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PubMedDate not supplied

An exploration of lesbians' images of recovery from alcohol problems.

The author's purposes in this article are to explore the images lesbians use to describe their recovery from alcohol problems and to derive from this exercise relevant implications for health care. Lesbians' experiences in recovery are particularly significant because of growing concerns about the prevalence of alcohol problems among lesbians, the vulnerability of lesbians as an aggregate, and the cultural trend away from substance use in lesbian communities. Images of recovery are the descriptions that people offer about their healing from alcohol problems. They are the frameworks by which problem drinkers interpret the meanings of their experiences and determine which aspects of their lives are most pertinent to their recovery efforts. The images persons use to represent their progress and the difficulties they encounter in recovery also provide important bases for developing relevant resources, therapeutic techniques, and social support. Excerpts from an ongoing ethnographic interview study about the recovery experiences of lesbians with alcohol problems illustrate the diversity of recovery images that are characteristic of this population.

Alcoholism↗
PubMed1985

Bronchoalveolar lavage cell differential in the diagnosis of sarcoid interstitial lung disease. Likelihood ratios based on computerized data base.

With the use of a microcomputer, the authors prospectively stored the bronchoalveolar lavage (BAL) cell differential counts from 208 patients undergoing initial evaluation for chronic interstitial lung disease. Sarcoidosis subsequently was diagnosed in 46% of these patients; the remainder had several other etiologies of their lung disease. The BAL lymphocyte count did not allow for clear separation between these two groups. To facilitate the interpretation of the BAL percent lymphocyte data, the authors applied a modification of Bayes' theorem to calculate likelihood ratios for the differential diagnosis of sarcoidosis versus other interstitial lung disease. These values ranged from 0.15 for patients with less than 6% lymphocytes to 3.5 when more than 40% lymphocytes were found. Similar results were obtained with a subsequent, independently analyzed group of 46 patients. To provide a more meaningful interpretation of the BAL fluid lymphocyte count, the authors designed a reporting scheme that includes both a written description and a graphic representation of the likelihood ratio. Prospective collection of data using microcomputers should extend this useful form of reporting to additional laboratory studies.

Bayes Theorem↗
PubMed1998

Gender differences in general practice consultations: methodological challenges in epidemiological research.

BACKGROUND: Women consult their GP more often than men do. The distribution of complaints and diagnoses are different for women and men patients. Although several findings on gender differentials on mortality and health care consumption are rather consistent across studies, detailed findings and subsequent conclusions diverge in several important fields. OBJECTIVES: Our aim was to explore methodological aspects of research on gender differences in general practice. METHODS: We reviewed empirical studies within this field, aiming to identify methodological and interpretative intricacies which deserve special attention in epidemiological research on GP consultations. RESULTS AND CONCLUSIONS: We found that descriptive and explanatory levels of research are frequently confused. Simple questions, answers and explanations are commonly raised for complex issues within a poorly defined theoretical explanatory framework. There is a need to assess relevant approaches for various purposes, and to develop more uniform conceptual terms. Findings from one level are often transferred to another, incompatible level. Epidemiological issues must be considered, especially matters related to denominator level and standardization/confounders-not in order to decide which level represents 'reality', but to clarify the consequences of different measures for different research questions. The contents of the core variables and the potentials for bias should be discussed in order to provide a sound basis for future explanatory studies.

Epidemiologic Research Design↗
PubMed1994

Acute renal failure in trauma: current perspectives.

Trauma complicated by acute renal failure provides a challenge for the members of the critical care team. Clinicians face a wide range of clinical problems complicated by a climbing mortality rate, as high as 70%. To meet this challenge, clinicians need an understanding of the most recent studies, so they can determine whether the findings can be translated into practice. In addition, prevention needs to be made the frontline of care, and when this is not possible, the second consideration must be directed at selecting therapeutic modalities for the creation of a nonoliguric acute tubular necrosis. These efforts will assure that patients receive the most current and comprehensive care. This article supports these efforts by providing an explanation of the pathogenesis of acute tubular necrosis on a cellular level and interpreting this information on a renal structural level, as well as into the clinical practice by including a description of a variety of medical and nursing modalities as found in the literature.

Acute Kidney Injury↗
PubMedDate not supplied

The composition of the radiologic report.

In order to understand and evaluate fully the composition of the radiologic report, an experiment was performed in which eight readers each read the same 100 chest radiographs. The reports were dissected into individual statements, each of which was analyzed for accuracy, statement type (descriptive or etiologic), confidence, and specificity. In addition, each report was evaluated for stylistic factors of succinctness, orderliness, and the use of supplemental comments. Detailed analysis showed the radiologic report to be a series of largely descriptive statements in which confidence level, specificity, and orderliness were associated with the presence of errors in film interpretation. These factors can serve as important markers for identifying error-laden films. The use of specific, etiologic diagnoses in these film readings was limited. The composition of the report was not related to the length of radiologic training beyond the first year of residency. The implications of these findings concerning report composition in light of present day radiologic practice and new, automated radiologic reporting systems were discussed.

