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PubMed2004

High-fidelity simulation-based training in neonatal nursing.

Simulation-based training is a novel approach that facilitates the use of higher order thinking skills. Simulation-based training challenges medical professionals to develop cognitive, technical, and behavioral skills through the use of mannequins, working medical equipment, and human colleagues. During scenarios, trainees must make use of their knowledge base, analyze and synthesize factors contributing to the crises, and evaluate the effects of their actions. Feedback indicates that simulation-based training programs are more pertinent to and better accepted by adult learners than traditional programs. The instructional methodologies used in simulation-based training programs are more in line with the tenets of adult learning.

Education, Nursing, Graduate↗
PubMed1986

Mass media linkages with school-based programs for drug abuse prevention.

The most appropriate role the media can play in preventing drug abuse is the dissemination of school-based approaches of proven efficacy. In this paper, that statement is justified from theoretical and empirical perspectives. Suggestions for putting it into practice are offered. Review of the theoretical perspectives of Cartwright, Lazarsfeld and Merton, and Katz suggests that effective uses of mass media for drug abuse prevention must ensure adequate dissemination, maximize positive attention by the target audience (selectivity), encourage positive interpersonal communication, and maximize the principles of monopolization, canalization, and supplementation. Several major ways in which mass media programming can be linked with school-based or community-based programming to achieve these objectives are suggested. Mass media programs are seen as means to improve acceptance of school-based prevention programs by parents. Conversely, schools are seen as playing a crucial role in increasing exposure to media prevention programming, especially if it is an inherent component of a classroom curriculum, and increasing and improving interpersonal discussion about the issues, between students, between students and teachers, and particularly between students and parents.

Humans↗
PubMed1995

Development of a computer program for teaching periodontal diagnosis based on clinical epidemiological principles.

Multimedia teaching tools in dental education are still rare. This paper describes the development of an inexpensive yet powerful computer program for instruction in the principles of clinical epidemiology. The application was developed in the context of periodontal diagnostic methodologies at the third year D.D.S. level. Principles of probabilistic thinking are invoked as the student is guided from the application of raw research data to the derivation of likelihood ratios and how they affect clinical decision making. A questionnaire was used to evaluate student satisfaction with the program and the responses indicated good acceptance of the concepts presented in the program and an interest in further computer-aided instruction.

Computer-Assisted Instruction↗
PubMedDate not supplied

The problem resident: learning from our mistakes.

Every program has its "problem" resident(s). Residents who are academically deficient or who have aggressive styles are well-known to most programs. But, less frequent (or simply less discussed) is the true outlier resident: the resident with a drug or alcohol addiction, the severe personality disorder, the one who is physically and/or verbally aggressive, or one with a criminal history. Our program had the dubious distinction of encountering all of these problems in a single resident. Although we accepted him into the program following a standard reference check, little did we know how little we actually knew about him or his background. This paper is a description of our experience and effort in coping with this stressful situation and is a call for significant change in the whole recruiting process to help reduce or purge graduate medical education of severely dysfunctional trainees.

Family Practice↗
PubMed1998

California's county hospitals and the University of California graduate medical education system. Current issues and future directions.

California's county hospitals train 45% of the state's graduate medical residents, including 33% of residents in the University of California system. This paper describes the interrelationships of California's county hospitals and the University of California (UC) graduate medical education (GME) programs, highlighting key challenges facing both systems. The mission of California's county health care systems is to serve all who need health care services regardless of ability to pay. Locating UC GME programs in county hospitals helps serve the public missions of both institutions. Such partnerships enhance the GME experience of UC residents, provide key primary care training opportunities, and ensure continued health care access for indigent and uninsured populations. Only through affiliation with university training programs have county hospitals been able to run the cost-effective, quality programs that constitute an acceptable safety net for the poor. Financial stress, however, has led county hospitals and UC's GME programs to advocate for reform in both GME financing and indigent care funding. County hospitals must participate in constructing strategies for GME reform to assure that GME funding mechanisms provide for equitable compensation of county hospitals' essential role. Joint advocacy will also be essential in achieving significant indigent care policy reform.

California↗
PubMed2006

Patient-controlled analgesic infusion pumps.

Patient-controlled analgesic (PCA) infusion pumps allow patients to self-administer doses of pain-relieving medication as needed, rather than having to summon a caregiver. The most significant risk when using these pumps is overmedication leading to narcotic-induced respiratory depression. Several current PCA pumps offer advanced error-reduction features designed to minimize the odds of an accidental overdose: dose error reduction systems, bar-code readers, and computer-based pump-programming systems that entail downloading infusion protocols via a hardwired connection to a PC. The availability of these features plays a dominant role in our ratings. We tested 11 pumps from seven suppliers. Two pumps are rated Preferred because they offer easy-to-use advanced error-reduction features that have been proven effective in a hospital setting. Two other pumps offer computer-based programming and are rated Acceptable, although we note that not all facilities may be able to accommodate the workflow necessary to use the computer-based programming. The remaining pumps are rated Not Recommended because they lack advanced error-reduction features; although most of these pumps perform acceptably, better choices are available.

