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The interview and questionnaire responses of twenty-five graduate trainees, fifteen scientist advisors, and present employers are incorporated in this six-year review of the Postgraduate Training Program for Science Librarians at the University of Tennessee Medical Units. The program was supported by the National Library of Medicine.
There is today a wide consensus regarding the need to improve communication skills (CS) of health-care professionals (HCPs) dealing with cancer patients. Psychological training programs (PTPs) may be useful to acquire the needed CS. Testing the efficacy of PTP will allow to define their optimal content. The present study was designed to assess the impact of a PTP on HCP stress, attitudes and CS, and on HCP and patients' satisfaction with HCP communication skills in a randomised study. A total of 115 oncology nurses were randomly assigned to a 105-h PTP or to a waiting list. Stress was assessed with the Nursing Stress Scale, attitudes with a Semantic Differential Questionnaire, CS used during one simulated and one actual patient interview with the Cancer Research Campaign Workshop Evaluation Manual, and satisfaction with the nurses' CS with a questionnaire completed by the patients and the nurses. Trained (TG) and control (CG) groups were compared at baseline, after 3 months (just following training for TG) and after 6 months (3 months after the end of training for TG). Compared to controls, trained nurses reported positive changes on their stress levels (P</=0.05) and on their attitudes (P</=0.05). Positive training effects were found on CS used during the simulated interview: a significant increase in facilitative behaviours (open questions: P</=0.001; evaluative functions: P</=0.05) and a significant decrease in inhibitory behaviours (inappropriate information: P</=0.01; false reassurance: P</=0.05). Less positive training effects were found regarding interviews with a cancer patient: a significant increase in educated guesses (P</=0.001) was noticed. No training effect was observed on nurses' satisfaction levels, but a positive training effect was found on patients' satisfaction levels (P</=0.01). Although results outline PTP efficacy, they indicate the need to design PTP, amplifying the transfer of learned CS to clinical practice.
OBJECTIVE: To describe trends in the prevalence of human immunodeficiency virus (HIV) among socially and educationally disadvantaged US youth. DESIGN: Analysis of demographic and geographic trends of HIV infection among Job Corps students from January 1988 through December 1992. SETTING: The Job Corps is a national training program for disadvantaged and out-of-school youth. POPULATION SCREENED: Youths aged 16 to 21 years who entered the Job Corps residential training centers during the survey period. MAIN OUTCOME MEASURE: Trends in prevalence of HIV infection among Job Corps students stratified by sex, age, race, and region of the country. RESULTS: Of the 269,956 Job Corps students screened, 812 (0.3%) tested positive for the antibody to HIV type 1. Seroprevalence of HIV for young men decreased from 3.6 per 1000 in 1988 to 2.2 per 1000 in 1992 (chi 2 test for trend, P < .001). Seroprevalence for young women increased from 2.1 per 1000 in 1988 to 4.2 per 1000 in 1990 (P = .001), with seroprevalence remaining stable from 1990 through 1992. The decreasing trends in HIV prevalence among men and increasing trends among women were primarily due to changes in seroprevalence in African-American students. CONCLUSIONS: The overall prevalence of HIV infection of three per 1000 is high, given the youth of Job Corps students. The significant rise in HIV rates among female Job Corps students provides evidence of the increasing risk of infection for socioeconomically disadvantaged young women. Reasons for the declining trend in HIV prevalence among male Job Corps students are not clear. Efforts to prevent the spread of HIV infection among adolescents must focus on the group that is hardest to reach--out-of-school and impoverished youth.
A positive association has previously been demonstrated between chronic aerobic exercise and prior maximal exercise and enhanced dorsal foot skin perfusion in physically active individuals with type 2 diabetes. The current study examined whether an 8-week resistance training program would also positively affect cutaneous perfusion in type 2 diabetic individuals. Ten individuals with type 2 diabetes and nine similar nondiabetic controls participated in 8 weeks of moderate-intensity resistance training. Prior to training, dorsal foot cutaneous perfusion was measured noninvasively by continuous laser Doppler assessment at baseline and during localized heating to 44 degrees C. These measurements were repeated exactly 48-72 h following 8 weeks of resistance training performed 3 days per week. Interstitial nitric oxide (NO) levels were measured concurrently in the contralateral foot dorsum. Neither subject group experienced significant increases in dorsal foot perfusion responsiveness during local heating to 44 degrees C following moderate resistance training, nor did the training significantly enhance baseline skin perfusion. Interstitial NO levels were not significantly different under any condition. At baseline, groups differed only on fasting serum glucose and overall glycemic control. In conclusion, the responsiveness of cutaneous perfusion in response to heating to 44 degrees C is not significantly enhanced by 8 weeks of moderate resistance training in diabetic individuals or their matched controls, independent of interstitial NO levels.
