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At least 1,099 records · Page 61Linked to original sources

PubMed2002

[Intractable neonatal heart diseases: a controversy].

A congenital heart disease is said intractable when the only options are either heart transplantation or a complex palliative programme including several interventions leading to a mid-term Fontan-type circulation. The latter uses the single ventricle as a systemic one while the pulmonary circuit is a non-pulsed one which by-passes the absent right ventricle through a cavo-pulmonary anastomosis. Both of these are difficult to operate and have hazardous long term results. This is why prenatal detection of such lesions usually leads to termination of pregnancy. Yet, postnatally, a serious ethical issue emerges, opposing the above-mentioned options to a third way: abstention. Information delivered to the parents plays here a crucial role in decision making and everybody agrees for the need of the greatest objectivity. But to achieve such a wish is terribly challenging since many socio-cultural factors may puzzle the way to deliver and to receive the main messages. This can easily be demonstrated by the well-known instance of hypoplastic left heart syndrome.

Anastomosis, Surgical↗

PubMed2003

Need and use of psychotherapeutic interventions within a psychosomatic liaison service in neurology.

OBJECTIVES: The study addresses the evaluation of psychosocial distress, the need for care as determined by a psychotherapist and patients, and the realization of psychotherapeutic interventions within a routine psychosomatic liaison service. MATERIAL AND METHODS: A total of 84 patients from one unit at the Department of Neurology of the University of Freiburg, Germany, underwent a structured psychodiagnostic interview and filled out self-rating instruments to evaluate mental disorders, psychosocial distress, ways of coping strategies and quality of life. The need for treatment and the motivation of patients were estimated by both patients and a liaison psychotherapist. RESULTS: Using ICD-10-F criteria, mental and behavioral disorders were diagnosed in 35% of cases. Professional assessment indicated a need for psychotherapeutic treatment in 37% of patients; actual intervention occurred in 27%. Only slight agreement was found between the estimated need for treatment and the interventions actually performed. CONCLUSIONS: The realization of psychotherapeutic interventions is subject to a complex interaction between the needs of a patient, the "objective" psychosocial distress of the patient, and institutional factors. About 10% of the hospitalized patients considered in the study need continuous psychotherapeutic treatment.

Adult↗

PubMed1996

Applying cognitive-social theory to health-protective behavior: breast self-examination in cancer screening.

This article applies recent developments in cognitive-social theory to health-protective behavior, articulating a Cognitive-Social Health Information Processing (C-SHIP) model. This model of the genesis and maintenance of health-protective behavior focuses on the individual's encodings and construals, expectancies, affects, goals and values, self-regulatory competencies, and their interactions with each other and the health-relevant information in the course of cognitive-affective processing. In processing health information, individuals are assumed to differ in both the accessibility of these mental representations and the organization of relationships among them. In this article, the model is applied to analyze and integrate the often-confusing findings on breast self-examination in cancer screening. Implications are considered for assessments and interventions to enhance adherence to complex, long-term, health-protective regimens, tailored to the needs and characteristics of the individual.

Breast Neoplasms↗

PubMed1996

Using qualitative data to inform public policy: evaluating "choose to de-fuse".

There are many preventive programs and interventions designed to address the complex problems of youth violence. However, research that examines the effectiveness of such programs is scarce. This article describes the evaluation of a media communications strategy, Choose to De-Fuse, developed for at-risk inner-city youth, and provides a case study of how qualitative data can be used to inform public policy.

Adult↗

PubMed2006

Depression in end-stage renal disease hemodialysis patients.

Depression has been identified as a complicating comorbid diagnosis in a variety of medical conditions, including end-stage renal disease (ESRD). Despite this, the psychological health of hemodialysis patients is understudied. The purpose of this paper is to review the research and issues involved in the assessment of depression and its sequelae in ESRD. Accurate estimation of the prevalence of depression in the ESRD population has been difficult due to the use of different definitions of depression and varied assessment techniques, the overlap of depressive symptomatology with symptoms of uremia, and the confounding effects of medications. We suggest that depressive affect is a more important construct to study than diagnosis of depression syndromes per se in patients with chronic kidney disease. The Beck Depression Inventory is a reasonable measure of depressive affect in the ESRD population, if a higher than usual cutoff score is used or if its somatic components are omitted. Several pathways link depression and ESRD, and are probably bidirectional. As such, treatment of depressive affect could impact medical as well as psychological outcomes. The need for treatment intervention trials is great. Limited evidence regarding the safety and efficacy of treatment of hemodialysis patients with selective serotonin reuptake inhibitors is available, and cognitive behavioral therapy holds promise as an intervention for depression in this complex medical population.

Depression↗

PubMed2000

Investigating recovery from stroke: a qualitative study.

