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PubMed2006

Interactive approach to optical tweezers control.

We have developed software with an interactive user interface that can be used to generate phase holograms for use with spatial light modulators. The program utilizes different hologram design techniques, allowing the user to select an appropriate algorithm. The program can be used to generate multiple beams and can be used for beam steering. We see a major application of the program to be in optical tweezers to control the position, number, and type of optical traps.

Algorithms↗
PubMed1999

Early family-based intervention in the path to alcohol problems: rationale and relationship between treatment process characteristics and child and parenting outcomes.

OBJECTIVE: Risk for subsequent development of alcohol problems is not uniform across the population of alcoholic families, but varies with parental comorbidity and family history. Recent studies have also identified disruptive child behavior problems in the preschool years as predictive of alcoholism in adulthood. Given the quality of risk structure in highest risk families, prevention programming is more appropriately family based rather than individual. METHOD: A family-based intervention program for the prevention of conduct problems among preschool-age sons of alcoholic fathers was implemented to change this potential mediating risk structure. A population-based recruitment strategy enrolled 52 alcoholic families in a 10-month intervention involving parent training and marital problem solving. The study examined the interplay between parent treatment investment and parent and therapist expectations and satisfaction in predicting change in child behavior and authoritative parenting style during the program, and for 6 months afterward among the 29 families whose sustained involvement allowed these effects to be evaluated. RESULTS: Parent expectations at pretreatment influenced their early investment in the program, which in turn predicted child and parenting outcomes. Parent and therapist satisfaction ratings during treatment were associated with one another and with expectations that the program would continue to promote changes in their child. Parent investment was a particularly salient influence on outcome, as higher investment throughout the program was associated with improvement in child behavior and authoritative parenting at termination. CONCLUSIONS: Findings indicate that treatment process characteristics mediate the influence of baseline parent functioning on treatment success and that treatment changes themselves predict later child outcomes.

Alcoholism↗
PubMed1985

Chemotherapy administration precheck verification.

Inappropriate administration of antineoplastics can result in severe adverse reactions or potential therapeutic failure. This article reports the formation and evaluation of a program designed to assure appropriate antineoplastic administration and the creation of a continuous teaching document. The primary goal was to achieve and document safe and appropriate administration of antineoplastic medications. The program was organized, initiated, and evaluated by the clinical pharmacist and assistant director of nursing. Use of available resources allowed program development without additional cost to hospital departments. A teaching series and provision of reference data were made available, and completion of a chemotherapy verification form was required before the nurse administered the antineoplastic. Over 1,500 forms have been completed in a little more than 2 years. Nurses report a high level of compliance with form completion. One chemotherapy error report has been filed in the last 28 months, compared with three error reports in the 8 weeks prior to initiation of the program. Use of the chemotherapy verification form has achieved a high standard of correct administration without errors as defined by our institution and fostered continually conscientious and acceptable antineoplastic administration.

Antineoplastic Agents↗
PubMed1978

An economic evaluation of a genetic screening program for Tay-Sachs disease.

The resolution of policy questions relating to medical genetic screening programs will not be without considerable difficulty. Examples include such issues as the optimal degree of screening program expansion, the relative values of screening for different genetic diseases, the appropriate sources of program funding (public vs. private), and the relative value of funding expanded genetic screening programs vs. research directed toward elimination of genetic traits themselves. Information on the net impact of the relevant alternatives is greatly needed, and this need will increase if the National Genetics Act receives funding approval. We have provided what is hopefully a contribution toward this end. While our analysis pertains to a specific disease and a specific screening program for that disease, the methodology is readily generalizable to other genetic diseases, as well as programs of any size or structure. Hopefully, this will serve to stimulate further research efforts that we believe are needed for the objective consideration of resource allocation alternatives.

Cost-Benefit Analysis↗
PubMed1980

A program for in-house proficiency testing in clinical microbiology.

