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At least 649 records · Page 36Linked to original sources

PubMed1996

A clinician-friendly version of the interpersonal circumplex: structural analysis of social behavior (SASB).

Like the original Interpersonal Circumplex (IPC), the Structural Analysis of Social Behavior (SASB) model was developed in the clinic. Different from and more complicated than the IPC, the SASB model nonetheless is parsimonious. It is consistent with Leary's (1957) original goal of bringing objectivity and clarity to the diagnostic process while acknowledging the complexity and variety of human nature. SASB applications extend from diagnosis into the domains of etiology and treatment. Specific advantages that accrue from the SASB model's more complex structure and assessment techniques include the ability to: (a) define both hostile and friendly differentiation, (b) specifically link social learning experiences with self-concept, (c) define several predictive principles on an a priori basis and confirm them in a variety of data sets, (d) assess personality at all 5 of Leary's levels, (e) define normality and pathology in qualitative rather than quantitative terms, (f) compare and contrast self-ratings with observer ratings using the same metric, (g) generate reasonable parallel models for affect and cognitive style that can help account for "comorbidity" between Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) Axes I and II, (h) make contributions to understanding personality as a hypothetical construct (i.e., to make testable predictions about etiology and specific treatment interventions), (i) dissect complex communications into their underlying components, and (j) accurately characterize a given relationship through a relatively brief sample of behavior.

Humans↗

PubMedDate not supplied

[Pattern of intervention and patients' satisfaction with community mental health services in Bologna].

OBJECTIVE: To measure satisfaction with Community Mental Health Service (CSM) in patients and to check if it will be associated with some selected demographic and service variables. DESIGN: This study compares data from satisfaction scale administration in patients who attended CSM at least once every two months during 1998 and services that them have benefited from. SETTING: The Community Mental Health Service of Saragozza-Porto District in Bologna. Main outcome measures--Demographical, clinical and service variables taken from CSM informative system and Verona Service Satisfaction Scale (VSSS-32), a multidimensional instrument which measures satisfaction with community-based psychiatric service. RESULTS: Main results (145 subjects) pointed out higher satisfaction for technical and interpersonal skills of staff, information, drugs, help to get economical benefits and domiciliary care. Four issues stood out by comparing patients' satisfaction and their demographic, clinical and services' benefit features: 1) aged patients complained about high drugs costs and of contacts with other seriously ill patients into the waiting room; 2) relative's involvement was judged as insufficiently effective; 3) in young patients with serious mental disease high frequency of visits seemed to correlate with low satisfaction; 4) patients with complex pattern of intervention (including economical benefits) were the less satisfied ones with service's economical support. CONCLUSIONS: Patients' satisfaction differs according to their demographic and clinical features, but the pattern of intervention seems to influence their judgements too, sometimes in a incoherent way.

Adult↗

PubMed2003

Diagnostic and therapeutic percutaneous cardiac interventions without on-site surgical backup--review of 11 years experience.

BACKGROUND: Current clinical guidelines restrict catheterization laboratory activity without on-site surgical backup. Recent improvements in technical equipment and pharmacologic adjunctive therapy increase the safety margins of diagnostic and therapeutic cardiac catheterization. OBJECTIVE: To analyze the reasons for urgent cardiac surgery and mortality in the different phases of our laboratory's activity in the last 11 years, and examine the impact of the new interventional and therapeutic modalities on the current need for on-site cardiac surgical backup. METHODS: We retrospectively reviewed the mortality and need for urgent cardiac surgery (up to 12 hours post-catheterization) through five phases of our laboratory's activity: a) diagnostic (years 1989-2000), b) valvuloplasties and other non-coronary interventions (1990-2000), c) percutaneous-only balloon angioplasty (1992-1994), d) coronary stenting (1994-2000), and e) use of IIb/IIIa antagonists and thienopiridine drugs (1996-2000). RESULTS: Forty-eight patients (0.45%) required urgent cardiac surgery during phase 1, of whom 40 (83%) had acute coronary syndromes with left main coronary artery stenosis or the equivalent, and 8 (17%) had mechanical complications of acute myocardial infarction. Two patients died (0.02%) during diagnostic procedures. In phase 2, eight patients (2.9%) were referred for urgent cardiac surgery due to either cardiac tamponade or severe mitral regurgitation, and two patients (0.7%) died. The combined need for urgent surgery and mortality was significantly lower in phase 4 plus 5 as compared to phase 3 (3% vs. 0.85%, P = 0.006). CONCLUSION: In the current era using coronary stents and potent antithrombotic drugs, after gaining experience and crossing the learning curve limits, complex cardiac therapeutic interventions can safely be performed without on-site surgical backup.

