Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Directive Counseling”

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 613 records · Page 34Linked to original sources
PubMed2006

A comparison of written materials vs. materials and counselling for women with sexual dysfunction and multiple sclerosis.

AIM: Evaluate whether symptoms of vaginal dryness, low libido, less intense or delayed orgasm could be improved in women with multiple sclerosis who took part in an education or education plus counselling programme. BACKGROUND: Sexual dysfunction, a prevalent symptom in women with multiple sclerosis, can negatively affect quality-of-life. METHODS: Women attending a large multiple sclerosis clinic were invited and 62 were randomized into one of two groups. Group 1 received written materials on primary, secondary and tertiary sexual dysfunction in multiple sclerosis as well as additional resources (books, websites, list of local psychologists specializing in sexual counselling). Group 2 received the same written materials as well as three counselling sessions from the clinic nurse, the latter two by telephone. The primary outcome measures were the expanded disability status scale and the multiple sclerosis intimacy and sexuality questionnaire-19. Repeated-measures analysis of variance was used to evaluate sexual dysfunction score over time and to compare two groups. RESULTS: At baseline, total expanded disability status scale scores were not correlated with primary, secondary or tertiary sexual dysfunction. Total multiple sclerosis intimacy and sexuality questionnaire-19 score was correlated with use of anti-cholinergic medications [r (54) = 0.28, P < 0.05], but no other medications, alcohol or tobacco use. Both groups had equivalent and significant reductions in primary sexual dysfunction [F (1) = 14.79, P < 0.001] postintervention. There was a trend towards an interaction effect for tertiary sexual dysfunction [F (1) = 2.88, P = 0.096], in the direction of group 2 (education and counselling). Subjectively, women welcomed the opportunity to discuss sexual concerns and noted that the written information allowed a framework for initiating discussion with their spouses. CONCLUSION: Relatively straightforward interventions provided by a clinic nurse may help women cope with the symptoms of sexual dysfunction associated with multiple sclerosis. Women who do not benefit from basic interventions could then be referred to an expert sexual dysfunction practitioner. RELEVANCE TO CLINICAL PRACTICE: Women with multiple sclerosis experience many disease-related physical and emotional challenges of which sexuality is only one. Sensitivity to sexual dysfunction and being willing to approach the topic is appreciated by women with multiple sclerosis. Nurses do not require in-depth expertise to offer some basic suggestions which may significantly improve life quality and assist the woman with multiple sclerosis to talk about or cope with sexuality issues.

Adult↗
PubMed2003

[Impact of face-to-face counseling on duration of exclusive breast-feeding: a review].

OBJECTIVE: To review the scientific literature on and evaluate studies of face-to-face counseling for the promotion of exclusive breast-feeding. SOURCES OF DATA: Three databases were reviewed for the 1990-2001 period: MEDLINE, Latin American and Caribbean Health Sciences ("LILACS"), and the Cochrane Library. We selected studies describing face-to-face counseling with mothers during only the postnatal period or both the pre- and postnatal periods. Studies describing interventions only during pregnancy were not considered. We classified the selected studies using a modification of the criteria of Downs and Black for assessing the methodological quality of studies of health care interventions. RESULTS: Nineteen studies were included. The duration of follow-up, type of intervention performed, and ethnic, socioeconomic, and reproductive characteristics of the groups studied varied widely. In terms of limitations, the most frequent ones were an inadequate description of confounding factors and of the characteristics of the sample, poorly documented methodology, and no adjustment for confounding factors. Seventeen studies reported a beneficial effect of the intervention, although the magnitude of this effect differed widely across the various studies. Two studies reported a dose-response effect, with the impact being directly proportional to the number of counseling sessions. Only one study reported no effect of the intervention on exclusive breast-feeding, at 3 and 5 months postpartum; of the 19 studies assessed, this one had the smallest number of counseling sessions, just one or two. CONCLUSIONS: Face-to-face counseling, given during different time periods, led to significant changes in the rate of exclusive breast-feeding. Our analysis suggests that the support to the mothers must continue after hospital discharge and must include guidance on breast-feeding techniques and ways to resolve problems that occur.

