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PubMed1978

Techniques for locating, filing, and retrieving scientific information.

Guidelines for improving the effectiveness and efficiency of conducting a search of scientific literature are presented. Initial leads can be gained by contacting a local expert or consulting a textbook. An impression of advances being made in a particular field can be gained efficiently by scanning weekly issues of Current Contents, containing the tables of contents of most scientific journals. Recent review articles on most topics can usually be found listed in the Index Medicus. With at least one significant reference dealing with a specific topic of interest, the Science Citation Index may be used to identify articles published during a particular indexing period which cited the article as a reference. Practical guidelines are also presented for establishing a simple but comprehensive personal system for filing and retrieving on demand reprints, pamphlets, and notes.

Abstracting and Indexing↗
PubMed2005

Paired-organ and other selected absorbed fraction for the Korean Reference Adult Male model.

The authors have developed a mathematical model for calculating internal radionuclide dosimetry for the Korean Reference Adult Male, and have also derived paired-organ and other selected inter-organ photon-specific absorbed fractions for this model. Each lung, kidney and adrenal gland was set as a separate source region even though each of them shares an identical physiological function with their complementary half. The thyroid gland was also set as a source region. Specific absorbed fractions (SAFs) were then derived by selecting 10 photon energies from 0.02 to 4.0 MeV inclusive. For this purpose the Monte Carlo methodology was used, and the derived SAF was compared with the resulting value of MIRD Pamphlet No. 5 and ORNL TM-8381, both of which were derived on the basis of the ICRP-23 reference man. The comparison showed that MIRD No. 5 and ORNL TM-8381 resulted in a higher absorbed fraction, but the phantom created on the basis of the Korean reference man led to a higher SAF. The weight of the organs of the phantom, and the size and location of the trunk seem to account for the differences. The energy-dependent differences in the SAFs are considered to be related to the distance between the source and target regions, the composition of the intervening tissues, and the photon energies and mean free paths. Also, as a result of deriving SAFs after setting each separate lung, kidney and adrenal gland as a source region, it was found that, although they are of the same physiological function, each individual organ serves as a source region on its own. Differences were noted in SAFs exerted on the source and target organs in accordance with the location of the organs, that is, whether they were located to the left or right of the source organs. The SAF derived in this study can be used for a more accurate internal radionuclide dosimetry for Koreans and other Orientals whose physiology, lifestyle and dietary habits are similar to those of Koreans.

Adrenal Glands↗
PubMed1990

Tools for patient education.

There are many pamphlets, brochures and educational videos available for use in patient teaching. This article is a listing of some of the many items available and where to obtain them.

Digestive System Diseases↗
PubMed1999

Long-term quality of life in patients after total gastrectomy.

This study used a questionnaire survey to evaluate the long-term quality of life (QOL) in 51 patients who underwent total gastrectomy. Activities of daily living (ADL) were good in 20, relatively good in 9, relatively poor in 13, and poor in 6 patients. The other 3 patients were treated on an inpatient basis. Of 38 patients who had been employed before surgery, 18 (47%) resumed working. Physically, body weight increased or showed no changes in 38 patients (74%), but decreased in the other 13 patients, of whom 3 showed a 15% or more decrease. Dumping symptoms developed in 13 patients (26%), 2 of whom had a severe condition. Clear decreases in physical strength and mental strength (spiritual energy) were reported by 10 and 8 patients, respectively. Comprehensive QOL was good in 20, slightly poor in 17, and poor in 14 patients. Quality of life was poor in 12 (41%) of the 29 patients with good ADL. The following were suggested as necessary for patients and their families: sufficient preoperative explanation about pathophysiology and nutritional management after total gastrectomy; execution of a continued patient education program until after discharge; and explanations in specific terms about cooking methods, nutritional management, exercise therapy, periodic medical checks, and patients' associations using pamphlets and food models to describe daily living of the patients after discharge.

Activities of Daily Living↗
PubMed2001

African American women and breast cancer: notes from a study of narrative.