A recent randomized controlled trial evaluated the effects of specialist nurses providing information, advice and support to caregivers and patients at home during the first year after a stroke. Reported here are the results of a complementary study which used qualitative methods to examine the experience of patients and caregivers during the year of recovery after a stroke. We used semi-structured interviews with a purposively selected sample of 30 patients and 15 caregivers at the end of a randomized controlled trial (13-16 months post-stroke). Patients and caregivers provided vivid descriptions of the recovery process. Recovery was perceived in terms of the degree of congruence patients identified between their lives before, and after, stroke. Patients therefore had individual and personal yardsticks for measuring their recovery. In conclusion, further research and interventions must consider the diverse, complex, dynamic and highly personal character of stroke recovery. Traditional outcome measures are too simplistic to capture patients' and caregivers' experiences. There do not appear to be single or simple solutions to the problems of facilitating psycho-social adjustment.

Aged↗

PubMedDate not supplied

Mothers of children and adolescents with intellectual disability: social and economic situation, mental health status, and the self-assessed social and psychological impact of the child's difficulties.

BACKGROUND: Few large-scale studies with well-constructed samples have compared the socio-economic circumstances and social impact of raising a child with intellectual disability (ID). The aims of the present paper were to: (1) compare the socio-economic situation of mothers raising a child with ID to that of mothers of non-ID children; (2) assess the contribution of raising a child with ID to negative psychological outcomes for mothers; and (3) identify variables associated with negative psychological outcomes among mothers of children with ID. METHODS: The 1999 Office for National Statistics survey, Mental Health of Children and Adolescents in Great Britain, 1999, collected information on a multistage stratified random sample of 10 438 children between 5 and 15 years of age across 475 postal code sectors in England, Scotland and Wales. Secondary analysis was undertaken of the social and economic circumstances, and stress reported by 245 mothers of sampled children with ID and a comparison group of 9 481 mothers of sampled children who did not have ID. RESULTS: The results indicate that: (1) families supporting a child with ID were significantly economically disadvantaged when compared with families supporting a child who did not have ID; (2) when compared with mothers of sampled children who did not have ID, mothers of sampled children with ID reported that their child's difficulties resulted in greater social and psychological impact; (3) having a child with ID marginally reduced the odds of mothers screening positive for having mental health problems (once all other variables were taken into account); and (4) among mothers of children with ID, mental health problems were associated with the child's difficulties having a greater social impact, having a boy, the child experiencing more than one potentially stressful life event, poverty, receipt of means-tested welfare benefits and 'unhealthy' family functioning. CONCLUSIONS: These results highlight the importance of combating poverty among children with ID and their families, and the need to develop more complex models of understanding and intervention.

Adolescent↗

PubMed2002

Malaria control reinvented: health sector reform and strategy development in Colombia.

The consequences of health sector reforms on control of malaria were analysed using Colombia as an example. One of the most complex health sector reform programmes in Latin America took place in the 1990s; it included transferring the vertical vector-borne disease control (VBDC) programme into health systems at state and district levels. A series of studies was undertaken in 1998-2000 at the national level (Ministry of Health Study), at the state level (Departamento Study) and at the health district level (District Study) using formal and informal interviews among control staff and document analysis as data collection tools. A government-financed national training programme for VBDC staff - which included direct observation of control operations - was also used to analyse health workers' performance in the postreform period (longitudinal study). The results showed that some shortcomings of the old vertical system, such as the negative aspects of trade union activity, have not been overcome while some positive aspects of the old system, such as capacity building, operational planning and supervision have been lost. This has contributed to a decrease in control activity which, in turn, has been associated with more malaria cases. Malaria control had to be reinvented at a much larger scale than anticipated by the reformers caused by a whole series of problems: complex financing of public health interventions in the new system, massive staff reductions, the difficulty of gaining access to district and state budgets, redefining entire organizations and - in addition to the reforms - introducing alternative strategies based on insecticide-treated materials and the growth of areas of general insecurity in many parts of Colombia itself. However, positive signs in the transformed system include: the strengthening of central control staff (albeit insufficient in numbers) when transferred from the Ministry of Health to the National Institute of Health, the opportunities offered by the Basic Health Plan (PAB) for new planning initiatives and intersectoral co-operation and the integration of malaria diagnosis and treatment into the general health services (associated with a decrease of malaria mortality). The potentials of the new system have not yet been fully exploited: capacity building, communication and management skills need to be improved and it require guidance from the national level.

Colombia↗

PubMed1998

Algorithms for radiological image registration and their clinical application.

