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PubMed1978

Treatment of erythrophobia by paradoxical intention.

A 25-year-old male was treated by paradoxical intention for erythrophobia that had been present for 12 years. Severe blushing episodes decreased from 28 during the month preceding treatment to three during treatment; there were never more than two severe blushing episodes per month during the 6-month follow-up. The mean duration of each severe episode was 13 minutes before treatment, 8 minutes during treatment, and varied from 4 to 9 minutes during follow-up. Although this treatment is easy for both the patient and therapist, it is important that the patient be highly motivated. A good relationship with the therapist and the use of humor can enhance the therapeutic efficacy of paradoxical intention.

Adult↗
PubMed1993

Wound complications after cardiac surgery: a new approach to healing by secondary intention.

Sternal wound complications after cardiac surgery occur in 0.4% to 8% of all cases and have a mortality rate as high as 27%. Treatment varies and does not always yield favorable results. This article discusses normal wound healing versus healing by secondary intention. Risk factors and factors that delay healing are highlighted. A case study describes the utilization of the Bard absorption dressing to promote the healing process in a sternal wound complication. This treatment modality proved to be effective as a nontraditional approach to healing by secondary intention.

Aged↗
PubMed1982

Commitment predictors of nursing personnel's intent of leave.

The simultaneous investigation of job, organizational, career, and community commitment on intent to leave is empirically tested in a study of 73 hospital personnel. Previous work on organizational commitment served as the proxy for definitional clarification and measurement development of a 44-item questionnaire for all commitment concepts. Three measures of the "importance" of correlated predictors are used to indicate the findings. Higher intent to leave was predicted by lower job commitment. Limitations of the study and implications of the results are discussed.

Adult↗
PubMedDate not supplied

Becoming an intentional teacher.

This series of articles, Managing Your Academic Career, presents ways to intentionally improve your teaching. This first article explains the concept of becoming an intention teacher. Subsequent articles will deal with strategies that are useful in clinical teaching, such as preparing students to value and use research in practice, and providing feedback to students in the clinical setting.

Attitude of Health Personnel↗
PubMed1995

The spirit and intent of the Americans With Disabilities Act.

I have been asked to speak about the spirit and intent of the Americans With Disabilities Act (ADA). It is not a topic that I can be very scholarly about, because one cannot talk about the spirit through research. You can only talk about the spirit and intent through feelings and perceptions, and experience. That is what I want to do today. I describe the context of the ADA so that the following speakers can talk more directly to you about your professional involvement. I hope that you will be able to apply what I say to their presentations.

Civil Rights↗
PubMed1998

Are newspapers a viable source for intentional injury surveillance data?

BACKGROUND: Previous researchers have reported that newspapers were useful adjuncts to unintentional injury surveillance efforts in a nearby southern state. The current study sought to determine whether newspaper accounts of intentional injuries could provide a reliable source of primary or secondary surveillance data. METHODS: Newspaper accounts of assaults, homicides, suicides, and rapes occurring in Jefferson County, Alabama, between January 1, 1991, and December 31, 1991, were compared with similar data from official governmental agencies whose responsibility it is to investigate and/or document the occurrence, details, and characteristics of violent events resulting in death or injury. RESULTS: Newspapers greatly underreported suicides, rapes, and assaults, and reported firearms-related incidents in numbers that substantially exceeded their actual occurrence. CONCLUSIONS: Much information of potential value for injury surveillance purposes appears to be excluded from newspapers by editorial process and policy. Thus, newspapers are neither a valid nor reliable source for intentional injury surveillance purposes.

Alabama↗
PubMed2003

Intentional warfarin overdose.

