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PubMed2006

Characteristics of nosologically informative data sets that address key diagnostic issues facing the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) and International Classification of Diseases, eleventh edition (ICD-11) substance use disorders workgroups.

AIMS: Over the past two decades, many nosological issues have been addressed by the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) substance use disorders workgroups. Even with those efforts, there are key issues that have not been resolved and must be revisited, or addressed de novo, by the workgroups. These lingering points are broad, due to the array of substances classified under the diagnostic umbrella of substance use disorders. They include substantive issues ranging from dimensional approaches, similar criteria for each substance, cut-points and thresholds, distinct abuse and dependence classifications, new criteria and drugs, to less substantive ones, such as the adjectives used to describe the severity of the behaviors. RESULTS: This paper describes the characteristics of the data sets that will be needed to resolve the key nosological issues. Ten points are described: (1) data must be true to nomenclature under study; (2) flexible regarding rearrangements of scoring algorithms; (3-4) able to assess substances individually and retain former versions of the criteria; (5) not rely on shortened versions; (6) utilize samples that are generalizable; (7) make diagnoses with transparent algorithms; (8) combine mixed methods for corroborating data; (9) utilize assessments that collect reliable and valid diagnoses and criteria; and (10) stretch the limits by allowing for new discoveries. CONCLUSIONS: This paper describes each of these and gives examples of the limitations and strengths of data for the purpose of defining a useful, unified concept of addictive behaviors.

Algorithms↗
PubMed1995

Analysing qualitative interview data: addressing issues of validity and reliability.

Over the last 20 years qualitative research methods have increased in popularity in the field of nursing research, yet critical issues of validity and reliability are often overlooked in published research reports. Thus, the aim of this paper is to describe the steps which the author followed to address issues of rigour in one qualitative research study. The study was conducted to explore the health visitor's role in identifying and working with vulnerable families in the community in relation to child protection. This paper will focus on how issues of validity and reliability were addressed in terms of qualitative interview data.

Child↗
PubMed2005

A study on how mental health practitioners address ethical issues in clinical audit.

Although much debate has taken place within the literature on the differences between research and clinical audit, the ethical dimensions of audit have frequently been neglected. Furthermore, no research has of yet explored what ethical issues auditors consider in relation to their projects or how they manage them in practice. Using data collected from audit documentation, semi-structured interviews and a researcher-administered questionnaire, this study sought to advance this position by exploring how 14 clinicians undertook audits in one mental health Trust addressed the ethical dimensions of their project. Analysis of the data revealed that the Trust had no formal mechanisms for reviewing and monitoring audit projects whilst other informal mechanisms were not utilized by all auditors. A number of projects had contact with both clinicians and service users through interviews, focus groups and questionnaires; however, issues such as informed consent, confidentiality and anonymity were not adequately addressed by auditors. The implications of these findings are discussed and recommendations for practice outlined.

Attitude of Health Personnel↗
PubMed1994

A practical intervention to address ear and lung disease in Aboriginal primary school children of central Australia.

Australian Aboriginal populations have an extremely high prevalence of lung disease and ear disease. In addition to an improvement in socio-economic conditions, implementation of strategies to address the problem, within the limitations of present conditions, is needed. A 5 month trial was conducted to investigate the effectiveness of a school-based intervention programme involving nose blowing, deep breathing and coughing combined with exercise performed daily. This was a community-based trial, designed to give priority to cultural and ethical considerations, to be non-intrusive and to utilize local skills and resources. Results of the trial showed that signs of upper and lower respiratory tract disease and pulmonary function measurements were statistically significantly improved. Hearing levels showed no statistically significant change. The programme met with a good response from children and teachers. This study does suggest that this strategy may help address the existing problems of lung and ear disease in Aboriginal primary school children, providing some immediate benefits within the limitations of the present socio-economic conditions.

Breathing Exercises↗
PubMed2005

The development and process evaluation of an information-based intervention for pregnant women aimed at addressing rates of caesarean section.

