Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Expression of Concern”

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.

At least 415 records · Page 23Linked to original sources
PubMedDate not supplied

Patients attitude towards asthma in Ile-Ife.

BACKGROUND: There seems to be a paucity of data concerning the attitude of asthmatics towards asthma, its treatment and its effects on their lives in most developing countries. Inadequate attention paid to the psychological and social aspects of asthma could be a significant factor responsible for increase in morbidity and mortality from asthma despite major advances in our understanding of the pathophysiology of the disease. This study aimed at investigating the attitude of asthmatics to the disease (using an asthma dislike questionnaire) to form the basis of a more comprehensive health education programme for asthmatics. METHODS: An asthma-dislike questionnaire was administered to asthmatic patients who were invited for an Asthma Education Programme. This was done prior to the commencement of the lectures. Information elicited was on dislike of physical condition, emotional dysfunction, dislike of psychosocial effects, public-life interference and dislike of medication. RESULTS: Two-third of the asthmatics complained of interference with physical activities. Over 25% indicated being more intolerant towards others. 50% of the patients expressed the fear of dying from sudden asthmatic attack. Two-thirds of the patients expressed concern over the increasing cost of medication and adverse effects of asthma on their public lives. CONCLUSION: This study confirmed that asthma is not just a physical condition, but also has psychosocial components, which varies from person to person. The use of a biopsychosocial approach to augment asthma therapy is advocated.

Adolescent↗
PubMed2001

A relatively minor adult case becomes significantly complex: A lesson in humility.

A 41-year-old white woman with no particular concerns about facial esthetics was first seen with bilateral Class II molar relationship, a Class I right canine, and a Class II left canine. Overjet was 3 mm and overbite was 0.5 mm, with no incisor contact. A maxillary right premolar was missing for unknown reasons and all 4 third molars had previously been extracted. The maxillary midline was 2 mm to the right of the facial midline, and the mandibular midline was 3.5 mm to the left of the maxillary midline. There was 7 mm of crowding in the maxillary arch and 6 mm of crowding in the mandibular arch, with an increased curve of Spee. The patient had a well-positioned maxilla, a retrognathic mandible with increased convexity, a Class II denture base relationship, and a vertical facial pattern. The treatment plan consisted of extracting the maxillary left first premolar and the mandibular left central incisor. After 4 months of treatment, an open bite from second premolar to second premolar was noted. After 6 months of treatment, the patient expressed concern with her chin position and mentalis hyperactivity. It was apparent that the orthodontic treatment had resulted in molar extrusion, which the musculature was not able to withstand. Treatment continued and the case was set up for posterior maxillary impaction and mandibular advancement surgical procedures.

Adult↗
PubMed2004

Clinical use of immunoassays in assessing exposure to fungi and potential health effects related to fungal exposure.

OBJECTIVE: To review and summarize current evidence regarding the proper role of immunoassays in clinical assessments of exposure to fungi and health effects related to fungal exposure. DATA SOURCES: We reviewed relevant scientific investigations and previously published reviews concerning this topic. STUDY SELECTION: The authors' clinical, laboratory, and public health experiences were used to evaluate relevant data for scientific merit. RESULTS: Testing to determine the presence of IgE to specific fungi may be a useful component of a complete clinical evaluation in the diagnosis of illnesses that can be caused by immediate hypersensitivity such as allergic rhinitis and asthma. Detection of IgG to specific fungi has been used as a marker of exposure to agents that may cause illnesses such as hypersensitivity pneumonitis. However, the ubiquitous nature of many fungi and the lack of specificity of fungal antigens limit the usefulness of these types of tests in the evaluation of potential building-related illness and fungal exposure. Specific serologic tests (such as tests for cryptococcal antigen, coccidioidal antibody, and Histoplasma antigen) have been shown to be useful in the diagnosis of some fungal infections, but these are the exception not the rule. CONCLUSIONS: There is currently not enough scientific evidence to support the routine clinical use of immunoassays as a primary means of assessing environmental fungal exposure or health effects related to fungal exposure. Health care providers who care for persons expressing concerns about the relationship of symptoms to potential exposure to fungi are advised to use immunoassay results with care and only as an adjunct to a comprehensive approach to patient care.