Survival after breast cancer and after all cancers is significantly worse for African American women than for others. Although many reasons have been proposed, no studies have explored the reception of messages about breast cancer by African American survivors of this disease, and how public images and discourses about breast cancer affects both their perceived risk for this disease and their experiences of illness. Narrative accounts of their lived experiences with breast cancer were collected from 23 African American survivors of breast cancer. Three themes have emerged: (a) Breast cancer is perceived to be a white woman's disease; (b) cancer is caused by experiences of repeated traumatic heartbreak; and finally, (c) there is a perceived lack of social support and understanding for the unique life experiences of the African American survivor of breast cancer. Nurses are on the front line of patient care. In the context of the managed care environment, they spend more time with patients than other health care providers and are soundboards for many patient concerns. As such, they can use the information provided in this study to inform high-risk women, current patients, partners, and other individuals in the medical community of how African American women might inaccurately access their personal risks for breast cancer, despite the public emphasis on this disease. Through the use of culturally sensitive pamphlets, nurses and other medical practitioners can also open discussions with underserved and minority patients as a means of realistically addressing some of these women's fears about breast cancer. These fears are barriers to effective cancer prevention because these individuals may consciously or unconsciously link a diagnosis of breast cancer, or even behaviors related to cancer prevention, to a potential death sentence.

Adaptation, Psychological↗
PubMed2003

Physical models and dose factors for use in internal dose assessment.

Internal dose assessment depends on the use of mathematical formulas for dose calculation and models of the human body and its organs. A simple, unified method for internal dose calculations is described, which brings together and simplifies concepts used in nuclear medicine and occupational internal dose systems previously described. Using the best current decay data and phantoms for internal dose calculations, dose factors for internal dose assessment are provided. Decay data for over 800 radionuclides from the data service at Brookhaven National Laboratory were combined with absorbed fraction data from a number of currently available mathematical whole body and organ models to provide the dose factors. This represents the first published update on nuclear medicine dose factors since MIRD Pamphlet No. 11 in 1975; in this paper, dose factors for many more nuclides are given (816 vs. 117 in MIRD 11), including some alpha emitters. New models are also employed, and dose factors for bone and marrow have been updated with recently suggested corrections. The good agreement of the new dose factors with previously published values for several of the models gives good confidence in their accuracy. This article gives an overview of the technical basis for these dose factors and some example tables of data, but the bulk of the data files will be distributed electronically. The use of an "electronic publishing" approach permits the publication of this kind of voluminous information in mainstream journals while facilitating rapid access and use without the need to purchase often expensive and bulky paper documents.

Adolescent↗
PubMedDate not supplied

Cooking-related burn injuries in the elderly preventing the "granny gown" burn.

Cooking-related burn injuries accounted for 27% of the elderly female admissions at one burn center. The primary mode of injury was found to be ignition of clothing while reaching across a stove. To develop a prevention program for this problem, biologic and environmental hazards were identified. From this information, a two-phase prevention program was designed. Phase one, education, entailed the development, publication, and distribution of a pamphlet to a variety of local agencies. Phase two, an environment evaluation, consisted of contacting consumer relation departments of major stove manufacturers suggesting a product safety review. The community response to this program has been favorable. Its design should provide the foundation for preventing increased incidence of cooking-related burn injuries.

Aged↗
PubMed2000

Parental refusal to immunize a 2-month-old infant.

At a 2-month health supervision visit, Monica's pediatrician was surprised by her mother's wish to withhold immunizations. At prior encounters with her parents, including a prenatal visit, the meeting after Monica's birth, and the 2-week health supervision visit, there was no indication that standard immunizations would be refused. Monica's parents informed her pediatrician that the potential side effects from the immunization led them to think that their healthy child should not be immunized. After talking with other parents in the neighborhood, watching a television program on "children who were brain damaged after getting their shots," and looking at several web sites for parents on the Internet, they concluded that it was safer to withhold the immunizations. "Monica is so healthy.....why give her shots that may make her very sick?" Monica was the first child born to these college-educated parents who had been married for 5 years. The pregnancy was full term and notable for two transient episodes of spotting in the first trimester. Both parents looked forward to Monica's birth. There were no perinatal problems, breast feeding was successful with an appropriate weight gain, and the physical examination was normal. The pediatrician explained to the parents that she understood their concerns. "Most of the things we give children for prevention or treatment of disease may be associated with possible side effects. In the case of immunizations, the chance of a serious side effect is much less than the risk that Monica might acquire one of the diseases we can prevent with an immunization. I have seen a few unimmunized infants who were hospitalized with a very serious case of whooping cough, one of the diseases we can prevent by immunizing Monica." The parents thanked the pediatrician for the information and agreed to read several pamphlets about immunizations. The pediatrician observed that her interchange with the parents was cordial but stressful, for both herself and Monica's parents. As the parents left the office, she wondered if there was a more effective way to talk about immunizations with parents who refuse to immunize their children.

Communicable Disease Control↗
PubMed1995

Efficacy and safety of pneumococcal revaccination after splenectomy for trauma.

