Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “SPECIALISM”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,315 records · Page 73Linked to original sources
PubMed1997

Effects of specialization and client differentiation on the status of nurses: the case of AIDS.

This is a study of how change in the organization of work within hospitals affects the disputes over contested professional jurisdictions. We employ the natural experiment in hospital work reorganization motivated by the AIDS epidemic to empirically document the effects of specialization and client differentiation on the increased intra-organizational status of nurses. We demonstrate that specialized AIDS units represent a form of hospital reorganization in which responsibility, authority, and autonomy devolve toward nurses. Measures of organizational outcomes are derived from the aggregated evaluations of the nurses working in 40 units in 20 hospitals. Our analyses show that different organizational forms are mirrored in differences in the presence of features related to the status and autonomy of nurses. Our work provides some new sociological perspectives on nursing and the changing medical division of labor.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Tuberculosis morbidity risk in medical nurses in specialized institutions for the treatment of lung diseases in Zagreb.

SETTING: Specialized institutions for the treatment of lung diseases in Zagreb, Croatia. OBJECTIVE: To assess the risk of TB disease among medical nurses. DESIGN: Retrospective cohort analysis. RESULTS: It was found that the incidence rate was 6 to 17 times greater among medical nurses employed in institutions in which there was regular exposure to patients with TB. The tuberculosis incidence rate in Croatia among all women aged 20-49 was 48 per 100,000 in 1987. The cumulative incidence was 5 to 12 times greater among nurses of this age range working at high-exposure institutions; relative tuberculosis morbidity risk for medical nurses, if employed in the chest services studied, was up to 17 times higher (95% CI 5.3-58.0). CONCLUSION: The results of the study showed that tuberculosis morbidity risk among medical nurses employed in specialized institutions for lung disease treatment in Zagreb, expressed by relative risk for age group 20-49, was up to 17 times higher than among medical nurses in the control institutions.

Adult↗
PubMed1998

[The influence of the physician's speciality on ambulatory "essential laboratory tests"].

The purpose of this study was to examine the influence of a physician's speciality on the choice of "essential laboratory tests" and their response to the test results. A retrospective case-control study was conducted in divisions of the Department of Internal Medicine in Jichi Medical School Hospital. Twenty-seven parameters were evaluated in 213 outpatients (mean age 47 +/- 17 years; 53% female). Forty-three percent (2443 of 5751) of the tests were conducted by the physician under study and 10.5% (257 of 2443) of their tests were abnormal. The physician's speciality influenced the choice of the ambulatory medical examinations and their response to abnormal tests. Physicians tend to be more sensitive to the abnormality of tests related to their specialty. Hence, it is necessary to constitute guidelines on the response to abnormal "essential laboratory tests".

Adolescent↗
PubMed1998

[Additional qualifications in "special pain therapy"--an advantage to surgeons as well?].

Deficits in the treatment of patients with chronic pain lead the German Parliament of Physicians (Deutscher Arztetag) in 1996 to adapt a special curriculum called "Special Pain Treatment". Objectives and contents are defined in detail in guidelines accepted from 10 out of 17 federal commissions in Germany at this time. Because transitional regulations have been administered until now, surgeons have not yet been required to obtain the qualification. The prescribed curriculum and particularly the contract between the association of general practitioners and the insurance companies make the acquisition of the qualification and the permission to use it in private practice covered by insurance very difficult for surgeons.

Chronic Disease↗
PubMed1978

Columnar epidermal necrosis. A special form of toxic epidermal reaction?

A bizzare erythematosquamous, partially verrucose, crustly or eroded eruption developed in a 6-year-old boy one week after his first measles vaccination. The eruption regressed completely after a two-year clinical course. Histologically, the epidermis showed unique columnar eosinophilic degeneration. There was a dense, mononuclear cell infiltration in the upper part of the dermis. To our knowledge these clinical and histologic features have not been reported in the literature, although they resemble, in some aspects, Kyrle's disease, Mucha-Haberman's disease, or lichen planus verrucosus. Regarding the pathomechanisms underlying the development of this unique epidermal change, a postulate was made that it represented a special form of toxic epidermal reaction, probably resulting from autoagressive lymphoid cell response to epidermal cells. Furthermore, relationship of measles vaccination to this special response is suggested.

