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PubMed1980

Prediction of college drug use from personality and inner experience.

The purpose of this study was to determine the extent to which subjects comprising substance use criterion groups (nonusers, alcohol only users, marijuana only users, polydrug users) could be differentiated on the basis of theoretically relevant personality and inner experience constructs. The test battery included variable from the domains of needs, daydreaming and mental style, optimal level of stimulation, and locus of control. Separate stepwise discriminant analyses were computed for males and females in order to predict drug-use pattern. The analyses were replicated, and the best set of predictor variables was used to predict classifications in different samples. The results indicate that it is possible to differentiate among the criterion groups in a statistically reliable manner on the basis of well-conceived assessment instruments with an accuracy of 60 to 65%. The consistency of the obtained discriminant results across four different samples suggests that rather than seeking some superordinate personality trait to differentiate substance users from nonusers, a general cluster of variables which may be described under the rubric "hang loose ethic" will best separate the groups.

Exploratory Behavior↗

PubMedDate not supplied

The lived experience of grieving for persons living with HIV who have used injection drugs.

Parse's research method was used to investigate the lived experience of grieving for 10 persons self-identified as HIV-positive injection drug users. These individuals compose an understudied and poorly understood population, and their grief experiences have rarely been documented. The losses grieved by persons living with HIV infection include the loss of life, friends, family members, employment, energy, and sex. The lived experience of grieving was found to be "overwhelming anguish that shapes hopes and intentions as a wretched aloneness is punctuated with cherished uplifting engagements, while gratitude inspires courage in the midst of ambiguity." This new conceptualization of the grieving process is discussed in light of Parse's human becoming theory of nursing.

Adult↗

PubMed1993

The use of hypertext: demonstration of the methods for investigating an epidemic of meningitis.

The Meningitis Hypertext Case Study is a computer-assisted learning module developed by the Liverpool Epidemiology Programme as part of a comprehensive set of modules and case studies to assist health workers to learn epidemiology. The objectives of the case study are to highlight important concepts in diagnosing an epidemic of meningitis. It has been developed using hypertext software (LINKWAY) which allows interactions with other epidemiological software (EPI INFO) for the analysis of the data. The case study makes extended use of graphical displays, has a 'user-friendly' presentation and can be used by individuals and groups. Our initial experience indicates that this form of computer-assisted learning has considerable potential by providing users with an organized path through a series of problems set in a realistic environment. This could prove to be potentially useful in developing countries where up-to-date learning materials are often unavailable.

Computer-Assisted Instruction↗

PubMed2006

Contraceptive counselling and social representations: a qualitative study.

BACKGROUND: Contraceptive use is a complex issue and several studies have been conducted in an effort to understand user behaviour. It is of interest to explore the representations of professionals who give advice on contraception, since their views could have an impact on contraceptive use. METHODS: Individual in-depth interviews of 65 healthcare professionals likely to provide contraceptive advice to patients at a Swiss maternity unit. RESULTS: 83% of healthcare professionals interviewed were favourable to contraception in general while being highly critical of its practical efficacy. The methods most often spontaneously cited were oral contraceptive pills, male condom, intrauterine devices and hormonal implants. Theoretically, all methods should be proposed during contraceptive counselling but in practice interviewees have different social representations of user groups and associate them with specific contraceptive methods. Personal experience appears to play a bigger role than scientific knowledge. CONCLUSIONS: The counsellor's social representations probably play an important role in determining user behaviour. These representations should be taken into consideration in the training of healthcare professionals in this field.

Adult↗

PubMed2006

Use of cyclo-oxygenase 2 inhibitors (COX-2) and prescription non-steroidal anti-inflammatory drugs (NSAIDS) in UK and USA populations. Implications for COX-2 cardiovascular profile.