OBJECTIVE: To assess the outcome of patient education after splenectomy and vaccination and to determine the safety and efficacy of pneumococcal revaccination 2 or more years after primary vaccination. MAIN OUTCOME MEASURES: Titers to serotype no. 6 and no. 23 pneumococcus and cutaneous and systemic reaction to revaccination. RESULTS: A total of 112 consecutive postsplenectomy patients receiving pneumococcal vaccine were identified; 45 were contacted and offered revaccination; 24 patients demonstrated a lack of understanding of the postsplenectomy state (unaware of splenectomy n = 2, unaware of splenectomy risk n = 8, unaware of vaccine n = 23); 3 patients had infections requiring hospitalization (pneumonia, strep throat and tonsillitis, pneumonia and bacteremia); 40 patients agreed to revaccination, and 33 patients returned for follow-up titers; 16 of 33 (48%) demonstrated at least a two-fold increase in at least one titer. Only 15% described the revaccination as worse than a tetanus shot. CONCLUSIONS: (1) Despite physician-patient conversations, pamphlets, and Medic Alert bracelets, patient retention was poor. (2) All splenectomy patients should be revaccinated and reeducated between two and six years after splenectomy. (3) Revaccination after two years was well tolerated. (4) There were no fatal episodes of pneumococcal sepsis in over 200 patient years.

Adult↗
PubMed1992

Improving adherence to screening follow-up among women with abnormal Pap smears: results from a large clinic-based trial of three intervention strategies.

In a large randomized trial involving over 2,000 women with abnormal cervical cytology (pap smear), three clinic-based interventions were tested as strategies to increase return rates for screening follow-up: 1) a personalized follow-up letter and pamphlet; 2) a slide-tape program on pap smears; and 3) transportation incentives (bus passes/parking permits). The three interventions were evaluated using a 2 x 2 x 2 factorial design. Results of this study confirm a high rate of loss to screening follow-up (i.e., no return visits) among women with abnormal pap smears (29% overall), with substantial variability among the 12 participating clinics (13% to 42/%). For the sample as a whole, both transportation incentives and the combined intervention condition of personalized follow-up and slide-tape program had a significant positive impact on screening follow-up. However, transportation incentives emerged as the dominant intervention condition among patient subgroups that can be characterized as more disadvantaged socioeconomically and at higher risk of developing cervical cancer, including patients receiving care from the county health department (odds ratio (OR) = 1.51; P less than .05); patients without health insurance (OR = 1.77; P less than .01); and patients with more severe pap smear results (OR = 1.71; P less than .05). In contrast, among patient subgroups that can be characterized as relatively more advantaged and at lower risk of developing cervical cancer, only the combined intervention condition of personalized follow-up and slide-tape program was associated with a higher patient return rate. Subgroups reflecting this pattern included patients seen in noncounty clinics (OR = 4.54; P less than .05) and patients with less severe pap smear results (OR = 5.16; P less than .01). The implications of these findings are discussed in terms of designing clinic-based interventions to improve screening follow-up.

Adolescent↗
PubMedDate not supplied

Acceptance of hepatitis B vaccination by pregnant adolescents.

PURPOSE: To determine (1) the rate of prenatal hepatitis B virus (HBV) vaccine acceptance in HBV nonimmune pregnant adolescents, (2) if postulated behavioral and attitudinal factors are associated with HBV vaccine, and (3) the rate of actual receipt of HBV vaccine postpartum in eligible subjects. DESIGN AND METHODS: During 1999-2000, at an inner-city tertiary-care center prenatal clinic, 160 HBV nonimmune adolescents <18 years who were receiving prenatal and delivery care at the center were identified. The research nurse provided an HBV information pamphlet and offered immediate in-hospital postpartum HBV vaccination. Risk factors for nonacceptance of the vaccine were measured with structured questionnaires and medical record review documenting care attendance. Subsequently, all subjects, irrespective of prenatal acceptance of vaccine, were offered vaccine before postpartum discharge, and the rate of actual acceptance was determined. RESULTS: In these predominantly African American (95%) adolescents, the rate of vaccine acceptance was 91%. Actual vaccination rate was 86%, but it was not associated with prior acceptance of vaccination or behavioral or attitudinal factors. CLINICAL IMPLICATIONS: Acceptance of vaccination and actual vaccination were high in this population of high-risk adolescents. The authors found that reoffering vaccine was a successful intervention, even with adolescents who had less-than-optimal attendance at prenatal visits. Given the high rate of acceptance and vaccination in this setting, the authors would encourage public health programs to implement vaccination programs in adolescent prenatal clinics and to offer vaccination postpartum to those who do not receive it prenatally.

