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PubMed2004

Patient control and end-of-life care part II: the advanced practice nurse perspective.

PURPOSE/OBJECTIVES: To explore the nature of what people with advanced cancer want regarding personal control and comfort at the end of life. RESEARCH APPROACH: Descriptive, naturalistic, using Denzins model of interpretive interactionism. SETTING: A variety of urban and rural communities throughout the state of Texas. PARTICIPANTS: 7 people with advanced cancer diagnoses. METHODOLOGIC APPROACH: Participants were recruited via oncology advanced practice nurses who also participated in the study. Interviews were recorded on audiotape and analyzed via Denzins interpretive process of data analysis. MAIN RESEARCH VARIABLES: Patient control. FINDINGS: Thematic analysis revealed six themes: protection of dignity, control of pain and other symptoms associated with disease, management of treatment, management of how remaining time is spent, management of impact on family, and control over the dying process. CONCLUSIONS: Participants expressed a wide variety of preferences for personal control and comfort. Their desires reflected personal values and beliefs about how they spend their time and how they want control over their care. INTERPRETATION: Nurses must be sensitive to the variety of preferences their patients with advanced cancer may have for engagement in decisions regarding treatment, care management, and activities of daily life.

Adult↗

PubMed2003

H as a measure of complexity of social information processing.

Many studies have used H (a measure of unpredictability derived from information theory) to quantify the complexity of descriptions of persons across multiple roles. Interpreting these studies is problematic, though, because H confounds unpredictability across roles (which is typically the construct of interest) and unpredictability within roles (which is simply a function of the proportion of traits endorsed). The need to control for unpredictability within roles was highlighted by 3 demonstration studies in which controlling for unpredictability within roles eliminated relations between well-being and H. I also show how, controlling for unpredictability due to the number of traits endorsed and number of roles described, H provides a unique measure of role dependence and independence. However, H does not measure the type of role overlaps that would predict "spillover effects" between roles; therefore, I recommend an alternative index of role similarity for future research on spillover effects.

Adult↗

PubMed2005

[Utilization of task projects in a public sector health organization in Argentina: paradoxes, dilemmas, and opportunities].

The purpose of this article is to present the experience with application of a management tool in a health organization from the public sector in Argentina and to reflect on the interactions between its components, potentialities, and difficulties and the complications involved in reporting, analyzing, and interpreting it. The study followed a descriptive design, analyzing records, files, and institutional documents, consulting key informants, and conducting a literature review. The introduction of personnel planning was analyzed from the perspective of workers' development and performance improvement in organizations. The main finding was that task projects helped orient individual effort towards meeting institutional objectives and provided elements for organizational design. The projects were characterized by different degrees of adherence and compliance, besides generating conflicts, distrust, and resistance. Finally, in public sector health organizations it is possible to achieve results-based management and a balance between trust and oversight. The scope reflects the tensions from external pressures, internal power struggles, non-compliance with supervision and monitoring, rigidity of centralized norms, and the tendency to turn management tools into mere elements for routine control.

Argentina↗

PubMed2004

Phenotype characterisation using integrated gene transcript, protein and metabolite profiling.

Multifactorial diseases present a significant challenge for functional genomics. Owing to their multiple compartmental effects and complex biomolecular activities, such diseases cannot be adequately characterised by changes in single components, nor can pathophysiological changes be understood by observing gene transcripts alone. Instead, a pattern of subtle changes is observed in multifactorial diseases across multiple tissues and organs with complex associations between corresponding gene, protein and metabolite levels. This article presents methods for exploratory and integrative analysis of pathophysiological changes at the biomolecular level. In particular, novel approaches are introduced for the following challenges: (i) data processing and analysis methods for proteomic and metabolomic data obtained by electrospray ionisation (ESI) liquid chromatography-tandem mass spectrometry (LC/MS); (ii) association analysis of integrated gene, protein and metabolite patterns that are most descriptive of pathophysiological changes; and (iii) interpretation of results obtained from association analyses in the context of known biological processes. These novel approaches are illustrated with the apolipoprotein E3-Leiden transgenic mouse model, a commonly used model of atherosclerosis. We seek to gain insight into the early responses of disease onset and progression by determining and identifying--well in advance of pathogenic manifestations of disease--the sets of gene transcripts, proteins and metabolites, along with their putative relationships in the transgenic model and associated wild-type cohort. Our results corroborate previous findings and extend predictions for three processes in atherosclerosis: aberrant lipid metabolism, inflammation, and tissue development and maintenance.

Algorithms↗

PubMed2006

Association of stellate mammographic pattern with survival in small invasive breast tumors.