This paper reviews recent work in radiological image registration and provides a classification of image registration by type of transformation and by methods employed to compute the transformation. The former includes transformation of 2D images to 2D images of the same individual, transformation of 3D images to 3D images of the same individual, transformation of images to an atlas or model, transformation of images acquired from a number of individuals, transformations for image guided interventions including 2D to 3D registration and finally tissue deformation in image guided interventions. Recent work on computing transformations for registration using corresponding landmark based registration, surface based registration and voxel similarity measures, including entropy based measures, are reviewed and compared. Recently fully automated algorithms based on voxel similarity measures and, in particular, mutual information have been shown to be accurate and robust at registering images of the head when the rigid body assumption is valid. Two approaches to modelling soft tissue deformation for applications in image guided interventions are described. Validation of complex processing tasks such as image registration is vital if these algorithms are to be used in clinical practice. Three alternative validation strategies are presented. These methods are finding application outside the original domain of radiological imaging.

Algorithms↗

PubMed2002

Fifty years of skin aging.

In developed countries, interest in cutaneous aging is in large part the result of a progressive, dramatic rise over the past century in the absolute number and the proportion of the population who are elderly (Smith et al, 2001). The psychosocial as well as physiologic effects of skin aging on older individuals have created a demand for better understanding of the process and particularly for effective interventions. Skin aging is a complex process determined by the genetic endowment of the individual as well as by environmental factors. The appearance of old skin and the clinical consequences of skin aging have been well known for centuries, but only in the past 50 y have mechanisms and mediators been systematically pursued. Still, within this relatively short time there has been tremendous progress, a progress greatly enhanced by basic gerontologic research employing immunologic, biochemical, and particularly molecular biologic approaches (Figs 1, 2).

Animals↗

PubMed2001

Ovarian cyst in a premature infant treated with spironolactone.

We describe the late occurrence of an ovarian cyst in a premature infant, the second of a set of monochorionic diamnionic twins, during treatment with spironolactone. Spironolactone is commonly used in the management of neonatal chronic lung disease in combination with other diuretics because of its potassium-sparing effect. It has progestational activity and has been reported to cause gynecomastia. It is used widely for its antiandrogenic properties in the treatment of female hirsutism and hyperandrogenism and it has a role in the management of familial male-limited precocious puberty. However, the estrogenic influence induced during therapy may significantly alter the hormonal milieu in newborn females, resulting in the formation of ovarian cysts. Simple ovarian lesions <5 cm merit close ultrasonographic surveillance for resolution while larger complex masses may warrant surgical intervention.

Diseases in Twins↗

PubMed2001

Experience with monoclonal antibodies in allergic mediated disease: seasonal allergic rhinitis.

Current therapies for the treatment of seasonal allergic rhinitis include allergen avoidance; pharmacologic interventions such as sympathomimetics, topical and systemic cortico-steroids, and chromones; and immunotherapy. In an attempt to create a novel therapy, therapeutic agents have been designed to inhibit IgE responses that are intimately involved in the induction of the allergic response. Omalizumab, a humanized monoclonal antibody against IgE, represents a novel therapeutic intervention for seasonal allergic rhinitis. Complex formation of omalizumab with serum-free IgE reduces the amount of IgE available for binding to effector cells and thus has the potential to reduce IgE-mediated allergic symptoms. Clinical trial results confirmed that omalizumab reduces free IgE to a level that is associated with suppressed allergic symptoms, reduces concomitant rescue medication use, and improves rhinitis-specific quality of life. Patients treated with omalizumab during one pollen season can be re-treated during the subsequent season with minimal risk of adverse events. Omalizumab is non-allergen-specific and does not induce acute anaphylaxis because of the lack of IgE crosslinking with basophil- or mast-cell-bound IgE. Furthermore, subcutaneous or intravenous administration of omalizumab does not invoke the generation of anti-omalizumab antibodies. Thus, omalizumab represents a novel agent that should assist in the treatment of allergic rhinitis.

Anti-Allergic Agents↗

PubMed2006

Living with a person with Alzheimer's disease: experiences related to everyday occupations.

The aim of this study was to illuminate experiences of daily occupations among spouses living with a person with Alzheimer's disease (AD). The study contains phenomenological-hermeneutic interpretation of interviews with eight spouses. The analysis revealed the participants as being in the process of a changing occupational situation. They come to live an occupational life intertwined with their partners' needs. An ongoing process of occupational adjustment is taking place as a response to the changing situation. The spouses were occupied with consequences of their partner's disease. They were striving for occupational meaning and at the same time living with threats to meaningful occupations. It can be concluded that living with a partner with AD is a complex dealing with occupational meaning. This complexity should be considered in interventions.

Aged↗

PubMed2006

Integrative care and bridge building among health care providers in Norway and Denmark.

