Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Acceptance Process”

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 667 records · Page 37Linked to original sources
PubMed2006

The acceptability and impact of a randomised controlled trial of welfare rights advice accessed via primary health care: qualitative study.

BACKGROUND: Qualitative research is increasingly used alongside randomised controlled trials (RCTs) to study a range of factors including participants' experiences of a trial. The need for a sound evidence base within public health will increase the need for RCTs of non-clinical interventions. Welfare rights advice has been proposed as an intervention with potential to reduce health inequalities. This qualitative study, nested within an RCT of the impact of welfare rights advice, examined the acceptability of the intervention, the acceptability of the research process and the perceived impact of the intervention. METHODS: 25 men and women aged 60 years or over were recruited from four general practices in Newcastle upon Tyne (UK), a sub-sample of those who consented to be contacted (n = 96) during the RCT baseline interview. Semi-structured interviews were undertaken and analysed using the Framework Method. RESULTS: Participants viewed the trial positively although, despite agreeing that the information leaflet was clear, some had agreed to participate without being fully aware of what was involved. Some participants were unaware of the implications of randomisation. Most thought it fair, but a few concerns were raised about the control condition. The intervention was acceptable and made participants feel confident about applying for benefit entitlements. 14 out of 25 participants received some financial award; median weekly income gain was pounds 57 (Euro 84, dollar 101). The perceived impact of additional finances was considerable and included: increased affordability of necessities and occasional expenses; increased capacity to deal with emergencies; and a reduction in stress related to financial worries. Overall, perceived independence and ability to participate in society increased. Most participants perceived benefits to their mental well-being, but no-one reported an improvement in physical health. The RCT showed little or no effect on a wide range of outcome measures. CONCLUSION: Participation in the trial and the intervention was acceptable to participants. Welfare rights advice targeted at people aged 60 years or over and accessed via primary care had a positive impact on quality of life and resulted in increased social participation. The divergence of qualitative and quantitative findings suggests that both methods make important contributions to the evaluation of complex social interventions.

Aged↗
PubMed2004

Psychology of group relations: cultural and social dimensions.

Cross-cultural psychology attempts to understand the development and expression of human behavior in relation to the cultural contexts in which it occurs. It adopts the perspective of "universalism," which assumes that all human beings share basic psychological processes, but which are then shaped by cultural influences. This perspective allows for the comparison of individuals from different cultures (based on the process commonality), but also accepts behavioral variability (based on the cultural shaping). In the case of behavior that takes place during interactions between individuals coming from two (or more) cultures, the task is more complex; we now need to understand at least two sets of culture-behavior phenomena, as well as a third set--those that arise at the intersection of their relationships. In cross-cultural psychology, we have adopted concepts and methods from sociology and political science to inform work on "ethnic relations," and from cultural anthropology we have been informed in our work on the process and outcomes of "acculturation." In the former domain are phenomena such as prejudice and discrimination; in the latter are the strategies people use when in daily contact with people from other cultures (such as assimilation, integration, separation, and marginalization). These phenomena take place in cultural contexts, which need to be understood in terms of the core dimensions of cultural difference (such as diversity, equality, and conformity). During prolonged and intimate contact between persons of different cultural backgrounds, all these psychological concepts and processes, and cultural influences need to be taken into account when selecting, training, and monitoring individuals during their intercultural interactions.

Acculturation↗
PubMed2005

Transforming the obstetric nursing workforce in NE Brazil through international collaboration.

AIMS: This paper seeks to analyse the content, people and process of transformational change to introduce new ways of working for specialized obstetric nurses in northeast Brazil, and identify the lessons learned. BACKGROUND: Countries across the globe are beginning to focus on improving the nursing workforce through new ways of working. High numbers of caesarean sections coupled with high indices of maternal mortality in northeast Brazil prompted the introduction of a British Council Higher Education Links scheme to work collaboratively to transform the role of the specialist obstetric nurse and introduce the principles of Safe Motherhood. The concept of a normal birth had not been widely accepted, with the birth process viewed as a medical condition requiring pharmaco-therapeutic interventions rather than as a natural process. METHOD: Between 2000 and 2003, a more woman-centred approach to childbirth was introduced through the local delivery of two in-house education programmes and the qualification of 38 nurse-midwives. DISCUSSION: In spite of its slow progress, the success of the Higher Education collaboration has been recognized nationally, a new philosophy is guiding practice and new ways of working have been established. CONCLUSION: Lessons learned include the need to set achievable goals (content), respond to the emotional needs of those involved in the change (people) and make best use of reciprocal visits to rally the teams and sustain the focus for change (process). Although the Higher Education link is complete, funds are being sought for formal evaluation and dissemination. Overall, the process and outcomes of this collaboration suggest that to embrace such an opportunity to learn from each other can lead to real improvements in service and the lives of women.

