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 685 records · Page 38Linked to original sources

PubMed1997

Defining goals and conditions for a sustainable world.

Sustainable development is being approached component by component--socioeconomic, sustainable agriculture, transportation, forestry, energy use, cities, and the like--but, leaving a habitable planet for future generations will require the development of a widely shared paradigm. Further, the paradigm should be ecological from a scientific point of view. This development will be facilitated by a discussion of goals and those conditions necessary to meet them. The presently shared paradigm is that economic growth is the cure for all of society's problems, such as poverty, overpopulation, environmental degradation, and the increasing gap between rich and poor. A paradigm shift from growth to sustainability might result either from suffering painful consequences of continuing to follow out-moded paradigms or by discussing what sort of ecosystems will be available to future generations. The purpose of this paper is to help initiate such a discussion.

Ecosystem↗

PubMed1995

Major gene analysis for diseases and disorders of complex etiology.

Genetic analysis of complex diseases is undergoing a paradigm shift as the DNA technology and computational resources for analysis become more precise. In this review we compare the old paradigm for genetic disease analysis with the new, more powerful and efficient methods, which rely on the application of genetically linked markers. To illustrate the utility of the new approach, we apply it in the study of ankylosing spondylitis.

DNA↗

PubMed2003

[Medical care and long-term care insurance and clinical practice guideline for neurological disorders].

Society in 21st century is a global community, and undergoes a paradigm shift to a new value. This is about the significance of clinical practice guideline for neurological disorders as a new paradigm in information technology society and global community. Medical care is required to be "safer, more effective, more efficient and more transparent" in 21st century. In order to improve the quality of medical care, not only the improvement of the quality in manpower but also the betterment of the response to patients based on proper balance between quality and efficiency of medicine is required and clinical practice guideline for patients and medical doctors should be actively utilized. Guidelines are socially positioned following regulations, directives and recommendations and it is not restriction upon practitioner and patient decisions about appropriate health care. In the definitions of Institute of Medicine and Medline-MeSH, a word "assist" is used and it is said that guidelines are "means to realize EBM assisting decision making" for medical doctors to expertise their specialties. It has a significant meaning in connection with doctors' discretion. When clinical practice guidelines clarify the intended purpose and are applied as suggestion instead of obligation, they would not invade doctors' discretion.

Delivery of Health Care↗

PubMed2000

The Worldwide Web: a panacea or a nuisance for nurses?

This report describes the use of the Web in many arenas as new venture e-health companies are being created. There is much controversy over whether these companies provide appropriate access to health care information. There also are many debates on how these e-health companies alter the patient-provider relationship. Nurses are frontline caregivers who must understand this new market and the shift in how information is increasingly available to the patient. This information transference change is more apparent daily. How nurses handle this paradigm shift and their attitude toward these changes will result in them viewing the web as a panacea or a nuisance in their practice.

Humans↗

PubMed1996

Curriculum revolution: realities of change.

This article describes the experience of a generic nursing baccalaureate program's shift from a Tylerian model to a humanistic-educative model. A shift to a humanistic-educative model required a change in views, beliefs, and values of education and nursing practice. Kuhn's (1962) model for paradigm shift is used as a framework for presenting the stages of change which occurred, beginning with considerations to change the old curriculum model and continuing through implementation of the new. The issues which surfaced during implementation are presented. The struggles and realities of change are discussed in terms of how they affected and influenced this department of nursing's move to a new paradigm.

Curriculum↗

PubMed1996

Dissociating executive functions of the prefrontal cortex.

An analysis is provided of three distinct paradigms that have been used to study executive functions of the prefrontal cortex involving planning, self-ordered memory or attentional set-shifting. Psychological and anatomical dissociations are sought from the perspective of studies of patients with frontal lobe lesions, functional neuroimaging, psychometric studies in normal volunteers and experimental studies in non-human primates. Particular attention is paid to attempts to dissociate mnemonic from other executive capacities. Thus, patients with frontal damage are shown to have deficits in their (1) use of strategies to improve performance in a spatial working memory task and (2) capacity to make an extra-dimensional shift due to a high-order failure of inhibition in an attentional set-shifting paradigm. These results are discussed in terms of anatomical and neuropharmacological dissociations of different aspects of executive function within the prefrontal cortex shown in monkeys.

