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Sadaqat, Ameelia, Sana Sattar, Irem Rasheed, Anaab Wasim, Muhammad Shoaib Nabi, and Tayyiba Wasim. "PHYSICIANS PERSPECTIVE OF BREAKING BAD NEWS-SPIKES PROTOCOL." Journal of Akhtar Saeed Medical & Dental College 04, no. 02 (2024): 70–76. https://doi.org/10.51127/jamdcv06i02oa05.
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Background:Doctor patient relationship is one of the closest and trusted relationship. An effective and good communication is the key to a satisfied client with enhanced capacity to take right decisions. To assess physician knowledge and attitude about SPIKES protocol of breaking bad news.Material and Methods:This crosssectional study was conducted at Ghurki Trust Teaching hospital affiliated with Lahore Medical & Dental College from 1stOctober 2023 to 31stDecember 2023. We used convenient sampling through a questionnaire based on SPIKES protocol which will be filled by doctors who consented to participatein the study.Results: A total of 182 doctors belonging to different specialties of the hospital participated in the study. There were 153(84.1%) females and 29(15.9%)males. Majority (63.1%) were residents and had less than 10 years of experience. 90.6% were not aware of the SPIKES protocol for breaking bad news and (68.1%) learnt by seeing experts or by hit and trial. About 48.9% considered setting of BBN should be in an office. Majority (80.2%) had a tendency to tell the truth about diagnosis to both patients and family members. About 60.4% admitted that they listened to questions asked by patients without interruption. Half of the participants (53.8%) felt sad while delivering bad news. About fears faced by doctors while BBN 37.9% feared they will be ending hope forpatient and 20.3% feared of patient’s reaction. One hundred and sixty (87.9%) participants believed that it is very important to incorporate “how to break bad news” in graduation course.Conclusion:Breakingbadnewsisanessentialcommunicationskillfordoctors.Trainingshouldbegivenaboutprotocolinundergraduateyears.Keywords:Ssetting,Pperception,Iinvitationorinformation,Kknowledge,Eempathy,andSsummarizeorstrategize(SPIKES),Breakingbadnews,Communicationskills
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Gesser, Ana Maria, Mirian Silva Dos Santos, and Marcelo Vier Gambetta. "Spikes: um protocolo para a comunicação de más notícias / Spikes: a protocol for communicating bad news." Brazilian Journal of Development 7, no. 11 (2021): 103334–45. http://dx.doi.org/10.34117/bjdv7n11-111.
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Kayrouz, Rony, Christine Irene Senediak, and Roy Laube. "Building a bridge: A case report on communicating mental-health diagnoses to patients of a culturally and linguistically diverse background." Australasian Psychiatry 25, no. 5 (2017): 478–80. http://dx.doi.org/10.1177/1039856217726685.
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Objective: This paper is based on a case report, describing a protocol to help practitioners communicate mental-health diagnosis to patients from culturally and linguistically diverse (CALD) backgrounds. The protocol was presented by integrating the DSM-5 Cultural Formulation Interview (CFI) and the SPIKES protocol for communicating the diagnosis of cancer, yielding a modified CFI-SPIKES protocol (i.e. S, Support; P, Perception using CFI; I, Invitation; K, Knowledge; E, Emotions). The protocol was demonstrated using a case report with a patient of a Middle-Eastern background experiencing generalised anxiety disorder. Conclusions: The CFI-SPIKES protocol for communicating mental-health diagnosis allows for a collaborative process, whereby the CALD patient and practitioner can address the stigma associated with communicating a mental-health diagnosis, ensuring patient engagement and informed shared decision making.
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Delgado-García, Gabriel, Isabel M. Martín-López, Fulgencio Soto-Méndez, Arturo Quílez-Maimón, and Salvador Boned-Gómez. "Does the Fatigue Induced by a 30-Minute Run Affect the Lower Limb Acceleration Spikes’ Asymmetries?" Bioengineering 12, no. 3 (2025): 294. https://doi.org/10.3390/bioengineering12030294.
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Running-induced fatigue affects several biomechanical parameters, and yet few studies are focused on the acceleration spikes’ asymmetries. This study aimed to evaluate the effects of a 30 min run on lower limbs spikes’ asymmetries. Eighteen recreational runners (35.6 ± 7.5 years; seven women) performed a treadmill running protocol at a moderate speed and acceleration spikes’ asymmetries and kinematic (temporal) parameters were measured via accelerometers—on the tibias and sacrum—and photogrammetry. Acceleration spikes’ parameters were continuously measured and averaged per minute to assess the relationship between fatigue and acceleration spike asymmetries via a linear regression model. Right tibial acceleration spikes increased over time (r = 0.9; p < 0.001) and left tibia spikes decreased (r = 0.78; p < 0.001), with a rise in tibial load asymmetry from 9% to 25% at the end (r = 0.98; p < 0.001). This study suggest that fatigue affects the acceleration spikes of the two legs differently, with increasingly greater acceleration spikes in the right (dominant) leg. These findings should be considered, as greater asymmetries are related to overuse injuries and lower efficiency. Also, in studies focusing on running mechanics with fatigue, it is recommended that researchers collect data from both limbs, and not only from the right (dominant) leg.
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Peixoto, Vanessa Giffoni de Medeiros Nunes Pinheiro, Rosiane Viana Zuza Diniz, and Clécio de Oliveira Godeiro Junior. "SPIKES-D: a proposal to adapt the SPIKES protocol to deliver the diagnosis of dementia." Dementia & Neuropsychologia 14, no. 4 (2020): 333–39. http://dx.doi.org/10.1590/1980-57642020dn14-040001.
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ABSTRACT. Dementia is a life-threatening and stigmatizing condition, with devastating impacts on the patient's personal identity and caregivers. There are many barriers to an effective diagnosis disclosure of dementia, including fear of causing distress, uncertainty of diagnosis, caregivers’ objection and lack of training in communication skills in undergraduate medical schools. Although some studies have been published on how to help physicians deliver an Alzheimer's disease diagnosis, no specific protocol has been published yet. The SPIKES protocol is a didactic approach designed to deliver bad news related to cancer, but it has been used globally and in a variety of clinical settings, including the teaching of communication skills to medical students and residents. It is known, however, that the cognitive impairment of Alzheimer's disease and other dementias may limit the understanding of the diagnosis’ complexity; hence, a few adaptations of this model were made after reviewing the current literature on dementia diagnosis disclosure. The suggested SPIKES-D protocol seems to encompass current guidelines about the communication of the diagnosis of dementia, keeping its didactic approach on breaking bad news and helping fulfill the gaps in this topic.
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Gold, Carl, Cyrille C. Girardin, Kevan A. C. Martin, and Christof Koch. "High-Amplitude Positive Spikes Recorded Extracellularly in Cat Visual Cortex." Journal of Neurophysiology 102, no. 6 (2009): 3340–51. http://dx.doi.org/10.1152/jn.91365.2008.
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We simulated the shape and amplitude of extracellular action potentials (APs or “spikes”) using biophysical models based on detailed reconstructions of single neurons from the cat's visual cortex. We compared these predictions with spikes recorded from the cat's primary visual cortex under a standard protocol. The experimental data were derived from a large number of neurons throughout all layers. The majority of spikes were biphasic, with a dominant negative peak (mean amplitude, −0.11 mV), whereas a minority of APs had a dominant positive peak of +0.54-mV mean amplitude, with a maximum of +1.5 mV. The largest positive amplitude spikes were recorded in layer 5. The simulations demonstrated that a pyramidal neuron under known biophysical conditions may generate a negative peak with amplitude up to −1.5 mV, but that the amplitude of the positive peak may be at most 0.5 mV. We confirmed that spikes with large positive peaks were not produced by juxtacellular patch recordings. We conclude that there is a significant gap in our present understanding of either the spike-generation process in pyramidal neurons, the biophysics of extracellular recording, or both.
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Obioma, Ezeani Chukwuemeka, and E. C. Amadi. "Analysis of Optimal Routing Protocol for an Inter-Campus Private Cloud Network System." International Journal of Modern Developments in Engineering and Science 3, no. 2 (2024): 8–12. https://doi.org/10.5281/zenodo.12643596.
