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Current Experiences (current + experience)
Selected AbstractsMechanical Circulatory Support for AMI and Cardiogenic ShockJOURNAL OF CARDIAC SURGERY, Issue 4 2010Yasir Abu-Omar D.Phil. The dismal prognosis associated with post-MI cardiogenic shock, allied with surgical and technological advancements, has shifted the treatment paradigm toward wider use of mechanical circulatory support devices (MCSD). Current experience demonstrates that better outcomes may be achieved with early MCSD deployment (prior to the onset of end-organ dysfunction). However, perceived limitations with existing devices mean that they remain infrequently applied. There is an urgent need for increased awareness of MCSD options among clinicians treating post-MI shock patients. (J Card Surg 2010;25:434-441) [source] Introduction: Enhanced external counterpulsation (EECP),Current experience and future directionsCLINICAL CARDIOLOGY, Issue S2 2002C. Richard Conti M.D. No abstract is available for this article. [source] Current experiences with robotic surgery at Severance Hospital, Yonsei University in KoreaASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 1 2010WJ Lee Abstract We started performing laparoscopic cholecystectomies in 1991. Since that time, many surgeons have been trained in laparoscopic and minimally invasive surgery, and laparoscopic surgery has been used in numerous procedures, with patients benefitting as a result. We performed the first automated surgery in Korea using Automated Endoscopic System for Optimal Positioning in June 1996. Inspired by Inbae Yoon and assisted by his generous donation, our hospital started the IB Yoon Multi-Specialty Endoscopic Research & Training Center in 1998. Subsequently in March 2005, we started the Severance Robotic and Minimally Invasive Surgery Center. The establishment of these centers has enabled us to widen the use of laparoscopic surgery and to teach many surgeons the principles of and the techniques involved in laparoscopic and robotic surgery. We performed our first robotic surgery using the da Vinci Surgical System in July 2005. In the 4 years since introducing the da Vinci Surgical System, we have successfully performed more than 2600 robotic surgical procedures. As the collaboration between medicine and robotic engineering produces more technically advanced results, we hopefully can develop our own version of the robotic system in the near future. [source] To Explant or Not to Explant: An Invasive and Noninvasive Monitoring Protocol to Determine the Need of Continued Ventricular Assist Device SupportCONGESTIVE HEART FAILURE, Issue 2 2009Satoru Osaki MD Predictors of myocardial recovery after ventricular assist device (VAD) implantation are not well defined. The authors report their current VAD weaning protocol. Between 2003 and 2006, 38 patients received VAD implants. The authors performed 5 tests in 4 patients in whom echocardiography findings suggested myocardial recovery after implant. The protocol consists of assessing symptoms, electrocardiographic findings, hemodynamics, and cardiac function at baseline and as VAD support is weaned. As a result, 3 patients passed the weaning protocol and were explanted. There has been no recurrence of heart failure 667, 752, and 1007 days after explant, respectively. One patient failed the protocol after 151 days of support because of low cardiac index during the protocol. This patient was transplanted. This current experience of VAD weaning protocol is a novel tool to identify candidates for successful VAD explantation. [source] Obstacles in large-scale epidemiological assessment of sensory impairments in a Dutch population with intellectual disabilitiesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 8 2004H. Evenhuis Abstract Background A population-based epidemiological study on visual and hearing impairment was planned in a random sample of 2100 clients, drawn from a base population of 9012 users of Dutch residential and day-care intellectual disability (ID) services with the whole range of IDs. Stratification was applied for age 50 years and over and Down syndrome. Visual and hearing functions were assessed according to a standardized protocol, in cooperation with regular ophthalmologists and regional audiological centres. Anticipated obstacles in sample collection, random inclusion, informed consent, expertise of investigators, time and costs were eliminated by a careful preparation. However, inclusion and participation were incomplete. Method In a descriptive retrospective design, we collected data from our study files on inclusion and participation as well as reasons for non-participation, to identify unanticipated obstacles for this kind of research. Results Consent was obtained for 1660 clients, and 1598 clients participated in the data collection (76% of intended sample of 2100). Inclusion and participation rates were especially lower in community-based care organizations, resulting in unintentional skewing of the sample towards more severe levels