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At least 433 records · Page 24Linked to original sources

Expanding the range of therapies for acute ischemic stroke: the early experience of the Regional Stroke Center at Hartford Hospital.

PURPOSE: Three to four percent of all patients with acute ischemic stroke (AIS) receive the only FDA-approved therapy, intravenous tissue plasminogen activator. We sought to assess the impact of a regional stroke program, the Stroke Center at Hartford Hospital, in facilitating various therapies for patients with AIS, and their early outcomes. METHODS: For a 34-month period (May 2001 to February, 2004), 113 patients received either i.v. and/or intra-arterial thrombolysis, or an experimental protocol as a therapy for AIS. The Hartford Hospital and Stroke Center databases were queried for the diagnosis of AIS using ICD-9 codes, site of patient presentation, transportation modality, stroke severity, and clinical outcome. RESULTS: The percentage of patients with AIS treated has increased each of the past five fiscal years, to 15.4% for fiscal year 2004 to date. This growth is paralleled by increases in mean annual stroke severity of all stroke patients admitted to Hartford Hospital and in the numbers of patients transferred with AIS from other hospitals in southern New England. Symptomatic hemorrhage rate for the 113 patients was 5.3%. In-hospital mortality rate was 25.7%. Most patients (56.6%) were discharged from Hartford Hospital either to home or to acute rehabilitation. CONCLUSIONS: A regional stroke program greatly facilitated acute stroke treatment interventions. We attribute this growth to widespread educational programming, an Acute Stroke Team, catheter-based therapies with a dedicated Interventional Neuroradiology service, a 1800 Acute Stroke Hotline, and clinical trials.

Algorithms↗

HIV disease: educational needs of Oregon family physicians.

Questionnaires were sent to 200 Oregon family physicians to assess their attitudes and educational needs concerning human immunodeficiency virus (HIV) related conditions. Completed questionnaires were returned by 160 (80%). Fifty-one percent had already managed patients with HIV disease or AIDS. Seventy-three percent indicated that HIV would have an effect on their future practice. Physicians were least comfortable in management areas concerning direct medical skills and most comfortable with counseling and behavioral science issues. Physicians were more likely to participate in "hotline consults," one-day regional workshops, and written protocols than in more high-tech, time-consuming methods of continuing medical education.

Attitude of Health Personnel↗

Management of sexually abused children by non-forensic sexual abuse examiners.

Physicians who do not intend to examine children suspected of having been sexually abused still need information about the disorder and its management. A history from the caretaker and child is vital to determine the safety of the child from further abuse and the urgency of a physical evaluation for health and forensic purposes. The disclosure interview of a young child in Arkansas generally should be by an agency investigator to avoid multiple interviews, after a legally mandated report to the Child Abuse Hotline. The physical evaluation can be delayed when the conditions listed in the Table are met, and a referral to a secondary or tertiary level examiner would follow. Otherwise, immediate referral likely will be to a primary level examiner, such as in an emergency department; the child will receive an examination and tests for acute findings and possible referral to a secondary or tertiary level examiner for a more thorough examination. The child and frequently an adult family member should be referred for counseling.

Child↗

How many illnesses does one emergency department visit represent? Using a population-based telephone survey to estimate the syndromic multiplier.

INTRODUCTION: Syndromic surveillance monitors trends in nonspecific health indicator data to detect disease outbreaks in a timely manner; however, only a limited percentage of persons with mild illness might exhibit behaviors that could be detected by syndromic surveillance. OBJECTIVES: The objectives of this study were to 1) examine the demographic characteristics of New Yorkers with recent flu-like or diarrheal illness, 2) describe behaviors associated with having flu-like illness, and 3) estimate the citywide burden for selected illnesses by calculating the syndromic multiplier (i.e., the number of citywide illnesses represented by each visit to an emergency department [ED]). METHODS: A cross-sectional telephone survey of 2,433 adult residents of New York City (NYC) was conducted during March 19-March 31, 2003, and October 27-November 23, 2003. Respondents were asked about flu-like illness, behaviors related to flu-like illness, and diarrheal illness during the 30 days before the interview. Estimated numbers of citywide illnesses were compared with ED visits for flu-like and diarrheal illnesses that were recorded by the NYC syndromic surveillance system for the same periods. RESULTS: Every ED visit for flu-like illness represented approximately 60 illnesses among city residents; every visit for diarrheal illness represented approximately 251 illnesses. Among adults who reported a recent flu-like illness, 53.2% purchased over-the-counter (OTC) medications; 32.6% reported missing school or work; 29.1% visited a physician; 21.4% called a physician for advice; 8.8% visited an ED; and 3.8% called a nurse or health hotline for advice. Of those who reported multiple behaviors, respondents most commonly reported purchasing OTC medications as their first response to a flu-like illness. CONCLUSIONS: Population-based survey data can be used in conjunction with syndromic surveillance data to better understand the relation between nonspecific health indicators and the burden of certain illnesses in the community, and to assess the representativeness of different syndromic data sources.