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With the need for resources sharing and the integration of cost-effective IT solution across tertiary institution in Nigeria, the need for an inter-campus private cloud network is presented in this project. The inter-campus private cloud network provides a platform for sharing resources across campuses instead of replicating such resources which are in many cases underutilized. This work presents the optimal routing protocol for an inter-campus private cloud network system that connects 5 campuses together within Owerri city in Nigeria. A star-star hybrid network topology was adopted in this project work and was modelled using Packet Tracer simulator. The network was simulated using the three main routing protocols namely RIP (routing information protocol), OSPF (open shortest path first) and EIGRP (enhanced interior gateway routing protocol) which were tested and compared to determine the routing protocol with the shortest convergence time. The connection time of the three routing protocols used on the exchange point network was run at a TTL value of 24 and packet size of 32 bytes. The RIP provided a convergence time that is within 3 and 4 seconds, with slightly varied spikes of not up to 10 seconds, OSPF and EIGRP also tries to maintain a time of between 3 and 4 seconds but is plagued with so many spikes of up 20 seconds for EIGRP and 17seconds for OSPF. The results showed that with a routing protocol like RIP, connections between the campuses via the exchange point will converge faster. As a result, RIP routing protocol was adopted as the optimal routing protocol to be used for the network configuration due to its better convergence time.
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Mehrez Mahmoud Ali, Marwa, Amany Sayed Eweas Mohamed, Doaa El Demerdash, Hala Eid Mohammed, Manal Mohamed Ahmed Ayed, and Aida Faried Abdelwanees Ali. "Evaluating SPIKES Protocol Implementation in Critical Care Setting." Egyptian Journal of Health Care 15, no. 3 (2024): 1269–80. http://dx.doi.org/10.21608/ejhc.2024.390705.
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Girardi, José Marcos, Beatriz Amélia Monteiro de Andrade, Flavio Rogerio de Carvalho Leao, Mairla Machado Protazio, Márcia Pedrosa de Oliveira, and Cristianne Soares Chaves. "O protocolo spikes na comunicação de más notícias em saúde: revisão integrativa." Revista Brasileira de Educação e Saúde 14, no. 1 (2024): 142–50. http://dx.doi.org/10.18378/rebes.v14i1.10218.
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Introdução: A competência de comunicação em saúde exigida para o cuidado está associada a melhores resultados e maiores índices de satisfação, em especial quando profissionais fornecem más notícias, que alteram negativamente a visão do paciente sobre seu futuro. O protocolo SPIKES, realizado em seis etapas, é abordagem didática relacionada ao câncer, mas tem sido usado em diversos cenários clínicos, como em doenças crônico-degenerativas e infertilidade, destacando o direito do paciente de não saber. Intervenções educacionais parecem eficazes para ensinar os educandos a lidar com esta competência. Objetivo: Identificar o papel do protocolo SPIKES na comunicação de más notícias em saúde. Metodologia: Busca bibliográfica de artigos em línguas inglesa ou portuguesa realizada no mês de agosto de 2023 nas bases eletrônicas de dados da literatura em saúde (MEDLINE e LILACS via BIREME, PUBMED, SciELO e SCOPUS), utilizando os termos “communication in health”, AND “breaking bad News” AND “SPIKES protocol”, sem limitação para o ano de publicação. Resultados: De 175 artigos incialmente identificados foram selecionados 39, excluídos aqueles que não atendiam à pesquisa, permanecendo 19 que embasaram a revisão. O protocolo SPIKES é plataforma valiosa, cujos modelos de comunicação centrados nas preferências dos pacientes podem resultar em melhores resultados de tratamento. Conclusão: Comunicação de más notícias é tarefa difícil para profissionais de saúde, para a qual a educação médica oferece pouca preparação, pois as habilidades de comunicação não são parte essencial dos currículos. O protocolo SPIKES fornece mensagem clara e compreensível de acordo com as necessidades e desejos dos pacientes.
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Kachkovska, Vladyslava. "THE UTILIZATION OF THE SPIKES PROTOCOL WITHIN RHEUMATOLOGY PRACTICE." Eastern Ukrainian Medical Journal 12, no. 3 (2024): 670–77. http://dx.doi.org/10.21272/eumj.2024;12(3):670-677.
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Introduction. The beginning of the patient-physician relationship often involves the delivery of bad news. The work of rheumatologists is unique in that they have to form strong relationships with their patients while delivering bad news. Many rheumatology patients stay with their doctors for their entire lives, which makes it essential to create a positive and caring experience for them. This depends on the physician's professional skills, ability to understand the patient, and engage in respectful and understandable communication when discussing complicated information. Currently, no specific recommendations exist for constructing an appropriate approach for every patient, especially in the case of rheumatology patients. This paper will adapt the SPIKES protocol for rheumatology practice. Methods. The literature search was done via MEDLINE/PubMed, Scopus, and Google Scholar. Search terms included “Ethics”, “Rheumatology”, “Bad news”, “SPIKES” and “Difficult patient”. These keywords were used in different combinations, using a filter box with an option for the recent 5 years. Firstly, articles’ abstracts were analyzed, and only articles that met inclusion criteria were included. Also, references from the selected articles were analyzed, except for the older publications and those irrelevant to the specific topic. Since there was not enough information for these requests, we tried to narrow the search by combining the names of various (most common) rheumatological diseases and using them along with the main purpose of the search. Then, we focused on the publications that met criteria and analyzed the sources cited in them. The 'Related Citations' function was also used in the search strategy. In the literature review process, we included 10 MEDLINE/PubMed articles, 4 Scopus articles, and 2 Google Scholar articles. Aim. This paper analyzes utilization of the SPIKES protocol in rheumatology practice. Results. Currently, no studies have been conducted on the utilization of these approaches in rheumatology practice. There is insufficient data regarding comparison of the effectiveness of different protocols in enhancing communication between the healthcare provider (physician or nurse) and the patient. Effective communication between physicians and patients can be achieved by following the six-step SPIKES approach, which involves specific communication skills. Conclusion. Delivering bad news requires different approaches, but none of them have been specifically tailored for rheumatic disease patients. These patients have unique behavior patterns due to the nature of their illnesses, which can lead to a decrease in their quality of life, limited activity, and painful symptoms. As a result, they often turn to their doctors in a state of personal and mental suffering. Thus, the SPIKES protocol is a useful tool for rheumatology practice
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Carver, Courtney. "The Fear of Dying: A Case Study Using the SPIKES Protocol." Families in Society: The Journal of Contemporary Social Services 99, no. 4 (2018): 333–37. http://dx.doi.org/10.1177/1044389418803444.
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The SPIKES protocol will be discussed in the context of working with a patient who was referred to palliative care in the hospital setting. Palliative care is complex because it is not only medical care but also emotional and spiritual care. Those working in palliative care often explain a diagnosis to the patient, both what the diagnosis is and what it likely means for the future. The SPIKES protocol, a conversational tool for delivering bad news, has applications for social workers. This case study will tell the story of a patient whose fear of death almost cost him the ability to live fully at the end of his life and how the SPIKES tool was implemented in helping this patient understand and come to terms with his diagnosis.
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Su, Wen-Hao, Jiajing Zhang, Ce Yang, et al. "Automatic Evaluation of Wheat Resistance to Fusarium Head Blight Using Dual Mask-RCNN Deep Learning Frameworks in Computer Vision." Remote Sensing 13, no. 1 (2020): 26. http://dx.doi.org/10.3390/rs13010026.
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In many regions of the world, wheat is vulnerable to severe yield and quality losses from the fungus disease of Fusarium head blight (FHB). The development of resistant cultivars is one means of ameliorating the devastating effects of this disease, but the breeding process requires the evaluation of hundreds of lines each year for reaction to the disease. These field evaluations are laborious, expensive, time-consuming, and are prone to rater error. A phenotyping cart that can quickly capture images of the spikes of wheat lines and their level of FHB infection would greatly benefit wheat breeding programs. In this study, mask region convolutional neural network (Mask-RCNN) allowed for reliable identification of the symptom location and the disease severity of wheat spikes. Within a wheat line planted in the field, color images of individual wheat spikes and their corresponding diseased areas were labeled and segmented into sub-images. Images with annotated spikes and sub-images of individual spikes with labeled diseased areas were used as ground truth data to train Mask-RCNN models for automatic image segmentation of wheat spikes and FHB diseased areas, respectively. The feature pyramid network (FPN) based on ResNet-101 network was used as the backbone of Mask-RCNN for constructing the feature pyramid and extracting features. After generating mask images of wheat spikes from full-size images, Mask-RCNN was performed to predict diseased areas on each individual spike. This protocol enabled the rapid recognition of wheat spikes and diseased areas with the detection rates of 77.76% and 98.81%, respectively. The prediction accuracy of 77.19% was achieved by calculating the ratio of the wheat FHB severity value of prediction over ground truth. This study demonstrates the feasibility of rapidly determining levels of FHB in wheat spikes, which will greatly facilitate the breeding of resistant cultivars.