Breast Feeding↗
PubMed1997

HIV counseling and testing: its evolving role in HIV prevention.

The development of an enzyme-linked immunosorbent assay (ELISA) for screening blood for antibodies to HIV was a major milestone in the history of AIDS prevention and treatment. Since early 1985, the Centers for Disease Control and Prevention (CDC) has provided public funds to state and local health departments to support a national HIV counseling-and-testing (HIV CT) program directed toward persons at risk of transmitting or becoming infected with HIV. The implementation and ongoing development of this national program has often been marked by intense policy debate, especially in the area of mandatory testing. Furthermore, the lessons learned during its 11-year program history are highly relevant to understanding the challenges that might arise when implementing other new biomedical or behavioral HIV prevention technologies. Using the construct of public health infrastructure, this article describes key features, events, lessons learned, and future challenges of this evolving national prevention program.

AIDS Serodiagnosis↗
PubMed2003

Screening fetal echocardiography by telemedicine: efficacy and community acceptance.

OBJECTIVE: Our aim was to assess whether tertiary level screening fetal echocardiography can be extended to primary care facilities with telemedicine assistance. METHODS: Assessment of image quality and the adequacy of fetal echocardiograms recorded after random transmission at 128, 384, or 768 kbits/s was performed. Live fetal echocardiograms were transmitted at 384 kbits/s (3 integrated services digital network lines) from the remote primary care center. Patient satisfaction was assessed by surveys obtained after office-based and telemedicine consultations. RESULTS: A total of 58 recorded normal studies had similar image quality and adequacy on transmission at 384 and 768 kbits/s (P =.08 and.49, respectively) and were significantly better than 128 kbits/s (P <.01). During live screening transmitted at 384 kbits/s from the primary care center, 3 of 34 fetuses were diagnosed with heart disease. Surveys from patients with direct physician contact and by telemedicine showed a high satisfaction with telemedicine-assisted screening and counseling. CONCLUSION: Adequate screening for fetal heart disease is technically feasible at or above data transmission rates of 384 kbits/s. Community acceptance for telemedicine-assisted screening and counseling is not adversely affected by a lack of direct personal contact with the specialist.

Behavior↗
PubMed1996

Genetic counseling in an extended attenauted familial adenomatous polyposis kindred.

OBJECTIVES: To provide DNA-based genetic counseling to family members in the direct genetic lineage of a family fulfilling phenotypical criteria for the autosomal, dominantly inherited, attenuated familial adenomatous polyp (AFAP) syndrome. This enabled highly targeted cancer risk estimation based on cancer phenotype in concert with the presence or absence of the adenomatous polyposis coli (APC) germline mutation. Management recommendations could then be fully responsive to this syndrome's natural history. METHODS: Detailed family history with pathology verification of colonic polyps and cancer was performed on an extended AFAP kindred. Endoscopic gastrointestinal examinations enabled detailed knowledge of the syndrome's upper and lower gastrointestinal tract phenotype. Molecular genetic evaluation of DNA led to the identification of the APC germline mutation which co-segregated with the phenotype. RESULTS: Forty-two members of this extended AFAP family underwent DNA testing, wherein 27 were found to harbor the APC germline mutation,thereby enabling precision in their genetic counseling. Anecdotal examples of this counseling experience, with particular attention to psychological reactions, as well as concerns about such issues as insurance and employer discrimination, have been described. CONCLUSIONS: When DNA-based testing is offered to AFAP family members, genetic counselors must compassionately consider patients' psychological concerns when providing detailed risk status and available surveillance and management programs.

Adenomatous Polyposis Coli↗
PubMed1982

Direction for nutrition education determined by target group segmentation.

Target group segmentation was carried out on the basis of data from a Dutch national survey concerning knowledge of, attitudes toward, and behavior concerning cardiovascular risk factors. Objectives were to characterize those persons with less desirable dietary practices and to seek clues for directing nutrition education to them or the primary prevention of coronary heart disease. Results of the study indicated that nutrition education should be directed primarily toward men 18 to 44 years of age, with large families, in the lower socioeconomic strata, and with food practices that are least in accord with the dietary recommendations. The education methods should include television programs as well as group counseling or face-to-face instruction directed at young families.