Adult↗

The "drip-and-ship" approach: starting IV t-PA for acute ischemic stroke at outside hospitals prior to transfer to a regional stroke center.

PURPOSE: Acute stroke therapy with intravenous (IV) tissue plasminogen activator (t-PA) is vastly underutilized. Increasingly, patients are being started on IV t-PA and being transferred to regional Stroke Center programs, where additional therapies can be offered in a multimodal format. We describe our experience at the Stroke Center at Hartford Hospital with interhospital patient transfers who received IV t-PA prior to transfer to our medical center. METHODS: A retrospective analysis of our Acute Stroke Therapies database was undertaken, encompassing the intial four-year period of our Stroke Center program (May 1, 2001 to April 30, 2005). We evaluated the patient characteristics, clinical outcomes, and adjunctive therapies of patients who were started on IV t-PA at referring hospitals prior to their emergent transfer to our Stroke Center. RESULTS: From a total of 229 patients who received IV and/or IA thrombolysis and newer catheter-delivered devices or clinical trials at our Stroke Center, a total of 33 (14.4%) were started on IV t-PA at an outside hospital prior to transfer. Symptomatic hemorrhage occurred in one of the 33 patients (3.0%), and in-hospital mortality rate for these patients was 6.1%. A total of 26 patients (78.8%) had a positive outcome in that they were discharged either to home or to acute rehabilitation. CONCLUSIONS: Use of IV t-PA in a "drip-and-ship" approach is growing at the regional Stroke Center at Hartford Hospital. This protocol is safe and offers several advances for the care of patients with AIS: (a) empowering emergency physicians and neurologists at outside hospitals, via access to a 24/7 Acute Stroke Hotline, to treat patients with AIS; (b) facilitating the early initiation of IV t-PA; and (c) offering adjunctive therapeutic approaches, following arrival at our facility, for patients not sufficiently improving with IV t-PA alone.

Acute Disease↗

'Make a move' falls prevention project: an area health service collaboration.

ISSUE ADDRESSED: Since a lack of physical activity is a risk factor for falling, effective interventions to increase participation rates among older people need to be found. This project assessed the viability of a metropolitan Area Health Service collaboration to increase physical activity rates among older people. METHODS: A collaboration involving six Area Health Services in the Sydney metropolitan area, central coast of New South Wales (NSW), and NSW Department of Health was established. Interventions included a communication strategy to raise awareness of the benefits of physical activity for preventing falls and enhancement of local physical activity programs for older people. A repeated measures cross-sectional design was used to assess increases in physical activity programs and older people's participation, and data of fall-related hospital admissions were examined. Annual activity logs were completed to track local project activities. Semi-structured interviews with key stakeholders and workshops were used to review the collaborative management model. RESULTS: Response to the communication strategy and gains in physical activity programs for older people varied among Area Health Services. Overall, approximately 2,929 people called the campaign inquiry hotlines in response to the media campaign, Area Health Service-supported exercise programs for older people increased by 19%, participation rates increased by 16%, and fall-related hospital admissions were observed to plateau. The collaborative management model used was somewhat effective, but had difficulties for the issue being addressed. CONCLUSION: 'Make a Move' added value to local physical activity programs for older people and increased the number of older people participating in Area Health Service-supported exercise programs. Collaborative projects are worthwhile if they address the right issue, involve the right partners and have sound management processes.

Accidental Falls↗

Current approaches to prevention of HIV infections.

The HIV education and prevention strategy of the Centers for Disease Control has three principal components: (a) public information and education, (b) education for school-aged populations, and (c) risk reduction education and individual counseling and testing services for people at increased risk of HIV infection. The most visible components of the public information and education programs are the National Public Information Campaign ("America Responds to AIDS"), the National AIDS Hotline system, and the National AIDS Information Clearinghouse. Components of the youth education program consist of funding for national health and education organizations, funding for State and local education departments, training, surveillance of education efforts, and evaluation. Counseling and testing has entailed performance of approximately 2,500,000 HIV antibody tests with pre- and post-test counseling, notification and counseling of sexual and needle-sharing partners of those infected with HIV, and targeted risk reduction education through community-based organizations. Over time, these activities will continue to evolve and become more effective.

