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PubMed2005

What do nurses do when they take to the streets? An analysis of psychiatric and mental health nursing interventions in the community.

Little research can be found on nursing practice for populations needing non-traditional mental health care. A descriptive study was done with the nurses on the Community Link Service (CLS), an intensive psychiatric community follow-up program, to identify nursing interventions and the types of situations encountered. These nurses use the guiding principles of two current treatment modalities, Assertive Community Treatment and Clinical Case Management. The Nursing Interventions Classification System (NIC, McCloskey & Bulecheck, 2000) was used to code nursing interventions reported through interviews and critical incidents. The nursing interventions represented 93 interventions and included 400 different activities. The analysis showed that Case Management (79%) and Complex Relationship Building (71%) were their most common interventions followed by Medication Management (64%) and Surveillance (60%). Systems such as the NIC are useful tools, but they may not give a complete description of nursing practice in this setting.

Case Management↗
PubMed2002

The emergence of global disease control priorities.

How do global disease control priorities emerge? This paper examines the post-World War II histories of efforts to control three diseases--polio, malaria and tuberculosis--to investigate this issue. The paper draws from the policy studies literature to evaluate three models of the priority generation process. A rational model suggests logical selection based on global burden and the availability of cost-effective interventions. An incremental model suggests a drawn out process in which health priorities emerge gradually and interventions reach affected populations through slow diffusion. A punctuated equilibrium model suggests a more complex pattern: long periods of stability during which interventions are available only to select populations, punctuated by bursts of attention as these interventions spread across the globe in concentrated periods of time. The paper finds that the punctuated equilibrium model corresponds most closely to efforts to control these three diseases. Bursts are associated with the convergence of three conditions: the widespread acceptance of the disease as a threat; a perception that human interventions can control disease transmission; and the formation of a transnational coalition of health actors concerned with fighting the disease. The generation of each condition requires considerable groundwork, the reason for long periods of stability. Initiatives take off rapidly when the conditions couple, the reason for bursts. The paper aims to spark additional research on the subject of global disease control agenda setting, a neglected issue in the health policy literature.

Communicable Disease Control↗
PubMed2003

Blending quantitative and qualitative methods in language research and intervention.

Best practice in speech-language pathology should be informed by current research findings. Traditional research methods are not always geared to address some of the complex, individual questions that arise in clinical intervention, however. Qualitative research methods may provide useful tools for bridging the gap from research to practice. Combinations of qualitative and quantitative procedures may be particularly helpful in sorting out some of the important issues surrounding language intervention in both clinical and research contexts. Examples of research blending qualitative and quantitative methods, as well as the case study of Sid, an 11-year-old boy with specific language impairment, are presented to illustrate how a combination of procedures can be used to enhance language research and intervention.

Anxiety↗
PubMed2000

A pattern catalogue of surgical interventions for computer-supported operation planning.

In this paper we present a new operation planning system which was evaluated in the clinic for Cranio-Maxillo-Facial-Surgery at the University of Heidelberg. In opposite to commercial systems our goal was, that the system considers the complete surgical intervention and not only a single procedure of it. A second goal was, that the system enables managing of complex operations, independent of which way the intervention will be intraoperatively performed (without technical support, with passive navigation support or active support by robots). Our system supports the surgeon during the preoperative planning as well as during the intraoperative execution phase. Therefore we developed a course model by which the managing of surgical interventions is possible. The focus of this paper is on this course model. At first we introduce instruction graphs and describe the structure of each activity observing its attributes and their context. Additionally, various surgical scopes will be presented which enable the surgeon to select one view among different ones of the individual operation procedures in accordance to medical and technical knowledge as well as in accordance to different degrees of abstraction. At last we demonstrate operation patterns, used as expert knowledge.

Computer Simulation↗
PubMed2005

Kidney insufficiency and nutrient-based modulation of inflammation.

