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PubMedDate not supplied

The development of clinical practice guidelines for treatment of peptic acid diseases in a VA ambulatory care clinic.

The costly treatment of peptic acid diseases at a Veterans Affairs ambulatory care clinic prompted the development of clinical practice guidelines (CPGs) for the disorders. A committee consisting of a clinical pharmacist, the chiefs of ambulatory care and medicine, and a gastroenterologist guided the process. A consensus-style conference format involving medical staff and residents, pharmacists, and other health providers was chosen to develop the CPGs. Before the conference each participant received a list of key issues and literature on practice guidelines, and on peptic acid diseases and their treatment. At the conference the participants were divided into four groups; each group discussed specific key issues using a modified nominal group process. Recommendations from each group were made to the entire conference. Final recommendations were compiled into what was adopted and readily received as the CPGs for the institution.

Algorithms↗
PubMed2004

A blueprint for interprofessional learning.

Interprofessional education (IPE) has been promoted as a method to enhance the ability of health professionals to learn to work together. This article examines several approaches to learning that can help IPE fulfill its expectations. The first is aimed at the transfer of learning novel situations and involves two ideas. Students need to be challenged with progressively more complex tasks and those tasks need to reflect the reality in which they will be working. Second, the learning situation needs to be structured using the five elements of best-practice cooperative learning: positive interdependence, face-to-face promotive interaction, individual accountability, interpersonal and small-group skills, and group processing. Finally, the learning process itself needs to be approached from an experiential learning framework cycling through the four-stage model of planning, doing, observing and reflecting. By using increasingly complex and relevant cases in cooperative groups with an experiential learning process interprofessional education can be successful.

Cooperative Behavior↗
PubMed2005

A blueprint for interprofessional learning.

Interprofessional education (IPE) has been promoted as a method to enhance the ability of health professionals to learn to work together. This article examines several approaches to learning that can help IPE fulfill its expectations. The first is aimed at the transfer of learning novel situations and involves two ideas. Students need to be challenged with progressively more complex tasks and those tasks need to reflect the reality in which they will be working. Second, the learning situation needs to be structured using the five elements of best-practice cooperative learning: positive interdependence, face-to-face promotive interaction, individual accountability, interpersonal and small-group skills, and group processing. Finally, the learning process itself needs to be approached from an experiential learning framework cycling through the four-stage model of planning, doing, observing and reflecting. By using increasingly complex and relevant cases in cooperative groups with an experiential learning process interprofessional education can be successful.

Canada↗
PubMed2002

Developing standards of care: a tale of two panels.

OBJECTIVE: How will a group of experts convened to develop standards of care communicate in meaningfully different ways when interacting online in contrast to traditional face-to-face meetings. Furthermore, does online interaction facilitate discussion among participants from diverse cultural backgrounds and at what cost? DESIGN: A project to develop standards of care for deaf and hard of hearing adults used two panels of experts operating in two different formats: online and face-to-face. One panel interacted via an online system while the other met in a day-long face-to-face conference. As one component of the project, we tracked the interactions of these two groups in order to describe and contrast their group processes. STUDY PARTICIPANTS: The subjects were volunteer experts in hearing impairment and health care, from organizations across the United States. They were a geographically diverse group with widely varying communication needs. We applied two different systems for facilitating communication among culturally diverse participants, and assessed interaction and satisfaction. MAIN OUTCOME MEASURES: Data were collected on the two groups on the pattern of interactions, satisfaction with the process, and satisfaction with outcomes. RESULTS: The results showed a high level of user satisfaction with both process and outcomes, and provide data for a description of the source of user satisfaction and the management of the groups. CONCLUSION: Online interaction offers unique advantages but poses unique management requirements for success.

Adult↗
PubMed1988

[Perioperative treatment of patients with varicose veins using calcium dobesilate].

Altogether 120 patients with medium to serious forms of varicositas were examined perioperatively after having been divided into 3 groups. Groups I and II were administered perioperatively a daily dosage of 1000 mg (2 x 1 capsule) of the preparation Doxium (Ebewe Arzneimittel GmbH, Unterach am Attersee) during 8 weeks - 2 weeks preoperatively and 6 weeks postoperatively. Group III was used for control purposes. The following was valued as parameter of comparison: kind and seriousness of perioperative trouble, alteration of peripheric oedemas, results of plethysmographic examinations as well as light-reflex-rheography examinations and the post-operative healing-process. Groups I and II (medication of Doxium) showed a significant (p less than 0.05) reduction of the peripheric oedemas already in the preoperative state and postoperatively, the patients had less trouble and a quicker healing-process was observed compared with group III.

