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PubMed2004

A concept analysis of palliative care in the United States.

PURPOSE: The purpose of this analysis is to trace the evolution of the concept of palliative in the United States, explicate its meanings, and draw comparisons with other related concepts such as hospice care and terminal care. METHODS: Rodgers' evolutionary method was used as an organizing framework for the concept analysis. Data were collected from a review of CINAHL, MEDLINE, CANCERLIT, PsycINFO and Sociological Abstracts databases using 'palliative care' and 'United States' as keywords. Articles written in the English language, with an abstract, published between 1965 and 2003 were considered. Data were synthesized to identify attributes, antecedents and consequences of palliative care. FINDINGS: There has been a significant evolution in understanding of the palliative care concept in the United States over the last few decades, which has resulted in the emergence of new models of palliative care. Four attributes of the current palliative care concept were identified: (1) total, active and individualized patient care, (2) support for the family, (3) interdisciplinary teamwork and (4) effective communication. Results reinforce that cure and palliation are not mutually exclusive categories. CONCLUSIONS: The scope of palliative care has evolved to include a wide range of patient populations who may not be appropriately termed 'dying' but for whom alleviation of suffering and improvement of quality of life may be very relevant goals. The ultimate success of the new models of palliative care will eventually rest upon the commitment of health professionals to recognize and integrate the changing concept of palliative care into everyday practice.

Humans↗
PubMed2005

Attachment in older adulthood: concept clarification.

AIMS: This paper is an analysis to clarify the concept of attachment by: (1) specifying the antecedents of attachment in older adulthood, (2) describing the defining or critical attributes of attachment as relevant for development beyond adulthood, including older adulthood and old age, and (3) specifying the consequences of attachment in older adulthood. BACKGROUND: Attachment is a concept that has been studied both within and outside the discipline of nursing. Most of the scholarly work on the concept has involved investigations of the concept as it applies at very early developmental phases of the lifespan. Despite this concentration of effort on the concept in childhood, theorists have consistently called for attention to the concept in adulthood and older adulthood to advance our understanding of how such close and supportive relationships relate to health. RESULTS: Antecedents of attachment behaviour include any number of fear-provoking or challenging situations, as well as interactions that involve conflict. Illnesses commonly have these characteristics and so are broadly included as antecedents. Defining attributes of attachment behaviour include three distinct behaviours: (1) proximity, or keeping to one or more 'preferred others', (2) protest following involuntary and perceived permanent separation from a preferred other and, (3) the presence of a secure base, viewed as necessary for developmental exploration and growth. Consequences include environmental interaction secure in the belief that a safe haven exists should reliable clues to danger present themselves, and the mobilization of personal and interpersonal assets called developmental resources. CONCLUSIONS: Nursing implications include the ability of nurses to intervene positively with older clients who may be experiencing age-related transitions that affect health. Knowledge about attachment will help nurses mediate the potentially negative impact of health transitions on developmental tasks and promote high-level wellness and successful ageing.

Aged↗
PubMed2005

An evolutionary concept analysis of caring.

AIM: The aim of this paper is to identify the core, enduring attributes of nursing caring in order to increase understanding of the concept and to identify its implications for research and practice. BACKGROUND: Caring is considered a core concept in nursing as a practice discipline. During the past 20 years, research into nurse caring has been evolving, but the concept of caring remains ambiguous. METHODS: Using a rigorous evolutionary method of concept analysis, the concept caring was examined for its significance, use and application as it has unfolded over time, between 1988 and 2002. After applying inclusion and exclusion criteria and a sampling method, a total of 61 articles was included in the final analysis. RESULTS: Defining attributes, antecedents, and consequences of caring were identified. Core attributes included relationship, action, attitude, acceptance and variability. CONCLUSION: Identification of the core attributes of concepts, including caring, allows nurses to determine appropriate research questions, develop theory and identify practice priorities at a time of increasing demands and constrained resources.

Attitude of Health Personnel↗
PubMed1996

Organizational culture: a useful concept for nurse managers?

The use of the term culture, in the context of health care organizations, has become commonplace in a wide range of literature, however, the exact meaning intended when this word is used is not always clear. This paper questions the current widespread recourse to the concept of organizational culture as a way of explaining all 'soft' organizational issues and suggest a greater degree of clarity is necessary if the concept is to retain its explanatory utility. Using three components of the concept as an organizing framework to guide the analysis, its application to health care organizations, and nursing in particular, is examined. This demonstrates how the concept can be effectively utilized without losing an appreciation of its inherent complexity. The dimensions of the concept identified for this purpose are: instrumental; cognitive; and interpretive. It is argued that, when clearly defined and appropriately applied, culture can be a useful concept for nurse managers in that it increases understanding of, and thereby contributes to, the effective management of complex health care organizations.