Child↗
PubMed2003

Comparison of the quality of oral anticoagulant therapy through patient self-management and management by specialized anticoagulation clinics in the Netherlands: a randomized clinical trial.

BACKGROUND: Several studies have demonstrated that patient self-management of oral anticoagulant therapy (OAT) can improve treatment quality. However, most of these studies were not conducted within a specialized anticoagulation care system. The objective of the present study was to determine whether patient self-management of OAT improves the quality of care delivered by anticoagulation clinics. METHODS: In this randomized study by 2 Dutch anticoagulation clinics 341 patients aged between 18 and 75 years and receiving long-term OAT were divided into 4 groups: an existing routine care group of patients untrained in self-management; a routine care group of trained patients; a group managed weekly at an anticoagulation clinic where international normalized ratios were measured by trained patients; and weekly patient self-management. A 2-step randomization procedure was followed: first, a Zelen-design randomization was performed to distribute patients (without informing them) to the existing care group or to receive training in self-management; second, trained patients were randomized to the 3 other study groups. RESULTS: Only 25.6% of invited patients agreed to participate in the training program. Patients who remained in the existing care group were within the international normalized ratio target range 63.5% of the time. The type of coumarin taken was a major predicting factor of OAT quality. In all study groups phenprocoumon outperformed acenocoumarol by 11.6% (95% confidence interval [CI], 6.6%-16.5%). Weekly management with phenprocoumon led to a 6.5% improvement (95% CI, 0.0%-13.1%) in time in the international normalized ratio target range when patients were managed at an anticoagulation clinic and to an 8.7% improvement (95% CI, 1.6%-15.9%) when patients were self-managed. Weekly management with acenocoumarol did not improve the quality of OAT. CONCLUSION: With selected patients, the quality of OAT obtained through patient self-management is at least as high as that delivered by specialized physicians at anticoagulation clinics. Weekly management of OAT with long-acting phenprocoumon has to be preferred at anticoagulation clinics or, where possible, through patient self-management.

Adult↗
PubMed1983

Hemispheric specialization and the neurology of emotion.

The regulation of such biologic drives as sex and aggression is a critical evolutionary function required of the nervous system. There is evidence that, in humans, the right hemisphere is dominant for many "emotional" functions. In the cortical regions involved in emotion, there are two important, complementary, sensorilimbic connective pathways: a dorsal system critical for surveillance, attention, and arousal and a ventral system specialized for stimulus identification, learning, and emotional response. Hemispheric specialization may introduce lateral asymmetries in these sensorilimbic connections, which could account for contrasting dominance in both emotional functions and some cognitive domains.

Affect↗
PubMed1989

Functional outcome following spinal cord injury. A comparison of specialized spinal cord injury center vs general hospital short-term care.

The functional outcomes of 185 patients with spinal cord injuries undergoing rehabilitation who were initially treated in a specialized short-term care unit (center patients) were compared with those of 153 patients initially treated in general hospitals (noncenter patients). After stabilization, all patients were admitted to the Rehabilitation Institute of Chicago (Ill) and received the same rehabilitation program. The groups were comparable in terms of demographic, injury, and medical characteristics at the time of rehabilitation center admission, but the duration from injury to rehabilitation was more than twice as long for noncenter patients. While center patients were discharged from the rehabilitation center at equivalent functional skill levels, their daily rate of functional gains during the rehabilitation center stay was significantly greater than that of noncenter patients although the length of stay at the rehabilitation center was comparable for the two groups. These results support the practice of specialized short-term spinal cord injury care as a means of enhancing rehabilitation outcome.

Activities of Daily Living↗
PubMed1987

Growth and phosphorus metabolism in premature infants fed human milk, fortified human milk, or special premature formula. Use of serum procollagen as a marker of growth.

