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Study Phase (study + phase)

Distribution by Scientific Domains

Medical Sciences	68%
Psychology	18%

Selected Abstracts

Can First Responders Be Sent to Selected 9-1-1 Emergency Medical Services Calls without an Ambulance?

ACADEMIC EMERGENCY MEDICINE, Issue 4 2003
Craig B. Key MD
Objectives: To evaluate the feasibility and safety of initially dispatching only first responders (FRs) to selected low-risk 9-1-1 requests for emergency medical services. First responders are rapidly-responding fire crews on apparatus without transport capabilities, with firefighters trained to at least a FR level and in most cases to the basic emergency medical technician (EMT) level. Low-risk 9-1-1 requests include automatic medical alerts (ALERTs), motor vehicle incidents (MVIs) for which the caller was unable to answer any medical dispatch questions designed to prioritize the call, and 9-1-1 call disconnects (D/Cs). Methods: A before-and-after study of patient dispositions was conducted using historical controls for comparison. During the historical control phase of six months, one year prior to the study phase, basic life support ambulances (staffed with two basic EMTs) were dispatched to selected low-risk 9-1-1 incidents. During the six-month study phase, a fire FR crew equipped with automated external defibrillators (AEDs) was sent initially without an ambulance to these incidents. Results: For ALERTs (n= 290 in historical group vs. 330 in study group), there was no statistical difference in the transport rate (7% vs 10%), but there was a statistically significant increase in the follow-up use of advanced life support (ALS) (1% vs 4%, p = 0.009). No patient in the ALERTs historical group required airway management, while one patient in the study group received endotracheal intubation. No patient required defibrillation in either group. Analysis of the MVIs showed a significant decrease (p < 0.0001) in the patient transport rate from 39% of controls to 33% of study patients, but no change in the follow-up use of ALS interventions (2% for each group). For both the ALERTs and MVIs, the FR's mean response time was faster than ambulances (p < 0.0001). Among the 9-1-1 D/Cs with FRs only (n= 1,028), 15% were transported and 43 (4%) received subsequent ALS care. Four of these patients (0.4%) received intubation and two (0.2%) required defibrillation. However, no patient was judged to have had adverse outcomes as a result of the dispatch protocol change. Conclusions: Fire apparatus crews trained in the use of AEDs can safely be used to initially respond alone (without ambulances) to selected, low-risk 9-1-1 calls. This tactic improves response intervals while reducing ambulance responses to these incidents. [source]

The use of gabapentin in chronic cluster headache patients refractory to first-line therapy

EUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2007
S. Schuh-Hofer
Chronic cluster headache (CCH) is a rare but challenging condition. About 20% of CCH patients get refractory to treatment. Gabapentin has recently been reported to be efficacious in the treatment of CCH. To test the potential of gabapentin as second-line drug, we prospectively studied the efficacy of gabapentin as add-on drug in eight patients suffering from CCH refractory to first-line treatment. Six of eight CCH patients responded to treatment. After the end of the study phase, the patients' clinical course was further followed up until January 2006. The longest period of being continuously pain-free under gabapentin treatment was 18 months. In some individuals, increasing doses were needed with time. We conclude that gabapentin may be offered as treatment trial in patients refractory to first-line treatment. However, patients may fail to respond to treatment and drug tolerance may occur with time. [source]

Selective hippocampal damage in rhesus monkeys impairs spatial memory in an open-field test,

