–retest results demonstrated a tight linear relationship between BP_D calculated either with plasma or with a reference input and high reproducibility.     

Percutaneous Radiofrequency Ablation of Appendicular Skeleton Chondroblastoma—an Experience from a Tertiary Care Cancer Center

PurposeTo evaluate safety and long-term efficacy of radiofrequency (RF) ablation in treatment of chondroblastoma.Materials and MethodsThis retrospective analysis comprised 27 consecutive patients with histopathologically proven chondroblastoma treated by RF ablation. The tumors were located in the proximal humerus (n = 6), proximal tibia (n = 8), proximal femur (n = 6), distal femur (n = 5), acromion process (n = 1), and lunate (n = 1). In 19 patients (70.3%), the tumor was in the weight-bearing area of the bone. Clinical response was assessed by comparing pain scores and functional assessment by Musculoskeletal Tumor Society (MSTS) score before and after ablation. Patients were followed for a minimum of 1 year to rule out complications and recurrence.ResultsTechnical success rate was 100%. Mean pain score before the procedure was 7.34 (range, 7–9); all patients experienced a reduction in pain, with 25 (92.6%) patients reporting complete pain relief at 6 weeks. Mean MSTS score before the procedure was 15.4, whereas mean MSTS score at 6 weeks after the procedure was 28.6, suggesting significant functional improvement (P < .0001). Two patients developed osteonecrosis and collapse of the treated bone. There were no recurrences.ConclusionsPercutaneous RF ablation is a safe and effective option for treating chondroblastoma of the appendicular skeleton.