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Training teachers in generalized writing of behavior modification programs for multihandicapped deaf children.

In contrast to previous studies where teachers were instructed how to implement behavior modification programs designed by an experimenter, teachers in the present experiment were taught how to write as well as implement behavior modification programs. The generalized effects of two training conditions on teacher and pupil behaviors were assessed by a multiple baseline design where, following baseline, two teachers of multi-handicapped deaf children were taught to set objectives and measure pupil performance (measurement training), Later, through a training manual, they learned a general problem-solving approach to writing behavior modification programs (programming training). After both training conditions, experimenter feedback was given for teachers' application of training to a target behavior for one pupil and generalization was measured across target behaviors for the same pupil and across pupils. It was found that measurement training had little general effect on either teacher behavior or pupil behavior. However, after programming training, teachers increased their program writing and correct use of behavior modification procedures and generalized this training across pupils and target behaviors. Along with these effects, there was improvement in pupil behaviors. Possible explanation for generalized effects of teacher training were considered.

Adult

Mental health promotion among American Indian children.

Programs designed to promote mental health of the children of the Navajo Indian Tribe bear priority status. 1. Among these programs are the Brazelton Neonatal Behavioral Assessment Scale, a psychological and physical assessment of the neonate. It is designed to enhance bonding as well as identify and treat neonates affected by intrauterine alcohol or other drug use of the mother during pregnancy. 2. Description of a Fetal Alcohol Syndrome project enabling over 90% of those enrolled to refrain from using alcohol during their pregnancies. Many alcohol counsellors are employed for the entire Reservation. 3. Outreach to day and boarding school aids in many ways, including suicide prevention. 4. Use of knowledge and respect for patients' culture as vital to the treatment process. 5. "Back to Native values" program, involving using not only families but clans in the treatment of problems of children, including sexual or physical abuse and violence. This provides another treatment dimension, while enhancing the self-esteem of the Native people. 6. The social work, substance abuse and mental health programs have been combined into one department named "Place of Healing", a Navajo term.

Child

PCS-I--a point counting stereology program for cell biology.

PCS-I is a versatile BASIC program designed to collect and process stereological point counting data from electron micrographs of cells. The program can accept the point counts from three sources: (i) a set of user-definable keys programmed as counters; (ii) a numeric pad that enters counts line by line; and (iii) a data tape cartridge. The program calls for all the information needed to solve stereological equations and then helps the user to interpret the suitability of the sample size by drawing error curves. The coefficients of the stereological equations and the output headings can be readily modified to accommodate a new set of experimental parameters, which gives a substantial amount of flexibility to the program. PCS-I is easy to use and offers a practical solution to the problem of data management for biological stereology.

Cell Biology

A program for achieving generalization of grammatical rules to spontaneous discourse.

Four language-disordered children were presented with a 4-step program designed to achieve generalization of target grammatical rules to spontaneous discourse. A multiple baseline design was used to compare trained and untrained rule usage. During each step of the program, the clinician arranged for the child's own intentions to evoke the target rule. Progression through the program entailed systematically increasing the number of nontarget events the child needed to convey, and decreasing the frequency with which the clinician modelled the target. Trained target rules increased in frequency while untrained rules did not. When therapy was then initiated on the untrained rules, they also increased in frequency while the first rules continued to be produced at mastery level.

Child

Issues in human immunodeficiency virus (HIV) screening programs.

Unlike test sensitivity and specificity, the false positive and negative predictive values (probabilities of mislabeling an individual being tested) depend heavily on the prevalence of the infection of the human immunodeficiency virus (HIV) as well as the quality of the kit. A consequence of this dependence is that the false positive predictive value can reach a high magnitude such as 0.9; that is, 90% of the positive tests are false. This raises many important issues pertaining to the current practice of HIV screening such as to how to control these misclassification errors, how to interpret test results, and how to estimate prevalence using test results. These issues are examined in detail here by considering the factors that dictate the quality of a screening program. Some real data examples are used to illustrate the importance of this consideration in designing programs to achieve the desired goals. The rationale behind the common two-step sequential protocol in HIV screening is examined to point out its limitations under practical situations. Finally, the use of entropy in evaluating the informativeness of a screening program is discussed.

