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PubMedDate not supplied

[Description of a computer program and results of its application to the follow up of enteral nutrition].

Computerization has been introduced little by little in the different activities which take place in a department of pharmacy, due to the fact that it means an increased agility of the tasks to be performed as well as an improvement of the care and managerial quality. In our hospital, the department of pharmacy makes up enteral nutrition units, and it participates in the follow up and control of the patients with this type of nutrition through a computer program designed for this purpose. The objective of the present study is to describe this computerized program as well as the results obtained by its application. The enteral nutrition computer program is made up of two data bases which are indexed between each other: that of daily follow up of the enteral nutrition prescriptions, and that of the follow up of the patients who have been given this nutritional support. In this way it allows us to obtain identification labels and consumption listings. During a two year period a total of 632 enteral nutrition treatments were given. The department with the greatest number of prescriptions was internal medicine (187, 29.5%). The polymeric diets were the most frequently used (435, 68.7%). The have mainly been used as a supplement to a hospital kitchen diet (149, 41.8%). The oral administration was the most frequent route of administration (331, 52.4%). The main reason for not implementing the nutrition was refusal by the patient (114, 38%). The computer program allows greater agility of the circuit which in our hospital generates the preparation of the enteral nutrition formulations, which are made up in the Department of Pharmacy, and given the large number of variables which this implies, this means a quality guarantee in the preparation and follow up of the patients with enteral nutrition.

Enteral Nutrition↗
PubMed1997

Needle exchange programs: an economic evaluation of a local experience.

OBJECTIVE: To determine whether providing a needle exchange program to prevent HIV transmission among injection drug users would cost less than the health care consequences of not having such a program. DESIGN: Incidence outcome model to estimate the number of cases of HIV infection that this program would prevent over 5 years, assuming that the HIV incidence rate would be 2% with the program and 4% without it, and that an estimated 275 injection drug users would use the service over this time. SETTING: Hamilton, Ont. OUTCOME MEASURES: Estimated number of cases of HIV infection expected to be prevented with and without the program over 5 years; estimated lifetime health care costs of treating an AIDS patient. The indirect costs of AIDS to society (e.g., lost productivity and informal caregiving) were not included. Projected costs were adjusted (discounted) to reflect their present value. In a sensitivity analysis, 3 parameters were varied: the estimate of the HIV transmission rate if no needle exchange program were provided, the number of injection drug users participating in the program, and the discount rate. RESULTS: With very conservative estimates, it was predicted that the Hamilton needle exchange program will prevent 24 cases of HIV infection over 5 years, thereby providing cost savings of $1.3 million after the program costs are taken into account. This translates into a ratio of cost savings to costs of 4:1. The sensitivity analysis confirmed that these findings are robust. CONCLUSION: Needle exchange programs are an efficient use of financial resources.

Canada↗
PubMedDate not supplied

Population-based growth stunting.

Growth stunting, defined as height for age below the fifth percentile on a reference growth curve, is traditionally used as an indicator of nutritional status in children. Growth stunting is a population-based indicator and can indicate the prevalence of malnutrition or nutrition-related disorders among an identified population of children. Among certain segments of the U.S. child population, most notably poor children, growth stunting occurs more often than expected, suggesting that inadequate nutrition may be a problem for these children. Available general population data are not recent enough to allow for an assessment of the impact of several major public programs designed to address the risk of inadequate nutrition among children. Analysis of data from these programs does show, however, a higher-than-expected-albeit-declining level of stunting among program participants. The serious consequences of growth stunting and malnutrition-particularly impaired cognitive development-suggest that careful consideration of the growth stunting indicator should remain an important part of policy discussions on public nutrition programs.

Adolescent↗
PubMed1996

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↗
PubMed1989

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↗
PubMed1978

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↗
PubMedDate not supplied

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↗
PubMed1994

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↗
PubMed1995

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↗
PubMed1997

Visual BLAST and visual FASTA: graphic workbenches for interactive analysis of full BLAST and FASTA outputs under MICROSOFT WINDOWS 95/NT.