BACKGROUND: COX-2 and NSAIDS differ in their gastrointestinal (GI) and cardiovascular (CV) toxicity from pharmacological, clinical and epidemiologic point of views. OBJECTIVE: Describe the patterns of use of NSAIDS and COX-2 in The Health Improvement Network (THIN) database in UK and the PharMetrics database in USA. METHODS: We examined the experience of 10 distinct cohorts of new users of diclofenac, naproxen, ibuprofen, piroxicam, other NSAIDS, meloxicam, celecoxib, etoricoxib, rofecoxib and valdecoxib. The study period was 1 January 1995 through 2004 (31 March in UK and 28 February in USA). We collected information on covariates including history of upper GI disease, CV disease, hepatic disease, dosage, concomitant medication, and visits to a rheumatologist. RESULTS: We identified 486 076 unique patient-drug pairs in UK and 1 533 239 in USA. In UK population 78 201 (16%) were COX-2 users and in PharMetrics 324 206 (21%) were COX-2 users. Diclofenac and ibuprofen (NSAIDS), and celecoxib and rofecoxib (COX-2) were the agents prescribed most frequently. The duration of therapy was longer among celecoxib and rofecoxib users than among other users. More COX-2 users than NSAIDS users received concomitant gastroprotective agents (GPA), corticosteroids and anti-platelet therapy, and had a history of thromboembolic events and hypertension. PharMetrics patients were prescribed higher doses of NSAIDS and COX-2. The use of any single agent for more than 90 days was uncommon, but more frequent in PharMetrics. Switching was uncommon and was generally to a NSAID. DISCUSSION: Our results confirm some previous findings from other authors such as the presence of both GI and CV channelling to COX-2 agents but refute others, such as the frequency of drug switching between these agents. The typical use of COX-2 agents in practice is for shorter duration, and at lower doses, than was employed in randomized clinical trials. This difference may help clarify the apparent discrepancy with respect to CV toxicity between the results from clinical trials, which showed a higher CV risk with these drugs, and non-experimental epidemiologic studies, which showed lower or no increase in risk.

Adolescent↗

PubMed1996

Alcohol pretreatment increases preference for cocaine over monetary reinforcement.

Non-dependent cocaine users participated in a two-phase experiment conducted under controlled laboratory conditions. During phase 1, subjects sampled intranasal cocaine (100 mg) and placebo (96 mg lactose + 4 mg cocaine) in separate sessions and under double-blind conditions. Sampling sessions were followed by a single choice session in which subjects made a maximum of ten choices between 10 mg unit doses of cocaine or placebo. Only subjects who reliably (> or = 70%) chose cocaine over placebo in phase 1 participated in phase 2. During phase 2, subjects participated in a series of nine experimental sessions conducted on different days in which they were pretreated with varying doses of alcohol (placebo, 0.5, and 1.0 g/kg) and made a maximum of ten choices between 10 mg unit doses of cocaine and an alternative reinforcer (i.e., varying amounts of money). Visual-analog ratings of drug effects and cardiac function were monitored across all experimental sessions. Cocaine was reliably chosen over placebo by the majority (9 of 11) of subjects during phase 1, demonstrating that the drug functioned as a reinforcer. During phase 2, alcohol pretreatment significantly increased choice of cocaine over the alternative reinforcer, while increasing monetary value decreased cocaine choice. Ratings on some visual-analog scales (e.g., good effects) paralleled cocaine choice, with alcohol pretreatment increasing ratings and greater monetary value decreasing them. Cardiac output increased above baseline levels across all alcohol and monetary conditions, but maximal effects were observed during sessions involving pretreatment with the active alcohol doses. Overall, these results demonstrate (a) that alcohol can increase preference for cocaine over alternative reinforcers and thereby may thwart efforts to reduce or abstain from cocaine use, (b) that availability of an alternative, non-drug reinforcer can effectively decrease preference for cocaine, and (c) that combined use of alcohol and cocaine increases cardiac risk compared to use of cocaine alone.

Adult↗

PubMed1987

Buoyant density and molecular weight calculations on an Apple II microcomputer from equilibrium banding experiment on analytical ultracentrifuge.

