The goal of this clinical trial is to use contingency management (CM) as an intervention tool to address methamphetamine use.
The main objectives are to:
* Gather effectiveness data on a pilot a CM program for participants in Hawaii who use methamphetamine following hospitalization due to traumatic injury
* To assess participant perspectives on engaging with a CM program based at a Level 1 Trauma Center. Researches will assess both patient-reported and biologically-confirmed medium-term program effectiveness and conduct qualitative interviews with participants post-program.
Participants will:
* Visit a follow-up clinic up to three times per week to complete urinalysis following discharge from the trauma unit
* Complete Treatment Effectiveness Assessments at 6 and 12-weeks
* Engage in a qualitative interview at the end of the CM program

开始日期2024-10-15

申办/合作机构

The Queen's Medical Center

[+1]

NCT06227052 / Recruiting临床4期IIT

Vapocoolant Application for Pain Reduction During Office-based Gynecologic Procedures: a Randomized Controlled Trial (VAPOR)

The purpose of this study is to assess if Num vapocoolant spray decreases pain associated with paracervical block in gynecology procedures.

开始日期2024-02-05

申办/合作机构

The Queen's Medical Center

NCT04771208 / Enrolling by invitationN/AIIT

I Kua na'u "Let Me Carry Out Your Last Wishes" Advance Care Planning for Native Hawaiian Elders - Trial Phase

Communication surrounding serious illness decision making is formalized in Advance Care Planning (ACP), a process involving verbal or written information designed to inform patients of possible medical options including palliative and hospice care services. Numerous studies have suggested that improved ACP rates better align health care delivery with patient preferences. Despite expansion of ACP services in the health care system, Native Hawaiians (NHs) consistently have negligible rates of ACP and low use of palliative and hospice care services. To address these shortcomings, our multi-disciplinary community and research group has partnered to create the I kua na'u "Let Me Carry Out Your Last Wishes" ACP video intervention. Our Community-Based Collaborative Approach will create, develop and test the I kua na'u comprehensive video-based ACP program honoring the history, opinions, and culture of NHs. Indeed, NH culture is primarily an oral tradition in which the spoken word permeates the life of NHs and is the normal way of interacting with neighbors, including in its most recent adaptation with the use of video media. The I kua na'u program will include videos tailored for the different settings in which older NHs live and get medical care. The videos will explain the importance of ACP, empower NHs to tell their story ('olelo Kama'ilio; "Talk Story") by allowing the recording of personal video declarations of ACP wishes, and the ability to share the personal video declaration with family, friends and clinicians. The overall objective is to conduct a five-year program that includes two years of development of the I kua na'u ACP video program with focus group testing, and then three years of implementation in the NH community. Demonstrating the effectiveness of using the video program in NHs represents an essential step to implement this tool in practice. The Specific Aim is to compare the ACP engagement, knowledge, decisional conflict, and ACP completion rates in 220 NHs over the age of 55 in: (a) a pre-post study design in 110 people living on Homestead or Assisted Living using the video intervention, and (b) a randomized trial of 110 people recruited from Ambulatory Clinics.

开始日期2023-03-16

申办/合作机构

Tufts Medical Center, Inc.

[+2]

100 项与 The Queen's Medical Center 相关的临床结果

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4,711

项与 The Queen's Medical Center 相关的文献（医药）

2024-12-01·Neurology-Clinical Practice

A General Neurologist's Practical Diagnostic Algorithm for Atypical Parkinsonian Disorders

Review

作者: Golbe, Lawrence I ; McFarland, Nikolaus R ; Honig, Lawrence S ; Montaser-Kouhsari, Leila ; Duquette, Antoine ; Rodriguez-Porcel, Federico ; Wills, Anne-Marie A ; Siddiqui, Junaid ; Shurer, Jessica ; Spears, Christopher C ; Diaz, Kristophe ; Mari, Zoltan ; Lamotte, Guillaume ; Dhall, Rohit ; Haq, Ihtsham U ; Bruno, Michiko K

