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 1,513 records · Page 84Linked to original sources

PubMed2006

Socio-cultural determinants of treatment delay for childhood malaria in southern Ghana.

We studied socio-cultural determinants of timely appropriate treatment seeking for children under 5 years suspected of having a perceived malaria-related illness. Caretakers of children with suspected malaria were interviewed about illness-related experiences, meanings and behaviour in two endemic villages in southern Ghana. Only 11% of children suspected of having a perceived malaria-related illness received timely appropriate treatment consistent with the Abuja target of treating malaria within 24 h of illness onset; 33% of children received appropriate treatment within 48 h. Reported perceived causes of phlegm predicted timely, appropriate treatment within 24 h of illness onset (P = 0.04) in a multivariate logistic regression model; playing on the ground (P < 0.01) predicted such treatment within 48 h. Two categories of distress, paleness or shortage of blood (P = 0.05) and sweating profusely (P = 0.03), also predicted timely, appropriate treatment within 24 h in a multivariate logistic regression model. Knowing that mosquitoes transmit malaria was not associated with timely, appropriate help seeking for the children, even though such knowledge may promote personal protective measures, especially use of bednets. Patterns of distress and PC were related to timely, appropriate help seeking, but not as expected. Effects on health seeking of illness-related experience and meaning are complex, and explaining their role may strengthen interventions for childhood malaria.

Adolescent↗

PubMed2004

The impact of guidelines on mild hypertension in pregnancy: time series analysis.

OBJECTIVE: To determine the impact of a national strategy to promote implementation of a guideline on the management of mild, non-proteinuric hypertension in pregnancy. DESIGN: Simple, interrupted time series analysis. SETTING: Four maternity units in Scotland. POPULATION: Women delivering a live or stillborn baby. METHODS: Dissemination of the guideline under the auspices of a national clinical effectiveness programme, supported by a national launch meeting and feedback from a survey of obstetricians highlighting aspects of care that could be improved. MAIN OUTCOME MEASURES: Appropriateness of initial investigation and subsequent clinical management, and costs of guideline development and implementation activities. DATA COLLECTION: Twenty-four months pre-intervention and 12 months post-intervention data were abstracted from a random sample of case notes. RESULTS: Initial investigation was consistent with recommendations for 59.9% out of 1263 women and subsequent clinical management for 67.6% out of 1081 in whom a diagnosis could be made from available data. There were no significant changes in the appropriateness of initial investigation (10.6%; 95% confidence interval [CI] -0.1% to 19.3%; decreasing by 1.2% per month post-implementation, 95% CI -2.5% to 0.1%) or clinical management (-0.3%; 95% CI -8.7% to 11.2%). Guideline development and implementation cost an estimated pound 2784 per maternity unit in Scotland. CONCLUSIONS: Clinical care of mild hypertension in pregnancy remains highly inconsistent. The lack of the intervention effect may be related to the complexity of the guideline recommendations and the nature of the implementation strategy.

Adult↗

PubMed2000

Molecular gerontology. Bridging the simple and the complex.

It is clear, both empirically and theoretically, that the mechanisms of aging are multiple and complex. Nevertheless, single gene mutations and simple interventions such as calorie restriction have broad effects on the senescent phenotype. The major challenge is to unite highly reductionist analysis of molecular components with integrative model systems that can "put it all together." Two themes are developed. In the first, biochemical models are described that show how the network concept of cellular aging can be used to integrate multiple biochemical mechanisms that contribute to cellular instability. In the second theme, the role of intrinsic developmental chance is examined as a major factor contributing, in addition to genes and environment, to the divergence of the senescent phenotype. The implications of these themes for research strategies in molecular gerontology are discussed.

Aging↗

PubMed1995

Mechanical and dosimetric quality control for computer controlled radiotherapy treatment equipment.

