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PubMed2002

Towards clarification of the meaning of spirituality.

BACKGROUND: Rhetoric about spirituality and nursing has greatly increased, as scientific-based approaches are not fully able to address many human problems, such as persistent pain. Despite the renewed interest and growing literature on spirituality, there is no consensus on a definition of this concept. There is also ambiguity on how this concept is incorporated into nursing practice, research, and education. AIM: This paper aims to contribute toward clarification of the meaning of spirituality in relevance to health and nursing today through a conceptual analysis process. METHODS: Information was obtained through dictionary definitions and electronic database searches of literature on spirituality spanning the past 30 years. The criteria for selection included scholarly articles and books with a definition of spirituality, and research studies that investigated the meaning of spirituality to individuals' health. A total of 76 articles and 19 books were retrieved for this analysis. FINDINGS: Spirituality is an inherent component of being human, and is subjective, intangible, and multidimensional. Spirituality and religion are often used interchangeably, but the two concepts are different. Spirituality involves humans' search for meaning in life, while religion involves an organized entity with rituals and practices about a higher power or God. Spirituality may be related to religion for certain individuals, but for others, such as an atheist, it may not be. CONCLUSION: In order to provide clarity and enhance understanding of this concept, this analysis delineates antecedents, attributes, constructed case examples, empirical referents, and consequences of spirituality. A proposed definition of spirituality emerged from this process, which may be applied broadly. Implications for nursing practice, education, and research are discussed.

Holistic Nursing↗
PubMed2000

The role of Adam Politzer (1835-1920) in the history of otology.

PURPOSE: To study and understand the contribution made by Adam Politzer (1835-1920) to 20th century otology and analyze his place in the history of otology. METHOD: A study of his four reference works, some of his hundreds of publications in medical journals, and diverse publications written about him. RESULTS: All areas of otology have been studied, compiled, and improved through his assorted publications, notably his atlas of otoscopy published in 1865, the first work of its kind, expanded and reedited in 1896; his 10 tables of the anatomy of the ear amended in 1873; his textbook of the diseases of the ear, which was first published in two volumes in 1878 and 1882 and subsequently reedited four times as one volume, the last time being in 1908; his anatomy and histology book published in 1889; and his book on the history of otology, which up to now is the most complete tome existing on the subject, edited in two volumes in 1907 and 1913. No other has been as prolific as he. He invented, in particular, a revolutionary method of making the eustachian tube permeable--a method that made him famous and carries his name. He also developed an acoumeter to measure hearing and was the first to describe certain pathologic conditions histologically, of which otosclerosis is one. CONCLUSION: Politzer is certainly the greatest otologist of the 19th century and probably one of the greatest of all time. His influence on the 50 years of otology has never been equaled. He deserves a double mention in the history of otology: as an otologist and as a historian. It is in his honor that the International Society of Otology bears his name.

Anatomy, Artistic↗
PubMedDate not supplied

[Spanish influenza as a cause of death in Zagreb in 1918].

With reference to the fact that so far there have been no comprehensive investigations of the occurrence of outbreak of Spanish influenza in the area of the city of Zagreb, in this study, on the basis of the public records and documents as well as the report given by the Municipal Authorities of the General Administration of the free and royal capital Zagreb, a retrospective analysis of the outbreak of Spanish influenza in Zagreb is given. Since the official reports of the evidence of infectious diseases did not give exact insight in the epidemiological events in 1918, a detailed analysis of the books of autopsy records of the Public health institutions has been done. The aim was to determine the very beginning of Spanish influenza in the city of Zagreb in 1918. It has been found that the first patients suffering from Spanish influenza appeared in July 1918. In the period from 1 September to the end of 1918, a total of 861 persons died because of Spanish influenza and complications caused by pneumonia. The analyzed autopsy records have demonstrated that the usual complication following influenza was pneumonia characterized by hemorrhagic edema. Knowing the tendency of influenza outbreak to recur at regular intervals more eminent onset of the pandemic type similar to that of 1918 may be expected.

Croatia↗
PubMed1994

Appointment access: planning to benchmark a complex issue.

BACKGROUND: Kaiser Permanente-Southern California Region carried out an external benchmarking project to improve appointment access. This article provides practical guidelines for planning a benchmark project around a complex issue such as appointment access. METHOD: Before conducting external site visits, team members determined the goals of the project, defined internal processes, and identified 16 key elements of access (or those factors important to member satisfaction with appointment access). Once a questionnaire was finalized, external benchmark partners were identified and on-site visits conducted. CONCLUSION: On the basis of the on-site visits, team members identified innovative and best practices for each of the 16 key elements of access. Based on these recommendations, some improvements were made across the Southern California region, such as the elimination of provisional booking. Reports of the results have also been sent to Kaiser Permanente medical centers in the region and across the country. Each medical center is encouraged to use these results to internally improve its own appointment access.

