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Establishment of an inservice training program for rural health workers in a decentralized system.

The maintenance of the effective functioning of peripheral health workers in isolated working environments has long been a subject of contemplation by health planners and managers. It depends on training, motivation and skill. This paper describes the development of an inservice training program for rural health workers based on the establishment of a core group of trainers in each province. Training of trainers utilized a combination of formal training, workshops, distance-learning techniques and regular on-site consultation.

Allied Health Personnel↗

Benefits of cardiac rehabilitation and exercise training programs in elderly coronary patients.

The authors review several studies from the Ochsner Heart and Vascular Institute showing the benefits of formal phase II cardiac rehabilitation and exercise training programs in elderly patients with coronary artery disease, including benefits on plasma lipids, obesity indices, exercise capacity, peak oxygen consumption, behavioral characteristics (especially depression), and quality of life. Marked benefits were noted in elderly women and all elderly patients over the age of 75 years. The authors conclude that the therapy has proved to be safe and effective for elderly coronary patients, and that these individuals should be routinely referred to, and vigorously encouraged to attend, cardiac rehabilitation programs following major coronary events.

Age Factors↗

Education in adult advanced cardiac life support training programs: changing the paradigm. Members of the Advanced Cardiac Life Support Education Panel.

To develop a consensus for change in the educational aspects of the Advanced Cardiac Life Support (ACLS) Training Program, the American Heart Association appointed panel members to engage in a consensus process. At a preconference meeting held in the fall of 1991, panel members received broad input from experts in adult education, experienced ACLS educators, and resuscitation scientists. The panel then developed a statement based on the preconference discussions and presented it at the National Conference on CPR and Emergency Cardiac Care held in February 1992. The conference's recommendations and the process that led to them are described in this paper. The key conclusions of the consensus process are as follows. The purpose of ACLS programs is the education of health professionals whose jobs include the management of patients in arrest or near-arrest. The goal of each ACLS course is to have each participant succeed in acquiring the skills and knowledge required for resuscitation. Aspects of the course which threaten failure or raise anxiety should be minimized or eliminated. ACLS course directors are strongly encouraged to design courses whose content and presentation are best suited to the training, experience, and needs of the course participants. Flexibility is strongly encouraged. Evaluation (testing) should be used primarily for its educational value, to help both learners and instructors identify areas needing improvement. The problem learner should be identified as early as possible and should receive intensive remediation to achieve the goal of every participant acquiring the targeted skills and knowledge. Because skill retention is variable, rescuers should practice skills frequently in regular refresher sessions. At a minimum, retraining every two years is strongly recommended.

Adult↗

An American anesthesia training program in East Africa.

A unique 5-year program designed to improve the quality and availability of anesthesia care in developing nations has been initiated in East Africa. Based upon North American anesthesiologists serving as volunteer teachers, the program emphasizes teaching to the exclusion of taking over anesthesia care. The teaching is practical and relevant to the clinical practice of anesthesia in developing countries. The volunteers teachers serve, one at a time, 12 months of the year for several years in two pre-existing structured East African anesthesia training programs, thereby providing the advantages of consistent, reliable teaching assistance for a period of years to programs of demonstrable interest and experience in anesthesia training.

Africa, Eastern↗

Evaluation of a geriatric mental health training program for nursing personnel in rural long-term care facilities.

Although mental illness among elderly living in nursing homes is a substantial and growing concern, the behavioral problems associated with mental illness or threats to mental health are not well understood, tolerated, or effectively managed by nursing home staff. As a result, resident care and quality of life, and staff morale often suffer. The need for geriatric mental health training in long-term care settings has become increasingly apparent. Psychiatric/mental health nurses are in an advantageous position to address this current need and future challenge through the development, implementation, and evaluation of geriatric mental health education and training programs in long-term care settings. This article describes one such innovative training effort, designed to improve the quality of psychosocial care provided by nursing personnel in rural long-term care settings, and highlights evaluation outcomes related to participant satisfaction, staff knowledge, and attitudes.

Aged↗

Safety, feasibility, and efficacy of a resistance training program in preadolescent obese children.

