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PubMed1987

Improving Falope-Ring application in laparoscopy training.

Laparoscopic Falope-Ring sterilization was performed by residents on 71 women. Immediately following application of the ring, methylene blue was injected through the cervix to assess tubal patency. Unilateral spillage of the dye was demonstrated in four patients (5.6%). In these instances a new ring was applied, or the tube was tied surgically. The high rate of tubal patency was attributed to the surgeons' inexperience. The findings suggest that the use of a patency test as an adjunct to sterilization with the Falope-Ring in training programs is likely to decrease the rate of surgical failures.

Fallopian Tube Patency Tests↗
PubMed1986

The management of sexual issues in adolescent treatment programs.

Disturbed adolescents confined to inpatient treatment settings present special problems for the management of sexual behaviors. Ego impaired, delinquent, and autonomy-seeking adolescents provoke unique conflicts among their peers and staff. Staff's sexual anxiety caused by societal stereotypes of adolescents, inexperience with the techniques of unbiased observation and limit-setting, ignorance of normal adolescent development, and countertransference may lead to inadequate or inappropriate interventions. The authors describe the goals of a training program to reduce staff sexual anxiety: to develop a body of knowledge about the interaction between normal sexual development and psychopathology; to promote awareness about the staff's own feelings and the ways they influence observation and interaction; to lessen anxiety about self-exposure in the group setting; and to gain mutual support. Specific guidelines regarding effective staff interventions at an individual and group level are described. Alertness to the broad implications of sexuality in staff and patients and the necessity for careful monitoring of ward anxiety is emphasized.

Abortion, Induced↗
PubMedDate not supplied

Active bacterial core surveillance of the emerging infections program network.

Active Bacterial Core surveillance (ABCs) is a collaboration between the Centers for Disease Control and Prevention and several state health departments and universities participating in the Emerging Infections Program Network. ABCs conducts population-based active surveillance, collects isolates, and performs studies of invasive disease caused by Streptococcus pneumoniae, group A and group B Streptococcus, Neisseria meningitidis, and Haemophilus influenzae for a population of 17 to 30 million. These pathogens caused an estimated 97,000 invasive cases, resulting in 10,000 deaths in the United States in 1998. Incidence rates of these pathogens are described. During 1998, 25% of invasive pneumococcal infections in ABCs areas were not susceptible to penicillin, and 13.3% were not susceptible to three classes of antibiotics. In 1998, early-onset group B streptococcal disease had declined by 65% over the previous 6 years. More information on ABCs is available at www.cdc.gov/ncidod/dbmd/abcs. ABCs specimens will soon be available to researchers through an archive.

Bacterial Infections↗
PubMed1978

The delta EEG (sleep)-inducing peptide (DSIP). XI. Amino-acid analysis, sequence, synthesis and activity of the nonapeptide.

A peptide which induces slow-wave EEG (sleep) after intraventricular infusion into the brain has been isolated from the extracorporeal dialysate of cerebral venous blood in rabbits submitted to hypnogenic electrical stimulation of the intralaminar thalamic area. It was shown by amino-acid analysis and sequence determination to be Trp-Ala-Gly-Gly-Asp-Ala-Ser-Gly-Glu and named "Delta Sleep-Inducing Peptide" (DSIP). This compound was synthesized as well as 5 possible metabolic products (1--8, 2--9, 2--8, 1--4 and 5--9), 2 nonapeptide analogues (with one and two amino-acids exchanged) and a related tripeptide (Trp-Ser-Glu). All 9 synthetic peptides were infused intraventricularly in rabbits (6 nmol/kg in 0.05 ml of CSF-like solution over 3.5 min) and tested under double-blind conditions. A total of 61 rabbits including controls were used. The EEG from the frontal neocortex and the limbic archicortex were subjected to direct fast-Fourier transformation and analyzed by an 1108 computer system. A highly specific delta and spindle EEG-enhancing effect of the synthetic DSIP could be demonstrated. The mean increase of EEG delta activity reached 35% in the neocortex and limbic cortex as compared to control animals receiving CSF-like solution or any of the other 8 peptides. The final chemical characterization of the synthetic DSIP revealed that only the pure alpha-aspartyl peptide is highly active in contrast to its beta-Asp isomer. A neurohumoral modulating and programming activity was suggested.

Amino Acid Sequence↗
PubMed1999

The tyrosine kinase c-Abl regulates p73 in apoptotic response to cisplatin-induced DNA damage.

