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PubMed1994

Autogenic-feedback training: a potential treatment for orthostatic intolerance in aerospace crews.

Postflight orthostatic intolerance has been identified as a serious biomedical problem associated with long-duration exposure to microgravity in space. High priority has been given to the development of countermeasures for this disorder that are both effective and practical. A considerable body of clinical research has demonstrated that people can be taught to increase their own blood pressure voluntarily, and that this is an effective treatment for chronic orthostatic intolerance in paralyzed patients. The current pilot study was designed to examine the feasibility of adding training in control of blood pressure to an existing preflight training program designed to facilitate astronaut adaptation to microgravity. Using an operant conditioning procedure, autogenic-feedback training (AFT), three men and two women participated in four to nine training (15-30-minute) sessions. At the end of training, the average increase in systolic and diastolic pressure, as well as mean arterial pressures, that the subjects made ranged between 20 and 50 mm Hg under both supine and 45 degrees head-up tilt conditions. These findings indicate that AFT may be a useful alternative treatment or supplement to existing approaches for preventing postflight orthostatic intolerance. Furthermore, the use of operant conditioning methods for training cardiovascular responses may contribute to the general understanding of the mechanisms of orthostatic intolerance.

Adult↗

PubMedDate not supplied

Designing a medical Web site.

BACKGROUND: A web site is a valuable shop window for any medical unit with something to sell or something to say. AIMS: The aim of this report is to outline the basic steps of web page design for the individual or unit with limited financial resources. METHODS: There are two ways of designing a web site. A reputable web design company can be employed, but this is usually expensive. Alternatively, a web site can be designed in-house using commercial software, following a few simple steps. The basic requirements are a personal computer, software that is available on most computers and access to a few peripheral items of hardware. An outline of the page design should first be put down on paper. This can be transferred to a computer file using a web page design program. This file is then sent to a server for publication on the World Wide Web (WWW). CONCLUSION: Designing and publishing a web page can take time and effort, but the rewards can be great and the results will reflect the message and motto of the unit.

Humans↗

PubMed1987

Evaluation and implementation of self-management programs for children with asthma.

We have reviewed the needs and problems associated with the evaluation and implementation of programs designed to assist children with asthma and their parents to manage the illness. To date, there are several programs that have been evaluated and found to be effective in terms of the objectives and dimensions described. Implementation has presented a larger problem because there are few implementors and because of the major barriers to be overcome by those who would make these programs available to the significant numbers of children and families who would benefit. Unless ways can be found to overcome the medical and reimbursement barriers, asthma self-management programs will not thrive. The growing number of individuals enrolled in some form of health maintenance organization, however, suggests a greater market for asthma self-management programs, under circumstances in which the costs of emergency room use and hospital services must be borne by physicians and hospitals, rather than by their patients.

Asthma↗

PubMed1982

Families at risk of poor parenting: a descriptive study of sixty at risk families in a model prevention program.

Sixty families assessed to be at risk of poor parenting were the subject of this study. These families were participants in a model multidisciplinary program designed for the secondary prevention of poor parenting and the extremes of child abuse and neglect. The model program consists of special medical, psychological, social and developmental services to families on an inpatient, outpatient, and in-home basis. Demographic information on these 60 families was tabulated. Each family was given a monthly rating on a simple measure of family function. Ratings over time were observed, and families were characterized in terms of a family rating vector (up, up-plateau, plateau, fluctuating, and down). Families were also described in terms of the constellation of problems brought to the therapy situation. Problem lists for each family were subjected to factor analysis. Five factor constructs which made clinical sense emerged from the analysis. Each factor could be labeled as a "family type." These types were: (I) Abusive Family, (II) Neglectful or Antisocial Family. (III) Family with an Emotionally Unstable Parent, (IV) Family with Cultural or Intellectual Limitation, and (V) Family with Child-Rearing Difficulties. Approximately 20% of these families did not fit the typology. Families were then divided into two groups--those who were relatively long-term, ongoing recipients of services, and those who left the program in the observation interval. Families were categorized according to family function rating vector and "family type." It was noted among long-term families, measured improvement in family function was most evident in families with transient situational crisis (who did not fit the typology) and those with intellectual and cultural deficits (Type IV). Among the families who dropped from the program, 15% were no longer at risk. Sixty-three percent of the remaining families were not improving. These techniques may be useful in determining which at risk families are more successful candidates for prevention efforts.

Adolescent↗

PubMed2005

Nitrogen isotope ratios in estuarine biota collected along a nutrient gradient in Narragansett Bay, Rhode Island, USA.

