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At least 1,693 records · Page 94Linked to original sources
PubMed2002

Treating adolescents with eating disorders in the family context. Empirical and theoretical considerations.

The author described the Maudsley approach for family treatment of adolescent AN and the empirical evidence supporting its use in this population. This treatment focuses on the family as a resource for recovery and puts the patients in charge of re-feeding their affected child. Its success seems to depend on the successful motivation of parents to take on this task and see it through while simultaneously supporting the processes of adolescent development as they reemerge. Although this treatment is promising, substantial data to support its being the best approach for adolescents with AN are lacking. The author also described a theoretical model for involving parents in CBT for adolescents with BN. Although CBT is accepted as the most efficacious treatment for adults with BN, it has not been tested systematically in adolescents. At the same time, it is clear that the adult models of CBT for BN are unlikely to be successful without modifications that take into account the realities of adolescence. Although CBT as a model is likely to be acceptable to adolescents, parents are needed to promote motivation, provide a supportive milieu for behavioral change, and provide guidance and support in stressful periods that lead to relapse. It is important that CBT that is appropriately modified to include parents be tested for its efficacy in adolescents with BN. Preliminary, uncontrolled results are promising.

Adolescent↗
PubMed1995

[Locus of control and process of "pseudo-internality" in an alcoholic patient].

In clinical practice with alcoholics we frequently encounter a phenomenon whereby the subject claims he is able to cope with a situation, whereas in reality he cannot. This discrepancy between the claimed and the actual capacity for "control" led us to devise a study which would permit a better understanding of the phenomenon. We gave patients two questionnaires which deal with the concept of control. Comparison of the MHLC (Multidimensional Health Locus of Control, Wallston, 1978; a questionnaire which investigates the subjective degree of control in relation to health) and the GEFT (Group Embedded Figures Test, Witkin, 1971; a questionnaire which focuses more on actual behaviour and field-dependency) allowed us to test the hypothesis that alcoholics have a "pseudointernal" locus of control, that although, in what they say, they evince a strongly internal subjective locus of controls, in reality they are particularly external and dependent. The data confirm that the tendency towards an "internal" selfportrayal on the MHLC which is not backed up by the GEFT is significantly higher in alcoholics than in nonalcoholic subjects. Thus, all in all, this supports the hypothesis of a "pseudointernality" syndrome in alcoholics.

Adaptation, Psychological↗
PubMed2006

[Malaria vaccines: prospects and reality].

The development of a malaria vaccine has been accelerating in the last ten years. The number of clinical trials has increased and some malaria antigens have been tested in endemic areas. No potential vaccine has yet shown sufficient and lasting efficacy to justify its inclusion in a public health program. However, trials have unambiguously shown that some level of anti-malaria clinical immunity can be achieved by vaccination, both in experimental and in field conditions. Advances in malaria vaccine development are presented.

Animals↗
PubMed1995

Protein contact dermatitis: myth or reality?

Protein contact dermatitis is a dermatosis which usually presents as a chronic eczema with episodic acute exacerbations a few minutes after contact with the offending allergen. Patch tests with the responsible allergen are usually negative, and the diagnosis can only be made by means of scratch or prick tests with the allergen. Sometimes, specific IgE antibodies can be detected in the blood. As there is considerable confusion about this entity, we have reviewed the cases reported in the literature.

Dermatitis, Contact↗
PubMed2002

Reliability and validity of Endotower, a virtual reality trainer for angled endoscope navigation.

We hypothesized that a simulator designed to train surgical novices angled laparoscopic navigation would show an improvement in subjects' performance, a high test re-test reliability and high internal validity as measured by standardized coefficient alpha. It was also predicted that simulator performance would be strongly related to objectively assess perceptual and visuospatial ability. EndoTower has good face validity in that it mimics precisely the performance of an angled laparoscope and previous studies suggest construct validity. In this study, EndoTower is shown to be a trainer intended for laparoscopic skill than can test for inherent perceptual and visuospatial ability.

Computer Simulation↗
PubMed1980

[Pathology of cor pulmonale. Idea and reality (author's transl)].

