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At least 919 records · Page 51Linked to original sources
PubMed2003

[Assessment of insulin sensitivity during exercise training program in obese women. Comparison of simple indices with hyperinsulinemic euglycemic clamp technique].

Insulin resistance is a key element of metabolic syndrome, which includes disturbances of glucose tolerance, obesity, hypertension, coronary heart disease dyslipidemia and many other defects. An important problem in scientific research is precise measurement of insulin sensitivity. The method considered "the gold standard" is glucose clamp, however, it is difficult to apply this method in large studies. Therefore, simple indices of insulin resistance are proposed. It remains unclear whether those indices are able to reflect changes occurring during insulin-sensitizing intervention. The aim of the present study was to assess the use of indirect indices for the changes in insulin sensitivity during exercise training and to compare those indices with results derived from clamp. Fourteen obese normoglycemic women participated in 12-week exercise training program, which included exercise performed on a bicycle ergometer, 5 days a week for 30 minutes. Insulin sensitivity (M/FFM value) before and after training was measured with hyperinsulinemic euglycemic clamp technique. Simple indices of insulin resistance were also assessed: fasting plasma insulin (INS), logarithm INS (log [INS]), homeostasis model assessment (HOMA), logarithm HOMA (log [HOMA]) and quantitative insulin sensitivity check index (QUICKI). Before training, all those indices were markedly related to M/FFM. After training, an increase in M/FFM was observed. None of the examined indices markedly changed after training. There was no correlations between changes of evaluated indices and in M/FFM during training, and no relationships of those parameters after training. Our study indicates that simple indices are not able to reflect changes occurring during insulin-sensitizing intervention.

Adult↗
PubMed1999

Effects of cardiac rehabilitation and exercise training programs in women with depression.

Depression is prevalent in women with coronary artery disease, and increases morbidity and mortality following major coronary events. We demonstrated that women with depression had markedly abnormal overall cardiovascular risk profiles and have marked benefits in exercise capacity, obesity indexes, behavioral characteristics (including depression), and quality of life following formal, outpatient phase II cardiac rehabilitation and exercise training programs.

Coronary Disease↗
PubMed1997

The need for specialized training programs in palliative medicine.

Canada faces a significant and growing burden of terminal illness. There are major unresolved economic, ethical and social issues related to care at the end of life. Despite the international reputation for Canadian efforts in palliative care, the medical profession in Canada has largely failed to recognize the importance of the field, as evidenced by the lack of commitment on the part of most medical faculties at Canadian universities to developing academic strength in palliative medicine, the lack of content in the undergraduate curriculum and of postgraduate programs in palliative medicine, and the lack of support for research into end-of-life care. The authors propose a conjoint initiative by the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada to develop specialized training programs in palliative medicine as a critical step in addressing this crisis.

Canada↗
PubMed1993

Internal medicine housestaff and attending physician perceptions of the impact of the New York State Section 405 regulations on working conditions and supervision of residents in two training programs.

OBJECTIVES: To assess the attitudes of internal medicine housestaff and their attending physicians regarding the impact of the reduction in on-call working hours and increased supervision mandated in New York by a revision of the State Health Code (Section 405). DESIGN: Survey of senior medical housestaff and attendings two years after the adoption of the mandated changes. SETTING: Two independent medicine housestaff training programs of the Albert Einstein College of Medicine in the Bronx, New York. PARTICIPANTS: Fifty-three percent of third- and fourth-year residents (n = 79) and 60% of voluntary and full-time attendings (n = 266) responded. MEASUREMENTS: A factor analysis of 13 variables that appeared on both versions of the survey identified two interpretable factors. A multivariate analysis of variance compared responses to each factor by group and by campus, and Bonferroni post-hoc comparisons analyzed the items within factors. Chi-square analyses compared responses of residents and attendings to the open-ended questions. RESULTS: Significant differences between the housestaff and attendings groups were found for all fixed-response items (minimum p < 0.05 for all analyses), but both groups agreed that the regulations had a positive impact on resident attitudes regarding the demands on their time. Both groups were also uncertain whether the new regulations had a beneficial effect on the choice of internal medicine as a career, the quality of resident supervision, and residents' intellectual interest in challenging medical problems. Whereas residents agreed that the regulations diminished their fatigue, had no impact on their ability to observe the full impact of interventions on patients, and resulted in better patient care, attendings were uncertain or disagreed. While attendings agreed that the regulations had caused a shift-work mentality among residents, housestaff were uncertain. CONCLUSIONS: Housestaff had more positive attitudes about the impact of the mandated changes in working conditions for residents than did attending physicians in the same institutions. The major benefits seen by residents were less fatigue and more spare time. There was no consensus about whether these changes had a positive impact on internal medicine practice and clinical supervision. There was some concern that a shift-work mentality is developing among residents and that continuity of patient care has suffered. Thus, despite some substantial benefits, Section 405 may not be achieving its goals of improving resident supervision and the quality of patient care by houseofficers.