Angioplasty, Balloon, Coronary↗

PubMed2006

A Bayesian belief network for quality assessment: application to employment officer support.

BACKGROUND: 'Supported' employment stipulates that disabled people should have real jobs for real pay. This paper models kinds of supported employment, assesses how the support and placement features affect its outcomes and its quality from the perspective of the employees, and provides a dynamic model to help explore what types of interventions might promote greater social inclusion for people with learning and other disabilities. METHOD: Bayesian belief networks (BBNs) provide the general framework for modelling the relationships between the variables and features of interest. The structure, probabilistic specification and quality indicators were elicited from project advisory groups, including people with learning disability, and took into account a pilot survey of 30 individuals. A subsequent survey of 1,461 supported employees was used to update the model and to provide actual assessments of quality of placement. RESULTS: We present the BBN methodology in some detail, as novel to this discipline. We show how the model was constructed, and its implications for supported employment. We derive indices for quality of placement, taking into account the views of clients. We show how survey and individual results can be used to update the model. Use of the model suggests that quality of placement is, on average, relatively high, with small differences between groups with differing primary disability. CONCLUSIONS: The BBN is the appropriate methodology to model complex relationships and interventions for problems such as these. The model developed in this study can be used to assess and improve the fit between people and jobs, both at the individual level and for groups of employees, and can take into account different kinds of quality for different stakeholders.

Adult↗

PubMedDate not supplied

[Australia antigen in rheumatoid arthritis].

Australian antigen (Au Ag) was first described by Blumberg in the serum of an Australian aborigen. Its main clinical significance is based on the fact of its association with the presence of hepatitis B (Okochi, Nurakami, 1968; Prince, 1968) (9). Almeida (1969) outlines the intervention of immune complexes on the production of the referred illness. Later works show the importance of the type of immunologic response created by Au Ag (2). Alpert et al. (1) (1970) state the possibility that immune complexes developed by Au Ag and anti Au Ag antibodies may produce in patients with hepatitis B other allied manifestations including arthritis. On the basis of similar immunopathological findings (illnesses including immunocomplexes on their production), Au Ag investigation in rheumatoid arthritis (RA) has been the object of several works, whose results reveal certain discrepancies. We have investigated the presence of Au Ag on 70 patients whose diagnostic was RA "classical (according to the judgement of the American Rheumatism Association). We used immunoelectrophoresis (counter immunoelectrophoresis-CIEP-) and radioimmunoassay (RIA) techniques. We prepared individual records including clinical, epidemic, biochemical and personal data. Au Ag investigation both through different techniques gave negative results in 70 cases, of which only four referred a possible previous hepatitis B clinic history, not showing during the investigation suggestive clinical data of hepatitis or biochemical alterations. Panus et al. (1970) (5), Desche-Labarte et al. (1972), Trempo (1972), Burrel (1973) (6), Serré et al. (1973) (8), obtained negative results in the matter, with similar or lower casuistics than ours. Notwithstanding Roqués et al. (1975) (7), in 300 cases of RA showed the presence of Au Ag in a significant number of cases (5%) as compared to Au Ag incidence in the French population (estimated in about 0.22%) (6). However, Roqués did not find in their Au Ag positive cases any evidence which enables to think that this antigen has played an important role on the origin and development of the rheumatic illness. These important discrepancies may be due to different reasons: a) Use of different techniques for Au Ag detection. b) The transitory character of the presence of Au Ag in the serum. c) Important differences in the antigen geographic distribution. d) Previous hepatitis B. There are som other factors which have attained importance recently, as a consequence of the broad epidemiological studies carried out. So, Au Ag increased incidence has been found--statistically significant--on groups of persons who have been submitted to several surgical interventions and/or have needed repeated hospitalizations or reiterated blood transfusions (6). These three conditions--especially the first two--are accomplished in an illness with chronic and invalidating characteristics as RA...

