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Results for “Complex intervention”

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PubMed1987

T-cell mitogenesis and natural killer cell activity in colonic tumor-bearing and nontumor-bearing rats fed diets high in lipid with and without cholesterol.

It has been shown that rats fed diets high in lipid and cholesterol develop more 1,2-dimethylhydrazine (DMH)-induced bowel tumors than those fed diets low in lipid or without cholesterol. To further explore the effects of these dietary regimens on immune function, rats were fed diets containing 20% safflower or coconut oil, with or without cholesterol (1%) and cholic acid (0.3%), for 35 weeks during which time they were given DMH. Only rats bearing one or more colon tumors and that showed no evidence of weight loss were utilized. Two parameters of cell-mediated immune function were assessed in tumor- and nontumor-bearing control rats: a) response to the T-cell mitogen, phytohemaglutinin (PHA), and b) natural killer cell activity (NKCA). Nearly total suppression of PHA response was observed in the polyunsaturated fat diet group compared with the saturated fat diet groups. Addition of cholesterol to either the polyunsaturated or saturated fat diets diminished PHA response and, to a lesser degree, of T-lymphocytes from rats fed these diets. NKCA, however, was unaffected by either the quality of dietary fat or cholesterol. There were no detectable effects of DMH per se 15 weeks after the last injection (or in the presence or absence of tumors) on T-lymphocyte response to PHA or on NKCA. The relationships among lipid nutrition, carcinogen-induced tumorigenesis, and immunologic events is obviously complex. These studies imply that nutritional interventions may have a selective rather than a generalized effect on various immunocompetent cell populations. Furthermore, the effects of lipid nutriture, rather than long-term effects of carcinogen administration, or the presence of bowel tumors appear to play the major role on perceived alterations in in vitro immune function. Thus the effects of these lipid nutritional interventions on DMH-induced tumorigenesis seem independent of their effects on immune phenomena with the immune probes utilized.

1,2-Dimethylhydrazine↗

PubMed2002

Acoustic phonetics in a clinical setting: a case study of /r/-distortion therapy with surgical intervention.

Acoustic measures are used to document the speech of a 6-year-old child with persistent /r/-distortion through several treatment interventions. The child originally presented a complex of speech disorders and was treated by a speech-language pathologist using phonological process techniques. The procedures successfully corrected most of his speech problems, although /r/ remained severely distorted. The primary acoustic manifestation of this distortion was a high third formant. Surgical correction of a banded lingual frenulum, along with adenoton-sillectomy indicated for sleep apnea, is shown to have had a small effect in lowering the third formant. A dramatic change was seen on reintroduction of therapy, when an extreme drop in third formant frequencies for /r/ was observed. The acoustic data are interpreted using speaker-internal controls derived from a dialect-appropriate adult model.

Articulation Disorders↗

PubMed2005

Oxidative stress and inflammatory response during and following coronary interventions for acute myocardial infarction.

BACKGROUND: In acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI), myocardial injury results from complex processes during both ischemia and reperfusion. Release of reactive oxygen species (ROS) may contribute to the accumulated myocardial damage. AIMS: To examine by frequent sampling of peripheral blood oxidative stress and early inflammation in patients undergoing primary PCI for AMI. Secondly, to assess whether a correlation exists between these parameters and the extent of myocardial damage. METHODS: Sixteen patients undergoing primary PCI within 6 h of AMI onset were included. Peripheral blood was sampled at start of procedure (t0) and repeatedly over 24 h following reperfusion. Main plasma analyses were: 8-iso-PGF2alpha (oxidative stress), 15-keto-dihydro-PGF2alpha (cyclooxygenase-mediated inflammation); and troponin-T (myocardial injury). Additional analyses included: total antioxidant status (TAS); vitamins; hsCRP and lipids. RESULTS: 8-Iso-PGF2alpha increased following restoration of blood flow, returned to t0 values after 3 h and was reduced below t0 the following day. TAS decreased significantly from t0 to the next day. There was no significant correlation between 8-iso-PGF2alpha and troponin T values. 15-Keto-dihydro-PGF2alpha was elevated during the first hour. There was a major rise in hsCRP after 24 h. CONCLUSION: Following reperfusion by primary PCI in AMI, oxidative stress and an inflammatory response are induced immediately. A rise in 8-iso-PGF2a during ischemia indicate that ROS generation may also take place during severely reduced coronary blood flow and hypoxia. No direct relationship between 8-iso-PGF2alpha or 15-keto-dihydro-PGF2alpha and troponin T was evident. The present study adds to the increasingly complex pathophysiological roles of ROS acting both as signal molecules and as mediators of tissue injury.

