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At least 217 records · Page 12Linked to original sources
PubMed1979

[A study of the obstacles to reduction in congenital dislocation of the hip (author's transl)].

Investigation on ten patients with typical congenital dislocation of the hip generalized joint laxity indicated the changes in the antero-inferior part of the acetabulum, which are mainly adhesion and narrowing produced by the capsule pulled superoposteriorly, as the major obstacle for successful reduction. Inverted limbus, pulvinar mass and ligamentum teres may represent secondary obstacles mostly due to iatrogenic procedures. The purpose of the closed reduction is to get rid of the obstacles during the conservative treatment. The cause of the failure of conservative treatment of congenital dislocation of the hip is a misjudgement of true reduction, allowing enough cavity for the femoral head in the antero-inferior part of the joint without the presence of the capsule between the femoral head and the acetabular cartilage. To get better understanding of the true reduction, tangential view in the arthrography of the hip joint gives us more precise data about the antero-inferior part of the joint because the acetabulum faces the joint cavity laterally and anteriorly.

Arthrodesis↗
PubMedDate not supplied

Obstacles to cancer care: focus on the economically disadvantaged.

PURPOSE/OBJECTIVES: To provide additional documentation of the unmet cancer prevention and control needs of poor Americans. DESIGN AND SETTING: Qualitative analysis of testimony provided at American Cancer Society hearings on cancer and the poor. SAMPLE: 46 economically disadvantaged individuals with personal experiences with cancer. METHODS: Review of transcription of oral testimony and qualitative analysis for recurrent themes to identify common obstacles to cancer care. FINDINGS: Six major obstacles were identified: care was deferred because of costs; care was described as "fragmented," "impersonal," and "symptomatic;" patients were discouraged from worrying about bodily changes; patients were discouraged from seeking state-of-the-art care; poor patients experienced difficulty communicating their needs and concerns; and poverty interfered with efforts to participate in volunteer activities. CONCLUSIONS: Testimony is suggestive of the problems that poor patients with cancer face. Challenges to improve the situation include expanding and extending diagnostic, treatment, and rehabilitative services to the poor; facilitating education and prevention; and further research to document the scope of the problem. IMPLICATIONS FOR NURSING PRACTICE: Nurses should engage in the debate over healthcare reform and take advantage of the opportunities to define and participate in the development of procedures, strategies, and systems for removing obstacles to quality cancer prevention and care for the poor.

Adult↗
PubMedDate not supplied

Obstacles predicting lack of a regular provider and delays in seeking care for patients at an urban public hospital.

OBJECTIVE: To determine the correlation among obstacles to medical care, lack of a regular source of care, and delays in seeking care. DESIGN: Cross-sectional survey of patients presenting for ambulatory care during a 7-day period. Multiple logistic regression models were used to identify obstacles independently associated with outcome variables. SETTING: Urban public hospital. PATIENTS: A total of 3897 disadvantaged and predominantly minority patients. MAIN OUTCOME MEASURES: Lack of a regular source of medical care and delay in seeking medical care for a new problem. RESULTS: The majority (61.6%) of patients reported no regular source of care. Of 2341 patients reporting a new medical problem, 48.4% waited more than 2 days before seeking medical care. No health insurance (adjusted odds ratio [OR], 2.2; 95% confidence interval [CI], 1.89 to 2.61), no transportation (OR, 1.44; 95% CI, 1.23 to 1.70), exposure to violence (OR, 1.21; 95% CI, 1.08 to 1.45), and living in a supervised setting (OR, 1.50; 95% CI, 1.00 to 2.25) were independent predictors of lack of a regular source of care. No insurance (OR, 1.24; 95% CI, 1.02 to 1.51), no transportation (OR, 1.45; 95% CI, 1.19 to 1.77), and less than a high school education (OR, 1.22; 95% CI, 1.08 to 1.49) were independent predictors of delaying care for a new medical problem. CONCLUSIONS: Obstacles in addition to lack of insurance impede provision of medical care to disadvantaged patients. The adoption of universal health care coverage alone will not guarantee access to appropriate medical care.