Arthritis, Rheumatoid↗

PubMed1993

Dietary strategies for cancer prevention.

BACKGROUND: Two-thirds of cancer cases are associated with two lifestyle practices: 35% with the typical American diet, and 30% with tobacco use. In contrast to the field of tobacco control, research and resources dedicated to the field of nutrition have been limited, in part because dietary change has been considered controversial and requires a more complex set of interventions. METHODS: This series of papers reviews the science base underlying diet as a cancer control strategy, including research about diet-cancer relationships, current nutrition policy recommendations, American dietary trends, models of dietary behavior change, and diet in health care delivery. The history of technology transfer of new knowledge into widespread application will be compared and contrasted with other cancer control measures. RESULTS: There is scientific and policy agreement about three priority dietary goals for the year 2000: increase fruit and vegetable consumption to 5 or more servings every day, increase breads, cereals, and legumes to 6 or more servings daily, and decrease fat to no more than 30% of total calories. Current data do not indicate that these goals will be reached. As yet there is no organized effort, with clearly identified steps, to translate research into practice. The parallel with delays in implementing other cancer control measures, including Papanicolaou testing, mammography, and tobacco intervention, is striking. CONCLUSION: Without resources dedicated to dietary modification in the general population, it is not likely that the potential savings of more than 300,000 new cases, 160,000 deaths, and the $25 billion in associated costs will be realized in the foreseeable future.

American Cancer Society↗

PubMedDate not supplied

Diagnostic laparoscopy in the intensive care patient. Avoiding the nontherapeutic laparotomy.

Evaluation of a potential acute abdomen in patients who require intensive care for concurrent medical/surgical problems is often difficult due to ambiguities in the physical exam and ancillary diagnostic tests. Between August 1990, and February 1992, 25 ICU patients underwent diagnostic laparoscopy to evaluate a suspected acute intraabdominal process. Thirteen laparoscopies were negative, and 12 were positive. The overall accuracy for laparoscopy was 96% as confirmed by subsequent laparotomy, autopsy, or clinical course. Laparoscopic findings led to a change in management in nine patients (36%), leading to earlier exploration in four patients, and avoidance of laparotomy in five. No significant hemodynamic effects were noted during laparoscopy, and the procedure-related morbidity was low (8.0%). Diagnostic laparoscopy is a safe and accurate guide for managing the ICU patient with a suspected acute surgical abdomen. The use of laparoscopy can help avoid nontherapeutic laparotomy or confirm the need for operative intervention in these complex cases.

Abdomen, Acute↗

PubMed1990

Current techniques for infrainguinal arterial reconstruction.

Infrainguinal reconstruction for peripheral vascular occlusive disease comprises an increasingly complex array of interventions which provide unparalleled options for the salvage of threatened limbs. Conventional autogenous saphenous vein bypass remains the most durable revascularization with anticipated graft patency rates approaching 80 percent after five years and excellent long term limb salvage. These excellent results are equally applicable to vein grafts carried to infrapopliteal and even inframalleolar levels, possibly reflecting increased utilization of the in situ method. Although 20 per cent of grafts fail within five years, secondary intervention results in sustained limb salvage in the majority of patients. In the absence of autogenous vein, however, prosthetic material performs poorly such that new interventions consisting of percutaneous transluminal angioplasty, rotary atherectomy devices and laser systems are under aggressive development. Although initial results with these devices are encouraging, long term patency rates remain poor largely due to restenosis. Further progress seems to depend primarily on an increased understanding of the natural healing response of the injured artery.