Humans↗
PubMed2002

A concept analysis of uncertainty in illness.

PURPOSE: To examine the concept of uncertainty in illness and to propose an alternate model of uncertainty in the illness experience. ORGANIZING CONSTRUCT AND METHODS: Following a review of the literature, Morse's description of concept analysis by critically appraising the literature was used as a guideline in examining the concept of uncertainty. FINDINGS: Characteristics of the illness situation--ambiguity, vagueness, unpredictability, unfamiliarity, inconsistency, and lack of information--underlie the process of uncertainty. Three attributes of the concept of uncertainty were identified as probability, temporality, and perception. Loss of personal control is often erroneously equated with uncertainty. CONCLUSIONS: Uncertainty is a multidimensional concept that in its purest form is a neutral cognitive state and should not be mistaken for its emotional outcomes. To clarify the concept of uncertainty, further research is needed to determine the relationship of uncertainty to loss of control and psychosocial outcomes.

Attitude to Health↗
PubMed1991

Conception rates in European fallow does (Dama dama dama) following intrauterine insemination with frozen-thawed semen from Mesopotamian fallow (Dama dama mesopotamica) and crossbred (Dama dama dama x Dama dama mesopotamica) bucks.

Ninety eight parous fallow does received laparoscopic intrauterine insemination of frozen-thawed semen at one of 2 fixed intervals following oestrus synchronisation treatment. Semen was collected from a Mesopotamian (Dama dama mesopotamica) and a crossbred (F1) (Dama dama dama x Dama dama mesopotamica) fallow buck. Does were inseminated at either 56 or 66 hours after the removal of an intravaginal controlled internal drug releasing device. Eighty eight does received a single straw of frozen-thawed semen containing a total of 50 x 10(6) spermatozoa, while the remaining 10 received split straws containing 25 x 10(6) spermatozoa. Overall, the use of F1 semen containing 50 x 10(6) spermatozoa resulted in a 68% (17/25) conception rate compared with the Mesopotamian semen, which resulted in a 41% (26/63) conception rate. Conceptions were also achieved using 25 x 10(6) spermatozoa of either Mesopotamian or F1 semen (3/8 versus 2/2, respectively). Overall, the conception rate was higher for F1 than Mesopotamian semen (P less than 0.025) and there was a significant interaction with time of insemination (P less than 0.05); for F1 semen there was no difference in conception rate at the 2 insemination times, but for Mesopotamian semen conception was significantly higher (P less than 0.005) following insemination at 66 hours than at 56 hours.

Animals↗
PubMed1998

Fundamental concepts in statistics: elucidation and illustration.

Fundamental concepts in statistics form the cornerstone of scientific inquiry. If we fail to understand fully these fundamental concepts, then the scientific conclusions we reach are more likely to be wrong. This is more than supposition: for 60 years, statisticians have warned that the scientific literature harbors misunderstandings about basic statistical concepts. Original articles published in 1996 by the American Physiological Society's journals fared no better in their handling of basic statistical concepts. In this review, we summarize the two main scientific uses of statistics: hypothesis testing and estimation. Most scientists use statistics solely for hypothesis testing; often, however, estimation is more useful. We also illustrate the concepts of variability and uncertainty, and we demonstrate the essential distinction between statistical significance and scientific importance. An understanding of concepts such as variability, uncertainty, and significance is necessary, but it is not sufficient; we show also that the numerical results of statistical analyses have limitations.

Humans↗
PubMed2003

Problems and solutions: two concepts of mankind in cognitive-behavior therapy.

Scientific theories that are concerned with experience and behavior of human beings always include anthropological core assumptions. This applies in particular to psychotherapeutic theories. These anthropological core assumptions (i.e., concepts of mankind) affect techniques that are derived from these theories but they also have a great influence on acceptance and spreading of psychotherapeutic methods. This article examines the concept of mankind in cognitive-behavior therapy. In this connection two highly differing conceptions of the human being are identified: the early behavioristic black-box model and the conception of the human being as an actively performing subject ("man the scientist") in the framework of the self-management approach and in cognitive therapy. The image problem of today's behavior therapy, the lack of application of efficient methods of behavior therapy and problems in finding a professional identity as a behavior therapist can be seen as stemming from the differing concepts of mankind. To solve these problems we propose: an integrative concept of mankind, an increased emphasis of a cooperative therapist-patient relationship, and the taking into account of unconscious processes.