Diagnostic Errors↗
PubMedDate not supplied

A reassessment of ground water flow conditions and specific yield at Borden and Cape Cod.

Recent widely accepted findings respecting the origin and nature of specific yield in unconfined aquifers rely heavily on water level changes observed during two pumping tests, one conducted at Borden, Ontario, Canada, and the other at Cape Cod, Massachusetts. The drawdown patterns observed during those tests have been taken as proof that unconfined specific yield estimates obtained from long-duration pumping tests should approach the laboratory-estimated effective porosity of representative aquifer formation samples. However, both of the original test reports included direct or referential descriptions of potential supplemental sources of pumped water that would have introduced intractable complications and errors into straightforward interpretations of the drawdown observations if actually present. Searches for evidence of previously neglected sources were performed by screening the original drawdown observations from both locations for signs of diagnostic skewing that should be present only if some of the extracted water was derived from sources other than main aquifer storage. The data screening was performed using error-guided computer assisted fitting techniques, capable of accurately sensing and simulating the effects of a wide range of non-traditional and external sources. The drawdown curves from both tests proved to be inconsistent with traditional single-source pumped aquifer models but consistent with site-specific alternatives that included significant contributions of water from external sources. The corrected pumping responses shared several important features. Unsaturated drainage appears to have ceased effectively at both locations within the first day of pumping, and estimates of specific yield stabilized at levels considerably smaller than the corresponding laboratory-measured or probable effective porosity. Separate sequential analyses of progressively later field observations gave stable and nearly constant specific yield estimates for each location, with no evidence from either test that more prolonged pumping would have induced substantially greater levels of unconfined specific yield.

Environmental Monitoring↗
PubMed2004

An automated method for the quantification and fractal analysis of immunostaining.

AIMS: In tissue counter analysis (TCA) digital images of complex histologic sections are dissected into elements of equal size and shape, and digital information comprising grey level, colour and texture features is calculated for each element. In this study we assessed the feasibility of TCA for the quantitative description of amount and also of distribution of immunostained material. METHODS: In a first step, our system was trained for differentiating between background and tissue on the one hand and between immunopositive and so-called other tissue on the other. In a second step, immunostained slides were automatically screened and the procedure was tested for the quantitative description of amount of cytokeratin (CK) and leukocyte common antigen (LCA) immunopositive structures. Additionally, fractal analysis was applied to all cases describing the architectural distribution of immunostained material. RESULTS: The procedure yielded reproducible assessments of the relative amounts of immunopositive tissue components when the number and percentage of CK and LCA stained structures was assessed. Furthermore, a reliable classification of immunopositive patterns was found by means of fractal dimensionality. CONCLUSIONS: Tissue counter analysis combined with classification trees and fractal analysis is a fully automated and reproducible approach for the quantitative description in immunohistology.

Fractals↗
PubMedDate not supplied

The experience of using decisional support aids by patients with breast cancer.

PURPOSE/OBJECTIVES: To explore the lived experience of patients with breast cancer using decisional support aids during the prediagnosis, diagnosis, and treatment phases of their disease. RESEARCH APPROACH: Descriptive, phenomenologic. SETTING: Community-based. PARTICIPANTS: 12 women, ages 38-68, diagnosed with and treated for breast cancer. METHODOLOGIC APPROACH: Audiotaped interviews were transcribed and analyzed according to Colaizzi's method. MAIN RESEARCH VARIABLES: Use of decisional support aids. FINDINGS: Six major themes were identified: being too stressed and overwhelmed to make a decision, feeling an internal sense of urgency to have the breast cancer managed quickly, trusting the opinion and advice of physicians about treatment decisions, appreciating the importance of support from family and friends in decision making, finding nurses were unavailable or uninvolved in decision making initially, and missing out on the benefits of a multidisciplinary approach. CONCLUSIONS: Being presented with the diagnosis of breast cancer evokes a range of feelings and emotions. By identifying, explaining, and expressing their accounts, participants revealed their lived experience and its meaning. The description of this phenomena may assist other women diagnosed with breast cancer in the decision-making process. INTERPRETATION: Oncology nurses need to be aware of and understand the issues surrounding the decision-making process of patients with breast cancer. Gaps clearly exist in the information and support provided to these participants. Nurses must target areas that are insufficient in providing decisional support aids and plan for partnerships to ensure a multidisciplinary approach in this process.

Adult↗
PubMed1983

A psychodynamic approach to MMPI Interpretation.