Modern computer controlled radiotherapy treatment equipment offers the possibility of delivering complex, multiple field treatments with minimal operator intervention, thus making multiple field conformal therapy practical. Conventional quality control programs are inadequate for this new technology, so new quality control procedures are needed. A reasonably fast, sensitive, and complete daily quality control program has been developed in our clinic that includes nearly automated mechanical as well as dosimetric tests. Automated delivery of these quality control fields is performed by the control system of the MM50 racetrack microtron, directed by the CCRS sequence processor [D. L. McShan and B. A. Fraass, Proceedings of the XIth International Conference on the use of computers in Radiation Therapy, 20-24 March 1994, Manchester, U.K. (North Western Medical Physics Department, Manchester, U.K., 1994), pp. 210-211], which controls the treatment process. The mechanical tests involve multiple irradiations of a single film to check the accuracy and reproducibility of the computer controlled setup of gantry and collimator angles, table orientation, collimator jaws, and multileaf collimator shape. The dosimetric tests, which involve multiple irradiations of an array of ionization chambers in a commercial dose detector (Keithly model 90100 Tracker System) rigidly attached to the head of the treatment gantry, check the output and symmetry of the treatment unit as a function of gantry and collimator angle and other parameters. For each of the dosimetric tests, readings from the five ionization chambers are automatically read out, stored, and analyzed by the computer, along with the geometric parameters of the treatment unit for that beam.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗

PubMed2003

Adverse drug event trigger tool: a practical methodology for measuring medication related harm.

Adverse drug events continue to be the single most frequent source of healthcare mishaps, continually placing patients at risk of injury. This is not unexpected, given that drug treatment is the most common medical intervention and medication use is a highly complex, multidisciplinary, and largely manual process. Assessing the actual safety of drug use has been historically difficult, mainly because traditional methods such as chart audits and voluntary reporting of data have been shown to be expensive, insensitive, and largely ineffective for detecting mistakes in drug administration and drug related adverse clinical events (ADEs). Computerized methods for detecting ADEs, employing sentinel words or "triggers" in a patient's medical record, are effective but expensive and require customized software linkage to pharmacy databases. This paper describes the use of the "trigger tool", a relatively low cost and "low tech" modification of the automated technique. The adapted technique appears to increase the rate of ADE detection approximately 50-fold over traditional reporting methodologies.

Adverse Drug Reaction Reporting Systems↗

PubMedDate not supplied

Educational interventions in delirium.

In the absence of specific therapies, interventions for delirium are largely educational. This paper reviews educational interventions targeted at physicians, nurses, patients and their families. Most studies to date have had methodological deficiencies, and few have been developed in keeping with current principles for adult learning. Early studies focused on increased recognition of delirium, with less consistent measurement of patient centred outcomes. Subsequent studies provide limited evidence to suggest that, as a result of educational interventions, individual symptoms can be prevented, and, when delirium is present, its consequences - including death and prolonged hospital stays - can be diminished. Future studies should incorporate principles of adult learning and have improved methodological rigour. The strength of educational interventions needs to be assessed carefully. Interventions which are time-sensitive, less complex, directed to observable, patient-focused endpoints are more likely to be successful.

Adult↗

PubMed2004

Relationship between psychosocial distress, treatment need and use of psychotherapeutic interventions within a psychosomatic liaison service in hematological oncology.

BACKGROUND: Psychosocial distress is common in patients with hematological malignancies in the acute phase of the disease. The aim of the study was to evaluate the treatment need and the realization of psychotherapeutic interventions of a routine psychosomatic liaison service delivery in hematological oncology. PATIENTS AND METHODS: 72 patients of the transplantation ward and of the general hematological oncological ward were consecutively included in the study. Assessments involved both self- and observer rating instruments. RESULTS: The need for psychotherapeutic treatment was 38 or 49%, depending on patients' or professional's view, respectively. 39% of the patients underwent psychotherapeutic treatment. But there was a great discrepancy between the treatment need estimated by observer and patients and the actual psychotherapeutic interventions. CONCLUSIONS: The utilization of psychotherapeutic interventions seems to be subject to a complex interaction between patient's need, 'objective' psychosocial distress and institutional conditions. The results highlight the importance of need for better identification of patients with psychosocial distress and better targeting of psychotherapeutic treatment.

Attitude to Health↗

PubMedDate not supplied

Long-term vitreous replacement with perfluorohexyloctane and silicone oil: preliminary reports of a multicentric study.

