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At least 469 records · Page 26Linked to original sources
PubMed2000

Interruptions to the physician-patient encounter: an intervention program.

BACKGROUND: Israeli physicians are very familiar with the problem of interruptions during encounters with patients. However, a thorough search of the medical literature revealed only one report of this problem from Israel, and none from other countries. OBJECTIVES: To characterize the phenomenon of interruptions to the patient-physician encounter in a clinic in Dimona and to assess the effect of an intervention program designed to reduce the magnitude of this problem. METHODS: During an 8 day work period in March 1997 all patient-physician encounters were recorded and characterized. An intervention program was then designed and implemented to reduce the number of interruptions. Data were again collected a year after the initial data collection. RESULTS: During the 8 day study period prior to the intervention program there were 528 interruptions to 379 encounters (mean of 1.39 per encounter). The main causes of interruptions were entrance of uninvited patients to the examination room (31%) and telephone calls (27%). Most of the interruptions occurred during the morning hours between 8 and 10 a.m. (45%) and at the beginning of the week (Sunday 30%). After the intervention program there were 402 interruptions to 355 encounters (mean of 1.13 per appointment, P = 0.21). CONCLUSIONS: There was no statistically significant improvement in the number of interruptions following the intervention program. This finding is either the result of a local cultural phenomenon, or it indicates a national primary care health system problem that may require a long-term educational program to resolve it. Further research is needed on the magnitude, causes and consequences of interruptions in family practice and, if warranted, methods will have to devised to cope with this serious problem.

Humans↗
PubMed1995

Physician office laboratory education and training in primary care residency programs.

OBJECTIVE: To assess the status of office laboratory residency education and training in family practice, internal medicine, obstetrics and gynecology, and pediatric residency programs. DESIGN: A single mailed survey to 1299 residency programs from December 1992 to February 1993. PARTICIPANTS: Primary care residency directors from 507 (39%) of 1299 programs. INTERVENTIONS: A 27-item survey of residency-based office laboratory practices, education, training, and resources. MAIN OUTCOME MEASURES: Differences between specialties in provision and quantity of office laboratory education and training, presence of a residency-based office laboratory, laboratory classification under the Clinical Laboratory Improvement Amendments, and available laboratory tests. RESULTS: Of those responding, office laboratories were present in 89% of family practice, 19% of internal medicine, 29% of obstetrics and gynecology, and 24% of pediatrics residency programs. Laboratory training was available at 60% of family practice, 16% of internal medicine, 15% of obstetrics and gynecology, and 30% of pediatrics programs. The median number of hours of formal skills training was 10 hours for family practice residency programs but less than 2 hours for the other specialties. Only 25% of the programs reported educational assistance from pathologists. Merely 4% of the programs had postassessment examinations and 2% awarded certificates of achievement. A majority of family practice programs performed waivered tests and physician-performed microscopy tests, but moderately complex tests were performed in less than 50% of family practice programs. CONCLUSIONS: Family practice residency programs provide more office laboratory training for residents than other specialties. There is a need for improved residency training in the basics of office laboratory practice.

Curriculum↗
PubMed1995

DNA Strider. An inexpensive sequence analysis package for the Macintosh.

DNA Strider is a user-friendly Macintosh program designed for analysis of molecular sequence data. The program shows great versatility in choice of genetic codes, restriction enzymes, algorithms for hydropathy plots, and interconversions between types of sequence data. It is very straightforward and interacts well with other sequence and phylogenetic analysis packages, importing and exporting data easily. The graphic outputs can be used directly for manuscript-quality figures, or exported to more sophisticated text or graphic programs.

Amino Acid Sequence↗
PubMed2000

Differences in in vitro fertilization (IVF) outcome between white and black women in an inner-city, university-based IVF program.