Stable nitrogen isotope ratios were used to study the incorporation of anthropogenically-derived nitrogen into the food webs of salt marsh systems along a contamination gradient in Narragansett Bay. Nitrogen isotope ratios (delta(15)N) were measured in six estuarine species collected from three marshes along this gradient, monthly from June to October between 1997 and 1999. A significant decrease in delta(15)N was found with distance along the estuary for four of the six species. Significant differences were found among monthly isotope ratios for some species. Nitrogen isotope ratios in sea lettuce (Ulva lactuca) increased during the summer season with highest delta(15)N values measured during September and October. This trend was most pronounced at the station receiving the highest nutrient inputs. Elevated delta(15)N values at this station appeared to correlate with seawater ammonia/nitrate concentration ratios. The temporal variations in delta(15)N suggest that care should be taken in species selection and the design of sampling schemes of studies using delta(15)N for monitoring anthropogenic nutrients in aquatic systems. Sampling programs designed to determine long-term trends should consider species that do not show rapid fluctuations in isotope ratios. The mud snail, Nassarius obsoletus, responded this way in the present study. Studies designed to measure short-term changes should include species such as U. lactuca, which rapidly respond to isotope changes. The results from this study also help to establish a baseline for nitrogen isotope values in Narragansett Bay. This information can be used to monitor future trends in nitrogen inputs to this estuary.

Animals↗

PubMed1999

Who participates in the Get Fit to Ski program?

The Get Fit to Ski program, run by the Australian Physiotherapy Association, is a pre-season conditioning program designed for, and marketed to, alpine sports participants. This paper describes the characteristics of Get Fit to Ski program participants in Melbourne during 1997. All participants were surveyed prior to commencement of the program to determine their demographics, skiing experience, recent injury history, self-perceived fitness level and expectations of the program. Descriptive statistics and chi-square tests were used to analyse the data. Mostly, participants are experienced skiers from a professional background who attend the program to improve their fitness and recovery for subsequent days of skiing. Understanding the characteristics of program participants helps with marketing and program development which could potentially result in a greater number of satisfied participants.

Journal Article↗

PubMed2001

Endometrial receptivity in an in vitro fertilization program as assessed by spiral artery blood flow, endometrial thickness, endometrial volume, and uterine artery blood flow.

OBJECTIVE: To investigate the role of sonographic parameters in assessing endometrial receptivity in an in vitro fertilization (IVF) program. DESIGN: Prospective clinical study. SETTING: University setting. PATIENT(S): One hundred thirty-five patients in our IVF program, selected prospectively on the day of oocyte retrieval. INTERVENTION(S): Transvaginal ultrasound examination was performed before oocyte collection. MAIN OUTCOME MEASURE(S): Association between implantation rate and spiral artery blood flow (primary outcome measure) and between implantation rate and endometrial measurements as well as uterine artery blood flow (secondary outcome measures). RESULT(S): Overall implantation rate was 23.7% per cycle. Subendometrial blood flow was detected in 113 (83.7%) cases, with pregnancy occurring in 21.2%. Mean spiral artery pulsatility index values were 1.12 +/- 0.28 and 1.21 +/- 0.27 for nonconception and conception cycles, respectively. Nondetectable spiral artery blood flow was not associated with a lower implantation rate. Neither endometrial thickness nor endometrial volume was correlated with the likelihood of successful implantation. Minimum endometrial thickness and volume associated with pregnancy were 6.9 mm and 1.59 mL, respectively. CONCLUSION(S): Neither Doppler sonography of the spiral or uterine arteries nor measurement of the endometrial thickness or volume allowed a reliable prediction of subsequent IVF outcome.

Arteries↗

PubMed1996

Partners in Health: a case study of a comprehensive disability management program.

When absenteeism threatened to raise health care costs and affect the quality of care at Tillsonburg District Memorial Hospital, a multidisciplinary team came together to develop a strategic response. The hospital seized the opportunity to initiate the ¿Partners in Health¿ program, an innovative and collaborative disability management program designed to improve its response to the health issues of all its staff. This paper describes how the program was developed and outlines its comprehensive approach. Partners in Health has proven to be extremely successful at increasing attendance awareness, improving work accommodation and/or rehabilitation after illness or injury, and reducing costs associated with health and lost-time claims. Partners in Health was recognized with the 1995 Health Care Quality Team Award sponsored by the Canadian College of Health Service Executives and 3M.

Absenteeism↗

PubMed1988

Automated classification of candidate structures for computer-assisted structure elucidation.

In computer-assisted structure elucidation, a large number of candidate structures for the unknown compound can be generated. A computer program designed to aid in the recognition of significant differences between these structures is described. The goal of the program is to group the candidates into meaningful classes with a minimum of input from the user; each class is distinguished by a substructure its members have in common. A computational approach is developed based on the combinatorial problem of set covering. The program evaluates its results using an information-theoretical criterion. An application of the program to a real-word structure problem is presented.

