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Developing a comprehensive, community-based asthma education and training program.

The Community Asthma Prevention Program (CAPP) is a comprehensive, community-based asthma education and training program focused on the prevention of asthma exacerbations in the pediatric/adolescent population. Details of starting a community-based education program are described. The asthma class series is taught for 5 hours, delivered in 1-hour sessions once each week. Programs are held in schools, daycare centers, churches, and community centers. Classes are conducted simultaneously in separate rooms with parents being taught by a health educator and children taught by a peer educator. To date, 774 parents and 570 children have completed the community classes. The retention rate of participants who complete the 5-week program is 80%. The train-the-trainer model is used for training community members such as parents, teens, school nurses, daycare providers, and foster care workers to provide the community with many members who are trained in asthma education. Strategies used to obtain support and promote program visibility and use in the targeted community are presented.

Adolescent↗

Psychomotor disturbances in psychiatric patients as a possible basis for new attempts at differential diagnosis and therapy. V. Evaluation of psychomotor training programs in depressed patients.

Parts I-III of this series used psychometric assessment of motor performance in psychiatric patients and indicated a "psychotic-motor syndrome" (PMS) in schizophrenic and affective psychoses, which was not found in "neurotic"/reactive or healthy persons. Part IV yielded signs of concomitant brain dysfunction in these patients, demonstrated by EEG mapping as well as other (SPECT/PET) neuroimaging methods. Apart from this "basic science" interest into the pathophysiology of endogenous psychoses we engaged in the development of motor training programs using the PMS as "target" syndrome. We hypothesized, that motor training would not only improve disturbed motor behaviour, but ameliorate other symptoms of psychopathology also. These assumptions were supported in the first two independent studies involving n = 45 and n = 31 ICD-9 mono- and/or bipolar endogenous depressed patients, respectively (the studies on schizophrenic patients being reported finally as part VI of this series, along with the final version of our modified motor test battery). Examples of the motor training programs are provided in this paper, although the final version of the complete programs will be published separately for space reasons and for better availability for routine clinical use.

Adult↗

Alberta's suicide prevention training programs: a retrospective comparison with Rothman's developmental research model.

Developmental research is used to transform existing knowledge into applied programs. A social research and development (R&D) method, developed by Rothman for the human service professions, is compared with the method used to develop the Suicide Prevention Training Programs in Alberta, Canada. A retrospective review compares the development of these programs, which have since been implemented both nationally and internationally, with Rothman's model; discusses social R&D as a transformation methodology; and draws conclusions about the probable success of using developmental research methods in the human services. The review finds that the Alberta method closely paralleled the phases of Rothman's model. Results show that the transformation of knowledge about suicide into widely disseminated suicide prevention training programs can be attributed to the application of social R&D principles. The study concludes that the use of developmental research methods to establish human service programs should increase the probability of their success.

Alberta↗

Carbon dioxide monitoring in emergency medicine training programs.

OBJECTIVES: Although the measurement of carbon dioxide (CO2) in breath is the standard of care for verification of endotracheal tube placement in all anesthesia practice and in the prehospital setting, there is currently no uniform consensus on the status of CO2 monitoring in emergency medicine. We conducted this survey to delineate practice patterns of CO2 monitoring in academic emergency medicine training programs and to describe the preference for type of CO2 monitoring device. METHODS: We surveyed the availability, presence, and types of CO2 monitoring in all general emergency medicine (GEM) residency programs and all pediatric emergency medicine (PEM) fellowship programs. A two-question survey was used, and data were collected from March 1998 to June 1998. The clinicians surveyed were asked whether their emergency department (ED) used CO2 monitoring for detection of endotracheal tube placement and, if so, what type of CO2 monitoring devices was used. Types of CO2 monitoring devices were categorized as colorimetric, capnometric, capnographic, or combinations of these. RESULTS: Of the 168 programs surveyed, all GEM and PEM programs responded, and the survey results showed that 136 of 168 (81%) used some form of CO2 monitoring, and 32 of 168 (19%) did not use CO2 monitoring. The majority of programs (115/168, 68%) used a single device. Colorimetric devices were used most frequently (76/168, 45%), and capnometry was used the least (9/168, 5%). PEM programs had a significant preference for quantitative CO2 monitoring, whereas GEM programs had a significant preference for qualitative CO2 monitoring. CONCLUSIONS: Although the majority of academic emergency medicine training programs used CO2 monitoring, 19% did not. Colorimetric devices were the most frequently used CO2 monitoring technology.