PURPOSE OF REVIEW: Patients with chronic kidney disease have a high cardiovascular mortality rate. Despite recent advances in dialysis techniques, over 20% of US dialysis patients die every year. Protein-energy malnutrition and inflammation are common and usually concurrent in chronic kidney disease patients, and have been implicated as the main cause of high mortality. We reviewed the pathophysiology of the malnutrition-inflammation complex syndrome and its potential modulation by dietary and other nutritional interventions in chronic kidney disease patients. RECENT FINDINGS: The malnutrition-inflammation complex syndrome is a main cause of the atherosclerotic cardiovascular disease epidemic in chronic kidney disease. This may be by virtue of the syndrome's inflammatory components. Malnutrition and inflammation lead to weight loss over time, i.e. cachexia in slow motion, and result in decreased serum cholesterol and homocysteine levels. A 'reverse epidemiology' of cardiovascular risk factors is observed in chronic kidney disease, in that obesity, hypercholesterolemia and hyperhomocysteinemia are paradoxically associated with better survival. Among the possible etiologies of the malnutrition-inflammation complex syndrome, anorexia, low nutrient intake and oxidative stress are theoretically amenable to dietary modulation; however, the bulk of findings are epidemiological. SUMMARY: There is no consensus as to how to correct the malnutrition-inflammation complex syndrome in chronic kidney disease patients. Because the malnutrition-inflammation complex syndrome is multifactorial, its correction probably requires a battery of simultaneous interventions, rather than one single modality. Clinical trials focusing on the syndrome are currently non-existent and are therefore urgently required to improve poor clinical outcome in chronic kidney disease patients.

Humans↗
PubMed2002

Hybrid approaches to complex congenital cardiac surgery.

OBJECTIVES: A hybrid operation is a joint procedure involving the interventional cardiologist and the cardiac surgeon concomitantly to optimise surgical management. The aim of our study was to demonstrate the conceptual development and the feasibility of a hybrid approach to complex congenital cardiac surgery. METHODS: Descriptive study of two different indications for concomitant intervention by the cardiologist and the cardiac surgeon. Seven patients with complex congenital heart defects requiring high risk operative interventions were included in the study. The indications were: (1) intraoperative stenting of a pulmonary artery stenosis with concomitant additional surgical procedures (n=4). (2) Balloon occlusion of Blalock-Taussig shunts or major aorto-pulmonary collateral artery to control pulmonary blood flow during surgical repair (n=3). RESULTS: All patients had successful hybrid procedures. There were no important complications related to the temporal proximity of the interventional procedure and cardiac surgery, the latter being significantly facilitated by the former. CONCLUSIONS: Intraoperative stenting of pulmonary artery stenosis with additional surgical repair and balloon occlusion on cardiopulmonary bypass can be performed safely and may be complementary in patients with complex lesions by providing a better result in combination than either alone can offer.

Adolescent↗
PubMed2006

Identification of an hexapeptide that binds to a surface pocket in cyclin A and inhibits the catalytic activity of the complex cyclin-dependent kinase 2-cyclin A.

The protein-protein complexes formed between different cyclins and cyclin-dependent kinases (CDKs) are central to cell cycle regulation. These complexes represent interesting points of chemical intervention for the development of antineoplastic molecules. Here we describe the identification of an all d-amino acid hexapeptide, termed NBI1, that inhibits the kinase activity of the cyclin-dependent kinase 2 (cdk2)-cyclin A complex through selective binding to cyclin A. The mechanism of inhibition is non-competitive for ATP and non-competitive for protein substrates. In contrast to the existing CDKs peptide inhibitors, the hexapeptide NBI1 interferes with the formation of the cdk2-cyclin A complex. Furthermore, a cell-permeable derivative of NBI1 induces apoptosis and inhibits proliferation of tumor cell lines. Thus, the NBI1-binding site on cyclin A may represent a new target site for the selective inhibition of activity cdk2-cyclin A complex.

