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PubMedDate not supplied

Physician-patient interaction and hysterectomy decision making: the ENDOW study. Ethnicity, Needs, and Decisions of Women.

OBJECTIVE: To investigate physician-patient communication in the context of hysterectomy decision making. METHODS: A series of 17 focus groups with African American and white women (n=82) between the ages of 30 and 65 were run. Personal interviews with physicians (n=7) also were conducted. Transcripts were analyzed using NUD*IST software and note-based techniques. RESULTS: For both patients and physicians, the optimal physician-patient interaction would be for the physician to provide plain, usable information to the patient allowing the patient to make the hysterectomy decision. CONCLUSIONS: The current state of physician-patient interaction represents collaboration but not a shared approach approximating the deliberative model.

Adult↗
PubMed1999

Mental health services for children who witness domestic violence.

Exposure to domestic violence has significant negative repercussions for children's social, emotional, and academic functioning. In the past decade, mental health professionals have developed treatment programs and approaches aimed at mitigating these deleterious effects. Their efforts, however, are often hampered by difficulty identifying and gaining access to the target population because the occurrence of domestic violence remains a family secret in many households. Clinicians and researchers have published descriptions of group and individual therapy approaches for children who witness domestic violence. These approaches share several goals: promoting open discussion about children's experiences with domestic violence, helping children to deal with the emotions and consequences that follow such exposure, reducing the problematic symptoms children experience, strengthening children's relationships with their nonabusive caregivers, and helping children and their families to create and maintain relationships and living situations that are free from violence and abuse. One limitation of the literature describing these interventions is the absence of controlled outcome studies demonstrating the effects of these programs, in the short and long terms. Thus, development of such evaluative components is an important future direction for this field. Some of the other challenges that confront clinicians include working with children's families, addressing children's complex and intense emotional experiences, and determining whether children have themselves been victims of abuse or neglect (and then interfacing with child protective services).

Child↗
PubMed2002

Kinetic modeling in positron emission tomography.

Most PET kinetic modeling approaches have at their basis a compartmental model that has first-order, constant coefficients. The present article outlines the one-, two-, and three-compartment models used to measure cerebral blood flow, cerebral glucose metabolism, and receptor binding, respectively. The number of compartments of each model is based on specific knowledge of the physiological and/or biochemical compartments into which the tracer distributes. Additional physical and biochemical properties of the tracer distribution are considered in specifying the use of first-order rate constants. For example, in cerebral blood flow and receptor binding studies transport across the blood-brain barrier by diffusion can be modeled as a first-order process. A saturable carrier-mediated process or saturable enzyme catalyzed reaction, when tracer doses of the labeled substrate are used and the natural substrate is in steady-state, also results in first-order rate constants, as in glucose metabolism studies. The rate of ligand binding, on the other hand, depends on the concentrations of both substrate and available receptors. In order to appropriately model the reaction as pseudo first-order during a specified experimental interval, protocols are carefully designed to assure that the number of available binding sites remains approximately constant throughout the given interval. A broad array of scanning protocols is employed for kinetic analyses. These include single-scan approaches, which function like their autoradiographic counterparts in animal studies and are often called "autoradiographic" methods, which allow estimation of a single parameter. Dynamic scanning to obtain the time course of tissue activity allows simultaneous estimation of multiple parameters. Scanning may be conducted during a period of tracer uptake or after attainment of steady-state conditions. All quantitative modeling approaches share the common requirement that an arterial input function be measured or an appropriate surrogate be found. A vast array of methods is available for estimation of model parameters, both micro and macro. In the final analysis, it is the interaction among all elements of the PET study, including careful tracer selection, model specification, experimental protocol design, and sound parameter estimation methods, that determines the quantitative accuracy of the estimates of the physiological or biochemical process under study.

Animals↗
PubMedDate not supplied

Sharing good practice in the care of older people.

