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PubMed2000

Perceived obstacles to career success for women in academic surgery.

HYPOTHESIS: We conducted this study to determine whether concerns expressed by male and female surgeons at 1 academic center are generally reflective of broader concerns for academic surgery and academic medicine. We reviewed published studies concerning women in academic surgery within the context of reporting the results of a survey of both male and female surgeons at 1 academic center. DATA SOURCES: We developed a survey that included demographic information, work experience, and social issues. The survey was distributed to the entire faculty. For key questions, we compared answers between male and female faculty. Additional data came from the published literature. STUDY SELECTION: We reviewed all available studies identified by a MEDLINE search with key words women and academic and medicine or physician. Included studies contained either data collection or editorial comment concerning women in academic medicine. DATA EXTRACTION: Data and opinions from all included studies paralleling survey questions were extracted from each article. DATA SYNTHESIS: Male and female faculty members reported different experiences and perceptions, specifically relating to relationships between family and professional life and perceptions of subtle sex-related biases. Both men and women reported insufficient mentoring and difficulties in balancing personal and professional responsibilities. CONCLUSIONS: Attitudes, behaviors, and traditions surrounding how we structure work and evaluate participation in academic surgery are more difficult to change than just addressing obvious inequities in support for female surgeons. However, attempting the deeper changes is worthwhile, because addressing obstacles faced by female faculty, many of which also affect men, will allow progress toward environments that attract and retain the best physicians, regardless of sex.

Academic Medical Centers↗
PubMed1998

Cine film replacement: digital archival requirements and remaining obstacles.

The acceptance of the Digital Imaging and Communication in Medicine (DICOM) standard and the Compact Disk-Recordable (CD-R) as the interchange medium have been critical developments for laboratories that need to move forward on the cine replacement front, while at the same time retain a means to communicate with other centers. One remaining essential component which has not been satisfactorily addressed is the issue of how digital image data should be archived within an institution. Every laboratory must consider the diverse issues which affect the choice of a digital archiving system. These factors include technical and economic issues, along with the clinical routines prevailing in their laboratory. A complete understanding of the issues will lead to the formulation of multiple options which may prove acceptable and will help to overcome the last obstacle which remains for the complete replacement of cine film in the cardiac catheterization laboratory.

Archives↗
PubMed1997

Evaluating the diagnostic interview: obstacles and future directions.

The diagnostic interview plays a prominent role within the field of clinical psychology and occupies a fundamental component in graduate training. Educators seem to be focusing less on objective measures to evaluate student skill performance and the overall quality of the interview. The authors review the current methods for evaluating the diagnostic interview in psychology training and identify some of the major obstacles in accurately assessing student interview proficiency. Recommendations are made to address these difficulties, and the authors note some promising future directions.

Attitude of Health Personnel↗
PubMed1994

Randomized clinical trials in oncology. Principles and obstacles.

Cancer clinical trials have two broad objectives: To identify promising treatments and to determine whether such treatments really do reduce morbidity and mortality. These two objectives generally require different types of clinical trials. The guiding principle of clinical trials is to ask an important question and get a reliable answer. Asking an important question generally means asking a question that has the potential for influencing medical practice, using a control treatment that is widely accepted, using an experimental treatment that is widely applicable, using an endpoint that is a direct measure of patient benefit, and studying a group of patients who are broadly representative. Getting a reliable answer also has many components, including randomized treatment assignment, adequate sample size, intent-to-treat analysis, and testing of prestated hypotheses on mature data. These components are discussed. Several recent developments in clinical trials methodology: interim monitoring boundaries, large simple trials, and metaanalysis, are highlighted here. Major obstacles to conducting randomized clinical trials are also described.

Humans↗
PubMed1985

Euler buckling in a wheelbarrow obstacle course: a catastrophe with complex lag.

This article studies human physical work capacity under increasing load from a general systems theory perspective. There are several points of generalization between the structure of nonliving (building materials) and living systems (humans) with respect to stress, strain, and fatigue. A catastrophe model for Euler buckling was transposed and tested for human performance in a wheelbarrow obstacle course under varying loads. Subjects were 129 employees of a Midwest manufacturing plant. A cusp model was hypothesized and verified (R2 = .68, control R2 = .11) where vertical load was the asymmetry factor, and body balance, height, and sex-related differences all contributed to bifurcation. A catastrophe model in codimension 10 was also invoked to explain memory in the system. Principal control variables were exercise habits, weight, balance, and sex-related differences (R2 = .75). The core model of human load-to-failure was concluded to be similar to that for Euler buckling: additional complexities were discovered which were attributed in part to systemic memory. Discussion points included the use of large dimension catastrophe models for problems involving complex lag effects, and the transposability of the model to the organizational systemic level.