Buoyant density is one of the non-destructive measurements of viruses, nucleic acids etc. which help in characterizing these entities in terms of their chemical composition and physical conformation. In recent years equilibrium sedimentation in CsCl buoyant density gradient has been proved to be a powerful tool for genome characterization. The method enables one to obtain information such as the absolute and the relative buoyant density of the material and its molecular weight. This communication describes a program in BASIC which calculates these parameters from the raw data obtained directly from the experiment. The program is fully interactive, user-oriented, and written keeping in view biologists and biochemists as the main users. The program has a built-in option to calculate either the absolute or the relative buoyant density and the molecular weight.

Algorithms↗

PubMed2005

The morning after on the internet: usage of and questions to the emergency contraception website.

OBJECTIVE: The objective of this study is to understand the concerns of users of a medical information website on emergency contraception (EC). METHODS: This study analyzes e-mails sent to the EC website over a 5-year period. It also reports on the website's most frequently viewed pages using Microsoft Site Server Analysis. RESULTS: Of the 7022 e-mails received, 29% did not contain questions about EC. The remaining e-mails reveal that EC users are concerned with how to use EC (23%), side effects (21%), pregnancy (17%), whether EC is needed in a given situation (14%), EC access (8%), EC effectiveness (4%) and how EC works (3%). Analysis of website page visits shows that visitors were chiefly interested in how to use EC and how to interpret bleeding after EC use. CONCLUSION: The e-mails point to the need for further research on EC-related questions that cannot be answered with the extant medical literature but are of concern to patients - questions such as bleeding after EC use and sexual intercourse that occurs shortly after taking EC pills. The language that writers use to express themselves reveals how users conceptualize their contraceptive and sexual health experiences. Many writers referred to sex with a hormonal contraceptive but not a barrier contraceptive as "unprotected sex," suggesting that patients may be using terms that do not mean what medical professionals might expect. E-mails sent to the site also demonstrate the importance of alternative resources that provide accurate medical information for patients who are unable to access health care or to discuss certain subjects with their providers.

Coitus↗

PubMed1997

Extending the duration of active oral contraceptive pills to manage hormone withdrawal symptoms.

OBJECTIVE: To test the hypothesis that extending the number of consecutive active oral contraceptives (OC)s given will decrease the frequency of menstrual-related problems including dysmenorrhea, menorrhagia, premenstrual-type symptoms, and menstrual migraines. METHODS: A prospective analysis was designed to track the experiences of 50 women taking OCs and experiencing menstrual-related problems. Fifty consecutive patients, who were taking OCs and had symptoms during the pill-free interval, were followed in a multispecialty clinic by an individual physician and nurse practitioner team. The patients were permitted to extend the number of consecutive active OCs to delay menstrual-related symptoms. RESULTS: Immediate outcome of the 50 patients revealed 74% (37 patients) stabilized on an extended regimen of 6 to 12 weeks of consecutive days with active OCs. Twenty-six percent (13 patients) either discontinued OCs or returned to the standard regimen with 3 weeks of active pills. Of the 37 patients who were stabilized on an extended regimen, 27 have completed thus far between five and 13 extended cycles with 6-23 months of follow-up (mean 16 months). CONCLUSIONS: Experience in a series of 50 OC users with menstrual-related symptoms demonstrated that delaying menses by extending the number of consecutive days of active pills is well tolerated and efficacious. We believe that a large prospective study is warranted to further our knowledge in this area.

Adult↗

PubMed2005

Real-time luminescence reporting of circadian gene expression in mammals.