of ID. Complete and reliable data to diagnose visual impairment were obtained for 1358/1598 (85%) and to diagnose hearing impairment for 1237/1598 participants (77%). Unanticipated obstacles had to do with the quality of coordination within care organizations, with characteristics of screening methods, and with collaboration with the regular health care system. Assessments of visual function were more easy to organize than were those of hearing. Based on our current experience, practical recommendations are given for future multicentre research, especially in community-based settings. [source] Achieving positive change in people's lives through the National Learning Disability Strategy: an invitation to partnership between higher education and the world of practiceBRITISH JOURNAL OF LEARNING DISABILITIES, Issue 4 2000David Towell Summary The launch of the National Learning Disability Strategy (NLDS) in England (and parallel initiatives in Scotland and Wales) provides the best opportunity for a generation to close the huge gap between the aspirations of people with learning disabilities and their families for a full life, and most people's current experience. The implementation of the NLDS is a complex challenge, requiring new forms of partnership among a wide range of stakeholders to deliver sustainable change. The present paper describes an enhanced role for universities as champions of local progress, promoting, supporting and evaluating informed change through a range of functions which go well beyond the traditional focus on research and teaching. It is also an invitation to relevant centres, or coalitions of centres on a regional basis, to explore with people, families and public agencies the optimum form of their contribution to these new partnerships. [source] Thirty years of social accounting, reporting and auditing: what (if anything) have we learnt?BUSINESS ETHICS: A EUROPEAN REVIEW, Issue 1 2001Rob Gray In an increasingly complex world with increasingly powerful organisations it seems inevitable that society , or groups in society , would become anxious about whether these organisations could be encouraged to match that power with an appropriate responsibility. This is the function of accountability , to require individuals and organisations to present an account of those actions for which society holds them , or would wish to hold them , responsible. And the history of social accounting, at its most fundamental, is a history of attempts to develop this accountability. It seems to me that the widespread and systematic practice of social and environmental accounting is a deeply essential element in any well-functioning, complex democracy. The corollary is that the absence of such mechanisms raises fundamental questions about the nature of modern democracies. This article briefly outlines what I believe to be the three strands of social accounting. It then identifies a few of the lessons that we may be able to learn from current experience and, in particular, how social accounting is related to accountability, democracy and sustainability. The central issue of the tension between accountability and control is touched upon: I then illustrate how the stakeholder model can be used to help define the social account, and conclude with a few words on attestation. [source] Lumbar disc herniation in young childrenACTA PAEDIATRICA, Issue 1 2010R Haidar Abstract Aim:, This article explores lumbar disc herniation in young children through focusing on matters relevant to patient presentation, physical examination, differential diagnosis, imaging and treatment. Methods:, Major databases were searched for studies that addressed lumbar disc herniation in young children. Results:, Diagnosis of lumbar disc herniation in young children is usually delayed because of the rarity and lack of experience with this entity and the difficulty in extracting a reliable medical history. Nevertheless, lumbar disc herniation should be considered in the differential diagnosis of any young child presenting with a chief complaint of back pain and/or radiculopathy, especially in the setting of recent trauma. This should be coupled with a directed physical examination to elicit signs and narrow the differential diagnosis. Imaging studies, mainly magnetic resonance imaging, will help establish a diagnosis; yet radiographs are still required to exclude other spinal lesions. The initial management of lumbar disc herniation in children is the same as that in adults and consists of conservative treatment unless lumbar disc herniation affects the patient's motor and neurological functions in which case, early surgical treatment must be undertaken. Although the latter remains more difficult, current experience suggests a favourable outcome. Conclusion:, Awareness of lumbar disc herniation will help the paediatrician extract a relevant medical history, perform a directed physical examination, and order appropriate imaging studies. This will aid in initiating early intervention, be it conservative or operative, and