AIDS Serodiagnosis

Evaluation of continuing education for long-term care personnel: impact upon attitudes and knowledge.

Nursing assistants (aides) and licensed practical nurses (LPNs) from three proprietary nursing homes participated in a continuing education program designed to enhance knowledge and attitudes about the elderly in long-term care. The program covered six weeks for the initial 115 aides and one full-day seminar for the 83 LPNs. The content covered knowledge and human anatomy, the physiology of normal aging, physical and psychosocial problems of the elderly and, for the nurses, problems associated with cardiovascular accidents. The final participants (29 aides and 52 LPNs) consisted of those who were tested before and after their training with respect to knowledge, life satisfaction, and attitudes toward the elderly. Results indicated overall favorable changes for both aides and LPNs, particularly in the areas of increased knowledge and more positive attitudes. The data suggest that continuing education is an effective means of influencing the knowledge and attitudes of personnel in long-term care facilities, and it should be a first step toward improving the quality of care for elderly residents.

Adult

[Obstetric factors associated with low birth weight].

An analysis was made of 18,804 of 19,446 consecutive births of the number analysed 15.93% presented low birth-rate. Significant statistical association was found in relation to maternal age, pre-natal care, previous pregnancies, smoking and gestational age at birth. Measures with a view to the attenuation of the problem are proposed, among them being: educational programs for teenagers on human reproduction, programs designed to create awareness of the harm done by smoking, amplification of antenatal assistance, medical programs for the limitation of premature labor, all of these and others, in association with programs of socio-economic support.

Adolescent

Three faculty-facilitated, community-based level I fieldwork programs.

Finding sufficient placements for students' Level I fieldwork experiences has become a major challenge in occupational therapy education and has led to the increased involvement of faculty members in facilitating these experiences. The conceptualization, site selection, program implementation, and outcome of three faculty-facilitated Level I fieldwork programs, designed for occupational therapy fieldwork students at Eastern Kentucky University, are presented here. The first program involved moving a faculty member and students to a small town in the mountains of Eastern Kentucky for 4 weeks and assigning the students to pediatric fieldwork at local agencies. The second, organized and developed by a faculty member and implemented by faculty members and students, provided an enrichment opportunity to adult consumers of psychosocial services. The third, also organized and developed by one faculty member and implemented by faculty members and students, provided day-care services to persons with Alzheimer's disease. In all three programs, persons receiving services as well as the agencies, students, and faculty members benefited from the experience. The use of faculty role models is recommended to demonstrate and reinforce the application of theory to practice.

Aged

Opinions and approaches to continuing education among obstetrician/gynecologists.

This national survey of Fellows of The American College of Obstetricians and Gynecologists found that obstetrician/gynecologists are actively involved in continuing medical education activities and appear satisfied with the resources available, yet desire additional opportunities for lifelong learning. Traditional resources (eg, journals, seminars) are used much more extensively than newer, electronic resources (eg, video cassettes, cable television), probably as a result of unfamiliarity with these latter methods and limited access to them. However, the majority of Fellows want increased exposure to these newer educational programs. Relevance of content, caliber of faculty, and potential for professional growth were important factors in choosing continuing medical education programs. Strong interest was expressed in individualized learning programs designed in collaboration with university faculty. These findings are of value in producing future educational programs for practitioners in obstetrics and gynecology.

Attitude of Health Personnel

Recruitment of ethnic and socio-economically disadvantaged students into dentistry.

A program designed to attract and graduate underrepresented minorities and disadvantaged students in dentistry is reported. The program consisted of three phases: career orientation, recruitment, and academic enrichment/retention. In the six years of this program's existence, the number of minority students enrolled increased from 1 to 28, including 12 who were graduated by June 1979. Only two were lost because of academic difficulties. An analysis of grades and tutorial needs showed that students experienced the most difficulty with first-year basic science courses. Recommendations are presented for program improvement.