A design for an in-house blind proficiency testing program in clinical microbiology has been developed using a multi-level approach to proficiency testing, with progressive levels of organism identification difficulty. Flexibility of design allows the program to be used in any laboratory by starting the program at the appropriate level of difficulty. The necessary steps to initiate a similar testing program are detailed and benefits of the program are analyzed.

Laboratories↗
PubMed1982

Problems associated with establishing a clinic for the elderly.

Actual use of a newly established geriatric clinic in a low-cost housing unit was appreciably below projected numbers, even though cost and transportation were removed as barriers to care. In a survey of building occupants, 20% were unaware of the clinic's existence. More than 90% of the occupants did not know clinic hours but a third could identify clinic staff. About half of the occupants had used the clinic, often for minor services. The major reason for lack of use of the clinic was an established pattern of receiving medical care which occupants were reluctant to risk or abandon. Needs must be appropriately assessed before service programs are designed for the elderly. Assumptions may at times be incorrect. A thorough understanding of needs and existing methods of meeting them leads to more appropriately designed programs.

Aged↗
PubMed1988

Evaluation of hospital-based aeromedical transport programs using therapeutic intervention scoring.

The number of patients transported by hospital-based aeromedical transport programs is increasing rapidly across the country. How many of these patients really need this kind of transport and how to compare the performance of different services in this regard remain controversial issues. We examined these questions in a prospective analysis of 1,081 flights in 5 aeromedical transport programs using the Therapeutic Intervention Scoring System (TISS) as the basis for an index of appropriateness. An average of 41.5% of flights in all programs were clearly appropriate according to the index, i.e., had scores associated with a 99% probability of validation by direct review. Another 34.9% of flights had a greater than 50% probability of being appropriate. From 18 to 28% of flights had scores associated with only a 20% probability of justification. Although TISS scoring, which is carried out after transfer, cannot provide a means of selecting individual patients for aeromedical transfer, a TISS-based index appears to be a simple and useful method for examining overall appropriateness of program activity, and could be used to set objective standards of appropriateness for evaluation and comparison of aeromedical programs.

Aircraft↗
PubMedDate not supplied

Childhood immunizations: a parent education and incentive program.

This article describes some strategies to help reduce the immunization barriers of parental knowledge deficits and transportation costs through a parent education and incentive program. A record review of 471 children in 22 licensed Norfolk, Virginia, day-care centers revealed that 141 (29.9%) had inadequate age-appropriate immunizations. Educational programs included depictions of preventable communicable diseases and their consequences. Upon completion of appropriate immunizations, parents received transportation vouchers and gifts. By June 2000, 255 parents, day-care administrators, teachers, and staff had participated in educational programs and seven day-care centers earned certificate awards for improved immunization rates among enrollees. Four centers had 100% age-appropriate immunization rate, and three had a rate of 92% to 95%.

Child↗
PubMed2006

Are Canadian General Internal Medicine training program graduates well prepared for their future careers?

BACKGROUND: At a time of increased need and demand for general internists in Canada, the attractiveness of generalist careers (including general internal medicine, GIM) has been falling as evidenced by the low number of residents choosing this specialty. One hypothesis for the lack of interest in a generalist career is lack of comfort with the skills needed to practice after training, and the mismatch between the tertiary care, inpatient training environment and "real life". This project was designed to determine perceived effectiveness of training for 10 years of graduates of Canadian GIM programs to assist in the development of curriculum and objectives for general internists that will meet the needs of graduates and ultimately society. METHODS: Mailed survey designed to explore perceived importance of training for and preparation for various aspects of Canadian GIM practice. After extensive piloting of the survey, including a pilot survey of two universities to improve the questionnaire, all graduates of the 16 universities over the previous ten years were surveyed. RESULTS: Gaps (difference between importance and preparation) were demonstrated in many of the CanMEDS 2000/2005 competencies. Medical problems of pregnancy, perioperative care, pain management, chronic care, ambulatory care and community GIM rotations were the medical expert areas with the largest gaps. Exposure to procedural skills was perceived to be lacking. Some procedural skills valued as important for current GIM trainees and performed frequently (example ambulatory ECG interpretation) had low preparation ratings by trainees. Other areas of perceived discrepancy between training and practice included: manager role (set up of an office), health advocate (counseling for prevention, for example smoking cessation), and professional (end of life issues, ethics). CONCLUSION: Graduates of Canadian GIM training programs over the last ten years have identified perceived gaps between training and important areas for practice. They have identified competencies that should be emphasized in Canadian GIM programs. Ongoing review of graduate's perceptions of training programs as it applies to their current practice is important to ensure ongoing appropriateness of training programs. This information will be used to strengthen GIM training programs in Canada.