Cancer chemotherapeutic agents such as cisplatin exert their cytotoxic effect by inducing DNA damage and activating programmed cell death (apoptosis). The tumour-suppressor protein p53 is an important activator of apoptosis. Although p53-deficient cancer cells are less responsive to chemotherapy, their resistance is not complete, which suggests that other apoptotic pathways may exist. A p53-related gene, p73, which encodes several proteins as a result of alternative splicing, can also induce apoptosis. Here we show that the amount of p73 protein in the cell is increased by cisplatin. This induction of p73 is not seen in cells unable to carry out mismatch repair and in which the nuclear enzyme c-Abl tyrosine kinase is not activated by cisplatin. The half-life of p73 is prolonged by cisplatin and by co-expression with c-Abl tyrosine kinase; the apoptosis-inducing function of p73 is also enhanced by the c-Abl kinase. Mouse embryo fibroblasts deficient in mismatch repair or in c-Abl do not upregulate p73 and are more resistant to killing by cisplatin. Our results indicate that c-Abl and p73 are components of a mismatch-repair-dependent apoptosis pathway which contributes to cisplatin-induced cytotoxicity.

3T3 Cells↗
PubMed2002

Logic modeling: a tool for improving educational programs.

PURPOSE: Palliative care education programs must be systematically designed and accurately evaluated in order to account for their impact on learners and learning communities. Logic modeling is a framework for designing educational programs and monitoring their influence. METHODS: We applied a logic modeling process to a Palliative Care Educational Program (PCEP), embedded within a required month-long geriatrics rotation for third-year general internal medicine residents at the VA Medical Center in Milwaukee, Wisconsin. Each of four main categories of a logic model and the process for applying the steps to the PCEP are described. The four logic model categories that form the basis of the analysis are: (1) inputs, the raw resources consumed by the program (human resources, money, and space); (2) outputs, program activities and the number and types of actual participants; (3) outcomes, what the program will achieve in the short term (knowledge, attitudes and behavior change); and (4) impact, the results that are of ultimate interest to program stakeholders, such as placement in medically underserved areas, improved health or more efficient care. RESULTS: The application of logic modeling to the PCEP exposed achievements (e.g., resident knowledge gains) and gaps (no evidence of long-term impact) in each of the model categories and has resulted in the design team's reassessment of each program component. DISCUSSION: Palliative care educators can improve their programs by using the logic model categories and process steps to explicitly define and assess the links between key program components.

Education, Medical↗
PubMed1993

Institutional policy: use of restraints in extended care and nursing homes.

1. The percentage of patients restrained on these nursing home and extended care units was 32%, similar to that for other nursing home studies. 2. The archetypical restrained patient was older, new on the unit, had altered thought processes and a high potential for injury, and required extensive nursing care. Typically, the type of restraint a patient wore was a vest posey, on the day shift while in his room. 3. The most frequent rationale given by nurses for applying restraints was to prevent patient falls; however, half the time, this rationale was not charted. 4. Upon examining institutional restraint policy, nurses should be prepared to implement changes in documentation format, provide staff education regarding restraint use and alternatives available, institute a rehabilitative and restorative nursing care and fall prevention program, redesign the physical environment, and designate adequate resources for an effective diversion activity program.

Aged↗
PubMed1982

A university of department of family medicine after ten years.

The Department of Family Medicine at the University of Washington was started ten years ago after a major curriculum change in the medical school placed new emphasis on education and training of family physicians for the surrounding region in Washington, Alaska, Montana and Idaho (WAMI). This department has organized active programs in patient care, teaching and research at the university base and in a number of affiliated community sites throughout the region. The department is well accepted within the mission of the medical school. Almost a third of graduating medical students choose postgraduate training in family practice. Almost 90 percent of the graduates of the ten programs within the department's network of family practice residencies are established in active family practices, with more than two thirds settling in the WAMI region. Follow-up studies show that these graduates feel well prepared for their practices; are providing a broad range of services in rural, suburban and urban settings; are typically involved in partnership or group practice; and are generally well satisfied with their personal and professional lives.

Curriculum↗
PubMed2003

Deficiency of different nitric oxide synthase isoforms activates divergent transcriptional programs in cardiac hypertrophy.

