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At least 667 records · Page 37Linked to original sources
PubMedDate not supplied

Diabetes management during glucocorticoid therapy for nonendocrine disease.

OBJECTIVE: To determine current attitudes about management of diabetes during glucocorticoid therapy for nonendocrine disease, as assessed by a pilot survey. METHODS: A 27-item questionnaire was designed to determine areas of consensus and of disagreement on diabetes management during glucocorticoid therapy for nonendocrine disease and was mailed to 84 Chicago-area academic general internists, endocrinologists, pulmonologists or allergists, rheumatologists, and certified diabetes nurse-educators. RESULTS: The response rate was 55%. For new-onset "steroid diabetes," 43% of respondents agreed with use of insulin and 44% with use of sulfonylurea therapy. Respondents indicated 91 to 95% agreement on the desirability of self-monitoring of blood glucose on initiation of glucocorticoid therapy. For a fasting plasma venous glucose level of 150 mg/dL at the time of initiation of long-term glucocorticoid therapy, 54% of respondents disagreed with immediate increase of insulin in the case of a patient already taking insulin, and 80% disagreed with immediate substitution of insulin in the case of a patient on maximal glyburide therapy (P = 0.0053 for mean change of position). During tapering of glucocorticoid therapy, 75% of respondents approved close observation without immediate insulin reduction. Two anticipatory management plans, opposed by 54% and 45% of respondents, respectively, elicited strongly correlated attitudes: immediate increase of NPH insulin dosage during initiation of glucocorticoid therapy and immediate reduction of NPH insulin dose during tapering of glucocorticoids (r = 0.6296; P<0.0001). Finally, 78% perceived a paucity of objective information about diabetes management during glucocorticoid therapy for nonendocrine disease. CONCLUSION: The surveyed sample of practitioners reported a paucity of objective data about management of diabetes during glucocorticoid therapy for nonendocrine disease and conservatism in adjusting diabetes management during initiation and tapering of glucocorticoid therapy.

Journal Article↗
PubMed1999

Do students' attitudes toward women change during medical school?

BACKGROUND: Medical school has historically reinforced traditional views of women. This cohort study follows implementation of a revitalized curriculum and examines students' attitudes toward women on entry into an Ontario medical school, and 3 years later. METHODS: Of the 75 students entering first year at Queen's University medical school 70 completed the initial survey in September 1994 and 54 were resurveyed in May 1997. First-year students at 2 other Ontario medical schools were also surveyed in 1994, and these 166 respondents formed a comparison group. Changes in responses to statements about sex-role stereotypes, willingness to control decision-making of female patients, and conceptualization of women as "other" or "abnormal" because they are women were examined. Responses from the comparison group were used to indicate whether the Queen's group was representative. RESULTS: Attitudinal differences between the primary group and the comparison group were not significant. After 3 years of medical education students were somewhat less accepting of sex-role stereotypes and less controlling in the doctor-patient encounter. They continued, however, to equate adults with men and to see women as "not adult" or "other." Female students began and remained somewhat more open-minded in all areas studied. INTERPRETATION: A predicted trend toward conservatism was not seen as students became older, more aware and closer to completion of medical training, although they continued to equate adults with male and to see women as "other." Findings may validate new curricular approaches and increased attention to gender issues in the academic environment.

Adult↗
PubMed1979

How the AHA meets the challenge of change.

The American Hospital Association and its member institutions have always adapted, and must continue to adapt, to change. Socioeconomic developments that must be reckoned with include the energy crisis, an economic recession, and the growth of consumer consciousness. Political developments include the growing similarity of the two major political parties, increased fiscal conservatism, and an antigovernment mood.

American Hospital Association↗
PubMedDate not supplied

[Electrophoretic study of liver histones in the postnatal ontogeny of white rats: the effect of testosterone propionate and gonadectomy].

By means of polyacrylamide gel disc electrophoresis heterogeneity, electrophoretic mobility and relative content of different fractions of histones in nuclei of liver cells were studied in gonadectomized Wistar rats and in castrated in intact animals, administered with testosteone propionate. In all the experiments a significant conservatism of histone proteins was found in postnatal development. In animals, treated with the endocrine preparations, the age peculiarities were shown to reflect the quanitative proportion of different histone fractions.

Age Factors↗
PubMedDate not supplied

Refocusing the hospital/physician relationship. It's time for physicians to share the risk.

