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PubMed2005

Hope against the cold: individual differences in trait hope and acute pain tolerance on the cold pressor task.

Hope theory (see Snyder, 1994) is presented as a useful framework for understanding reactions to pain. In Study 1, persons scoring higher on the trait Hope Scale (Snyder, Harris et al., 1991) kept their hands in the freezing water (of a cold pressor task) for significantly longer. In Study 2, the higher-hope males, and not females, as measured by both trait and state hope (Snyder, Sympson et al., 1996), recognized the onset of the pain threshold significantly later. Moreover, in Study 2, results showed that individual differences measures of optimism, self-efficacy, depression, and positive and negative affects did not relate to the pain onset and tolerance variables. The implications of hope as related to the pain process and related research are discussed.

Acute Disease↗

PubMed2004

Determinants of growth retardation in Southern Brazil.

A cross-sectional population-based study of determinants of growth retardation in under-five children (3,389) in the city of Porto Alegre, Rio Grande do Sul, Brazil estimated odds ratios (OR) for stunting, defined as height-for-age < -2 zeta-scores of the NCHS standards. Hierarchical modeling based on a framework of the process of stunting was used. Stunting prevalence was 6.8%; the main determinants were per capita family income < 0.8 times the minimum wage (OR: 3.95; 95%CI: 2.10-7.42), maternal illiteracy (OR: 17.17; 95%CI: 4.43-66.54), living in a wooden or mixed-construction house (OR: 2.33; 95%CI: 1.35-4.01), inadequate housing (OR: 2.75; 95%CI: 1.70-4.43), maternal age at the child's birth < 20 years (OR: 1.73; 95%CI: 1.11-2.70), being an adopted child (OR: 3.28; 95%CI: 1.52-7.07), third-born child or greater (OR: 2.04; 95%CI: 1.15-3.62), birth interval < 24 months since previous child (OR: 1.69; 95%CI: 1.13-2.53), subsequent sibling (OR: 1.91; 95%CI: 1.16-3.13), multiple birth (OR: 2.40; 95%CI: 1.04-5.50), low birth weight (OR: 3.79; 95%CI: 2.38-6.02), and hospitalization in the first year of life (OR: 1,65; 95%CI: 1.01-2.68). The findings can be used by primary healthcare services to design specific interventions to prevent stunting.

Brazil↗

PubMed2003

Quality assessment of primary health care in a military setting.

PURPOSE: The aim of this study was to analyze the quality of primary care in Israeli Defense Forces primary care clinics and physicians (PCPs) and to test the hypotheses that: (1) the quality of primary care provided in battalions is higher than that provided by other primary care providers and (2) the evaluation of a specific PCP within the framework of the quality assessment program results in an improved score during a second evaluation. METHODS: Teams of two physicians carried out the control process. Each primary care clinic is evaluated in a standardized manner by filling a prospectively established form. Five parameters are examined: (1) direct inspection of the PCP, (2) medical record audit, (3) high-risk patients' management evaluation, (4) evaluation of secondary health care characteristics, and (5) medical staff guidance evaluation. The various clinics and physicians evaluated were classified as: battalion clinics, division and brigade clinics, training center clinics, and home-front clinics. RESULTS: Between the years 1999 and 2001, 149 primary care clinics and 250 PCPs were evaluated. Seventy-four PCPs (29.6%) were evaluated twice. Battalion clinics scored higher than the other clinics. PCPs evaluated twice had significantly better quality assessment results at the second encounter. CONCLUSIONS: Quality of primary health care is the highest in battalion troops clinics. We interpret the increase in quality assessment scores from one examination to the other as an index of improvement resulting from the feedback given to the providers.

Humans↗

PubMed2005

The hard side of change management.

