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Currently the prevalent perception is that regular exercise training, besides increasing maximal oxygen uptake (VO2max), may have a beneficial effect on blood pressure and plasma lipid fractions. This is the basis for recommending exercise training for health maintenance and as a part of any prevention program for middle aged and older individuals. The purpose of this work was first, to review whether a basis exists for these recommendations and if so, to secondly design an exercise training program adjusted to these groups. Its parameters should be efficient enough to cause improvements in VO2max and risk profile, yet prevent cardial and orthopedic problems. The structure and the results of exercise programs in 27 experimental studies (n = 1153) were reviewed. The findings indicate that significant changes in VO2max, apart from individuals having least favourable values initially, do not necessarily effect simultaneous improvements in either blood pressure or plasma lipid fractions. Results strongly indicate the permanent benefits of participating in a long-term exercise program. This program should therefore provide a very useful and natural addition to the accepted dietary and pharmacological therapies.
INTRODUCTION: Logger safety training programs are rarely, if ever, evaluated as to their effectiveness in reducing injuries. METHOD: Workers' compensation claim rates were used to evaluate the effectiveness of a logger safety training program, the West Virginia Loggers' Safety Initiative (LSI). RESULTS: There was no claim rate decline detected in the majority (67%) of companies that participated in all 4 years of the LSI. Furthermore, their rate did not differ from the rest of the WV logging industry that did not participate in the LSI. Worker turnover was significantly related to claim rates; companies with higher turnover of employees had higher claim rates. Companies using feller bunchers to harvest trees at least part of the time had a significantly lower claim rate than companies not using them. Companies that had more inspections per year had lower claim rates. CONCLUSIONS: High injury rates persist even in companies that receive safety training; high employee turnover may affect the efficacy of training programs. The logging industry should be encouraged to facilitate the mechanization of logging tasks, to address barriers to employee retention, and to increase the number of in-the-field performance monitoring inspections. Impact on industry There are many states whose logger safety programs include only about 4-8 hours of safe work practices training. These states may look to West Virginia's expanded training program (the LSI) as a model for their own programs. However, the LSI training may not be reaching loggers due to the delay in administering training to new employees and high levels of employee turnover. Regardless of training status, loggers' claim rates decline significantly the longer they work for a company. It may be that high injury rates in the state of West Virginia would be best addressed by finding ways to encourage and facilitate companies to become more mechanized in their harvesting practices, and to increase employee tenure. Increasing the number of yearly performance inspections may also be a venue to reduce claim rates. Future research could investigate in better detail the working conditions of West Virginia loggers and identify barriers to job tenure, particularly for workers whose primary job task is chainsaw operation. A larger-scale study of the effect of performance monitoring inspections on claim rates is also warranted.
Child psychiatry training programs have encountered a number of administrative problems resulting from efforts to recognize, without isolating or submerging, the unique aspects of child psychiatry within existing departments of psychiatry. This paper questions the validity of the concept of general psychiatry, which may be responsible for many of these administrative dilemmas. The thesis is advanced that adult and child psychiatry actually represent distinct fields of practice, however, training programs for each should be integrated within departments of psychiatry through both adult and child divisional administrative lines.
A control group (CG, n = 1,138) that implemented a traditional Basic Combat Training (BCT) physical training (PT) program was compared to an evaluation group (EG, n = 829) that implemented a PT program newly designed for BCT. The Army Physical Fitness Test (APFT) was taken at various points in the PT program, and injuries were obtained from a medical surveillance system. After 9 weeks of training, the proportion failing the APFT was lower in the EG than in the CG (1.7 vs. 3.3%, p = 0.03). After adjustment for initial fitness levels, age, and body mass index, the relative risk of an injury in the CG was 1.6 (95% confidence interval [CI] =1.2-2.0) and 1.5 (95% CI = 1.2-1.8) times higher than in the EG for men and women, respectively. The newly designed PT program resulted in higher fitness test pass rates and lower injury rates compared to a traditional BCT physical training program.
OBJECT: Patient care and educational experience have long formed a dichotomy in modem surgical training. In neurosurgery, achieving a delicate balance between these two factors has been challenged by recent trends in the field including increased subspecialization, emerging technologies, and decreased resident work hours. In this study the authors evaluated the experience profiles of neurosurgical trainees at a large Canadian academic center and the safety of their practice on patient care. METHODS: Two hundred ninety-three patients who underwent surgery for intracranial aneurysm clipping between 1993 and 1996 were selected. Prospective data were available in 167 cases, allowing the operating surgeon to be identified. Postoperative data and follow-up data were gathered retrospectively to measure patient outcomes. In 167 cases, a total of 183 aneurysms were clipped, the majority (91%) by neurosurgical trainees. Trainees performed dissections on aneurysms that were predominantly small (< 1.5 cm in diameter; 77% of patients) and ruptured (64% of patients). Overall mortality rates for the patients treated by the trainee group were 4% (two of 52 patients) and 9% (nine of 100 patients) for unruptured and ruptured aneurysm cases, respectively. Patient outcomes were comparable to those reported in historical data. Staff members appeared to be primary surgeons in a select subset of cases. CONCLUSIONS: Neurosurgical trainees at this institution are exposed to a broad spectrum of intracranial aneurysms, although some case selection does occur. With careful supervision, intracranial aneurysm surgery can be safely delegated to trainees without compromising patient outcomes. Current trends in practice patterns in neurosurgery mandate ongoing monitoring of residents' operative experience while ensuring continued excellence in patient care.
