PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Paradigm shift”

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.

At least 631 records · Page 35Linked to original sources
PubMed1995

Shifting the paradigm for the treatment of dilated cardiomyopathy.

Dilated cardiomyopathy (DCM) has emerged as a major health problem during the past two decades. In spite of recent advances, it has become clear that the underlying heart disease is relentlessly progressive in almost all patients who develop symptoms of overt failure; morbidity and mortality continues to be unacceptably high with an incidence of approximately 30% for death or hospital admission at one year. Cardiac transplantation remains the only current prospect for dramatically improving survival in many patients. Trying to enhance cardiac function during the later stages of heart failure is ultimately fruitless; it cannot be done over the long term. The solution to failure lies in defining and preventing its causes or arresting and reversing its evolution. We propose a model where the target for therapeutic intervention becomes the arrest of progressive myocardial disease throughout the course of the cardiomyopathy. In this paradigm, the selection of therapeutic agents for the treatment of heart failure takes into consideration both the stage of the disease and differences in pathogenesis. In addition it broadens our approach from one which focuses on enhancing myocardial function to one which encompasses strategies which are designed to inhibit the progressive loss of myocytes and the inexorable deterioration of the failing myocardium.

Cardiomyopathy, Dilated↗
PubMed2002

The chest pain center strategy for delivering community heart attack care by shifting the paradigm of heart attack care to earlier detection and treatment.

Heart attack remains the number one health problem in the United States and throughout the world. It has been that way for more than 100 years. Unless we change our course, heart attack will continue to exert its horrendous casualties, not only in the United States but also throughout the world. Our present strategy in dealing with this problem needs both leadership and a change in direction. In an effort to search "outside the box" for the solution to this problem, this symposium is a call to action that challenges us to approach the heart attack problem with a mindset bent on winning this war against heart disease, and not coexisting and accepting the problem as an inescapable fate.

Angina Pectoris↗
PubMed2003

Spiral CT for pulmonary embolism: the paradigm has shifted.

Computed tomography (CT) is rapidly becoming the first-line modality for imaging pulmonary embolism (PE). However, limitations for the accurate diagnosis of small peripheral emboli have prevented the unanimous embrace of CT as the new standard of reference for imaging PE, although the actual significance of isolated peripheral emboli is uncertain. At the same time, the high negative predictive value of CT pulmonary angiography for excluding clinically significant PE has been established. The introduction of multidetector-row spiral CT has greatly improved visualization of peripheral pulmonary arteries and detection of small emboli. Previous concerns regarding the use of spiral CT for the accurate diagnosis of peripheral pulmonary emboli should thus be overcome. Multidetector-row spiral CT has become a widely available and cost-effective technology and appears to have surpassed other imaging modalities for the accurate detection of central and peripheral PE. In this review, the authors assess the current role of spiral CT in the diagnostic algorithm of PE.

Contrast Media↗
PubMedDate not supplied

Shifting the paradigm: toward integrative research on mothers and children.

The mother-child relationship has been examined extensively but most research has centered on maternal characteristics associated with poor childhood developmental outcomes or maternal response to stressors. The "maternal deficit" model has misdirected research and intervention. Research on maternal depression based on the maternal deficit model has resulted in research designs that do not adequately address maternal outcomes. Research must be conceptualized to address parent-child relationships and situational factors that influence them.

Humans↗
PubMed1998

Planning psychosocial care for cancer patients: if at first you don't succeed, shift your paradigm.

Concerned with our capacity to bridge the gap between patients' and families' psychosocial needs and the services provided, we developed a psychosocial intake and referral service. This paper will describe the lessons learned in trying to introduce an innovation whose time had not yet come and, after analyzing the outcome, to present a new approach to planning. The service was not approved and, on reflection, eight factors were identified as contributing to the failure of the service to reach fruition. In light of what we learned, we developed a new planning model that reflects planning as a circular, iterative process rather than as a linear process.

Cancer Care Facilities↗
PubMed2005

Shifting the paradigm in geriatric care management: moving from the medical model to patient-centered care.

Studies of Geriatric Care Management Programs have had mixed results at best. Little evidence exists to attest to the effectiveness of these programs in improving patient outcomes and decreasing avoidable acute care service use. In response to these data, Kaiser Permanente's Geriatric Care Management program initiated a randomized trial to test an integrated, multifaceted depression treatment model within the care management framework and it's ability to detect and treat moderately and severely depressed older adults. This paper presents case studies of the geriatric care managers' practice changes associated with this intervention as well as case studies of two depressed clients, their experiences and outcomes associated with this study. Implications of this model are discussed.

Activities of Daily Living↗
PubMed1998

Senior centers. Shifting student paradigms.

The purpose of this study was to evaluate an innovative service learning experience for new nursing students involving senior citizen centers. Junior nursing students (n = 128) were assigned in cohorts to one of five centers for a 5-week rotation. A questionnaire was administered post hoc to the students, teaching assistants, center directors, and a sample of senior citizens at each site. The majority of students believed the experience was a valuable part of the curriculum and saw prospects for community health nursing roles. However, they had concerns regarding losing time in acute care and relevance and number of assignments, and reported some difficulty in applying classroom content in the setting. Directors and senior citizens were universally positive about the experience. Student and teaching assistant reports were key in revising the curriculum. Revisions include logistics of the placement of the experience and assignments as well as incorporation of this experience within the community context.

Adolescent↗
PubMed1996

Shifting the paradigm: monitoring access in Medicare managed care.

Medicare managed care enrollment growth points to the need to develop an approach for monitoring access to care for the increasing number of beneficiaries who use these arrangements. This article describes the issues to be addressed in designing a system for monitoring managed care plan enrollees' ability to obtain needed medical care on a timely basis. We review components of the monitoring approach used for traditional fee-for-service (FFS) Medicare, including the conceptual framework, data, measures, and subgroups targeted in monitoring efforts, and discuss the adaptation of that approach for monitoring access in Medicare managed care.

Fee-for-Service Plans↗