Everyone agrees that managing change is tough, but few can agree on how to do it. Most experts are obsessed with "soft" issues, such as culture and motivation, but, say the authors, focusing on these issues alone won't bring about change. Companies also need to consider the hard factors-like the time it takes to complete a change initiative, the number of people required to execute it, and so forth. When the authors studied change initiatives at 225 companies, they found a consistent correlation between the outcomes of change programs (success versus failure) and four hard factors, which they called DICE: project duration, particularly the time between project reviews; integrity of performance, or the capabilities of project teams; the level of commitment of senior executives and staff; and the additional effort required of employees directly affected by the change. The DICE framework is a simple formula for calculating how well a company is implementing, or will be able to implement, its change initiatives. The framework comprises a set of simple questions that help executives score their projects on each of the four factors; the lower the score, the more likely the project will succeed. Companies can use DICE assessments to force conversations a bout projects, to gauge whether projects are on track or in trouble, and to manage project portfolios. The authors have used these four factors to predict the outcomes and guide the execution of more than 1,000 change management programs worldwide. Not only has the correlation held, but no other factors (or combination of factors) have predicted outcomes as successfully.

Commerce↗

PubMed1979

[Vegetative phenomena in the course of depressive states].

Depressive psychoses are accompanied by vegetative disorders. Third-order blood-pressure waves are an expression of vasomotor rhythms which through diencephalic and limbic structures tend to adjust the blood pressure to the respective overall psychovegetative situation. In the case of depressions with an axious increase of impulse, statistical evidence was obtained, within the framework of clinical improvement, for a correlation between a decreasing score of depression and an increasing frequency of third-order waves. The same central trends of these quantities suggest that both of them are different manifestations of a common functional disorder in the limbic system and diencephalon.

Affective Disorders, Psychotic↗

PubMed1978

Eye movements and a dynamic stimulus situation.

Two experiments were conducted to investigate performance with and without voluntary eye movements in a dynamic stimulus situation. Experiment I used a combined tracking and prediction task. Level of training, complexity of the signal, and visual region sampled were the variables of interest. Experiment II manipulated the same variables in only the prediction task. Thus, the amount of attention allotted to the prediction task was varied between experiments. The d' measure indicated that under peripheral vision instructions accuracy on the prediction task was the same as under foveal vision instructions provided that: (1) the level of task complexity was low, (2) the subjects were well trained, and (3) only the prediction task was performed, or in the dual task situation only visual regions near the fovea were sampled. All other combinations of the variables resulted in a lower performance scores under peripheral vision instructions. Results are interpreted within the framework of current theories of the functional visual field.

Eye Movements↗

PubMed2026

A nucleolar stress gene signature enables quantitative scoring across multi-omics contexts.

The nucleolus is essential for ribosome biogenesis and cellular homeostasis, and its dysfunction can induce nucleolar stress, a process implicated in cancer and other diseases. However, nucleolar stress is commonly inferred from morphological changes or a limited set of functional assays, and quantitative approaches based on gene expression profiles remain lacking. Here, we integrate literature curation with multi-dataset screening to define a nucleolar stress gene signature and develop a nucleolar stress score (NuS) applicable to bulk transcriptomics, single-cell transcriptomics, proteomics, and spatial transcriptomics. Using this framework, we show in colorectal cancer models that oxaliplatin induces nucleolar stress, suppresses nascent rRNA synthesis, and activates p53 signaling, whereas these responses are attenuated in oxaliplatin-resistant cells. Combined with a ribosome biogenesis activity score (RiboSis), NuS captures related but distinct dimensions of nucleolar function and stratifies tumors into functional states associated with clinical outcomes. NuS-based analysis of perturbational transcriptomes further prioritizes compounds with putative nucleolar stress-inducing activity. Collectively, this study provides a quantitative framework for evaluating nucleolar stress and illustrates its applications in disease stratification and drug mechanism discovery.

Cell Nucleolus↗

PubMed2005

[Exploration on the basic framework of standard for macrocosmic diagnosis of syndrome].

Starting from the thinking characteristics of TCM in the holistic approach of syndrome and process of syndrome differentiation, the problems in the criteria of syndrome diagnosis was analyzed, combining with the outcome of investigation on macrocosmic diagnosis of syndrome carried on twice by expert group nationwide in China, a concept for designing basic framework of standard for macrocosmic diagnosis of syndrome was advocated in this study. In order to recognize and master fully the standard, the following items would be the contents of the framework: give a standardized term of each syndrome; the basic clinical features of a syndrome; the qualitative parameters which could be used to distinguish the nature of a syndrome, and indexes to be used to judge the affected location of a syndrome during identifying process for a syndrome; the order of pertinent indexes with their given score, and the threshold for quantitative diagnosis. It is considered that the above framework defined the sufficient criteria which is constructed on the bases of the approaches with integrated qualitative and quantitative methods. It may enable the syndrome differentiation to access the real world of a patient to be used appropriately this framework.