OBJECTIVE: We tested whether the stellate mammographic pattern of presentation of small breast tumors is a better indicator of survival than other patterns. MATERIALS AND METHODS: Patients with primary invasive breast cancer diagnosed in 1993-1997 were grouped according to the size of the lesion: 0.1-0.9 cm and 1.0-1.4 cm. Each tumor was placed in one of five mammographic prognostic categories: stellate without calcifications; circular without calcifications; and calcifications with or without tumor mass in a casting, crushed-stone, or other (powdery, punctuate, or round) pattern. To assess reproducibility, a second radiologist gave an independent interpretation in the first 109 cases. Descriptive data were stratified by tumor size, and tests of association were done with an extension of Fisher's exact test. Odds ratios and confidence intervals were computed. Weighted log-rank test and Kaplan-Meier survival curves were used to compare breast cancer survival in the stellate group compared with the other groups. RESULTS: Two hundred one consecutive patients with a median follow-up period of 7.4 years were identified. There were nine breast cancer deaths. The stellate morphologic pattern was most common (91 [45.3%] of 201 cases), yet there was only one breast cancer death in this group (survival rate, 98.9%; 95% confidence interval [CI], 96.7-100%). In the group of stellate lesions smaller than 1.0 cm, 67.6% (25/37) of the tumors were well-differentiated without lymph node metastasis (30 [96.8%] of 31 cases), and there were no deaths. In the group of stellate lesions measuring 1.0-1.4 cm, 66.7% (36/54) of the tumors were well-differentiated with a 19.6% risk of lymph node metastasis, one death, and a survival rate of 98.1% (52/53; 95% CI, 94.4-100%). Circular tumors accounted for 29.9% (60/201) of tumors and 55.6% (5/9) of breast cancer deaths. Casting and crushed-stone microcalcifications were associated with 33.3% (3/9) of disease-specific deaths. A weighted kappa value of 0.89 (CI, 0.83-0.94) indicated very high agreement of pattern assignment. CONCLUSION: Stellate tumors had a significantly better survival prognosis than tumors with other patterns even though there were no differences in treatment. By recognizing these small malignant lesions, trained radiologists may be able to identify tumors that pose negligible risk of breast cancer death.

Aged↗

PubMed2000

Effects of prandial glycemic changes on objective fetal heart rate parameters.

BACKGROUND: There is confusion in the literature about the potential effect of maternal glucose levels on the fetal heart rate (FHR) cardiotocographic interpretation. METHODS STUDY DESIGN: prospective clinical descriptive study. SUBJECTS: 21 pregnant women with diabetes mellitus, 23 women with gestational diabetes and 18 healthy non-diabetic pregnant volunteers (control group). TREATMENT: maternal capillary glucose measurement and objective FHR analysis (Oxford System 8002) pre- and 1 h post-meal. STATISTICAL ANALYSIS: descriptive statistics. Student t-tests and Pearson correlation studies. RESULTS: Maternal capillary glucose levels ranged between 2.7-10.5 mmol/l pre-meal and 4.2 14.8 mmol/l post-meal. The differences between objective FHR parameters pre- and postmeal were not significant in any of the groups of women studied. No correlation was found between prandial glycemic and FHR changes. Women with optimal and suboptimal glycemic control exhibited similar objective FHR parameters pre- and post-meal. Women with gestational diabetes showed similar prandial cardiotocographic changes irrespective of whether they were on insulin therapy or on hypoglycemic diet only. CONCLUSIONS: Objective FHR parameters are unaffected by prandial glycemic changes over a wide range of maternal glucose levels. Timing the non-stress test in relation to the meals seems irrelevant in clinical practice.

Adult↗

PubMed2001

Three-dimensional Hess screen test with binocular dual search coils in a three-field magnetic system.

PURPOSE: To establish an objective Hess screen test that allows a simultaneous and binocular analysis of all three axes of eye rotation. METHODS: In orthotropic and strabismic human subjects, both eyes were recorded with dual scleral search coils in a three-field magnetic system. Before mounting the search coil annuli on the eyes, the voltage offsets of each channel and the relative magnitudes of the three magnetic fields were determined. For calibration, subjects were only required to fix monocularly on a single reference target. During fixation of targets on the Hess screen by the uncovered eye, the three-dimensional eye position of both the occluded and the viewing eye was simultaneously measured. RESULTS: For clinical interpretation, an easy to understand graphical description of the three-dimensional Hess screen test was developed. Positions of orthotropic and strabismic eyes tended to follow Listing's law, which in both eyes allowed the determination of the primary position, that is, the position of gaze from which pure horizontal and pure vertical movements do not lead to an ocular rotation about the line-of-sight. To a first approximation, the location of primary position is a result of the summation of the individual rotation axes of the six extraocular muscles and thus can be used to infer which muscle is paretic. CONCLUSIONS: The three-dimensional Hess screen test with binocular dual search coils in a three-field magnetic system is an objective method to assess the ocular alignment in three dimensions with high precision. From these recordings, the clinician can relate deviations of primary position to specific eye muscle palsies.