Attitude of Health Personnel↗
PubMed2004

[Survival of breast cancer patients treated with inhibitors of the aromatase vs tamoxifen].

BACKGROUND: In Mexico the breast cancer occupies the second place as cause of death by oncological illness and the etiology is considered multifactorial. The systemic treatment of this cancer is necessarily after the surgery and simultaneously when radiotherapy is used; therefore the recent introduction of newly non toxics and efficient antiestrogens which block the effect of estrogens from circulation have become drugs of first line in the metastasis illness. OBJECTIVE: To compare the clinical evolution and the survival of patients with locally advanced breast cancer and metastasis with the use of two therapeutic modalities. MATERIAL AND METHODS: Under informed consent 20 patients with diagnosis of breast cancer and out of oncological therapeutic processing were included. Randomly an inhibitor of the aromatase (anastrozole, 1 mg for day) was used in 10 patients and in the other 10 patients tamoxifen (20 mg for day) both for 2 years, subject to verification of positive estrogens-progesterone receptors. RESULTS: Half of the patients of each group had a clinical stage III. The most frequent histological diagnosis was the ductal carcinoma in 70% of the group with tamoxifen use, while in anastrozole group was 90%; the mastectomy prior to the tamoxifen was carried out in 60% of the patients and in 50% of the group with anastrozole. The acceptable response to the processing in the patients with tamoxifen was complete in the 60% of the cases, but with the use of anastrozole was 80%; survival in the group with anastrozole was of 100% in two years of follow up, while in women that received tamoxifen the survival was 90% (p<0.001). CONCLUSIONS: The use of anastrozole improved the survival as well as the quality of life, showing no side effects in this group of patients.

Anastrozole↗
PubMed2003

Collaborative referencing between individuals with aphasia and routine communication partners.

H. H. Clark (1992) argues that successful referencing depends on speakers and listeners working together to establish shared perspectives on target objects. In his collaborative referencing model, he identifies 3 phases in the referencing process: initiation, refashioning, and acceptance. For referencing tasks, successful collaboration can be seen in the streamlining of referencing expressions and in the decrease of overt collaborative effort across trials. Although previous studies have shown that speakers with aphasia can be successful on referencing tasks, they have not examined how that success is achieved through the collaborative work of the partners. Using a referencing task adapted from H. H. Clark and D. Wilkes-Gibbs (1986), this study examined how 4 adults with moderate-to-severe aphasia collaborated with routine communication partners (spouses or children). Overall, these pairs completed the referencing task trials with 96% accuracy and displayed referencing processes that generally conformed to Clark's collaborative referencing model. Close analysis of the discourse of these interactions revealed patterns of collaboration that went beyond Clark's model-the pairs used diverse verbal and nonverbal resources, actively negotiated the task across trials, and layered their own personal goals and perspectives onto these interactions. This study highlights the plasticity of functional communication (the diversity of ways the pairs worked together to complete the same task) and points to the importance of understanding processes of tacit learning that take place in social interactions.

Adolescent↗
PubMed2007

Dynamics of hospital-based plastic surgery.