Angioplasty, Laser↗

PubMedDate not supplied

Mismatch of coronary risk and treatment intensity under the National Cholesterol Education Program guidelines.

OBJECTIVE: To assess the match between multifactorial risk of coronary heart disease (CHD) and treatment intensity under the National Cholesterol Education Program (NCEP) guidelines for primary prevention of CHD. METHODS: The multiple logistic regression equation from the Framingham Study was used to derive predicted risks for development of CHD over eight years of follow-up for different age-gender groupings, with serum total cholesterol (TC) values chosen in light of the NCEP cutoff points for both TC and low-density-lipoprotein cholesterol levels. Additional risk factors--hypertension, glucose intolerance, and smoking--were considered in combination for each of these values. RESULTS: Controlling for the effects of age and gender, there is little difference in the ranges of absolute CHD risks for persons who would receive interventions of differing intensities (i.e., general dietary advice, dietary treatment, or drug therapy). Those who are candidates for drug treatment because of serum lipids alone are often at low levels of risk for the development of CHD when compared with those of the same age with lower TC values who have other risk factors. Discrepancies in CHD risk are wider still when age is also allowed to vary. Furthermore, in every age grouping, women with high TC levels (e.g., 6.9 mmol/L) and two other risk factors are eligible for drug treatment but have a CHD risk that is no higher, and often much lower, than that of males with one other risk factor and TC levels of 4.8 mmol/L or 5.7 mmol/L who are candidates for dietary advice or dietary therapy, respectively. CONCLUSIONS: Inconsistencies exist in the NCEP guidelines such that persons at low risk for the development of CHD are offered more intensive interventions than are other who actually are at much higher risks, and vice versa. Women in particular tend to be overtreated, relative to men. These findings point out the difficulties of promulgating guidelines that will appropriately match risk to preventive interventions in a complex multifactorial disease.

Adult↗

PubMed1991

Automated real-time data acquisition and analysis of cardiorespiratory function.

Microcomputer generation of an automated record without complexity or operator intervention is desirable in many circumstances. We developed a microcomputer system specifically designed for simplified automated collection of cardiorespiratory data in research and clinical environments. We tested the system during possible extreme clinical conditions by comparison with a patient simulator. Ranges used were heart rate of 35-182 beats per minute, systemic blood pressures of 65-147 mmHg and venous blood pressures of 14-37 mmHg, all with superimposed respiratory variation of 0-24 mmHg. We also tested multiple electrocardiographic dysrhythmias. The results showed that there were no clinically relevant differences in vascular pressures, heart rate, and other variables between computer processed and simulator values. Manually and computer recorded physiological variables were compared to simulator values and the results show that computer values were more accurate. The system was used routinely in 21 animal research experiments over a 4 month period employing a total of 270 collection periods. The file system integrity was tested and found to be satisfactory, even during power failures. Unlike other data collection systems this one (1) requires little or no operator intervention and training, (2) has been rigorously tested for accuracy using a wide variety of extreme patient conditions, (3) has had computer derived values measured against a standardized reference, (4) is reliable against external sources of computer failure, and (5) has screen and printout presentations with quick and easily understandable formats.

Computer Systems↗

PubMedDate not supplied

The intracellular equilibrium thermodynamic and steady-state concentrations of metabolites.

