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Results for “Complex intervention”

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At least 1,081 records · Page 60Linked to original sources

PubMed2003

[Psychosomatic liaison service in neurology. Accordance between need for psychotherapeutic interventions and their realization].

The study addresses the realization of psychotherapeutic interventions in the framework of an integrated psychosomatic liaison service in neurology. Eighty-four patients from one unit at the Department of Neurology of the University of Freiburg, Germany, underwent structured psychodiagnostic interviews and filled in self-rating instruments to evaluate mental disorders, psychosocial distress, ways of coping, and quality of life. Motivation and the need for treatment were estimated by both patients and a liaison psychotherapist. Using ICD-10-F criteria, mental and behavioral disorders were diagnosed in 35% of the cases. Thirty-seven percent of the patients desired psychological support. Actual intervention occurred in 27%, with a mean consultation rate of 3.7 sessions. There was only slight agreement between the estimated need for treatment and the interventions actually performed. The realization of psychotherapeutic interventions was subject to a complex interaction between patient needs, "objective" psychosocial distress, and institutional factors. Differentiation between primary medical care and psychotherapy was difficult.

Adult↗

PubMed2003

Ethics curricula in surgery: needs and approaches.

Surgeons practice an intense form of applied ethics. The growing complexity of medical and surgical interventions combined with reduced opportunity to serve as ethical role models for trainees necessitates formal ethics curricula in surgery and the development of continued ethics education for surgeons through all stages of their careers. The Royal College of Physicians and Surgeons of Canada and the American College of Surgeons ethics curricula provide practical methods for dealing with the ethical issues that confront surgical residents each day. We can improve and expand upon curricula for surgical residents by taking into consideration the evolutionary stages of life of a surgeon: the pre-surgeon, the medical student, the beginning resident, the midlevel resident, the senior resident, the young to midlevel surgeon, and the advanced surgeon.

Curriculum↗

PubMed2001

Improving mobility and functional independence in persons with multiple sclerosis.

Persons with multiple sclerosis (MS) commonly experience restrictions in mobility and everyday functional activities. A wide range of factors including physical, psychological, environmental and economic issues may contribute to these difficulties. This is particularly the case as the disease evolves, and the impairments and disabilities become more numerous, inter-related and hence more complex. Effective management of these complex problems requires assessment and intervention from a variety of different perspectives by using a coordinated, goal-oriented, multi-disciplinary management approach. Crucially, it requires management to be considered from a long-term perspective rather than as a fragmented series of isolated "quick-fixes".

Activities of Daily Living↗

PubMed2006

A review of health care models for coronary heart disease interventions.

This article reviews models for the treatment of coronary heart disease (CHD). Whereas most of the models described were developed to assess the cost effectiveness of different treatment strategies, other models have also been used to extrapolate clinical trials, for capacity and resource planning, or to predict the future population with heart disease. In this paper we investigate the use of modelling techniques in relation to different types of health intervention, and we discuss the assumptions and limitations of these approaches. Many of the models reviewed in this paper use decision tree models for acute or short term interventions, and Markov or state transition models for chronic or long term interventions. Discrete event simulation has, however, been used for more complex whole system models, and for modelling resource-constrained interventions and operational planning. Nearly all of the studies in our review used cohort-based models rather than population based models, and therefore few models could estimate the likely total costs and benefits for a population group. Most studies used de novo purpose built models consisting of only a small number of health states. Models of the whole disease system were less common. The model descriptions were often incomplete. We recommend that the reporting of model structure, assumptions and input parameters is more explicit, to reduce the risk of biased reporting and ensure greater confidence in the model results.

Coronary Disease↗

PubMed1988

Misdiagnoses in obstetric and gynecologic ultrasound examinations: causes and possible solutions.

Two small series of cases documenting ultrasound misdiagnoses are presented. The first concerns obstetric ultrasound misdiagnoses originating in the private offices of physicians. The second concerns gynecologic ultrasound misdiagnoses originating in a level II medical center. A dichotomy exists in the use of diagnostic ultrasound examination in the practice of obstetrics and gynecology. The dichotomy is a serious defect in our specialty that needs urgent addressing. The institutional problem can be partially resolved by furnishing the sonographer with the referred patient's history and physical findings. The problem of the ultrasound machine in the office of a private physician is much more complex. It may require government intervention and strict licensing measures for resolution.