OBJECTIVE: To compare IVF outcomes between white and black women in an inner-city, university-based IVF program. DESIGN: Retrospective study. SETTING: University-based IVF program. PATIENT(S): Ninety-five white women undergoing 121 cycles and 37 black women undergoing 47 cycles. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Implantation rate and pregnancy rate (PR). RESULT(S): Black women constituted 28. 0% of the population and underwent 28.0% of the total cycles. There were no statistically significant differences in age, basal FSH, number of ampules, duration of stimulation, endometrial thickness, P on the day of hCG, cancellation rate, number of oocytes, or embryos transferred. However, the duration of infertility, body mass index (BMI), incidence of tubal-factor infertility, and peak E(2) levels were significantly higher in black women. In addition, a larger proportion of black women required aggressive stimulation than white women (70.2% and 43.0%). Both implantation rates and clinical PRs were significantly lower in black women than in white women (9.8% and 19.2% compared with 23.4% and 42.2%, respectively). CONCLUSION(S): Black women have poorer IVF outcomes than white women. These differences can be partly explained by higher BMI, longer duration of infertility, higher incidence of tubal-factor infertility, and higher peak E(2).

Academic Medical Centers↗
PubMed2001

A comparison of intrauterine versus intracervical insemination in fertile single women.

OBJECTIVE: To compare the efficacy of intrauterine insemination (IUI) and intracervical insemination (ICI) when used by fertile single women in a donor insemination program. DESIGN: Prospective randomized crossover study. SETTING: Donor insemination program (not an infertility clinic). PATIENT(S): Single fertile women choosing to inseminate with frozen donor semen. INTERVENTION(S): Clients received procreative counseling and screening and were then randomly assigned to begin office insemination with ICI or IUI. If additional insemination cycles were required, the clients used the method opposite their previous method of insemination until pregnancy was achieved. MAIN OUTCOME MEASURE(S): Monthly fecundity rate was compared between the two methods of insemination. RESULT(S): Sixty-two women contributed a total of 189 cycles, 94 by IUI and 95 by ICI. The monthly fecundity rate for IUI was 15%, as compared with 9% for ICI, (P=0.14). When the analysis was confined to cycles in which only one insemination was performed (64 IUI and 65 ICI cycles), the monthly fecundity rates were 14% for IUI and 5% for ICI (P=0.04). CONCLUSION(S): Intrauterine insemination with frozen donor sperm is more effective than intracervical insemination for single women without known fertility problems.

Adult↗
PubMed2001

Measurement of endometrial tissue blood flow: a novel way to assess uterine receptivity for implantation.

OBJECTIVE: To assess endometrial receptivity in terms of endometrial tissue blood flow (ETBF) measured hysterofiberscopically by laser blood-flowmetry, and to examine the technique's effectiveness in an in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) program. DESIGN: A prospective clinical study. SETTING(S): IVF program in a university hospital. PATIENT(S): A total of 75 infertile women with normal menstrual cycles undergoing IVF/ICSI. INTERVENTION(S): ETBF, conventional ultrasonographic, endocrinologic, and histologic parameters for receptivity and immunoreactivity for vascular endothelial growth factor (VEGF) in endometrium were assessed between days 4 and 6 of the luteal phase in a spontaneous menstrual cycle. Then all patients underwent IVF/ICSI. MAIN OUTCOME MEASURE(S): Achievement of clinical pregnancy by IVF/ICSI. RESULT(S): ETBF, VEGF expression, and the number of embryos were significantly higher in the women who became pregnant than in those who did not. By stepwise multiple logistic regression, significant predictors of pregnancy were the number of embryos and ETBF but not conventional receptivity markers. The rate of pregnancy was significantly higher in women with ETBF values of at least 29 mL/min per 100 grams of tissue than in women with lower values (42 vs. 15% in 36 and 39 women, respectively). ETBF was significantly greater in morphologically normal than abnormal uteri. In normal uteri, ETBF was greatest in the fundus. Correspondingly, in normal uteri 85% of gestational sacs were implanted in the fundus. CONCLUSION(S): ETBF is superior to conventional parameters for determining endometrial receptivity for implantation.

Adult↗
PubMed1992

Intrauterine insemination outperforms intracervical insemination in a randomized, controlled study with frozen, donor semen.

OBJECTIVE: To assess the efficacy of intrauterine insemination (IUI) in a donor insemination program. DESIGN: Prospective randomized clinical trial. SETTING: Donor insemination program. PATIENTS, PARTICIPANTS: Women undergoing insemination were randomly assigned to receive either IUI or intracervical insemination for a maximum of six cycles. INTERVENTIONS: None. MAIN OUTCOME MEASURE(S): Cycle fecundity rates between the two routes were compared. RESULTS: The monthly fecundity rate for intracervical insemination was 5.1% compared with 23% by IUI. By life table analysis, pregnancy rates for IUI were significantly higher than intracervical insemination (P = 0.02). CONCLUSIONS: Intrauterine insemination with quarantined donor sperm is superior to intracervical insemination.