Adolescent↗

A local area network for medical research; planning, realization and experience.

This report focuses on the planning and realization of an interdisciplinary local area network (LAN) for medical research at the University of Heidelberg. After a detailed requirements analysis, several networks were evaluated by means of a test installation, and a cost-performance analysis was carried out. At present, the LAN connects 45 (IBM-compatible) PCs, several heterogeneous mainframes (IBM, DEC and Siemens) and provides access to the public X.25 network and to wide-area networks for research (EARN, BITNET). The network supports application software that is frequently needed in medical research (word processing, statistics, graphics, literature databases and services, etc.). Compliance with existing "official" (e.g., IEEE 802.3) and "de facto" standards (e.g., PostScript) was considered to be extremely important for the selection of both hardware and software. Customized programs were developed to improve access control, user interface and on-line help. Wide acceptance of the LAN was achieved through extensive education and maintenance facilities, e.g., teaching courses, customized manuals and a hotline service. Since requirements of clinical routine differ substantially from medical research needs, two separate networks (with a gateway in between) are proposed as a solution to optimally satisfy the users' demands.

Costs and Cost Analysis↗

Poison control centers: can their value be measured?

Most regions of the United States are served by poison control centers that provide 24-hour toxicologic guidance resulting in the home management of most poison exposures. It has been suggested that without public access to a poison control hotline the majority of poison-exposed patients would seek medical care in emergency departments or other outpatient visits. This study compares the patterns of community response to poison exposure in Louisiana before and after the discontinuance of the state poison control service, and also compares these patterns to the situation in Alabama, which maintained poison center services throughout the study period. After discontinuance of the poison control service in Louisiana, poison exposure cases had up to four times the rate of "self-referral" to health care facilities and less than half the rate of home management when compared to Alabama cases. Before the closing of the Louisiana center, Alabama and Louisiana triage patterns for poison exposures were nearly identical. The maximum annual cost attributable to unnecessary outpatient service utilization in Louisiana was estimated to be $1.4 million, an amount more than three times the annual poison control center state appropriation.

Alabama↗

Recommendations for the prevention of malaria among travelers.

Recommendations for the prevention of malaria among travelers have been developed by CDC in consultation with representatives from the Offices of Medical Services of the Department of State and the Peace Corps; the Division of Experimental Therapeutics of the Walter Reed Army Institute of Research; the Office of the Surgeon General, U.S. Army; the Office of the Surgeon General, U.S. Air Force; and the Bureau of Medicine and Surgery, U.S. Navy. Resistance of Plasmodium falciparum to chloroquine has spread to most areas with malaria. Alternative drugs to chloroquine are either associated with adverse reactions, are of limited efficacy, or require complex and detailed instructions for use that reduce compliance. These factors have contributed to a threefold increase in the number of reported P. falciparum infections among U.S. travelers to malarious areas since 1980. A new drug, mefloquine (Lariam), is expected to be highly effective against both chloroquine-resistant and Fansidar-resistant P. falciparum infections. Mefloquine is now recommended as the drug of choice for travelers at risk of infection with chloroquine-resistant P. falciparum. Alternative drugs for travelers who cannot take mefloquine include 1) doxycycline alone or 2) chloroquine alone, with Fansidar available for standby treatment while medical care is sought for evaluation of febrile illness when travelers are in a malarious area. Prospective travelers and health-care providers are advised to call the CDC Malaria Hotline at (404) 332-4555 for detailed recommendations for the prevention of malaria.

Adult↗

From the Centers for Disease Control. Recommendations for the prevention of malaria among travelers.

Recommendations for the prevention of malaria among travelers have been developed by CDC in consultation with representatives from the Offices of Medical Services of the Department of State and the Peace Corps; the Division of Experimental Therapeutics of the Walter Reed Army Institute of Research; the Office of the Surgeon General, U.S. Army; the Office of the Surgeon General, U.S. Air Force; and the Bureau of Medicine and Surgery, U.S. Navy. Resistance of Plasmodium falciparum to chloroquine has spread to most areas with malaria. Alternative drugs to chloroquine are either associated with adverse reactions, are of limited efficacy, or require complex and detailed instructions for use that reduce compliance. These factors have contributed to a threefold increase in the number of reported P. falciparum infections among U.S. travelers to malarious areas since 1980. A new drug, mefloquine (Lariam), is expected to be highly effective against both chloroquine-resistant and Fansidar-resistant P. falciparum infections. Mefloquine is now recommended as the drug of choice for travelers at risk of infection with chloroquine-resistant P. falciparum. Alternative drugs for travelers who cannot take mefloquine include 1) doxycycline alone or 2) chloroquine alone, with Fansidar available for standby treatment while medical care is sought for evaluation of febrile illness when travelers are in a malarious area. Prospective travelers and health-care providers are advised to call the CDC Malaria Hotline at (404) 332-4555 for detailed recommendations for the prevention of malaria.