Human milk promotes less than optimal growth and is associated with phosphorus deficiency and decreased bone mineralization in very-low-birth-weight (VLBW) infants. In this study, the effects of feeding premature infants either human milk (HM), fortified human milk (FHM), or special premature formula (Similac Special Care [SSC]) on growth, phosphorus metabolism, and serum type I procollagen (pColl-I-C) were evaluated. Infants fed FHM exhibited a rate of weight gain and an increase in head circumference comparable with infants fed SSC and significantly greater than infants fed HM, despite the fact that both the FHM group and the HM group demonstrated biochemical evidence of phosphorus deficiency. The pColl-I-C concentrations in VLBW infants were tenfold to 20-fold greater than concentrations in normal children older than 2 years of age. The pColl-I-C levels correlated positively with weight gain and were significantly greater in the FHM and SSC groups than in the HM group. By contrast, serum alkaline phosphatase levels did not correlate with weight gain and were significantly lower in the rapidly growing SSC group than in either of the two groups with phosphorus deficiency and presumed poor bone mineralization. We conclude that the serum pColl-I-C concentration is a biochemical marker of growth in VLBW infants and may prove useful as a predictor of growth responses to various nutritional and therapeutic interventions.

Blood Proteins↗
PubMed1993

Health maintenance organizations and children with special health needs. A suitable match?

OBJECTIVE: To address how well health maintenance organizations (HMOs) meet the needs of almost 700,000 children with disabilities due to chronic conditions enrolled in these plans. DESIGN: A cross-sectional survey. MEASUREMENTS/MAIN RESULTS: Health maintenance organizations offered better protection than conventional plans against out-of-pocket expenses and were much more likely than fee-for-service plans to cover ancillary therapies, home care, outpatient mental health care, and medical case management. In addition, few HMOs maintained exclusions for preexisting conditions. Other aspects of HMO policies, however, were found to operate against the interest of families with chronically ill children. In particular, HMOs commonly made specialty services available only when significant improvement was expected within a short period. Also, HMOs typically placed limits on the amount and duration of mental health, ancillary services, and certain other services frequently needed by chronically ill children. Probably the most serious problems for chronically ill children enrolled in HMOs were the lack of choice among and access to appropriate specialty providers. PARTICIPANTS: Individual HMO plans. SELECTION PROCEDURE: A sample of 95 geographically representative HMOs were selected; 59 (62%) responded. INTERVENTIONS: None. CONCLUSIONS: Health maintenance organizations offer several advantages over traditional fee-for-service plans for families whose children have special health needs. However, the results also indicate that HMOs do not always operate effectively as service provision systems for these children. To a large extent, the availability and quality of services available to a child with special needs is likely to depend on the parents' ability to maneuver within the system.

Adolescent↗
PubMed2005

Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s.

CONTEXT: Information on the school-age functioning and special health care needs of extremely low-birth-weight (ELBW, <1000 g) children is necessary to plan for medical and educational services. OBJECTIVE: To examine neurosensory, developmental, and medical conditions together with the associated functional limitations and special health care needs of ELBW children compared with normal-birth-weight (NBW) term-born children (controls). DESIGN, SETTING, AND PARTICIPANTS: A follow-up study at age 8 years of a cohort of 219 ELBW children born 1992 to 1995 (92% of survivors) and 176 NBW controls of similar sociodemographic status conducted in Cleveland, Ohio. MAIN OUTCOME MEASURES: Parent Questionnaire for Identifying Children with Chronic Conditions of 12 months or more and categorization of specific medical diagnoses and developmental disabilities based on examination of the children. RESULTS: In logistic regression analyses adjusting for sociodemographic status and sex, ELBW children had significantly more chronic conditions than NBW controls, including functional limitations (64% vs 20%, respectively; odds ratio [OR], 8.1; 95% confidence interval [CI], 5.0-13.1; P<.001), compensatory dependency needs (48% vs 23%, respectively; OR, 3.0; 95% CI, 1.9-4.7; P<.001), and services above those routinely required by children (65% vs 27%, respectively; OR, 5.4; 95% CI, 3.4-8.5; P<.001). These differences remained significant when the 36 ELBW children with neurosensory impairments were excluded. Specific diagnoses and disabilities for ELBW vs NBW children included cerebral palsy (14% vs 0%, respectively; P<.001), asthma (21% vs 9%; OR, 3.0; 95% CI, 1.6-5.6; P = .001), vision of less than 20/200 (10% vs 3%; OR, 3.1; 95% CI, 1.2-7.8; P = .02), low IQ of less than 85 (38% vs 14%; OR, 4.5; 95% CI, 2.7-7.7; P<.001), limited academic skills (37% vs 15%; OR, 4.2; 95% CI, 2.5-7.3; P<.001), poor motor skills (47% vs 10%; OR, 7.8; 95% CI, 4.5-13.6; P<.001), and poor adaptive functioning (69% vs 34%; OR, 6.5; 95% CI, 4.0-10.6; P<.001). CONCLUSION: The ELBW survivors in school at age 8 years who were born in the 1990s have considerable long-term health and educational needs.