Adult↗
PubMed1998

Serum copper concentration in HIV-infection patients and relationships with other biochemical indices.

We have determined the degree of abnormalities in serum copper concentrations in HIV-seropositive individuals. The study was conducted at the Virgen de las Nieves Universitary Hospital in Granada (Spain). A total of 142 HIV-infected individuals and 84 control subjects were included in the study. The HIV-infected subjects were divided into three groups following the 1993 criteria of the Center for Disease Control and Prevention (Atlanta, USA). Serum copper levels in HIV-infected subjects were significantly higher than those found in control individuals (P < 0.001). Moreover, there were no statistically significant (P > 0.05) differences in serum Cu levels among the three groups considered although serum Cu enhancement occurred at the beginning of the infection process (group A). This increase then remains constant in advanced stages of HIV infection (groups B and C). The mean serum Cu concentration in women (1.41 mg/l) was not significantly higher than that found in men (1.39 mg/l) (P > 0.05). Linear regression analyses between serum copper concentrations and nutritional or biochemical indices (prealbumin, albumin, transferrin, lymphocytes CD4, body mass index, weight) were not statistically correlated (P > 0.05). These data suggest that copper which is an acute phase reactant, may be a useful marker of HIV activity and progression to AIDS as in other chronic infective diseases.

Adult↗
PubMedDate not supplied

Nurse educators'/administrators' ways of handling conflict.

Using women's standpoint research to analyze the data, a qualitative, retrospective case study was undertaken to study the group process among 27 female nurse educators/administrators who met from 1987 to 1990. The group was engaged in making major changes to integrate nursing education programs from a variety of institutions. Part of the research involved studying the group's conflict-handling strategies. These strategies were compared and contrasted with strategies found in traditional, feminist, and nursing management literature. In the traditional management literature, five conflict-handling modes are described: competing, compromising, avoiding, integrating, and accommodating. Although the research results indicated similarities between the conflict-handling modes used by the group studied and those reported in the research literature, there also were significant differences. One unique strategy identified was not competing. Competing as a strategy was rejected. Compromising and avoiding were used frequently by the group. Integrating, the most efficacious strategy, was used to resolve only two issues, whereas accommodating was not identified as an obvious strategy, although two aspects of it were apparent. One conclusion is that conflict management theories based on men's behavior do not adequately explain nurses' (women's) conflict management behavior. This study suggests that nurse educators/administrators may have a distinct approach to conflict management that has not been recognized.

Canada↗
PubMed2000

Conceptual and methodological issues in public health performance measurement: results from a computer-assisted expert panel process.

As part of the developmental process for the National Public Health Performance Standards Program, the CDC convened a group of experts in the fields of public health practice and research to evaluate key conceptual and methodological issues involved in measuring the performance of public health organizations. Participants engaged in a nominal group process and an electronic polling exercise designed to elicit expert opinions about these issues. Results revealed broad consensus around the need for measurement systems that support quality improvement and accountability applications, with scientific investigation viewed as an important but secondary objective of measurement. Substantial variation was observed in perceptions about the importance of specific measurement concepts and methods. Results highlight the need for performance measurement systems to reflect multiple organizational perspectives in their design and implementation.

Health Planning Councils↗
PubMed2000

An agenda for research into uterine artery embolization: results of an expert panel conference.

PURPOSE: To develop a research agenda for uterine artery embolization (UAE) for the treatment of symptomatic leiomyomata. MATERIALS AND METHODS: An expert panel was convened to examine data and develop a consensus for UAE research. Panelists reviewed data from articles about UAE and data on hysterectomy and myomectomy, which were abstracted into evidence tables. A modified Delphi process was used to rate the importance of measuring specific outcomes and a nominal group process was used to develop ideas for study designs. RESULTS: Panelists agreed that UAE studies would have to examine certain key measures. Outcomes identified as either "important to measure" or "essential to measure" were death, reoperation, operative injury, menorrhagia, premature menopause, recurrence of myomata, and satisfaction. The panel proposed four areas for research: randomized trial, prospective registry, disease-specific quality-of-life instrument, and cost analysis. CONCLUSIONS: Symptomatic uterine leiomyomata are a major health concern for women. New techniques that promise to provide symptom relief deserve careful consideration. Traditionally, surgical procedures have been poorly studied until after they have been widely used. If the process described in this article can guide the acquisition of knowledge in this field, it may serve as a model for evaluating other new technologies before they become widely adopted.

