Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “SPECIALISM”

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 1,009 records · Page 56Linked to original sources
PubMed2004

Headache treatment before and after the consultation of a specialized centre: a pharmacoepidemiology study.

Our aim was to study and compare pharmacoepidemiology of headache treatment in two different settings: inside and outside a specialized Centre. We analysed the differences in headache treatment between 612 subjects admitted for the first visit ('naive') (F/M: 2.41; mean age = 37.31 +/- 14.09 years) and 620 subjects admitted for a control visit (F/M: 3.18; mean age = 44.30 +/- 15.37 years) to the Headache Centre of the University of Modena and Reggio Emilia. Most patients suffered from migraine. As acute treatment, on the first visit, 49.4% of them were taking drugs prescribed by a doctor; 41.5% were taking over-the-counter analgesics (OTCAs); 9.1% were not taking any drug. On the control visit, 81.3% of patients were taking prescription drugs; 15.8% OTCAs; 2.9% were not taking drugs (overall chi-square = 139.229, P < 0.001). Non-selective analgesics were the most-used drugs. Triptans were used by 9.1% of 'naive' patients and by 31.8% of patients attending for the control visit (Fisher's Z = 7.655, P < 0.001). Nimesulide was the most-used drug. A prophylactic treatment was made by 16.8% of 'naive' patients, and by 58.2% of patients admitted to the control visit (Fisher's Z = 12.135, P < 0.001). Antidepressants were the class of drugs most used for prophylaxis. Amitriptyline was the drug for prophylaxis most frequently used by patients attending the control visit, while flunarizine was the most frequently used by 'naive' patients. Before being examined in a specialized centre, few patients take prescription drugs, triptans, or prophylactic drugs; specialized care increases the proportion of patients taking prophylactic drugs, and changes the type of acute treatment used into disease-specific medication for headache.

Adolescent↗
PubMed1995

Community nursing in Finland: the division of fields of activity and patterns of care--comprehensive or specialized care?

The aim of this study was, first, to describe the changes taking place in the division of fields of activity in Finnish community nursing during a national project on primary health care; second, to describe and analyze patterns of care by categorizing different points of view in nurses' personal experiences. Data on the division of fields of activity in all project areas were collected in a survey and in annual registrations of public health nurses' tasks (n = 87-113). Care patterns were discerned in focused interviews with public health nurses (n = 18). Three types of division of fields of activity were identified: the comprehensive, semi-comprehensive and specialized model. The comprehensive and semi-comprehensive models became more common during the project and the specialized one less common. Patterns of care were classified into four main categories: structural, individualistic, family-centred and community-centred. The division of fields of activity was not always compatible with the care patterns. The study identified several issues that should be considered in the definition and implementation of comprehensive and specialized care.

Community Health Nursing↗
PubMed2004

Identifying children with special health care needs in the National Health Interview Survey: a new resource for policy analysis.

OBJECTIVE: To test the feasibility of using the National Health Interview Survey (NHIS) to identify children with chronic illness through a noncategorical approach, as exemplified by the Children with Special Health Care Needs (CSHCN) screener. The ability to use the NHIS to identify CSHCN will permit analyses of the effects of welfare reform and public insurance eligibility expansions during the late 1990s on CSHCN. DATA SOURCES: The NHIS from 1997, 1999, and 2000. The NHIS is an ongoing household survey representative of the civilian, noninstitutionalized population of the United States. STUDY DESIGN: Survey items were selected from the NHIS and thresholds designated to replicate the content and logic of the CSHCN screener. The screener asks explicit questions concerning an elevated need for, or use of health care services, and about limitations in activity, both caused by a chronic health condition. The algorithm created was applied to the pooled 1999-2000 NHIS to generate national prevalence estimates. Multivariate logistic regression was estimated to determine the effect of having particular demographic characteristics on the likelihood of being identified as CSHCN. Log odds ratios were compared to those from earlier NHIS-based estimates and from a pretest of the CSHCN screener. PRINCIPAL FINDINGS: An estimated 12 percent of noninstitutionalized children aged 0 through 17 have a chronic condition that results in elevated service use or limitations in normal activity. This estimate is sensitive to inclusion of children with a broader array of less serious or shorter-term conditions. The estimated effects of child characteristics on the likelihood of being identified as having special health needs are similar but not identical to other algorithms that have been used to identify CSHCN. CONCLUSIONS: It is feasible to use existing questions in the NHIS to identify a population of CSHCN that is substantially similar to children identified through other algorithms or through use of a screening instrument imbedded in a household survey. The availability of this algorithm will permit use of the NHIS for important analyses of the effects of welfare reform and public insurance expansions on children with special health care needs.