Animals↗
PubMed2005

Weight and its relationship to adolescent perceptions of their providers (WRAP): a qualitative and quantitative assessment of teen weight-related preferences and concerns.

PURPOSE: To examine the relationship of body weight to satisfaction with care in adolescents, and to obtain qualitative data on preferences for general and weight-related medical care in normal weight and overweight adolescents. METHODS: The Weight and its Relationship to Adolescent Perceptions of their Providers survey, a 4-page questionnaire containing previously validated satisfaction scales and open-ended qualitative questions regarding health care preferences, was administered to 62 severely overweight (body mass index [BMI] 38.9 +/- 8.4 kg/m2) and 29 normal weight (BMI 22.5 +/- 4.0 kg/m2) adolescents (age 13.9 +/- 1.7 years; 57% female; 50% Caucasian, 47% African-American, 3% Hispanic). RESULTS: The affective subscale of the medical satisfaction scale was negatively correlated with BMI standard deviation score (r = -.22, p < .05). Multiple regression models predicting affective satisfaction with medical care included BMI standard deviation score; however, continuity with provider appeared to be the strongest independent predictor of affective satisfaction. Fifty-five percent of participants identified their mother as the person they felt most comfortable talking with about weight, although 68% believed their provider knew the most about healthy eating. "Overweight" was identified by 47% of participants as the preferred term for heavy teens. Seventy-nine percent of overweight adolescents stated their health care provider discussed their weight with them; however, only 41% of overweight adolescents desired to discuss their weight. Compared to normal-weight adolescents, overweight teens were more likely to report that their provider raised topics of weight (p < .001), diet (p < .01), and exercise (p < .01) at their last physical, and were more likely to report that they would have liked their provider to discuss diet and exercise (both p < .05). Ten percent of overweight teens expressed concerns regarding the public location of their provider's office scale. CONCLUSIONS: Satisfaction with affective aspects of the provider-patient relationship is negatively correlated with BMI standard deviation score. Length of experience with one's provider is also a strong predictor of teen satisfaction with their medical care. Teens prefer the term "overweight" for those with high body weight. Sensitivity to confidentiality, privacy, and embarrassment regarding physical examination and weight are important for teen satisfaction.

Adolescent↗
PubMedDate not supplied

State regulation of managed care: the impact on children.

As more and more children enroll in managed care, states have responded to concerns expressed by their constituents by passing legislation and developing credentialing requirements to assist families with children in receiving appropriate care from managed care plans. Although most of the legislation and credentialing requirements apply to the population generally, a few provisions apply specifically to children. The legislation and credentialing requirements attempt to improve both access to medical care and the quality of care by enacting access-to-care and quality-of-care provisions, reducing the financial incentives for providers to offer inappropriate care, and providing families with more information about their choices and opportunities to redress their grievances. Although there is no empirical evidence, analysis of similar types of legislation suggests that certain approaches will be more successful than others; one obvious indicator of success is the ability of the regulatory agency to develop clear, unambiguous, enforceable rules. Existing legislation varies widely across states in terms of the issues addressed and the specificity of the laws. For the most part, this legislation has been piecemeal, addressing specific issues as they arise. In the long run, state legislatures may not have the time or the expertise to regulate the managed care industry, and other regulatory bodies may be better equipped to address concerns about managed care. If utilized, however, existing regulatory bodies, which historically monitored fee-for-service medicine, will need to be redesigned to monitor managed care.

Child↗
PubMed2003

The value of the aesthetic component of the Index of Orthodontic Treatment Need in the assessment of subjective orthodontic treatment need.

Previous studies carried out using the Index of Orthodontic Treatment Need (IOTN) have reported that the Aesthetic Component (AC) has limited use in schoolchildren. The purpose of this study was to estimate whether dental concern expressed by the grade of the AC chosen by subjects is reliable and whether it may be predictive for potential co-operation. Such a correlation would indicate if the AC of the IOTN may help to identify individuals interested in orthodontic treatment who would co-operate well, and consequently who might derive the greatest benefits. The investigation was carried out in north-west Poland among 84 schoolchildren (42 girls and 42 boys) aged 12 years and was based on a questionnaire and clinical examination. The questionnaire contained items relating to the subjective assessment of dental appearance, demand for orthodontic treatment, the influence of the dentition on the general appearance, and any functional disorders (speech, mastication, muscular pain, etc.). Clinical examination was carried out at the schools each time by the same dentist. For statistical analysis chi-square (Yates corrected) and McNemar tests were used. A probability at the 5 per cent level or less (P < 0.05) was considered statistically significant. The outcome shows that the AC of the IOTN moderately reflects the subjective perception of dental aesthetics and demand for orthodontic treatment. The results indicate that using professional rating the AC scale does not seem to be more precise or reliable than self-evaluation. The correlation between dental concern and the AC would be higher if the 'no treatment need' category was split into two parts (e.g. 1-2 'no need', 3-4 'slight need') or the 'borderline need' category was moved two grades lower. The AC would then help to identify patients interested in treatment who would potentially be co-operative.