Costs and Cost Analysis↗
PubMed2001

The focus group: a tool for programme planning, assessment and decision-making--an American view.

The objective of this paper is to describe the focus group process used with hospital librarians in the National Network of Libraries of Medicine, Pacific Southwest Region (NN/LM/PSR), in order to illustrate how focus groups can be effectively used in the library setting to plan programmes around identified needs. This paper explores the focus group methodology, a qualitative research technique, by discussing why it is used and the process involved in its use. Aspects of the methodology that are discussed include participant selection, question development, data analysis, and use of results in programme planning. The focus group findings assisted NN/LM/PSR in understanding the needs of hospital librarians related to integrating electronic resources into library services. The focus group data were used to determine the forum, content and speakers for a day-long symposium and subsequent planning meeting. The use of the focus group technique to assess the needs of a specific group on a specific issue resulted in activities and programmes that met these needs successfully. Based on the experiences detailed in this paper, the authors are confident that focus groups are an effective tool for programme planning, needs assessment and decision-making for all types of libraries.

Arizona↗
PubMed2003

Visual information processing under time pressure in high and low level soccer players.

The present study investigated differences in information processing rate of high and low level soccer players under three time-pressure conditions: High (0.5 sec.), Medium (1 sec.), and Low (2 sec.). No significant difference was found under Low time pressure, but under Medium time pressure the higher skilled group processed more visual information than the lower skilled group (p<.05).

Adult↗
PubMed2001

Radiocarpal dislocations: classification and proposal for treatment. A review of twenty-seven cases.

BACKGROUND: The radiographic characteristics and treatment of radiocarpal dislocation are not well defined. There have been only two reported series of more than eight patients. Thus, there are many questions concerning treatment and functional results. METHODS: Two groups of patients were defined. Group 1 included all patients with pure radiocarpal dislocation and patients with only a fracture of the tip of the radial styloid process. Group 2 included patients with radiocarpal dislocation and an associated fracture of the radial styloid process that involved more than one-third of the width of the scaphoid fossa. A retrospective review and a clinical evaluation were performed. RESULTS: From 1975 to 1998, we observed twenty-seven cases of radiocarpal dislocation. Four were displaced volarly, and twenty-three were displaced dorsally. Fourteen patients presented with associated lesions. Four patients were treated with closed reduction and immobilization in a plaster cast; five, with percutaneous Kirschner wire fixation and cast immobilization; and two, with an external fixator. Eleven patients had open reduction with Kirschner wire fixation and cast immobilization. The seven patients in Group 1 had a highly unstable injury, and four of the seven patients presented with ulnar translation of the carpus. At the time of follow-up, at an average of 26.8 months, pronation averaged 76 degrees; supination, 66 degrees; wrist flexion, 54 degrees; wrist extension, 54 degrees; radial inclination, 15 degrees; and ulnar inclination, 18 degrees. The average grip strength was 27 kg. Group 2 included twenty patients. Only thirteen, with dorsal dislocation, were evaluated at the time of follow-up, which averaged fifty-one months. At that time, six reported no pain; four, slight pain; and two, moderate pain. Pronation averaged 63 degrees; supination, 76 degrees; wrist flexion, 51 degrees; wrist extension, 56 degrees; radial inclination, 21 degrees; and ulnar inclination, 39 degrees. Grip strength averaged 38 kg. Seven patients had complications. CONCLUSIONS: On the basis of our experience and a review of the literature, we believe that patients with pure radiocarpal dislocation or with radiocarpal dislocation with a fracture of the tip of the radial styloid process should be treated with reattachment of the ligaments through a volar approach. In patients with radiocarpal dislocation and a fracture of the radial styloid process that involves more than one-third of the width of the scaphoid fossa, the ligaments are still attached to the radial fragment. We believe that in this group of patients, exact articular reduction should be performed through a dorsal approach. Additional studies are needed to support these hypotheses.