OBJECTIVE: Few strategies aimed at addressing rising rates of caesarean section have explicitly involved information-based approaches for pregnant women. This study describes the development and evaluation of such an intervention for pregnant women, encompassing pamphlets and a peer support network (PSN). DESIGN: Process evaluation. SETTING: The study was undertaken at a metropolitan teaching hospital in Adelaide, South Australia. POPULATION: A consecutive sample of pregnant women attending the ultrasound clinic over a two-month period, recruited at 18 weeks of gestation. METHODS: Participants received two pamphlets at 18 weeks of gestation and information on a PSN at around 28 weeks of gestation. A questionnaire was sent to women at seven weeks postnatal, asking them to evaluate the intervention. MAIN OUTCOME MEASURES: The extent to which the intervention resources were used and participants were satisfied with the resources they received. RESULTS: Ninety-two women returned questionnaires (response rate of 62%). Women generally resisted engaging with the informational resources, citing irrelevance to their situation, for example, 53% (49/92) read all of the pamphlets. None of the women used the PSN. Women who had experienced childbirth previously and those of higher education were significantly more likely to read the pamphlets. While generally satisfied with pamphlet content, one in five women reported feeling distressed by some of the information. CONCLUSIONS: This exploratory study casts doubt on the notion of information provision for pregnant women as a panacea for addressing rising rates of caesarean section.

Adult↗
PubMed2004

Factors associated with physician interventions to address adolescent smoking.

OBJECTIVE: To determine the percent of adolescent Medicaid patients with medical record documentation about tobacco use status and cessation assistance; and factors associated with providers documenting and intervening with adolescent smokers. DATA SOURCE: Secondary analysis of data collected in 1999 from medical records of Wisconsin Medicaid health maintenance organization (HMO) recipients 11 to 21 years old. STUDY DESIGN: Random reviews and data collection were related to visits from January 1997 to January 1999. Data collected included patient demographics, provider type, number of visits, and whether smoking status and cessation interventions were documented. DATA EXTRACTION METHODS: Medical charts were reviewed and a database was created using a data abstraction tool developed and approved by a committee to address tobacco use in Medicaid managed care participants. PRINCIPAL FINDINGS: Among adolescents seen by a physician from 1997 to 1999, tobacco use status was documented in 55 percent of patient charts. Most often tobacco use status was documented on history and physical or prenatal forms. Of identified adolescent smokers, 50 percent were advised to quit, 42 percent assisted, and 16 percent followed for smoking cessation. Pregnant patients were more likely to have tobacco use documented than nonpregnant patients (OR=10.8, 95 percent CI=4.9 to 24). The odds of documentation increased 21 percent for every one-year increase in patient age. CONCLUSIONS: Providers miss opportunities to intervene with adolescents who may be using tobacco. Medical record prompts, similar to the tobacco use question on prenatal forms and the tobacco use vital sign stamp, are essential for reminding providers to consistently document and address tobacco use among adolescents.

Adolescent↗
PubMed2000

Uncommon strategies for a common problem: addressing racism in family therapy.

Race and racism have a profound effect on our daily lives and the practice of family therapy. Whether individual or institutional level, overt or covert, intentional or unintentional, there are a variety of ways in which racism can infiltrate the therapeutic process. Before therapists can take steps to address racism effectively within the context of family therapy, it is important to attend to the development of their racial awareness and racial sensitivity. These provide the critical foundation upon which specific skills and strategies associated with effectively identifying and responding to racism in therapy are based. This article defines racial awareness and sensitivity and provides suggestions for enhancing both. In the section that follows, three major ways in which racism can infiltrate the therapeutic process are described. Skills and strategies for addressing each of these in family therapy are presented.

Awareness↗
PubMed1998

Addressing urinary incontinence with educational continence-care competencies.

This article is a report of a task force formed from a discussion group hosted by the American Nurses Association on the AHCPR Guidelines on Urinary Incontinence. The need to standardize content related to bladder incontinence to be used in curriculums was identified as an initial step in implementing the guidelines. A task force was formed to develop educational competencies to be used by schools in identifying content that should be addressed at various levels of preparation. Although special training is needed when continence care is a significant part of a nurse's practice, it is expected that by using the educational competencies, schools will produce graduates at the basic level able to provide beginning continence care and graduate nurses able to address advanced incontinence problems.

