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PubMed2000

Development and initial evaluation of a culturally sensitive cholesterol-lowering diet program for Mexican and African American patients with systemic lupus erythematosus.

OBJECTIVE: To develop and evaluate acceptability of an intensive and ethnic-specific cholesterol-lowering diet program with a strong behavioral component in patients with systemic lupus erythematosus (SLE). METHOD: A comprehensive program with a behavioral component and culturally sensitive menus was developed in an effort to alter dietary behavior in patients with SLE. Four SLE patients, 2 African American and 2 Mexican American, enrolled in this program. Data on food intake (3-day food record), acceptability of the program (subjective response), and physiologic variables were collected at baseline, 6 weeks, and 12 weeks. RESULTS: The program was highly rated by all patients and found to be informative, easy to understand, ethnically sensitive, and to contain useful behavioral maintenance strategies. All 4 patients surpassed or were close to their diet goals at both 6 and 12 weeks. In this small group of patients, there was a statistically significant reduction in low-density lipoprotein cholesterol (P = 0.04) and body weight (P = 0.001), as assessed by repeated measures analysis of variance. CONCLUSION: The culturally specific cholesterol-reducing diet program was highly rated and appeared to be effective in changing the diet of this small group of SLE patients, as determined by their food records and body weight. The impact of this program, including the individual components on cardiovascular disease risk factors, needs to be evaluated in a larger multiple-arm study with a lengthier intervention.

Adult↗
PubMed1992

The end-stage renal disease program: trends over the past 18 years.

Data from the Michigan Kidney Registry and the US Renal Data System (USRDS) show that the number of patients receiving treatment for end-stage renal disease (ESRD) increased sevenfold following the introduction of Medicare coverage for ESRD in 1973. The number of new patients added per year has also increased dramatically--approximately fourfold. Initial selection criteria for acceptance into the ESRD Program included age less than 65 years and absence of systemic diseases such as diabetes. During the past 18 years, the gradual acceptance of older patients and of diabetic patients has led to an increase in the median age of new patients from 46 to 61 years and a 12-fold increase in the incidence of treatment in patients with ESRD due to diabetes. Given the broad acceptance of sicker and older patients, withdrawal from dialysis has become a consideration when dialysis no longer benefits the patient. Treatment modalities have also changed, and increasing numbers of patients undergo successful renal transplantation or receive continuous ambulatory peritoneal dialysis (CAPD). During the 1980s, hemodialysis treatment times and dialysis staffs decreased; however, several improvements in the care of patients on dialysis occurred during this period.

Aged↗
PubMedDate not supplied

Prioritizing safe patient handling: The American Nurses Association's Handle With Care Campaign.

Nurses continue to suffer debilitating injuries secondary to manual patient handling. Patient care ergonomics has emerged to redesign patient care with reduced exposure to physical hazards. Safe patient handling programs are being increasingly accepted by healthcare organizations to prevent occupational injury and to enhance patient safety. The authors discuss national-level efforts to promote patient care ergonomics principles and safe patient handling programs and their impact on nursing shortages and quality patient care.

American Nurses' Association↗
PubMed1986

Rapid computation with the personal computer of the percent cholesterol saturation of bile samples.

A microcomputer program to calculate the cholesterol saturation of bile is described. The program is designed to accept most of the conventional concentration units for bile salts, phospholipid, and cholesterol. The calculated cholesterol saturation can be corrected for the presence of ursodeoxycholic acid conjugates in bile. The program is designed to make appropriate statements when the input data produce results that are out of range of the solubility data available in the published literature. The program makes possible not only a very rapid calculation of the cholesterol saturation of bile, but eliminates arithmetical errors that are occasionally encountered during conventional calculations.

Animals↗
PubMed1988

Effect of systematized "behavior shaping" on acceptance of dental treatment in children.

The aim of this study was to compare the acceptance level of children treated by dentists who had participated in a training program of psychologic care and systematized "behavior shaping", with the acceptance level of children treated to a large extent by the same dentists before their training program. The material consisted of 2400 children treated by 149 dentists, to be compared with the material of 2773 children treated by 161 dentists in the "before training" study; 127 dentists took part in both studies. The training program included a video film, a manual, and a case form. Of the children treated before the dentists underwent the training program, 79% showed positive acceptance of all treatment steps encountered during dental visits, 13% reluctant acceptance, and 8% negative or no acceptance. The corresponding figures for children treated after the training program were 92, 6, and 2%. The distributions of overall positive acceptance in the two studies were compared by means of a logistic regression model. The level of overall positive acceptance was significantly increased after the dentists had participated in the training program. The improvement was most pronounced among the youngest children and children in need of restorative treatment or extraction. Of all the background variables studied, age, present need of treatment, and the before/after training variable had the greatest influence. The study shows that dentists can be trained to obtain significantly increased positive acceptance of dental treatment in children, and that the method does not require extra time in the dental chair.

