SEARCH · Search PubMed
Results for “Directive Counseling”
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.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Telehealth intervention for adolescents with type 1 diabetes.
Explore the source record for details and available documents.
Office-based intervention for tobacco dependence.
A successful office approach for any behavior change, including for tobacco, makes the intervention part of the everyday work of the medical practice. This article recommends how to integrate tobacco treatments efficiently into clinical practice. Specific ways to think systematically about smoking cessation and intervene with patients are discussed. Strategies to implement office-based changes to improve tobacco intervention are then presented.
Willingness of pulmonologists to guide COPD patients in smoking cessation.
Effective smoking cessation interventions include steps often protocolised as the 4A method. This study assessed how pulmonologists address the smoking behaviour of chronic obstructive pulmonary disease (COPD) patients and analysed psychosocial differences between pulmonologists who intend to use the 4A method and those who do not intend to use it. A nationwide survey was conducted among Dutch pulmonologists (N = 320), of whom 63% responded. Pulmonologists routinely assessed patients' smoking behaviour and their willingness to quit, but were least experienced in actually assisting patients to quit. Pulmonologists intending to use the method perceived a more supportive social environment in working with it and were more convinced of their ability to use it. Overall, pulmonologists were not convinced that the method would result in more patients quitting, and were pessimistic about their ability to use it. Pulmonologists need to be convinced of the effectiveness of the 4A method and their ability to use it. Skills training and the creation of a social environment supportive toward smoking cessation assistance are recommended.
Communication strategies and interpersonal skills of instructors of esophageal speech: an observation study.
OBJECTIVE: In this article, the way that the Instructor of Esophageal Speech (IES) works is considered from an interactive-analytic perspective. METHODS: The observation project data were gathered during 6 months in 2004 at the training sessions of the Ginreikai-Asian Federation of Laryngectomees' Association using the Six Category Intervention Analysis framework (6CIA) by a trained communication specialist as an active-observer. RESULTS: Mean scores of each of the six categories and a series of percentage distributions were extracted from the usage-frequency data and interpreted together with the results of Chi-square analysis of usage-frequency units. We found the IES used more frequently authoritative categories and used less facilitative categories. Our results of the data analysis show that the 30 IES used more authoritative interventions and used more frequently the prescription and information giving than the confrontation or cathartic interventions. CONCLUSION: The results of the present study show that the 6CIA framework has its potential and value as an analytic tool to explore the IES' actual behavior in a specific therapy related context. PRACTICE IMPLICATIONS: We argue for the utility of the 6CIA as an analytic framework to investigate the interpersonal behavior of the IES in the Japanese cultural setting.
Variations in physicians' advice for managing hypertension in women: a study using NHANES III.
OBJECTIVE: To examine the pattern of physician advice-giving to individuals with hypertension and to determine if advice-giving and adherence to advice vary by race. METHODS: Frequency of physician recommendations and patient adherence to such advice were analyzed using data from the Third National Health and Nutrition Examination Survey conducted from 1988 to 1994. A total of 2066 women were included in the study. RESULTS: The frequency of advice-giving and patient adherence to that advice varied as a function of the type of advice dispensed. Physician advice-giving and patient adherence also varied as a function of race; compared to Black women, White women were 60% less likely [OR (95% CI): 0.41 (0.25, 0.65)] to be told to take prescribed medicines and 56% less likely [OR (95% CI): 0.44 (0.26, 0.76)] to be told to exercise. Regarding patient adherence, compared to Black women, White women were 37% less likely [OR (95% CI): 0.63 (0.44, 0.91)] to use prescribed medicines, 59% less likely [OR (95% CI): 0.41 (0.26, 0.66)] to report reducing use of salt/sodium, and among overweight women, 50% less likely [OR (95% CI): 0.50 (0.31, 0.81)] to report efforts to control/lose weight. CONCLUSIONS: The variability of physician advice and patient adherence as a function of race warrants further study.
Identification of a stop codon mutation in exon 2 of the collagen 2A1 gene in a large stickler syndrome family.
PURPOSE: To describe the clinical features and identify the mutation responsible for an autosomal dominant vitreoretinal degeneration occurring in a previously unreported large family. DESIGN: Cohort study. METHODS: Family members were evaluated clinically over a 30-year period. Genealogical investigation, genetic linkage to known vitreoretinal degenerations, and mutation screening of the COL2A1 gene were performed. RESULTS: We identified a single large family (2,384 total family members) with vitreoretinal degeneration spanning 12 generations. We reviewed the clinical records of 165 family members (95 affected and 70 unaffected). The common clinical findings in affected individuals included early-onset posterior perivascular retinal degeneration, vitreous degeneration, and retinal detachment. The incidence of retinal detachment was 57% (95/165) and the mean age of onset was 15.2 years. Orofacial, skeletal, and auditory abnormalities were seen in 0%, 5%, and 7.5%, respectively, in a subset of 28 affected subjects. Linkage to the collagen COL2A1 locus was demonstrated and a cytosine to adenosine transition identified within exon 2, leading to the creation of a stop codon at position 86 (Cys86Stop). CONCLUSIONS: Identification of the mutation in this family enables diagnosis of individuals at risk for potentially blinding complications in this condition at an early age. Given the variability of the Stickler phenotype, mutation detection allows for more comprehensive genetic counseling and directs clinical monitoring to family members inheriting the disease gene.