A new model for the organization and flow of metabolites through a metabolic pathway is presented. The model is based on four major findings. (1) The intracellular concentrations of enzyme sites exceed the concentrations of intermediary metabolites that bind specifically to these sites. (2) The concentration of the excessive enzyme sites in the cell is sufficiently high so that nearly all the cellular intermediary metabolites are enzyme-bound. (3) Enzyme conformations are perturbed by the interactions with substrates and products; the conformations of enzyme-substrate and enzyme-product complexes are different. (4) Two enzymes, catalyzing reactions that are sequential in a metabolic pathway, transfer the common metabolite back and forth via an enzyme-enzyme complex without the intervention of the solvent environment. The model proposes that the enzyme-enzyme recognition is ligand-induced. Conversion of E2S and E2P results in the loss of recognition of E2 by E1 and the concomitant recognition of E2 by E3. This model substantially alters existent views of the bioenergetics and the kinetics of intracellular metabolism. The rates of direct transfer of metabolite from enzyme to enzyme are comparable to the rates of interconversion between substrate and product within an individual enzyme. Consequently, intermediary metabolites are nearly equipartitioned among their high-affinity enzyme sites within a metabolic pathway. Metabolic flux involves the direct transfer of metabolite from enzyme to enzyme via a set of low and nearly equal energy barriers.

Biological Evolution↗

PubMed2000

Susceptibility to critical illness: reserve, response and therapy.

Risk of critical illness is determined both by genetic and environmental influences, particularly those relating to infectious and cardiovascular diseases. Physiologically-based scoring systems cannot measure prior risk because they do not quantify physiological reserve independently of the acute illness. Genetic profiling could be useful for risk assessment. Early detection of critical illness involves identifying physiological 'triggers' for referral; this requires the education of nursing and medical staff in their significance. Analysis of the relationship between risk factors and interventions may need complex modelling techniques. Therapeutic strategies depend on the nature of the underlying problem: the most useful are likely to be those which enhance tissue oxygen delivery and resistance to infection.

Critical Care↗

PubMedDate not supplied

Radiology of small bowel obstruction: contemporary approach and controversies.

The radiologic workup of patients with known or suspected small bowel obstruction and the timing of surgical intervention in this complex situation have undergone considerable changes over the past two decades. The diagnosis and treatment of small bowel obstruction, a common clinical condition often associated with signs and symptoms similar to those seen in other acute abdominal disorders, continue to evolve. This article examines the changes related to the use of imaging in the diagnosis and management of patients with this potentially dangerous problem and revisits pertinent controversies.

Barium Sulfate↗

PubMed1998

5 years' experience with a structured operative training programme for neurosurgical residents.

The operative neurosurgical training programme in our clinic was restructured from 1991-93 with the concept of having a frame for the categories and the volume of operations for training year 1 to 6 and to continuously escalate the complexity of the interventions. In the present report the experiences gained so far as well as the deficiencies are described. Between 1991 and 1995 the number of major neurosurgical operations was in the range of 2100 per year, and about 41-48% of these operations were done--under supervision--by residents. By slowly reducing the number of residents from 13 to 9, the trainees started to gain surgical experience earlier, and the average number of operations performed per year increased markedly (from 82 to 122), approximating more to our preplanned figures, also in the various categories. An important aspect is therefore to adapt the number of trainees relative to the available operative case material. According to our preliminary data, about 250-300 operations per year are needed to train adequately one resident. The evaluation also showed deficiencies in some categories, e.g., in pain treatment and peripheral nerve surgery, where care must be taken to better fulfil the official requirements. The object of a 6-year education is to offer a well balanced training programme with systematic escalation of surgical responsibility until full competency is reached. However, this goal needs to be defined more precisely. The plan presented recently by the Committee for Graduate and Postgraduate Education of the German Society of Neurosurgery [1] may serve as a proposal. A personal surgical log-book would allow a much better record and evaluation the progress of the individual trainee as well as the engagement of the teachers.

Clinical Competence↗

PubMed2006

[CT assisted mandibular osteodistraction with reconstruction of the temporomandibular joint and two piece maxilla].