Adult↗

PubMed1991

Age-related changes of the dental pulp complex and their relationship to systemic aging.

The dental pulp and its associated structures, the dentin and the cementum, are discussed. Because many of the age-related pulpal changes have components considered in several of the current theories of aging, these theories are briefly reviewed. Part 2 describes the age-related changes of the dental pulp, the dentin, and the cementum (the dental pulp complex). An attempt is made to differentiate inherent aging changes from physiologic defensive changes and pathologic irritant-induced changes. Part 3 describes the relationship of age-induced changes in the dental pulp complex to components of the current aging theories together with a unified concept of the dental pulp complex aging. Part 4 considers whether dental pulp complex aging can be used as a biomarker for generalized aging. Whether age-related changes of the dental pulp complex can be altered by interventions is discussed.

Aging↗

PubMed1988

School sexual abuse prevention: unintended consequences and dilemmas.

In view of the recent proliferation of school sexual abuse prevention programs and materials, this article critically examines current assumptions about the role of elementary school personnel in prevention and possible unintended consequences of such assumptions. These unintended consequences include emphasizing a simple solution to a complex social problem and contributing to victim blaming. Some dilemmas that arise for classroom teachers around predeveloped curricular materials and mandatory reporting are also explored. Teacher use of predeveloped materials may mean a diminishing of wider teaching skills and reduction of complex concepts to brief, noncontroversial interventions that may serve to mystify sexuality and unduly frighten students. Mandatory reporting, as it is frequently presented to teachers, can create further dilemmas by obscuring the ethical decisions inherent in the process, assuming consistently positive outcomes after reporting, and neglecting the context in which teachers work. The authors suggest that educators should be aware of these possible unintended consequences and dilemmas in order to maintain a broad perspective on child sexual abuse and to focus their efforts more effectively within a larger network addressing the problem.

Child↗

PubMed1984

Minimal interventions for weight control: a cost-effective alternative.

Two studies were conducted to evaluate simpler, less intensive interventions for weight control which presumably would be more cost-effective and efficient than a "full-length" behavioral treatment program. In Study 1, participants in a minimal intervention (MI1) program who attended no regularly scheduled meetings and initially only received three simple verbal instructions about how to lose weight, lost an average of 11.1 lb. by 7-month follow-up. Subjects in three variations of a shortened, less intensive, 6-week behavioral weight loss program lost 7.8, 6.5 and 6.3 lb. but did not significantly differ from MI1 subjects in the amount of weight lost. In Study 2, MI2 subjects lost 5.5 lb. compared to subjects in two variations of a full-length program who lost 8.1 and 11.1 lb. by 6-month follow-up. Again, none of the groups significantly differed from each other in the amount lost. It was concluded that a minimal intervention program seems to produce weight loss and to be a cost-effective and efficient method for some subjects. The difference between the two minimal intervention programs may be related to the payment of a monetary deposit; a model for future research was presented to investigate simpler, less intensive interventions in combination with more complex ones in a "stepped-care" fashion.

Adolescent↗

PubMed1996

Role of oxygen free radicals in cancer development.

In aerobic life, oxidative stress arises from both endogenous and exogenous sources. Despite antioxidant defence mechanisms, cell damage from oxygen free radicals (OFR) is ubiquitous. OFR-related lesions that do not cause cell death can stimulate the development of cancer. This review discusses the effects of oxidative stress at the different stages of carcinogenesis. Mutagenesis through oxidative DNA damage is widely hypothesised to be a frequent event in the normal human cell. A large body of evidence suggests important roles of OFR in the expansion of tumour clones and the acquisition of malignant properties. In view of these facts, OFR may be considered as an important class of carcinogens. Therefore, the ineffectiveness of preventive antioxidant treatments, as documented in several recent clinical trials, is surprising. However, the difficulties of antioxidant intervention are explained by the complexity of both free radical chemistry and cancer development. Thus, reducing the avoidable endogenous and exogenous causes of oxidative stress is, for the present, the safest option. In the near future, new insights in the action of tumour suppressor genes and the DNA repair mechanisms may lead the way to additional tools against carcinogenesis from OFR.

Antioxidants↗

PubMed2006

Neuroimmunopathology in a murine model of neuropsychiatric lupus.