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JAIN, VIBHU, ASHWITHA RAVI, VIPUL THAKUR, ANIKET MISHRA, DEVESH DHAMOR, and SIDDHANT KHARE. "Breaking bad news: Awareness and practice of the SPIKES protocol among general surgery residents at a tertiary care institute in northern India." National Medical Journal of India 36 (May 16, 2024): 320–22. http://dx.doi.org/10.25259/nmji_950_2022.
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Background In general surgery, a clinician is commonly required to break bad news. However, training in communication is not a part of the formal curriculum either in medical school or in surgical residency and there is a paucity of data on awareness of the SPIKES (Setting up the interview, Perception, Invitation, Knowledge sharing, Emotion, Strategy and Summary) protocol among practising surgeons and residents in India. Methods We did a cross-sectional study in the Department of General Surgery at our institution. Junior residents were invited to take part in a one-on-one interview. Descriptive statistics were used to describe the findings of the study. Comparison for categorical data was done using Fisher exact test or chi-square test (whichever was applicable). Results A total of 82 residents with mean (SD) age of 27 (2.5) years (range 23–37 years) participated in the study. Only 31 (37.8%) had ever received training for breaking bad news, though 80 (97.6%) had broken bad news at least once. Twenty-one (26.3%) participants had a bad experience while breaking bad news. Seventy-seven (93.9%) participants felt the need for training in breaking bad news and 76 of them were willing to attend the same. Although the complete SPIKES protocol was followed only by 25 (31.3%) residents, 46 (56.1%) felt that it was practically possible to follow the SPIKES protocol. Conclusion Resident doctors in general surgery face situations of breaking bad news and adherence to the SPIKES protocol is poor. Formal training at every level may enhance their communication skills and enable better healthcare delivery.
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van Proosdij, ER. "The role of the equine veterinarian in end-of-life phase of geriatric horses." UK-Vet Equine 7, no. 6 (2023): 237–41. http://dx.doi.org/10.12968/ukve.2023.7.6.237.
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The role of a veterinarian during the end-of-life phase can be divided into four stages, which are covered in detail in this article. The decision-making process involves both the horse's owner and the veterinarian. In a welfare assessment, ‘a life worth living’ should be aspired to. Euthanasia should be advised by the veterinarian if a horse is found to have ‘a life not worth living’. The decision to end the horse's life is made considering the welfare of the horse and involving the owner. Communicating the decision should be done via the COMFORT and SPIKES protocols. The COMFORT protocol contains elements used for communication, and the SPIKES protocol relates to the order in which the decision is made. After communicating the decision, the veterinarian should also address matters related to the logistics of the horse's euthanasia. Enacting the decision by the veterinarian: the medical and technical aspects of the procedure of euthanasia are important, as well as the interaction and support of the owner by the veterinarian. Finally, after euthanising a horse, attention should be given to the aftercare of the body and to the emotional support of the owner.
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CERQUERA, Edwin Alexander, Jeimy MUÑOZ, Joaquín ARAYA, and Olivero GÓMEZ. "REGISTRO DE ACTIVIDAD ELÉCTRICA EN LA RETINA DE UNA RATA ALBINA EMPLEANDO UNA MATRIZ DE MICROELECTRODOS." Acta Biológica Colombiana 20, no. 3 (2015): 37–46. http://dx.doi.org/10.15446/abc.v20n3.46216.
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<p>Las matrices de microelectrodos son dispositivos que permiten la detección de potenciales de acción o espigas en poblaciones de células excitables, ofreciendo varias aplicaciones en el campo de las neurociencias y la biología. Este trabajo muestra un protocolo para el registro de espigas en una población de células ganglionares retinales empleando una matriz de microelectrodos. La retina de una rata albina fue extraída y preparada para ser estimulada <em>in vitro </em>con luz led blanca, con el fin de registrar sus espigas evocadas ante estos estímulos. Cada microelectrodo puede registrar espigas de más de una célula ganglionar, razón por la cual se determinó a qué célula pertenece cada espiga aplicando un procedimiento conocido como “clasificación de espigas”. El trabajo permitió obtener el registro de un periodo de estimulación y otro de no estimulación, con el fin de representar los potenciales de acción evocados con luz y los espontáneos. Los registros fueron almacenados para visualizar las espigas de las células ganglionares y poder aplicar la herramienta de clasificación de espigas. De este modo, se almacenan los instantes de tiempo en los cuales cada célula ganglionar registrada generó potenciales de acción. Este trabajo conllevó al establecimiento de un protocolo de experimentación básico enfocado al uso de matrices MEA en el laboratorio de adquisición de potenciales extracelulares de la Universidad Antonio Nariño Sede Bogotá, no sólo para caracterizar los potenciales de acción de células ganglionares retinales, sino también para otro tipo de células que puedan ser estudiadas empleando matrices de microelectrodos.</p><p align="center"><strong>Recording of Electrical Activity in the Retina of an Albino Rat Employing a Microelectrode Array</strong></p><p>The microelectrode arrays (MEA) are devices that allow the detection of action potentials or spikes in populations of excitable cells, offering a wide spectrum of applications in topics of Neurosciences and Biology. This work describes a protocol for recording of spikes in a population of retinal ganglion cells employing a microelectrode array. The retina of an albino rat was dissected and prepared to be stimulated<em> in vitro </em>with white led light and to record their evoked spikes. Each microelectrode can record spikes from more than a ganglion cell, for which it was necessary to determine which cell fires each spike applying a procedure known as spike sorting. The work allowed to obtain the recording of a stimulation period and another of non-stimulation, representing evoked and spontaneous action potentials. The recordings were saved, in order to visualize the action potentials of the ganglion cells detected and to apply a computational method for the spike sorting. In this way, it was saved the time stamps in which each action potential was fired by its respective cell. This work established a basic experimentation protocol focused to the use of MEA devices in the laboratory for acquisition of extracellular potentials at the Antonio Nariño University – Bogota Headquarters, not only for characterization of action potentials fired by retinal ganglion cells populations, but also for other kind of cells that can be studied employing MEA devices.</p><p> </p>
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Sadler, R. Mark, and John Goodwin. "Multiple Electrodes for Detecting Spikes in Partial Complex Seizures." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 16, no. 3 (1989): 326–29. http://dx.doi.org/10.1017/s0317167100029164.
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ABSTRACT:The contribution of various electroencephalographic electrodes in detecting spikes from patients with seizures of suspected anterior temporal origin was prospectively studied with a standard protocol. The following electrodes were studied: International Standard 10-20 positions F7-8 and A1-2, sphenoidal (SP), nasopharyngeal (NP), anterior temporal (Tl-2), mandibular notch surface (MNS), and mandibular notch subdermal (MNSD). Twenty patients were recorded of whom 16 demonstrated anterior temporal spikes. There was no difference in the number of spikes detected by SP, MNS, MNSD, or Tl-2 electrodes (p < 0.05); however these electrodes detected significantly more spikes than NP, F7-8, or A1-2. The SP electrode recorded spikes of highest amplitude (p < 0.05). We conclude that for patients suspected of having seizures of anterior temporal origin, (1) a substantial number of spikes will be missed if only the International Standard electrode system is employed; (2) in comparison to SP electrodes the noninvasive and easily applied MNS or Tl-2 electrodes will detect almost all spikes and should be used in outpatient EEG recordings; (3) NP electrodes provide no information that cannot be obtained by more reliable and better tolerated electrodes.
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Alana, de Souza Rodrigues, Soto Santana Alice, Oliveira Vasconcelos Joana, Mateus Soares Júlia, and do Trabalho: Ihann Almerio Diniz Antônio Guimarães Costa Orientador. "EFETIVIDADE DO PROTOCOLO SPIKES PARA COMUNICAÇÃO DE MÁS NOTÍCIAS PARA MÉDICOS E ESTUDANTES DE MEDICINA: UMA REVISÃO SISTEMÁTICA." Revistaft 28, no. 132 (2024): 27. https://doi.org/10.5281/zenodo.10825327.