Adolescent↗
PubMed1994

Obstacles to use of hormonal contraception.

Enabling women to control the timing of their childbearing has positive consequences on their physical and mental well-being as well as for society as a whole. Identifying and removing the obstacles to effective contraceptive use, coupled with improvements in the delivery of contraceptive services, must be given high priority from all sectors, both private and governmental. The consequences to a woman of an unintended pregnancy can be physically, psychologically, and economically far-reaching. Assisting women to control the timing or spacing of their childbearing or to help women effectively prevent any future childbearing is a challenge that must be addressed by health professionals and educators. Therefore identification of women who are at risk of unintended pregnancy as a result of inadequate use of contraception, lack of its use, or use of inappropriate methods is important to help women and couples achieve their reproductive goals as well as to reduce the high rate of unintended pregnancy in the United States. In addition, overcoming common obstacles to effective contraceptive use as well as those within the health service delivery arena will enable women to take better control of and improve their lives.

Contraception↗
PubMed1993

The relationship between smoothness and performance during the practice of a lower limb obstacle avoidance task.

The relationship between performance (movement time) and smoothness was examined as subjects (n = 8) practiced a simple lower limb obstacle avoidance task. Smoothness was quantified by endpoint 3D jerk-cost, partitioned into magnitudinal and directional components. Data were collected with two WATSMART cameras at a sampling rate of 200 Hz for three sets of two trial blocks, including trials 1, 2, 13, 14, 25, and 26. Ten practice trials were performed between blocks of recorded trials. A DLT method was used to reconstruct 3D position coordinates of the fifth metatarsal of the subject's right (dominant) foot, considered to be the endpoint. After the data were smoothed with a fourth order, zero lag Butterworth filter, the time period was normalized so that a comparison of jerk-cost could be made between trials. Very rapid decreases in both movement time and jerk-cost measures were followed by gradual decreases, indicating that the movement became smoother as performance improved. Correlation coefficients between movement time and the various components of jerk-cost ranged from 0.70 to 0.78, supporting the hypothesis that moving more smoothly enables a person to move more rapidly during an obstacle avoidance task.

Cybernetics↗
PubMedDate not supplied

Integrative study in physiology and medicine: obstacles on the road to integration.

A recent report of the Long-Range Planning Committee of the American Physiological Society identifies physiology with "integrative biology" and urges that physiologists make their field "a unique branch of biology that deals with synthesis and integration." However, certain institutional, procedural, and psychological obstacles lie in the way of those who would embark upon this task. The hurdles to be overcome include the following: the erroneous belief that biomedical scientists are already integrative; the inapplicability of the powerful methods of areas of specialization to integrative study; the fear of failure; the identification of integrative biology with the study of function; the disregard of hierarchy; the undervaluation of the abstract; and the loss of a sense of mystery. These obstacles, though insidious, pervasive, and powerful, can be surmounted.

Animals↗
PubMed2006

Obstacles to organ donation in Swedish intensive care units.

OBJECTIVE: To identify obstacles to organ donation in Swedish intensive care units. DESIGN: A survey exploring attitudes and experiences of organ donation activities was sent to half of all anaesthetists and all neurosurgeons in Sweden (n=644). Total response rate was 67%; 69% from the anaesthetists and 54% from the neurosurgeons. RESULTS: Neurosurgeons had more experiences of caring for potential donors and requesting donation than anaesthetists. Twenty-seven percent of the anaesthetists were not confident with clinical neurological criteria for brain incarceration. Nine per cent found donation activities solely burdensome, and 14% wanted an external team to take over the donation request. A quarter regarded the request definitely as an extra load on the family, and more than half of the respondents had refrained from asking in emotionally strained situations. Forty-nine per cent had a neutral approach to relatives when requesting donation while 38% had a pro-donation approach. Thirty-six per cent terminated ventilator treatment for a potential donor without waiting for total brain infarction. Lack of resources in the ICUs resulted in not identifying a possible donor according to 29% of respondents. Knowing the prior wish of the deceased was regarded as the single most important factor that facilitated the work with organ donation for the intensivists. CONCLUSIONS: The identified obstacles (neutral approach of donation request, ethical problems concerning the potential donor and the relatives, varying competence in diagnosing total brain infarction, and lack of intensive care bed resources) require tailored efforts in order to increase organ donation. Checking these factors can be used as a quality control when analysing donation activities at hospitals.