Market forces are destroying the traditional hospital/physician relationship and replacing it with something far better suited to a price-sensitive environment marked by severe excess capacity. Many hospitals are exploring ways to alter a hospital/physician relationship that has survived--more of less unchanged--for nearly 70 years. Managing change of this magnitude is a difficult task and many hospital/physician communities have been seriously divided by resulting conflicts. On the other hand, a price competitive environment frequently rewards innovation and leadership and penalizes conservatism. Charting a course in these troubled waters is a challenge for healthcare executives, but if we are successful in managing this change, our facilities, our communities and our patients will benefit.

Economic Competition↗
PubMedDate not supplied

Achieving population health goals: perspectives on measurement and implementation from Australia.

Health goals and targets have been widely used to indicate strategic direction and priority for health improvement on a population basis. This paper provides an overview of Australia's experience in using health targets and considers the relevance of this experience for Canada. It gives special attention to the challenge of developing a broadly based set of targets that reflect the social, economic and environmental determinants of health alongside more traditional measures of health status. It examines how the technical challenge of measurement, the bureaucratic barriers between government departments, and the political conservatism inherent in federal systems of government present formidable barriers to effective action on comprehensive national health targets. The paper concludes with a reminder of the need for inter-sectorial action to address the determinants of health. Based on the Australian experience, it suggests for Canada an ideal combination of a national population health framework to guide direction and priority, to be implemented through action at a more local level, through well-defined partnerships.

Australia↗
PubMed2000

Laser treatment of pigmented lesions.

Lasers are powerful tools in the treatment of benign pigmented lesions. Their role in the treatment of pigmented lesions other than those which are benign has not been defined. As with other ablative treatments, avoidance of lesions with malignant potential is essential. The wise adage First do no harm applies. By presenting the patient with a realistic goal and expectations, as well as discussing alternatives, limitations and risks, an informed decision for laser treatment can be made. Care and conservatism protect both the patient and the integrity of the laser surgeon.

Guidelines as Topic↗
PubMed2000

Structural and functional characterization of insulin receptor substrate proteins and the molecular mechanisms of their interaction with insulin superfamily tyrosine kinase receptors and effector proteins.

The literature data on the role of IRS1/IRS2 proteins, endogenous substrates for insulin receptor tyrosine kinase, in transduction of signals generated by insulin superfamily peptides (insulin, insulin-like growth factor) were analyzed. The molecular mechanisms of the functional coupling of IRS proteins with peptide receptors possessing a tyrosine kinase activity and SH2 domain-containing proteins (phosphatidylinositol 3-kinase, Grb2 adaptor protein, protein phosphotyrosine phosphatase) were discussed. The structural and functional properties of IRS proteins (distribution of functional domains and sites for tyrosine phosphorylation; conservatism of amino acid sequences) were characterized. The data on the alternative pathways of transduction of signals which are generated by insulin and related peptides and do not involve IRS proteins were analyzed. These pathways are realized through Shc proteins or via direct interaction between receptors and SH2 proteins. Amino acid sequences of IRS proteins and insulin superfamily tyrosine kinase receptors were compared. The homologous regions in IRS proteins and receptors, which can be responsible for their coupling with phosphatidylinositol 3-kinase and protein phosphotyrosine phosphatases, were identified.

Amino Acid Sequence↗
PubMed2000

Air transport of passengers of advanced gestational age.

Many airlines and defense forces have policies relating to the routine air transport of pregnant females in advanced stages of gestation. These vary, but on average flying is discouraged once gestational age reaches 32 to 38 wk. These recommendations probably evolved out of historical conservatism and anecdotal inflight events. Review of the literature and the basic physiology involved suggests that air transport, both rotary wing and fixed wing, does not predispose to either an increase in or acceleration of obstetric events. In fact, the literature strongly suggests that air transport is frequently extremely valuable in obstetric emergencies, and has no impact in advanced uncomplicated pregnancy. It is concluded that obstetric cases can be safely transported at any gestational age.

Adult↗
PubMed1975

Some problems and potentialities of present-day psychoanalysis.

In a critical review of the current historical situation of psychoanalysis and its unique problems, the author considers a variety of specific but interacting factors. The potentialities for advance as therapy and science, their interrelationship, and the possible channels for such advance are examined. The social, clinical, and scientific importance of derivative 'psychotherapies' and of rationally flexible boundaries of 'indication' are discussed. As differentiated from rational conservatism, the phenomenon of analysts' irrational resistance to potential change in basic tenets of technique or theory is held to be a critically formidable impediment to the further development of psychoanalysis.

Attitude of Health Personnel↗
PubMed2000

[The precautionary principle and the obligation of medical action].