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<strong>Introdução</strong>: Uma má notícia pode ser compreendida como aquela que altera drasticamente e negativamente a perspectiva do paciente em relação ao futuro da sua saúde. A comunicação da mesma aos pacientes, é um dos obstáculos que os profissionais de saúde enfrentam. A importância das estratégias serem bem aplicadas na prática médica, é estabelecer um bom desfecho clínico para o paciente. <strong>Objetivo</strong>: Esse estudo tem como objetivo realizar uma revisão de dados da literatura verificando se existe efetividade na implementação do protocolo SPIKES para uma melhor comunicação de más notícias que pode ser utilizado por médicos e estudantes de medicina. <strong>Método</strong>: Trata-se de uma revisão sistemática, sendo uma análise qualitativa e descritiva na qual foi utilizada a Biblioteca Virtual em Saúde (BVS), PubMed e SciELO como bases de dados. <strong>Resultados</strong>: Através desta revisão, foram encontrados 11 estudos longitudinais que abordaram o uso e efeito do protocolo SPIKES na comunicação de más notícias entre médico e estudantes de medicina com os seus pacientes. <strong>Conclusão: </strong>Desse modo, o estudo busca revelar que, seguindo os passos do protocolo, é possível aprimorar a capacidade comunicativa, obter mais segurança ao dar o diagnóstico ao paciente e seus familiares, realizando o manejo do paciente sabendo lidar com suas possíveis reações.
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Coutinho, Filipe, and Anisha Ramessur. "An Overview of Teaching Communication of Bad News in Medical School: Should a Lecture be Adequate to Address the Topic?" Acta Médica Portuguesa 29, no. 12 (2016): 826. http://dx.doi.org/10.20344/amp.7909.
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Introduction: Delivering bad news is very common in medical daily practice. Several studies have shown a lack of effective communication skills amongst medical students, particularly concerning how to deliver bad news. The SPIKES protocol allows communicating bad news in a 6-step method. The aim of this study is to investigate the perspective of students related to this subject.Material and Methods: A 45 minute lecture “Breaking Bad News” was given to 160 students in the fifth and sixth years of the Medicine course, using the SPIKES’ protocol training. After the lecture, an online survey was given to all students, and a cross-sectional and descriptive analysis of data extracted from survey was undertaken.Results: Fifty-four students (21% of overall) answered the online survey. Eighty three percent said that theme should have an important role in their further daily medical practice, and most of students rated the physicians’ role as challenging. Sixty percent of students expressed that communicating bad news was an integral part of the medical course curriculum. Regarding the SPIKES´ protocol, 48% felt that the first step would be the easiest to put in practice, and 40% felt that the fifth step related to “Emotions” would be the most difficult.Discussion: In general, the students would like to gain competencies in breaking bad news using a practical approach Conclusions: Students highly valued theoretical and practical approaches in teaching of communication of bad news. Therefore, we encourage a combination approach in pre-graduate medical education.
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M Ryan, Patrick. "Mental health in the injured athlete–why the spikes protocol matters." MOJ Sports Medicine 5, no. 3 (2022): 67–70. http://dx.doi.org/10.15406/mojsm.2022.05.00121.
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Athletes are a unique subset of patients that pose unique challenges to the treating physician. The mental health of injured athletes is becoming increasingly recognized as a vital part of adequate care of these patients. Numerous studies link poor mental health function and pre-existing mental health diagnoses to poor outcomes including delayed return to play, inability to return to play, risk of re-injury, and exacerbation of underlying mental health problems. Because this is a topic not often studied by team physicians and this manuscript aims to provide a practical tool to help these physicians communicate with injured athletes. The SPIKES protocol is an effective way to acknowledge and adequately communicate with this unique patient population.
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Naderi Nabi, Bahram, Zahra Rafiei Sorouri, Ali Pourramzani, et al. "Physicians’ Skills in Breaking Bad News to Patients With Cancer Using SPIKES Protocol." Caspian Journal of Neurological Sciences 8, no. 4 (2022): 234–43. http://dx.doi.org/10.32598/cjns.4.31.96.5.
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Background: Breaking bad news is an unpleasant task for physicians, especially for patients with cancer. In this regard, the SPIKES protocol, which is prevalent in several countries, has not been discussed in Iran. Objectives: This study evaluated how the SPIKES protocol was followed by physicians. Materials & Methods: This descriptive cross-sectional study was conducted at Guilan academic hospitals from December 2021 to April 2022. Patients with cancer participated in the survey who were referred to the oncology academic centers for follow-ups or radiotherapy and chemotherapy. They were over 18 years old with the ability of proper communication. The SPIKES questionnaire consists of 12 questions with 6 subscales (settings, invitation, perception, knowledge, emotion, and strategy). It was filled out through a direct interview. Results: The data from 280 patients were analyzed. Everyone stated that at the time of receiving the diagnosis, the doctor was not in a hurry and made appropriate eye contact. About 61.1% believed they were emotionally supported, and 65.4% were satisfied with their final knowledge about the disease and treatment planning. Patients with older ages and lower levels of education were significantly more likely to state that physicians’ language was not comprehensive; physicians did not understand them, and the patients were not emotionally supported (P=0.0001). Conclusion: This study showed that more attention should be paid to older patients with lower levels of education. They needed more time for conversation and simpler dialect. Some areas, such as “invitation” are required to be improved
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Rauter, Carolin, Markus Mueller, Isabel Diterich, et al. "Critical Evaluation of Urine-Based PCR Assay for Diagnosis of Lyme Borreliosis." Clinical Diagnostic Laboratory Immunology 12, no. 8 (2005): 910–17. http://dx.doi.org/10.1128/cdli.12.8.910-917.2005.
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ABSTRACT Many approaches were made in recent years to establish urine PCR as a diagnostic tool for Lyme borreliosis, but results are contradictory. In the present study, a standardized protocol spiking urine from healthy donors with a defined amount of whole Borrelia or Borrelia DNA was established. The development of a nested real-time PCR targeting ospA enabled a highly sensitive and quantitative analysis of these samples. We show the following. (i) Storage of spiked urine samples for up to 6 months at −20°C had no negative effect on spike recovery. (ii) Centrifugation of 10 ml of urine at 40,000 × g for 30 min resulted in a concentration of both spikes, i.e., whole Borrelia and DNA. (iii) The inhibition of DNA spike recovery in 48% (11 of 23 samples) of urine samples tested could be attributed to nuclease activity. This was abrogated by alkalizing the urine or by working with the samples on ice. Despite optimized conditions, analysis of urine samples of 12 patients with erythema migrans, the clinical stage considered to be associated with the highest bacterial load, revealed a positive result in only one sample. All 12 samples were negative by an alternative PCR targeting flagellin. The results of our study support doubts that urine is a suitable material for diagnosis of Lyme borreliosis.
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Oetliker, Ueli, and Christian Reber. "A Combined Acquisition and Analysis Protocol to Eliminate Spikes in near Infrared Spectra Measured with Germanium Detectors." Journal of Near Infrared Spectroscopy 3, no. 2 (1995): 63–71. http://dx.doi.org/10.1255/jnirs.57.
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A new software-based method for eliminating voltage spikes in near infrared (NIR) spectra measured with germanium (Ge) detectors is described. The digitised signal from the detector is analysed statistically in order to reject spikes before the average signal at a given wavelength is calculated and stored. This analysis is an integral part of the data acquisition process and its properties and implementation are described in detail. The protocol is used to measure NIR luminescence spectra of inorganic materials and we show that acquisition times for spectra with equivalent signal-to-noise ratios are shorter by an order of magnitude than for conventional experiments. This low-cost methodology is easily adapted to other spectroscopic techniques involving Ge detectors.
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Kim, Su Hyun, Youn Seon Choi, Young Mee Lee, Dae Gyeun Kim, and Jeong A. Kim. "Teaching ‘Breaking Bad News’ Based on SPIKES Protocol during Family Medicine Clerkship." Korean Journal of Medical Education 18, no. 1 (2006): 55–63. http://dx.doi.org/10.3946/kjme.2006.18.1.55.
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Raturi, M., and A. Kusum. "Utilizing SPIKES protocol for breaking bad news to sero-reactive blood donors." Transfusion Clinique et Biologique 27, no. 3 (2020): 165–67. http://dx.doi.org/10.1016/j.tracli.2020.05.004.
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Udgata, Shirsa, Aishwarya Sunil, Katherine A. Johnson, Cheri A. Pasch, and Dustin A. Deming. "Abstract 5929: Individual organoid level analyses reveal hidden tumor molecular heterogeneity." Cancer Research 83, no. 7_Supplement (2023): 5929. http://dx.doi.org/10.1158/1538-7445.am2023-5929.