Adenosine Triphosphate↗
PubMed1998

Pharmacologic and psychologic interventions for procedural pain.

OBJECTIVE: This study evaluated a combined pharmacologic and psychologic intervention (combined intervention, CI) relative to a pharmacologic-only (PO) intervention in reducing child distress during invasive procedures in childhood leukemia. Predictors of child distress included age, group (CI, PO), and procedural variables (medications and doses, technical difficulty, number of needles required). METHODOLOGY: This was a randomized, controlled prospective study that compared the PO (n = 45) and CI arms (n = 47), at 1, 6, and >12 months after diagnosis. A cross-sectional control group consisted of parents of 70 patients in first remission before the prospective study. Parent questionnaires, staff and parent ratings, and data on medications administered, technical difficulty of the procedure, and needle insertions were obtained for each procedure. This article reports on the final data point for the project (>12 months). RESULTS: Mothers and nurses reported lower levels of child distress in the CI than the PO group. The CI and PO groups showed lower levels of child and parent distress than the cross-sectional control group. Distress decreased throughout the time, and child age was inversely related to distress (younger children had more distress) regardless of group. Child distress was associated with staff perceptions of the technical difficulty of the procedure and with child age, but not with medications administered. CONCLUSIONS: The data showed that pharmacologic and psychologic interventions for procedural distress were effective in reducing child and parent distress and support integration of the two approaches. Younger children experienced more distress and warranted additional consideration. Staff perceptions of the technical difficulty of procedures were complex and potentially helpful in designing intervention protocols.

Adaptation, Psychological↗
PubMed1998

The role of the neutrophil in ischaemia-reperfusion injury: potential therapeutic interventions.

The pathogenesis of the reperfusion syndrome is complex and as yet not fully elucidated. It is characterized by the development of increased microvascular permeability, oedema and tissue necrosis, and is associated with free radical release, cellular calcium overload and activation of neutrophils. Furthermore, systemic release of putative mediators may result in distant organ injury (lung, kidney, heart). This review, after briefly describing the role of neutrophils in these events, will concentrate on potential therapeutic interventions that might be employed to minimise ischaemia-reperfusion syndrome. Issues of safety will be considered, and potential applications of these techniques in patient management discussed.

Animals↗
PubMed2001

A motivational intervention to improve adherence to treatment of chronic disease.

PURPOSE: To describe an approach to intervention, based on Motivational Interviewing (MI) and the Transtheoretical Model (TTM) of Change that allows the health care provider to support medication adherence in a client-centered fashion. DATA SOURCES: Review of selected research-based and theoretical articles on MI, TTM, and medication compliance issues. CONCLUSIONS: Adherence is a complex phenomenon that requires a personalized intervention. The response must focus on clients' readiness to adhere, their sense of self-efficacy in taking medicines in all circumstances, and their personal pros and cons related to adherence. IMPLICATIONS FOR PRACTICE: Adherence to complex medication regimens is important to long-term treatment of chronic diseases, such as HIV disease. Adherence in HIV is particularly critical to adequately suppress viral replication as well as to prevent opportunistic infections.

Chronic Disease↗
PubMed1997

Complete rupture of the distal semimembranosus complex in a professional athlete.

Complete ruptures of the distal hamstring tendons rarely cause functional disability significant enough to warrant surgical intervention. Isolated ruptures of the distal semimembranosus tendon complex have not been reported previously in the literature. A case of a complete rupture of the distal semimembranosus tendon complex occurring in a professional football player with resultant functional disability is reported here. The magnetic resonance imaging scan was essential for an accurate diagnosis. Subsequent surgical repair and postoperative rehabilitation is described. Strict attention to recreating the multiple attachments of the semimembranosus tendon complex is recommended.

Adult↗
PubMed1997

Evolution of risk behaviors over 2 years among a cohort of urban African American adolescents.

