動物を提供する研究は、英国食糧環境農村省と欧州連合(EU TSE参照研究所の資金提供を通じて)によって資金提供されました。私たちは、プロジェクトマネージャー、シモンズ博士、ジェフリー博士.M.Mサポートを受け入れます。

1. 姿勢評価
<ol><li>邪魔されない間に動物の姿勢を評価する。</li>
	<li>TSEの影響を受ける動物は、広いベースの手足で立ったり、ハンチングしているように見えたり、頭のキャリッジが低い状態で立ったりすることがあります。</li>
</ol>2. 行動評価
<ol><li>動物の行動を研究する,放置したとき,近づくと,取り扱われた時。</li>
	<li>TSEの影響を受けた動物は、他の羊とは別に立っているか、他の羊の直後に立つことによって、変化したメンテーションを示す可能性があります。</li>
	<li>動物が近づくと、逃げ出して倒れたり、取り扱い時に床に倒れたりする。非定型のスクレーピーを持つ羊では、時計回りまたは反時計回りに強制的に回っているのが見られます。</li>
</ol>3. 脅威反応試験
<ol><li>脅威反応のテストのために動物の頭を保持する:点滅応答を誘発するために動物の各目に向かって手または数本の指を数回動かすが、顔の毛に触れたり、動物が点滅する原因となる空気の乱気流を作り出さないように注意してください。</li>
	<li>脅威反応は、スクレーピーの影響を受けた動物、特に非定型の擦り傷を持つ羊では存在しない可能性がある。脅威応答の検査はプロトコルの一部として使用される唯一の脳神経検査であるが、この処置の間に顔の目視検査は、例えば顔面麻痺 など 、擦り傷に通常見られない神経学的欠損の他の徴候を明らかにすることができる。動物が脅威に反応して点滅しない場合は、動物が点滅できないことが顔面麻痺によって引き起こされていないことを確認するために、まぶたに触れることによって触手反射をテストすることをお勧めします。</li>
</ol>4. スクラッチ応答のテスト
<ol><li>この手順では、苦しんでいる動物ではテストを解釈できないため、動物が落ち着いているかどうかを確認してください。</li>
	<li>胸部、腰椎、仙骨領域の背中のスクラッチ領域は、各スクラッチエピソードの間に一時停止します。</li>
	<li>動物がリズミカルな頭や体の動きに反応する場合、または特定の領域の傷を付けて唇を動かしたり舐めたりする場合は、スクラッチテストを繰り返してスクラッチ応答の再現性を確認します。</li>
	<li>反復可能な応答は、通常、古典的なスクレーピーを持つ羊または掻痒の形態のヤギを含む掻痒性の動物で引き出されるが、他の掻痒性皮膚状態または外在植物が存在しない限り、一般的に非定型スクレーピーを持つ羊では反応がない。</li>
</ol>5. ウールの損失と皮膚病変のチェック
<ol><li>皮膚を点検します。</li>
	<li>擦傷による掻痒は通常、下層の皮膚が正常に見える過度の擦り傷や引っ掻き傷のために、世論調査、背中、ランプ、胸部または腹部の側面にある可能性のある脱毛を引き起こす。</li>
	<li>動物が鋭利な物体をこする機会がある場合、擦り傷は後で現れる可能性があります。咬傷は、特に手足の過度のニブリングのために、手足に現れる可能性があります。</li>
</ol>6. スコアリングボディコンディション
<ol><li>腰椎の背中と横のプロセスを触診することによって、動物の体の状態を評価します。</li>
	<li>擦り傷は、腰椎の横方向のプロセスが個別に容易に感じることができ、プロセスの終わりが鋭く見える体の状態の進行性喪失を引き起こす可能性があります。</li>
</ol>7. 動物の目隠し
<ol><li>動物の目をフードで覆い、動物の呼吸を可能にするために1つのコーナーが切り取られた非見の袋を使用して作ることができます。</li>
	<li>安全上の懸念がなく、パニック動物による怪我の危険性がない場合にのみ、動物を解放します。それ以外の場合は、羊を保持し、動物の制御中に動物の動きを研究します。</li>
	<li>目隠しは、前庭系または小脳機能障害の徴候を悪化させる可能性があり、これは動物がその視力を補う能力によって隠される可能性がある。バランスの喪失、不整合、または旋回は、特に非定型スクレーピーを有する臨床的に顕著でない羊において引き起こされ得る。</li>
</ol>8. 動物の動きの評価
<ol><li>動物が自由に動くときの歩行と筋肉の動きを研究する。</li>
	<li>不整合は、後肢の広いベースの動き、両方の後肢でホッピング、または後ろの四肢で過度に揺れ、つまずいたり一時的に座ったりする可能性があります。</li>
	<li>頭部振戦の存在は、動物が邪魔されないが、臨床検査の完了中または後により顕著になる可能性がある場合、しばしば微妙である。</li>
</ol>9. 解釈
<ol><li>スクレーピーに関する調査結果の重要性を考えてみましょう。</li>
	<li>個々の徴候の存在は、傷、振戦、異常行動、回り回り、崩壊するエピソード、運動失調、または不在の脅威反応に対する反復可能な応答など、様々な原因を有する可能性があるが、これらの徴候の2つ以上の組み合わせの発生は、羊またはヤギの擦傷を非常に示唆している。</li>
</ol>