American Nurses' Association↗
PubMed2002

Portfolios: possibilities for addressing emergency medicine resident competencies.

Portfolios are an innovative approach to evaluate the competency of emergency medicine residents. Three key characteristics add to their attractiveness. First, portfolios draw from the resident's actual work. Second, they require self-reflection on the part of the resident. Third, they are inherently practice-based learning since residents must review and consider their practice in order to begin the portfolio. This paper illustrates five different applications of portfolios. First, portfolios are applied to evaluating specific competencies as part of the training of emergency physicians. While evaluating specific competencies, the portfolio captures aspects of the general competencies. Second, the article illustrates using portfolios as a way to address a specific residency review committee (RRC) requirement such as follow-ups. Third is a description of how portfolios can be used to evaluate resident conferences capturing the competency of practice-based learning and possibly other competencies such as medical knowledge and patient care. Fourth, the authors of the article designed a portfolio as a way to demonstrate clinical competence. Fifth, they elaborate as to how a continuous quality improvement project could be cast within the portfolio framework. They provide some guidance concerning issues to address when designing the portfolios. Portfolios are carefully structured and not haphazard collections of materials. Following criteria is important in maintaining the validity of the portfolio as well as contributing to reliability. The portfolios can enhance the relationship between faculty and residents since faculty will suggest cases, discuss anomalies, and interact with the residents around the portfolio. The authors believe that in general portfolios can cover many of the general competencies specified by the ACGME while still focusing on issues important to emergency medicine. The authors believe that portfolios provide an approach to evaluation commensurate with the self-evaluation skills they would like to develop in their residents.

Clinical Competence↗
PubMed2004

Research fundamentals: follow-up of subjects in clinical trials: addressing subject attrition.

Many published clinical trials have less than adequate follow-up. When conducting a clinical trial, researchers attempt to minimize data loss; however, some data may not be collected, particularly when subjects are lost to follow-up. Careful planning of research protocols, including comprehensive initial data collection, identification of locators, flexible scheduling, systematic subject tracking, monitoring subject loss, and systematically approaching problem cases can ensure high follow-up rates. This article presents a compendium of techniques and procedures that researchers can use to enhance follow-up and address attrition in their studies. Finally, this article outlines statistical techniques that can be used to address the effects of missing data, particularly when patients are lost to follow-up.

Appointments and Schedules↗
PubMed2006

Predictors of physicians' involvement in addressing sexual health issues.

OBJECTIVES: Although the World Health Organization has declared that sexual health is an integral part of overall health, physicians seem to engage in taking the sexual health history less than their patients would desire. This study aimed at investigating the factors that predict physicians' involvement in addressing sexual health issues, including their attitudes toward the doctor-patient relationship, as well as sexual issues. METHODS: Physicians participating in educational courses on erectile dysfunction were the study sample, and anonymously and optionally completed a battery of questionnaires. In addition to demographics and a questionnaire on their involvement in taking sexual histories, the beliefs about the doctor-patient relationship were measured by the Patient-Practitioner Orientation Scale, while the Physician Belief Scale was used as the measurement of the psychosocial aspects of patient care. Finally, participants completed the Derogatis Sexual Functioning Inventory--Attitude subscale, in order to determine the possible role of physicians' sexual attitudes. RESULTS: Previous training in communication skills was found to be the strongest predictor for sexual history taking. Physicians addressing patients' psychosocial concerns were found to be more likely to ask for sexual health problems and to consider their management as less difficult. Other identified predictors of their involvement in sexual history taking were their medical specialty-possibly reflecting their level of education in sexual medicine--and having liberal sexual attitudes; female physicians and general practitioners reported more difficulty in dealing with sexual problems. CONCLUSIONS: Physicians' training in communication skills seems to be fundamental for sexual history taking and the management of sexual problems, as it improves their level of comfort in dealing with sexual issues; exposure to sexual medicine courses, and psychosocial orientation, as well as physicians' personal sexual attitudes, are also important factors affecting their involvement in sexual medicine.