A previous study from this institution revealed laparoscopic tubal sterilization failure rates of 26.5 per 1000 and 45.5 per 1000, respectively, for the tubal ring and spring-loaded clip in procedures performed by residents in training. In an effort to identify potential anatomical reasons for this unacceptably high failure rate, 20 patients becoming pregnant after laparoscopic tubal occlusion underwent bilateral salpingectomy. Gross and histologic evaluation of the surgical specimens demonstrated improper application of the occlusive device in all cases. Seventeen patients were found to have nonoccluded or partially occluded tubes on one or both sides, with all occlusive devices located in the infundibular segment. Two patients were missing tubal rings on one side, and the remaining patient had a tubal ring misapplied to the round ligament. Sixteen residents who had completed a 1-month rotation on the ambulatory surgery service were given a standardized interview to assess their knowledge of proper sterilization techniques as well as their training experience. The frequency of incorrect responses given to four specific questions concerning proper placement of the tubal ring and spring-loaded clip ranged from 43.8-81.2%. The sterilization failure rate at this institution appears to be directly related to the resident surgeon's lack of understanding of the operative technique. Realizing that our institution is not unlike most other resident training programs, we developed a standardized education program including formal instruction of residents in proper sterilization technique and have altered supervisory guidelines for attending surgeons.
Reports on the efficacy of physical activity intervention trials usually only include discussion of the primary outcomes. However, assessing factors such as participant retention, adherence and compliance can assist in the accurate interpretation of the overall impact of a program in terms of reach and appeal. A quasi-randomised trial was carried out to assess and compare retention and adherence rates, and compliance with, a twice weekly resistance training program provided either individually at home or in a group format. Retirement villages (n=6) were assigned to either 'Have A Try' (HAT, home-based) or 'Come Have A Try' (CHAT, group-based); both programs included nine strength and two balance exercises. The program involved a 20-week Intervention Phase a 24-week Maintenance Phase and a 20-week On-going Maintenance Phase. One hundred and nineteen participants (mean age 80+/-6 years) were recruited (HAT=38, CHAT=81). There was no difference in retention rates at the end of the Intervention Phase, but significantly more HAT than CHAT participants had dropped out of the study (p<0.01) after the Maintenance Phase and the On-going Maintenance Phase. During the Intervention Phase, over half the HAT and CHAT participants completed > or =75% of the prescribed activity sessions, but adherence was significantly greater in CHAT than HAT during the Maintenance Phase (p<0.01). Participants in CHAT were significantly more compliant than HAT participants (p<0.05). Both home- and group-based formats were successful over the short-term, but, in retirement villages, the group program had better adherence and compliance in the longer-term.
1. A certified technician supervises the training of new ophthalmic assistants, but the entire technical staff is involved in the instruction. 2. The program lasts for 10 weeks: 8 weeks of training with ophthalmic procedures and 2 weeks of observation. 3. The essential elements of a well-rounded training program include knowledgeable trainers, role playing, and hand-on experience.
UNLABELLED: Falls are a common hazard in the elderly. Orthostatic hypotension (OH) is prevalent in older patients and contributes to the high incidence of falls. Our aim was to test whether a home-based resistance-training program (HBRT) using elastic resistance bands could safely and effectively increase muscle strength and functional ability, and attenuate the orthostatic fall in blood pressure. Eight subjects (> 60 yrs) underwent orthostatic provocations; muscle strength testing (isometric and dynamic), and a functional test of gait and mobility (Timed Up & Go), at baseline and following 8 weeks of training. Ten exercises were assigned and customized to each participant. At 8 weeks, significant increases occurred in dynamic strength in the chest press ( p = 0.017), quadriceps extension ( p = 0.017), and leg press (p = 0.025); no significant differences occurred in isometric strength or in blood pressures. Functional mobility increased in 7 of 8 subjects. There were no falls during the investigation period. CONCLUSIONS: A HBRT program using elastic resistance bands effectively increases dynamic muscle strength in elderly individuals with OH. Although no changes occurred in orthostatic blood pressures, which could be attributed to the limited length of the program, this therapy may be recognized as a safe method to improve strength, functional ability, and promote physical activity - variables that can reduce the incidence of falls and enhance the quality of life in this population.
