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PubMed1995

Biosensor markets: opportunities and obstacles.

Currently, glucose sensing for the control of diabetes is the only high-volume market for biosensors. Yet, a variety of lower-volume niches are available for exploitation in medical diagnostics and the pharmaceutical and other industries. There are problems waiting for biosensor solutions, but the balance between market opportunities and technical and/or financial obstacles will control the future expansion of biosensor technology.

Biosensing Techniques↗

PubMed1986

Public hospitals: the legal obstacles of entering into joint ventures.

Public hospitals, as public entities, are limited in many of their activities by state constitutions and statutes. One area where activity can be particularly limited is the joint venture. Constitutional and statutory limitations can influence several aspects of the joint venture: scope of activities, geographic boundaries, authority to enter into joint ventures, gift of public funds prohibition, and stock ownership. Therefore, public hospitals must be aware of possible legal obstacles and carefully consider their options.

Financial Management↗

PubMed1989

Mutual aid in remote areas: addressing the obstacles.

Mutual aid is a powerful tool for individual and group change and an excellent means of promoting mental and physical health. This article examines the main factors that may hinder the development of self-help groups (SHGs) in rural and remote areas, specifically the Sudbury-Manitoulin region of Northern Ontario. It considers several issues common to rural areas, such as population distribution, geographic isolation, lack and inaccessibility of human and material resources, and local factors such as multiculturalism and multilingualism. One of the strategies considered for overcoming these obstacles is a model for a community mutual-aid organization based on a computerized network of mutual-aid services (central organization with regional units). The originality of the model lies in the recognition of computer technology and telecommunications as promising solutions to the problems of geographic, social and cultural isolation faced by remote and rural communities, solutions that may play a part in fully developing the potential for mutual aid in this type of community.

Community Mental Health Services↗

PubMed1999

Obstacles to early discharge after cardiac surgery.

CONTEXT: Cardiovascular disease and cardiac surgery, in particular, are associated with a large expenditure of healthcare resources. Identifying the factors that affect length of stay for patients hospitalized for cardiac surgery and ways to safely and effectively shorten stays could have significant impact on healthcare costs. OBJECTIVE: To identify obstacles to and the effects of early discharge on outcome after cardiac surgery. STUDY DESIGN: A prospective approach using a protocol consisting of modifying anesthesia, limiting the use of postoperative narcotics, early extubation, and early mobilization, with a goal of discharge at < 5 days. PATIENTS AND METHODS: The study group consisted of 422 consecutive patients (age range 15-89 years, 65% males): coronary artery bypass graft (CABG) (n = 290), valve procedures (n = 54), and CABG + valve procedures (n = 78). The discharge criteria included hemodynamic stability, normal bowel function, independence in activities of daily living, absence of fever, and no incision problems. RESULTS: Predictors of prolonged postoperative stay were prolonged intensive care unit stay (P < 0.0001), postoperative atrial fibrillation (P = 0.0006), preoperative congestive heart failure (P = 0.002), combined CABG and valve procedure (P = 0.005), prolonged ventilator support (P = 0.01), increasing age (P = 0.012), history of peripheral vascular disease (P = 0.02), and female gender (P = 0.025). The 30-day readmission rate for the early discharge group was 7.8% vs 16.2% for the late discharge group (P = 0.01). The mortality rate for the entire group was 3.3%.

Adolescent↗

PubMed1991

Obstacles to Adolescent Care: Economic Issues.

This article discusses economic issues that are relevant to a medical practice that deals with teenagers. The economic obstacles are divided into four major categories: (1) attitude toward physician; (2) sources of referrals and recruitment of patients; (3) overhead; and (4) billing procedures and accounts receivable.

Journal Article↗

PubMed1991

Overcoming Obstacles to Adolescent Care: Legal Issues.

Although the complex patchwork of laws governing adolescent health care remains imperfect and continues to present obstacles for some adolescents seeking care, the recent trend in the law represents a move toward a beneficial accommodation of the interest of adolescents, their parents, and the state.

Journal Article↗

PubMed1999

Physiological determinants of performance on an indoor military obstacle course test.

