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PubMed2005

Creativity, ingenuity, serendipity.

Some of the earliest experiences of invasive cardiology centred on studying the physiology of congenital heart disease in a series of ongoing attempts to understand pathophysiology and anatomy, and then devising strategies to treat the lesion. Tremendous growth in the field and rapid advances in patient care have become possible due to the collaboration of early investigators, including pediatric cardiologists, cardiovascular pathologists, embryologists, physiologists and cardiovascular surgeons. This group has expanded to include radiologists, vascular biologists and engineers. Mason Sones' serendipitous encounter with a patient led to the thought that one patient's 'complication' might lead to another therapy and, as a result, studies were conducted. Early equipment was bulky, rigid and inflexible. Andreas Gruentzig was instrumental in the development of several new techniques. Throughout the development of invasive cardiology, great attention has been paid to the evaluation of both successful and failed outcomes. Over the intervening years, multiple advances in technology have improved procedures by making invasive cardiology easier, safer and more predictable and have expanded the patient population that could benefit from it. These advances included new devices, such as atherectomy transluminal extraction catheters, as well as with directional coronary atherectomy, rotational atherectomy and laser-based techniques. Interventional cardiology has soared with single-centre and multicentre randomized trials. Intracoronary stents have completely revolutionized therapy, becoming smaller, more flexible and more easily deliverable. With the introduction of drug-eluting stents, restenosis rates have been dramatically reduced. However, chronic total occlusion continues to be a problem in interventional cardiology due to increased risk of early and late complications and increased restenosis rates. New areas continue to be developed, combining the inventions and designs of collaborators. An increased knowledge of the basic pathophysiology of cardiovascular disease, combined with creative technology and imaginative operators, will continue to advance the field.

Angioplasty, Balloon, Coronary↗
PubMed2005

Creative and innovative statistics in clinical research and development.

OBJECTIVES: The aim of this paper is to show that even in a highly regulated area such as clinical research and development in pharmaceutical industry, there are needs and ample opportunities for statisticians and other medical informatics professionals to further creatively develop and implement methods in order to support the collection, analysis and interpretation of clinical data. METHODS: The recently published "Critical Path" initiative of the US Food and Drug Administration discusses the decline in new drug submissions in the last decade and illustrates potential causes in the present clinical development process. Areas where statisticians can and have begun to look for new innovative ways to overcome these shortcomings are presented and examples of such novel approaches that have been developed by statistical methodologists in the pharmaceutical industry together with statisticians in academia are given. RESULTS: In Early Development, i.e., in the first studies in man with a new compound, a combination of Bayesian methods and modeling approaches is particularly promising to increase the efficiency of decision making whereas in later phases (IIb and III) a marriage of modeling and classical frequentist approaches together with novel adaptive designs is expected help to chose the right dose regimen and to perform the trials more efficiently in reduced time. CONCLUSIONS: The combination of known statistical methods and thinking and the development of new approaches are in line with the present paradigm of "learning and confirming" in regulated clinical development while increasing the efficiency of both.

Bayes Theorem↗
PubMed2006

Texas hospitals share creative uses of non-clinical staff to reduce ER costs.

Texas hospitals share creative uses of non-clinical staff to reduce ER costs. In central Texas, Christus Spohn Hospital and Seton Health Care are independently exploring the use of non-clinical staff to improve utilization of clinical and emergency services, but their existing programs employ different structures and outcomes measurements.

Cost Control↗
PubMedDate not supplied

Creative permanency planning: residential services for families.

A children's institution offers a creative program for single mothers and their families--a 24-hour child care facility on the campus that provides residential service for the entire family. Over several months, the staff helps with family problems such as income, housing, abuse and other family dysfunctions and prevention of separation. Though small, the program has experienced success and has operated on a small budget for the last 10 years.

Adult↗
PubMed1990

The myth of Athena and Arachne: some oedipal and pre-oedipal aspects of creative challenge in women and their implications for the interpretation of Las Meninas by Velazquez.