Attitude of Health Personnel↗
PubMed1994

Evaluation of a training program for improving adherence promotion skills.

A workshop for improving the adherence counseling skills of health professionals was developed and evaluated. Target audiences have included medical students, nursing students, dietetic interns, and practising nurses and dietitians. Four categories of skills are taught: relationship building, interviewing, problem diagnosis, and behavioral intervention. Teaching methods include faculty demonstration, participant rehearsal, and group and individual feedback. The Adherence Promotion Training (APT) workshop has been offered as a 3- to 5-day intensive course and as a semester-long elective. A reliable coding system was developed to assess these skills from videotaped provider-patient interactions. A standardized patient task was given to 60 subjects before and after participation in the adherence counseling skills workshop. Videotapes were coded by trained raters, who were masked to whether the tape came from before or after the workshop. Significant short-term improvements were observed in all four core skills. This uncontrolled evaluation suggests that the Adherence Promotion Training program is a promising way to enhance the ability of health professionals to care for nonadherent patients.

Clinical Competence↗
PubMed1975

A training program for elementary school teachers. Optometrist-teacher communications.

Communication between optometrists and teachers is critical to optometric involvement in interdisciplinary team approaches to learning disabilities. The classroom teacher may be a prime source of referrals to the general optometrist as well as the vision development specialist. Optometry's contribution to classroom learning cannot be fully realized without sound optometrist-teacher communication. The basic design of a training program to enhance optometrist-teacher communications is presented in this paper. The individual optometrist may modify and supplement the program to suit the special needs of the teachers involved.

Child↗
PubMed1999

Proposed model for interaction between residents and residency training programs, and pharmaceutical industry.

Medical residents in training are as much targets of pharmaceutical-industry marketing as are physicians in practice. This interaction is often subtle and takes the form of sponsorship of meals at academic events, support for conference travel, books, and items such as pens and notepads. Most residency programs direct little time towards training in ethics and the critical analysis of pharmaceutical-industry marketing. We propose a model for the relationship between residents and residency programs, and the pharmaceutical industry that addresses the need for such interaction to be viewed in light of the patient-centered ethic of professional conduct and the ideal of unbiased medical practice. A committee of residents at different levels of training and two staff physicians received the mandate to examine this issue. The committee developed a set of guidelines and a proposed schema for the handling of funds from pharmaceutical companies (still not implemented). Each residency program would develop a common fund for money donated by pharmaceutical companies. This fund would be administered by a committee with defined priorities. The presence of residents on this committee under staff preceptorship would serve as a springboard for education on the subject. Guidelines for acknowledgement of sponsorship, solicitation of funds, gifts for care of patients, ongoing education, and the wider applicability of these proposals were also developed. Residents' interaction with the pharmaceutical industry during training could have lifelong influence on medical practice. We hope that our model will promote critical appraisal of the potential risks and benefits of this interaction.

Advertising↗
PubMed1983

Evaluating the effectiveness of a communication board training program.

This study introduces a technique for systemically observing the consequences of various aspects of treatment on the communicative effectiveness of nonspeaking persons using communication boards in natural settings. The case study of Kay, a 24-year-old nonspeaking woman residing in a nursing home, is presented. Three major factors were found to operate cumulatively in increasing Kay's overall communicative effectiveness: 1) revising the design of her original communication board; 2) training her to functionally use her new board to meet her daily communicative needs; and then 3) introducing interaction strategies to her listeners through an inservice training program. Highlights of Kay's and her staff's programs are discussed.