Obstacle courses (OCs), physical challenge courses, and confidence courses are valuable in training and assessing military troops. However, OCs are not well characterized with regard to physical demands and requisite abilities. The purpose of this study was to evaluate the physical capabilities associated with success on an OC. Male subjects (N = 47) were assessed on an OC, skinfolds, upper and lower body aerobic and anaerobic power, muscular strength, and endurance. Faster performers were lighter (p < 0.003), leaner, and, relative to body weight, averaged greater arm anaerobic peak and mean power, leg aerobic power, one-repetition maximum leg press, and one-repetition maximum latissimus dorsi pull-down, than slower performers. There were significant correlations between OC time and weight (0.59), percent fat (0.54), anaerobic leg mean power (-0.43), arm anaerobic peak (-0.48) and mean power (-0.48), and arm (-0.51) and leg aerobic power (-0.53), all expressed relative to body weight. A three-variable regression model accounted for 35% of the variation in OC time. Good performers on this OC displayed many diverse physical capabilities.

Adult↗

PubMed2000

[Problems, obstacles and complications of femoral lengthening with the use of the Italian modification of the Ilizarov device].

The results of femoral lengthening using the Italian modification of the Ilizarov are presented. Mean age of the patients was 14 years (ranging from 7 to 29). The most frequent etiology of limb shortening was femoral hypoplasia (7 patients) and sequelae of septic arthritis of the hip and/or the knee (6 patients). Indications for surgical treatment were limb shortening from 3 to 12 cm (mean 6.5 cm), along with axial deviation ranging from 10 degrees to 40 degrees in 6 patients. Mean follow-up time was 15 months (ranging from 6 to 35 months). The Ilizarov apparatus was based on two distal rings, stabilized by "K" wires, and proximally by a ring connected with an Italian femoral arch, stabilized by a Schanz screw. Planned lengthening (ranging from 3.5 cm to 12 cm) was achieved in all treated patients. The healing index ranged from 0.8 to 2.1 month/cm (mean 1.4). Problems, obstacles and complications were analyzed according to the Paley classification. In all 16 patients without primary knee stabilization, limited knee flexion ranging from 5 degrees to 90 degrees (mean 40 degrees) was noted during the distraction phase, which didn't improve significantly during the consolidation phase. Knee flexion improved to a mean 90 degrees after a 6 month follow-up. Bone regenerate defects (cysts, narrowing) were noted in 4 patients. Secondary knee stabilization was performed in 2 cases. In the first case because of knee pain and a severe limitation of knee motion. In the second, during a revision procedure because of distal femur angulation. Premature consolidation was noted in one patient and was treated by osteotomy. In one case axial deviation during the consolidation phase required osteotomy. In another case a fracture of the femur was treated by a plaster cast. In one case 1.5 years after the lengthening procedure subluxation of the hip was noted. Permanent knee flexion limitation to less than 90 degrees was noted in 6 patients. Femoral lengthening with the use of the Italian modification of the Ilizarov device give a high incidence of knee range of motion limitation, which can be decreased by preserving more than 30 degrees knee flexion during the distraction phase.

Adolescent↗

PubMed2001

Private investment in AIDS vaccine development: obstacles and solutions.

The development of vaccines for the prevention of AIDS, malaria, tuberculosis, and other diseases requires both public and private investment. Private investment, however, has been far lower than might have been hoped, given the massive human toll of these diseases, particularly in the poorest countries. With a view to understanding this situation and exploring potential solutions, the World Bank AIDS Vaccine Task Force commissioned a study on the perspectives of the biotechnology, vaccine, and pharmaceutical industries regarding investment in research and development work on an AIDS vaccine. It was found that different obstacles to the development of an AIDS vaccine arose during the product development cycle. During the earlier phases, before obtaining proof of product, the principal barriers were scientific. The lack of consensus on which approach was likely to be effective increased uncertainty and the risks associated with investing in expensive clinical trials. The later phases, which involved adapting, testing, and scaling up production for different populations, were most influenced by market considerations. In order to raise the levels of private research and development in an AIDS vaccine there will probably have to be a combination of push strategies, which reduce the cost and scientific risk of investment, and pull strategies, which guarantee a market.

