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At least 91 records · Page 5Linked to original sources
PubMed1992

First derivative of right ventricular pressure, dP/dt, as a sensor for a rate adaptive VVI pacemaker: initial experience.

Ten patients underwent implantation of a rate adaptive ventricular pacing system with a new pulse generator and lead. The unipolar lead has a steroid eluting tip and a pressure sensor. The first derivative of the signal from this sensor, dP/dt, is determined and the pacemaker rate is varied in response to changes in the right ventricular dP/dtMAX. During implantation, dP/dt values were in the range of 180-720 mm Hg/sec. The autothreshold for pacing at 2.5 V remained unchanged 1 month after implantation (0.065 +/- 0.045 msec, range 0.05-2.00 msec) and only slightly increased after 3 months (0.075 +/- 0.045 msec, range 0.05-2.00 msec). A significant correlation existed between the dP/dt measured during implantation and the right ventricular pressure measured by telemetry at follow-up visits (r = 0.93, P = 0.0001). Initial pacemaker programming was performed on the second day after implantation following a short walk and was adjusted subsequent to follow-up visits according to the patient's subjective assessment and in accordance with the results of exercise tests and Holter monitoring. Exercise and Holter tests did not significantly change initial programming. There was a significant correlation between right ventricular systolic pressure and the rate response setting (r = -0.66, P less than 0.05). During dP/dt pacing, all patients felt well, and eight of these reported an improvement compared to nonrate adaptive pacing. The heart rate response to effort and recovery was appropriate. It was concluded that: (1) right ventricular dP/dt is a suitable parameter for controlling the pacing rate; (2) appropriate programming of the dP/dt pacemaker results in a suitable heart rate response to exercise and recovery.

Aged↗
PubMed2003

Monitoring antimicrobial resistance for public health action.

Antibiotics are used both to treat infections in individual patients and in public health interventions to control disease outbreaks. In both circumstances the outcome, as measured by morbidity and mortality, is compromised by antimicrobial resistance (AMR) in the causative organism. Of necessity, antibiotics are frequently given empirically and their selection is based on presumptions of efficacy and the susceptibility of the infecting agent. AMR surveillance provides reassurance with regard to efficacy and guides the formulation of standard treatment regimens. However, AMR surveillance is not always appropriately performed nor are the data generated necessarily used to best advantage. Optimal use of AMR surveillance data requires for each disease of importance: an understanding of the applications of AMR surveillance and a clear definition of the type of data required: the 'triggers for surveillance'; construction of AMR surveillance programs appropriate to differing requirements; and better linkages between AMR surveillance data and disease control functions so that the thresholds for initiating public health action are clearly defined. Examples which illustrate the application of these principles are provided from experience with surveillance of AMR in the pathogenic Neisseria (N. gonorrhoeae and N. meningitidis).

Anti-Infective Agents↗
PubMed1998

Rodent quarantine programs: purpose, principles, and practice.

In animal research, validity and reproducibility of data are critically influenced by the microbial status of the experimental animals. One of the most crucial aspects of assuring quality in animal research is providing research personnel with confidence that experimental results will not be invalidated due to interference caused by infectious disease. An effective quarantine program is essential to providing this assurance. Quarantine programs are generally instituted to prevent the introduction of rodent pathogens into established specific-pathogen-free colonies in a facility. Therefore, programs should be designed to isolate newly acquired rodents until their health status can be determined and to maximize the probability that microorganisms of interest will be detected before the animals are introduced into (and thus, could potentially contaminate) established colonies. Important principles that are critical to designing an effective quarantine program will be discussed here, as will the practical implementation of these principles. Although quarantine programs may be costly in terms of time and effort, these costs must be balanced against the potential costs of disease outbreaks that could invalidate long-term studies, alter normal biological baselines, and cause the loss or necessitate re-derivation of rare or valuable strains of rodents. Reducing the incidence of quarantine failures through appropriate program design and implementation helps to maintain the confidence of research personnel in the value of quarantine programs and in our competence as specialists in laboratory animal management and as partners in the research process.

Animal Husbandry↗
PubMed1975

Challenging residents to assume maximal responsibilities in homes for the aged.

A program for activating residents of homes for the aged to assume maximal responsibilities is described. Promoting maximal physical and mental health through various modalities including activity programs, appropriate exercise and participation in democratic self-government mechanisms, will result in a happier, healthier population of residents in institutions for the aged. The increased demands on staff time and patience will be compensated for by relief of the too-frequent feelings of hopelessness and boredom endemic among the staff of long-term care facilities. Such programs demand constant effort by all staff members, patients, volunteers and relatives because if they succumb to the usual human dislike of persistency, short-term gains can easily be lost.

