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PubMedDate not supplied

Utilizing grassroots workers in family planning programs in India: prospects and problems.

In order to rapidly expand the network of delivery systems and speed up the process of acceptance of family planning messages and methods, a shift took place in the Indian family planning program from the bureaucratic "clinical" approach to the people oriented "extension" approach. As a result, there is an increasing emphasis on moving the family planning efforts closer to the grassroots level. A key methodological issue centers on the proper selection, cultural acceptability, and the effectiveness of the grassroots workers who are to be trained and through whom family planning motivational messages and methods are to be introduced. The Indian government, from time to time, has trained and utilized different groups of grassroots workers in its family planning promotional efforts. Anthropological field studies were conducted in two different regions in India to examine the potential and actual roles of two groups of grassroots workers--opinion leaders and traditional birth attendants--in the delivery of family planning services in the rural areas. These studies revealed that while the traditional birth attendants can be trained and utilized to a limited extent in promoting family planning efforts, especially to the eligible female clients, the role of the opinion leaders in such efforts is at best questionable. Based on these field studies, cultural and technical (including bureaucratic) problems in training and utilizing opinion leaders and traditional birth attendants are explored in detail. Modifications in the training program strategies are suggested to improve and expand the family planning delivery system in rural India.

Advertising↗
PubMed1992

People's Community Clinic: collaboration in the Third World.

A West African government undertook to improve primary health care (PHC) training of mid-level health workers. In partnership with a neighboring squatter settlement, the premiere local training institution created a community-sponsored clinic, providing low-cost, PHC services, and a birthing center, as well as student experiences. Their collaboration in mobilization, research, planning and operations are described. Their success should encourage other educational and training institutions to consider a similar approach.

Africa, Western↗
PubMed2003

Experience with validation of clinical trial materials: an inspector's viewpoint.

The new EU directive now states quite clearly that GMP applies to Clinical Trials Manufacturers and implicit in this is process validation. Although it is generally accepted that full process validation may not be possible at Clinical Trails, there are many areas which can and should be validated, and certainly when a product is administered to patients. It is also noteworthy that Annex 13 is currently being revised and this has implications with regard to validation, especially of equipment and facilities.

Animals↗
PubMed2004

[Use of new computer technologies in surgical education--virtual surgery].

Education is a process of accepting knowledge and skills or manners modification throught training. One of the most important characteristics in surgery education are classical education program through adequate literature and observation in operation room. Lip and palate clefts are relative rare diseases and classical knowledge acquirement of surgery methods in this field is sometimes defficient. Progress in computer technologies have potential and capacity to improve continuate and self-education training. We used this advancement in additional education in field of lip and palate clefts surgery, thanks to our partnership relations with Smile Train International Organisation. Accent of our cooperation was put in straight of new technology of virtual surgery--The Smile Train Virtual Surgery Videos.

CD-ROM↗
PubMed2004

The Royal College of Psychiatrists and the death penalty.

The Royal College of Psychiatrists recently issued a revised statement on its position concerning capital punishment. The College proposes to support psychiatrists who refuse to be involved in the capital process, but accepts that some may take up limited involvement in the manner set out in the document. The Royal College is the professional body for psychiatric practitioners in the United Kingdom and Ireland. Almost no public statements are issued from the College without first being deliberated on within at least two of its three major committees. The new document on capital punishment remains in the spirit of the previous ones. The topic of capital punishment is noncontroversial within the British medical profession. In all European countries, capital punishment is against the law, because there is an overarching directive from the Council of Europe (a wide group of nations, wider than the European Union) insisting that it be abolished.

Attitude of Health Personnel↗
PubMed1992

Prosthetic management of hemicorporectomy patients: new approaches.

Functional outcome with hemicorporectomy prosthetic management has improved little in the last 20 years. Patient expectations for independence, comfort, and cosmesis have been disappointed with traditional bucket designs. This report describes the prosthetic management of a paraplegic patient who underwent hemicorporectomy at T12 secondary to complications from a lumbar ependymoma. Four successive prostheses were developed using foam and resin combinations, computer-assisted pressure monitoring, and interdisciplinary team feedback regarding design and fabrication. A total-contact bucket with removable liner was created, allowing management of the ileal diversion and colostomy. Prosthetic legs were attached to improve wheelchair balance and cosmesis. In his final prosthesis, the patient's function and appearance was equivalent to a well-rehabilitated midthoracic spinal cord trauma patient. Sitting tolerance exceeded 12 hours a day. Each prototype is discussed, including design, materials, fabrication process, patient acceptance and functional independence, and complications.

Adult↗
PubMed2001

Medico-legal aspects of histopathology practice.