Antenatal ultrasonographic appearance of a cloacal anomaly.
BACKGROUND: Cloacal anomalies are rare abnormalities with highly variable forms, which makes them difficult to diagnose antenatally. We present a cloacal anomaly case with interesting antenatal ultrasonographic findings. CASE: A 24-year-old woman, gravida 1, para 0, presented at 23 weeks' gestation with ultrasonographic evidence of fetal ascites. Between 23 and 30 weeks' gestation, serial ultrasounds showed changing features of a cloacal anomaly, consisting of fetal ascites, a cystic pelvic mass, hydronephrosis, and oligohydramnios. CONCLUSION: Serial antenatal ultrasound helped diagnose changing features of a cloacal anomaly in our case, thus allowing directed antenatal counseling and appropriate perinatal treatment.
Drug use during pregnancy: are risk classifications more dangerous than the drugs?
Explore the source record for details and available documents.
Huntington's chorea. The basis for long-term prevention.
A long-term programme to reduce the incidence of Huntington's Chorea has been established in South Wales, based on a study of all individuals known to be affected or at high risk in a defined population of 1.7 million people. Systematic but non-directive genetic counselling is being given to all adults at risk, accompanied by regular follow-up to provide both further information and practical support where required. The number of observed and projected new cases of the disorder born between 1900 and 1970 has remained almost constant, despite a progressive reduction in birth-rate in the general population during this period. Prospective monitoring of all births in the high-risk population will allow an estimate to be made of future trends and will show whether preventive measures are having any significant effect on the future incidence of the disorder in the population.
Quantifying risk and assessing outcome in cardiac surgery.
Quality improvement, research, and reporting of outcome results can be stratified by preoperative risk by using a logistic regression equation or scores to correct for multiple risk factors. The more than 30-fold mortality differences between lowest and highest risk patients make it critical to stratify outcome results by patient severity. Probabilities are not predictions, however, and caution must be exercised when applying scores to individuals. Outcome assessment will grow in its importance to professionals, initially in the guise of quality reporting and improvement, but increasingly as a tool for risk assessment, patient counseling, and directing therapeutic decisions based on more complete information about patient subgroups. Physicians may be called on for recommendations in choosing systems for their hospitals and communities. Therefore, it is important to have an understanding of how such systems are developed, what factors indicate adequate performance of a system, and how such systems of risk stratification should be applied in practice.
New OTC drugs and devices 1998: a selective review.
OBJECTIVE: To create a heightened awareness of the marketing strategy of dual labeling, i.e., labeling of two benefits on a nonprescription drug product, and to review a selection of new self-care products that became available in 1998 for consumer use in the United States. DATA SOURCES: Recent clinical and pharmaceutical industry literature. DATA SYNTHESIS: It is critical for the pharmacist to be aware of the use of dual labeling and to be able to appropriately counsel and direct patients on how to read and understand dual labeling. In addition, numerous nonprescription products, including home diagnostic products and accessories, will continue to become available on the U.S. market. It is important that the pharmacist become as knowledgeable as possible about these, and be well positioned to educate patients about their appropriate use. CONCLUSION: The new products cited in this review represent valuable new additions to the self-care product pool.
Gamete donation - where is the evidence that there are benefits in removing the anonymity of donors? A patient's viewpoint.
The Department of Health has recently initiated a consultation exercise seeking input on the subject of removing gamete donor anonymity. This paper examines the case for disclosure alongside that of providing additional non-identifying information. The author questions the availability of scientifically based research to demonstrate that children's best interests can only be served by the provision of identifying information. The author also questions whether all the possible implications of legislative change have been identified and debated. The paper states that the harmful effects of disclosure on the lives of other interested parties, an inevitable downward trend on donor numbers, and a negative emotional impact in the event of a mismatch in expectations between donors and donor offspring guard against the identification of gamete donors. It is proposed that egg share schemes without anonymity, possibly the only reliable source of donor eggs, would become impractical in the UK. It concludes that given the far-reaching and irreversible impact of disclosure, the removal of anonymity should be considered only when research provides unequivocal proof that improved levels of non-identifying information are insufficient for the well-being of donor offspring.
Pre-conception practices among family physicians and obstetrician-gynaecologists: results from a national survey.