Appointments and Schedules↗
PubMed2001

An appraisal of the literature on centric relation. Part III.

The literature directly and indirectly related to centric relation (CR) has been reviewed chronologically. More than 300 papers and quoted sections of books have been divided into three sections. The first two parts are related to CR. Studies in this group mainly compared, either the position of the mandibular condyle or the mandible itself in different CR recordings. Various tools were discussed for this purpose. The third part of the paper is about CR-centric occlusion (CO) discrepancy. CR still remains one of the controversial issues in prosthodontics and orthodontics. Debates such as mounting casts on the articulator by reproducible records for orthodontic treatment planning and end results, and whether or not orthodontic treatment based on CO causes TMJ dysfunction, remain unsolved. The references are listed at the end of Part III.

Centric Relation↗
PubMedDate not supplied

Value of XML in the implementation of clinical practice guidelines--the issue of content retrieval and presentation.

The purpose of guidelines in clinical practice is to improve the effectiveness and efficiency of clinical care. It is known that nationally or internationally produced guidelines which, in particular, do not involve medical processes at the time of consultation, do not take local factors into account, and have no consistent implementation strategy, have limited impact in changing either the behaviour of physicians, or patterns of care. The literature provides evidence for the effectiveness of computerization of CPGs for increasing compliance and improving patient outcomes. Probably the most effective concepts are knowledge-based functions for decision support or monitoring that are integrated in clinical information systems. This approach is mostly restricted by the effort required for development and maintenance of the information systems and the limited number of implemented medical rules. Most of the guidelines are text-based, and are primarily published in medical journals and posted on the internet. However, internet-published guidelines have little impact on the behaviour of physicians. It can be difficult and time-consuming to browse the internet to find (a) the correct guidelines to an existing diagnosis and (b) and adequate recommendation for a specific clinical problem. Our objective is to provide a web-based guideline service that takes as input clinical data on a particular patient and returns as output a customizable set of recommendations regarding diagnosis and treatment. Information in healthcare is to a very large extent transmitted and stored as unstructured or slightly structured text such as discharge letters, reports, forms, etc. The same applies for facilities containing medical information resources for clinical purposes and research such as text books, articles, guidelines, etc. Physicians are used to obtaining information from text-based sources. Since most guidelines are text-based, it would be practical to use a document-based solution that preserves the original cohesiveness. The lack of structure limits the automatic identification and extraction of the information contained in these resources. For this reason, we have chosen a document-based approach using eXtensible Markup Language (XML) with its schema definition and related technologies. XML empowers the applications for in-context searching. In addition it allows the same content to be represented in different ways. Our XML reference clinical data model for guidelines has been realized with the XML schema definition. The schema is used for structuring new text-based guidelines and updating existing documents. It is also used to establish search strategies on the document base. We hypothesize that enabling the physicians to query the available CPGs easily, and to get access to selected and specific information at the point of care will foster increased use. Based on current evidence we are confident that it will have substantial impact on the care provided, and will improve health outcomes.

Computer Systems↗
PubMed1992

Expansion of a unique subpopulation of cytotoxic T cells that express a C alpha V delta 1 T-cell receptor gene in a patient with severe persistent neutropenia.

CD8+ T-lymphocyte populations may be expanded in the peripheral blood of patients with chronic idiopathic neutropenia and may be involved in suppression of granulopoiesis. In this report, we have analyzed the T-cell receptor (TCR) used by the T lymphocytes of a patient with chronic severe neutropenia. Using specific oligonucleotides in the polymerase chain reaction (PCR) to amplify cDNA specific for the different families of the V alpha, V beta, and V delta TCR genes, and monoclonal antibodies (MoAbs) to examine T-lymphocyte subsets and their TCR, a persistent expansion of CD3+CD8+ T lymphocytes and a reduced repertoire of TCR V alpha and V beta genes were found in the patient's peripheral blood mononuclear cell (PBMC) preparations. A predominant portion of the T lymphocytes expressed a unique TCR structure. Thus, we found that, despite the fact that 98% of the T cells expressed alpha beta TCR on the surface membrane and less than 2% expressed tau delta TCR, nonetheless, 40% to 60% of the T cells stained positively with anti V delta 1 MoAb. Using the PCR analysis, the V delta 1 gene segment was found to be rearranged to C alpha, rather than to C delta genes. The expanded C alpha V delta 1+ cells, which are found only rarely in normal PB, expressed CD8 and were cytotoxic, and the C alpha V delta 1 receptor was functional in cytotoxicity. This constitutes the first description of an expansion of cytotoxic CD8+ lymphocytes expressing a functional "hybrid" C alpha V delta 1 gene in vivo, and suggests a pathogenic role for CD8+ C alpha V delta 1+ cells in some patients with idiopathic neutropenia.

