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At least 235 records · Page 13Linked to original sources
PubMedDate not supplied

Design of custom hip stem prostheses using three-dimensional CT modeling.

Long life expectancy, demand for high activity levels, and bone loss at the time of revision motivate the search for reliable and successful noncemented hip stem designs. It is hypothesized that improved implant fit may increase the longevity of noncemented total joints. Quantitative X-ray CT has enabled the use of a computerized stem design program, which designs an optimal-fit hip stem for individual femurs. Computed tomography and interactive image processing methods are used to generate the individual three-dimensional femoral models, which are used by the stem design program. Optimal-fit design provides maximum stem-bone contact while satisfying the requirement of being surgically insertable. Previous methods of custom implant design, including those that use three-dimensional CT modeling, have not provided optimal stem-bone fit. Quantitative results of this new process are presented.

Aged↗
PubMed1996

Residents on the transport team. Balancing service and education.

OBJECTIVES: To describe an educational program for pediatric house staff who participate in interhospital transport and to present an evaluation of the educational program. DESIGN: Educational program evaluation that used multiple confidential surveys of participating pediatric house staff. SETTING: The interhospital transport team of a large, urban pediatric hospital. PARTICIPANTS: Twenty-six pediatric second-year residents who participated in required rotations with the transport service. INTERVENTION: The institution of an educational program designed specifically for the clinical transport rotation. RESULTS: Before their service with the transport team, residents have doubts about their clinical skills, fund of knowledge, and ability to practice independently in a mobile environment. These doubts decrease as the residents participate in the educational program during their transport clinical service. All residents perceive service on the transport rotation to be of educational benefit with regard to communications or cognitive skills. Alternatively, transport service provides little opportunity for residents to improve technical skills. Among the various skills that residents could obtain during transport service, improvement in clinical judgement was most commonly cited by residents who performed more than 10 transports. Among the specific curricular components in the educational program, interactive teaching methods were judged to be more valuable than written materials. CONCLUSIONS: Serving as a physician on interhospital transports can be an important educational opportunity for pediatric house staff when that experience is concentrated in a designated rotation and combined with a focused educational program. Contrary to expectations, there was little opportunity for residents to develop technical skills on transport. Therefore, educators should focus on the development of communications and cognitive skills. Interhospital transport programs that debate the use of residents as members of the service should consider the potential educational benefit of the clinical service to house staff.

Adult↗
PubMedDate not supplied

Management of an unusual extreme extension contracture of the wrist: role of a custom-designed exercise program in achieving a good range of movement and prevention of recontraction.

An extreme extension contracture of wrist with dorsal contracture of fingers 15 years after burn injury is described. Shortening of extensor tendons, secondary lengthening of flexor tendons, contracted wrist joint capsule, unusual dislocation of carpals, dorsal dislocation of metacarpophalangeal joints of fingers, and provision of sufficient amount of good-quality skin were some of the issues that had to be addressed in treatment. The contracture was released, the carpals and metacarpophalangeal joint dislocations were corrected and fixed with K wires, and the resulting defect was covered with a sheet split-thickness skin graft. An exercise program was designed that consisted of isotonic, isokinetic, and isometric resistance exercises and passive, active, and active-assistive range of motion exercises. These exercises were pursued with the intention of increasing dynamic strength, endurance, and overall functional recovery of the flexor muscles by exploiting the immature nature of early scar tissue. The resultant enhanced flexor muscle power from exercises along with the dynamic splint helped in lengthening of extensor tendons, wrist joint capsule, and split-thickness skin graft. It also helped in resisting the recontracting tendency, with further recovery of good range of wrist and fingers movements, obviating the need of tendon-lengthening surgery and flap coverage. One and half years of follow up didn't show any sign of recontracture, and the patient was able to perform his routine activities. Postburn wrist contractures of such magnitude have been seldom described. Emphasis is put on simple contracture release and a postoperative exercise program.

Adolescent↗
PubMedDate not supplied

African American men: the ideal AIDS program.

Because designing programs based on an understanding of the target population's perceptions, expectations, and experiences is not only beneficial but feasible, a convenience sample of 17 African American men who have sex with men attended one of four focus groups to identify the needs of AIDS clients and what constitutes an ideal AIDS program. These men articulated what they needed and expected from the health care system. These needs and expectations should be incorporated into program planning to promote a more productive relationship between provider and providee and, thus, more efficacious programs. Their needs are competent comprehensive health care, adequate funds, and emotional support to enhance inner strength to cope with dying and death, dependency, and uncertainty. The ideal AIDS program would be holistic, providing health care needs as well as financial, social, emotional, and familial needs by means of both traditional and alternative treatments.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The AHF SCENE II Preceptorship Program: rationale and design of an educational program to optimize management of advanced heart failure.