Algorithms↗

PubMedDate not supplied

Item response theory in affective instrument development: an illustration.

The benefits of item response theory (IRT) analysis in obtaining empirical support for construct validity make it an essential step in the instrument development process. IRT analysis can result in finer construct interpretations that lead to more thorough descriptions of low- and high-scoring respondents. A critical function of IRT is its ability to determine the adequacy with which the attitude continuum underlying each dimension is assessed by the respective items in an instrument. Many nurse researchers, however, are not reaping the benefits of IRT in the development of affective instruments. The purpose of this article is to familiarize nurse researchers with this valuable approach through a description of the Facets computer program. Facets uses a one parameter (i.e., item difficulty) Rasch measurement model. Data from a survey of 525 new mothers that assessed the psychometric properties of the Postpartum Depression Screening Scale are used to illustrate the Facets program. It is hoped that IRT will gain increased prominence in affective instrument development as more nurse researchers become aware of computer programs such as Facets to assist in analysis.

Affect↗

PubMedDate not supplied

Diagnostic investigations. Part 1. Lumbar puncture.

This article, the first in a three-part series on clinical investigations, discusses the technique and uses of lumbar puncture. This diagnostic procedure involves making a puncture into the subarachnoid space of the spinal cord, to remove an excess of fluid; to obtain fluid for examination and analysis, or to inject medication. The article includes an explanation of the relevant anatomy and the composition and role of cerebrospinal fluid, a detailed description of the procedure and the interpretation of results.

Anatomy↗

PubMed2004

[Axial length and branch retinal vein occlusion].

PURPOSE: To determine whether there is a connection between the axial length and the occurrence of the branch retinal vein occlusion (BRVO). METHOD: 18 patients that had been diagnosed with BRVO have been selected retrospectively. The diagnosis has been made according to the clinical criteria (fundus aspect). A control group of 18 patients has ben constituted. The patients in the control group matched the age distribution and the prevalence of high arterial blood pressure and diabetes mellitus of the patients in the BRVO group. The measurements of the axial lengths have been performed by the same examiner, for the affected and fellow eye, in the BRVO group and for the right eye, in the control group. The data were interpreted by the help of the descriptive statistics. The Student t test has been used and was considered significant, if the p value was < 0.05. RESULTS: The mean axial length of the eyes with BRVO was 22.42 mm (range, 21.5 mm-24.1 mm) and of the fellow eyes, 22.44 mm (range, 21.3 mm-24.2 mm). The difference is not statistically significant: p = 0.776. The mean axial length of the eyes in the control group was 23.42 mm (range, 21.5 mm-24.4 mm), the difference being statistically significant when compared with the BRVO eyes: p = 0.00064. DISCUSSIONS: The possible connections between a shorter axial length and the incidence of BRVO are analyzed, taking into account the known factors that are involved in the pathogenesis of this disease. CONCLUSION: The shorter axial length is a risk factor for BRVO.

Aged↗

PubMed1989

[Differential diagnosis of corneal dystrophies of the Groenouw I, Reis-Bückler and Thiel-Behnke type].

In the literature there are different definitions of Reis-Bücklers' corneal dystrophy. The corneal disease corresponding to the original description of Reis and Bücklers is interpreted by some authors as an atypical form of granular corneal dystrophy. On the other hand, the honeycomb-shaped corneal dystrophy of Thiel and Behnke is erroneously considered to be Reis-Bücklers' dystrophy. To establish the criteria to make a proper differential diagnosis, we studied the clinical, genetic, histological and electron-microscopical features of the three types of corneal dystrophy in 177 subjects with granular corneal dystrophy, 25 subjects with Reis-Bücklers' dystrophy, and 19 subjects with Thiel-Behnke's dystrophy. Granular corneal dystrophy shows typical corneal opacity patterns, and in our series these were divided into two family-specific variants. Histologically, there are amorphous granules under the epithelium (and possibly throughout the stroma) that consist of electron-dense rod-shaped bodies. The clinical symptoms in Reis-Bücklers' dystrophy (ocular pain in early childhood) differ from those in granular dystrophy. In addition, the corneal opacity pattern (maplike appearance) and the sheetlike arrangement of the deposits in a histological section are different, but the two types of dystrophy are similar with regard to histochemistry and electron microscopy. Thiel-Behnke's corneal dystrophy resembles Reis-Bücklers' dystrophy clinically, but differs from it in its honeycomb-shaped opacity pattern, the fibrous tissue in histology, and the curly dense filaments found in electron microscopy. Correct classification of the three corneal dystrophies is essential for precise diagnosis and may eliminate the present misunderstandings.