AIDS Vaccines↗

PubMed2001

Sharable computer-based clinical practice guidelines: rationale, obstacles, approaches, and prospects.

Clinical practice guideline automation at the point of care is of growing interest, yet most guidelines are authored in unstructured narrative form. Computer-based execution depends on a formal structured representation, and also faces a number of other challenges at all stages of the guideline lifecycle: modeling, authoring, dissemination, implementation, and update. This is because of the multiplicity of conceptual models, authoring tools, authoring approaches, intended applications, implementation platforms, and local interface requirements and operational constraints. Complexity and time required for development and structure are also huge obstacles. These factors argue for convergence on a common shared model for representation that can be the basis of dissemination. A common model would facilitate direct interpretation or mapping to multiple implementation environments. GLIF (GuideLine Interchange Format) is a formal representation model for guidelines, created by the InterMed Collaboratory as a proposed basis for a shared representation. GLIF currently addresses the process of authoring and dissemination; the InterMed team's major focus now is on tools to facilitate these tasks and the mapping to clinical information system environments. Because of limitations in what can be done by a single team with finite resources, however, and the variety of additional perspectives that need to be accommodated, the InterMed team has determined that further development of a shared representation would be best served as an open process in which the world community is engaged. Under the auspices of the HL7 Decision Support Technical Committee, a GLIF Special Interest Group has been established, which is intended to be a forum for collaborative refinement and extension of a standard representation that can support the needs of the guideline lifecycle. Significant areas for future work will need to include demonstrations of effective means for incorporating guide-lines at point of care, reconciliation of functional requirements of different models and identification of those most important for supporting practical implementation, im-proved means for authoring and management of complexity, and methods for automatically analyzing and validating syntax, semantics, and logical consistency of guidelines.

Artificial Intelligence↗

PubMed2001

Mental health. Obstacle course.

Focus groups of mental health practitioners, service users and carers, designed to test the competence of staff to deliver modern services, revealed wide discrepancies in perceptions. Staff saw the persistence of the medical model, and the risk-averse culture of trusts, as obstacles to delivering effective care. Users and carers felt generally uninvolved in care planning.

Clinical Competence↗

PubMed2002

Injury surveillance and systematic investigation identify a rubber matting hazard for anterior cruciate ligament rupture on an obstacle course.

In June 1998, six unexpected anterior cruciate ligament ruptures within 12 months were detected by routine injury surveillance in a cohort of Australian Army recruits. A systematic investigative process was used to identify the probable cause. Review of the case histories, followed by on-site assessment of the common hazard, revealed that all ruptures occurred as recruits twisted or landed on newly laid rubber matting at one obstacle course. The matting was laid with the intention of countering ground wear, shock of impact, and slipping to reduce the risks of ankle sprain and stress fracture. Review of the literature indicated that the interface between the rubber boot sole and rubber matting was associated with a very high coefficient of friction, probably causing excessive torque at the knee. Similar mechanisms of anterior cruciate ligament injury have been reported in sports and skiing. A subsequent study of intervention effects, reported separately in this issue, was conducted to confirm the damaging role of the matting. Routine injury surveillance and systematic investigation are valuable tools for injury prevention. Clinicians are well equipped for both.

Adolescent↗

PubMed2001

Obstacles to negotiating dual protection: perspectives of men and women.

This article presents findings from a qualitative study on the perspectives of sexually active men and women about the risks of unwanted pregnancy and HIV/AIDS. The study found that there is a high level of awareness of the risk of unwanted pregnancy and HIV/AIDS. Knowledge of condoms as a method of preventing pregnancy and HIV/AIDS is also relatively good. However, there are many real and perceived barriers to condom use especially in stable sexual relationships. In stable long-term relationships, resistance to condom use was found to be strongly related to its association with STIs (including HIV/AIDS). Men and women do not see the need for condoms in stable, ongoing sexual relationships if a more effective method is used for pregnancy prevention. Condom use in such relationships may be seen as a clear sign of infidelity. These attitudes represent a major obstacle to the use of condoms as a dual method of protection.

