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PubMed1997

A citizens' AIDS Task Force: overcoming obstacles.

This article analyzes the experience of a state-wide Task Force on AIDS using grassroots techniques to construct policy responsive to the needs of people living with HIV. The four primary obstacles to effective policy making were the need (1) to include disenfranchised groups; (2) to avoid the domination of governmental bureaucracy so that community-based organizations could offer solutions, as well as services; (3) to overcome resistance to anonymous testing; and (4) to reach "hard to reach" populations. Task Force members' perspectives colored what were deemed appropriate policies. Members tended to polarize into two groups: those community-based groups and individuals who focused on the needs of people with HIV on one side, and on the other side, more institutional players who wanted to identify and isolate "HIV carriers." The article closes by analyzing the resulting HIV Omnibus Bill. Those who focused on the needs of people with HIV seized the opportunity to draft and successfully pass an omnibus bill through the Arizona Legislature. This success demonstrates that highly organized communities can affect policy making, even to the extent that it offsets more institutionalized power.

AIDS Serodiagnosis↗
PubMed2002

Control of micronutrient deficiencies in India: obstacles and strategies.

Micronutrient deficiencies of vitamin A, iron, and iodine continue to be of public health significance in India. The government of India initiated national programs to prevent, control and combat these deficiencies and their serious consequences. The interventions involved (1) distribution of iodized salt in the endemic areas, (2) administration of semiannual massive dose of vitamin A to young children, and (3) distribution of iron-folic acid tablets to the vulnerable groups. Evaluations revealed that the biologic impact of these interventions was unsatisfactory. Inadequate allocation of funds (10% of the actual needs) necessary to cover the enormous number of beneficiaries was one of the important obstacles. Consequently, the allocation of supplies to different provinces was far short of the requirements (10-30%). As a result of poor orientation, the functionaries were not adhering to the guidelines, leading to woefully inadequate (1-20%) and irregular coverage. There was no proper monitoring or supervision to make midcourse corrections to improve the functioning. The community was not informed of the purpose and details of each intervention. Hence, it did not utilize the resources completely and remained passive recipients. The community was not aware of the dietary approaches to prevent micronutrient disorders owing to absence of nutrition education. With the adoption of National Nutrition Policy by the government of India, a concerted and focused approach should be adopted. The future strategies should include a mix of short-term supplementation and food-based strategy encompassing food fortification and home gardening. Innovative approaches in information, education, and communication (such as social marketing strategy) for making the interventions sustainable should be adopted.

Dietary Supplements↗
PubMed1993

Obstacles to discharge of ventilator-assisted children from the hospital to home.

Home care for ventilatory-assisted children improves psychosocial development and reduces medical costs compared with hospital care; yet, many ventilator-assisted children remain hospitalized for lengthy periods of time after they have achieved medical stability. To identify factors that contributed to a delay in hospital discharge from the time medical stability was achieved, we reviewed the records of 54 ventilator-assisted children (age 4.6 +/- 5.9 [SD] years at discharge) who were discharged from the hospital on a regimen of home mechanical ventilation. The length of the hospitalization from which the ventilator-assisted children were initially discharged on the ventilator was 172 +/- 161 days (range, 2 to 756). The time from medical stability to discharge was 118 +/- 144 days (range, 2 to 724), or 73 percent +/- 29 percent of the total hospitalization. Fifty-one ventilator-assisted children were discharged to their natural parents' homes, and three were discharged to foster care. Once ventilator-assisted children were medically stable, it took 99 +/- 141 days for third-party payers to approve home care funding, and only 48 +/- 87 days to be discharged once funding was approved. For the 27 ventilator-assisted children with public funding, it took 184 +/- 177 days for home care funding approval, compared with 52 +/- 43 days for the 27 ventilator-assisted children with private funding (p < 0.001). Parent training took only 52 +/- 65 days. It took 369 +/- 334 days (range, 44 to 711 days) to find placement for the three ventilator-assisted children who were placed in medical foster care. In summary, ventilator-assisted children often remained hospitalized for prolonged periods of time, after they were medically stable, for nonmedical reasons. The greatest obstacle to hospital discharge was seeking approval for home care funding and for arranging out-of-home placement. Public funding agencies took significantly longer to approve home care funding than private insurance agencies.

