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PubMedDate not supplied

[Total intravenous anesthesia with ketamine and the condition of the higher psychic function in the early and remote postoperative periods].

Influence of total intravenous anesthesia with ketamine on the higher psychic function was studied, immediately after surgery and in the remote postoperative period, in 143 patients with different typological properties of the nervous system after a scheduled surgery--supravaginal uterectomy in fibromyoma of the uterine body. The authors defined 6 groups of patients with different typological properties of the nervous system. Persistent impairment of the higher nervous functions were established, immediately after surgery and in the remote postoperative period, in patients with a weak nervous system, biased nervous balance towards excitation, and with lability of nervous processes. Total intravenous anesthesia with ketamine, when used in patients with the robust nervous system, biased nervous balance towards excitation, and with lability of nervous processes, caused changes in the higher nervous functions and an intensified level of nervous-and-psychic loads, which were unstable and were arrested by the 30th postoperative day. The use of such anesthetic scheme was found to be inadvisable in the above groups of patients. The described impairments were not registered when total intravenous anesthesia was used in patients with a balanced nervous system irrespective of its type, a biased nervous balance towards inhibition and with inertness of nervous processes. The above anesthetic management is acceptable for such patients.

Adult↗
PubMed2002

The decision to accept treatment for osteoporosis following hip fracture: exploring the woman's perspective using a stage-of-change model.

Despite the availability of medications that reduce fracture risk, most women who sustain a hip fracture are not evaluated or treated for osteoporosis. While a number of studies have attributed this to a lack of physician awareness, no studies have evaluated this problem from the patient's perspective. To explore the process a woman negotiates when deciding to accept pharmacologic treatment for osteoporosis after hip fracture, we used a stage-of-change model to characterize a consecutive series of 70 postmenopausal women (mean age 85 years) admitted to a tertiary care hospital with an acute low-impact hip fracture between May 2000 and August 2000. We measured stage-of-change using a modified form of the Weinstein Precaution Adoption Process Model (PAPM). The majority of patients (65%) were ineligible because of dementia or delirium; only 29 were eligible and 21 were enrolled. Most women (62%) were in stages 1 or 2 of the PAPM, indicating that they were unaware of osteoporosis or had never considered pharmacologic treatment for it. The only factors associated with a more advanced PAPM stage (indicating active consideration or currently taking treatment) were a previous bone mineral density (BMD) evaluation ( p = 0.007) and a diagnosis of osteoporosis ( p = 0.001). Although 48% of women had a previous fragility fracture and osteoporosis knowledge was poor overall (mean score 52% correct), neither was associated with a more advanced PAPM stage in this sample. In conclusion, women evaluated after hip fracture were not ready to accept pharmacologic treatment for osteoporosis; they were unaware that they had osteoporosis or had never considered treatment for it. For a woman to advance through the behavior change process, she must first be made aware of the problem that requires a change in behavior. Physicians play a crucial role in promoting awareness of the diagnosis of osteoporosis after fracture, which in turn is associated with patient advancement through the behavior change process and the decision to accept pharmacologic intervention. The large number of cognitively impaired patients in this population, however, will certainly make efforts to improve osteoporosis awareness, diagnosis and intervention more challenging.

Aged↗
PubMed2026

Innovation-related perception as a key driver of alternative protein acceptance: evidence from an early-stage model for cultivated meat and algae-/microalgae-based alternative protein products in Italy.

Alternative proteins are increasingly considered part of the transition toward more sustainable food systems, yet their diffusion depends critically on consumer acceptance. This study investigates the early-stage acceptance of two alternative protein categories in Italy-cultivated meat and algae-/microalgae-based alternative protein products. Focusing on the first three phases of acceptance, the analysis examines how innovation-related perception (IRP) shapes consumer perceived value (CPV), consumer perceived risk (CPR), and subsequent affective (AFF), cognitive (COG), and conative (CON) responses. Data were collected through an online survey administered to 238 Italian respondents and analysed using partial least squares structural equation modelling (PLS-SEM). The results show that IRP is the main upstream driver of early-stage acceptance in both product domains: more favourable perceptions strongly increase perceived value and reduce perceived risk. In turn, CPV exerts a much stronger influence than CPR on both affective and cognitive attitudes. A tentative cross-model comparison suggests only a descriptive variation in the final transition toward conative acceptance: affective and cognitive responses were both significant in the two models, with a relatively larger affective coefficient for cultivated meat and more balanced coefficients for algae-/microalgae-based products. Overall, the findings support a process-based interpretation of alternative protein acceptance and highlight the central role of innovation-related perception in shaping early consumer responses. These results provide relevant implications for communication strategies, product positioning, and policy actions aimed at improving the acceptability of alternative proteins in food cultures characterised by strong culinary traditions.

