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PubMed2005

Nursing home social worker skills and end-of-life planning.

Little empirical information exists on nursing home social worker's involvement in advance care planning and end-of-life decision- making with nursing home residents and their family members. The purpose of this exploratory study was twofold: (1) to identify the frequency of skills associated with advance care planning that social workers use, and (2) to explore the factor structure of the scale used in the study. Results from 138 nursing home social worker respondents from New York State showed high frequency of advance directive discussions, care planning, and conflict resolution with families. The instrument factors clustered around administrative duties, and grief issues. There was substantial interest in continuing education in grief counseling with families.

Adult↗
PubMed2003

The molecular genetics of the genodermatoses: progress to date and future directions.

The Human Genome Mapping Project and allied rapid advances in genetic technology over the past decade have facilitated accurate association of allelic variations in several genes with specific skin phenotypes. Currently the genetic bases of the majority of the more common genodermatoses have been elucidated. In scientific terms this work has been extraordinarily successful and has yielded many new biological insights. These advances, although exciting, have yet to be translated into direct benefit for patients with these diseases. Genetic counselling has been greatly aided by gene identification, by the better understanding of genotype-phenotype correlation and by the disclosure of unexpected genetic mechanisms in some families. Knowledge of the molecular basis of these disorders has also been vital in enabling DNA-based prenatal diagnosis in several conditions and DNA-based preimplantation diagnosis has been used in a selected few. While this successful period of gene mapping is now nearing completion, progress towards the next goal, that of developing therapeutic strategies based on the knowledge of these underlying genetic mechanisms, has proven frustratingly slow. Despite the ready access to the skin compared with solid internal organs, the challenges of cutaneous gene therapy are legion and many technical issues need to be surmounted to enable gene replacement or modification of gene expression to have a useful role in these disorders. In this article we make a comprehensive review of progress to date in gene identification, genotype-phenotype correlation, prenatal diagnosis and cutaneous gene therapy, and we examine future directions for research in this field.

Chromosome Mapping↗
PubMed2004

A comparison of the National Ambulatory Medical Care Survey (NAMCS) measurement approach with direct observation of outpatient visits.

BACKGROUND: The National Ambulatory Medical Care Survey (NAMCS) informs a wide range of important policy and clinical decisions by providing nationally representative data about outpatient practice. However, the validity of the NAMCS methods has not been compared with a reference standard. METHODS: Office visits of 549 patients visiting 30 family physicians in Northeastern Ohio were observed by trained research nurses. Visit content measured by direct observation was compared with data reported by physicians using the 1993 NAMCS form. RESULTS: Outpatient visit physician reports of procedures and examinations using the NAMCS method showed generally good concordance with direct observation measures, with kappas ranging from 0.39 for ordering a chest x-ray to 0.86 for performance of Pap smears. Concordance was generally lower for health behavior counseling, with kappas ranging from 0.21 for alcohol counseling to 0.60 for smoking cessation advice. The NAMCS form had high specificity (range, 0.90-0.99) but variable (range, 0.12-.84) sensitivity compared with direct observation, with the lowest sensitivities for health behavior counseling. The NAMCS physician report method overestimated visit duration in comparison with direct observation (16.5 vs. 12.8 minutes). CONCLUSIONS: Compared with direct observation of outpatient visits, the NAMCS physician report method is more accurate for procedures and examinations than for health behavior counseling. Underreporting of behavioral counseling and overreporting of visit duration should lead to caution in interpreting findings based on these variables.

Adolescent↗
PubMed1989

[Mental conflict of urban Korean housewives--a qualitative analysis of 20 interviews].