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Abstract Introduction: Tumor heterogeneity is a major cause of resistance to therapies in cancer patients occurring during disease progression or secondary to therapeutic intervention due to clonal selection. Mapping tumor heterogeneity is crucial for developing therapeutics for cancer patients. Currently there are no reliable models for identifying heterogeneity in vitro. Patient-derived cancer organoids (PDCOs) from tissue samples of patients capture clonal and subclonal mutations. Here we use PDCOs from colorectal cancer (CRC) patients to study molecular heterogeneity across individual organoids and how the heterogeneity changes with passages. Methods: Fresh CRC tissues from 4 patients undergoing endoscopy were obtained following consent on an IRB-approved protocol. PDCOs were cultured using Matrigel and previously published CRC organoid media. Following maturation, individual organoids (spikes) were separated into Matrigel domes and expanded. Parent cultures from high/low passage numbers and expanded spikes were collected for next generation sequencing (NGS). A variant allele frequency (VAF) was determined for each nonsynonymous variant and considered subclonal if the VAF was between 10%-30%. Variants were annotated pathogenic or not using ClinVar. Results: A total of 49 spikes were collected from 4 CRC PDCO lines and compared to the parent cultures using NGS. For low passage parent cultures, a median of 4 (range 3-8) subclonal alterations were identified. At high passages the number of subclonal variants decreased (median: 2 (range 2-4)). The individual organoid spikes maintained the founder (clonal) alterations and most also contained subclonal alterations, though at a lower frequency. Of those subclonal variants in the parent cultures, 31% were found in the spikes and an additional 54% found in the spikes were not identified in the parent. In a high tumor mutation burden line (MTB111), 12/17 spikes showed subclonal alterations in APCA896V, F1515C, Q1544* that were not present in the parent culture. Two PDCO lines (RC46A and RC46B) obtained from distinct sites of the same tumor were generated. One contained a subclonal mutation in MYCN26S in the high passage parent culture and 7/9 spikes. This mutation was not present in any RC46A samples. The high passage RC46A parent culture and 2/7 spikes showed an alteration in ARID1AG1037fs while it was present only in a single spike of RC46B. Conclusion: PDCOs identified subclonal alterations at the single-organoid level and are an exciting tool to study tumor heterogeneity. The spikes presented less subclonal variants than the parent but were largely not clonal. Future implications of using heterogeneity data from single organoids in therapeutic decisions are warranted. Citation Format: Shirsa Udgata, Aishwarya Sunil, Katherine A. Johnson, Cheri A. Pasch, Dustin A. Deming. Individual organoid level analyses reveal hidden tumor molecular heterogeneity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5929.
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Bur'yanov, O. A., V. P. Kvasha, V. O. Naumenko, M. Yu Karpinsky, and O. V. Yaresko. "Study of the stress-deformation state of models of the humerus in cases of supracondylar oblique fractures in children and adolescents with different options of percutaneous fixation." Paediatric Surgery. Ukraine, no. 3(84) (September 28, 2024): 86–94. https://doi.org/10.15574/ps.2024.3(84).8694.
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Fractures of the distal epimetaphysis of the humerus in children and adolescents are one of the most common injuries, accounting for 16 to 50% of all bone fractures. Among the injuries of this location, supracondylar (3-18%) and transcondylar fractures (57.5-70%) prevail, mainly in children aged 6-7 years. A significant problem when using a crossed fixation structure is iatrogenic damage to the ulnar nerve (2-8%), which requires a mini-open technique of medial spica or sonographic monitoring. Aim - to compare the level of stresses in the model of the humerus with a supracondylar oblique fracture with different options of percutaneous fixation under the influence of different loads. Materials and methods. A basic finite-element model of the humerus was developed, on the basis of which a model of an oblique supracondylar fracture was created. Two versions of osteosynthesis were modeled: with two spikes arranged crosswise and a bundle of three spikes. The stress-strain state of the models was studied under the influence of tensile, bending and twisting loads. Results. The presence of an oblique epicondylar fracture of the humerus leads to asymmetric changes in the distribution of stresses in the epicondyles above and below the fracture line during cross fixation with two spikes. With lateral fixation with three spikes under the influence of tensile load, the tension in the medial epicondylum is reduced to a minimum and their level on the lateral one is doubled. This is related to the one-sided conduction of a bundle of spikes. At the same time, the medial epicondyle remains unfixed and, accordingly, the loads on it are practically not transferred. The bone regenerate for this is too soft to prevent movement of the distal fragment. At the same time, a tighter fixation of the lateral epicondyle than in the version with two needles across, causes an increase in the level of stress in the lateral epicondyle. The total size of the cross-sectional area of the spike bundle with lateral fixation ensures a twice lower stress level in them, compared to cross fixation. Under bending loads, cross fixation with two spikes and lateral fixation with a bundle of three spikes work about the same. Under torsional loads, both methods of fixation of fragments of the humerus showed approximately the same results. In favor of the method of lateral fixation with a bundle of three spikes, the low level of stresses in the spikes can be attributed. The asymmetric arrangement of the bundle of three spokes during lateral fixation is compensated by the asymmetry of the passage of the fracture line. All this indicates that in the treatment of oblique supracondylar fractures of the humerus, both methods of fixation are equivalent from the point of view of stress distribution in the bone tissue, and the choice of one of them can be determined by other criteria. Conclusions. Mathematical modeling of the humerus with a supracondylar oblique fracture did not determine significant advantages of one or another method of fixation. The asymmetric location of the spikes during lateral fixation of bone fragments is compensated by the asymmetry of the fracture line. In favor of the method of lateral fixation with a bundle of three spikes, the low level of stresses in the spikes can be attributed. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors.
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Nyam, DD, NS Gonzuk, MD Sila, YC Tumba, EA Angyu, and EH Kwon-Ndung. "Agro-morphological Growth Response of Acha (FONIO) (Digitaria exilis and Digitaria iburua [kippist] Stapf.) Exposed to Colchicine: Number of Spikes, Spike Length, Number of Seeds per Spike and Grain Yield." Journal of Plant Science and Phytopathology 8, no. 2 (2024): 113–17. http://dx.doi.org/10.29328/journal.jpsp.1001142.
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This study aimed to investigate the effects of colchicine treatment on the reproductive traits and grain yield of two species of Acha, Digitaria exilis and Digitaria iburua. Colchicine, a mitotic inhibitor, is known for inducing polyploidy and altering plant characteristics. The study focused on evaluating number of spikes, spike length, number of seeds per spike, and grain yield per hectare. The experiment was conducted in a randomized complete block design with three replications. The treatment groups included colchicine-treated plants at varying concentrations (0.05, 0.10, 0.15, and 0.20 g/dL) and control plants (untreated). The colchicine treatment involved the soaking of both Acha species in the colchicine solution for a period of 24 hours. While the control groups were soaked in distilled water. The results showed that colchicine treatment significantly affected the agronomic traits and grain yield of both Digitaria exilis and Digitaria iburua. Colchicine treatment led to an increase in the number of spikes (5.80 and 9.90 for D. exilis and D. iburua respectively), spike length (13.60 cm and 19.50 cm for D. exilis and D. iburua respectively), and number of seeds per spike (168.30 and 253.30 for D. exilis and D. iburua respectively), compared to the control group. Additionally, the grain yield per hectare was significantly higher (427.80gha-1 and 2126.70gha-1 for D. exilis and D. iburua respectively) in the colchicine-treated group. These findings suggest that colchicine treatment can effectively enhance the agronomic traits and grain yield of both Digitaria exilis and Digitaria iburua. The induced polyploidy through colchicine treatment likely contributed to the observed improvements in plant productivity. Further research is warranted to investigate the underlying mechanisms and to optimize the colchicine treatment protocol for Acha cultivation and improvement.
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Martins, Beatriz Nascimento Figueiredo Lebre, César Augusto Migliorati, Ana Carolina Prado Ribeiro, et al. "THE CHALLENGES DENTISTS FACE TO COMMUNICATE CANCER DIAGNOSIS: SELF-ASSESSMENT BASED ON SPIKES PROTOCOL." Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology 134, no. 3 (2022): e202. http://dx.doi.org/10.1016/j.oooo.2022.01.623.
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Sivaganesan S, Maria Antony S, and Udayakumar E. "An Event-Based Neural Network Architecture with Content Addressable Memory." International Journal of Embedded and Real-Time Communication Systems 11, no. 1 (2020): 23–40. http://dx.doi.org/10.4018/ijertcs.2020010102.
