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James P McCormack PharmD Lisa Dolovich PharmD MSc † Mitch Levine MD MSc † Sheri Burns BA † Kalpana Nair MEd † Alan Cassels MPA ‡ Karen Mann PhD § Jean Gray MD ¶ 《Health expectations》2003,6(4):281-289
Background A common and often integral method of delivering patient information is the use of patient guides. However, the acceptability, utility and impact of evidence‐based therapeutic guides on physicians, pharmacists and patients have not been well evaluated. Methods This study was a prospective evaluation of 53 general practitioners' offices and 30 community pharmacies from three locations in Canada. Evidence‐based guides were provided to 1176 patients who presented to either a general practitioner or a community pharmacist and were interested in receiving information about sore throat, heartburn, or osteoporosis ( http://www.ti.ubc.ca/canadadrugguide ). The acceptability, utility and impact of the guides were assessed via structured patient telephone interviews, structured health professional interviews, and patient chart audits. Results Eighty to 90% of patients reported that the guides were ‘very easy’ to understand. Fifty six per cent/47%/38% (sore throat/heartburn/osteoporosis) of patients rated the guides as ‘very’ or ‘extremely’ useful. Seventy‐two per cent/67%/58% of respondents reported that the information helped them make decisions about their treatment. Ninety eight per cent of physicians and 92% of pharmacists reported that the guides helped their patients understand the issues involved in their treatment. None of the analyses showed any significant differences in prescribing of medications between the intervention and control groups. Interpretations Patients found these evidence‐based guides to be useful, easy to understand, and that they helped them in their understanding of treatment options and the decision‐making process. Physicians and pharmacists reported that the guides helped their patients understand the issues involved in their treatment. Further research is required to determine the degree to which providing evidence‐based guides to patients can impact on prescribing and patient outcomes. 相似文献
105.
The trouble with family medicine 总被引:1,自引:1,他引:0
BACKGROUND: The trouble with family medicine is that the perceptual
framework it uses to view the phenomena of health and illness is at
variance with the frameworks traditionally used by medicine generally. This
creates difficulties in communication between those in family medicine and
those in other disciplines, and sometimes leads to misunderstanding of the
nature of the discipline of family medicine and its place in the health
care system. Those who practise family medicine need to be 'multilingual',
able to understand and speak the language and use the metaphors of family
medicine, yet equally able to use the language and metaphors of other
disciplines. OBJECTIVES: This paper, which begins with a clinical scenario,
reviews the contemporary biomedical paradigm, proposes an alternative, and
examines the conceptual frameworks which underpin the discipline of family
medicine.
相似文献
106.
J L Bailey X Wang B K England S R Price X Ding W E Mitch 《The Journal of clinical investigation》1996,97(6):1447-1453
107.
Ahmad M. Eid Ohoud A. Alhaqbani Sultana M. Asfahani Mashail Alaql Anoud N. AlSaud Rafat S. Mohtasib Hesham M. Aldhalaan Mitch J. Fryling 《Journal of developmental and physical disabilities》2017,29(4):557-565
The present study trained six parents of children with Autism Spectrum Disorder to implement the Natural Language Paradigm in Saudi Arabia. Three of the parents participated in direct training using a Behavioral Skills Training (BST) model involving instructions, modeling, rehearsal, and feedback. As each of the three parents were being trained directly an additional parent observed the training (i.e., there were three trainee-observer dyads). While all of the parents learned from observing other parents being trained directly, only one observer met the predetermined performance criteria after observation alone, with the other two requiring direct training using BST. The parents demonstrated maintenance of their skills at follow-up, and social validity evaluations were strong. In addition, all parents implemented the NLP procedures at mastery criteria in another setting during generalization probes. Implications for further training research are provided. 相似文献
108.
The impact of a unique knowledge translation programme implemented in a large multisite paediatric hospital 下载免费PDF全文
109.