Luminescence reporters have been used successfully in studies of circadian rhythms. Real-time measurements of circadian variations in gene expression were made in living cells, cultured tissues, and whole organisms. Because this technique is relatively easy and continuous noninvasive measurement from tissue cultures allows for a drastic reduction in the number of experimental animals, we believe this method will become a common technique for studying circadian rhythms. Using a multichannel recording apparatus, it may also become a powerful tool for the discovery of new drugs. In the past, measurements were done using hand-made apparatuses or by modifying commercially available equipment. We, along with other investigators, have developed user-friendly equipment for performing circadian rhythms experiments, and these systems are now available commercially. This article describes the use of luminescence reporters in circadian research and provides detailed methods used in these experiments. One of our goals in this article is to reduce experimental variability in different laboratories by proposing standard protocols.

Animals↗

PubMed1998

Invariance in automatic influences of memory: toward a user's guide for the process-dissociation procedure.

Three experiments investigated assumptions of the process-dissociation procedure for separating consciously controlled and automatic influences of memory. Conditions that encouraged direct retrieval revealed process dissociations. Manipulating attention during study or manipulating study time affected recollection but left automatic influences of memory relatively invariant. However, paradoxical dissociations were found when conditions encouraged use of a generate-recognize strategy, violating assumptions underlying the estimation procedure. Use of subjective reports to gain estimates produced parallel results. Easily observed correlations are shown to be not useful for testing assumptions underlying the process-dissociation procedure. A multinomial model produced results that agree with those from the process-dissociation approach.

Automatism↗

PubMed1995

Investigating the influence of treatment philosophy on outcome of methadone maintenance.

This study is based on a 'natural experiment' in which a cohort of heroin users was assessed at one unit, then referred on geographic grounds for treatment to one of two clinics--one orientated to long-term maintenance (Clinic 2, with 61 subjects), the other to time-limited treatment aimed at achieving abstinence from all drugs including methadone (Clinic 1, 141 subjects). The outcome measure was heroin use as measured by urine testing performed regularly at both clinics. Overall, 25% of urine tests from Clinic 1 were positive for heroin compared to 18% in Clinic 2. This difference reflected in part a high rate of heroin use during the period of mandatory withdrawal from treatment in clinic 1. Statistical models were developed to identify factors associated with heroin use. There was a strong association between methadone dose and heroin use; relative to a daily dose of 40 mg, a dose of 80 mg/day of methadone was less likely to be associated with a heroin-positive urine (OR 0.55, 95% CI [0.45, 0.68]). Average doses prescribed in Clinic 1 were lower, reflecting the clinic's orientation to abstinence. Adjusting for dose, and for the fact that certain individuals tend to use heroin heavily while others do not, there was no difference between the clinics in risk of heroin use during maintenance treatment. The higher rates of heroin use in the abstinence-orientated clinic were attributable to time-limited treatment and the use of lower doses of methadone. This finding confirms that in investigating the effects of treatment factors, the powerful influence of methadone dose needs to be taken into account.

Adult↗

PubMed2001

Wheelchair use by patients with amyotrophic lateral sclerosis: a survey of user characteristics and selection preferences.

OBJECTIVES: To determine wheelchair types and features that are most beneficial to patients with amyotrophic lateral sclerosis (ALS), to ascertain at what stage of disease and disability patients benefit from wheelchair use, and to pinpoint the differences in patient characteristics between the users of manual and motorized wheelchairs. DESIGN: Internally generated questionnaire. SETTING: A neuromuscular clinic. PATIENTS: Forty-two patients (28 men, 14 women) with ALS who used wheelchairs and whose mean age was 53.9 years (range, 32-75yr). MAIN OUTCOME MEASURE: Wheelchair users completed a 39-item survey. RESULTS: At the time of the survey, the patients' mean Appel ALS rating scale total score was 84.5 (range, 48-138), indicating moderate disability. Forty-one patients reported that wheelchairs permitted them greater interaction in their communities; 33 were "very satisfied" with the positive impact of wheelchair use on their activity levels. Most users did not work and needed caregiver assistance for activities of daily living. The most desirable wheelchair features provide extra comfort (supports for the head, neck, trunk, extremities) and have improved maneuverability (lightweight frame, smaller wheelbase). Undesirable features are low sling backs and sling seats, nonremovable static leg rests, and large frames. No significant differences were reported between manual wheelchair users and motorized wheelchair users in terms of overall disease symptom severity, arm and leg strength, and bulbar function. However, motorized wheelchairs offer patients a greater sense of independence and an improved sense of well-being. CONCLUSION: Information obtained directly from wheelchair users with ALS provided first-hand experience concerning the most and least desirable features of wheelchairs and may help other ALS patients make informed decisions when purchasing a wheelchair.