Adolescent↗
PubMed1986

Financial cost as an obstacle to hypertension therapy.

A home health interview, including blood pressure measurements, was conducted on 4,688 adults representing the noninstitutionalized population of Georgia. Subjects with diastolic blood pressure greater than or equal to 90 mm Hg or on antihypertensive medication were considered hypertensive. The prevalence of uncontrolled moderate or severe hypertension (diastolic greater than or equal to 105 mm Hg) was 1.9 per cent. With the exception of White women, all race-sex groups with uncontrolled moderate or severe hypertension reported substantially lower per capita income than their mild or controlled hypertensive counterparts. A larger percentage of the uncontrolled moderate to severe hypertensives on medication, as compared to their mild or controlled counterparts, reported economic barriers to pharmacologic and medical care on cost of medicines (36 per cent vs 22 per cent); refills (36 per cent vs 16 per cent); and office visits (26 per cent vs 16 per cent). Black women reported these barriers more than Whites. These findings suggest that costs of antihypertensive care may be an obstacle in blood pressure control for certain population subgroups.

Adult↗
PubMed1999

Oral cancer chemotherapy in paediatric patients: obstacles and potential for development and utilisation.

Although most cancer chemotherapy in children is administered parenterally, oral formulations are becoming increasingly available for use in patients as young as infants. Incentives for this approach include safety, flexibility, reduced financial cost, improved quality of life, and the potential for improved efficacy. The ability to deliver chemotherapy at home and apply schedules of administration that increase the agent's efficacy because patients do not require hospitalisation or visits to the clinic renders oral chemotherapy particularly attractive. Obstacles to oral chemotherapy in paediatric patients include restrictions in dose size and schedule, uncertain or low bioavailability, adverse effects of malabsorption, and adherence (noncompliance and refusal to take oral chemotherapy). Techniques to overcome most of these limitations are available or can be developed, and lack of an oral formulation can be solved in many instances by the pharmaceutical industry. Future developments in oral chemotherapy should not be limited to adult patient applications.

Administration, Oral↗
PubMed2002

The promise and obstacle of p53 as a cancer therapeutic agent.

p53 is a tumor suppressor gene that is mutated in greater than 50% of human cancers. The action of p53 as a tumor suppressor involves inhibition of cell proliferation through cell cycle arrest and/or apoptosis. Loss of p53 function therefore allows the uncontrolled proliferation associated with cancerous cells. While design of most anti-cancer agents has focused on targeting and inactivating cancer promoting targets, such as oncogenes, recent attention has been given to restoring the lost activity of tumor suppressor genes. Because the loss of p53 function is so prevalent in human cancer, this protein is an ideal candidate for such therapy. Several gene therapeutic strategies have been employed in the attempt to restore p53 function to cancerous cells. These approaches include introduction of wild-type p53 into cells with mutant p53; the use of small molecules to stabilize mutant p53 in a wild-type, active conformation; and the introduction of agents to prevent degradation of p53 by proteins that normally target it. In addition, because mutant p53 has oncogenic gain of function activity, several approaches have been investigated to selectively target and kill cells harboring mutant p53. These include the introduction of mutant viruses that cause cell death only in cells with mutant p53 and the introduction of a gene that, in the absence of functional p53, produces a toxic product. Many obstacles remain to optimize these strategies for use in humans, but, despite these, restoration of p53 function is a promising anti-cancer therapeutic approach.

Genes, p53↗
PubMed1983

Facing a communicative obstacle: pragmatics of language-impaired children.

The ability of school-age, language-impaired children to respond when faced with a communicative obstacle was investigated. 18 language-impaired children were compared to 2 control groups, age-mates and language-mates. Language-impaired differed from both controls. They communicated more effectively than younger language-mates and less effectively than age-mates.

Child↗
PubMed1998

Vector development: a major obstacle in human gene therapy.