achieving a favourable outcome. [source] Knowledge, Market Structure, and Economic Coordination: Dynamics of Industrial DistrictsGROWTH AND CHANGE, Issue 3 2002Ron A. Boschma The industrial rise of the Third Italy has been characterized by the growth of dynamic networks of flexible small and medium,sized enterprises (SMEs) that are spatially concentrated in specialized industrial districts. This network type of coordination has been associated with horizontal, trust,based relations rather than vertical relations of power and dependency between local organizations. This would lower transaction costs (essential for local systems with an extreme division of labor), facilitate the transmission and exchange of (tacit) knowledge (and thus, learning and innovation), encourage cooperation mechanisms (such as the establishment of research centers), and stimulate political,institutional performance (e.g. through regulation of potential social conflicts). From an evolutionary perspective, the focus is on the dynamics of industrial districts drawing from current experiences in Italy. In this respect, this paper concentrates on two main features of industrial districts that have largely contributed to their economic success in the past, that is, their network organization and the collective learning process. The evolution of industrial districts is described in terms of organizational adjustments to structural change. The way in which the size distribution of firms has changed is discussed (in particular the role of large companies), how the (power) relationships between local organizations have evolved, what are the current sources and mechanisms of learning, and to what extent institutional lock,in has set in. Finally, a number of trajectories districts may go through in the near future are presented. [source] Factual memories of ICU: recall at two years post-discharge and comparison with delirium status during ICU admission , a multicentre cohort studyJOURNAL OF CLINICAL NURSING, Issue 9 2007Brigit L Roberts RN, IC Cert Aims and objective., To examine the relationship between observed delirium in ICU and patients' recall of factual events up to two years after discharge. Background., People, the environment, and procedures are frequently cited memories of actual events encountered in ICU. These are often perceived as stressors to the patients and the presence of several such stressors has been associated with the development of reduced health-related quality of life or post-traumatic stress syndrome. Design., Prospective cohort study using interview technique. Method., The cohort was assembled from 152 patients who participated in a previously conducted multi-centre study of delirium incidence in Australian ICUs. The interviews involved a mixture of closed- and open-ended questions. Qualitative responses regarding factual memories were analysed using thematic analysis. A five-point Likert scale with answers from ,always' to ,never' was used to ask about current experiences of dream, anxiety, sleep problems, fears, irritability and/or mood swings. Scoring ranged from 6 to 30 with a mid-point value of 18 indicating a threshold value for the diagnosis of post-traumatic stress syndrome. A P -value of <0·05 was considered significant for all analyses. Results., Forty-one (40%) out of 103 potential participants consented to take part in the follow-up interview; 18 patients (44%) had been delirious and 23 patients (56%) non-delirious during the ICU admission. The non-participants (n = 62) formed a control group to ensure a representative sample; 83% (n = 34) reported factual memories either with or without recall of dreaming. Factual memories were significantly less common (66% cf. 96%) in delirious patients (OR 0·09, 95%CI 0·01,0·85, p = 0·035). Five topics emerged from the thematic analysis: ,procedures', ,staff', ,comfort', ,visitors', and ,events'. Based on the current experiences, five patients (12%, four non-delirious and one delirious) scored ,18 indicative of symptoms of post-traumatic stress syndrome; this did not reach statistical significance. Memory of transfer out of ICU was less frequent among the delirious patients (56%, n = 10) than among the non-delirious patients (87%, n = 20) (p = 0·036). Conclusion., Most patients have factual memories of their ICU stay. However, delirious patients had significantly less factual recall than non-delirious patients. Adverse psychological sequelae expressed as post-traumatic stress syndrome was uncommon in our study. Every attempt must be made to ensure that the ICU environment is as hospitable as possible to decrease the stress of critical illness. Post-ICU follow-up should include filling in the ,missing gaps', particularly for delirious patients. Ongoing explanations and a caring environment may assist the patient in making a complete recovery both physically and mentally. Relevance to clinical practice., This study highlights the need for continued patient information, re-assurance and optimized comfort. While health care professionals cannot remove the