Aged↗
PubMed1991

Developing a quality assurance program through teamwork.

Clinic nurses and nursing faculty members collaborated to develop a quality assurance program appropriate to three different clinic sites. The nurse consultants maintained a supportive, rather than a leadership, role while guiding the three groups of clinic nurses through the change process structured around the familiar structure, process, outcome framework. Regularly scheduled meetings and the cooperative distribution and accomplishment of clearly defined tasks not only have produced an excellent standardized nursing quality assurance program but also forged a dynamic nursing team.

Goals↗
PubMed1991

Intergenerational continuity and reciprocity through the use of community-based services: theory and practice.

This paper aims to expand the current debate on intergenerational issues by examining the interactions of the generations and their sentiments as represented in recent community program studies, participant-observation reports, and autobiographical work. The error in intergenerational inequity thinking is asserted to be in its belief that a generation that otherwise would have had to support its parents would be in favor of cutting social security benefits. Two, if researchers and policy makers take into account only economic exchange, they will never be able to predict usage or plan appropriate programs. Three, the state has a stake in supporting informal caregivers. Finally, real equity lies in normative social exchange.

Activities of Daily Living↗
PubMed1980

Involuntary admissions to general hospitals: legal status is not the issue.

Because of California state laws emphasizing treatment at the local level, and because of a number of financial considerations, many general hospitals in California have developed inpatient psychiatric programs designed to meet the needs of all but the most difficult-to-handle patients. Based on their experience in California, the authors argue that general hospitals should not reject involuntary psychiatric patients out of hand simply on the basis of legal status. They suggest instead that a distinction be made between cooperative, participating patients, regardless of legal status, and all other patients, and that appropriate programs be developed for each group. The patient's symptomatology and the resources available on the unit should be the determining factors in admission decisions, not legal status.

California↗
PubMed1984

Supplemental Security Income for the aged, blind, and disabled; income, resources and exclusions deeming of income and resources: Medicaid program; financial requirements for categorically needy--HHS. Final rules.

The Social Security Administration (SSA) is adopting as final, interim regulations on deeming of income and resources, which was published on Friday, June 4, 1982. These rules address the problem of certain individuals who require costly medical care and who under the usual Supplemental Security Income (SSI) deeming rules are ineligible for SSI and Medicaid as long as they live with their families. These rules also address the problems of individuals who remain institutionalized because returning home for less costly medical treatment would result in loss of SSI and Medicaid eligibility. The rules provide that the Secretary, in appropriate circumstances, will not apply the usual SSI rules for deeming the income and resources of certain family members to a noninstitutionalized individual. This is a temporary policy that will deal with this concern while States, if they choose, develop appropriate programs of home and community-based services under their Medicaid programs.

Eligibility Determination↗
PubMed1985

Health personnel training in the Nicaraguan health system.

The "Unified National Health System" of Nicaragua was established in 1979, in an attempt to transform some of Latin America's worst health indices. This system, based on the stated principles of planning, regionalization, public participation, and primary care, has prioritized the development of health professions training programs appropriate to its special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. A new campus of the School of Medicine was opened in 1981, increasing the number of medical students by a factor of five. Formal residency training (never before available within the country) in primary care specialties has been established. Training for allied health personnel has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a tremendous need for educational resources both human and material. This article reviews the status of health personnel training in Nicaragua today, the integration of these programs into planning for the health system, and problems arising from their rapid appearance.

Allied Health Personnel↗
PubMedDate not supplied

Tobacco use and ethnicity: the existing data gap.

Tobacco use contributes substantially to the burden of illness throughout the world. Significant efforts have been made to design health promotion programs for the prevention and cessation of tobacco use in North America. However, most of these programs have been planned and implemented on the basis of needs assessments conducted among the dominant cultural group. Evidence exists that lifestyle modification and tobacco cessation programs must be culturally relevant to ensure successful outcomes. A review of the literature from nursing, anthropological and epidemiological perspectives suggests that there is a paucity of data available on the largely culture-dependent values which influence the decision to use tobacco in those groups which comprise the Canadian multicultural mosaic. The interpretation of results from existing studies is limited by a number of recurrent methodological flaws. The implications of this review for future research and public health planning are discussed. The development of culturally appropriate programs directed at the prevention and cessation of tobacco use remains a significant challenge for health professionals.

