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PubMed1970

An obstacle in preparing alloisoleucine.

Alloisoleucine, prepared from a mixture of racemic isoleucine-alloisoleucine diastereoisomers, can be heavily contaminated with isoleucine if the recrystallization of acetyl-dl-alloisoleucine is controlled by melting point only. Two commercial specimens were found to be thus contaminated.

Crystallization↗
PubMed2002

Professional and organizational obstacles to establishing a new specialist service in primary care: case study of an epilepsy specialist nurse.

BACKGROUND: Few evaluations of the effectiveness of specialist nurse-led services explore the nurse's experiences, attitudes and qualities. This can help us to understand why a service has the effects it does and to inform new specialist nurses of potential difficulties. AIM: To explore the experiences, feelings and perceived problems of providing a new specialist nurse service from the nurse's perspective. METHODS: This was a case study nested within a controlled trial that assessed the effectiveness of an epilepsy specialist nurse-led service on the quality of patient care. In-depth interviews were conducted with the specialist nurse at the end of the first and second year of the new service. Interviews were audio-tape recorded and transcribed verbatim. Transcribed text was methodically coded and themes were identified. A descriptive account, summarizing the findings of both interviews, was written based on the thematic coding of text. RESULTS: Overall, the epilepsy nurse felt a sense of achievement and believed that the service had had a beneficial impact on both patients and health care professionals in the locality. However, she experienced many operational problems, especially adapting to a primary care setting, difficulties in meeting practice staff and in motivating them, and contending with a heavy workload. These problems were partly attributable to her lack of community work experience and more generally to the structure of the service. CONCLUSIONS: Findings indicate that specialist nurses responsible for providing primary care services would benefit from having theoretical knowledge and practical experience of working in the community prior to starting in post. The aims of a service need to be consistent with the available resources. Accounts of other specialist nurse's experiences of providing a primary care service could help to reduce set up time. Finally, support in the form of a coherent team is important to avoid feelings of professional isolation and to maximize effective use of specialist skills.

England↗
PubMed2003

Unsatisfied basic needs of older patients in emergency care environments - obstacles to an active role in decision making.

Little attention is paid in Emergency Care Units (ECUs) in Sweden to the special needs of older people. The aim of this study was thus to analyse older people's basic needs in the emergency care environment. The study was carried out with a life-world interpretative approach, and the theoretical framework for interpretation was Abraham Maslow's theory of motivation and personality. Seven informants aged between 65 and 88 years, with various experiences of being patients with urgent as well as non-urgent health-related problems, were interviewed about their experiences of ECU care. Their basic needs at the lower levels of Maslow's hierarchy were well-represented in the data. Higher needs, such as desire to know and understand, appeared to be totally neglected. Safety needs dominated the whole situation. Our conclusion is that standards of care must be developed in Sweden to make older patients feel safer and more secure in ECUs. Furthermore, the principles of nursing care for older patients need to be defined in order to encourage them to take an active part in their own health process.

Aged↗
PubMed2002

Impaired endocytosis may represent an obstacle to gene therapy in polycystic kidney disease.

BACKGROUND: Autosomal-dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disease and a frequent cause of chronic renal failure. The cloning of the PKD1 and PKD2 genes, which are mutated in the great majority of patients with this disease, opens up the opportunity for somatic gene therapy by introduction of the wild-type gene or cDNA. Several publications have provided evidence, that many portions of the nephron and the collecting duct can form cysts, including the proximal tubule. Alterations in the proximal tubule may prevent the efficient endocytosis of filtered proteins and thus contribute to proteinuria, a frequent symptom in patients with polycystic kidney disease. At the same time this may also negatively affect various gene therapy strategies, since endocytosis is important for the uptake of foreign DNA at least under some circumstances. In the (cy/+) rat, a widely used animal model for ADPKD, cysts almost exclusively develop from proximal tubules, and we have therefore investigated whether proteinuria and defective endocytosis also occur in this model. METHODS: Proteinuria was demonstrated by direct measurement and by protein gel electrophoresis of urines from 16 week-old (cy/+) rats. Endocytosis was investigated by injection of FITC-dextran and immunohistochemical staining with anti-ClC-5 and anti-megalin antibodies. RESULTS: Similar to the observations made in ADPKD patients, proteinuria also develops in the (cy/+) rat. Using FITC-labeled dextran as an in vivo tracer for renal tubular endosomal function, we could show that portions of cyst-lining epithelia from proximal tubules have lost the ability to endocytose, which is necessary for the reabsorption of albumin and lower-molecular-weight proteins. By immunohistochemistry the expression of other proteins implicated in endocytosis, such as the chloride channel ClC-5 and the albumin receptor megalin, correlated well with the presence and absence of FITC-dextran in cyst wall epithelia. CONCLUSION: These data indicate that proteinuria and albuminuria in the (cy/+) rat model for ADPKD are due to a loss of the endocytic machinery in epithelia of proximal tubular cysts. Such a defect may also reduce the efficacy of certain gene therapy protocols.

Animals↗
PubMedDate not supplied

Supports and obstacles to cancer survival for Hawaii's native people.

