SEARCH · Search PubMed

Results for “Obstacles”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

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

At least 235 records · Page 13Linked to original sources

PubMed1999

Widespread short-latency stretch reflexes and their modulation during stumbling over obstacles.

The present study investigated whether short-latency stretch reflexes are present during human stumbling reactions. While subjects walked on a treadmill, the forward sway of the foot was unexpectedly obstructed with an obstacle. All subjects showed reflex responses with average latencies of 34-42 ms in both the upper and the lower leg flexors and extensors of the obstructed leg. The amplitudes of these responses depended on the phase in the step cycle and were not strictly related to either the background activity of the corresponding muscles or variations in the perturbation. Hence, mechanisms at a premotoneuronal level might play a role in the active phase-dependent control of these responses. The coactivation of antagonists as well as the lack of obvious kinesiologic consequences following the responses suggest that the short-latency responses may generate joint stiffness. This may be a first line of defense in preparing for the functional reaction, which is generated by longer latency responses, in order to take appropriate action concerning the obstacle.

Adult↗

PubMedDate not supplied

Distressed women's clinic patients: preferences for mental health treatments and perceived obstacles.

Women seen in public gynecology settings are at very high risk of developing psychiatric disorders. Because low-income and ethnic minority women seen in such settings underutilize mental health services, it is important to better understand treatment preferences and obstacles among this high-risk patient population. Public women's clinic patients (N = 105) who reported psychological or emotional distress were asked about their interest in medication, psychotherapy, and psychoeducational classes, as well as perceived obstacles to using these services. The vast majority were interested in receiving some form of mental health treatment, with the most interest shown for individual therapy and general psychoeducational classes about health and stress. Less interest was expressed in group therapy and medication. Women anticipated more instrumental barriers to using services, such as lack of money, transportation, and childcare, than stigma-related barriers, such as fear of embarrassment or rejection. However, Latinas, women with less education, and those with a current mood or anxiety disorder were more likely to anticipate stigma-related barriers to treatment than other women. Implications of these findings for referral and treatment of mental health problems among public women's clinic patients are discussed.

Adult↗

PubMed2000

General practitioners on dementia: tasks, practices and obstacles.

The objective of the study was to identify the GPs' perception of their tasks, their practice and obstacles concerning the diagnosis and management of dementia. Twenty-eight GPs participated in focus-group interviews and completed a questionnaire. The GPs perceived their tasks to diagnose, inform and manage dementia patients and their relatives preferably from an early stage on and in such a way that patients are able to stay at home as long as possible. Nevertheless, the GPs diagnose usually in a more progressed stage. As main reasons for this delay the GPs mentioned diagnostic uncertainty during the early stages, embarrassment to conduct a cognitive examination and communicate the diagnosis, non-consulting patients and a lack of time. A discrepancy was found between the GPs' views of their tasks and their clinical practice regarding dementia. Important obstacles were reported that can explain the diagnostic delay and may prevent appropriate education of family caregivers in dealing with demented patients such as embarrassment to examine and communicate this condition.

Attitude of Health Personnel↗

PubMed2001

Anticipatory locomotor control for obstacle avoidance in mid-childhood aged children.

The present work explored the anticipatory locomotor adjustments during obstacle avoidance by eight children aged 7--9 years. Analyses involved kinematic, kinetic and muscle mechanical power patterns at each lower limb joint, as well as electromyographic data from five muscles. The children demonstrated adult-like limb displacements and general dynamic strategies for obstacle clearance. However, when normalized to body mass, amplitudes of certain muscle power bursts related to anticipatory locomotor adjustments were decreased from those reported in the literature for adults, and an absence of the usual antagonistic knee extensor power burst at the end of the stance phase was frequently observed. The data suggest that the expression of anticipatory locomotor adjustments is still maturing during mid-childhood.

Adult↗

PubMed2000

Involving the public in general practice in an urban district: levels and type of activity and perceptions of obstacles.

This paper reports on a study of the level and type of activity used to involve the public in general practice in a city district in the north of England. The association of these activities with features of the general practice organisation and environment were studied. Service providers' perceptions of obstacles were also studied. Data were collected in a survey of all general practice organisations in the district using a postal questionnaire completed by a practice manager. Interviews were conducted with health service managers responsible for primary care development in the district. The study showed that the district had a good track record for innovation in primary care development and in giving emphasis to developing public involvement. However, it also showed that it was difficult to translate policy rhetoric into practical initiatives at the general practice level without evidence of models of best practice, and with limited resources. The survey had a high response of over 84%. It showed that levels of activity were low across the district and only a small minority of general practice teams had undertaken a range of activities to involve the public. The socio-economic environment did not appear to be a factor, but small practices (one or two partners and/or practice population under 3000) were much less likely to develop activities. Pressures of existing workload, lack of resources and public apathy were given as among the main obstacles by survey respondents. The study indicates the challenges faced by Primary Care Groups in developing strands of public involvement. Primary care teams need a clear strategic framework, models of best practice, and adequate resources to manage, change and develop initiatives.