Animal models are extremely useful tools in defining pathogenesis and treatment of human disease. For many years researchers believed that structural damage to the brain of neuropsychiatric (NP) patients lead to abnormal mental function, but this possibility was not extensively explored until recently. Imaging studies of NP-systemic lupus erythematosus (SLE) support the notion that brain cell death accounts for the emergence of neurologic and psychiatric symptoms, and evidence suggests that it is an autoimmunity-induced brain disorder characterized by profound metabolic alterations and progressive neuronal loss. While there are a number of murine models of SLE, this article reviews recent literature on the immunological connections to neurodegeneration and behavioral dysfunction in the Fas-deficient MRL model of NP-SLE. Probable links between spontaneous peripheral immune activation, the subsequent central autoimmune/inflammatory responses in MRL/MpJ-Tnfrsf6(lpr) (MRL-lpr) mice and the sequential mode of events leading to Fas-independent neurodegenerative autoimmune-induced encephalitis will be reviewed. The role of hormones, alternative mechanisms of cell death, the impact of central dopaminergic degeneration on behavior, and germinal layer lesions on developmental/regenerative capacity of MRL-lpr brains will also be explored. This model can provide direction for future therapeutic interventions in patients with this complex neuroimmunological syndrome.

Animals↗

PubMed2006

Behavioral interventions for diabetes self-management.

This article synthesizes the research on behavioral interventions aimed at diabetes self-management, describes current trends in diabetes self-management, and proposes future directions for diabetes self-management care and research. Interventions that are multifaceted, tailored to the individual, and provided six months or longer demonstrate modest effects in improving diabetes-related outcomes. Improving access to behavioral interventions, maintaining the effects of behavioral interventions, and addressing the more complex social and environmental factors that contribute to behavior change are current challenges in diabetes self-management that warrant further attention and research.

Behavior Therapy↗

PubMed2005

Predictive value of cumulus cell apoptosis with regard to blastocyst development of corresponding gametes.

OBJECTIVE: To test if a high degree of apoptosis in cumulus cells could indicate diminished oocyte quality and developmental competence. DESIGN: Prospective analysis. SETTING: Public hospital and university. PATIENT(S): Thirty seven women who gave written consent to participate in this study. INTERVENTION(S): Cumulus-oocyte complexes were denuded separately and the resulting cumulus cell suspensions were analyzed for presence of apoptosis using a terminal deoxynucleotidyl transferase-mediated digoxigenin-dUTP nick-end labeling (TUNEL) assay detection kit. MAIN OUTCOME MEASURE(S): Percentage of apoptotic cumulus cells and blastocyst formation rate. RESULT(S): Younger patients (< or = 35 years) showed significantly fewer apoptotic cumulus cells than older ones. In all patients gamete maturity was shown to be highly correlated to the rate of apoptosis in cumulus cells. At zygote and cleavage stages (days 1 to 4) no morphologic features were related to the degree of programmed cell death. However, blastocyst development was predictable taking into account the percentage of apoptosis in associated somatic cells. In addition, there was a trend toward better quality blastocysts from follicles with a lower rate of apoptotic cells. No influence on pregnancy and implantation rate was observed. CONCLUSION(S): Apoptotic processes within follicles seem to impair oocyte maturation. Though not manifested in the morphologic appearance, gametes and embryos derived from cumulus complexes with no or minor apoptosis have an increased chance of giving rise to optimal blastocysts.

Adult↗

PubMed2006

The systemic inflammatory response syndrome.

The systemic inflammatory response syndrome (SIRS) is the body's response to an infectious or noninfectious insult. Although the definition of SIRS refers to it as an "inflammatory" response, it actually has pro- and anti-inflammatory components. This review outlines the pathophysiology of SIRS and highlights potential targets for future therapeutic intervention in patients with this complex entity.

Biomarkers↗

PubMed1995

Microsurgical transfer of vascularized tissue to close problem wounds.

Interventions to achieve optimal wound healing challenge the skills of all health care professionals. Although most wounds are best managed by appropriate nursing intervention outside the OR, some complex wounds require more expeditious closure to ensure maximum preservation of vital structures and their functions. Microsurgical transfer of vascularized tissue (ie, flaps) often is the only method of achieving immediate wound coverage. Perioperative team members who treat such wounds must be aware of the distinct attributes and potential morbidity associated with flap procedures.

