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PubMed1999

A case study on expanding the concept of caring from individuals to communities.

Caring has been described as the essence of nursing and some theorists assert that caring occurs only on the interpersonal level. The purpose of this paper is to illustrate caring beyond the individual to communities. Patterns of caring explicated from a case study were matched with concepts of caring defined in the literature. The concepts of caring were modified through a reevaluation of caring based on the findings from a community case study. Findings suggest concepts of caring as (1) a moral imperative, (2) an affect, (3) a personal interaction, and (4) an action, can be found at the community level. Modification of the original patterns of caring included broadening the concepts to include community interaction and preparatory caring action.

Caregivers↗
PubMed2000

Caregiver burden: a concept analysis.

The development of the concept of burden for use in research lacks consistent conceptualization and operational definitions. The purpose of this article is to analyze the concept of burden in an effort to promote conceptual clarity. The technique advocated by Walker and Avant is used to analyze this concept. Critical attributes of burden include subjective perception, multidimensional phenomena, dynamic change, and overload. Predisposing factors are caregiver's characteristics, the demands of caregivers, and the involvement in caregiving. The consequences of burden generate problems in care-receiver, caregiver, family, and health care system. Overall, this article enables us to advance this concept, identify the different sources of burden, and provide directions for nursing intervention.

Caregivers↗
PubMed2000

[Evaluation of therapy of patients with rectal carcinoma. Goals of healing (outcome) and implementation of the quality of life concept in total medical care].

Quality of life (QL) assessment by means of standardised scales allows a valid representation of an individual's subjective sense of well-being in three dimensions: somatic (intensity and frequency of symptoms), psychological (anxiety, depression) and social (family life, employment, sexuality). The question, however, whether routine measurement, documentation and analysis of QL-data could lead to an improvement of patient care is still unsolved. Studies with a clearly defined practical goal in collaboration with physicians and patients should help to resolve this issue. The introduction of the QL concept into everyday clinical practice first requires that this tool is understandable and valuable to the clinician. In this respect, we propose to integrate the factor QL into a broader outcome-concept in parallel to the classical quality indicators (outcome-criteria), to demonstrate individual patient's clinical and therapeutical course in the form of QL-profiles and to correlate the patient's actual clinical and psychosocial situation with the results of QL measurement. We illustrate the feasibility of a stepwise concept of implementation of the QL concept by demonstrating interim results of our field trial on regional management and care of patients with rectal carcinoma in the county of Marburg-Biedenkopf.

Germany↗
PubMed2001

[Examination of body concept of female patients with borderline personality disorder].

The operationalized diagnosis of borderline personality disorder (BPD) by DSM-IV and ICD-10 (research criteria) is meanwhile considered as valid and reliable. A disturbed or inappropriate body image within the group of borderline patients is not assessed by these instruments. Using the "Frankfurter Körperkonzeptskalen" [6], we compared the body concept of 47 female patients with BPD with a group of patients with the diagnosis of Bulimia nervosa and with a representative sample of healthy subjects. We found highly significant differences between patients with BPD and the clinical controls as well as to the norm group. Neither dissociative symptoms nor sexual child abuse correlate with the extent of the negative body concept. Correlations between self-concept (Giessen-Test) and body concept as well as clinical implications of these findings are discussed.

Adult↗
PubMed2001

[The importance of the type concept in psychiatry].

The significance of the typological approach in psychiatry, which has been partly forgotten and partly considered to be outdated at present, is discussed. It follows from considerations of terminology and the critique of knowledge that on the basis of its taxonomic function logically and unambiguously determined by Hempel and in particular by Oppenheim, type, in contrast to class, is capable of categorizing majorities with blurred dividing lines. It was in this function that the concept of type entered psychology through W. Stern as a means of systematically categorizing the multiplicity of psychological varieties in different groups of persons, whereby the polar definition of the type concept as developed by Krueger and Wellek in genetic holistic psychology proved to be taxonomically effective. Type gained significance in psychiatry as polarity, in particular in the framework of research into constitution and psychopathy. Anglo-Saxon criticism of the concept of type and the evident differences between American DSM psychiatry and the German concept of type are examined. The current methods of typological research in psychiatry have been developed in the preceding thirty years mainly by Zerssen and his team using modern uni- and multivariate statistical methods and successfully applying them. As a result, it was possible to objectify in several studies in the meantime Tellenbach's typus melancholicus, the typus manicus (v. Zerssen), as well as the typus migraenicus (Peters) as premorbid personality types. In addition, a circular typology of personality variants is beginning to emerge ever more clearly in the latest studies on the basis of which it may be possible to identify individual personality disorders typologically.