Anthropology, Cultural↗
PubMedDate not supplied

Measuring perceptions of diabetes-related concepts: a preliminary study.

PURPOSE: This pilot study explored health professionals' and patients' perceptions of diabetes through the development of the Diabetes Semantic Differential Scales (DSDS). These scales evaluate the meaning of diabetes-related concepts. METHODS: Health professionals (n = 39) attending a CME course completed the health professional version of the DSDS. Patients (n = 70) completed the patient version of the DSDS. RESULTS: The reliability of the DSDS was supported. The scale scores of health professionals, African American patients, and Caucasian patients, examined initially by one-way analyses of variance, showed significant differences among the groups for 4 of the 18 diabetes concepts. Effect sizes were also examined among these groups. For 7 concepts, there was a significant practical difference between the perceptions of the health professionals and the African American patients. For the Caucasian patients, differences were noted for 6 concepts. CONCLUSIONS: There are 3 primary inferences from this pilot study. First, health professionals and patients are likely to hold different perceptions of key diabetes concepts. Second, the concepts on which professionals and patients differ are not always what one would expect. Third, health professionals should clarify patients' understanding of diabetes to minimize the potential for miscommunication.

Adult↗
PubMed2004

Outcomes of the Bobath concept on upper limb recovery following stroke.

OBJECTIVE: To determine the effectiveness of the Bobath concept at reducing upper limb impairments, activity limitations and participation restrictions after stroke. METHODS: Electronic databases were searched to identify relevant trials published between 1966 and 2003. Two reviewers independently assessed articles for the following inclusion criteria: population of adults with upper limb disability after stroke; stated use of the Bobath concept aimed at improving upper limb disability in isolation from other approaches; outcomes reflecting changes in upper limb impairment, activity limitation or participation restriction. RESULTS: Of the 688 articles initially identified, eight met the inclusion criteria. Five were randomized controlled trials, one used a single-group crossover design and two were single-case design studies. Five studies measured impairments including shoulder pain, tone, muscle strength and motor control. The Bobath concept was found to reduce shoulder pain better than cryotherapy, and to reduce tone compared to no intervention and compared to proprioceptive neuromuscular facilitation (PNF). However, no difference was detected for changes in tone between the Bobath concept and a functional approach. Differences did not reach significance for measures of muscle strength and motor control. Six studies measured activity limitations, none of these found the Bobath concept was superior to other therapy approaches. Two studies measured changes in participation restriction and both found equivocal results. CONCLUSIONS: Comparisons of the Bobath concept with other approaches do not demonstrate superiority of one approach over the other at improving upper limb impairment, activity or participation. However, study limitations relating to methodological quality, the outcome measures used and contextual factors investigated limit the ability to draw conclusions. Future research should use sensitive upper limb measures, trained Bobath therapists and homogeneous samples to identify the influence of patient factors on the response to therapy approaches.

Humans↗
PubMed2003

Integrating nursing diagnostic concepts into the medical entities dictionary using the ISO Reference Terminology Model for Nursing Diagnosis.

OBJECTIVE: The purposes of the study were (1) to evaluate the usefulness of the International Standards Organization (ISO) Reference Terminology Model for Nursing Diagnoses as a terminology model for defining nursing diagnostic concepts in the Medical Entities Dictionary (MED) and (2) to create the additional hierarchical structures required for integration of nursing diagnostic concepts into the MED. DESIGN AND MEASUREMENTS: The authors dissected nursing diagnostic terms from two source terminologies (Home Health Care Classification and the Omaha System) into the semantic categories of the ISO model. Consistent with the ISO model, they selected Focus and Judgment as required semantic categories for creating intensional definitions of nursing diagnostic concepts in the MED. Because the MED does not include Focus and Judgment hierarchies, the authors developed them to define the nursing diagnostic concepts. RESULTS: The ISO model was sufficient for dissecting the source terminologies into atomic terms. The authors identified 162 unique focus concepts from the 266 nursing diagnosis terms for inclusion in the Focus hierarchy. For the Judgment hierarchy, the authors precoordinated Judgment and Potentiality instead of using Potentiality as a qualifier of Judgment as in the ISO model. Impairment and Alteration were the most frequently occurring judgments. CONCLUSIONS: Nursing care represents a large proportion of health care activities; thus, it is vital that terms used by nurses are integrated into concept-oriented terminologies that provide broad coverage for the domain of health care. This study supports the utility of the ISO Reference Terminology Model for Nursing Diagnoses as a facilitator for the integration process.

Dictionaries, Medical as Topic↗
PubMed1991

Inhibin concentrations throughout the menstrual cycles of normal, infertile, and older women compared with those during spontaneous conception cycles.

