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[Relation between research and practice in analytic psychotherapy].

The technique of psychoanalytic treatment as an objective, operative-technological theory inevitably experiences a subjective refraction on analyst's personality and his or her own cognitive and interactional styles influencing therapeutic efficiency. Systematic clinical trials of treatment data integrating motions from psychoanalytic, social and cognitive science, reconcile the gap between research and practice, between basic science and application. It will be discussed how empirical research can delineate therapists' cognitive and perceptual skills and the process of transformation from declarative to procedural knowledge, further elaborated in reciprocal connection with practice. The models of Structural Analysis of Social Behavior (SASB) and Cyclic Maladaptive Pattern (CMP) are especially considered. We will also discuss the consequences for training in psychoanalysis.

Countertransference↗

[Individual needs of the health sciences faculty].

This study aimed to identify security, social, esteem, autonomy and self-actualization needs of faculty members at the Medical Sciences Campus of the University of Puerto Rico. Data was gathered during November and December, 1989, throughout a self-administered questionnaire to a randomized, stratified, proportional sample of 115 professors, 49.7% from a population of 231 members. Two "Likert"-type, five-points scales were included in the questionnaire in order to determine levels of satisfaction and levels of occurrence of faculty needs. An exploratory-descriptive design was used and the main statistical analysis included the mean, t test for correlated samples and factor analysis. Findings revealed that surveyed faculty members were satisfied with security and institutional autonomy and also felt self-actualized. Social needs were moderately satisfied, although were less satisfied with institutional opportunities for social interaction among professors and members of the academic community. Faculty members perceived that institutional recognition was low, which was considered as esteem need.

Faculty↗

Parametric estimation in a genetic mixture model with application to nuclear family data.

The apparent conflict between the biometrician and Mendelian genetics has been recently resolved by the introduction of a genetic mixed model to analyze continuous traits measured on human families and to elucidate the mechanism of underlying major genes. The mixed model formulated by Elston and Stewart (1971, Human Heredity 21, 523-542), extended by Morton and MacLean (1974, American Journal of Human Genetics 26, 489-503), and reviewed, with further extensions, by Boyle and Elston (1979, Biometrics 35, 55-68) has become an extremely useful tool of wide applicability in the field of genetic epidemiology. This model allows for segregation at a major locus, a polygenic effect, and a sibling environmental variation. The main concern of this paper is with estimating the model parameters by the method of maximum likelihood. The expectation-maximization (EM) algorithm is developed to derive the estimates iteratively. An approximation of the information matrix when using the EM algorithm is given. We illustrate the methodology by fitting the model to the arterial blood pressure data collected by Miall and Oldham (1955, Clinical Science 14, 459-487).

Biometry↗

[Mechanized system for planning technological processes].

A mechanized system for the production processes planning involving the use of an electronic code device for data preparation on a punched tape of the "EPECT-IT" type, at the base of which there are classifiers of standard operations and transitions to individual design members, is considered. A fragment of the classifier and a skeleton diagram of the system are presented. It is pointed out that the use of the system helps improve the quality of the design work, as well as to yield considerable economic advantages. The system is in operation at some enterprises of the medical engineering industry.

Electronic Data Processing↗

[Optimization of production diagrams in automated control systems for medical technology industries].

An algorhythm for drawing up optimal production schedule graphs covering a shop floor (production area) over a planned period of output, based on the criterion of minimizing the total time for the workpiece treatment that may be applicable in the APCS of biomedical engineering industry, is set forth. In this connection the notions of a critical workpiece, critical equipment and of a conflicting situation are introduced, and the LRT rule, that plays a dominant role in combination with those of the SIO and MIN idle time, is applied. A relation intended to settle the conflicting situation in compiling the optimal schedule graphs is adduced and its solution for computerized programming is given.

Electronic Data Processing↗

[Estradiol Reference Standard (Control 931) of National Institute of Health Sciences].

The raw material for estradiol was examined for preparation of the "National Institute of Health Sciences (NIHS) Estradiol Reference Standard (Control 931)". Analytical data obtained were as follows: melting point, 179.0 degrees C; infrared spectrum, the same as that of the present NIHS Estradiol Reference Standard; optical rotation, -alpha-20D = +80.4 degrees; thin-layer chromatography, no impurity was detected; high-performance liquid chromatography (HPLC), a trace amount of two impurities were detected; loss on drying, 0.24%; assay, 100.4% by UV spectrophotometry and 101.2% by HPLC. Based on the above results, the raw material was authorized as the NIHS Estradiol Reference Standard (Control 931).

Chemical Phenomena↗

Comparison of fixed-fee Grateful Med database use and searching success rates given the continued availability of MEDLINE in other formats.

This study compared in-house Grateful Med database use and searching success rates for four-month periods at four sites of the Library of the Health Sciences of the University of Illinois at Chicago. Data were collected from Grateful Med workstation uselogs and analyzed. Database use patterns and searching success rates were fairly consistent across the four sites. Though MEDLINE was available in other formats and use in these other formats remained high, 65.48% of all Grateful Med searching was done by using MEDLINE, and an additional 21.34% was done by using the MEDLINE Backfiles. In-house use patterns were similar to the overall use pattern for the University of Illinois, with the exception of MEDLINE Backfiles. Overall, 54.30% of searches were successful.