OBJECTIVE: To examine the evolution of risk behaviors over 2 years among a community-based cohort of low-income African American preadolescents and young adolescents enrolled in a randomized trial of an acquired immunodeficiency syndrome risk reduction intervention. DESIGN: Longitudinal, community-based cohort. SETTING: Nine recreation centers serving 3 public housing developments. SUBJECTS: Three hundred eighty-three African American youths aged 9 through 15 years at baseline. INTERVENTIONS: Frequency distributions, chi 2 analyses, and regression analyses regarding 10 risk behaviors were conducted. To assess whether a specific risk behavior or its protective (nonrisk) behavioral analogue, composing a risk-nonrisk behavioral complex (eg, was sexually active and was sexually abstinent or used drugs and refrained from drugs), was stable over time, kappa values were determined for the 10 risk-nonrisk behavioral complexes. MAIN OUTCOME MEASURES: Instrument assessing risk/ behaviors administered at baseline and every 6 months aurally and visually via talking computer. RESULTS: The prevalence of sexual intercourse, cigarette smoking, alcohol consumption, and drug use increased notably over time. Drug use increased from a 6-month cumulative prevalence of 7% at baseline to 27% at the 24-month follow-up (P < .001). Cumulatively over the 2-year study interval, 81% of youths had engaged in fighting, 58% had engaged in sexual intercourse, and from 33% to 40% had engaged in truancy, knife or bat carrying or both, alcohol consumption, drug use, and cigarette smoking. All of the risk-nonrisk behavioral complexes except weapon carrying were stable during the semiannual assessment intervals. Fighting (kappa = 0.22, P < .01), sexual intercourse (kappa = 0.33, P < .001), alcohol consumption (kappa = 0.21, P < .001), and unprotected sexual intercourse (kappa = 0.34, P < .05) were stable for 2 years. Six risk-nonrisk behavioral complexes were stable for the 2-year interval among youths aged 13 through 15 years at baseline, while only 2 risk-nonrisk behavioral complexes were stable among younger youths. The intervention seemed to affect the stability of 4 risk behaviors: truancy, drug use, unprotected sexual intercourse, and, possibly, fighting. For unprotected sexual intercourse, this intervention effect seemed to be due to stabilization of nonparticipation in risky behavior. Intervention youths were less likely to adopt a risk behavior (ie, engage in it for > or = 2 risk assessment periods) than control youths, but they were not less likely to experiment with a risk behavior. CONCLUSIONS: There is evidence that although the prevalence of risk behaviors does change with age, most risk-nonrisk behavioral complexes seem to be relatively stable over time and stability may increase with time. Risk reduction interventions seem to decrease risk adoption, stabilize nonrisk behaviors, and possibly destabilize risk behavior.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Understanding the latest advances in pharmacologic interventions for Alzheimer's disease.

Alzheimer's disease (AD) is a complex medical condition involving abnormalities in multiple biological and environmental domains. Current knowledge suggests that simultaneous intervention in these domains may be the most effective way to help AD patients and their families. Treatments for AD are centered on the inhibition of enzymes responsible for the degradation of acetylcholine--a neurotransmitter that is reduced in AD patients. Four cholinesterase inhibitors have been approved by the United States Food and Drug Administration, three of which are routinely used for the symptomatic treatment of mild-to-moderate AD. Strategies will be reviewed with regard to cognitive, functional, and behavioral domains. Providing a different treatment option for patients with AD, memantine is a low-to-moderate affinity, uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist that has been approved for the treatment of moderate-to-severe AD. The clinical efficacy and tolerability of memantine monotherapy and combination therapy in patients with AD will be presented. Finally, the role of nonpharmacologic intervention will be discussed.

Aged↗
PubMed1999

Angioscopic complex lesions are predominantly compensatory enlarged: an angioscopy and intracoronary ultrasound study.

