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At least 1,207 records · Page 67Linked to original sources
PubMed1999

Reasons for discontinuing intracavernous injection therapy with prostaglandin E1 (alprostadil).

OBJECTIVES: To clarify the reasons why experience with self-injection therapy for erectile dysfunction shows high dropout rates. METHODS: We studied 86 patients 36 to 76 years old who had been on home treatment for at least 3 months. Sixty-nine patients (80%) were continuing to use injections, and 17 (20%) had discontinued the treatment. Patients were evaluated by interview and clinical examination. RESULTS: Patients still in the program used one injection every 2 weeks, and those who had given up treatment had used one injection in 3 weeks (P = 0.31). They were in the program for 39+/-27 and 16+/-22 months (P = 0.002), respectively, and had used 50 (95% confidence interval [CI] 21 to 91) versus 12 (95% CI 4 to 20) injections, respectively (P<0.0001). Injections producing unsatisfactory penile rigidity, prolonged erections, hematoma at injection site, corporal fibrosis, secondary penile deviation, and mean estimated duration of a pharmacoinduced erection showed no significant differences. Patient satisfaction (P = 0.02), estimated partner satisfaction (P = 0.02), increase in self-esteem (P = 0.01), and negligible effort in performing injections (P = 0.001) all showed significantly better results for those still in the program. CONCLUSIONS: Reasons for dropout from self-injection therapy are not based on objective side effects and discomfort. Patients leaving the program are less motivated, less satisfied with the quality of pharmacoinduced sexuality, consider the effort to perform injections to be substantial, and have not achieved improved self-esteem.

Adult↗
PubMedDate not supplied

[The reasons for consultation and active problems. A key for the understanding of information in primary care].

The aim of this work is to assess the major differences found in the information content of the registers in primary care according to whether the registration includes the Reason (s) For Encounter (as ascertained by the professional) or the Active Health Problem (s). The information used is based on an observational study of a representative sample of the consultations to eight general practitioners from the Principate of Andorra. The study was performed during the period of May-June 1989. 547 consultations are analysed. A better specificity and information content is observed when both approaches are registered. Active Health Problems seem to be barely related to Reasons for Encounter and it seems that they could have as much, if no more. Influence in the process of care, than the RFEs it selves.

Adolescent↗
PubMed2001

Rise in popularity of complementary and alternative medicine: reasons and consequences for vaccination.

Complementary and alternative medicine (CAM) has become a popular form of healthcare and the predictions are that, it will increase further. The reasons for this level of popularity are highly diverse, and much of the motivation to turn to CAM pertains to a deeply felt criticism of mainstream medicine - many people (are led to) believe that conventional interventions, including immunisation, are associated with the potential to do more harm than good. Thus, it is hardly surprising that CAM also lends support to the "anti-vaccination movement". In particular, sections of the chiropractors, the (non-medically trained) homoeopaths and naturopaths tend to advise their clients against immunisation. The reasons for this attitude are complex and lie, at least in part in the early philosophies which form the basis of these professions. The negative attitude of some providers of CAM towards immunisation constitutes an important example of indirect risks associated with this form of healthcare. The best way forward, it seems, would be a campaign to clarify the risk-benefit profile of immunisations for both users and providers of CAM.

Chiropractic↗
PubMed2001

Pain as a reason to visit the doctor: a study in Finnish primary health care.

This study aims to demonstrate the prevalence of pain as a reason for seeing a physician in primary care. We also performed an analysis of the localization, duration and frequency of pains, as well as the diagnoses of patients having pain. A total of 28 physicians at 25 health centers in Finland collected the data, comprising 5646 patient visits. Pain was identified as the reason for 2237 (40%) of the visits. The most common localizations were in the lower back, abdomen and head. One-fifth of the pain patients had experienced pain for over six months. Analysis of the diagnoses revealed half of the pains to be musculoskeletal. Patients experienced considerable limitations in various activities of life due to pain. A quarter of the pain patients of active working age received sick leave. Our results confirm that pain is a major primary health care problem, which has an enormous impact on public health.

Activities of Daily Living↗
PubMedDate not supplied

Alcohol consumption in university students: the role of reasons for drinking, coping strategies, expectancies, and personality traits.

