PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Paradigm shift”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 235 records · Page 13Linked to original sources
PubMed2005

Pathophysiology, pleiotrophy and paradigm shifts: genetic lessons from Parkinson's disease.

PD (Parkinson's disease) is an aetiologically heterogeneous disorder characterized by a clinical phenotype consisting of resting tremor, rigidity and bradykinesia. Motor symptoms are associated with a progressive loss of dopaminergic neurons, with Lewy body inclusions within surviving neurons. Although heritability studies have shown evidence of familial aggregation, twin studies have provided limited support for a genetic aetiology. Nevertheless, classical linkage methods have nominated 11 regions of the genome and pathogenic mutations have been identified in several genes, including alpha-synuclein, parkin, ubiquitin C-terminal hydrolase L1, oncogene DJ-1, PTEN-induced protein kinase 1 and microtubule-associated protein tau. Most recently, heterozygous mutations in LRRK2 (leucine-rich repeat kinase 2) were found to cause late-onset, autosomal-dominant PD. Despite their consistent clinical phenotype, family members with LRRK2 mutations can have variable alpha-synuclein and tau pathologies. Lrrk2 is a member of the Roc (Ras of complex proteins) family, with Ras GTPase and MAPKKK (mitogen-activated protein kinase kinase kinase) catalytic domains. Thus its discovery highlights vesicle dynamics and secondary-messenger signalling in disease pathophysiology. To diagnose a disease accurately and effectively treat it, requires an understanding of its molecular pathogenesis. Herein, we provide an overview of the genetics of PD, how these discoveries are revolutionizing long-held beliefs and more importantly how this knowledge may be translated into patient therapy.

Humans↗
PubMed2003

Caesarean for breech: a paradigm shift?

The year 2001 became 'the year of Caesarean for the breech' after the results of the Term Breech Trial were published in October 2000. The purpose of the current paper is a retrospective observational study identifying the increase in Caesarean section rates that occurred in Fairfield Hospital after the Term Breech Trial. Fairfield Hospital is a level 2 hospital in the south-western Sydney health area with 1800 deliveries per year.

Breech Presentation↗
PubMed2003

Post-psychiatry: paradigm shift or wishful thinking? A speculative review of future possibles for psychiatry.

Psychiatric-mental health nurses have yet to arrive at a consensus definition and agreed operational summary of their roles and responsibilities. Although the craft seems often disunited and uneasy in its traditional alliances with general nursing and psychiatry, it remains subordinate to both. This paper identifies some actual or possible developments in social values, science and technology, workplace economics and management that could impact upon the nature and practice of psychiatry, and thereby influence the possible future scope and practice of psychiatric-mental health nursing.

Humans↗
PubMed2000

Permanent and stable housing for individuals living with a mental illness in the community: a paradigm shift in attitude for mental health nurses.

The provision of appropriate housing for individuals with a mental illness has been recognized by a number of researchers as a means to enhance effectiveness of treatment and rehabilitation services, to maintain treatment gains, and to decrease community opposition to deinstitutionalization. Whether community-based services, which are now meant to be the focus of treatment, are successful or not is crucially related to the nature and availability of accommodation. This paper argues a case for change in the current philosophical basis of, and services provided by, mental health professionals and agencies that are charged with the responsibility of meeting the housing needs of consumers of mental health services. This change, it is contended, needs to be to an approach that is more flexible, more supportive of the consumer, and in which the consumers are empowered to make decisions and choices about their housing needs.

Attitude of Health Personnel↗
PubMed2003

The Tidal Model: psychiatric colonization, recovery and the paradigm shift in mental health care.

Psychiatric research and practice involves the colonization of the personal experience of problems of human living. From a Western perspective, this process shares many similarities with the subjugation of women, people of colour and people embracing non-Christian faiths and cultures. The Tidal Model is a mental health recovery and reclamation model, developed to provide the framework for discrete alternatives to the colonizing approach of mainstream psychiatric practice. The Model asserts the intrinsic value of personal experience and the centrality of narrative in the development of contextually bound, personally appropriate, mental health care. This paper summarizes the features of the Model, which attempt to address the foci of the more significant critiques of psychiatric practice (and psychiatric nursing), against a background sketch of psychiatric colonization.

Humans↗
PubMed1999

Health reform for children in Japan's aging society: a paradigm shift for pediatricians.

Japan confronts a dilemma in reshaping its health care for children: the low birth rate is reducing the proportion of children in the overall population, while the health issues for children are becoming increasingly complex and connected to social behavior. The present paper reviews Japan's changing demographics and the declining proportion of children in the population structure. This change has important implications for how the government sets priorities in the health sector. Next, the paper considers how 'problems' are defined for health policy in society and how the agenda for health reform is determined. Attention is directed to the political dimensions of these two processes of problem definition and agenda setting. Two examples of health reform for children, in other countries, are discussed to show how these two processes have worked in practice. In the next section, the paper explores new health issues for children in Japan and the challenges to Japanese pediatricians in shaping the agenda for health reform.