Acute Disease↗

PubMedDate not supplied

Ethnicity, forced migration and psychosocial work in Croatia.

This article outlines the development of psycho-social work with refugees and displaced persons in Croatia, in the context of war and large-scale forced migration. The article, which is based upon original research on refugees and displaced persons in Croatia, considers the dominance of ethnicized nationalism within Croatia, examines the role of global agencies and how psychosocial programmes influence aspects of ethnicity. It ends with some recommendations for the development of an anti-nationalistic psychosocial work approach in complex emergencies and wider forms of intervention.

Croatia↗

PubMedDate not supplied

Exploring the effects of communication intervention for developmental pragmatic language impairments: a signal-generation study.

BACKGROUND: The remediation of pragmatic problems forms a significant part of the caseload for professionals working with children with communication problems. There is little systematic evidence that demonstrates the benefits of speech and language therapy for children whose difficulties lie primarily within the pragmatic domain or which indicates whether changes in pragmatic behaviours, which are a result of a specific intervention, can be measured over time. AIMS: To generate a signal of change in pragmatic and other language behaviours for children with pragmatic language impairments; to gauge the magnitude and nature of the signal and to make recommendations for future studies. METHODS AND PROCEDURES: A case series of six children with pragmatic language impairments without diagnosis of autism received 8 weeks of individual intensive speech and language therapy supported in a mainstream educational setting in the UK. Measures of pragmatic behaviours in conversation were made at seven data points before and after therapy using Bishop's ALICC procedure. Conversation coders were blind to the point of assessment. Inferential comprehension, narrative, sentence formulation and sentence recall skills were also tested before and after therapy. The opinions of teachers and parents were sought regarding any change in communication and social abilities of the children over time. OUTCOMES AND RESULTS: All children showed change in communication behaviour on some conversational measures, even if the child functioned at the ceiling on standardized language testing. Some conversation measures had more utility as outcome measures than others. Most children showed substantial change on standardized language measures, but there are limitations on the use of these due to heterogeneity within the group. Overall, the intervention produced a signal for change in pragmatics and/or language behaviour in all children. Parent/teacher opinion reported demonstrable change in communication behaviour and engagement in the curriculum. CONCLUSIONS: There is a strong signal that change in pragmatic language behaviour can be measured in well-controlled intervention studies but this signal is complex. Outcome measures should take into account changes in language processing skills that are significantly impaired in many children with PLI. For those children within the PLI group who function at ceiling on language tests, conversational measures may have the potential to signal change, but this finding has not been subjected to group study or to testing in generalized settings. Qualitative data regarding behaviour, classroom engagement and generalization of language gains will be an essential supplement to measuring progress in a diverse population.

Child↗

PubMedDate not supplied

The moral domain of the medical record: the routine ethics evaluation.

The structure, content, and orientation of the contemporary medical record inadequately reflect the appropriate influence of patients' rights and bioethics on health care. Most tellingly, the medical chart reveals a remarkable absence of attention to medical ethics, except in the case of crisis management. But medical ethics informs both crisis decision-making and virtually all clinical interventions. Indeed, clinical care embodies a complex array of choices influenced by individual and cultural values, themselves reflecting religious beliefs, personal histories, psychologies, and social mores. But the typical medical chart, which records clinical descriptions, analyses, and rationales for treatment, rarely identifies or accounts for this value-laden dimension of care and thus both over-simplifies and distorts the depiction of a patient's illness and its treatment. To better reflect the complex moral domain of clinical care, and assist in organizing its complex structure, a systematic procedure is proposed here to evaluate the ethical status of every patient: As a routine part of the clinical evaluation, in a designated Ethical Concerns section of the medical record, an "ethics work-up' is designed to serve as a moral 'diagnostic' analogous to its scientific counterpart. Adapted to the needs of individual patients, such evaluations should identify ethical problems, coordinate related data, resources, and opinion, and define the rationale for choices made and actions pursued. In establishing improved integration of the 'epistemologies' of care and the 'ethics' of care, the goals of a more humane, patient-centered medicine may be better met.

