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PubMedDate not supplied

Effectiveness of an emergency preparedness training program for public health nurses in New York City.

A public health workforce that is competent to respond to emergencies is extremely important. We report on the impact of a training program designed to prepare public health nurses to respond appropriately to emergencies. The program focused on the basic public health emergency preparedness competencies and the emergency response role of public health workers employed by the New York City School Department of Health and Mental Hygiene School Health Program. The evaluation methods included pre/post-testing followed by a repeat post-test one month after the program. The program resulted in positive shifts in both knowledge and emergency response attitudes.

Attitude of Health Personnel↗
PubMed1996

Regulation of oxidative metabolism and blood flow in skeletal muscle. Summary report of the first ACSM Basic Science Specialty Conference, Indianapolis, IN, September 28-30, 1995.

The first ACSM Basic Science Specialty Conference was held in Indianapolis, September 28-30, 1995. The topic was integration among cellular metabolism, blood flow regulation, and O2 supply during exercise, principally in skeletal muscle. The structure of the meeting was uniquely designed to emphasize free discussion among the 102 registrants; thus, this unique program design does not lend itself to a conventional collection of written symposium proceedings. On the other hand, the College, editor-in-chief Peter B. Raven, and the meeting organizers felt that a summary of the meeting's major points was important to compile and distribute to members via Medicine and Science in Sports and Exercise. Therefore, the organizing committee present a summary of the major issues discussed.

Endothelium, Vascular↗
PubMedDate not supplied

Evaluation of a peer assessment approach for enhancing the organizational capacity of state injury prevention programs.

To conduct a formative and pilot impact evaluation of the State Technical Assessment Team (STAT) program, a visitation-based (visitatie) peer assessment program designed to enhance the organizational capacity of state health department injury prevention programs. The formative evaluation was based on observational, record review, and key informant interview data collected during the implementation of the first 7 STAT visits. Pilot impact data were derived from semi-structured interviews with state injury prevention personnel one year after the visit. Formative evaluation identified 6 significant implementation problems in the first visits that were addressed by the program planners, resulting in improvements to the STAT assessment protocol. Impact evaluation revealed that after one year, the 7 state injury prevention programs had acted on 81% of the recommendations received during their STAT visits. All programs reported gains in visibility and credibility within the state health department and increased collaboration and cooperation with other units and agencies. Other significant program advancements were also reported. Specific program standards and review procedures are important to the success of peer assessment programs such as STAT. Early impact evaluation suggests that peer assessment protocols using the visitatie model can lead to gains in organizational capacity.

Adolescent↗
PubMed2005

Factors that influence prescribing within a therapeutic drug class.

RATIONALE, AIMS AND OBJECTIVES: The decision to prescribe one drug instead of another within the same therapeutic class may be influenced by a variety of drug-related, direct, or indirect factors; but little is known about which considerations are most important in such choices. The low-molecular-weight heparins (LMWHs) represent a class of drugs that are commonly used and for which therapeutic equivalence has been debated in the literature. The purpose of this study was to identify and compare factors perceived by doctors and clinical pharmacists to be influential in prescribing decisions among LMWHs. METHODS: Doctors and clinical pharmacists were interviewed to elicit information and to rank factors that influence the prescribing and use of LMWHs in community hospitals in the United States. For each factor, the mean and median of the rating were determined along with the frequency distribution across ratings. The non-parametric Mann-Whitney U-test was used to examine differences between doctors and clinical pharmacists. RESULTS: Both groups considered efficacy, formulary status, and policies restricting drug use to be highly influential in the decision to use one LMWH instead of another. Compared to clinical pharmacists, doctors rated personal experience as more influential, whereas they rated drug cost and prescribing guidelines lower. CONCLUSIONS: These findings suggest that doctors and clinical pharmacists differentiate between LMWHs based on differences between products and because of hospital administrative programs (such as drug formularies). This information may be of value in designing programs to alter medication use.

Choice Behavior↗
PubMed2004

Cost-effectiveness of post-transplantation quality of life intervention among kidney recipients.

BACKGROUND: The purpose was to demonstrate the cost-effectiveness of an experimental post-transplant care program designed to improve kidney transplant recipients' quality of life (QoL). The intervention program integrated a three-pronged interdisciplinary approach emphasizing: (i) proactive, patient-initiated care to prevent transplant-related morbidities, (ii) employment/vocational counseling, and (iii) enhancement of social support. METHODS: A cost-effectiveness analysis of a clinical trial was performed comparing QoL and costs in two groups: a retrospective cohort (n = 30) and those who received the experimental interventions (n = 150). Data were collected at baseline, 6 and 12 months. The number of quality-adjusted 'treatment-free days' was used as the primary outcome. The costs included those for direct intervention, direct inpatient and outpatient post-transplant health care, and indirect out-of-pocket expenses borne by patients. RESULTS: Patients in the intervention group had more quality-adjusted treatment-free days (289 vs. 272 and statistically significant) and lower cost per patient (although not statistically significant). Further, the superior outcome was delivered at an incremental cost of 29 US dollars per quality-adjusted treatment-free day. A one-way sensitivity analysis confirmed the robustness of the results. CONCLUSION: The experimental post-transplant care program is both effective and cost-effective; the superior results are attributed to improved QoL.