Adolescent↗
PubMed2002

Paradigm shift in surgical approaches to thymectomy.

BACKGROUND: Thymectomy is an established therapy in the management of myasthenia gravis (MG) used in conjunction with medical treatment. The optimal surgical approach to thymectomy, however, has remained controversial. METHOD: The present review discusses the author's experiences of and the literature regarding the management of MG using the video-assisted thoracic surgery (VATS) approach. RESULTS: This approach was shown to be technically safe in experienced hands and associated with less postoperative pain, better preservation of lung function in the early postoperative period and better cosmetic results than alternative techniques. The intermediate term results of VATS are comparable to those of more radical approaches. It is hoped that this patient-friendly approach will lead to greater support by patients and their neurologists, for earlier surgery. CONCLUSION: VATS is an attractive, alternative approach to thymectomy.

Adolescent↗
PubMed2002

Paradigm shift from classic anatomic theories to contemporary cell biological views of CAKUT.

Ectopic budding of the ureter from the Wolffian duct is the first ontogenic misstep that leads to many-if not all-congenital anomalies of the kidney and urinary tract (CAKUT). The ectopia results in hypoplastic kidney, ectopia of ureterovesical orifice, urinary outflow obstruction and/or reflux. Studies in several mutant mouse models have verified that ectopic ureteric budding indeed precedes formation of CAKUT. Often, the genes involved in navigating ureteric budding to the correct site also regulate later ontogenic events of the kidney and urinary tract. The wide spectrum of CAKUT, for example, multicystic dysplastic kidney, megaureter and atretic ureter, portray the additional important functions of these same genes that are activated at multiple sites and stages during the normal morphogenesis of the kidney and urinary tract

Animals↗
PubMed1998

What is happening in the real world in lipid therapy and is it appropriate? The need for a paradigm shift.

Cardiovascular disease is now the leading cause of death and disability in our society. Current strategies in the United States have been very effective in treating the symptomatic manifestations of severe obstructions but have done little to alter the long-term outcome of cardiovascular disease. Although lipid-lowering therapies have proven beneficial in secondary prevention for patients with cardiovascular disease, they are not as widely employed in contemporary practice as they should be. Better implementation of lipid-lowering therapies, including such major issues as clear treatment guidelines, physician and patient compliance, and delivery of healthcare and quality of care, must be addressed to shift thinking about the treatment of cardiovascular disease as we advance into the next century.

Journal Article↗
PubMed1998

Early referral to the nephrologist and timely initiation of renal replacement therapy: a paradigm shift in the management of patients with chronic renal failure.

The high mortality rate among dialysis patients has spawned investigation into potentially correctable factors that are associated with an increased risk of death. Several studies have demonstrated a strong association between an increased risk of death in dialysis patients and suboptimal delivered dose of dialysis, malnutrition, and non-renal comorbidity. In addition, the use of unsubstituted cellulose dialyzers and reprocessed dialyzers also has been associated with an increased risk of death. Increased attention to these factors has resulted in a significant improvement in patient survival. Nonetheless, the mortality of dialysis patients remains unacceptably high and indicates that other factors may be operative. One of the factors that has thus far received scant attention, but could significantly affect morbidity and mortality in dialysis patients, is the timing and quality of care before initiation of dialysis. Optimal pre-end-stage renal disease care involves early interventions aimed at delaying progression of chronic renal failure, judicious management of uremic complications, timely placement of vascular access, timely initiation of renal replacement therapy, and implementation of educational programs targeted at maximum rehabilitation. Given the fact that early referral to the nephrologist is likely to result in optimal pre-dialysis care, the 1993 National Institutes of Health Consensus Statement on Morbidity and Mortality of Dialysis recommended that referral of a patient to a renal team should occur at a serum creatinine of 1.5 mg/dL in women and 2.0 mg/dL in men. Several investigators also have argued that patients with chronic renal failure who begin dialysis at a relatively "high level of residual renal function" (early start) may have lower morbidity and mortality compared with patients who begin dialysis at a more traditional "low level of renal function" (late start). This hypothesis is based on evidence that declining renal function is associated with malnutrition and that malnutrition at the start of dialysis is associated with poor clinical outcomes. Furthermore, patients are started on dialysis at an endogenous solute clearance that is lower than that accepted as optimum for patients on dialysis. Finally, limited clinical studies have demonstrated the benefit of early initiation of dialysis. Consequently, the Peritoneal Dialysis Adequacy Work Group of the National Kidney Foundation-Dialysis Outcomes Quality Initiative recommends that dialysis be initiated when the weekly renal Kt/Vurea decreases to below 2.0 unless all three of the following criteria are fulfilled: (1) stable or increased edema-free body weight, (2) normalized protein equivalent of total nitrogen appearance greater than 0.8, and (3) absence of clinical symptoms and signs attributable to uremia.