Antibodies, Monoclonal↗
PubMed2000

An appraisal of the literature on centric relation. Part II.

The literature directly and indirectly related to centric relation (CR) has been reviewed chronologically. More than 300 papers and quoted sections of books have been divided into three sections. The first two parts of the paper are related to CR. Studies in this group mainly compared either the position of the mandibular condyle or the mandible itself in different CR recordings. Various tools were discussed for this purpose. The third part deals with CR-centric occlusion (CO) discrepancy. CR remains one of the controversial issues in prosthodontics and orthodontics. Debates relating to mounting casts on the articulator by reproducible records for orthodontic treatment planning and end results, and whether or not orthodontic treatment based on CO causes temporomandibular joint (TMJ) dysfunction, remain unsolved. The references are listed at the end of Part III.

Centric Relation↗
PubMed2000

An appraisal of the literature on centric relation. Part I.

The literature directly and indirectly related to centric relation (CR) has been reviewed chronologically. More than 300 papers and quoted sections of books have been divided into three sections. The first two parts are related to CR. Studies in this group mainly compared either the position of the mandibular condyle or the mandible itself in different CR recordings. Various tools were discussed for this purpose. The third part of the paper is about CR-centric occlusion (CO) discrepancy. CR still remains one of the controversial issues in prosthodontics and orthodontics. Debates such as mounting casts on the articulator by reproducible records for orthodontic treatment planning and end results, and whether or not orthodontic treatment based on CO causes temporomandibular joint dysfunction, remain unsolved. The references are listed at the end of Part III.

Centric Relation↗
PubMed2006

Reducing surgical outpatient waiting is not the solution to meeting the 2005 colorectal cancer target.

OBJECTIVES: The majority of colorectal cancers (CRC) are not diagnosed through the Rapid access route (RAR) and follow-ups (FU) may prolong outpatient-waiting time for new referrals. The aim of this study was to assess the relative contributions of an efficient colorectal clinic and a stringent colonoscopy booking system on the total journey time for CRC. PATIENTS AND METHODS: We reduced the number of follow-up appointments with the introduction of 'Paper clinics'. The composition of the new clinic was determined by the known cancer yield through RAR and non-RAR route. A prospective analysis of clinics and CRC journey times was undertaken from November 2003 for 13 months, with the new outpatient clinic template introduced in December 2003. This coincided with a stringent policy on referral pattern for colonoscopy. RESULTS: In our hospital, only 4% of RAR yield CRC. Seventy-five percent of our CRC are referred through the non-RAR route. Eighty-one percent of follow-ups in a 'paper clinic' were discharged. A flexible template for the outpatient clinics, introduced a corresponding reduction in follow-up and increased urgent and routine slots. There was a progressive drop in the follow-up to new ratio and the waiting times for routine and urgent category decreased from a median of 15.9 and 3.4 weeks to 6.7 and 0.7 weeks, respectively (P < 0.001). Average waiting times for all categories fell from 13.35 weeks in November 2003 to 3.5 weeks in December 2004, while the number of patients waiting less than 4 weeks rose from 46% to 71%. This was associated with reduction in total journey times from 93 days to 62 days (P < 0.05). DNA rates remained unaffected. CONCLUSION: Modifying outpatient clinic composition with 'paper clinics' reduces the waiting time for all referrals to a surgical clinic with a modest effect on CRC clinic waiting time. Reduction in the total waiting time to first treatment (for CRC) is due to reducing the demand on colonoscopy in favour of barium enema. Redirecting the flow of patients towards barium enema is perhaps one way of improving the existing CRC journey time to first treatment, within existing resources. Achieving the 62 day target for cancer journey time will be difficult unless traditional surgical clinic habits are challenged.

Ambulatory Care Facilities↗
PubMedDate not supplied

[Health education in the Spanish school manuals].