Humans↗
PubMed2001

["I am a Misunderstood Being on Earth" - Concept of illness of patients suffering from schizophrenic psychosis before and after psychoeducational treatment].

OBJECTIVE: To determine the effects of a psychoeducational intervention on the individual concepts of illness of patients suffering from schizophrenia. METHOD: 27 patients with a diagnosis of schizophrenia according to ICD-10 were interviewed with open ended questions about their concept of illness at admission to a day hospital and after 10 weeks of attending a psychoeducational program. Questions concerned terminology, diagnosis, prognosis, interventions and aetiology. A qualitative analysis of these data is presented. RESULTS: The terms used to describe the illness were mostly colloquial. Highly individualized and heterogeneous concepts of illness, aetiology and helpful interventions and a positive view regarding prognosis prevailed. Changes over time were limited and arbitrary. CONCLUSIONS: The concepts offered by professionals were adopted in a very limited way, which can be understood in the context of highly individualized ways of coping with diagnosis and illness.

Adolescent↗
PubMed2001

[Concepts in discussion groups in psychiatric outpatient care - an individual "Patchwork Design"? Results of a qualitative investigation].

OBJECTIVE: Research on concepts of discussion groups in the outpatient psychiatrist care is accounted for on the background of its practical relevance and the simultaneous lack of specialist literature. METHODS: Using qualitative proceedings, the subjective concepts of the discussion leaders concerning origin and feasibility are investigated, compared and put in relation to the specialist literature. RESULTS: Varied concepts and executed actions that were newly worked out at every one time, partly moulded rather on an individual than on subject-specific criteria and that are thus only restrictedly convertible become obvious. CONCLUSIONS: In order to secure the quality of this work further research concerning the development of scientifically founded concepts and educational offers as well as the transfer of relevant scientific cognition from the clinical sector are suggested.

Ambulatory Care↗
PubMedDate not supplied

[Qualitative analysis of subjective concepts of illness].

Patients' subjective concepts of illness play an important role in the progress and outcome of psychotherapeutic treatment. Therefore, their reliable and valid assessment is of high practical value. The subject of this article is the development and validation of a system of categories for the qualitative evaluation of open answers in a newly developed questionnaire for concepts of illness by Bischoff, Husen, Reichel and Schaefer (in preparation). The new instrument consists of an open and a closed part for assessing subjective concepts of illness. In order to evaluate the open answers a system of classification was constructed following to the principles of qualitative content analysis. Therefore, the answers were summarized into subcategories according to their topics. The subcategories again were assigned to major categories. Major categories emerged to be "unfavourable life circumstances", "interpersonal problems", "intrapersonal problems", "somatic/physical problems" as well as a residual category for unscorable answers. Besides examining the adequacy of the constructed categories and their reliability several hypotheses of validity were derived and empirically tested. It was possible to develop a categorical system for daily practical use which is able to assess contents of subjective concepts of illness.

Adult↗
PubMed2003

[Mental health promotion and prevention of mental diseases: are there population-based concepts? Looking abroad].

BACKGROUND: The rising public health relevance of mental health requires increased activities in the field of mental health promotion and prevention. In recent times interest in this sphere increases in Germany. OBJECTIVE: Which kinds of population-based mental health promotion programmes and prevention approaches are internationally available? What can be learned from their example? METHOD: Systematic search of the Internet and literature databases. Analysis and comparison of the available mental health promotion and prevention concepts with regard to targets, sub-targets, target groups, protagonists, settings, outcome indicators and evidence management. RESULTS: Concepts for mental health promotion and prevention programmes exist in England, Australia, the European Union and in Quebec, Canada. The concepts show similarities such as choosing similar settings like work place and schools or similar target groups like caretakers or adults in particular challenging life circumstances. CONCLUSIONS: Concepts for population-based mental health promotion and prevention have been created in some countries. For developing such programmes in Germany one should refer to internationally available experience as well as to own gathered experiences as to own expressions gathered pilot projects and the German Health Target Programme.