OBJECTIVES: Atherosclerotic remodeling of the coronary artery may lead to compensatory enlargement or to shrinkage. Post-mortem data suggest a relation between compensatory enlargement and histopathological markers of plaque vulnerability. In patients that required a coronary intervention, we investigated retrospectively the relation between the angioscopic appearance and the remodeling mode of the culprit lesion. METHODS: In 34 patients, coronary angioscopy and intracoronary ultrasound (ICUS) imaging was performed across the culprit lesion before the intervention. Only single de novo lesions were included. With angioscopy, lesions with a smooth surface without thrombus were classified as smooth, whereas lesions with an irregular surface with or without thrombus were classified as complex. With ICUS, remodeling of the culprit lesions was determined by the relative cross-sectional vessel area (lesion vessel area/reference vessel area) x 100%. Lesions were divided into three groups: compensatory enlargement (relative vessel area > or = 105%), no-remodeling (relative vessel area between 95 and 105%) and shrinkage (relative vessel area < or = 95%). RESULTS: In 22 patients good images were obtained with both imaging modalities. More complex lesions were compensatory enlarged compared to shrunken lesions, whereas more smooth lesions were shrunken compared to compensatory enlarged lesions, 8/9 versus 2/7 and 5/7 versus 1/9, respectively (p = 0.035). CONCLUSIONS: In patients selected for coronary intervention, angioscopic complex atherosclerotic lesions were found predominantly in compensatory enlarged arterial segments, whereas smooth lesions were found predominantly in shrunken arterial segments.

Adult↗
PubMed2002

[Complexity of help to children with developmental disabilities in the context of the establishment of Early Rehabilitation Services].

During of the years of restoration of independence of Lithuania a new model of services for children with developmental disorders was designed by Vilnius Child Development Center and Clinic of Social Pediatrics and Child Psychiatry, Vilnius University, and started to be implemented throughout all the country. Analysis of current situation of early intervention services in Lithuania is presented. The study was carried at the four randomly selected early intervention services. Patients and specialists of early intervention services together with patients and specialists of polyclinics where the services are located were interviewed using the questionnaires developed by the authors. Complexity of views of services providers and consumers together with the aspects of distribution of the information about the early intervention services and cooperation of early intervention services with other professionals was analysed. Data of the focus groups discussions with the specialists of early intervention services and analysis of the case histories are also presented. The data reflected the problems of the process of establishing the new services, period of creation and difficulties of working with children having severe disturbances and their families. Diagnosing and treatment of motor disabilities were dominating while emotional and behavioral disorders were underdiagnosed, case histories lacked complexity of the biopsychosocial view. Recommendations for the ways for future development are provided stressing the importance of seeking more complex interventions including psychosocial aspects of child development and family counseling.

Child↗
PubMed1987

Zonal high-performance affinity chromatography as a tool for protein interaction studies with special reference to the lipase-colipase complex.

The technique of zonal high-performance affinity chromatography applied to the lipase-colipase system (lipase B as eluted acceptor and colipase as silica-bonded ligand) gave qualitatively the same results as conventional affinity chromatography. The elution volume of the acceptor increases with decreasing load introduced at constant volume into the column of ligand-bonded silica. This led to the use of a mathematical treatment for calculating the dissociation constant (KD) of the lipase-colipase complex. The influence of some physical and chemical chromatographic parameters was studied. Increasing temperature and flow-rate reduced the affinity of lipase for colipase, whereas it was only slightly modified by increasing the ionic strength. The KD value was minimal and equal to 0.1 X 10(-6) M at pH 4.7 and 0.38 X 10(-6) M at pH 6.5, after correction for the flow-rate. The latter value is similar to that obtained by more conventional techniques. The absence of some marked KD modifications by ionic strength and the value of delta S for the complex association obtained by temperature studies suggest the intervention of mixed hydrophobic-ionic interactions in the formation of the lipase-colipase complex. Their respective importances are discussed.

Animals↗