HIPPOCAMPUS, Issue 7 2004
Robert R. Hampton
Abstract The hippocampus is critical for remembering locations in a wide variety of species, including humans. However, recent findings from monkeys following selective hippocampal lesions have been equivocal. To approximate more closely the situations in which rodents and birds are tested, we used a spatial memory task in which rhesus monkeys (Macaca mulatta) moved about freely in a large room, on a tether. We used MRI-guided stereotaxic surgery to produce selective hippocampal lesions in five monkeys, and retained five unoperated control monkeys. In the study phase of each trial of the matching-to-location task, monkeys found food in one site in an array of identical foraging sites. During the test, which occurred after a delay, monkeys could return to the site where the food had been found during study to obtain more food. In Experiment 1, normal monkeys showed a small significant tendency to return directly to a site where they had previously found food that day. Operated monkeys showed no such matching tendency. In Experiment 2, further training produced reliable matching-to-location performance in both groups at short delays, but monkeys with selective hippocampal lesions rapidly forgot the location of the food. In Experiment 3, we tested whether monkeys used a "cognitive map" to encode the location of the hidden food, by requiring them to relocate the food from a starting location different from that used during study. As a group, monkeys were more accurate than expected by chance, indicating that they did encode the rewarded location with respect to allocentric landmarks; however, both groups of monkeys were significantly worse at relocating the food when required to approach from a different location. In Experiment 4, probe trials using symmetrical test arrays found no evidence for egocentric coding of the rewarded location. © 2004 Wiley-Liss, Inc. [source]

Multimedia satellite communications experiments to the international space station

INTERNATIONAL JOURNAL OF SATELLITE COMMUNICATIONS AND NETWORKING, Issue 5 2002
Carlo Matarasso
Abstract In the present concept of the International Space Station ISS, it is planned to provide the communication services between the European Columbus module of the ISS and the ground equipment via the TDRS (tracking and data relay satellite) network provided by the American NASA (National Aeronautics and Space Agency). Especially because of its low uplink data rate, an unacceptable limitation of the communication services with Columbus is to be expected. In order to investigate possible improvements to this situation, the MEDIS proposal studies the feasibility of a 150 Mbps full duplex communication system to the Columbus Module on via two MEO satellites. A mixed topology with optical inter satellite links and Ka-band up/down-links shall be employed. Also possible liaisons with the Artemis mission will be considered. The MEDIS project is a collaboration of Astrium GmbH, which is project manager, Bosch SatCom, GMD-Fokus and the German Aerospace Center (DLR). The preparation phase of the project will investigate the concept of the communications infrastructure and the experiments that could be realized when the MEOs are launched. This stage has been completed in February 2001. An additional study phase followed, which will be completed with a presentation in July 2002. Briefly the following aspects have been studied by DLR in the preparation phase: the overall concept of experimental communication services for Columbus, the system requirements and network topology, the relevant protocol and hardware architectures, useful satellite constellations and link scenarios. Two phases could follow the preparation phase, in phase one the satellite will be launched and the link will be tested. In phase two the satellites will be connected to the ISS. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Choosing words at the study phase: The self-choice effect on memory from the viewpoint of connective processing1

JAPANESE PSYCHOLOGICAL RESEARCH, Issue 1 2003
Tetsuji Hirano
Abstract: The self-choice effect, that is the superior memory performance observed when participants are allowed to choose the item at the study phase than when they are not (lack of choice), has been explained by the encoding-strategy hypothesis (Takahashi, 1997). This hypothesis distinguishes between organizational processing, which focuses upon the relationship between chosen items, and item-speci,c processing, which itself focuses on the elements that make the chosen item distinctive. The encoding-strategy hypothesis predicts that the ability for the successive recall of chosen items can be affected by organized list (Experiment 1). The results of our experiments ran counter to the prediction and were interpreted by a new concept called connective processing, which would emphasize the relationship of paired items. Connective processing was examined through orienting tasks (Experiment 2). The results were more suitably interpreted by connective than organizational processing. [source]

Delivering ,Gold Standards' in end-of-life care in care homes: a question of teamwork?