Adolescent↗
PubMed1992

Functional roles of today's public health nutritionist.

This study found that functional roles of public health nutritionists in eight southeastern states differed significantly on the basis of education, dietetic registration status, years of experience, and type and level of service. Subjects (n = 992) were mailed a 95-item questionnaire with three parts: demographic, professional practice, and grant-writing experience. Results based on a 59% response rate indicated that most of the 14 functional roles studied were practiced in accordance with guidelines presented in Personnel in Public Health Nutrition for the 1980's. Only two roles, counselor and educator, were performed somewhat inconsistently. Personnel with bachelor's degrees did have more counseling responsibilities than those with more advanced degrees. However, nonregistered dietitians also had more counseling responsibilities than did registered dietitians. Direct care providers had fewer educator responsibilities than did personnel with administration/management job responsibilities. All personnel reported research responsibilities that increased with advanced education, training, years of experience, and type and level of service. We found that beyond-entry-level personnel had more administrative and policy-setting responsibilities, which is consistent with The American Dietetic Association's Role Delineation for Registered Dietitians and Entry-Level Dietetic Technicians (1990). We conclude that, with the exceptions of the counselor and educator roles, public health nutrition practice is consistent with personnel guidelines.

Administrative Personnel↗
PubMed2001

Tailoring tobacco counseling to the competing demands in the clinical encounter.

OBJECTIVES: We identified patterns of tobacco cessation counseling in primary care practices, including contextual factors that influence its provision. STUDY DESIGN: A cross-sectional study was performed using direct observation of outpatient visits. POPULATION: We included 91 outpatient visits by cigarette smokers visiting 20 family physicians in 7 Nebraska community family practices. OUTCOMES MEASURED: We measured patterns and quality of tobacco counseling assessed by direct observation. RESULTS: A hierarchy of 5 patterns was discernable, ranging from appropriate to inappropriate provision or nonprovision of tobacco cessation counseling. CONCLUSIONS: Since tobacco-specific discussions are appropriate only in approximately three fourths of primary care visits by smokers, clinical practice guidelines that recommend intervention at every visit are unrealistic. However, the finding that only one third of eligible visits addressed tobacco makes it imperative that tobacco cessation counseling be reliably integrated into visits for well care and tobacco-related illnesses that represent teachable moments.

Counseling↗
PubMed2002

Aging and physical disability: on integrating group and individual counseling with the promotion of physical activity.

This review examines selected conceptual models on physical disability that have been commonly employed in the study of chronic disease and aging, and suggests including self-efficacy beliefs and physical symptoms into the main pathway of the disablement process. The resulting model of disability has direct implications for integrating group and individual counseling into exercise prescription.

Activities of Daily Living↗
PubMed1998

CANDID--Counselling and Diagnosis in Dementia: a national telemedicine service supporting the care of younger patients with dementia.

OBJECTIVES: To audit and evaluate the introduction of a novel support service for younger people with dementia, their families and the professionals caring for them. DESIGN: A retrospective review of all calls received by a telephone helpline over a 2-year period. SETTING: CANDID (Counselling and Diagnosis in Dementia) offers direct access, by telephone and e-mail, to specially trained nurse/counsellors who record the caller's query, provide emotional support and practical advice. In addition to general advice, clinical details are held for patients registered with the service so that the advice given can be tailored to the patient's specific need and routed via the general practitioner for action. Advice is reviewed by a consultant neurologist and psychiatrist. SUBJECT: Callers to the CANDID helpline, who made a total of 1,121 calls. MAIN OUTCOME MEASURES: Details of the caller and of the patient they were caring for. Reason for calling and advice given to the caller RESULTS: Of the 1,121 calls received during the first 2 years of operation, 547 were 'registered' calls relating to 241 individual patients where more specific advice could be given through the GP. The remaining 574 'generic' calls were from members of the public and healthcare professionals who had heard about the service and were seeking information and advice. Reasons for calls were divided into three broad categories: general information; clinical advice; and advice on social issues. Among the registered callers, 50% of calls were for clinical advice. Letters were sent to GPs on 67 occasions; 48 (56%) provided information only for the GP, 16 (24%) advised a secondary referral and eight (12%) advised on the use of specific medication. CONCLUSION: The service has become rapidly accepted and used by families of patients and members of the public. Healthcare professionals have made less use of the service than anticipated, but it is hoped that this will increased as information about the service becomes disseminated.