BACKGROUND: The school manual or textbook is the educational tool most used by the teaching staff. This study is aimed as ascertaining how Education for Health is dealt with in Primary and Secondary school textbooks, which is of utmost importance as regards finding out how they are implemented in the classroom, as well as setting out some points for thought for the authors and editors of these texts and for the teaching staff and healthcare personnel providing assistance to the schools. METHOD: A total of 297 textbooks were analyzed, 123 of which were used at the Primary level, 149 at the Compulsory Secondary level and 25 at the Higher Secondary level. This study deals with five aspects: 1) Presence or absence of Education for Health 2) Health-related topics included 3) Degree of health covered 4) Included in the subject or dealt with on a transversal basis and 5) Methodological aspects. A number of criteria for analysis have been defined for each one of these aspects which will make it possible to consider the degree to which they are covered. RESULTS: Sixty-three percent of the books analyzed included topics related to Education for Health. The topics dealt with most were related to matters of hygiene (39.5%), followed by eating (26.5%). The health-related concept most often dealt with is that of being disease-free (36.9%) and a state of well-being (20%). Somewhat over half of the textbooks dealing with health provide learning activities, although only in certain isolated cases (57.7%). The methodology most often used is informative explanation (32.4%) without dealing with the procedure-related contents or attitude-related criteria. CONCLUSIONS: The current school manuals are not sufficient either as a point of reference or as an adequate resource in order for the teaching staff to provide Education for Health in the classroom, as they do not place sufficient emphasis thereon despite its being considered a transversal subject, and when they indeed do so, the way in which they are oriented does not set attitudes or behaviors into motion.

Health Education↗
PubMed1993

The body republic: social order and human body in Renaissance medical thought.

The representation of the human body built by medicine had historical references and analogical relations with other compounds of the culture of each particular period. The organic model, the coordinated and hierarchical dependence of the body parts, its subordination to a prevailing element (the brain or the heart, depending on the authors and times) guided directly by a soul infused by God... These are some of the aspects which reflect the relation between the image of the body and the justification of the ideological and social order, as a natural one. Among the numerous sources of Renaissance medicine that could bring significant facts about this theme, the present work is based on anatomical treatises and books of natural philosophy like those written by Bernardino Montaña de Monserrate, Alonso de Fuentes, Realdo Colombo, Hieronimus Montaltus, Andrea Cesalpino and Miguel Sabuco, all of whom are good exponents of Renaissance anatomy and physiological thought.

Anatomy↗
PubMed1998

Human resource management in the health care industry.

Human resource management practices with special reference to the latest developments of the 1990s such as environmental effects and managing diversity, were investigated. The purpose of the study was to unveil how the health care industry can benefit from these new concepts, as well as to describe how the traditional health care facilities can adapt these new ideas. Specific examples were provided to illustrate this point. In compilation of this report, both primary and secondary research was used. As primary research, many reputable individuals in the health care industry were consulted, and asked to comment on the rough draft of this report. Secondary sources included many journal articles, original researches and books that were written on this technical subject. It can be concluded from this research, that the health care industry should adapt the latest methods to compete and survive, such as use more marketing tools to attract human resource management personnel from other industries, promote diversity at the work place, promote from within the company, and cross-train personnel whenever possible. Health care industry has generally lagged behind other industries in securing high-performance individuals and marketing personnel; however, with the development of health maintenance organizations, this trend is changing.

Cultural Diversity↗
PubMed1996

The Health Care Ethics Consultant, edited by Françoise Baylis.

The Health Care Ethics Consultant marks a stage in the development of ethics consultancy. Ethics consultancy is a manifestation of a newly secularized society in which a new discipline has developed to fill a gap created by the combination of the diminishing influence of traditional moral authorities and the growth of new problems associated with the development of new technology and changes in society and culture. The stated primary objective of the book is to focus attention on an immediate practical problem: the role and responsibilities, the education and training, and the certification and accreditation of health ethics consultants. An edited collection of articles, the book originated as a research project financed by the Social Sciences and Humanities Research Council of Canada, undertaken by a Strategic Research Network which included faculty members from Dalhousie University, McGill University, the University of Toronto, McMaster University and the University of Calgary.

Canada↗
PubMed1977

Maternal serum alpha-fetoprotein and spontaneous abortion.

