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At least 883 records · Page 49Linked to original sources
PubMed1983

Anorexia nervosa and bulimia: diagnosis and comprehensive treatment.

The following principles are associated with successful treatment of anorexia nervosa and bulimia: (1) correct identification of these syndromes by history and mental examination, rather than by the elimination of all possible medical explanations; (2) a balanced approach between changing the abnormal weight or eating pattern and understanding and correcting the predisposing and underlying psychodynamics; (3) an empirical practical approach to treatment that avoids speculative concepts of origin; (4) an understanding of the natural history and underlying psychopathology of these disorders; (5) a non-blaming supportive approach, with variation in the specific kind of psychotherapy chosen according to the needs and abilities of the patient; (6) global treatment goals including psychologic, biologic, and social improvement; (7) avoidance of procedures with high morbidity such as tube feeding, hyperalimentation, and high-dose medication; and (8) an attitude of realistic optimism. Virtually all aspects of these disorders have the potential for complete improvement.

Anorexia Nervosa↗
PubMed1997

Empirical and subsequent use of antibacterial agents in the febrile neutropenic patient.

UNLABELLED: The objective of this analysis were an assessment of the feasibility of a more individually tailored approach of empirical antibiotic therapy in febrile neutropenia and an exploration of the reasons to modify the initial regimen. DESIGN, SETTING AND SUBJECTS: The main source was a database on febrile neutropenic cancer patients from an unblinded large trial conducted in 35 centres world-wide. This was supplemented by data from patients enrolled in a consecutive series of randomized trials at the Department of Haematology, University Hospital Nijmegen. INTERVENTIONS: Diagnostic procedures were standardized, types of possible infections defined and the reasons for modifying an empirical regimen were recorded. MAIN OUTCOME MEASURES: Survival of the febrile neutropenic episode, development of microbiologically and clinically defined infection in relation to causative organisms, and results of modification. RESULTS: Monotherapy was as effective as combination therapy with an overall mortality of < or = 7%, with 21% of neutropenic episodes accompanied by a clinically defined infection proving fatal compared with only 4% of episodes without a focus. At the end of treatment the empirical regimen had been added to in 60% of cases in the multicentre trial, in contrast to 39% in our own institution, in many cases simply because of continuing fever. CONCLUSION: The development of local guidelines for individually tailoring antibiotic therapy by complementing the empirical regimen is a feasible option for achieving an optimal anti-infective strategy for febrile neutropenic cancer patients.

Adolescent↗
PubMed2004

[Quality assurance and total quality management in residential home care].

Quality, quality assurance, and quality management have been important topics in residential care homes for several years. However, only as a result of reform processes in the German legislation (long-term care insurance, care quality assurance) is a systematic discussion taking place. Furthermore, initiatives and holistic model projects, which deal with the assessment and improvement of service quality, were developed in the field of care for the elderly. The present article gives a critical overview of essential developments. Different comprehensive approaches such as the implementation of quality management systems, nationwide expert-based initiatives, and developments towards professionalizing care are discussed. Empirically based approaches, especially those emphasizing the assessment of outcome quality, are focused on in this work. Overall, the authors conclude that in the past few years comprehensive efforts have been made to improve the quality of care. However, the current situation still requires much work to establish a nationwide launch and implementation of evidence-based quality assurance and quality management.

Aged↗
PubMed1992

Compensation for harm: the implications for medical research.

The rising incidence of medical litigation in the 1980's led to a relatively minor modification in January 1990 of the United Kingdom's negligence-based system of medical compensation, as a result of which employing Health Authorities now accept full vicarious liability for the negligent (but not other) actions of employed clinicians (Crown indemnity). During the same period, by contrast, bodies such as the Royal College of Physicians have strongly influenced locally established Research Ethics Committees towards favouring no-fault compensation for harm resulting from medical research. The discordance between these two approaches to compensation has caused anxiety during the last year. There has been particular concern about the possible discouragement of non-commercially sponsored research. Hitherto however, no data has been available to inform this discussion. This paper reports the findings of a questionnaire survey of all research ethics committees in the United Kingdom (64% response rate), which indicates that 61% of committees require no-fault compensation for at least some projects and that 33% of these committees have rejected projects solely or mainly due to the lack of such provision. Rejection is significantly more common in Health Districts which contain teaching hospitals. Our critical analysis of the arguments advanced in favour of no-fault provision for research subjects suggests that they do not place adequate emphasis upon respect for the autonomy of individuals. We consider that it is in general more consistent with such respect fully to inform research subjects of the available compensation arrangements, rather than for ethics committees to make no-fault compensation a general requirement before ethical approval is given.