OBJECTIVES/HYPOTHESIS: Complications of rhytidectomy have been widely reported in the literature. This study examines the incidence of complications after rhytidectomy in the hands of chief residents under appropriate attending supervision in an otolaryngology-head and neck surgery training program. MATERIALS AND METHODS: The charts of 96 consecutive SMAS rhytidectomy patients were retrospectively reviewed. Patients were selected for surgery from a clinic designed exclusively for cosmetic facial surgery patients. This clinic was run by the otolaryngology chief resident and was supervised by an attending staff surgeon. Most patients elected local anesthesia and sedation administered by the surgical team. Submental liposuction was performed followed by SMAS plication rhytidectomy. RESULTS: Follow-up ranged from 1 to 60 months. Complications included expanding hematoma (1%), temporary facial nerve weakness (3%), pretragal/mastoid skin slough (4.2%), permanent ear numbness (1%), hypertrophic scar (3.1%), wound infection (1%), and dissatisfaction with result (4%). There were no cases of permanent facial nerve injury. CONCLUSION: These complication rates compare favorably with reported rates of larger studies over the past 30 years. These data support the conclusion that rhytidectomy can be performed safely by otolaryngology residents with little morbidity and good patient satisfaction.
The Health Beliefs Model was originally developed in the 1950s to assess patient behavior toward preventative health strategies, and has evolved into a tool for measuring a variety of health related topics. Interns in an ambulatory care clinical training program were asked to complete a 62 item self-administered questionnaire based on concepts central to a modified Health Beliefs Model for assessment of their satisfaction with their internship program. A logistic regression was undertaken to identify relationships between interns' perceptions toward susceptibility and seriousness of illness, delivery of health care through outpatient clinics, supervisory professional personnel and their overall internship satisfaction rating. The data implies that the modified Health Beliefs Model is of value in predicting intern satisfaction.
The following case study offers a detailed description of a university-organization partnership, the basis for a collaborative outreach training program between community psychology graduate students and a lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth center. Students and youth collaborated over 2 semesters on the creation of a social meeting venue within an urban LGBTQ youth-operated center as part of a community outreach project in the students' course in community psychology. Semistructured interviews with the youth and the students provide first-person accounts and perspectives of the project as an effective learning tool for training students in community psychology and in working with LGBTQ youth.
OBJECTIVE: To determine whether strength training is beneficial for people with cerebral palsy (CP). DATA SOURCES: We used electronic databases to find trials conducted from 1966 though 2000; key words used in our search were cerebral palsy combined with exercise, strength, and physical training. We supplemented this search with citation tracking. STUDY SELECTION: To be selected for detailed review, reports found in the initial search were assessed by 2 independent reviewers and had to meet the following criteria: (1) population (people with CP), (2) intervention (strength training or a progressive resistance exercise program), and (3) outcomes (changes in strength, activity, or participation). Of 989 articles initially identified, 23 were selected for detailed review. DATA EXTRACTION: Empirical studies were rated for methodologic rigor with the PEDro Scale, and studies with a PEDro score of less than 3 were excluded. Review articles were evaluated for quality with the National Health Service Centre for Reviews and Dissemination form. DATA SYNTHESIS: Of the 23 selected articles, 11 studies (10 empirical, 1 review) met the criteria for quality and were included. Only 1 randomized controlled trial was identified. With respect to impairment, 8 of the 10 empirical studies reported strength increases as a result of a strength-training program, with effect sizes ranging from d equal to 1.16 (95% confidence interval,.11-2.21) to d equal to 5.27 (95% CI, 4.69-5.05). Two studies reported improvements in activity, and 1 study reported improvement in self-perception. No negative effects, such as reduced range of motion or spasticity, were reported. There was insufficient evidence from which to draw conclusions about the effects of environmental and personal contextual factors. CONCLUSIONS: The trials suggest that training can increase strength and may improve motor activity in people with CP without adverse effects. More rigorous studies are needed that have a greater focus on changes in activity and participation and that consider contextual factors.