Despite the popularity of the social learning perspective of alcohol abuse, there have been limited efforts devoted to developing comprehensive models that delineate the roles of the constituent components of this approach. In the present study, we determined whether reasons for drinking, coping strategies, alcohol expectancies, and personality traits predict binge drinking and alcohol consumption levels in university students. Escape drinking was the sole positive direct predictor of binge drinking. Social drinking predicted alcohol consumption and thereby exerted an indirect influence on binge drinking. Alcohol expectancies played a significant role in the model but only by influencing reasons for drinking. Although the use of alcohol and/or drugs to cope predicted alcohol consumption, none of a variety of other coping strategies exerted a significant influence in the model. Stress responsivity-related personality traits played a significant role, primarily via an influence on alcohol expectancies. These findings provide support for the social learning perspective of alcohol abuse and offer further insight into the factors that contribute to the development of risky alcohol consumption patterns.

Adaptation, Psychological↗
PubMed1997

Quantitative study of ductal breast cancer--patient targeted prognosis: an exploration of case base reasoning.

Current analytic methodologies allow the extraction, even from small tumor masses, of extensive information on the biologic characteristics of malignant lesions, such as tumor aggressivity, metastatic potential, drug resistance, and host interactions. Clinical practice now offers a wide range of therapeutic strategies. Information technological advances offer the opportunity to refer to very large data bases of patient anamnestic data, response to treatment and clinical outcome. There is a need to formulate therapy and prognosis for each individual case. Case based reasoning is a knowledge based methodology where the outcome for complex situations can be predicted by referring to a large data base of cases of known outcomes. The preliminary data obtained from this study suggest that case based reasoning may offer a promising approach to individual targeted prognosis.

Breast Neoplasms↗
PubMed2001

A critical review of the probable reasons for the poor variable bioavailability of rifampicin from anti-tubercular fixed-dose combination (FDC) products, and the likely solutions to the problem.

The problem of poor/variable bioavailability of rifampicin, which is shown in particular when the drugs are present in anti-tubercular fixed-dose combination (FDC) products, is a matter of serious concern. There is a potential of failure of therapy in patients with an active disease. It perhaps also is a contributory factor towards the increasing resistance to anti-tubercular drugs. Unfortunately, the origin and cause of the problem is not clearly understood, though GMP and crystalline changes in the drug are invariably cited as the principal reasons. In this write-up, various probable physical and/or chemical reasons are critically reviewed. The enhanced decomposition of rifampicin in the presence of isoniazid in stomach after ingestion is indicated to be the key factor behind the problem. Some simple solutions offered by the knowledge of the cause are discussed and it is concluded that there is a need to have a multifaceted approach to handle the problem.

Animals↗
PubMed2004

Context-dependent reasoning in a cognitive bias task Part II. SPECT activation study.

A cognitive bias task (CBT) delineates two different cognitive selection mechanisms in the prefrontal cortex. To identify functional anatomy of context-dependent reasoning, we used technetium-99mhexamethyl- propyleneamine oxime (99mTc HM-PAO) single photon emission computed tomography (SPECT) and statistical parametric mapping. Twelve right-handed men 20-24 years old were instructed to look at a target card and then select the choice card (among two) that they preferred (modified CBT; mCBT). They also selected a choice card 2 weeks later without prior presentation of a target card (control task). In both tasks, 99mTc HM-PAO was injected intravenously about 15 s after initiation of the mCBT or control task. Brain images were obtained using a gamma camera and reconstructed by a UNIX-based workstation. Statistical analysis compared all activated images to control images. Results associated with P values of less than 0.01 (Z score > 2.36) were depicted on T1-weighted magnetic resonance images. All subjects preferred choices more similar to the target. SPECT activation occurred bilaterally in the dorsolateral prefrontal cortices and middle temporal gyri during performance of the CBT. Additionally, the left inferior prefrontal cortex and left fusiform gyrus showed significant activation compared with the control task. A neural network linking the temporal and prefrontal cortices prominently seen in the left hemisphere participates in context-dependent reasoning. Knowledge of such neural systems is essential for understanding prefrontal lobe function and dysfunction.

Adult↗
PubMed1999

Three-dimensional magnetic resonance imaging of the interosseous membrane of forearm: a new method using fuzzy reasoning.