Career Choice

Long-duration submaximal exercise conditioning in hemodialysis patients.

Objective changes in exercise tolerance were evaluated in five chronic hemodialysis patients (HD) following a ten week aerobic treadmill exercise conditioning program designed to exercise patients at a level approximating their anaerobic threshold (AT). This exercise conditioning program resulted in a 21% increase in peak oxygen consumption, an increase in test duration from 17.40 +/- 1.26 to 22.60 +/- 0.87 min (P less than 0.025), and an increase in AT from 0.81 +/- 0.08 to 0.97 +/- 0.08 1/min (P less than 0.05). These physiologic changes in exercise tolerance resulted in an overall increase in work capacity permitting the HD patient to perform a larger portion of the imposed work load aerobically.

Adult

A simple and efficacious criterion based on serum LH levels to time hCG administration for human in vitro fertilization.

OBJECTIVE: To test the efficacy of a simple criterion--LH level--for administration of hCG in an IVF program. DESIGN: Prospective, with retrospective analysis of other criteria for hCG administration. SETTING: University hospital IVF program. PATIENTS AND INTERVENTIONS: Eighty-four patients, in 110 cycles, were given 150-300 IU at 10-11 A.M. daily beginning on day 3 of the cycle. Serum LH measured daily 8:30-9:30 A.M., hCG administered on night of day LH level first exceeded J, defined as minimum value + (day 3 value-minimum) x 1/3. OUTCOME MEASURES: Pregnancy (after IVF + ET); serum concentrations of estradiol and LH. RESULTS: Total and ongoing pregnancy per cycle: 35% and 27% respectively. If hCG is administered one day early or late by the J criterion, the pregnancy rate is reduced. CONCLUSIONS: Pregnancies occurred over wide follicle diameter (14-21 mm) and estradiol level (229-2,050 pg/mL) ranges. LH is recommended for timing hCG administration.

Chorionic Gonadotropin

Safer Choices: a multicomponent school-based HIV/STD and pregnancy prevention program for adolescents.

Given the serious consequences of HIV infection, other STDs, and pregnancy among teens, professionals must develop and evaluate new approaches to reduce risks associated with adolescent sexual behavior. The Safer Choices intervention is a comprehensive, theoretically based program designed to reduce risk behaviors and increase protective behaviors to prevent HIV, other STDs, and pregnancy among high school adolescents. The program includes five components: a School Health Promotion Council involving administrators, school staff, students, parents, and community members; curriculum and staff development activities; school environment activities designed and implemented by a team of peer educators; parent education activities; and school-community linkage activities. The School Health Promotion Council is responsible for planning and overseeing program implementation. This article describes the theoretical framework, process for intervention development, and key intervention strategies used in Safer Choices.

Adolescent

Management preparation for nurse executives: the dual degree option.

Nurses have the clinical expertise that enables them to better understand the complex issues inherent in management of the delivery of health care. Yet without adequate preparation in management, as well as training of higher levels of nursing theory and research, nurses will be less prepared to compete at higher levels as the system continues to change. The University of Colorado offers a program designed to meet these needs, which serves as a national model for other schools of nursing considering such a curricular change. Further research needs to be conducted to identify the specific components of a graduate program that will enable the nurse executive to develop advanced nursing practice skills while developing the management skills necessary to achieve effectiveness in the practice setting. Because the long-term outcome of the dual degree model is still unknown, the effectiveness of the program in the health care system over time will be evaluated in relation to three outcomes: first, the effectiveness of program goals and objectives for producing successful nurse executives; second, the effectiveness of the curriculum design in preparing successful nurse executives; and third, satisfaction of graduates with the program and with their preparation. Participants in the dual degree program look forward to meeting this challenge.

Administrative Personnel

Interdisciplinary health education: a case study of fact and fancy.

Meeting the health needs of patients and providing comphrehensive health care services require the integration and coordination of several professional health services. Traditional methods for training students in the health professions independently are being challenged by the need for future practitioners to understand and to utilize effectively the skills offered by the other disciplines. However, the movement of educational institutions toward interdisciplinary training programs entails the careful assessment of program design, content, and basic philosophy. Two and one-half years of experience with such a program at one academic health center are reviewed.