This study analysed marital conflicts, related factors, and adjustments to those conflicts described by urban Korean women. The purpose was to discover directions for resolutions that would enhance the helpfulness of volunteers or professionals working with women in counselling settings. The investigator interviewed 20 married women, all mothers and housewives living in Seoul, attending marriage encounter programs and the Lifeline telephone counselling service. An interview schedule using six open-ended questions guided the data collection which took place between May 31 and December 29, 1988. Content analysis of the data revealed, in order of reported frequency, the following areas of conflict: relationships between husband wife, relationships with children, relationships between the wife and her mother-in-Law, unsatisfied sexual needs, the husband's extra marital relationships, lack of self actualization and financial matters. Analysis of the data suggested the following factors were related to the conflicts: reasons for marriage, traditional views about marriage and divorce including to accept a marriage arranged by the parents, the husband's traditional attitude toward the sex role of the wife, the husband's patriarchal authoritarianism, and his attitude toward the wife's employment outside the home. The women thought these conflicts severely affected their relationships within the family, particularly with their children. Literature suggests links with such poor parent-child-family relationships and adolescent or young people's social problems. Volunteers or professionals working with married women in counselling situations need to be conscious of the possibility of these conflicts during assessment, and direct their guidance toward such conflict resolution. The researcher makes several suggestions which include the need for the husband to give emotional support to his wife, to recognize the worth of housework, to share the work of the home, to find ways to enhance the wife's self-actualization and to ease dreary housework routines by providing modern appliances.

Conflict, Psychological↗
PubMed2006

Prenatal genetic testing kits sold at your local pharmacy: promoting autonomy or promoting confusion?

Research groups around the world are developing non-invasive methods of prenatal genetic diagnosis, in which foetal cells are obtained by maternal blood test. Meanwhile, an increasing number of genetic tests are sold directly to the public. I extrapolate from these developments to consider a scenario in which PNGD self-testing kits are sold directly to the public. Given the opposition to over-the-counter genetic tests and the continuing controversy surrounding PNGD, it is reasonable to expect objections to PNGD self-testing kits. I focus on one potential objection, that PNGD self-testing kits would undermine the autonomy of potential test subjects. More specifically, that 'direct to the public' PNGD would fail to ensure that consumers exercise authority in the following PNGD-related choices: Should I use PNGD? Based on the results of the PNGD test, should I continue or terminate my pregnancy? Under the current system, PNGD is provided by health care practitioners, who are required to counsel women both before and after the test. In contrast, 'direct to the public' PNGD would allow women to make their PNGD-related decisions outside the context of the health care system. I compare these two decision-making contexts, arguing that the health care system is not unequivocally better at promoting the autonomy of potential test subjects. Therefore the promotion of autonomy does not constitute a strong argument against such test kits. Other objections may be more persuasive, so I do not offer an overall assessment of the acceptability of 'direct to the public' PNGD.

Abortion, Eugenic↗
PubMed1981

Late stage cancer patients: age differences in their psychophysical status and response to counseling.

Much has been written about working with dying patients. To evaluate counseling, 120 terminally ill cancer patients were randomly assigned to counseling or no counseling and studied before random assignment and at 1, 3, 6, 9, and 12 months on quality of life variables (alienation, depression, locus of control, life satisfaction, self-esteem) as well as functional status and survival. Counseled patients changed significantly in comparison to controls and in a favorable direction by 3 months. The purpose here was to see if older and younger cancer patients differed at baseline and if outcomes of counseling differed by age. Patients under age 60 were compared with those 60 and over. There was no multivariate difference at baseline but univariate differences of more disability and less life satisfaction in the older group. Overall, response to therapy was similar in old and young, with both improving.

Adult↗
PubMed2005

Smoking cessation for weight-concerned women: group vs. individually tailored, dietary, and weight-control follow-up sessions.

Postcessation weight gain is of concern to many female cigarette smokers. A multidisciplinary treatment combining psychological, dietary, and exercise components followed a 2-week smoking cessation program. Participants were randomly assigned to receive six follow-up relapse prevention sessions (in a group format or in an individually tailored format) directed by trained representatives from clinical psychology, dietary counseling, and exercise physiology. As predicted, abstinence rates were significantly higher among the individually tailored follow-up participants than among those assigned to the group follow-up condition at 3 and 6 months posttreatment. Differences between conditions in postcessation weight gain were not significant. However, the postcessation weight gain that did occur was significantly associated with subsequent smoking relapse in the group follow-up condition only.

Adult↗
PubMed2001

Brain tumors.