Medico-legal problems experienced by histopathologists differ from those of other clinicians as they are rarely in direct contact with patients. Nevertheless, the pathologist owes a duty of care to the patient and is liable for medical negligence. In the absence of local guidelines, it is prudent to follow guidelines published by learned Colleges elsewhere. This is also true when delegating duties to non-pathologists, technical and other support staff. Errors in diagnosis and documentation pose the most common problems in histopathology. In this, liability also depends on many factors including the provision of adequate clinical information by clinicians and competence of laboratory staff. Clinicopathological discussions, participation in quality assurance programmes and adherence to standard operating procedures are important audit activities to minimize and detect errors as well as prevent grievous outcome to patients. Issues also arise over the retention of specimens and reports. In general, wet, formalin-fixed tissues should be kept until histopathological assessment is finalized and preferably after clinicopathological sessions, and even longer if there is potential litigation. Reports should be archival. Paraffin blocks should be kept for at least the lifetime of the patient, and histology slides for at least 10 years, to facilitate review and reassessment. Despite adverse publicity in the foreign press over the use of human organs and tissues for research and education, it is accepted that processed tissues can be used for research and educational purposes provided the patient's identity is kept confidential. Nevertheless, it would be prudent to revise consent forms for surgery and autopsies to include the possibility that tissues removed can be stored or used for research and education. Good medical practice in pathology encourages a willingness to consult colleagues when in doubt, but advises that the treating clinician be informed if histopathological material is referred away for a second opinion. The Telemedicine Act of Malaysia (1997) requires practitioners outside Malaysia providing diagnosis through telepathology to hold a certificate to practice telemedicine issued by the Malaysian Medical Council. It is likely that the medico-legal scene in histopathology will change in the coming years with the advent of other new ancillary investigative techniques.

Diagnostic Errors↗
PubMed2006

Report of the 1st meeting of the "Vienna Initiative to Save European Academic Research (VISAER)".

The European Directive 2001/20/EC ("Clinical Trials Directive") was aimed at simplifying and harmonising European clinical research. The directive's attempt represents an important step because many European Member States lack national laws that specifically address details of research, but the goal has been only partly achieved. For academic investigators doing national or multi-national research the new European law and the requirements following its implementation are likely to have the opposite effect. Some areas seem to be of particular concern: trial sponsorship, the ethical review process, the participation of patients who are temporarily not able to consent in clinical trials, in particular the informed consent process, an accepted European registry for all clinical trials, insurance and pharmacovigilance. Furthermore there are fundamental problems of the conduct of clinical trials that could have been foreseen at the time of implementation of the new law, which are impeding academic basic clinical research. The bureaucratic burden for academic investigators has tremendously increased without representing any contribution to patients' safety or to the scientific value of research. Furthermore some large European academic trials cannot be conducted anymore due to the new regulations. This result in a reduction in the number of trials and additionally in a reduction in the number of patients enrolled in a study. European research and thus European patients will suffer from the loss of potential benefits of research. The Vienna Initiative to Save European Academic Research (VISEAR) brings together leading stakeholders from academic research groups and interested parties from industry, international organisations and regulatory authorities to focus on the issues of concern regarding the organisational and funding of academic clinical research in order to improve the development and use of medicines in Europe. The first step of the initiative was a meeting held on May 30, 2005 in Vienna. The resumés of the six parallel working groups are presented in this supplement of the Wiener Klinische Wochenschrift, a position paper with recommendations in relation to the EU Clinical Trials Directive and medical research involving incapacitated adults has been published separately.

Austria↗
PubMed1991

Conflict resolution: a strategy for growth.

We have ample opportunities to practice negotiation skills every day. Our goal is to create an environment in critical care where confrontation regarding patient care issues, collaborative practice, shared governance, and standards of professional practice is the norm. Winning and losing are not the important factors. We should instead strive for establishing mutual interests, shared values, and a framework for decision making. Mutual gain is the goal of confrontation and conflict resolution. We must develop our skills to address conflicting interests at the bedside. It is essential that we have a better process to accept our difference and foster our mutual and shared interest, caring for the critically ill patient.

Conflict, Psychological↗
PubMedDate not supplied

Why do Chinese women practice contraception? The case of rural Jilin Province.

This study focuses on the relationship between contraceptive behavior, family size preferences, and perceptions of the one-child policy among young Chinese women in rural areas of Jilin Province. In 1985, about 85 percent of rural married women with one surviving child were practicing contraception, although most of them reported two as their ideal number of children. Most women with one surviving child, including those with one-child certificates, were practicing contraception in response to the government campaign, while more than half of women with two or more children were doing so voluntarily. Most of the women with one child were using the IUD, whereas more than half of women with two or more children were sterilized. Through multivariate analysis of contraceptive behavior and method choice, additional factors were found to be associated with the contraceptive behavior of rural Jilin women; achievement of their ideal family size was a significant factor in the voluntary practice of contraception as well as in contraceptive method choice. Implications of the results are discussed.

Adolescent↗
PubMed1977

[Defluoridation of household water].

Fluorine enriched drinking water (1 ppm F-) is partially defluoridated with the aid of a simple (laboratory) apparatus. The material employed is tricalcium phosphate. The pH-values and electrical conductivity due to fluoridation are significantly changed by defluoridation. The duration of the defluoridation process appears acceptable and the efficiency of the system is adequate. The experimental conditions as well as the results show that an acceptable alternative exists to fluoridated drinking water in the household.

Calcium Phosphates↗
PubMed1990

[Resistance to contraception].

While contraception has been an acquired freedom for more than 10 years, a number of women present clinical manifestations resulting in the restriction or the suppression of this freedom. The symptoms are extremely diversified, from forgetting the pill to severe depression, from repeated infections to personality disorders. If many symptoms may be explained from an organic standpoint, others only derive from an unconscious resistance to contraception. The authors attempt to determine the origins of such resistance, their possible variations and advocate a management protocol for patients presenting this type of disorder.

Adult↗