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PubMed1998

Formal pathology rotation during obstetrics and gynecology residency: is it beneficial?

BACKGROUND: Our objective was to assess the educational benefits of a formal pathology rotation during an obstetrics and gynecology residency program and to determine the utility of this information in clinical practice. METHODS: In this descriptive study, the benefits of a 2-month rotation in pathology for obstetrics and gynecology residents were analyzed. A computerized listing of surgical cases processed by each resident was sent to the obstetrics and gynecology program director. RESULTS: Our resident accessioned 5.4% of the total pathology cases processed each month. Reports from previous residents (over a 17-year period) and from program directors at the annual educational retreat indicate that such information was not relevant to our graduates in their clinical practice. CONCLUSIONS: A formal pathology rotation for obstetric residents can improve knowledge base, but the usefulness of this knowledge in clinical practice is dubious.

Curriculum↗
PubMed2003

Mental health program monitoring: towards simplifying a complex task.

Finding measures that can assess areas of expected program impact, provide valid results, and be easily integrated into routine program practices is a significant challenge. This paper is intended to assist program staff by providing an accessible inventory of measures appropriate for routine monitoring of the status and outcome of individuals using mental health outpatient and community programs. The inventory is not exhaustive, but rather includes examples of solid measures for assessing outcomes in four key domains--symptoms, functioning, quality of life, and satisfaction. These can provide a core of information, to which measurement of more in-depth issues can be added to address specific concerns.

Activities of Daily Living↗
PubMed1999

Home-care use and expenditures among Medicaid beneficiaries with AIDS.

This article compares the use and cost of home-care services among traditional Medicaid recipients with acquired immunodeficiency syndrome (AIDS) and among participants in a statewide Human Immunodeficiency Virus (HIV)/AIDS-specific home and community-based Medicaid waiver program in New Jersey, using Medicaid claims and AIDS surveillance data. Waiver program participation appears to mitigate racial and risk group differences in the probability of home-care use. However, the program's successes are confined to its enrollees of which subgroups of the AIDS population are underrepresented. Our findings suggest the need to expand access to home-care programs to racial minorities and injection drug users (IDUs) with HIV/AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

A dedicated database program for cataloging recombinant clones and other laboratory products of molecular biology technology.

A novel computer database program dedicated to storing, cataloging, and accessing information about recombinant clones and libraries has been developed for the IBM (or compatible) personal computer. This program, named CLONES, also stores information about bacterial strains and plasmid and bacteriophage vectors used in molecular biology. The advantages of this method are improved organization of data, fast and easy assimilation of new data, automatic association of new data with existing data, and rapid retrieval of desired records using search criteria specified by the user. Individual records are indexed in the database using B-trees, which automatically index new entries and expedite later access. The use of multiple windows, pull-down menus, scrolling pick-lists, and field-input techniques make the program intuitive to understand and easy to use. Daughter databases can be created to include all records of a particular type, or only those records matching user-specified search criteria. Separate databases can also be merged into a larger database. This computer program provides an easy-to-use and accurate means to organize, maintain, access, and share information about recombinant clones and other laboratory products of molecular biology technology.

Database Management Systems↗
PubMed1989

Therapy: state-of-the-art assessment of quality. The National Cancer Institute perspective.

The National Cancer Institute (NCI) has a broad spectrum of responsibilities that range from support of basic laboratory research to the clinical testing of new therapeutics and, finally, the dissemination of results of this research to the practicing physician and the public. The reduction of cancer mortality is largely dependent on the responsibility for widespread application of state-of-the-art cancer treatments. A major cancer control focus of the NCI over the last decade has been the development and implementation of programs designed to improve awareness, access and application of state-of-the-art cancer treatment. In addition to the computerized Physician Data Query system, three targeted programs, the Cooperative Group Outreach Program (CGOP), the Community Hospital Oncology Program (CHOP), and the Community Clinical Oncology Program (CCOP) have all been aimed at establishing mechanisms to facilitate the transfer of new patient care technology; and, thereby, provide the highest quality cancer treatment in the community setting. An evaluation was conducted to determine if patterns and outcomes of cancer care management changed over time, and whether this could be related to the presence of CGOP, CHOP, and CCOP. Measurement of required program implementation was relatively straightforward. However, measurement of resultant changes in "quality of care" and the factors that influence physician performance are complex and controversial. Critical elements in the treatment of breast, colon, rectum, and small cell lung cancer were used as tracers to measure changes in the patterns of care in communities where programs were implemented. Results from this study highlight issues in state-of-the-art assessment of quality, such as the difficulty in defining quality cancer care, relationships between process and outcome indicators, and the problems of documentation and missing data. Assurance of quality cancer care requires the interaction of health care professionals with knowledge of the most up-to-date cancer research results working in a health care delivery system that encourages and rewards application of these results.