Attitude to Health↗
PubMed2005

Questioning care at the end of life.

BACKGROUND: The goal of the larger study was to explore physicians' emotional responses to the death of their patients; this study analyzed a subset of physician transcripts to elucidate the construct of questioning care, which emerged from the larger study. OBJECTIVE: To analyzes how physicians question care-expressing concern, unease, or uncertainty about treatment decisions and practices, errors, or adverse events-as they attend dying patients. DESIGN: Retrospective interview study of physicians caring for randomly selected deaths on the medical service of a major academic teaching hospital, using qualitative and quantitative measures. SETTING, SUBJECTS: 188 attendings, residents, and interns on the internal medical services of two academic medical centers were part of the larger study. A subsample of 75 physician narratives was selected for qualitative data analysis for this study. MEASUREMENTS: Qualitative measures included open-ended questions eliciting physicians' stories of the most recent and a most emotionally powerful patient death they have experienced. Grounded theory was used to analyze physician narratives. Quantitative instruments measured physician attitudes toward end-of-life care and responses to the most recent and most emotional patient death. RESULTS: Physicians question care more frequently in most emotional deaths (42%) than in most recent deaths (34%). Physicians question communication with patients and families and within medical teams, medical judgment and technique, standards of practice, and high-risk treatments, often assigning responsibility for medical management they perceive as inappropriate, futile, overly aggressive, or mistakes in judgment and technique. Responsibility ranges from the distal (the culture of medicine) to the proximal (personal). Frustration, guilt, and anger are more frequently expressed in these narratives when care is questioned. CONCLUSIONS: A typology of questioning care emerged from these physicians' narratives that parallels and reflects recent and classic research on medical error and the culture of medicine. Physicians' questions about care can contribute to designing training experiences for residents and to improving the quality of systems that affect patients' experiences at life's end and physicians' experiences in caring for dying patients.

Aged↗
PubMed1990

Recognition of unfamiliar faces in prosopagnosia.

Prosopagnosia is clinically defined as a specific and extreme inability to recognize familiar faces. However, doubts have been expressed concerning prosopagnosics' preserved ability to recognize unfamiliar faces and to make other within category discriminations. The present study pursues these doubts. If recognition of unfamiliar faces and objects is intact, then prosopagnosics should demonstrate normal processing for all tasks that depend on the possession of intact stored visual descriptions at the category level. In particular, they should show normal face and object superiority effects. A detailed investigation was carried out on a well documented prosopagnosic (KD) and less extensively on three other (RB, AH and OA) well attested cases. Experiments 1 and 2 considered whether face and object superiority effects were observed in these patients. No difference in the pattern of recognition performance was found between normal and unusual arrangements of faces and objects. Their pattern of performance differed both from unilateral brain-damaged patients and normal controls. The results suggest both that these prosopagnosic patients were impaired on the recognition of unfamiliar faces and that their problem is not specific to faces. Experiment 3 showed that KD was impaired on a face/non-face decision task but appeared to benefit by the stimulus being presented in the normal orientation. For normal controls, mental rotation of a face appeared to be a separate process from face categorization. Experiment 4 found that KD, AH and OA were impaired, compared to normal controls, in their ability to recognize emotional expressions but not more than brain-damaged controls. The impairment of the prosopagnosics tested in the present study is placed at the interaction between stored object descriptions and the structural encoding stage of Bruce and Young. Consideration is given to an elaboration of the structural encoding stage in which boundary (category defining) information is separately processed from surface (detailed texture) information.

