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991.
The objective of our project was to improve the efficiency of the physical examination screening service of a large hospital
system. We began with a detailed simulation model to explore the relationships between four performance measures and three
decision factors. We then attempted to identify the optimal physician inquiry starting time by solving a goal-programming
problem, where the objective function includes multiple goals. One of our simulation results shows that the proposed optimal
physician inquiry starting time decreased patient wait times by 50% without increasing overall physician utilization. 相似文献
992.
This study investigated the concurrent and longitudinal relations among children’s peer victimization, empathy, and emotional
symptoms. The sample consisted of 175 children (85 girls, mean age = 6.1 years) recruited from kindergartens in Switzerland
and followed for 1 year (Time 2). Parents and teachers reported on the children’s emotional symptoms, empathy, and victimization.
Children reported their empathy and victimization experiences. Peer victimization was a predictor of emotional symptoms at
Time 1; this association was stronger for children with average or high levels of empathy. Increases in peer victimization
predicted increases in boys’ emotional symptoms, and increases in victimization were related to decreases in empathy. The
results emphasize the role of negative peer relations and children’s social-emotional information processing for the development
of emotional symptoms. 相似文献
993.
Ira L. Cohen Tina Rovito Gomez Maripaz G. Gonzalez Elizabeth M. Lennon Bernard Z. Karmel Judith M. Gardner 《Journal of autism and developmental disorders》2010,40(2):246-254
Quantitative variations in score profiles from the parent version of the PDD Behavior Inventory (PDDBI) were examined in young
Autism and PDD-NOS groups defined by ADOS-G and ADI-R criteria, relative to a not spectrum (NS) group of similar age. Both
the Autism and the PDD-NOS group profiles markedly differed from the NS group. The most sensitive measures of group differences
were those domain and composite scores that assessed social communication competence, as well as the overall Autism Composite
score. Sensitivity, specificity and positive and negative predictability measures were quite good for these measures. It was
concluded that the PDDBI is useful in assisting in the differential diagnosis of autism spectrum disorder. 相似文献
994.
Flemming Wibrand PhD Tina D. Jeppesen MD Anja L. Frederiksen MD David B. Olsen MD Morten Duno PhD Marianne Schwartz PhD John Vissing MD PhD 《Muscle & nerve》2010,41(5):607-613
We evaluated the diagnostic value of respiratory chain (RC) enzyme analysis of muscle in adult patients with mitochondrial myopathy (MM). RC enzyme activity was measured in muscle biopsies from 39 patients who carry either the 3243A>G mutation, other tRNA point mutations, or single, large‐scale deletions of mtDNA. Findings were compared with those obtained from asymptomatic relatives with the 3243A>G mutation, myotonic dystrophy patients, and healthy subjects. Plasma lactate concentration, maximal oxygen uptake, and ragged‐red fibers/cytochrome c–negative fibers in muscle were also determined. Only 10% of patients with the 3243A>G point mutation had decreased enzyme activity of one or more RC complexes, whereas this was the case for 83% of patients with other point mutations and 62% of patients with deletions. Abnormal muscle histochemistry was found in 65%, 100%, and 85% of patients, respectively, in these three groups. The results indicate that RC enzyme analysis in muscle is not a sensitive test for MM in adults. In these patients, abnormal muscle histochemistry appears to be a better predictor ofMM. Muscle Nerve, 2010 相似文献
995.
996.
997.
Objectives
Several new methods are available, but we know little about successful integration of contraceptive technologies into services. We investigated provider factors associated with the initiation of new hormonal methods among women at high risk of unintended pregnancy.Methods
This cohort study enrolled 1387 women aged 15-24 starting hormonal contraception (vaginal ring, transdermal patch, oral contraceptive, or injectable) at four family planning clinics in low-income communities. We measured provider factors associated with method choice, using multinomial logistic regression.Results
Ring and patch initiators were more likely than women starting oral contraceptives to report that they chose their method due to provider counseling (p < 0.001). Contraceptive knowledge in general was low, but initiation of a new method, the ring, was associated with higher knowledge about all methods after seeing the provider (p < 0.001). Method initiated varied with provider site (p < 0.001). These associations remained significant, controlling for demographics and factors describing the provider-patient relationship, including trust in provider and continuity of care.Conclusion
Women's reports of provider counseling and of their own contraceptive knowledge after the visit was significantly associated with hormonal method initiated.Practice implications
More extensive counseling and patient education should be expected for successful integration of new hormonal methods into clinical practice. 相似文献998.
Meiksin R Chang JC Bhargava T Arnold R Dado D Frankel R Rodriguez KL Ling B Zickmund S 《Patient education and counseling》2010,81(3):462-467
Objective
Unplanned pregnancy is associated with psychosocial stress, post-partum depression, and future unplanned pregnancies. Our study describes how topics related to unplanned pregnancy were addressed with patients during the first prenatal visit.Methods
We audio-recorded and transcribed initial prenatal visits between 48 patients and 16 providers from a clinic serving racially diverse, lower-socio-economic patients. We conducted a fine-grained thematic analysis of cases in which the patient's pregnancy was unplanned.Results
Of the 48 patients, 35 (73%) had unplanned pregnancies. Twenty-nine visits for unplanned pregnancies (83%) included discussion of the patient's feelings about the pregnancy. Approximately half (51%) of the visits touched on partner or other types of social support. Six patients (17%) were offered referrals to counseling or social services. Only four visits (11%) touched on future birth control options.Conclusion
Most initial prenatal visits for unplanned pregnancies included discussion of patient feelings about the pregnancy. However, opportunities to discuss future birth control and for more in-depth follow-up regarding social support and psychological risks associated with unplanned pregnancy were typically missed.Practice implications
Obstetrics care providers should be cautious about making assumptions and should consider discussing pregnancy circumstances and psychosocial issues in more depth when treating patients facing unplanned pregnancy. 相似文献999.
1000.
Bullock L Bloom T Davis J Kilburn E Curry MA 《Journal of Midwifery & Women's Health》2006,51(5):361-369
Disclosure of abuse by pregnant women can vary depending on whether the woman is assessed directly by a trained interviewer versus written questionnaires, and if she is asked repeatedly during the course of pregnancy. One thousand pregnant women were enrolled in a randomized clinical trial designed to assess the effects of a nursing case management intervention on the mental and physical well-being of pregnant women experiencing or at risk for abuse. Thirteen percent of the total study participants reported current abuse and/or abuse within the past year, with only 2% of those reporting that the abuse occurred during pregnancy. The incidence of reported abuse was much higher among Medicaid-funded women (28.9%) than privately insured women (8.7%). Regardless of source of payment, women reporting abuse were significantly younger, less educated, nonwhite with lower income, and had significantly higher stress and lower self-esteem than women not reporting abuse. A high incidence of women reporting intimate partner violence described being choked on the Danger Assessment Screen (34%). We strongly urge that choking be added to routine screening questions used during pregnancy and that the Danger Assessment tool is used for further evaluation of women who screen positive. In addition, we believe another barrier to reporting abuse was fear of being reported to child protective services, contributing to the overall low rate of abuse disclosure. 相似文献