Canada↗
PubMed2002

Automatic mode switching of implantable pacemakers: II. Clinical performance of current algorithms and their programming.

While the hemodynamic and clinical significance of automatic mode switching (AMS) in patients with pacemakers has been demonstrated, the clinical behavior of AMS algorithms differ widely according to the manufacturers and pacemaker models. In general, a "rate-cutoff" detection method of atrial tachyarrhythmias provides a rapid AMS onset and resynchronization to sinus rhythm at the termination of atrial tachyarrhythmias, but may cause intermittent oscillations between the atrial tracking and AMS mode. This can be minimized with a "counter" of total number of high rate events before the AMS occurs. The use of a "running average" algorithm results in more stable rate control during AMS by reducing the incidence of oscillations, but at the expense of delayed AMS onset and resynchronization to sinus rhythm. Algorithms may be combined to fine tune the AMS response and to avoid rapid fluctuation in pacing rate. Appropriate programming of atrial sensitivity, and the avoidance of ventriculoatrial cross-talk are essential for optimal AMS performance.

Algorithms↗
PubMed1986

Adolescent pregnancy: the perspective of the sisterhood of black single mothers.

The Sisterhood of Black Single Mothers Inc. (The Sisterhood) is an organization which exemplifies the considerable potential of community members united for a common good. The Sisterhood began eleven years ago under the leadership of Ms. Daphne Busby. The objective of the Sisterhood is "salvation of a generation subject to insensitivity and misunderstanding--through helping families, especially those headed by women and adolescent women--to establish a new and positive mind set." The Sisterhood regards individuals and social phenomenon as parts of a complex and dynamic whole and uses a positive approach to assessment of situations. Therefore, adolescents who come to the Sisterhood already parents, as well as those who may become parents in their formative years, are provided programming appropriate to their overall needs. They are given opportunities for help in such areas as: securing medical care, public assistance, counseling, housing and financial assistance. Outreach to other significant persons in the life of these adolescents includes intervention with the service providers with whom they come in contact (doctors, teachers, social workers etc.). In addition to addressing the practical needs of adolescents who come to the Sisterhood, positive examples of healthy ways of relating to others and presentation of a system of values consonant with self and family development are provided. Examples are: the Youth Awareness Project (YAP) which deals with concerns of young people as a specific group. The program's focus is bringing young people together who are growing in positive ways and encouraging continuation of that growth.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Mandatory training in geriatric psychiatry: can programs deliver the goods?

There have been a number of recent attempts to establish guidelines and curricula for training of general psychiatry residents in geriatric psychiatry. However, concerns have arisen as to whether or not many training programs have the resources necessary to train residents using these guidelines. In an attempt to determine how closely training guidelines are adhered to, the Division of Geriatric Psychiatry at the University of Toronto anonymously surveyed all general psychiatry residents completing their mandatory training in geriatric psychiatry between June 1992 and July 1993 (N = 30). The supervisors of these residents were surveyed anonymously as well (N = 15). The response rate was 83% for the residents and 80% for staff. In general, the training guidelines were closely adhered to except possibly for the required number of patient contact hours per week. The author concludes that when training guidelines are developed which include consideration of appropriate program resources and the number of residents required to train, residents and supervisors adhere closely to these guidelines.

Aged↗
PubMed2001

The Psychology Graduate Applicant's Portal (www.psychgrad.org).

Applying to graduate school in psychology can be an intimidating process. Many obstacles must be overcome, such as applying to a program appropriate to the specific applicant, getting good GRE scores, submitting a clear and well-written statement of purpose, and obtaining letters of recommendation, to name just a few. Much information is available to assist applicants in these tasks, but finding this information can cause problems even for experienced Internet users. The goal of this project is to create an easily accessible Web clearing house of information on applying to graduate school in psychology. This Web site, called the Psychology Graduate Applicant's Portal (or PsychGrad.org), contains targeted links to other Web pages with valuable information, book recommendations on the applications process, polls to measure issues important to the graduate applicants, site-unique advice on graduate programs, a message board to exchange information and experiences, and other information relevant to the application process.

Education, Graduate↗
PubMed1993

The twelve steps. A pathway to recovery.