Adolescent↗
PubMed2001

Consensus statement on transcultural issues in depression and anxiety from the International Consensus Group on Depression and Anxiety.

OBJECTIVE: To provide primary care physicians with a better understanding of transcultural issues in depression and anxiety. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Five faculty invited by the chair also participated: Laurence J. Kirmayer, Jean-Pierre Lepine, Keh-Ming Lin, Osamu Tajima, and Yutaka Ono. EVIDENCE: The consensus statement is based on the 5 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. CONSENSUS PROCESS: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. CONCLUSION: The consensus statement underlines the prevalence of depression and anxiety disorders across all cultures and nations while recognizing that cultural differences exist in symptom presentation and prevalence estimates. In all countries, the recognition of depression by clinicians in the primary care setting is low (generally less than 50%), and the consensus group recommends a 2-step process to aid the recognition and diagnosis of depression. In line with the low recognition of depression and anxiety disorders is the finding that only a small proportion of patients with depression or anxiety are receiving appropriate treatments for their condition. Biological diversity across ethnic groups may account for the differential sensitivity of some groups to psychotropic medication, but this area requires further investigation.

Anxiety Disorders↗
PubMed1994

Multi-dimensional interaction analysis: a collaborative approach to the study of medical discourse.

This paper reviews the conceptual frameworks of several research approaches to the study of medical interactions. Two methods are discussed: process analysis and microanalysis. Adapted from Robert Bales's study of the behavior of small groups, process analysis sorts and tallies such interviewing processes as questioning and informing, achieving analysis of large numbers of interviews at the expense of attention to the content or context of the interview. When used in medical interaction research, process analysis seeks correlation between processes documented in the interview and outcomes of the interview. The methods of conversation analysts and discourse analysts, microanalyses subject medical conversations to close linguistic study and contextualization. This review focuses on the underlying assumptions, generalizability of findings, and the types of subjective judgment applied by the methods. It then describes the Multi-Dimensional Interaction Analysis (MDIA) system, a linguistic analytic instrument that combines features of process analysis and microanalysis to capture content, process, and context of medical conversations. The MDIA's validity and reliability are reported and implications for future research are outlined.

Communication↗
PubMed1995

Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Society of Critical Care Medicine.

OBJECTIVE: The development of practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit (ICU) setting for the purpose of guiding clinical practice. PARTICIPANTS: A task force of more than 40 experts in disciplines related to the use of analgesic and sedative agents in the ICU was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM). EVIDENCE: The task force members provided the personal experience and determined the published literature (MEDLINE articles, textbooks, pharmacopeias, etc.) from which consensus would be sought. Published literature was reviewed and classified into one of four predetermined categories, according to study design and scientific value. CONSENSUS PROCESS: The task force met several times as a whole, and numerous times in smaller groups by teleconference, over a 1-yr period to identify the pertinent literature and arrive at consensus recommendations for the whole task force to discuss. Consideration was given to the relationship between the weight of scientific information and the experts' viewpoints. Over the next year, draft documents were composed by a task force steering committee and debated by the task force members until consensus was reached by nominal group process. The task force draft was then reviewed, assessed, and edited by the Board of Regents of the ACCM. After steering committee approval, the draft document was reviewed and approved by the SCCM Council. DATA SYNTHESIS: To facilitate rapid communication of the six recommendations contained within the complete and unabridged practice parameter document, an executive summary was prepared for publication by the ACCM Board of Regents, and this executive summary was approved by the task force steering committee and the SCCM Executive Council. CONCLUSIONS: A consensus of experts provided six recommendations with supporting data for intravenous analgesia and sedation in the ICU setting: a) morphine sulfate is the preferred analgesic agent for critically ill patients; b) fentanyl is the preferred analgesic agent for critically ill patients with hemodynamic instability, for patients manifesting symptoms of histamine release with morphine, or morphine allergy; c) hydromorphone can serve as an acceptable alternative to morphine; d) midazolam or propofol are the preferred agents only for the short-term (< 24 hrs) treatment of anxiety in the critically ill adult; e) lorazepam is the preferred agent for the prolonged treatment of anxiety in the critically ill adult; f) haloperidol is the preferred agent for the treatment of delirium in the critically ill adult. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.

