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PubMed2005

[Team work in a family health care program: the team process concept and operational teams].

This work is a theoretical revision of team work in a family Health Care Program. We define team work in the health care field as a relationship network among people, power, knowledge, affection, and wishes, when there is a possibility of identifying group processes. We deal with concepts of Operational Group from the Argentinean School, which might help health professionals to get training in team work. We have visible (spoken) and invisible (unspoken) tasks within teams, which are modified and need to be combined and known. Communication, learning, the feeling of belonging, the atmosphere, the actions' pertinence for the team's purpose and power relations may help the team to get to know and analyze each other and to build a team. External supervision may help the team to turn itself into an operational team, working towards a life care project.

Cooperative Behavior↗
PubMed1996

The roles and functions of hospital-based ethics committees.

Ethics committees ar becoming much more visible on the Canadian health care scene. They range from research-ethics committees that decide whether research projects are ethically sound to case-oriented committees that look at particular issues and give advice. Eike-Henner Kluge says that ethics committees are useful tools, but only when they are appropriately constituted and function in a professional manner. Otherwise, he warns, they become either useless or a liability.

Canada↗
PubMed1989

[Comparison of the clinical value of an iterative reconstruction procedure with that of a filtered back projection in SPECT of the liver].

We have tested an iterative reconstruction procedure against the usual filtered back-projection in 14 patients with SPECT-examinations of various liver diseases. The aim of the examinations was to assess the presence of liver tumors in most cases. Further indications were Budd-Chiari syndromes and a liver malconfiguration in one case. Three of six haemangiomas and both liver metastases were better delineated with the iterative method, in one patient the haemangioma was visible only with this method. An irregular pattern after filtered back-projection led to misinterpretation as multiple metastases in another patient in whom there was no irregularity after iteration. Diagnostic improvement was not reached in the Budd-Chiari syndromes or in an atypical liver configuration, with a more homogeneous pattern after iteration however. The iterative reconstruction procedure was superior to the filtered back-projection method in the detection of small focal liver diseases.

Adult↗
PubMed2001

Children of the Philippines: attitudes toward visible physical impairment.

OBJECTIVE: This pilot study was designed to evaluate children's attitudes and understanding of physical disabilities with special reference to those with craniofacial anomalies in the Philippines. Children with and without craniofacial anomalies were studied. DESIGN: This was a two-group correlational design with additional statistical assessment of subgroup differences. Each group was interviewed and information obtained on a standard disability preference task, attributions for playmate choice, and frequency of contact with disabilities. Parents completed a structured interview. SETTING: Participants were 122 children recruited from Negros, Philippines. PARTICIPANTS: Fifty-four children with craniofacial anomalies (aged 7 to 12 years) were enrolled in the study, and 68 children without any disabilities were recruited from a local school in Bacolod City, Negros, Philippines. MAIN OUTCOME MEASURES: Participants completed a picture-ranking interview of specific physical disabilities and provided their reasons for their play choices and their contact with physical disabilities. RESULTS: The Kendall W correlation was significant for the children with craniofacial anomalies and for those without physical disabilities. Both groups reported lower preferences for disabilities that interfere with play and social interactions. Children depicted with facial anomalies received lower preference, compared with other physical disabilities. Children with craniofacial anomalies who have experienced surgical repair reported more positive rankings for the child depicted with a facial cleft. Sex differences in disability preference were noted. CONCLUSIONS: Children in the Philippines with and without craniofacial differences revealed similarities in preferences to children in several Western (United States) and non-Western countries. Children depicted with facial anomalies received lower preference than other visible physical differences. Children reported both positive and negative explanations for their disability play preferences. Facial differences may result in illogical and negative explanations for social avoidance among children. Similar reactions are noted in other parts of the world.

Attitude to Health↗
PubMed2005

Promoting safe nursing care by bringing visibility to the disciplinary aspects of interdisciplinary care.

The provision of safe and effective interdisciplinary care requires making the unique and interdependent aspects of disciplinary care visible and understandable. Ideally, the electronic health record (EHR) should capture both disciplinary and interdisciplinary care. This paper reports on a "real time" pilot of a technology supported method of documenting, communicating, and tracking the nursing component of the patient's plan of care for eventual integration into EHR. An intensive care unit tested the intervention that included the adoption and use of the NANDA, NOC, and NIC terminologies. Multiple methods were used to evaluate the impact of the care planning method for a 12 month period. We found that the increased visibility of nursing care promoted greater awareness and understanding (collective mind) of care and in turn enhanced continuity. The results of the pilot were used to further refine our theoretical framework and method for the multi-site study currently underway.

Attitude to Computers↗
PubMed1996

[Development of dementia to the year 2050. Model calculations for Germany with special reference to future mortality progress].

