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PubMed2004

[What is the profile of palliative care in Germany. Results of a representative survey].

Since 1996 a working group of palliative care physicians has been developing a core documentation for palliative facilities. The data on a total of 1304 patients were collected in 2001. Treatment in palliative care units was provided for 531 patients until their death (Pat-V), 604 patients could be discharged home, and 169 patients were transferred to other facilities (Pat-E). Infusion therapy, physical therapy, positioning and mobilization, together with counseling and social services were initiated in more than 30% of the patients, while specific measures such as ascites or pleura puncture were instituted in less than 10%. Chemotherapy, radiotherapy, immunotherapy, urinary catheter, physical therapy, mobilization, positioning, psychotherapy, and social services were documented more frequently in the Pat-E group than in the Pat-V group. Chemotherapy was started in only 35 patients and radiotherapy in only 31 patients while they were in the palliative care unit. Parenteral nutrition, infusion therapy, wound management, and counseling were documented more frequently in the Pat-V group. Advanced directives were available for 9,9% of the patients omission or discontinuation of therapies was documented for 28,1%. Specific indications for the quality of palliative care provided could not be identified with the documentation instruments applied. The core documentation does however furnish data from a representative sample of in-patient palliative care in Germany, which can be used as a comparative data pool for other studies and quality assurance measures.

Death↗
PubMed1992

Ethical issues in genetics.

Clinical genetics encompasses all ethical issues in medicine and health care. Geneticists, like all health care practitioners, regularly encounter problems of truth telling, paternalism, confidentiality, and rationing. The facts and circumstances under which familial ethical questions arise differ among specialties, but the underlying ethical questions cut across disciplines. The purpose of this article is to provide a review of the ethical issues that commonly arise in the clinical practice of genetics. Accordingly, the goal is primarily to identify common positions and justifications for various approaches as well as to identify consensus where they seem to exist.

Directed Tissue Donation↗
PubMed2003

A review of psychosocial interventions in infertility.

Counselling has been strongly recommended by numerous governmental, medical and community associations to help infertile people. The purpose of this review was to determine whether psychosocial interventions improved well-being and pregnancy rates, and to identify the kinds of interventions that were most effective. A systematic search identified all published and unpublished papers in any language and any source that (1) described a psychosocial intervention and (2) evaluated its effect on at least one outcome measure in an infertile population. A total of 380 studies met the first criteria but only 6.6% (n=25) of these were independent evaluation studies. Analysis of these studies showed that psychosocial interventions were more effective in reducing negative affect than in changing interpersonal functioning (e.g., marital and social functioning). Pregnancy rates were unlikely to be affected by psychosocial interventions. It was also found that group interventions which had emphasised education and skills training (e.g., relaxation training) were significantly more effective in producing positive change across a range of outcomes than counselling interventions which emphasised emotional expression and support and/or discussion about thoughts and feelings related to infertility. Men and women were found to benefit equally from psychosocial interventions. Directions for future research on the evaluation of psychosocial interventions are discussed.

Counseling↗
PubMed2000

Misconceptions about STD-protective behavior. Project RESPECT Study Group.

CONTEXT: Misconceptions about STD-protective behaviors have not been studied before and after STD counseling. Further, to the best of our knowledge, the relationship of these misconceptions to condom use and STD incidence has not previously been described in published reports. OBJECTIVES: The main purpose of the study was to determine the prevalence of misconceptions about STD prevention among STD clinic attendees (N=3498) in five large cities, as well as whether misconceptions decreased after STD diagnosis, STD counseling, or both. The study also identified predictors of persistent misconceptions and determined the relationship of STD incidence and unprotected sex to persistent misconceptions. METHODS: Data from a randomized controlled trial evaluating HIV/STD counseling interventions (Project RESPECT) were used for the present analyses. Participants completed an interview upon study enrollment and every 3 months following enrollment for a 1-year period. A portion of the interview assessed participants' misconceptions about STD-protective behaviors. RESULTS: At baseline, 16.3% believed that washing the genitals after sex protected from STDs. Likewise, urinating after sex (38.7%), douching (45.7%), and use of oral contraceptives (19. 9%) were believed to prevent STDs. Prevalence of misconceptions was significantly diminished at a 3-month follow-up (p<.001). Those continuing to have misconceptions were more likely to be aged > or = 24 and African American. Those continuing to have these misconceptions did not have higher STD incidence. CONCLUSIONS: Misconceptions about STD-protective behaviors are common, and the event of an STD or STD counseling or both generally reduces these misconceptions. Although these misconceptions may not directly translate into risky behavior, they may preclude movement toward safer sex.