Activation of caspase-3 is an initial step triggering accelerated muscle proteolysis in catabolic conditions 总被引:16,自引:0,他引:16
Du J Wang X Miereles C Bailey JL Debigare R Zheng B Price SR Mitch WE 《The Journal of clinical investigation》2004,113(1):115-123
With trauma, sepsis, cancer, or uremia, animals or patients experience accelerated degradation of muscle protein in the ATP-ubiquitin-proteasome (Ub-P'some) system. The initial step in myofibrillar proteolysis is unknown because this proteolytic system does not break down actomyosin complexes or myofibrils, even though it degrades monomeric actin or myosin. Since cytokines or insulin resistance are common in catabolic states and will activate caspases, we examined whether caspase-3 would break down actomyosin. We found that recombinant caspase-3 cleaves actomyosin, producing a characteristic, approximately 14-kDa actin fragment and other proteins that are degraded by the Ub-P'some. In fact, limited actomyosin cleavage by caspase-3 yields a 125% increase in protein degradation by the Ub-P'some system. Serum deprivation of L6 muscle cells stimulates actin cleavage and proteolysis; insulin blocks these responses by a mechanism requiring PI3K. Cleaved actin fragments are present in muscles of rats with muscle atrophy from diabetes or chronic uremia. Accumulation of actin fragments and the rate of proteolysis in muscle stimulated by diabetes are suppressed by a caspase-3 inhibitor. Thus, in catabolic conditions, an initial step resulting in loss of muscle protein is activation of caspase-3, yielding proteins that are degraded by the Ub-P'some system. Therapeutic strategies could be designed to prevent these events. 相似文献
110.
Rapid mobilization of hematopoietic progenitor cells in rhesus monkeys by a single intravenous injection of interleukin-8 总被引:13,自引:6,他引:13
Laterveer L; Lindley IJ; Heemskerk DP; Camps JA; Pauwels EK; Willemze R; Fibbe WE 《Blood》1996,87(2):781-788
Interleukin-8 (IL-8) is a chemoattractant cytokine involved in chemotaxis and activation of neutrophils. Because in vivo administration of IL-8 induces mobilization of hematopoietic stem cells in mice, we assessed the mobilizing properties of IL-8 in rhesus monkeys. Recombinant human IL-8 was administered as a single intravenous injection at doses of 10, 30, and 100 micrograms/kg to rhesus monkeys (age, 2 to 3 years; weight, 2.5 to 4.5 kg). Venous blood samples were obtained at time intervals ranging from 1 to 480 minutes after IL-8 administration. Cell counts, colony-forming unit-Mix assays, and fluorescence-activated cell sorter analysis were performed. Plasma was harvested to assess IL-8 levels. A time-controlled bolus intravenous injection of 100 micrograms IL-8 per kilogram of body weight resulted in peak IL-8 plasma levels up to 5 micrograms/mL. The calculated half-time life of free IL-8 was 9.9 +/- 2.2 minutes. IL-8 injection resulted in instant neutropenia that was due to pulmonary sequestration, as shown using 99mTc-labeled leukocytes. Within 30 minutes after IL-8 injection, neutrophilia developed with counts up to 10-fold greater than baseline levels. The numbers of hematopoietic progenitor cells (HPCs) increased from 45 +/- 48/mL to 1,382 +/- 599/mL of blood at 30 minutes after injection of 100 micrograms IL-8 per kilogram of bodyweight (mean +/- SD, n = 8). Individual animals showed 10- to 100-fold increase in numbers of circulating HPCs that returned to almost pretreatment values (92 +/- 52 CFU/mL) at 240 minutes after the injection of IL-8. Immunophenotyping showed no significant changes in lymphocyte (sub)populations. A second bolus injection of IL-8 with an interval of 72 hours resulted in similar numbers of mobilized stem cells as observed after the first injection, showing that no tachyphylaxis had occurred. We conclude that IL-8 induces mobilization of HPCs from the bone marrow of rhesus monkeys in a rapid and reproducible fashion. Therefore, IL-8 may be a potentially useful cytokine in the setting of blood stem cell transplantation. 相似文献