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At least 613 records · Page 34Linked to original sources
PubMed1999

Obstacles on the path to a primary-care led National Health Service: complexities of outpatient care.

An interpretive qualitative study was carried out as part of a large cohort study of factors affecting outpatient re-attendance. Individuals from three groups involved in the provision of care across the primary-secondary interface were interviewed: patients, general practitioners and consultants. The aim was to explore understandings concerning referral to and re-attendance at outpatients, and to elicit detailed descriptions of the complexities of the outpatient experience for both providers and recipients of care at the primary/secondary interface, given the policy commitment to a 'primary-care led National Health Service'. Semi-structured interviews were carried out with nine individuals currently attending outpatients, ten general practitioners, and ten consultants. Transcripts were analysed individually and cross-checked between analysts for validity of interpretation, to identify key themes and subthemes. Data were compared across the three groups. Negative case analysis was employed. Seven major issues were identified, some of which could be identified with interests and experience of the three obvious groupings, and some of which were common. The three groupings are not as homogeneous as is often supposed. From the cross-group analysis common themes included: interpersonal communication, knowledge, power relations and anxiety/reassurance. Issues of trust, social status, funding and consumerism/litigation were also highlighted. The analysis has implications for altering the balance of care across the interface, for example in the finding of what could be termed a dissonance in power perceptions, in that consultants perceived general practitioners as relatively powerful and able to influence things', whereas general practitioners often expressed themselves as relatively powerless and unable to be proactive in 'reclaiming' their patients. The analysis highlights the complexity of the outpatient experience, drawing attention to detailed areas of contradiction, irony and conflict in the total context of outpatient care. These areas should be addressed in policy development designed to shift the balance of care further towards the primary sector.

Ambulatory Care↗
PubMed2000

Obstacles to bystander cardiopulmonary resuscitation in Japan.

OBJECTIVE: bystander cardiopulmonary resuscitation (CPR) is performed infrequently in Japan. We conducted this study to identify Japanese attitudes toward the performance of bystander CPR. METHODS: participants were asked about their willingness to perform CPR with varying scenarios and CPR techniques (mouth-to-mouth ventilation plus chest compression (MMV plus CC) versus chest compression alone (CC)). RESULTS: a total of 1302/1355 individuals completed the questionnaire, including high school students, teachers, emergency medical technicians, medical nurses, and medical students. About 2% of high school students, 3% of teachers, 26% of emergency medical technicians, 3% of medical nurses and 16% of medical students claimed they would 'definitely' perform MMV plus CC on a stranger. However, 21-72% claimed they would prefer the alternative of performing CC alone. Respondents claimed their unwillingness to perform MMV is not due to the fear of contracting a communicable disease, but the lack of confidence in their ability to perform CPR properly. CONCLUSION: in all categories of respondents, willingness to perform MMV plus CC for a stranger was disappointingly low. Better training in MMV together with teaching awareness that CC alone can be given should be instituted to maximize the number of potential providers of CPR in the community, even in communities where the incidence of HIV is very low.

Attitude to Health↗
PubMed1997

The economics of parasite control: obstacles to creating reliable models.

Models of the population biology and transmission of helminth parasites of domestic ruminants do not generally include any explicit reference to production because that would require the identification of a systematic relationship between parasitism and production loss. This is difficult because (1) the relationship between parasitism and production loss (in so far as we can identify one) is non-linear, (2) it is by no means clear which index of parasitism we should use in defining the nature of the relationship and (3) time delays in the system and the multicausal nature of production losses make it difficult to tease out those components of the loss that are attributable to parasitism.

Animals↗
PubMed2003

Rationales, obstacles and strategies for local outcome monitoring systems in substance abuse treatment settings.

The need for outcome monitoring systems (OMS) in substance abuse treatment is now such a pervasive position that it has achieved 'motherhood' stature. Yet, for a variety of reasons, implementation of systematic, ongoing monitoring continues to lag in most settings. The position taken in this article is that a local approach to monitoring is a viable alternative to large scale monitoring programs when such programs are unavailable. Moreover, local OMS can supplement these more generic programs by providing data that are more in tune with the orientation and program development of a specific setting. This article argues that local OMS can be developed with a reorganization of customary documentation procedures, a modest investment of personnel and specialized technical resources, a shorter-term view to outcome, and a commitment to evidence-based treatment.

Cost-Benefit Analysis↗
PubMed1985

[Peridural morphine in intractable cancer pains. Means and obstacles].

Long-term analgesia with epidural morphine (EM) is a new tool in the management of intractable cancer pain. Twenty-six out of 160 cancer patients referred to the Pain Division for pain assessment were selected for analgesia with long-term epidural morphine, so aiming to define its place amongst more traditional methods of treatment, such as drugs, nerve-blocks, neurosurgery or radiotherapy. All 26 patients were cases of conventional analgesic failure, with very advanced cancer states. Thirteen patients became absolutely pain free throughout the treatment period: five of them were even allowed home. Another ten patients were satisfied with EM, though some residual pain of neurogenic and visceral type persisted. In three patients, epidural morphine was judged as a complete failure. The 134 other patients could be managed with either of the other above mentioned techniques. The most important selection criterion for patients requiring epidural morphine seemed to be continuous multiple site bilateral pain of deep somatic origin. The response was variable in continuous visceral pain, while neurogenic, cutaneous and intermittent pain due to intestinal obstruction responded only exceptionally. EM was most valuable in terminal situations when systemic opiates failed to give satisfactory analgesia, or in acute transitory situations, while waiting for a response to cancer-orientated therapy. Epidural morphine considerably improved the patients' quality of life, compared with conventional methods tried beforehand. Analgesic methods in cancer are palliative procedures. In terminal or temporary situations, other more invasive methods are not suited. The EM technique is simple, adjustable to advancing pain and has few side-effects, especially when compared with neurolytic and neurosurgical procedures.