Adipose Tissue↗
PubMed2005

What are the obstacles to generic substitution? An assessment of the behaviour of prescribers, patients and pharmacies during the first year of generic substitution in Sweden.

PURPOSE: The aim of the present study was to investigate obstacles to generic substitution and savings achieved during the first year after Sweden introduced generic substitution in October 2002. METHODS: Normal prescriptions encompassed by generic substitution were included. Data on dispensed prescriptions in the Vastra Gotaland region was obtained from the National Corporation of Swedish Pharmacies. The outcome variables were investigated in three categories of drugs represented by two indicator drugs each. RESULTS: In total, 501,400 dispensed prescriptions of six indicator drugs were analysed. The prescriber opposed substitution in 1-8% of the dispensed prescriptions, varying between the indicator drugs. Patients declined substitution more frequently when the average saving per substitution was low. Substitution occurred most frequently in indicator drugs where the average saving per substitution was high. The total possible saving was 26 million Swedish krona (Swedish krona 1=U.S. $0.13) for the indicator drugs. The actual saving achieved by substitution was on average 60% of the total possible savings and was largely dependent on the extent to which the pharmacies kept the cheapest brand in stock. CONCLUSIONS: Generic substitution has been implemented in practice although it did not reach full dividend during the first year. The potential savings from extended use of generic substitution are substantial.

Choice Behavior↗
PubMed1999

Spontaneous uprighting of permanent tooth germs after elimination of local eruption obstacles.

Four clinical cases are presented to demonstrate the self-correcting potential of aberrant tooth germs after the elimination of eruption obstacles (in 2 cases cysts, in 2 other cases severely infraoccluded primary teeth). In the case of the submerging deciduous teeth, the tilted adjacent teeth were orthodontically uprighted after the surgical procedure. Possible causative mechanisms are discussed.

Bicuspid↗
PubMed1991

Obstacles to and future goals of ten comprehensive community health promotion projects.

Over 100 project staff, community coalition members, and other representatives from 10 comprehensive community health promotion projects in the western United States were surveyed two years into a three year funding cycle about: (1) the problems or obstacles they judged as preventing successful completion of their current goals and objectives, and (2) future goals and objectives they envisioned for their projects. The key issues confronting respondents were diverse, although issues around the process of implementing community health promotion programs were cited more frequently than issues related to the content of health promotion. When respondents were asked to prioritize Future Goals in the second survey, consensus across communities was obtained despite broad differences in the type of community surveyed and the health problem targeted. This study identifies the common organizational and community development problems faced by newly emerging community health promotion programs and has implications for other communities involved in designing, implementing, and evaluating community-wide health promotion programs.

Community Health Services↗
PubMedDate not supplied

Managing chronic nonmalignant pain: overcoming obstacles to the use of opioids.

Physicians involved in cancer pain management treat thousands of patients with opioids, whose effective analgesia improves overall functioning. Side effects generally are tolerable, and treatment can be maintained with stable doses for long periods. Problems with addiction are infrequent. Many physicians, however, assume that opioids should be used only for chronic malignant pain. Research and clinical experience have demonstrated that opioids can safely and effectively relieve most chronic moderate to severe nonmalignant pain. Fears of addiction, disciplinary action, and adverse effects result in ineffective pain management. With current information on the use of opioids in chronic nonmalignant pain, primary care physicians can overcome these obstacles. Guidelines must clearly define the role of the primary care physician in the proper management of pain and the integration of opioid therapy. Used appropriately, opioids may represent the only source of relief for many patients.

Analgesics, Opioid↗
PubMed2004

[Prevention by vaccination of children and young people. Obstacles and examples of effective measures in the Federal State of Brandenburg].

