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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    BJOG 109 (2002), S. 0 
    ISSN: 1471-0528
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objectives To describe how women present unexplained menstrual symptoms to gynaecologists; to find out whether presentation reflects how intense their symptoms feel or how much benefit they expect from gynaecological treatment; and to test the prediction that surgical treatment decisions are more likely to follow specific types of presentation.Design A cross sectional cohort study.Setting Gynaecological outpatient clinics in a teaching hospital.Sample Fifty-nine patients, referred for menstrual problems, in whom investigations had excluded physical disease.Methods Patients indicated symptom intensity and expectations of treatment before consultation on self-completed questionnaires. Audiotape recordings of consultations with the gynaecologist were transcribed and patients' use of specific communication strategies was coded according to a previously reported scheme.Main outcome measures Treatment decision was noted.Results In a third to a half of patients, presentation extended beyond symptom report to include catastrophisation about consequences of symptoms, reference to other individuals to substantiate the patient's problems, criticism of previous or possible future interventions or request for hysterectomy. Those with greatest expectations of gynaecological treatment were more likely to catastrophise and request hysterectomy. Those with most intense subjective symptoms were more likely to catastrophise, refer to other individuals and request hysterectomy, and these strategies were more likely to be followed by surgical treatment decisions.Conclusions Surgical treatment for unexplained menstrual problems is not driven by gynaecologists. Reduction in unnecessary hysterectomies will require training in communication skills that reflects the challenging nature of many patients' presentation in the gynaecology clinic.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of advanced nursing 18 (1993), S. 0 
    ISSN: 1365-2648
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Two different strategies are possible for improving nurses’ interactions with elderly patients One is to arrange special periods, such as reality orientation, in which a high level of appropriate interaction is encouraged The other is to improve nurses’ attitudes to patients and treatment, or select nurses with better attitudes, on the grounds that poor attitudes might underly poor behaviour This study was designed to find out whether nurses’ interactions with elderly patients varied in relation to their attitudes, or differed between periods of routine care or of special activities based on reality orientation organized by the nurses Systematic observations were made of the behaviour of 27 nurses working on two psychogeriatric wards, before all nurses completed questionnaires measuring attitudes to nursing care and to elderly people A higher proportion of interactions were ‘positive’(i e involved nurses’ informing, questioning or making general conversation) during activity periods than at other times No attitudinal measure predicted the proportion of interactions which were positive, although this was greater in qualified nurses The results are consistent with the view that formal reality orientation periods can improve the quality of nurses’ interactions with elderly patients, but are inconsistent with the view that targeting nurses’ attitudes would be effective
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    Journal of advanced nursing 39 (2002), S. 0 
    ISSN: 1365-2648
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Aims of the study.  To formulate and evaluate an information leaflet for patients using patient-controlled analgesia (PCA), incorporating information thought to be important by patients. Rationale.  The benefit of current information leaflets, written by professionals, has not been studied and their value to patients is unknown. Background.  Previous studies have shown that information leaflets were poorly designed and written in language too difficult for patients to understand. Research methods.  Seven focus groups were conducted to establish what information patients wanted to know about PCA. This information was incorporated into a new information leaflet. One hundred patients were randomized to receive either the new leaflet or the old leaflet in current use. A questionnaire was used to establish whether the new leaflet was more clear and informative than the old one. Results.  Patients wanted to know that the drug used in PCA was morphine. They wanted more information about side-effects, needed to be reassured that it was safe, and that they could not overdose or become addicted. They wanted detailed instructions and diagrams about the technique. The questionnaire study established that the new leaflet was clearer and more informative. Conclusion.  Patients' contribution led to major change, producing a leaflet which was clearer, more attractive, more informative and which proved more satisfactory to patients.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd.