Alcoholics Anonymous and its 12 Steps and 12 Traditions have arisen out of the experiences of recovery of alcoholics. It offers an important treatment option to the clinician who sees destructive compulsive disease in his or her practice. Despite their nonscientific, nonrational approach, AA and other 12-step programs have evolved to offer a set of attitudes, beliefs, and behaviors that can facilitate change in this group of patients. AA is the forerunner of the others and offers as its most important characteristics an unconditional acceptance of the patient's alcoholism, an unshaken belief in the concept of alcoholism as a disease, and support to foster a healthy dependence in the alcoholic. The recovery of an alcoholic involves a fairly long initial stage in which denial about alcoholism is broken down with slow and halting identity change. This characteristic underscores the primitive level of ego development in the alcoholic and the need for much continuing support, nurturance, and tolerance. Clinicians can be an important part of this support network by working with AA and other 12-step groups to help break down denial in the patient and direct individuals to the appropriate program. By allying themselves with this method and groups, clinicians will be making powerful statements about their beliefs and attitudes toward these destructive illnesses.

Alcoholics Anonymous↗
PubMedDate not supplied

Family versus individually oriented intervention for weight loss in Mexican American women.

Mexican Americans are more likely to be obese than non-Hispanic whites, yet little research has been conducted on the treatment of obesity in Mexican Americans. The purpose of this study was to compare a family-based intervention with a traditional program oriented to the individual for achieving weight loss by obese Mexican American women. A total of 168 obese women were randomly assigned to one of three groups. Group 1 served as a comparison group and received only printed materials on nutrition, exercise, and behavioral principles for weight loss. Subjects in the individual group (group 2) received the same printed information, but they also attended classes led by bilingual registered dietitians. Subjects in the family group (group 3) received materials and attended classes that emphasized a family-oriented approach to making changes in eating habits and exercise behavior. Spouses and children attended classes with subjects in this group. Results revealed a significant linear trend in both body mass index and weight reduction across the groups, with losses greatest in the family group, followed by the individual group, and least in the comparison group. Both the individual and the family groups lost significantly more weight than the comparison group, although the difference between these two groups was not statistically significant. The results suggest that a culturally and linguistically appropriate program can achieve significant weight reduction among Mexican Americans. More research should be conducted on the effects of family and other types of social support on weight loss by Mexican Americans.

Adolescent↗
PubMed2004

Delineating the population served by a mobile crisis team: organizing diversity.

OBJECTIVE: While mobile crisis teams have proliferated to address gaps in service for individuals with serious mental illness, research into their effectiveness is limited. This study identifies specific cohorts of individuals served by a single mobile crisis team so that appropriate program evaluation could be designed and conducted for each unique grouping. METHOD: This retrospective study analyzes specific data from 4 sets of client records (n = 401) at 4 different time periods, using a qualitative, text-based approach. For the first 2 reviews (n = 69 and n = 40), only data related to referral source, sex, details of the reason for referral, and the mental status assessment were known to the researchers. The first 2 sets of records were used to identify the cohorts, the third set was used to confirm these cohorts, and the fourth set was used to determine the reliability of the classification tool. RESULTS: All individual cases for the mobile crisis team could be classified into one of the following categories: Symptoms Disturbing Others, Symptoms Disturbing Self, Information Seeking, For Your Information, and Other. After the third review, the cluster, Symptoms Disturbing Others, was subdivided into Symptoms Disturbing Others-General and Symptoms Disturbing Others-Suicide. CONCLUSIONS: This review was useful in identifying specific cohorts of individuals served by a single mobile crisis team. Clearly identifying who is served by a mobile crisis team is the first step in identifying practice guidelines and appropriate evaluation measures for each distinct group.

Canada↗
PubMed1984

Clinical implications of risk factors for breast cancer.

Little is known about the actual causes of breast cancer, but a great deal is known about risk factors: characteristics of individual patients that increase their chances of developing breast cancer above the level of risk in the general population. The factors may be classed generally as genetic (familial history), hormonal (age at menarche and at menopause, parity, age at first birth, etc.), nutritional (possibly including social, economic, and ethnic factors), morphologic (proliferative breast disease, including cancer predictive of later risk), and breast irradiation. Because current understanding of how these risk factors relate to breast cancer causation is minimal (except for irradiation), there are few practical measures for primary prevention. However, there can and should be major use of current knowledge in arranging secondary prevention through screening and possibly even prophylactic mastectomy. The author's concern was that, at the time the National Conference on Breast Cancer was arranged, there was little consideration of breast cancer risk in the woman who lacked risk factors. Since that time, other authors have published a strong statement to the effect that breast cancer rates still are substantial and important in these women. In the current report, the author illustrates the same point for other "low-risk" groups to support the argument that by current knowledge, no adult American woman is at such low risk for breast cancer that she can safely be excluded from the educational and screening programs appropriate for her age.

Adolescent↗