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At least 541 records · Page 30Linked to original sources
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↗
PubMed2005

Measuring the significance of participant evaluation of acceptability of cases in the College of American Pathologists Interlaboratory Comparison Program in cervicovaginal cytology.

CONTEXT: The quality of gynecologic cytology slides within educational and proficiency testing programs may deteriorate during use. Participant evaluation of the acceptability of these slides subsequent to possible deterioration is not known. OBJECTIVE: To assess participants' evaluation of the acceptability of slides circulating within an educational gynecologic cytology glass slide program. DESIGN: The College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology is a peer comparison and educational program that evaluates the ability of the participants to correctly classify gynecologic cytology preparations. The program uses both expert review and field validation to select slides for the graded portion of the program. Participants were asked to assess the acceptability of slides within the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology, and their responses were assessed with respect to type of slide preparation, validation status, and reference diagnosis. In addition, we compared the cytodiagnostic discordancy rates of slides that were deemed acceptable by participants with those that were deemed unacceptable. SETTING: Participant assessments were derived from pathologists and cytotechnologists from cytology laboratories of all types. RESULTS: A total of 17,210 slide interpretations were reviewed, and 2.91% of the cases were labeled unacceptable by participants. For all slides, the percentage of cases called unacceptable varied from 1.65% for cases with a reference interpretation of herpes to 45% for cases with a reference interpretation of unsatisfactory. The percentage of slides deemed unacceptable was higher for validated slides than for educational slides (3.27% vs 2.55%, P = .006). The discordancy rate (to reference diagnosis series) for cases deemed unacceptable was significantly higher than the discordancy rate for cases deemed acceptable for both validated (10.39% vs 1.76%) and educational slides (21.72% vs 3.53%, P < .001). CONCLUSION: Greater than 97% of all slides in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology were judged acceptable by participants. Despite expert review and field validation, a small percentage of slides (almost 3%) in this program were deemed unacceptable by participants. These results support the use of participant evaluation of cases to continually improve the quality of cases in this program.

Clinical Competence↗
PubMed2005

Developing effective physician leaders: changing cultures and transforming organizations.

In this article, the authors discuss the problematic issue of transformational change in the face of cultural conflict between the worlds of clinical care and organizational leadership, and describe a case study of organizational cultural change facilitated through a physician leadership development program. A locally developed physician leadership program can be extremely effective at both improving physicians' leadership skills and increasing understanding of the strategic goals and direction of the organization. The transformational change required for physicians to develop and appreciate business and leadership skills can be supported and encouraged in a leadership development program that includes the components of careful curriculum design, program monitoring, and opportunities to apply new skills in practice. For Columbus Children's Hospital, Columbus, Ohio, this organizational transformational change effort was successfully achieved when a new medical leadership development program helped academic and community physicians to become involved in organizational leadership. The authors describe the background and development of this program and provide results of their evaluation of the program, with discussion of future extensions to the program.

Academic Medical Centers↗
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↗
PubMed2005

Outcome evaluation of work hardening program for manual workers with work-related back injury.

OBJECTIVE: The purpose of this study was to investigate the effectiveness of a 12-week work hardening program designed for back injured workers. STUDY DESIGN: In this study, 32 subjects were recruited. Pre- and post-assessment results were used to measure the program effectiveness. The intensity of the work hardening program was based on the overloading training principle. Subjects were contacted by phone three months after the program completion for their work status. RESULT: The findings of this study suggested that there was a significant difference in the subjects' physical demand characteristic level before and after the work hardening program. Seventy-five percent of the subjects who completed the work hardening program were able to resume employment. CONCLUSION: The rate of returning to work for back injured workers in this study was comparable to that of other studies. Thus, this study suggests that the overloading principle should be used in designing a work hardening program to improve clients' physical function.

Adult↗
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↗
PubMed2006

Factors contributing to intervention fidelity in a multi-site chronic disease self-management program.

BACKGROUND AND OBJECTIVES: Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design. METHODS: The Florida Health Literacy Study (FHLS) was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance. RESULTS: This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation. CONCLUSION: Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.

Journal Article↗
PubMedDate not supplied

Worksite intervention for weight control: a review of the literature.