Chemical Phenomena↗

PubMed2001

The MCH Certificate Program: a new path to graduate education in public health.

OBJECTIVE: The purpose of the MCH Certificate Program was threefold: to develop a new educational initiative in response to national and local demands for increased MCH workforce capacity, to eliminate key financial and nonfinancial barriers to advanced MCH academic preparation, and to improve rates of recruitment and retention of students from minority communities, thus enhancing the quality of MCH services available to the region. METHODS: An MCH Certificate Program, designed for clinicians (e.g., nurses, occupational therapists and nutritionists) and public health practitioners as a bridge to graduate programs in public health, combined a competency based curriculum with skills workshops, leadership seminars, mentoring, small group activities, and an interactive teaching format. RESULSTS: Students from the first two cohorts (n = 45) report an expansion of core public health knowledge (issues, policies, and strategies), enhanced self-confidence, and efficacy. Half have experienced job changes that represent increased responsibility, leadership, and professional advancement. A third are enrolled in or have completed a formal program of graduate study in MCH. CONCLUSIONS: This innovative MCH Certificate Program, now in its fourth year, is a new approach to increasing workforce capacity and a successful model of instruction for adult learners. It has the potential for adaptation to a variety of educational settings and MCH populations, and helps to expand the continuum of MCH training experiences in schools of public health.

Boston↗

PubMed2006

The marriage moments program for couples transitioning to parenthood: divergent conclusions from formative and outcome evaluation data.

This article presents the results of a pilot study of the Marriage Moments program, designed to prevent relationship deterioration during the 1st year of parenthood. The self-guided, low-intensity program emphasizes strengthening marital virtues and partnership during this time of significant personal and family transition. One hundred fifty-five married couples participated in a randomized clinical trial with 2 psychoeducational treatment groups (a self-guided group and an instructor-encouraged group) and a comparable control group. Despite positive formative evaluation results from program participants, hierarchical linear modeling analyses failed to find significant Group x Time differences on spouses' reports of marital virtues and a set of relational outcome measures. This failure reinforces the need for psychoeducators to invest in outcome evaluation research before claiming program success.

Adult↗

PubMedDate not supplied

Local and national uses of a Road to Recovery evaluation.

Evaluation fellows from the George Washington University School of Public Health and Health Services conducted an evaluation of the Road to Recovery program of the Mid-Atlantic division of the American Cancer Society. The evaluation included qualitative analysis of program operation, mailed surveys, in-depth interviews with patients and drivers, and interviews with social workers from treatment centers. Results indicated that patients and drivers were satisfied with the program. Patients appreciated the ability of drivers to provide personalized, reliable service. The recruitment of sufficient drivers to meet transportation demand was a problem. High staff turnover and a lack of electronic tracking of standard information hindered program monitoring. A Mid-Atlantic Advisory Transportation Group reviewed the findings and made recommendations for service improvement. The Mid-Atlantic division evaluation contributed to an "evaluation synthesis" in which participants from the three divisions that had conducted Road to Recovery evaluations examined study data and made recommendations for reorganizing the national transportation program. A Transportation Program Design Team then held fact-finding meetings and adopted goals and objectives for a new national transportation program. The primary lesson learned was the far-reaching effects that a single program evaluation may have for various stakeholders and for an organization.

Cooperative Behavior↗

PubMed2001

Time required for blood lead levels to decline in nonchelated children.

OBJECTIVE: To determine the time for a decline in blood lead to less than 10 microg/dL in nonchelated children who are enrolled in case management. STUDY DESIGN: Retrospective analysis of venous blood lead data of lead-poisoned children followed in a case management program designed to decrease lead exposure. Children were excluded if their blood lead had not yet declined to less than 10 microg/dL, if they received chelation therapy, or if they had not received follow-up for more than 15 months. We calculated the time between peak elevation of lead and decline to less than 10 microg/dL. Data were categorized based on the child's peak blood lead and season in which their peak blood lead occurred. Data were analyzed using ANOVA and linear regression. Kaplan-Meier survival analysis was used to describe data in population form. RESULTS: 579 patients were included in the analysis. Blood leads of 25-29, 20-24, 15-19, and 10-14 microg/dL required 24.0, 20.9, 14.3, and 9.2 months, respectively, to decline to less than 10 microg/dL. For continuous data, a linear relationship was described by the following equation: Time (# of months required to achieve a blood lead less than 10 microg/dL) = 0.845 x peak lead; p < 0.0001. Kaplan-Meier curves complement the findings in a population-based fashion. CONCLUSIONS: The mean time for blood lead to decline was linearly related to the peak in blood lead. The time for 50% of the blood lead to decline to less than 10 microg/dL was not linear and varied with peak lead.