<ol>
	<li>Benestad, S. L., Arsac, J. N., Goldmann, W., N&#246;remark, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atypical/Nor98+scrapie:+properties+of+the+agent,+genetics,+and+epidemiology.">Atypical/Nor98 scrapie: properties of the agent, genetics, and epidemiology.</a> Vet Res.. 39 (4), 19 (2008).</li><li>D&#39;Angelo, A., Maurella, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+clinical+criteria+to+diagnose+scrapie+in+Italy.">Assessment of clinical criteria to diagnose scrapie in Italy.</a> Vet. J. 174 (1), 106-112 (2007).</li><li>Eloit, M., Adjou, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=BSE+agent+signatures+in+a+goat.">BSE agent signatures in a goat.</a> Vet. Rec. 156 (16), 523-524 (2005).</li><li>Fediaevsky, A., Maurella, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+prevalence+of+atypical+scrapie+in+sheep+from+positive+flocks+is+not+higher+than+in+the+general+sheep+population+in+11+European+countries.">The prevalence of atypical scrapie in sheep from positive flocks is not higher than in the general sheep population in 11 European countries.</a> BMC Vet. Res. 6, 9 (2010).</li><li>Healy, A. M., Weavers, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+clinical+neurology+of+scrapie+in+Irish+sheep.">The clinical neurology of scrapie in Irish sheep.</a> J. Vet. Intern. Med. 17 (6), 908-916 (2003).</li><li>Houston, E. F., Gravenor, M. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+signs+in+sheep+experimentally+infected+with+scrapie+and+BSE.">Clinical signs in sheep experimentally infected with scrapie and BSE.</a> 152 (11), 333-334 (2003).</li><li>Kittelberger, R., Chaplin, M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atypical+scrapie/Nor98+in+a+sheep+from+New+Zealand.">Atypical scrapie/Nor98 in a sheep from New Zealand.</a> J. Vet. Diagn. Invest. 22 (6), 863-875 (2010).</li><li>Konold, T., Bone, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Associations+of+clinical+signs+and+prion+protein+genotypes+in+British+sheep+with+scrapie.">Associations of clinical signs and prion protein genotypes in British sheep with scrapie.</a> Dtsch. Tier&#228;rztl. Wochenschr. 116 (11), 380-388 (2009).</li><li>Konold, T., Bone, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Scrapie+in+goats.">Scrapie in goats.</a> Vet. Rec. 161 (11), 395-396 (2007).</li><li>Konold, T., Bone, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pruritus+is+a+common+feature+in+sheep+infected+with+the+BSE+agent.">Pruritus is a common feature in sheep infected with the BSE agent.</a> BMC Vet. Res. 4, 16 (2008).</li><li>Konold, T., Bone, G. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Monitoring+of+clinical+signs+in+goats+with+transmissible+spongiform+encephalopathies.">Monitoring of clinical signs in goats with transmissible spongiform encephalopathies.</a> BMC Vet. Res. 6, 13 (2010).</li><li>Konold, T., Davis, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+findings+in+two+cases+of+atypical+scrapie+in+sheep:+a+case+report.">Clinical findings in two cases of atypical scrapie in sheep: a case report.</a> BMC Vet. Res. 3, 1 (2007).</li><li>Passler, T., Walz, P. H., Pugh, D. G., Pugh, D. G., Baird, A. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Diseases of the Neurologic System. In: Sheep and Goat Medicine. , 361-405 (2012).</li><li>Russel, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Body+condition+scoring+of+sheep.">Body condition scoring of sheep.</a> In Pract. 6 (3), 91-93 (1984).</li><li>Simmons, H. A., Simmons, M. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atypical+scrapie+in+sheep+from+a+UK+research+flock+which+is+free+from+classical+scrapie.">Atypical scrapie in sheep from a UK research flock which is free from classical scrapie.</a> BMC Vet. Res. 5, 8 (2009).</li><li>Simmons, M. M., Konold, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+natural+atypical+scrapie+phenotype+is+preserved+on+experimental+transmission+and+sub-passage+in+PRNP+homologous+sheep.">The natural atypical scrapie phenotype is preserved on experimental transmission and sub-passage in PRNP homologous sheep.</a> BMC Vet. Res. 6, 14 (2010).</li><li>Spiropoulos, J., Lockey, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Isolation+of+prion+with+BSE+properties+from+farmed+goat.">Isolation of prion with BSE properties from farmed goat.</a> Emerg. Infect. Dis. 17 (12), 2253-2261 (2011).</li><li>Ulvund, M. J., H&#246;rnlimann, B., Riesner, D., Kretzschmar, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Clinical Findings in Scrapie. In: Prions in humans and animals. , 398-407 (2006).</li></ol>