Carbon Dioxide↗

Preemployment multiphasic screening in an urban manpower training program.

Preemployment health examinations have long occupied a central role in industrial medicine, providing company physicians with baseline health status and physical limitations for each employee. We evaluated a similar multiphasic screening examination in 662 young, minority applicants to an urban manpower training program. Resulting from this screening was a substantial number of patients with positive serology (1%), positive gonorrhea cultures (3%), excessive daily ethanol ingestion associated with liver enlargement (13%), decreased visual acuity (24%) and dental caries (23%). These findings are markedly different than those reported for preemployment screening in industry, suggesting the need for a specific health screening protocol for applicants to manpower training programs.

Adult↗

Usefulness of a tilt training program for the prevention of refractory neurocardiogenic syncope in adolescents: A controlled study.

BACKGROUND: Recurrent syncope represents a debilitating disorder and quality of life deteriorates as a function of recurrence of symptoms. Although the administration of beta-blockers, vasoconstrictors, fludrocortisone, and serotonin reuptake inhibitors may be helpful in preventing episodes, many patients are intolerant of or respond poorly to these agents. Orthostatic training has been reported to be effective in preventing refractory syncope. Thus, to determine whether a tilt training program could prevent symptoms in adolescents, the following controlled study was undertaken. METHODS AND RESULTS: Forty-seven consecutive adolescents (18 male and 29 female, mean age 16.0+/-2.2 years) with recurrent syncope and positive head-up tilt test refractory to previous traditional therapies were distributed between 2 groups, depending on their consent (24 patients) or refusal (controls, 23 patients) to enter the program. Orthostatic training was started, in the presence of a family member, with a series of 5 in-hospital sessions. The 24 patients and their relatives were then instructed to perform the tilt training at home by standing against a wall twice a day for a planned duration of up to 40 minutes, depending on the in-hospital orthostatic tolerance. Head-up tilt response was reevaluated after 1 month, and the clinical effect was noted over a mean follow-up of 18. 2+/-5.3 months (range 15 to 23); 26.1% of patients in the control group and 95.8% of patients in the training group became tilt-negative (P<0.0001). Spontaneous syncope was observed in 56.5% versus 0% in the control and training group, respectively (P<0.0001). CONCLUSIONS: Orthostatic training was found to significantly improve symptoms of adolescents with neurocardiogenic syncope unresponsive to or intolerant of traditional medications. Twice-a-day training sessions of 40 minutes were well accepted by patients.

Adolescent↗

[A study of leadership training program demands of first-line nurse managers in university hospitals].

There is an important concern regarding the First-line nurse manager's leadership because of the recognition that effectiveness of Leadership in this position results in benefits for the whole health care organization. So knowledge and practice of effective leadership behavior are now more essential to nursing than ever before. First-line Nurse Managers must be effective leaders to meet today's challenge because staff nurse, patient are affected by them. So the purpose of this study was to identify and to analyse the need for Leadership program of First Line nurse managers in university hospitals. There were three major purposes of this study. First, identify First-line nurse managers general characteristic, second, identify their experience of leadership training, third, identify and analysis their demands for leadership training program. The subjects for this study was 167 First-line nurse manager randomly from 18 university hospitals in Korea. The data were collected through questionnaires from Oct. 13th to Nov. 20th, 1997, data was analysed using frequencies and percentages. Especially the steps of analysis of descriptions were as follows: Initial analysis centered on the identification of the demands of first-line nurse managers. Later analysis collapsed the demands into broad categories. From the collect data, 283 demands of first-line nurse managers were identified. These demands were then sorted into 3 broad categories that included: Self development as first-line nurse managers, relationship with others, and practice The result of the study were as follows: 1) Most of nurse managers (79.6%) had leadership training course and had good experience to improve self leadership. 2) Their demands of leadership training course are as follows: First, for self as first-line nurse managers, they want to learn leadership theory, identify their leadership style and then develop their leadership skill. Second, for others as first-line nurse managers, they want to improve their communication skill, empowering others, relationship with others. Third, for patients as first-line nurse managers, improve their knowledge of practice. From the above finding, this study can be suggested the following: 1. Develop a leadership training course to improve first-line nurse manager's leadership skill according to their demands, so they will be better able to lead staff nurses for organization purposes. 2. When develop leadership training program, it must be contained the factors which first-line nurse managers want to learn.