Agnosia↗
PubMed2026

A Preventive Social Media Intervention for Perinatal Depression and Anxiety in Regional, Rural, and Remote Communities: Participatory Co-Design Study.

BACKGROUND: Perinatal depression and anxiety are significant public health concerns, affecting up to 1 in 5 women globally, with disproportionate burden carried by women in regional, rural, and remote communities where structural and social inequities amplify vulnerability. Access to perinatal mental health support in these settings is severely constrained by geographical isolation, workforce shortages, financial barriers, and a lack of culturally safe services. Prevention is recognized as critical to reducing this burden, with evidence suggesting that effective preventive approaches can reduce population-level illness by up to 40% and alleviate downstream demand on overstretched services. Digital mental health interventions hold promise for improving access to support, yet few are co-designed with underserved perinatal populations. OBJECTIVE: This study aimed to identify the mental health needs of perinatal women in regional, rural, and remote communities and to co-design a framework for a preventive social media-based intervention informed by platform-specific affordances and constraints, using Northern Queensland, Australia, as an exemplar. METHODS: Using a participatory co-design approach, 26 perinatal women (21 postnatal and 5 antenatal) and 8 mental health care professionals from regional, rural, and remote Northern Queensland participated in focus groups or interviews, supplemented by ongoing consultation with a community advisory group comprising lived experience representatives, clinicians, and local community leaders. Qualitative data were analyzed using reflexive thematic analysis to identify core community mental health needs. Identified needs were then examined through a needs-affordances framework to determine how specific platform features could address, enable, or constrain those needs in the context of a preventive intervention. RESULTS: Five core mental health needs were identified: (1) social connection and support; (2) personalized and respectful health care; (3) information that empowers; (4) place-based and culturally safe support; and (5) accessible, low-burden digital formats. Participants viewed social media as a potentially useful platform for fostering peer connection, normalizing perinatal experiences, and providing timely psychoeducation. However, both mothers and professionals expressed concerns about misinformation, harmful social comparison, and privacy risks that must be proactively addressed in program design. These insights were synthesized into a set of prototype design guidelines specifying recommended content, features, tone, and delivery formats to inform subsequent intervention development. CONCLUSIONS: This study provides a place-based, co-designed needs-affordances framework to guide the development of a preventive social media-based intervention for perinatal mental health support in regional, rural, and remote communities. The findings demonstrate that social media is an acceptable and promising platform for preventive perinatal mental health support in these settings, provided that design is driven by community need, platform affordances are systematically analyzed, and known risks are explicitly mitigated. These findings address a significant gap in the literature and offer a replicable methodological approach for co-designing contextually relevant digital mental health interventions with underserved populations.

Humans↗
PubMed2003

A transformation method for obtaining marker-free plants of a cross-pollinating and vegetatively propagated crop.

It is generally thought that transformation of plant cells using Agrobacterium tumefaciens occurs at a very low frequency. Therefore, selection marker genes are used to identify the rare plants that have taken up foreign DNA. Genes encoding antibiotic and herbicide resistance are widely used for this purpose in plant transformation. Over the past several years, consumer and environmental groups have expressed concern about the use of antibiotic- and herbicide-resistance genes from an ecological and food safety perspective. Although no scientific basis has been determined for these concerns, generating marker-free plants would certainly contribute to the public acceptance of transgenic crops. Several methods have been reported to create marker gene-free transformed plants, for example co-transformation, transposable elements, site-specific recombination, or intrachromosomal recombination. Not only are most of these systems time-consuming and inefficient, but they are also employed on the assumption that isolation of transformants without a selective marker gene is not feasible. Here we present a method that permits the identification of transgenic plants without the use of selectable markers. This strategy relies on the transformation of tissue explants or cells with a virulent A. tumefaciens strain and selection of transformed cells or shoots after PCR analysis. Incubation of potato explants with A. tumefaciens strain AGL0 resulted in transformed shoots at an efficiency of 1-5% of the harvested shoots, depending on the potato genotype used. Because this system does not require genetic segregation or site-specific DNA-deletion systems to remove marker genes, it may provide a reliable and efficient tool for generating transgenic plants for commercial use, especially in vegetatively propagated species like potato and cassava.

Agriculture↗
PubMed2006

Association between health care providers' influence on parents who have concerns about vaccine safety and vaccination coverage.