The diagnosis of chronic cor pulmonale is made by the pathologist, but not by the clinician. Chest x-ray, ECG and lung function tests are not conclusive for the diagnosis. Considering the different pathogenetic possibilities it is evident that more than one factor is involved in the development of cor pulmonale. Explanations for the different reactions in similar anatomical and functional situations may be the influence of genetic factors, a different sensitivity to alveolar hypoxia, a difference in developing of muscular hypertrophy and a difference in the development of bronchopulmonary anastomoses in inflammatory or degenerative lung disease. In this regard it is suggested to omit the term chronic cor pulmonale in clinical diagnosis and to refer instead to pulmonary hypertension, or radiological or electrocardiographical signs of right ventricular hypertrophy. It seems more important, to define the status, the changes or the actual disease of the lungs.

Genes↗
PubMed1998

Hoffman-Tinel sign. The realities.

The Hoffman-Tinel sign, although originally described by Paul Hoffman, is commonly referred to as the Tinel sign. It is one of the most commonly used tests in the clinical evaluation of periperhal nerves. The sign is used in the diagnosis of compression neuropathies, such as carpal and cubital tunnel syndromes, but it is also useful in the diagnosis of a variety of neurological maladies. Despite controversy, the Hoffman-Tinel sign remains important in the diagnosis of peripheral neuropathies and for the evaluation of the regenerating nerve after injury.

Carpal Tunnel Syndrome↗
PubMed2000

HAART and medical management: the realities of clinical care. Interview with Keith Henry, M.D. Interview by John S. James.

In many outpatient HIV clinics the medical staff is so poorly funded that over 95% of the cost of patient care goes to drugs and laboratory tests--and less than 5% to physicians, nurses, other staff, clinic overhead, medical records, patient education, adherence monitoring, and other costs of care. This misdirection of resources results in patients not receiving the professional time and attention they need, and drug being taken incorrectly, leading to unnecessary drug failure and other medical problems. Keith Henry, M.D., who recently called for more cautious use of antiretroviral therapy, describes the realities of inadequate funding for medical care, and some needed steps for improvement. Also, we asked him to explain how his clinic has consistently performed leading-edge research without the major funding usually available at research institutions.

Antiretroviral Therapy, Highly Active↗
PubMed2006

Virtual reality simulator training equals mechanical robotic training in improving robot-assisted basic suturing skills.

BACKGROUND: This study aimed to investigate the effect of a virtual reality simulator on the learning of basic robotic suturing skills. METHODS: Two randomized groups of students underwent a controlled training program. Both groups completed an identical test before and after training. The increase in the number of stitches placed during the pretest and posttest was used as an objective measure of the training effect. To evaluate the subjective feeling of understanding and mastering, the students indicated this on a visual analog scale. RESULTS: Both groups showed a significant increase in the number of stitches placed during the posttest, and an increase in subjective feeling of understanding and mastering. The increase did not differ between the groups, indicating that the virtual reality simulator equaled the mechanical trainer in training of robotic suturing technique. CONCLUSIONS: Training in basic robot-assisted suturing skills using a virtual reality simulator without additional training equaled training using a mechanical simulator.

Computer Simulation↗
PubMedDate not supplied

Using situs for flexible and rigid-body fitting of multiresolution single-molecule data.

We describe here a set of multiresolution visualization and docking procedures that we refer to as the Situs package. The package was developed to provide an efficient and robust method for the fitting of atomic structures into low-resolution data. The current release was optimized specifically for the visualization and docking of single molecules. A novel 3D graphics viewer, volslice3d, was developed for the package to provide an immersive virtual reality environment for measuring and rendering volumetric data sets. The precision of single-molecule, rigid-body docking was tested on simulated (noise-free) low-resolution density maps. For spatial resolutions near 20 A typically arising in electron microscopy image reconstructions, a docking precision on the order of 1 A can be achieved. The shape-matching score captured the correct solutions in all 10 trial cases and was sufficiently stringent to yield unique matches in 8 systems. Novel routines were developed for the flexible docking of atomic structures whose shape deviates from the corresponding low-resolution shape. Test calculations on isoforms of actin and lactoferrin demonstrate that the flexible docking faithfully reproduces conformational differences with a precision < 2 A if atomic structures are locally conserved.

Actins↗
PubMed2007

[Risk communication through genetic counselling: requirements and problems].

