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PubMed1978

Ambulatory neurology in residency training programs: a perspective.

Inpatient care and teaching have been the central theme in academic medicine, including neurology, for the last several decades. However, pressures from within and outside of medicine are building to create a renewed commitment to ambulatory care and education. Most neurology training programs have not yet made that commitment. They should do so for the benefit of both the patients and residents served by the programs. Effective outpatient clinic training programs should include full-time staff devoted to ambulatory care, teaching, and research. The practicing clinical neurology staff could be used more effectively. Regular chart review, case management conferences, and other teaching strategies, and the reorganization of the clinic to include private patients, as well as group practice and interdisciplinary team concepts, could improve both the patient care and resident training in the neurology clinic.

Ambulatory Care↗
PubMed1992

What is the legal 'standard of medical care' when there is no standard medical care? A survey of the use of home apnea monitoring by neonatology fellowship training programs in the United States.

In treating a patient, a doctor is obliged to use the skill and care that is ordinarily used by reasonably well-qualified doctors in similar cases. In addition, the only way in which a juror may decide whether the defendant used the skill and care which the law required of him or her is from evidence presented by doctors called as expert witnesses (cf Illinois Pattern Jury Instructions). However, what should be done if expert opinions differ concerning the care that is "ordinarily used"? Home apnea monitoring (HAM) is prescribed at times for graduates of neonatal intensive care units despite the fact that indications for its use are not well established and efficacy is completely unknown. The authors attempted to determine standards for HAM as it is currently practiced in neonatology training programs. The primary teaching hospital for each of the 99 neonatology training programs in the United States was identified. Both the medical director (MD) and a neonatal intensive care unit nurse manager (RN) were asked about the use of HAM in their own nursery for four clinical vignettes. Each vignette depicted a 1000-g birth weight infant, currently 7 weeks old and ready for discharge. In three vignettes, the infant had demonstrated no apnea, mild apnea (resolved by 2 weeks of age), or moderate apnea (requiring theophylline therapy at discharge) during the hospital course. In the fourth vignette, the infant had no apnea but was to be discharged home with supplemental oxygen. For 67 of 99 training programs, paired responses of RN managers and MD directors were obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Aftercare↗
PubMed1977

Governmental peer review of training programs in child psychiatry.

The authors present the results of a review of grant applications from 84 child psychiatry training programs that was conducted by the Psychiatry Education Branch of NIMH during fiscal year 1975. They found that training programs whose applications were approved were (among other things) university based and successful in filling training positions; they provided experiences in two or more treatment modalities in varied settings and with diverse types of patients, had active liaison with community organizations and with departments of pediatrics, and provided research opportunities for trainees.

Child Psychiatry↗
PubMed1996

Results of an office-based training program in clinical breast examination for primary care physicians.

BACKGROUND: This study hypothesized that an office-based training program in clinical breast examination (CBE) would improve the lump-detection skills of primary care physicians. METHODS: A one-group pretest-posttest design was utilized, without outcome measurements taken prior to instruction, immediately afterwards, and six months later. Fifty physicians from 117 practices that had been randomly selected and met program eligibility criteria elected to participate. The intervention was a one-hour office-based CBE training program based on the MammaCare method, a standardized approach to teaching the detection of breast lumps using silicone breast models. RESULTS: There were five lumps in the silicone model. The mean number of correct lump detections increased significantly, from 0.66 before to 3.2 after instruction, and this gain was maintained at six-month follow-up. The mean number of false positives decreased from 2.9 before to 1.16 after instruction, increasing slightly to 1.6 at six-month follow-up. Ninety-six percent of the physicians reported that they had modified their methods of CBE as a result of the training. CONCLUSIONS: This office-based instruction using an academic detailing model improved the participating physicians' abilities to correctly detect lumps in a silicone breast model and was received favorably.

Adult↗
PubMed2000

Evaluation of communication training programs in nursing care: a review of the literature.