On the basis of existing age structures of the demented, a demographic-epidemiological model (DEPOP) is used to project the number of demented to the year 2050 in Germany. In particular a future progress in survivorship of the oldest is assumed in the simulation run in continuation of the already visible path of demographic aging. Taking future mortality reductions into calculation the total number of the demented population will increase at least threefold. Together with the stagnation or decline of the total population, this signifies a considerable increase in the relative importance dementia results.

Aged↗
PubMed1984

The photocurrent, noise and spectral sensitivity of rods of the monkey Macaca fascicularis.

Visual transduction in rods of the cynomolgus monkey, Macaca fascicularis, was studied by recording membrane current from single outer segments projecting from small pieces of retina. Light flashes evoked transient outward-going photocurrents with saturating amplitudes of up to 34 pA. A flash causing twenty to fifty photoisomerizations gave a response of half the saturating amplitude. The response-stimulus relation was of the form 1-e-x where x is flash strength. The response to a dim flash usually had a time to peak of 150-250 ms and resembled the impulse response of a series of six low-pass filters. From the average spectral sensitivity of ten rods the rhodopsin was estimated to have a peak absorption near 491 nm. The spectral sensitivity of the rods was in good agreement with the average human scotopic visibility curve determined by Crawford (1949), when the human curve was corrected for lens absorption and self-screening of rhodopsin. Fluctuations in the photocurrent evoked by dim lights were consistent with a quantal event about 0.7 pA in peak amplitude. A steady light causing about 100 photoisomerizations s-1 reduced the flash sensitivity to half the dark-adapted value. At higher background levels the rod rapidly saturated. These results support the idea that dim background light desensitizes human scotopic vision by a mechanism central to the rod outer segments while scotopic saturation may occur within the outer segments. Recovery of the photocurrent after bright flashes was marked by quantized step-like events. The events had the properties expected if bleached rhodopsin in the disks occasionally caused an abrupt blockage of the dark current over about one-twentieth of the length of the outer segment. It is suggested that superposition of these events after bleaching may contribute to the threshold elevation measured psychophysically. The current in darkness showed random fluctuations which disappeared in bright light. The continuous component of the noise had a variance of about 0.03 pA2 and a power spectrum that fell to half near 3 Hz. A second component, consisting of discrete events resembling single-photon responses, was estimated to occur at a rate of 0.006 s-1. It is suggested that the continuous component of the noise may be removed from scotopic vision by a thresholding operation near the rod output.

Animals↗
PubMed2006

Topical photodynamic therapy for primary cutaneous B-cell lymphoma: a pilot study.

Photodynamic therapy (PDT) is a treatment based on the accumulation of a photosensitizer in the target cells and their selective destruction by irradiation with visible light. In the past 10 years, several patients with cutaneous T cell lymphoma have been successfully treated. The use of PDT in cutaneous B cell lymphoma has not been reported to date. We report the successful PDT treatment of 3 patients with early primary cutaneous B cell lymphoma.

Adult↗
PubMed1994

Specificity and generality of motivational components in depression: a personal projects analysis.

Features of depression, as measured by the Beck Depression Inventory (BDI), were distinguished from anxiety, as assessed by the Beck Anxiety Inventory (BAI), and were explored from a goals perspective using the Personal Projects Analysis methodology (B.R. Little, 1983). Depression and anxiety were found to reflect a "negative" appraisal pattern characterized by goals rated high in stress and difficulty, and low in structure, control, perceived skill, and positive outcome expectancy. Depression also revealed distinctive features not found in anxiety (e.g., goals that are perceived as being less visible to important others). A goal-based approach to research and diagnosis is presented, and implications for future research are discussed.

Adult↗
PubMed2006

Spectral discomfort glare sensitivity under low photopic conditions.

Car headlamp manufacturers have to optimise the headlamp spectrum to produce maximum visibility and minimal glare. There are very few investigations on the best spectrum for mesopic visibility and even less data on the spectrum of discomfort glare. We have performed pilot measurements to determine the spectral discomfort glare sensitivity under situations similar to night-driving conditions and conclude that it is not a simple additivity of the V(lambda) and the V' (lambda) functions.

Adult↗
PubMed1987

Prognosis of patients with retinal embolism.

Eighty-five patients with retinal emboli, visible ophthalmoscopically, were studied retrospectively. All the patients had presented with transient or permanent visual loss. Follow up from the time of presentation was one year to 12 years with a mean of 4.5 years. Life expectancy in the 58 medically treated patients who presented with cholesterol emboli was significantly reduced (p = 0.028). Stroke was the commonest cause of death and was significantly more frequent than in the general population (p less than 0.001); there was also an increased total incidence of cerebrovascular disease (fatal and non-fatal) compared with the Oxfordshire Stroke Project (p less than 0.001). The mortality from ischaemic heart disease was not significantly increased. We report a series of 85 patients with retinal emboli, 69 of whom had cholesterol emboli (70 fundi), 15 calcific emboli and one platelet-fibrin embolus. The natural history of medically treated patients with cholesterol emboli is compared both with an age and sex matched population and with patients with amaurosis fugax but no visible retinal emboli.