BACKGROUND: The possibilities for computer assisted planning and its surgical conversion with stereolithographic templates are shown for complex maxillofacial surgical interventions. CASE REPORT: We describe the case of a patient with extreme micrognathia due to an ankylosis of the temporomandibular joint. In addition to the exact determination of the osteotomy lines on the mandibular angle and the segment osteotomy of the maxilla, vectors of the bidirectional osteodistraction were also predictable. CONCLUSION: In comparison with the conventional procedures, computer assisted planning achieved a much higher degree of precision and safety with reduced complication rates. The CMF module is a component of the SimPlant software which enables the precise planning of osteotomies and osteodistractions.

Adult↗

PubMedDate not supplied

Two sides of the same coin: Wnt signaling in neurodegeneration and neuro-oncology.

Wnts function through the activation of at least three intracellular signal transduction pathways, of which the canonical beta-catenin mediated pathway is the best understood. Aberrant canonical Wnt signaling has been involved in both neurodegeneration and cancer. An impairment of Wnt signals appears to be associated with aspects of neurodegenerative pathologies while overactivation of Wnt signaling is a common theme in several types of human tumors. Therefore, although therapeutic approaches aimed at modulating Wnt signaling in neurodegenerative and hyperproliferative diseases might impinge on the same molecular mechanisms, different pharmacological outcomes are required. Here we review recent developments on the understanding of the role of Wnt signaling in Alzheimer's disease and CNS tumors, and identify possible avenues for therapeutic intervention within a complex and multi-faceted signaling pathway.

Alzheimer Disease↗

PubMedDate not supplied

Management of anticipated and actual shoulder dystocia. Interpreting the literature.

Shoulder dystocia is a rare but serious obstetric complication that can result in significant neonatal and maternal morbidity and in costly litigation. Conflict exists in the literature regarding definition, incidence, predictability and preventability, relationship to neonatal injury, and appropriate management models. Anticipatory clinical interventions for potential shoulder dystocia have included ultrasound assessment of macrosomia; elective induction of labor; elective caesarean section; altered place of birth; and generous episiotomy/episioproctotomy. The authors note that these interventions often conflict with client desires and nurse-midwifery philosophy of birth, generate significant risks and costs in themselves, and do not address the poor predictability of shoulder dystocia. In recent literature, the safety and efficacy of maternal position change maneuvers (such as McRoberts maneuver, hands-knees position, and squatting) have been presented as methods to resolve most cases of shoulder dystocia. Despite the success of these more benign, external maneuvers, the episiotomy mandate remains in nearly all obstetric and midwifery texts and handbooks (1-8) and journal references (9-19). A literature review of related professional disciplines was undertaken to study these conflicts and to identify support for applying a philosophy of minimal, appropriate intervention to the complex issue of shoulder dystocia.

Delivery, Obstetric↗

PubMed2005

Safety of magnetic resonance imaging one to three days after bare metal and drug-eluting stent implantation.

Despite emerging evidence that magnetic resonance imaging (MRI) is safe within 8 weeks after bare metal coronary stenting, there are limited data on the safety of MRI imaging very early (1 to 3 days) after stent implantation and no published studies to date on the safety of MRI after insertion of drug-eluting stents (DESs). Forty-nine patients underwent cardiovascular MRI (1.5 T) at a median of 1 day after complex percutaneous coronary intervention. The average number of stents per patient was 2.2 +/- 1.1, and the average stent length per patient was 37.8 +/- 19.7 mm. In 15 of these patients > or =1 DES was used: paclitaxel DESs in 14 and sirolimus DESs in 1. In the DES group, the average number of stents was 1.75 +/- 1.0 per patient (3 patients received 3 DESs), and average DES length was 36.5 +/- 14.8 mm per patient. No acute thrombosis was recorded, and at 9-month clinical follow-up only 2 patients (4%) developed adverse events (1 target vessel restenosis and 1 nontarget vessel revascularization); these patients were in the non-DES group.

Adult↗