Adult↗
PubMed2003

[Effects of TES program on exercise capacity, self-efficacy and patient compliance in patients with myocardial infarction].

PURPOSE: This study aimed to develop a TES program to improve exercise capacity to promote patient compliance to the prescribed exercise, and to test the feasibility of the program. METHOD: The 8-week TES program consisted of three components : exercise training, self-efficacy enhancement and social support. Using the matching of gender, age, and the left ventricular ejection fraction, thirty one subjects were consecutively assigned to either TES group (n=15, 52+7 years) or Control group (n=16, 58+11 years) 3 weeks after MI. With the exception of exercise compliance (only after the TES program), the exercise capacity and exercise self-efficacy were both measured both before and after the 8-week TES program. RESULT: The VO2peak (p=.043), anaerobic threshold (p=.023) and exercise duration (p=.015) improved in TES group compared to Control group after 8 weeks. The cardiac exercise self-efficacy (p=.036) was significantly higher in TES group than Control group. There was a significant increase of exercise compliance(p=.005) in TES group compared to Control group. CONCLUSION: The 8-week TES program improved the exercise capacity, exercise self-efficacy and exercise compliance. A appropriately implemented TES program in cardiovascular nursing practice may promote healthy behavioral modification and, therefore, contributing to reduce the risk of mortality and morbidity in MI patients.

English Abstract↗
PubMedDate not supplied

[Geriatric assessment: possibilities and limits].

A recent meta-analysis has shown that comprehensive geriatric assessment can reduce mortality, increase survival at home, and improve functional status in elderly patients. Despite their high effectiveness, geriatric assessment programs have not yet been widely introduced into clinical practice. This review discusses the following four factors potentially explaining the limited spread of geriatric assessment programs. 1) There is a lack of accepted targeting criteria to select patients who need evaluation and management in costly in patient geriatric units. 2) There are effectiveness gaps in current knowledge on modifiable disability risk factors. 3) Geriatric assessment programs have been insufficiently integrated into the continuity of primary care. 4) More data are needed for evaluating the cost of geriatric assessment. Interdisciplinary research might help to optimize geriatric assessment programs and, at the same time, might ensure access of elderly patients to appropriate geriatric assessment programs despite current restraints in health care costs.

Activities of Daily Living↗
PubMedDate not supplied

Policies for the exclusion of ill children from group day care: an unresolved dilemma.

Although the problem of how to manage children with mild infectious illnesses who attend group day care programs arises often, appropriate criteria for the exclusion of ill children have not been determined. Substantial variation in the policies of different programs for excluding ill children exists. Studies of the epidemiology of common infectious illnesses indicate that asymptomatic children may transmit infections and that symptomatic children often shed infectious particles both before the onset and after the resolution of symptoms. The little information that is available supports the contention that the exclusion of mildly ill children has little effect on the incidence of infections among children who attend group day care programs. Consequently, policies for exclusion should focus on the needs and behavior of the ill child rather than on easily measured but less germane factors such as the child's body temperature. If the facilities and staff available are adequate to meet the needs of both the ill child and other children in the group, it is appropriate to allow children with mild infectious illnesses to attend group day care programs.

Child↗
PubMed1993

A PC BASIC program to double-check treatment planning calculation.