An important aspect of nursing care is communication with patients. Nurses' major communication tasks are not only to inform the patient about his/her disease and treatment, but also to create a therapeutically effective relationship by assessing patients' concerns, showing understanding, empathy, and providing comfort and support. In this review, 14 studies, which focus on the evaluation of the effects of communication training programs for nurses, have been evaluated. The selected studies were screened on several independent, process and outcome variables as described by Francke et al. [8]. In this way not only is the training program taken into account as a variable which may be responsible for nurses' behavioural change and for changes in patient outcomes, but also a range of other variables which can give more nuanced explanations for a training program's degree of effectiveness. On the whole, the studies reviewed showed limited or no effects on nurses' skills, on nurses' behavioural changes in practice, and on patient outcomes. Finally, the majority of the studies had a weak design. The use of experimental research designs should be pursued in future studies in order to eliminate the influence of confounding variables.

Clinical Competence↗
PubMed1991

Cost effectiveness of a training program for dementia carers.

An intensive 10-day residential training program for dementia carers has previously been shown to be associated with increased patient survival at home and decreased psychological morbidity in carers (Brodaty & Gresham, 1989). Results from a further follow-up, about 39 months after entry into the trial, were even more impressive. Patients whose carers had trained in the program had much higher adjusted rates of survival at home (53% versus 13%) and, unexpectedly, fewer deaths (20% versus 41%) than those whose carers did not have training. Patients whose carers had delayed training achieved intermediate results (31% surviving at home and 21% dying). These results were achieved with an average saving of $A7,967 ($U.S.5975) per patient over the first 39 months.

Aged↗
PubMed2001

Development of a skill training program for parents of substance-abusing adolescents.

This report discusses the development of a coping skill training program for parents of substance-abusing adolescents and presents preliminary data on the effects of the program on parent functioning and adolescent substance use. The behavioral-analytic model of program development was used to sample representative problematic situations experienced by parents of substance-abusing adolescents, obtain an effectiveness-scaling of responses to these situations, and derive alternate forms of a situational role-play measure of parental coping. These situations and scoring guidelines were then used to create the skill training program. Parents of substance-abusing adolescents not in treatment subsequently were randomly assigned in a pilot investigation to either a skill training or delayed treatment condition. Skill training resulted in significant improvement in parental coping skills relative to delayed treatment. Moderate to large improvement in the parent's report of their own functioning, family communication, and the teen's marijuana use also favored the skill training group.

Adaptation, Psychological↗
PubMed1985

Evaluation of two relaxation training programs under medication and no-medication conditions.

This study evaluated two taped relaxation training programs with 39 psychiatric inpatients, half of whom received minor tranquilizers in conjunction with relaxation training. It appeared that the procedurally enhanced relaxation program was able to produce slightly more therapeutic effects than the standard training program. Significant differences were found between the medicated and the unmedicated groups by multivariate analysis of variance on multiple measures, including heart rate and frontalis EMG. Procedural clarity in relaxation treatment research and the importance of considering contextual factors in the treatment setting are stressed.

Adolescent↗
PubMed1981

Pathologists' assistant training programs: a report.

This report describes the training of pathologists' assistants in three training programs: at Duke University, at Quinnipiac College associated with Yale University, and at the University of Maryland School of Medicine. The role of this new health profession is described as well as the job situation, experience, and current status of accreditation.

Accreditation↗
PubMed1990

1987-1988 Medical Oncology training programs.

A continuing survey of Medical Oncology training programs was conducted. In 148 programs, there were 841 trainees. This was an increase in the number of trainees recorded in a 1984 survey (767), with a substantial increase in third-year trainees. Since trainees in combined oncology/hematology programs intend to take the Medical Oncology certifying examination, a continuing output of medical oncologists can be expected.

Certification↗
PubMed1977

A psychodynamically oriented group training program for early childhood care givers.

A training program for enhancing the care-giving qualities of child-care workers was developed and implemented through semistructured groups for family day-care mothers. The authors describe the theoretical orientation, program goals, and the outcome for trainees and trainers. Most impressive was the group process and content, which indicated the effectiveness of psychodynamically oriented program for care givers--people who ordinarly would not be expected to integrate such an experience successfully.