Cornea↗

PubMed1994

From circadians of the fifties to chronomes in vitro as in vivo.

In a recent review of cellular mechanisms of entrainment, an ocular circadian rhythm of Bulla was reported (1). The isolated retina of this marine mollusk is described to contain a circadian oscillator. A glance at the spontaneous impulse frequency from eyes recorded in darkness at 15 degrees C suggests lower-frequency modulations of the about 24-h rhythm and prompts the quantitative assessment of the broader time structure, the chronome, in this extensively used model of a budding neurochronophysiology. The cultured retina of mollusks is interpreted by the original authors as descriptive of similar cellular mechanisms that may underlie mammalian as well as molluscan physiology. We report here the rhythmometric analysis of the original data by Block et al. (2), taken from Figure 2 of the article by Colwell et al. (1), resolved by computer just as the microscope resolves cellular structure. The results are further compared with those obtained on data kindly provided by Stephan Michel on another retina of Bulla. The findings of multiple chronome components (beyond the circadian system) are placed into the broader context of cell biophysics and its implications for biomedicine within the scope of an international chronome endeavor.

Action Potentials↗

PubMed1979

A rapid ocular smear technique for optometrists: a preliminary report.

The preliminary report discusses a clinical procedure in acquiring conjunctival smears, fixing the acquired sample and interpreting the results. Included is a description of the white blood cells frequently found in ocular smears and the clinical significance of each.

Bacterial Infections↗

PubMedDate not supplied

[The understanding of psychopathology and the role of phenomenology. Contribution to a controversy].

The sense of psychopathology is interpreted as the development of a descriptive language, that allowed the approach to the psychiatric disease in the context of natural sciences. The phenomenology was introduced as a methodological tool for the improvement of this language. Since then this topic has been present in the foundations problems of psychiatry. In this paper the discussion is set towards the influence of phenomenology in psychopathology, as a controversy between two opposite points of view. The authors establish their own arguments about the limits of psychopathological knowledge and psychiatric experience.

Humans↗

PubMed1998

[Dermoscopy: magnified imaging of pigmented cutaneous tumors].

The early clinical identification of malignant melanoma is important. Pigmented neoplasms are sometimes difficult to diagnose by visual inspection alone. Dermoscopy increases the reliability of the clinical assessment. Dermoscopic criteria of malignancy are well defined on a descriptive ground. They allow an optimal interpretation of the clinical aspect without, however, reaching the sensitivity and specificity of the microscopic examination.

Diagnosis, Differential↗

PubMedDate not supplied

Statistical concepts and methods for the reader of clinical studies in emergency medicine.

An understanding of statistical concepts and methods is essential for the clinician who wishes to interpret the results of clinical studies. In this article the concepts of descriptive statistics, classical hypothesis testing, P values, a priori information, and Type I and Type II errors are discussed with examples to illustrate their application to the interpretation of clinical trials. In addition, descriptions of Student's t test, the chi-squared test, Fisher's exact test, the rank sum test, and sequential methods are given.

Bias↗

PubMed2005

Separation-individuation revisited: on the interplay of parent-adolescent relations, identity and emotional adjustment in adolescence.

The objective of this study was to test our alternative interpretation of the separation-individuation hypothesis. This interpretation states that separation from the parents is not a precondition for individuation, but rather separation and individuation are two parallel processes of development during adolescence. We investigated our interpretation in two ways. Firstly, we looked at descriptive age differences in parental support and development of relational and societal identity. Secondly, we investigated the variation with age of the associations between parental support and emotional adjustment, and identity and emotional adjustment. Data of a representative Dutch sample of 2814 adolescents, aged 12-24 were used. In both cases, the findings supported our interpretation of the separation-individuation hypothesis and similar results were found in the descriptive analyses and the structural equation models. Parental support decreased with age, and so too did its association with emotional adjustment. In other words, as adolescents become older, they experience less parental support, while its importance for their emotional adjustment also declines. The opposite pattern was observed with respect to identity development: as adolescents become older, their relational and societal identity commitments develop, and the degree to which these commitments are developed also becomes more important for their emotional adjustment.

Adaptation, Psychological↗

PubMed1993

[Problems in Papanicolaou classification].

There are several reasons why Papanicolaou classification should not be used for the interpretation of cytologic findings. First, many different classification criteria are sometimes used for a single pathologic condition. Second, inflammatory change or hormonal evaluation are not included in the system. Third, the classification is not compatible for the evaluation of endometrial lesions or chorionic diseases. Fourth, mismanagement of the patient is sometimes encountered when this classification is only used. Instead of Papanicolaou classification, descriptive diagnosis should be used for cytologic interpretation.

Aged↗