Animals↗

PubMed2003

Perceptual attentional set-shifting is impaired in rats with neurotoxic lesions of posterior parietal cortex.

The posterior parietal cortex (PPC) is believed to be involved in the representation of spatial information, including spatial attentional processing. Because the PPC is extensively interconnected with frontal cortical regions involved in attention and executive function, we sought to determine whether PPC was involved in nonspatial attentional processes such as those of the frontal areas to which it projects. Lesions of the medial frontal cortex (in rats) or lateral prefrontal cortex (in nonhuman primates) impair the ability to shift attention from one perceptual dimension of a stimulus to another (referred to as an extradimensional shift). Rats with neurotoxic lesions of the PPC tested in an attentional set-shifting paradigm demonstrated a pattern of impairment identical to that of rats with medial frontal cortex lesions: they were selectively impaired on the extradimensional shift phase of the task. Performance in other phases of the task was indistinguishable from that of control rats, including the ability to reverse a previously learned discrimination. These findings are consistent with models that assign the PPC a prominent role in cortical attentional processing networks, as well as a role for the PPC in processing information about expectancy and surprise. They also suggest, importantly, that the interaction between the PPC and the frontal cortex is not limited to spatial attentional processing.

Animals↗

PubMed2002

The Golgi apparatus: balancing new with old.

Most models put forward to explain cellular processes do not stand the test of time. The 'lucky' few that are able to survive extensive experimental tests and peer critique may eventually become dogmas or paradigms. When this happens, the amount of experimental data required to overturn the paradigm is extensive. To some, such inertia may seem prohibitive to scientific progress but rather, in our opinion, this helps to maintain a degree of coherence. It is needed so that experiments and interpretations may be conducted within relatively safe boundaries. In the field of protein transport in the secretory pathway, we have enjoyed a relatively stable and productive period for quite some time (more than 30 years!). It is only very recently that the field has entered into a phase where all bets seem to be off. As in any paradigm shift, the accumulation of experimental observations inconsistent with the old dogma eventually reached a critical point. As we 'reluctantly' dispense with the long-standing paradigm of forward vesicular transport, we face a time that is bound to be trying as well as exciting.

Animals↗

PubMed2025

The Application of Preventive Medicine in the Future Digital Health Era.

A number of seismic shifts are expected to reshape the future of medicine. The global population is rapidly aging, significantly impacting the global disease burden. Medicine is undergoing a paradigm shift, defining and diagnosing diseases at earlier stages and shifting the health care focus from treating diseases to preventing them. The application and purview of digital medicine are expected to broaden significantly. Furthermore, the COVID-19 pandemic has further accelerated the shift toward predictive, preventive, personalized, and participatory (P4) medicine, and has identified health care accessibility, affordability, and patient empowerment as core values in the future digital health era. This "left shift" toward preventive care is anticipated to redefine health care, emphasizing health promotion over disease treatment. In the future, the traditional triad of preventive medicine-primary, secondary, and tertiary prevention-will be realized with technologies such as genomics, artificial intelligence, bioengineering and wearable devices, and telemedicine. Breast cancer and diabetes serve as case studies to demonstrate how these technologies such as personalized risk assessment, artificial intelligence-assisted and app-based technologies, have been developed and commercialized to provide personalized preventive care, identifying those at a higher risk and providing instructions and interventions for healthier lifestyles and improved quality of life. Overall, preventive medicine and the use of advanced technology will hold great potential for improving health care outcomes in the future.

Humans↗

PubMedDate not supplied

Interpreting problematic behaviour in people with learning disabilities: 2.

The main theme of the first part (Vol 5(8): 546-50) of this two-part article was a focus on understanding the causative factors of problematic behaviour in people with a learning disability. A logical sequence to the identification of causes of problematic behaviours is that interactions to lessen such behaviours are identified. In this article, a discussion on interventions to guide nursing practice is offered. A short list of some interventions which emanate from the identified causes is presented in Table 1 for guidance; these interventions are analogous with many nursing and related theories (Peplau, 1952; Johnson, 1980; Wolfensberger, 1983; Roper et al, 1985; Jenner, 1992; Burford, 1993; Quinn and Mathieson, 1993). It is suggested that there is need for a paradigm shift to take place in the interpretation and understanding of problematic behaviours, and it is further suggested that nursing theories should be utilized within such a paradigm.

