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At least 451 records · Page 25Linked to original sources
PubMedDate not supplied

Involuntary smoking cessation: a treatment option in chemical dependency programs for women and children.

Recent research has indicated that a relationship exists between nicotine addiction and the abuse of other substances. This relationship, as well as the severe impact of nicotine addiction on the health of women, their children, and the developing fetus, provides the basis of a rationale for developing chemical dependency programs for women where smoking is not allowed. Involuntary smoking cessation (ISC) programs have been tried recently in mixed-gender and male-only programs, and have met with strong resistance from clients. In most published reports this resistance was strong enough to force the programs to eliminate the ISC policy. This article describes the development of an ISC program at a residential substance abuse treatment center for pregnant and postpartum women and their children. It traces the evolution of tactics to defuse resistance and enlist client support for the program. The development of techniques to measure the effectiveness of the program are also presented. Preliminary results indicate that a properly designed program can be instituted at a residential treatment center for women without excessive program disruption and with positive results.

Adult↗
PubMedDate not supplied

Student projects enhance competency in community-based nursing practice.

Trends in healthcare delivery toward community-based care challenge nurse educators to design nursing curricula and learning experiences that prepare students for practice in community settings. The authors describe how faculty used student projects to enhance community learning experiences. The projects were designed to help students gain skill in the process of program design and evaluation and an appreciation and enthusiasm for community-based nursing practice.

Clinical Competence↗
PubMed1980

Trustee Week: education for trustees, by trustees.

Trustee Week, an in-depth educational program designed and conducted by the University of Washington's Graduate Program in Health Administration and Planning under a grant from the W. K. Kellogg Foundation to the Western Network for Education in Health Administration, uses a graduated workshop format to allow trustees to select the level best suited to their needs.

Governing Board↗
PubMed1992

MSNJ Auxiliary: responsibility on water.

The Medical Society of New Jersey Auxiliary kicked off its Responsibility on Water program. Designed and planned by MSNJA President Marion H. Geib, the program is intended to make children and adults aware of the deadly mix of alcohol and water activities.

Accident Prevention↗
PubMed1978

Abortion storms--projection for the future.

Most abortions are of an endemic and sporadic nature but some problems reach epidemic (storm) proportions. In many laboratories, the etiological agent is determined in about 25% of the cases. In the future, practitioners and laboratories working together can: 1) respond to owner concern, 2) quickly determine if one of the better defined contagious diseases is present, and 3) cooperate in developing a responsive, field oriented diagnostic and investigative program designed to better define factors concerned in abortion problems. A program for meeting these needs is suggested.

Abortion, Veterinary↗
PubMed1993

The development of a comprehensive bereavement program to assist families experiencing pediatric loss.

One of the most difficult situations encountered by pediatric nurses is dealing with families experiencing the death of a child. This article describes the development of the H.O.P.E.S. Program (Healing of Parents Experiencing Sorrow), a comprehensive bereavement program designed to assist families who have experienced pediatric loss. This program has been well-received by both families and staff and has enabled staff to interact more confidently with families at a very difficult time in their lives.

Adult↗
PubMed1996

Family practice instructional development models in Taiwan, review and prospective.

The National Health Insurance Program began in March 1995 in Taiwan. The success of the program depends largely on the operation of "Regionalization Medical Networks" which rely on family practice to provide cost-effective medical care. Instructional development activity needs to be addressed as the highest priority, to meet the impelling needs of family practice training. The acute shortage of family practice educators in Taiwan draws attention for a need of family practice faculty development programs, including short-term seminars and long-term fellowships. Continuing education programs in family practice help keep abreast the scientific as well as the social developments in familiarizing new guidelines of the National Health Insurance Program. Residency training programs that are community-based and ambulatory-oriented will prepare family practice resident physicians to make contributions for the future of "Regionalization Medical Networks". As well, the undergraduate family practice education programs will prepare future physicians with the adaptations and the challenges of the National Health Insurance Program. The allied health education programs are fundamental to build family practice teams to meet community health needs. Lastly, public education programs designed to familiarize the public with the National Health Insurance Program will help give the public an understanding and appreciation of the contributions of family practice in the health care delivery.

Education, Continuing↗
PubMedDate not supplied

A comparison of prostate knowledge of African-American and Caucasian men: changes from prescreening baseline to postintervention.