Adult↗
PubMed2006

Task selection and enriched environments: a functional upper extremity training program for stroke survivors.

Functional tasks using real-life objects in an enriched environment provide a multidimensional approach to treatment. Functional tasks are therapeutic for stroke survivors, because they require the simultaneous use of motor control, cognition, visual perception, sensation, and motor planning. Therapists utilizing functional tasks as treatment modalities must also be multidimensional in their implementation. This article provides a systematic approach to guide therapists in developing a functional upper extremity training program for stroke survivors.

Activities of Daily Living↗
PubMed1985

A pediatric emergencies training program for emergency medical services.

Accidents are the leading cause of death in children, accounting for more pediatric deaths than all other causes combined. Accidents also account for 21.7 million injuries to children that require medical care annually. Despite recognition of this major public health problem, little emphasis is directed toward the pediatric patient in emergency medical services education. In response to this need, Children's Hospital National Medical Center developed a three-day training program in pediatric emergencies for field emergency medical technicians, intermediate paramedics, and paramedics. The course consists of 18 hours of lectures and skill stations focusing on medical emergencies, care of the injured child, the special needs of the infant, and the emotional response of the child and family in an emergency. Test evaluations before and after the course from the 190 participants demonstrate a significant improvement in their knowledge and skills in treating pediatric emergencies (P less than 0.001).

Allied Health Personnel↗
PubMed2000

The Andro Project: physiological and hormonal influences of androstenedione supplementation in men 35 to 65 years old participating in a high-intensity resistance training program.

BACKGROUND: Since the passage of The Dietary Supplement Health and Education Act in 1994, there has been a flood of new "dietary" supplements promoting anti-aging benefits such as the enhancement of growth hormone or testosterone levels. Androstenediol and androstenedione are such products. This study's purpose was to elucidate the physiological and hormonal effects of 200 mg/d of oral androstenediol and androstenedione supplementation in men aged 35 to 65 years while participating in a 12-week high-intensity resistance training program. METHODS: Fifty men not consuming any androgenic-enhancing substances and with normal total testosterone levels, prostate-specific antigen, hemoglobin, and hematocrit, and with no sign of cardiovascular or metabolic diseases participated. Subjects were randomly assigned to a placebo, androstenediol (diol), or androstenedione (dione) group using a double-blind study design. Main outcomes included serum sex hormone profile, body composition assessment, muscular strength, and blood lipid profiles. RESULTS: During the 12 weeks of androstenedione or androstenediol use, a significant increase in the aromatization by-products estrone and estradiol was observed in both groups (P =.03). In the dione group, total testosterone levels significantly increased 16% after 1 month of use, but by the end of 12 weeks, they returned to pretreatment levels. This return to baseline levels resulted from increases in aromatization and down-regulation in endogenous testosterone synthesis based on the fact that luteinizing hormone was attenuated 18% to 33% during the treatment period. Neither androstenediol nor androstenedione enhanced the adaptations to resistance training compared with placebo for body composition or muscular strength. However, both androstenediol and androstenedione supplementation adversely affected high-density lipoprotein cholesterol (HDL-C) levels, coronary heart disease risk (representing a 6.5% increase), and each group's respective (low-density lipoprotein cholesterol [LDL-C]/HDL-C)/(apolipoprotein A/apolipoprotein B) lipid ratio (diol: +5.2%; dione: +10.5%; P =.05). In contrast, the placebo group's HDL-C levels increased 5.1%, with a 12.3% decline in the (LDL-C/HDL-C)/(apolipoprotein A/apolipoprotein B) lipid ratio. These negative and positive lipid effects occurred despite no significant alterations in body composition or dietary intakes in the supplemental groups or placebo group, respectively. CONCLUSIONS: Testosterone precursors do not enhance adaptations to resistance training when consumed in dosages recommended by manufacturers. Testosterone precursor supplementation does result in significant increases in estrogen-related compounds, dehydroepiandrosterone sulfate concentrations, down-regulation in testosterone synthesis, and unfavorable alterations in blood lipid and coronary heart disease risk profiles of men aged 35 to 65 years.