Adult↗
PubMed1977

Undergraduate pharmacological training programs applicable to agricultural science majors.

Undergraduate training programs leading to degrees in pharmacology or toxicology do not exist on most university campuses. Agricultural science students who may ultimately use large quantities of herbicides, pesticides, and other agricultural products may obtain degrees without any exposure to the disciplines of pharmacology or toxicology; some reasons for this are discussed. The design and implementation of some courses suited to the qualifications of most undergraduate agricultural science majors are outlined. In general, a blend of lectures, discussions, and student presentations facilitates adequate presentation of the course material. Specific suggestions for student term projects are mentioned. Some of the available textbooks suitable for undergraduate courses of this type are very briefly discussed. It is suggested that in order to educate nonacademic users of agricultural chemicals, pharmacologists and toxicologists may have to work closely with both industry and those closer to the agricultural community such as county agricultural extension agents and farm youth organizations.

Agriculture↗
PubMedDate not supplied

Influence of a brief aerobic training program on heart rate and subjective response to a psychologic stressor.

An experiment was conducted to determine whether a brief program of aerobic exercise would reduce the heart rate and subjective responses of high- and low-fit subjects to a psychologic stressor. Thirty-four high-fit and 34 low-fit subjects were exposed to a moderate stressor (recall of digits backwards test) while their heart rates and subjective responses were monitored. Approximately half of the high- and low-fit subjects then participated in a 13-week aerobic exercise training program, whereas the other subjects did not. After the 13-week period, the subjects were again exposed to the stressor. Results indicated that a) in the pretest the low-fit subjects showed a greater heart rate response to the stressor than the high-fit subjects, b) the training program was effective for increasing subjects' levels of aerobic fitness, and c) the training program was effective for reducing the heart rate response to the stressor of low-fit subjects. These findings provide support for the relationship between fitness and the response to psychologic stressors and they suggest that aerobic training may be an effective way of helping low-fit persons deal with psychologic stressors.

Adolescent↗
PubMedDate not supplied

[Effectiveness of an intensive treatment and training program for patients with type I diabetes mellitus].

The authors analyze the results of comprehensive, prospective, controlled investigation of the program for intensive care and training of 121 patients with insulin-dependent diabetes mellitus (IDDM). The basic principles of the program are training on a team's basis, intensive insulin therapy, auto-monitoring of metabolism, and liberal diet. The results demonstrate that glycemia level approaching the normal may be attained and maintained in the majority of patients without increasing the risk of grave hypoglycemia, cases with severe diabetic ketoacidosis may be eliminated, and periods of temporary invalidity of patients reduced by 7-10 times. The selected training program was equally effective for patients of various age groups and levels of education, as well as for patients with "labile" diabetes. Results of treatment did not depend on the type of insulin preparations used. The authors come to a conclusion on a higher efficacy of new strategy of IDDM treatment in comparison with the traditional approaches.

Adolescent↗
PubMed1998

Evaluation of a bicycle skills training program for young children: a randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a skills training program in improving safe cycling behavior, knowledge, and attitudes in young children. METHODS: Grade 4 children from six elementary schools in East York (a borough of Metropolitan Toronto) participated. The intervention--playground based instruction on bicycle handling skills by certified instructors--was randomly allocated to three schools. Altogether 141 children participated: 73 in the intervention group and 68 in the control group, with follow up evaluations available on 117 (83%). The primary outcome was safe cycling behavior (straight line riding, coming to a complete stop, and shoulder checking before a left turn). A self report questionnaire collected data on knowledge and attitudes. Baseline assessments were made in June, with follow up evaluations in September, 1995. RESULTS: The prevalence of safe cycling behaviors at follow up in the intervention and control groups respectively, were: straight line riding (90% v 88%; p = 0.782), coming to a complete stop (90% v 76%; p = 0.225), and shoulder checking (0% v 2%; p = 1.000). Over time (from baseline to follow up) children in both groups were more likely to maintain straight line riding, less likely to ride on the sidewalk, and less likely to consider that a car had more right to the road. CONCLUSIONS: This brief skills training program was not effective in improving safe cycling behavior, knowledge, or attitudes among grade 4 children.

