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BackgroundThere has been relatively little theoretical research exploring the cognitive complexity of how patients decide the level to which they adhere to prescribed regimens.ObjectivesTo integrate various psychosocial theories into a conceptual framework to review how patients relate their medication use behavior to therapeutic outcomes and how such relationships affect subsequent medication use.MethodsKey psychosocial theories were reviewed involving health beliefs and medication adherence, individual control, and how individuals might compare outcomes with expectations and alternatives. These concepts were integrated into one larger multilevel explanatory model, the Dynamic Exchange Model for Medication Adherence Levels and Comparison of Outcomes (DEMMALCO), explaining how patients might attribute outcomes related to their medication use and choose future actions based on expectations and alternatives available. Key assumptions of the model were also identified.ResultsDEMMALCO indicates that patients make initial attributions of their control over their illness, which affects their subsequent adherence to their regimens. The model suggests that patients actively compare their treatment outcomes with their expectations about outcomes and the outcomes that are related to their best alternative. They are thought to reassess how their control in treatment was related to those outcomes and subsequently modify their adherence behavior based on the presence or absence of resources.ConclusionsStrengths and limitations of the model are noted. DEMMALCO may help inform researchers and clinicians on new ways to conceptualize, monitor, and change medication adherence behavior. 相似文献
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Albert NM, Gillinov AM, Lytle BW, Feng J, Cwynar R, Blackstone EH. A randomized trial of massage therapy after heart surgery. Heart Lung 2009; 38: 480–90. 相似文献
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Computer simulation in conjunction with medical thermography as an adjunct tool for early detection of breast cancer 总被引:1,自引:0,他引:1
Background
Mathematical modelling and analysis is now accepted in the engineering design on par with experimental approaches. Computer simulations enable one to perform several 'what-if' analyses cost effectively. High speed computers and low cost of memory has helped in simulating large-scale models in a relatively shorter time frame. The possibility of extending numerical modelling in the area of breast cancer detection in conjunction with medical thermography is considered in this work.Methods
Thermography enables one to see the temperature pattern and look for abnormality. In a thermogram there is no radiation risk as it only captures the infrared radiation from the skin and is totally painless. But, a thermogram is only a test of physiology, whereas a mammogram is a test of anatomy. It is hoped that a thermogram along with numerical modelling will serve as an adjunct tool. Presently mammogram is the 'gold-standard' in breast cancer detection. But the interpretation of a mammogram is largely dependent on the radiologist. Therefore, a thermogram that looks into the physiological changes in combination with numerical simulation performing 'what-if' analysis could act as an adjunct tool to mammography.Results
The proposed framework suggested that it could reduce the occurrence of false-negative/positive cases.Conclusion
A numerical bioheat model of a female breast is developed and simulated. The results are compared with experimental results. The possibility of this method as an early detection tool is discussed.108.
Idiopathic thrombosis often precedes the diagnosis of occult cancer by several years. Whether hypercoagulability predisposes for malignancy or the converse holds true is an unresolved paradigm that stems from the known vicious cycle of clot formation and tumor growth. Central to this paradigm is the interplay between tissue factor (TF), the initiator of coagulation, and angiogenesis, the life support of tumors. Both clotting-dependent and -independent mechanisms of TF-induced angiogenesis have been elucidated that may signal through distinct pathways. This review focuses on the latest studies of TF and angiogenesis and highlights recent applications that have led to the development of promising new TF-targeted cancer therapeutics. Finally a cautionary note is given about unexpected complications arising from antiangiogenic therapy that may potentially involve TF. 相似文献
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K. M. Kilbride F. L. Paveglio A. L. AltstattRID=""ID="" <E>Present address:</E> Chiswell Lane Silver Spring MD USA W. G. Henry C. A. JanikRID=""ID="" <E>Present address:</E> Palo Verde Albuquerque NM USA 《Archives of environmental contamination and toxicology》1998,35(2):236-248
Throughout the western United States, studies have identified various detrimental effects of contaminants to aquatic biota
from the use of agricultural drainage water for management of arid wetlands. However, little is known about the relative contributions
of contaminant loading from pollutants dissolved in water compared with those carried by drifting material (e.g., detritus) associated with drainage water. Consequently, we determined loading rates for contaminants dissolved in water and
those incorporated by drifting material for drainage (Diagonal Drain) as well as fresh (S-Line Canal) water used for wetland
management at Stillwater National Wildlife Refuge (SNWR), Nevada during the early, middle, and late periods of the irrigation
season (June through mid-November) in 1993. We found loading rates for trace elements throughout the irrigation season were
almost entirely (> 98%) associated with contaminants dissolved in the water rather than incorporated by drift. Although drift
contributed little to the total loading for trace elements to SNWR wetlands, contaminant concentrations were much greater
in drift compared with those dissolved in water. Loading rates for dissolved As, B, Hg, and total dissolved solids (TDS) differed
among periods for the Diagonal Drain. Along the Diagonal Drain, loading rates for dissolved As, B, Hg, Mo, unionized ammonia
(NH3-N), TDS, and Zn differed among its three sampling sites. B was the only trace element with differences in loading rates for
drift among periods from the Diagonal Drain. In contrast, loading rates for As, B, Cr, Cu, Hg, Se, and Zn in drift differed
among periods for the S-Line Canal. Along Diagonal Drain, loading rates in drift for B (middle and late periods), Cr, Cu,
and Zn differed among sites. Hg (xˉ ≥ 12.0 ng/L) and NH3-N (xˉ ≥ 0.985 mg/L) dissolved in water as well as B (xˉ ≥ 97.4 μg/g DW) and Hg (xˉ ≥ 0.461 μg/g DW) in drift from the Diagonal
Drain and S-Line Canal exceeded screening levels (SLs) for protection of aquatic biota throughout the irrigation season. Dissolved
As (xˉ ≥ 0.0426 mg/L) in water from the Diagonal Drain during all periods exceeded the SL for protection of aquatic biota.
Dissolved B (xˉ = 1.03 mg/L) in water from the Diagonal Drain during the early period exceeded the SL for protection of aquatic
biota.
Received: 18 September 1997/Accepted: 5 February 1998 相似文献
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The occurrence of venous thromboembolism complicates the management of the patient with malignant disease because of the need for anticoagulant therapy. Cancer patients have an ongoing thrombotic stimulus due to the underlying cancer and its associated treatments, but are also considered to be at increased risk for anticoagulant-related bleeding. In recent years, the results of clinical trials have demonstrated the safety and efficacy of bodyweight-adjusted subcutaneous low-molecular-weight heparin administered at home for patients with acute deep vein thrombosis. This approach is particularly attractive in patients with cancer, in whom quality of life is an important consideration. There are no trials to date which specifically address the question of the duration of oral anticoagulant therapy in cancer patients. However, data can be extrapolated from trials evaluating the duration of oral anticoagulant therapy in other high-risk patients. Hence, cancer patients should continue oral anticoagulant therapy for as long the cancer remains active (usually at least 6 months). There remain a number of unanswered questions regarding the clinical management of thromboembolism in the cancer patient. 相似文献