Adolescent↗
PubMed1983

A geriatric special-care unit: experience in a university hospital.

Responding to a perceived need for specialized care for the acutely ill elderly, a 14-bed geriatric special-care unit was established in the University of Massachusetts Hospital in January 1980. Patients were selected for admission after assessment of their potential to benefit from restorative care. Most patients were admitted from the emergency room or outpatient clinics or were scheduled admissions; a few were in-hospital transfers. This report deals with a retrospective analysis of the first 514 admissions (431 patients) to the unit. Admissions by major service were: Medicine, 64 per cent; Surgery, 14 per cent; Neurology, 10 per cent; Orthopedics, 7 per cent; and other, 5 per cent. Approximately 64 per cent of patients were between the ages of 70 and 84. The overall average length of stay per admission was 11.5 days. Mortality rate of patients undergoing surgery (n = 125) was 4 per cent. The percentage of admissions that were discharged home was 78.7 per cent. Only 7.3 per cent of admissions were discharged to a nursing home, when those that were admitted to the unit from a nursing home are excluded. The authors conclude that a special nursing unit for acutely ill elderly patients may serve several purposes in a university hospital: overall patient care may be improved; length of hospital stay may be shortened; and medical students, housestaff, and attending physicians may gain an opportunity to learn the fundamentals of geriatric medicine as demonstrated by the staff of the unit.

Aged↗
PubMed1998

Environmental correlates of resident agitation in Alzheimer's disease special care units.

OBJECTIVE: To determine the point prevalence of agitated behaviors in a representative sample of Alzheimer's disease Special Care Units, and to determine the extent to which agitation is associated with aspects of the treatment environment. DESIGN: A cross-sectional study in which nonparticipant observers recorded 3723 observations of resident behaviors in 53 Alzheimer's disease Special Care Units. Observational data were gathered on the physical environment and staff treatment in these settings, and resident characteristics were extracted from a data base developed in the study states by the Health Care Financing Agency. Analyses studied the association between aspects of the staff and physical environment and resident agitation levels, controlling for resident cognitive and functional status. SETTING: Special Care Units in nursing homes in Kansas, Maine, Mississippi, and South Dakota. PARTICIPANTS: All residents and staff of the participating units. MAIN OUTCOME MEASURES: Eight specific agitated behaviors and two indexes of resident agitation were measured by direct observation by research assistants on three to four data collection walk-throughs in each of the study facilities. RESULTS: The most common agitated behaviors noted were repetitive mannerisms (4.5% of resident observations) and non-loud verbal excess (3.8%). Wandering, which frequently reflects agitation, was noted in 6.5% of resident observations. The proportion of residents exhibiting an agitated behavior varied from none in some units to 38% in one unit. Independent correlates of low unit agitation levels included favorable scores on measures of the physical environment and of staff treatment activities, low rates of physical restraint use, a high proportion of residents in bed during the day, small unit size, low levels of resident functional dependency, and fewer numbers of comorbid conditions. CONCLUSIONS: While the prevalence of agitation tends to increase as Alzheimer's disease progresses, modifiable treatment factors appear to have a strong influence on the prevalence of agitation. Both physical design and staff treatment appear to influence agitation rates, as do some measures consistent with a low stimulus approach to Alzheimer's care.

Activities of Daily Living↗
PubMed1991

New views on periodontal microbiota in special patient categories.

The microorganisms in periodontitis of special patient categories have been only partially elucidated. The periodontitis microbiota of HIV-infected individuals, cancer patients on myelosuppressive therapy, and persons with other medical disorders includes common suspected periodontal pathogens as well as enteric rods, pseudomonads, staphylococci and yeasts. Failing implants also may be associated with classical periodontal pathogens as well as primarily nonoral potential pathogens. Refractory periodontitis in systemically healthy adults can show a great variety of oral and nonoral organisms. The frequent occurrence of unusual periodontal organisms in special patient categories may be due to a weakened host response and/or usage of various chemotherapeutic regimens. The unusual organisms may contribute to progressive periodontitis and in leukemia patients may even give rise to life-threatening systemic manifestations. The primary therapeutic goal in special periodontitis patients is control of pathogens and amid the wide range of pathogenic microfloras, an effective treatment strategy should include a comprehensive microbiological analysis, especially if systemic antimicrobial therapy is contemplated.

Bacteria↗
PubMed1991

Utilization of primary care versus specialized care in children with and without chronic illness. A population-based study.