BACKGROUND: Legislative regulations, decreasing reimbursements for office procedures, and malpractice premiums have transformed plastic surgery from an office-based specialty into a hospital-based one. Simultaneously, hospital economics has altered, wherein the "business model" has all but subsumed the old "medical care" model. Integration between plastic surgeons and the new hospital structure has been difficult for both. Limited understanding of the financial dynamics of hospital-based practices, unfamiliarity with the administrative processes, and resistance to accept and assimilate changes by both sides pose hurdles, in some situations even forcing plastic surgeons out of hospital settings. METHODS: Using well-defined financial terminology, changing national development in health care policy, and hospital-based administrative strategies as a backdrop, this study finds common ground for the plastic surgery specialty to coapt with the hospital. RESULTS: Key missing elements in the interaction between plastic surgeons and hospital administrations and ways of integrating these components are identified. To do so effectively, plastic surgeons must first understand the basic tenets of management that drive hospital administrators, participate at every level they can in guiding these processes, and assume leadership roles that will ultimately dictate the way they work and conduct their professional lives. CONCLUSIONS: It is critical that plastic surgeons engage in important processes that govern the economics of hospital-based health care delivery. This commitment will also ensure that all three groups (the patients, physicians, and hospital administrators) achieve a degree of satisfaction. The message to plastic surgeons is clear: be proactive and lead a campaign of change.

Financial Management, Hospital↗
PubMed1988

Heavy metals removal from anaerobically digested sludge by chemical and microbiological methods.

The metal removal from anaerobically digested sludge was studied by chemical treatment and microbial leaching processes in laboratory reactors. The removal of metals increased with decreased sludge solid concentration and pH. In the acid treatment process, a pH of 1.5 was required to reduce the copper concentration in the sludge to an acceptable level. In the microbial processes mixed culture gave 10% better solubilisation of metals than in single culture. The acid requirement was lower for the microbial process. The cost of sludge treatment in terms of chemicals was found to be decreased by 80% in microbial leaching.

Journal Article↗
PubMed2006

Accommodating space, time and randomness in network simulation.

Interest in the possibility of dynamically simulating complex cellular processes has escalated markedly in recent years. This interest has been fuelled by three factors: the generally accepted value in understanding living processes as integrated systems; the dramatic increase in computational capability; and the availability of new or improved technology for making the quantitative measurements that are needed to drive and validate cellular simulations. Between the extremes of atom-scale and organism-scale simulation is a vast middle-ground requiring simulation strategies that are capable of dealing with a range of spatial, temporal and molecular abundance scales that are crucial for a comprehensive understanding of integrative cell biology. Although at an early stage, methodological improvements and the development of computational platforms provide some hope that simulations will emerge that can bridge the gap between network models and the true operation of the cell as a complex machine.

Animals↗
PubMed2002

A new process for converting SO2 to sulfur without generating secondary pollutants through reactions involving CaS and CaSO4.

Nonferrous smelters and coal gasification processes generate environmentally harmful sulfur dioxide streams, most of which are treated to produce sulfuric acid with the accompanying problems of market shortage and transportation difficulties. Some sulfur dioxide streams are scrubbed with an alkali solution or a solid substance such as limestone or dolomite, which in turn generates wastes that pose other pollution problems. While the conversion of sulfur dioxide to elemental sulfur has many environmental advantages, no processes exist that are environmentally acceptable and economically viable. A new method for converting sulfur dioxide to elemental sulfur by a cyclic process involving calcium sulfide and calcium sulfate without generating solid wastes has been developed. In this process, calcium sulfate pellets as the starting raw material are reduced by a suitable reducing agent such as hydrogen to produce calcium sulfide pellets, which are used to reduce sulfur dioxide producing elemental sulfur vapor and calcium sulfate. The latter is then reduced to regenerate calcium sulfide. Thermodynamic analysis and experimental results indicated that the CaS-SO2 reaction produces mainly sulfur vapor and solid calcium sulfate and that the gaseous product from the CaSO4-H2 reaction is mainly water vapor. The rates of the two reactions are reasonably rapid in the temperature range 1000-1100 K, and, importantly, the physical strengths and reactivities of the pellets are maintained largely unchanged up to the tenth cycle, the last cycle tested in this work. Sulfur dioxide-containing streams from certain sources, such as the regenerator off-gas from an integrated gasification combined cycle desulfurization unit and new sulfide smelting plants, contain much higher partial pressures of SO2. In these cases, the rate of the first reaction is expected to be proportionally higher than in the test conditions reported in this paper.

Air Pollutants↗
PubMed1988

The enhancement of radiographic images from a multiwire camera using a maximum entropy algorithm.