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The literature for parent training interventions with conduct-problem preschool-aged children is reviewed. Although previous reviews have identified the preschool years as a critical point for intervention [J. Clin. Psychol. 21 (1992) 306; School Psychol. Rev. 22 (1993) 437], there still remains a paucity of well-designed outcome studies that have focused exclusively on preschoolers. Interventions that utilize parents as active sources of change remain predominant. The review reveals the need for further research to improve accessibility and delivery of interventions. Treatments that have undergone modification in their delivery format (e.g., use of telephone and videotape) were also identified and critically evaluated. Results of the review indicate that many studies are still accompanied by methodological limitations. Although promising interventions exist for young conduct-problem children, it is recommended that treatment effectiveness for preschoolers be evaluated more rigorously.
The purpose of this study was to gain insight into what prevocational medical practitioners (PMPs) learnt during a six-month public health medicine and primary health care training program (the Program) in remote Aboriginal Australia in 2001-2002. The Program's curriculum objectives included clinical and public health management of sexually transmitted infections, immunization, clinical audit and quality improvement, primary health care in remote Aboriginal communities, and working as part of an interdisciplinary team with health and non-health professionals, and lay people. The mode and location of delivery of these objectives was determined by the healthcare needs of the Kimberley population, and availability of safe, supported workplaces. Qualitative data from a variety of sources, including PMPs' reflective journals, were examined in the context of the Program's curriculum objectives and by conducting a content analysis of journal notes. Findings are presented using the curriculum objectives and other comments that emerged while examining the data. Preliminary data indicated that PMPs gained knowledge and practical experience in clinical and public health management of sexually transmitted infections, immunization and primary health care in poorly resourced remote Aboriginal settings. Deeper understandings of health and illness in a cross-cultural setting also developed, along with professional and personal growth, as illustrated by the following quotations from PMPs: "I have learnt ... a different way of looking at people's health ... I was encouraged to think more deeply than before about the whys and wherefores of medical practice, and thus consider the most effective ways of influencing patients' behaviours for the better." "I was encouraged to examine the thought processes behind the ways ... healthcare was provided ... [after leaving the Kimberley] I am constantly questioning the reason why we are practising medicine in a certain way in the big city hospitals-much to the consternation of my colleagues ... ." The Program was successful in teaching its first four PMPs the basic tools of public health medicine and remote area primary health care.
The Authors suggest a training programme for surgeons in post graduates courses. With this object in view, the inguinal hernia repair by Lichtenstein has been chosen as the most suitable one. The training course has been divided into theoretic lessons and surgical practice in the operating theatre, carried out in stages as assistant and then as operating surgeon. The good standard achieved, together with the clinical results obtained, demonstrates the effectiveness of the teaching method.
The effects of swimming training upon mechanical and metabolic properties of heart are investigated in two groups of male Sprague Dawley rats, fed ad libitum: a control group and a swimming group. The chronic training improves myocardial mechanical performances: coronary flow, cardiac output and left ventricular pressure are increased in isolated working conditioned heart preparations. Oxygen consumption and work performance are greater than in control group, but cardiac efficiency is not significantly different between the two groups. Intrinsic conditioned heart rate is lower than in control heart. Endogenous triglycerides and exogenous FFA utilization rates are increased in trained perfused heart. We found a significant correlation (P less than 0,01) between exogenous FFA utilisation and coronary flow.
INTRODUCTION: Despite some progress, the air medical transport profession continues to experience widely publicized accidents that result in injuries and death to crew members and patients. An air medical crew member's experience, training and confidence may affect his or her ability to deal effectively with an in-flight emergency, and may also affect his or her behavior before and after the emergency. SETTING: A hospital-based, rural rotor- and fixed-wing program flying approximately 890 flights per year. Seventy-seven percent of these flights are interfacility. METHODS: A pretraining survey evaluated the experiences of air medical crew members and pilots. A 20-question assessment tool based on a 5-point Likert scale evaluated how confident the individuals were in their ability to react to in-flight emergencies. An extensive in-flight emergency training program was then conducted. Personnel were asked to complete the same questionnaire one month and six months after the training. RESULTS: On the pretraining questionnaire, flight crew members with neither prior training nor actual experience in in-flight emergencies showed the lowest level of confidence. Those with prior training, actual in-flight emergency experience or both, responded with higher levels of confidence. The mean confidence scores of the study participants increased from 82 pretraining to 89 at one month post-training and remained at the increased level six months after training. CONCLUSIONS: A training program focusing on in-flight, aircraft-related emergencies can increase the crew's confidence during such situations. This increase in confidence is most noticeable in those without previous training or experience and is maintained for at least six months. Several other benefits occur from the training program.