Adult↗
PubMedDate not supplied

Colorectal cancer screening and surveillance with CT colonography: current controversies and obstacles.

Computed tomographic (CT) colonography has been advocated as an alternative colorectal screening method because studies in populations with a high prevalence of polyps have demonstrated that sensitivity for patients with large (> or =10 mm) polyps is generally high (approximately 90%). In three recent studies in low-prevalence populations, however, these values vary from 55% to 94%. Many questions have been raised as to the cause of this remarkable variability, which hampers the implementation of CT colonography in colorectal cancer screening and surveillance. We provide an overview of some potential causes and discuss the available, often indirect, evidence. In addition, several other obstacles that may influence implementation are discussed. Many differences between the study with high sensitivity (94%) and the two studies with low sensitivity (55% and 64%) exist: the primary method to review the data (two or three dimensional), bowel preparation (with or without oral contrast agents), study design (verification method and analysis of adenomas only), reader's experience, and scanning technique (single vs. multislice, thin vs. thick sections). Additional obstacles for implementation in prevention of colorectal cancer may be controversial results concerning patient acceptance, the large-scale use of ionizing radiation, difficulties in detecting flat adenomas, and extracolonic findings. Use of primary three-dimensional review methods, addition of oral contrast agents to bowel preparation, and endoscopic verification of false-positive results on CT colonography are speculated to have a positive influence on sensitivity. Future investigations should demonstrate the influence of these potential factors on sensitivity of CT colonography. Despite a growing body of evidence, it remains uncertain to what extent patient acceptance, radiation issues, flat lesions, and extracolonic findings will be a stumbling block to using CT colonography for colorectal cancer screening.

Adenoma↗
PubMed1995

Studying the causes of kidney disease in humans: a review of methodologic obstacles and possible solutions.

Until recently, epidemiology has contributed little to the understanding of kidney disease etiology. In the past, the immediate need for therapy eclipsed the longer-term need to develop preventive strategies. As a result, kidney disease epidemiology lacked sufficient institutional and financial support. These difficulties are being progressively (albeit yet incompletely) resolved. Other obstacles pertained to research methods. The need for large cohort studies to investigate a relatively uncommon outcome can be overcome by the use of alternative study designs, such as nonconcurrent prospective studies or case control studies. Unfortunately, other methodologic obstacles remain. These include (1) lack of sensitive markers of early renal insufficiency for use in general populations, (2) variations in access to end-stage renal disease therapy, (3) uncertainty regarding cause-of-death certification in persons with kidney diseases, (4) ambiguous criteria for diagnosing specific renal diseases, (5) lack of independence between risk factor assessments and kidney disease definition, (6) inconsistent risk factor assessments, and (7) inadequate conceptual models for causation of kidney failure. We suggest a global framework, including (1) defining rigorous diagnostic criteria for renal diseases, (2) conducting etiologic studies of "all-cause" end-stage renal disease, (3) systematically collecting data on risk factors for renal injury, and (5) distinguishing between initiators and promoters of renal insufficiency and between proximate and distal risk factors. These suggestions aim to foster a multidisciplinary debate on etiologic research on renal diseases. Identification of modifiable risk factors may provide a basis for effective preventive interventions.

Epidemiologic Methods↗
PubMed1984

Obstacles to the practice of licensed lay midwifery.