Gene therapy has been proposed for a wide variety of human conditions including monogenic disorders, such as the haemoglobinopathies and immunodeficiency syndromes, cancer and many other diseases. Prerequisites for the success of this approach include the ability to deliver the therapeutic gene intact to the target cell, persistent levels of transgene expression sufficient to correct the disease phenotype, lack of unwanted side-effects associated with vector exposure or gene transfer and relative simplicity allowing the widespread use of this methodology. Although substantial progress has been made in animal models since the inception of genetic therapy in the early 1980s, significant obstacles remain for human therapy, most notably in the area of vector development. The first generation of gene therapy vectors has failed to overcome many of the biological hurdles cited above necessitating the development of alternate means of gene delivery and expression.

Adenoviridae↗
PubMed1996

A force feedback joystick and control algorithm for wheelchair obstacle avoidance.

Many powered wheelchair users have difficulty manoeuvring in confined spaces. Common tasks such as traversing through doorways, turning around in halls or travelling on a straight path are complicated by an inability to accurately and reliably control the wheelchair with a joystick or other common input device, or by a sensory impairment that prevents the user from receiving feedback from the environment. An active joystick with force feedback to indicate obstacles in the environment has been developed. Two force feedback schemes designed to assist a powered wheelchair user have been developed and implemented using the active joystick. The development of the joystick and associated control algorithms are described.

Algorithms↗
PubMed1996

AAC systems: obstacles to effective use.

This paper investigates some of the issues which contribute to the lack of use of Augmentative and Alternative Communication (AAC) systems. It presents findings from a two-year research study which examined the communication of 93 adolescent and adult AAC users with cerebral palsy and 186 of their communication partners. The methods of data collection were questionnaires, interviews and field notes. The results show that some of the obstacles to effective use of AAC systems include lack of availability and accessibility of AAC systems, communication partners' lack of knowledge of AAC systems, insufficient amount of therapy provided, type of vocabulary in AAC systems and other modes of communication available to AAC user.

Adolescent↗
PubMedDate not supplied

Overcoming obstacles to skin cancer examinations and prevention counseling for high-risk patients: results of a national survey of primary care physicians.

OBJECTIVE: Primary care physicians are in a unique position to perform skin cancer examinations and provide prevention counseling, given that approximately 40% of office visits to physicians in the United States are to a family practitioner or internist. Compared with family or self-detection, physician detection is associated with an increased probability of detecting thinner melanomas. However, little research has attempted to identify the major obstacles to performing a skin cancer examination and recommending prevention practices. METHODS: In the spring of 2002, we surveyed primary care physicians from all 50 states, including family medicine physicians, internists, and general practitioners sampled from the American Medical Association's Medical Marketing Services' database. There were 4 primary outcome variables related to early detection and prevention practices for average-risk patients and patients with risk factors: performing a full-body skin examination; recommending regular skin self-examination; and recommending sun protection practices and avoidance of tanning booths for patients younger than age 35. RESULTS: We received surveys from 380 (60%) of 632 eligible physicians. Nearly 60% of physicians routinely performed full-body examinations with their high-risk patients. In the regression analysis of factors influencing physician examination of high-risk patients, lack of time was the strongest barrier [odds ratio (OR) 0.3 (95% confidence interval (CI) 0.2 to 0.6)]. Physicians using the most information sources [OR 2.5 (95% CI 1.3 to 4.8)] were the most likely to examine their high-risk patients. Physicians whose patients requested a skin examination were more likely to examine their patients compared with physicians whose patients did not request such an examination (P < .01). CONCLUSIONS: Concerted public and professional education efforts must be made to provide resources that help physicians efficiently weave skin cancer examinations and prevention counseling into routine practice while also motivating high-risk patients to request full-body examinations and counseling.

Health Care Surveys↗
PubMedDate not supplied

Rural nurses as self-directed learners: overcoming obstacles to continuing education.

Evaluation of a fieldtest of a self-directed learning (SDL) program included assessing rural nurses' self-perceived competencies in this method and loci of control for motivation. A significant negative relationship occurred between high scores for learner skills and internal motivation ratings. Sixty-two percent rated themselves above the mean as self-directed learners regardless of perceived loci of control in the stressful rural practice environment. SDL can offer an alternative way to meet continuing education needs of rural nurses in their efforts to overcome the many obstacles to professional growth in rural practice.