PURPOSE: This study was undertaken to determine if a community screening program designed to overcome key barriers (lack of awareness, cost of program, ease of access to care) could successfully impact on African-American males' knowledge, attitudes, and behaviors regarding prostate cancer screening. The focus of this report is knowledge. To date, there are no reported studies that examine differences in knowledge from a prescreening baseline to a postintervention level for minority participants. PATIENTS AND METHODS: A total of 944 men were enrolled in the study in a 20-month period. Prostate screening and education were offered as a new service at an existing senior health clinic. In addition, mass screenings were offered approximately monthly at various locations in the community (including senior community centers, senior apartment complexes, and some public housing projects). Screening included both the digital rectal examination and the prostate specific antigen test. A brief questionnaire was administered during client intake (the pretest) and repeated after the education and screening participation (the posttest). Test items targeted three constructs: (1) etiology, (2) risk status, and (3) clinical factors. RESULTS: The largest difference on pretest scores between the racial groups resulted from clinical factor knowledge. African-American men were significantly less likely than Caucasian men to correctly identify early symptoms of prostate cancer and the basic components of a prostate checkup. Although scores were initially significantly lower for African-American participants, these differences were not evident after program involvement. There was a significant increase in knowledge level for all men when comparing pretest and posttest scores. Significant improvement was noted for each test item, with the exception of one key item. Even after participation in the program, African-American men were still more likely to believe that "pain" was the first symptom of prostate cancer. DISCUSSION: An item-by-item analysis revealed that there was only one test item in which program participation did not "correct" knowledge. African-American men were still more likely to believe that pain was the first symptom that would alert them to the presence of cancer. The screening program included information (both printed and oral content) that emphasized the importance of routine screening to detect cancer at an early stage, because most men would experience no symptoms. The only other reported study that examined knowledge documented similar findings with respect to an understanding of symptomology. These findings can be used to direct or guide the educational component of future screening programs that hope to target African-American men.

Black or African American↗
PubMed1993

The role of outcome and efficacy expectations in an intervention designed to reduce infants' exposure to environmental tobacco smoke.

The purpose of this paper is to examine the role of a theoretical framework in an intervention program designed to reduce infants' exposure to environmental tobacco smoke (ETS). The content of a nurse-based intervention focused on two psychosocial constructs: expectations of outcomes which may result from behaviors associated with ETS exposure and expectations of self-efficacy associated with the mother's ability to engage in these behaviors. This study found both constructs predictive of change in, and maintenance of, ETS exposure control. In particular, mothers reporting both low outcome and low efficacy expectations tended to have infants with the highest levels of ETS exposure. We also found that our intervention was effective in changing outcome and efficacy expectations in the desired direction. These findings suggest that outcome and efficacy expectations are changeable, and, therefore, represent important targets in future programs aimed at controlling ETS exposure.

Adolescent↗
PubMed1999

Quality management practices in Medicaid managed care: a national survey of Medicaid and commercial health plans participating in the Medicaid program.

CONTEXT: Rapid expansion of Medicaid managed care has raised concerns about the capacity and willingness of health plans enrolling Medicaid beneficiaries to provide high-quality care. Recently, legislation has facilitated market entry of Medicaid plans, health plans that draw most of their enrollment from the Medicaid population. OBJECTIVE: To characterize and compare the organizational characteristics and programs related to quality of care of commercial and Medicaid health plans that participate in the Medicaid program. DESIGN: Cross-sectional survey conducted September 1997 to April 1998. SETTING: The Medicaid program in 11 states and the District of Columbia. PARTICIPANTS: All 154 health plans in these localities that provided prepaid general medical care to Medicaid beneficiaries during June 1997, of which 130 (84%) responded to the survey. MAIN OUTCOME MEASURES: Health plan reports of structural characteristics, services offered, performance measurement and feedback, disease management programs, information systems capabilities, and provider network composition and relationships. RESULTS: Half of the respondents were Medicaid plans, with 75% or more of enrollees drawn from the Medicaid population. Medicaid plans tended to be smaller and newer than commercial plans that also served the Medicaid population and had more enabling programs targeting the special needs of the Medicaid population, such as inadequate transportation (85% of Medicaid plans vs 62% of commercial plans; P = .003) and illiteracy (66% vs 38%, respectively; P = .002). Overall, 71% of Medicaid plans vs 43% of commercial plans had enabling programs targeted at 6 or more of the 8 special needs we specified (P = .001). While commercial plans had a higher proportion of board-certified primary care physicians (81% vs 73%; P = .01), we found no major differences between Medicaid plans and commercial plans in collection and dissemination of performance measures, designation of specific areas for quality improvement, or use of disease management programs targeted at conditions prevalent in the Medicaid population. Neither commercial nor Medicaid plans reported high success in improving quality of care. CONCLUSIONS: Based on our survey, while Medicaid plans resemble commercial plans serving the Medicaid population in many aspects of quality management, they are more likely to target programs directed to the specific needs of the Medicaid population. Neither commercial nor Medicaid plans have notably strong records in actual quality improvement.