Curriculum↗

[Occupational health services to assist workers' health promotion based on a participatory training program of staff members for public health centers].

Work-related health problems among employees of small-scale enterprises and un-employed workers are still serious in Japan. Occupational health services related to their working conditions and environment are limited and more provison needs to be made. Our participatory training program is aimed at allowing staff members of public health centers to provide occupational health services and assist workers' health promotion. In this program, participants examine occupational risk factors affecting workers' health problems with ergonomic check-lists and discuss potential improvements in the workplace. Participants experience practical visits to small-scale enterprises in their communities and the resultant occupational health services are discussed and evaluated at the final step in this program. The essential feature of successful case was that the public health center had coordinated community resources and occupational health services with ergonomic check-lists accepted by small-scale enterprises. This participatory training program is effective from the viewpoint of evaluating occupational risk factors affecting workers' health problems and proposing improvements in the workplace. In order to optimally provide occupational health services for the employees of small-scale enterprises and un-employed workers, the community resources including health facilities and the parties concerned must be organized and utilized effectively.

Education↗

A survey of pediatric resident training programs 5 years after the Task Force report.

Twenty-nine pediatric residency training programs responded to a survey with detailed descriptions of the scheduled rotations before and after the Report of the Task Force on Pediatric Education. This survey documented some changes in the overall structure of residency programming in that all programs demand 3 years of general pediatric training. Little if any changes were noted in the traditional emphasis on inpatient and neonatal training. Some changes in content area have been noted, namely a modest increase in the experiences in adolescent medicine. The survey failed to demonstrate any trend indicating increased emphasis on training experiences in the "new morbidity."

Curriculum↗

[Computer-assisted training programs in aphasia therapy].

This article shows how aphasic patients can use computer-aided training programs that enable them to train the language more or less independently apart from speech therapy. The computer offers help or feedback the moment it is asked for. The patient evaluates this as a mature method of therapy.

Aged↗

Effect of endurance training program based on anaerobic threshold (AT) for lower limb amputees.

We have already reported that the one-leg cycling test driven by the subject's sound leg as the exercise load test is effective in measuring the anaerobic threshold (AT) of unilateral lower limb amputees. The aim of this research is to investigate whether or not endurance training based on each subject's AT gained from the one-leg cycling test is useful in improving the physical fitness of lower limb amputees. The test subjects were all unilateral transfemoral amputees comprising a group of 14 undertaking endurance training and a control group of 10. The form of endurance training is driving an ergometer with the sound limb only in the same way as the load test. The training program was designed so that the subjects would exercise at a target heart rate corresponding to AT point for 30 minutes per day, 3-5 days each week for 6 weeks. After the training periods, in the training subjects the AT and maximum oxygen uptake (__O2max) increased significantly. The rate of increase averaged 36.5%, 26.0%, respectively, compared to their levels before the training. On the contrary, no changes occurred in the control subjects. These results suggest that our chosen training program based on each subject's AT is effective in improving the physical fitness of lower limb amputees.

Adult↗

Evaluation of a training program intended to calibrate examiners of temporomandibular disorders.

The adequacy of a training program intended to calibrate examiners of temporomandibular disorders (TMD) was evaluated. Eight examiners blindly rated 12 subjects with various TMD signs and symptoms after participating in a 5-h intense training procedure. Some examiners had earlier experience of TMD examinations, and some were newly trained. The Craniomandibular Index was used as the assessment instrument. Agreement within the whole group of examiners was low. Training tended to increase the probability of correctly registering signs. It is concluded that the program was not sufficient to create reliability among multiple examiners. More extensive training, not only to a standard but also between the different examiners, appears necessary. Revision of the examination technique is suggested, and recommendations for strengthening the calibration procedures are made.

Adult↗

Resident research in internal medicine training programs.