Advanced heart failure requires specialized treatment to improve symptoms, increase survival, and reverse or slow disease progression. The Advanced Heart Failure Shared Clinical Experiences Network, or AHF SCENE, was founded in 1995 to provide small groups of health care professionals with better advanced heart failure management strategies by sharing clinical experiences from centers treating large numbers of patients. The original AHF SCENE program has since been modified to provide health care professionals with more information on current strategies for advanced heart failure management and to better serve the educational needs of professionals who care for these patients. AHF SCENE II promotes new methods, programs, procedures, and pharmacologic interventions and also describes strategies for tracking and improving clinical and economic outcomes in the management of advanced heart failure. AHF SCENE II supports the understanding that rapid, aggressive medical management is essential and is more effective in the context of a well designed program that spans the continuum of care. (c)2000 by CHF, Inc.

Journal Article↗
PubMed2005

Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain.

BACKGROUND: Exercise therapy encompasses a heterogeneous group of interventions. There continues to be uncertainty about the most effective exercise approach in chronic low back pain. PURPOSE: To identify particular exercise intervention characteristics that decrease pain and improve function in adults with nonspecific chronic low back pain. DATA SOURCES: MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004 and citation searches and bibliographic reviews of previous systematic reviews. STUDY SELECTION: Randomized, controlled trials evaluating exercise therapy in populations with chronic (>12 weeks duration) low back pain. DATA EXTRACTION: Two reviewers independently extracted data on exercise intervention characteristics: program design (individually designed or standard program), delivery type (independent home exercises, group, or individual supervision), dose or intensity (hours of intervention time), and inclusion of additional conservative interventions. DATA SYNTHESIS: 43 trials of 72 exercise treatment and 31 comparison groups were included. Bayesian multivariable random-effects meta-regression found improved pain scores for individually designed programs (5.4 points [95% credible interval (CrI), 1.3 to 9.5 points]), supervised home exercise (6.1 points [CrI, -0.2 to 12.4 points]), group (4.8 points [CrI, 0.2 to 9.4 points]), and individually supervised programs (5.9 points [CrI, 2.1 to 9.8 points]) compared with home exercises only. High-dose exercise programs fared better than low-dose exercise programs (1.8 points [CrI, -2.1 to 5.5 points]). Interventions that included additional conservative care were better (5.1 points [CrI, 1.8 to 8.4 points]). A model including these most effective intervention characteristics would be expected to demonstrate important improvement in pain (18.1 points [CrI, 11.1 to 25.0 points] compared with no treatment and 13.0 points [CrI, 6.0 to 19.9 points] compared with other conservative treatment) and small improvement in function (5.5 points [CrI, 0.5 to 10.5 points] compared with no treatment and 2.7 points [CrI, -1.7 to 7.1 points] compared with other conservative treatment). Stretching and strengthening demonstrated the largest improvement over comparisons. LIMITATIONS: Limitations of the literature, including low-quality studies with heterogeneous outcome measures and inconsistent and poor reporting; publication bias. CONCLUSIONS: Exercise therapy that consists of individually designed programs, including stretching or strengthening, and is delivered with supervision may improve pain and function in chronic nonspecific low back pain. Strategies should be used to encourage adherence. Future studies should test this multivariable model and further assess specific patient-level characteristics and exercise types.

Adult↗
PubMed1978

The design of a training program for adolescent medicine. Thoughts of fellows in training.

Program design for training in Adolescent Medicine is still in an evolutionary state. Postgraduate fellows and program directors have different perceptions with regard to the importance of various components of the ideal training program. Fellows indicate a higher priority for problems associated with the female reproductive system than do their mentors. Inpatient experience received lesser emphasis by the Fellows. Adolescent Medicine as a subspecialty discipline is discouraged.

Adolescent↗
PubMed2002

A comparison of a lecture and computer program to teach fundamentals of the Draw-a-Person test.