Boston↗

PubMed2004

Inhibiting the Arp2/3 complex limits infection of both intracellular mature vaccinia virus and primate lentiviruses.

Characterizing cellular factors involved in the life cycle of human immunodeficiency virus type 1 (HIV-1) is an initial step toward controlling replication of HIV-1. Actin polymerization mediated by the Arp2/3 complex has been found to play a critical role in some pathogens' intracellular motility. We have asked whether this complex also contributes to the viral life cycles including that of HIV-1. We have used both the acidic domains from actin-related protein (Arp) 2/3 complex-binding proteins such as the Wiscott-Aldrich syndrome protein (N-WASP) or cortactin, and siRNA directing toward Arp2 to inhibit viral infection. HIV-1, simian immunodeficiency virus (SIV), and intracellular mature vaccinia virus (IMV) were sensitive to inhibition of the Arp2/3 complex, whereas MLV, HSV-1, and adenovirus were not. Interestingly, pseudotyping HIV-1 with vesicular stomatitis virus G protein (VSV-G) overcame this inhibition. Constitutive inhibition of the Arp2/3 complex in the T-cell line H9 also blocked replication of HIV-1. These data suggested the existence of an Arp2/3 complex-dependent event during the early phase of the life cycles of both primate lentiviruses and IMV. Inhibiting the HIV-1's ability to activate Arp2/3 complex could be a potential chemotherapeutic intervention for acquired immunodeficiency syndrome (AIDS).

Acquired Immunodeficiency Syndrome↗

PubMed2002

Increasing compliance with maternal and child care quality standards in Ecuador.

OBJECTIVE: To determine the effects of hospital quality assurance interventions on compliance with clinical standards, availability of essential drugs, client satisfaction, and utilization. DESIGN: Quasi-experimental, prospective study with four intervention hospitals and four control hospitals. All eight facilities were purposively selected and of comparable complexity. SETTING: Ministry of Health secondary care facilities in Ecuador. INTERVENTIONS: Facility-based quality improvement teams, job clarification, standards communication, refresher training, strengthening hospital pharmacy committees, monthly monitoring of compliance indicators, and formation of users' committees. MEASURES: Compliance with input and process standards, utilization of services, and patient satisfaction were measured monthly in both groups through review of clinical and administrative records, exit interviews, and patient satisfaction surveys. RESULTS: After 12 months, the quality assurance interventions produced rapid increases in compliance with clinical standards in the intervention hospitals as compared with the control group. These improvements appeared as early as 2 months after the onset of the interventions. No differences were found between intervention and control groups in terms of trends in utilization patterns or client satisfaction. CONCLUSION: Quality assurance interventions made a difference in technical quality of care. Patient satisfaction and utilization do not appear to be directly associated with short-term improvements in compliance with clinical standards. Quality improvement interventions may require longer periods and a specific aim at clients' needs to demonstrate effects on utilization and satisfaction outcome variables.

Adult↗

PubMed2001

A proteinase-storing body that prepares for cell death or stresses in the epidermal cells of Arabidopsis.

Plants degrade cellular materials during senescence and under various stresses. We report that the precursors of two stress-inducible cysteine proteinases, RD21 and a vacuolar processing enzyme (VPE), are specifically accumulated in approximately 0.5 microm diameter x approximately 5 microm long bodies in Arabidopsis thaliana. Such bodies have previously been observed in Arabidopsis but their function was not known. They are surrounded with ribosomes and thus are assumed to be directly derived from the endoplasmic reticulum (ER). Therefore, we propose to call them the ER bodies. The ER bodies are observed specifically in the epidermal cells of healthy seedlings. These cells are easily wounded and stressed by the external environment. When the seedlings are stressed with a concentrated salt solution, leading to death of the epidermal cells, the ER bodies start to fuse with each other and with the vacuoles, thereby mediating the delivery of the precursors directly to the vacuoles. This regulated, direct pathway differs from the usual case in which proteinases are transported constitutively from the ER to the Golgi complex and then to vacuoles, with intervention of vesicle-transport machinery, such as a vacuolar-sorting receptor or a syntaxin of the SNARE family. Thus, the ER bodies appear to be a novel proteinase-storing system that assists in cell death under stressed conditions.