BACKGROUND: Safe and effective exercise programs are needed to prevent and treat chronic diseases in childhood. In particular, preadolescent obese children should participate in activities that are specific to their special needs. Resistance or strength training has been prescribed for adult obese persons. Research is limited concerning the use of resistance training in programs that treat obese preadolescents. METHODS: Nineteen treatment subjects (7-12 years of age) were enrolled in a 10-week weight management program which included diet, behavior modification, and aerobic and flexibility exercises. Forty-eight control subjects (7-12 years of age) participated in the diet, behavior modification program, and a thrice-a-week walking program. The efficacy of the overall weight management program was examined by anthropometry at 10 weeks and 1 year. RESULTS: Fifteen treatment subjects completed the 10-week program (retention rate, 78.9%). Thereafter compliance decreased by approximately 33% for the long-term study. Seventeen control subjects completed the program (retention rate, 35%). Weight, percent of ideal body weight, and body mass index were reduced significantly at 10 weeks (P<0.0001) and did not increase significantly at 1-year follow-up in both treatment and control groups. Height increased significantly at 1 year in both treatment and control subjects. In the treatment subjects, percent fat decreased significantly (P<0.001), whereas fat-free mass did not change significantly (P>0.05). CONCLUSIONS: A resistance-training program may be included safely in a multidisciplinary weight management program for obese preadolescent male and female children. The addition of specific exercise regimes such as resistance training may improve program retention especially in severely obese youth.

Body Mass Index↗

Sources of information on postgraduate medical training programs--2000 update.

This is the biennial update listing directories, journal articles, Web sites, and general books that aid the librarian, house officer, or medical student in finding information on medical residency and fellowship programs. The World Wide Web has surpassed print resources as the most current and complete location of information about postgraduate training programs and specialties.

Education, Medical, Graduate↗

Proposed fellowship training program in international emergency medicine.

Interest in international emergency medicine (EM) has grown steadily over the last ten years. This growth has been fueled by increased demand for emergency services abroad and the proliferation of emergency physicians (EPs) working in international relief and development. As a response, several academic EM programs have developed international EM fellowships for the purpose of providing formal training to EPs interested in international health. Although there have been preliminary articles describing fellowship curricula, to the authors' knowledge no recommendations have been proposed by national consensus that suggest emphasis or required components of a fellowship program. Therefore, a group of EPs interested in fellowship training convened for the purpose of developing goals and objectives for a postgraduate training program in international EM. To that end, this article proposes guidelines for a fellowship training program for international EM.

Curriculum↗

Evaluating outcomes in a substance abuse training program for Southeast Asian human service workers: problems in measuring change cross-culturally.

The following article describes the evaluation challenges faced in a cross-cultural substance abuse training program. Non-Southeast Asian instructors designed and taught courses for Cambodian and Vietnamese human service workers over a two-year period. Although cultural considerations were a central focus in the design of the program, instructors underestimated the difficulty of modifying standard questionnaires for use with Southeast Asian participants. As a consequence, the formal evaluation process had limited benefit but several insights were gleaned through alternative evaluation methods.

Adult↗

Drug abuse in anesthesia training programs. A survey: 1970 through 1980.

Experience at our institution with drug dependence among anesthesia residents, coupled with a lack of published data, prompted us to survey US anesthesia training programs. Two hundred eighty-nine programs were surveyed, 247 (85.5%) responded, and 184 (74%) of these programs had at least one suspected incident of drug dependence to report. Three hundred thirty-four confirmed persons were reported, including a substantial number of instructors. Meperidine and fentanyl were the most frequently mentioned drugs. Behavior changes were frequently noted by staff personnel, and in general such changes led directly to detection. After confirmation of abuse, the majority of impaired anesthetists were referred for psychiatric care, with few in need of actual detoxification. Detailed follow-up was available for about 40% of the total; 71 persons were offered a return to their original place of employment, while 30 persons died of drug overdose. Chemical impairment may be more common than usually thought in anesthesia, perhaps in part because of drug availability.

Alcoholism↗

The benefit of a single-leg strength training program for the muscles around the untrained ankle.

Severe ankle injuries can require extended periods of immobilization that adversely affect the strength of the ankle muscles. We have investigated a single-leg strength training program of the muscles surrounding the ankle to determine if it produces a crossover benefit for the contralateral ankle muscles. Twenty subjects without any history of ankle injuries were randomly divided into a control and a training group. Both groups underwent isokinetic testing of the ankle muscles at the beginning and end of an 8-week period. The control group maintained normal activities between the tests. Half of the training group trained the dominant leg only and the other half trained the nondominant leg only for the 8-week period, three times per week. The subjects who trained the dominant leg improved peak torque values by 8.5% in the trained leg and 1.5% in the untrained leg. Similarly, the subjects who trained the nondominant leg improved peak torque values by 9.3% in the trained leg and 3.5% in the untrained leg. In contrast, the control group showed no significant change in peak torque, power, or endurance between the initial and final tests. With improvements in peak torque as high as 40% in the trained leg and a crossover benefit of 19% in the untrained leg in eccentric inversion, this strength training technique deserves further investigation in an injured population where the benefits may be more substantial.