Purpose of Review:

The most common four neurodegenerative atypical parkinsonian disorders (APDs) are progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal syndrome (CBS), and dementia with Lewy bodies (DLB). Their formal diagnostic criteria often require subspecialty experience to implement as designed and all require excluding competing diagnoses without clearly specifying how to do that. Validated diagnostic criteria are not available at all for many of the other common APDs, including normal pressure hydrocephalus (NPH), vascular parkinsonism (VP), or drug-induced parkinsonism (DIP). APDs also include conditions of structural, genetic, vascular, toxic/metabolic, infectious, and autoimmune origin. Their differential diagnosis can be challenging early in the course, if the presentation is atypical, or if a rare or non-neurodegenerative condition is present. This review equips community general neurologists to make an early provisional diagnosis before, or in place of, referral to a tertiary center. Early diagnosis would allay diagnostic uncertainty, allow prompt symptomatic management, provide disease-specific information and support resources, avoid further pointless testing and treatments, and create the possibility of trial referral.

Recent Findings:

We address 64 APDs using one over-arching flow diagram and a series of detailed tables. Most instances of APDs can be diagnosed with a careful history and neurological exam, along with a non-contrast brain MRI. Additional diagnostic tests are rarely needed but are delineated where applicable. Our diagnostic algorithm encourages referral to a tertiary center whenever the general neurologist feels it would be in the patient's best interest. Our algorithm emphasizes that the diagnosis of APDs is an iterative process, refined with the appearance of new diagnostic features, availability of new technology, and advances in scientific understanding of the disorders. Clinicians' proposals for all diagnostic tests for the APDs, including repeat visits, should be discussed with patients and their families to ensure that the potential information to be gained aligns with their larger clinical goals.

Summary:

We designed this differential diagnostic algorithm for the APDs to enhance general neurologists' diagnostic skills and confidence and to help them address the less common or more ambiguous cases.

2024-11-01·HEART RHYTHM

Real-world data of radiofrequency catheter ablation in paroxysmal atrial fibrillation: Short- and long-term clinical outcomes from the prospective multicenter REAL-AF Registry

Article

作者: Hebsur, Shrinivas ; Dukes, Jonathan ; Hoyos, Carolina ; Thorne, Christopher ; Mazer, Sean ; Sellers, Matthew ; Newton, David ; Ro, Alex S ; Patel, Parin ; Oza, Saumil R ; Miranda-Arboleda, Andres F ; Singh, David ; Moretta, Antonio ; Costea, Alexandru I ; Morales, Gustavo X ; Rajendra, Anil ; Kang, Steven ; D'Souza, Benjamin ; Nazari, Jose ; Varley, Allyson L ; Salam, Tariq ; Magnano, Anthony R ; Romero, Jorge E ; Senn, Todd ; Matos, Carlos ; Velasco, Alejandro ; Goyal, Sandeep K ; Silverstein, Joshua R ; Metzl, Mark D ; Zei, Paul C ; Osorio, Jose ; Sackett, Matthew

BACKGROUND:

The safety and long-term efficacy of radiofrequency (RF) catheter ablation (CA) of paroxysmal atrial fibrillation (PAF) has been well established. Contemporary techniques to optimize ablation delivery, reduce fluoroscopy use, and improve clinical outcomes have been developed.

OBJECTIVE:

The purpose of this study was to assess the contemporary real-world practice approach and short and long-term outcomes of RF CA for PAF through a prospective multicenter registry.

METHODS:

Using the REAL-AF (Real-world Experience of Catheter Ablation for the Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation; ClincalTrials.gov Identifier: NCT04088071) Registry, patients undergoing RF CA to treat PAF across 42 high-volume institutions and 79 experienced operators were evaluated. The procedures were performed using zero or reduced fluoroscopy, contact force sensing catheters, wide area circumferential ablation, and ablation index as a guide with a target of 380-420 for posterior and 500-550 for anterior lesions. The primary efficacy outcome was freedom from all-atrial arrhythmia recurrence at 12 months.