AIM: To report on the use of a combined intra-ocular tamponade with silicone oil and perfluorohexyloctane (F(6)H(8)) in the treatment of complex retinal detachment. DESIGN: A prospective consecutive interventional case series from seven study centres. PARTICIPANTS: 69 patients presenting a retinal detachment with proliferative vitreoretinopathy (PVR) and retinal breaks of the inferior two quadrants of the fundus. METHOD: Patients were divided into two groups: (1) 28 eyes which had not been operated on before; (2) 41 eyes affected by recurrent retinal detachment that had had unsuccessful previous surgery with silicone oil or gas tamponade. A pars plana vitrectomy, membrane peeling and -- when necessary -- a retinotomy were performed; the vitreous cavity was filled with two thirds of F(6)H(8) and one third of silicone oil 1,000 mPas (double filling, DF). The endotamponade was removed after 30-45 days (median 38) and replaced by balanced salt solution or silicone oil according to the condition of the retina. RESULTS: Retinal reattachment was achieved in 52 out of 69 cases (75%) 6 months after removal of the DF without any endotamponade. CONCLUSION: The DF with F(6)H(8) and silicone oil allows a good endotamponading to the inferior retina and the posterior pole. The DF appeared to be well tolerated. Further studies are necessary to evaluate whether a DF is advantageous in respect to silicone oil filling alone in case of retinal breaks and PVR of the inferior retina.

Adult↗

PubMedDate not supplied

Connexin43 gene expression in the rabbit arterial wall: effects of hypercholesterolemia, balloon injury and their combination.

The specialized functions of endothelium require intercellular communication between endothelial cells within the monolayer, and between endothelium and other cells present in the vessel wall. This is accomplished by a combination of paracrine soluble mediators and direct gap-junctional intercellular communication (GJIC) mediated by a family of connexin proteins. A prominent connexin expressed by vascular cells in vivo and in vitro is connexin 43 (Cx43). We have investigated the in vivo gene regulation of Cx43 in the context of vascular pathology, as a result of mechanical injury, hypercholesterolemia or both. The aortoiliac bifurcation in the rabbit was examined following three types of insult: (1) diet-induced hypercholesterolemia resulting in macrophage-rich fatty streak lesions, (2) mechanical, stretch-denudation injury resulting in intimal smooth muscle cell (SMC) proliferation and (3) mechanical injury superimposed on hypercholesterolemia resulting in a complex vascular lesion having characteristics of both interventions. The normal rabbit iliac artery expressed approximately equal levels of Cx43 mRNA in the medial SMC layers and in the endothelium. In hypercholesterolemia-induced atherosclerosis, Cx43 expression was most prominent in macrophage foam cells even though normocholesterolemic precursor monocytes did not express Cx43 mRNA. Antibodies directed specifically to Cx43 protein confirmed the expression of macrophage gap junction protein in these cells. Medial SMC in hypercholesterolemia exhibited less Cx43 than their normal counterparts in control animals. Mechanical injury in the absence of hypercholesterolemia resulted in intimal thickening in which Cx43 expression in the intimal SMC was equivalent to that in the subjacent medial SMC, both being approximately equivalent to normal uninjured rabbit medial SMC expression. Cell-specific expression of Cx43 in combined mechanical injury/hypercholesterolemia was similar to that observed in hypercholesterolemia alone: Cx43 upregulation in macrophages, while medial SMC were downregulated. Normo- and hypercholesterolemic alveolar macrophages of the lung and Kupffer cells of the liver did not exhibit induction of Cx43 mRNA, nor did macrophages isolated from peritoneal or bronchial lavage fluid of the same animals. This work extends our previous finding of Cx43 upregulation in human atherectomy tissue and demonstrates that atherosclerotic lesions in situ, in a controlled animal model of atherosclerosis, exhibit cell-specific changes in Cx43 gene expression. Changes in medial SMC migration, proliferation and phenotype, as well as enhanced interactions between adherent/infiltrating monocytes and endothelium may be related to modified GJIC pathways in the vessel wall.

Animals↗

PubMed2000

Assessing infant suck dysfunction: case management.