OBJECTIVE: To determine the pre-conception practices among obstetrician-gynaecologists and family physicians in Canada. METHODS: Between October 2001 and May 2002, a survey was mailed to a national random sample of obstetricians and gynaecologists (n = 539) and family physicians (n = 2378) who were current members of the College of Family Physicians of Canada or the Society of Obstetricians and Gynaecologists of Canada. RESULTS: Response rates were 41.7% among obstetrician-gynaecologists and 31.1% among family physicians. More than 85% of physicians frequently discussed birth control and Pap testing with women of childbearing age, but fewer than 60% frequently obtained a detailed history of alcohol use. Fewer than 50% of physicians frequently discussed the following with women of childbearing age: weight management, workplace stress, mental health, addiction history, or the risks of substance use during pregnancy. Fewer than 15% enquired about a history of sexual or emotional abuse. Family physicians were significantly more likely than obstetrician-gynaecologists to discuss mental health (41.1% vs. 28.1%), depression (44.5% vs. 29.0%), and history of alcohol use (59.8% vs. 47.9%) with women of childbearing age (all P < 0.05). Obstetrician-gynaecologists were significantly more likely than family physicians to discuss folic acid (57.8% vs. 47.2%), sexual abuse (18.2% vs. 10.8%), smoking (56.0% vs. 46.1%), and drug use (45.8% vs. 35.9%) (all P < 0.05) with women of childbearing age who were not pregnant. CONCLUSION: There are missed opportunities in pre-conception screening to identify women with suboptimal reproductive health status who are at risk for adverse conception, pregnancy, and birth outcomes. Physician training in identification of women at risk would allow for increased primary and secondary prevention efforts through referral to appropriate treatment and resources.
Eugenics and genetic testing.
Pressures to lower health-care costs remain an important stimulus to eugenic approaches. Prenatal diagnosis followed by abortion of affected fetuses has replaced sterilization as the major eugenic technique. Voluntary acceptance has replaced coercion, but subtle pressures undermine personal autonomy. The failure of the old eugenics to accurately predict who will have affected offspring virtually disappears when prenatal diagnosis is used to predict Mendelian disorders. However, when prenatal diagnosis is used to detect inherited susceptibilities to adult-onset, common, complex disorders, considerable uncertainty is inherent in the prediction. Intolerance and the resurgence of genetic determinism are current pressures for a eugenic approach. The increasing use of carrier screening (to identify those at risk of having affected offspring) and of prenatal diagnosis could itself generate intolerance for those who refuse the procedures. Genetic determinism deflects society from social action that would reduce the burden of disease far more than even the maximum use of eugenics.
A survey of genetic counselors' strategies for addressing ethical and professional challenges in practice.
There is limited research about ethical and professional dilemmas that genetic counselors encounter in their practice and their strategies for addressing them. In this study, 454 genetic counselors rated the frequency with which they encounter each of 16 ethical/professional challenges identified and categorized previously (McCarthy Veach P., Bartels DM, LeRoy BS (2001) J Genet Couns 10(2):97-119). Over 40% indicated these issues occurred frequently: patient emotions, diversity, financial constraints, uncertainty, and colleague error. Two hundred and fifty-five respondents provided personal anecdotes describing exceptionally challenging situations and recommended strategies for addressing them. Most of their anecdotes involved informed consent, value conflicts, confidentiality, colleague error, withholding information, and resource allocation. The most frequently recommended strategies were further discussion with patients, consultation with other professionals, and referral to other health sources. Thirty-five respondents were unable to/did not offer strategies. Respondent demographics were not related to frequency of issues, type of anecdote, or recommended strategies. Practice, policy, and research implications are discussed.
Do Internet-based support interventions change perceptions of social support?: An experimental trial of approaches for supporting diabetes self-management.
Internet-based support groups are a rapidly growing segment of mutual aid programs for individuals with chronic illnesses and other challenges. Previous studies have informed us about the content of online exchanges between support group members, but we know little about the ability of these interventions to change participants' perceptions of support. A randomized trial of 160 adult Type 2 diabetes patients provided novice Internet users with computers and Internet access to 1 of 4 conditions: (a) diabetes information only, (b) a personal self-management coach, (c) a social support intervention, or (d) a personal self-management coach and the support intervention. After 3 months, individuals in the 2 support conditions reported significant increases in support on a diabetes-specific support measure and a general support scale. Participants' age was significantly related to change in social support, but intervention effects were still significant after accounting for this relationship. This report is a critical first step in evaluating the long-term effects of Internet-based support for diabetes self-management. The discussion identifies directions for future research.
A multiple case study of rape victim advocates' self-care routines: the influence of organizational context.
This study assumes that rape victim advocates who provide community outreach services to victimized women must adjust to a heightened awareness of sexual violence to do their jobs. Using qualitative methodology, this multiple case study explored rape victim advocates' strategies for incorporating repeated exposure to sexual assault into their daily lives as well as ways that organizations can support such endeavors. Findings suggest that advocates' self-care routines draw upon various personal resources (i.e., cognitive, physical, social, spiritual, verbal), and serve 2 roles for coping with rape-related pain: (a) cathartic releasing of traumatic material, and (b) improving capacity to integrate the traumatic material into one's life. Additionally, over 20 organizational characteristics that workers perceive to be supportive (e.g., weekly meetings, flexible hours) were identified. Nonparametric and categorical statistical analyses were used to analyze the relationship between organizational support and self-care routines, finding that advocates working in organizations with higher levels of support utilize more strategies that are integrative in nature. Implications of these findings are discussed.