Diagnosis, Differential↗

PubMed2006

Eco-cultural frameworks and childhood disability: a case study from Puerto Rico.

Social and physical environments are powerful influences on disability status. The purpose of this case report is to consider the usefulness of scores on the Pediatric Evaluation of Disability Inventory (PEDI) of a child living in Puerto Rico for developing an intervention plan within the context of the child's eco-cultural niche. A 5 year-old boy with cerebral palsy, his family, therapists, and teacher are described by using ethnographic interviews and participant observation of the family, speech, occupational, and physical therapists, and teachers over a 9-month period. A physical therapy evaluation of the child, including administration of the PEDI and use of the eco-cultural niche concept to develop an intervention plans are described... The child's abilities and inabilities as measured by the PEDI were influenced by several aspects of the environment; family beliefs, values and resources; community resources; and personal characteristics of the child. An eco-cultural framework was useful for interpreting the scores of this standardized measure of disability.

Cerebral Palsy↗

PubMed2006

A survey validation of generic objectives for community-based education in undergraduate medical training.

INTRODUCTION: A framework for the definition of generic objectives for community-based education (CBE) was developed for undergraduate medical programmes, particularly for developing countries. To probe the validity of the set of CBE objectives generated by this approach, opinions from a wider audience were sought. METHOD: Questionnaires were sent to 72 medical schools in 36 developing countries. Half of the addressees were randomly drawn from the list of institutional members of The Network: Toward Unity For Health (TUFH) and stratified according to developing countries. Another 36 medical schools were randomly drawn from non-Network: TUFH schools from the same country where the selected Network: TUFH addressee was located, or from a neighbouring country. RESULTS: A total of 43 medical schools responded to the questionnaire (60% response rate), 31 out of the 36 addressed Network: TUFH members (86%) and 12 out of 36 addressed non-Network: TUFH schools (33%). Out of all 43 respondents 39 (91%) had implemented CBE in their curricula. Opinions of Network: TUFH and non-Network: TUFH schools on the framework and the generic objectives were not significantly different. Out of the 21 proposed objectives, 17 were scored as relevant by 75% or over of all responders and one out of the four objectives considered to be less relevant by the responders was deleted. CONCLUSION: A framework to develop generic CBE objectives and a derived set of 21 objectives were modified based on input by 43 medical schools residing in developing countries distributed all over the globe. The outcome is a validated set of 20 generic objectives for CBE programmes in developing countries.

Chi-Square Distribution↗

PubMed1995

Body image disturbances in young adults with cancer. Implications for the oncology clinical nurse specialist.

The impact of the diagnosis of cancer and its treatments on the body image of young adults (18-29 years) diagnosed with cancer is relatively unknown. This descriptive comparative study examined body image scores of young adults diagnosed with cancer and young adults without cancer. The conceptual framework for this study was taken from body image and developmental theory. Secord and Jourard's body cathexis/self-cathexis scales and a demographic sheet were mailed to 162 young adults diagnosed with cancer and to 150 young adults without cancer. A t test was used to compare the mean scores between the two groups. A statistically significant difference was found between the mean scores reported by the young adults diagnosed with cancer for the body cathexis and self-cathexis scales. The self-cathexis and body cathexis scores indicated that the young adults diagnosed with cancer had a more positive body image than the young adults without cancer. The mean scores were also compared in relation to the demographic data collected using t tests and analysis of variance. Within the group diagnosed with cancer, male subjects demonstrated a more secure body-cathexis (p value of 0.012) and married subjects demonstrated a more secure self-cathexis than the single subjects did (p value of 0.04). No statistically significant difference was found within the group without cancer related to demographic variables. Implications for the oncology clinical nurse specialist are explored.

Adolescent↗

PubMed1997

A prospectively planned cumulative meta-analysis applied to a series of concurrent clinical trials.