Adult↗
PubMed1993

The pain resource nurse training program: a unique approach to pain management.

Adequate pain management is a 24 hr a day responsibility for health-care professionals working with cancer patients. Because nurses spend more time with patients in pain than any other member of the health-care team, they play a central role in pain assessment and pain management. The City of Hope National Medical Center, a clinical cancer center, developed a pain management course for staff nurses entitled "The Pain Resource Nurse (PRN) Training Program." The purpose of this innovative course was to prepare staff nurses to assume an active role in pain management. Twenty-six registered nurses participated in the 40-hr didactic and clinical course. The curriculum included information on pain assessment, pharmacology, nondrug interventions, and cultural, ethical, and psychosocial issues related to pain. After completion of the course, program staff have remained available to the PRNs to provide current information on pain management, and to assist with role implementation and guidance on interfacing with staff. This paper reports on the development, implementation, and 3-mo evaluation of this unique program.

Education↗
PubMed2002

The clinical pharmacist as a preceptor in a family practice residency training program.

BACKGROUND: According to a recent survey, 27% of 579 family practice residency programs in the United States employ a full-time clinical pharmacist. The majority of pharmacists' time is spent teaching, usually at the point of care either on inpatient rounds or precepting in the outpatient clinic. This paper describes the precepting activity of a full-time clinical pharmacist in a community-based family practice residency training program. METHODS: A computer program written in Microsoft Access captured the following data on each pharmacist-physician encounter: date, time, requestor, topic, therapeutic category, type of question, summary of question and answer, resources used to answer the question, and time spent answering the question. The database was updated daily to include all encounters. RESULTS: Between February 1, 1999, and January 31, 2001, we documented 2,260 precepting encounters. Almost half of the questions related to general pharmacotherapeutic management of chronic or acute diseases. The most common therapeutic categories encompassed cardiovascular, psychiatric, infectious disease, and neurologic disorders. Seventy-six percent of questions were answered using clinical knowledge and experience, while 24% were based on published resources. CONCLUSIONS: Based on more than 2,000 precepting encounters between a faculty pharmacist and family practice residents, most encounters represented requests by residents for information on general drug management of diseases. The pharmacist answered most questions based on clinical knowledge and experience. Evaluations of the pharmacist by the residents indicated that she is an effective teacher and useful in helping take care of patients.

Data Collection↗
PubMedDate not supplied

Minority international research training program: global collaboration in nursing research.

In the current century, nurses, along with other health professionals, require preparation for their roles in international health. For faculty and students to practice and learn in this global community, they also will want to have added knowledge of economics, business, and public policy. To gain an immersion experience in global health, nursing faculty and students will need to spend time abroad collaborating with nursing colleagues in other countries. This report describes an academic-research training program (Minority International Research Program [MIRT]) established 7 years ago to enhance the international health experience of minority nursing students. Qualified undergraduate and graduate nursing students are recruited and paired with faculty mentors to conduct short-term research abroad for a period of 10 to 14 weeks. The purpose of international research experiences for minority nursing students is to develop leaders in nursing science and to increase collaboration in the resolution of global health issues. To date, 26 undergraduate students, 22 graduate students, 6 postdoctoral trainees, and 11 faculty mentors have participated and completed the program through research immersion experiences in 9 countries. The program is described in terms of its strengths, challenges, and lessons learned, as well as opportunities for future activities.

Chicago↗
PubMed1981

An educational training program for the care at the site of injury of trauma to the central nervous system.