Adult↗
PubMed1998

Health Initiatives for Youth: a model of youth/adult partnership approach to HIV/AIDS services.

Health Initiatives for Youth (HIFY) in San Francisco, California, is an innovative organization providing health-related services for and by young people funded in part by the Special Projects of National Significance (SPNS) Program. The HIFY Youth Health Initiative (YHI) is composed of eight youth staff and aims to bring about individual and systemic change, enhance the quality of life for human immunodeficiency virus (HIV)-positive and at-risk young people, and increase the responsiveness and youth sensitivity of organizational and community systems. Comprehensive services have been delivered to 136 young men under 25 years, 33.1% of whom are HIV positive, and 164 young women, of whom 12.2% are HIV positive. In addition, thousands of youth and young adults have received lower-intensity services through dozens of educational workshops and presentations. YHI services are implemented through a comprehensive collection of education, training, and support activities that benefit the youth staff who produce them, along with the participants who benefit from the services provided. These activities include a speaker's bureau, health and advocacy trainings, internships, return-to-work and life skills training, publications, and conferences. Regional and national findings suggest that many youth do not yet comprehend their risk for HIV infection or understand the impact of HIV on their community. In direct response to these needs, HIFY programs inform and encourage access to counseling and testing, and provide meaningful access to adolescent care, treatment, and services.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Research promoting better patient education on reproductive health after cancer.

Although research on cancer survivors' experiences and attitudes about infertility is relatively new, existing literature suggests that only about half of men and women of childbearing age receive the information they need from their health care providers at the time of diagnosis and treatment planning. Thus, better patient education strategies are needed. Although the ideal would be to have oncologists conduct detailed discussions of options to preserve or restore fertility with all interested patients, this standard is unrealistic. A more practical alternative is to train nonphysician providers such as nurses and social workers to address this topic. In addition, innovative strategies of direct patient education could be helpful, including use of computerized media, peer counseling, or special educational modules tailored to a particular age group or cancer site.

Adolescent↗
PubMed2001

Preventing needlesticks in emergency medical system workers.

Emergency medical system (EMS) workers frequently use sharp devices in injury-prone circumstances that involve limited visibility, confined spaces, rapidly moving vehicles, and uncooperative victims. This study examined the efficacy of an automatic self-retracting lancet in reducing needlestick injuries and related direct and indirect costs. Subjects were 477 active-duty EMS workers. Counseling, laboratory testing (hepatitis B and C, hepatic function enzymes, and human immunodeficiency virus), antiviral prophylaxis, and immunizations were provided according to US Public Health Service guidelines. Baseline and biennial laboratory testing for hepatitis B and C and liver function enzymes were conducted. After the introduction of a spring-loaded automatic-retracting type glucometer lancet device, needlestick injuries decreased from 16 per 954 EMS worker-years to 2 per 477 EMS worker-years. The annualized cost of treatment declined from $8276 to $2068. The change to a self-retracting device decreased the number of needlestick injuries and was cost-effective with a minimal increase in device cost (annualized $366 per year).

Accidents, Occupational↗
PubMed2004

Diagnostic radiography in pregnancy: risks and reality.

BACKGROUND: The use of X-rays, computed tomography scanning and nuclear medicine imaging in the pregnant woman is a source of great anxiety for the patient, her family and the treating doctor. METHODS: A literature review of appropriate databases, articles and relevant institutional protocols was performed. Data was sought regarding any adverse effects of diagnostic radiation in pregnancy, fetal absorbed dose of diagnostic radiation and how the timing of exposure and form of administration might influence these effects. RESULTS: The estimated radiation dose for a fetus from background sources as well as medical imaging was identified. Most diagnostic radiation procedures will lead to a fetal absorbed dose of less than 1 mGy for imaging beyond the abdomen/pelvis and less than 10 mGy for direct or nuclear medicine imaging. Potential adverse outcomes related to radiation exposure during pregnancy include teratogenicity, genetic damage, intrauterine death and increased risk of malignancy. The only adverse effect statistically proven at the dose levels associated with diagnostic radiation procedures is a very small increase in childhood malignancy, with an estimated increase of one additional cancer death per 1700 10 mGy exposures. The important exception was the risk to the fetal thyroid from radioiodine exposure after 12 weeks' gestation. CONCLUSION: In practice, diagnostic radiography during pregnancy not involving direct abdominal/pelvic high dosage, is not associated with any significant adverse events. Counselling of pregnant women who require diagnostic radiographic procedures as well as those inadvertently exposed should be based on the available human data with an emphasis on the minimal impact of such procedures.