Children's utilization of curative care was studied to analyse the division of responsibilities between undifferentiated primary care and specialized care. All chronically ill (n = 510), a control group (n = 287) and the total population 0-15 years of age (n = 6080) in a primary care district were studied using register data. Chronically ill children comprised 8.4% of the total child population and were registered for 1/10 of the primary health care visits, 1/3 of the specialized visits, 1/3 of the hospitalizations and 1/2 of the in-patient days of all children. The yearly ambulatory visits were 3.7/child in the chronically ill and 1.5/child in the control group, of which 1/3 and 2/3, respectively, were to primary care. Utilization of specialized care increased with disability. Chronically ill children visited primary care mainly for acute respiratory infections but seldom for allergic or other chronic conditions.

Adolescent↗
PubMed1993

A model for training community-based providers for children with special health care needs.

Children with special health care needs pose many challenges for community-based providers. Programs such as school, child care, and Head Start provide services to children that previously would have been delivered in hospitals or at home. The need for a system of care to assure safe, quality services for these children is paramount. While health procedure manuals for schools have been developed, few recommendations address the actual training of providers or the trainers of providers. This article describes a system of training which includes steps in managing the care of children with special health care needs, levels of training, and expected competencies for the care providers of children with special health care needs.

Adult↗
PubMed1993

Guidelines for working with students having special health care needs.

Students with special health care needs present challenges to persons involved with their education, but school staff are accepting the challenge to create safe, nurturing, and stimulating environments for these students. This article proposes guidelines for school staff working with students having special health care needs. The guidelines evolved from the authors' experiences and are child-related, family-related, and school-related. Discussion of each guideline includes illustrations of issues arising from them. Considerations for implementing the guidelines are presented and include discussion of school policies and procedures and state laws and regulations related to school staff working with students having special health care needs.

Child↗
PubMed1994

A program to address the special needs of drug-exposed children.

The Ravenswood-Stanford Coalition for At-Risk Children promotes school success by intervening with K-3 students identified as drug-exposed, either prenatally or environmentally, enabling them to remain in regular classrooms rather than diverted to special education. This goal was accomplished through professional partnerships, home involvement, individual intervention plans, special school-based services, and mentorships. Results from the project indicate these children are not significantly different from their peers; home involvement promotes better school linkages and reinforces positive behavior change; appropriate short-term, school-based services can increase academic and behavioral performance; dedicated volunteers working individually with students accelerate change processes; and these special at-risk students must be assigned to caring, supportive, and predictable classrooms.

Child↗
PubMed2006

The effect of rural residence on dental unmet need for children with special health care needs.

BACKGROUND: Unmet need for dental care is the most prevalent unmet health care need among children with special health care needs (CSHCN), even though these children are at a greater risk for dental problems. The combination of rural residence and special health care needs may leave rural CSHCN particularly vulnerable to high levels of unmet dental needs. OBJECTIVE: To examine the effects of rural residence on unmet dental need for CSHCN. METHODS: We use the nationally representative National Survey of CSHCN Needs. We performed logistic regression to estimate the independent effects of rural residence on the likelihood of having an unmet dental need, using a measure of unmet need based on professional society recommendations and a measure based on parental report. RESULTS: Using either of the measures, a substantial percentage of CSHCN do not receive all needed dental care. Rural CSHCN are more likely to forgo needed dental care than their urban counterparts. Our results suggest that rural CSHCN have unmet needs for dental care due to both difficulty accessing care and because their parents do not recognize a need. CONCLUSION: Traditional access barriers for rural children, such as inadequate provider supply and lack of insurance, may increase unmet needs both directly and indirectly, through their effects on parents' perceptions of need. Reducing unmet needs for dental care in rural children with special needs will require addressing both access issues and parents' understanding of dental care need.

Child↗
PubMed2000

Noah grows up: transitioning problems from special feeding routes to oral intake.

As more children with special health care needs survive into adulthood, there is an increased need for help with the transition from special feeding routes to oral intakes. In infancy and early childhood, emphasis is often placed on the medical aspects of treatment for these children. As they grow and integrate more fully into the community, attention shifts to their educational needs. Throughout life, however, the need for attention to nutrition issues and needs remains. A case study illustrates the experiences of a young man with special oral intake needs; feeding and related transitions were required for independent functioning as he matured into a young adult. His many struggles are summarized, nutrition implications are outlined, and recommendations are provided for dealing with similar patients.

Adult↗
PubMedDate not supplied

Dental fear and anxiety as a barrier to accessing oral health care among patients with special health care needs.