PURPOSE: Investigators have suggested that high cancer mortality rates among Native Hawaiians are due to fatalistic attitudes toward the disease, poor access to care, and lack of consideration of Native Hawaiian cultural values in Western approaches to healthcare. This study used qualitative methods to examine these factors in Native Hawaiian cancer survivors. METHODS: Eight focus groups were held on five islands, attracting 45 Native Hawaiian cancer survivors from both rural and urban locales. The focus groups explored survivors' experiences with cancer diagnosis, treatment, and recovery. Participatory research methods were used, with researchers gaining community input on study design, incorporating appropriate Native Hawaiian cultural protocols into the focus groups, and engaging participants in the interpretation of the data. RESULTS: Similar to cancer survivors of other ethnicities, these individuals demonstrated the following: success in accessing healthcare information, professionals, facilities, and insurance; the ability to overcome the barriers confronted; and proactive health behaviors regarding screening, diagnosis, and treatment. They also demonstrated ways in which they were sustained through the cancer experience by Native Hawaiian traditions, such as helping others, gaining strength from Hawaiian spiritual beliefs, and relying on family for personal support. Participants did not respond passively to their cancer diagnoses, and they expressed few fatalistic attitudes. Participants did give numerous examples of other Native Hawaiians who did not seek screening or treatment for cancer because they lacked insurance, had poor access to care, or felt alienated by Western healthcare. CLINICAL IMPLICATIONS: The findings suggest that improving access to care and incorporating cultural values in health education and services can enhance survivorship and quality of life for Native Hawaiians with cancer. These themes may have applications for other minority groups.

Attitude↗
PubMed1975

Obstacles in implementation of higher unit dosage of psychotropics drugs.

Practitioners, nurses, pharmacists and patients themselves must be considered in a discussion of higher unit dosage of psychotropic medication. Physicians need postgraduate education to overcome their reluctance to prescribe higher unit dosages. Nurses need in-service training regarding principles in clinical pharmacology to comply with changing prescribing practices. Higher unit dosage leads to less medication error and frees considerable nursing time. Pharmacists face a problem in inventory costs, therefore are reluctant to stock a variety of dosages. Patients taking multiple medications in high dosages hesitate to take large numbers of low dosage pills, thus patient compliance is enhanced with higher unit dosage. Blood level data on formulations of higher unit dosage should be the basis of FDA considerations, rather than treating a higher unit dosage as a new drug. The final responsibility in providing higher unit dosage rests with the pharmaceutical companies. However, the introduction of higher unit dosage should not be used as a justification to increase cost per milligram of the same medication. Utilization of a different salt to introduce a higher unit dosage should be done only if there is substantial difference between the new salt and the one already available.

Costs and Cost Analysis↗
PubMed2001

[Data protection--an obstacle for prospective studies? Solutions exemplified by a cohort study].

Prospective studies require the storage of the participants' personal data for follow-up. This demands special precautions for the protection of these data. Additional to the informed consent of the participant which enables the researchers to collect the prospective study data, the participant's right of informal self-determination should be protected. In the EPIC (European Prospective Investigation into Cancer and Nutrition) Potsdam study, therefore, an internal trustee was established that collects follow-up information from participants, physicians, clinics, health offices, tumour and population registries with the aim to obtain valid information on vital status and diseases of the participants. The internal trustee is a spatial and organizational separated working group. The isolated electronic data processing network, the alarm system which controls the rooms of the working group, the access control for employees are special security arrangements. During follow-up the individual identification number of the study data base is replaced by a specific identification number solely for the follow-up. Further, unique identification numbers are allocated to every single action and every single document such as inquiry forms which are sent to physicians, health offices, or population registries, that allow anonymous mailing and processing of the collected information. On copies of important documents, the name is erased and replaced by a specific record number. The inquiry forms for the physicians, for instance, contain the name of the participant at the head which has to be cut off before returning the form to the internal trustee. The identification number is also printed as bar code on each document facilitating its processing with technical aids such as scanners. If checkbacks are necessary, only certain work group members are able to reconnect the document number with the name. Depending on the task, the computer programmes confine automatically the details presented to the assistant. All arrangements to protect personal data do not interfere with research interests; on the contrary they lead to an efficient work routine and guarantee follow-up according to international rules.

Cohort Studies↗
PubMedDate not supplied

[Unreported cases--obstacle to exact research in clinical orthopedics and traumatology].

In number 2 1991 of the "Orthopädie Mitteilungen" we referred to problems in obtaining valid data in orthopaedics and orthopaedic traumatology. There we mentioned several unknown cases in the epicrisis related to anamnestic facts. Now we continue the report with the support of our completely quality checked basis documentation. The comparison of the operation-report and the epicrisis shows us that data in three out of four cases are identical. We get nearly the same result, if we compare the operation-site (left or right are in four out of five cases identical). Furthermore we discuss a critical research of aneurysmatic bone cysts out of 24,000 epicrisis. Research into benign tumors or tumorlike lesions is very difficult, because the patients normally leave the hospital before the exact diagnosis was made. Therefore we must take into account uncertain results of our investigations. As far as possible our results take into account rare bibliographic data. Therefore we can show that our modified documentation of all epicrisis should be preferred to documentation of specific forms. Furthermore the investigation demonstrates, that our "frame coding system" is superior to a "precise coding system" for the precise system does not regard the background of the inquiries. But considering the background, we are able to discover most of the unknown cases and make them part of our conclusions.

Humans↗
PubMed2005

Forced solitary waves and fronts past submerged obstacles.

Herein, an efficient numerical method is presented to describe the flow of a liquid in an open channel with various types of bottom configurations. The method is developed for steady two-dimensional potential free surface flows. The resulting nonlinear problem is solved numerically by boundary integral equation methods. In addition weakly nonlinear solutions are derived. New solutions which complement those of Dias and Vanden-Broeck [J. Fluid Mech. 59, 93-102 (2004)] are presented. Furthermore some solutions for channel flows past dips in the bottom are discussed.

Algorithms↗