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A hybrid analog/digital very large-scale integration (VLSI) implementation of a spiking neural network with programmable synaptic weights was designed. The synaptic weight values are stored in an asynchronous module, which is interfaced to a fast current-mode event-driven DAC for producing synaptic currents with the appropriate amplitude values. It acts as a transceiver, receiving asynchronous events for input, performing neural computations with hybrid analog/digital circuits on the input spikes, and eventually producing digital asynchronous events in output. Input, output, and synaptic weight values are transmitted to/from the chip using a common communication protocol based on the address event representation (AER). Using this representation, it is possible to interface the device to a workstation or a microcontroller and explore the effect of different types of spike-timing dependent plasticity (STDP) learning algorithms for updating the synaptic weights values in the CAM module.
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Ruiz Sancho, Elena, Miguel Ángel Pérez Nieto, Francisco J. Román, et al. "Differences in the Communication of Cancer Diagnoses by Different Health Professionals and the Impact of Oncologist Communication on Patients’ Emotions." Cancers 16, no. 13 (2024): 2444. http://dx.doi.org/10.3390/cancers16132444.
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The field of healthcare is increasingly adopting a humanistic perspective in the physician–patient relationship. One of the more salient aspects being studied is the communication between the two. This study serves a dual purpose. Our initial aim was to study how a cancer diagnosis is disclosed to patients by different physicians (GPs/other specialists/oncologists). Secondly, we set out to study how the way in which oncologists normally communicate with their patients impacts variables such as a patient’s anxiety, depression, coping mechanisms, and perception of both their health and their quality of life. A total of 177 patients answered a battery of questionnaires on sociodemographic and disease data: the SPIKES protocol, the EORTCQLQ-COMU26, and the ADAF screening questionnaire. The analyses recorded medium or high scores for some of the steps in the SPIKES protocol when delivering the diagnosis, and significant differences were observed for some of them among different physicians. The level of a cancer patient’s satisfaction with the communication by oncologists was related to their levels of anxiety, depression, vulnerability, and perception of their health and quality of life. Better communication strategies are called for among all healthcare professionals to facilitate the task of breaking bad news to their patients.
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Farrell, Tommie Wade, Josh Reed, and Michael Roffers. "Beyond SPIKES: Key principles to enhance communication in difficult conversations." Journal of Clinical Oncology 32, no. 31_suppl (2014): 138. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.138.
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138 Background: The SPIKES protocol for delivering bad news developed by Buckman et al. has been a standard since published. Though helpful those in practice understand that further training is needed for these difficult conversations and for those that follow when deciding on treatment options. What skills can be taught to prepare for these conversations? Methods: At our program Hospice/Palliative and Oncology fellows rotate with the hospital Supportive Care team. They are trained in Three Key Principles after training in the SPIKES protocol: EMOTIONAL ALIGNMENT: aligning team goals with the goals of the patient/family. This includes eliciting the goals of the patient, clarifying the basis of these goals and showing alignment. Example phrases: Tell me what your hopes are for your treatment. What do you feel will happen when you attempt this? Your desire to live as long as possible makes perfect sense. TRANSPARENCY: sharing the ambiguity inherent in care. This includes presenting all options of care, and the variability that exists with all options. Examples: We don't always know exactly what will happen with treatment, but if your goal is to live as long as possible this will possibly extend life by months. If your goal is to maximize time with family, a person may choose to use the services of the hospice team who focus on you being at home. CLARITY: clarifying misconceptions and ensuring that goals and treatment plans match. This includes asking for expectations of treatment, giving accurate expected outcomes, and using language that is clear. Examples: When we say that this treatment is palliative we mean that we don't expect that it will cure, but it may provide on average an extra few months. You have told me you hope to get stronger by doing this treatment. I need to tell you that typically this treatment does not make a person stronger and fatigue is actually a potential side effect. Results: Fellows find these principles helpful in discussing treatment options. They universally evaluate this skill set as being achievable and also report it enhances patient-physician relationships. Conclusions: Applying these key principles is a skill that can enhance communication when making treatment decisions in potentially terminal illness.
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Dvořáčková, Veronika. "A genre-based approach in ESP classes to teaching clinical communication focusing on breaking bad news to patients." Discourse and Interaction 17, no. 1 (2024): 30–50. http://dx.doi.org/10.5817/di2024-1-30.
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Healthcare professionals have the responsibility to regularly convey difficult information such as unfavourable diagnoses, as well as adverse treatment outcomes. While this task can be uncomfortable, successfully carrying it out plays a crucial role in determining patient outcomes (Sweeney et al. 2011: 230). This necessity has led to the creation of evidence-based protocols such as SPIKES developed by Baile et al. (2000). The goal of the paper is to explore the suitability of the genre-based approach for the study and teaching of medical English, focusing on the integration of the selected clinical communication tool into the ESP classroom. As this study stems from the ESP practitioner’s experience and its outcomes will directly influence her future ESP classroom teaching, action research has been conducted. The feasibility of using an authentic clinical tool in an ESP lesson was assessed through a two-step methodology: i) devising an ESP task based on the SPIKES protocol, emphasizing linguistic elements, and ii) obtaining student feedback focusing on the perceived usefulness of the tool. Overall, the collected data indicate that students acknowledged the significance of effective clinical communication for successful therapeutic practice. However, given the fact that medical English is inconveniently scheduled in a pre-clinical phase of their curriculum, they also exhibited a certain level of hesitancy, unsurprisingly, when it came to readiness in handling serious communication scenarios.
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Yaghoubi, Tahereh, and Fereshteh Araghian Mojarad. "The Need for Developing a Protocol for Delivering Bad News During Natural Disasters in Iran." Current Psychosomatic Research 1, no. 3 (2023): 262–65. http://dx.doi.org/10.32598/cpr.1.3.126.1.
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In the last century، more than 2. 6 billion people in the world have been affected by natural disasters، such as earthquakes، floods، storms، landslides، and climate changes. The delivery of bad news after natural disasters is one of the responsibilities of therapists. The bad news refers to any information that cause negative changes in a patient's view of the future. It is not possible to use the same protocol to deliver bad news for all situations. It is not possible to use the same protocol to deliver bad news for all situations. It is necessary to localize or develop the Persian version of the SPIKES protocol to break bad news during natural disasters in Iran، and it is recommended to be included in the emergency response plan. Such protocol can be used in line with the activity and evaluation of the validity criterion of "breaking bad news to the patient/legal guardian by the ethical principles and predetermined methods"، and also for the use of pre-hospital and hospital cares.
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von Blanckenburg, Pia, Mareike Hofmann, Winfried Rief, Ulf Seifart, and Carola Seifart. "Assessing patients´ preferences for breaking Bad News according to the SPIKES-Protocol: the MABBAN scale." Patient Education and Counseling 103, no. 8 (2020): 1623–29. http://dx.doi.org/10.1016/j.pec.2020.02.036.
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Baile, Walter F., Robert Buckman, Renato Lenzi, Gary Glober, Estela A. Beale, and Andrzej P. Kudelka. "SPIKES—A Six‐Step Protocol for Delivering Bad News: Application to the Patient with Cancer." Oncologist 5, no. 4 (2000): 302–11. http://dx.doi.org/10.1634/theoncologist.5-4-302.
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Kotov, M. A., and V. V. Gushchin. "How would you deliver bad news most professionally? SPIKES protocol for breaking bad news disclosure." Endoskopicheskaya khirurgiya 24, no. 5 (2018): 45. http://dx.doi.org/10.17116/endoskop20182405145.
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Gardner, E. P., and C. I. Palmer. "Simulation of motion on the skin. II. Cutaneous mechanoreceptor coding of the width and texture of bar patterns displaced across the OPTACON." Journal of Neurophysiology 62, no. 6 (1989): 1437–60. http://dx.doi.org/10.1152/jn.1989.62.6.1437.