Plasma immunoreactive inhibin levels have been measured in a series of normal conception cycles (group I; n = 7), and the data compared to inhibin concentrations in normal menstrual cycles (group II; n = 8), in women with luteal phase defects (group III; n = 7), and in women in the perimenopausal period (group IV; n = 6). Daily plasma levels of LH, FSH, progesterone, estradiol, and inhibin were determined in each subject, and daily mean profiles for each hormone in each subject group were calculated and expressed as geometric means with 68% confidence limits. During the follicular and early luteal phases, inhibin concentrations in the normal nonpregnant group (group II) were significantly higher than those in the conception cycles of group I, but after implantation in the conception cycles, inhibin concentrations increased to levels in excess of those seen at any time in nonconception cycles (716-1352 U/L; P less than 0.02). The postimplantation rise in inhibin did not initially appear to follow the same pattern as progesterone. While progesterone concentrations rose within 24 h of the first detectable increase in hCG, inhibin levels did not increase until 3 days later, although after this point concentrations increased serially and in parallel with progesterone. LH and FSH concentrations were markedly suppressed after implantation. Follicular and early luteal inhibin concentrations in cycles with luteal phase defects were also higher than those in conception cycles, although this difference was only significant in the midfollicular phase. Follicular phase inhibin concentrations in cycles from older women (group IV) were lower than those in groups II and III, but were not distinguishable from those in the conception cycles. Estradiol concentrations in the same subjects were significantly lower during the early follicular phase, while follicular and luteal FSH concentrations were significantly higher than those during conception cycles. Finally, examination of the relationship between inhibin, FSH, and estradiol around menstruation in the older women revealed a far closer temporal association between FSH and estradiol than between FSH and inhibin. In conclusion, inhibin concentrations rise and fall throughout the human menstrual cycle in a manner that is similar to but at specific times significantly different from that of either of the ovarian steroids estradiol and progesterone. It is considered to be a peptide of granulosa cell origin and may be an indicator of the size of the follicular pool during the early stage of the cycle. However, although there is some degree of inverse correlation between profiles of inhibin and profiles of FSH, this relationship is not particularly clear.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2001

Identifying and assessing the conceptions of teaching of secondary school physics teachers in China.

BACKGROUND: Recent research indicates that how lecturers think about the nature of teaching influences both the way they teach and the way their students learn and ultimately the learning outcomes they achieve. Such research has primarily been conducted at the tertiary level in Western countries and its relevance for school teaching and in non-Western contexts has yet to be demonstrated. AIMS: Study 1 aimed to develop a model of the conceptions of teaching of Chinese secondary school teachers of physics and an instrument to assess these conceptions. Study 2 then tested the reliability and within-construct validity of responses to the latter and the relationships between teaching experience and gender and teaching conceptions were investigated. SAMPLE: The interview sample in Study 1 comprised 18 teachers of physics in Guangdong, China. The instrument was administrated to 450 physics teachers from the province in Study 2. METHOD: An in-depth emic approach involving both interviews and classroom observations was utilised to develop the model. Confirmatory factor analysis was used to test the fit of responses to the instrument to the proposed model. RESULTS: Five lower order conceptions (Knowledge Delivery, Exam Preparation, Ability Development, Attitude Promotion, and Conduct Guidance) and two higher order orientations (Moulding and Cultivating) were identified. Responses to the instrument were found to be of satisfactory internal consistency reliability and to fit the expected underlying factor model. Neither teaching experience nor gender was found to be related to conceptions of teaching. CONCLUSIONS: The model developed differed in some respects from those found in the Western tertiary literature due probably to cultural factors which emphasise more an affective, moral view of teaching and to a school contextual emphasis on exams. The instrument developed had very adequate psychometric properties and seems promising as a tool for assessing teaching conceptions in future research within China and across cultures.

Adolescent↗
PubMed2006

Optimization of star-oriented and layer-oriented wavefront sensing concepts for ground layer adaptive optics.

Multiconjugate adaptive optics is one of the major challenges in adaptive optics. It requires the measurement of the volumic distribution of the turbulence. Two wavefront sensing (WFS) concepts have been proposed to perform the wavefront analysis for such systems: the star-oriented and layer-oriented approaches. We give a performance analysis and a comparison of these two concepts in the framework of the simplest of the multi-guide-star adaptive optics systems, that is, ground layer adaptive optics. A phase-related criterion is proposed to assess analytically the performance of both concepts. This study highlights the main advantages and drawbacks of each WFS concept and shows how it is possible to optimize the concepts with respect to the signal to noise ratio on the phase measurement. A comparison of their optimized versions is provided and shows that one can expect very similar performance with the two optimized concepts.