stressors of the ICU treatments, we must minimize the impact of the stay. It must be remembered that most patients are aware of their surroundings while they are in the ICU and it should, therefore, be part of ICU education to include issues regarding all aspects of patient care in this particularly vulnerable subset of patients to optimize their feelings of security, comfort and self-respect. [source] A qualitative study of adaptation to the euro in the Republic of Ireland: I. attitudes, the ,euro illusion' and the perception of pricesJOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY, Issue 2 2005Rob Ranyard Abstract This is the first of two reports of a study using semi-structured, in-depth interviews to explore the current and recollected experiences of Irish people for the period before, during, and after the introduction of euro notes and coins (1 January 2002). Twenty-four adults, 12 males and 12 females, covering a range of ages and educational attainment, were interviewed between October 2002 and February 2003. We found that most had welcomed the new currency initially, though some had felt less positive about it, whilst current experiences were more mixed. People's explanations for their attitudes seemed to focus more on the economic and practical aspects of currency change rather than symbolic meanings. Initially, most had experienced a euro illusion (prices in euros seeming to be more expensive than in punts). However, for most, the strength of the illusion appeared to diminish quite quickly. Nonetheless, current prices were believed to be higher, and many respondents attributed this either directly or indirectly to the change of currency. Although independent evidence found that there had been price increases in certain sectors, it was concluded that perceived price rises were, in part, illusory, and driven by expectations and selective price monitoring. Copyright © 2005 John Wiley & Sons, Ltd. [source] Rejoinder to Harold Blum,THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS, Issue 3 2003Peter Fonagy The author's main disagreement with Harold Blum is over Blum's contention that symptomatic improvement is directly linked to the recovery of memories. The idea that memories are laid down in childhood and preserved until the time of their later recovery flies in the face of what we now understand as the creation of memories by the neurobiological systems underpinning this aspect of mental function. No evidence directly links symptomatic improvement to reconstruction and thus to outcome; care should be taken to avoid confusing co-occurrence with causality. While reconstruction of how things actually were in childhood can significantly contribute to therapeutic action, it is the process rather than the outcome of this reconstruction that is therapeutic, due to the opportunity thus afforded to rework current experiences in the context of other perspectives. The author clarifies his definition of transference to show some areas of agreement between his position and Blum's. He disusses contemporary neuroscientific views on memory and identifies a number of psychoanalytic writers who have used these productively. [source] Disrupting the Master Narrative: Global Politics, Historical Memory, and the Implications for Naturalization EducationANTHROPOLOGY & EDUCATION QUARTERLY, Issue 1 2010Daryl M. Gordon Dramatic increases in immigration pose challenges for democratic citizenship education to involve national members with different historical memories and current experiences of national belonging. The article draws on ethnographic research with Laotian refugees, who were the target of U.S. violence during the Vietnam War and later became naturalized U.S. citizens. The author contrasts the narrative of citizenship that informs naturalization education with complex ideologies of citizenship articulated by refugees. She argues that a nuanced understanding of citizenship can lead to more meaningful naturalization education, which is necessary to produce citizens with a full sense of national membership and agency in the democratic process.,[naturalization, national belonging, citizenship education, refugees] [source] Remembering White Detroit:Whiteness in the Mix of History and MemoryCITY & SOCIETY, Issue 2 2000John Hartigan Jr. Detroit provides a unique perspective on issues of whiteness because it grounds many situations where whites are racially objectified,in settings where the nor-motive status of their racial position cannot be assumed, and where whiteness is not often an unmarked identity. The distinct class texture of their objectifications are evident in comments by white Detroiters grappling with the city's history, either through their personal memories or their current experiences. The heterogeneity of their versions of Detroit's history suggests that whites contend with die continuing cultural significance of race and of whiteness from a range of uneven social positions. [Whiteness, urban underclass, social memory, race, Detroit] [source] | |||||||||||||||||||||||||