Analgesia, Patient-Controlled↗
PubMed1998

Cognitive behavioral interventions for children during painful procedures: research challenges and program development.

The purpose of this report is to describe a pilot program designed to introduce the use of cognitive behavioral interventions for painful pediatric procedures at a university hospital, and to discuss the challenges that occurred during this process. Participants in the program included ten parents and their children who were newly diagnosed with leukemia, and staff who provided treatment for these children. Measures included direct videotaped observations of the children, perceptions of pain and anxiety completed by children, parents, and staff, and parent and staff ratings of satisfaction with the program. Results indicated strong acceptance of the interventions. This report discusses the challenges encountered, implications of the findings, and plans for future program development.

Adolescent↗
PubMed1991

Increasing habilitative services for persons with profound handicaps: an application of structural analysis to staff management.

We evaluated a structural analysis methodology for enhancing the utility of a staff management program. In Experiment 1, a structural analysis of direct-care staff behavior in a mental retardation facility revealed differences in work patterns over time. Specific times were identified when few basic care duties were necessary and staff engaged in nonwork activity. In Experiment 2, a management program was implemented to increase staff members' training activities during periods identified through the structural analysis. The program was accompanied by increases in training activities and decreases in nonwork behavior. The improvements were maintained during a 43-week period while the most labor-intensive component of the program was withdrawn. Staff acceptability measures indicated a positive response to the management intervention, although responses varied across components within the multifaceted program. The increased training was accompanied by beneficial changes among clients with profound handicaps. Results are discussed regarding practical considerations for improving staff performance and for adopting innovations resulting from applied research.

Adult↗
PubMed1995

[Comprehensive obesity therapy program].

Being overweight is now accepted as one of the big health problems of our society. A major extent of overweight is associated with numerous disease and has to be considered as a disease itself. Considerable and intensive efforts are necessary to terminate the increasing trend or to turn it into the opposite direction. The OPTIFAST-program is an extensive therapy program with nearly guaranteed success. As compared to other programs, the longterm results are good, though they still need considerable improvement. A common strategy should be developed for a longterm and permanent program.

Adult↗
PubMed1988

Evolution of the technologist specialist in gastrointestinal radiology.

Over the past few years, a program was initiated at the author's institution to train radiologic technologists to perform the fluoroscopic aspect of gastrointestinal examinations. The program was undertaken in an attempt to improve patient flow through the division, as well as in response to the decreasing number of residents being accepted into the radiology program. The results with respect to diagnostic quality of examination, improved patient flow, and patient and resident acceptance have been satisfactory.

Fluoroscopy↗
PubMed2005

Graduate study in psychology: 1971-2004.

This article traces the evolution of graduate study in psychology in the United States and Canada during the past 3 decades. The authors summarize the 2003-2004 characteristics of graduate programs and departments in psychology and compare these data to those obtained in 1970-1971, 1979-1980, and 1992-1993. The most recent data were obtained from the 2005 edition of Graduate Study in Psychology and were based on 495 institutions, 601 departments, and 1,970 graduate programs. Information is presented for both entire departments (e.g., faculty characteristics, student profiles, admission criteria, Graduate Record Examination and grade point averages, tuition costs, financial assistance) and individual graduate programs (e.g., areas of study, number of applicants, acceptance rates, enrollment statistics, retention rates). Particular attention is devoted to the emergence of PsyD programs in professional psychology, the ascendancy of neuroscience programs in academic psychology, and the steady rise in acceptance rates across programs over the past 33 years.

Canada↗
PubMed1999

Effect of speech processor program modifications on cochlear implant recipients' threshold and maximum acceptable loudness levels.

This study's purpose was to determine whether or not modifications in speech processor electrical stimulation levels were associated with changes in five Nucleus 22 cochlear implant recipients' thresholds or maximum acceptable loudness levels (MALs). These modifications in minimum and maximum stimulation levels were made to optimize hearing in everyday life. One threshold and one MAL were obtained on each active electrode during six, weekly test sessions, three before and three after program modification. Only one participant had a significant change in threshold after program modification; this participant and four others had significant changes in MAL. Participants' threshold variability was the same, but MAL variability was higher than that observed in other studies. Because these participants had no experience making MAL judgments prior to this study, this result suggests that implant recipients should be given sufficient practice in making MAL judgments to provide a stable clinical estimate of the upper boundary of the electrical dynamic range.

Acoustic Stimulation↗
PubMed2003

Evaluating the effectiveness of a multimedia program on home safety.

PURPOSE: This study was designed to test the effectiveness and acceptance of multimedia home safety programming by community-dwelling seniors. DESIGN AND METHODS: A prototype CD-ROM was produced that required no reading or computer skills because the program included an audio narration of content and directions for operating the program on a touchscreen computer monitor. Volunteers (N = 126) from a senior center aged 55 and older were randomly assigned to (1) a multimedia group that used the interactive program to learn about home safety, (2) a traditional learning group that read well-established booklets on home safety, and (3) a control group that received no instruction on safety between the pre- and posttests. RESULTS: Repeated-measures multivariate analysis of variance showed that the multimedia group was the only group to improve in knowledge. The group was also very satisfied with the approach. IMPLICATIONS: Multimedia formats can effectively and economically provide information to older clients.