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1. These experiments assay the functional significance of receptive-field architecture for information processing. Rapidly adapting (RA) afferents have been previously shown to converge information from clusters of 14-25 Meissner's corpuscles, whereas afferents innervating Pacinian corpuscles (PCs) have only a single, large receptor terminal. We tested two opposing hypotheses of functional architecture: 1) summation models, in which an afferent integrates signals from all of its terminals, showing monotonic increases in activity as a function of contact area, and 2) winner-take-all models, in which the most strongly activated receptor in the cluster dominates axonal output by cancellation of signals from other branches. 2. Bar and stripe patterns have been swept across the finger or palm of the monkey's hand at speeds of 30-120 mm/s with the use of a computer-controlled grid of sequentially activated miniature probes (OPTACON stimulator). The dense packing of OPTACON probes permits placement of up to five groups of stimulators within an individual receptive field, allowing us to activate one or more clusters of Meissner's corpuscles simultaneously and to stimulate the bulbar corpuscle of PC afferents at different orientations through the skin. Integration of information from moving bar patterns has been tested with two protocols. In the variable width protocol, the total number of activated rows in the pattern is varied from one to five, with a constant spacing of 1.2 mm between pulsed rows. In the variable density protocol, the length of skin stimulated is held constant at 5 mm and the spacing of stimuli varied. 3. RA afferents show no evidence of summation of inputs within their receptive fields. Motion of wide bars across the field increases the duration of firing but not the total spikes evoked by each pulse. Responses to the leading edge of wide bars were found to be identical to those evoked by a single-row bar. Simultaneous activation of two to five rows evokes the same or fewer spikes per pulse than the most effective individual row tested alone. When broad-bar patterns are centered over the field, contacting the maximum number of receptors, RAs follow activity in the dominant branch or terminus, suppressing additional inputs. Lack of summation is observed at all pulse frequencies tested (25-100 Hz). 4. Moving bar patterns evoke responses as long as at least one row stimulates the receptive field; broader patterns evoke longer spike trains whose total number of impulses is proportional to bar width.(ABSTRACT TRUNCATED AT 400 WORDS)
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Ganiem, Leila Mona, and Hasanah Suryani Utami. "Patient Expectations on How Doctors Deliver Bad News (Case Study of Cancer Patients in Jambi City)." International Journal of Science, Technology & Management 2, no. 3 (2021): 755–66. http://dx.doi.org/10.46729/ijstm.v2i3.190.
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Abstract:
 Research related to patient expectations has existed, but not specifically in Indonesia, especially in Jambi. For this reason, this study is aimed, firstly, to find out the patient's opinion on how doctors deliver bad news according to the SPIKES stage. The second objective was to explore patients' opinions regarding their expectations about the way doctors communicate bad news, namely cancer diagnosis and prognosis in breast cancer patients, taking into account the SPIKES protocol. This case study research uses a qualitative approach. Research in the city of Jambi in January - November 2019, used interviews with eight informants, namely female patients who saw an oncologist (cancer). Interviews were conducted with each informant and also to the group. Doctors only use some stages, namely stages, interview, giving knowledge, strategy, and summary. The patients studied think that the doctor passes through stages, perception, and invitation. There was a large tendency in the Emotions with the empathic response stage, patients who felt that they were given attention to the patient's emotional condition with an empathetic response, only a small proportion did not feel the doctor's empathic response. Expectations of patients, doctors pay attention to the stages of SPIKES as well as the dimensions of content and dimensions of relationships in delivering bad news about a diagnosis of the disease.
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Rocha, Vinícius Pinto Costa, Bruna Aparecida Souza Machado, Helenita Costa Quadros, et al. "High-Content Imaging-Based Assay for SARS-CoV-2-Neutralizing Antibodies." Vaccines 12, no. 3 (2024): 236. http://dx.doi.org/10.3390/vaccines12030236.
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The COVID-19 pandemic and the consequent emergence of new SARS-CoV-2 variants of concern necessitates the determination of populational serum potency against the virus. Here, we standardized and validated an imaging-based method to quantify neutralizing antibodies against lentiviral particles expressing the spike glycoprotein (pseudovirus). This method was found to efficiently quantify viral titers based on ZsGreen-positive cells and detect changes in human serum neutralization capacity induced by vaccination with up to two doses of CoronaVac, Comirnaty, or Covishield vaccines. The imaging-based protocol was also used to quantify serum potency against pseudoviruses expressing spikes from Delta, Omicron BA.1.1.529, and BA.4/5. Our results revealed increases in serum potency after one and two doses of the vaccines evaluated and demonstrated that Delta and Omicron variants escape from antibody neutralization. The method presented herein represents a valuable tool for the screening of antibodies and small molecules capable of blocking viral entry and could be used to evaluate humoral immunity developed by different populations and for vaccine development.
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Seifart, C., M. Hofmann, T. Bär, J. Riera Knorrenschild, U. Seifart, and W. Rief. "Breaking bad news–what patients want and what they get: evaluating the SPIKES protocol in Germany." Annals of Oncology 25, no. 3 (2014): 707–11. http://dx.doi.org/10.1093/annonc/mdt582.
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Șerbănescu, Mircea-Sebastian, Ruxandra-Mădălina Florescu, and Mirela-Elena Jianu. "Leveraging ChatGPT and Contextual Frameworks for Optimal SPIKES protocol implementation in Ophthalmology, Gynecology, and Palliative Care." Procedia Computer Science 246 (2024): 3495–502. http://dx.doi.org/10.1016/j.procs.2024.09.207.
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Al-kishi, Nihad, Ali H Bu Zaid, Hassan Yousef Aldhneen, et al. "Physicians’ Practices and Attitudes Regarding the Delivery of Bad News to Patients under the SPIKES Protocol." Egyptian Journal of Health Care 16, no. 1 (2025): 935–45. https://doi.org/10.21608/ejhc.2025.422257.
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Steynberg, Petré, Leila L. Goedhals-Gerber, and Esbeth van Dyk. "An Analysis of the Impact of Logistics Processes on the Temperature Profile of the Beginning Stages of a Blueberry Supply Chain." Horticulturae 8, no. 12 (2022): 1191. http://dx.doi.org/10.3390/horticulturae8121191.
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Blueberries are highly perishable and temperature sensitive. The main purpose of the study was to determine whether logistics processes in the beginning stages of the blueberry supply chain have an influence on the temperature profiles and quality of the fruit further downstream. Temperature trials were conducted on three farms in the Gauteng and three in the Western Cape provinces of South Africa. Observations were made, and iButton® temperature monitoring devices were used to record ambient temperatures experienced by blueberries from harvesting until after forced cooling in the cold store. Descriptive statistics were used to analyse the temperature data. The results showed poor adherence to protocols and a large number of temperature and chilling injury spikes and breaks. Many trials did not reach pre-cooling and forced cooling protocol temperatures within the required time. Quality reports indicated that pallets were downgraded owing to cartons being underweight, probably as a result of moisture loss, and other quality defects such as collapsed berries and mould. By minimizing the breach of protocols and improving the beginning stages of the blueberry supply chain, a better-quality product will be ensured, thus reducing costs, food loss and food waste.
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Kong, Dewei, Song Jiang, Jianzhi Shi, et al. "Cryopreservation Protocol Optimization for Penaeus monodon Sperm: Reagent Screening and Parameter Refinement." Biology 14, no. 4 (2025): 408. https://doi.org/10.3390/biology14040408.
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Penaeus monodon (black tiger shrimp) is one of the important shrimp species in aquaculture. Cryopreserving its sperm not only provides technical support for breeding but also effectively prevents the decline of genetic resources, promoting the sustainable development of its aquaculture industry. This study screened different types of diluents, cryoprotectants, and concentrations and explored equilibration time, cooling protocols, and thawing conditions, ultimately determining the optimal cryopreservation protocol for P. monodon sperm. The results showed that the optimal cryopreservation protocol involved using natural seawater as the diluent with 10% dimethyl sulfoxide (DMSO) as the cryoprotectant, in which the sperm suspension and cryoprotectant were mixed at a 1:1 (v/v) ratio and equilibrated at 4 °C for 30 min. Subsequently, cooling was performed using a programmable controlled-rate freezer: the temperature was reduced to −20 °C at −5 °C/min and held for 5 min; then cooled to −80 °C at −10 °C/min and held for 5 min; finally, the temperature was reduced to −180 °C at −20 °C/min. After cooling, the sperm samples were transferred to liquid nitrogen for long-term storage. The results demonstrated that thawing in a 37 °C water bath achieved the highest sperm motility compared to conditions at 27 °C, 32 °C, 42 °C, and 60 °C. After 15 days of liquid nitrogen storage, the sperm survival rate was 53.33 ± 9.18%. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) observations revealed that the sperm structure was intact before freezing, with a rounded head, a distinct acrosomal spike anterior to the head, a concentrated nucleus in the head, dense chromatin, and a smooth cell membrane surface. However, after freezing and thawing, the acrosomal spikes of some sperm were fractured, and the membrane structure was damaged. Enzyme activity analysis showed that during liquid nitrogen storage from 0 to 15 days, the enzyme activity of alkaline phosphatase (AKP) and acid phosphatase (ACP) in sperm gradually increased with significant differences observed compared to day 0 (p < 0.05). The activity of malondialdehyde (MDA) showed a gradual increase at 0, 5, and 10 days, but then decreased at day 15. The enzyme activity of catalase (CAT) showed no significant changes from 0 to 10 days (p > 0.05) but significantly increased on day 15 (p < 0.05). The activity of total superoxide dismutase (T-SOD) showed no significant changes from 0 to 5 days (p > 0.05) but significantly increased from days 10 to 15 (p < 0.05). These findings provide valuable insights into the cryopreservation of P. monodon sperm and will guide the optimization of cryoprotectant combinations and freezing protocols aimed at improving sperm survival rates.