Adult↗
PubMed2002

Addressing use of herbal medicine in the primary care setting.

PURPOSE: To critically evaluate existing approaches to the integration of allopathic and complementary and alternative medicine (CAM) and develop a middle ground approach to addressing use of herbal medicine and other forms of CAM in the primary care setting. DATA SOURCES: Extensive review of scientific literature and Internet sources supported by legal, philosophical, and ethical arguments. CONCLUSIONS: A review of medical literature indicates that a growing number of people perceive both allopathic and CAM to be valued aspects of health care. Whether we agree with this perception or not, ethical, legal, clinical, and social considerations dictate that we assist patients in their efforts to derive benefit from use of CAM while helping them to minimize risks. Yet the current approach to addressing CAM in primary care is "don't ask, don't tell," with approaches to filling this clinical void ranging from "just say no" to CAM use, to allopathic practitioners who also are CAM practitioners. IMPLICATIONS FOR PRACTICE: It is possible to occupy the middle ground, neither rejecting nor embracing CAM, but recognizing its significant impact on health care. In order to do this safely, clinicians need to be informed about herbs and other CAM practices, document thoroughly the informed consent and decision-making process, and monitor patients carefully for adverse effects.

Complementary Therapies↗
PubMedDate not supplied

High-speed addressable confocal microscopy for functional imaging of cellular activity.

Due to cellular complexity, studying fast signaling in neurons is often limited by: 1. the number of sites that can be simultaneously probed with conventional tools, such as patch pipettes, and 2. the recording speed of imaging tools, such as confocal or multiphoton microscopy. To overcome these spatiotemporal limitations, we develop an addressable confocal microscope that permits concurrent optical recordings from multiple user-selected sites of interest at high frame rates. Our system utilizes acousto-optic deflectors (AODs) for rapid positioning of a focused laser beam and a digital micromirror device (DMD) for addressable spatial filtering to achieve confocality. A registration algorithm synchronizes the AODs and DMD such that point illumination and point detection are always colocalized in conjugate image planes. The current system has an adjustable spatial resolution of approximately 0.5 to 1 microm. Furthermore, we show that recordings can be made at an aggregate frame rate of approximately 40 kHz. The system is capable of optical sectioning; this property is used to create 3-D reconstructions of fluorescently labeled test specimens and visualize neurons in brain slices. Additionally, we use the system to record intracellular calcium transients at several sites in hippocampal neurons using the fluorescent calcium indicator Oregon Green BAPTA-1.

Animals↗
PubMed1997

Cross-language analysis of phonetic units in language addressed to infants.

In the early months of life, infants acquire information about the phonetic properties of their native language simply by listening to adults speak. The acoustic properties of phonetic units in language input to young infants in the United States, Russia, and Sweden were examined. In all three countries, mothers addressing their infants produced acoustically more extreme vowels than they did when addressing adults, resulting in a "stretching" of vowel space. The findings show that language input to infants provides exceptionally well-specified information about the linguistic units that form the building blocks for words.

Adult↗
PubMed1975

Prevalence of asbestos bodies in a necropsy series in East London: association with disease, occupation, and domiciliary address.