Journal Article↗
PubMed2004

The concept of psychical trauma: a bridge in interdisciplinary space.

The concept of trauma currently occupies a central position in interdisciplinary dialogue. Using the concept of psychical trauma as a bridge, the author attempts an interdisciplinary dialogue with psychiatry, biology and neuroscience. Beginning with the concept of psychical trauma in Freud, the author reviews the evolution of Freud's thinking, and links it with the ideas of Ferenczi and post-Freudian psychoanalytical authors. From a different framework, he considers the present state of research on post-traumatic stress disorder in current psychiatric nosography and attempts an interdisciplinary approximation to the concept of psychical trauma. Interesting ideas like the traumatic situation, trauma spectrum and psychopathological spectrum emerge, which enable a better understanding of the concept of psychical trauma through its relatedness, as a bridge connecting a broad psychopathological range extending from normality to psychosis. The ensuing possible relative loss of nosographical rigour is more than compensated by the resulting increased understanding and enlarged therapeutic possibilities. In the second part of the paper, the author attempts a dialogue with neuroscience, taking into account new advances in current research on emotion and memory, and making them compatible with the psychoanalytical concept of trauma. In this sense, the paper underlines the importance of emotion and crucially of memory, regarded as a fundamental axis of the subject explored in this paper. Here a substantial distinction which is pertinent for analytical work appears: declarative memories versus non-declarative or procedural memories. In a concluding discussion the author argues that, taking into account the implications of these current notions regarding a number of theoretical and technical aspects, psychoanalysis currently holds a privileged position, both in its potential for prevention and regarding the treatment of patients, in so far as, through interdisciplinary dialogue, psychoanalysis can be receptive to and be enriched by the contributions of other disciplines, just as it enriches them with its own contributions.

Emotions↗
PubMed2005

Amplification of the concept of meaning as the validating principle in psychodynamic science.

In two previous articles by this author, the concept of psyche was given legitimate scientific status insofar as a necessarily new and unique scientific paradigm for psychodynamics was elaborated, stemming from the idea that positivistic science is not appropriate to the subjective data of psychoanalysis. This paradigm includes the idea that the concept of meaning as scientific validation is central to psychodynamic science. The concepts of erroneous meaning, synchronicity, and numinosity were introduced as aspects of this new scientific paradigm. In the present article, the complementary relationship between psychodynamic and traditional science is explored. The concepts of synchronicity, numiosity, and meaning are elaborated, together with discussion of the phenomenon of anxiety as it impinges on these dynamics. The concept of erroneous meaning is in this article separated from the concept of meaning itself through the idea that the activation of anxiety separates the two.

Anxiety↗
PubMed2005

Deprivation and variations in teenage conceptions and abortions in England.

There are substantial variations between local authorities in the conception rate of teenagers and the proportion of these that end in abortion. This study builds two deprivation models that explain part of the variation in conceptions and abortions. It then identifies outliers, local authorities with teenage conception and abortion rates that are above or below those predicted by the model. It is suggested that the local authorities with lower than expected conceptions are the ones to look to when seeking to discover how to prevent teenage conceptions and those with higher than expected abortion rates may have abortion services that are more accessible. In general, spatial comparisons of conceptions and abortion should take into account variations in deprivation.

Abortion, Induced↗
PubMed2006

Monitoring of pH inhibition on microbial activity in a continuous flow reactor by pseudo toxic concentration (C(PT)) concept and time delay model.

The pseudo toxic concentration (C(PT)) concept was introduced as a quantification method to describe pH as an inhibitor concentration. In this research, the applicability of the C(PT) concept model for the detection of pH inhibitions was expanded for a continuous flow activated sludge reactor. A pilot equipped with an inhibition detection system was installed. Inhibitory wastewater was injected for 1 h and the relative activity was calculated by the maximum respiration rate. At the same time, the coefficients for the C(PT) concept model were estimated. At the dynamic conditions, the estimated relative activity by the C(PT) concept model showed time lag compared to the measured one. However, the time lag problem was successfully resolved by introducing a transfer function into the C(PT) concept model. The C(PT) concept model combined with a transfer function (C(PT) + TF model) successfully tracked the variation of the relative activity under dynamic conditions. The C(PT) + TF model could detect 50% inhibition faster than the respirometry based method by approximately 10 min. Moreover, it had additional advantages such as being inexpensive, easy to install and simple to operate. In conclusion, the C(PT) + TF model was an effective and convenient detection method of pH inhibition.

Bioreactors↗