JOURNAL OF CLINICAL NURSING, Issue 12 2009
Alistair Hewison
Aim., This paper reports findings from a study which investigated the introduction of the Gold Standards Framework for improving end-of-life care into care homes in England. Background., The Gold Standards Framework was developed in primary care to improve the care provided for people at the end-of-life. Following its successful introduction to this setting it was adapted and implemented in care homes. Design., A case study approach was appropriate for this study of a care programme into a ,real life' setting. Method., Fourteen managers participated in an initial telephone interview. Ten of these homes participated in the case study phase and 61 staff participated in individual or group interviews. Seven residents and three relatives participated in face to face interviews. Qualitative data were analysed in line with the template approach. Survey data were also analysed and a validated Teamworking Questionnaire was used. Results., It was found that teamwork is central to the successful introduction of the Gold Standards Framework in Care Homes. Good staffing levels and management support were also perceived to be key factors in homes where the Framework became established. Conclusion., Effective teamwork was necessary for changes in end-of-life care to be achieved in the care homes. If end-of-life care and other improvements in practice are to continue, teamwork will need to be supported and developed. Relevance to clinical practice., Effective teamwork appears to be a pre-requisite for successful implementation of new programmes of care. Organisations wishing to implement such programmes should assess the quality of teamwork and may need to address this first. [source]

Investigating Women's Preference for Sildenafil or Tadalafil Use by Their Partners with Erectile Dysfunction: The Partners' Preference Study

THE JOURNAL OF SEXUAL MEDICINE, Issue 5 2008
Helen M. Conaglen PhD
ABSTRACT Introduction., Several preference studies comparing a short-acting with a longer-acting phosphodiesterase type 5 inhibitor have been conducted in men. Most men in those studies preferred tadalafil rather than sildenafil, and recent post hoc analysis of one study described several factors associated with men's treatment preference. No prospective studies have investigated the woman partners' preferences. Aim., To investigate the treatment preference of women who were partners of men using oral medications for erectile dysfunction (ED) in a single-center open-label crossover study. Methods., One hundred heterosexual couples in stable relationships, with male partners having ED based on the erectile function subscale of the International Index of Erectile Function, were randomly assigned to receive sildenafil or tadalafil for a 12-week phase, followed by another 12-week period using the alternate drug. Male and female participants completed sexual event diaries during both study phases, and the female participants were interviewed at baseline, midpoint, and end of study. Main Outcome Measures., Primary outcome data were the women's final interviews during which they were asked which drug they preferred and their reasons for that preference. Results., A total of 79.2% of the women preferred their partners' use of tadalafil, while 15.6% preferred sildenafil. Preference was not affected by age or treatment order randomization. Women preferring tadalafil reported feeling more relaxed, experiencing less pressure, and enjoying a more natural or spontaneous sexual experience as reasons for their choice. Mean number of tablets used, events recorded, events per week, and days between events were not significantly different during each study phase. Conclusion., Women's preferences were similar to men when using these two drugs. While the women's reasons for preferring tadalafil emphasized relaxed, satisfying, longer-lasting sexual experiences, those preferring sildenafil focused on satisfaction and drug effectiveness for their partner. Conaglen HM, and Conaglen JV. Investigating women's preference for sildenafil or tadalafil use by their partners with erectile dysfunction: The partners' preference study. J Sex Med 2008;5:1198,1207. [source]

Memory of children's faces by adults: Appearance does matter,

APPLIED COGNITIVE PSYCHOLOGY, Issue 7 2009
Vicki Silvers Gier
Accurately detecting faces of children when their appearance has been altered is especially important in recognizing abducted or missing child. Face recognition studies have focussed on recognizing the adult perpetrator; however, there is lack of research on recognizing a child's face under different appearances. Two studies were conducted to determine what type of photos may increase recognition of missing children. In Experiment 1 participants were shown pictures of children's faces in a study phase in which their faces were either dirtied with negative affect or clean with positive affect, followed by a recognition phase. Accuracy and confidence were higher when the face at recognition was the same type as in the study phase. Experiment 2 replicated Experiment 1, adding four delay conditions: 10-minute interval (10-MI), 3, 6 or 12 week. Accuracy and confidence decreased over time and we again found a significant interaction between face at study and face at recognition. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Verapamil augmentation of lithium treatment improves outcome in mania unresponsive to lithium alone: preliminary findings and a discussion of therapeutic mechanisms