To ensure quality assurance at The New York Hospital, the treatment plans are checked manually and then double-checked. The goal is to ensure that the dose at the normalization point adds up to the correct value. This double checking procedure can become cumbersome. A BASIC program was written to help speed up the procedure. The program was written on an IBM personal computer. The program also has an option to calculate doses at various points along the central axis with respect to the isocenter dose. The program requires the user to answer a few simple questions to help perform the appropriate calculations. The programs are used only as a double check on the hand calculations.

Humans↗
PubMed2004

Resistance training for chronic heart failure patients on beta blocker medications.

BACKGROUND: Resistance training increases the skeletal muscle strength and functional ability of chronic heart failure patients. However, there is limited data regarding the effect of resistance training on the hemodynamic responses and peak oxygen consumption (peak VO(2)) of chronic heart failure patients treated with beta-blocker. This study examined the effect of resistance training on hemodynamics, peak aerobic capacity, muscle strength and quality of life of chronic heart failure patients on beta-blockers medication. METHODS: Fifteen men diagnosed with chronic heart failure were matched to either a resistance training program or non-training control group. At baseline and after 8 weeks of resistance training patients performed both Balke incremental and maximal strength tests and completed quality of life questionnaires. RESULTS: The resistance training group demonstrated a significant increase of walking time and peak VO(2) by 11.7% (p=0.002) and approximately 19% (p<0.05), respectively. Peak VO(2) was significantly correlated with both walking time (r=0.54, p=0.038) and change in total weight lifted (r=0.55, p=0.034). Quality of life significantly increased by 87% (p=0.030). The improvement in quality of life was correlated with post training peak VO(2) (r=0.58, p=0.025) and total weight lifted during the post maximal strength test (r=-0.52, p=0.047). CONCLUSIONS: The benefits from resistance training for chronic heart failure patients on beta-blocker medication included an increased aerobic and exercise capacity, skeletal muscle strength and most importantly, an improvement in the quality of life, which is the main goal of cardiac rehabilitation programs. Furthermore, with appropriate supervision, it is recommended that resistance exercise be added to the exercise rehabilitation program of these patients when possible.

Adaptation, Physiological↗
PubMed2006

Universal perinatal depression screening in an Academic Medical Center.

OBJECTIVE: To develop a department-based program to identify and treat women at risk for perinatal depression. METHODS: Private and employed physician groups were engaged to conduct antepartum maternal depression screening using the Edinburgh Postnatal Depression Scale. A comprehensive program was established to ensure that patients identified as being at risk would receive appropriate care. The program 1) developed a network of existing community mental health providers to accommodate screen-positive referrals, 2) created a 24/7 hotline staffed by mental health workers to respond to urgent/emergent patient needs, 3) provided nursing and physician education via a comprehensive curriculum on perinatal depression, and 4) facilitated outpatient depression screening that included a centralized scoring and referral system. RESULTS: A total of 4,322 women completed 4,558 screens during the initial 24 months (June 2003-May 2005). Although initial uptake of the screening program was gradual, all 20 departmental obstetric practices were screening their patients at the end of the first year. Depression screening was accomplished between 28-32 weeks of gestation, and postpartum screening (during the 6-week postpartum visit) was subsequently added. Overall, 11.1% of women screened positive in the antenatal period, and 7.3% screened positive in the postnatal period. Three hundred three women were referred for evaluation and care. CONCLUSION: Department-based, perinatal depression screening was feasible when individual physician practices were not required to develop the infrastructure necessary to respond to at-risk patients. We believe that the provision of clinical safety nets (mental health provider network and the hotline) were essential to the universal acceptance of this program by practitioners. LEVEL OF EVIDENCE: III.

Adult↗
PubMed1990

The future of family practice training in California.