Adolescent↗
PubMed2006

The roles of critical care advanced practice nurse.

PURPOSE: To determine and compare the perception among nurses and doctors of the roles and tasks of critical care advanced practice nurses (APNs) in order to establish standardized and formally agreed role criteria for such critical care APNs. METHOD: This study measured and analyzed the necessity of each of the roles and tasks of critical care APNs, as perceived by nurses and doctors, through a survey of 121 participants: 71 nurses in 7 intensive care units (ICUs) at a general hospital in Seoul, and 50 doctors who used ICUs. Data collection utilized a questionnaire of 128 questions in the following fields: direct practice (79), leadership and change agent (17), consultation and collaboration (15), education and counseling (11), and research (6). RESULTS: Both the nurses' and the doctors' groups confirmed the necessity of critical care APNs, with doctors who frequently used ICUs indicating a particularly strong need. As for the priority of each role of critical care APNs, the nurses considered direct practice to be the most critical, followed by education and counseling, research, consultation and collaboration, and leadership and change agent. The doctors also considered direct practice to be the most critical, followed by education and counseling, consultation and collaboration, research, and leadership and change agent. There was a statistically significant difference between how the two groups regarded all the roles, except for the consultation and collaboration roles. As for the necessity of each role of critical care APNs, the nurses considered research to be the most necessary, followed by education and counseling, consultation and collaboration, leadership and change agent, and direct practice. The doctors, on the other hand, considered education and counseling to be the most necessary, followed by research, consultation and collaboration, leadership and change agent, and direct practice. The responses of the two groups to all the roles, except for education and counseling roles, were significantly different. CONCLUSION: Nurses and doctors have different perceptions of the roles and tasks of critical care APNs. Thus, it is necessary for the combined nursing and medical fields to reach an official agreement on a set of criteria to standardize for the roles and tasks of critical care APNs.

Adult↗
PubMed2003

Identification of germline 185delAG BRCA1 mutations in non-Jewish Americans of Spanish ancestry from the San Luis Valley, Colorado.

BACKGROUND: Germline mutations in the BRCA1 and BRCA2 genes are associated with an inherited predisposition to breast and ovarian carcinoma, and specific mutations in these genes are found at increased frequency in certain populations. The authors observed a repeated occurrence of the 185delAG mutation (BRCA1; also known as 187delAG) in a non-Jewish population that originated from the San Luis Valley in Colorado. METHODS: This was a retrospective analysis of mutations that occur in non-Jewish Americans of Spanish ancestry from Colorado who were tested clinically for BRCA1 and BRCA2 genetic mutations using DNA sequencing. RESULTS: Between August 1994 and December 2001, 19 Spanish/Latin American individuals from different families underwent genetic counseling and clinical genetic testing using direct DNA sequencing for mutations of the BRCA1 and BRCA2 genes. The results showed that 10 of 19 individuals had mutations or variants of BRCA1 or BRCA2, and 6 of 10 individuals (60%) carried the 185delAG mutation in BRCA1. All six families originated from the San Luis Valley in Colorado, indicated that they were of Spanish/Latin American ethnicity, and denied Jewish ancestry. CONCLUSIONS: The 185delAG mutation is common in families of non-Jewish ancestry originating from the San Luis Valley in Colorado with hereditary breast/ovarian carcinoma, possibly due to a founder effect. Further investigation may lead to simplified genetic testing and may allow clinicians to serve this population better. The repeated occurrence of the 185delAG mutation in this specific population may have clinical and public health implications.

Adult↗
PubMed2001

Higher carbohydrate intake is associated with decreased incidence of newborn macrosomia in women with gestational diabetes.