We now report newly developed three-dimensional magnetic resonance imaging (3D-MRI) system which is based on semiautomatic tissue extraction from the axial MR images utilizing the fuzzy reasoning calculation method and 3D-image reconstruction with surface rendering. We also studied normal in vivo dynamic changes of the interosseous membrane (IOM) of forearm during rotation using this 3D-MRI. Serial axial MRI of right forearms of five healthy volunteers was obtained in five rotational positions, and extraction and 3D-reconstruction of the radius, ulna, and IOM was made using the system. Extraction results were well with the fuzzy reasoning method. 3D-MRI of the radius and ulna, IOM were reconstructed from these images respectively, and their 3D-shapes were almost identical to the anatomic shape. 3D-MRI showed there were wavy deformities on the IOM in pronation position in the all five subjects and dorsiflexion on the most dorsal portion of the IOM at maximum supination in three forearms. In neutral position, the IOM of all five volunteers was almost flat. From anatomic orientation, these dynamic changes of the IOM mainly occurred at the membranous portion, which is soft, thin, and elastic. Otherwise, the tendinous portion which is a thick and strong complex of 5 to 10 bundles run from proximal one third of the radius to distal one fourth of the ulna, demonstrated minimal dynamic changes on the 3D-MRI. Therefore, the tendinous portion is considered to be taut during rotation to provide stability between the radius and the ulna, while the membranous portion is easy to deform and allowing smooth rotation. Furthermore, because of wide-use, our 3D-MRI system is useful for in vivo analysis of soft tissue kinesiology in normal and abnormal musculoskeletal systems.

Adult↗
PubMed1996

Diagnostic reasoning in neurology.

Studies examining physicians' clinical decisions have demonstrated considerable variation in decisions and practices and identified numerous challenges to effective, efficient, and accurate decision making. Although use of the decision aids and tools described in this article may help overcome many of these challenges, greater self-awareness of the diagnostic reasoning process and the factors influencing decisions also should help improve clinical decisions and reduce variation, irrespective of the use of these tools. Continued research into the determinants and nature of the diagnostic reasoning process will provide additional insights that can be used to develop and apply improved decision aids and corrective procedures to overcome persistent problems.

Decision Support Techniques↗
PubMedDate not supplied

The "Think Aloud" seminar for teaching clinical reasoning: a case study of a child with pharyngitis.

The "Think Aloud" seminar is a group teaching method to assist pediatric nurse practitioner students to develop critical thinking and clinical reasoning skills. Seminar proceedings simulate the iterative clinical reasoning process that occurs in an actual clinic or office visit. Students' requests for subjective and objective data must be followed by the rationale as to why the information was requested. This method is effective for teaching and evaluating students' skills in differential diagnosis and management of common illness in children. The process will be demonstrated with the presenting symptom of a sore throat followed by a description of the procedures that are used. J Pediatr Health Care.

Child, Preschool↗
PubMed2003

The neural substrate of analogical reasoning: an fMRI study.

This study investigated the anatomical substrate of analogical reasoning using functional magnetic resonance imaging. In the study, subjects performed a verbal analogy task (e.g., soldier is to army as drummer is to band) and, to control for activation caused by purely semantic access, a semantic judgment task. Significant activation differences between the verbal analogy and the semantic judgment task were found bilaterally in the prefrontal cortex (right BA 11/BA 47 and left BA45), the fusiform gyrus, and the basal ganglia; left lateralized in the postero-superior temporal gyrus (BA 22) and the (para) hippocampal region; and right lateralized in the anterior cingulate. The role of these areas in analogical reasoning is discussed.

Adult↗
PubMed2001

Medical informatics: reasoning methods.

The progress of medical informatics has been characterized by the development of a wide range of reasoning methods. These reasoning methods are based on organizing principles that make use of the various relations existing in medical domains: associations, probabilities, causality, functional relationships, temporal relations, locality, similarity, and clinical practice. Some, such as those based on associations and probabilities have been developed to the point where there are off-the-shelf tools available for the researcher to develop new decision support tools. Others such as temporal relations require more effort to use effectively. Even so, we have learned the importance of a separate explicit representation of the domain knowledge and have considerable experience and an impressive armamentarium with which to face the new milieu provided by the Internet.

Artificial Intelligence↗
PubMed2001

Case-based reasoning for antibiotics therapy advice: an investigation of retrieval algorithms and prototypes.