Good nursing care, informed by best practice, is an integral part of achieving positive health outcomes for older people. The first article in a two-part series on gerontological nursing discusses collaboration between higher education and clinical practice which aims to improve practice in the specialty. It outlines the development of a Scottish project that promoted such an exchange of information by holding regular forums. The project has been a success and it is hoped that it will lead to the establishment of a centre of excellence for gerontological care. Next week's article focuses on the shared approach to care.

Aged↗
PubMed2003

ICT in health care: sociotechnical approaches.

The importance of the social sciences for medical informatics is increasingly recognized. As ICT requires inter-action with people and thereby inevitably affects them, understanding ICT requires a focus on the interrelation between technology and its social environment. Sociotechnical approaches increase our understanding of how ICT applications are developed, introduced and become a part of social practices. Socio-technical approaches share several starting points: 1) they see health care work as a social, 'real life' phenomenon, which may seem 'messy' at first, but which is guided by a practical rationality that can only be overlooked at a high price (i.e. failed systems). 2) They see technological innovation as a social process, in which organizations are deeply affected. 3) Through in-depth, formative evaluation, they can help improve system design and implementation.

Computer Communication Networks↗
PubMed2004

Acquisition protocol considerations for combined PET/CT imaging.

UNLABELLED: Since its introduction in 1998, dual-modality PET/CT imaging has received great attention in the medical community. For the first time, patients can be examined with both CT and PET in a single examination. A whole-body survey is the standard mode of acquisition. The CT images are used for anatomic reference of the tracer uptake patterns imaged in PET, as well as for attenuation correction of the PET data. The routine use of CT-based attenuation correction and user preferences for the quality and type of the CT examination have led to the introduction of different PET/CT scanning protocols. DISCUSSION: Two general approaches to PET/CT imaging can be distinguished today. One uses CT as a fast transmission source with little additional information for anatomic labeling. The other uses CT as a fast transmission source as well as a state-of-the-art diagnostic tool to maximize image quality using optimal acquisition parameters together with oral and intravenous contrast agents. Variations of these approaches share common concerns about image artifacts that result from mismatches in respiration and patient positioning between the CT and the PET examinations. Protocol requirements for the more complex radiologic PET/CT scenario also include alternative contrast application schemes or modifications to the attenuation correction procedure to handle CT contrast agents appropriately. CONCLUSION: High-quality PET/CT studies can be provided routinely with existing PET/CT technology that is used efficiently by trained and motivated technologists and physicians. Only then will the potential diagnostic benefit of this new imaging modality be explored fully.

Artifacts↗
PubMed2005

[Pain treatment in patients on chronic opioid therapy and in drug abusers].

BACKGROUND: Substance abuse in pain management can undermine treatment compliance, the effectiveness of therapies, and social support and functioning. MATERIAL: An overview is given regarding pain management for patients on chronic use of opioids and for patients with drug dependence and substance abuse. RESULTS: Clinical experience as well as relevant documentation demonstrates that management of these patients remains one of the most challenging problems in clinical medicine. CONCLUSION: Assessment and treatment plans for this patient group require an understanding of tolerance, physical dependence and drug abuse. It is imperative that the patient's ongoing treatment is planned in a multidisciplinary setting, so as to assure a consistent, structured and shared approach by all caregivers.

Acute Disease↗
PubMed1991

Polymerase chain reaction and Q beta replicase amplification.

The polymerase chain reaction (PCR) and Q beta replicase are two methods in which nucleic acid polymerases are used for amplification. Although these approaches share many similar problems concerning target contamination and probe specificity, they differ dramatically in their mechanisms of action and modes of application. The PCR method amplifies target sequences between two priming oligonucleotides and in essence amplifies a portion of the analyte. Q beta replicase, on the other hand, amplifies a specific template molecule hybridized to target sequences and therefore amplifies a signal component of the system. For this reason, Q beta replicase amplification has applications in areas other than for the detection of nucleic acid sequences. The requirements for application and the advantages of both PCR and Q beta replicase amplification are reviewed.