The multiwire camera (MWC) produces high speed, quantitative autoradiography of radiolabelled substances in two-dimensional systems. While greatly superior to film-based systems in respect of speed and quantitativity the MWC has significantly poorer spatial resolution (particularly for high energy beta-emitting radiolabels) and the performance is ultimately limited by the noise induced in the images by Poisson statistics and counter background. Processing the MWC images with a maximum entropy algorithm significantly improves the performance of the system in these respects. The algorithm has been tested using one-dimensional data taken from images of known tritium, 14C and 125I distributions. Processed images are visually more acceptable with improved quantitative accuracy and spatial resolution. Quantitative accuracy, calculated as the root mean square deviation between an image and the known sample activities, is 10-40% lower for processed images compared with original camera images. Spatial resolution, calculated from slopes in the images representing edges of activity in the sources, is improved by 20-40% for the processed images. The algorithm is used to improve a two-dimensional image from a biological study. The source distribution consisted of a set of circular dots of varying activity. The dots with lowest activity were barely discernible in the raw MWC image but are clearly resolved after processing. The algorithm used is simple and effective and executes acceptably quickly on a personal computer. It should prove useful in any context where the imaging performance of a system is limited by Poisson statistics.

Algorithms↗
PubMed2003

Top-level modeling of an ALS system utilizing object-oriented techniques.

The possible configuration of an Advanced Life Support (ALS) System capable of supporting human life for long-term space missions continues to evolve as researchers investigate potential technologies and configurations. To facilitate the decision process the development of acceptable, flexible, and dynamic mathematical computer modeling tools capable of system level analysis is desirable. Object-oriented techniques have been adopted to develop a dynamic top-level model of an ALS system. This approach has several advantages; among these, object-oriented abstractions of systems are inherently modular in architecture. Thus, models can initially be somewhat simplistic, while allowing for adjustments and improvements. In addition, by coding the model in Java, the model can be implemented via the World Wide Web, greatly encouraging the utilization of the model. Systems analysis is further enabled with the utilization of a readily available backend database containing information supporting the model. The subsystem models of the ALS system model include Crew, Biomass Production, Waste Processing and Resource Recovery, Food Processing and Nutrition, and the Interconnecting Space. Each subsystem model and an overall model have been developed. Presented here is the procedure utilized to develop the modeling tool, the vision of the modeling tool, and the current focus for each of the subsystem models.

Astronauts↗
PubMedDate not supplied

Cell death and cell proliferation in the control of normal and neoplastic tissue growth.

The development of reliable methodology for the assessment of rates of cell replication and cell death has enabled the study of how these 2 fundamentally opposed processes work to form and maintain tissue and to remodel tissue following diseases resulting in cell loss. The balance between these 2 processes and the consequences of an imbalance are fundamental to a clearer understanding of how hyperplasia and neoplasia develop in tissues under the influence of chemicals and drugs. An understanding of the changes that occur in target organs and tissues following chemical or drug exposure has enabled a better understanding of the mechanism by which these chemicals are able to induce cancer after prolonged exposure. Studies of the control of cell replication and the changes that occur following drug exposure have defined 2 types of response, 1 in which the cell replicative response is sustained and the other in which the cell replicative response is transient and occurs during the first few days of exposure. Although regulatory and scientific opinion appears ready to accept sustained cell replicative processes as an increased risk factor in the development of cancer, the role played by transient increases in cell replication remains unclear. Concurrent events in target organs following treatment with chemicals that induce transient increases in cell replication have revealed that the rates of apoptosis are suppressed at the same time as the cell replication levels are induced. Additional evidence suggests that growth and antigrowth factors are central in controlling these responses. Escape from the regulatory action of these factors is postulated to be one of the ways in which nongenotoxic carcinogenic chemicals, such as the peroxisome proliferators and sodium phenobarbitone, may induce cancer, with apoptosis playing a key role in the process.

Animals↗
PubMed2001

Death at home following a targeted advance-care planning process at home: the kitchen table discussion.