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The "lanes" concept of training was integrated into a medical site support mission of the 804th Medical Brigade, U.S. Army Reserve, during Annual Training, 1993 at Fort Drum, New York. This training, termed Hospital Integrated Lanes Training (HILT), included STX, FTX, patient play, and full use of Deployable Medical Systems equipment. The medical care of over 33,000 personnel participating in tactical annual training exercises was not interrupted during any concurrent phase of lanes training. Brigade operations planners developed an array of medical exercises that involved both moulaged and paper patient play. These exercises began prior to hospital set-up and continued for 24 hours a day throughout the tactical exercise. Injuries likely to be encountered during combat operations were inserted into the play singly and under a mass-casualty scenario. The standard of care for all injuries was determined with the Army Medical Department Center and School guidance. Prior coordination of brigade medical assets with external air and ground ambulance organizations broadened the scope of the training and facilitated effective use of command and control, communications, and equipment over a wide geographic area. Medical records were collected and evaluated at the conclusion of all exercises. After-action reviews were conducted by all medical units to assist in the planning of future HILT exercises. The HILT concept is a valuable tool for the complex training requirements of field medical units organized under medical Force 2000. The concept of integrated lanes training allows for the development and continuous improvement of individual and sectional skills for medical personnel and should be applied within all echelons of care.
Program design for training in Adolescent Medicine is still in an evolutionary state. Postgraduate fellows and program directors have different perceptions with regard to the importance of various components of the ideal training program. Fellows indicate a higher priority for problems associated with the female reproductive system than do their mentors. Inpatient experience received lesser emphasis by the Fellows. Adolescent Medicine as a subspecialty discipline is discouraged.
OBJECTIVE: The new Accreditation Council for Graduate Medical Education (ACGME) requirements regarding resident work hours have been implemented since July 2003. Neurological surgery training programs have been especially affected because of the limited number of residency positions and the residents' long duty hours. The perceptions of program directors and residents may provide important insight into the evolution of new guidelines for improvement of resident training. METHODS: We conducted a nationwide survey of 93 program directors and 617 residents to characterize their perceptions regarding the changes in their training programs related to compliance with the ACGME requirements. The survey was conducted from July through September 2003 using electronic mail. RESULTS: The response rates were 45% and 23% among the program directors and residents, respectively. Most programs offered one (37%) or two (38%) resident training positions per year. Although 92% of programs had implemented the ACGME work hours requirements before or since July 2003, 8% had not yet implemented these guidelines. Sixty-eight percent of program directors indicated employment of ancillary health care professionals to fulfill the ACGME duty hours reform; 84% (95% confidence interval [CI], 64-94%) thought that this practice has not limited the residents' clinical experience. Eleven percent of respondents (18 of 164 respondents) who provided Level I trauma coverage were unable to maintain compliance with the ACGME guidelines. Ninety-three percent (95% CI, 89-96%) of all respondents thought that the work hour reform has had a negative impact on the continuity of patient care. Fifty-five percent (95% CI, 46-63%) of the residents and only 33% (95% CI, 20-50%) of the program directors thought that the ACGME requirements are likely to result in improved American Board of Neurological Surgery written test scores. Twenty-nine percent (95% CI, 22-37%) of the residents and 17% (95% CI, 8-32%) of the program directors thought that resident attendance at national conferences would increase. Similarly, although 46% (95% CI, 37-54%) of residents perceived that these work hour limitations would facilitate residents' research/publication-related activities, only 21% (95% CI, 11-37%) of program directors agreed. Forty-one percent (95% CI, 33-49%) of the residents and 74% (95% CI, 58-86%) of the program directors perceived that the chief residents operate on fewer complex cases since the institution of the ACGME duty hour guidelines. Seventy-five percent of residents think they are less familiar with their patients. Overall, 61% (95% CI, 53-69%) of the residents and 79% (95% CI, 63-89%) of the program directors noted that the ACGME guidelines have had a negative effect on their training programs. CONCLUSION: On the basis of their early experience, the majority of the residents and program directors think that the ACGME duty hour guidelines have had an adverse effect on continuity of patient care and resident training. The effects of these guidelines on neurosurgery programs should be carefully monitored, because more sophisticated solutions may be needed to address house staff fatigue. Strategies to enhance the educational content of the residents' work hours and to preserve continuity of patient care are necessary.