RESULTS:

A total of 2470 patients undergoing CA from January 2018 to December 2022 were included. Mean age was 65.2 ±11.14 years, and 44% were female. Most procedures were performed without fluoroscopy (71.5%), with average procedural and total RF times of 95.4 ± 41.7 minutes and 22.1±11.8 minutes, respectively. At 1-year follow-up, freedom from all-atrial arrhythmias was 81.6% with 89.7% of these patients off antiarrhythmic drugs. No significant difference was identified comparing pulmonary vein isolation vs pulmonary vein isolation plus ablation approaches. The complication rate was 1.9%.

CONCLUSION:

Refinement of RF CA to treat PAF using contemporary tools, standardized protocols, and electrophysiology laboratory workflows resulted in excellent short- and long-term clinical outcomes.

2024-10-01·Pediatric nephrology (Berlin, Germany)

Addressing the psychosocial aspects of transition to adult care in patients with cystinosis

Review

作者: Batte, Suzanne ; Ariceta, Gema ; Willem, Lore ; Levtchenko, Elena ; Topaloglu, Rezan ; Stabouli, Stella ; Emma, Francesco ; Haffner, Dieter ; Sommer, Anna ; Oh, Jun ; Bertholet-Thomas, Aurelia ; Bacchetta, Justine ; Schweer, Katharina ; Bethe, Dirk ; Kraft, Stefanie ; Brengmann, Sandra

Abstract:

Cystinosis is a rare autosomal-recessive lysosomal storage disease that progressively affects multiple organs beginning with the kidneys. Patients require lifelong multidisciplinary care for the management of kidney disease and progressive extra-renal manifestations, and thus, they are especially fragile and vulnerable during transition from pediatric to adult care. Previous documents have provided guidance to help the medical transition of these highly burdened patients. Patients and their families often experience great psychological distress and face significant social challenges; for these reasons, they often need help from psychologists, social workers, and other psychosocial professionals. Due to the rarity of the disease, most psychosocial professionals have no expertise in this disorder and require advice. To this end, a steering committee (SC) composed of six experts, including pediatric nephrologists, psychologists, and social workers with experience in the care for patients with cystinosis, have identified and addressed seven key questions related to psychosocial challenges of the disease and the burden of treatment. Ten additional international experts (the extended faculty, EF) were invited to answer these questions. Since robust evidence is lacking, as in many rare diseases, conclusions were based on collective agreement between members of the SC and the EF, and the consolidated answers were summarized into expert opinion statements. The present document contains information on the concerns and psychosocial burden of patients with cystinosis and of their caregivers, and provides practical advice for timely and appropriate support to facilitate the transition to adult care.Graphical abstract