Genetic counselling is the single most important instrument for the individual communication of genetic risks. Beyond medical and psychosocial purposes in terms of preparing diagnostic measures and coping with results, genetic counselling also serves as a means to ensure the clients' decision autonomy through adequately informed consent. Accordingly, indispensable preconditions of the counselling process are voluntariness, individuality, non-directiveness, and respect of the right not to know. However, the requirement that any genetic diagnosis should be embedded into genet ic counselling is all too often neglected in today's reality of medicine. Consequently, there is urgent need of legislation ensuring mandatory counselling at least before prenatal and predictive genetic testing. Additionally, clear standards must be established and enforced for the quality of the counselling process as well as for the qualification of counsellors, and sufficient personal and institutional resources must be provided.

Communication↗
PubMed1982

On participant-observation as a component of evaluation. Strategies, constraints and issues.

Described here is a participant-observation strategy employed as one portion of the evaluation research at Family House, a residential treatment program for alcoholic mothers and their children. Major objectives of this leg of a two-legged research design combining this approach with a more standard pre- and post-test strategy were to document and analyze the processes of social development in the new "small society." The ethnographer acted as consultant, with "raw data" generated in the form of daily observations dictated on the rotating basis by staff members over a two-year period. The resulting narrative was coded and analyzed by the anthropologist, utilizing a phenomenological or interpretationist perspective which allowed the "native categories" of significance to emerge and guide the analysis. This novel research strategy is compared with standard ethnographic fieldwork, as well as with pre- and post-test design, in terms of its strengths and weaknesses. Strengths include access to an authentic "inside view" of Family House reality, as well as an unusually rich longitudinal record of daily life in the facility. Problems include danger of contaminating the data by means of the "feedback" provided to reward staff for their cooperation in the research effort. The author concludes, however, that since reactive effects are present in all designs, and since "feedback" is a normal feature of therapeutic milieux, validity is not unusually threatened. Finally, the purposes of evaluation research are scrutinized.

Alcoholism↗
PubMed2005

Representing different views of acupuncture in a single ontology.

A major challenge for health informatics is to model the health-care domain knowledge into appropriate and useful ontologies. This is difficult, and modellers tend to simplify things dramatically by ignoring the fact that the health care domain encompasses a global perspective. The influx of complementary and alternative medicines from the East to the West, or indeed the ongoing colonialization of orthodox Western medicine into other non-western traditions requires multiple paradigms of delivering treatment to be considered simultaneously, side by side. Models and specifications need to be developed to encompass this richness and represent this complex reality so as to understand what the different concepts and terms in each tradition achieve. Acupuncture is used as a test case of cross-membership between two different paradigms. Here, we briefly outline requirements and answer possible objections to our approach before illustrating how we have modelled heterogeneous domain knowledge from different cultures, and across different paradigms, within a single ontology.

Acupuncture↗
PubMed1996

Dichloronitrobenzene: a reappraisal of its skin sensitization potential.

Unlike the closely related chemical dinitrochlorobenzene (DNCB), which is a very strong contact allergen, dichloronitrobenzene (DCNB) has been widely regarded as a non-allergen and, as such, a useful control for its strongly sensitizing counterpart. Nevertheless, it is still an organic chemical species readily capable of penetrating skin and, rather than being regarded as completely inert, it has even been suggested to react with the immune system in such a way that it induces specific tolerance to its chemical structure. We investigated whether DCNB was in reality a non-allergen, or rather merely a weak contact sensitizer. In both a rigorously conducted guinea pig maximization test and in a modified murine local lymph node assay, DCNB was demonstrated to possess weak sensitizing activity. On this basis, DCNB cannot be regarded as inert with respect to contact allergic potential, and is therefore inappropriate as a negative control in studies of skin sensitization.

Animals↗
PubMed2005

Correlation between perceptual, visuo-spatial, and psychomotor aptitude to duration of training required to reach performance goals on the MIST-VR surgical simulator.