Adaptation, Physiological↗

PubMed1994

Case report: treatment of an intracranial arteriovenous malformation in a patient with complicated hemophilia.

The authors describe a young man with hemophilia complicated by chronic hepatic dysfunction, hypodysfibrinogenemia, and immune thrombocytopenia that resulted in a complex coagulopathy. The patient had a ruptured occipital arteriovenous malformation. The malformation was managed by temporary correction of the coagulopathy using cryoprecipitate, platelet transfusions, and plasmapheresis with fresh frozen plasma replacement. The patient underwent staged preoperative embolization followed by surgical excision of the lesion. Hemostasis was acceptable during the neurointerventional and subsequent surgical management, and no complications of coagulopathy occurred. Plasmapheresis may provide effective preparation for patients with hemophilia and complex coagulation abnormalities who require neurosurgical intervention.

Adult↗

PubMed2003

Preparing CNSs for prescriptive authority: Winona State University Model Course.

Medical-surgical clinical nurse specialists (CNSs) have always been involved in treating disease-based and nondisease-based health problems. Recently, expanding state nurse practice acts have allowed medical-surgical CNSs to add pharmacologic agents to their arsenal of advanced practice interventions to best manage their patients' complex healthcare needs. This article discusses the history of prescriptive authority for medical-surgical CNSs, describes a new university program for preparing CNSs for prescriptive authority, summarizes interview responses of 4 students who have completed the university program, and highlights implications for practice and education. The university program includes coursework and clinical training and integrates distance-education strategies to reach students with diverse geographic and scheduling challenges. Themes from the 4 student interviews are positive and support CNSs having prescriptive authority. Facilitators and barriers to actualizing CNS prescriptive authority, implications for educational programs, and issues surrounding distance-education and clinical training are highlighted.

Adult↗

PubMed2003

High-speed video analysis of head-first and feet-first sliding techniques in collegiate baseball players.

OBJECTIVE: To determine the method of sliding that propels the baseball athlete to the desired base in the shortest amount of time. To assess the athlete's perception of the quickest, safest, and preferred sliding technique. DESIGN: A single occasion with repeated measures design was used. The independent variable was slide type, and the dependent variable was time. SETTING: The study was conducted in October 2000 at the University of Kentucky baseball complex. PARTICIPANTS: Twenty collegiate baseball players. INTERVENTIONS: High-speed video (to 1/200th of second) analysis of 20 collegiate baseball players performing 3 trials each of both head-first and feet-first sliding techniques. Additionally, each participant was asked to complete a sliding survey. MAIN OUTCOME MEASURES: The videotape of each slide performed was reviewed separately (using the same viewing equipment) by 2 of the study investigators. Slide type and time were recorded for each slide. RESULTS: There was no significant difference between head-first versus feet-first slide times (P = 0.357). The average time for feet-first slides was 3.67 seconds, while that for head-first was 3.65 seconds. Sixty-eight percent of the players felt that head-first slides were faster than feet-first slides. Seventy-four percent identified the feet-first slide as the technique they most used, while 90% of the athletes perceived the feet-first technique to be safer. CONCLUSIONS: On average, head-first and feet-first sliding techniques employed at the end aspect of base running propel the baseball player to the base in similar times. The head-first sliding technique is perceived to be faster and more dangerous.

Adult↗

PubMed2006

Cash-based interventions: lessons from southern Somalia.

Commodity distributions, the predominant relief response, are subject to growing criticism, while donors and humanitarian actors are increasingly viewing cash-based interventions as a viable alternative. This paper aims to contribute to the current debate on cash-based interventions by drawing on the experience of Action Contre la Faim in southern Somalia, where it has implemented cash for work programmes since 2004. The authors conclude that cash-based interventions are a feasible option in complex emergencies as well as in highly insecure environments as long as appropriate modalities are employed and objectives are clearly set in accordance with the needs and the context. Cash as a relief response offers wide-reaching possibilities for the future from both the perspective of the donor/agency and the standpoint of the beneficiary. It enables the beneficiaries to take control of the relief themselves and to adapt it to their individual requirements in a timely manner.

Altruism↗

PubMed1997

Radiofrequency ablation of accessory pathways associated with congenital heart disease.