Humans↗
PubMed2006

Randomized EVAR trials and advent of level i evidence: a paradigm shift in management of large abdominal aortic aneurysms?

The recent endovascular aneurysm repair (EVAR) 1 and 2 and Dutch Randomized Endovascular Aneurysm Management (DREAM) trials addressed management of abdominal aortic aneurysms (AAAs) larger than 5.5 cm in diameter. The DREAM and EVAR 1 trials randomized patients appropriate for open repair between endovascular repair (EVAR) and open repair (OR), and the EVAR 2 trial randomized patients unfit for OR between EVAR and conservative nonoperative management (No Rx). The EVAR 1 trial showed a 3% lower initial mortality for EVAR, with a persistent reduction in aneurysm-related death at 4 years. Improvement in overall late survival was not demonstrated. Similarly, the DREAM trial observed an initial mortality advantage for EVAR, but overall 1-year survival was equivalent in both groups. Both trials found significantly higher complication and intervention rates and higher hospital costs with EVAR, and by 1 year a quality of life (QOL) benefit was not evident. The EVAR 2 trial did not demonstrate a survival advantage of EVAR with respect to nonoperative management, while noting that EVAR was associated with greater likelihood of treatment complications, subsequent interventions, and threefold higher costs. Both EVAR trials were limited by long delays between randomization and treatment. Moreover, 27% of patients in EVAR 2 crossed over from nonoperative to endovascular repair, and these patients had a lower procedure mortality from EVAR than those originally assigned to it (2% v 9%). These 47 cases, and the exclusion of 14 patients dying while waiting for EVAR, appears to confer a survival advantage to those receiving EVAR over those receiving no treatment in a post-hoc analysis, but per-protocol analysis of the EVAR 2 trial data performed by the EVAR investigators did not show a significant difference in either all-cause or aneurysm-related mortality. Thus, outcomes of the EVAR 2 trial have not settled the choice between EVAR and no treatment in this scenario to everyone's satisfaction. In patients with large AAAs who are fit for OR, EVAR offers an initial mortality advantage over OR, with a persistent reduction in AAA-related death at 4 years. However, EVAR offers no overall survival benefit, is more costly, and requires more interventions and indefinite surveillance with only a brief QOL benefit. It may or may not offer a mortality benefit over nonoperative management in patients with large AAAs who are unfit for open repair, but the statistical significance of this comparison is inconclusive.

Angioplasty↗
PubMed2000

Small-diameter portacaval H-graft shunt: a paradigm shift back to surgical shunting in the management of variceal bleeding in patients with preserved liver function.

Small-diameter portacaval H-graft (SDPHG) shunts are partial portosystemic shunts that control variceal bleeding while preserving nutrient blood flow to the liver, minimizing postoperative encephalopathy and liver failure. Since July 1, 1997, we placed SDPHG shunts in 18 patients (age, 52.1 +/- 2.6 years; range, 35 to 72 years) with cirrhosis (Child's class A, B, and C in 6, 10, and 2 patients, respectively) and refractory variceal bleeding who were not candidates for transplantation. Ten procedures (55.6%) were urgent or emergent. SDPHG shunts effectively reduced the portacaval pressure gradient (18 +/- 3 v 5 +/- 2 mm Hg; P <.05). Surgical times (210 +/- 11 minutes), estimated blood losses (358.3 +/- 107.8 mL), transfusion requirements (0 transfusions in 10 patients; 55.6%; mean, 0.9 +/- 0.3 units), and postoperative hospitalization (7.7 +/- 1.0 days) were excellent. Surgical mortality (30 days) was 0%. During 14. 0 +/- 1.9 months (range, 1.1 to 29.1 months) of follow-up, 4 patients (22.2%) died, including both patients with Child's class C cirrhosis. The cumulative 1-year survival rate was 82.1% (Child's class A, B, and C, 83.3%, 90%, and 0%, respectively). Long-term survivors had significantly lower preoperative Child-Pugh scores compared with nonsurvivors (7.8 +/- 0.3 v 9.5 +/- 1.0; P <.05). Postoperative encephalopathy developed in 3 survivors (20%). Fifteen patients (83.3%) have not experienced rebleeding; shunt failure led to rebleeding in only 1 patient (5.6%). SDPHG shunt placement can be performed with low morbidity and surgical mortality. Nontransplantation candidates with Child's class A and B cirrhosis have excellent long-term survival with this safe, effective, and definitive treatment for refractory variceal bleeding.

Adult↗