SEARCH · PubMed Health

Results for “Complex intervention”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,495 records · Page 83Linked to original sources

PubMed2004

Expressed emotion in family members of depressed older adults.

This study examined similarities between the Expressed Emotion (EE) construct developed in the psychiatric literature and interpersonally relevant constructs derived from gerontology caregiver research. Expressed emotion and other indices derived from the Camberwell Family Interview (CFI) were assessed in 46 adult children and spouses providing care to an older adult hospitalized for major depressive disorder. The relationship of CFI indices with the family member's past and current relationship with the depressed relative, illness attributions, and emotional functioning was examined. Of the family members, 60.9% were classified as high EE. Measures of past and current relationship and illness attributions were significantly associated with most of the CFI indices. In multivariate analyses, past relationship and illness attributions predicted high EE status. Only past relationship predicted the CFI index of warmth. There is conceptual and empirical overlap between the EE construct and interpersonally relevant gerontology variables. Expressed emotion holds promise for a more complex understanding of caregiving and better caregiver interventions.

Affect↗

PubMed2000

Demoralisation, depression and desire for death: problems with the Dutch guidelines for euthanasia of the mentally ill.

OBJECTIVE: Given the recent publication of Dutch guidelines for euthanasia of the mentally ill, our aim in this paper is to review the clinical role of the psychiatrist in assessing patients who seek euthanasia or physician-assisted suicide. METHOD: Three areas are examined that are informative of the role of the psychiatrist in assessing patients who desire death: recent surveys of psychiatrists' attitudes, empirical and clinical studies, and treatment issues. RESULTS: Demoralisation and depression emerge as pertinent clinical issues worthy of psychiatric intervention. The role of the psychiatrist is complex and includes issues of assessment, systems, countertransference and treatment. CONCLUSIONS: Dutch guidelines for physician-assisted suicide in the mentally ill generate serious concern given the uncertainty of prognosis, potential range and variability of outcome of treatments of suicidality and the boundary violations that are involved for the psychiatrist. The guidelines have the potential to dangerously alter the practice of psychiatry and should be condemned.

Attitude to Death↗

PubMed2000

Can we put aside the LNT dilemma by the introduction of the controllable dose?

Recently, Professor R Clarke, ICRP Chairman, published his proposal for a renewal of the basic radiation protection concept (1999 J. Radiol. Prot. 19 107-15). The two main points of his proposed system are: (a) the term 'controllable dose' is introduced and (b) the protection philosophy is based on the individual. For practical use terms like 'action level', 'investigation level' etc are introduced. The outline of the new system promises a much less complex frame; no distinction between practices and interventions and unified treatment for occupational, medical and public exposures. There is, however, an inconsistency within the new system: though linearity is not assumed, the relations between the definitions of the new terms of the system of protection and the doses assigned to them are still based on the LNT hypothesis. To avoid this inconsistency a new definition of action level is recommended as a conservative estimate of the lowest dose where harmful effects have ever been demonstrated. Other levels should be defined by the action level and safety factors applied on the doses.

Humans↗

PubMed1998

A multiple case study of implementation in 10 local Project ASSIST coalitions in North Carolina.

Community health promotion relies heavily on coalitions to address a multitude of public health issues. In spite of their widespread use, there have been very few studies of coalitions at various stages of coalition development. The purpose of this study was to identify factors that facilitated or impeded coalition effectiveness in the implementation stage of coalition development. The research design was a multiple case study with cross-case comparisons. Each of the 10 local North Carolina Project ASSIST coalitions constituted a case. Data collection included: semi-structured interviews, observation, document review, and surveys of members and staff. Some of the major factors that facilitated implementation included: the ability of the coalition to provide its own vision, staff with the skills and time to work with the coalition, frequent and productive communication, cohesion or a sense of belonging on the coalition, and complexity of the coalition structure during the intervention phase. Barriers to effective implementation included: staff turnover and staff lacking community organization skills, dependence on the state-level staff during the planning phase and lack of member input into the action plan. Conflict contributed to staff turnover, reluctance to conduct certain activities and difficulty in recruiting members, all of which had implications for implementation.

Communication↗

PubMed2004

Improving assessment and treatment of pain in the critically ill.