Adult↗

PubMed2002

The Wheelchair Skills Test: a pilot study of a new outcome measure.

OBJECTIVE: To evaluate the practicality, safety, reliability, validity, and usefulness of a new Wheelchair Skills Test (WST). DESIGN: A pilot study with within-subject comparisons. SETTING: Rehabilitation center. PATIENTS: Twenty-four wheelchair users (11 with amputations, 4 with stroke, 3 with musculoskeletal disorders, 3 with spinal cord injury, 3 with neuromuscular disorders). INTERVENTION: The WST. MAIN OUTCOME MEASURES: Subjects were videotaped while performing 33 skills twice (>10d apart). Their ability to perform each skill was rated on a 3-point ordinal scale. The test-retest, intra-, and interrater reliabilities were determined. Each subject's occupational therapist completed a visual analog scale (VAS), reflecting a global rating of the subject's manual wheelchair skills. We assessed validity by evaluating whether the WST detected expected changes (construct validity) and how well the total WST scores correlated with the occupational therapists' global ratings (concurrent validity). Each occupational therapist also used a VAS to quantify the usefulness of the WST. RESULTS: The mean time required to administer the WST was 29 minutes. There were no adverse incidents. For the test-retest, intra-, and interrater reliabilities, the correlations for the total scores were .65 (P =.001), .96 (P <.001), and .95 (P <.001), respectively. The 9 therapists unanimously endorsed 30 (91%) of the 33 WST skills. The correlation between the mean changes in the WST and global rating scores was .45 (P <.05). There was a slight negative relationship between total WST score and age (P <.05). There were no significant differences related to the diagnoses accounting for wheelchair use. Wheelchair users with more than 3 weeks of experience with their wheelchairs scored higher than those with less experience (P =.0085). The correlations between the WST and global rating scores ranged from .40 to .54 (P <.05). Through Rasch analysis, we eliminated 6 skills, with the remaining skills comprising a unidimensional screening test of wheelchair ability. The mean VAS score for perceived usefulness was 59%. CONCLUSIONS: The WST is practical, safe, well tolerated, exhibits good to excellent reliability, excellent content validity, fair construct and concurrent validity, and moderate usefulness. This pilot study makes an important contribution toward meeting the need for a well-validated outcome measure of manual wheelchair ability.

Adult↗

PubMed2005

Dilemmas and paradoxes in providing and changing antenatal care: a study of nurses and midwives in rural Zimbabwe.

This paper describes the experiences of caregivers in a rural district in Zimbabwe, in caring for pregnant women within a context of changing antenatal care routines. Data were generated using individual interviews with 18 nurses and midwives. The caregivers experienced their working situation as stressful and frustrating due to high staff turnover, inconsistent policies, parallel programmes and limited resources, including time. They also faced difficulties when implementing some of the proposed changes. Furthermore, the caregivers had to deal with the pressure and resistance from the pregnant women, whose reasoning and rationale for using care appeared different from those of the health professionals. In light of the above, we stress the necessity for reflecting on and including the experiences and perspectives of caregivers and the users of care, as well as their contexts and realities, when implementing change.

Evidence-Based Medicine↗

PubMed1995

Design and development of a utilization review program in Portugal.

