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PubMed2005

Breast cancer: a manual for a proposed group treatment integrating evidence based resilience factors.

The paper presents the structure and content of a manual for a proposed treatment of breast cancer patients in groups. The proposed treatment is structured, time limited, and integrates elements from 1995 work of Spiegel and the Yalom 1995 theory of group therapy as well as empirically derived resilience factors. Addressing the psychological specificity of breast cancer, the overall treatment goals are to help patients to acquire new coping skills for relieving stress, to increase their personal and social competence and their use of available social support, to increase family coherence, to enhance optimism and quality of life, and to help patients develop new values and priorities that comply with their current and future life situation.

Adaptation, Psychological↗
PubMed2001

Integration of neuropsychological and cognitive theory in rehabilitation.

Clinical neuropsychology has focused on the diagnosis and localization of brain damage. Much of the early progress in the field relied upon an atheoretical-actuarial approach. Recently a link between neuropsychology and cognitive psychology has emerged. From the early focus upon brain-behavior relationships, neurocognitive theories have emerged to explain observed brain functions. Although many researchers have enjoyed the collaboration between neuropsychology and cognitive psychology, others continue to investigate functions without considering the merging of finds. This article reviews integrative elements of cognitive and neuropsychological research and the emergence of cognitive neuropsychology.

Brain↗
PubMed1999

Homocyst(e)ine and heart disease: pathophysiology of extracellular matrix.

Occlusive coronary artery disease is an important factor of cardiovascular morbidity and mortality. The rupture of the thin fibrous cap of the atheroma may be one of the causes of acute coronary syndrome, however, the mechanism of formation of fibrous plaque are poorly understood. Elevation of plasma homocysteine, hyperhomocystinemia, H(e), has emerged as an independent risk factor for hypertension and fibrotic heart disease. The extracellular matrix (ECM) components, particularly fibrillar collagen, are elevated in the atherosclerotic lesions and are the essential integral element in holding the oxidized low density lipoproteins (LDL), homocystine, macrophage and foam cells in milieu, constituting the primary atherosclerotic and secondary restenotic lesions. In vivo and in vitro physiological, morphological, cellular, biochemical and molecular experiments have suggested the role of tissue homocystine in cardiovascular fibrosis and adverse ECM remodeling following H(e). The tissue homocystine induces cardiovascular fibrosis and may lead to heart failure via the redox-receptor pathway. The underlying cause and mechanism of cardiovascular fibrosis associated with arteriosclerosis, atherosclerosis, hypertension and coronary heart disease, involve changes in the levels of tissue redox state.

Animals↗
PubMed1992

Integrating rehabilitation into the care team.

The role of rehabilitative services in the home has been evolutionary. From consultants to home care in the 1960s, therapists have developed into integral elements of the health care team. What issues does this pose?

Community Health Nursing↗
PubMed1988

Economics, dollars and nursing practice.

Primary production and overseas debt seem a far cry from nursing practice but its import on the Australian economy has far reaching effects on how our health and hospital system is funded. This article covers a good deal of territory from a broad consideration of health economics and the relevance of traditional market theory to health, to the fiscal problems of State administration and how these are placing pressures on individual hospitals. The article concludes with some of the strategies open to the nursing profession and concludes that a participative model of joint decision-making is an integral element in meeting a changing environment.

Australia↗
PubMed1999

A decision support system for diabetes care: ethical aspects.

In this paper the design and implementation of a decision support system for diabetes care is examined from an ethical perspective. It is noted that the system creates potential for enhancing the realization of the principle of autonomy through improved information to patients and participation by patients. However, there is also potential for using the system in a way that is contrary to good health care. It may provide patients with information they are unable to interpret and handle, and it may be used by healthcare authorities for controlling their personnel in ways contrary to good quality working conditions. In order for a decision support system to function as a well-integrated element in ethically based health care, different ethical aspects have to be taken into account during the design of the system. The ethical aspects also constitute one perspective of a systematic re-evaluation and re-design process.

Decision Making, Computer-Assisted↗
PubMed2000

Obstructive sleep apnea in children.