Since Antiquity, medicine has been based upon the principle of prudence. In recent years, the principle of precaution has stolen over the medical conscience and has especially been forced on doctors under pressure from a Society searching for a new Holy Grail; the utopia of zero risk and the fear for magical power of an omnipotent medicine. The principle of precaution should be capable of warding off all these evils of techno-scientific progress applied to Health. Thus, in a few years, a new norm has established itself first for the environment but which has today extended to the domain of medical decisions. It is essential that the medical authorities attract the attention of politics and of the judiciary to the dangers of blindly transposing the principle of precaution in ecology to the world of medicine. The risks of deviation are numerous, the eventual perverse effects would be detrimental to patients and health security would be endangered by paralysis and conservatism. Medicine is neither the Art of Curing nor the Art of not Harming, ... it is the Art of Caring! ...

Defensive Medicine↗
PubMed2000

Some dilemmas of master's level nurse education.

Despite an increase in the growth of master's level provision for qualified nurses in the United Kingdom uncertainty exists regarding the characteristics of master's level performance in respect of professional practice. This paper presents selected findings from a multidisciplinary study that sought to examine the characteristics of master's level performance in health professional courses that had an expressed practice orientation. It focuses specifically on dilemmas nurse educators encountered in relation to British master's level nurse education. Following an initial pilot stage involving focus group interviews with separate groups of nurses, occupational therapists and physiotherapists, an interview agenda was developed to explore participants' perspectives of the characteristics of master's level performance. Individual in-depth interviews were undertaken with a purposive sample of 18 nurse educators drawn from eight universities in England. Interview transcripts were coded and thematically analysed. Six kinds of dilemma emerged from the interviews. These were breadth vs. depth in the conceptualization of master's level for nursing, relevance to practice vs. academic detachment, facilitating creative thinking vs. reinforcing rigidity, encouraging or suppressing different modes of critical thinking, postgraduate nurses as loyal change agents vs. the problem of well-qualified mavericks, and professional experience as facilitating or hindering master's level performance. These dilemmas raise important questions about course design and the role of stakeholders in determining curriculum content. Moreover, a pervasive tension between a utilitarian emphasis on the application and utility of knowledge on one hand, and aspirations to promote creativity and critical thinking which look to alternative possibilities on the other hand, suggests that nurse educators exercise a degree of conservatism in relation to master's level. It is concluded that this apparent quest to maintain a safe variant of the status quo as the best way of promoting the wellbeing of patients should be subject to profound questioning.

Attitude of Health Personnel↗
PubMed2001

Body composition in women with sickle cell disease.

INTRODUCTION: Adults with sickle cell disease (SCD) have increased morbidity and low perceived health status, similar to patients with other chronic conditions. These patients may be sedentary due to exercise intolerance, physical incapacity due to sickle cell-related complications or medical conservatism. Obesity is an indicator of low health status and overall well-being in the general population, and we hypothesize that adults with SCD will have a high total body fat (%BF). The purpose of this study was to assess body composition in women with SCD using dual-energy X-ray absorptiometry (DXA). METHODS: Baseline medical examination, laboratory assessments, and seven-day activity recall to estimate energy expenditure (EE) were obtained for 22 women with SCD. BMI was calculated and whole body DXA was performed [fat mass (FM), fat-free soft tissue (FFST), and bone mineral content (BMC)]. Descriptive statistics were obtained and associations between body composition indices, total hemoglobin (Hb), treatment with hydroxyurea (HU), and EE were determined. RESULTS: Patient age was 30.5+/-9.3 years and total Hb was 8.85+/-1.92 g/dL (mean+/-SD). Mean body mass index (BMI) (22.6 kg/m2) was in the 'acceptable' range, while DXA measurement of mean % fat (32.6%) indicated obesity. Fat-free mass (FFM) was 40.0+/-5.62 and bone mineral density (BMD) was 1.13+/-0.14 g/cm2 (mean+/-SD). There were no correlations between body composition indices and total Hb, HU, or EE. CONCLUSIONS: This is the first report of high levels of adiposity, low FFM, and low BMD in normal weight women with SCD. The findings were not affected by total Hb, EE, HU. Further studies are needed to better define body composition, body composition determinants, and their impact on overall health status in adults with SCD.

Absorptiometry, Photon↗
PubMed1979

Deciphering deinstitutionalization: complexities in policy and program analysis.