Based on this more thorough assessment, the lactation consultant may be able to identify all of the factors contributing to this complex case. In some situations, her skilled interventions will suffice once the underlying problem is addressed. Occasionally, she will identify a factor that falls outside of her area of expertise; when this happens, she must make the appropriate referrals. For example, a referral to a physician for a frenotomy or suspected neurological or other medical problem is appropriate. It is clear that because Baby E's problems were not resolved after 6 weeks of concerned effort, something was missed. It would certainly be appropriate for the lactation consultant to refer the dyad to another lactation consultant who has more expertise in handling clinically challenging breastfeeding problems. If possible, the referring lactation consultant should accompany the dyad so that she can improve her clinical skills. Assuming Baby E does not have underlying medical problems, the most likely causes of Baby E's difficulties are anatomical variation and/or sucking dysfunction. Because the baby is so fussy, it also would be wise to consider the possibility of allergies or food tolerance. Our first rule is " Feed the baby." The second rule is " Correct or work on correcting the problem or problems." Our goal is to achieve exclusive breastfeeding or as close an approximation as possible. We almost never give up on this goal, but we do educate the mother and work professionally with her choices. Until the baby is breastfeeding well, the lactation consultant will probably need to instruct the mother to continue using a pump ( preferably a hospital-grade, electric, bilateral pump). The mother should use the pump physiologically, pumping as many times a day as the baby would breastfeed. As soon as the situation improves, the mother should be instructed to wean gradually from the pump and any other breastfeeding equipment she is using. The goal should always be to help the mother and baby acheive a breastfeeding relationship, preferably without the use of any devices. We usually suggest that the mother avoid all rubber nipples and pacifiers during this learning period. Babies have a strong need to suck. Correct sucking helps the baby organize and be soothed. Whenever possible, we prefer infants to use their mother's breasts for pacification, warmth, love, smell, and food rather than artificial nipples and devices. Mothers almost always want to know how much work and time is involved before committing to following suggested treatment plans. As a general rule, we have found that it will take approximately the same number of weeks as the baby's age to solve the problems completely. In this case, it will probably take about 6 weeks until mother and baby graduate from "breastfeeding school." The first 2 weeks would most likely be very intense for the whole family, with the mother getting very little sleep. VJ is likely to cry when talking to the lactation consultant during this period of intense change. It is helpful during these times to listen to the mother, reinforce that you know how hard she is working and that what she is feeling is normal. Giving the mother a hug and complimenting her mothering efforts go a long way toward encouraging her to continue. It is not a time to give up. The second 2 weeks typically are easier, as everybody is used to the workload and required skills. The focus becomes refining skills. The last 2 weeks is usually a time to reduce and then wean off the equipment and exercises. This timing is just a guideline and must always be individualized. Although it is a tremendous amount of work for the mother, baby, family, and lactation consultant to correct well-established but incorrect breastfeeding behaviors, we have never met a mother who was sorry that she chose to tackle the problem. Even if she tries and then gives up or achieves only a partial milk supply or partial breastfeeding relationship, she can take pleasure in knowing that she left no stone unturned. Unfortunately, mothers and babies with presentations similar to that of VJ and Baby E all too often fail to establish an exclusive breastfeeding relationship. Not only are patience, dedication, time, and skills needed, but there are often multiple underlying problems that need to be solved. With a thorough assessment and appropriate use of skills and equipment by the lactation consultant, success is much more likely. This particular dyad should be able to acheive an exclusive breastfeeding relationship.

Adult↗

PubMedDate not supplied

Multimodal therapy for acute and chronic venous thrombotic and occlusive disease.

Critical deep venous thrombosis and occlusion constitutes a small percentage of patients with venous disease. However, these patients exhibit severe symptomatology including pain and extensive edema that may progress to limb- or life-threatening complications such as phlegmasia cerulea dolens and superior vena cava syndrome. This paper reviews the different multimodal percutaneous interventions currently available for the treatment of complex critical venous thrombotic and occlusive disease.

Acute Disease↗

PubMed2004

Tumour necrosis factor and other proinflammatory cytokines in systemic lupus erythematosus: a rationale for therapeutic intervention.

Systemic lupus erythematosus (SLE) is an autoantibody and immune complex mediated disease. However, it is the ensuing inflammatory process that leads to irreversible organ damage. In fact several murine models of SLE suggest that this inflammatory organ damage can be prevented even in the presence of autoantibodies. Given data from experimental models as well as from patients, proinflammatory cytokines including tumour necrosis factor (TNF) alpha apparently play a significant role in the inflammatory process, but may have immunoregulatory functions at the same time. Therefore, anti-TNF alpha therapy may constitute an interesting candidate approach for treating SLE inflammatory organ disease, but potentially at the cost of increased autoantibody formation. Clinical trials will be required to answer whether TNF alpha blockade fulfils this hope with an acceptable safety profile. Interferon (IFN)-gamma, interleukin (IL)-18, IL-6 and possibly IL-1 are increased in SLE and likewise involved in the inflammatory process. Specific therapeutic agents for blocking these cytokines should be available in the near future.