Adult↗
PubMed1990

Aerobic fitness, physical activity, and psychophysiological reactions to mental tasks.

The association between aerobic fitness, exercise, and psychophysiological reactivity was assessed in cross-sectional and prospective analyses. Seventy-five healthy but sedentary adults carried out a sub-maximal exercise test and easy and difficult problem solving tasks. Blood pressure, heart rate, skin conductance level, respiration rate, tidal volume, and oxygen consumption were monitored and additional heart rate was also computed. Differences between relatively fit and unfit individuals were found in respiration rate during tasks and in skin conductance level during post-task recovery periods, with a tendency toward diminished heart rate reactivity in fitter people. Subjects were subsequently allocated to four conditions: high intensity aerobic training, moderate intensity aerobic training, an undemanding strength and flexibility program (designed as an attention-placebo condition), and waiting list control. Training programs were conducted over a 10-week period, and were followed by a second laboratory session. Appropriate changes in aerobic performance over the training period were observed in the 12-min run/walk test. There were no important modifications in psychophysiological stress reactions associated with the different experimental conditions. These results are discussed in relation to the literature concerning the effects of fitness and physical activity on physiological response patterns.

Adult↗
PubMedDate not supplied

First Steps: participants and outcomes of a maternity support services program.

OBJECTIVE: To describe characteristics and pregnancy outcomes of participants in a maternity support program and to compare these characteristics and outcomes with those for women who were eligible for, but did not participate in, the program. DESIGN: Descriptive, ex post facto. SETTING: An inland northwest city. PARTICIPANTS: Two hundred twenty postpartum patients who received Medicaid during their pregnancy. MAIN OUTCOME MEASURE: Quantitative data were obtained from a structured interview that gathered demographic information. Subjects also completed the Social Support Apgar, an investigator-designed instrument. RESULTS: Demographic characteristics and overall pregnancy outcomes were similar for program participants and nonparticipants; however, more program participants than nonparticipants quit smoking during their pregnancy. CONCLUSIONS: Findings are consistent with results documented by other researchers on the effectiveness of similar programs in different locales. The findings support the need for continued efforts to better define appropriate target populations, interventions, and expectations for these programs.

Adolescent↗
PubMed2006

Effects of a CHANGE intervention to increase exercise maintenance following cardiac events.

BACKGROUND: Despite participation in a cardiac rehabilitation program, there is a downward trajectory of exercise participation during the year following a cardiac event. PURPOSE: The purpose of this study was to test the effectiveness of CHANGE (Change Habits by Applying New Goals and Experiences), a lifestyle modification program designed to increase exercise maintenance in the year following a cardiac rehabilitation program. The CHANGE intervention consists of 5 small-group cognitive-behavioral change counseling sessions in which participants are taught self-efficacy enhancement, problem-solving skills, and relapse prevention strategies to address exercise maintenance problems. METHOD: Participants (N = 250) were randomly assigned to the CHANGE intervention (supplemental to usual care) or a usual-care-only group. Exercise was measured using portable wristwatch heart rate monitors worn during exercise for 1 year. Cox proportional hazards regression was used to determine differences in exercise over the study year between the study groups. RESULTS: Participants in the usual-care group were 76% more likely than those in the CHANGE group to stop exercising during the year following a cardiac rehabilitation program (hazard ratio = 1.76, 95% confidence interval = 1.08-2.86, p = .02) when adjusting for the significant covariates race, gender, comorbidity, muscle and joint pain, and baseline motivation. Most participants, however, had less than recommended levels of exercise amount and intensity. CONCLUSIONS: Counseling interventions that use contemporary behavior change strategies, such as the CHANGE intervention, can reduce the number of individuals who do not exercise following cardiac events.

Adult↗
PubMedDate not supplied

Beyond health promotion: reducing need and demand for medical care.

A population's medical need represents its illness burden. Medical demand represents the service level requested for a particular need. Medical care costs are, in large part, a function of need and demand. Our review of health education programs designed to reduce health risks and reduce costs identified thirty-two programs with documented effectiveness, generally achieving claims reductions of 20 percent. Specific program features including chronic disease self-management, risk reduction, and increased self-efficacy appear important. A broadened definition of health promotion focused on increased personal responsibility for health-related actions and directed at improvement of long-term health outcomes also could reduce health care costs.