Chelation Therapy↗

PubMed2004

Standardized protocol improves asthma management in emergency department.

This study assessed, 30 months after its initiation, the impact of a standardized asthma management program designed to facilitate the implementation of asthma management guidelines in a tertiary teaching hospital adult emergency department. The program was initiated in a stepwise manner: first, a retrospective baseline audit; followed by generation of local guidelines; validation of these guidelines by all staff involved; distribution of the guidelines; a second practice audit; use of these results to further improve the program; feedback to the staff; twice-yearly information meetings; and a new audit 2 years later. The main results were a significant improvement in history taking (p < 0.001), increased use of serial airflow measurements (p < 0.001), increased steroid use (p < 0.001), and better documentation of follow-up arrangements (p < 0.01). Several tests of questionable value were no longer prescribed routinely. The improvements persisted after 2.5 years. In contrast, there was no improvement in the proportion of medical files that contained records of discharge prescriptions for outpatients. Implementation of locally agreed guidelines resulted in a marked improvement in several aspects of asthma management in an emergency department; the program must be pursued to maintain and further improve quality of care.

Adult↗

PubMed1981

A multi-component program to increase family physicians' faculty skills.

A fellowship program designed to increase nonclinical faculty skills among academic family physicians is described. In contrast to most faculty development programs, the fellowship is continuous for a full academic year and involves activities at a university medical center and the participants' home settings. The fellowship curriculum addresses five components of the academic physician's responsibilities: (a) curriculum planning, evaluation, and instruction; (b) clinical and educational research; (c) professional and organizational development; (d) ethics and human values; and (e) professional communication. Methods of program planning and operation are discussed, and particular attention is given to the match between the fellowship curriculum and the realities of academic medical work. Preliminary evidence suggests the program is achieving its intended goals.

Curriculum↗

PubMed1994

Medicaid managed care: the next generation?

The author provides an overview of the motivation leading nearly every state to develop managed health care arrangements under the state and federally funded Medicaid program for the poor. With managed care already a reform movement in state Medicaid efforts, further expansions of similar types of organized systems of care are anticipated in the future U.S. health care system. The author explores the acceleration of state investment in managed care planning and operations in terms of what is happening and whether expectations are being met. Specific plan features representing two very different managed care models within the evolution of how these plans have developed over time--Arizona's statewide prepaid plan begun in 1982 and New York's recently expanded statewide program designed to enroll 50% of those eligible within five years--are described. The author raises questions about these programs based on recent literature and discussions with key informants. Are sufficient providers out there and are there optimum ways to organize delivery networks? What additional safeguards may be required to protect consumers under managed care arrangements, and what are the effects of such programs on access to services and quality of care? What obstacles do health plans that traditionally serve mainly poor women and children have to overcome when serving people with disabilities or those with chronic health conditions? The author considers other barriers faced by states, providers, and policymakers in meeting the high expectations for the current generation of state-supported managed care plans. These questions and issues will remain important for some time as the states' efforts to promote managed care continue their anticipated expansion under health care reform.

Arizona↗

PubMedDate not supplied

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↗

PubMed2004

The use of telemedicine in the management of diabetes-related foot ulceration: a pilot study.

OBJECTIVE: To determine if the management of forefoot ulcerations through telemedicine is medically equivalent to ulcer care at a diabetes foot program. DESIGN: Nonrandomized comparison of forefoot ulcer healing rates. SETTING: The Louisiana State University Health Sciences Center Diabetes Foot Program, Baton Rouge, LA, and Lallie Kemp Medical Center, Independence, LA. PARTICIPANTS: Twenty consecutive patients with diabetes were treated for neuropathic forefoot ulcerations via telemedicine consultation and 120 consecutive patients with diabetes were treated face-to-face at a diabetes foot program. INTERVENTIONS: Management of forefoot ulcers by a certified wound care nurse trained in the use of a staged management approach algorithm and alternative off-loading methods, supported by real-time interactive telemedicine consultation. MAIN OUTCOME VARIABLES: Forefoot ulcer healing time in days, percentage of wounds healed in 12 weeks, and healing time ratio (adjusted for age, gender, ulcer duration, location, size, crossover, and grade). RESULTS: No differences were found between the telemedicine and diabetes foot program groups in the average forefoot ulcer healing time (43.2 + 29.3 vs. and 45.5 + 43.4 days, P =.828), the percent of forefoot ulcers healed in 12 weeks (75 % vs. 81%, P =.546) and the adjusted healing time ratio (1.40 vs 1.00, P =.104). CONCLUSION: These data appear to support the effectiveness of real-time interactive telemedicine consultation in the management of diabetes-related forefoot ulceration.

Algorithms↗