Humans↗

PubMed2002

Hemispheric asymmetry in human lateral prefrontal cortex during cognitive set shifting.

Functional organization of human cerebral hemispheres is asymmetrically specialized, most typically along a verbal/nonverbal axis. In this event-related functional MRI study, we report another example of the asymmetrical specialization. Set-shifting paradigms derived from the Wisconsin card sorting test were used, where subjects update one behavior to another on the basis of environmental feedback. The cognitive requirements constituting the paradigms were decomposed into two components according to temporal stages of task events. Double dissociation of the component brain activity was found in the three bilateral pairs of regions in the lateral frontal cortex, the right regions being activated during exposure to negative feedback and the corresponding left regions being activated during updating of behavior, to suggest that both hemispheres contribute to cognitive set shifting but in different ways. The asymmetrical hemispheric specialization within the same paradigms further implies an interhemispheric interaction of these task components that achieve a common goal.

Adult↗

PubMed1996

Measurement issues in curve-shift analysis of apomorphine effects on rewarding brain stimulation.

The direct dopamine agonist apomorphine has been reported to reduce the rewarding efficacy of lateral hypothalamic (LH) self-stimulation. This effect has been claimed to support the notion that dopamine mediates the rewarding effects of LH self-stimulation. Using a standard rate-frequency curve-shift paradigm with ascending order of frequency presentation, we also found that apomorphine (0.1-0.8 mg/kg, SC) appeared to decrease LH self-stimulation reward. These apparent rightward curve shifts were exacerbated by shortening the test duration, which also produced a number of sessions in which the subjects did not respond at all. When the presentation order of stimulation frequencies was reversed, apomorphine did not produce large reward decreases. These results suggest that the previously reported effects of apomorphine on LH self-stimulation were the result of artifact, perhaps related to apomorphine-induced stereotypical behavior combined with rapid pharmacological recovery.

Animals↗

PubMed2005

Minimally invasive surgery for gastric cancer--toward a confluence of two major streams: a review.

The minimalization of therapeutic invasiveness in order to preserve quality of life (QOL) is a major topic in the management of early gastric cancer. After laparoscopic surgery for gastric cancer was introduced by Kitano et al. in 1991, an enthusiasm to develop laparoscopic procedures has grown steadily. In the initial phase, early gastric cancer limited to the mucosal layer with no risk of lymph node metastasis was treated by laparoscopic wedge resection or intragastric mucosal resection. Since technical and instrumental advances in endoscopic treatment were achieved by gastroenterologists, these cases can be managed by intraluminal endoscopic approaches. The attention of surgeons then shifted to more radical procedures such as laparoscopic gastrectomy with lymph node dissection, which is comparable to open surgery and can be indicated even in advanced cancer. Although this paradigm shift has already been realized in the field of colorectal surgery, we must pay attention to the particular biological nature of gastric cancer in terms of the potential of peritoneal dissemination. While early-phase recovery after surgery has been improved by laparoscopic surgery, preservation of late-phase QOL by function-preserving surgery is also essential in this regard; therefore, the sentinel node (SN) concept has been a much-discussed topic in gastric cancer surgery to approach this aspect. Recently, the validity of the SN concept has been demonstrated by a number of single institutional studies, and prospective multicenter trials are currently ongoing. Theoretically, various types of function-preserving surgery could be applied in cases of early gastric cancer with negative SNs as less invasive surgery to improve long-term QOL. Although we still have to solve several remaining issues in the treatment of gastric cancers, a confluence of these two major streams, laparoscopic surgery and sentinel node navigation surgery, would enable us to apply a novel individualized minimally invasive approach, both in terms of degree of incisional access and extent of function preservation.

Gastrectomy↗

PubMed2001

The emergence of the microstatistical paradigm in managed care.

Although commentators have argued that managed care constitutes a paradigm shift in the American health care system, it is argued that the guiding organizational assumptions driving orthodox managed care arrangements (i.e., HMOs and capitation) have been drawn from a paradigm that is 300 years old: the business of insurance. As such, traditional managed care directives have taken a macrostatistical organizational viewpoint. However well a macrostatistical paradigmatic view serves certain constructs such as the business of insurance, it is far too coarse a method for organizing and reforming the badly fragmented production processes of health care. As a corrective complement, a new microstatistical paradigmatic view is coming of age whose methodological directives are based in the episode of care, and which will ultimately allow for a more highly refined pricing and care process system to emerge.