Warfarin toxicity is common and usually results from dose changes or drug interactions. There are few reported cases of intentional overdose. The management of warfarin overdose is usually complicated by the patient using warfarin therapeutically, often for a mechanical heart valve or pulmonary embolus prophylaxis. Untreated patients have a significant bleeding risk, but treatment carries a significant risk of complete reversal of anticoagulation and consequent risk of thrombosis. The objective of this study was to describe warfarin overdoses and complications of treatment and develop a safe approach to management. Three patients are described. Two patients received a single 10-mg dose of vitamin K. Both required anticoagulation, and in one, warfarin resistance persisted for 2 weeks. In a third patient serial INR, factor levels and warfarin concentrations were measured, and incremental doses of vitamin K (up to 7.5 mg) were given based on INR. This patient did not require anticoagulation, and regular warfarin therapy was recommenced after 4 days. Patients intentionally overdosing on warfarin can be classified into three groups based on preexisting indications for warfarin: nontherapeutic, moderate risk, and major risk for thromboembolic complications. All patients should have regular INR measurements (6-hourly) to catch rapid rises. Patients not on warfarin therapeutically can be given 10 mg of vitamin K1 and repeat INRs as an outpatient. Titrating intravenous vitamin K with doses of 0.5 to 2.0 mg when INR > 5 is appropriate to reduce INR without causing warfarin resistance. The high-risk group must be kept anticoagulated, and warfarin resistance avoided.

Adult↗
PubMed2002

Sunbathing intentions in Irish people travelling to Mediterranean summer holiday destinations.

As exposure to UV light is thought to be the most significant environmental and behavioural risk factor for avoiding skin cancer, we have analysed the sunbathing intentions and attitudes of Irish people travelling to Mediterranean and Iberian holiday destinations. Ninety per cent of respondents planned to get a suntan on their vacation with 44% likely to burn their skin in the process. Although all intended to apply sun cream on holiday only 40% would apply >SPF 15. Sixty-four per cent planned to sunbathe between 11.00 am and 3.00 pm, with 25% intending to spend <5 hours in the sun. One-third of those intending to sunbathe for >6 hours per day were aged between 16 and 24 years. Approximately eight out of 10 people thought suntans made them feel healthier or attractive. Fifty-six per cent regularly checked their moles but men were less likely to check their skin for pigment changes. The results provide baseline information on sunbathing attitudes of Irish people. They show that while most people feel they adopt a careful approach to sunbathing, the experiences and intentions, especially in younger people, are influenced by the desirability of a suntan, and reflect a behaviour that increases their risk of skin cancer.

Adolescent↗
PubMed2000

Association of pesticide safety knowledge with beliefs and intentions among farm pesticide applicators.

Although a number of health hazards associated with pesticide exposure have been well documented, relatively little is known about the knowledge and health beliefs that may influence pesticide handling. This study measured knowledge levels concerning pesticide safety and precautionary handling among applicators and examined relationships between knowledge scores and intentions to use handling precautions, perceptions of pesticide safety peer norms, and perceived self-efficacy to prevent personal exposure. Telephone interviews were conducted with a randomly selected sample of 164 dairy farmers who were pesticide applicators residing in Wisconsin (response rate = 77.4%). The percentage of correct responses to 18 knowledge items ranged from 100% to 45.7%. Knowledge levels were positively related to intentions, beliefs, and self-efficacy regarding use of personal protective gear but were not significantly related to risk perceptions and peer norms concerning pesticide safety.

Adult↗
PubMed2002

Fatal intentional poisoning cases admitted to the University Hospitals of Leuven, Belgium from 1993 to 1996.

Between January 1993 and July 1996, a total of 2827 intentional cases of poisoning were registered in the University Hospitals of Leuven, Belgium. Ten of these cases were fatal. This study was set up to evaluate the substances involved, the circumstances, the features and the characteristics of the patients who died due to intentional poisoning. The male to female ratio of these fatal cases was 9 : 1. The median age was 43 years. Two groups of substances were revealed to be associated with fatal outcome. The first group consisted of chemicals (seven lethal cases): cholinesterase inhibitors ( =3), methanol ( =2) and paraquat ( =2). The second group consisted of benzodiazepines (three lethal cases). In the cases of poisoning with chemicals, death was directly related to product toxicity and the severity of the poisoning, whilst with benzodiazepines, which are considered to be relatively safe drugs even when taken in overdose, there was a clear relationship between a fatal outcome and a delay between ingestion and medical support. Product toxicity, complications and a delay in medical support may be considered as predictors for the effectiveness and efficacy of treatment and may influence which medical treatments need to be administered.