OBJECTIVE: To determine whether home health agency patients' preferences to die at home can be honored following a structured, professionally facilitated advance-care planning (ACP) process provided in the home. DESIGN: A case series of patients who were identified by their home health agency nurses as having a life-limiting illness and then referred for social service assessment, followed for at least 6 months, with median follow-up of 191 days. SETTING: A large, urban, home health agency owned by a not-for-profit integrated healthcare system. PARTICIPANTS: Eighty-four adult patients (median age 75, range 37-94) receiving home care services other than hospice. INTERVENTION: Formally structured social work visits at patients' homes to discuss end-of-life issues, with communication of results to home health nurses and attending physicians. Social workers performed standard psychosocial assessments, obtained patient and family preferences regarding end-of-life care, and provided education about hospice services. MEASUREMENTS: Acceptance of the ACP process, preferences for location of end-of-life care, location of care at the end of life, adequacy of timing of intervention as measured by length of life after ACP, and use of hospice services. RESULTS: Eighty-three of 84 participants (99%) were willing to complete an ACP process in the home setting. Of the 54 patients expressing a clear preference for location of end-of-life care, 46 (82%) wanted this care to be at home. Thirty-nine (46%) of the participants died within 90 days of ACP; 58 (69%) died by the end of the study. Forty-three (75%) of these deaths occurred at home or in a hospice residence. Fifty-one (61%) patients used home, residential, or nursing home-based hospice services during the study. CONCLUSION: In this series of seriously ill home health patients, most preferred to die at home and virtually all were willing to participate in a home-based ACP process. Facilitating ACP among such patients and their families was associated with end-of-life care at home. Use of hospice services was common following ACP in this population.

Adult↗
PubMed1986

T-cell antigen-receptor genes in autoimmune mice.

The developmental patterns of rearrangement and expression of the T-cell antigen-receptor genes are precisely regulated during T-cell differentiation and education. The beta- and gamma-subunit RNAs of the T-cell receptor are abundantly expressed in immature thymocytes. In mature thymocytes the alpha- and beta-subunit RNAs are preferentially expressed, whereas there is minimal expression of the gamma RNA. Although aspects of the pattern of known organization and rearrangement of the T-cell receptor gene in the thymus have been studied and the concept of a thymus selection process generally has been accepted, the cellular and molecular basis of thymus education remains obscure. Certain strains of mice with predilections for autoimmunity demonstrate T-cell developmental abnormalities. This is especially true for the lpr/lpr or gld/gld genotypes, in which the major population of peripheral T cells is developmentally disturbed. We have studied the development, expression, and rearrangement of T-cell receptor genes in the C3H/HeJ gld/gld mouse. Our results indicate a high level of expression of the beta and alpha RNAs in C3H/HeJ gld/gld T cells residing in the periphery. In addition, the beta-subunit gene of gld/gld peripheral T cells undergoes more rearrangements than does its normal C3H/HeJ T-cell counterparts. We speculate that this rearrangement pattern and high level of T-cell receptor mRNA reflects an abnormality or deficit in a thymus selection process that permits emigration of T cells with nonfunctionally rearranged T-cell receptor genes to secondary lymphoid organs. However, the normal level of gamma-subunit RNA expression argues that gamma-subunit gene rearrangements are distinct from processes related to alpha- and beta-subunit selection.

Animals↗
PubMedDate not supplied

A trial of structured implicit review of randomly selected peer review organization cases.

OBJECTIVE: In order to learn more about peer review's acceptability, efficiency, and reliability, we performed structured implicit review with and without use of a structured case review form on a random selection of peer review organization cases. METHODS: We compared the results between methods and with previously obtained review results. Twenty-five charts with physician review completed during the Health Care Financing Administration's Third Scope of Work were randomly selected for rereview. Eight physician advisors, none of whom had seen any of these charts previously, were divided into two groups. Both groups received identical formal instruction in the structured implicit review method. Half of the physicians used a structured review form when performing chart review. The other half did not use this form but completed their reviews using the previously used reporting form. Participating physicians were instructed in the structured review method as described by Rand Corporation. The review process was examined regarding acceptability and efficiency. Review results were analyzed for reliability regarding identification of adverse and potential adverse effects and identification of the source of quality concerns. RESULTS: Instructions regarding structured implicit review methods were understood easily and accepted by physician advisors. Use of the structured review form was less efficient, averaging 50% longer per review. There was no difference in the rate at which adverse events were detected. Potentially serious adverse events were found less often using structured review than in the original review. There was greater agreement among reviewers using the structured form than among those using the historic worksheet, but structured review using the Rand form identified fewer potentially significant adverse events than did the reviewers using the historic worksheets. CONCLUSIONS: Application of structured implicit review methods is clearly feasible for peer review organization case review. Use of a simple worksheet was more time efficient than use of a highly structured form. There was not only less variation in review results but also identification of fewer potentially significant adverse events when the highly structured form was used. Teaching the structured approach to chart review may be more important to obtaining good results than using a structured review form.

