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Embryo implantation rates in oocyte donation: a prospective comparison of tubal versus uterine transfers.

OBJECTIVE: To compare pregnancy and implantation rates in tubal and uterine transfers during a hormonal replacement cycle in an oocyte donation program. DESIGN: Prospective randomized. PATIENTS: Forty-two consecutive patients who entered an oocyte donation program. INTERVENTIONS: Twenty-two patients were assigned for uterine transfer and 20 for tubal embryo transfer (ET). RESULTS: Twenty-three pregnancies were achieved, 12 (54.5%) after uterine transfers and 11 (57.9%) after tubal transfers. Implantation rates in both groups are not significantly different (17.4% uterine transfers versus 21.5% tubal ETs). CONCLUSIONS: Our results suggest that in hormonal replacement cycles (uniform endometrial stimulation) there is no advantage in transferring embryos to the fallopian tube. Furthermore, embryo quality and endometrial receptivity appear to be significantly more important than the time of entrance of an embryo to the uterine cavity in determining its chances of implantation.

Embryo Implantation

[Psychosocial intervention for persons infected with HIV].

We describe a psychosocial intervention program designed to enhance coping with the stress associated with HIV infection. The NUCARE intervention program is based on six components of coping including: cognitive reframing, problem-solving, relaxation, goal setting, social support and use of resources and services. The rationale and development of the intervention is discussed and practical case examples illustrating the benefits of each component are presented.

Adaptation, Psychological

SAPHIRE--an information retrieval system featuring concept matching, automatic indexing, probabilistic retrieval, and hierarchical relationships.

SAPHIRE (Semantic and Probabilistic Heuristic Information Retrieval Environment) is an experimental computer program designed to test new techniques in automated information retrieval in the biomedical domain. A main feature of the program is a concept-finding algorithm that processes free text to find canonical concepts. The algorithm is designed to handle a wide variety of synonyms and convert them to canonical form. This allows natural language to be used for query input and also serves as the basis for a new approach to automatic indexing based on a combination of probabilistic and linguistic methods.

Abstracting and Indexing

Issues in human immunodeficiency virus (HIV) screening programs.

Unlike test sensitivity and specificity, the false positive and negative predictive values (probabilities of mislabeling an individual being tested) depend heavily on the prevalence of the infection of the human immunodeficiency virus (HIV) as well as the quality of the kit. A consequence of this dependence is that the false positive predictive value can reach a high magnitude such as 0.9; that is, 90% of the positive tests are false. This raises many important issues pertaining to the current practice of HIV screening such as to how to control these misclassification errors, how to interpret test results, and how to estimate prevalence using test results. These issues are examined in detail here by considering the factors that dictate the quality of a screening program. Some real data examples are used to illustrate the importance of this consideration in designing programs to achieve the desired goals. The rationale behind the common two-step sequential protocol in HIV screening is examined to point out its limitations under practical situations. Finally, the use of entropy in evaluating the informativeness of a screening program is discussed.

AIDS Serodiagnosis

Interdisciplinary health education: a case study of fact and fancy.

Meeting the health needs of patients and providing comphrehensive health care services require the integration and coordination of several professional health services. Traditional methods for training students in the health professions independently are being challenged by the need for future practitioners to understand and to utilize effectively the skills offered by the other disciplines. However, the movement of educational institutions toward interdisciplinary training programs entails the careful assessment of program design, content, and basic philosophy. Two and one-half years of experience with such a program at one academic health center are reviewed.

Adult

Teaching humanistic and psychosocial aspects of care: current practices and attitudes.

OBJECTIVE: To assess current practices and attitudes toward teaching humanistic and psychosocial aspects of care in internal medicine residency programs. DESIGN AND PARTICIPANTS: Survey questionnaires were sent to residency directors at all 434 internal medicine residency programs accredited in 1985-1986. Response rate for two mailings was 71%. MEASUREMENTS AND MAIN RESULTS: 78% OF RESIDENCY DIRECTORS and 70% of department chairpersons had high or moderately high levels of commitment to teaching humanistic/psychosocial aspects of care, but only 44% of responding programs offered mandatory training, and only 18% offered elective training in these areas. Obstacles to expanded teaching of the humanistic/psychosocial aspects rated high or moderately high by residency directors included insufficient curriculum time (51%), lack of trained faculty (44%), and pressures to reduce both training costs (40%) and patient-care costs (37%). CONCLUSIONS: Most of the training that does occur in the humanistic/psychosocial aspects of care probably happens informally via mentoring and role modeling. Appeals to expand teaching in these areas raise questions regarding what to include in medical training and the proper scope of internal medicine. Sustainable change will depend on the politics of resource distribution and the influence of general internal medicine and primary care on traditional training.