Female↗
PubMed1994

Omnibus Budget Reconciliation Act of 1990 and voluntarism: logistic regression analysis of pharmacist responsibility.

OBJECTIVE: To examine the relationship between pharmacists' willingness to assume further professional responsibilities, as measured by attitudes to the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) requirements, and their attitudes toward voluntarism as their responsibility to society and their level of interest in their jobs. DESIGN: A survey was distributed to a convenience sample of 443 pharmacists who were asked to indicate their responses on a number of items. SETTING: Surveys were distributed to participants in an annual pharmacy continuing education program. PARTICIPANTS: The response rate was 65 percent with completed surveys from 290 Florida pharmacists who were typically male (73 percent) and practicing in the community setting (39 percent) for over 25 years (33 percent). MAIN OUTCOMES: Questions were aimed at gathering the following information: (1) demographics; (2) attitudes concerning the benefits of the three OBRA '90 requirements: patient counseling, prospective drug-use review (DUR), and information recording; (3) attitudes toward voluntarism; and (4) job interest. RESULTS: Pharmacists tended to agree that all three of the OBRA '90 mandates will be beneficial. Fifty-six percent favored the prospective DUR requirements, while 68 percent favored the patient counseling requirements and 66 percent favored the information-recording requirements. Logistic regression analysis showed that unit increases in scaled responses, indicating more favorable attitudes toward believing that voluntarism was one's responsibility, increased the odds of favoring counseling by 38.7 percent and information recording by 32.4 percent. A similar directional relationship was found for the DUR requirement. Job interest did not add to the predictive ability of the variables already in the models. CONCLUSIONS: This study suggests a possible association between pharmacists' attitudes toward social responsibility and their acceptance of expanded professional responsibility.

Attitude of Health Personnel↗
PubMed2006

Mechanisms, manifestations, and management of digoxin toxicity in the modern era.

Because of the common use of digoxin and because of its narrow therapeutic index, digoxin toxicity has been prevalent historically and, therefore, most clinicians are well aware of the classical dose/concentration-related signs and symptoms of toxicity. Yet, in the modern era the incidence of digoxin toxicity has been declining for a variety of reasons, including a new (lower) therapeutic range, the development of more effective drug therapies for heart failure, and more accurate dosing methods. In addition, digoxin toxicity, once commonly fatal, can now be quickly and effectively treated by the emergency administration of antidigoxin Fab fragments. Indeed, it may be possible to expand the use of Fab fragments to select patients with non-life-threatening digoxin toxicity, in order to save costs and improve patient comfort. Most cases of digoxin toxicity are caused by inappropriately high dosages, which are usually prescribed in the setting of renal dysfunction, while other cases can be attributed to system errors such as multiple prescriptions, poor patient counseling, or errors in transcribing. With modern computerized prescribing systems, such as direct physician order entry and prompts that alert the clinician to the potential for error, it is possible to decrease the incidence of digoxin toxicity even further. A realistic goal is to nearly eradicate once commonplace digoxin toxicity or at least make its occurrence a rare event.

Adverse Drug Reaction Reporting Systems↗
PubMed2000

Effectiveness of HIV prevention interventions in developing countries.

OBJECTIVE: To review the effectiveness of projects and programs in developing countries that aim to reduce sexual transmission of HIV infection or transmission related to injection drug use. DESIGN: We identified 34 published studies undertaken in 18 developing countries that met rigorous inclusion criteria. These criteria included the length of follow-up, use of statistical analysis, the inclusion of a comparison group, and type of outcomes measured. RESULTS: We found that behavioral change interventions are effective when targeted to populations at high risk, particularly female sex workers and their clients. Few studies have evaluated harm reduction interventions in injecting drug users (IDUs). Evidence on the effectiveness of voluntary counseling and testing programs was promising, and VCT was most effective when directed at discordant couples. Treatment of sexually transmitted diseases (STD) appears highly effective in reducing HIV/STD transmission, particularly in the earlier stages of the epidemic. CONCLUSIONS: This review demonstrates that HIV prevention interventions can be effective in changing risk behaviors and preventing transmission in low and middle-income countries. When the appropriate mix of interventions is applied, they can lead to significant reductions in the prevalence of HIV at the national level. Additional research is needed to identify effective interventions, particularly in men who have sex with men, youth, IDUs and HIV-infected persons. Structural and environmental interventions show great promise, although more evaluation is needed.

Developing Countries↗
PubMed1992

Conservative treatment methods in craniomandibular disorder.