OBJECTIVES: Parents who have concerns about vaccine safety may be reluctant to have their children vaccinated. The purpose of this study was to explore how vaccination coverage among children 19 to 35 months of age is associated with health care providers' influence on parents' decision to vaccinate their children, and with parents' beliefs about vaccine safety. METHODS: Parents of 7695 children 19 to 35 months of age sampled by the National Immunization Survey were administered the National Immunization Survey Parental Knowledge Module between the third quarter of 2001 and the fourth quarter of 2002. Health care providers were defined as a physician, nurse, or any other type of health care professional. Parents provided responses that summarized the degree to which they believed vaccines were safe, and the influence providers had on their decisions to vaccinate their children. Children were determined to be up-to-date if their vaccination providers reported administering > or = 4 doses of diphtheria and tetanus toxoids and acellular pertussis vaccine, > or = 3 doses of polio vaccine, > or = 1 dose of measles-mumps-rubella vaccine, > or = 3 doses of Haemophilus influenzae type b vaccine, and > or = 3 doses of hepatitis B vaccine. RESULTS: Of all of the parents, 5.7% thought that vaccines were not safe, and 21.5% said that their decision to vaccinate their children was not influenced by a health care provider. Compared with parents who responded that providers were not influential in their decision to vaccinate their children, parents who responded that providers were influential were twice as likely to respond that vaccines were safe for children. Among children whose parents believed that vaccines were not safe, those whose parents' decision to vaccinate was influenced by a health care provider had an estimated vaccination coverage rate that was significantly higher than the estimated coverage rate among children whose parents' decision was not influenced by a health care provider (74.4% vs 50.3%; estimated difference: 24.1%). CONCLUSIONS: Health care providers have a positive influence on parents to vaccinate their children, including parents who believe that vaccinations are unsafe. Physicians, nurses, and other health care professionals should increase their efforts to build honest and respectful relationships with parents, especially when parents express concerns about vaccine safety or have misconceptions about the benefits and risks of vaccinations.

Child, Preschool↗
PubMedDate not supplied

Attitudes of Israeli family physicians toward clinical guidelines.

BACKGROUND: Many clinical guidelines (CGs) have been written during the past few years. Although family physicians (FPs) stand to benefit from many of these CGs, incorporating new CGs into daily practice seems to present a challenge. OBJECTIVE: To evaluate Israeli FPs' attitudes toward CGs. METHODS: We administered an anonymous questionnaire to general practitioners, residents, and board-certified FPs who participated in continuing medical education programs throughout Israel during May and June 1998. Our survey focused on physician attitudes and behaviors regarding CGs in general, and to CGs for treating the patient with diabetes mellitus (DM) in particular. The CGs for patients with DM have recently been promoted in the context of primary care quality improvement programs. Respondents also provided demographic and professional data. RESULTS: Of the 404 questionnaires distributed, 293 questionnaires were returned for a response rate of 83%. The average (+/-SD) age of respondents was 40.2 +/- 7.0 years, with a mean (+/-SD) of 13.3 +/- 8.0 years in practice. Overall, opinion regarding CGs was positive. About half of the respondents thought CGs improved patient compliance. Comparisons between the various physician groups highlighted several notable differences. Two thirds of the general practitioners believed CGs improved patient compliance, while this was true of only one third of the FPs (P<.001). Most FPs (62%) and senior residents (69%) felt CGs did not constrain their clinical freedom, while less than half of the general practitioners and junior residents felt this way (P =.045). Eighty-three percent of all respondents agreed that the CGs for the treatment of DM were able to be implemented, and 75% believed the CGs assisted them in the management of patients with DM. Whereas 39% expressed concern about being able to adapt generic CGs to individual patient needs, only 27% (P =.002) felt this way about the DM CGs. The vast majority (92%) were interested in understanding the scientific evidence supporting CGs as a prerequisite to adopting them. Most respondents preferred limiting CG length to a maximum of 5 pages. CONCLUSIONS: We found support among Israeli FPs for the use of CGs. Clinical guidelines seem to be used in the field, in particular those developed for treating DM. In light of our findings, attention should be focused on optimally tailoring new CGs to meet scientific standards and crafting them to suit the preferences of local FPs.

Adult↗
PubMedDate not supplied

Twenty years beyond medical school: physicians' attitudes toward death and terminally ill patients.