Adult↗

Current CDC efforts to prevent and control human immunodeficiency virus infection and AIDS in the United States through information and education.

The human immunodeficiency virus (HIV) is estimated to have infected more than a million people in the United States and millions more in other countries. Even though there is no vaccine or effective treatment, HIV infection can be prevented through behavioral change. As the lead Public Health Service Agency for disease prevention, the Centers for Disease Control (CDC) has designed and implemented information and education activities with the ultimate goal of preventing HIV infection and AIDS in the United States. The target populations include the general public, school- and college-aged populations, persons infected or at increased risk of infection, minorities, and health workers. Because AIDS will be with us for a long time, CDC views educating the public as a long-term undertaking. The agency has initiated an intensive continuing national public information campaign, an informational brochure to be distributed to every U.S. household, a national AIDS information toll-free hotline, and a clearinghouse system that will maintain a comprehensive inventory of AIDS information resources and services. CDC also supports public information and education efforts by State and local health agencies. To reach school- and college-age youth, CDC, in consultation with governmental and national private sector organizations, developed guidelines for effective school health education to assist school health personnel in determining the scope and content of AIDS education. CDC also works with State and local education agencies to help carry out and evaluate educational efforts to prevent the spread of HIV among school- and college-age youth. The populations with the highest priority for AIDS information and education efforts are those who are at increased risk of acquiring or transmitting the AIDS virus because they use illicit intravenous drugs and share needles, engage in anal intercourse, have many sexual partners, practice prostitution, or engage in sex with those who practice these behaviors. Another high-priority population, because they can infect their offspring,is reproductive age women engaging in high-risk behavior and women infected with HIV who become pregnant. CDC programs targeted to these groups include community health education and risk reduction interventions, counseling and testing for HIV infection, AIDS community demonstration projects, perinatal AIDS prevention projects,and programs focused on preventing AIDS in minority populations. CDC is developing a variety of educational approaches for health workers in clinical settings because they are an important channel for providing accurate AIDS information, helping to assess risk, and counseling to actively reduce risk for the patient, sex partners of the patient, friends, and family members of the patient. CDC has conducted research and provided information and training on the use of HIV laboratory tests. CDC has also developed numerous scientific and technical guidelines and recommendations in consultation with practitioners, public health officials, and others and disseminated these through the Morbidity and Mortality Weekly Report. In addition,CDC has provided information about the risk of HIV transmission in the workplace and about methods of prevention. CDC will continue to evaluate these activities and support research in education and related interventions that may be necessary to prevent infection by the HIV virus. By providing educational support for behavior changes that decrease HIV transmission, we can contribute to AIDS prevention in the 1990s.

Acquired Immunodeficiency Syndrome↗

Cigarette advertising and black-white differences in brand preference.

Anecdotal evidence indicates that the cigarette industry is targeting the sale of specific brands, notably menthol cigarettes, to black consumers. This paper presents data on the types of cigarettes smoked by white and black smokers. The cigarette brand preferences of two populations of smokers were examined. The first comprised 70 white and 365 black adult smokers seen at the Deaconness Family Medicine Center located in Buffalo, NY. The second population included 1,070 white and 92 black smokers who called a Stop Smoking Hotline in Buffalo. The results showed that, in both populations, blacks were twice as likely to smoke mentholated cigarettes compared with whites. In an attempt to evaluate the targeting of cigarette ads to black smokers as a possible explanation for black-white differences in brand preferences, cigarette ads appearing in magazines targeted to predominantly white or black readers were compared. Cigarette ads appearing in seven magazines were reviewed, four directed to predominantly white readers (Newsweek, Time, People, Mademoiselle) and three with wide circulation among black audiences (Jet, Ebony, Essence). The results showed that the magazines targeted to black readers contained significantly more cigarette ads and more ads for menthol brand cigarettes than magazines similar in content but targeted to white readers. The observation that a higher percentage of blacks smoke menthol cigarettes than do whites is consistent with the findings regarding differences in the type of cigarette ads appearing in magazines intended for black or white readers. However, it is not possible to determine from this study whether cigarette advertising is the cause of the differences in preference of cigarette brands between white and black smokers. Future research focusing on understanding the reasons for cigarette brand preferences may provide ideas for anti smoking campaigns aimed at specific target groups.