BACKGROUND: Few affordable training opportunities are specifically designed for the long-term care facility infection control practitioner. There is also little evidence of the success of training in improving infection control practices. The Nebraska Infection Control Network developed a 2-day basic skills training program for Midwestern long-term care facility infection control practitioners that was later disseminated to eastern and western training sites. In this study we examined the effectiveness of the training program in terms of trainee knowledge and practice. METHODS: From 1986 to 1990, a total of 17 courses conducted at the three sites were attended by a total of 266 infection control practitioners. Trainees completed a 40-item multiple choice test before and after training to evaluate their knowledge gain. Implementation of eight key infection control practices and time devoted to infection control duties were measured before training and at 3 and 12 months after training. Implementation of infection control practices was also evaluated in a second study, with infection control practitioners randomly assigned to trained and wait-control conditions. RESULTS: Significant increases after training were found at each site for both knowledge and implementation measures. These increases were maintained at 12 months follow-up. Time devoted to infection control duties increased significantly at the midwest and western sites but not at the eastern site. In the second study, significant differences were found between the trained and the wait-control group in use of infection control practices, providing evidence for a causal relationship between training and increased use of practices. CONCLUSIONS: The training program was effective in producing improvements in knowledge and implementation of recommended infection control practices in long-term care facilities. These improvements were consistent across three diverse geographic areas. There were some specific geographic differences.
This is the third survey of physician clinical nutrition training programs. Current training programs were identified, descriptive information obtained, and training program content was compared with that recommended at the 1984 Conference on Clinical Nutrition Training. In general, goals as to the quantity of research, clinical, and teaching training are being met. Virtually all programs provide training in nutritional support activities. Most training programs are not as broad in scope of exposure to the less clinical aspects of nutrition nor to all the illness and age groups recommended by the 1984 conference. Consideration of broadening the scope of physician training programs or redefinition of training guidelines is warranted. A program-certifying agency may be helpful in identifying programs achieving certain minimal standards.
Principles for managing training programs for supportive personnel and new pharmacist employees in hospital pharmacy departments are discussed, and ongoing staff development activities are described. General management objectives of training programs are outlined. Training programs for supportive personnel should include general theory, such as basic pharmacology and metric conversions, and practice in the specific skills required for the job. The practical component of the training program should be based on a job analysis, and behavioral objectives of the training program should be developed. Various approaches for structuring and monitoring training programs for supportive personnel are described. Besides mastering specific practice skills, new pharmacist employees must become thoroughly familiar with the pharmacy department's policy and procedure manual. Hospital pharmacy managers should implement ongoing activities for developing the decision-making, interpersonal, and practice skills of staff pharmacists. Well-organized training programs can effectively raise the performance standards of pharmacy departments and decrease the time spent in monitoring, evaluating, and correcting performance deficiencies of the staff.
This program integrates training with the clinical interdisciplinary aspects of health care by directly involving pharmacy and other health professional students in an on-going team model of health care delivery. The training program model allows pharmacy students to learn the conceptual basis of team care and to experience directly how this concept is applied in an ambulatory health care setting. Learning strategies include specialty and team delivery of health care, participation in weekly interdisciplinary team training seminars, involvement in problem-solving and other skill building activities, and development of an interdisciplinary team project. Program evaluation results have indicated that students perceive that the interdisciplinary training increased their knowledge and positive attitudes towards interdisciplinary teams. The training also increased their sensitivity to patients, and enhanced the understanding of the problems of delivering health care to an urban community. The results have also shown that through this structured interdisciplinary experience, students reported having a better understanding of the roles of other health professionals and a greater awareness of how these different roles are integrated into a health care team.
Weight training is an integral part of most athletic conditioning programs; yet, the effect of these programs on neuromuscular function remains unclear. To examine the neuromuscular effects of training and conditioning at the knee joint, 32 volunteers (16 men and 16 women; average age, 25.4 years) were placed into one of four groups: isokinetic, isotonic, agility, or control. Each group trained 3 days per week for 6 weeks. The knee function of all participants was evaluated just before and after the 6-week training period. The agility-trained group significantly improved the spinal reflex times of the lateral and medial quadriceps muscles in response to anterior tibial translation. The cortical response time of the agility group also significantly improved in the gastrocnemius, medial hamstring, and the lateral quadriceps muscles. Interestingly, the cortical response time of the medial hamstring and the medial quadriceps muscles in the isokinetic group slowed significantly, by 39.1 and 32.4 msec, respectively, after 6 weeks of training. Isotonic and isokinetic strength training of the lower extremities do not appear to improve muscle reaction time to anterior tibial translation, whereas agility exercises potentially improve this parameter.