Compensation and Redress↗
PubMed2006

Antifungal therapy in febrile neutropenic patients: review of treatment choices and strategies for aspergillar infection.

RATIONALE: Invasive fungal infections, especially aspergillosis, are a major problem in patients who undergo aggressive therapy for haematological malignancies. Presently, the standard therapy for demonstrated aspergillar infection is voriconazole. Because the morbidity and the mortality of proven aspergillar infection is relatively high, empirical and preemptive approaches have been explored. FINDINGS: Empirical therapy is effective at the cost of overtreatment in a significant number of patients. This can be reduced through the preemptive approach; however, its equivalence in terms of successful therapy and mortality should be studied further and, optimally, in prospective controlled clinical trials.

Antifungal Agents↗
PubMed2006

Is multi-impulsive bulimia a distinct type of bulimia nervosa: Psychopathology and EMA findings.

OBJECTIVE: To determine if clinically defined multi-impulsive bulimia (MIB) can be validated using an empirical classification approach. METHOD: One hundred and twenty-five women who met DSM-IV criteria for bulimia nervosa were interviewed and completed a two-week EMA protocol. Participants who reported at least three highly impulsive behaviors were compared to participants who did not report such impulsive behavior. Also, Latent Class Analysis (LCA) was conducted to determine if the MIB classification could be replicated empirically. RESULTS: LCA produced a two-class solution consistent with the traditional clinical approach to MIB classification. In both approaches, MIB was associated with higher levels of anxiety disorders, child abuse, and daily self-damaging behaviors than the non-MIB class. CONCLUSION: Clinical classification of MIB was empirically supported through LCA. Although the classes failed to differ in bulimic behavior, MIB appears to represent a group of bulimic individuals with significant trauma histories and associated psychopathology.

Adolescent↗
PubMed2005

Eating disorders and personality: a methodological and empirical review.

Methodological approaches utilized to evaluate models of the relationship between personality and eating disorders, as well as empirical support for each model, are reviewed. Limited prospective research suggests that negative emotionality, perfectionism, drive for thinness, poor interoceptive awareness, ineffectiveness, and obsessive-compulsive personality traits are likely predisposing factors. Limited family study research suggests that obsessive-compulsive personality disorder (OCPD) and anorexia nervosa share a common familial liability. Potential pathoplastic personality factors include Cluster B personality disorders and OCPD, which predict a poorer course and/or outcome, and histrionic personality traits and self-directedness, which predict a more favorable course and/or outcome. Future research should focus upon sophisticated prospective and family study research in order to best evaluate competing models of the eating disorder-personality relationship.

Anorexia Nervosa↗
PubMed1996

The public health information infrastructure. A national review of the law on health information privacy.

Our objectives were to review and analyze the laws in the 50 states, the District of Columbia, and Puerto Rico that regulate the acquisition, storage, and use of public health data and to offer proposals for reform of the laws on public health information privacy. Virtually all states reported some statutory protection for governmentally maintained health data for public health information in general (49 states), communicable diseases (42 states), and sexually transmitted diseases (43 states). State statutes permitted disclosure of data for statistical purposes (42 states), contact tracing (39 states), epidemiologic investigations (22 states), and subpoena or court order (14 states). The survey revealed significant problems that affect both the development of fair and effective public health information systems and the protection of privacy. Statutes may be silent about the degree of privacy protection afforded, confer weaker privacy protection to certain kinds of information, or grant health officials broad discretion to disseminate personal information. Our proposals for law reform are based on a meeting of experts at the Carter Presidential Center under the auspices of the Centers for Disease Control and Prevention and the Council of State and Territorial Epidemiologists: (1) an independent data protection commission should be established, (2) health authorities should justify the collection of personally identifiable information, (3) subjects should be given basic information about data practices, (4) data should be held and used in accordance with fair information practices, (5) legally binding privacy and security assurances should attach to identifiable health information with significant penalties for breach of these assurances, (6) disclosure of data should be made only for purposes consistent with the original collection, and (7) secondary uses beyond those originally intended by the data collector should be permitted only with informed consent.

