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541.
Rationale, aims and objective The effect of Electronic Medical Record (EMR) use on Patient–Doctor Communication (PDC) has rarely been studied. As data accumulate, the purpose of this article is to review the literature on EMR effect on PDC, to identify recurring themes and to offer preliminary guidelines and future directions for medical education and research.
Method A database search was conducted and 14 articles that met inclusion criteria (published in the past 10 years, empirical investigations, direct assessment of the EMR impact on patient–doctor communication) were selected for review. A qualitative, grounded theory-like approach was employed to analyse the data.
Results EMR use often has a positive impact on information exchange, but exerts a negative influence on patient centredness. Some physician characteristics such as their computer skills and behavioural style assist in overcoming this negative influence.
Conclusion The use of EMR exerts both positive and negative impacts on physician–patient relationships. The negative impacts can be overcome by some simple means as well as better designs of EMR systems and medical education interventions. Physicians' everyday practices of integrating EMR use into the clinical encounter as well as better design of EMR systems and EMR and communication training may facilitate PDC in computerized settings. 相似文献
Method A database search was conducted and 14 articles that met inclusion criteria (published in the past 10 years, empirical investigations, direct assessment of the EMR impact on patient–doctor communication) were selected for review. A qualitative, grounded theory-like approach was employed to analyse the data.
Results EMR use often has a positive impact on information exchange, but exerts a negative influence on patient centredness. Some physician characteristics such as their computer skills and behavioural style assist in overcoming this negative influence.
Conclusion The use of EMR exerts both positive and negative impacts on physician–patient relationships. The negative impacts can be overcome by some simple means as well as better designs of EMR systems and medical education interventions. Physicians' everyday practices of integrating EMR use into the clinical encounter as well as better design of EMR systems and EMR and communication training may facilitate PDC in computerized settings. 相似文献
542.
Ash Ederies MBChB Heng‐Wai Yuen MBBS Joseph M. Chen MD Richard I. Aviv MBChB Sean P. Symons MPH MD 《The Laryngoscope》2009,119(6):1195-1197
A 41‐year‐old man presented after forceful penetrating ear injury. He had incapacitating vestibular symptoms. Computed tomography revealed pneumolabyrinth with a fractured stapes that was >90° rotated and subluxed into the vestibule, such that the crura and capitulum could be seen in the vestibule. Surgical repair reversed the vestibular symptoms, but there was persistent hearing loss. Stapes fractures are unusual and rarely associated with subluxation into the vestibule. When this does occur, there is usually simple footplate depression. This case demonstrates a rare stapes fracture with pneumolabyrinth and >90 degrees stapes rotation, then subluxation into the vestibule. Laryngoscope, 2009 相似文献
543.
Arthur Bohdjalian Gerhard Prager Christoph Rosak Rudolf Weiner Ralf Jung Markus Schramm Ricardo Aviv Karin Schindler Walid Haddad Norbert Rosenthal Bernhard Ludvik 《Obesity surgery》2009,19(9):1221-1227
Background Gastric electrical stimulation synchronized to the refractory period of gastric electrical activity and applied during meals
was evaluated for safety and for improvement of body weight and glycemic control in obese type 2 diabetes.
Methods The study involved obese diabetic type 2 (ODM) patients in a multicenter open-label European feasibility trial. A total of
24 ODM (nine males, 15 females) treated with insulin and/or oral hyperglycemic agents and body mass index between 33.3 to
49.7 kg/m2 were implanted laparoscopically with a TANTALUS system.
Results There were 18 adverse events related to the implant procedure or the device reported in 12 subjects. All were short lived
and resolved with no sequelae. In the 21 subjects that reached the 1-year visit weight was reduced by 4.5 ± 2.7 kg (p < 0.05) and HbA1c by 0.5 ± 0.3% (p < 0.05). In a subgroup (n = 11) on stable or reduced oral medication, weight was reduced by 6.3 ± 3.4 kg (p < 0.05) and HbA1c by 0.9 ± 0.4% (p < 0.05). The group on insulin (n = 6) had no significant changes in weight and HbA1c.
Conclusions The TANTALUS system is well tolerated in obese type 2 diabetic subjects. Gastric electrical stimulation can potentially improve
glucose metabolism and induce weight loss in obese diabetic patients, who are not well controlled on oral antidiabetic therapy.
Further evaluation is required to determine whether this effect is due to induced weight loss and/or to direct signal dependent
mechanisms. 相似文献
544.