MOTIVATION: When routinely analysing protein sequences, detailed analysis of database search results made with BLAST and FASTA becomes exceedingly time consuming and tedious work, as the resultant file may contain a list of hundreds of potential homologies. The interpretation of these results is usually carried out with a text editor which is not a convenient tool for this analysis. In addition, the format of data within BLAST and FASTA output files makes them difficult to read. RESULTS: To facilitate and accelerate this analysis, we present for the first time, two easy-to-use programs designed for interactive analysis of full BLAST and FASTA output files containing protein sequence alignments. The programs, Visual BLAST and Visual FASTA, run under Microsoft Windows 95 or NT systems. They are based on the same intuitive graphical user interface (GUI) with extensive viewing, searching, editing, printing and multithreading capabilities. These programs improve the browsing of BLAST/FASTA results by offering a more convenient presentation of these results. They also implement on a computer several analytical tools which automate a manual methodology used for detailed analysis of BLAST and FASTA outputs. These tools include a pairwise sequence alignment viewer, a Hydrophobic Cluster Analysis plot alignment viewer and a tool displaying a graphical map of all database sequences aligned with the query sequence. In addition. Visual Blast includes tools for multiple sequence alignment analysis (with an amino acid patterns search engine), and Visual FASTA provides a GUI to the FASTA program.

Amino Acid Sequence↗
PubMed1994

Interdisciplinary team training in geriatrics: reaching out to small and medium-size communities.

Since 1989, six teams in the state of Michigan have been involved in a team training program designed to promote the development of geriatric services in small to medium-size communities. The program was enthusiastically received by participants, but after 18 months, only half of the teams had implemented clinical services for older adults. Monitoring the progress of the teams over 18 months and analyzing the activities of two teams revealed that financially stable and supportive sponsoring agencies and the community were critical factors in the implementation of interdisciplinary clinical services in geriatrics. Future team training programs trying to promote the development of geriatric services in small to medium-size communities should try to address these issues through community organization interventions.

Community Participation↗
PubMed1985

United Kingdom Heart Disease Prevention Project: 12-year follow-up of risk factors.

Ten of the original 24 factories from the United Kingdom Heart Disease Prevention Project were resurveyed in 1983 to assess the long-term (12-year) effects of an education program on diet, smoking, and exercise. These 10 factories had previously been grouped into five pairs matched for size, location, and nature of industry, with one of each pair randomly chosen for intervention. Men in intervention factories were given advice on reduction of cholesterol in diet, stopping smoking, weight reduction, and regular exercise. High-risk workers (13%) received personal counseling in addition to the factory-wide education program. A total of 1,204 workers randomly selected from those still employed in 1978 were surveyed. There were significant differences observed in cigarette consumption, butter use, and several other dietary behaviors; however, the differences were small and insignificant for the proportion smoking and leisure-time exercise. The largest effects were in the high-risk group who had received personal counseling. This education program appears to have some lasting effects on behavior associated with coronary disease risk factors. Similarly designed programs may serve as models for community-wide coronary disease prevention programs.

Adult↗
PubMed1996

Outcome measures of a chronic pain program: a prospective statistical study.

OBJECTIVE: To provide outcome data measuring objective and subjective variables of an individualized, multidisciplinary, comprehensive pain management program. DESIGN: The study is a prospective evaluation of 50 consecutive patients who completed the pain management program. Objective measures were medication use and return to work. Subjective measures included self-reports of pain levels and completion of a Personal Concerns and Goals Assessment (PCGA) examining issues of lifestyle and emotional well-being. These measures were compared at program onset and completion by using appropriate statistical analyses. RESULTS: Objective measures: Medication use by the study subjects decreased overall by 72% within all drug categories. Opioid use was eliminated. Regarding return to work, the study subjects increased their work hours by twofold overall. Of patients working fewer than 30 h per week at program onset, representing 62% of the study population, a fivefold return to work was observed. Subjective measures: Overall pain levels improved by 33%, with an 18 to 47% improvement in all descriptors (average pain levels on good or bad days, average number of good or bad days). Of the PCGA factors, patients improved 24 to 46% in all categories concerning lifestyle and emotional well-being. Correlative analysis of the data produced prognostic information as well as insights into chronic pain development. CONCLUSIONS: This study of objective and subjective outcome measures demonstrates that a comprehensive program employing specific principles and methods produces an effective approach for the management of chronic pain. Patients disabled by chronic pain regain a quality of life that allows them to resume a functioning, productive role.