Sequential designs are now a familiar part of clinical trial methodology. In particular, the triangular test has been used in several individual studies. Methods of combining studies are also well-known from the literature on meta-analysis. However, the combination of the two approaches is new. Consider the situation where a series of studies is to be conducted, following broadly similar protocols comparing a new treatment with a control treatment. In order to obtain an answer as quickly as possible to an efficacy or safety question it may be desirable to perform a cumulative meta-analysis on one particular variable. This could, for example, be the primary efficacy variable, an expensive assessment conducted in only a subgroup of patients, or a serious side-effect. To allow for the size of the treatment difference varying from study to study we might wish to provide a global estimate. Hence a random effects combined analysis, within a sequential framework, would appear to be appropriate. A methodology which utilizes efficient score statistics and Fisher's information is presented. Simulations show that the proposed methodology will achieve the specified error probabilities with reasonable accuracy provided that any random effect is relatively small. Ignoring random effects when they are present can lead to inaccuracies. A simulated example illustrates a number of practical issues.

Clinical Trials as Topic↗

PubMed1996

The assessment of disability with the Groningen Activity Restriction Scale. Conceptual framework and psychometric properties.

The conceptual framework, psychometric properties, descriptive statistics, and the rules for administration and scoring of the Groningen Activity Restriction Scale (GARS) for assessing disability in the area of ADL (Activities of Daily Living including mobility) as well as IADL (Instrumental Activities of Daily Living) are presented. The result show that the GARS, which can be administered both face-to-face and by mail questionnaire, is an easy to administer, comprehensive, reliable, hierarchical, and valid measure for assessing disability in older people. By integrating previously developed scales measuring different domains of disability (ADL, IADL, and mobility) and the use of a four-category response format, an accurate and detailed measure of disability can be obtained and a broader range of needs of subjects can be described. The GARS manual, including detailed procedures for administration and scoring, encourages unambiguous administration and interpretation which results in more comparable research outcomes.

Activities of Daily Living↗

PubMedDate not supplied

Family assessment tools: a review of the literature from 1978-1997.

Traditionally, nursing practice in critical care settings has been focused on recognizing and addressing the needs of the patient with an acute and serious health problem and individual family members. Little progress has been made in understanding how families manage this hospitalization experience; however, family health has been reported to be a significant factor in the patient's recovery. The purpose of this article is to review the literature from 1978 to 1997 that has examined family assessment tools in a variety of clinical settings. The ultimate goal of the review is to determine their usefulness for critical care environments and their congruence with family systems nursing, which is aimed at the cognitive, behavioral, and affective domains of family functioning. The following characteristics are used to review each of the selected instruments: theoretical framework; purpose; description; the unit of analysis; ease of administration and scoring; reading level; psychometric evaluation; and utility to guide clinical practice and research. Although the instruments have a variety of strengths, none of them are congruent with the philosophy of family systems nursing. Therefore instruments need to be developed that would guide assessment and interventions for nurses in critical care settings.

Critical Care↗

PubMed2001

Visual analog scales for interpretation of back and leg pain intensity in patients operated for degenerative lumbar spine disorders.

STUDY DESIGN: A prospective observational study of visual analog scale (VAS) scores for pain in patients operated at one institution within the framework of a national registry. OBJECTIVE: To describe the use of recording VAS for pain intensity in patients operated on for lumbar spine problems. SUMMARY OF BACKGROUND DATA: There is no consensus regarding pain outcomes assessment in spine patients. Pain intensity, recorded on a VAS, is one of the most used measures. Still, many aspects of its interpretation are still debated or unclear. METHODS: A total of 755 consecutive patients, mean age 50 years (range, 15-86 years), operated from 1993 to 1998 were included in the study; there were 420 males and 335 females. Diagnoses included herniated nucleus pulposus (45%), central stenosis (19%), lateral stenosis (14%), isthmic spondylolisthesis (9%), and degenerative disc disease (9%). Local pain, radiating pain, analgesic intake, and walking ability were recorded before surgery and at 4 and 12 months after surgery. The patients' opinions regarding the change in pain and satisfaction with the result were assessed separately. Correlation among variables reflecting perceived pain was sought. RESULTS: Preoperative VAS mean values for local and radiating pain were significantly different in the five diagnostic groups. Significant but moderate correlation between different types of pain outcomes and with patient satisfaction was present in all cases. CONCLUSIONS: Measuring pain intensity with VAS is a useful tool in describing spine patients. In the search for a standard in the evaluation of pain as an outcome, the differences between the various methods should be taken into account.