動物に関するすべての手続きは、英国政府内務省のライセンスの下で、1986年の動物(科学的手続き)法に従って行われました。 著者らは、競合する財政的利益はないと宣言している。

スクレイは、世界保健機関(OIE)によってリストされた病気であり、迅速かつ信頼性の高い アンティ死後 検査がない場合、この疾患に関連する臨床徴候を認識する農家または獣医師の能力に依存しています。しかし、ほとんどのスクラッパー症例、特に非定型スククレーピー症例は、現在、標的となるTSE監視、 すなわち 殺処分または落下したストック動物の対象となる小さな反すう人の脳検査によって発見されている。古典的なスクラッパーの数を減らした古典的なスクレーピーに対する耐性のために羊を繁殖させることは、羊の神経疾患の鑑別診断であまり考慮されにくくなるように、病気に対する人々の意識を低下させた可能性が最も高い。非定型スクラッパーはまた、アバトワールで約5例、ヨーロッパ4でテストされた10,000人当たりの下落株で8例と低い有病率を有する。また、掻痒は、通常、排泄の有無にかかわらず脱毛症として明らかであり、しばしば擦物13の特徴的な徴候と考えられる。したがって、非定型スククレーピー12 または非不作尿形態のカプリンスクレーピー11 で観察される付随性掻痒のない神経疾患は、スクレーピーの疑いを引き起こさない可能性がある。
この検査プロトコルは、様々なタイプのスククレー(非定型で古典的なスクラッパー、後者は非定型BSE接種羊に代表される非定型のスクラッパー)に関連する特定の臨床徴候を評価することによって、羊のTSEの臨床徴候を同定するように設計された。古典的なスクラッパーでは、肯定的な傷反応(「ニブル反射」)を示した症例の割合は、100頭以上の羊の50-77の範囲であった5,8を研究した。運動障害は、様々な研究に基づいて古典的なスククレーピー症例の最大81%で観察することができる18.また、非整型スクリューの様々な自然発生症例の主要な兆候であり、しばしば行動変化を伴う1が、自然および実験的に感染した非定型スククレーピー羊の両方で報告された追加の徴候は、目隠しおよびメナス応答の検査が試験プロトコルに含まれる理由である12,15,16を回っていた。体の状態をスコア付けすると、例えば6点スコアリングシステム14を用いて、斑点に影響を受けた羊5で観察され得る気化の評価が可能になる。羊のスクレーピーの検出を支援するための臨床基準は以前2に提案されているが、これらは古典的なスクラッパーの検出にのみ関連し、動物がアバトワールで提示された場合には利用できない可能性のある臨床歴を考慮に入れた。
現在のプロトコルは、短期間でスクレーピーの兆候のために多くの動物のスクリーニングを可能にする。さらに、検査プロトコルは、臨床発症、進行、および終点を監視するために、羊およびヤギのスクイチーの実験的研究に適用することができる。しかし、より詳細な身体的および神経学的検査を臨床症例歴の適切な記録に置き換えるものではなく、おそらく補助的な診断検査(血液および脳脊髄液の検査;適切であればより洗練されたイメージング技術)が続き、その後、同様の徴候を有する小さな反すrumants剤の様々な他の状態を排除する必要があるかもしれない代謝や炎症性の神経疾患、脳膿瘍、腫瘍など。
臨床検査は、プリオンタンパク質2,11の検出に基づく死後の検査よりも一般的にTSEの影響を受けた動物の検出にあまり敏感ではありませんが、特にインキュベーション期間の初期段階では、これは現在、生きている動物の唯一の検出方法であり、TSEの影響を受けた小さな反する動物を識別するための標的監視システムを持たない国に最も関連しています。