Obstructive sleep apnea (OSA) is a frequent albeit underdiagnosed condition in children, which if left untreated may lead to substantial morbidity. Important recent advances in the understanding of the pathophysiological mechanisms underlying OSA in children have been coupled with improved approaches towards the diagnosis and management of OSA. This review provides a detailed and current description of OSA in children, and focuses on the integrative elements necessary for increasing the awareness and diagnostic yield of the community practitioner.

Child↗
PubMed2001

Playing by the rules. How Intel avoids antitrust litigation.

Microsoft and Intel are both obvious targets for antitrust litigation; both wield considerable control in their respective segments of the computer industry. But while Mircrosoft has been mired in court for years now--its name and business practices dragged through the mud, and its very future as a single company thrown into doubt--Intel has avoided a prolonged, high-profile antitrust case. Intel's success is not a matter of luck. The company's antitrust compliance program, refined over many years, has been an integral element in the chip maker's business strategy. In this article, the authors suggest that Intel's approach to compliance provides a valuable model for any enterprise that may come under regulators' scrutiny. They describe how Intel created extremely conservative antitrust compliance standards and then instituted a series of unique training events that had active support from then--CEO Andy Grove and others in senior management. First, live training -- not just instructional pamphlets or videos -- was given to all affected employees. Those classes were followed by customized training programs for different parts of the company. Then, to drive antitrust awareness deeper into the company's memory, Intel carried out random audits of employees' files and conducted mock depositions. "It's fascinating to see," Grove says. "A memo is introduced into evidence and you shrug. You fully understand how that memo could be written. Moreover, you could have written it yourself. And then you see that memo turned into a tool and a weapon against you, in front of your eyes." Intel recognizes that no matter how cautious it is, it will always face extraordinary scrutiny as a market leader. But "since antitrust is embedded in everything we do," Grove says, "we can control our destiny."

Antitrust Laws↗
PubMed2001

Making the best of corporate integrity agreements.

Corporate integrity agreements (CIAs) imposed by the Office of Inspector General (OIG) of HHS have increased dramatically in the past five years. Healthcare organizations that enter into a CIA face burdensome monitoring and reporting requirements. However, it may be possible to lessen these burdens by negotiating modifications to the CIA's requirements. Organizations that have compliance programs in place can negotiate with the OIG to integrate elements of their existing compliance programs into the CIA. The organization also should attempt to negotiate limiting the scope of the monitoring to include only the area that was originally investigated. In addition, it may be valuable to negotiate insertion of a clause in the CIA allowing the organization to request renegotiation of the terms and duration of certain elements of the agreement after the first year, if conditions are met. An organized CIA negotiation process may be valuable in obtaining a reduced scope of the procedures required by the CIA and preparing the organization to meet its obligations.

Annual Reports as Topic↗
PubMed2002

[New master arm for transurethral resection with a robot].

OBJECTIVE: In 1998, we designed a robot for transurethral resection that consisted of a master arm and a slave arm that reproduced the movements of the master. We describe the innovative master arm developed in two university departments that supersedes the mere "joystick" concept to become a true, operative surgical instrument. METHODS: The new master arm was developed from a conventional resectoscope working element integrated into a robotic manipulative device and fitted with angular displacement sensors. Each sensor, part of a computer-controlled feed back system commands the position and movements of the slave arm which, in turn, move the resectoscope. The surgeon freely chooses and manages precisely within a three-dimensional surgical field four basic resectoscope maneuvers; horizontal and vertical displacement, penetration-withdrawal, and rotation; he also controls the movements and operation of the resectoscope cutting loop. Additional computer-programs provide the surgeon with an error-free, fail-safe surgical instrument that denies any movements outside the planned surgical field. RESULTS: The fact that the new easily used instrument is similar in shape and works like conventional resectoscopes greatly helps familiarization and training. Advanced technology reduces the number of errors usually associated with fatigue or inexperience of the surgeon. CONCLUSIONS: The new surgical instrument handles just like conventional instruments so surgeons do not need to change their usual operating procedures. In addition, an early-warning program detects instantly and denies inappropriate maneuvers. This facility confers peace of mind to the surgeon and ensures patient satisfaction.

Equipment Design↗
PubMed2003

Introns in gene evolution.