This paper interprets the myth of Athena and Arachne, as told by Ovid, as a metaphor for mother-daughter conflict. It discusses pre-oedipal and oedipal aspects of the myth with particular focus on creative challenge and artistic competition. A fragment of a clinical case in which the transference exhibited dynamics inherent in the myth is presented. It is proposed that the analyst's knowledge of myth can be helpful in understanding transference manifestations. Finally, Velazquez's Las Meninas is discussed in the light of the myth, which is the subject of the small painting on the back wall above and to the left of the mirror. The author argues that, just as myth can elucidate psychoanalysis, so psychoanalysis can elucidate myth and its inclusion in an artist's iconography.

Aptitude↗
PubMedDate not supplied

Creative lecture: chronic health care of the elderly.

Designing lectures that stimulate interest and active learning is a constant challenge to nurse educators. This is particularly so for lecture content related to the elderly. The author discusses a variety of creative teaching strategies that were used in a lecture on chronic health care of the elderly.

Aged↗
PubMedDate not supplied

A creative safety program.

Mandatory safety programs can be creative and fun using the instructional game approach. Games can be completed on the patient care unit when a free moment is available. Once the instructional games are developed, they can be used throughout the year to help the staff review safety policies, procedures, and standards.

Accident Prevention↗
PubMed1983

[Rehabilitation of cancer patients including creative therapies].

When sufficient experience had been accumulated to support the view that intensive aftercare of the consequences of cancer will have a favourable impact on the individual's prognosis, the German social insurance institutions extended coverage to aids for vocational reintegration, and a medical indication of cancer rehabilitation. Own experience gathered since in the longterm care of cancer patients, which lasted up to three years, almost invariably brought about improvements in the quality of life, often a prolongation of survival time that was worth living, and occasionally a shorter incapacity for work. The decisive factor in this connexion was found to be individualized occupational therapy measures, which, when appropriate, included art and music therapy, structured psychotherapy that included relaxation exercises and group talks as well as recreational activities, both active and passive. The significance of these therapy plans is understood when one takes into account that cancer patients tend to withdraw from their environment due to their anxieties and an impaired self-worth. On account of misconceptions on the disease and its causes those affected by it are often kept away from and further isolated, which aggravates the already existing deficit of social contacts. Insufficient ability to creatively use excessive leisure time will invariably entail brooding over one's personal fate, with depressive reactions being an often unavoidable result.

Art Therapy↗
PubMed1980

[Ernst L. Kirchner - psychoanalytic perspectives of the psychoeconomy of his creative achievements].

Looking back on Ernst L., Kirchner's life and work, the close interdependence of both becomes apparent. The artist and his art form a community of fate. In the light of psychoanalytical narcissistic research this interdependence presents itself as a symbiotic relationship of 'real' and 'ideal ego' (= art), the purpose of which it is to regulate the self-esteem of the narcissistically disturbed. Kirchner's example demonstrates well the creative and therapeutic forces set freeby this kind of regulation. It also shows, however, the instability of this state and the risk of the 'narcissistic catastrophe' to which an unfavourable course may lead.

Art↗
PubMed1982

[Creative-work therapy as an essential method in the complex treatment of neuroses].

A specialized psychotherapy of neurotic developments should take aim at elucidating the more or less unconscious intrapsychic roots of these disorders. A clinical task in the medical psychotherapy is to facilitate and to promote the abilities of the patient to experience himself more adequate. We attribute to the experience a central role in the treatment. In this sense the creative work therapy is a valuable supplementing method in the group-psychotherapy by means of loosening instinctive impulses, making more transparent intrapsychic conflicts and facilitating to deal with these conflicts in a constructive way. This psychotherapeutic method furthermore stimulates the self-experience of the patient by improving his ways of communicating. By this better preconditions and stimulations for a constructive way of coping with the social milieu are created. Methods and techniques are represented in detail.

Humans↗
PubMed1979

Creative management engineers foster communication, change.