OBJECTIVE: Efforts to improve pain assessment and treatment in critically ill patients are poorly studied and represent an opportunity to improve quality of care. We sought to improve pain assessment and treatment in patients in a surgical intensive care unit at an academic medical center. DESIGN: We performed a prospective study of pain assessment and treatment in two surgical intensive care units in 2001. We measured pain assessment as the percentage of 4-h intervals where the patient's pain was measured using a visual analog scale. We measured pain treatment as the percentage of 4-h intervals where the patient's pain score on the scale was < or =3. We then implemented four separate "plan-do-study-act" cycles to improve pain assessment and treatment. MAIN OUTCOME MEASURES: We evaluated the percentage of 4-h patient-nursing intervals that were scored numerically pre- and post-intervention. We evaluated the percentage of 4-h patient-nursing intervals where the patients had a pain score of < or =3 pre- and post-intervention. In addition, we monitored naloxone use as a measure of adverse events related to pain treatment. RESULTS: Our baseline assessment of pain was 42% and the baseline treatment was 59%. After 5 weeks, pain assessment improved to 71% and pain management improved to 97%. CONCLUSION: Our interventions were associated with significant improvements in pain assessment and treatment without an increase in adverse events related to pain therapy. Our interventions were relatively simple and may be implemented broadly. Our interventions provide insights into the application of complexity theory in improvement efforts.

Academic Medical Centers↗

PubMedDate not supplied

Positive supports for people who experience behavioral and cognitive disability after brain injury: a review.

BACKGROUND: Behavioral and cognitive problems are among the most common and troubling consequences of traumatic brain injury. Furthermore, behavioral and cognitive challenges typically interact in complex ways, necessitating an integrated approach to intervention and support. OBJECTIVES: This article reviews literature on behavioral outcome in children and adults with traumatic brain injury, traditional approaches to behavioral intervention and cognitive rehabilitation, and the history, principles, and assessment and treatment procedures associated with context-sensitive, support-oriented approaches to behavioral and cognitive intervention. We propose a clinical framework that integrates cognitive and behavioral intervention themes.

Adult↗

PubMed1995

Intracoronary Doppler flow velocity measurements for the evaluation and treatment of coronary artery disease.

The functional significance of coronary artery disease is often inadequately revealed by the solely anatomic information provided by coronary angiography, especially with respect to intermediate-severity stenoses and the complex lesions that result from percutaneous coronary intervention. The clinical application of coronary flow velocity measurements using the Doppler flow wire during cardiac catheterization represents a promising means for providing immediate physiologic assessment of coronary artery lesion significance. Recent correlations with translesional hemodynamics and noninvasive perfusion imaging have confirmed the accuracy and reliability of Doppler translesional flow velocity assessment. The use of intracoronary flow velocity data for functional assessment can refine the selection of patients for revascularization. Furthermore, measurements of translesional and distal coronary flow velocity dynamics during procedures provide immediate data regarding the physiologic adequacy of the intervention. The information provided by the analysis of coronary blood flow using the Doppler guide wire can serve to improve the diagnostic and therapeutic capabilities of interventional cardiology.

Angioplasty, Balloon, Coronary↗

PubMed1990

Risks of endoscopic retrograde cholangiopancreatography and therapeutic applications.

Endoscopic retrograde cholangiopancreatography and its therapeutic applications are the most invasive and risky procedures performed regularly by endoscopists. Potential complications include those of the endoscopy (sedation reactions, infection transmission, perforation, etc.), those specific to instrumentation of the bile duct and pancreas (sepsis, pancreatitis) and those caused by therapeutic intervention, especially sphincterotomy (perforation and bleeding). These complex procedures require two fully trained GI nurse assistants. One is responsible for the safety of the patient (who is often elderly and frail) before, during and after the procedure. The other is responsible for ensuring that all necessary equipment is available and correctly disinfected and assists the endoscopist during the examination.

Cholangiopancreatography, Endoscopic Retrograde↗

PubMed2001

Implementation of the Interdisciplinary Generalist Curriculum Project: considerations of structure, funding, and design.

Implementation of the Interdisciplinary Generalist Curriculum (IGC) Project involved complex processes that reflect structural, funding, and intervention design considerations. Among structural considerations, the IGC Project benefited from a national structure above the level of the demonstration schools. Governance by committee was highly effective because it harnessed and balanced power. At the national level, governance by committee was enhanced by strong central coordination, and it had a role-modeling effect for governance at the school level. The IGC experience over the seven-year course of the project suggests that it is important to revisit the role of a national advisory committee over time and to revise that role as warranted. Funding considerations, including the importance of funding evaluation for a period of time long enough to measure intended impacts and the length and amount of funding to demonstration schools, are discussed. Prescription of the IGC intervention and the focus on years one and two of medical education are critical design considerations. The authors conclude that the IGC Project used relatively few federal dollars to demonstrate a highly prescribed intervention in a limited number of medical schools toward a clear and limited goal. IGC lessons apply to programs specifically targeting primary care education, but also to other medical school curricular innovations, and perhaps, to a larger framework of multi-site educational interventions.