Adult↗
PubMed1995

Practice parameters for sustained neuromuscular blockade in the adult critically ill patient: an executive summary. Society of Critical Care Medicine.

OBJECTIVE: The development of practice parameters for achieving sustained neuromuscular blockade in the adult critically ill patient for the purpose of guiding clinical practice. PARTICIPANTS: A task force of more than 40 experts in disciplines related to the use of neuromuscular blocking agents in the intensive care unit was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM). EVIDENCE: The task force members provided the personal experience and determined the published literature (MEDLINE articles, textbooks, pharmacopeias, etc.) from which consensus would be sought. Published literature was reviewed and classified into one of four predetermined categories, according to study design and scientific value. CONSENSUS PROCESS: The task force met several times as a whole, and numerous times in smaller groups by teleconference, over a 1-yr period to identify the pertinent literature and arrive at consensus recommendations for the whole task force to discuss. Consideration was given to the relationship between the weight of scientific information and the experts' viewpoints. Over the next year, draft documents were composed by a task force steering committee and debated by the task force members until consensus was reached by nominal group process. The task force draft was then reviewed, assessed, and edited by the Board of Regents of the ACCM. After steering committee approval, the draft document was reviewed and approved by the SCCM Council. DATA SYNTHESIS: To facilitate rapid communication of the three recommendations contained within the complete and unabridged practice parameter document, an executive summary was prepared for publication by the ACCM Board of Regents, and this executive summary was approved by the task force steering committee and the SCCM Executive Council. CONCLUSIONS: A consensus of experts provided three recommendations with supporting data for achieving sustained neuromuscular blockade in critically ill patients: a) pancuronium is the preferred neuromuscular blocking agent for most critically ill patients; b) vecuronium is the preferred neuromuscular blocking agent for those patients with cardiac disease or hemodynamic instability in whom tachycardia may be deleterious; c) patients receiving neuromuscular blocking agents should be appropriately assessed for the degree of blockade that is being sustained. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.

Adult↗
PubMed2003

Quality assurance in human molecular genetics testing: status and recommendations.

OBJECTIVE: The role of genetic testing has expanded with rapidly developing technology and completion of the International Human Genome Project. Development of universally acceptable quality control methods and quality assurance standards trails technology. The principle that high-quality genetic testing is important for public health motivated the Centers for Disease Control and Prevention to formulate ways for improving quality assurance of human molecular genetics testing. PARTICIPANTS: Twenty-eight panelists were chosen based on expertise in molecular genetics testing and knowledge of quality assurance practices. Representatives of professional organizations, industries, and federal agencies participated in one or more of 3 panel meetings. Consensus recommendations were developed by the 15 panelists in the third meeting. EVIDENCE: Evidence was derived from experts' opinion during 3 panel meetings. Data compiled through laboratory visits and literature review were used as reference information. Need for this project was derived from the Final Report of the Task Force on Genetic Testing, produced by the National Institutes of Health and the Department of Energy in 1997, and the Summary Report of the Subcommittee Meeting on Genetics of the Clinical Laboratory Improvement Act Advisory Committee in 1997. CONSENSUS PROCESS: Research and development needs were identified using a participatory visioning approach. A modified nominal group process was used to reach consensus. CONCLUSIONS: Five core consensus recommendations were made: research for developing positive samples for quality assurance purposes, performance evaluation programs supplementing those in existence, establishment and support of laboratory-oriented consortia, establishment of a laboratory-focused database, and support of molecular genetics training programs.

Centers for Disease Control and Prevention, U.S.↗
PubMed1998

[Not Available].

Are there, besides the unique and outstandingly creative personality of S.H. Foulkes specific roots in contemporary thinking of his early days? The author shows important stimulations Foulkes received from gestalt theory and traces back some of its central positions to Hegel's argument against cartesian and empiristic views. Foulkes' orignal adaptation of gestalt statements to group processes is discussed in the following part of this paper. Having "the whole" of the group and the individual in balance, the author shows how not to slip into any holistic mystification of the group, how to remain in a continuous interchange between matrix view and personal aspects. In this context, a supervision situation of inpatient psychiatric treatment is discussed.

History, 20th Century↗