BACKGROUND: Patients in Norway and Demmark with the medical diagnoses of cancer, multiple sclerosis (MS), and HIV/AIDS use complementary and alternative treatment (CAT) in growing numbers, most often in addition to receiving conventional treatment. At the same time, the interest and demand from patients for more holistic-oriented care is strongly increasing. Following this, there is a desire and need for better communication and cooperation among the conventional medical establishment, CAT practitioners, and patients. This development raises new demands on research designs to incorporate complexity and diversity concerning the intervention, effect mechanisms, and outcomes. DISCUSSION: This article outlines different models used to combine conventional, complementary, and alternative treatment (CCAT), describing various degrees of integration among therapies. The authors are closely involved in three current and planned research projects in Norway and Denmark focusing on cancer, MS, and HIV/AIDS. These research projects are briefly introduced as examples of bridge-building efforts dealing with integrative care. Despite explicit political good will in Norway and Denmark, initiatives to enhance integration face challenges connected to lack of knowledge; resistance toward CCAT; lack of time, space, and economic resources; and patients left without any claim on insurance in the case of treatment failure. These challenges are outlined based on the researchers' experience from being involved in the research projects. CONCLUSIONS: To optimize treatment outcomes in the future, it is argued that the need for closer cooperation among conventional and alternative therapists across professional boundaries in an interactive partnership with patients is evident. Researchers have to rethink research design and methods in meeting the new trend toward bridge building based on integrative health care.

Complementary Therapies↗

PubMed2003

Improving medication safety: the measurement conundrum and where to start.

The use of medication remains the most common intervention in health care. The complexity of both medication use and the medication management process, especially in the in-patient setting, create a significant risk for hospitalized patients. Despite the widespread recognition of the hazards that medication use poses to patients, there are no widely accepted or standardized methods to measure the safety of medication use. Where to focus measurement in medication safety is the subject of ongoing debate. Various groups have suggested measuring error-prone aspects of the medication use process such as errors in administration of medications or errors in dispensing of medications. Other groups have suggested measuring adverse drug events as a measure of the safety of medication use. Many studies in this area have outlined the great difficulty associated with getting clinicians to report either medication errors or adverse drug events voluntarily. In response to these challenges, yet more groups have developed non-voluntary reporting methods based on the use of "triggers", in either a chart review or electronic format. Medication safety is a complex process and measurement of it needs to be a core component throughout the whole process. With the introduction of computerized analysis of patient information, measurement becomes much easier and potentially more powerful and achievable than either incident reporting or chart reviews for purposes of accountability, prevention, and ongoing improvement of both process and clinical practice. This paper reviews approaches to measuring medication safety from the perspective of both harm and error, and outlines a strategy that combines both approaches in the electronic era.

Adverse Drug Reaction Reporting Systems↗

PubMed2000

Multiple-digit onychomycosis: a simple surgical cure.

The management of intractable onychomycosis involving multiple fingernails continues to be optimized. Failure of pharmacological treatment necessitates operative intervention. Current surgical procedures are complex and have frequent donor site complications. This report describes a safe, simple, and effective surgical treatment that eradicates the disease, results in low morbidity, and yields high patient satisfaction.

Adult↗

PubMed1988

A clinical evaluation system for anesthesiology residents.

Practitioners, educators, and residents in anesthesiology are concerned about issues of reliable evaluation, as advocated by such groups as the American Board of Anesthesiology and the Society for Education in Anesthesia. Further, there is a growing demand by accrediting bodies that training programs demonstrate a consistent and equitable means of evaluating residents' performance. In this article, the authors describe the development of the evaluation system employed by the Baylor College of Medicine and its affiliated hospitals to assess the clinical progress of residents in anesthesiology. The system evaluates the residents' progress in terms of levels of performance that are based on case complexity and degree of staff intervention.

Anesthesiology↗

PubMed1995

Making a place for teaching about family violence in medical school.

Although family violence is a common cause of patients' problems, it has not yet received sufficient attention in medical school curricula. There are several possible reasons for this delay, including the fact that teaching about family violence is complicated because there are no "quick fix" interventions, the approaches are often complex and multidisciplinary, and there may be limited resources for response in many communities. The author offers a variety of suggestions for incorporating family violence topics in the medical school curriculum, such as: (1) expose students to information about family violence in their preclinical training, and integrate family violence issues into clinical instruction (several examples are given); (2) use problem-based teaching formats when possible, since these lend themselves well to the integration of family violence issues into case presentations; (3) enrich the curriculum by the participation of a variety of non-MD experts who deal with family violence issues, and take students out of the classroom to shelters and other relevant locations; (4) teach a prevention-oriented approach, just as is taught for the areas of smoking, seat belt use, weight control, etc.; (5) use standardized patients, interactive computer-based learning, and other innovative methodologies to help preclinical students perfect their interviewing and examination skills; (6) during the clinical years, include violence as part of the differential diagnosis of common medical complaints; (7) give attention to the education of residents for consistent teaching and reinforcement of principles learned in medical school, and integrate family violence education into the entire continuum of physicians' education; (8) build appropriate expectations into accreditation requirements and into medical licensing and specialty certifying examinations.(ABSTRACT TRUNCATED AT 250 WORDS)

Accreditation↗