Cost of Illness↗
PubMed2005

The effects of short-term and long-term pulmonary rehabilitation on functional capacity, perceived dyspnea, and quality of life.

STUDY OBJECTIVES: The purposes of this study were as follows: (1) to determine whether physical performance, quality of life, and dyspnea with activities of daily living improved following both short-term and long-term pulmonary rehabilitation (PR) across multiple hospital outpatient programs; (2) to examine the differences in these parameters between men and women; and (3) to determine what relationships existed between the psychosocial parameters and the results of the 6-min walk (6MW) test performance across programs. DESIGN: Non-experimental, prospective, and comparative. SETTING: Seven outpatient hospital PR programs from urban and rural settings across North Carolina. PARTICIPANTS: Three hundred nine women and 281 men who were 20 to 93 years of age (mean [+/- SD] age, 66.7 +/- 11.1 years) with chronic lung disease. INTERVENTIONS: All 6MW tests and health surveys were administered prior to and immediately following 12 and 24 weeks of supervised PR participation. Scores from the 6MW tests, the Ferrans and Powers quality of life index-pulmonary version III (QLI), the Medical Outcomes Study 36-item short form (SF-36), and the University of California at San Diego shortness of breath questionnaire (SOBQ) were compared at PR entry, at 12 weeks, and at 24 weeks for differences by gender with repeated-measures analysis of variance. The study entry and follow-up SF-36 physical and mental component summary scores, the QLI health/function and overall scores, and the SOBQ scores were also compared to the 6MW test scores with Pearson correlation coefficient analysis. RESULTS: The mean summary scores on the SF-36 and the QLI increased after 12 weeks of PR (p < 0.05), and improvements were maintained by 24 weeks of PR participation (p < 0.05). Scores on the SOBQ improved after 12 weeks (p < 0.001) among the short-term participants, but not until after 24 weeks among the long-term participants (p = 0.009). The 6MW test performance improved after 12 weeks (p < 0.001) and again from 12 to 24 weeks (p = 0.002) in the long-term participants. No relevant correlational relationships were found between 6MW scores and the summary scores of the administered surveys (r = -0.43 to 0.36). CONCLUSIONS: Physical performance, as measured by the 6MW test, continued to improve with up to 24 weeks of PR participation. Quality-of-life measures and the perception of dyspnea improved after 12 weeks of PR participation, with improvements maintained by 24 weeks of PR participation. It is recommended that PR patients participate in supervised PR for at least 24 weeks to gain and maintain optimal health benefits.

Activities of Daily Living↗
PubMed2000

Application of a cumulative strategies model for drug abuse prevention: exploring choices for high risk children.

The current state of knowledge, as indicated by existing literature, is extremely limited in terms of published descriptions of drug abuse prevention programs targeting high risk children, such as children from drug abusing families. A Cumulative Strategies Model posits four basic principals for effective prevention for high risk children and guides prevention program design. Representing a Cumulative Strategies Model, described herein is a multicomponent prevention program that is theory-driven, risk-based, and targets children affected by familial alcohol abuse. Three components of this program and specific methods of implementing each component are discussed, and field reactions are reviewed.

Adaptation, Psychological↗
PubMed2004

Domestic violence and post-traumatic stress disorder severity for participants of a domestic violence rehabilitation program.

Domestic violence has been a long-standing problem for our nation's active duty and military veterans. The purpose of this article is to describe participants of a domestic violence program, the program design to help lessen attrition, and the completers and noncompleters of the program. There was a significant relationship between post-traumatic stress disorder (PTSD) and domestic violence severity for the sample. PTSD severity was also related to reports of domestic violence in the family of origin. Completers and noncompleters were compared on demographic and violence variables and on nine research measures. Completers were more likely younger than 35 years old, employed, had higher self-ratings of relationship mutuality, lower levels of stress and post-traumatic stress, and were regularly court monitored. The results of a logistic regression significantly predicted completers and noncompleters based on age, relationship mutuality, PTSD, and court-monitored status (model chi2 statistic of 31.08, p = 0.0000).

Adult↗
PubMed2000

Work-site cancer screening: a Latino case study.

PURPOSE/OBJECTIVES: To develop a work-site cancer education and detection program targeted for Latino women and evaluate the effectiveness of the program in a firm with a majority of employees from Latino backgrounds. DESIGN: Program implementation and evaluation. SETTING: A Latino-owned industrial firm in Detroit, MI. SAMPLE: 560 of 857 female employees. Among the 202 women who were eligible for mammography, 142 participated in the screening. METHODS: Education and mammography were offered to women employees of Mexican Industries in Michigan. Education programs and mammograms were conducted at the work site. The programs were offered in English and Spanish. MAIN OUTCOME MEASURES: Participation in education and mammography and evaluation of program components. FINDINGS: Pre- and post-tests of knowledge indicated increases in the understanding of breast cancer. Evaluation of the educational program indicated high ratings of the presentations and materials. CONCLUSIONS: Work-site cancer education and detection programs are cost effective in firms where the majority of employees are from one ethnic/racial group and where the programs take into consideration the cultural background of the employees. IMPLICATIONS FOR NURSING PRACTICE: Cancer education and detection programs should consider the possibility of work-site interventions as well as the ethnic/racial background of employees during program development.