Italy↗
PubMedDate not supplied

Driven to abstraction: writing an abstract for presentation or publication.

A manuscript's abstract may be the determining factor in the article's acceptance for publication or presentation. It may also be the key to the work's future as a reference article. Specific guidelines for abstract writing are offered to guide the new author through the publication process. The ultimate goal is an accepted manuscript and a prepared presenter.

Abstracting and Indexing↗
PubMedDate not supplied

[Core relational process--its dynamics in child and adolescent psychotherapy].

FREUD's postulate of indirect validation of interpretations is accepted as something given. From this an unconscious relational process between and within each participant in the therapeutic process is deduced. This relational process represents the essence of the intra- and intersubjective point of view, also known as the communicative approach of psychoanalysis. This point of view is compared with concepts of transference and object relations theories, and it is shown that the bulk of transference conceptions and object relations theories are one-person-psychologies whereas the communicative approach of psychoanalysis is a two- and one-person-psychology. Case studies from the area of psychoanalytic child therapy are drawn upon to illustrate this.

Adolescent↗
PubMed2007

Phonological typicality and sentence processing.

In studies of language, it is widely accepted that the form of a word is independent of its meaning and syntactic category. Thus, the relationship between phonological form and grammatical class would not be expected to affect reading time. However, Farmer et al. have now shown that the phonological typicality of a noun or verb influences how rapidly it is read. This finding has implications for both sentence processing and the interpretation of fixation patterns in reading.

Comprehension↗
PubMed1997

Initial experience with soft-copy display of computed radiography images on three picture archive and communication systems.

We recently installed picture archive and communication systems (PACS) from three different vendors on our campus for evaluation. A major part of this evaluation involved assessing the capabilities of these systems for displaying computed radiography (CR) images for primary interpretation. The three PACS provided different functionality for CR image display in terms of availability of the proprietary Fuji CR image processing algorithms, availability of user-specified contrast look-up tables, and application of the processing at the time of CR image capture or image display. We found that the Fuji processing algorithms were important for printing film, but were not necessary for acceptable soft-copy display. Non-linear contrast processing produced superior results compared to simple linear processing (via standard window width and level controls). Display processing was best applied immediately prior to the display operation, as opposed to at the image capture time. This allows the display to be adjusted to demonstrate the full 10-bit range of the CR image, and also allows raw CR data (i.e. not optimized for any particular display device) to be stored in the long-term archive.

Algorithms↗
PubMed2006

[The emergence of the German 'Anstalt': lunatic asylums and hospitals competing].

Based on the wider thesis of the "grand renfermement", psychiatric asylums as well as hospitals (and prisons) should have developed to "total institutions" from late 18th century onwards by gaining public space and further resources devoted to the healing of the (mental) ill who had to be isolated from the healthy citizen following criteria of the modernising medicine. But vis-a-vis to the enormous problems of the early general hospitals to separate the curable based on strictly medical criteria one is astonished, why modern medicine developed two types of institutions and thus doubling its claims on public resources. The article aims to take a look at an early 19th century psychiatric asylum in the town of Dusseldorf from the perspective of the general hospital. That way it tries to get into account the difficult allocation of ill people to one or another hospital. As both had to prove their ability to effectively cure their patients they had to be quite aware whom to let in--and whom to refuse. As they were financed, organised and administrated on different political levels and thus dependent to different governmental bodies (town vs. region) a couple of conflicts become visible which had to be solved in order to establish institutionalisation. Finally, in the long run both had to gain public recognition and acceptance, which only could mean the acceptance of potential patients. The perspective opened by the theorem of the "total institution" seems not to be all-to helpful to that purpose, as it tends to neglect institutional competition as well as the process of gaining the potential patients' acceptance. A more useful perspective could be a comparative analysis based on local examples, which could open the view to the competing establishment of prisons, psychiatric asylums and general hospitals as "useful" types of organizations in a modernising society.

Germany↗
PubMed1986

Acceptance and use of patient-carried health records.

The ultimate goals of providing health records to patients are to improve continuity of care, to improve patient understanding of instructions, and to encourage patients to take a more active role in maintaining their health. In the current study, four types of patient-carried health records were evaluated in a hospital-based outpatient service to determine whether records would be accepted and used, to estimate the cost of the process, and to obtain patient and provider reactions. Records were provided at moderate cost and the primary determinants in record acceptance and use were physicians' support of the process, the type of record, and the employment status of the patient. A small record which could be carried in a wallet seemed suited to most patients; other more elaborate participatory records appeared to have benefits for selected patients. More extensive use of participatory records appears to require changes in the way health care would be delivered.