スクレーピーは、牛の牛海綿状脳症(BSE)、鹿の慢性消耗性疾患、ヒトのクロイツフェルト・ヤコブ病などのタンパク質誤折障害のグループに属する羊とヤギの伝染性スポンジ状脳症(TSE)です。診断は、通常脳内でプロテイナーゼ耐性であるプリオンタンパク質の異常な形態を検出することによって死後に行われる。2つの主要な天然のスクレーピー形態は、疫学的、病理学的、および生化学的に異なる区別することができる:古典的なスククレーピーおよび非定型スククレーピー。また、古典的な擦り傷のような臨床徴候を有する神経疾患は、BSE剤6,10-11との実験的感染によって羊およびヤギに誘発され得る。実際、天然に発生するBSEはヤギ3,17で診断されている。プリオンタンパク質遺伝子を標的とした遺伝的抵抗性の繁殖によって古典的なスクラッパー(および天然に生じた場合は羊のBSE)の制御が達成されたが、これは散発性疾患であると考えられており、古典的なスクラッパーから解放されていると考えられている国で診断されている非定型スクラッパーにとってより困難である7。 
スクイリーは、成人の羊やヤギの神経疾患であり、行動、感覚、運動の変化をもたらすが、この疾患は徐々に進行性であり、動物飼育員や獣医が臨床徴候に精通していないか、または小さな反すう動物の神経疾患の鑑別診断ではスクレーピーが全く考慮されていないため、臨床徴候はしばしば認識されない。
提案された検査プロトコルは、2つの目的を念頭に置いてスクレーピーの臨床診断を支援するように設計されました:それは短期間で多くの動物のスキャンを可能にするためにかなり簡単であるべきですが、スクレーピーの影響を受けた動物の検出を可能にするのに十分な具体的なものである必要があります。このプロトコルは、古典的なスクラッパー11 の徴候についてヤギを監視するために使用されるものからのわずかな変更であり、通常はスククレーピー9に関連しない臨床徴候を悪化させる可能性のある動物の目隠しを含む。

clinical examination protocol to detect atypical and classical scrapie in sheep

羊とヤギの伝染性スポンジ状脳症(TSE)であるスクレーピーの診断は、現在、 死後 の検査による疾患関連プリオンタンパク質の検出に基づいています。羊やヤギの集団のランダムなサンプルがスクレーピーについて積極的に監視されていない限り、スククレー症例の同定は、病気に関する個人の精通と擦り傷に関連する臨床徴候を認識する能力に依存する臨床容疑者の報告に依存する。スクレーピーは、小さな反する人の神経疾患の鑑別診断では考慮されない場合があります, 特にスクレーピーの有病率が低い国で, またはそれは非定型のスクレーピーのような非不作尿形態として提示する場合は認識されません.臨床容疑者の同定を支援するために、短い検査プロトコルが提示され、ヤギにも適用できる羊の掻痒および非不全形態のTSEに関連する特定の臨床徴候の表示を評価する。これには、行動の評価、視力(脅威反応のテストによる)、掻痒(スクラッチへの応答をテストすることによる)、および動き(目隠しの有無にかかわらず)が含まれます。これは、スクレーピー容疑者として動物を報告するより詳細な神経学的検査につながる可能性があります。また、病気の進行を評価したり、臨床の終点を特定するために、羊やヤギの実験的なTSE研究で使用することができます。

臨床的に健康な羊。ニュージーランド起源の牛の脳を脳内に接種し、接種後49ヶ月で調べたスクレーピーフリーの群れからのポーリングドーセットウェザー。この羊は正常な姿勢を持ち、正常に動作し、正常な脅威反応(図1)を表示し、スクラッチテストに反応せず、無傷のフリースを有し、非常に良好な体の状態を有する。目隠しをすると臨床的に顕著で、運動障害の徴候を示さない。
羊の中のTSEの非不作尿形態を呈する非定型のスクレイピー羊。同じプリオンタンパク質遺伝子型(AHQ/AHQ)の非定型スククレーピーフィールドケースから脳ホモゲネートで脳ホモゲネートを接種し、接種後36ヶ月で調べたスクレーピーフリーの群れからシェビオット・ウェザー。この羊はまた、通常の姿勢を持っていますが、ペンの他の羊とは異なる振る舞い、時計回りに円を描きます。脅威反応がテストされたときに点滅しません。傷は何の反応も引き出さないし、フリースの変化は明らかではないが、体の状態は公正に過ぎない。目隠しをすると時計回りに回り、バランスが崩れる。歩行は無数で、細かい頭部の揺れが見える。
古典的な擦り傷に影響を受けた羊の臨床プレゼンテーションに臨床的に似ている羊のTSEの慎重な形態を提示する非定型BSE羊。このため、古典的なスクレーピーケースは含まれていません。ペールドーセットは、ウシ非定型(L型)BSE脳ホモゲネートで脳内に接種された脳内で排他性の群れからドーセットウェザーをポーリングし、接種後50ヶ月で調べた。この羊は少し腰を下ろし、後肢を広く保ち、捕まえると床に落ちる傾向があります。脅威反応は弱い。背中の様々な領域の傷は頭や唇の動きを引き出し(図3)、世論調査では軽度の皮膚外傷を伴う羊毛の損失がある。体の状態が良いです。目隠しをすると、動きに消極的で、バランスを保つために後端をハードルの上に置きます。羊は無菌であり、前肢のハイパーメトリアを表示します。
<img alt="Figure 1" fo:content-width="5in" fo:src="/files/ftp_upload/51101/51101fig1highres.jpg" src="/files/ftp_upload/51101/51101fig1.jpg"> 図 1.脅威応答テスト。 動物の目に向かって威圧的なジェスチャーは、瞬き応答を誘発する。 <a href="https://www.jove.com/files/ftp_upload/51101/51101fig1highres.jpg" target="_blank">ここをクリックすると、より大きな画像が表示されます。</a>
<img alt="Figure 2" fo:content-width="5in" fo:src="/files/ftp_upload/51101/51101fig2highres.jpg" src="/files/ftp_upload/51101/51101fig2.jpg"> 図 2.目隠し。 フードで羊を目隠しすることによって引き出される時計回りの周りを回る。 <a href="https://www.jove.com/files/ftp_upload/51101/51101fig2highres.jpg" target="_blank">ここをクリックすると、より大きな画像が表示されます。</a>
<img alt="Figure 3" fo:content-width="5in" fo:src="/files/ftp_upload/51101/51101fig3highres.jpg" src="/files/ftp_upload/51101/51101fig3.jpg"> 図 3.スクラッチ応答のテスト。 背中の引っ掻きは、頭の横方向の動きで唇を舐める引き出す <a href="https://www.jove.com/files/ftp_upload/51101/51101fig3highres.jpg" target="_blank">ここをクリックすると、より大きな画像を表示します。</a>