Today's hospitals need creative management engineers to bring about innovative change, to foster a participative climate, and to strengthen training systems. However, management engineers need to work with hospital administrators who understand the field and who can expand their expectations beyond the traditional areas normally thought of as being within the purview of management engineering.

Administrative Personnel↗
PubMed1995

A creative form of skill development. Elective courses in nurse education.

1. Nurse education needs to continue to strive to enhance teaching and learning in nurse education by the use of creative and innovative activities. 2. The philosophy underpinning electives is that often learners know what they want to learn and how they wish to go about this. 3. The use of nursing electives allows learners to cultivate their abilities in relation to self-directed study. 4. Evaluation of the elective experience undertaken enhances peer group activity and promotes self-confidence.

Curriculum↗
PubMed1994

Creative alliances between nursing service and education in times of economic constraint.

Health care and higher education in America are both in economic crisis and undergoing reform. Forming collaborative relationships between health care providers and nursing educational institutions is a savvy, economical, and mutually beneficial strategy in these changing times. Creative alliances between service and education are addressed in terms of clinical educational preceptorships for senior nursing students and joint appointments between service and education. The educational and service perspectives are discussed, from development to implementation.

Clinical Competence↗
PubMed1994

Gaming: a creative strategy for staff education.

Providing staff development in a stimulating, innovative manner is the challenge of all nurse educators. This article discusses gaming, a creative teaching strategy that can help meet these needs. Games designed specifically for the education of dialysis staff will be reviewed. Advantages of the various games will also be examined.

Dialysis↗
PubMedDate not supplied

The Evaluation of the Resolving Conflict Creatively Program: an overview.

The Resolving Conflict Creatively Program (RCCP) is a comprehensive, school-based program in conflict resolution and intercultural understanding implemented in more than 110 New York City public schools. The National Center for Children in Poverty is currently conducting an evaluation of the program in grades 1-6, although the program itself is implemented in grades K-12. The following components are included: teacher training, classroom instruction and staff development, the program curriculum, administrators' training, peer mediation, parent training, and a targeted intervention for high-risk youth. The program evolved out of practice-based theory. Researchers and practitioners have collaborated on and designed an evaluation that illustrates how the practice-based theory is consistent with and can be put into operation using developmental and ecological theories of the etiology of violence-related behaviors in middle childhood. The target population for this study is approximately 9,600 children, 5-12 years of age, in 15 elementary schools in New York City. The evaluation is being conducted over two years with two data-collection points in each year. A cross-sequential design is being used to examine the short- and intermediate-term utility with children at different ages/developmental stages. The relative effect of the beginning program can be compared to more comprehensive models. A total of 8,233 students responded to the baseline survey. The study population is largely Hispanic (41%) and African American (37%). Preliminary analyses indicate that baseline means of such constructs as aggressive fantasies, hostile attributional biases, and conduct problems increase with grade level. Ten years of practice-based experience and one year of a two-year quantitative evaluation have taught several important lessons about school-based program implementation and the evaluation of such programs. The scope and longevity of the RCCP and the empirically rigorous evaluation now under way will make a significant contribution to the field of violence prevention and field-based program evaluation.

Age Distribution↗
PubMedDate not supplied

Retirement communities as creative clinical opportunities.

The extraordinary number of elderly expected to live into the next century calls for creative inclusion of this population in learning experiences for students in baccalaureate nursing programs. Retirement communities offer a rich environment for interaction and learning with the well elderly that encourages students to consider the limitless possibilities for nursing interventions with our greatest national resources: the elderly.

Aged↗
PubMed1998

Chronic complications of diabetes: a creative management approach.

The chronic hyperglycemia of diabetes is associated with long-term damage to and failure of various organs, especially the eyes, kidneys, heart, blood vessels, nerves, and, eventually, the individual's sense of well being. With the new diagnostic criteria for diabetes, the incidence of clinical disease is expected to soar. This article will focus on creative management techniques aimed at lessening these complications of diabetes by using the clinical visit efficiently.

Algorithms↗