Attitude of Health Personnel↗
PubMed2004

The physiology of learning and memory: role of peptides and stress.

The neuropeptides, as well as their respective receptors, are widely distributed throughout the mammalian central nervous system. During learning and memory processes, besides structural synaptic remodeling, changes are observed at molecular and metabolic levels with the alterations in neurotransmitter and neuropeptide synthesis and release. While there is consensus that brain cholinergic neurotransmission plays a critical role in the processes related to learning and memory, it is also well known that these functions are influenced by a tremendous number of neuropeptides and non-peptide molecules. Arginine vasopressin (AVP), oxytocin, angiotensin II, insulin, growth factors, serotonin (5-HT), melanin concentrating hormone, histamine, bombesin and gastrin-releasing peptide (GRP), glucagon-like peptide-1 (GLP-1), cholecystokinin (CCK), dopamine, corticotropin releasing factor (CRF) have modulatory effects on learning and memory. Among these peptides CCK, 5-HT and CRF play strategic roles in the modulation of memory processes under stressful conditions. CRF is accepted as the main neuropeptide involved in both physical and emotional stress, with a protective role during stress, possibly through the activation of the hypothalamo-pitiuitary (HPA) axis. The peptide CCK has been proposed to facilitate memory processing and CCK-like immunoreactivity in the hypothalamus was observed upon stress exposure, suggesting that CCK may participate in the central control of stress response and stress-induced memory dysfunction. On the other hand, 5-HT appears to play a role in behaviors that involve a high cognitive demand and stress exposure activates serotonergic systems in a variety of brain regions. The physiological role and therapeutic efficacy of various neuropeptides and the impact of stress exposure in the acquisition and consolidation of memory will be reviewed thoroughly.

Animals↗
PubMedDate not supplied

The relationship between age, processing speed, working memory capacity, and language comprehension.

A total of 50 elderly individuals and 48 college students were tested on several measures of processing speed and of working memory capacity. Language processing was tested with an on-line measure of sentence processing efficiency, an end-of-sentence acceptability judgement task, and a paragraph comprehension test. Elderly individuals performed more poorly than college students on the speed of processing and working memory measures and had longer listening times overall on the sentence processing measures. Elderly individuals did not, however, have overall longer listening times at the most capacity-demanding regions of the harder sentence types. Correlational analyses failed to establish a relationship between the increase in syntactic processing load at the capacity-demanding region of the harder sentence type and the measures of working memory capacity, but did establish a relationship between paragraph comprehension and working memory capacity. The data are argued to provide evidence that the WM system used to structure sentences syntactically is separate from that used in other aspects of language comprehension.

Adult↗
PubMed2005

Implementing institutional change: an institutional case study of palliative sedation.

Palliative sedation is used in the rare patient who has intractable distress at the end of life. Implementation of palliative sedation, however, may meet resistance from various clinicians and other hospital staff. To ensure that our patients had access to this important treatment modality, we found it necessary to engage in a process of institutional change that resulted in acceptance of the use of palliative sedation in the non-ICU setting.* In this paper, we will review the processes we found to be successful in hopes that they will also be efficacious for others wishing to produce similar change within their institutions. We first will review the theoretical foundations described in organizational development and change management literature. Next we describe our implementation strategies (including education, multidisciplinary alliances, and the development and approval of a practice guideline). Finally, we discuss in detail the role of interpersonal interactions. Three clinical cases are used to demonstrate the change in attitudes, processes, and outcomes.

Aged↗
PubMed2002

Proposing an evidence-based policy process.

Nurses' involvement with policy development may appear more feasible if the policy process is viewed as another example of an evidence-based decision-making process. Evidence-based practice is widely accepted in medicine and across health care as a sound principle or approach when attempting to establish "best" practice. The process of searching for and synthesizing the evidence is applied to the policy design process with the use of policy examples that are relevant to nurse administrators.

Benchmarking↗
PubMed1999

Towards a feasible model for shared decision making: focus group study with general practice registrars.