Adult↗
PubMed2003

Laparoscopic lymph node dissection for gastric cancer with intraoperative navigation using three-dimensional angio computed tomography images reconstructed as laparoscopic view.

BACKGROUND: Laparoscopic extended lymph node dissection for gastric cancer is difficult to perform because it requires dissection with preservation of vessels. Therefore, an intraoperative navigation system for the angioarchitecture would be helpful. Recent enhanced volume-rendering computed tomography (CT) can produce clear intraluminal three-dimensional (3D) images. This advanced radiological technology can provide 3D angiographic images reconstructed in the same view as would be observed from a laparoscope inserted into the abdominal cavity. We report our experience with laparoscopic gastrectomy with radical lymph node dissection using this advanced radiological technology. METHODS: 3D CT angiographic images from the celiac axis to the proper hepatic artery were reconstructed in two ways preoperatively. The first was only 3D angiographic images that were reconstructed as the laparoscopic view (LapView 3D CT angiography). The second was LapView 3D CT angiography with images of the body of the pancreas, which was more useful for intraoperative navigation in comprehensing anatomy. Two monitors were placed over the shoulder of the patient during surgery. One monitor, which was controlled by the image mixer, projected the laparoscopic images with picture in picture of 3D CT angiographic images. The surgeon performed the surgery with reference to this monitor during lymph node dissection. RESULTS: 3D angiographic CT clearly showed all vessels of interest in laparoscopic lymph node dissection for gastric cancer in 10 cases. The anatomy of vessels appeared as if looking beyond visible surface. LapView 3D CT angiography was useful for laparoscopic navigation surgery.

Adult↗
PubMed2002

Prime-sight in a blindsight subject.

A subject (D.B.) who had no experience of visual stimuli in a field defect caused by visual cortex damage but could discriminate them ('blindsight') nevertheless reported visible after-images of the stimuli when they were turned off ('prime-sight'). This was investigated using projected visual stimuli of varying colors, contrasts, shapes and spatial frequencies, and by measuring the properties of the after-images, including their duration, size scaling, color and interocular transfer, comparing the capacity of the blindsight and prime-sight modes. These phenomena offer a unique opportunity to compare conscious and unconscious neural events in response to the same visual events.

Adult↗
PubMed2003

Immigrant closets: tactical-micro-practices-in-the-hyphen.

The theoretical and material moves within this essay suggest that culturally hybrid agents use the "closet" as a space to negotiate the intersections of sexuality and ethnicity in everyday life. Discussing some conclusions of my ethnographic research project with the Russian Gay and Lesbian Group of West Hollywood, this essay applies Michel de Certeau's notion of tactics to the daily micro-practices of queer identified immigrants as they move between the demands of overlapping and contradictory cultures. Examining the circumstances in the Russian-American-immigrant-imagined community shared by the informants in this site, I argue that, contrary to a popularized valorization of queer "outness," there is a great deal of power in the oscillation between visibility and invisibility.

Emigration and Immigration↗
PubMed1983

A trial of Biolite ventilation tubes in children: is further use warranted?

A prospective controlled pilot study was undertaken in which Biolite (carbon-coated) ventilation tubes were placed in 44 ears and a conventional silicone tube in the contralateral ear. Long-term follow-up of these patients has revealed little difference in the incidence of tube occlusion or early extrusion. In addition, there were several disadvantages noted with the Biolite tubes: incomplete coating of the tube (especially within the lumen), shedding of the Biolite coating over time, "tattooing" of the tympanic membrane, poor otoscopic visibility, and the higher cost of these tubes. Since the Biolite tube has no documented advantages and, actually, several disadvantages, we believe its use in the treatment of middle ear disorders should be discontinued until significant benefits are demonstrated and present deficiencies are corrected.

Adolescent↗
PubMed1997

Primary clinical response and long-term follow-up of solar keratoses treated with topically applied 5-aminolevulinic acid and irradiation by different wave bands of light.