Introns are integral elements of eukaryotic genomes that perform various important functions and actively participate in gene evolution. We review six distinct roles of spliceosomal introns: (1) sources of non-coding RNA; (2) carriers of transcription regulatory elements; (3) actors in alternative and trans-splicing; (4) enhancers of meiotic crossing over within coding sequences; (5) substrates for exon shuffling; and (6) signals for mRNA export from the nucleus and nonsense-mediated decay. We consider transposable capacities of introns and the current state of the long-lasting debate on the 'early-or-late' origin of introns. Cumulative data on known types of contemporary exon shuffling and the estimation of the size of the underlying exon universe are also discussed. We argue that the processes central to introns-early (exon shuffling) and introns-late (intron insertion) theories are entirely compatible. Each has provided insight: the latter through elucidating the transposon capabilities of introns, and the former through understanding the importance of introns in genomic recombination leading to gene rearrangements and evolution.

Alternative Splicing↗
PubMed2003

Implant prosthodontics: what next?

Treatment concepts that are "ideal" from a medical perspective, representing an excellent simulation of missing tissues (alveolar ridge, teeth), are not automatically tantamount to high treatment cost and difficult clinical procedures. An analysis of different treatment concepts has shown that relatively simple implant-borne solutions are made possible by preserving and integrating elements of the residual dentition; by not including complicated and technically elaborate constructions (such as screw fixation, attachments, splints); and by using prefabricated components (abutments shaped extraorally; conical crowns). In this context, there cannot be a single clear-cut answer to the question, "Implant prosthodontics: What next?"; it can be answered only in terms of probabilities. There is one certainty: implant prosthodontics is here to stay, whatever its path and whatever its destination, and it will become established as an essential--a constituent part of current-day dental practice. As so often happens with medical progress, what once was a very specialized treatment modality is becoming a standard procedure. The concomitant cost reduction will allow us to apply treatment concepts that include implant procedures in a much larger number of cases than today.

Alveolar Ridge Augmentation↗
PubMedDate not supplied

[Intervention programs in hospital nutrition: actions, design, components and implementation].

Metabolic, Nutrient and Feeding Intervention Programs must become the methodological tool for dealing with the health problem posed by disease-associated-malnutrition on one side, and the "Bad Practices" affecting the nutritional status of the patient, on the other one. Programs like these ones should prescribe clear policies and actions in the three domains of contemporary medical practice: assistance, research and education. The fullfillment of these Program's objectives, and the relization of the implicit benefits, will only be possible if a methodological platform that armonically integrates elements of Continuous Education, Cost Analysis, Recording and Documentation, and Quality Control and Assurance, is created. The experience acumulated after the inception and conduction of the Intervention Program at the Clinical-Surgical "Hermanos Ameijeiras" Hospital (Havana City, Cuba) has served to demostrate that it is feasible not only to create a theoretical and practical body to satisfy the aforementioned goals, but, also, to export it to another institutions of the country, in view of the fact that minimal investments for adquiring the resources needed to deploy such Program, as well as for training and capacitation of medic and paramedic personel in the corresponding Recording & Documentation and Feeding & Nutrition Good Practices might result in short-term economical and medical care benefits.

Costs and Cost Analysis↗
PubMedDate not supplied

Clinical strategy in hereditary hemorrhagic telangiectasia.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is a recurrent bleeding tendency caused by vascular malformations and preferentially involving the mucous membrane of the nose. The rhinological management of epistaxis is a challenge in which the frequency of bleeding has to be reduced without damage to the nasal mucosa, despite the fact that therapy necessarily has to be repeated. METHODS: The clinical course in 30 patients with HHT was monitored prospectively. Nasal mucosal efflorescences underwent Nd:YAG laser therapy at individually defined intervals, and the effect on the frequency and duration of bleeding was documented, as were adverse effects. RESULTS: No serious adverse effects (e.g., septal defects or synechiae) were observed as a consequence of therapy. During the course of laser therapy and ongoing compliance with nasal mucosal care instructions, the frequency of bleeding fell from "several times daily" to "every 2 weeks." CONCLUSION: In conjunction with Nd:YAG laser therapy, ongoing and consistent care of the nasal mucosa is a proven and effective treatment regimen in HHT. As an integral element in an interdisciplinary strategy for diagnosis and therapy, this regimen yields satisfactory quality of life while avoiding local complications.

Adolescent↗
PubMed2006

[Urinary citrate excretion in children with calcium urolithiasis].

