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PubMedDate not supplied

Speaking up and talking out. Barriers and obstacles to nurse-midwifery practice.

There are internal as well as external barriers to nurse-midwifery practice. We have let others define us. It is time to articulate a new vision for nurse-midwifery that speaks to what midwifery does better than obstetrics. We need to claim our "partnership" model and argue for its integration into health policy for all childbearing women.

Attitude of Health Personnel↗
PubMedDate not supplied

Sexual abuse evaluations: conceptual and empirical obstacles.

Evaluating children for possible sexual abuse is widely regarded as a difficult clinical endeavor. Practitioners are concerned with both the basis for professional opinions and the accuracy of their ultimate judgments. Current approaches are critically analyzed for conceptual integrity and empirical support. The authors conclude that improvements in practice will be more productive than efforts to devise a procedure for classification of cases. Implications of this approach and recommendations for further research are discussed.

Child↗
PubMed1993

Obstacles to the care of patients with medical-psychiatric illness on general hospital psychiatry units.

Although patients with both physical and mental illness (combined illness) are common in general hospitals, psychiatric units have been traditionally reluctant to accept such patients for intensive psychiatric care. This article presents three case reports of patients with combined illness who were largely refused at psychiatric units despite stable vital signs, and discusses factors compelling and hindering psychiatric unit acceptance of such patients. Such patients can be managed on psychiatric units when hindering factors are addressed. The most critical factor is an ongoing collegial relationship with nonpsychiatrist consultant physicians and nurses. The psychiatric unit can improve its worth and reduce stigma and mystique within the general medical hospital by becoming more accepting of these patients.

Adult↗
PubMed1993

Interaction of the natural anti-Gal antibody with alpha-galactosyl epitopes: a major obstacle for xenotransplantation in humans.

Cells of nonprimate mammals express an abundance of the carbohydrate structure Gal alpha 1-3 Gal beta 1-4 GlcNac-R (termed the alpha-galactosyl epitope). The natural anti-Gal antibody, which interacts specifically with alpha-galactosyl epitopes, is present in high concentrations in all humans. Here, Uri Galili argues that the interaction between anti-Gal in the serum and alpha-galactosyl epitopes on cells of nonprimate grafts may act as an immunological barrier which prevents xenotransplantation.

Animals↗
PubMed1995

Donor card registration system in Japan: an obstacle to procuring kidneys for transplantation.

Donor cards are a simple and effective way to give a consent to organ donation in cases of unexpected death. In Japan the prevalence of donor cards is low (0.4%) compared to the United States (24.6%), although about 50% of Japanese people are reported to be willing to donate their organs after death, a figure equivalent to the United States. We hypothesized that the donor card registration system can explain the low prevalence, and an introduction of a free delivery system will increase the prevalence. From April 1992 to April 1993, 402 high school students and 3391 workers in the Tokyo metropolitan area were requested to answer questionnaires; all the questionnaires were returned. Few respondents (15.5%) knew the way in which to be registered as a donor card holder. If donor cards were delivered freely and registration to carry a donor card was not required, 48.8% replied that they would be willing to carry donor cards. The most commonly cited reason for not carrying a donor card was 'I had no opportunity to get a donor card'. This study indicates that the introduction of free delivery of donor cards will increase the prevalence dramatically if a sufficient number of opportunities are offered. We recommend that a free delivery system should be introduced in order to increase the prevalence and secure the will of the deceased rather than the will of the family.

Adolescent↗
PubMed1984

Obstacles to successful fertility control in Nigeria.

Despite the fact that modern family planning activities in Nigeria date back to the 1950s, data on fertility are indicative of relatively high levels in the country. This paper reviews some data on fertility levels in Nigeria; it then focuses on family planning activities and examines some of the conditions encouraging pronatalist attitude among couples in Nigeria.

Attitude↗
PubMed1984

Small cell lung cancer 1973-1983: early progress and recent obstacles.

The recognition that the vast majority of patients with small cell lung cancer have distant metastatic disease at the time of diagnosis led to the use of systemic chemotherapy and consequent major improvements in survival in the early to mid-1970's. In the past five years, however, the pace of therapeutic advances has slowed. Recently evaluated treatment strategies, including more intensive induction chemotherapy, "late intensive" therapy of responding patients, alternation of chemotherapeutic regimens, integration of chest irradiation with drug therapy, large field irradiation, and reappraisal of the value of surgical resection, are discussed in this review. Advances in understanding of the cell biology of small cell lung cancer which may eventually lead to new forms of treatment are summarized.

Antineoplastic Combined Chemotherapy Protocols↗