项与 The Queen's Medical Center 相关的新闻（医药）

2023-08-26

·药时代

柳叶刀子刊：用音乐触发基因开关，激活胰岛素分泌，治疗糖尿病

糖尿病是全世界范围内非常常见的代谢性疾病，由于胰岛素分泌缺陷和/或其生物作用受损，导致高血糖，进而导致各种组织，特别是眼、肾、心脏、血管、神经的慢性损害、功能障碍。患者通常依赖于注射或使用胰岛素泵来额外提供胰岛素。近年来，科学家们希望通过直接在体内重新产生和施用胰岛素的方法来帮助糖尿病患者生活的更轻松。其中一个解决方案是将产生胰岛素的工程化细胞封装后植入体内，为了能够从外部控制这些细胞何时以及将多少胰岛素释放到血液中，研究人员开发了几种不同的触发因素——光、温度和电场。而最近，苏黎世联邦理工学院的研究人员开发出了一种新方法——通过播放音乐刺激细胞在几分钟内释放胰岛素，例如皇后乐队的热门歌曲《We Will Rock You》。这项研究以：Tuning of cellular insulin release by music for real-time diabetes control 发表在了《柳叶刀》子刊 The Lancet Diabetes & Endocrinology 上。让细胞接收声波为了让产生胰岛素的细胞接受声波，研究团队使用了一种来自大肠杆菌的离子通道蛋白。这种蛋白对机械刺激作出反应，其位于细菌的细胞膜上并调节钙离子进入细胞内部。研究团队将这种细菌离子通道蛋白整合到了产生人类胰岛素的细胞中，嵌入细胞膜。正如预期的那样，这些细胞中的离子通道在“听到声音”后打开，允许带正电的钙离子流入细胞。这会导致细胞膜的电荷逆转，进而导致细胞内充满胰岛素的小泡与细胞膜融合，并向外界释放胰岛素。特定音乐促进胰岛素分泌研究团队首先确定了激活离子通道效果最强烈的音乐的音量和频率，他们发现，60分贝左右的音量水平和50赫兹的低音频率是触发离子通道打开的最有效条件。为了激发胰岛素的最大释放，声音或音乐必须持续至少3秒，并暂停最多5秒。如果间隔太久，释放的胰岛素就会大大减少。最后，他们研究了在85分贝的音量下，哪种音乐类型能引起最强的胰岛素反应。结果显示，皇后乐队的《We Will Rock You》等低沉的摇滚乐位居榜首，其次是动作电影《复仇者联盟》的配乐。相比之下，胰岛素对古典音乐和吉他音乐的反应相当弱。该研究的领导者、苏黎世联邦理工学院的 Martin Fussenegger 教授表示，《We Will Rock You》在5分钟内触发了大约70%的胰岛素反应，而所有的反应都在15分钟内发生。这与健康人在天然葡萄糖诱导的胰岛素反应相当。不必担心环境噪音干扰为了测试整个系统，研究团队将产生胰岛素的细胞植入小鼠体内，并将动物的腹部直接放在音响上，此时播放音乐能够触发小鼠体内植入的细胞释放胰岛素。而如果小鼠能够自由活动，播放音乐就无法触发胰岛素释放。研究团队表示，该研究设计的细胞只有当合适的声音直接在植入细胞的皮肤上方播放时才会触发胰岛素释放。因此不会受到环境噪音的影响。此外，植入细胞中的胰岛素释放完后需要大约四小时来重新产生，因此，这些细胞即使每隔一小时就暴露在声音中，也不可能每次都释放出充足的胰岛素而导致危及生命的低血糖。这项研究距离临床应用还有很长的路要走，但它提供了一个概念证明，表明可以通过声波等机械刺激来控制基因网络。此外，除了用于控制胰岛素释放外，该系统还可用于控制其他治疗性蛋白质的释放。论文链接：https://www.thelancet.com/journals/landia/article/PIIS2213-8587(23)00153-5/fulltext封面图来源：123rf面对这种影响全球4%人口的疾病，强生有一个计划……诺华剥离山德士，日子定下来了！点击这里，与药时代一起快乐学习！

2023-07-31

·BioSpace

MicroVention Celebrates One-Year Anniversary of FRED™ X Flow Diverter with Over 1,000 Patients Treated Across the U.S.