CD-ROM↗

Linking information needs with evaluation: the role of task identification.

Action Identification Theory was used to explore user's subjective constructions of information tasks in a primary care setting. The first part of the study involved collecting clinician's descriptions of their information tasks. These items were collated and then rated by another larger group of clinicians. Results clearly identified 6 major information tasks, including communication, patient assessment, work monitoring, seeking science information, compliance with policies and procedures, and data integration. Results discussed in terms of implications for evaluation and assessing information needs in a clinical setting.

Communication↗

Bioinformatics in neurosurgery.

WITH THE COMPLETION of the Human Genome Project, the amount of molecular biological sequence data available in public databases has reached staggering proportions. Data continue to accumulate at an exponential rate in the postgenomic era. Compilation, storage, searching, sharing, studying, and transmitting of all these data present formidable challenges. To keep pace with this extant database, the science of bioinformatics (sometimes called computational biology) has evolved. Bioinformatics is the combination of biology and computers and usually involves the storage or analysis of molecular biological sequence data at either the deoxyribonucleic acid, ribonucleic acid, or protein (amino acid) level. Most bioinformatics tools are freely available on the Internet for use by investigators around the globe. The collective wisdom from bioinformatics databases worldwide will continue to spawn advances in the neurological sciences for generations to come. Neurosurgeons must be aware of the power and potential applications of bioinformatics for the analysis of neurosurgical diseases.

Animals↗

Effectiveness of a comprehensive diabetes lower-extremity amputation prevention program in a predominantly low-income African-American population.

OBJECTIVE: To compare patient outcomes 1 year before and 1 year after enrollment in a comprehensive diabetes lower-extremity amputation prevention program. RESEARCH DESIGN AND METHODS: Outcome data were obtained on 197 patients enrolled in the Louisiana State University Health Sciences Center Diabetes Foot Program, which provides foot care to a predominantly low-income African-American population in Louisiana. Data were obtained using a structured interview administered by a registered nurse. Recordings were made of number of days with an open foot ulcer, number of times hospitalized for a foot problem, number of days spent in the hospital for a foot problem, number of visits to the emergency room for a foot problem, number of times an antibiotic was prescribed for a foot problem, number of all foot operations, number of lower-extremity amputations, and number of missed workdays for a foot problem. Data were obtained on all patients at the initial visit and at the 1-year follow-up. RESULTS: Analysis of data showed a reduction in foot-related ulcer days (-49%), hospitalizations, (-89%), hospital days (-90%), emergency room visits (-81%), antibiotic prescriptions, (-57%), foot operations (-87%), lower-extremity amputations (-79%), and missed workdays (-70%) after 1 year of comprehensive foot care compared with the 1-year period before treatment. CONCLUSIONS: This single cohort outcome study showed a large reduction in foot-related complications after the first year of comprehensive preventive foot care.

Black or African American↗

Epidemiology tools program and selected medical applications.

In epidemiological research the calculation of appropriate measures of disease frequency is the basis for a comparison of populations and, therefore, the identification of disease determinants. Two frequencies being compared can be combined into a single summary parameter that estimates the association between an exposure and a disease. This can be accomplished by calculating either the ratio of the measures of disease frequency for two populations which indicates how much more likely one population is to develop a disease than another, or the difference between the frequencies which indicates how much greater the frequency of a disease is in one population compared with the other. In epidemiology we often need to compute measures of disease frequency mentioned above. We can do that by means of complex statistical software, but sometimes it is not easy or possible to use this software for an analysis of epidemiological data. At the EuroMISE Center of Charles University and Academy of Sciences in the framework of the research supported from grant COPERNICUS JRP-10053 the E. T. program (Epidemiology Tools) was developed. This program can be used for practical analysis of data from retrospective (case-control) studies or prospective (cohort) studies and for standardization. However, the program can be also a useful teaching tool in the epidemiology courses.

Adolescent↗

Scientific progress - wireless phones and brain cancer: current state of the science.

CONTEXT: The current science is not definitive about health risks from wireless phones; however, the legitimate questions about safety that have arisen from recent studies make claims of absolute safety no longer supportable. OBJECTIVE: The objective of this paper is to outline for primary care providers the results of the most current research on the possible impact of wireless phone use on human health. Presented are study results from Wireless Technology Research (WTR) program, the 7-year, $27 million effort funded by the wireless industry in the United States, that represents the world's most comprehensive research effort addressing this issue to date. Science-based recommendations for consumer interventions and future research are presented. DATA SOURCES: Original studies performed under the WTR program as well as other relevant research from around the world. STUDY SELECTION: This article presents a synopsis of the peer-reviewed in vitro and in vivo laboratory research, and the peer-reviewed epidemiology studies supported by the WTR, as well as a summary of other relevant work. DATA EXTRACTION: Only peer-reviewed scientific studies are presented, primarily WTR-sponsored research. In addition, results of the WTR literature surveillance program, which identified other relevant toxicology and epidemiology studies on an ongoing basis, are presented. These studies are presented in the context of their usefulness in providing intervention recommendations for consumers. DATA SYNTHESIS: Following a qualitative synthesis of specific relevant non-WTR research and a critical assessment of the WTR results, the following represents the current state of scientific understanding relevant to the public health impact of wireless phones: laboratory studies appear to have confirmed that radio frequency radiation from wireless phone antennas is insufficient to cause DNA breakage; however, this same radiation appears to cause genetic damage in human blood as measured through the formation of micronuclei. An increase in the rate of brain cancer mortality among hand-held cellular phone users as compared to car phone users, though not statistically significant, was observed in the WTR cohort study. A statistically significant increase in the risk of neuro-epithelial brain tumors was observed among cellular phone users in another case-control study. CONCLUSIONS: As new data emerge, our understanding of this complex problem will improve; however, at present there is a critical need for ongoing and open evaluation of the public health impact of new science, and communication of this science and derivative intervention options to those who are potentially affected.