Adolescent↗

Improving human capabilities for combined manual handling tasks through a short and intensive physical training program.

The primary objectives of this study were to test whether the muscular endurance, muscular strength, cardiovascular endurance, and workload perception of individuals engaged in combined manual handling tasks could be improved through a short and intensive physical training program. Three groups were formed to achieve the objectives of this study, and five subjects participated in each group. Two groups were trained using the concept of progressive resistance exercise; one group used the concept of six-repetition maximum (6 RM) while the other group followed the ten-repetition maximum (10 RM) protocol. The third group was used as a control group to monitor the effectiveness of the training groups. The training groups required subjects' attendance at 16 sessions for a period of 6 weeks. The control group performed the same tests given to the training group twice, separated by a period of 6 weeks. Endurance time, heart rate, ratings of perceived exertion, and static and dynamic strength were the response variables. Based on the results of this study, the following conclusions could be made: (1) it is possible to significantly improve muscular endurance, muscular strength, and cardiovascular endurance through the short and intensive training protocols examined in this investigation (the 10 RM training protocol, however, yielded better improvement in human physical capability than the 6 RM training protocol); and (2) for a fixed work load, endurance time can increase without changing job demand perception.

Adult↗

Using RPE to regulate exercise intensity during a 20-week training program for postmenopausal women: a pilot study.

Feelings of effort sense quantified via the Borg Rating of Perceived Exertion (RPE) scale have been validated for regulating exercise intensity. Most studies validating RPE for exercise prescription have used young, male subjects and only a few exercise sessions. As part of a larger study we examined the accuracy of RPE for regulating exercise intensity in a group of postmenopausal women. Six women (70.0+/-7.1 yr.) were given a maximal graded exercise test. Target RPEs equivalent to 40%, 50% and 60% VO2 max were developed from this test using standard techniques. These RPEs were used to regulate intensity during a 20-wk. training program. During the initial 5 wk. of training target intensity was increased from 40% to 60% VO2 max and exercise duration from 15 to 30 min. Accuracy of exercise intensity regulation was determined by comparing the heart rate during exercise to a target heart rate equivalent to the desired %VO2 max. At Week 2 of training (target 40% VO2 max) the mean intensity produced did not differ from target. During Weeks 4 (target 50% VO2 max), 6 and 10 of training (target 60% VO2 max) the mean exercise intensity was below target. At Week 20 the mean intensity produced was not different from target. This suggests that elderly women can accurately use RPE to regulate exercise intensity, but at intensities above 40% VO2 max an acclimation period is needed.

Aged↗

A comprehensive training program for multidisciplinary treatment plans.

A client-oriented treatment plan that will direct and coordinate health care staff, thereby ensuring efficient quality client care, is a worthy goal. After planning, implementing, and evaluating a training program for this purpose, the authors concluded that the key to quality client care and successful implementation of this program lies in proper preparation and administrative support.

Education, Nursing, Continuing↗

Changes in physical capacity, heart size and function in patients after myocardial infarction, who underwent a 4-to 6-week physical training program.

From findings in 1,200 coronary patients after myocardial infarction, it was shown that a stationary course of treatment in a rehabilitation center, where a gradually intensifying, individually adapted physical training program is administered, can lead to statistically highly significant improvements in the functional efficiency of the heart, as well as in physical capacity, in a short period of 4-6 weeks. It should be stressed that these positive effects can be demonstrated in the early stages of rehabilitation from infarction, that is, directly following discharge from the hospital, in the same way as in a late course of treatment of the repeated therapy; it is also important to point out that similar favorable results were obtained for older groups as for younger ones under all parameters, within the same time. A 6-week training period is more effective than a 4-week one.

Blood Pressure↗

Perceived behavioral changes observed with adaptive seating devices and training programs for multihandicapped, developmentally disabled individuals.

The purpose of this study was to assess, by analyzing survey responses, the perceived behavioral changes that were observed when adaptive seating devices and training programs were provided to multihandicapped, developmentally disabled individuals. Results for 41 clients were analyzed. Statistical analysis revealed that significant changes in social interaction, positioning, tracking, grasping, and self-feeding were perceived by parents, guardians, or trainers. The necessity of a prospective study to analyze data about the influence of behavior programs used with adaptive seating devices is discussed.

Adaptation, Psychological↗

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↗