SEARCH · PubMed Health
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.
A course on interpersonal skills (IPS) has been introduced as part of the clerkship in internal medicine. The course is given in small groups (8-10 students) with two tutors attached to each group. The use of trigger films in the IPS course has been described previously (Alroy & Ber, 1982). An evaluation of the short-term (2-month) effects of the method is now reported.
Explore the source record for details and available documents.
OBJECTIVE: To assess experts' opinions about the future of, and potential to improve individual and public health through "tobacco harm reduction" (THR), the use of novel nicotine containing products purporting to reduce the health risks from cigarette smoking. DESIGN: Semi-structured telephone interviews on nine topic areas, with qualitative content analysis of coded transcripts. PARTICIPANTS: 29 professionals with expertise related to tobacco and interest in THR, including prominent tobacco control advocates (7), pharmaceutical (3) and tobacco industry scientists/officials (5), non-industry scientists (12), and Congressional staff (2). RESULTS: Respondents agreed that harm reduction is at minimum theoretically plausible, that characteristics of "good" and "bad" THR products can be identified, that government regulation is essential but not likely in the foreseeable future, and that additional scientific data are very much needed. However, there was no consensus on specifics, such as preferred regulatory strategies or examples of ideal THR products. Disagreement was seen not only across but also within respondent categories. Mistrust of key stakeholders-for example, tobacco control advocates distrust of tobacco industry scientists and vice versa-was pervasive, and cited frequently as a barrier to regulation and collaboration. CONCLUSIONS: Continued dialogue and debate are essential as we enter a new and uncertain era of products purporting to reduce tobacco produced harm. Experts have concluded that effective government regulation is crucial to minimising the risks associated with THR and maximising potential benefits.
Explore the source record for details and available documents.
OBJECTIVE: The topic "A Day in the Life of a Psychiatry Resident" is an opportunity to explore residents' experiences to inform the delivery of education. METHODS: An open-ended, qualitative approach was used in a pilot project to explore contemporary residents' experiences with education, similar to a patient-centered model of health care. RESULTS: Key themes for residents include balancing multiple roles at work, balancing work and home, identity formation, diversity (gender, ethnic, cultural, learner styles, and other dimensions), and challenges in training with advances in the field (e.g., neuroscience, technology, culture, spirituality). Contemporary residents have some issues as did their predecessors, but they also have unique experiences, issues, talents, and interests. CONCLUSIONS: A larger qualitative analysis of these issues, followed by testing of theories by quantitative methods, is indicated.
The authors conducted a pilot study in preparation for a larger investigation that will rely on telephone surveys to assess select health behaviors of teens and their parents, with a focus on indoor tanning. This study used a randomized design to assess the impact of a presurvey letter on response rates to a telephone survey, as well as prevalence estimates of ever having used an indoor tanning facility. The letter did not have a significant effect on response rates or prevalence estimates in the two cities under study. Findings suggest that researchers should not assume that a letter sent in advance of a telephone survey will necessarily increase response rates enough to justify their use.
The purpose of this descriptive study was to explore the concerns of parents following a child's discharge from a bone marrow transplant unit. A qualitative approach which included components of grounded theory was used to explore the posttransplant experience from the parents' perspective. Seven parents of five children who were transplanted for a variety of malignancies at a number of out-of-state centers were interviewed about their experiences. Chart analysis and participant observation provided additional sources of data. Initial coding of audio-taped interviews revealed 32 topics of concern voiced by the parents. Use of the constant comparative analysis technique resulted in the emergence of six major themes of the posttransplant experience. The Return Home, Changing Relationships, Working with This, Learning the Rules, The New Norm, and The Uncertain Future were components of this transitional period for each family. Similarities were found between the experiences of study parents and the parents of chronically ill children and parents or spouses of organ transplant recipients. Awareness of posttransplant concerns may facilitate the efforts of both transplant and referral center staff to educate, support, and care for these children and their families.