Adolescent↗
PubMedDate not supplied

The effect of structured preoperative teaching on patients' use of patient-controlled analgesia (PCA) and their management of pain.

This study examined the effect of structured preoperative teaching on patients' understanding of patient-controlled analgesia (PCA) and their management of pain. The experimental group received a written pamphlet and structured preoperative teaching on the use of PCA to manage their pain. The control group received the usual preoperative preparation normally provided by the physician. Both groups were later asked to complete a posttest to determine how well they understood the use of PCA and how well they managed their pain. There was no statistically significant evidence that the experimental group's knowledge of PCA was different from that of the control group. However, there was significant evidence that the experimental group managed their pain better.

Adult↗
PubMedDate not supplied

Profile of callers to the Centers for Disease Control and Prevention national sexually transmitted diseases hotline.

BACKGROUND AND OBJECTIVES: The Centers for Disease Control and Prevention funds a national telephone hotline as a source of information for persons with questions about sexually transmitted diseases. Hotline callers were last surveyed in 1980. GOAL: To determine the current profile of callers to the Centers for Disease Control and Prevention National sexually transmitted diseases hotline, assess their concerns, and identify their sources for the hotline telephone number. STUDY DESIGN: The survey sampled 1,100 callers: 19 per day distributed across 3 work shifts using a systematic random selection process. Nine short-answer questions were asked, and passively collected data were recorded. RESULTS: The survey showed callers' demographics (68.4% white); socioeconomics (47.6% with incomes < $15,000); residence (79.8% urban); information requests (20.7% general sexually transmitted diseases); concerns about exposure or infection (76.5% concerned they might be infected); acceptance of referrals (35.7% to public clinics); and hotline telephone number sources (20.4% from pamphlets). CONCLUSIONS: The hotline is called by persons from all segments of the public and addresses their concerns.

Adolescent↗
PubMed2000

Can chronic disability be prevented? A randomized trial of a cognitive-behavior intervention and two forms of information for patients with spinal pain.

STUDY DESIGN: A randomized controlled design superimposed on treatment as usual was used to compare the effects of a cognitive-behavior intervention aimed at preventing chronicity with two different forms of information. OBJECTIVE: To develop a coping-oriented preventive intervention applicable in primary care, and to compare its impact with educational information. SUMMARY OF BACKGROUND DATA: Preventing long-term disability resulting from spinal pain has proved difficult. The information provided by health care professions and early interventions aimed at preventing long-term disability may be important, but little scientific evidence exists concerning their use. METHODS: A protocol for a six-session cognitive-behavior group intervention was developed on the basis of earlier research. The main focus was to prevent long-term disability by changing patients' behaviors and beliefs so they can cope better with their problems. Comparison groups received either a pamphlet shown earlier to have an effect, or a more extensive information package consisting of six installments. All the groups continued to receive treatment as usual in primary care. There were 243 patients with acute or subacute spinal pain who perceived that they were at risk for developing a chronic problem. These patients were randomized to the cognitive-behavioral intervention or one of the two information groups. Because the aim was to prevent long-term disability, the key outcome variables at the 1-year follow-up assessment were sick absenteeism and health care use. Other variables were pain, function, fear-avoidance beliefs, and cognitions. RESULTS: The comparison groups reported benefits. However, the risk for a long-term sick absence developing was lowered ninefold for the cognitive-behavior intervention group as compared with the risk for the information groups (relative risk, 9.3). Participants in the cognitive-behavior group also reported a significant decrease in perceived risk. In addition, the cognitive-behavior group demonstrated a significant decrease in physician and physical therapy use as compared with two groups receiving information, in which such use increased. All three groups tended to improve on the variables of pain, fear-avoidance, and cognitions. CONCLUSIONS: This study demonstrates that a cognitive-behavior group intervention can lower the risk of a long-term disability developing. These findings underscore the significance of early interventions that specifically aim to prevent chronic problems. This approach might be applied to primary care settings.

Absenteeism↗
PubMedDate not supplied

A model for dealing with sudden death.

The purpose of this study was to attempt to provide health professionals working in emergency departments with guidelines to use in order to ensure the therapeutic management of the dead or dying client, the suddenly bereaved families, and fellow colleagues (health professionals). A 4-year action research study was undertaken involving semistructured interviews with health professionals (doctors and nurses) working in selected Level I emergency departments, suddenly bereaved families belonging to a local bereavement support group, and mortuary staff in KwaZulu-Natal, South Africa. Further analysis of the categories and themes that emerged from the interviews informed the development of the Dealing with Sudden Death Model, a family information pamphlet, a preparation checklist, and an incident evaluation checklist.