BIPOLAR DISORDERS, Issue 8 2008
Alan G Mallinger
Objectives:, Attenuation of protein kinase C (PKC) is a mechanism common to both established (lithium, valproate) and some novel (tamoxifen) antimanic agents. Verapamil, although primarily known as a calcium channel blocker, also has PKC inhibitory activity. Verapamil has shown antimanic activity in some but not all studies. Therefore, we investigated verapamil, used alone or as an adjunctive treatment, in manic patients who did not respond to an initial adequate trial of lithium. Methods:, Each study phase lasted three weeks. Subjects were treated openly with lithium in Phase 1 (n = 45). Those who failed to respond were randomly assigned to double-blind treatment in Phase 2 with either verapamil (n = 10) or continued-lithium (n = 8). Phase 2 nonresponders (n = 10) were assigned to combined verapamil/lithium in Phase 3. Results:, Response in Phase 2 did not differ significantly between verapamil and continued-lithium. During Phase 3, response to combined treatment was significantly better than overall response to monotherapy in Phase 2 (Fisher's Exact test, p = 0.043). Mania ratings improved during combined treatment in Phase 3 by 88.2% (linear mixed model analysis, F = 4.34, p = 0.013), compared with 10.5% improvement during Phase 2. Conclusions:, In this preliminary investigation, verapamil monotherapy did not demonstrate antimanic efficacy. By contrast, the combination of verapamil plus lithium was highly efficacious. Our findings thus suggest that verapamil may have potential utility as an adjunct to lithium. This effect may be mediated by additive actions on PKC inhibition, which may be an important mechanism for antimanic agents in general. [source]

Emergency Department Information System Implementation and Process Redesign Result in Rapid and Sustained Financial Enhancement at a Large Academic Center

ACADEMIC EMERGENCY MEDICINE, Issue 5 2010
Jason S. Shapiro MD
Abstract Objectives:, The objectives were to measure the financial impact of implementing a fully integrated emergency department information system (EDIS) and determine the length of time to "break even" on the initial investment. Methods:, A before-and-after study design was performed using a framework of analysis consisting of four 15-month phases: 1) preimplementation, 2) peri-implementation, 3) postimplementation, and 4) sustained effects. Registration and financial data were reviewed. Costs and rates of professional and facility charges and receipts were calculated for the phases in question and compared against monthly averages for covariates such as volume, collections rates, acuity, age, admission rate, and insurance status with an autoregressive time series analysis using a segmented model. The break-even point was calculated by measuring cumulative monthly receipts for the last three study phases in excess of the average monthly receipts from the preimplementation phase, corrected for change in volume, and then plotting this against cumulative overall cost. Results:, Time to break even on the initial EDIS investment was less than 8 months. Total revenue enhancement at the end of the 5-year study period was $16,138,953 with an increase of 69.40% in charges and 70.06% in receipts. This corresponds to an increase in receipts per patient from $50 to $90 for professional services and $131 to $183 for facilities charges. Other than volume, there were no significant changes in trends for covariates between the preimplementation and sustained-effects periods. Conclusions:, A comprehensive EDIS implementation with process redesign resulted in sustained increases in professional and facility revenues and a rapid initial break-even point. ACADEMIC EMERGENCY MEDICINE 2010; 17:527,535 © 2010 by the Society for Academic Emergency Medicine [source]

Once-daily OROS®,hydromorphone for the management of chronic nonmalignant pain: a dose-conversion and titration study

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2007
M. Wallace
Summary Background:, The use of opioid analgesics for patients with chronic nonmalignant pain is becoming more widely accepted, and long-acting formulations are an important treatment option. Aim:, To assess conversion to extended-release OROS® hydromorphone from previous stable opioid agonist therapy in patients with chronic nonmalignant pain of moderate-to-severe intensity. Methods:, In this open-label multicentre trial, patients were stabilised on their previous opioid therapy before being switched to OROS® hydromorphone at a ratio of 5 : 1 (morphine sulphate equivalent to hydromorphone hydrochloride). The OROS® hydromorphone dose was titrated over 3,16 days to achieve effective analgesia, and maintenance treatment continued for 14 days. Results:, Study medication was received by 336 patients; 66% completed all study phases. Stabilisation of OROS® hydromorphone was achieved by 94.6% of patients, the majority in two or fewer titration steps (mean time, 4.2 days). Mean pain intensity scores, as determined by the Brief Pain Inventory, decreased during OROS® hydromorphone treatment (p , 0.001). The percentage of patients rating their pain relief as ,good' or ,complete' increased, and the use of rescue analgesics for breakthrough pain decreased. The interference of pain with everyday activities (e.g. walking or work), and the effects on mood and enjoyment of life, also improved during the study (all p < 0.001). OROS® hydromorphone was well tolerated, and adverse events were those expected for opioid agonist therapy. Conclusion:, Patients with chronic nonmalignant pain who had been receiving opioid therapy easily underwent conversion to OROS® hydromorphone, with no loss of efficacy or increase in adverse events. [source]