Journal Article↗

PubMed2002

Poor communication and knowledge deficits: obstacles to effective management of children's postoperative pain.

AIM OF THE STUDY: To explore the perceptions of nurses and parents of the management of postoperative pain in children. This paper focuses on issues of knowledge and communication. BACKGROUND: Nurses are the key health care professionals with responsibility for managing children's pain, however, nurses are not well supported educationally to manage the level of responsibility. RESULTS: Using matched interviews between 20 parents and 20 nurses many issues arose relating to the nurse/parent communication process. It was also clear that despite nurses' knowledge of pain management being deficient, they had expectations that required parents to have a level of knowledge they did not possess. CONCLUSIONS: The findings suggest that nurses' poor communication with parents and nurses' knowledge deficits in relation to children's pain management create obstacles to effective pain management. These obstacles need to be addressed in order to improve the management of children's pain through better education of nurses and two way communication with parents.

Attitude of Health Personnel↗

PubMed2002

Problems, obstacles and complications with transpalatal distraction in non-congenital deformities.

INTRODUCTION: The transpalatal distractor is a bone-borne device that eliminates negative orthodontic effects during and after maxillary expansion. It produces virtually parallel expansion in the coronal plane. Orthodontic appliances can be installed at an earlier date than when tooth-borne expanders are used. Our aim was to improve the technique by reviewing the difficulties encountered during applications in the past. PATIENTS AND METHODS: The files of 57 patients were analyzed for problems (difficulties requiring surgical intervention), obstacles (difficulties requiring surgical intervention but not interfering with the result), and complications (difficulties not resolved at the end of the treatment). RESULTS: Twenty-nine difficulties occurred. In 25 cases they were considered to be a 'problem'. Nine problems were surgery related and 16 problems were related to the distraction device itself (14 episodes of loosening of the module, two instances of loss of one osteosynthesis screw). 'Obstacles' occurred in three cases, i.e. loosening of an abutment plate. There was only one 'complication': unilateral infraorbital hyposensibility in a case of a high level corticotomy. CONCLUSION: The expansion goal was achieved in all patients. Loosening of the module proved to be the major cause of discomfort. The incidence of difficulties has lead to a change in the design of the hardware and in the surgical protocol.

Adolescent↗

PubMed2001

Improving obstacle detection by redesign of walking canes for blind persons.

This paper describes an experiment in which the performance of cane walkers with the traditional straight long cane and a redesigned cane, the curved cane, was compared. The curved cane has a curve where the tip touches the ground. Participants were 18 experienced cane walkers who were totally blind. The aspects of cane walking that were investigated included obstacle detection, drop-off (slope) detection and walking speed. The performance with both canes was investigated in two different ways: (1) by means of constructed courses in which objective measures of cane walking were derived; and (2) by means of more qualitative measures based on the participants' experiences with the curved cane during a 3-week try-out period. Results showed that obstacle-detection was significantly better with the curved cane, whereas drop-off detection and walking speed were comparable for the two canes. The participants' experiences mirrored these results.

Adult↗

PubMed2003

Obstacles to carrying out brief intervention for heavy drinkers in primary health care: a focus group study.

The objective of this study was to identify possible obstacles to carrying out competent early identification and brief intervention (EIBI) of heavy drinkers in primary health care. Qualitative focus group discussion method study applying the deductive framework approach. Six focus groups involving 18 general practitioners and 19 nurses were recruited from primary health care of the City of Tampere, Finland. Possible obstacles are: (1) confusion regarding the content of early-phase heavy drinking, (2) lack of self-efficacy among primary health care professionals, (3) sense of lacking time needed for carrying out brief intervention, (4) not having simple guidelines for brief intervention, (5) sense of difficulty in identifying of early-phase heavy drinkers, and (6) uncertainty about the justification for initiating discussion on alcohol issues with patients. The main actions to be taken to promote brief intervention are to educate professionals about the content of early-phase heavy drinking and to produce directing, but not excessively demanding guidelines for carrying out EIBI. Probably successful personal experiences carrying out EIBI can improve professionals' self-efficacy and give to them final justification for discussion alcohol issues with their patients.

Alcoholism↗

PubMed2003

A comparison of functional mobility in standard vs. ultralight wheelchairs as measured by performance on a community obstacle course.