Bereavement↗
PubMed2000

Design, implementation, and evaluation at entry of a prospective cohort study of homosexual and bisexual HIV-1-negative men in Belo Horizonte, Brazil: Project Horizonte.

BACKGROUND AND OBJECTIVES: Project Horizonte, an open cohort of homosexual and bisexual HIV-1-negative men, is a component of the Minas Gerais AIDS Vaccine Program of the Federal University of Minas Gerais, Belo Horizonte, Brazil. Its objectives included the evaluation of seroincidence of HIV, to ascertain the role of counseling on behavior modification and to assess their willingness to participate in future HIV vaccine trials. METHODS: Various means of recruitment were used, including pamphlets, notices in community newspapers, radio, and television, at anonymous testing centers, and by word of mouth. RESULTS: From October 1994 to May 1999, 470 volunteers were enrolled. Their mean age was 26 years and over 70% of them had high school or college education. During the follow-up, they were seen every 6 months, when they received counseling and condoms, and when HIV testing was done. Eighteen seroconversions were observed, and the incidence rates estimates were 1.75 per 100 and 1.99 per 100 person-years, for 36 and 48 months of follow-up, respectively. During the entire period, 139 volunteers were lost to follow-up. Among them, 59 (42.4%) never returned after the initial visit and 51 (36.7) came only once after their initial visit. No losses were observed for those observed during follow-up for more than 3 years. At enrollment, 50% of participants said they would participate in a vaccine trial, and 30% said they might participate. CONCLUSIONS: The results obtained up to this moment confirm the feasibility of following this type of cohort for an extended period, estimating HIV incidence rate, and evaluating counseling for safe sexual practices in preparation for clinical trials with candidate HIV vaccines in Brazil.

Adult↗
PubMed2005

Educating patients about anaesthesia: effect of various modes on patients' knowledge, anxiety and satisfaction.

PURPOSE OF REVIEW: This review summarizes the current research on the effects of preoperative education about anaesthesia on patient knowledge, anxiety, and satisfaction. RECENT FINDINGS: Misconceptions about the process and the risks of general and regional anaesthesia are common. Information leaflets should be formally assessed to ensure that patient knowledge is increased. Patients should be surveyed to see what information they want, rather than just providing what healthcare professionals think is appropriate. The amount of information requested by patients can vary considerably. Providing detailed drug information leaflets for anaesthetic drugs was not thought necessary by many patients, but was not associated with increased preoperative state anxiety. Information sessions to small groups of patients by multidisciplinary healthcare professionals were useful for patients undergoing total hip arthroplasty, with a small reduction in preoperative state anxiety, but patient satisfaction levels remained unchanged. Patient satisfaction should be measured by a valid and reliable questionnaire. When this was done, the introduction of pamphlets did not improve patient satisfaction. The evidence for better patient outcomes after patient education interventions is not convincing. SUMMARY: Preoperative patient education should recognize that different patients have various misconceptions, expectations and needs. Multiple modes may be required to increase knowledge for informed consent and decrease patient anxiety. Patient satisfaction is generally high irrespective of the mode of patient education.

Journal Article↗
PubMed2006

Integrating palliative and critical care: description of an intervention.

A large proportion of deaths in the United States occur in the intensive care unit (ICU) or after a stay in the ICU, and there is evidence of problems in the quality of care these patients and their families receive. In an effort to respond to this problem, we developed a multifaceted, nurse-focused, quality improvement intervention that is based on self-efficacy theory applied to changing clinician behavior. We have called the intervention "Integrating Palliative and Critical Care." This five-component intervention includes: 1) critical care clinician education to increase knowledge and awareness of the principles and practice of palliative care in the ICU, 2) critical care clinician local champions to provide role modeling and promote attitudinal change concerning end-of-life care, 3) academic detailing of nurse and physician ICU directors to identify and address local barriers to improving end-of-life care in each ICU, 4) feedback of local quality improvement data, and 5) system supports including implementation of palliative care order forms, family information pamphlets, and other system supports for providing palliative care in the ICU. The goal of this report is to describe the conceptual model that led to the development of the intervention, and for each of the five components, we describe the theoretical and empirical support for each component, the content of the component, and the lessons we have learned in implementing the component. Future reports will need to examine the ability of the interventions to improve outcomes of palliative care in the ICU.

Attitude of Health Personnel↗