Computer Security↗
PubMed2001

Connectionist psycholinguistics: capturing the empirical data.

Connectionist psycholinguistics is an emerging approach to modeling empirical data on human language processing using connectionist computational architectures. For almost 20 years, connectionist models have increasingly been used to model empirical data across many areas of language processing. We critically review four key areas: speech processing, sentence processing, language production, and reading aloud, and evaluate progress against three criteria: data contact, task veridicality, and input representativeness. Recent connectionist modeling efforts have made considerable headway toward meeting these criteria, although it is by no means clear whether connectionist (or symbolic) psycholinguistics will eventually provide an integrated model of full-scale human language processing.

Journal Article↗
PubMed2005

Not so different after all: a comparison of methods for detecting amino acid sites under selection.

We consider three approaches for estimating the rates of nonsynonymous and synonymous changes at each site in a sequence alignment in order to identify sites under positive or negative selection: (1) a suite of fast likelihood-based "counting methods" that employ either a single most likely ancestral reconstruction, weighting across all possible ancestral reconstructions, or sampling from ancestral reconstructions; (2) a random effects likelihood (REL) approach, which models variation in nonsynonymous and synonymous rates across sites according to a predefined distribution, with the selection pressure at an individual site inferred using an empirical Bayes approach; and (3) a fixed effects likelihood (FEL) method that directly estimates nonsynonymous and synonymous substitution rates at each site. All three methods incorporate flexible models of nucleotide substitution bias and variation in both nonsynonymous and synonymous substitution rates across sites, facilitating the comparison between the methods. We demonstrate that the results obtained using these approaches show broad agreement in levels of Type I and Type II error and in estimates of substitution rates. Counting methods are well suited for large alignments, for which there is high power to detect positive and negative selection, but appear to underestimate the substitution rate. A REL approach, which is more computationally intensive than counting methods, has higher power than counting methods to detect selection in data sets of intermediate size but may suffer from higher rates of false positives for small data sets. A FEL approach appears to capture the pattern of rate variation better than counting methods or random effects models, does not suffer from as many false positives as random effects models for data sets comprising few sequences, and can be efficiently parallelized. Our results suggest that previously reported differences between results obtained by counting methods and random effects models arise due to a combination of the conservative nature of counting-based methods, the failure of current random effects models to allow for variation in synonymous substitution rates, and the naive application of random effects models to extremely sparse data sets. We demonstrate our methods on sequence data from the human immunodeficiency virus type 1 env and pol genes and simulated alignments.

Amino Acids↗
PubMed1999

A hierarchical Bayesian approach to age-specific back-calculation of cancer incidence rates.

We propose a Bayesian hierarchical model to estimate age-specific cancer incidence per year from age-specific cancer mortality. The model is based upon the empirical Bayesian approach of Liao and Brookmeyer (1995) and extends that model by consideration of the dependence on age. The incident cases per year are considered as observations from a discrete-time stochastic process following an autoregressive structure within a Poisson regression model. The model assumes that the survival probability among those with cancer is known. We have investigated the sensitivity of the model to the choice of this distribution and have found that this is the most sensitive part of the model. By comparison the predictions of the model are relatively robust to changes in other key areas, such as the number of years an incident case contributes before death, assumptions about parameter equality for identification and the initial prior distributions. The proposed methodology has been investigated using lung cancer mortality data from Scotland. Parameter estimates were obtained through Markov chain Monte Carlo methods, implemented using BUGS.

Age Factors↗
PubMed2004

Defining dignity in terminally ill cancer patients: a factor-analytic approach.