Accident Prevention↗
PubMed2000

[Therapy of fecal incontinence in elderly patients: Study of a home biofeedback training program].

UNLABELLED: The increased prevalence of urinary and fecal incontinence is one of the most important factors in the loss of independence and mobility in the elderly population. It is also one of the major reasons for elderly people to give up their household and move into a nursing home. Anorectal biofeedback therapy is a very effective treatment for fecal incontinence. However, due to the increased immobility of elderly people, ambulatory biofeedback training programs which require the participants to leave their homes and travel to the next available outpatient clinic on a regular basis, especially when depending on public transportation, may prove particularly difficult for elderly, incontinent subjects. Supervised home biofeedback training programs may offer an alternative for those patients, who are motivated enough and not mentally impaired. Two different age groups of women (between 49 and 63; and between 65 and 78 years old) suffering from fecal incontinence due to external anal sphincter impairment, received a supervised home biofeedback program, after extensive anorectal diagnostics including manometry. The program focused on improving voluntary sphincter contraction. After an average of 9 months, anorectal manometry was repeated, and anal resting and squeeze pressure as well as minimal rectal perception threshold were determined. There was no effect on anal resting pressure and rectal perception. However, anal maximum squeeze pressure as well as squeeze pressure over 10 s was substantially increased with no difference between the age groups. CONCLUSION: Supervised home biofeedback for sphincter insufficiency was effective in improving the voluntary contraction of the anorectum in both age groups. Therefore, biofeedback home training programs may offer an alternative to ambulatory programs for those individuals, who are not mobile enough to regularly attend an outpatient clinic.

Aged↗
PubMed2001

Screening for sexually transmitted infections among economically disadvantaged youth in a national job training program.

PURPOSE: To evaluate results of screening for syphilis, gonorrhea, and chlamydia among youth in a federally funded job training program. METHODS: Data were evaluated from medical records of 12,881 randomly selected students in 54 U.S. job training centers during 1996. The intake medical evaluation includes serologic testing for syphilis. The policy was for females to receive a pelvic examination with gonorrhea and chlamydia testing and for males to be first screened with a urine leukocyte esterase (LE) assay, with follow-up gonorrhea and chlamydia testing for those with positive LE results. RESULTS: Adjusting for our sampling strategy, among females, an estimated 9.2% had a positive chlamydia test, 2.7% a positive gonorrhea test, and 0.4% had a positive syphilis test. Gonorrhea and chlamydia rates among females were highest in African-American followed by Native American students. Chlamydia infection was most common in younger women < or = 17 years of age. An estimated 0.1% of males had a positive syphilis test, and 4.8% of males a positive urine LE test. Of 103 LE-positive males tested for gonorrhea and chlamydia, only 27 (26%) had a positive test for one of these STDs. CONCLUSIONS: Our study supports routine screening of adolescents for gonorrhea and chlamydia, including those youth from socioeconomically disadvantaged backgrounds. Because individuals from such backgrounds may not regularly interact with traditional clinical health care systems, screening and treatment should be offered in alternative settings, such as the job training program described in this study.

Adolescent↗
PubMed1975

The effect of preceptorship and rural training programs on physicians' practice location decisions.

This study analyzes the relationship between medical student participation in rural training programs, including preceptorships, and the decision to locate medical practice in rural areas. Data consist primarily of responses to questionnaires mailed in 1972 to all graduates of United States medical schools in 1965. Study findings indicate that the overall impact of such programs on practice location decisions is relatively slight, but is most pronounced with respect to urban-reared physicians in nonprimary care specialties. It was also found that a large proportion of urban-located physicians had seriously considered rural practice and that the reluctance of many physicians to locate in rural areas is linked to fear of professional isolation. The findings suggest that an increased orientation toward urban-reared students and dissemination of information on nonsolo practice opportunities in rural areas are means of increasing the effectiveness of preceptorships and other rural training programs in attracting young physicians to underserviced areas.

Attitude of Health Personnel↗