The total care of a patient with an incurable brain tumor is a complex task. It is best performed by a team of specialized care providers including neurologists, neuro-oncologists, neurosurgeons, radiation oncologists, nurses, neuropsychologists, social workers, and physical and occupational therapists. Hospice providers, and spiritual counselors provide particular skilled services and comfort to patients nearing the end of life. The role and prominence of each team member evolves during the course of the illness as the disease progresses and the symptoms and needs of the patient change. Family members often provide the bulk of the direct care, and themselves require support, education, and counseling. While we currently lack curative therapies for most patients with malignant brain tumors, careful attention to symptom diagnosis and management can greatly enhance the quality of life of a patient with a brain tumor throughout the course of the illness and at the end of life.

Brain Neoplasms↗
PubMed2002

Exploring family needs during withdrawal of life support in critically ill patients.

Withdrawal of life support is a process where medical interventions are taken away from the patient with the expectation that the patient will die. This deliberate decision occurs when it is determined that medical options are exhausted and the prognosis is terminal. With this study, the primary family member of twenty adult patients who had undergone withdrawal of life support was contacted and interviewed by the research team 3-5 weeks after the patients' death. Interview questions related to their experience with the withdrawal of life support process. Specifically, whether or not the situation was anticipated, a description of the events surrounding withdrawal, events that made the process easier, and what they would like to see changed. This information was used to determine if and to what extent family needs are met and to determine if further interventions are required.

Advance Directives↗
PubMedDate not supplied

HIV in older Americans: an epidemiologic perspective.

The elderly population is increasing as baby boomers are beginning to approach retirement. People 65 years of age or older already constitute approximately one eighth of the U.S. population; this proportion is expected to double in the next 50 years. Older Americans have their own population-specific health challenges, such as Alzheimer's disease, osteoporosis, adult-onset diabetes, prostate cancer, menopause, and hypertension. Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are seldom discussed within this community. Prevention, counseling, testing, and education efforts are not being directed their way. In addition, few practitioners are experts both in HIV and health problems associated with aging, resulting in misdiagnosis, especially in the early stages when AIDS symptoms such as fatigue, weight loss, night sweats, and diminished appetite are dismissed as part of the aging process. Very few HIV-related social support services have been aimed at the needs of the elderly, perhaps because older Americans are not suspected to be sexually active or are assumed to be in a monogamous, heterosexual relationship. Older Americans are not suspected of drug use. Yet many are sexually active, often demonstrating risky sexual behavior, such as dispensing with the use of condoms; and the isolation that frequently accompanies old age can lead to alcoholism and injectable drug use. This article examines methods suggested in the literature both in terms of primary and secondary prevention of HIV/AIDS in older Americans. The cost of these efforts is enumerated, and organizations who gear their efforts in reaching and educating older Americans regarding their risks are described.

Aged↗
PubMed2001

Interest in smoking cessation among injection drug users.

We describe the degree of nicotine addiction and readiness to quit smoking among people with a history of injection drug use, comparing those in a methadone maintenance treatment program (MMTP) with active illicit drug injectors in a needle exchange program (NEP). Interview data were collected from 452 persons in Providence, RI, from July 1997 to March 1998. Ninety-one percent (91%) of the population currently smoked cigarettes. Smokers were more likely to be female and from an NEP. Higher nicotine dependence by the Fagerstrom Test for Nicotine Dependence was found in Caucasians, those with a Methadone dose greater than 80 mg per day, those with less than high school education, and those with active alcohol abuse. Those more likely to be contemplating smoking cessation in the next six months were those from MMTP, older than 35, and without alcohol abuse. Although smoking cessation counseling should be offered to all smokers, interventions directed towards older individuals enrolled in MMTP may target the group most interested in smoking cessation.

Adult↗
PubMed1977

Familial balanced translocation 4p+/17q- as a suggested cause of primary trisomy-21 Down's syndrome.

A case is presented in which a 4p+/17q- familial balanced reciprocal translocation in the mother produced a son with primary trisomy-21, as well as the structural chromosomal anomaly. A number of similar situations have been reported, suggesting that the two events are related. In practice, this (as well as other direct risks) should be taken into account when counseling those families in which one parent carries a balanced translocation. A hypothesis, based on experiments in Drosophila, has been put forward by Grell to explain the mechanism which links the balanced structural abnormality to an aneuploidy of chromosomes not taking part in the structural change, and this has been extended to similar human situations.