Deinstitutionalization as a public policy promised to be a major departure from previous psychiatric practice. Decrying traditional "medical paradigms" and the custodial "warehousing" of mental patients, policy makers advanced a "bold new approach" for care in the community. Progressive humanitarian reform could go hand in hand with fiscal conservatism. Community Mental Health Centers were to be the heart of a new national effort. But the rhetoric of reform failed to coalesce the activities among competing federal and state interests and systems. Intended beneficiaries may have become unfortunate victims.

Community Mental Health Services↗
PubMed2001

[Karyological study of some Corvine birds (Corvidae, aves)].

Karyotypes were studied in the hooded and carrion crows, their naturally occurred hybrids, the jungle crow, the azure-winged magpie (2n = 80 in all aforementioned birds), and the magpie (2n = 82). Corvine birds of Primorskii Krai were karyotyped for the first time. In addition to the similarity in the diploid chromosome sets, corvine birds were shown to have a similar structure of karyotype: in all studied birds, 14 macrochromosomes (Mchs) classified into three groups according to their size were detected. By karyotype structure, birds belonging to the same genus are similar. Some intergeneric differences are due to a change in the position of centromeres of the largest and sex chromosomes. Karyotypes of interspecific hybrids of crows are remarkable for the presence of heteromorphic (t/st) chromosome pair 2 in some individuals, which apparently does not affect their fecundity. Using differential C-banding, the sex chromosome W in female magpies was identified. In addition, heteromorphism was detected in C-bands of homologs of Mch pair 4 in the hooded crow. In the jungle crow, the azure-winged magpie, and the magpie, bright QH-bands and numerous G-bands were detected on Mchs and on some microchromosomes only. Active Ag-NOR-bands were detected on one macrochromosome pair in the magpie. In all, the karyotype structure of corvine birds is comparable to the basic structural scheme of the karyotype in the order Passeriformes, which confirms the concept of conservatism of the avian karyotype.

Animals↗
PubMed2001

Medical migration.

The issue of professional migration, however emotional it may have become, ought not to be regarded in moralizing terms. The history of western medicine is the history of migrating physicians. A doctor who moves from a locality to another to take up a new assignment there cannot be said to have "abandoned his patients". This emotional bond has become the victim of specialization and of depersonalization of medical services and not of medical migration, brain drain or otherwise. The primary reason for medical migration is not financial; the desire to migrate usually begins with the desire to learn. Professionals crave in the first line for professional satisfaction. The migration of medical manpower cannot be stopped with administrative measures and will not be stopped by exhortations and appeals, moralization and condemnations. Brain drain is a global phenomenon and has always been so. A country which loses its professionals, its doctors, should examine the social relationships within the profession and should investigate whether the opportunities for deriving professional satisfaction from everyday work exist or whether these have been thwarted by the hierarchy, conservatism, cronyism and the general lack of comprehension of what good medical care is about.

Emigration and Immigration↗
PubMed1998

Médecine à la Molière.

Of Moliere's thirty six plays, seven deal, to a greater or lesser extent, with medicine; the medicine as practiced in Paris during the reign of Louis XIV. In these days, Moliere satirises the recalcitrant conservatism of the Paris medical faculty. It is, however, an informed satirisation. This paper explores Moliere's motives and attempts to place Moliere's medical plays against a broad canvas of his other works. The ultimate purpose is to assess to what extent Moliere's philosophical persuasions and how he balanced them against the needs of contemporary, commercial theatre.

Drama↗
PubMed2001

Systematic review of conservative operative caries management strategies.

The relationship between cavity preparation extension and restoration longevity is examined through a systemic review of the available evidence on specific conservative, operative caries-management strategies. Evidence tables are provided for three specific techniques in the permanent dentition: 1) the proximal "tunnel" restoration, 2) the proximal "box-only" restoration, and 3) the preventive resin restoration. In the primary dentition, the clinical trials involving the proximal box-only restoration, most of which involved glass-ionomer materials, are reviewed. In the permanent dentition, the evidence reveals low effectiveness for "tunnel" restorations, limited but supportive results for proximal-only restorations, and generally favorable outcomes for the occlusal composite resin-sealant restoration. The weak link in the latter is the overlying fissure sealant, which requires adequate ongoing maintenance. Conservative operative strategies in the primary dentition have not been uniformly successful, and deleterious material effects dominate restoration performance. This systematic review concludes that operative conservatism per se does not guarantee increased restoration longevity and that all restorations are vulnerable to caries recurrence, material failures, and technical deficiencies. The more successful conservative strategies are expected to enhance tooth longevity, provided concomitant caries control is effective.

Composite Resins↗