Adult↗
PubMed2006

Reintegration success of osseotite implants after intentional countertorque liberation in the endentulous human mandible.

PURPOSE: Implants that rotate during abutment screw tightening may not necessarily constitute implant failure. This prospective study was designed to determine to what degree integrated implants could gain a state of reintegration after intentional countertorque to liberation from the bone. MATERIALS AND METHODS: There were 11 patients with fully edentulous mandibles restored with 2 "clinical" implants (3.75 x 10 mm) placed in the canine sites and an additional nonused "test" implant (3.75 x 10 mm) placed at the symphysis of the anterior mandible. At second-stage surgery, the test implant was countertorqued (T1) using a torque-metering wrench until it detached from the bone. The implant was returned to its original position and allowed to heal for a period until a second countertorque test (T2) was performed. In group A, patients (n = 5) received the countertorque T1 at 3 months and T2 at 5 months. In group B (n = 6) T1 was at 1.5 months, and T2 was at 3.5 months. After completion of T2, the group A test implants were removed with a 5-mm trephine for histologic examination. RESULTS: For both groups, peak forces, all higher than 37.4 Ncm at T1, indicate that all implants were integrated. At T2, torque values were higher than T1 values for most of the test implants. The clinical implants were restored with "patrix" abutments and an overdenture. Histology staining showed distinction between old and new bone, which formed during the remodeling process. DISCUSSION: The increase in peak forces needed to detach implants at T2 may be explained by bone-to-bone healing or the additional bone contact promoted by bleeding that occurred during the T1 procedure. CONCLUSION: The results suggest that all implants were reintegrated after being intentionally countertorqued to liberation and resumed healing in the original osteotomy position.

Aged↗
PubMed2004

Posttrial HIV vaccine adoption: concerns, motivators, and intentions among persons at risk for HIV.

BACKGROUND: Suboptimal uptake of existing vaccines, potential obstacles specific to HIV/AIDS stigma and mistrust, and marked health disparities suggest that it is vital to investigate consumer concerns, motivations, and adoption intentions regarding posttrial HIV vaccines before a vaccine is publicly available. METHOD: Nine focus groups were conducted with participants (n = 99; median age, 33 years; 48% female; 22% African American, 44% Latino, and 28% white) recruited from 7 high-risk venues in Los Angeles using purposive venue-based sampling. A semistructured interview guide elicited concerns, motivators, and adoption intentions regarding hypothetical U.S. Food and Drug Administration-approved HIV vaccines. Data were analyzed using narrative thematic analysis and Ethnograph qualitative software. RESULTS: Concerns included vaccine efficacy, vaccine-induced infection, vaccine-induced HIV seropositivity, side effects, cost/access, trustworthiness, and relationship issues. Motivators included protection against HIV infection and the ability to safely engage in unprotected sex. Participants expressed reluctance to adopt partial efficacy vaccines and likelihood of increased sexual risk behaviors in response to vaccine availability. CONCLUSION: Tailored interventions to facilitate uptake of future U.S. Food and Drug Administration-approved HIV vaccines and to prevent risk behavior increases may be vital to the effectiveness of vaccines in controlling the AIDS pandemic.

AIDS Vaccines↗
PubMed2006

Intentional retrieval of viabil stent-grafts from the biliary system.

The present report describes the intentional retrieval of six Viabil stent-grafts from the biliary system. The six stent-grafts were successfully removed from five patients with a mean time from placement to retrieval of 38 days. Successful retrieval was independent of underlying disease etiology and included strictures associated with benign disease, malignant disease, disease of unknown etiology, and stent-graft misplacement. There were no complications resulting from stent-graft retrieval. Intentional removal of Viabil stent-grafts is technically feasible. Further study is necessary to establish its potential role in the management of biliary disease.

Adult↗
PubMedDate not supplied

End-of-life decision making in nursing home residents with dementia and pneumonia: Dutch physicians' intentions regarding hastening death.