The prevalence of asbestos bodies was measured in lung sections in a necropsy series carried out at the London Hospital (1965-66) after exclusion of all known asbestos factory workers and cases of asbestosis and of mesothelioma. Associations were sought between the presence and number of asbestos bodies with the patients' sex, domiciliary address, occupation, industry, and diseases recorded at necropsy. Asbestos bodies were present in 42% of the 216 men in the series and in 30% of the 178 women. The number of bodies in the positive cases was small in comparison with the numbers seen typically in asbestosis; thus there were less than 6 asbestos bodies per 6-75 mm-3 lung tissue in 107 of the total 145 positive cases in contrast to 1 000 or more in asbestosis. In comparison with the overall series, an increased number of asbestos body positives was present in males with carcinoma of stomach and females with carcinoma of breast. In view of this finding lung sections were counted in further post-mortem examples of these carcinomas making a total of 50 males with carcinoma stomach and 82 females with carcinoma breast. Thirty-five positive cases were found in the carcinoma stomach group as against 22-7 expected and 38 in the carcinoma breast group against 26-35 expected. There was no excess of observed over expected asbestos body positives in 51 males with carcinoma of bronchus. There was an excess of asbestos body positives (60-9%) in heavy manual workers and in both heavy and light manual male workers in the shipping (61%), electrical and engineering (56%), and transport (54%) industries. The incidence in male clerical workers was 12-8%. The incidence of asbestos body positives according to home address was highest (53% in males, 45% in females) in patients living in the industrial and cockland area due east of the hospital. The incidence fell in the less industrial areas north-east of the hospital. Consideration of possible environmental sources of the inhaled asbestos suggests that in this survey occupation, industry, and comiciliary area all play a part. The comparatively minor intensity of asbestos pollution in our positive cases showed a positive association with carcinoma of stomach and breast, possibly playing a direct pathogenic role in carcinoma of stomach. No positive association was identified with any other neoplastic disease including carcinoma of bronchus.

Adolescent↗
PubMed2001

The simultaneous recurrent neural network for addressing the scaling problem in static optimization.

A trainable recurrent neural network, Simultaneous Recurrent Neural network, is proposed to address the scaling problem faced by neural network algorithms in static optimization. The proposed algorithm derives its computational power to address the scaling problem through its ability to "learn" compared to existing recurrent neural algorithms, which are not trainable. Recurrent backpropagation algorithm is employed to train the recurrent, relaxation-based neural network in order to associate fixed points of the network dynamics with locally optimal solutions of the static optimization problems. Performance of the algorithm is tested on the NP-hard Traveling Salesman Problem in the range of 100 to 600 cities. Simulation results indicate that the proposed algorithm is able to consistently locate high-quality solutions for all problem sizes tested. In other words, the proposed algorithm scales demonstrably well with the problem size with respect to quality of solutions and at the expense of increased computational cost for large problem sizes.

Algorithms↗
PubMedDate not supplied

Challenges in addressing community concerns regarding clusters of multiple sclerosis and potential environmental exposures.

Citizens living around hazardous waste sites in the USA have expressed concern to public health officials at the local, state and federal level about a perceived high prevalence of multiple sclerosis (MS) in their communities. Many believe the occurrence of the disease is directly linked to exposure to chemical agents from the nearby hazardous waste site. Although the public's concern regarding these clusters should be addressed, epidemiologists have long known that evaluating perceived clusters is rarely fruitful for identifying an etiologic agent. In order to adequately address concerns regarding clusters of MS, as well as examining the role of environmental exposures and genetic susceptibility in the causal mechanism of disease, several activities need to be conducted including characterizing the occurrence of disease, developing a standardized case definition and establishing partnerships to develop innovative research techniques. Only with collaboration across disciplines and lessons learned from past research will we be able to effectively guide research efforts directed at determining the etiology of this disease.

Cluster Analysis↗
PubMed2004

Addressing the effects of culture on the boundary-keeping practices of psychiatry residents educated outside of the United States.

OBJECTIVE: The author sought to develop a curriculum for international medical graduate (IMG) psychiatry residents that addresses their culture-based deviations from normative boundary-keeping practices common to U.S.-based psychotherapy practices. METHODS: A group consisting of 12 IMG psychiatry residents and one United States graduate (USG) participated in a curriculum consisting of eight monthly, 1-hour seminars. An eight-item, Likert-type 7-point scale, post-then-pre questionnaire assessed the instructional impact of the curriculum. RESULTS: Responses indicated that participation in the curriculum significantly increased the IMG residents' levels of confidence with respect to boundary theory and practice. CONCLUSION: International medical graduates confidence levels regarding psychotherapeutic boundaries can be significantly increased through participation in a curriculum that addresses cultural differences.

Cultural Characteristics↗