PURPOSE: Published research on worksite weight-control programs is reviewed with the objective of assessing success in (1) reaching populations in need, (2) achieving sustained weight loss, and (3) improving employee health and productivity. SEARCH METHOD: Reviewed are 44 data-based articles published between 1968 and 1994. The initial search was part of a larger review on the health impact of worksite health promotion programs conducted by Centers for Disease Control and described in the introduction to this issue. We supplemented the resulting list with articles found in a search of our own reference files. IMPORTANT FINDINGS: Methodologically the literature is relatively weak, consisting largely of uncontrolled case studies. Worksite interventions appear to be successful in reaching large numbers of people: the median participation rate among overweight employees was 39% in the six studies that provided this type of information. Worksite programs produced reasonable short-term weight loss: typically 1 to 2 pounds per week. Long-term weight loss, reductions in sitewide obesity prevalence, and health or productivity benefits have yet to be demonstrated. MAJOR CONCLUSIONS: Recommendations for future research include improved methods, more attention to recruitment and secondary outcomes, more direct comparison of different programs, and more creative use of worksites as environments and social units in designing programs.

Health Promotion↗
PubMed2000

Enhancing hope in people with a first recurrence of cancer.

Enhancing hope in people with a first recurrence of cancer Researchers and clinicians have identified the need for well-defined intervention studies to test the efficacy of interventions designed to strengthen hope. This quasi-experimental study sought to determine if a specific nursing intervention program designed to enhance hope would positively influence levels of hope and quality-of-life (QOL) in a convenience sample of 115 people with a first recurrence of cancer who were randomly assigned to one of three groups: treatment group (hope), attention control group (informational), or control group (usual treatment). The Herth Hope Index (HHI) and the Cancer Rehabilitation and Evaluation Systems, Short Form (CARES-SF) were administered prior to intervention, immediately after intervention and at 3, 6, and 9-month intervals. Treatment and control groups differed significantly with regard to level of hope (P=0.02) and QOL (P=0.03). Both the level of hope and QOL were significantly increased (P=0.03) immediately after intervention and across time (3, 6 and 9 months). This study was a preliminary attempt to design, implement, and evaluate a theory-driven hope intervention program. Knowledge about the effectiveness of specific interventions designed to enhance hope is vital if nurses are to significantly influence hope in those whom are in their care.

Adaptation, Psychological↗
PubMed2003

Assessment of basic human performance resources predicts operative performance of laparoscopic surgery.

BACKGROUND: Interest in laparoscopic surgery has prompted development of educational programs designed to teach and assess laparoscopic skills. Although these programs are beneficial, because of the inherent demands imposed by laparoscopy some aspects of operative performance might not improve with practice. This suggests that innate ability could predict level of operative skill. Assessment of operative and technical potential to date has relied largely on subjective rather than objective criteria. In this study, the relationships between objective measures of human basic performance resources (BPRs) and laparoscopic performance were evaluated using Nonlinear Causal Resource Analysis (NCRA), a novel predictive and explanatory modeling approach based on General Systems Performance Theory. STUDY DESIGN: Twenty urology residents were voluntary enrolled. Thirteen validated BPRs were measured and analyzed relative to operative laparoscopic performance (assessed by two experts) of two porcine laparoscopic nephrectomies (LN). The laparoscopic procedure, representing a High Level Task (HLT), was evaluated using a modified Global Rating of Operative Performance Scale. NCRA models were devised to predict performance of the HLT laparoscopic nephrectomies based on BPRs and to determine the limiting performance resource. RESULTS: NCRA models predicted excellent agreement with actual operative performance, suggesting that measures of innate ability (or BPRs) predicted performance of laparoscopic nephrectomy. In 65%, the prediction by NCRA was near identical to the expert rating on the HLT. In 25% of cases, NCRA overpredicted performance; in 10%, NCRA underpredicted performance of the HLT compared to the subjective ratings. Neuromotor channel capacity was the most common performance-limiting resource. CONCLUSIONS: Preliminary findings suggest objective prediction of laparoscopic performance with limiting resource diagnostics for an individual surgeon is possible and practical using appropriate new measurement and modeling methods. Selection of surgical candidates, training, and educational curriculum could be positively affected.

Adult↗
PubMed1999

WinGene/WinPep: user-friendly software for the analysis of amino acid sequences.

WinGene1.0/WinPep1.2 is a pair of Microsoft Windows programs designed to read nucleotide or amino acid sequence data. These versatile programs have the following capabilities: (i) searches for open reading frames and their translation, (ii) assisting the design of primers for PCR and (iii) calculation of molecular weight, isoelectric point and molar absorbtion coefficients of polypeptides. Furthermore, hydropathic plots and helical wheel displays are easily produced. The programs run with an intuitive Windows interface, contain a comprehensive help file and enable data exchange with other applications by means of the Copy&Paste command. The software is free for academic and noncommercial users.

Amino Acid Sequence↗