Accidental Falls↗
PubMed2005

Improving adolescent health: focus on HPV vaccine acceptance.

The success of future human papillomavirus (HPV) vaccination programs will depend on individuals' willingness to accept vaccination, parents' willingness to have their preadolescent and early adolescent children vaccinated, and health care providers' willingness to recommend HPV vaccination. The purpose of this article is to provide a qualitative review of the relevant literature, including research on knowledge and attitudes about HPV infection and its clinical sequelae, the acceptability of HPV vaccination to individuals and parents, and health care providers' attitudes about recommending HPV vaccination. Additionally, strategies are suggested by which providers of adolescent health care can discuss and recommend HPV vaccines with parents and their children. The research published to date suggests that there is a good deal of misunderstanding about HPV infection, cervical cancer screening, and the sequelae of HPV infection. However, the majority of research studies to date indicate that young women, parents, and health care providers are interested in vaccines that prevent HPV and other sexually transmitted infections (STIs). Of particular note are the consistent findings that providers are less comfortable vaccinating younger versus older adolescents and that endorsement of vaccination by a professional organization is of great importance. Furthermore, research suggests that most parents are interested in having their preadolescent and adolescent children vaccinated against HPV. Parents value the information and recommendations provided by their children's health care providers. To the extent that providers are concerned about potential negative reactions of parents to a recommendation of HPV vaccination, these findings should provide reassurance. At the same time, health care providers will need to be prepared to provide patients and parents with information about HPV and HPV immunization and to respond productively to the rare parent who expresses opposition to HPV vaccine or any other vaccine.

Adolescent↗
PubMed1982

Trial of labor following cesarean section: a two-year experience.

Elective repeat cesarean section is one of the major factors responsible for the increase in the total cesarean section rate observed since 1970. Beginning in January, 1980, a voluntary program encouraging a trial of labor for patients with a documented previous low-transverse cesarean section and no apparent recurring indication was instituted. Two hundred seven patients were managed with an adequate trial of labor, and 84.5% were delivered vaginally over a 2-year period. There were no deaths associated with a trial of labor, and maternal and fetal morbidity was negligible. This voluntary program resulted in a 27.9% decrease in the repeat cesarean section rate over the 2 years reported. Patient and physician acceptance of such a program was evaluated by follow-up questionnaires. Current recommendations include a mandatory trial of labor in patients with only one previous low-transverse cesarean section and no current indication for cesarean delivery. A more liberal management policy regarding patients with two or more previous low-transverse cesarean sections also seems warranted.

Cesarean Section↗
PubMed1998

Experience with a novel vaginal progesterone preparation in a donor oocyte program.

OBJECTIVE: To compare the efficacy of a vaginal progesterone preparation with our standard IM preparation within a donor egg program. DESIGN: Prospective randomized trial. SETTING: Donor egg program at a university assisted reproductive therapy program (Jones Institute for Women's Health). PATIENT(S): Couples accepted into the donor egg program because of either premature ovarian failure or evidence of diminished ovarian reserve. INTERVENTION(S): Women were randomized into either a group receiving IM progesterone replacement or a group receiving vaginal progesterone replacement. Both groups underwent Estraderm patch/progesterone treatment in a mock cycle leading to an endometrial biopsy on day 26 followed by a second cycle in which ET was performed. Subjects with residual ovarian function received a GnRH agonist. In the IM treatment group, 100 mg was administered from cycle days 15 to 27. In the vaginal treatment group, Crinone 8%, a polycarbophil-based gel preparation containing 90 mg of micronized progesterone, was administered twice daily from the evening of day 14. MAIN OUTCOME MEASURE(S): Endometrial histology, serum levels of progesterone (on days 13, 17, 20, 24, and 26), the occurrence of pregnancy, implantation rate, and pregnancy outcome. RESULT(S): Fifty-four women randomized into the vaginal progesterone treatment group and 18 women in the IM treatment group achieved ET. Mean serum progesterone levels were higher in the IM treatment group than in the Crinone group. Endometrial histology was "in phase" for all subjects in both groups. Clinical pregnancies were observed in 26 of 54 women and 5 of 18 women in the Crinone and IM progesterone groups, respectively. The ongoing pregnancy rate (PR) of 31% (17/54) and implantation rate of 23% in the subjects receiving Crinone was not statistically different from the IM progesterone group's ongoing PR of 22% (4/18) and implantation rate of 18%. CONCLUSION: Vaginal progesterone replacement with the polycarbophil gel preparation was as effective as IM progesterone in producing clinical and ongoing pregnancies within our donor egg program in the dosages administered.

17-alpha-Hydroxyprogesterone↗