UNLABELLED: Citrate is thought to be one of the most important inhibitor of calcium salts crystallization in the urine. Therefore, an assessment of urinary citrate excretion is an integral element of metabolic evaluation in urolithiasis. The reported incidence of urolithiasis associated with hypocitraturia varies from 10% to 63%. The purpose of the study was to assess urinary citrate excretion in children with calcium urolithiasis living in region of Lublin. The study comprised 60 children (34 boys and 26 girls) aged 4.3-18 years. In 36 of them, calcium oxalate urolithiasis was diagnosed by spectrophotometry. In the remaining children, an assessment of stone composition was impossible. However, in all children, stones were radiopaque. Hypercalciuria (HC) and mild hyperoxaluria (HOx) were diagnosed in 23 and 16 children, respectively. In the remaining 21 children urolihiasis was classified as idiopathic. The controls were 35 healthy age- and gender-matched children. Urinary citrate excretions were assessed by enzymatic method in 24-hour urine specimens and expressed as citrate/creatinine ratios (Cit/Cr). Decreased Cit/Cr were observed in 9 (15%) children with calcium urolithiasis. However, there was no significant difference between the mean Cit/ Cr in children with calcium urolithiasis and controls (410 +/- 207 mg/g vs 385 +/- 144 mg/g). There was also no significant difference between the mean Cit/ Cr in children with HC and controls. Similarly, the mean Cit/Cr did not differ significantly between children with HOx and controls. However, the lowest mean Cit/Cr was revealed in children with HOx (306 +/- 161 mg/g). CONCLUSIONS: In most children with calcium urolithiasis urinary citrate excretion was normal. However, in some children with urolithiasis, detection of hypocitraturia allows to explain pathogenesis of stone formation and to carry on a causative prophylaxis.

Adolescent↗
PubMedDate not supplied

[The eclectic individual psychotherapy of a dysthymic patient--case study].

The article describes the case of eclectic individual psychotherapy of a dysthymic patient. The therapeutic process integrated elements of the following psychotherapeutic approaches: psychodynamic, behavioural-cognitive, systemic, interpersonal, existential and Gestalt. The paper discusses history of treatment, diagnosis of dysthymia, indications for psychotherapy, course of the sessions. Anamnesis, factors contributing to the disorder, triggers and factors sustaining the symptoms, personality factors were also analysed. Therapeutic goals and applied techniques are presented.

Adult↗
PubMed1991

Risk management in dentistry.

Risk management continues to define itself as an integral element in quality dental care. Issues reviewed range from periodontal record keeping to assessment of temporomandibular joint dysfunction and from cosmetic patients to after-hours emergency care. Two common denominators emerge throughout the articles reviewed. First, thorough and accurate documentation of all phases of patient contact and treatment remains at the heart of risk management. Communication, as a system of relationships between physician, staff, and patients, ensures understanding and agreement toward a common goal. Risk management remains a unifying principle that joins legal responsibilities with sound clinical practice.

Dental Records↗
PubMedDate not supplied

[The effects of occluding dysfunction on marginal parodontopathies].

Occluding dysfunction (occluding dysharmony, occluding trauma) is an important etiologic factor of parodontal disease. It is an integrating element of the destructive process which characterizes the parodontal disease. Occluding dysfunction does not trigger gingivitis, or the development of parodontal pouches, but it does exert an influence on the progress and the importance of parodontal pouches determined by local irritation due to tartar and to bacterial plaques. Occluding dysfunction and the inflammation of parodontal tissues are different processes which occur in the course of the same disease namely of marginal parodonthitis. The inflammation develops in the gums and propagates in the parodontal sustaining tissues. Occluding dysfunction (also known as occluding dysharmony or occluding trauma) occurs in the parodontal sustaining tissues, and both determine tissue destruction. Occluding dysfunction and inflammation become codestructive factors which are interconnected, and are both capable to determine clinical and radiologic changes which are typical for diseased marginal parodontium. Due to the fact that individuals have variable parodontal reactions to local irritation factors, and considering the fact that inflammation and occluding dysfunction occur together but with variable degrees of severity, it is possible that they will not determine in all cases intraosseus pouches with angular lesions, or crater-like lesions. However, when we are confronted with such lesions it is very likely that the combined effects of inflammation and occluding dysfunction are at the origin.

Dental Occlusion, Traumatic↗