Child↗
PubMed1996

Formation of synaptic specializations in the inner plexiform layer of the developing chick retina.

The development of synapse-like specializations was investigated in the inner plexiform layer of the developing chick retina by using light and electron microscopy. Six monoclonal antibodies, directed against glycine and gamma-aminobutyric acid (GABA)A receptor subunits, the intracellular receptor-associated protein gephyrin, synaptotagmin, and synaptophysin were used to determine the initial appearance and distribution of their antigens. Synaptophysin and synaptotagmin immunoreactivity was detected in the retina concurrent with the formation of the inner plexiform layer at embryonic day 7. This early appearance before synaptic differentiation, together with the transient expression of synaptotagmin immunoreactivity in the synapse-free optic fiber layer, suggests that in the developing central nervous system (CNS) these proteins are not confined to synapses. The first immunofluorescence signal detected with specific antibodies against the beta 2 and beta 3-subunits of the GABAA receptor, the glycine receptor, and gephyrin appeared at embryonic day 12. In contrast, the alpha 1-subunit of the adult-type glycine receptor heteromeric complex was detectable only at later stages of development, after embryonic day 16, suggesting a change in the subunit composition of some glycine receptor complexes. The staining was clearly punctate, indicating the clustering of the alpha 1-subunit at synapses. Electron microscopic investigation revealed the first postsynaptic densities and active zones in the inner plexiform layer of the retina at embryonic day 12. These results reveal different patterns of development for the investigated pre- and postsynaptic proteins and indicate a parallel appearance of gephyrin, glycine receptor, and the beta 2 and beta 3-subunits of the GABAA receptor with the first synaptic specializations in the inner plexiform layer of the developing chick retina.

Animals↗
PubMed1999

Efferent neurons and specialization of abdominal segments in grasshoppers.

A specialized behavior, oviposition, is produced by the eighth and ninth abdominal segments of female grasshoppers. To begin to understand how these segments produce the behavior, which is not displayed by males or pregenital regions of the abdomen in females, the structure and function of efferent neurons in abdominal ganglia of both sexes were examined. In females, the eighth and ninth segments are specialized differently for oviposition: 20 ovipositor motor neurons were found in the eighth segment, and 26 were found in the ninth segment. Males had fewer motor neurons in their eighth segment, but the same number in the ninth segment, which is the only genital segment in males. However, the axons of several of the ninth segmental male motor neurons traveled to the periphery in the genital nerve, which is only found in males. In both sexes, pregenital ganglia had the most motor neurons, but these neurons, for the most part, had morphologies that strongly resembled those of genital segments. Efferent modulatory neuron numbers were not sexually dimorphic in the segments examined, except that males had a greater number in their ninth segment. Experimental methods that activate oviposition were found to also activate a rhythmical motor pattern in pregenital abdominal segments of both sexes. In females, the pattern was phase-coupled to oviposition, but persisted after the connections with the terminal abdominal ganglion were severed. The preponderance of similarities among efferent neurons and elicited motor activity suggests a common pattern of neural circuitry in the behaviorally diverse abdominal segments of grasshoppers.