    Health & social care in the community 11 (2003), S. 0 
    ISSN: 1365-2524
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Because of the need to maximise treatment adherence and minimise costs, the duration of treatment for alcohol problems should not be longer than is necessary to achieve clinical benefit. The present authors have previously demonstrated the effectiveness of a 10-week outpatient treatment programme. In this paper, they evaluate the effects of reducing the length of the programme to 6 weeks by comparing the outcomes to those of the original programme. One hundred and twenty-four patients were followed up 11 months after choosing the revised 6-week programme. Eighty-eight patients (71%) were successfully contacted. Data collected included alcohol-related problems, use of other services, drinking patterns throughout the follow-up period and details of alcohol intake for the week prior to interview. Reducing the programme length significantly increased the number of patients completing the programme at no cost to clinical effectiveness.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford : Blackwell Science Ltd
    Anaesthesia 53 (1998), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Oxford : Blackwell Science Ltd
    Anaesthesia 53 (1998), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Two hundred patients completed a questionnaire about their experiences of patient-controlled analgesia. The questionnaire covered the following topics: pre-operative information, reasons for pressing and not pressing the button, pain relief, side-effects, safety, advantages and disadvantages of patient-controlled analgesia, worries associated with its use and control over pain. A high level of satisfaction with the device, together with a view that it afforded control over pain, emerged from replies to simple, general questions. However, more detailed questions revealed side-effects and fears that constrained its use and hence patients' ability to control pain. Control is predominantly a feature of the professional's view of patient-controlled analgesia, rather than the patient's experience of this analgesic technique.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Annals of the New York Academy of Sciences 469 (1986), S. 0 
    ISSN: 1749-6632
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Natural Sciences in General
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Psychopharmacology 98 (1989), S. 412-416 
    ISSN: 1432-2072
    Keywords: Adrenoceptors ; Behaviour ; Noradrenaline ; Open field ; Rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Rats were injected IP once daily for 14 consecutive days with propranolol (5 mg/kg), yohimbine (2.5 mg/kg) or saline vehicle. A fourth group was unhandled during this time. Each rat was then placed in an open field for 4 min and its activity and defaecation recorded. Immediately after this, the animals were killed and cerebral cortices removed for radioligand binding to α2- and β-adrenoceptors and measurement of noradrenaline content. We report two sets of findings. First, β-adrenoceptor density correlated positively, and affinity negatively, with the number of movements towards the centre of the field in the final 3 min of the trial. α2-Adrenoceptor K d, in contrast, correlated both with movements around the field and those directed towards the centre. Secondly, whereas the only specific drug effect was an increase in defaecation after treatment with propranolol, β-adrenoceptor density was increased and affinity decreased in all injected groups, suggesting a non-specific effect of the stress of injection. Movements to and from the centre of the field were also increased in injected groups during the first minute of the trial. In both sets of findings the association of β-adrenoceptor density with greater resistance to stress is hard to reconcile with existing theories of the role of β-adrenoceptors in behavioural responses to stress.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1432-2072
    Keywords: 6-Hydroxydopamine ; Differential reinforcement of low rates of response (DRL) ; Sympathetic nervous system ; Noradrenaline ; Rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract First, it was confirmed that systemic injection of the neurotoxin 6-hydroxydopamine HBr (30 mg/kg IP) depleted noradrenaline levels in rat heart, but not centrally. Losses averaged 90% of control 1 day after injection, and 50% at 42 days. The same drug and dose was then administered to 50% of a group of rats which had been trained to lever-press for food reward on continuous reinforcement (CRF). After further CRF sessions, the rats were changed to a schedule of Differential Reinforcement of Low Rates of Response with a 20-s criterion (DRL 20). The drugged rats earned fewer reinforcements during DRL than did controls, and made fewer responses. Temporal discrimination (shown by the IRT/Opp distribution) was disrupted. It is concluded that peripheral noradrenergic systems may be involved in the control over responding by temporal cues associated with reward and non-reward.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-2072
    Keywords: Propranolol ; d-Propranolol ; l-Propranolol ; Punishment ; Conditioned suppression ; Non-reward ; Rat
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In Experiment I, two groups of rats were rewarded for lever-pressing under RI 64. During signalled 3-min intrusion periods shocks were delivered response-contingently (on RI 64) for the Punishment group and non-contingently (on RT 64) for the Conditioned Suppression group.d,l-Propranolol (2, 5 mg/kg) released intrusion responding to a similar extent in the two groups. Experiment II comprised two distinct experiments: two groups of rats were trained in parallel on signalled multiple schedules in which responding during the baseline component was rewarded on RI 20. For the second component responding was extinguished in Experiment IIa; it continued to be rewarded but was also punished by electric shock in Experiment IIb. Shock levels were adjusted individually so as to produce similar levels of response suppression in these two groups.d,l-Propranolol released non-rewarded responding (2–5 mg/kg; Expt IIa) but had no effect on punishment (2–10 mg/kg; Expt IIb).l-Propranolol (2.5 mg/kg) but notd-propranolol (2.5 mg/kg) also released non-rewarded responding in Expt IIa. In a further triald,l-propranolol (5 mg/kg) released punished responding in Expt IIb in a group of animals in which response suppression had been partially relieved by reducing shock intensity. It is hypothesized that beta-adrenergic stimuli may influence response suppression to the extent that the unconditioned aversive event causing suppression is not salient.
    Type of Medium: Electronic Resource
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