Clinical Trials as Topic↗
PubMed1998

W2H: WWW interface to the GCG sequence analysis package.

MOTIVATION: The user-friendly, graphical X-windows interface (WPI) to the GCG sequence analysis package can often not be used due to the lack of an X-server on PC or Macintosh computers. Because Web browsers like Netscape are much more common on those platforms, we decided to develop W2H, a WWW interface to the GCG Sequence Analysis Software Package with nearly the same functionality as the X-windows interface WPI. RESULTS: The new WWW interface (W2H) to the GCG Sequence Analysis Software Package (Wisconsin Package) supports modern Web technologies, like client-pull method, or embedded scripting language, and provides a reasonable platform independence. The interface is quite comprehensive with advanced features like sequence selector, search set builder, enzyme chooser, access to sequence databases, uploading client files to the GCG server or displaying and manipulating graphical outputs in addition to GCG analysis programs. W2H also manages secure access to both GCG server and user data. For special environments, like workshops, conferences and company intranets, there is a special mode (Intranet mode) with less security constraints. The behaviour of W2H is mostly controlled by meta-data files describing the applications and giving a base for dynamic creation of HTML documents. This paper presents mainly the development approaches used, and architectural design aspects of W2H. AVAILABILITY: W2H is available by ftp://ftp.ebi.ac. uk/pub/software/unix/w2h or ftp://genome.dkfz-heidelberg.de/pub/w2h CONTACT: m.senger@ebi.ac.uk

Computational Biology↗
PubMed2003

A community-based group exercise program for persons with chronic stroke.

PURPOSE: The purpose of this study was to evaluate the physical and psychosocial effects of an 8-wk community-based functional exercise program in a group of individuals with chronic stroke. METHODS: Twenty-five subjects (mean age 63 yr) participated in a repeated measures design that evaluated the subjects with two baseline assessments 1 month apart, one postintervention assessment, and one retention assessment 1 month postintervention. Physical outcome measures assessed were the Berg Balance Test, 12-Minute Walk Test distance, gait speed, and stair climbing speed. Psychosocial measures assessed were the Reintegration to Normal Living Index (RNL) and Canadian Occupational Performance Measure (COPM). The 8-wk training consisted of a 60-min, 3 x wk-1 group program that focused on balance, mobility, functional strength, and functional capacity. The program was designed to be accessible by reducing the need for costly one-on-one supervision, specialized settings, and expensive equipment. RESULTS: Improvements from the exercise program were found for all physical measures and these effects were retained 1-month postintervention. Subjects with lower function improved the most relative to their initial physical status. Significant effects were found for the COPM, but not the RNL Index; however, subjects with lower RNL improved the most relative to their initial RNL Score. CONCLUSION: A short-term community-based exercise program can improve and retain mobility, functional capacity, and balance and result in a demonstrable impact upon the performance of activities and abilities that were considered meaningful to the subjects. Implementation of such community-based programs has potential for improving activity tolerance and reducing the risk for secondary complications common to stroke (e.g., falls resulting in fractures and cardiac events).

Activities of Daily Living↗
PubMed2002

[Infection control team].

Infection control(IC) is a quality-improvement activity that focuses on improving the care of patients and protecting the health of staff. The infection control committee(ICC) should function as the central decision-making and policy-making body for IC. The infection control team(ICT) is responsible for carrying out all aspects of the IC program. ICT should have appropriate access to medical relevant staff members who can provide information on the adequacy of the institution's compliance with regard to IC programs. Healthcare facilities should use ICT to assist in maintaining compliance with IC programs. Surveillance of hospital-acquired infections should be performed and surveillance data should be analyzed appropriately and used to monitor and improve IC and healthcare outcomes.

Cross Infection↗
PubMed1997

Increasing numbers of AV fistulas for hemodialysis access.

As part of our CQI program, we initiated an effort to see if we could successfully increase the total number of native arterio-venous (AV) fistulas relative to synthetic PTFE grafts in our dialysis population. This was a combined effort of the nephrology and surgery departments. The program emphasized placement of brachial fistulas in elderly patients and diabetics. Permcaths were placed in the internal jugular position to allow adequate time for maturation of fistulas. The percentage of AV fistulas in our total dialysis population increased from 28% (93 of 328) in the base period 1990 through 1992 to 44% (170 of 386) in the period from 1993 through 1995 (p < 0.0001). Initial AV fistula insertions increased from 38% (52 of 137) in 1990-1992 to 71.8% (102 of 142) in the years 1993 through 1995 (p < 0.0001). 86.5% (45 of 52) of initial fistulas placed in 1990-1992 were useable compared to 63.7% (65 of 102) in 1993-1995 (p < 0.01). Patient demographics were unchanged throughout the study. In conclusion, the number and percentage of AV fistulas in our dialysis population was significantly increased through a coordinated CQI initiative. We expect that this will have a positive impact on decreasing future thrombosis rates and decreasing the cost of access management.