This article identifies successful vaccination strategies, obstacles to such strategies and the role that schools can play in terms of health education by analysing vaccination rates among children in the Federal State of Brandenburg. The analysis is based on the vaccination status of Brandenburg's children at day care centres and schools in relation to the social status of their parents, the extent to which preventive examinations (U up to J1) is taken advantage of and regional location. Furthermore, an evaluation is rendered of the vaccination awareness campaign which has been carried out in sixth grade students since 2002 to assess the impact of health promotion at schools. In the Federal State of Brandenburg vaccination coverage among infants and toddlers is good, with approximately 94% having received complete basic vaccination in 2003. By contrast, there are marked deficits among tenth grade schoolchildren in terms of refresher vaccinations, basic hepatitis B vaccinations and the second measles, mumps and rubella (MMR) vaccinations. Vaccination status is strongly dependent on the social status of parents and the extent to which preventive medical examinations and regional medical health-care provision are utilized. Systematic checking of vaccination documents by the public health services promotes vaccination awareness. Prevention by vaccination is most effective when combined with preventive medical examinations, effective local vaccination management and interdisciplinary interventions: education at schools, systematic tracking of vaccination documents combined with the provision of vaccinations in doctors' surgeries and additionally by the public health services.

Adolescent↗
PubMed2003

Grasp effects of the Ebbinghaus illusion: obstacle avoidance is not the explanation.

The perception-versus-action hypothesis states that visual information is processed in two different streams, one for visual awareness (or perception) and one for motor performance. Previous reports that the Ebbinghaus illusion deceives perception but not grasping seemed to indicate that this dichotomy between perception and action was fundamental enough to be reflected in the overt behavior of non-neurological, healthy humans. Contrary to this view we show that the Ebbinghaus illusion affects grasping to the same extent as perception. We also show that the grasp effects cannot be accounted for by non-perceptual obstacle avoidance mechanisms as has recently been suggested. Instead, even subtle variations of the Ebbinghaus illusion affect grasping in the same way as they affect perception. Our results suggest that the same signals are responsible for the perceptual effects and for the motor effects of the Ebbinghaus illusion. This casts doubt on one line of evidence, which used to strongly favor the perception-versus-action hypothesis.

Adolescent↗
PubMed1999

Coordination of reaching and grasping by capitalizing on obstacle avoidance and other constraints.

Reaching and grasping an object can be viewed as the solution of a multiple-constraint satisfaction problem. The constraints include contact with the object with the appropriate effectors in the correct positions as well as generation of a collision-free trajectory. We have developed a computational model that simulates reaching and grasping based on these notions. The model, rendered as an animation program, reproduces many basic features of the kinematics of human reaching and grasping behavior. The core assumptions of the model are: (1) tasks are defined by flexibly organized constraint hierarchies; (2) manual positioning acts, including prehension acts, are first specified with respect to goal postures and then are specified with respect to movements towards those goal postures; (3) goal postures are found by identifying the stored posture that is most promising for the task, as determined by the constraint hierarchy, and then by generating postures that are more and more dissimilar to the most-promising stored posture until a deadline is reached, at which time the best posture that was found during the search is defined as the goal posture; (4) depending on when the best posture was encountered in the search, the deadline for the search in the next trial is either increased or decreased; (5) specification of a movement to the goal posture begins with straight-line interpolation in joint space between the starting posture and goal posture; (6) if an internal simulation of this default movement suggests that it will result in collision with an obstacle, the movement can be reshaped until an acceptable movement is found or until time runs out; (7) movement reshaping occurs by identifying a via posture that serves as a body position to which the actor moves from the starting posture and then back to the starting posture, while simultaneously making the main movement from the starting posture to the goal posture; (8) the via posture is identified using the same posture-generating algorithm as used to identify the goal posture. These processes are used both for arm positioning and, with some elaboration, for prehension. The model solves a number of problems with an earlier model, although it leaves some other problems unresolved.

Avoidance Learning↗
PubMed1988

Collaborative nursing research--advantages and obstacles.

The experiences outlined in this paper are based upon the collaborative research efforts of nurse researchers in an academic setting and a clinical setting. It is apparent that intra-disciplinary collaborative nursing research is a necessity in a practice discipline such as nursing. While an obvious benefit of collaborative research is to provide a scientific basis for nursing practice other advantages and potential obstacles are presented for consideration. Differences in the missions of clinical practice setting and educational setting were the basis for the challenges in planning and completing this research project. Consideration of all of these factors and the development of methods to work with existing structures seems to have contributed to the successful completion of this project.

Communication↗
PubMed1989

Measurement of the turning, rolling and obstacle resistance of wheelchair castor wheels.

The turning resistance and rolling resistance of a range of wheelchair wheels up to 200 mm in diameter were measured on three types of indoor surface. Rolling resistance values were found by measuring deceleration on a flat surface and also by direct measurement on a treadmill. The horizontal forces required to push the front wheels of a wheelchair over small step obstacles were also found. Measurements were made for a variety of front wheels and the relationship between the horizontal force, step height, load, and type compressibility was investigated.