BACKGROUND: Although computer-assisted education has been used to augment education in many areas, there are few studies of programs designed to replace lectures in a medical curriculum. OBJECTIVE: To test whether a thoughtfully designed computer program can replace a standard lecture in a pediatrics curriculum while teaching the subject matter equally well. METHODS: A computer program was developed to teach the Draw-a-Person developmental test using the multimedia-authoring tool Director. One of us (A.E.C.) tested and modified the program several times during its creation after submitting it to several objective evaluators. Thirty-nine students taking the clinical pediatrics rotation were chosen by month to interact with the program or attend the lecture. All students then scored 3 drawings and assigned them a developmental age according to the Draw-a-Person test rules. Students assigned to the computer program also completed a questionnaire evaluating the program in several subjective areas. A t test for 2 samples assuming equal variance was used to analyze the test results. RESULTS: Students receiving the lecture (control group) scored the 3 drawings as 5.43 years (age range, 4.5-8 years), 9.08 years (age range, 7-12 years), and 3.5 years (age range, 2-5 years), respectively. Those using the computer program (study group) scored the 3 drawings as 5.91 years (age range, 5-7 years), 7.68 years (age range, 7-8 years), and 4.34 years (age range, 3-5 years), respectively. The correct answers for the ages were 6, 7.75, and 4.25 years, respectively. A t test for 2 samples assuming equal variance showed that students using the computer program performed better on all 3 drawings (P<.05, P<.02, and P<.002, respectively). CONCLUSIONS: Students using the computer program were more accurate than students attending the lecture when scoring drawings and estimating a developmental age from them. These results support the conclusion that a thoughtfully designed computer program can replace a standard lecture in a pediatrics curriculum.

Attitude to Computers↗
PubMedDate not supplied

Changing behaviors. Nurse educators and clinical nurse specialists design a discharge planning program.

In this article, the authors describe a discharge planning program developed for geriatric and maternal-child nurses at Mount Sinai Medical Center. King's theory of goal attainment was used in the program design and teach strategies were selected that matched behavioral objectives in the cognitive, psychomotor, and affective domain. Evaluation methods include participants' pre- and post-surveys regarding their comfort in implementing discharge planning and concurrent review of their documentation 1 month after the program. After participating in the program, staff nurses displayed a change in behavior in terms of increased documentation relating to discharge planning.

Education, Nursing, Continuing↗
PubMed1999

The Childhood Asthma Management Program (CAMP): design, rationale, and methods. Childhood Asthma Management Program Research Group.

The Childhood Asthma Management Program (CAMP) is a multicenter, randomized, double-masked clinical trial designed to determine the long-term effects of three inhaled treatments for mild to moderate childhood asthma: budesonide (a glucocorticoid used daily) and albuterol (a short-acting beta-agonist bronchodilator used as needed); nedocromil (a nonsteroid anti-inflammatory agent used daily) and albuterol; and placebo and albuterol. One thousand forty-one children (32% from ethnic minority groups), aged 5 to 12 years at screening, are currently participating. The primary outcome measure is lung growth as indicated by postbronchodilator forced expiratory volume in 1 second (FEV1) percent of predicted, observed over 5- to 6-year period. The trial also assesses differences between treatment groups with respect to airway responsiveness, morbidity, physical growth and development, and psychological growth and development. This report describes the design of the trial, the rationale for the design choices made, and the methods used to carry out the trial.

Albuterol↗
PubMed1994

Issues for designing marrow transplant programs.

Centers that design a creative and effective BMT program can be viable in this era of limited health care dollars. Ongoing evaluation of cost and outcome is of critical importance to the center, patients, insurers, and health care policy makers. The program design, operational design, staffing and education needs, and economic considerations are important components of a marrow transplant program.

Bone Marrow Transplantation↗
PubMed2000

The structure of inosine 5'-monophosphate dehydrogenase and the design of novel inhibitors.

The enzyme IMPDH is a homotetramer of approximately 55 kDa subunits and consists of a (beta/alpha)(8) barrel core domain and a smaller subdomain. The active site has binding pockets for the two substrates IMP and NAD. The enzymatic reaction of oxidation of IMP to XMP proceeds through a covalent mechanism involving an active site cysteine residue. This enzyme is a target for immunosuppressive agents because it catalyzes a key step in purine nucleotide biosynthesis which is important for the proliferation of lymphocytes. Several X-ray structures of inhibitors bound to IMPDH have been published. The uncompetitive IMPDH inhibitor MPA is the active metabolite of the immunosuppressive agent mycophenolate mofetil (CellCept(R)) which is approved for the prevention of acute rejection after kidney and heart transplantation. The bicyclic ring system of MPA packs underneath the hypoxanthine ring of XMP*, thereby trapping this covalent intermediate of the enzymatic reaction. Ribavirin monophosphate, the active metabolite of the antiviral agent ribavirin, is a substrate mimic of IMP. The structure of the two inhibitors 6-Cl-IMP and SAD binding in the IMP and NAD pockets of IMPDH, respectively, gives information for the binding mode of the di-nucleotide cofactor to the enzyme. At Vertex Pharmaceuticals a structure-based drug design program for the design of IMPDH inhibitors was initiated. Several new lead compound classes unrelated to other IMPDH inhibitors were found. Integrating structural information into an iterative drug-design process led to the design of VX-497. VX-497 is a potent uncompetitive enzyme inhibitor of IMPDH. The phenyl-oxazole moiety of the molecule packs underneath XMP*, analogous to MPA. VX-497 also makes several new interactions that are not observed in the binding of MPA. VX-497 is a potent immunosuppressive agent in vitro and in vivo. A Phase I clinical trial has been successfully concluded and the compound is currently in Phase II trials in psoriasis and hepatitis C. The rapid progress from initiation of the drug design program to a compound entering clinical trials illustrates the power of structure-based drug design to accelerate the drug discovery process. The structural information on IMPDH has also significantly increased our knowledge about the mechanistic details of this fascinating enzyme.