Adolescent↗

PubMed1985

Effect of gender role identity on patterns of feminine and self-concept scores from late pregnancy to early postpartum.

Relationships among gender role identity, feminine scores, self-concept, and perception of comfort in the mothering role were examined. Fifty-two primiparous and 21 multiparous women completed study questionnaires during the third trimester, 2 to 3 weeks postpartum, and 4 to 6 weeks postpartum. Low feminine gender role identity groups demonstrated the greatest change in feminine and self-concept scores over time. Differences in patterns emerged among the groups regarding size and significance of correlations between feminine and self-concept scores. Implications of findings for nursing practice and the study conceptual framework, as well as study limitations, are discussed.

Adult↗

PubMed2005

Packaging: a grounded theory of how to report physiological deterioration effectively.

AIM: The aim of this paper is to present a study of how ward-based staff use vital signs and the Early Warning Score to package physiological deterioration effectively to ensure successful referral to doctors. BACKGROUND: The literature tends to emphasize the identification of premonitory signs in predicting physiological deterioration. However, these signs lack sensitivity and specificity, and there is evidence that nurses rely on subjective and subtle indicators. The Early Warning Score was developed for the early detection of deterioration and has been widely implemented, with various modifications. METHOD: The data reported here form part of a larger study investigating the practical problems faced by general ward staff in detecting physiological deterioration. During 2002, interviews and observations were carried out using a grounded theory approach, and a total of 44 participants were interviewed (30 nurses, 7 doctors and 7 health care support workers). FINDINGS: Participants reported that quantifiable evidence is the most effective means of referring patients to doctors, and the Early Warning Score achieves this by improving communication between professionals. Rather than reporting changes in individual vital signs, the Early Warning Score effectively packages them together, resulting in a much more convincing referral. It gives nurses a precise, concise and unambiguous means of communicating deterioration, and confidence in using medical language. Thus, nurses are empowered and doctors can focus quickly on identified problems. CONCLUSION: The Early Warning Score leads to successful referral of patients by providing an agreed framework for assessment, increasing confidence in the use of medical language and empowering nurses. It is essential that nurses and nursing students are supported in its use and in developing confidence in using medical language by continued emphasis on physiology and pathophysiology in the nursing curriculum.

Clinical Competence↗

PubMed2001

Perspectives of people with enduring mental ill health from a community-based qualitative study.

BACKGROUND: The views of people with enduring mental ill health have received limited exploration. Existing work has largely focused on patients in specialist mental health settings, rather than on a wider range of patients in the community. AIM: To explore experiences and perceptions of health care of people with enduring mental ill health. DESIGN OF STUDY: A community-based qualitative study using theoretical sampling, in-depth interviews, and grounded methodology. SETTING: A total of 34 responders registered with four general practices, serving five wards with a mean Townsend Deprivation Score of 7.75. METHOD: Subjects were chosen using a theoretical sampling framework and they participated in one-to-one interviews which were audiotaped. Themes were identified and developed by reading transcripts, then they were further refined and classified manually by open coding into key categories using a grounded approach. RESULTS: The primary goal of the responders was to enhance, sustain, and take control of their mental health. The building of positive therapeutic relationships with professionals based upon effective communication, trust, and continuity were important to achieving this aim. However, the settings in which their health care took place could affect responders' attempts to deal with social stigma. Experiences of social isolation, socioeconomic privation, and stigmatisation were often pervasive. These compromised responders' opportunities and their capacity to enhance their mental health, compounding their illness and marginalisation. CONCLUSIONS: This study shows the potential of health professionals to empower people with enduring mental ill health, by attending to the quality of communication and continuity of care they provide and to where this takes place. It further underlines a need to address the social stigma and exclusion this group experiences.

Adult↗