Cervix Uteri↗
PubMed1994

Correction of irregular astigmatism with the excimer laser.

BACKGROUND: Correction of irregular astigmatism has not been possible using available keratorefractive technology. METHODS: The authors used a topographic map as a guide and created a custom excimer ablation program, designed to create a more regular surface. The program consisted of a combination of phototherapeutic and photorefractive ablation patterns. The amount of tissue to be removed was calculated on the basis of the diameter and steepness of the irregular areas of the corneal surface. RESULTS: A more regular surface, as evidenced by topographic analysis, reduced astigmatism, and improved uncorrected visual acuity, was produced. CONCLUSION: Using the corneal topographical map as a guide, excimer laser ablation can be used to create a more regular optical surface with improved visual function.

Adult↗
PubMed2002

Exercise adherence and 10-year mortality in chronically ill older adults.

OBJECTIVES: To compare mortality of adherents and nonadherents of an exercise program. DESIGN: Prospective intervention study. SETTING: Supervised geriatric fitness program called Gerofit. PARTICIPANTS: One hundred thirty-five adults aged 65 and older who enrolled in Gerofit between January 1, 1990, and November 30, 1999. All participants had a baseline medical screen and exercise test. They were classified as adherent (n = 70) if they participated in Gerofit for more than 47 sessions or nonadherent (n = 65) if they did not complete 47 sessions within the first 6-month period. INTERVENTION: Program participation was voluntary and consisted of aerobic, strength, flexibility, and balance exercises. The program met three times week for 90 minutes. MEASUREMENTS: All-cause mortality. RESULTS: Twenty-six deaths occurred within the 10-year follow-up period. Using proportional hazards, time to death was not related to adherence group. However, in multivariate analyses controlling for age, sex, race, baseline risk/health status, history of heart disease, cancer, diabetes mellitus, and baseline smoking status, there was significant group-by-time interaction (P =.004), indicating a crossover in mortality risk. The initial survival benefit observed in nonadherers changed over time, resulting in a long-term protective survival effect on mortality for the adherent group (hazard rate = 0.75, 95% confidence interval = 0.61-0.91 for the interaction term). CONCLUSIONS: Older adults with chronic diseases experience a long-term beneficial mortality effect from participation in exercise programs. Physicians should strongly encourage their patients, including those with comorbidities, to maintain a regular exercise program.

Aged↗
PubMed2000

Using cognitive strategies to enhance bladder control and comfort.

Compromised urinary bladder syndrome (CUBS), a combination of frequency and incontinence, causes multiple discomforts for community-dwelling adults. A holistic intervention--audiotaped cognitive strategies--was designed to augment the effects of an educational program designed to treat CUBS. CUBS was operationalized with a voiding diary, and comfort related to bladder health was operationalized in a questionnaire. In this quasi-experimental design the outcomes were measured at four time points. Repeated measures multivariate analyses of variance and nonparametric analyses were conducted to assess differences between the two groups. Results indicated that the treatment group had more comfort and improved CUBS compared with the control group.

Adult↗
PubMed1996

Issues inherent in measuring the impact of care coordination on pregnancy outcomes.

Care coordination is a Medicaid benefit designed to help low-income women gain access to pregnancy-related services. Measuring the outcomes of care coordination is hampered because experimental designs are difficult to carry out on entitlement programs. The purpose of this study was to examine whether a care coordination-adequacy index, based on number of home visits, onset of home visits, and weeks' gestation at delivery, would outperform a simple count of the number of home visits in predicting birthweight. Data from a pilot project in Indianapolis were used. The adequacy index outperformed "number of home visits" in the prediction of birthweight with this sample. Those who received intermediate level of care coordination delivered infants weighing 162 g more than those who received inadequate care coordination. The adequate level of care coordination did not predict birthweight, which may have resulted from an insufficient number of participants in this category (n = 20). An inherent selection bias based on the length of gestation when admitted to the program is also discussed. Research on care coordination with clear delineation of the measurement issues involved must continue to ensure effective program design and continued funding.

Adolescent↗
PubMed2001

Evaluation of a program to promote positive parenting in the neonatal intensive care unit.