Curriculum↗

PubMed1989

A qualitative investigation of reassurance.

The findings in this exploratory investigation bear witness to the existence of good nursing practice in a system that is often criticized as inhumane. Nurses do attend to clients' emotional needs in health crises and health care situations that undermine clients' abilities to understand their experiences, to make choices, and to exercise control over their circumstances. The findings also disclose the complexity of reassurance as concept and nursing intervention. We note nevertheless a nursing style that includes physical proximity, touch, ministrations, and accompaniment over time through the experiences that threaten clients' assurance and challenge their resources. These are features of nursing practice that need to be given utmost importance through formal conceptualizations in order to preserve them in our shared nursing culture. From a research perspective, we have learned that nurses are able to describe well their experiences when asked to share in an atmosphere of expectation that experiences contribute to nursing knowledge. Qualitative approaches are especially well suited to establish such an atmosphere and to facilitate explications of nurses' work. The line of inquiry into caring as the core concept of nursing practice, which has gained the attention of nurse scholars in recent years, has enormous potential to advance humanistic nursing practice. This investigation of reassurance provides evidence of its significance for us and its relevance to the construction of knowledge about caring. Future studies of reassuring another and of being reassured using qualitative strategies contain the promise of protecting nursing expertise and contributing to its refinement.

Adolescent↗

PubMed1996

Amputation versus reconstruction in traumatic defects of the leg: outcome and costs.

This retrospective review covers global aspects of reconstructive efforts to salvage severely injured legs. Eighteen patients with traumatic lower leg amputation were compared to 21 patients who underwent complex microvascular reconstruction. The mean number of interventions was 3.5 for amputation and 8 for reconstruction (p < 0.009). Total rehabilitation time was 12 months for amputation and 30 months for reconstruction (p < 0.009). Changes in lifestyle were consistently more important in the amputee group. The mean annual hospital costs for amputated patients were 15,112 Swiss Francs (SD 7,094 SF) for the first 4 years. The mean annual hospital costs for reconstructed patients were 17,365 Swiss Francs (SD 8,702 SF) for the first 4 years. Fifty-six percent of the amputees and 19% of the reconstructed patients were retrained to a different profession (p < 0.025). Fifty-four percent of the amputees and 16% of the reconstructed patients were drawing an extremely costly and life long invalidity pension (p < 0.02). We conclude that for potentially salvageable legs reconstruction is advisable because the functional outcome was better than for amputation and there was no permanent social disintegration due to the long treatment. Total costs (including pensions) for reconstruction were far lower than for amputation.

Adolescent↗

PubMed1997

Partial failure of a free flap salvaged by using the surviving portion as a "bridge" flap for revascularizing a second free flap.

Partial failure of a free flap can create an unusual dilemma, as guidelines suggesting appropriate further intervention are not well defined. The increased complexity of a second free flap attempt is not necessarily contraindicated, but must be minimized if the same fate as the first is to be avoided. For the unique circumstance where the initial failed flap contained a vascular flow-through, the most distal patent vessels can then secondarily serve in an expeditious manner as the recipient vessels for the second or salvage free flap. The efficacy of this concept has been here validated after limited necrosis occurred in the distal portion of a radial forearm free flap. Following the requisite debridement, the residual flap still maintained a satisfactory arterial and venous flowthrough as a "bridge flap" that supported the attachment of a gracilis muscle free flap, and both flaps in turn preserved a sensate transtarsal amputation stump.

Amputation, Surgical↗

PubMed2001

Medical and surgical therapy of the cystine stone patient.

Cystinuria is an inherited defect in renal tubular and intestinal transport of dibasic amino acids that results in elevated urinary excretion of cystine, ornithine, lysine, and arginine. The only clinical manifestation of this disease is the development of urinary tract cystine calculi. Cystinuric patients suffer recurrent stone episodes, requiring an aggressive multi-modal approach to management. This article reviews the results of medical prevention regimens, the role of minimally invasive urologic intervention, and the recent insights into the complex genetic basis for the varied cystinuric phenotypes.

Cystine↗

PubMedDate not supplied

Targeting T lymphocytes for immune monitoring and intervention in autoimmune diabetes.