Photodynamic therapy with 5-aminolevulinic acid (ALA-PDT) is based on photosensitization by endogenous synthesis of protoporphyrin IX and its transient accumulation especially in malignant epithelially derived tissues. Recent studies have indicated that ALA-PDT is effective for the treatment of solar keratoses (SK), but there has been a lack of long-term clinical follow-up. The goal of the present study was to investigate the immediate and long-term effect of ALA-PDT on SK. Twenty-eight patients with a total of 251 SK were enrolled in the study. Standard treatment involved the topical application of 20% ALA, under occlusive and light-shielding dressing for 4 hours before exposure to UVA and/or different wave bands or wave band combinations of polychromatic visible light (full-spectrum visible light, and/or different wave bands of filtered visible light > 515, > 530, > 570, or > 610 nm) in one or two treatment sessions. The primary complete response rate of SK to ALA-PDT was 64% after one treatment, but 85% when the responses to a second treatment were included. Taken all treatments together, the complete response rate for lesions on face, scalp and neck was 93% for full-spectrum visible light, 96% for the combination of full-spectrum visible light and filtered light, 91% for different wave bands of filtered visible light, and 100% for the combination of long wave UVA and full-spectrum visible light, respectively. The complete response rate for lesions on forearms and hands was 51% for full-spectrum visible light and 33% for the combination of full-spectrum visible light and filtered light. The greater response rate for SK on the face, scalp, and neck was associated with a higher surface fluorescence and immediate response rate after ALA photosensitization at these sites (chi 2; p = 0.0001). However, due to the treatment protocol the mean light dose applied to lesions on the face, scalp and neck (50 J cm-2) was substantially higher than that for lesions on forearms and hands (35 J cm-2). In the long term follow-up of SK on face scalp and neck, the projected disease-free rate at 36 months after therapy was 71% for lesions treated with full-spectrum visible light versus 23% for lesions treated with different wave bands of filtered light (Log rank-Mantel Cox; p = 0.0001). These results indicate that treatment with full-spectrum visible light at higher light doses may be the most effective and promising form of light exposure in ALA-PDT of SK.

Administration, Topical↗
PubMed1980

Perception of relative velocity: a revision of the hypothesis of relational determination.

The conventional formulation of the hypothesis of relational determination asserts that the perceived relative velocities of two or more objects depend upon their relative rates of displacement with respect to stationary referents in the visual field. Experiment 1 showed that this formulation is too restrictive by demonstrating the transposition-of-velocity effect under conditions in which two light spots moved in the absence of static visible contours and traversed unequal path lengths. Experiment 2 showed that angular velocity per unit of relative angular extent, and not relative linear or perceived extent, of the respective motion paths influences perceived relative velocity in nonarticulated space. The retinal dimensions of static visible frameworks were shown in experiment 3 to influence perceived relative velocity in a direction consistent with the conventional formulation of the relational-determination hypothesis, but the weight of the evidence suggested a reformulation along the following lines: the perceived relative velocities of two objects are significantly affected by the proportions of the retinal projections of the respective movement fields traversed by the two objects in the same unit of time, even when the motion fields consist only of the objects' motion paths.

Discrimination Learning↗
PubMed2000

Improving the monitoring of immunization services in Kyrgyzstan.

Following the disbanding of the Soviet Union in 1991, the government of Kyrgyzstan was unable to maintain the previous level of health services. To revitalize the health services, the Ministry of Health (MOH) first focused on improving their immunization services, including the immunization component of the Health Management Information System (HMIS). Secondly, to increase immunization coverage, the MOH set as a priority the elimination of prescribing false contraindications to immunization. To accomplish both goals, the MOH updated the national immunization policies and established a more effective structure for managing immunization services. To support the MOH, the US Agency for International Development (USAID) Resources for Child Health (REACH) and Basic Support for Institutionalizing Child Survival (BASICS) projects provided technical assistance through a resident coordinator and consultants, and by organizing an international seminar. The improvements extended beyond systems and forms, but, instead, emphasized monitoring by the frontline health worker and supervising the quality of health information. To accomplish their objectives, the MOH appointed a Working Group to define the problems, revise record-keeping procedures, and develop monitoring tools. This group, representing both national and local levels, was composed of MOH epidemiologists, paediatricians and a management information specialist. To reduce the burden of excessive record-keeping and reporting requirements, the Working Group identified four key indicators for the service delivery level: (1) DPT3 immunization coverage rates for children less than 1 year of age; (2) contraindication rates for DPT; (3) usage of DPT vaccine; and (4) daily refrigerator temperatures. Additional indicators were included at district and provincial levels. After a successful 1-year trial, the MOH implemented the revised HMIS nationally. Not only did the quality of the information system improve, but the new approach provided visible evidence, from facility to national levels, that the MOH was approaching their objective of reducing contraindication rates for DPT immunizations to 5% or less, and that vaccine wastage could be substantially reduced. The project demonstrated that giving health workers the basic epidemiologic skills to monitor their own work measurably improved the quality of the data, and by acquiring the new skills, the workers developed a sense of pride in their work.

Child↗