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At least 595 records · Page 33Linked to original sources
PubMed1998

Sexual Assault Response Team: overcoming obstacles to program development.

After several years of planning, The SART at Immanuel St. Joseph's--Mayo Health Systems became a reality in August 1997. The nurses who were trained for this program were already providing 24-hour coverage in the emergency department for psychiatric emergencies and patients with chemical dependency. The SANE responsibilities were added to their on-call duties. Five nurses participated in a 40-hour training program by SANE specialists and experts in the local community. As expected, nurses were apprehensive as they conducted their first examinations; however, all has gone well. Over time, the providers' and clients' satisfaction with the program has improved. The examination is completed in less time, and the person assaulted does not have to wait as long for the SANE to arrive. Members of law enforcement and the prosecutor's office are especially pleased with the quality of evidence collected and the procedures followed to maintain chain of evidence so the evidence obtained can be used in prosecution. The program has resulted in kind and compassionate care for persons who have been sexually assaulted. The providers are continuing to meet monthly as an interdisciplinary, interagency team and are addressing concerns as they arise. Members of the SART are developing a good working relationship. Everyone involved agrees that developing this program has been a worthwhile effort and that the hospital is providing a valued service for the community.

Emergency Nursing↗
PubMed2003

Obstacles to cancer immunotherapy: expression of membrane complement regulatory proteins (mCRPs) in tumors.

Monoclonal antibodies (mAbs) are being increasingly used in cancer therapy owing to their ability to recognize specifically cancer cells and to activate complement- and cell-mediated cytotoxicity and/or to induce growth arrest or apoptosis. The therapeutic potential of anticancer antibodies is significantly limited due to the ability of cancer cells to block killing by complement. Of the multiple resistance strategies exploited by cancer cells, the expression of membrane complement regulatory proteins (mCRPs), such as CD46 (membrane cofactor protein (MCP)), CD55 (decay-accelerating factor (DAF)), CD35 (complement receptor type-1 (CR1)) and CD59, has received most attention. CD46, CD55 and CD35 block the complement cascade at the C3 activation stage and CD59 prevents assembly of the membrane attack complex of complement (MAC). These proteins protect normal tissues from accidental injury by activated complement, but also confer resistance on cancer cells, thereby limiting the effect of complement-fixing monoclonal antibodies. Expression of mCRPs on malignant cells is highly variable, yet there is clear indication that certain tumors express higher mCRP levels than the normal tissue from which they have evolved. mCRP level of expression and cellular location may also vary during malignant transformation and between differentiated and undifferentiated tumors. Neutralizing anti-mCRP mAbs have been used in vitro to elucidate the significance of mCRP expression to the tumor complement resistance phenotype. In general, CD59 appears to be the most effective mCRP protecting tumor cells from complement-mediated lysis. Nevertheless, it acts additively, and in certain tumors even synergistically, with CD55 and CD46. It is envisaged that treatment of cancer patients with mCRP blocking antibodies targeted specifically to cancer cells in combination with anticancer complement-fixing antibodies will improve the therapeutic efficacy.

Antigens, CD↗
PubMedDate not supplied

Xenotransplantation: how to overcome the complement obstacle?

The xenotransplantation research is driven by the shortage of allografts for transplantation of patients with end-stage organ failure and by lack of success in developing suitable artificial organs. Pigs are now generally accepted to be the donor species of choice, although a possible risk for transmission of xenozoonoses, particularly pig endogenous retroviruses, should be born in mind. A vascular xenograft from pig to human is usually rejected hyperacutely due to naturally occurring antibodies and complement. This hyperacute rejection can be prevented by manipulating with either of these systems. In this review we briefly describe the hyperacute rejection and how it can be prevented by complement modulation. Pigs made transgenic for human complement regulatory proteins seem very promising for future clinical experiments. Control of fluid-phase complement activation should be obtained as well. The latter is discussed based on our own recent studies in this field.

Animals↗
PubMed2000

Obstacles to identifying viruses that cause autoimmune disease.