The relationship between spontaneous abortion and maternal serum alpha-fetoprotein (AFP) levels was investigated between 9 and 25 weeks of pregnancy. Seven out of 126 (5-6 per cent) women who had spontaneous abortions had raised maternal serum AFP levels at their antenatal booking visit compared to 4 out of 247 (1-6 per cent) control patients who were delivered of single liveborn infants, a statistically significant differences. The raised AFP concentrations were, however, associated with spontaneous abortion only if the serum samples had been taken immediately before, or at sometime after the abortion was first clinically suspected. This suggests that high levels do not predict the development of abortion in women who have not already threatened to abort. It is therefore unlikely that women who have not already threatened to abort. Therefore, when maternal serum AFP levels are used to screen for fetal neural tube defects, women referred for a diagnostic amniocentesis on account of a high level are unlikely to have been selected on the basis of a tendency to abort.

Abortion, Spontaneous↗
PubMed1997

Self-study program on HTML browser--application to Clinical Nursing General Remarks Course.

We created a self-study program using HTML browser on the Clinical Nursing General Remarks Course, Eighty-three students each selected a published book on a personal history (written personal reflections from individuals who had undergone medical treatment and hospitalization), read it and submitted reports of their impressions of the histories. Their reports were arranged from a nursing perspective and entered on the home page of our college using HTML browser. We intended that the students would become more interested in reading of the personal histories, and that they would acquire new self-study skills and increase their interest in Internet through use of our program. In addition, we hoped that this program would encourage positive communication and mutual sharing of information. The students were able to easily refer to a personal history according to their interest from a nursing perspective. Therefore this program realized the mutual learning among students and other users.

Computer Communication Networks↗
PubMed1990

[Quantitative Chinese pharmaceutical study on children pneumonia treated by Pu fu-zhou].

By method of quantitative Chinese pharmacy, the author studied the children pneumonia cases recorded in two books, "Pu Fuzhou's Medical Cases" and "Pu Fuzhou's Medical Experiences". The rule of Chinese medicine used by Pu Fuzhou was probed preliminarily. It was a characteristic that Pu Fuzhou treated the children pneumonia cases by using Pinelliae Tuber, Exocarpium Citri Rubrum, Jujube and Radix Glycyrrhizae. But the rate of using Herba Lophatherum was less in pneumonia group than in non-pneumonia (contrast) group. According to the rate of overdose prescriptions, 11 Chinese herbal medicines used frequently in pneumonia group were classified into 4 sections. Only overdosage rate of section B (Radix Glycyrrhizae and Peucedanum Decursivum Maxim) was correlated with various kinds of diseases. Referring to the compatibility of dosage of the two Chinese medicines used, there were positive correlation in 35 of 38 pairs, among them, P less than 0.05 in 20; negative correlation in 3 of 38 pairs, among them, P less than 0.05 in 1. It was revealed that in 18 of 38 pairs, in which no significant positive correlation was present, the dosages of Chinese medicine used by Dr. Pu varied with different degree of severity and kind of symptoms he treated.

Child↗
PubMed1992

Vagal reflexes referred from the upper aerodigestive tract: an infrequently recognized cause of common cardiorespiratory responses.

OBJECTIVE: To review the physiologic basis for normal and abnormal vagal reflexes arising from the pharynx, larynx, and esophagus, as well as the relevance of vagal reflexes to the pathogenesis of such clinically common cardiorespiratory responses as bradycardia, tachycardia, dysrhythmia, coronary angiospasm, bronchospasm, laryngospasm, prolonged apnea, and singultus (hiccups). DATA SOURCES: Pertinent articles and reviews were identified through a MEDLINE search (April 1966 to October 1991). Older studies and others not identified in the MEDLINE search were found through a manual search of the bibliographies of the retrieved articles. STUDY SELECTION: Experimental studies in both humans and animals, as well as case series and single case reports, were selected for evaluation and citation. In instances where a similar phenomenon was described in multiple independent reports, only studies that provided a novel finding or interpretation were cited. More authoritative book chapters and peer-reviewed summaries were also cited in support of commonly accepted principles. DATA EXTRACTION AND SYNTHESIS: Most of the clinical data are derived from case reports and small case series and are therefore anecdotal; equal weight was given to all such studies. Reports of conflicting observations or interpretations were clearly identified and were cited without exception. CONCLUSIONS: Stimulation of the upper aerodigestive tract can lead to clinically significant cardiorespiratory responses. Although the prevalence of and risk factors for such responses have not been established, we suggest that a pharyngeal, a laryngeal, or an esophageal source for abnormal cardiorespiratory responses be sought whenever a detailed clinical evaluation fails to reveal a cause, particularly when there are concurrent symptoms or signs of upper aerodigestive tract disease, such as dysphagia or gastroesophageal reflux.

Cardiovascular System↗