Australia↗
PubMed2005

[Integrated skills laboratory concept for undergraduate training in internal medicine].

BACKGROUND AND OBJECTIVE: An amendment to the German medical curriculum in April 2002 will place basic practical skills at the centre of medical training. We report here on the implementation and evaluation of an obligatory, tutor-guided, and integrated skills laboratory concept in the field of internal medicine. METHODS: To test the effectiveness of a skills laboratory training on OSCE performance a pilot study was carried out. The experimental group, of 77 students, participated in seven sessions of communication training, skills laboratory training, and bedside teaching, each lasting one and a half hours. The control group of 66 students had as many sessions but was only offered bedside-teaching. The evaluation of acceptance of skills' training as well as the related increase in individual competence is on-going (summer term 2004: n = 176 students). RESULTS: The integrated skills laboratory concept was rated at 3.5 (SD = 1.2) on a 5-point scale and was acknowledged as practice-oriented (M = 4.2; SD = 1.0) and relevant for doctors' everyday lives (M = 3.6; SD = 1.1). Increased levels of competence according to individual self-evaluations proved to be highly significant (p<.001), and results of the pilot study showed that the experimental group had a significantly better OSCE performance than the control group (p<.001). CONCLUSION: This pilot study shows that curriculum changes promoting basic clinical skills are effective and lead to an improved practical education of tomorrow's physicians. The integrated skills laboratory concept is well accepted and leads to a relevant increase in competence in the practice of internal medical. The presented skills laboratory concept in internal medicine is proving to be a viable and efficient learning tool.

Adult↗
PubMed2006

[A new concept for the treatment of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD)].

In practice, antimicrobial treatment is usually thought to be regularly indicated in the treatment of patients with acute exacerbations of COPD. However, data supporting this practice are very limited. Most placebo-controlled studies do not satisfy currently required methodological quality standards. We develop a concept of restrictive indications for antimicrobial treatment from the available data. Cornerstones of this concept include the selection of treatment setting as well as the indication for antimicrobial treatment according to the severity of the acute exacerbation (not primarily of COPD) and to the type of exacerbation (Anthonisen type I). The selection of antimicrobial agents is based on an intraindividual rotation concept in order to limit antimicrobial selection pressure. The concept presented here can at the same time be used as a clinical guide as well as a framework for future studies dealing with currently unresolved issues.

Acute Disease↗
PubMed1999

[Vascular depression--a new concise concept?].

Many studies pointed out that in the elderly depression is underdiagnosed, probably due to the uncharacteristic psychopathologic symptoms. Often elder people complain about somatic disorders and cognitive impairment, sometimes covering the psychopathologic symptoms and hampering diagnostic classification. Cerebrovascular disorders has been considered to be one major cause for depressive mood in the elderly. In a recent paper Alexopoulos et al. (1997) proposed the concept of vascular depression (VD) which is different from that of post-stroke depression established by the group of Robinson and Starkstein. The new concept is critically reviewed with regard of its clinical feasibility. In contrast to the ICD-10 guidelines the vascular depression concept requires no connection between the occurrence of psychopathology and of cerebrovascular disorder. Therefore it appears to be more feasible in clinical practice. However, a differentiation of vascular depression into two subtypes according to the CT/MRI findings seems to be more promising: type I (macroangiopathy) is similar to post-stroke-depression, while type II is characterized by microangiopathy and its clinical description resembles that for vascular depression of Alexopoulos et al. Up to now possible therapeutic consequences have not been investigated. Moreover, the concept of vascular depression basing only on two clinical studies needs further confirmation.

Cerebrovascular Disorders↗
PubMed1995

[Which dosage concept for adrenaline is correct in cardiopulmonary resuscitation? A data analysis of preclinical resuscitations].