Although the number of physicians in California has doubled since 1963, the number of family and general practice physicians has declined. The ratio of office-based primary care physicians to population has also decreased. Graduate medical education is funded largely from patient care revenues, but the low rate of reimbursement for ambulatory care makes training in primary care specialties especially dependent on public support. Medicare, the Veterans Administration, and the University of California provide more than $325 million a year in support of graduate medical education in California. Federal and state grant programs provide $5 million a year for family physician training in the state, but appropriations to these programs have been reduced in real terms. California family practice residencies are disproportionately located at county hospitals, where funding shortfalls make them especially vulnerable to cuts in grant programs. Additional resources will be needed if more family physicians are to be trained.

California↗
PubMed2006

Cardiovascular disease prevalence and risk factors of persons with mental retardation.

This paper reviews the recent literature on cardiovascular disease (CVD) prevalence, CVD-related mortality, physiological CVD risk factors, and behavioral CVD risk factors in adults with mental retardation (MR). The literature on the potential influences of modifiable behavioral CVD risk factors and the physiological CVD risk factors are also reviewed. Adults with mild to moderate MR residing in community settings appear to have an elevated disease prevalence, elevated CVD-related mortality, more adverse physiological CVD risk factors, and elevated behavioral risk compared to others with and without MR. Preliminary evidence supports the benefits of participating in the recommended physical activity levels and consuming the recommended diets to reduce the risk for CVD. The lack of large-scale longitudinal or experimental research indicates a gap in the research. The development of research-based, appropriate, primary prevention programs and intervention strategies aimed at lowering the risk for CVD is highly recommended. Programs should focus on educating individuals with MR along with direct care providers and family members on the importance of appropriate dietary concepts, physical activity habits, and regular health screenings by physicians. Programs should be individualized to regional and cultural issues.

Cardiovascular Diseases↗
PubMed2003

Interpretative comments and reference ranges in EQA programs as a tool for improving laboratory appropriateness and effectiveness.

INTRODUCTION: Laboratory information is generated when a meaning is given to certain data. This is usually achieved by comparing a laboratory test result with the reference range/decisional limit (RL), and by providing consultation for the interpretation of data, advice, and follow-up testing. AIM: In this paper, we investigate factors affecting the conversion of data into useful information with regard to biochemical markers of myocardial damage (CK-MB mass, myoglobin, and troponins), in view of their importance in detecting myocardial necrosis. Our aim was to report results obtained in order to verify the consensus between laboratories with reference to interpretative comments and the reference ranges/decisional limits added to clinical reports. METHODS: A questionnaire and simulated medical reports on three different patients were distributed to participants (94 laboratories) in the 2001 cycle of the External Quality Assessment (EQA). Moreover, we analysed 113 medical reports sent by laboratories during the most recent EQA cycle 2002, and checked the number of different RLs used, both independent and within the diagnostic system used. We also compared each laboratory result of a control sample, obtained in the 2002 cycle, with declared RL in order to verify the clinical significance of results ("normal" or "pathological") for troponin I and CK-MB. RESULTS: Our findings show that few laboratories regularly add interpretative comments to medical reports. On the contrary, they cooperate with clinicians who require consultation, advice, and information for the appropriate use of biochemical markers. There is a general consensus among participants regarding probable syndromes suggested by the interpretation of the same result and most laboratories also agree on further investigations to be carried out for several diseases. Concerning RL, the data demonstrate that numerous different RLs are used to report the results of the biochemical markers evaluated, both when considered independent of the diagnostic system used and within the diagnostic system used. DISCUSSION AND CONCLUSIONS: The biochemist does not have the opportunity to verify the efficacy of the interpretation that he/she provided. An audit of this activity is therefore required to allow the laboratory to monitor its own performance and to assure good practice. The evaluation of interpretative comments, through specific surveys, should be a prime objective of EQA organisers. Well-designed EQA programs can, moreover, support laboratories in establishing appropriate RL and in verifying the clinical significance of their results with respect to that of other laboratories. Our survey on interpretative comments and the analysis of the RLs further demonstrate how laboratory medicine can contribute to the objective evaluation of the patients' health status.

Clinical Laboratory Techniques↗