Brain Neoplasms↗

Influence of tutors' subject-matter expertise on student effort and achievement in problem-based learning.

PURPOSE: To investigate the effects of tutors' subject-matter expertise on students' levels of academic achievement and study effort in a problem-based health sciences curriculum. Also, to study differences in tutors' behaviors and the influences of these differences on students' performances. METHOD: Data were analyzed from 336 staff-led tutorial groups involving student participants in seven four-year undergraduate programs at the University of Limburg Faculty of Health Sciences in 1989-90. Overall, 1,925 data records were studied, with each student participating in an average of 1.7 groups led by either content experts or non-experts. The basic analyses were of (1) students' achievement scores as a function of tutors' expertise levels and students' curriculum year; (2) students' estimates of self-study time as a function of tutors' expertise levels and students' curriculum year; and (3) the average ratings of the tutors' behaviors as a function of tutors' expertise levels. Statistical methods included analysis of variance and Pearson correlations. RESULTS: The students guided by subject-matter experts were shown to spend more time on self-directed study, and they achieved somewhat better than did the students guided by non-expert tutors. The effect of subject-matter expertise on achievement was strongest in the first curriculum year, suggesting that novice students are more dependent on their tutors' expertise than are more advanced students. Also, the content-expert tutors made more extensive use of their subject-matter knowledge to guide students. However, in addition to the tutors' knowledge-related behaviors, the tutors' process-facilitation skills affected student achievement. Moreover, these two sets of behaviors were correlated, indicating that both are necessary conditions for effective tutoring. CONCLUSION: The results indicate that, at least for the curriculum studied, the assumption in the literature that tutors do not necessarily need content knowledge so long as they are skilled in the tutoring process is not entirely justified: the students who were guided by content experts achieved somewhat better and spent more time on self-directed learning. More important, tutoring skill and content knowledge seemed to be necessary and closely related conditions for effective tutoring.

Achievement↗

Balancing animal research with animal well-being: establishment of goals and harmonization of approaches.

A resource is provided for the creation of an institutional program that balances the scientific mission of an institution with the well-being of the animals used in support of the research. The concept of harmonizing scientific goals with animal well-being was first suggested in the early part of the twentieth century and later revitalized in the literature of the 1950s. Harmonization can best be achieved through the promotion of a team initiative. The team should include, at a minimum, the scientist, veterinarian, institutional animal care and use committee, and animal care staff. It is the responsibility of this animal research team to promote and balance the generation of scientifically valid data with animal well-being. The team must strive to minimize or eliminate non-protocol variables that could adversely affect the validity and repeatability of the experimental data. Good experimental design coupled with excellent communication between team members can often minimize or eliminate many variables and result in both better science and animal well-being. To ensure the scientific validity of experimental data, scientists must be aware of the complex nature of the environment in which their animals are maintained. To ensure repeatablity of an experiment, scientists must document and publish both the inanimate and social environments in which their animals are housed. Better documentation of environmental variables and their correlation with experimental results will promote critical knowledge about the relationships between an animal's environment, its well-being, and science.

Animal Experimentation↗

[Nursing Informatics: state of the art and future of a subspecialty in nursing].

Nursing Informatics is defined as a specialty that combines nursing science, computer science and informatics to capture, process, store and communicate data, information and knowledge from the nursing domain. Therefore, Nursing Informatics is understood as a subspecialty within nursing. In Germany, Switzerland and Austria, Nursing Informatics looks back to more than 10 years of experience in the field. A Nursing Informatics Framework is proposed to represent the scientific and practical work. It goes beyond a mere definition and forms an action space for showing present achievements and the need for future activities. An analysis of the state of the science reveals that applications in patient care, management and education and training are nearly equally covered by Nursing Informatics. However, a deficit in basic research is apparent mainly in formalising and representing nursing knowledge. There is also a lack of system descriptions following the phases of the software-engineering process. In the requirements specification phase for nursing information systems meaningful reporting applications for use in quality assurance, evidence based nursing and management will have to be identified. Systematic software-engineering including scientific evaluations is needed in particular of systems in emerging areas such as case management. However, the activities proposed require a thorough education and training in Nursing Informatics on all levels.

Austria↗