We have developed an antibiotics therapy advice system called ICONS for patients in an intensive care unit (ICU) who have caught an infection as additional complication. Since advice for such critically ill patients is needed very quickly and as the actual pathogen still has to be identified by the laboratory, we use an expected pathogen spectrum based on medical background knowledge and known resistances. The expected pathogen spectra and the resistance information are periodically updated from laboratory results. To speed up the process of finding suitable therapy recommendations, we have applied case-based reasoning (CBR) techniques. As all required information should always be up to date in medical expert systems, new cases should be incrementally incorporated into the case base and outdated ones should be updated or erased. For reasons of space limitations and of retrieval time an indefinite growth of the case base should be avoided. To fulfill these requirements we propose that specific single cases should be generalised to more general prototypical ones and that subsequent redundant cases should be erased. In this paper, we present evaluation results of different generation strategies for generalised cases (prototypes). Additionally, we compare measured retrieval times for two indexing retrieval algorithms: simple indexing, which is appropriate for small and medium case bases, and tree-hash retrieval, which is advantageous for large case bases.

Algorithms↗
PubMed1998

Case-based reasoning in IVF: prediction and knowledge mining.

In vitro fertilization (IVF) is a medically-assisted reproduction technique, enabling infertile couples to achieve successful pregnancy. Given the unpredictability of the task, we propose to use a case-based reasoning system that exploits past experiences to suggest possible modifications to an IVF treatment plan in order to improve overall success rates. Once the system's knowledge base is populated with a sufficient number of past cases, it can be used to explore and discover interesting relationships among data, thereby achieving a form of knowledge mining. The article describes the TA3IVF system--a case-based reasoning system which relies on context-based relevance assessment to assist in knowledge visualization, interactive data exploration and discovery in this domain. The system can be used as an advisor to the physician during clinical work and during research to help determine what knowledge sources are relevant for a treatment plan.

Artificial Intelligence↗
PubMed1998

Case-based reasoning for medical decision support tasks: the Inreca approach.

We describe an approach for developing knowledge-based medical decision support systems based on the new technology of case-based reasoning. This work is based on the results of the Inreca European project and preliminary results from the Inreca + project which mainly deals with medical applications. One goal was to start from case-based reasoning technology for technical diagnosis and 'scale-up' to more general non-technical decision support tasks as typically given in medical domains. Inreca technology has been used to build an initial decision support system at the Russian Toxicology Information and Advisory Center in Moscow for diagnosing poison cases caused by psychotropes.

Artificial Intelligence↗
PubMed2003

End-of-life decisions in Swedish ICUs. How do physicians from the admitting department reason?

OBJECTIVE: To study how physicians from the admitting department reason during the decision-making process to forego life-sustaining treatment of patients in intensive care units (ICUs). DESIGN: Qualitative interview that applies a phenomenological approach. SETTING: Two ICUs at one secondary and one tertiary referral hospital in Sweden. PARTICIPANTS: Seventeen admitting-department physicians who have participated in decisions to forego life-sustaining treatment. RESULTS: The decision-making process as it appeared from the physicians' experiences was complex, and different approaches to the process were observed. A pattern of five phases in the process emerged in the interviews. The physicians described the process principally as a medical one, with few ethical reflections. Decision-making was mostly done in collaboration with other physicians. Patients, family and nurses did not seem to play a significant role in the process. CONCLUSION: This study describes how physicians reasoned when confronted with real patient situations in which decisions to forego life-sustaining treatment were mainly based on medical--not ethical--considerations.

Admitting Department, Hospital↗
PubMed2003

Academic radiology: the reasons to stay or leave.

RATIONALE AND OBJECTIVES: To find major reasons why junior academic radiologists leave academia for private practice and to suggest future changes to motivate them to stay. MATERIALS AND METHODS: 2000 surveys were sent to every tenth member of the Radiological Society of North America (RSNA) who completed training within the past decade. Those in academic institutions and those who left within 5 years were asked to respond. RESULTS: 132 radiologists responded. Thirty-two percent of responders were in academic radiology. Of those in academic radiology, 71% plan to stay at the same institution, 7% are planning to move to another academic institution, 17% are considering private practice, and 5% are leaving for private practice. The main reasons to leave were low pay and lack of academic time. Sixty-eight percent of responders already left academia after an average of 3.28 years. Ninety-five percent feel the decision was good, and 65% would not go back. Forty-nine percent experienced more than 100% pay increase, 60% feel they work harder, and 62% feel quality of life is better. CONCLUSION: Significant changes should be made to motivate junior radiologists to stay in academia. Developing leaders in radiology is a must, and should be a top priority. Academic radiologists should not be expected to read private practice volumes and still have time to produce quality research and teaching. Clinical duties should be limited to 32 hours per week. At least 1 day a week should be protected academic time. Efforts should be made to decrease the discrepancy between incomes. Mentoring is important, allowing a smooth transition for junior faculty members to optimize academic progress and lead to promotion.

Academic Medical Centers↗