Watch this Scientific Journal Video about Clinical Examination Protocol to Detect Atypical and Classical Scrapie in Sheep at JoVE.com

Clinical Examination Protocol to Detect Atypical and Classical Scrapie in Sheep

短い臨床検査プロトコルは羊およびヤギの古典的および非定型的なスククレーピーの検出を助けるために提示される。

羊の非定型および古典スククレープを検出する臨床検査プロトコル

The diagnosis of scrapie, a transmissible spongiform encephalopathy (TSEs) of sheep and goats, is currently based on the detection of disease-associated ...

clinical-examination-protocol-to-detect-atypical-classical-scrapie

Research

JoVE Journal

Medicine

12.7K ビュー.  Animal Health and Veterinary Laboratories Agency Weybridge. 短い臨床検査プロトコルは羊およびヤギの古典的および非定型的なスククレーピーの検出を助けるために提示される。

ビデオ: Clinical Examination Protocol to Detect Atypical and Classical Scrapie in Sheep

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is respect for patient's values, preferences, and expressed needs. Yet specific approaches to gaining this understanding and translating it to quality care in the clinical setting are lacking. From a patient perspective quality is not a simple concept but is best understood in terms of five dimensions: technical outcomes; decision-making efficiency; amenities and convenience; information and emotional support; and overall patient satisfaction. Failure to consider quality from this five-pronged perspective results in a focus on medical outcomes, without considering the processes central to quality from the patient's perspective and vital to achieving good outcomes. In this paper, we argue for applying the concept of fair process in clinical settings. Fair process involves using a collaborative approach to exploring diagnostic issues and treatments with patients, explaining the rationale for decisions, setting expectations about roles and responsibilities, and implementing a core plan and ongoing evaluation. Fair process opens the door to bringing patient expertise into the clinical setting and the work of developing health care goals and strategies. This paper provides a step by step illustration of an innovative visual approach, called photovoice or photo-elicitation, to achieve fair process in clinical work with acquired brain injury survivors and others living with chronic health conditions. Applying this visual tool and methodology in the clinical setting will enhance patient-provider communication; engage patients as partners in identifying challenges, strengths, goals, and strategies; and support evaluation of progress over time. Asking patients to bring visuals of their lives into the clinical interaction can help to illuminate gaps in clinical knowledge, forge better therapeutic relationships with patients living with chronic conditions such as brain injury, and identify patient-centered goals and possibilities for healing. The process illustrated here can be used by clinicians, (primary care physicians, rehabilitation therapists, neurologists, neuropsychologists, psychologists, and others) working with people living with chronic conditions such as acquired brain injury, mental illness, physical disabilities, HIV/AIDS, substance abuse, or post-traumatic stress, and by leaders of support groups for the types of patients described above and their family members or caregivers.

This paper illustrates an innovative visual approach (photovoice or photo-elicitation) to achieve fair process in clinical care for patients living with chronic health conditions, illuminate gaps in clinical knowledge, forge better therapeutic relationships, and identify patient-centered goals and possibilities for healing.

臨床ケアのフ​​ェアプロセスを達成するために、Visualと物語メソッドの使用

The Institute of Medicine has targeted patient-centeredness as an important area of quality improvement. A major dimension of patient-centeredness is ...