When patients with severe dementia become acutely ill, little is known about the extent to which physicians take actions intended to hasten death. For 143 nursing home patients with dementia who died of pneumonia after a decision not to treat with antibiotics, we asked Dutch facility-employed physicians whether they intended to hasten death and any estimated life shortening. In 53% of cases, the physicians reported an explicit intention to hasten death; in another 41% of cases they reported taking into account a probability or certainty that the withholding of antibiotics or other palliative treatments would hasten death. Opiates were frequently used for symptom control (43%), but the administration of medications specifically intended to induce death was rare (2%). Considering all treatments, physicians estimated that life was shortened by 24 hours or less in 46% of patients and 1 month or longer in 24% of patients. The frequent withholding of antibiotics with an intention to hasten death may reflect a willingness to abandon a cure-oriented approach in dying patients for whom prolongation of life is not an aim. The results reflect the importance of explicit goals for medical interventions in patients with end-stage dementia where life-prolonging treatments may be seen as prolonging suffering.

Aged↗
PubMed2004

Incidental and intentional encoding in young and elderly adults.

Event-related potentials (ERPs) were recorded in young and elderly adults during the performance of an incidental encoding task (subjects were unexpectedly given a recognition test) followed by an intentional task (subjects expected the recognition test). Both tasks consisted of an encoding stage in which subjects classified words (natural/artificial) and a recognition stage in which they indicated whether the words were old (presented during the encoding stage) or new. In both groups and tasks, the ERPs, during encoding, differed as a function of subsequent recognition: the old words correctly recognized generated greater amplitude potentials than the incorrect ones. The memory processes expressed by these ERPs are preserved in elderly adults, independently of whether the information is incidentally or intentionally encoded.

Adult↗
PubMed2001

Breakdown of the internet under intentional attack.

We study the tolerance of random networks to intentional attack, whereby a fraction p of the most connected sites is removed. We focus on scale-free networks, having connectivity distribution P(k) approximately k(-alpha), and use percolation theory to study analytically and numerically the critical fraction p(c) needed for the disintegration of the network, as well as the size of the largest connected cluster. We find that even networks with alpha < or = 3, known to be resilient to random removal of sites, are sensitive to intentional attack. We also argue that, near criticality, the average distance between sites in the spanning (largest) cluster scales with its mass, M, as square root of [M], rather than as log (k)M, as expected for random networks away from criticality.

Computer Security↗
PubMed2001

The detection of constancy amidst change in children: a dissociation of preattentive and intentional processing.

This study examined whether 7-9-year-old children preattentively build memories of constancy for individual stimulus features, and if these representations are affected by variability of other stimulus features. This was achieved by looking at the mismatch negativity (MMN) event-related potential to a duration deviant occurring in a stimulus environment in which one or two other features constantly changed. Performance data were also collected, to look at the correspondence between the effects of this manipulation on preattentive and intentional deviance detection. MMN data indicated that the children built a preattentive feature-based memory of constancy that was not affected by the number of varying features. In contrast, intentional deviance detection was considerably impaired by the introduction of feature variability. This dissociation is at variance with previous studies that usually report close association between MMN and behavior.

Acoustic Stimulation↗
PubMed2005

Intentional infliximab use during pregnancy for induction or maintenance of remission in Crohn's disease.

AIM: To study the effects of infliximab on pregnancy and foetal outcome. METHODS: We conducted a retrospective chart review of women with Crohn's disease treated intentionally with infliximab during pregnancy. The primary outcome measure was the occurrence of congenital malformations. Secondary outcome measures were the rate of premature birth, low-birth weight, small for gestational age infants, intrauterine growth retardation and caesarean section. RESULTS: Ten women were identified. Eight women received maintenance infliximab infusions throughout their pregnancy and two women received their initial infliximab infusions during pregnancy. All 10 pregnancies ended in live births. No infants had congenital malformations, intrauterine growth retardation or small for gestational age parameters. Three infants were premature and one had low-birth weight. Eight women had a caesarean section. CONCLUSIONS: This is the first reported series of intentional infliximab use throughout pregnancy. These data, combined with other studies of inadvertent use of infliximab during pregnancy, suggest that the benefits of infliximab in achieving response and maintaining remission in mothers with Crohn's disease may outweigh the risk to the foetus of exposure to the drug. Further prospective data collection will be helpful to confirm these findings.

Abnormalities, Drug-Induced↗