OBJECTIVE: To determine how well medical residency programs are prepared to meet the new Accreditation Council of Graduate Medical Education (ACGME) accreditation guidelines for resident scholarly activity. DESIGN: Cross-sectional study using a mailed survey. PARTICIPANTS: Program directors of all ACGME-accredited internal medicine residency programs. MEASUREMENTS: Program directors were asked to list the scholarly activities and products of their residents and their programs' minimal expectations for resident research; available academic, faculty, technical, and personnel support for resident research; perceived barriers to resident research; and the desired educational and skill outcomes of resident research. The responses of university-based training programs were compared with those of non-university-based programs. RESULTS: 271 program directors returned the survey, yielding a response rate of 65%. Ninety-seven percent of all programs have established scholarly guidelines consistent with accreditation requirements. Although only 37% of programs reported having an organized, comprehensive research curriculum, 70% taught skills important to research. Technical support and resources were generally available for resident research; the most frequently cited barrier to resident research was lack of resident time. University-based and non-university-based training programs differed in important ways. Generally, non-university-based programs had more research activity and structure, and they exceeded university-based programs in the number of oral and poster presentations given at local, state, and national professional meetings. CONCLUSIONS: Most programs have in place the basic elements conducive to resident research. Program directors have identified and teach educational outcomes and skills that are likely to have lifelong benefits for most of their graduates.

Accreditation↗

Measuring surgical skill and proclivity in ophthalmology residency training program applicants using the American Dental Association Dental Admission (Sample) Test (DAT).

PURPOSE: To determine if typical DAT perceptual ability questions which are used to determine potential surgical skills in dental school applicants also do so for surgical ability for eye surgery. METHOD: The subjects were all applicants for admission into the Ophthalmology Residency Training Program at the University of Florida. All applicants answered 11 questions from the "Perceptual Ability" section of the DAT. Their answers were neither reviewed nor scored at the time they took the test but were sealed and set aside. After completing the 3 year training program, each of fifteen consecutive trainees was scored by five masked faculty members for their surgical skill. Their tests were unsealed and scored. Data were obtained on 15 applicants. RESULTS: There was a [Good] positive correlation between masked faculty surgical skill scores and DAT scores: r= +0.58, p < or -0.02. CONCLUSION: DAT perceptual ability questions do indicate candidates with best innate and potential eye surgical skills.

American Dental Association↗

An analysis of the physical punishment component of a parent training program.

One component of a well-researched, standardized parent training program is to spank children for escape from time-out. The contribution of the spanking component to compliance acquisition in a clinic analog setting was evaluated. Time-out duration and child disruption at time-out release were balanced across spank and no-spank ("barrier") conditions. Sixteen noncompliant, clinic-referred pre-school children participated. The data indicated that both spank and barrier procedures were equally effective at increasing compliance ratios. Physical punishment did not appear to be a critical component. Given prior research, it was concluded that the enforcement of a minimum time-out duration is critical for compliance acquisition within the analog setting.

Behavior Therapy↗

Increase in hand-alcohol consumption among medical staff in a general hospital as a result of introducing a training program and a visualization test.

To assess the impact of training programs, including a visualization test for hand disinfection, we monitored the hand-alcohol consumption of medical staff. The consumption increased steadily from 5.7 L of hand alcohol per capita per year in 1990 to 9.1 L in 1998. There was no significant increase in skin problems.

Anti-Infective Agents, Local↗

Reference equations used to predict pulmonary function. Survey at institutions with respiratory disease training programs in the United States and Canada.

Adult respiratory disease training programs in the United States and Canada were surveyed to determine which reference equations were used to predict normal pulmonary function and how ethnic differences were approached. Replies from 139 of the 180 (77.2 percent) institutions surveyed were received and evaluated. Surprisingly few studies account for most of the equations in use: three studies account for 85 percent of the spirometric equations, two for 83 percent of the lung volume equations and five for 84 percent of the diffusing capacity equations. Although there are no definite data, the form of many of the replies suggests that equipment default settings may influence the selection process. Of those responding to the ethnic difference question, 53 percent of institutions applied no correction for ethnic differences. There was no consistent pattern to the method of correction among those who did.

Canada↗