Efficiency, Organizational↗
PubMed2002

Structural versus outcomes measures in hospitals: a comparison of Joint Commission and Medicare outcomes scores in hospitals.

Outcomes performance measures are increasingly important in health care. The Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) continues to rely on structure and process measures based on accepted good practice. One of the first tasks in moving to a more outcomes-oriented approach is to compare the two measurement approaches. This article compares seven non-federal general hospital performance measures derived from Medicare against Joint Commission scores. Joint Commission measures are generally not correlated with outcome measures. The few significant correlations that appear are often counterintuitive. We conclude that a potentially serious disjuncture exists between the outcomes measures and Joint Commission evaluations.

Accreditation↗
PubMed2004

Preparation of PLGA microparticles by an emulsion-extraction process using glycofurol as polymer solvent.

PURPOSE: To develop biodegradable poly(lactic-co-glycolic acid) (PLGA) microparticles prepared by an original emulsion-extraction process, with glycofurol, a nontoxic excipient, as polymer solvent. METHODS: The preparation of microparticles consisted in dissolving polymer in glycofurol. This solution was emulsified in a vegetable oil, and then amphiphilic agent was added into the emulsion to extract glycofurol and lead to microparticle formation. Physicochemical studies were carried out, and an experimental design was prepared in order to elucidate the impact of the formulation composition on the microparticle characteristics. Finally, encapsulation tests were made with a model protein. RESULTS: In a ternary diagram, a small feasibility area allowing particle formation was located. The resulting microparticles were spherical with a homogeneous, polymeric matrix structure. They exhibited a variable size from 3 to 15 microm, which was controlled by the different formulation parameters. Differential scanning calorimetry (DSC) analysis made it possible to detect their composition. Preliminary results showed that these particles were able to encapsulate a protein model, lysozyme. CONCLUSIONS: This simple and convenient technique enabled us to obtain spherical, biodegradable microparticles from acceptable excipients. Moreover, the process conditions made possible the encapsulation of drugs, including proteins.

Emulsions↗
PubMed1997

The risks of disease transmission by embryo transfer in cattle.

Guidelines for the safe international movement of livestock embryos are provided in the International Animal Health Code of the Office International des Epizooties, and recommendations for embryo processing, based on numerous research papers on embryo-pathogen interaction studies, are given in the Manual of the International Embryo Transfer Society. Risk assessment is the logical extension of these approaches, since it provides veterinary authorities with a complete package of information on which to base their import/export decisions. Risk assessment includes evaluation of disease prevalence, effectiveness of Veterinary Services and competence of the embryo collection team. It also takes account of the epidemiology and pathogenesis of the disease concerned. The application of risk assessment for embryo movement is illustrated in this paper by comparisons of the probabilities of transmitting foot and mouth disease, bluetongue and vesicular stomatitis by bovine embryos. The risk scenario pathway was divided into three phases for analysis. The first phase deals with the potential for embryo contamination, which depends on the disease situation in the exporting region, the health status of donor herds and donor cows, and on the pathogenetic properties of the disease agent. The second phase covers risk mitigation by use of the internationally accepted standards for embryo processing, and the third phase considers the risk reductions resulting from post-collection surveillance of donors and donor herds, and also from testing of embryo-collection (flushing) fluids for the disease agent. It was evident from this assessment that low risks of transmitting disease by international movement of bovine embryos depend initially on a low disease incidence in the exporting region and on easily recognisable disease signs. Competent embryo processing was also of great importance, and in the case of bluetongue, vector ecology had a major influence. In addition to providing a logical basis for import/export decisions, risk assessment is useful for evaluating the potential outcome of new research and for assessing the safety of the movement of embryos of other species for which little or no research information is available on embryo-pathogen interactions.

Animals↗