The coexistence of significant congenital cardiac disease with accessory pathways is not uncommon, and presents a number of issues for clinical management. These issues include the propensity of such patients to have poorly tolerated tachycardia; the difficulties in choosing appropriate medical management given potential problems with preexisting sinus node disease, poor contractility, and the possibility of proarrhythmia; the need to seriously consider ablation prior to, or at the time of, intracardiac repair of congenital cardiac defects; and finally, the difficulties that complex anatomy may pose to the interventional electrophysiologist. Definitive management requires expertise both in electrophysiology and in pediatric cardiology. Success can usually be achieved with a careful, anatomically precise approach, combined with imagination and persistence. Because of the difficulties with medical management, catheter ablation may be the most attractive modality for control of accessory pathway tachycardia in this patient population.

Atrioventricular Node↗

PubMed2002

Coronary artery "pseudothrombus" due to collateral flow artifact distal to left circumflex coronary stenosis.

Since the complexity, morbidity, and costs of coronary interventions are increased when coronary thrombus is present, identification of the cause of an angiographic filling defect is potentially important. We present a case report and review our experience with a flow artifact that mimicked thrombus ("pseudothrombus") in the setting of a severe proximal stenosis in the left circumflex coronary artery.

Collateral Circulation↗

PubMed2005

Percutaneous closure of congenital and acquired ventricular septal defects--considerations on selection of the occlusion device.

Nonsurgical closure of congenital and acquired ventricular septal defects (VSD) has become increasingly acceptable with the availability of various occlusion systems that allow percutaneous treatment of muscular and membranous defects. This study describes a series of 12 patients (0.2-74-years-old) who underwent defect closure with six different occlusion systems. Device selection according to anatomy and outcome is highlighted. Seven VSDs were located in the membranous part of the septum, five in the mid-muscular septum. Complex heart lesions were present in five postmyocardial infarction VSD in one and residual postsurgical defects in three patients. The size of the VSD ranged from 2.6 to 10 mm. The applied devices were: Amplatzer muscular VSD occluder (n=4), Amplatzer septal occluder (n=2), Amplatzer duct occluder (n=1), Amplatzer membranous VSD occluder (n=2), Nit-Occlud coil (n=2), and Cook PDA coil (n=1). The devices were implanted successfully in nine patients. There was complete VSD closure in eight patients within the first 24 hours. In one patient, a trivial residual shunt disappeared at 6 months follow-up. Because of device instability, two occluders were removed during catheterization. In two other cases, tricuspid valve tissue was entrapped in the occluder and had to be removed surgically, one of them during the consecutive Rastelli operation. Neither significant arrhythmia, nor thromboembolism or hemolysis occurred in out patients during follow-up. Transcatheter closure of VSD is an attractive alternative to surgery. In complex congenital heart disease, surgical-interventional hybrid therapy may improve morbidity and total outcome. The recently developed Amplatzer VSD devices allow closure of muscular and membranous VSDs. Implantation and short-term follow-up are superior to the formerly used devices. Long-term effects have to be evaluated in further studies.

Adolescent↗

PubMed1996

Health education in Jinja, Uganda.

A community-based health care program in Uganda is described. Perceived learning needs of a group of adults with 3-4 years of elementary school education were assessed and prioritized. A decision was made to teach a few subjects in depth as opposed to many superficially after hearing the large amount and type of topics requested. Teaching sessions included practical applications based upon the availability of materials and local practices and beliefs. Basic needs, such as the need for food and water, were continuously addressed. Traditional ways of healing were only encouraged when these did not endanger health. Teaching a group of adults with limited knowledge of anatomy or physiology was a challenge that demanded simplification of complex problems and the use of interventions that were sometimes unusual.

Adult↗

PubMed1991

Medication-taking by the frail elderly in two ethnic groups.

A complex and dangerous area of medical intervention with the elderly population is drug therapy. Although drugs have contributed to the well-being of many older persons, some elderly individuals are at risk due to polypharmacy and age-related factors. The purpose of this preliminary study was to investigate the medication-taking behaviors of two ethnic groups of noninstitutionalized frail elderly individuals. The findings indicate that these individuals may be at risk for harm due to their medication-taking practices. Healthcare professionals must evaluate drug use by the elderly and be aware of the risks of drug misuse by this vulnerable group.

Aged↗