Aged↗
PubMedDate not supplied

Asking age and identification may decrease minors' access to tobacco.

BACKGROUND: Many merchant education programs entail efforts to increase cashiers' requests for minors' age and/or identification (proving themselves old enough to purchase cigarettes) as a means of decreasing minors' access to tobacco. However, whether such questions are actually associated with decreased sales to minors has never been investigated. We present the first investigation of the role of such questions in sales of tobacco to minors. METHODS: Thirty-six minors, representing equal numbers of girls, boys, whites, blacks, and Latinos and of 10-, 14-, and 16-year-olds, each attempted to purchase cigarettes once in each of 72 stores, for a total of 2,567 purchase attempts. The frequency of asking the children their age and/or for identification (ID) was analyzed along with the role of these questions in subsequent sales. RESULTS: The data revealed that requesting age/ID was rare (occurring 17% of the time) despite the laws in California requiring clerks to do so. When age was asked, however, minors were refused cigarettes 95.8% of the time, and when ID was requested, they were refused cigarettes 99.0% of the time. Asking for ID may be more strongly associated with decreased sales than asking age. For example, for 16-year-olds, asking age decreased sales from 57.2% (when no questions were asked) to 8.5% of the time, and asking ID decreased sales to 2.4% of the time. CONCLUSIONS: These data provide empirical support for the widespread belief that the success of interventions with retailers can be improved by enhancing efforts to increase merchants' requests for children's ID.

Adolescent↗
PubMedDate not supplied

Educating international nurses: curricular innovation through a bachelor of science in nursing bridging program.

A curricular innovation was designed to provide internationally educated nurses with access to nursing licensure and employment. Through a program that includes professionally relevant English language support, mentorship, academic upgrading, workplace experiences, and clinical skills support, a mechanism has been created for internationally educated nurses to earn a bachelor of science in nursing degree and overcome barriers to practicing their profession.

Curriculum↗
PubMed2005

Increasing mammography screening among low-income African American women with limited access to health information.

BACKGROUND: Previous research showed low-income African American women with limited access to breast screening information through mass media to have a low likelihood of obtaining screening. This report describes a controlled evaluation of a component of a community-based breast screening promotion program focused on increasing screening among low-income African American women. METHODS: A direct-contact screening promotion component tailored to the needs of low-income African American women was conducted between 1990 and 1997 in one of two matched Florida study areas. Before and after assessments of breast screening, behavior and psychosocial mediators of screening were examined using logistic regression analyses for 1201 women with differing levels of exposure to media information about breast screening. RESULTS: Recent/repeat mammography use increased significantly in the program area for women with limited access to media information, although there was no significant program impact on hypothesized psychosocial mediators of screening. CONCLUSIONS: The program led to increased mammography use among low-income African Americans having limited access to screening information through the media. For these women, using direct contact to deliver educational messages and facilitation of access to services may be the best method available to promote regular mammography.

Adult↗
PubMed2004

School-based asthma disease management.

BACKGROUND: Asthma is the most common chronic childhood illness and the leading cause of missed school days. School is a potential location for establishing an asthma education program for children and their parents/caregivers designed to improve disease management. OBJECTIVE: To determine whether a comprehensive, school-based asthma management program, in addition to a conventional disease management program, can reduce measures of asthma control, student absenteeism, and caregiver lost workdays. METHODS: School nurses recruited parents/caregivers of students with asthma from three urban elementary and middle schools. Children were identified as having asthma by a previous diagnosis from their personal physician. Parents were invited to attend educational sessions about the program. Students received peak flow meters and training in their use and had access to an interactive asthma diary to record symptoms, peak flow, and medicine usage. They received monthly asthma education at school and had access to an online asthma education program and additional handouts. Parents received several educational calls regarding asthma and had a 24-hour, 7-days-a-week emergency number to call if problems arose. RESULTS: At 6 months, missed school days and unscheduled doctor visits were reduced by two thirds (n = 41; p< 0.01 for each). Caregivers' perception of children's activity level increased by 11% (n = 26; p = 0.037). Daytime and nighttime frequency of symptoms dropped by 62% and 34%, respectively (n = 32; p < 0.007 and p<0.03 for each). These trends continued at 12 months, although only reduction in frequency of symptoms attained statistical significance. CONCLUSIONS: A comprehensive, school-based asthma management program can successfully improve asthma control and reduce absenteeism in elementary and middle school students and caregiver lost workdays.