Adult↗
PubMed2000

Use of timelines in senior design--an efficient project management tool for faculty.

An important part of any multi-tasked project or undertaking is a work plan. Large contractors with multi-year design projects use a work plan to schedule resources and identify critical design decisions; a smaller company may map out the course and order of work as well as schedule resources. Either way, the work plan is an indispensable tool that assists the project manager in the planning and timely execution of the project. Introduced is the concept of the timeline (or work plan) and its utilization in an Undergraduate Senior Design Course by both Faculty and Student as a Project Management Tool and device from which to chart student progress towards completion of course requirements. Discussed are examples of student project planning and comments with regards to the effectiveness of project planning for the student as well as a discussion of how this device has assisted faculty in charting student progress towards project completion, meeting course requirements, and grading. Project and Time Management issues described in this paper are through the Senior Design Program at the University of Connecticut (UCONN) with National Science Foundation Senior Design Projects to Aid Persons with Disabilities and industry-sponsored projects [1].

Management Information Systems↗
PubMed2002

Program targets HIV+ injection drug users.

A large intervention program designed specifically for HIV-positive injection drug users may provide HIV programs with a workable way to teach this population about safety measures.

HIV Infections↗
PubMed1996

Integrating a theoretical framework with street outreach services: issues for successful training.

HIV/AIDS prevention projects utilizing indigenous outreach workers often rely on the life experiences and skills of the staff to structure the intervention, without grounding in theory. However, to be most effective, community outreach projects which target harder-to-reach high-risk populations should both utilize and enhance the natural strengths of indigenous field workers' experience and style of interaction, while guiding intervention content with theoretical rigor. In this paper we demonstrate that the challenge of successfully integrating a theoretically guided program design with field staff's credibility with, and sensitivity toward, drug-using clients can be practically and satisfactorily met through appropriate training. This training is an important investment for better utilizing valued and scarce prevention resources. The Philadelphia site of the AIDS Evaluation of Street Outreach Project (AESOP), a cooperative agreement of the Centers for Disease Control and Prevention, designed and implemented staff trainings to reflect the enhancement of the outreach program by the Stages of Change model. Through these trainings, the outreach workers have learned to integrate their natural street and intervention skills into the structure of a theoretical framework. This paper presents specific training components, relevant issues within these components, and areas for evaluation and feedback.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

New-building occupancy. The role of nursing staff development.

Orienting hospital staff to a new patient care facility presents many unique challenges for the Nursing Staff Development Department. Today's healthcare climate demands that staff orientation to a new facility be done quickly and with few disruptions to patient care. Nursing staff development specialists are well positioned to lead this process. Their expertise in program design, implementation and evaluation, problem solving and communication skills, and ability to view the learning needs of hospital staff holistically are vital to a successful facility move. This article will describe the opening of a new 150-bed inpatient facility in a large acute rehabilitation center. The principles used by the Nursing Staff Development Department in this new facility orientation process can be applied in multiple health care settings.

Health Facility Moving↗
PubMed1994

The role of quality in today's research university.

Today's research universities strive to meet goals in education, research, and service within an academic environment. A quality assurance and quality control program is critical to achieving excellence in all areas. However, the role of quality in research at higher education institutions is difficult to determine or consistently implement due to the broad nature of the research and academic goals. In addition, it is compounded by the loose organizational structure common to most universities. Formal quality assurance programs are not historically found at academic institutions. Faculty and staff often have neither the experience nor training in good quality assurance practices. Implementation of a formal quality assurance program is made more difficult by university space and financial limitations and a reward system based on peer-reviewed publications. A successful formal quality assurance program must be sufficiently flexible to meet all needs, must focus on those needs, and must be willingly supported by all participants. The Institute of Wildlife and Environmental Toxicology (TIWET) at Clemson University in South Carolina has implemented a quality assurance program designed to comply with several quality assurance regulations, including the good laboratory practice (GLP) standards. The program relies on study protocols or plans, standard operating procedures (SOPs), data collection forms, a quality assurance manual, quality assurance checklist/plans, and a quality assurance unit. The program maximizes flexibility while complying with several quality regulations and consensus standards. Since implementation, improvements in communication, study design, data recording, and reporting have been noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Facility Regulation and Control↗