Adolescent↗

PubMed1992

The integration of research in the clinical setting: obstacles and solutions. A review of the literature.

One of the most influential factors in the successful genesis of any profession is the development and growth of research. Professions need to have their roots planted firmly in a fertile body of knowledge. Nursing is a developing profession; in order for it to progress, the utilisation of valid research findings is essential. In this paper, the author has reviewed some of the available literature on the subject of research utilisation, highlighting the obstacles and providing some possible solutions.

Clinical Nursing Research↗

PubMed2004

[Diagnosis and treatment of insertion obstacle(report of 32 cases)].

OBJECTIVE: To point out and define "insertion obstacle" (IO) as another sort of sexual dysfunction. METHODS: A retrospective review was done on 32 patients with IO. They were diagnosed by self-rating insertion scale(SIS) designed by reference to the first five questions in OLeary's "Brief Male Sexual Function Inventory for Urology" (1995), involving sexual desire and erection and insertion, and treated mainly by psychological behavior therapy. RESULTS: Of the 32 cases, 30 patients were diagnosed as IO, 29 (90.6%) were simple psychological IO, and successfully cured by psychological behavior therapy. CONCLUSIONS: IO, as a sort of sexual dysfunction, could be diagnosed by SIS, and cured by psychological behavior therapy.

Adult↗

PubMed2002

Long-term care insurance and public policy: an analysis of obstacles to utilization.

This article investigates the phenomenon of long-term care insurance and the policy environment in which it has evolved. Further discussion focuses on the obstacles that may exist to wide acceptance of long-term care insurance by those who derive the most benefit from the protection it could provide. The authors review the role of employers and the advantages of long-term care insurance as an employee benefit as compared to individual policies.

Aged↗

PubMed2004

Obstacles to successful antiretroviral treatment of HIV-1 infection: problems & perspectives.

Mutations in human immunodeficiency virus type 1 (HIV-1) are a major impediment to successful highly active antiretroviral therapy (HAART) and the design of anti-HIV vaccines. Although HAART has made long-term suppression of HIV a reality, drug resistance, drug toxicity, drug penetration, adherence to therapy, low levels of continued viral replication in cellular reservoirs and augmentation of host immune responses are some of the most important challenges that remain to be sorted out. Continuing viral replication in the face of HAART leads to the accumulation of drug resistance mutations, increase in viral loads and eventual disease progression. Patients who fail therapy have minimal options for their clinical management. Therefore, a clear understanding of the pathogenesis of drug-resistant HIV-1, and all of the issues that influence the success of HAART is urgently needed. In the present article, we discuss various obstacles to HIV therapy, and provide perspectives relating to these issues that are critical in determining the success or failure of HAART.

Anti-HIV Agents↗

PubMed2004

Obstacles which patients with type 2 diabetes meet while adhering to the therapeutic regimen in everyday life: qualitative study.

AIM: To explore type 2 diabetic patients' attitudes, thoughts, and fears connected with their illness; their expectations of the health care system; and the problems they encountered while adhering to the therapeutic regimen. METHOD: Explanatory descriptive focus groups were held with 49 type 2 diabetic patients. Patients were recruited by their general/family practitioners and divided into seven focus groups. The group discussions were audio taped and transcribed, then analyzed to find emerging themes and sub-themes. Textual data were explored inductively using content analysis to generate categories and explanations. Hypotheses were derived from the qualitative content analysis. RESULTS: Eight major themes and explanatory models of patient's perspective emerged out of the data: confronting the diagnosis, illness-related changes, treatment of illness, social context, relation to the health professionals, self-control, knowledge about the illness, and expectations from health professionals. Health beliefs, quality of the doctor-patient relationship, social environment of the family, workplace, health care system, and quality of the information they receive from health professionals and media were all important factors in patient adherence. CONCLUSIONS: There were many obstacles for bettering patients adhering to the therapeutic regimen, as from the patients' socio-economical aspect, and in the existing health system of Croatia as well. Providing of updated information about the disease, empathy and support of physicians can improve adherence to treatment.

Adult↗