Adult↗
PubMed1998

Social and economic factors as obstacles to blood pressure control.

Further improvement in blood pressure control at the population level will result from dealing with hard-to-solve problems, such as access to care, long-term management of a chronic disease, and societal influences on lifestyle. Additional knowledge and experimental data are needed, reinforced by clear public health choices in this direction.

Antihypertensive Agents↗
PubMed1999

[Congenital diaphragmatic hernia. II. Is pulmonary hypoplasia an indefinable obstacle?].

Despite major insights into the pathogenesis and pathophysiology of congenital diaphragmatic hernia, and despite the availability of an antenatal diagnosis and continuous progress in neonatal intensive care, little improvement has been obtained in the prognosis of this malformation. Thus obstetricians, neonatologists and pediatric surgeons are still facing a several dilemma: dilemma before birth to predict the prognosis, i.e., to evaluate the severity of the associated pulmonary hypoplasia in order to decide whether or not to interrupt pregnancy; dilemma after birth in case of severe respiratory failure to decide how far to go in life support. Based on a review of the literature and their own experience, the authors attempt to recapitulate the perinatal management and outcome of this severe malformation.

Abortion, Induced↗
PubMed2003

Dietary n-3 fats as adjunctive therapy in a prototypic inflammatory disease: issues and obstacles for use in rheumatoid arthritis.

Eicosanoids derived from the n-6 fatty acid, arachidonic acid, and the cytokines interleukin-1beta and tumour necrosis factor-alpha are involved in the signs and symptoms of inflammatory joint disease, as well as the cartilage degradation seen in established rheumatoid arthritis (RA). Then n-3 fatty acids in fish and fish oil can inhibit production of both eicosanoid and cytokine inflammatory mediators and therefore, have the potential to modify RA pathology. Epidemiological studies suggest that fish intake may be preventive for RA and double-blind placebo-controlled studies demonstrate that dietary fish oil can alleviate the signs and symptoms of RA. The implementation of these findings will require among other things, a range of n-3 fat enriched foods, as well as physician awareness of the possibilities for dietary n-3 fat increases to be used as adjunctive therapy in RA.

Arthritis, Rheumatoid↗
PubMed2002

Opportunities and obstacles in developing a vaccine for Entamoeba histolytica.

The development of a vaccine against Entamoeba histolytica, the causative agent of amebic colitis and liver abscess, would reduce childhood mortality in countries such as Bangledesh where community-based studies have demonstrated a high prevalence of E. histolytica. Immunological studies from this population have shown that protection from amebiasis is associated with mucosal anti-E. histolytica Gal/GalNAc lectin antibodies, suggesting that a vaccine is an achievable goal. However, garnering resources for vaccine development is a challenge when the vaccine is targeted to poor people living in developing countries.

Animals↗
PubMed1996

House officer education and organizational obstacles to quality improvement.

BACKGROUND: House officers are physicians-in-training who provide the bulk of direct medical care for patients in teaching hospitals. Because of their intimate, ongoing role in patient care, they occupy a particularly advantageous position in the health care system for identifying and solving common organizational problems that undermine the quality and increase the cost of care. Yet most house officers are inadequately prepared to address problems in organizational and technical support systems which undermine the delivery of health care. In fact, house officers' strategies for coping with the demands of residency training often perpetuate problems. CASES: Cases describing prescription errors, lost laboratory data, and inappropriate beeper-related interruptions in care illustrate how house officers contribute unwittingly to poor quality and costly care. RECOMMENDATIONS: Department chairs, residency program directors, and senior clinicians should create opportunities for house officers to participate in interdisciplinary problem-solving teams. Medical faculty should instruct house officers in the principles and practice of quality improvement, integrating this material into existing teaching conferences and other educational activities. Instruction should be case based, data intensive, and jargon free, modeled by clinicians with training and experience in quality management and related disciplines. Senior clinicians and department officials should endorse organizational problem solving as a legitimate, appropriate, and valuable activity for every well-trained physician.

Boston↗
PubMed2002

Large-scale genotyping by mass spectrometry: experience, advances and obstacles.

Single nucleotide polymorphism (SNP) genotyping has become a key technology for genetic studies. In recent years, matrix-assisted laser desorption/ionization (MALDI) time-of-flight mass spectrometry has emerged as a very powerful method for SNP genotyping. Here, we discuss our experience in implementing a high-throughput SNP genotyping facility based on MALDI, and the issues encountered in adapting this to large-scale genetic studies. Most of these issues are not specific to using MALDI approaches, and they will also serve as valuable pointers for establishing high-throughput genotyping with other methods.

Genetic Testing↗
PubMed2003

Forward chemical genetics: progress and obstacles on the path to a new pharmacopoeia.

Forward chemical genetics is a new method to systematize the discovery and use of small molecules as tools for basic biological research. This approach requires three basic components: a library of compounds; an assay, in which the library is screened for a cellular or organismal phenotype; and a method to trace an active compound to its biological target. Bioactive compounds have traditionally been isolated from natural product extracts, although 'diversity-oriented synthesis' and commercial compound collections are gaining in prominence. New techniques, such as image-based screening and the cytoblot method, have increased the throughput of phenotypic assays. Strategies are also being developed to streamline target identification using molecular biological approaches.

Drug Evaluation, Preclinical↗