Intensive interviews with licensed lay midwives in one of ten states that have recently reactivated and revised legislation legalizing such alternative practitioners for low risk clientele revealed a number of obstacles to their practice. The obstacles stem from the same rules and regulations developed by medical practitioners that made their homebirth service legal. Even after surmounting the difficulties of obtaining a license, the midwives find widespread unwillingness among private physicians to provide the required prenatal screening examination and medical back-up. The opposition of physicians to the licensed midwifery program is voiced in terms of concern about the safety of homebirths, particularly those attended by nonphysicians. Yet, the outcomes from the first 4 years of the program give no support for such concerns. Physician reluctance to cooperate with the legal program, combined with restrictions prohibiting the licensed midwives from suturing minor tears and administering a single dose of an antihemorrhagic drug in an emergency transfer, do compromise the overall quality of midwifery care. While accepting their subordinate position to medical practitioners, the midwives are struggling to establish the continuum of care for homebirth women implied in their licensure law.

Adult↗
PubMed1993

Obstacles to medical audit: British doctors speak.

Currently, British doctors are being encouraged by government, managers and their professional associations to undertake medical audit. How easy a task will it be to introduce audit? In an attempt to find out, doctors working in general, geriatric and accident and emergency medicine in four district general hospitals were interviewed. Twenty-eight consultants and 34 junior doctors participated. Generally speaking, doctors accepted the need for audit. In this paper we have focussed deliberately on their worries, since it is these which are of most importance in developing better methods of implementation. The 19 obstacles to audit that respondents identified can be grouped into four categories: perceptions of the need for and the role of audit; practical considerations; the effects of audit; and anxieties about the use of audit. In general, criticisms were levelled at the way audit was being implemented rather than at the principles of the approach. While some obstacles could be overcome by simple, practical measures, others will require a change in doctors' knowledge, beliefs and attitudes. The difficulty of achieving such changes should not be underestimated.

Adult↗
PubMed1991

Obstacles to implementing cancer clinical trials.

There are numerous obstacles to implementing and conducting clinical trials. Patient accrual and the costs of clinical trials are difficult problems for researchers. Additional obstacles to implementing clinical trials are patient-related, physician-related, and nurse-related barriers.

Clinical Trials as Topic↗
PubMed2006

Reproduction obstacles for the female green neon shrimp (Neocaridina denticulata) after exposure to chlordane and lindane.

The purpose of this study was to investigate the effects of chlordane and lindane on reproduction obstacles and endocrine disruption in female green neon shrimp (Neocaridina denticulata). Individuals of N. denticulata, a common inhabitant of freshwater systems in Taiwan, was exposed to different levels of chlordane (1 and 10 ngl(-1)) and lindane (0.1 and 1 microgl(-1)). The reproductive ability and reproductive hormone levels were observed after exposure. According to our findings, an increase in estrogen, induction of a vitellogenin-like protein, and changes in reproductive performance were observed in both chlordane- and lindane-treated shrimp. Thus, it was concluded that chlordane and lindane may cause some reproduction obstacles and disruption of endocrine functions in N. denticulata.

Animals↗
PubMed2005

Dissociating size representation for action and for conscious judgment: Grasping visual illusions without apparent obstacles.

Visual illusions provide important evidence for the co-existence of unconscious and conscious representations. Objects surrounded by other figures (e.g., a disc surrounded by smaller or larger rings, Ebbinghaus/Titchener illusion) are consciously perceived as different in size, while the visuo-motor system supposedly uses an unconscious representation of the discs' true size for grip size scaling. Recent evidence suggests other factors than represented size, e.g., surrounding rings conceived as obstacles, affect grip size. Use of the diagonal illusion avoids visual obstacles in the path of the reaching hand. Results support the dual representation theory. Grip size scaling follows actual size independent of illusory effects, which clearly bias conscious perception in direct comparisons of lengths (Experiment 1) and in finger-thumb span indications of perceived length (Experiment 2).

Adult↗
PubMed2006

Effect of Tai Chi on gait and obstacle crossing behaviors in middle-aged adults.