OBJECTIVE: To study the influence of energy and macronutrient intake on infant birthweight in women with gestational diabetes mellitus undergoing intensive management. DESIGN: This prospective study evaluated the impact of intensive management of gestational diabetes on maternal and fetal morbidity, and addressed the relationship between food intake and infant birthweight. SETTING: Fifteen maternity hospitals in northern France. SUBJECTS: Ninety-nine women with gestational diabetes or gestational mild hyperglycemia diagnosed between 24 and 34 weeks of gestation were surveyed. After 1 was excluded because of a premature birth and 18 were excluded as underreporters, 80 women were included in the final analysis. Diet intake was assessed by a dietary history at the first interview, and by two 3-day diet records at the 3rd and 7th week after diagnosis. RESULTS: In a forward-stepwise regression analysis (controlling for maternal age; smoking; parity; prepregnancy BMI; pregnancy weight gain; gestational duration; infant sex; fasting and 2-hour postprandial serum glucose; insulin therapy; and energy, fat, protein and carbohydrate intake during treatment) infant birthweight was positively associated with gestational duration (beta = +0.34, P<.002), and negatively with smoking (beta = -0.27, P<.02) and carbohydrate intake (beta = -0.24, P<.03). There were no large-for-gestational-age infants among women whose carbohydrate intake exceeded 210 g/day. CONCLUSION: For women with gestational diabetes undergoing intensive management, higher carbohydrate intake is associated with decreased incidence of macrosomia. APPLICATION: These findings suggest that nutrition counseling in gestational diabetes must be directed to maintain a sufficient carbohydrate intake (at least 250 g per day), which implies a low-fat diet to limit energy intake. A careful distribution of carbohydrate throughout the day and the use of low-glycemic index foods may help limit postprandial hyperglycemia.

Adult↗
PubMed1992

Management of patients with sickle cell disease.

The ever-increasing body of information regarding the molecular pathogenesis of sickle cell disease has raised expectations that a specific and effective therapy could be devised to inhibit polymerization of hemoglobin S. Despite an intense international research effort, this goal has not yet been realized. Supportive care continues to be the mainstay in the management of patients with sickle cell anemia. Empiric measures were used in early attempts to treat sickle cell anemia. Herrick reported gratifying improvement after "rest, nourishing food, the administration of iodide, arsenic, thymol and the application of boric ointment to leg ulcers." Many of these suggestions are similar to those of today. Several factors have significantly improved the prognosis of patients with this disease. Improved medical care, genetic counseling, and universal neonatal screening have directly resulted in improved outcome. Molecular biologic techniques have allowed us to approach this disease in a pathophysiologic way. Now we can envision antenatal diagnosis with the use of molecular probes and treatment by gene amplification. Still, however, the most important and challenging link in the chain between the biology of the disease and the clinical sequelae is an astute and interested physician who must remain objective at all times.

Anemia, Sickle Cell↗
PubMed2001

Care of patients with Alzheimer's disease and their families.

Although the medical management options in Alzheimer's disease are limited, physicians have a central role in addressing multiple associated care needs of these patients and their families. These needs change according to different stages of the disease. Sensitive disclosure of diagnosis and providing education, guidance, and appropriate referrals to community resources are essential components to an effective care plan. By making use of a multidisciplinary network of care providers, the physician can ensure the family of proactive management throughout the course of the disease.

Activities of Daily Living↗
PubMed2003

Predictors of repeat pregnancy in a program for pregnant teens.