Decreased nitric oxide synthase (NOS) activity induces left ventricular hypertrophy (LVH), but the transcriptional pathways mediating this effect are unknown. We hypothesized that specific NOS isoform deletion (NOS3 or NOS1) would activate different transcriptional programs in LVH. We analyzed cardiac expression profiles (Affymetrix MG-U74A) from NOS-/- mice using robust multi-array average (RMA). Of 12,422 genes analyzed, 47 genes were differentially expressed in NOS3-/- and 67 in NOS1(-/-) hearts compared with wild type (WT). Only 16 showed similar changes in both NOS-/- strains, most notably decreased heat-shock proteins (HSP10, 40, 70, 86, 105). Hypertrophied NOS1-/- hearts had unique features, including decreased myocyte-enriched calcineurin interacting protein and paradoxical downregulation of fetal isoforms (alpha-skeletal actin and brain natriuretic peptide). Cluster analyses demonstrated that NOS1 deletion caused more pronounced changes in the myocardial transcriptome than did NOS3 deletion, despite similar cardiac phenotypes. These findings suggest that the transcriptional basis for LVH varies depending on the inciting biochemical stimulus. In addition, NOS isoforms appear to play distinct roles in modulating cardiac structure.

Animals↗
PubMed1996

Impact of a 12-month exercise program on the physical and psychological health of osteopenic women.

OBJECTIVE: To describe the effect of a supervised physical activity program on the physical and psychological health of osteopenic women. DESIGN: A randomized controlled trial. SETTING: Sherbrooke, Quebec, Canada. PARTICIPANTS: A total of 124 community-living postmenopausal women, between 50 and 70 years of age, with low bone mass took part in the study. INTERVENTION: Subjects allocated to the experimental group performed weight-bearing exercises (walking, stepping up and down from benches), aerobic dancing, and flexibility exercises for 60 minutes, three times a week, over a period of 12 months. All subjects were invited to attend bi-monthly educational seminars covering topics related to osteoporosis. OUTCOME MEASURES: Spinal and femoral bone mineral density (BMD), functional fitness (flexibility, coordination, agility, strength/endurance, cardiorespiratory endurance), psychological well-being, back pain intensity, and self-perceived health. RESULTS: Spinal BMD stabilized in the exercisers while decreasing significantly in the controls (P = .031). No change in femoral BMD was observed in either group (P = .597). Four of the five parameters chosen to evaluate functional fitness, namely flexibility, agility, strength, and endurance, were affected positively by the exercise program (all P < .01). Adjusting for prescores by means of an analysis of covariance revealed a significant difference between the groups in psychological well-being, which favored the exercisers (P = .012). After 12 months, back pain reported by exercisers was lower than that reported by controls (P = .008). Finally, self-perceived health increased in the exercise group, whereas no difference was observed in the control group (P = .790). CONCLUSION: These results suggest that after 12 months, exercising can produce a significant increase above initial levels in the functional fitness, well-being, and self-perceived health of osteopenic women. Intensity of back pain can also be lowered by exercise. The exercise program succeeded in stabilizing spinal BMD but had no effect on femoral BMD.

Aged↗
PubMed1990

Community health nurses and family planning services for men.

Current concerns about sexually transmitted diseases (STDs) and acquired immunodeficiency syndrome (AIDS), as well as unintended pregnancy, have drawn increasing attention to reproductive health services for men. This report presents information about responses by 844 community health nurses (CHNs) to a self-administered mailed questionnaire that included questions about the extent of the nurses' involvement in delivering or administering family planning services to men, their knowledge and attitudes about men and family planning, and their preparation for working with men. Our sample included CHNs in practice in five states and a sample of CHNs belonging to a national organization of public health nursing, in order to gain information about CHNs in practice in the field and CHNs more likely to be in an educational or administrative position and thus able to influence or to set policy. Two thirds of the nurses surveyed work with men in their reproductive years but only 17.8% delivered or administered family planning services to men (23% of the state sample and 12.5% of the organization sample). Deficits in knowledge about male birth control methods were identified; for example, only 32% knew the use-effectiveness rate of the condom. However, 90% of the CHNs knew the condom has to be put on before any genital contact is made. The CHNs' attitudes were positive; more than 90% said they felt men had equal responsibility with their partners in preventing unwanted pregnancies, using contraception, and contraceptive decision making. Yet, only 9.6% of the CHNs felt men have as much knowledge about contraception as women do. Seventy percent of the nurses felt tha sex education in schools was directed more to female students than to male students. More than 90% said they believed that family planning providers have a responsibility to provide services to men; but two thirds felt that nurses are not as well prepared to work with male as with female clients. Increased educational preparation may improve CHNs' knowledge about men and family planning and enable them to feel professionally prepared to deliver and administer the services they feel are necessary for male as well as female clients. There are 101,430 CHNs in the United States, working in public health departments or other service agencies in almost every community across the country. These CHNs are a major resource for the family planning field.

Community Health Nursing↗