Adult

Teaching humanistic and psychosocial aspects of care: current practices and attitudes.

OBJECTIVE: To assess current practices and attitudes toward teaching humanistic and psychosocial aspects of care in internal medicine residency programs. DESIGN AND PARTICIPANTS: Survey questionnaires were sent to residency directors at all 434 internal medicine residency programs accredited in 1985-1986. Response rate for two mailings was 71%. MEASUREMENTS AND MAIN RESULTS: 78% OF RESIDENCY DIRECTORS and 70% of department chairpersons had high or moderately high levels of commitment to teaching humanistic/psychosocial aspects of care, but only 44% of responding programs offered mandatory training, and only 18% offered elective training in these areas. Obstacles to expanded teaching of the humanistic/psychosocial aspects rated high or moderately high by residency directors included insufficient curriculum time (51%), lack of trained faculty (44%), and pressures to reduce both training costs (40%) and patient-care costs (37%). CONCLUSIONS: Most of the training that does occur in the humanistic/psychosocial aspects of care probably happens informally via mentoring and role modeling. Appeals to expand teaching in these areas raise questions regarding what to include in medical training and the proper scope of internal medicine. Sustainable change will depend on the politics of resource distribution and the influence of general internal medicine and primary care on traditional training.

Clinical Competence

Effectiveness of two training methods to improve the quality of foodservice in small facilities for adult care.

OBJECTIVE: Community-based adult-care facilities (ACFs) with fewer than 25 beds provide homes for persons with disabilities who cannot live independently. The staff in these facilities are not required to have any formal foodservice training, yet they provide meals for the residents. The objective of this study was to evaluate the quality of foodservices before and after a foodservice training program. DESIGN: Forty-six ACFs from six health-unit areas throughout the province of British Columbia were enrolled in the study, which involved a pretest-posttest design over a 5-month period. The health units were randomly assigned to one of three programs. INTERVENTION: The ACFs received either a training workshop plus foodservice manual developed specifically for ACFs, the manual only, or no intervention. MAIN OUTCOME MEASURES: Facilities were audited on performance in food purchasing, menu planning, food safety, and food storage. These areas were rated according to established minimum government regulations and other foodservice standards. Differences between the two audit scores (postintervention score minus preintervention score) were analyzed for each program section. Group comparisons were done using analysis of covariance procedures, with the initial score being the covariable. RESULTS: No treatment effect was found on performance for food purchasing and food storage. Training via workshop plus manual resulted in a significant improvement in audit scores for menu planning and food safety compared with training via the manual alone. APPLICATION: Dietitians should consider providing foodservice training workshops for similar types of facilities. The benefits of providing a manual alone are negligible.

Adult

A simple approach to intracytoplasmic sperm injection.

OBJECTIVE: To describe a simple injection apparatus and method for performing intracytoplasmic sperm injection in a clinical IVF program. DESIGN: A prospective clinical trial of intracytoplasmic sperm injection. SETTING: A private office-based fertility program. PATIENTS: Five couples undergoing IVF-ET with intracytoplasmic sperm injection as a treatment for male factor infertility. INTERVENTIONS: Intracytoplasmic sperm injection was performed at room temperature (23.5 to 24.5 degrees C) in a simple zwitterion-buffered medium. MAIN OUTCOME MEASURES: Fertilization rates, cleavage rates, clinical pregnancy rates, implantation rates. RESULTS: Intracytoplasmic sperm injection was performed on 44 fresh oocytes from five patients. Twenty-three oocytes fertilized (52.3%) and 22 zygotes cleaved (95.7%). Three of five patients became pregnant (60%), resulting in the live birth of one normal male infant, one continuing singleton pregnancy, and one continuing twin gestation (46XX, 46XY). The implantation rate was 23.5%. CONCLUSION: Intracytoplasmic sperm injection can be performed successfully in a simple medium at room temperature using commercially available microtools.

Cytoplasm