PURPOSE: To describe and evaluate a parent education program to promote positive parenting in the NICU. DESIGN: Program evaluations completed by parent participants and staff members. SAMPLE: 104 parents (59 mothers and 45 fathers) who attended the Parent's Circle; also 44 NICU or SCN staff members. MAIN OUTEOME VARIABLE: Family and staff evaluations of the Parent's Circle program. RESULTS: Families reported that attending Parent's Circle helped them gain perspective on their situation, feel supported, learn key developmental concepts, locate hospital and community resources, and optimize interactions with their fragile infant. Staff reported that the knowledge parents gained from Parent's Circle influenced their interactions and behaviors in the NICU.

Adaptation, Psychological↗
PubMedDate not supplied

A comprehensive cardiovascular waveform analysis program for IBM-compatible personal computers.

Computerized cardiovascular waveform processing has become a necessary and fundamental tool in the analysis of physiologic data. The availability of numerous commercial data-analysis programs has significantly enhanced the efficiency of waveform analysis. Many such programs come with their own programming language, which enables the researcher to create an application program suited to a specific series of calculations. Once written, an application program can significantly increase the efficiency with which data from a specific experiment can be analyzed. However, creating or modifying a program for each new experimental protocol can be time-consuming, especially in the error-detection and verification stages. Single-purpose programs also prove somewhat inflexible to unexpected changes in experimental formats. These problems suggested the need for a more flexible program, but one that is nevertheless specifically suited to the analysis of cardiovascular signals. This need led to the development of a program designed in collaboration with surgeons and physiologists. This program addresses some important analysis problems in cardiovascular research, and allows the user to survey and manipulate cardiovascular waveforms in an intuitive and spontaneous manner.

Algorithms↗
PubMed1991

An ecological approach to tracking battered women over time.

The current study examined the difficulties inherent in using an experimental, longitudinal design to determine the effects of an advocacy program designed to increase battered women's access to community resources. The current research employed a multitude of techniques to follow battered women over the first year following their stay at a shelter for women with abusive partners. The tracking rate was very successful; 96% were found and interviewed at the 10-week project termination point, 96% at the 6-month follow-up, and 94% at the 12-month followup. The intricate system of procedures used for successfully tracking this mobile population over time are presented as an effective methodology for doing necessary longitudinal research with battered women as well as other transient, or "difficult to follow" populations.

Female↗
PubMedDate not supplied

Clinical skill-building simulations in cardiology: HeartLab and EkgLab.

HeartLab and EkgLab are two simulation-based programs designed to teach medical students the essentials of the auscultatory cardiac examination and of electrocardiogram interpretation, respectively. The issues considered throughout the development of these projects, namely implementation language selection, program architecture, simulation design, patient models, and the approach to verification, are applicable to the design of any simulation-based system.

Cardiology↗
PubMed1995

Adherence to worksite exercise programs: an integrative review of recent research.

1. Improving worker physical fitness through worksite exercise programs offers many benefits to the employee and the employer. Unfortunately, a small percentage of workers who begin an exercise program adhere to it. 2. It is essential to design program strategies to promote exercise adherence among persons who do not currently exercise at levels that achieve health benefits. 3. The results of this review of worksite research suggest a number of strategies that were successful in increasing at least short term exercise adherence. 4. Carefully controlled studies are needed to identify specific worksite exercise interventions or combination of interventions that maximize the initiation of exercise as well as short and long term adherence. A combination of strategies improves exercise adherence for at least 6 months, but more research is needed to determine long term maintenance of an exercise program.

Exercise Therapy↗
PubMed1984

Apple II PASCAL programs for molecular biologists.

A collection of PASCAL programs designed for the Apple II microcomputer is presented. These DNA sequence handling and analysis programs are interactive and may be used even by people with no computer experience. The package allows the user to enter a sequence from the keyboard, to modify it, to generate the reverse complement, to create new sequences from parts of other ones, to display or print sequences in various formats. Some analysis tasks are also performed: Translation, searches for restriction sites, for homology with subsequences, either perfect or with an adjustable match percentage. In addition, two programs are also included: The first one allows DNA data sequences generated with a BASIC program under the CP/M operating system to be used with these PASCAL programs. The second one is designed for the automatic assembly of DNA fragments sequences, obtained with the GILBERT-MAXAM or M13 techniques, into a complete sequence.

Amino Acid Sequence↗