Adolescent↗

Eating disorders and cocaine abuse: a survey of 259 cocaine abusers.

A structured clinical interview designed to diagnose eating disorders was administered to 259 consecutive callers to the National Cocaine Hotline who met DSM-III criteria for cocaine abuse. Thirty-two percent of those surveyed met DSM-III criteria for either anorexia nervosa, bulimia, or both disorders. The prevalence rates for each of these disorders in this sample appeared elevated even when narrow diagnostic criteria were applied. The data suggest that drug abusers should be screened carefully for the presence of an eating disorder and that abnormalities of eating behaviors seen among these individuals should not be attributed simply to drug use.

Adolescent↗

["Round the clock"--an information service for malignant hyperthermia emergencies].

A 24-hour 7-day telephone service has been created for emergency consultation: MH-hotline 030/3035504 (daytime) or 030/30351 (after office hours). In emergencies callers should ask for a consultant, indicating the code word "malignant hyperthermia" and give their name, the name of the institution and the telephone number.

Emergency Medical Service Communication Systems↗

The 1990 objectives for the nation for control of stress and violent behavior: progress report.

The control of stress and violent behavior is 1 of the 15 priority areas addressed in the Public Health Service's Objectives for the Nation. The National Institute of Mental Health, which provides a national focus for the Federal effort to increase knowledge of, and promote effective strategies dealing with, issues associated with mental illness and mental health, has been designated the lead Federal agency in this priority area. The authors summarize progress achieved and further activities planned with respect to 10 objectives for control of stress and violent behavior that have been selected for Federal implementation. The objectives for control of stress include improved public and professional awareness of community agencies that can provide professional services, hotlines, and mutual support groups. The objectives for control of violent behavior address three major problems: deaths from homicide among young black males, suicide among the young, and child abuse. Achievement of several of the objectives is currently impeded by lack of a valid data base. Efforts have been initiated, both by individual agencies and through collaboration among the various participating Public Health Service components, to develop valid and reliable baseline data and surveillance procedures.

Adolescent↗

Adolescent suicide: a response to developmental crisis.

Suicide is an increasing problem among adolescents. Developmental concerns and inability to resolve problems stemming from feelings of alienation are often at the core of an adolescent's suicide attempt. Nurses can be instrumental in primary prevention by educating the public about persons at risk for suicide, in helping parents deal more effectively with children's growth, and by supporting programs in the school system and other agencies that help young people communicate with others and resolve problems before they become crises. The nurse can also play an important role in secondary prevention through participation in or referral to hotline services, through intervention in the emergency service, or in community mental health programs or inpatient treatment programs. The psychiatric nurse specialist, in particular, can play a very significant role in the treatment of the adolescent in a suicidal crisis and also in consultation with other nurses and professionals who may assess suicidal risk in young people in the community. Finally, tertiary prevention may be necessary to help families and friends resolve their grief over the loss if a family member or close friend has succeeded at a suicide attempt. Feelings of guilt, anxiety, anger, and depression are usually present in the surviving family members of a successful suicide. They need to be given the opportunity to talk about the events leading up to the suicide, their feelings about the persons involved, especially the lost person, and to ventilate their anger, guilt, and sadness. The rising rate of suicide or suicide attempts among this country's adolescents--the third cause of death among adolescents--cries out for stronger support systems for our young people.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Magic Johnson and public attitudes toward AIDS: a review of empirical findings.

The public announcement of HIV seropositivity and early professional retirement of basketball star Earvin "Magic" Johnson acted as a naturalistic experimental manipulation of media representations of persons living with HIV infection. This article reviews empirical studies of psychological and behavioral changes that occurred following the announcement. Several studies reported substantial increases in public interest in HIV/AIDS-related information and public awareness of AIDS, as well as changes in high-risk behaviors. Increases in calls to AIDS hotlines and increased rates of HIV antibody testing were also observed. However, most effects were short-lived, subsiding within three weeks of the announcement, and few changes in AIDS-related knowledge or personal risk perceptions were reported. Patterns of results indicated different levels of impact among high- and low-risk groups and among ethnic groups. Findings across studies are consistent with previous research on media effects on public attitudes and theories of risk perception.

Acquired Immunodeficiency Syndrome↗