The FRED X Flow Diverter is the Next Generation in Flow Diversion Technology SAN DIEGO & ALISO VIEJO, Calif.--(BUSINESS WIRE)-- MicroVention, Inc., a global neurovascular company and wholly owned subsidiary of Terumo Corporation, is celebrating the one-year anniversary of the company’s FRED™ X Flow Diverter. In close collaboration with physician partners across the United States, over 1,000 patients have been successfully treated with the FRED X device. MicroVention is at the Society of NeuroInterventional Surgery (SNIS 2023) in San Diego this week, booth number 615, and is hosting a Symposium featuring FRED X on Tuesday, August 1, at the Manchester Grand Hyatt, 32nd Floor, Vista ABC from 5:00 – 7:00 PM. This press release features multimedia. View the full release here: MicroVention FRED™ X -- The Next Advancement in Flow Diversion Technology (Photo: Business Wire) Optimized for small vessel flow diversion, FRED X is the only FDA PMA approved portfolio with a 0.021" delivery system for smaller device sizes, and no distal lead wire. FRED X offers the same precise, predictable placement and immediate opening of the FRED™ device – now with X Technology. Derived from over 30 years of study and use at Terumo, X Technology is a proprietary, nanoscale surface treatment covalently bonded to the FRED X Flow Diverter for a permanent chemical change to the device surface. X Technology creates an optimized, protective hydration layer that is designed to reduce material thrombogenicity while maintaining natural vessel healing and endothelial cell growth. MicroVention’s research and testing of X Technology was also published in the Journal of NeuroInterventional Surgery (JNIS) in September 2022. The first publication on FRED X was released in March 2023 and can be found in the American Journal of Neuroradiology (AJNR). This European-based publication shows strong safety and efficacy of the FRED X device at mean of 7 months follow-up. Across the United States, hundreds of physicians are also finding success and promising outcomes on their FRED X treatments. “We have seen great success with the FRED X Flow Diverter in the over 80 patients we have treated,” said Dr. Jonathan Zhang, Neurosurgeon at Queens Medical Center in Honolulu, HI. “Our six-month follow-ups show very low complication rates and good aneurysm occlusion. We look forward to publishing our experience soon.” “The FRED X device provides consistent, precise and reliable flow diversion for challenging aneurysms with tortuous anatomy," explains Dr. Stavropoula Tjoumakaris, Cerebrovascular & Endovascular Neurosurgeon at Thomas Jefferson University and National P.I. of the FRED X Post Approval Study. “MicroVention’s innovative surface modification, X Technology, has promising characteristics and initial results show great efficacy and patient safety.” Featuring just a handful of our many physician partners, please take a look at MicroVention’s 1-year anniversary celebration summary video. “We are excited to celebrate the anniversary of our FRED X Flow Diverter technology since its commercial launch last year, and we also look forward to sharing U.S. clinical data on FRED X in the near future,” said Carsten Schroeder, President and CEO, MicroVention, Inc. “We are thankful for our remarkable partnerships with a large number of physicians across the United States who have helped with the advancement of this innovative yet critical technology while we continue our mission of helping to save patient lives.” About MicroVention, Inc. Founded in 1997, MicroVention develops and markets medical devices that enable or significantly improve treatment of cerebrovascular diseases. In 2006, Terumo Corporation, a major worldwide medical device company headquartered in Tokyo, Japan, acquired MicroVention into their family of Companies. Terumo’s acquisition of MicroVention allowed both Companies to leverage their unique, proprietary technologies toward an increased focus on treating cerebrovascular diseases. Headquartered in California, MicroVention products are today sold in more than seventy countries through a direct sales organization alongside strategic distribution partnerships. Manufacturing facilities are in Aliso Viejo, California and San José, Costa Rica. For more information on MicroVention, please visit . About Terumo Corporation Terumo (TSE:4543) is a global leader in medical technology and has been committed to "Contributing to Society through Healthcare" for one hundred years. Based in Tokyo and operating globally, Terumo employs more than 28,000 associates worldwide to provide innovative medical solutions in more than 160 countries and regions. The company started as a Japanese thermometer manufacturer and has been supporting healthcare ever since. Now, its extensive business portfolio ranges from vascular intervention and cardio-surgical solutions, blood transfusion and cell therapy technology, to medical products essential for daily clinical practice such as transfusion systems, diabetes care, and peritoneal dialysis treatments. Terumo will further strive to be of value to patients, medical professionals, and society at large. For more information on Terumo, please visit . ** Editor’s Note: For a Clinical Glossary of Terms, please visit . View source version on businesswire.com: Contacts Christine McCullough Global Corporate Communications MicroVention, Inc. + 1 714 206 9800 christine.mccullough@microvention.com Source: MicroVention, Inc. Smart Multimedia Gallery Photo MicroVention FRED™ X -- The Next Advancement in Flow Diversion Technology (Photo: Business Wire) Logo View this news release and multimedia online at:

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