AIM: Epinephrine is the drug of choice in cardiopulmonary resuscitation. Its dosage, however, is controversially discussed. The American Heart Association recommends for standard use in adults 1 mg epinephrine every 3-5 minutes, but classifies a medium dose, a high dose and a step-by-step escalating dosage concept as potentially useful alternatives. Aim of this study was to develop a rationale for the escalating dosage concept using an analysis of preclinical resuscitation data. METHODS: Bonn city (141 km2, 310,000 residents, 52% female, 13.9% > 65 years) was served by a double-response system of two ALS-units (staffed by physicians) and four BLS-units (staffed by paramedics). All patients were included in this data analysis, which were cardiopulmonary resuscitated according to the AHA guidelines by the ALS-unit Bonn-North (66% of area and 240,000 residents) from 1989 to 1994. All relevant data were documented by the emergency physicians using preformed treatment sheets. Discharge rates were determined by reviewing the hospital records, and one-year survival data were collected by mail contact with the primary physicians. The correlations between duration of cardiac arrest, dosage of epinephrine and outcome were determined by regression analysis in patients older than 17 years suffering from unwitnessed and bystander-witnessed cardiac arrest. Statistical significance was assumed for p < 0.05. RESULTS: Within 1989 to 1994 the ALS-team of Bonn-North resuscitated 685 cardiac arrest patients with presumed cardiac aetiology in 383 (56%) return of spontaneous circulation (ROSC) could be achieved. The epinephrine dosage required to achieve ROSC increased with prolongation of cardiac arrest interval (1989-1994; patients with ROSC selected, n = 263; r = 0.2276; p = 0.0002). Resuscitation success, however, decreased with increasing, dosage of epinephrine (1989-1992; n = 345; ROSC: r = -0.2643; p < 0.001; survival > 24 h: r = -0.3393; p < 0.001; discharge: r = -0.1677; p = 0.0018; survival > 1 year: r = -0.2685; p < 0.001). CONCLUSION: Based on these data, we recommend an escalating epinephrine dosage concept, which facilitates titration of the drug to an effective level and meets the needs of the individual patient. This concept avoids overdosage in patients who had just collapsed shortly before initiation of CPR, attains higher levels of epinephrine in patients suffering from prolonged cardiac arrest, and takes into consideration that the effective epinephrine dose varies individually and increases with prolongation of the cardiac arrest interval.

Adolescent↗
PubMed2006

The evolution of the Environmental Quality concept: from the US EPA Red Book to the European Water Framework Directive.

BACKGROUND: Water Quality Criteria were firstly defined in the 1970s by the EPA in the USA and the EIFAC in Europe, recognizing the need for protecting water quality in order to allow the use of water resources by man. In the 1990s, the European Commission emphasized the importance of safeguarding structure and function of biologic communities. These approaches were chemically-based. The European Water Framework Directive (WFD) substantially changes the concept of Water Quality, by assuming that a water body needs to be protected as an environmental good and not as a resource to be exploited. In this frame, the biological-ecological quality assumes a prevailing role. MAIN FEATURES: The Water Quality concept introduced by the WFD is a challenge for environmental sciences. Reference conditions should be defined for different typologies of water bodies and for different European ecoregions. Suitable indicators should be developed in order to quantify ecological status and to define what a 'good' ecological status is. Procedures should be developed for correlating the deviation from a good ecological to the effects of multiple stressors on function and structure of the ecosystem. The protection of biodiversity becomes a key objective. In this frame, the traditional procedures for ecotoxicological risk assessment, mainly based on laboratory testing, should be overcome by more site-specific approaches, taking into account the characteristics and the homeostatic capabilities of natural communities. In the paper an overview of the present knowledge and of the new trends in ecotoxicology to get these objectives will be given. A procedure is suggested based on the concept of Species Sensitivity Distribution (SSD). RECOMMENDATIONS AND PERSPECTIVES: The need for more site-specific and ecologically-oriented approaches in ecotoxicology is strongly recommended. The development of new tools for implementing the concept of 'Stress Ecology' has been recently proposed by van Straalen (2003). In the same time, more 'cological realism' is needed in practically applicable procedures for regulatory purposes.

Animals↗
PubMed2002

Neonatal outcomes in immediate versus delayed conceptions after spontaneous abortion: a retrospective case series.