Given the dynamic nature of modern surgical education, determining factors that may improve the efficiency of laparoscopic training is warranted. The objective of this study was to analyze whether perceptual, visuo-spatial, or psychomotor aptitude are related to the amount of training required to reach specific performance-based goals on a virtual reality surgical simulator. Sixteen MS4 medical students participated in an elective skills course intended to train laparoscopic skills. All were tested for perceptual, visuo-spatial, and psychomotor aptitude using previously validated psychological tests. Training involved as many instructor-guided 1-hour sessions as needed to reach performance goals on a custom designed MIST-VR manipulation-diathermy task (Mentice AB, Gothenberg, Sweden). Thirteen subjects reached performance goals by the end of the course. Two were excluded from analysis due to previous experience with the MIST-VR (total n = 11). Perceptual ability (r = -0.76, P = 0.007) and psychomotor skills (r = 0.62, P = 0.04) significantly correlated with the number of trials required. Visuo-spatial ability did not significantly correlate with training duration. The number of trials required to train subjects to performance goals on the MIST-VR manipulation diathermy task is significantly related to perceptual and psychomotor aptitude.

Adult↗
PubMedDate not supplied

[Major depression and "deterioration" of intellectual function].

Forty five subjects with major depression or bipolar disorder were studied during the symptom-free period using the Wechsler and Rorschach tests. The tests revealed a reduced capacity to utilise data obtained by analysis and to integrate them by the organisation of complex thought processes as well as frequent loss of contact with reality. This finding seems to demonstrate that the apparently symptom-free periods of depression often display alterations in the capacity for thought.

Adult↗
PubMed1987

[Subacute cutaneous lupus: critical study].

Subacute cutaneous lupus erythematosus has been identified as a bioclinical entity associating particular clinical signs (diffuse superficial cutaneous lesions evolving without atrophy or scarring), biological markers (anti-Ro/SSA, HLA A1 B8 DR3) and a good prognosis. We assessed the reality of this entity: 1) all the anti-Ro/SSA sera at H.-Mondor Hospital was examined over a 2 year period; 58 of the 963 sera tested were positive. Thirty one of the 58 positive patients had lupus (53 p. 100), but only 12 (21 p. 100) had subacute cutaneous lupus; 2) a photographic dossier was examined by three dermatologists who classified the photos of 74 patients independently. All three observers agreed on the diagnosis of subacute cutaneous lupus erythematosus in only 32 p. 100 of cases. The 17 patients in whom the diagnosis was retained did not differ clinically from the 23 cases of systemic lupus. Anti-Ro/SSA antibodies were found in 42 p. 100 of cases of subacute cutaneous lupus and in 23 p. 100 of cases of systemic lupus erythematosus (not significant). The results of this double blind study indicate that the reality of subacute cutaneous lupus erythematosus as a separate entity is debatable.

Diagnosis, Differential↗
PubMed2006

Private practitioners' communications with patients around HIV testing in Pune, India.

Unlike any other disease so far, the 'exceptional' nature of HIV/AIDS has prompted debate about the necessity, but also the challenges, of regulating practitioner-patient communication around HIV testing. In India, the National AIDS Control Organization (NACO) has adopted the guidelines of the World Health Organization with regard to HIV testing and counselling, yet the extent to which these guidelines are fully understood or followed by the vast private medical sector is unknown. This paper examines the gaps between policy and practice in communications around HIV testing in the private sector and aims to inform a bottom-up approach to policy development that is grounded in actual processes of health care provision. Drawing on 27 in-depth interviews conducted with private medical practitioners managing HIV patients in the city of Pune, we looked specifically at practitioners' reported communications with patients prior to an HIV test, during and following disclosure of the test result. Among these practitioners, informed consent is rare and pre-test communication is prescriptive rather than shared. Confidentiality of the patient is often breached during disclosure, as family members are drawn into the process without consulting the patient. While non-adherence to guidelines is a matter of concern, practitioners' communication practices in this setting must be understood in the given social and legal context of the patient-practitioner relationship in India. Communication with their patients is strongly influenced by practitioners' perceptions of their own roles and relationships with patients, perceived characteristics of the patient population, limitations in knowledge and skills, moral values as well as perceptions of legal guidelines and patient rights. We suggest that policy guidelines around patient-practitioner communication need to take sufficient cognizance of existing practices, cultures and the realities of care provision in the private sector. Patients themselves need to be empowered in order to grasp the importance and implications of HIV testing and counselling.

Communication↗