In addition to a clear genetic disposition, environmental factors and viral infections are thought to play a role in the pathogenesis of autoimmune diseases such as type I diabetes or multiple sclerosis (MS). This article will explore, by use of paradigms developed in a transgenic mouse model, why it has been so difficult to prove a causative association between viral infections and autoimmunity. Potential pathogenetic mechanisms and their impact on devising the best strategy to prove such an association will be discussed. These thoughts might also be important for applying new immune interventions in type I diabetes or MS.

Animals↗
PubMed1999

Genetic polymorphism near HIV-1 reverse transcriptase resistance-associated codons is a major obstacle for the line probe assay as an alternative method to sequence analysis.

The performance of the line probe assay (LIPA) for the detection of mutations conferring resistance to nucleoside inhibitors of HIV-1 reverse transcriptase was evaluated in comparison with sequence analysis. The tests were undertaken on plasma samples from 63 patients (61 receiving combination therapy and 2 without treatment at the time of inclusion). In 27 cases (43%) which included codons 41, 69, 70, 74, 184 and 215, the sequence of the RT gene was distinct from the hybridization probes used in LIPA. Correspondingly, LIPA gave uninterpretable results in 15, 30 and 41% of cases for codons 184, 215 and 41, respectively. Overall, the concordance between LIPA and sequence analysis varied from 52% (codons 41 and 215) to 85% (codon 70). These data show that the polymorphism of the nucleotide sequence near resistance-associated codons is a major shortcoming of LIPA.

Codon↗
PubMed2003

Interleukin-10 as a CNS therapeutic: the obstacle of the blood-brain/blood-spinal cord barrier.

Interleukin (IL)-10 exerts beneficial effects on the central nervous system (CNS) after peripheral administration, but its penetration across the blood-brain barrier (BBB) has not been quantified. We show that 125I-IL-10 is stable in circulating blood but does not cross the intact BBB after intravenous delivery. Thus, peripheral IL-10 probably can serve as a CNS therapeutic only when the BBB is disrupted.

Albumins↗
PubMed2003

Pain and the blood-brain barrier: obstacles to drug delivery.

Delivery of drugs across the blood-brain barrier has been shown to be altered during pathological states involving pain. Pain is a complex phenomenon involving immune and centrally mediated responses, as well as activation of the hypothalamic-pituitary-adrenal axis. Mediators released in response to pain have been shown to affect the structure and function of the blood-brain barrier in vitro and in vivo. These alterations in blood-brain barrier permeability and cytoarchitecture have implications in terms of drug delivery to the central nervous system, since pain and inflammation have the capacity to alter drug uptake and efflux across the blood-brain barrier. An understanding of how blood-brain barrier and central nervous system drug delivery mechanisms are altered during pathological conditions involving pain and/or inflammation is important in designing effective therapeutic regimens to treat disease.

Animals↗
PubMed1997

Informed consent: protection or obstacle? Some emerging issues.

There is widespread consensus on the need for informed consent procedures in medical research. Nevertheless, aspects of the informed consent process remain controversial, and innovative approaches to research may raise new issues and concerns. The randomized consent design for clinical trials, proposed by Zelen (N Engl J Med 1979; 300:1242-1245), permitted physicians to randomize patients without consent, then obtain informed consent from only those patients randomized to the experimental (as opposed to the standard treatment) arm. More recently, the proposal has been made to allow waiver of informed consent for study of patients in emergency circumstances who may be temporarily incapable of providing such consent, and for whom no family member is immediately available to give a "proxy" consent (Biros M.H. et al. JAMA 1995; 273:1283-1287). The medical community and federal regulatory policy have responded differently to these proposals.

Emergency Treatment↗
PubMedDate not supplied

[Obstacles to overcome in the control of pulmonary tuberculosis in the border region of Chiapas, Mexico].