Animals↗
PubMed2003

Concepts, theories and design components for nutrition education programs aimed at older adults.

This article examines characteristics of older adult learners and discusses adult education theory and empowerment concepts, along with nutrition education and behavioral change strategies for older adult nutrition education programs. Design components for older adult nutrition education programs are presented. Educational and behavioral change strategies should be selected based on characteristics of the intended audience, including their nutrition needs, wants and desires, and should be based on appropriate theory. Multi-disciplinary research is needed to develop behavioral and educational theoretical frameworks, as well as designs, intervention strategies, and evaluation methods for educational programs that lead to older adults adopting more healthful nutrition practices. This is one of a series of recent literature reviews on nutrition education for older adults.

Aged↗
PubMed1991

OVID and SUPER: two overlap programs for drug design.

Two programs, OVID and SUPER, for exploring the similarity of molecules with respect to their action at a receptor are described. OVID accepts two molecules as input and optimizes the three-dimensional overlap of specified atoms in one molecule with specified atoms in the second molecule. The result is expressed as a percent of the theoretical maximum. OVID gives a quantitative measure of the extent of a guessed correspondence between two molecules based on volume overlap of selected atoms. The Achilles' heel of OVID is that the correspondence between the two molecules has to be guessed. We realized that it would be better to systematically examine all possible correspondences of two structures to minimize the chance of overlooking a superior correspondence. We created SUPER to satisfy this need. SUPER accepts two molecules as input and finds the top twenty correspondences of their surfaces and charge distributions, giving a quantitative measure of the extent of each correspondence. An instructive example of the application of OVID and SUPER to the design of leukotriene D4 receptor antagonists is described. SUPER appears to be a practical brain-storming tool for the medicinal chemist trying to understand how molecules whose structures may not resemble one another in an obvious way can bind to the same site.

Acetophenones↗
PubMed1986

Community-wide prevention strategies: evaluation design of the Minnesota Heart Health Program.

The Minnesota Heart Health Program (MHHP) is a community-based research and demonstration program designed to accelerate population-wide changes in coronary risk factors and disease. MHHP is on-going in three pairs of communities in Minnesota, North and South Dakota. To strengthen inference of program effects, its basic design involves elements of control, repetition, sensitive trend measurements and evaluation of the effects of program components. Its evaluation design is presented here as a comprehensive measurement system for disease endpoints, risk factor levels and efficacy of specific educational programs. The MHHP design is able to compare risk factor levels and mortality rates between education and comparison communities. MHHP statistical power is sufficient to detect community-wide changes of public health import. Early results show comparability of education and comparison communities for most variables. Widespread community awareness of and participation in MHHP programs is reported.

Adult↗
PubMedDate not supplied

Establishing and maintaining competency.

The recruitment and hiring processes are crucial to quality assurance and cost containment in home healthcare. Competency-based orientation programs designed to provide outcome-focused orientation for the intravenous nurse who is new to homecare will benefit both the new employee and the homecare agency. Development of such a program is discussed, and consideration is given to program design, program evaluation, and ongoing employee education. Sample employee and program assessment tools are provided.

Clinical Competence↗
PubMed1991

Object-oriented design and programming in medical decision support.

The concept of object-oriented design and programming has recently received a great deal of attention from the software engineering community. This paper highlights the realisable benefits of using the object-oriented approach in the design and development of clinical decision support systems. These systems seek to build a computational model of some problem domain and therefore tend to be exploratory in nature. Conventional procedural design techniques do not support either the process of model building or rapid prototyping. The central concepts of the object-oriented paradigm are introduced, namely encapsulation, inheritance and polymorphism, and their use illustrated in a case study, taken from the domain of breast histopathology. In particular, the dual roles of inheritance in object-oriented programming are examined, i.e., inheritance as a conceptual modelling tool and inheritance as a code reuse mechanism. It is argued that the use of the former is not entirely intuitive and may be difficult to incorporate into the design process. However, inheritance as a means of optimising code reuse offers substantial technical benefits.

Adult↗