BACKGROUND: In response to consumer demands and recent changes in health care, the American Medical Association and the Association of American Medical Colleges have expressed concern about how physicians relate to patients, especially those who are seriously ill. OBJECTIVE: To determine the impact of 20 years of medical practice on the attitudes of physicians toward terminally ill patients and their families. METHODS: Data were gathered from questionnaires mailed in 1976 and again in 1996 to physicians who graduated from medical school between 1972 and 1975. RESULTS: Responses were received from 71% and 63% of the 1664 and 1109 physicians surveyed in 1976 and 1996, respectively. Using a t test for paired variables, statistically significant differences were noted for physicians' responses to all of the 11 Likert-type attitudinal statements on death and terminally ill patients and their families. Physicians in 1996 were more willing to inform terminally ill patients of their prognosis and in general seemed more confident with dying patients than they were in 1976. CONCLUSIONS: After 2 decades of practicing medicine, physicians' attitudes toward terminally ill patients seem to have changed; physicians appear to be more open to communicating with terminally ill patients and their families on issues concerning death and dying.

Attitude of Health Personnel↗
PubMed1999

Impediments to writing do-not-resuscitate orders.

BACKGROUND: Physicians are frequently unaware of their patients' desires regarding end-of-life care. Consequently, opportunities to implement do-not-resuscitate (DNR) orders are often missed. OBJECTIVE: To determine the reasons attending physicians do not write DNR orders when patients face increased mortality. METHODS: Over 4 months, the medical records of all inpatients on the General Medicine Service were reviewed at the time of discharge to identify patients with conditions predicting increased mortality. These cases were presented to a 5-member panel who decided if a DNR order was indicated. Reasons for missing DNR orders were discussed with the attending physicians. RESULTS: Of 613 consecutive admissions, the panel identified 149 patients (24%) for whom DNR orders were indicated. In 88 (59%) of these, DNR orders were absent. The lack of a DNR order did not correlate with age (P = .95), sex (P = .61), or race (P = .80). The attending physicians' explanations for not writing DNR orders in these 88 cases included the belief that the patient was not in imminent danger of death (n = 49 [56%]), the belief that the primary physician should discuss DNR issues (n = 43 [49%]), and the lack of an appropriate opportunity to discuss end-of-life issues (n = 38 [43%]). In 11 (12%) of the 88 cases, patients or their families did not accept the recommendation for a DNR order. No physicians expressed concerns regarding the morality of DNR orders, discomfort discussing end-of-life issues, or the threat of litigation as reasons for not writing a DNR order. CONCLUSIONS: Limitations in the extent and depth of the physician-patient relationship appear to be the most frequent impediments to writing DNR orders in our institution.

Adult↗
PubMed2001

Practice guidelines: useful and "participative" method? Survey of Italian physicians by professional setting.

BACKGROUND: Professional setting might be a key determinant of physicians' attitudes toward practice guidelines, influencing the effect of their implementation. Because no previous surveys have specifically considered this aspect, we evaluated the perceived role and usefulness of guidelines, as well as barriers to and facilitators of their implementation, for hospital, primary care, and nonpracticing clinicians. METHODS: A 43-item self-administered questionnaire was sent to all National Health Service physicians in the province of Modena, Italy (593 primary care physicians, 1049 hospital physicians, and 149 nonpracticing clinicians), and 1199 (66.9%) responded. Opinions and attitudes were assessed using 5-point ordinal scales and an attitude measurement scale. Results were evaluated overall and by professional setting, sex, age, year of graduation, and academic background. RESULTS: Practice guidelines were generally perceived to be less useful than other sources of medical information (eg, personal experience, conferences, colleagues, articles, the Internet, and textbooks [pharmaceutical representatives were the exception]). Most physicians thought that guidelines are developed for cost-containment reasons and expressed concerns about their limited applicability to individual patients and local settings. Most respondents did not favor the involvement of health professionals other than physicians in guideline development and use and preferred nonmonetary incentives for their implementation. Answers to individual items and attitude scores varied significantly across professional settings. Primary care physicians showed, in general, the least favorable attitudes toward practice guidelines, toward nonphysicians participating in guideline development and use, and toward incentives for guideline users. CONCLUSIONS: Physicians perceived practice guidelines as externally imposed and cost-containment tools rather than as decision-supporting tools. Regularly monitoring attitudes toward practice guidelines can be helpful to evaluate potential barriers to their adoption.