Clinical Competence

SILMUT: a computer program for the identification of regions suitable for silent mutagenesis to introduce restriction enzyme recognition sequences.

We describe a set of IBM-compatible computer programs designed to selectively identify the potential sites for silent mutagenesis within a target DNA sequence. This program is based on a novel strategy of identifying amino acid motifs compatible with each restriction site (BioTechniques 12:382-384, 1991). The programs can be used to identify the suitability for the introduction of any 6-base nucleic acid sequences, such as restriction enzyme sites in cassette mutagenesis strategies. The Table program generates a table of multiple amino acid motifs for each restriction enzyme, obtained by translating each unique recognition sequence in all three reading frames. The Silmut program, which utilizes the features of Table, will further identify the presence of a match between any amino acid motif of each restriction enzyme and the input target sequence. Minor manipulations of the data base files will enable the individual researcher to identify the potential for introduction of any 6-base sequences by silent mutagenesis.

Base Sequence

Cognitive modifiability in retarded adolescents: effects of instrumental enrichment.

The Instrumental Enrichment program, designed to modify the cognitive structures of retarded, disadvantaged adolescents, was contrasted with a General Enrichment program both in a residential setting and a day center. This study is based on 57 matched pairs drawn from the total research sample of 218 adolescents. One group in a residential center (n = 24) and one group in a day center (n = 33) received Instrumental Enrichment; one group in a residential center (n = 24) and one group in a day center (n = 33) received General Enrichment. The Instrumental Enrichment program extended over 2 years, and the subjects were pre- and posttested on a battery of criterion measures: general and specific cognitive tests, scholastic achievement, classroom interaction, and self-concept. The results indicated significantly better performance by the groups receiving Instrumental Enrichment than by the groups receiving General Enrichment on the tests of specific cognitive functions and scholastic achievement and on some of the classroom interaction scales. Results for the residential groups compared with the day-center groups revealed significant differences on the tests of scholastic achievement, in favor of the residential groups and on the classroom interaction scales in favor of the day-center groups.

Achievement

A systematic approach to continuing education for radiologic technologists.

As continuing education programs for radiologic technologists expand, it is important that needs be properly assessed and well-designed programs be developed. This reports on the step-by-step process of a regional medical education center to provide continuing education for technologists that would be most beneficial to them and indirectly to the patients they serve.

Curriculum

Guidelines for the functioning of a helping service.

The purpose and the operation of an effective helping service are defined along the principles developed by R. R. Carkhuff. A functional operationalism directly linking each aspect of a helping service to the objective of servicing the needs of those people for whom the service exists is developed. The personal fitness of the staff as defined by their effectiveness at living is identified as the critical variable determining service effectiveness. The level of staff performance on the operational indices of physical, emotional, and intellectual functioning including, specifically, the interpersonal dimensions of empathy, respect, genuineness, concreteness, confrontation, and immediacy is designated as the operational basis for the organizational decisions of hiring, firing, promotion, and role assignment. Systematic programs designed to meet specific client needs serve to complete staff and service effectiveness.

Counseling

The Pawtucket Heart Health Program. Influencing adolescent eating patterns.

The Pawtucket Heart Health Program, a research effort testing a process of community activation for cardiovascular risk factor behavior change, risk factor change, and coronary heart disease event rate change, utilizes risk factor behavior change programs for the entire population of a northeastern city. A diversity of nutrition programs designed to teach new skills and to alter the nutrition environment have been delivered. These include group programs, highlighting restaurant menus, labeling grocery shelf items, screening for blood cholesterol levels accompanied by nutritional counseling, and provision of programs in schools. In addition to standard curricula, the Heart Healthy Cook-Off for both junior high school and high school students has been developed. Students select recipes, make substitutions to lower fat, saturated fat, and cholesterol content, analyze original and substitution recipe nutrient content using a microcomputer and nutrient analysis software, and prepare the food. A panel of judges assesses presentation, taste, and health-promoting characteristics. In one junior high school class, cholesterol measure before and after the cook-off decreased by 10.7% among those with elevated cholesterol. The Heart Healthy Cook-Off is an education program that influences the culinary practices of children in an enjoyable, challenging format.