PURPOSE: Appropriate wheelchair prescription requires maximizing user function while justifying cost. The purpose of this study was to investigate differences in a user's performance of mobility skills (on a community obstacle course) between an ultralight (UWC) and standard wheelchair (SWC). SUBJECTS: Sixty healthy adults (mean = 28.3 years) without wheelchair experience performed one course trial. METHODS: Participants were randomly assigned to an UWC or a SWC. Researchers recorded time for completion, Rating of Perceived Exertion (RPE), and number, location, and types of errors committed. Errors included contact of WC and any obstacle, front casters leaving the ground, or loss of directional control (veering). RESULTS: A MANOVA of the data (p < 0.05) showed a significant difference in numbers of contact errors (higher in the SWC) and castor errors (higher in the UWC) between the two wheelchairs. Number of veering errors, time to complete, and RPE were not significantly different. CONCLUSIONS: Differences in wheelchair design can lead to differences in a user's performance of functional mobility skills. Choice of wheelchair may affect a user's ability to be independent in a community setting.

Adult↗

PubMed2004

Examining ethical dilemmas as obstacles to hospice and palliative care for advanced cancer patients.

Oncologists deal almost exclusively with patients with serious and life-threatening diseases, many who are terminally ill. While hospice care remains an ideal model of care for cancer patients with life-ending disease, many obstacles are present in the clinical setting that either impede or prevent the otherwise appropriate referral of patients eligible for this type of end-of-life care. These obstacles are best viewed as ethical dilemmas for oncology clinicians, as they often challenge or obscure a clinician's perceptions about what is in the best interests of their advanced cancer patients. These dilemmas include: Issues surrounding prognosis determination and communication, Concerns about effectively communicating a terminal prognosis while still allowing patients and families to maintain hope, Conflicts of interests for involved clinicians and, Potential problems of the current reimbursement mechanisms for hospice which may be inadequate to meet the needs of all dying cancer patients. For oncologists caring for advanced cancer patients, it is essential that they have a working knowledge regarding these ethical issues, and overt dilemmas, present in end-of-life cancer care in order that they might better appreciate how, and when, to initiate palliative and hospice care for as many of their patients as possible.

Conflict of Interest↗

PubMed2006

A European survey on the possibilities and obstacles of electronic prescriptions in cross-border healthcare.

This study investigated the possibilities and obstacles for cross-border electronic prescriptions within the European internal market. Cross-border electronic prescribing requires interoperability of the systems and use of standardized solutions. We conducted a survey-based case study. A questionnaire on the use of electronic prescriptions was sent by e-mail to the delegates from 14 European Union (EU) member countries and 2 European Economic Area (EEA) countries during spring-summer 2003. A reply was received from 11 delegates in 11 countries contacted. Currently electronic prescriptions are in everyday use in only a few EU member countries, while many others are running or considering pilot projects. We found that electronic prescribing across national borders is impeded by many obstacles, which may relate to other systems or to lack of standardization. Information technology is likely to gradually spread to prescribing in Europe. Before more countries will integrate electronic prescribing into national healthcare, it would be important to ensure interoperability and common standards between national systems. Only then can electronic prescribing offer its full potential, and cross-border electronic prescribing can be realized at the EU level.

Computer Communication Networks↗

PubMed1999

Pathways from symptoms to medical care: a descriptive study of symptom development and obstacles to early diagnosis in brain tumour patients.

BACKGROUND: The time between experiencing symptoms and treatment in cancer diseases is a time of insecurity and despair. Brain tumour disease is a severe disease with dramatic manifestations and it is important that this time be kept as short as possible. METHODS: A consecutive sample of 28 patients with malignant gliomas and their spouses were interviewed about symptom development, help-seeking and experiences of medical care. The cumulative development of their symptoms was described and factors acting as obstacles to medical care were identified. RESULTS: Most spouses witnessed months of global dysfunction preceding the symptom leading to physician consultation. The patient factors 'less alien symptoms', 'personality change' and 'avoidance'; the spouse factors 'spouse's passivity' and 'spouse's successive adaptation'; and the physician factors 'reasonable alternative diagnosis', 'physician's inflexibility' and 'physician's personal values' were identified as obstacles on the pathway to appropriate medical care. The importance of acknowledging the power of the spouse as a provider of substantial information from everyday life facilitating differential diagnosis is stressed.

Adult↗

PubMed2002

Obstacles to effective treatment of depression: a general practice perspective.

BACKGROUND: The Clinical Standards Advisory Group (CSAG) was asked by UK health ministers to advise on the standards of clinical care attainable for people with depression. The GP survey reported here is one part of a multicomponent UK-wide study of services for depression that also included visits to a sample of services and structured patient telephone interviews. OBJECTIVES: The aim of this study was to survey GPs' perceptions of the availability and quality of primary and community-based services for people with depression, and to seek their views on barriers to the provision of good clinical services. METHODS: A structured postal questionnaire was sent to all GPs (3530) in the 11 geographical areas visited during the CSAG study. RESULTS: A total of 1703 (48%) GPs returned the questionnaire. The main obstacles to providing a good service for people with depression included not having enough time, a lack of services to refer to and difficulty in accessing services. More than half of the respondents (58%) were aware of guidelines for the management of depression, and 62% had attended a teaching session on depression within the last 3 years. Factors that influenced GPs to refer people with depression to other services were risk to the patient, a clear need for specialist treatment and the need for assessment. Overall, GPs appeared to be satisfied with the quality of specialist services. CONCLUSIONS: GPs appeared to view obstacles to providing effective treatment of depression as being more allied to external issues, in particular service provision, rather than internal factors such as their own knowledge and skills. The study revealed continuing concerns over excessive workload, and longstanding difficulties with the interface between primary and secondary mental health services.