Recognition of a peptide-MHC complex by the T cell receptor (TCR) is a key interaction that initiates T lymphocyte activation or silencing during an immune response. Fluorochrome-labeled recombinant MHC class II-peptide reagents function as soluble mimetics of this interaction, bind to their specific TCR, and allow for detection of antigen-specific CD4+ T cells. These reagents are now under scrutiny for "immune staging" of patients at risk of type 1 diabetes, in an effort to diagnose islet autoimmunity early enough to block immune-mediated beta cell destruction. Several issues are currently being addressed to improve the performance of these T cell assays: enrichment steps for better sensitivity, multiplexing of several islet epitopes, simultaneous monitoring of CD4+ and CD8+ responses, detection of low avidity T cells, combination of quantitative (number of positive cells) and qualitative (cytokine secretion, naive/memory phenotype) readouts. CD4+ T cells are key effectors of autoimmunity, and these MHC class II peptide reagents, through their signaling properties, might also provide therapeutics to block the autoimmune process at its onset, analogous to the use of OKT3gammao1(AlaAla) anti-CD3 antibody but in an antigen-specific fashion. The aim of such therapeutics is to potentiate different physiological control mechanisms to restore immune tolerance. Mechanisms initiated by this pathway may be capable of triggering elimination of pathogenic T cells through antigen-specific apoptosis and anergy, combined with the induction of regulatory T cells with broad suppressive function.

Apoptosis↗

PubMed2000

Pathogenesis of pneumococcal infection.

The pathogenesis of pneumococcal infection is a complex interplay between pneumococcal virulence determinants and the host immune response. Molecular studies have considerably advanced our knowledge and understanding of the precise structures and functions of the different determinants and their pathogenic roles. This review describes the mechanisms by which pneumococci attach, invade, evade lung defences and cause severe disease. Better understanding of the critical steps in this complex process will enable more effective clinical intervention to be developed to reduce the mortality exacted by this versatile pathogen.

Animals↗

PubMed1991

Management of prolactinomas.

The management of prolactinomas requires a complex interaction of medical, surgical and radiotherapeutic intervention. With the judicious use of all these modalities, patients can usually be managed with great success and, perhaps more importantly, their presenting complaints (gonadal dysfunction and infertility) are usually completely corrected.

Bromocriptine↗

PubMed1978

The effects of the referral process on hospital in-patients.

Decisions relating to the preparation for hospital discharge of medical patients can take place at any time after admission to hospital. Referrals to the hospital departments of social work, occupational therapy and physiotherapy, and to community nursing, health visiting and social services are a key factor in this preparation. The referral process is complex and multifaceted and can be analyzed in terms of the questions of who initiates the referral, for what reasons, and at what point in the patient's career. The variant views of role of those professionals involved in the referral process and their perceptions of the situation affect what subsequently takes place and can be examined in relation to each other and to the referral process itself. The complexity may be increased further by the intervention of a patient's relatives. Referrals are made on the basis of a social diagnosis, the sources of information for which are diverse, with the result that the referral process is unstandardized and unpredictable.

Adaptation, Psychological↗

PubMed2005

Caring for older patients at an emergency department -- emergency nurses' reasoning.

AIM: The aim of the study was to use the experiences of emergency nurses to illuminate what constitutes good nursing care for patients 75 years or older transferred to emergency departments. BACKGROUND: Emergency departments have a medical technical character and the number of visits there increases dramatically as people age. Older patients require increased healthcare services in terms of nursing care, interventions and hospitalizations due to an increased complexity of their problems. For these reasons it is important to study what good nursing care of the older patients consists of at an emergency department from the emergency nurses' point of view. METHOD: Ten emergency nurses from a university hospital emergency department in Sweden were interviewed. A thematic content analysis was performed. RESULTS: The study showed that it was necessary to be knowledgeable, to be understanding of the older patients' situation and to take responsibility for them in order to be able to provide good nursing care. The emergency nurses shifted focus from describing the central aspect of good nursing care to describing what hinders the provision of it. Their experience was that prioritizing medical procedures, everyday tasks and routines threatens good nursing care of older patients in emergency departments. The emergency nurses held that the older patient is often sent to an emergency department where the level of care is not appropriate to their needs. CONCLUSIONS: The result can be seen as a challenge for the organization and the nurses in the future; to prioritize differently, thereby maintaining a balance between good nursing and medical/technical tasks when treating older patients. RELEVANCE TO CLINICAL PRACTICE: The present day healthcare system is not organized to appropriately meet the needs of the older patients. Nurses themselves hold they can better serve the older patient. By sharing their experiences, both can be accomplished.

Aged↗