Adolescent

Measuring the effectiveness of the Star Parenting Program with parents of young children.

This study evaluated the effectiveness of the STAR Parenting Program, designed specifically for parents with children between the ages of 1 and 5 yr. The 8-hr. program was completed by 35 parents. There was a significant increase in parents' favorability and a significant decrease in anxiety afterwards. Parents also significantly lowered their expectations, reduced the emotionality of their reactions to their child's problem behaviors, and increased their use of time-out and tangible rewards following training. These changes were maintained at a 6-wk. follow-up.

Adult

Psychological improvement in infertile women after behavioral treatment: a replication.

OBJECTIVE: To replicate previously reported psychological improvements in infertile women attending a group behavioral treatment program. DESIGN: Psychological and demographic data were collected before entering and again upon completion of a behavioral medicine program on a second cohort of patients. SETTING: The program was offered in the Division of Behavioral Medicine, an outpatient clinic of the Department of Medicine at New England Deaconess Hospital. All patients were receiving care from infertility specialists not affiliated with this hospital. PATIENTS: Fifty two self-referred women receiving medical treatment for infertility attended the program. INTERVENTION: A 10-week group behavioral treatment program. MAIN OUTCOME MEASURES: Three validated psychological instruments. RESULTS: Psychological improvement was statistically significant (Profile of Mood States Tension/Anxiety: P less than 0.0001; Depression/Dejection: P less than 0.0122; Vigor/Activity: P less than 0.0431; Confusion/Bewilderment: P less than 0.0057; Spielberger Anger Expression: P less than 0.0013; Spielberger State Anxiety: P less than 0.0037, and Trait Anxiety: P less than 0.0001). CONCLUSIONS: Behavioral treatment is associated with significant decreases in negative psychological symptoms.

Adult

Teaching physicians to teach: a three-year report.

To meet the needs for an expanded preceptor faculty, the Department of Family Medicine at the College of Medicine and Dentistry of New Jersey-Rutgers Medical School has for three years conducted yearly training programs designed to prepare practicing family physicians for the teaching role. Thirty-six physicians have completed the program, which consists of four group seminars and three individual learning site visits spent in the office of an experienced preceptor while a fourth year student is present. Many lessons were learned in the course of these yearly programs which may be useful to others who plan to undertake similar faculty development activities. Therefore, detailed, practical, experiential information is presented regarding recruitment, orientation, the educational program of seminars and individual learning experiences, evaluation, and required resources. Some problems proved to be particularly difficult, such as the uneven quality of the individual learning visits and the attrition of some participants from the program. Feedback from participating physicians has been extremely positive.

Faculty, Medical

Components in program development.

There has been a great deal of discussion and deliberation concerning the composition of program development. Nonetheless, the question still remains--what is program development? What are possible components in program development? In this paper the following components are described, differentiated, and integrated: Statement of Purpose, Curriculum Design, Program Competencies, Content, Content Competencies, and Practice Environments.

Curriculum

The culturally diverse student: a model for empowerment.

The student who is at a disadvantage due to race, educational background, or cultural background is often unsuccessful in higher education. Specific programs designed to assist the culturally diverse student can make a significant difference in the successful completion of a program of nursing and passing of the National Council Licensure Examination (NCLEX). The authors discuss a model that assists culturally diverse students' success in a program of nursing.

Cultural Characteristics

Nutritional status of black preschool children in Mississippi. Influence of income, mother's education, and food programs.

The nutritional status of 247 black preschoolers in two counties of Mississippi was studied by relating caloric and nutrient intakes and anthropometric measurements to homemaker's education, family income, and participation in Food Stamp and donated food programs..23AUTHOR Low intakes of calories, iron, calcium, vitamin A, and ascorbic acid were found in many of the children, regardless of the variable considered. These findings--in comparison with similar studies--imply that, as time passes, low education and income are having less impact on child nutrition. This ameliorating effect may be due to programs designed to educate parents and extend purchasing power of food dollars. Thus, it seems advisable to continue these programs.?23AUTHOR

Black or African American

A cost-effective, unit-based approach to computerized care planning education.

This article describes a grassroots approach to developing an educational program on nursing diagnosis and computerized care planning. The process involved staff nurses in program design, implementation, and evaluation. Using this process, staff development educators will be better able to successfully initiate grassroots programs that educate large numbers of nurses at minimal cost.

Computer User Training