Community Mental Health Services↗

PubMed2003

GPs working in solo practice: obstacles and motivations for working in a group? A qualitative study.

OBJECTIVE: Our aim was to analyse the obstacles and eventual motivations of solo GPs for working in group practice. METHODS: A qualitative study using 12 focus groups was carried out in primary care in French-speaking Belgium. The subjects comprised four samples of GPs: 20 GP trainers, 18 GP trainees, 25 women GPs and 25 other GPs. The focus groups were taped and transcribed. Two independent researchers carried out the analysis using the QSR NUD.IST software. RESULTS: The participants (88 GPs) did not share a common definition of group practice-in particular multidisciplinary working-the need for a common pool of patients and shared premises. Their main sources of motivation for eventually setting up a group practice were better quality of life, continuity of care and sharing professional knowledge. The main obstacles were a required agreement between colleagues, the loss of a personal patient-GP relationship, budgetary constraints, and divergent views on group practice and GPs' profession (especially true for the association of GPs from different age groups). CONCLUSION: The current study shows that GPs working solo have divergent views of group practice. However, they clearly perceive advantages to this type of association (e.g. better quality of life and continuity of care). This study also confirms the high level of stress and tiredness felt by GPs and especially senior practitioners.

Adult↗

PubMed1995

Neuropsychological predictors of complex obstacle avoidance in healthy older adults.

Global cognitive impairment in older adults has been associated with a greater risk of falling, and tripping has been implicated as an important factor in a large percentage of these falls. In order to evaluate the role of specific cognitive domains in tripping and falling, 23 healthy older adults completed basic and complex obstacle avoidance tasks, as well as a battery of neuropsychological tests. Using multiple regression analysis, a select pattern of neuropsychological measures was found to predict the decrement in performance evident as avoidance task complexity increased. Whereas measures of problem solving, response inhibition, general anxiety, and variability in attention were found to be significant predictors (in that order) of the relative decline in successful obstacle avoidance, measures of visuo-spatial discrimination and memory did not.

Accidental Falls↗

PubMed1992

Research in social work practice: benefits of and obstacles to implementation in the Department of Veterans Affairs.

Although research is an important part of social work practice in health care, there is little systematic information that sheds light on research productivity, the benefits of conducting research, or the obstacles that must be overcome. This article represents the viewpoints of nearly all the directors of social services departments in the largest multihospital system in the United States, the Department of Veterans Affairs. The organizational characteristics of hospitals and the attitudes of the directors about research were important correlates of research productivity. Although lack of time, resources, and interest were cited as common obstacles, more than one-third of the departments were conducting or involved in at least one study. Information about the research efforts of other social services departments was considered an important resource, particularly for departments with no ongoing studies. The implications of these findings for social work research in health care are discussed.

Attitude↗

PubMed2000

Obstacles to collaborative quality improvement: the case of ambulatory general medical care.

OBJECTIVE: To assess the effectiveness of inter-site collaboration and report-card style feedback of quality measures on quality improvement in the outpatient setting and to identify major barriers to improvement. DESIGN: A collaborative quality improvement effort consisting of a large cross-sectional data collection effort (chart reviews and patient surveys), feedback of comparative quality of care data to improvement teams, and collaboration between sites. SETTING: Eleven primary care sites in the Boston area. STUDY PARTICIPANTS: Quality improvement teams at each site with physician leaders. INTERVENTION: Education about techniques of rapid-cycle quality improvement, coaching of on-site teams, and report-card style feedback of comparative site-specific quality of care data. RESULTS: Multiple quality improvement projects were undertaken through this collaboration. However, though we were careful to educate teams on methods of continuous quality improvement and to name specific clinical leaders, the degree of collaboration and quality improvement fell short of expectations. Major impediments to improvement included lack of team members' time and resources, lack of incentives, and unempowered team leadership. The primary obstacle to collaboration was the diversity of sites and inability of teams to create interventions that were relevant to other sites. CONCLUSION: Despite ample quality of care data, quality improvement education, and a structured collaborative process, achieving quality improvement in the ambulatory setting is still a difficult challenge. Organizations need to find ways of overcoming the obstacles faced by improvement teams in order to maximize quality improvement.

Ambulatory Care↗