Development and validation of a learning needs assessment scale: a continuing professional education tool for multiple sclerosis specialist nurses

JOURNAL OF CLINICAL NURSING, Issue 6 2007
Alison While BSc
Aim., To develop and validate a learning needs assessment scale. Background., Learning needs analysis is a central component of continuing professional development but there is a lack of psychometrically developed learning needs assessment tools. Self-assessment questionnaires are emerging as a key method. The development of a learning needs analysis scale for multiple sclerosis specialist nurses is described. Design., A psychometric approach comprising the three phases of the development and testing of the scale are outlined. Method., Phase 1: Item identification using a literature review; postal survey of stakeholders (n = 320), 20 nurse interviews; four nurse focus groups; five telephone interviews with people with MS. Phase 2: Refinement of draft scale and establishing face and content validity testing using an expert panel. Phase 3: Testing of draft scale using data from a postal survey (n = 47 MS specialist nurses) to assess the feasibility and effectiveness of scale, internal consistency and construct validity. Test,retest reliability was assessed using data from 17 MS specialist nurse respondents to calculate intra-class correlation coefficients. Results., The data from the different study phases informed scale refinement. The validity and reliability of the scale was confirmed through testing. Conclusion., The study provides an example of how a robust learning needs assessment scale may be developed for a specialist area of nursing practice to be used in conjunction with more subjective approaches. Relevance to clinical practice., High quality nursing care depends upon a competent nursing workforce that engages in continuing professional development. This study provides an example of a psychometrically developed learning needs assessment scale to inform continuing professional development needs of nurses working in a specialist area of practice. [source]

Investigating Women's Preference for Sildenafil or Tadalafil Use by Their Partners with Erectile Dysfunction: The Partners' Preference Study

Knowledge Translation of the American College of Emergency Physicians Clinical Policy on Hypertension

ACADEMIC EMERGENCY MEDICINE, Issue 11 2007
Jill F. Lehrmann MD
Objectives To determine if dissemination of the American College of Emergency Physicians clinical policy on hypertension to emergency physicians would lead to improvements in blood pressure reassessment and referral of emergency department (ED) patients with elevated blood pressure. Methods Two academic centers implemented a pre-post intervention design, with independent samples at pre and post phases. ED staff were blinded to the investigation. A total of 377 medical records were reviewed before policy dissemination and 402 were reviewed after policy dissemination. Medical records were eligible for review if the patient was at least 18 years of age, was not pregnant, was discharged from the ED, and had a triage systolic blood pressure ,140 mm Hg or diastolic blood pressure ,90 mm Hg. Patient records with a chief complaint of chest pain, shortness of breath, or neurologic complaints were excluded. Demographics, blood pressures, and evidence of discharge referral were abstracted from the medical record. The policy was disseminated after the initial medical record review. Post,policy dissemination medical record review was conducted within two weeks. Results A total of 779 medical records were reviewed. The mean age of patients was 45 years, 55% were male, and 46% were white, 13% Hispanic, 35% African American, and 6% other. No differences in reassessment or referral rates were found between study phases. Blood pressure reassessments were low during both phases: 33% (pre) and 37% (post). Referral rates of patients with elevated blood pressure were very low: 13% (pre) and 7% (post). Conclusions Knowledge of guidelines did not translate into changes in physician practice. Additional systems-based approaches are necessary to effectively translate guidelines into clinical practice. [source]