医学

EEG Mu Rhythm in Typical and Atypical Development

Electroencephalography (EEG) is an effective, efficient, and noninvasive method of assessing and recording brain activity. Given the excellent temporal resolution, EEG can be used to examine the neural response related to specific behaviors, states, or external stimuli. An example of this utility is the assessment of the mirror neuron system (MNS) in humans through the examination of the EEG mu rhythm. The EEG mu rhythm, oscillatory activity in the 8-12 Hz frequency range recorded from centrally located electrodes, is suppressed when an individual executes, or simply observes, goal directed actions. As such, it has been proposed to reflect activity of the MNS. It has been theorized that dysfunction in the mirror neuron system (MNS) plays a contributing role in the social deficits of autism spectrum disorder (ASD). The MNS can then be noninvasively examined in clinical populations by using EEG mu rhythm attenuation as an index for its activity. The described protocol provides an avenue to examine social cognitive functions theoretically linked to the MNS in individuals with typical and atypical development, such as ASD.&#160;

Assessment of the EEG mu rhythm provides a unique methodology for examining brain activity and when combined with behaviorally based assays, can be a powerful tool for elucidating aspects of social cognition, such as imitation, in clinical populations.

定型および非定型開発における脳波ムーリズム

Electroencephalography (EEG) is an effective, efficient, and noninvasive method of assessing and recording brain activity. Given the excellent temporal ...

A Neuroscientific Approach to the Examination of Concussions in Student-Athletes

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 million concussions occur in sports and recreational activities annually. Concussion as defined by the 2013 Concussion Consensus Statement &#8220;may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an &#8216;impulsive&#8217; force transmitted to the head.&#8221; Concussions leave the individual with both short- and long-term effects. The short-term effects of sport related concussions may include changes in playing ability, confusion, memory disturbance, the loss of consciousness, slowing of reaction time, loss of coordination, headaches, dizziness, vomiting, changes in sleep patterns and mood changes. These symptoms typically resolve in a matter of days. However, while some individuals recover from a single concussion rather quickly, many experience lingering effects that can last for weeks or months. The factors related to concussion susceptibility and the subsequent recovery times are not well known or understood at this time. Several factors have been suggested and they include the individual&#8217;s concussion history, the severity of the initial injury, history of migraines, history of learning disabilities, history of psychiatric comorbidities, and possibly, genetic factors. Many studies have individually investigated certain factors both the short-term and long-term effects of concussions, recovery time course, susceptibility and recovery. What has not been clearly established is an effective multifaceted approach to concussion evaluation that would yield valuable information related to the etiology, functional changes, and recovery. The purpose of this manuscript is to show one such multifaceted approached which examines concussions using computerized neurocognitive testing, event related potentials, somatosensory perceptual responses, balance assessment, gait assessment and genetic testing.

There is great variability in an individual&#8217;s risk for concussion and their corresponding recovery. A multifaceted approach to concussion evaluation is warranted; including baseline testing of athletes before participation in sport and timely evaluation post injury. The goal of this protocol is to provide an appropriate multifaceted approach to examine concussions.

学生·アスリートで脳震盪の検討に神経科学のアプローチ

Concussions are occurring at alarming rates in the United States and have become a serious public health concern. The CDC estimates that 1.6 to 3.8 ...

Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination

Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described to assess MGT. Still, a standardized examination procedure is missing. Literature argues for weightbearing examination but the degree of knee flexion needed to eliminate the restraining effect of the M. gastrocnemius on ankle dorsiflexion (ADF) is unknown. This manuscript investigates the effect of knee flexion on ankle dorsiflexion and provides a detailed description of a standardized examination protocol. Examination on 20 healthy individuals revealed, that 20&#176; of knee flexion is sufficient to fully eliminate the influence of the M. gastrocnemius on ADF. This builds the prerequisite for a standardized examination for MGT. Non-weightbearing and weightbearing examination of ADF has to be conducted with the knee fully extended and at least 20&#176; flexed. Two investigators should conduct non-weightbearing testing with the subject in supine position. In order to obtain reliable results, the axis of the fibula should be marked. One examiner can conduct weightbearing examination with the subject in lunge stance. Isolated MGT is present if ADF is impaired with the knee fully extended and knee flexion results in a significant ADF increase. The herein presented standardized examination is the prerequisite for future studies aiming at establishing norm values.

Diagnosis of Musculus Gastrocnemius Tightness - Key Factors for the Clinical Examination

Isolated Musculus gastrocnemius tightness is a common cause for foot and ankle pathologies. Currently no standardized examination procedure exists. This manuscript demonstrates that 20 degree of knee flexion eliminates the restraining effect of the M. gastrocnemius on ankle dorsiflexion and presents a video description of a standardized examination protocol.

の診断<em&gt;腓腹筋</em&gt;気密性 - 臨床検査のための主要因

Common foot and ankle pathologies have been linked to isolated Musculus gastrocnemius tightness (MGT). Various examination techniques have been described ...