DNA-Directed DNA Polymerase↗
PubMed1990

Continuous arteriovenous hemofiltration in the patient with hepatorenal syndrome. A case study.

CAVH has gained increasing medical acceptance, as favorable outcomes in the critically ill have proven its worth. Unfortunately, CAVH is often used as a "last ditch" effort for the patient with multisystem organ failure and septicemia. Performing the procedure in such a setting sometimes seems little more than an exercise in futility. However, as more patients such as the patient described in this case study are shown to benefit from CAVH, the nursing role needs to be examined both in performing the procedure and in caring for the critically ill patients. The nursing literature has kept abreast of the procedural aspects of CAVH. Now, critical care nurses must move on to the patient-oriented approach, share case studies, and work together to formulate nursing diagnoses, develop specialized care plans, and identify areas for nursing research.

Adult↗
PubMed2007

Acción Mutua (Shared Action): a multipronged approach to delivering capacity-building assistance to agencies serving Latino communities in the United States.

Culturally appropriate, theory-based capacity-building assistance can serve a vital role in helping HIV prevention providers remain up-to-date, effective, and responsive to those they serve. Funded by the Centers for Disease Control and Prevention (CDC), AIDS Project Los Angeles, in collaboration with San Francisco State University's César E. Chávez Institute, conducted full-day site visits and qualitative interviews in 2005 with mid-level management staff of CDC-funded community-based organizations delivering HIV prevention services to Latino communities in the western region of the United States. We found that agencies we visited (1) had not yet adapted the evidence-based interventions they were using at the time of our visit and (2) requested technical assistance and training in the areas of program development, evaluation, group facilitation techniques, consumer recruitment, client retention, intervention adaptation, and materials development. Findings from this needs assessment were used to inform our seven-pronged approach to delivering capacity-building assistance entitled "Acción Mutua" (Shared Action). The approach emphasizes strategic partnerships, stakeholder involvement, organizational self-assessment, culturally appropriate materials development, interactive training, tailored onsite technical assistance, and professional networking opportunities. This article describes our approach in detail, the assessment process we used to develop it, and its implications for capacity-building practice.

California↗
PubMed2003

[Shared decision making: an approach to strengthening patient participation in rehabilitation].

In this paper, the concept of Shared Decision Making, i. e. the participation of the patient regarding the selection of therapeutic goals and treatment options, is presented. The degree of patient participation in medical decisions varies widely across different models of the physician-patient relationship. According to the paternalistic model, the physician knows best what is in the patient's interest; patient participation is limited. This model clearly does not take into account patients' autonomy and desire for information appropriately. In contrast, the informative model claims that values are well-known to the patient while the physician's role is restricted to providing him with the necessary information. However, the assumption of fixed values may be challenged. Patients expect their doctors to be not only technical experts but also caring persons. In the interpretive model, the physician's task is to help the patient to identify and express his values. In the deliberative model, both physician and patient engage in an open discussion about the values the patient could and should pursue. The physician is allowed to present his own preferences, and conflicting values are discussed explicitly. Thus, the patient is empowered to choose between alternative preferences. This model forms the basis of shared decision making, which involves at least two participants who engage in a process of both mutual information and interactive discussion. Patient participation should result in a greater sense of personal control, more satisfaction with treatment, better compliance and transfer into the daily routine of disease management and, consequently, better outcomes. Although it is largely unknown whether these outcomes are achieved, indirect evidence may be gained from systematic reviews showing that a favourable physician-patient communication (i. e. allowing patients to express their information needs and concerns and to receive both information and emotional support) produced better outcomes regarding both mental and physical health. There are several barriers to shared decision making. No information exists regarding the degree to which physicians are interested in shared decision making. While there is ample evidence that patients' needs for information are high, patients' wishes for participation seem to vary widely, though. Both physicians and patients require the ability to make shared decisions. Structural restraints include time and institutional inflexibility. To conclude, shared decision making is a promising approach to enhance patient participation in rehabilitative care.

Choice Behavior↗