The treatment of head and spinal cord injuries must be directed towards prevention of secondary insults which will increase the extent of permanent disability. Improved extrication techniques at the scene of the accident, earlier recognition and treatment of complications and improved transfer management have all reduced the acute morbidity and mortality of injuries to the central nervous system. At the University of Virginia we have implemented a comprehensive training program in the acute care of the head and spinal cord injured patient for Emergency Medical Technicians (EMT), nurse, community referring physicians, and house staff within the medical center. A booklet, prepared for care at the site of injury, outlines the assessment, care and intervention with the head and spinal injury patient for the EMT. Another booklet provides guidelines for care of the patient in the emergency department. Included here are instructions in respiratory care, adequate circulation and spinal splinting. The greatest emphasis is placed on the history and physical examinations, which documentation of the extent of neurologic deficit, including the Glasgow coma scale. Data on 900 pre-hospital calls by volunteer EMTs demonstrate a 90% compliance in basic life support skills outlined in the educational program. A similar compliance has been achieved with referring physicians and house staff in the medical center, in the acute management of the CNS injured patient, due primarily to this educational program and increase in the optimal care of these patients has resulted.

Accidents↗
PubMed2006

Practical sources of error in measuring pulmonary artery occlusion pressure: a study in participants of a special intensivist training program of The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI).

BACKGROUND: Physiological data obtained with the pulmonary artery catheter (PAC) are susceptible to errors in measurement and interpretation. Little attention has been paid to the relevance of errors in hemodynamic measurements performed in the intensive care unit (ICU). The aim of this study was to assess the errors related to the technical aspects (zeroing and reference level) and actual measurement (curve interpretation) of the pulmonary artery occlusion pressure (PAOP). METHODS: Forty-seven participants in a special ICU training program and 22 ICU nurses were tested without pre-announcement. All participants had previously been exposed to the clinical use of the method. The first task was to set up a pressure measurement system for PAC (zeroing and reference level) and the second to measure the PAOP. RESULTS: The median difference from the reference mid-axillary zero level was - 3 cm (-8 to + 9 cm) for physicians and -1 cm (-5 to + 1 cm) for nurses. The median difference from the reference PAOP was 0 mmHg (-3 to 5 mmHg) for physicians and 1 mmHg (-1 to 15 mmHg) for nurses. When PAOP values were adjusted for the differences from the reference transducer level, the median differences from the reference PAOP values were 2 mmHg (-6 to 9 mmHg) for physicians and 2 mmHg (-6 to 16 mmHg) for nurses. CONCLUSIONS: Measurement of the PAOP is susceptible to substantial error as a result of practical mistakes. Comparison of results between ICUs or practitioners is therefore not possible.

Calibration↗
PubMedDate not supplied

A randomized, controlled study of an Alzheimer's caregiver skills training program.

This study was an attempt to improve the quality of the relationship between dementia caregivers and their loved ones by decreasing the gap between caregivers' expectations and patients' actual functional abilities and by teaching supportive skills. Although a group of 49 caregiver-patient dyads were recruited, the outcome measures of only those dyads (47) that completed the week seven session were used for analysis. Half of the dyads were randomized to an intervention group and the other half to a waiting list. The intervention group (N = 24) completed a four-session caregiver training program in which caregivers first watched investigators administering to their loved ones the Texas Functional Living Scale and later progressed to helping their loved ones by appropriate cueing to perform the tasks involved. Comparisons were made between baseline scores, scores at seven weeks, and scores at the end of 17 weeks on the congruence between caregiver estimates and patients' actual performance on the Independent Living Scale and measures of cognition, function, preillness quality of relationship, caregiver mood, feeling of self-efficacy, and several other measures. We were not able to increase the congruence between caregiver estimates and patients' actual performance and found no change in any other measure. We didfind the expected relationship between depression and caregiver sense of self-efficacy.

Activities of Daily Living↗
PubMed1993

Laparoscopic management of ectopic pregnancy in a resident training program.

The range of procedures now routinely done through the laparoscope has continued to expand due to improved equipment for insufflation, hemostasis, and tissue manipulation, and to imaginative approaches to otherwise "routine" gynecologic problems traditionally treated by laparotomy. As with all new technologies, advocates predict that the methodology will prove to have an almost unlimited potential, while established skeptics predict that it will have a narrow applicability. With time and further clinical application, a consensus somewhere between the two positions will be reached. But while this technology develops and experience begins to accumulate, it is necessary to train residents in the technique. We discuss our experience with introducing laparoscopic management of ectopic pregnancy into a residency training program. Our results indicate a rapid learning curve, with minimal patient morbidity, brief hospitalization, and rapid convalescence.

Adult↗