Persons with special health care needs due to physical and cognitive impairment can be at increased risk for dental disease which can be attributed to, as well as exacerbate, existing medical conditions. This study assessed the nature of perceived barriers to obtaining oral health care among a special-needs population and the influence of these factors (in particular, fear and anxiety) on utilization of dental services. A total of 27.9% of the sample reported fear/anxiety about dental visits, with approximately half of those reporting to be very nervous or "terrified". There was an inverse relationship between the frequency of dental visits and the proportion of respondents reporting themselves as very nervous or terrified, and between the perception of oral health status and the level of dental fear/anxiety (P < 0.001). A large difference was reported between patient preference for pharmacologic modalities for anxiety control and those received at dental visits, with 40% of the youngest age group indicating that they would go to the dentist more frequently if sedation or general anesthesia were offered. The levels of self-reported fear/anxiety and the high proportion of respondents indicating an unmet need for adjunctive anesthesia services suggest that fear/anxiety acts as a barrier to dental care among this special-needs group which could be ameliorated with greater use of these services.

Activities of Daily Living↗
PubMedDate not supplied

Special considerations for treating dental patients exhibiting the "post-polio syndrome".

A condition called "Post-polio Syndrome" (PPS) is a special type of neuromuscular disturbance that affects some elderly patients who had polio myelitis either as children or as young adults. It has been reported that approximately 1,600,000 polio survivors are alive today. Most will seek dental care, and up to half of the survivors will present with some form of PPS. This paper describes polio, its characteristics, and the long-term consideration of PPS, and discusses the special clinical implications related to this condition. Special emphasis is placed on physical impairments, breathing problems, and difficulty swallowing. Also included are sections discussing such topics as patient scheduling, office design and housekeeping, patient management, oral hygiene, diagnostic procedures, drug and pain management, and general health considerations.

Aged↗
PubMedDate not supplied

Outreach dental service for persons with special needs in Hong Kong.

The authors describe the acceptance and efficiency of an outreach dental service, which provided oral health care to persons with special needs in Hong Kong. Portable dental equipment was transported to various institutions. Basic dental care including prevention, scaling, restoration, extraction, and denture repair was provided free of charge. Elderly adults living in institutions were the main service recipients, but other people with special needs, including physically disabled and persons with mental retardation were also reached. One-third of the patients had dental pain or sensitivity, and 70% had not visited a dentist for more than three years. Dental care was provided to 6,867 patients over four years. Feedback from the patients showed that more than 90% of them were satisfied with the service. These findings indicate that patients with special needs in Hong Kong are in great need of dental care. An outreach dental service appears to be both appropriate and efficient in providing care to these persons.

Adolescent↗
PubMed1989

Occurrence of eye disorders and need for treatment in the elderly in special dwellings and nursing homes [corrected].

The prevalence of eye disorders and need for ophthalmological procedures due to pathological processes were studied among elderly people living in 8 special dwellings [corrected] and nursing homes in northern Finland (N = 268). The participation rate was 100%. Hyperopia was the most common disorder found (men: 78%, women 77-78%). Macular degeneration was found in 54-55% of men and 45-46% of women, senile cataract in 32-33% of men and 28-31% of women and palpebral dermatochalasis or blepharochalasis in 25-26% of men and 31% of women. Hyperopia was more common in younger persons, but senile cataract, macular degeneration and palpebral dermatochalasis or blepharochalasis were more common in older persons. Basic ophthalmological examinations led to a high number of secondary procedures. Ophthalmological treatment and rehabilitation seemed to be neglected in these Finnish special dwellings [corrected] and nursing homes. Because sight is an important determinant of elderly people's ability to manage their daily activities, the authors propose that more attention should be paid to the screening of ophthalmological problems and to ophthalmological treatment and rehabilitation in special dwellings and nursing homes [corrected].

Age Factors↗
PubMed1994

Ageing and the retrieval of specialized and general knowledge: performance of Masterminds.

Contestants in the television quiz show Mastermind attempt to answer correctly as many questions as possible in two minutes on: (1) A specialized subject of their own choosing and (2) general knowledge. In this study, past contestants were asked to provide details of their performance in the competition. It was predicted that younger contestants would outperform older contestants under the speeded conditions of Mastermind because of their superior fluid intelligence. The main results were as follows: (1) Higher scores and lower tip-of-the-tongue (TOT) rates were achieved in the specialized subject round than in the general knowledge round. (2) TOT rate was positively related across the two rounds. (3) There was no effect of age on performance in the specialized subject round. In the general knowledge round, age was positively correlated with both score and accuracy. Thus, contrary to predictions, the older contestants actually outperformed the younger contestants (at least in the general knowledge round), presumably because of their superior crystallized intelligence. The results are discussed in terms of 'limited impact' theories of ageing, such that age-related decline in fluid intelligence does not necessarily occur for (a) everybody or (b) everything.

Adult↗
PubMed1984

Activation of dormant genes in specialized cells.

In several experimental systems the genomic capacity in specialized cells can be assessed by examining the activation of dormant genes. Since some of these specialized cells can be induced to change cell phenotype, all cell specializations do not necessarily involve irreversible genetic changes.

Animals↗