Abdomen↗
PubMed1996

The sensorineural specializations of the trunk tip (finger) of the Asian elephant, Elephas maximus.

BACKGROUND: The dorsal extension of the tip of the trunk of Asian elephants (Elephas maximus), often referred to as "the finger," possesses remarkable mechanical dexterity and is used for a variety of special behaviors including grasping food and tactile and ultimately chemosensory recognition via the vomeronasal organ. The present study describes a unique sensory innervation of this specialized region of the trunk. METHODS: The tip of the dorsal aspect of the trunk is referred to as the trunk tip finger and has been studied grossly in 13 living elephants. One tip from a male Asian elephant was obtained for histologic study when it was accidentally severed. The tissue was fixed in 10% neutral buffered formalin, and portions were either sectioned frozen or embedded in paraffin and serial sectioned. Sections were stained with silver in both cases. RESULTS: The skin of the trunk tip finger differs from that of the surrounding areas; it contains a high density of free nerve endings, numerous convoluted branched small corpuscles, and vellus vibrissae that resemble vellus hairs, which do not protrude beyond the skin surface. The finger is thus densely innervated with three distinctive types of sensory terminals. Corpuscular receptors consist of small Pacinian corpuscles and convoluted branched simple corpuscles. Both are present in the superficial dermis. Abundant regular vibrissae are present in the skin surrounding the trunk tip finger. Short vibrissae that do not protrude from the skin surface, referred to as vellus vibrissae, are abundant in the finger tip. Both types of vibrissae are innervated by hundreds of axons resembling the mystacial vibrissae of rodents. Free nerve endings are numerous in the superficial dermis, often making intimate contact with the basal cells of rete pegs. CONCLUSIONS: The dorsal finger of the trunk tip of Asian elephants has a unique sensory innervation that resembles aspects of sensory innervation of mystacial skin of rodents or lip tissue of monkeys. This dense sensory innervation can be correlated with the tactile ability of these animals to use the trunk finger to grasp small objects for feeding and to insert chemically active samples into the ductal orifices of the vomeronasal organ for subsequent chemosensory processing.

Animals↗
PubMed1999

Structural specializations of the eye in the vizcacha (Lagostomus maximus maximus).

Vizcachas (Lagostomus maximus maximus, Chinchillidae) are nocturnal rodents living in burrows in many regions of Argentina, Bolivia, and Chile. We have studied the eye of the vizcacha using several light and electron microscopic procedures, with the purpose of understanding the role of vision in the behavior of this species. Our observations demonstrated an avascular, rod-rich retina, with a specialized region spanning through most of the equator of the eye. In this central band, all neural retinal layers exhibited a high cell density, whereas the photoreceptor layer was characterized by the presence of very long rods. In addition, the central region was associated with a distinct pigmentation pattern, including scarce granulation of the pigment epithelium, low pigmentation of the choroid, and the selective attachment of suprachoroidal cells to the inner scleral surface. These central modifications probably form the structural basis of a reflecting tapetum. The eye of the vizcacha received both long and short ciliary vessels, and a specialized cilio-sclero-choroidal vascular network appeared at the equatorial region. Our findings suggest that the equatorial region of the eye of the vizcacha could be a highly sensitive light detector related to foraging behaviors during crepuscular or nocturnal hours.

Animals↗
PubMed1997

Angioplasty followed by coronary stenting at the anastomotic site of saphenous vein bypass graft with the native vessel: a case that needs special procedural strategy.

In this report we describe a case in which a saphenous vein graft stenosis at the site of anastomosis with the left anterior descending artery (LAD) was dilated with a special Controlled Angioplasty Technology (CAT) balloon, and then stented. Balloon angioplasty and stenting at the site of anastomosis represents a technical problem because of diameter discrepancy and needs special attention in order to avoid minor or major complications.

Aged↗
PubMed1998

Direct coronary stenting without predilatation: a new therapeutic approach with a special balloon catheter design.