Certification↗
PubMed2002

Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data.

OBJECTIVES: Our falls prevention research group has conducted four controlled trials of a home exercise program to prevent falls in older people. The objectives of this meta-analysis of these trials were to estimate the overall effect of the exercise program on the numbers of falls and fall-related injuries and to identify subgroups that would benefit most from the program. DESIGN: We pooled individual-level data from the four trials to investigate the effect of the program in those aged 80 and older, in those with a previous fall, and in men and women. SETTING: Nine cities and towns in New Zealand. PARTICIPANTS: One thousand sixteen community dwelling women and men aged 65 to 97. INTERVENTION: A program of muscle strengthening and balance retraining exercises designed specifically to prevent falls and individually prescribed and delivered at home by trained health professionals. MEASUREMENTS: Main outcomes were number of falls and number of injuries resulting from falls during the trials. RESULTS: The overall effect of the program was to reduce the number of falls and the number of fall-related injuries by 35% (incidence rate ratio (IRR) = 0.65, 95% confidence interval (CI) = 0.57-0.75; and, respectively IRR = 0.65, 95% CI = 0.53-0.81.) In injury prevention, participants aged 80 and older benefited significantly more from the program than those aged 65 to 79. The program was equally effective in reducing fall rates in those with and without a previous fall, but participants reporting a fall in the previous year had a higher fall rate (IRR = 2.34, 95% CI = 1.64-3.34). The program was equally effective in men and women. CONCLUSION: This exercise program was most effective in reducing fall-related injuries in those aged 80 and older and resulted in a higher absolute reduction in injurious falls when offered to those with a history of a previous fall.

Accidental Falls↗
PubMed1988

DESIGN: computerized optimization of experimental design for estimating Kd and Bmax in ligand binding experiments. I. Homologous and heterologous binding to one or two classes of sites.

We have developed a versatile computer program for optimization of ligand binding experiments (e.g., radioreceptor assay system for hormones, drugs, etc.). This optimization algorithm is based on an overall measure of precision of the parameter estimates (D-optimality). The program DESIGN uses an exact mathematical model of the equilibrium ligand binding system with up to two ligands binding to any number of classes of binding sites. The program produces a minimal list of the optimal ligand concentrations for use in the binding experiment. This potentially reduces the time and cost necessary to perform a binding experiment. The program allows comparison of any proposed experimental design with the D-optimal design or with assay protocols in current use. The level of nonspecific binding is regarded as an unknown parameter of the system, along with the affinity constant (Kd) and binding capacity (Bmax). Selected parameters can be fixed at constant values and thereby excluded from the optimization algorithm. Emphasis may be placed on improving the precision of a single parameter or on improving the precision of all the parameters simultaneously. We present optimal designs for several of the more commonly used assay protocols (saturation binding with a single labeled ligand, competition or displacement curve, one or two classes of binding sites), and evaluate the robustness of these designs to changes in parameter values of the underlying models. We also derive the theoretical D-optimal design for the saturation binding experiment with a homogeneous receptor class.

Binding Sites↗
PubMed2001

Self assessment for quality and assurance. An essential component of effective health care delivery at the worksite.

Programs designed to ensure high quality performance, whatever name they are given, have the same basic elements. They measure compliance with established standards, provide feedback, institute changes as necessary to improve outcomes, and measure again. The first steps include determining which programs need evaluation and identifying the standards. Measurement tools are then developed and the self assessment takes place. After the results are analyzed, the necessary program changes are made, and the cycle is repeated. Failure to determine levels of compliance with government regulations can leave a company vulnerable to sanctions if noncompliance is significant. Self identification of problems before they become apparent outside the department allows the occupational and environmental health nurse to make program and process improvements before the problems become crises. Self assessments are designed to monitor activities, determine program or procedure effectiveness, validate decision making, and investigate unsolicited observations and comments. Self regulation is the hallmark of a mature profession (Phaneuf, 1972), and as such, occupational and environmental health nurses have a professional responsibility to actively engage in formalized self regulation activities.