Animals↗

PubMed1986

A psychosocial perspective on chronic pain and depression in the elderly.

Chronic pain and depression often coexist in elderly individuals. This paper explores, from a clinical perspective, the antecedents for depressive symptoms in older chronic pain patients. A case is made for active social work intervention with elderly patients who manifest this complex syndrome of chronic pain.

Aged↗

PubMed1996

Experiences of battered women in health care settings: a qualitative study.

Interventions to help battered women seek and receive optimal health care must be informed by battered women's experiences in health care settings. In this study, we used a Systems Model to categorize the barriers battered women encounter in health care settings into patient, provider, and organizational levels. We conducted in-depth, face-to-face interviews with 31 battered women recruited by random digit dialing of households and by a publicity recruitment campaign. The data revealed that at the patient level, many women chose to conceal their abuse from their health care professionals, some fearing retaliation from their partners if they revealed the source of their injuries. At the provider level, the women perceived health care professionals to be disinterested or unsympathetic toward the needs of battered women, causing the women to feel ignored or trivialized. And at an organizational level, battered women believed that the structure of the health care system did not allow health care professionals enough time to deal with issues beyond treating their immediate presenting injuries. To ensure that battered women seek and receive optimal health care, multicomponent interventions should be designed to address the complex barriers at the three levels. We conclude by suggesting possible ways to help battered women get the tools they need to raise the issue of domestic violence with their health care professional. We also suggest ways to enable these professionals to identify battered women, validate their experiences, and provide appropriate referrals.

Adult↗

PubMed2002

Approaches to the reversal of malnutrition, inflammation, and atherosclerosis in end-stage renal disease.

Uremic malnutrition and chronic inflammation are important comorbid conditions that predict poor clinical outcome in end-stage renal disease (ESRD) patients. These conditions are also closely associated with cardiovascular disease, the major cause of death in ESRD patients. A pathophysiologic link between malnutrition, inflammation, and atherosclerosis has been proposed in this patient population. Indeed, multiple lines of evidence suggest that chronic inflammation can predispose ESRD patients to a catabolic and atherogenic state. Malnutrition can also result from chronic inflammation and can accelerate the progression of cardiovascular disease. Whereas a single common etiology has not been identified in this complex process, nutritional and anti-inflammatory interventions provide potential treatment options to counter the high mortality and morbidity in ESRD patients.

Arteriosclerosis↗

PubMed2006

The floating shoulder.

The floating shoulder is defined as ipsilateral fractures of the midshaft of the clavicle and the neck of the glenoid. This rare injury can be difficult to manage without a thorough understanding of the complex anatomy of the shoulder girdle. Surgical intervention needs to be considered for all of these injuries. While acceptable results can be expected with non-operative management of minimally-displaced fractures, displacement at one or both sites is best managed with surgical reduction and fixation.

Biomechanical Phenomena↗

PubMed1994

Clinical applications: the transition from research to practice.

As validated and improved alcoholism treatment methods emerge from Project MATCH and other studies, a dedicated and systematic effort will be needed to incorporate them into ongoing programs, to monitor their success in real world settings and to make adjustments and refinements as needed. Accomplishing this involves responsibilities for both researchers and practitioners. A complex continuum of activities designed to move interventions from research to practice is common to all therapeutic areas, with a fundamental component being researcher-provider interactions. Challenges include "debunking" myths; realistic evaluations of the feasibility of making changes in the treatment system; effective communication between providers and researchers; and proactive guidance from leaders who set standards of practice. Findings from relevant studies in alcoholism research can be assimilated into the treatment system with as little delay as possible as linkages between researchers and providers are strengthened. These linkages will be further strengthened by research in organizational, management and delivery mechanisms conducted by emerging applied research areas such as health services.

Alcoholism↗

PubMed2005

[Academic activity report as a strategy for learning research].

This study aimed to analyze academic activity reports about the structure and mental abilities developed by graduate students of two nursing curriculum proposals at a Brazilian university. The study was based on 83 students: 39 from the Transition Curriculum (group I) and 44 from the Integrated Curriculum (group II). Data were collected through a registration card with topics from the December 2002 report by group I and the December 2003 report by group II. The results, presented as frequency percentages, showed that group II elaborated the academic activity report with a better structure than group I. This group also developed a more complex reasoning, especially in the "development" topic. Interventions with group II present a better development in this teaching strategy.

Education, Nursing↗