A study of doctor-patient communication offers convincing arguments for using multiple methods of data collection incorporating both meanings and practices. Multiple realities emerged clearly that would have remained invisible had only one data source been used. Two case studies illustrate how four factors interact to produce different versions of reality: setting, participants, time, and forms of data recording. The author discusses the apparent markedly different realities of doctors and patients, and the researcher's role in synthesizing these multiple accounts. Only by using multiple methods can attention be paid to the central tensions, the gaps and white spaces, and the discrepancies and misunderstandings that are so important in understanding human interaction. However, this approach is labor- and time-intensive, and requires skilled, experienced researchers.
Liver transplantation is the treatment of choice for children with end-stage liver disease. Few studies have examined the experience of transplantation from the child's perspective. Using a phenomenological approach establishes a safe environment for children to reflect on their lives as transplant recipients. The aim of this study was to uncover the experiences of pediatric liver transplant recipients from the period prior to transplantation, through surgery, and beyond. In-depth conversations with 9 pediatric recipients were carried out. Phenomenological methodology guided the data collection and analysis. The children faced many challenges, including surviving a life-threatening illness while accomplishing normal developmental tasks. The predominant theme was striving for normalcy in their lives.
This paper presents the findings of an exploratory research study which considers the effect of organisational change on social work practice in hospitals in four local authorities in England. Its aims were (1) to obtain the views of hospital social workers and their managers about the effect of implementing the NHS (National Health Service) and Community Care Act of 1990 and policies for Care in the Community on the practice of social work and (2) to elicit issues of concern to form the basis of a national study. Semi-structured interviews were carried out in hospital social work departments which were providing a service to adults with health needs. Interviews with a representative sample of 85 workers and 36 managers (including Assistant Directors and Principal Training Officers) in 11 hospitals were held between June-December 1993, three months after the introduction of the policies. The interviews were tape-recorded and transcribed. A questionnaire provided some quantitative data, and additional information was obtained through non-participant observation at team meetings. The interviews covered four topic areas: the nature of social work in hospitals; the changes introduced by implementing the legislation; the management of that change; and the effect of the new policies on practice. Results show an increase in the volume of referrals particularly in assessment for nursing home care; and an overwhelming amount of administrative work to process the new procedures for providing community care. Most relates to filling in forms, duplication of assessments and repetitive bureaucracy. Workers struggle to meet their expectation of professional practice with organisational demands. The discussion centres on three issues raised by practitioners; the changing nature of social work due to the alternative models of service being imposed by local authorities; the lack of consultation and involvement by management of the frontline workers in the management of this change; the dissonance felt by hardworking and committed practitioners to whom the increasing paper work is yet another obstacle to user involvement. This may have clear implications for management, for the degree of stress and perceived pressure resulting from these organisational changes is counterproductive to job satisfaction. If the reforms are not to be undermined, they need proactive management. This requires a sensitivity to workers' needs, investment in training and working together to integrate the care management role into social work practice.
The research reported in this article examined the effectiveness of a dedicated, timed, recurring Master's level social work intervention with patients new to dialysis. Study participants were evaluated for depression and levels of adjustment when first beginning dialysis and three months later. A control group received standard, mandated social work services while the experimental group received an additional counseling component. The experimental group showed statistically significant changes over time in lowered levels of depression and maladjustment.
Explore the source record for details and available documents.
For thirty years Jack Wennberg has studied variations in medical practice, from rates of tonsillectomy in Vermont villages in the 1970s to the cost of dying in the nation's major medical centers today. Along the way he has spawned the field of clinical evaluative science, created the Dartmouth Atlas of Health Care, stimulated the creation of a new federal agency (the Agency for Healthcare Research and Quality), and challenged many presumptions about what constitutes good medical care. In this interview with Fitzhugh Mullan, he reflects on health care reform and how to change clinical practice.
Although community-based research is intended to be culturally sensitive, more advanced consideration of the impact of race, gender, and class is needed for health disparity research involving women of color. Research processes must permit the simultaneous disclosures of the racial, gender, and class identities among women of color that are assumed and imposed. The authoritative knowledge that women of color have about their lives and their health should form the basis for collaboration between researchers and study participants. The dissemination of research findings to study participants, and dialogue on those findings, is imperative for the development of sustainable interventions.