The construct of 'dignity' is frequently raised in discussions about quality end of life care for terminal cancer patients, and is invoked by parties on both sides of the euthanasia debate. Lacking in this general debate has been an empirical explication of 'dignity' from the viewpoint of cancer patients themselves. The purpose of the present study was to use factor-analytic and regression methods to analyze dignity data gathered from 213 cancer patients having less than 6 months to live. Patients rated their sense of dignity, and completed measures of symptom distress and psychological well-being. The results showed that although the majority of patients had an intact sense of dignity, there were 99 (46%) patients who reported at least some, or occasional loss of dignity, and 16 (7.5%) patients who indicated that loss of dignity was a significant problem. The exploratory factor analysis yielded six primary factors: (1) Pain; (2) Intimate Dependency; (3) Hopelessness/Depression; (4) Informal Support Network; (5) Formal Support Network; and (6) Quality of Life. Subsequent regression analyses of modifiable factors produced a final two-factor (Hopelessness/Depression and Intimate Dependency) model of statistical significance. These results provide empirical support for the dignity model, and suggest that the provision of end of life care should include methods for treating depression, fostering hope, and facilitating functional independence.

Aged↗
PubMed2001

Analytic approaches for assessing long-term treatment effects. Examples of empirical applications and findings.

Analytic approaches, including the structural equation model (autoregressive panel model), hierarchical linear model, latent growth curve model, survival/event history analysis, latent transition model, and time-series analysis (interrupted time series, multivariate time-series analysis) are discussed for their applicability to data of different structures and their utility in evaluating temporal effects of treatment. Methods are illustrated by presenting applications of the various approaches in previous studies examining temporal patterns of treatment effects. Recent advancements in these longitudinal modeling approaches and the accompanying computer software development offer tremendous flexibility in examining long-term treatment effects through longitudinal data with varying numbers and intervals of assessment and types of measures. A multimethod assessment will contribute to a more complete understanding of the complex phenomena of the long-term courses of substance use and its treatment.

Alcoholism↗
PubMed1998

Community-acquired pneumonia: a North American perspective.

The North American guidelines for pneumonia generally show agreement in both the Canadian and American approaches. However, much new data have appeared since the original recommendations, and revisions are needed. The general approach to empiric therapy that has been proposed in both the Canadian and American Thoracic Society documents does appear to be valid, and future recommendations will probably use the original approach as a framework for a more refined approach.

Canada↗
PubMed1982

Bayesian approach for a nonlinear growth model.

Nonlinear least squares methods are currently used for fitting a well-known growth model, namely the Jenss model, to the length measurements of a child followed throughout the first six years of life. An empirical Bayes approach is developed for fitting the model, and the prior distribution of the growth-model parameters is estimated from a large sample of least squares parameters. An expression which is proportional to the posterior distribution is derived so that the posterior mode can be estimated. Given the observations on a child, this posterior mode provides Bayes estimates of the Jenss curve parameters for the child.

Bayes Theorem↗
PubMed1993

The influence of gender on conflicts of interest in the allocation of limited critical care resources: justice versus care.

After noting that the principle of autonomy has been inadequate for the resolution of many of the complex and difficult moral dilemmas involving conflicts of interest in the allocation of limited critical care resources, this paper analyzes the concepts of justice and care as alternative solutions to moral problems and applies them to the issue of repeat organ transplants to a single recipient. These concepts are found to be the basis of the notions of moral reasoning and moral orientation, respectively, which serve in moral development theory as two fundamentally different ways to approach moral problem solving. Following an elaboration of moral reasoning as found in Kohlberg's cognitive moral development theory, the influence of gender on moral reasoning is investigated. The empirical data show that women (mean Defining Issues Test score, 47.18) score significantly higher (P < or = .0001) than men (mean Defining Issues Test score, 41.77) in the use of moral reasoning based on the concept of justice for resolving moral dilemmas. Following an elaboration of moral orientation as found in Gilligan's moral theory of the ethics of care, the influence of gender on moral orientation is investigated. The empirical data show that women use the concept of care significantly more often (P < or = .0139) than their male colleagues in resolving moral dilemmas. From these data it is concluded that men are more likely than women to use justice in the resolution of moral dilemmas, such as the conflicts of interest in the allocation of limited critical care resources, but that if women do use, or are required by the social system to use, justice in the resolution of moral dilemmas, they do a better job of it than men.

Critical Care↗