Absenteeism↗
PubMed2003

Outcomes of homeless adults with mental illness in a housing program and in case management only.

OBJECTIVE: The effectiveness of two types of service programs in ameliorating homelessness among individuals with severe mental illness was compared. METHODS: Homeless persons with severe mental illness were recruited into the study on their entry into one of two types of homeless service programs. The first was a comprehensive housing program, in which consumers received guaranteed access to housing, housing support services, and case management. The second was a program of case management only, in which consumers received specialized case management services. In a quasi-experimental or nonrandom-assignment design, participants responded to instruments measuring housing status, mental health symptoms, substance use, physical health, and quality of life at baseline (program entry) and at six months and 12 months after entry. The baseline interview was completed by 152 participants and at least one of the two follow-up interviews by 108 participants. High-, medium-, and low-impairment subgroups, based on psychiatric symptoms and degree of alcohol and illegal drug use, were formed by means of a propensity score subclassification. RESULTS: Persons with high psychiatric symptom severity and high substance use achieved better housing outcomes with the comprehensive housing program than with case management alone. However, persons with low and medium symptom severity and low levels of alcohol and drug use did just as well with case management alone. CONCLUSIONS: The results suggest that the effectiveness, and ultimately the cost, of homeless services can be improved by matching the type of service to the consumer's level of psychiatric impairment and substance use rather than by treating mentally ill homeless persons as a homogeneous group.

Adult↗
PubMedDate not supplied

Current status of clinical education in paramedic programs: a descriptive research project.

Development of competence in exercising therapeutic judgment skills represents the goal of clinical education. Time (clock hours) is not a valid predictor of attainment of competence in paramedic clinical education. Quantity of patient contact experiences facilitates development of judgment skills, and offers a valid measure of progress toward competence. This project uses national survey data from accredited programs to describe the availability and accessibility of patient contact experiences within paramedic clinical education. Data from this local program supplements the national survey results. The components of clinical judgment are enumerated, and strategies to teach and evaluate clinical judgment skills are discussed.

Allied Health Personnel↗
PubMed2006

Position of the American Dietetic Association: local support for nutrition integrity in schools.

It is the position of the American Dietetic Association that the schools and the community have a shared responsibility to provide all students with access to high-quality foods and school-based nutrition services as an integral part of the total education program. Educational goals, including the nutrition goals of the National School Lunch Program and the School Breakfast Program, should be supported and extended through school district wellness policies that create overall school environments that promote access to healthful school meals and physical activity and provide learning experiences that enable students to develop lifelong healthful eating habits. The National School Lunch and School Breakfast Programs are an important source of nutrients for school-age children, and especially for those of low-income status. The American Dietetic Association was actively involved in the 2004 reauthorization of these programs, ensuring access through continued funding, promoting nutrition education and physical activity to combat overweight and prevent chronic disease, and promoting local wellness policies. The standards established for school meal programs result in school meals that provide nutrients that meet dietary guidelines, but standards do not apply to foods and beverages served and sold outside of the school meal. Labeled as competitive foods by the US Department of Agriculture, there is a growing concern that standards should be applied to food in the entire school environment. Legislation has mandated that all school districts that participate in the US Department of Agriculture's Child Nutrition Program develop and implement a local wellness policy by the school year 2006-2007. Resources are available to assist in the development of wellness policies, and dietetics professionals can assist schools in developing policies that meet nutrition integrity standards.

Adolescent↗
PubMed1996

Baltimore Vision Screening Project.

PURPOSE: This study estimates the prevalence of common visual disorders (amblyopia, strabismus, refractive errors) in a group of inner-city school children. In addition, the study addresses the issue of access to care for vision-screening programs, specifically for children with recognized difficulties in obtaining routine medical care. METHODS: School children from an inner-city elementary school were enrolled into a prospective vision-screening program combining the identification arm (screening) and diagnostic/treatment arm (ophthalmic examination). The screening consisted of Snellen E optotypes presented at a 10-foot test distance. Each child failing the vision screening was examined by an ophthalmologist at the school using standard protocol. This allowed the authors to examine all children identified through the vision-screening program. RESULTS: Six-hundred eighty children were screened during the 1993 to 1994 school year. Eleven percent (76) failed the vision screening and were examined, 68 of whom failed the ophthalmic examination. The estimated prevalence of visual morbidity was as follows: amblyopia, 3.9%; strabismus, 3.1%, and refractive errors, 8.2%. CONCLUSION: Amblyopia, strasbismus, and refractive errors were found in relatively high frequencies for this population sample of inner city children. These findings underscore the necessity of comprehensive vision-screening programs that integrate follow-up care. Children with limited access to specialized eye care must be provided with a mechanism for obtaining these services.

Amblyopia↗

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