This study investigated whether long-term, habitual practice of Tai Chi (or Taiji) results in behavioral modifications during gait. Specifically, we examined whether Tai Chi (TC) experience alters gait behavior during normal and obstructed walking. Fifteen experienced TC practitioners and fifteen control subjects (average age 45 years, 23-66 year range) completed level walking trials with or without a stationary obstacle placed in their path. TC practitioners in this study had an average of 6.5 years (1.5-15 year range) of Chen-style Tai Chi experience. Kinematic analyses performed on their step-to-step gait characteristics over multiple steps revealed that TC practitioners used a more cautious strategy by using slower gait speeds and shorter and slower steps than controls (p <or= 0.003). TC practitioners also spent significantly longer time in single leg support while crossing the obstacle (p < 0.001). The deleterious effect of this typically risky behavior may be mitigated in TC practitioners because of their comfort with single leg stance due to continual practice in this posture. It has been suggested that TC may reduce the risk of falls in older adults. Future studies will need to determine whether these observed gait behaviors are found in older adults and are related to reductions in fall risk.

Accidental Falls↗
PubMed2005

Inter-segmental coordination: motor pattern in humans stepping over an obstacle with mechanical ankle joint friction.

This study examined the influence of a mechanical perturbation of the ankle joint on obstacle avoidance pattern. A decoupled control between the distal joint and the combined (hip-knee) proximal joints was observed according to the task requirement. In this context, a greater mechanical friction at the ankle should be compensated at this joint (local compensation) or alternatively, by regulating more combined proximal joints (knee and/or hip). The leading limb inter-segmental coordination was evaluated in both no constraint and constraint conditions in calculating ranges of motion (ROM), moments of force and powers (from heel-off to obstacle) at the ankle, knee and hip joints. Electromyographic activities were also analyzed. With the constraint, the dorsiflexor moment and the tibialis anterior activity remained unchanged while both ROM and power bursts (absorbed and generated) decreased. The hip and knee ROM remain invariant. At heel-off the absorption by hip extensors decreased and the forthcoming generation by knee flexors increased in the constraint condition. To quantify the inter-joint coordination, principal component analysis was used and indicated a high level of inter-joint coupling (synergy) that decreased with the constraint (i.e. less inter-joint coupling). At the ankle joint, the results suggest that the central command was the same in both conditions thus, not be adapted. At both the hip and knee joints, a combined joints modulation occurred to overcome additional friction.

Adaptation, Physiological↗
PubMed2005

Early Mendelism and the subversion of taxonomy: epistemological obstacles as institutions.

This paper presents and discusses a series of hybridization experiments carried out by Nils Herman Nilsson-Ehle between 1900 and 1907 at a plant breeding station in Svalöf, Sweden. Since the late 1880s, the Svalöf station had been renowned for its 'scientific' breeding methods, which basically consisted of an elaborate system of record-keeping through which the offspring of individual plants were traced over generations while being meticulously described. This record system corresponded to a certain breeding technique (the so-called 'pedigree method') and certain theoretical convictions (mutational rise of new varieties, and non-productivity of selection). Inspired by Tschermack's translation of Mendel's Pisum-paper, Nilsson-Ehle began his experiments in 1900 and published a first, major synthesis of his findings in 1908. If one compares these experiments as documented in the breeding records, with their representations in print, one encounters discrepancies in terms of procedure and presentation of data. This can be explained by the fact that Nilsson-Ehle was obliged to follow the recording and breeding procedures institutionalised at Svalöf, and these procedures, grounded in a taxonomic discourse, left little room for Mendelian hybridisation experiments. The twists and turns that this story takes are analysed in terms of Bachelardian philosophy of science, where the 'epistemological obstacle' functions as a central, analytic category. In contrast to Bachelard, however, I will characterise these obstacles as being of an institutional, rather than mental, nature. Thus characterized, moreover, they turn out to have been prerequisites as much as barriers to scientific progress.

Academies and Institutes↗
PubMed2006

The future of organ replacement: needs, potential applications, and obstacles to application.

The supply of organs available for transplantation is already far smaller than the demand, and the demand may grow substantially in the near future. For this reason, it is timely to consider how organ function might be replaced in the future. In this article, we consider new technologies that might be used to replace organ function, the obstacles to applying new technologies, and how those obstacles might be overcome in the development of new strategies for organ replacement.

Animals↗