OBJECTIVES: To explore the views of general practice registrars about involving patients in decisions and to assess the feasibility of using the shared decision making model by means of simulated general practice consultations. DESIGN: Qualitative study based on focus group interviews. SETTING: General practice vocational training schemes in south Wales. PARTICIPANTS: 39 general practice registrars and eight course organisers (acting as observers) attended four sessions; three simulated patients attended each time. METHOD: After an introduction to the principles and suggested stages of shared decision making the registrars conducted and observed a series of consultations about choices of treatment with simulated patients using verbal, numerical, and graphical data formats. Reactions were elicited by using focus group interviews after each consultation and content analysis undertaken. RESULTS: Registrars in general practice report not being trained in the skills required to involve patients in clinical decisions. They had a wide range of opinions about "involving patients in decisions," ranging from protective paternalism ("doctor knows best"), through enlightened self interest (lightening the load), to the potential rewards of a more egalitarian relationship with patients. The work points to three contextual precursors for the process: the availability of reliable information, appropriate timing of the decision making process, and the readiness of patients to accept an active role in their own management. CONCLUSIONS: Sharing decisions entails sharing the uncertainties about the outcomes of medical processes and involves exposing the fact that data are often unavailable or not known; this can cause anxiety to both patient and clinician. Movement towards further patient involvement will depend on both the skills and the attitudes of professionals, and this work shows the steps that need to be taken if further progress is to be made in this direction.

Attitude of Health Personnel↗
PubMed1997

Psychiatric consultations in stiff-man syndrome.

BACKGROUND: Stiff-man syndrome is a rare central nervous system disease first described nearly 40 years ago. Its cause has been attributed to both neurologic and psychiatric processes. In recent years, it has been accepted as a neurologic condition in which the gamma-aminobutyric acid (GABA) system malfunctions, probably because of an autoimmune process. Published reports that have described psychiatric manifestations of the disease have relied on descriptions of one or two cases and literature reviews. METHOD: We reviewed the medical records of 24 patients with confirmed stiff-man syndrome, 12 of whom had received psychiatric consultation. This review was done to better determine the psychiatric manifestations of stiff-man syndrome. RESULTS: Retrospective analysis of these 12 cases showed that the most common psychiatric symptoms were anxiety, depression, and alcohol abuse. CONCLUSION: We speculate that the GABA system is involved in both the neurologic and psychiatric symptoms of these patients. Psychiatrists have a significant role in the management of patients with stiff-man syndrome and may be expected to manage anxiety, depression, and substance misuse.

Adult↗
PubMed1995

Issues in evaluation of bioanalytical method selectivity and drug stability.

Evaluation of selectivity is one of the most controversial aspects of method validation and application of methods to studies. The focus of selectivity testing should address the question: Above what level will interference significantly impact on study conclusions? Four key issues will be addressed: the statistical relevance of any selectivity test performed; a criterion for significant interference; experimental methods to establish selectivity; and criteria for acceptance. To ensure that compound integrity is maintained throughout the work-up process, statistically meaningful methods of stability evaluation which are associated with specific acceptance criteria are required. Suitable methods for evaluating stability of analyte and/or solutions of analyte, in process stability, processed sample stability, long term stability and freeze-thaw stability, as well as meaningful acceptance criteria, are presented.

Animals↗
PubMed1987

Acceptance and use of patient-carried health records.

The ultimate goals of providing health records to patients are to improve continuity of care, to improve patient understanding of instructions, and to encourage patients to take a more active role in maintaining their health. In the current study, four types of patient-carried health records were evaluated in a hospital-based outpatient service to determine whether records would be accepted and used, to estimate the cost of the process, and to obtain patient and provider reactions. Records were provided at moderate cost and the primary determinants in record acceptance and use were physicians' support of the process, the type of record, and the employment status of the patient. A small record which could be carried in a wallet seemed suited to most patients; other more elaborate participatory records appeared to have benefits for selected patients. More extensive use of participatory records appears to require changes in the way health care would be delivered.

Attitude of Health Personnel↗
PubMedDate not supplied

Building and maintaining an interdisciplinary research team.

Successful grant-writing in Alzheimer disease research, as with many other diseases, requires collaborative work among a group of individuals who represent various disciplines of relevance to the research problem. Interdisciplinary teams in Alzheimer disease research have the potential to explore more facets of a given research problem than teams that are not interdisciplinary in nature. Such teams also have the potential to produce better science and to disseminate results to a wider spectrum of relevant groups, may be more successful in achieving funding, and are stimulating and growth-enhancing for members. Building and maintaining these teams is a complex and challenging process, but identification and proactive resolution of challenges is essential. Important elements of success include establishing common goals, using a democratic group process, maintaining open communication, developing mutually acceptable policies for disseminating research results, and facilitating achievement of team members' personal and professional goals.

Aged↗