Coronary stenting is the primary therapeutic option for many coronary lesions, after the risk of subacute stent thrombosis and bleeding complications has been reduced by antithrombotic regimens and improved stent expansion. It would be desirable to shorten the procedure and the duration of ischemia, and to reduce the risk of ischemic complications during balloon inflation by implanting the stent without previous dilatation of the lesion. This is not possible with the presently available stent delivery systems. This new therapeutic concept was tested with a specially designed balloon catheter, on which slotted-tube stents can be fixed between two conical radiopaque markers. Sixty-one patients eligible for angioplasty underwent direct stent implantation without predilatation. Four procedures were performed for acute myocardial infarction, and two as high-risk PTCA. Single slotted-tube stents (Palmaz-Schatz, NIR, or JOStent) of 14-16-mm length were mounted between the conical radiopaque markers of a special balloon which provided a fixation for the crimped stent. The direct implantation was successful in 80% of all patients, while in 10% the stent could be deployed after predilatation of the lesion. In 10% of lesions a stent could not be implanted with this and any other delivery system. When patients with successful direct stenting were compared with those with indirect (after predilatation) or unsuccessful stent deployment, the presence of angiographically visible calcification was higher in the unsuccessful cases (75% vs. 19%; P < 0.01), and the patients were older (72+/-8 vs. 61+/-12 years; P < 0.01). Radiation exposure time was only 8.7+/-5.1 min as compared with 12.6+/-7.6 min in conventional stent procedures with predilatation (P < 0.05). The number of balloons used per lesion was also lower than with conventional stenting. Stent dislocation was observed in 5%, and no embolization occurred. The new therapeutic approach of direct stenting without predilatation proved to be a safe and successful procedure in this initial series of coronary angioplasties. When calcified coronary lesions are avoided, it provides a way to rationalize stent implantation with shorter radiation exposure times, fewer balloons, and the potential advantage of fewer ischemic complications as no balloon predilatation is required.

Adult↗
PubMed1999

Study on the formation of specialized inter-Sertoli cell junctions in vitro.

An in vitro culture system using Sertoli cells was employed to assess the expression of component genes pertinent to occluding junctions (OJ) (such as zonula occludens-1, ZO-1), anchoring junctions (AJ) (such as N-cadherin and beta-catenin), and communicating gap junctions (GJ) (such as connexin 33, Cx33) when they are being formed in vitro. Freshly isolated Sertoli cells from 20-day-old rats with a purity of greater than 90% were cultured either at low- (2.5 x 10(4) cells/cm(2)) or high-cell density (0.6 x 10(6) cells/cm(2)) on Matrigel-coated dishes for 7 days in vitro to allow the establishment of specialized junctions. In low cell density Sertoli cell cultures, specialized OJ such as tight junctions did not form during the entire culture period when assessed by the transepithelial electrical resistance (TER). In high cell density cultures, there was an increase in ZO-1 expression in days 1 to 3 preceding the establishment of tight junctions by day 4. When Sertoli cells were cultured at both cell densities, there was a transient increase in Sertoli cell N-cadherin expression, which peaked by days 4-5, suggesting the time course for the establishment of AJ may overlap with the OJ. A significant increase in the expression of Sertoli cell beta-catenin was also detected by days 5-7 in the high but not low cell density cultures. The expression of Cx33 was also enhanced at days 4-5 in both high and low density cultures. These results suggest that OJ, AJ, and GJ are formed between Sertoli cells in high density cultures, whereas OJ cannot be formed in low density cultures. A full-length cDNA clone coding for rat testicular beta-catenin was also isolated. The deduced amino acid sequence of rat beta-catenin yielded a 781 amino acid polypeptide which displayed a 99.9% identity with the mouse homolog. Conditioned medium of germ cells induced a dose-dependent stimulation on Sertoli cell beta-catenin expression, suggesting germ cells may affect the N-cadherin/beta-catenin-mediated signal transduction pathway. In summary, this study illustrates several target genes can be used as molecular markers to monitor the inter-Sertoli junction formation. This system should be applicable to screen new male contraceptives in vitro targeted at the interference of junction formation by disrupting the timely expression of genes necessary for junction establishment and/or maintenance.

Amino Acid Sequence↗