OBJECTIVE: This study was undertaken to determine differences in neonatal outcomes between successful pregnancies conceived immediately after a spontaneous abortion (SAB) and successful pregnancies conceived after two menstrual cycles or at least 100 days from the spontaneous abortion. STUDY DESIGN: This study was a retrospective case series. Deliveries were identified from the University of California-San Francisco Perinatal Database among patients with a history of one SAB. Medical records of 268 patients were reviewed. Sixty-four patients fulfilled study criteria, with 19 in the immediate conception group and 45 in the delayed conception group. Categorical variables were analyzed using chi(2) tests and Fisher exact tests for variables with expected values of <5, whereas continuous variables were analyzed using Student t tests. RESULTS: Neonatal outcomes for the 2 groups were similar, although neonates in the delayed conception group were more likely to have at least one of the following: low birth weight, an Apgar score <7 at 5 minutes, or admission to the neonatal intensive care unit. CONCLUSION: In this small retrospective case series, there was no evidence of adverse neonatal outcomes associated with conception immediately after a SAB.

Abortion, Spontaneous↗
PubMed2002

Concept mapping: a tool to bridge the disciplinary divide.

The American College of Women's Health Physicians has been exploring an on-line educational tool-concept mapping-to facilitate the development of an interdisciplinary and woman-centered women's health curriculum, and to implement The Women's Health Care Competencies for Medical Students. By using an on-line concept map of the menstrual cycle, we have built upon a standard piece of curricula that describes a unique aspect of female physiology and transformed it into a knowledge framework that builds capacity. The concept map highlights relationships between concepts and across disciplines, connecting the competencies to enable meaningful learning so that a learner can adapt their knowledge to multiple settings, incorporate new learning, and generate new knowledge to grow the interdisciplinary field of women's health. The on-line format allows access from multiple sites and courses, and allows the curricula to grow organically over time without upsetting current curricular design.

Artificial Intelligence↗
PubMed1971

On the concept of orbital steering in catalytic reactions.

Angular displacement from linear overlap of but a few degrees in the transition state of the enzyme-substrate complex has been postulated to be of great kinetic significance ("orbital steering"). The concept of orbital steering is shown to have evolved from the orientation parameters of an equation previously proposed to evaluate the kinetic importance of propinquity. This equation is shown to be naive. Arguments provided against the concept of orbital steering include: (a) force constants predicted from orbital steering are about 100 times those experimentally determined from displacement of nuclei in a direction normal to the axis of a covalent bond (for example, at room temperature vibrational bending amplitudes of +5 degrees or more are common); (b) because of the lessened directionality of orbitals containing nonbonded electron pairs, the force constants in transition states should be even smaller than in the case of a covalent bond; and (c) molecular orbital calculations predict shallow total energy minima for orbital alignment. The experimental rate data offered as a basis for the concept of orbital steering are shown to find rationalization in the previously observed dependence of DeltaSdouble dagger on kinetic order and the energy requirements for the freezing-out of single bonds in the transition state leading to the formation of medium-size ring compounds from extended ground states. It is concluded that if orbital steering does exist, experimental and theoretical evidence to support this concept have yet to be presented.

Journal Article↗
PubMed1999

Coming home to Hume: a sociobiological foundation for a concept of 'health' and morality.

Assessing the normative status of concepts of health and disease involves one in questions regarding the relationship between fact and value. Some have argued that Christopher Boorse's conception of health and disease lacks such a valuational element because it cannot account for types of harms which, while disvalued, do not have evolutionarily dysfunctional consequences. I take Boorse's account and incorporate some Humean-like sociobiological assumptions in order to respond to this challenge. The possession of moral sentiments, I argue, offers an evolutionary advantage (thus falling within Boorse's definition of normal functional abilities). However, this does not amount to emotivism: on the contrary, these sentiments can be the basis of a value system. This value structure introduces the concept of sympathizing with a fellow being's suffering as the basis of a normative dimension to disease. For example, it holds the disvalue of disease to lie in the fact that disease involves suffering and functional limitations. The naturalistic Humean type of account presented here thus jumps the normative-descriptive divide. When Boorse's account is extended to include social sentiments and behaviors, a conception of health emerges which is broader than Boorse's or Kass's, but narrower than the WHO's.

Bioethics↗