This paper describes the work that has been under way in the Portuguese government hospital sector, with respect to the use of an adapted version of the Appropriateness Evaluation Protocol (AEP). Modifications to the original system were determined through a series of experiments at pilot hospitals and reliability and user profile studies were subsequently conducted using the modified criteria. Results were of great value in terms of the identification and quantification of problems. On average, approximately one in every four non-obstetric admissions and one in every 2 days of stay were deemed inappropriate and 75% of all inappropriate days were related to patients who were ready for discharge. It is expected that the use of the modified AEP will be extended and enhanced over the next few years. In this regard, advantage has already been taken of the implementation of an output-based funding system, combining retrospective statistical analysis of the hospitals' inpatient databases with targeted reviews of individual patients.

Health Services Research↗

PubMed1997

Virtual reality: teaching tool of the twenty-first century?

Virtual reality (VR) is gaining recognition for its enormous educational potential. While not yet in the mainstream of academic medical training, many prototype and first-generation VR applications are emerging, with target audiences ranging from first- and second-year medical students to residents in advanced clinical training. Visualization tools that take advantage of VR technologies are being designed to provide engaging and intuitive environments for learning visually and spatially complex topics such as human anatomy, biochemistry, and molecular biology. These applications present dynamic, three-dimensional views of structures and their spatial relationships, enabling users to move beyond "real-world" experiences by interacting with or altering virtual objects in ways that would otherwise be difficult or impossible. VR-based procedural and surgical simulations, often compared with flight simulators in aviation, hold significant promise for revolutionizing medical training. Already a wide range of simulations, representing diverse content areas and utilizing a variety of implementation strategies, are either under development or in their early implementation stages. These new systems promise to make broad-based training experiences available for students at all levels, without the risks and ethical concerns typically associated with using animal and human subjects. Medical students could acquire proficiency and gain confidence in the ability to perform a wide variety of techniques long before they need to use them clinically. Surgical residents could rehearse and refine operative procedures, using an unlimited pool of virtual patients manifesting a wide range of anatomic variations, traumatic wounds, and disease states. Those simulated encounters, in combination with existing opportunities to work with real patients, could increase the depth and breadth of learners' exposure to medical problems, ensure uniformity of training experiences, and enhance the acquisition of clinical skills.

Anatomy↗

PubMed1997

A comparison of vowel production by children with multichannel cochlear implants or tactile aids: perceptual evidence.

OBJECTIVE: To examine changes in perceived vowel production accuracy over time in prelingually deafened children who use a multichannel cochlear implant (Nucleus 22 channel) or a multichannel tactile aid (Tactaid 7) and to compare the levels of perceived vowel production accuracy attained by the two device groups. DESIGN: The subjects were participants in longitudinal studies of the effects of sensory aids on the development of perceptual, speech, and language skills. As part of these studies, imitative vowel productions were elicited and transcribed before each child received their sensory aid and at 6 mo intervals thereafter. Data for the current study was obtained from the predevice interval and a later interval (postdevice) that was an average of 1.8 yr after the subjects received their respective devices. The subjects' vowel productions were judged for accuracy in matching an imitative model and for correctness of vowel features (height and place). Within-group analyses were completed to determine if vowel production scores improved over the course of the study for each device group. Between group comparisons were performed to examine differences in mean scores at each interval. RESULTS: Before receiving their multichannel devices, the two groups of subjects demonstrated similar imitative vowel production skills. After an average of 1.8 yr of device use, the cochlear implant subjects demonstrated significantly improved production of diphthongs and all vowel categories except low vowels. The Tactaid 7 subjects demonstrated significant improvement only in the production of diphthongs. Thus, cochlear implant recipients' vowel production skills were found to be significantly better than those of the Tactaid 7 users after a comparable amount of device experience. CONCLUSIONS: The vowel production gains of the cochlear implant subjects were similar in amount to those noted in other studies of children who use the Nucleus multichannel cochlear implant and further confirm the potential of this device for improved speech production in prelingually deafened children. The differences between the performance of the two groups demonstrate that vowel production skills improved to a greater degree through use of a multichannel cochlear implant than through use of the Tactaid 7.

Child↗