Female↗

PubMed2003

Development of a LC-LC-MS complete heart-cut approach for the characterization of pharmaceutical compounds using standard instrumentation.

A total heart-cut LC-LC-MS technique is described for the analysis of pharmaceutical compounds. Utilizing ordinary LC-MS equipment, a standardized multi-dimensional, highly selective approach was developed. The system was developed on synthetic mixtures containing ten active pharmaceutical compounds. The methodology would be further deployed for the impurity characterization of batches of active chemical, process intermediates, and reference standards. Column-switching was employed to heart-cut sequential fractions from one set of LC conditions to another set of LC conditions. Two high efficiency columns, including the Merck Chromolith C18, for fast LC-LC analysis were used. The system provides a highly automated, turnkey, multi-dimensional approach applicable to a variety of complex mixtures with little user intervention. It is envisioned that this idea could be viewed as a platform for other types of LC-LC analyses including peptide and achiral-chiral analyses.

Chromatography, High Pressure Liquid↗

PubMed1995

Patient perceptions of self-induced water intoxication.

This study comprehensively examines self-induced water intoxication (SIWI) from a patient perspective including demographics, reasons for seeking fluids, patterns/behaviors of fluid seeking, and symptoms frequently experienced while in a state of SIWI. The subjects were 45 of an original convenience sample of 62 individuals with a serious mental illness (SMI), hospitalized in a long-term state psychiatric facility, who engaged in self-induced water intoxication. All participants were interviewed in a structured format to complete a 40-item Likert-type questionnaire developed for the study, titled the Self-induced Water Intoxication Questionnaire (SIWIQ). In the study, the majority of participants were smokers, and reported no past problem with alcohol. SIWI occurred more in males than females, and was more predominant in those participants who had longer hospital stays. Anger and vomiting were found to be the two most predominant symptoms experienced when excess fluid consumption occurred. Behaviors of drinking from the shower, the toilet, and one's own urine are consistent with findings of previous studies and illustrate the difficulty in keeping individuals with SIWI from fluids. Data show that participants with SIWI experience considerable anxiety and cognitive difficulties and express these as reasons for engaging in excess fluid consumption. Boredom, obtaining a high, and sad mood were also predominant reasons identified for excess fluid drinking. Significant relationships were found and discussed. The findings provide support for the position that SIWI represents an attempt at treatment by the dysfunctional individual and is pursued for anxiolytic effects and alleviation of boredom. The data support the idea of approaching the problem from a dysfunctional coping framework, realizing that SIWI is a very complex problem, needing examination and intervention at multiple levels, beyond exclusive focus on fluid control.

Adaptation, Psychological↗

PubMedDate not supplied

Rapid protyping technology in medicine--basics and applications.

Using medical models built with Rapid Prototyping (RP) technologies represents a new approach for surgical planning and simulation. These techniques allow one to reproduce anatomical objects as 3D physical models, which give the surgeon a realistic impression of complex structures before a surgical intervention. The shift from the visual to the visual-tactile representation of anatomical objects introduces a new kind of interaction called 'touch to comprehend'. As can be seen, from the presented case studies of maxillo-cranio-facial surgery, the RP models are very well suited for use in the diagnosis and the precise preoperative simulation of skeleton modifying interventions.

Acrocephalosyndactylia↗

PubMed2001

HIV risks of men in methadone maintenance treatment programs who abuse their intimate partners: a forgotten issue.

Accumulating findings suggest a relationship between partner violence and HIV risk among women, however, this issue has yet to be adequately researched among men. This study examines the relationship between perpetrating intimate partner violence and HIV risk behavior among a sample of men in methadone maintenance treatment programs (MMTPs). Data were collected on 273 sexually active men, who were recruited from four inner-city MMTP clinics. More than a third of the sample reported perpetrating intimate physical abuse and 15% reported severe physical abuse in the past 12 months. Results from multiple logistic regression analyses indicate that after adjusting for demographic, poverty, and drug-use factors, men who abused an intimate partner were almost 4 times more likely to have more than one intimate partner, almost 3 times more likely to have unprotected anal sex, and 2.6 times more likely to have sex with a drug-injecting sexual partner than their counterparts. This study showed that men who perpetrated partner violence were at higher risk for HIV transmission. HIV prevention interventions need to consider the complex relationship between partner violence and HIV risk.

Adult↗