Child, Preschool↗
PubMed1993

Why the Operation I Prefer is the Modified Long Vertical Gastroplasty.

I have performed a modified Long 'highest gastric reduction' vertical gastroplasty (LVG) for over 10 years, and the advantages include simplicity in principle, speed of performance, ease of revision, ease of subsequent endoscopic examination, minimal mortality and low morbidity. The biggest advantage is the lack of long-term nutritional disturbance and the need for lifelong surveillance which characterizes malabsorptive procedures. The cost of surgery is relatively low with only one application of staples, a short hospital stay and an infrequent need for rehospitalization or investigation. A further bonus is that LVG is a good antireflux operation in contrast to gastric banding. The individual weight loss achieved depends greatly on the motivation and use of the operation by the patient, and this is directly related to the quality and content of counseling given to the patient before and after the surgery. Given good motivation, a good operation technique and good education, patients can achieve weight loss comparable to that from more invasive procedures.

Journal Article↗
PubMed1996

[Perception of blockage or facilitation of communication: an experiment].

Based on the reference work of FORREST (1983), we conducted an experiment in order to determine how interviewees (6th semester nursing undergraduate course) perceive a dialogue, taking into consideration 12 items of evaluation (opening, interest, changing subject, directed questions, disapproval of the subject, tranquility, tension, counseling, recognizing feelings, reflection about the topics, approval, and flight from the topics). Treatment consisted of interviews with different proportions of categories of facilitating (F) and blocking (B) communication: Group A-55% F category and 45% B category; Group B-75% B category and 25% F category. There was no statistical difference between groups in terms of any of the proposed evaluation items. We emphasize the fact that the interviewer was known by interviewees. The topic was easy to approach and the level of relationship was of the horizontal type.

Attitude↗
PubMed2005

[Indirect cystic fibrosis carrier detection in two Chilean families by analysis of DNA polymorphisms closely linked to the CFTR gene].

BACKGROUND: Molecular genetic analysis is the only method that allows accurate detection of Cystic Fibrosis (CF) carriers. Nevertheless, its application is restricted to those families in which the affected child holds known mutations. Since most Chilean CF patients already studied are heterozygous and carry a mutation not yet characterized, direct identification of carriers is limited. Linkage analysis of Restriction Fragment Length Polymorphisms (RFLP), using DNA markers closely linked to the CFTR gene, is a useful tool for the detection of carriers in families in which the patient carries an unknown mutation. AIM: To emphasize the usefulness of KM19 and MetH markers for RFLP analysis in extended genealogies in order to identify carriers of unknown mutations. MATERIAL AND METHODS: Selection of three families, in which a sibling of an index case, identified as EthF-508/unknown mutation, could not be identified as heterozygous carrier or a normal homozygous. Haplotypic characterization for KM19 and MetH markers was performed by PCR amplification of genomic DNA followed by allele specific restriction enzymatic digestion. RESULTS: The siblings of two families were identified as carriers and the sibling of the third family was identified as normal. CONCLUSIONS: KM19 and MetH haplotypic analysis provided a rapid method for carrier detection in the families under study. The analysis may be used as a supplement to direct genetic diagnosis and be helpful in genetic counseling.

Child↗
PubMed1996

Computerization: reengineering the lawyering process for the 21st century.

Alvin and Heidi Toffler, describe the benefits of "informationware" and how one of the most tradition-bound organizations, the armed forces, has substantially changed its operations. According to the authors, mere knowledge is not sufficient to prevail; how one manages or uses knowledge separates winners from losers. Further, the authors say "...basically add new elements or create new combinations of old elements within an existing 'game.' A true revolution goes beyond that to change the game itself, including its rules, its equipment, the size and organization of the 'teams,' their training, doctrine, tactics, and just about everything else. Even more important, it changes the relationship of the game to society itself." Application of this theory to today's litigation is obvious and compelling. The ways in which clients and defense counsel obtain, analyze, and strategically apply evidence and legal principles must change to incorporate the informationware this society uses in other lines of business. This means more extensive and appropriate usage of computer hardware in a software environment that fully supports emerging client and defense counsel needs. The computer system must provide case direction, helpful suggestions, and direct, rapid access to data bases containing information presently available only through person-to-person networking.

Computer Systems↗