Capitation Fee↗

PubMed2006

Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder.

Reflecting a paradigm shift in clinical neuroscience, many chronic psychiatric illnesses are now hypothesized to result from perturbed neural development. However, most work in this area focuses on schizophrenia. Here, we extend this paradigm to pediatric bipolar disorder (BD), thus demonstrating traction in the developmental psychobiology perspective. To study amygdala dysfunction, we examined neural mechanisms mediating face processing in 22 youths (mean age 14.21 +/- 3.11 yr) with BD and 21 controls of comparable age, gender, and IQ. Event-related functional MRI compared neural activation when attention was directed to emotional aspects of faces (hostility, subjects' fearfulness) vs. nonemotional aspects (nose width). Compared with controls, patients perceived greater hostility in neutral faces and reported more fear when viewing them. Also, compared with controls, patients had greater activation in the left amygdala, accumbens, putamen, and ventral prefrontal cortex when rating face hostility, and greater activation in the left amygdala and bilateral accumbens when rating their fear of the face. There were no between-group behavioral or neural differences in the nonemotional conditions. Results implicate deficient emotion-attention interactions in the pathophysiology of BD in youth and suggest that developmental psychobiology approaches to chronic mental illness have broad applicability.

Adolescent↗

PubMedDate not supplied

Teaching becomes learning. Our lived experience.

Two teachers involved in the curriculum transformation process describe how they created and implemented a new learning environment with first-year nursing students in a basic baccalaureate nursing program. The authors have taught the introductory nursing course within this paradigm shift and describe the process of developing ends-in-view and relevant student experiences. They also reflect on the new meaning of the teaching-learning process within this paradigm.

Curriculum↗

PubMed2006

Bioactivation and hepatotoxicity of nitroaromatic drugs.

Certain drugs containing a nitroaromatic moiety (e.g., tolcapone, nimesulide, nilutamide, flutamide, nitrofurantoin) have been associated with organ-selective toxicity including rare cases of idiosyncratic liver injury. What they have in common is the potential for multistep nitroreductive bioactivation (6-electron transfer) that produces the potentially hazardous nitroanion radical, nitroso intermediate, and N-hydroxy derivative. These intermediates have been associated with increased oxidant stress and targeting of nucleophilic residues on proteins and nucleic acids. However, other mechanisms including the formation of oxidative metabolites and mitochondrial liability, as well as inherent toxicokinetic properties, also determine the drugs' overall potency. Therefore, structural modification not only of the nitro moiety but also of ring substituents can greatly reduce toxicity. Novel concepts have revealed that, besides the classical microsomal nitroreductases, cytosolic and mitochondrial enzymes including nitric oxide synthase can also bioactivate certain nitroarenes (nilutamide). Furthermore, animal models of silent mitochondrial dysfunction have demonstrated that a mitochondrial oxidant stress posed by certain nitroaromatic drugs (nimesulide) can produce significant mitochondrial injury if superimposed on a genetic mitochondrial abnormality. Finally, there may be mechanisms for all nitroaromatic drugs that do not involve bioactivation of the nitro group, e.g., AHR interactions with flutamide. Taken together, the focus of research on the hepatic toxicity of nitroarene-containing drugs has shifted over the past years from the identification of the reactive intermediates generated during the bioreductive pathway to the underlying biomechanisms of liver injury. Most likely one of the next paradigm shifts will include the identification of determinants of susceptibility to nitroaromatic drug-induced hepatotoxicity.

Benzophenones↗

PubMedDate not supplied

Transformational obstacles in special education.

Practitioners in the field of special education who embrace an alternative paradigm for understanding and educating students with learning problems often face the challenge of "job role dissonance" in the daily execution of their responsibilities. Such dissonance arises when their attempt to shift paradigms or simply restructure current practice is impeded by institutional obstacles. From an experiential perspective, the authors examine these obstacles and how they have affected the reframing of the field of learning disabilities. Specifically, they identify legal mandates, the systemic nature of schools, parents' belief systems, and time limitations of staff as impediments to a more healthy and viable service delivery to children. Finally, dissonance is proffered as a normal component of a true restructuring movement.

Education, Special↗