An interpretive approach to the Minnesota Multiphasic Personality Inventory (MMPI), based on a psychodynamic conceptual system, is presented. Scale elevations and configurations on the MMPI are viewed as reflecting the following dimensions of personality: (a) characteristic security and defense operations, (b) capacity to manage or tolerate anxiety, c) characteristic ways of dealing with aggression and hostility, d) stability of reality contact, e) quality of object relations, and f) level of psychopathology. Various MMPI profile configurations, and empirical research findings where applicable, are related to variations in personality functioning and psychopathology within each of these six dimensions. The interpretive approach described is consistent with the authors' belief that psychological assessment should go beyond the level of description and attempt to understand the individual in a more comprehensive and integrated manner.

Aggression↗
PubMed1995

Parental representations among preschoolers and fourth-grade children: integrating object relational and cognitive developmental frameworks.

The aim of this research was the empirical study of the development of object representations among preschool and fourth-grade children. Psychometric properties and age differences on structural and qualitative dimensions of parental descriptions are reported. The relationships between the dimensions of object representations and children's self-perceptions and interpretations of situations depicting typical interferences of ongoing parent-child relations were explored. Our findings point to multidimensional representations, underlying the importance of the structural dimensions of the representation. More mature representations were related to more advanced conflict resolution strategies. More positive perceptions of self in middle childhood and less idealized self-concept among preschoolers were associated to higher conceptual levels of parental representations. The constraints, as well as the possibilities, inherent to research based on narrative models of object representations are discussed.

Child↗
PubMed1997

[Ethnographic studies in nursing].

This article makes an deals with ethnographic research in nursing. It discusses the goal and the relevance of this kind of research the professional context. It includes also issues related to rigor and ethics. It points out basic aspects of participant-observation and ethnographic interview methods, and makes an overview of data collection, analysis and utilization of this data for culture description.

Anthropology, Cultural↗
PubMed1997

Engineering department physical plant staffing requirements.

There is a considerable effort in the health care arena to establish credible engineering manpower yardsticks that are universally applicable as a benchmark. This document was created by using one facility's own benchmark criteria that can be used to help develop either internal or competitive benchmarking comparisons.

Contract Services↗
PubMed2001

[Activities and staffing in intensive care units in Norway--still need of better registration].

BACKGROUND: Standards in Intensive Care Medicine were approved by the Board of the Norwegian Medical Association in 1997. Their purpose is to clarify issues of responsibility, accountability and management in intensive care units. It also gives recommendations on management, staffing, education and resources. MATERIAL AND METHODS: In order to obtain a reference point for any future assessment of the impact of the Standards document, a survey was carried out, addressing work load, medical staff, and questions of accountability, responsibility and cooperation. RESULTS: 16 hospitals responded (76%). The results seem to indicate that medical staff in relation to work load is smaller than recommended. It also seems that junior doctors only to a small extent are present in the intensive care units during ordinary working hours, and consequently have little opportunity to learn from working with experienced colleagues. However, both conclusions, especially the first one, are not entirely reliable, as close examination of the answers indicate that important concepts concerning the description of work load and staffing are poorly defined, and that the monitoring of work load is insufficient. INTERPRETATION: It is concluded that staffing and work load in intensive care units are still insufficiently defined and monitored. The training environment for specialists is not optimal.

Humans↗
PubMed1990

[Freud's Moses study as day dream].

Starting from a description of the Moses-manuscripts and an examination of certain peculiarities in the published text, the author interprets Freud's last book as a day-dream. She reads therein indications of a crisis precipitated by the Nazi persecution, which Freud mastered by day-dreaming and through self-analysis. Considering the Moses study in this way it becomes clear that Freud's late discoveries concerning archaic mechanisms of defense were essentially the outcome of self-analysis--as were his first insights into the laws of dreaming in the beginnings of psychoanalysis. In his old age, Freud took up this work again in dialogue with Arnold Zweig and Thomas Mann; it also led him to an immersion in the tora and the Philippson bible commentary, familiar to him from his childhood.

Bible↗
PubMed1988

Sarcoidosis in the United States--1968 to 1984. Hospitalization and death.

In order to provide national data on the epidemiology of sarcoidosis in the United States, data from the National Center for Health Statistics were examined for the period 1968 to 1984. Sarcoidosis appeared among the diagnoses of over 20,000 hospital discharges in recent years. It was mentioned on 605 death certificates in 1982, and as underlying cause of death on 339.In blacks, rates of hospital discharge with the diagnosis were eight times those of whites in 1981, and death rates were 20 times those of whites at ages 15 to 44 years. Women had higher rates than men. Both hospitalization and mortality data may give distorted pictures of this frequently mild or asymptomatic condition. Furthermore, no information was available on the percentage of diagnoses confirmed by biopsy, or on severity of disease in hospitalized patients.Race-specific hospital discharge rates must be interpreted with caution in this survey. Nevertheless, patterns were generally consistent with studies of prevalence and incidence. Further descriptive and analytic studies of the epidemiology of sarcoidosis are needed to help identify modifiable risk factors and possible causes.

Adolescent↗