Clinical Competence↗
PubMed2006

Biogenerics: potential benefits and obstacles.

Stakeholders in the prescription drug process are familiar with the savings possible when generic substitution is available. When drugs that enjoy a large market share come off patent, multiple generic manufacturers usually are ready to market a lower-cost generic. Today, the fastest growing segment of the pharmaceuticals market is biologics. Although the patents for several costly and successful biologics have expired or will expire in the near future, no biogenerics have yet been approved. The scientific difficulties of replicating large sugar- and protein-based molecules and related safety issues represent obstacles to an abbreviated biologics approval process.

Biological Products↗
PubMed2006

Imatinib resistance: obstacles and opportunities.

OBJECTIVE: To review the current status of resistance to imatinib mesylate (IM) in patients with chronic myelogenous leukemia, and the obstacles and opportunities presented by the development of this resistance. DATA SOURCES AND STUDY SELECTION: Review of selected studies obtained from a MEDLINE search encompassing the years 1950 to 2004. DATA EXTRACTION AND DATA SYNTHESIS: Relevant information from the selected studies was abstracted and summarized. CONCLUSIONS: The identification of the Philadelphia chromosome and the subsequent discovery that it represents a translocation between the long arms of chromosomes 9 and 22 producing an aberrant tyrosine kinase, known as BCR-ABL1, has catalyzed our understanding and treatment of this hematologic malignancy. An extensive search for molecules to block the aberrant BCR-ABL1 protein resulted in the development of IM as an orally bioavailable agent with remarkable efficacy in producing hematologic, cytogenetic, and molecular remissions. However, follow-up of patients treated with IM has demonstrated that some patients can develop resistance to IM with progression of their leukemia. Multiple mechanisms of resistance have been identified. The dominant mechanism appears to be mutations in the kinase domain of BCR-ABL1, which result in altered affinity of IM for the BCR-ABL1 protein. Recently, small-molecule, combined SRC and ABL1 inhibitors have been developed and entered into clinical trials. These inhibitors appear effective in inhibiting most of the mutant BCR-ABL1 molecules that are resistant to IM. The rapid development of new therapies for treatment of chronic myelogenous leukemia brings the promise that this disorder can be cured or controlled in many patients with oral drugs that have a low toxicity profile.

Antineoplastic Agents↗
PubMedDate not supplied

Obstacles to defining the role of the mental health nurse.

BACKGROUND: This article review 0s the available literature to find a definition of the primary function of the mental health nurse. CONCLUSION: A number of obstacles were encountered that would need to be tackled to achieve a consistency of thought across the profession.

Creativity↗
PubMed1992

CQI for imaging services: Part II, Obstacles to success.

Continuous quality improvement (CQI) as an operations philosophy is quickly gaining acceptance in the American healthcare industry. But despite successes with this type of program in Japan and certain American industries, the quality improvement process is not problem free. In fact, there will be obstacles for many who implement such a program. For example, changes in work systems frequently stimulate emotional reactions from those affected. And while fear, apprehension and resistance can be addressed by the radiology manager, lack of corporate and administrative support will limit or prevent a CQI program's success. However, radiology managers must overcome such problems to survive in today's healthcare environment.

Attitude of Health Personnel↗
PubMed1995

Disease management faces obstacles.

Health plans and providers are encountering many obstacles in their attempts to manage disease. Among them are patients' refusal to follow doctors' instructions, and the costliness and complexity of information systems that could help resolve treatment questions.

Continuity of Patient Care↗
PubMed1996

Commentary: obstacles to scientific discovery.

Over the last two centuries, obstacles to scientific discovery frequently have been encountered by visionary scientists. From Semmelweis to Marshall, many scientists have faced rigid and nonintellectual academic environments that refused to recognize innovative advances. Their heroic journeys should be a constant reminder to us to create an academic environment that fosters intellectual freedom.

Diffusion of Innovation↗