Ellen G. Levine Caryn Aviv Grace Yoo Cheryl Ewing Alfred Au 《Supportive care in cancer》2009,17(3):295-306
OBJECTIVES: Prayer is becoming more widely acknowledged as a way to cope with cancer. The goal of this study was to compare differences in use of prayer between breast cancer survivors from different ethnic groups and examine how use of prayer is related to mood and quality of life. METHODS: This study used a mixed methods design. One hundred and seventy-five breast cancer survivors participated in a longitudinal study of survivorship. Women completed in-depth qualitative interviews and a battery of measures including quality of life, spirituality, social support, and mood. RESULTS: Eighty-one percent of the women prayed. There were no significant differences between the groups for any of the psychological, social support, or quality of life variables with the exception of higher benefit finding and spiritual well-being among those who prayed. The data did show that women who prayed were able to find more positive contributions from their cancer experience than women who did not pray. The interviews showed that those who prayed tended to be African American or Asian, Catholic or Protestant. The prayers were for petitioning, comfort, or praise. Some of the women stated that they had difficulty praying for themselves. CONCLUSIONS: While there seems to be few differences in terms of standardized measures of quality of life, social support, and mood between those who prayed and those who did not, the interviews showed that certain ethnic minority groups seem to find more comfort in prayer, felt closer to God, and felt more compassion and forgiveness than Caucasian women. 相似文献
545.
Many human large intergenic noncoding RNAs associate with chromatin-modifying complexes and affect gene expression
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Ahmad M. Khalil Mitchell Guttman Maite Huarte Manuel Garber Arjun Raj Dianali Rivea Morales Kelly Thomas Aviva Presser Bradley E. Bernstein Alexander van Oudenaarden Aviv Regev Eric S. Lander John L. Rinn 《Proceedings of the National Academy of Sciences of the United States of America》2009,106(28):11667-11672
We recently showed that the mammalian genome encodes >1,000 large intergenic noncoding (linc)RNAs that are clearly conserved across mammals and, thus, functional. Gene expression patterns have implicated these lincRNAs in diverse biological processes, including cell-cycle regulation, immune surveillance, and embryonic stem cell pluripotency. However, the mechanism by which these lincRNAs function is unknown. Here, we expand the catalog of human lincRNAs to ≈3,300 by analyzing chromatin-state maps of various human cell types. Inspired by the observation that the well-characterized lincRNA HOTAIR binds the polycomb repressive complex (PRC)2, we tested whether many lincRNAs are physically associated with PRC2. Remarkably, we observe that ≈20% of lincRNAs expressed in various cell types are bound by PRC2, and that additional lincRNAs are bound by other chromatin-modifying complexes. Also, we show that siRNA-mediated depletion of certain lincRNAs associated with PRC2 leads to changes in gene expression, and that the up-regulated genes are enriched for those normally silenced by PRC2. We propose a model in which some lincRNAs guide chromatin-modifying complexes to specific genomic loci to regulate gene expression. 相似文献
546.
Rolf A Heckemann Alexander Hammers Daniel Rueckert Richard I Aviv Christopher J Harvey Joseph V Hajnal 《BMC medical imaging》2008,8(1):9
Background
Diagnostic decisions in clinical imaging currently rely almost exclusively on visual image interpretation. This can lead to uncertainty, for example in dementia disease, where some of the changes resemble those of normal ageing. We hypothesized that extracting volumetric data from patients' MR brain images, relating them to reference data and presenting the results as a colour overlay on the grey scale data would aid diagnostic readers in classifying dementia disease versus normal ageing. 相似文献547.
H Aviv M Y Khan J Skurnick K Okuda M Kimura J Gardner L Priolo A Aviv 《Atherosclerosis》2001,159(2):281-287
RATIONALE: Aneuploidy and telomere length are two major parameters that have been associated with cellular senescence in vitro. In order to explore the role of aneuploidy and telomere length in aging of the human vasculature, we studied these two parameters in direct preparations of endothelial cells of the human abdominal aorta. METHODS: Using fluorescent in situ hybridization on 'touch prep' slides, we evaluated aneuploidy of two autosomes (chromosomes 6 and 16) and sex chromosomes in non cultured endothelial cells of the abdominal aorta as a function of the donor's age. RESULTS: We found that the frequency of aneuploidy of vascular endothelial cells significantly increased with age. This was expressed by age-dependent tetrasomy (r(s)=0.56, P=0.006 for chromosome 6; and r(s)=0.54, P=0.008 for chromosome 16), and age dependent loss of the Y chromosome (r(s)=0.85, P=0.0003). In addition, we found that telomere length was inversely correlated with age (r=-0.38, P=0.008). DATA INTERPRETATION: These findings suggest that indicators of cellular senescence, earlier observed in vitro, are also expressed in the human vascular endothelium in vivo. Aneuploidy and telomere attrition might thus play a role in the aging of the human vasculature. 相似文献
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