OBJECTIVE: To improve the control of the pulmonary tuberculosis in the Border Region of Chiapas, Mexico. DESIGN: Academic researchers, health development workers from the nongovernmental sector and government health authorities met in a workshop to analyze recent experiences with tuberculosis. RESULTS: Among the important issues addressed were: with regard to official health services, the lack of resources, particularly medication, organizational problems which result in poor or absent communication within and among different health entities, the under diagnosis of cases and the lack of sufficient index of suspicion for tuberculosis among health personnel. With regard to the population at risk, there are profound socio-cultural barriers which include a lack of confidence in the quality of government health care centers and little attention given to chronic cough. Poorest, indigenous and more remote people have less access to care and are more likely to have advanced tuberculosis before seeking treatment if at all. New strategies proposed were to integrate communication efforts in tuberculosis control among all the involved health services, including private physicians, identify those patients at greatest risk, improve diagnostic skills of health providers, develop education campaigns in rural areas. CONCLUSIONS: Certain factors which impede better TB control seem amenable to change, others, such as severe poverty, particularly among peasants and indigeneous people, as well as the current political disruption, will require much broader intersectorial interventions.

Communication Barriers↗
PubMed1988

The main obstacle to a malaria vaccine: the malaria parasite.

The challenge to development of a malaria vaccine will be the variability of the sequences of target antigens. We discuss the variability in the T cell epitopes on the circumsporozoite protein of Plasmodium falciparum and the rapid selection of mutants after immunization with a protein from the asexual erythrocytic stage of P. knowlesi.

Animals↗
PubMed2000

Renal rehabilitation: obstacles, progress, and prospects for the future.

The definition of rehabilitation for end-stage renal disease (ESRD) patients has changed significantly over the past 40 years. Initially, the concept focused on return to employment. In the early days, most members of the small, select group of patients chosen for dialysis met this criterion and were considered successfully rehabilitated. However, this "success" could not be replicated in the broader ESRD population when Medicare coverage was expanded to include older and more debilitated patients. This raised serious questions about the feasibility of renal rehabilitation efforts. Government policy makers and the nephrology community responded by (1) gathering data to enable the measurement and improvement of health-related quality of care, and (2) redefining rehabilitation and its goals. Today, renal rehabilitation is defined broadly, in terms of optimal functioning for individual patients and restoration to productive activities-not simply employment. To foster renal rehabilitation and guide program development, the Life Options Rehabilitation Advisory Council (LORAC) identified five core principles, called the "5 E's"-Encouragement, Education, Exercise, Employment, and Evaluation. Considerable progress has been made in measuring outcomes of care and in establishing a connection between rehabilitation interventions and improved outcomes. Increasingly, research is focused on the relationship between patient self-reports and health status outcomes. In the years ahead, clinicians and researchers will see growing evidence of relationships between specific rehabilitation interventions, improved outcomes (including health-related quality of life), and cost-effective delivery of care.

Aged↗
PubMed1998

Obstacles to achieving adequate dialysis dose: compliance, education, transportation, and reimbursement.

There are numerous barriers to delivering the prescribed quantity of dialysis. Noncompliance in terms of shortening and skipping treatments is common and negatively impacts on delivered dialysis. A significant number of shortened treatments are caused by reasons within the patient's control, whereas others, such as transportation, can be influenced by others. This article will review the prevalence of patient noncompliance with the dose of dialysis and the relationship to process and outcome measures. Educational and quality improvement programs resulting in increasing the delivered dialytic dose will also be explored.

Health Services Accessibility↗
PubMed1998

Obstacles to addressing professional misconduct.

The Ethical Principles exhort psychologists "to encourage ethical behavior by students, supervisees, employees, and colleagues, as appropriate" (American Psychological Association, 1992, p. 1599). In spite of a clear directive to attempt resolution of unethical conduct by colleagues, research indicates that satisfactory resolution or actual reporting of misconduct is infrequent. This paper will address some of the forces that discourage psychologists from dealing responsibly and appropriately with professional misconduct by colleagues. The goals of this paper are to promote understanding of factors that interfere with the effective resolution of ethical misconduct, to identify possible signs of reluctance to address misconduct, and to propose strategies to combat those forces that keep us in silent collusion with colleagues who engage in unethical practices. A flowchart of steps for addressing possible misconduct by a colleague is provided, and educational, organizational, and professional considerations are discussed.

Awareness↗