Echocardiographic and Histological Examination of Cardiac Morphology in the Mouse

An increasing number of genetically modified mouse models has become available in recent years. Moreover, the number of pharmacological studies performed in mice is high. Phenotypic characterization of these mouse models also requires the examination of cardiac function and morphology. Echocardiography and magnetic resonance imaging (MRI) are commonly used approaches to characterize cardiac function and morphology in mice. Echocardiographic and MRI equipment specialized for use in small rodents is&#160;expensive and requires a dedicated space. This protocol describes cardiac measurements in mice using a clinical echocardiographic system with a 15 MHz human vascular probe. Measurements are performed on anesthetized adult mice. At least three image sequences are recorded and analyzed for each animal in M-mode in the parasternal short-axis view. Afterwards, cardiac histological examination is performed, and cardiomyocyte diameters are determined on hematoxylin-eosin- or wheat germ agglutinin (WGA)-stained paraffin sections. Vessel density is determined morphometrically after Pecam-1 immunostaining. The protocol has been applied successfully to pharmacological studies and different genetic animal models under baseline conditions, as well as after experimental myocardial infarction by the permanent ligation of the left anterior descending coronary artery (LAD). In our experience, echocardiographic investigation is limited to anesthetized animals and is feasible in adult mice weighing at least 25 g.

Echocardiographic examination is frequently used in mice. Expensive high-resolution ultrasound devices have been developed for this purpose. This protocol describes an affordable echocardiographic procedure combined with histological morphometric analyses to determine cardiac morphology.

マウスの心臓形態の心エコー検査・組織学的検討

An increasing number of genetically modified mouse models has become available in recent years. Moreover, the number of pharmacological studies performed ...

Protocol to Create Chronic Wounds in Diabetic Mice

Chronic wounds develop as a result of defective regulation in one or more complex cellular and molecular processes involved in proper healing. They impact ~6.5M people and cost ~$40B/year in the US alone. Although a significant effort has been invested in understanding how chronic wounds develop in humans, fundamental questions remain unanswered. Recently, we developed a novel mouse model for diabetic chronic wounds that have many characteristics of human chronic wounds. Using db/db-/- mice, we can generate chronic wounds by inducing high levels of oxidative stress (OS) in the wound tissue immediately after wounding, using a one-time treatment with inhibitors specific to the antioxidant enzymes catalase and glutathione peroxidase. These wounds have high levels of OS, develop biofilm naturally, become fully chronic within 20 days after treatment and can remain open more for more than 60 days. This novel model has many features of diabetic chronic wounds in humans and therefore can contribute significantly to advancing fundamental understanding of how wounds become chronic. This is a major breakthrough because chronic wounds in humans cause significant pain and distress to patients and result in amputation if unresolved. Moreover, these wounds are very expensive and time-consuming to treat, and lead to significant loss of personal income to patients. Advancements in this field of study through the use of our chronic wound model can significantly improve health care for millions who suffer under this debilitating condition. In this protocol, we describe in great detail the procedure to cause acute wounds to become chronic, which has not been done before.

Chronic wounds are developed from acute wounds on a diabetic mouse model by inducing high levels of oxidative stress after a full-thickness cutaneous wound. The wound is treated with inhibitors for catalase and glutathione peroxidase, resulting in impaired healing and biofilm development by bacteria present in the skin microbiome.

糖尿病マウスの慢性創傷を作成するためのプロトコル

Chronic wounds develop as a result of defective regulation in one or more complex cellular and molecular processes involved in proper healing. They impact ...

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based three-chamber bags (3CBs) and soybean-oil-based compounded bags (CoBs) in hospitalized adult patients. We designed a multicenter, randomized, prospective, open-label, noninferiority protocol to compare the efficacy, safety, and distribution of olive-oil-based 3CBs and soybean-oil-based CoB formulations in adult Chinese patients requiring PN during surgical intervention. Subjects were randomized to receive either one of the study treatments using an interactive voice or web-based recognition system in accordance with the randomization code. Randomization was further stratified based on the study site and surgical category. Both treatment groups received similar amounts of calories and protein. In addition, the two study treatments contained a similar composition of the amino-acid component. The only difference between the two PN formulations was the lipid constitution. The duration of administration of study treatments was a minimum of 5 days up to a maximum of 14 days after the surgical procedure. The primary efficacy endpoint was serum prealbumin levels on day 5 of the study. Noninferiority was proved if the anti-log of the lower bound of the 95% confidence interval (CI) of the treatment difference was at least 0.80. Other efficacy measures included treatment preparation time; duration to achieve tolerability of oral nutrition; associated infectious complications; length of hospitalization; and laboratory assessment of markers of nutrition, inflammation, metabolism, and oxidative stress. A total of 458 patients were enrolled in the study. The results showed that olive-oil-based 3CBs were non-inferior to soybean-based CoBs, besides being well tolerated. The infection rate was found to be significantly lower in the olive-oil-based 3CB group. Thus, this study may be used as a reference for future research on lipid emulsion and 3CBs.

Here, we present a protocol for a study comparing the efficacy, safety, and delivery of olive-oil-based 3CB and soybean-oil-based CoB formulations in adults requiring parenteral nutrition. The results revealed that olive-oil-based 3CBs is non-inferior and well tolerated compared to soybean formulations.