STUDY OBJECTIVE: To describe repeat pregnancy among adolescents and to compare those who experienced a repeat pregnancy to those who did not. DESIGN, SETTING, PARTICIPANTS: Retrospective case control of all adolescents who entered and exited the Teen Mother & Child Program, a multidisciplinary clinic for pregnant and parenting teens and their children, between 1985 and 2000. MAIN OUTCOME MEASURE: Repeat pregnancy. RESULTS: Over the 16-yr study period, 1838 teens entered and exited the program with the mean time in the program of 1.9 yrs. 194 (10.6%) teens went on to have a second pregnancy, and 4 of those had a third pregnancy. Ninety-two percent (n=175) of these pregnancies resulted in a live birth. The mean interval between delivery of the initial child and delivery of the second child was 21.8 months (range 5.4-53.2). Teens repeating (R) were compared to those who did not repeat (NR). R were younger at entry and older at exit from the program (both P<0.0001). R were more likely to be Hispanic (P=0.009) or have a partner who was Hispanic (P=0.02). R were more likely to have experienced a poor initial pregnancy outcome (miscarriage, stillbirth) (P=0.03). R were more likely than NR to be in a stable relationships with the father of the baby (i.e., married or engaged) (P=0.03). Self-report of physical and sexual abuse, depression, and substance abuse were common, but did not differ between R and NR. However, R were more likely than NR to self-report suicide gestures/attempts and to have a significant psychiatric history (P=0.01, P=0.004). Only 24% of R and 26% of NR had completed high school by the time of exit from the program. CONCLUSIONS: Ten percent of adolescents served by comprehensive multidisciplinary teen pregnancy program experienced a repeat pregnancy while in the program. Compared to nonrepeaters, adolescents who experienced a repeat pregnancy were younger, were more frequently Hispanic, and were more likely to be in a stable relationship with the baby's father. Many of the program's clients have psychosocial factors reported in the literature to be associated with repeat pregnancy. A history of suicide gestures/attempts and a significant psychiatric history were more common in those who had a repeat pregnancy. Disappointingly, only about 25% of the adolescents completed high school by the time they exited the program whether they experienced a repeat pregnancy or not. Although directing interventions (e.g., mental health services, counseling those who miscarried) to teens who appear to be at highest risk for a repeat pregnancy may decrease their risk of repeating, all teens in our program would likely benefit from such services.

Adolescent↗
PubMed2005

GPs' opinions of their role in prenatal genetic services: a cross-sectional survey.

BACKGROUND: In the UK about 4.5% of the population carry cystic fibrosis, whilst in the inner city areas an even higher proportion carry one of the haemoglobin disorders such as thalassaemia. Couples who both carry the same recessive disorder have a 1 in 4 risk of an affected child in every pregnancy. OBJECTIVES: To assess GPs' confidence in their ability to provide initial prenatal advice for couples carrying common autosomal recessive disorders (either the cystic fibrosis or thalassaemia gene), and their opinions of different approaches for referral to prenatal diagnostic services for such at-risk couples. METHODS: A cross-sectional postal survey of all 644 GPs in 388 general practices in Nottinghamshire. Practices were randomly allocated to receive either the cystic fibrosis or the thalassaemia scenario survey. The survey questions predominantly used six-point Likert scales to assess confidence and opinions of prenatal services. RESULTS: The questionnaire was returned by 62% (397) of GPs. Only 23% (91) were confident in providing prenatal advice to the at-risk carrier couples. GPs were more confident about advising cystic fibrosis carriers than thalassaemia carriers (P = 0.01). The least popular approach to prenatal service provision was direct referral to prenatal services after counselling with 52% (194) scoring this as useful, whilst 60.5% (233) of GPs scored referral to the obstetric services with the prenatal diagnosis organised by the obstetrician as useful. CONCLUSIONS: GPs perceive that they lack the confidence to provide basic prenatal genetic advice to women at risk of the commonest recessive disorders, with particularly low confidence where the couple both carry thalassaemia. A significant knowledge gap was demonstrated by the poor awareness of the importance of rapid referral to prenatal diagnostic services.

Adult↗
PubMed1977

Psychiatric consultations for 112 pediatric inpatients.

The investigator, a child psychiatry consultant for a pediatric service, studied 112 consecutive consultations, categorizing the presenting psychiatric problems, mental status, psychiatric diagnoses, final physical diagnoses, and psychiatric recommendations. The 112 patients represented 3.4% of all pediatric patients in the same age range admitted to the hospital. Girls comprised 59% of the sample studied. The most common presenting problems were unexplained physical symptoms, while the most frequent physical diagnoses were seizure disorder and diabetes. Psychiatric diagnoses were made for 82% of the patients seen; the most common diagnosis was "reactive" disorder. Specific recommendations for either inpatient or outpatient psychiatric care were made for 42 patients, of whom 23 were known to have followed through with the recommendations. However, most recommendations involved technics that could be applied by the primary care physician, eg, advice to parents, counseling the child, liaison with schools, direction of hospital staff.

Adolescent↗