Adolescent↗
PubMed1989

Alcohol and drug abuse prevention in Wisconsin public schools.

This survey assessed the status of Wisconsin public school district programs designed to prevent alcohol and other drug related problems among students. The assessment involved surveying prevention program directors of 102 school districts that received grants for prevention initiatives since 1981. Most districts (70%) implemented programs at the elementary, middle, and senior high school levels. Typical program strategies involved combining information dissemination with refusal skill and self-concept development. School programs predominantly were school-based and did not systematically involve community members or agencies. The greatest obstacles to providing effective prevention services include high rates of alcohol and other drug use in homes and communities, denial of alcohol and other drug related problems among students, parents, and community members, and lack of staff time for prevention activities. Project directors indicated a need for schools to initiate greater involvement of parents, nonschool alcohol and drug abuse prevention agencies, and other community organizations in school efforts.

Adolescent↗
PubMedDate not supplied

Community-based exercise intervention: Zuni Diabetes Project.

Non-insulin-dependent diabetes mellitus (NIDDM) is a serious health problem among the Zuni Indians of New Mexico. In July 1983, Indian Health Service personnel initiated a community-based exercise program designed to help control NIDDM in the community. To retrospectively evaluate the effects of the exercise program, the medical records of 30 participants with NIDDM were compared with the medical records of 56 nonparticipants with NIDDM matched by age, sex, health-care provider, and duration of NIDDM. From 1 July 1983 through 1 October 1985, participants had a mean weight loss of 4 kg, whereas nonparticipants had a mean weight loss of 0.9 kg (P less than .05). Participants' fasting blood glucose values dropped by a mean of 43 mg/dl, compared to a mean drop of 2 mg/dl among the nonparticipants (P less than .05). Participants were significantly more likely than nonparticipants to have stopped their hypoglycemic medication (relative risk 4.2) and to have decreased their medication dosage (relative risk 2.2). These results suggest that participation in a community-based exercise program can produce significant weight loss and improvement in glycemic control among a group of Native Americans with NIDDM.

Adolescent↗
PubMed1980

Utility of electromyographic biological feedback in chronic stuttering: a clinical study with follow-up.

A systematic case study is presented in which eight chronic adult stutterers underwent an electromyographic (EMG) biological feedback training program designed to reduce masseter muscle tension in an effort to improve fluency. All subjects mastered the program within 10 30-min. sessions. Measures of muscle tension and fluency indicated improvement at the end of treatment that were maintained at 3- to 6-mo. follow-up.

Adult↗
PubMed1992

SILMUT: a computer program for the identification of regions suitable for silent mutagenesis to introduce restriction enzyme recognition sequences.

We describe a set of IBM-compatible computer programs designed to selectively identify the potential sites for silent mutagenesis within a target DNA sequence. This program is based on a novel strategy of identifying amino acid motifs compatible with each restriction site (BioTechniques 12:382-384, 1991). The programs can be used to identify the suitability for the introduction of any 6-base nucleic acid sequences, such as restriction enzyme sites in cassette mutagenesis strategies. The Table program generates a table of multiple amino acid motifs for each restriction enzyme, obtained by translating each unique recognition sequence in all three reading frames. The Silmut program, which utilizes the features of Table, will further identify the presence of a match between any amino acid motif of each restriction enzyme and the input target sequence. Minor manipulations of the data base files will enable the individual researcher to identify the potential for introduction of any 6-base sequences by silent mutagenesis.

Base Sequence↗
PubMed1988

[Birth in the rural area: an evaluation of prevention of perinatal risk in rural areas].

A study was designed and implemented between 1983 and 1985 in order to evaluate the effectiveness of a personalized health education program designed for pregnant women in the specific context of rural areas. The action succeeded in increasing the proportion of women benefiting from a monthly antenatal surveillance but many other results underline the limitations of such prevention programs that would be restricted to the information of the general public and health professionals. Perinatal morbidity in the north-alpine rural area ranks very favourably compared to the regional or national figures.

Evaluation Studies as Topic↗