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Pereira, Carolina Rebello, Marco Antônio Marchetti Calônego, Lino Lemonica, and Guilherme Antonio Moreira de Barros. "The P-A-C-I-E-N-T-E Protocol: An instrument for breaking bad news adapted to the Brazilian medical reality." Revista da Associação Médica Brasileira 63, no. 1 (2017): 43–49. http://dx.doi.org/10.1590/1806-9282.63.01.43.
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Summary Objective: There are plenty of published tools for breaking bad medical news; however, none of them is culturally appropriate to our reality or published in the Brazilian literature. This study proposes a genuinely Brazilian communication tool and evaluates its acceptance among doctors and nurses. Method: This was a prospective study. The data were collected after specific training of doctors and nurses on the bad news communication techniques based on the P-A-C-I-E-N-T-E ("patient," in Portuguese) Protocol. This instrument is in accordance with the Brazilian reality and was based on the SPIKES communication tool. Results: The worst task to be performed during communication is "talking about death" followed by "discussing the end of curative treatment attempts" and "diagnosis" itself. Among the respondents, 48% reported they did not receive formal training for communicating. Also, 52% of respondents do not use any systematic approach in their daily practice when communicating with patients, but 97% considered the proposed P-A-C-I-E-N-T-E Protocol as a useful and appropriate communication tool. Conclusion: The P-A-C-I-E-N-T-E Protocol proved to be suitable to the Brazilian context.
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Dunaievska, Olha V., and Tetyana A. Chaiuk. "Modifying “Breaking Bad News” Communication: Cross-Cultural and Cognitive-Semantic Approaches." Academic Journal of Interdisciplinary Studies 9, no. 2 (2020): 1. http://dx.doi.org/10.36941/ajis-2020-0017.
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The paper addresses the alteration strategies to be implied by a health care professional in the situation of breaking bad news in terms of patient-centered paradigm applied to modern medical communication agenda. The investigation is based on linguistic analysis through semantic framing of “breaking bad news” situation and is specified by onomasiological and semasiological interpretations. The conventional cognitive perception of “breaking bad news” situation is realized as one predetermined by invoked framing. The diversification of 'SPIKES' protocol with optional implementation of a cultural component is regarded as an effective educational medium in cross-cultural medical settings. In the paper the latter is employed as a valuable tool for modification of the way the participants view the situation. The modified protocol implicates the properties to influence the prospective treatment pattern. The interdisciplinary nature of the study outlines the valuable grounding for the shift from the mutually expressed negative attitudes to situational consistency via evoked experience of the medical professionals.
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Kamińska, Katarzyna, Kamil Bielak, and Marzena Świstak. "Deontology of the communication process the oncologist and the patient." Journal of Life and Medical Sciences 2(36)/2023 (October 23, 2023): 3–11. https://doi.org/10.5281/zenodo.10035091.
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The research objective the authors have set themselves is to discuss ethical aspects relating to the oncologist-patient relationship in the context of cancer treatment. The authors consider the problem of ethical aspects such as the autonomy of the patient, i.e. his/her right to self-determination and to decide on his/her treatment, and trust, which is the foundation of the doctor-patient relationship. Issues relating to the doctor's independence and his or her loyalty to the patient are also referred to. The authors helpfully refer to principles derived from the SPIKES protocol to help overcome basic communication difficulties. Indeed, communicating unhelpful information should be a basic skill of the oncology physician and should be based on deontological principles, moral values, and a proper communication process, all of which are indispensable in the context of effective cancer treatment, while, of course, complying with current legislation. As a result of the research, it was noted that the area of cancer treatment is a particularly difficult area of interface between current legislation, deontological norms and the treatment process. It is therefore crucial to find a so-called 'third way' that, while respecting the applicable law, will allow the patient to feel treated with dignity, with the highest possible ethical standards. This article is a starting point for further research work around aspects of patient rights, particularly in the context of the right to information, in the context of a specific category of people undergoing cancer treatment. This issue is extremely complex, multifaceted, interdisciplinary and, due to its topicality, deserves an in-depth study. In conducting the research, a method of analysis was used which included current studies, reports relating to the issue of communication between the oncologist and the patient. In addition, a formal and dogmatic method was used to identify legal issues.
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Varsha, R., P. S. Manoharan, Vigneshvar Chandrasekaran, and K. Savitha. "A Journey toward Immediate Denture: Overcoming Bitter Reality with Psychotherapy." Case Reports in Dentistry 2022 (July 26, 2022): 1–4. http://dx.doi.org/10.1155/2022/3080039.
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The loss of teeth affects the aesthetics, function (mastication and speech), confidence, mental state, and the overall quality of life of an individual. Aggressive periodontitis is a destructive condition leading to loss of teeth at early stages of the disease. Individuals facing this inevitable condition of losing the teeth and replacement at a younger age experience formidable psychological distress. The prosthodontic procedure when supported with psychotherapeutic interventions can support the patient in accepting the prognosis and treatment. We report the scenario where psychological intervention was provided in a systematic manner adopting the SPIKES protocol for a 42-year-old man presenting with aggressive periodontitis.
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Prozorovskyi, D. V., K. K. Romanenko, M. Yu Karpinsky, and O. V. Yaresko. "Biomechanical rationale for choosing a means of fixation of bone fragments during proximal osteotomy of the first metatarsal bone." Paediatric Surgery. Ukraine, no. 4(77) (December 27, 2022): 68–74. http://dx.doi.org/10.15574/ps.2022.77.68.
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One of the most common pathologies that occurs in static deformities of the anterior joint of the foot in the foot is valgus deformity of the first toe. Distal or diaphyseal osteotomies are used for mild degrees, and proximal osteotomies for severe ones. Spikes, screws or plates with angular stability are most often used to fix bone fragments. Purpose - with the help of biomechanical studies, to study the stress-deformed state of the foot model with different options for osteosynthesis of the first metatarsal bone after the proximal osteotomy. Materials and methods. Mathematical modeling of osteosynthesis of the first metatarsal bone during correction of valgus deformity of the first toe using proximal osteotomy was carried out. Three variants of osteosynthesis were modeled: Kirschner pins, screws, and a bone plate. Results. During osteosynthesis with spikes, maximum stresses of 2.1 MPa occur in distal fragment. In the proximal fragment, the stresses are twice as low - 1.2 MPa. The tension in the resection zone is 0.1 MPa. During osteosynthesis with screws, the stresses in the proximal and distal fragments of the bone are almost the same, and are 0.9 MPa and 0.8 MPa, respectively. The tension in the osteotomy zone is 0.1 MPa. Osteosynthesis with a bone plate provides a low level of stresses in the osteotomy zone - 0.1 MPa, as well as an even distribution of stresses between the proximal and distal fragments of the metatarsal bone - 0.8 MPa and 0.7 MPa, respectively. During osteosynthesis with spikes and screws, the relative deformation of the bone regenerate does not exceed 0.13%. During osteosynthesis with a bone plate, this figure reaches 0.5%. Conclusions. For osteosynthesis of bone fragments during proximal osteotomy of the first metatarsal bone in order to eliminate valgus deformity of the first toe, spikes, screws and a bone plate can be used. All investigated types of osteosynthesis provide a low level of stress in the osteotomy zone of the first metatarsal bone, but, according to the criterion of stress values in the proximal and distal fragments of the bone, osteosynthesis with spikes showed the worst result, and osteosynthesis with a bone plate showed the best. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.
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Peckler, Brad, Inchoel Park, Amit Gupta, Kaivon Mandani, and Laura Haubner. "Breaking bad news education for emergency medicine residents: A novel training module using simulation with the SPIKES protocol." Journal of Emergencies, Trauma, and Shock 3, no. 4 (2010): 385. http://dx.doi.org/10.4103/0974-2700.70760.
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