Documentation↗
PubMed1990

A comparison of two fitness programs to reduce the risk of coronary heart disease in public safety officers.

The purpose of this investigation was to determine the effectiveness of a fitness program designed as an alternative to the standard weight-training and running program and using limited resources and facilities. Forty-three men from the North Carolina Justice Academy, randomly assigned into two groups, completed 12 weeks of physical training. The WT group used a standard weight training and running, whereas the REC group ran and completed a resistive exercise circuit. The REC circuit consisted of nine exercises designed to improve muscular strength and endurance separated by 30 seconds of aerobic exercise. The exercises used chairs, tables, sawhorses, and body weight to provide the resistance. The results indicated that the REC program improved muscular strength and aerobic capacity as well as the WT program. Furthermore, the REC group lost more weight, reduced body fat, and improved their lipid profiles significantly more than the WT group. Thus, the REC program is a viable alternative for the training of public safety officers when only limited resources are available.

Cholesterol↗
PubMed1994

Not guilty by reason of insanity: getting it right or perpetuating the myths?

In Exp. 1 50 subjects were randomly assigned to one of two videotape conditions. The experimental group watched a TV news program designed to expose some myths about the not-guilty-by-reason-of-insanity plea (NGRI) while controls watched a neutral program. A seven-item test designed to measure knowledge about each myth was administered before and twice after exposure to the videotapes. Analysis showed no significant difference for any exposure. Exps. 2 and 3 showed that reading a brief factual report about NGRI significantly reduced the belief in these myths as compared to beliefs of groups who watched a TV news program.

Adolescent↗
PubMedDate not supplied

Intelligent dialogue based on statistical models of clinical decision-making.

The independence Bayesian model has been used widely in computer programs designed to support clinical decision-making. A reasoning strategy has been developed to enable these programs to conduct clinically pertinent dialogue and explain their reasoning. It has been implemented in a program for the diagnosis of acute abdominal pain based on the Bayesian model of de Dombal et al. Several features of the dialogue design have been adopted from artificial intelligence research, including shared initiative and critiquing. The program adopts a flexible goal-driven strategy, attempting to confirm the clinician's diagnosis or rule out the likeliest alternative. Symptoms and signs are selected in order of their expected weights of evidence in favour of the hypothesized disease.

Abdomen↗
PubMed2000

Development and evaluation of an interactive CD-ROM refusal skills program to prevent youth substance use: "refuse to use".

An interactive CD-ROM program designed to reduce adolescent substance use was developed and evaluated. The program uses video vignettes to teach refusal skills and socially acceptable responses to substance use situations, specifically offers of marijuana. In a randomized pretest-to-posttest experiment with 74 public school students from six classes in three high schools, significant changes were observed at posttest on (1) the adolescent's personal efficacy to refuse the offer of marijuana, (2) the adolescent's intention to refuse marijuana if offered, and (3) the adolescent's perceptions of the social norms associated with substance use and the importance of respecting another's decision to refuse a drug offer. In addition, adolescents in the treatment condition were able to recall approximately 50% of the portrayed refusal strategies. Findings are discussed with regard to the potential benefits of an interactive multimedia approach for conducting substance use interventions.

Adolescent↗
PubMed1999

Problems and our solutions for implementing telemedicine systems.

There are several problems on the practical use of telemedicine, for example, the difficulties involved in promoting communication between medical facilities, uncooperative clinicians, and the absence of high-speed circuits and high-resolution CRT. From the Japanese point of view, we suggest ways to resolve these problems. We will analyze and propose scenarios for realizing successful communications among medical institutions, medical communication and its characteristics, barriers to the promotion of communications among medical institutions, second-opinion centers, and separate satellites and separate circuits. We also mention the World Wide Web for teleconsultation, provision of assistance to people with data handicaps via a communications satellite, and assistance to programs designed for training telemedicine specialists. Using a communication satellite, we offer programs that explain preventive medicine, support activities for nursing at home, explain the risks of fast food, and support activities for the handicapped and women in a simple manner to computer illiterates.

Communication↗