Biomedical Engineering↗
PubMed1996

Obstacles to community health promotion.

The health transition ushered into the world in this century calls for a reorientation of traditional health services to manage the new causes of morbidity and mortality, renewing interest in disease prevention and health promotion. Community-based health promotion emphasizes prevention and community participation with people's empowerment to overturn current inequities and increase control over their health. Encouraged worldwide by the World Health Organization for the last two decades, some community health promotion programs have been implemented and lessons learned. However, the shift in focus required means nothing less than a paradigm change demanding not only a reorientation of professional training, but also a reorganization of social structures in communities. This article discusses nine of the interrelated obstacles that must be overcome to further develop community health promotion.

Community Health Services↗
PubMed1996

Assessing and overcoming situational obstacles to dietary adherence in adolescents with IDDM.

PURPOSE: To develop and evaluate a tool for assessing selected aspects of dietary adherence in adolescents with diabetes mellitus (IDDM). METHODS: The Situational Obstacles to Dietary Adherence Questionnaire (SODA) is a 30-item inventory that yields a total self-efficacy score and scales that measure cognitive and behavioral coping strategies. Alternative forms of the SODA were administered at the beginning and end of a summer camp for youngsters with IDDM in order to obtain evidence for its reliability and validity, and to evaluate the impact of an educational intervention. The program consisted of two 50-minute small group sessions intended to help adolescents with IDDM improve their ability to cope with challenging dietary situations. Using the method of anchored instruction, the campers first viewed a video about a teenager with diabetes who faces common situations that make diabetes self-management difficult. Group problem-solving sessions led by a registered dietitian were used to help campers learn more effective ways to solve dietary problems. RESULTS AND CONCLUSIONS: Results suggested that the SODA has reasonable reliability and validity. In addition, anchored instruction improved dietary self-efficacy and changed young adolescents' estimates of how often they would use selected cognitive and behavioral strategies to solve dietary problems.

Adolescent↗
PubMed2005

Feasibility of a computerized alcohol screening and personalized written advice in the ED: opportunities and obstacles.

This study evaluates the feasibility of a computerized alcohol screening and intervention in patients seeking care at an emergency department. The aim of the study was to explore prevailing attitudes among nursing staff to alcohol prevention in general and the computerized screening concept before the introduction of the computerized screening procedure. Interviews were performed with six nursing staff members and a written questionnaire applied to all staff participating in training before the implementation of the concept. Observation was done in order to evaluate how the screening was performed and implemented in order to gain more knowledge about possible obstacles to alcohol screening at an emergency department. The project concept of computerized screening and low staff involvement was found to be a feasible way to overcome organizational barriers such as time limitation but there were still important attitudinal barriers among staff; thus a great disparity in practices between different staff members was observed. The results suggest that it is possible, given the time limitation, to include a computerized screening and intervention in the routines of an emergency department, when the staff regard prevention as part of their responsibilities. The findings provide evidence about the acceptability by nursing staff and feasibility of a computerized screening and personalized print out as feed back to the patients.

Alcohol-Related Disorders↗
PubMed2005

Overcoming obstacles to immunization in patients with chronic liver disease.

The importance of vaccination to protect against hepatitis A virus (HAV) and hepatitis B virus (HBV) infections in patients with chronic liver disease has been established. However, in this population, a number of obstacles can interfere with appropriate and timely hepatitis immunization. The costs of hepatitis A and B vaccine series are out of reach for many uninsured patients. Many private and government-sponsored insurance programs do not routinely cover these vaccinations for patients with chronic liver disease. Varying recommendations by government and national organizations, such as the Centers for Disease Control and Prevention (CDC) and the American Association for the Study of Liver Diseases (AASLD), may lead to uncertainty and inconsistent vaccination practices. Because of the need for multiple office visits for prescreening assessment and vaccine administration, patient adherence can be an issue as well. Improved coverage of vaccines by government and third-party health plans is needed, as are uniform guidelines regarding the vaccination of patients with chronic liver disease. Providers should counsel such patients about the serious health risks incurred by infection with HAV or HBV and encourage vaccination in these patients. A combination of interventions can be used to facilitate timely and appropriate vaccination against hepatitis and to improve the affordability of vaccination for patients with chronic liver disease.

Chronic Disease↗