HIV and STD prevention is an essential component of public health initiatives in countries throughout Central and Eastern Europe. Liberalization in sexual values, declining age at first sex, higher levels of sexual activity, and inconsistent condom use have been well-documented among young people in the region following the political, economic, and cultural transitions after the end of the state socialism era. Less well-understood are the reasons for high-risk sexual behavior and psychosocial factors that must be addressed in the development of effective HIV/STD prevention programs. This study recruited members of 12 high-risk social networks of young adult men and women (n= 66 participants) in two cities, St. Petersburg, Russia, and Budapest, Hungary. In-depth focus groups were conducted with all members of each network, and qualitatively analyzed to examine factors surrounding high-risk sexual behavior. Main themes that emerged were that STDs are less known and less feared than AIDS, HIV risk factors were relatively well known among young adults in both countries but vulnerability is perceived differently, pregnancy prevention is a more immediate concern than protection from HIV or STDs, condom use declines quickly following first sex with a new partner, reintroducing condom use in a relationship is very difficult, and young adults report many barriers to condom use including those related to alcohol or other substance use. HIV/STD prevention programs are needed that extend beyond risk education alone and that also address critical psychological, social, and relationship factors related to sexual risk behavior.
Therapists working in an experimental stroke unit were interviewed about how they set goals for rehabilitation, how they measure progress, and about problems of discharging patients. In addition the interview covered the topics of quality in rehabilitation, the relationship between patient and therapist, and therapists' evaluation of the stroke unit. The therapists felt that current outcome measurement instruments did not capture the kinds of results that they felt were important. They were process-oriented, and not only outcome-oriented as in traditional studies of stroke rehabilitation. This explorative study provides an insight into how therapists view the stroke rehabilitation process, and elaborates themes for future studies of physical and occupational therapy in rehabilitation.
The purpose of this article is to explore the topic of friends as a spontaneously occurring response in open-ended interviews with dementia caregivers and to propose guidelines for assessment and intervention based on current knowledge. The sample includes 176 open-ended baseline interviews with dementia caregivers drawn from the National Caregivers Training Study, a 4-year multi-site, randomized, community-based, psycho-educational intervention study. References to friends were present in 60 of the 176 baseline transcripts. More than 50% of the references were positive, 63% referred to the present, 80% of the content scores were greater than 1, and 66% were categorized as emotional support or social integration for caregivers. Meaningful categories exist and can be helpful in structuring the assessment of support from friends. Data support prior research suggesting that friends are providers and facilitators of emotional support and social integration. Although further research is needed on the concept of social support in general and social network providers in particular (e.g., friends), current knowledge allows for preliminary recommendations for assessment and intervention of friends and social support.
The purpose of this study was to describe how older adults with low vision make decisions to use low vision assistive devices (LVADs). Analysis of participants' narratives, from both group and individual interviews, revealed three topic areas affecting device use. Two are discussed in this paper: Experiences and Characteristics Leading to Successful LVAD Use Decision Making and Challenges to Successful LVAD Use Decision Making. The third, Adjustment to Low Vision Disability, is briefly discussed. Of particular importance to occupational therapy practitioners in the growing field of low vision rehabilitation was the value placed on low vision rehabilitation services to assist with acquiring devices and integrating them into daily routines. Occupational therapy services were highly regarded. Participants demonstrated the importance of becoming a part of a supportive network of people with low vision to gain access to information about resources. They emphasized the need for systems and policy changes to reduce barriers to making informed decisions about LVAD use. Results indicate that occupational therapists working in low vision can support clients by facilitating development of a support network, acting as liaisons between clients and other health practitioners, especially ophthalmologists, and encouraging policy development that supports barrier-free LVAD acquisition and use. These topics should be incorporated into continuing and entry-level education to prepare practitioners for leadership in the field of low vision rehabilitation.