非経た栄養のためのオリーブオイルベースの3チャンバーバッグの安全性、有効性、および送達を評価する臨床試験

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based ...

Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) may detect adverse events of interventions such as fluid overload at an early stage. The Simple Intensive Care Studies (SICS) is a research line that focuses on the prognostic and diagnostic value of combinations of clinical variables.
The SICS-I specifically focused on the use of clinical variables obtained within 24 h of acute admission for prediction of cardiac output (CO) and mortality. Its sequel, SICS-II, focuses on repeated evaluations during ICU admission. The first clinical examination by trained researchers is performed within 3 h after admission consisting of physical examination and educated guessing. The second clinical examination is performed within 24 h after admission and includes physical examination and educated guessing, biochemical analysis and CCUS assessments of heart, lungs, inferior vena cava (IVC) and kidney. This evaluation is repeated at days 3 and 5 after admission. CCUS images are validated by an independent expert, and all data is registered in an online secured database. Follow-up at 90 days includes registration of complications and survival status according to patient&#39;s medical charts and the municipal person registry. The primary focus of SICS-II is the association between venous congestion and organ dysfunction.
The purpose of publishing this protocol is to provide details on the structure and methods of this on-going prospective observational cohort study allowing answering multiple research questions. The design of the data collection of combined clinical examination and CCUS assessments in critically ill patients are explicated. The SICS-II is open for other centers to participate and is open for other research questions that can be answered with our data.

Structured protocols are necessary to provide answers on research questions in critically ill patients. The Simple Intensive Care Studies (SICS) provides an infrastructure for repeated measurements in critically ill patients including clinical examination, biochemical analysis and ultrasonography. SICS projects have specific focus but the structure is flexible to other investigations.

頻回の臨床検査と重要な観測的研究プロトコルは気に簡単な集中治療研究内超音波検査

Longitudinal evaluations of critically ill patients by combinations of clinical examination, biochemical analysis and critical care ultrasonography (CCUS) ...

Transthoracic Echocardiographic Examination in the Rabbit Model

Large animal models such as the rabbit are valuable for translational preclinical research. Rabbits have a similar cardiac electrophysiology compared to that of humans and that of other large animal models such as dogs and pigs. However, the rabbit model has the additional advantage of lower maintenance costs compared to other large animal models. The longitudinal evaluation of cardiac function using echocardiography, when appropriately implemented, is a useful methodology for preclinical assessment of novel therapies for heart failure with reduced ejection fraction (e.g. cardiac regeneration). The correct use of this non-invasive tool requires the implementation of a standardized examination protocol following international guidelines. Here we describe, step by step, a detailed protocol supervised by veterinary cardiologists for performing echocardiography in the rabbit model, and demonstrate how to correctly obtain the different echocardiographic views and imaging planes, as well as the different imaging modes available in a clinical echocardiography system routinely used in human and veterinary patients.

Here we describe, step by step, a detailed protocol for performing echocardiography in the rabbit model. We show how to correctly obtain the different echocardiographic views and imaging planes, as well as the different imaging modes available in a clinical echocardiography system routinely used in human and veterinary patients.

ウサギモデルにおける経胸部心エコー検査

Large animal models such as the rabbit are valuable for translational preclinical research. Rabbits have a similar cardiac electrophysiology compared to ...

Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit

Creative music therapy for preterm infants and their parents (CMT) has emerged as a promising family-integrated early intervention involving communicative musicality to improve infant development, parental well-being, and bonding. It aims at relaxing and nurturing the infant as well as promoting safety and social interaction for the parent-infant dyad. A music therapist specially trained in CMT hums or sings in an infant-directed, improvised, lullaby style continually adjusting to the individual needs, expressions, and breathing pattern of the preterm infant. Based on the principles of family-integrated care, the family is incorporated individually in the therapeutic process, namely by delivering CMT during kangaroo care (KC) and by motivating and facilitating parental vocal interaction with their infant to strengthen the parent-infant bonding. CMT aims at relaxing, stimulating, and coregulating premature infants at a time when many other interventions are still risky and can overwhelm the vulnerable patient group. CMT may be advantageous not by educating and teaching parents, but rather by uncovering the intuitive capacities of parenting that are often overshadowed by the traumatic experience of preterm birth. However, CMT can only be provided when the infants are clinically stable. CMT with parental integration is feasible when parents are available and receptive to participate. This paper presents a detailed protocol on how to use CMT to empower preterm infants and their families.

Creative music therapy for preterm infants and their parents has emerged as a promising family-integrated early intervention. We present a detailed protocol on how to use vocal interaction, humming, or singing to empower preterm infants and their families.

新生児集中治療室における早産児とその親のための創造的音楽療法の臨床実践プロトコル

Creative music therapy for preterm infants and their parents (CMT) has emerged as a promising family-integrated early intervention involving communicative ...