Conservative methods should be a basic treatment principle in CMD. In spite of similar signs and symptoms, the etiology may vary and treatment should, if possible, be directed towards the cause, but the management may often just be mitigating. Counselling may be crucial. Occlusal appliances of different design obviously influence the muscular activity significantly but equilibration may include a strong placebo effect. While relaxation is incompletely investigated, biofeedback seem possibly effective. The application of physical medicine procedures is almost entirely empirically based. Experience from other areas also motivates pharmacotherapy in CMD while intra-articular injections seem reasonably well founded. Investigations of pain-alleviating methods like TENS and acupuncture, though sometimes promising, are often uncontrolled. Manipulation, even if effective, may not necessarily be a "disc recapturing" manoeuvre. The results of conservative treatment for joint clicking seem unpredictable and long-term results of treatment with repositioning splints are not encouraging. A need for well-controlled, randomised clinical studies in diagnostic subgroups and controls has been expressed. Although most patients with CMD can be successfully treated with different conservative methods, often with remarkably similar results, other options must be considered for some.

Biofeedback, Psychology↗
PubMed2004

Triaging patients with post-abortion complications: a prospective study in Nepal.

The first manual vacuum aspiration (MVA) services unit in Nepal was established in 1995 at the country's largest national maternity hospital in Kathmandu. This research sought to assess and evaluate the safety, acceptability, and effectiveness of MVA services. This prospective study was conducted during 12 months in 1998, and follow-up was made at six weeks. Two groups of patients were compared: 529 patients treated in the MVA unit and 236 patients who were clinically eligible for treatment in the MVA unit but were treated instead in the main operation theatre (OT) owing to the unavailability of services in the MVA unit during the hours of their admission. The two groups differed with respect to some of their background characteristics but were similar in their clinical characteristics. The MVA group received contraceptive counselling and services and had significantly shorter stays in hospital. However, the direct cost incurred by the patients, regardless of the type of facility they used, was about the same. Follow-up at six weeks revealed that the MVA patients had significantly fewer complaints and were generally more satisfied with the services they had received than their counterparts. Slightly more than half of the women in the MVA group were using contraception at the time of follow-up compared to no women in the OT group. It is concluded that the MVA unit provided safe, effective, and efficient services to about 50% of all the patients admitted to the hospital with post-abortion complications. An additional 25% of the post-abortion patients could be served if the unit were kept open 24 hours a day, saving resources and time for patients and hospital staff. As a parallel development, both MVA and main OT services would need to be more effectively integrated with outside antenatal and family-planning clinics to address the reproductive health needs of women, thereby reducing the number of patients requiring post-abortion care.

Abortion, Induced↗
PubMedDate not supplied

"Just therapy" with families on low incomes.

This article addresses the inadequacies of counseling, therapy, and social work that occurs with low-income families. The author argues that many families who seek help arrive with problems that are usually assessed separately from their socioeconomic and cultural contexts. Careful questioning will often lead to the discovery that the onset of many family problems are located in events external to the family, such as unemployment, bad housing, and racist, sexist, or heterosexist experiences. They can be extremely depressing ongoing experiences that eventually lead parents and children into a state of stress that opens them up to physical and mental illnesses. This article argues that a wide body of research supports such a view and that counseling, therapeutic, and social work practices should address these issues much more directly. It also argues that practitioners have an important role to play in social and economic policy development out of respect for their clients' struggles.

Culture↗
PubMed1991

Molecular markers of fragile X: clinical aspects of carrier detection and prenatal diagnosis.

In our families, a determination of carrier or affected status was made in more than 75% of cases using a standard panel of five marker systems: three proximal (F9, DXS105, DXS98) and two distal (F8, DXS52). Five additional systems, three proximal (DXS10, DXS51, DXS102) and two distal (DXS15, DXS33), were used in cases resistant to analysis with the standard panel. In 60% of cases, flanking markers were identified (proximal and distal). Utilizing the complete panel, only 5% of cases did not have any informative markers identified. In order to facilitate the appropriate application of molecular methods, several simple rules should be followed by the genetic service provider when dealing with fra(X) families: 1. Cytogenetic prescreening of females may be helpful. Only negative or ambiguous fra(X) expression levels justify the labor-intensive DNA-based family studies. 2. At present, DNA-based studies are the only way to ascertain male carrier status. 3. Every effort should be made to perform DNA-based studies under maternal phase-known conditions. 4. Information should be collected and pedigrees prepared for both sets of maternal grandparents. 5. Fathers of female consultands should be directly DNA-typed to rule out non-paternity. 6. Genetic counseling should be conservative, i.e. the "worst" scenario presented to these families, in order to avoid underestimating the risk of transmission to the next generation.

Cells, Cultured↗