Attitude of Health Personnel↗
PubMed2005

Complex visual hallucinations in the visually impaired: a structured history-taking approach.

OBJECTIVE: To study complex visual hallucinations in visually impaired individuals. METHODS: A prospective comparative study involving structured history taking and cognitive assessment in 48 consecutive visually impaired individuals with best-corrected visual acuity of 20/200 or worse and an age-matched cohort of 48 consecutive patients with visual acuity of 20/40 or better in at least 1 eye. RESULTS: Thirty visually impaired subjects (63%) experienced hallucinations, unrelated to specific ocular pathology. None volunteered the symptom; 2 admitted hallucinations on nonleading questioning and 28 on direct questioning. All displayed insight into the unreality of their hallucinations, although 18 (60%) achieved this after initial deception. Seventeen (57%) expressed concern; 7 (23%) experienced disturbing images. Nineteen (63%) feared being labeled as insane were they to admit to hallucinations, while 10 (33%) were fearful of impending insanity. Sixteen (94%) of 17 concerned patients derived comfort from sympathetic reassurance that their hallucinations did not represent sinister pathology. In contrast, none of the individuals with normal vision experienced any hallucinations (P<.001). Cognition was intact in all groups. CONCLUSIONS: Complex visual hallucinations with insight commonly occur in visually impaired, cognitively intact individuals due to acquired visual impairment and are unrelated to chronological age. Hallucinatory experiences are almost invariably admitted to only on direct questioning, due to fears of being considered insane. Although generally pleasant, hallucinations may cause distress, because of content or implications of the hallucinatory activity. Sympathetic explanation affords significant emotional relief.

Adult↗
PubMed1996

Effects of global competition on health care administration in Finland and the United States. What you can do to save your practice.

Global competition, a faltering Finnish economy, and deep recession are forcing difficult decisions on the health care administrators of this Nordic country known for its extensive social welfare safety net and socialized health care system. In the first part of this article the Finnish health care system and its problems, as well as possible solutions, are presented. Similarities to our own system are noted and discussed. In an interview, the director general for the Minister of Social Affairs and Health of Finland, Kimmo Leppo, expressed concern about future funding sources in his country for the same levels of social welfare and health care programs that presently exist. The Finns are considering managed competition among providers, increasing copayments, excess hospital beds, anticipated hospital closures in their country, block grants, and how to deal with rising physician unemployment. He was interested in the proposed US government health care plans, and especially the state of Tennessee's TennCare plan, a state plan that closely resembled the failed Clinton health care reform package. The second part of this article explores how global competition has brought the pressure of modern competitive economics into the US medical arena.

Cost Savings↗
PubMed2002

Handgun safety: what do consumers learn from gun dealers?

OBJECTIVE: To explore the type and quality of handgun safety information a typical consumer would obtain from a licensed gun dealer. METHODS: Semistructured, interactional on-site interviews were conducted with licensed handgun dealers in 2 metropolitan areas. A variety of dealers (gun shops, pawnshops, general merchandise stores, and sporting goods stores) were visited. Investigators posed as customers interested in buying a handgun. During the interview, investigators expressed concern that as the parent of a 4-year-old child, they needed suggestions about keeping their child safe with a gun in the home. Information collected included basic dealer demographics, opinions on whether a 4-year-old child could pull a handgun trigger, handgun safety advice and recommendations, and the type of safety devices and handgun safety educational materials that were available in the store. RESULTS: There were 96 visits made to gun dealers. The typical salesperson was a man who appeared to be older than 40 years. Trigger locks were the most common safety devices available. When asked what a consumer should know about purchasing a handgun, 85% of salespeople did not mention safe storage. Only 9 (9%) offered advice that included all of the following: keeping the gun securely locked, keeping the gun unloaded, and storing the gun separately from the ammunition. One third answered "no" or "don't know" or "uncertain" when asked if a 4-year-old could pull the trigger. The majority (92%) did not have any handgun safe storage educational materials on site. CONCLUSIONS: Salespeople offered potential buyers little or no education about safe storage of handguns. The information provided was often inconsistent with the recommendations of the American Academy of Pediatrics.

Accident Prevention↗