Adolescent↗
PubMed1999

[Partial inpatient cardiologic after-care].

In Germany the in-hospital rehabilitation of patients with cardiac diseases is standard. Especially because of criticism of effectiveness and wasting of resources we evaluated in a pilot study a rehabilitation program with an in-hospital start, followed facultatively on ambulatory basis at the same institution, at the cardiac rehabilitation clinic. The aims of the study were to find out the acceptance of the the program by the patients, the safety and the impact of the facultative ambulatory rehabilitation program on cardiovascular risk factors. From January 1993 to December 1995 the primary enclosing criteria (cardiac disease suitable for rehabilitation, age < 70 years, lodging < 40 km) were fulfilled by 612 patients, 122 female. 268 (43.8%) were disclosed on medical grounds because of the rigid pilot character of the study, for 74 (12.1%) patients was the participation on organisational grounds not possible. Sixty-six of the remaining 270 patients preferred the facultative continuation of the rehabilitation on ambulatory basis for 1 or 2 weeks, the entire rehabilitation lasting up to 4 weeks. During the ambulatory phase the patients slept at home, otherwise these patients followed the same procedure as the in-hospital participants. Despite of severe medical concerns 4 further patients wished to participate on facultative ambulatory continuation of the rehabilitation, among these were 2 women, only 5 of the total 70 patients of the facultative ambulatory program group being female. There were no significant differences among 24 patients with CAD of both groups during the rehabilitation and in a control after 14.8 months (Table 3). The impact on serum total cholesterol and LDL cholesterol was positive (Table 2), albeit after 14.8 months no more significant. Over the control period there were a negative development of serum triglyceride level and significant negative effects on the body weight. There were no complications among the 66 patients during the facultative ambulatory phase of the rehabilitation, in contrast to those 37 of 268 patients who had to be disclosed because of medical concerns (Table 1). During the rehabilitation the drug therapy was optimized for many participants. The control after 14.8 months revealed that these remedies were followed with great accuracy by the physicians at home (Figure 1). In conclusion, a cardiac rehabilitation program with an in-hospital start of 2 weeks, going over to ambulatory rehabilitation for 1 to 2 weeks, is as effective and safe as an in-hospital cardiac rehabilitation. As known, amelioration of the long-term results has yet to be achieved.

Adult↗
PubMed2006

[How do self-help agencies work for recovery of drug dependence in Japan?].

DARC (Drug Addiction Rehabilitation Center) is the first and largest private half-way house agency for drug addiction in Japan, in which the programs are centered on 12 step meetings and the staff is made up of only those recovered from drug dependence. The purpose of this report is to elucidate how DARC works in the recovery from drug dependence. We made two studies: staff in 30 DARC facilities and 108 users in 7 male residential facilities. The results showed that 330 clients with drug dependence were participating in DARC programs at the time of research and about 600 clients use the programs each year. According to our research, three fourths of the users could maintain sobriety. Although many users had severe mental symptoms and socioeconomic difficulties, most users evaluated DARC programs highly to help them recover from these conditions. DARC rated highly because it provides companionship for recovered addicts and flexible frameworks to enhance drug addicts' motivation to recover, such as accepting dropouts and restarting programs, the provision of facilities away from areas where users were at high risk of relapse, and various program modalities.

Adolescent↗
PubMed2003

A multiple in silico program approach for the prediction of mutagenicity from chemical structure.

We have conducted an evaluation of three of the most widely used commercial toxicity prediction programs, Toxicity Prediction by Komputer Assisted Technology (TOPKAT), Deductive Estimation of Risk from Existing Knowledge (DEREK) for Windows (DfW) and CASETOX. The three programs were evaluated for their ability to predict Ames test mutagenicity using 520 proprietary drug candidate (Test set 1) and 94 commercial (Test set 2) compounds. The study demonstrates that these three commercially available programs are useful, with limitations in their ability to predict mutagenicity over a wide range of chemical space, i.e. global predictivity. Individually, each of the programs performed at an acceptable level for overall accuracy, i.e. the ability to predict the correct outcome. However, analysis of the predictions indicates that the overall accuracy figure is heavily weighted by the ability of the programs to correctly predict non-mutagens, whereas none of the programs individually performed well in the prediction of novel mutagenic structures, i.e. Ames positive compounds. The performance of these programs' in predicting Ames positive mutagens appeared to be independent of the chemical utility of the compound, i.e. industrial, agricultural or pharmaceutical. The combination of program predictions provided some improvement in overall accuracy, sensitivity and specificity.

Mutagenicity Tests↗
PubMed2006

Predicting sex offender treatment entry among individuals convicted of sexual offense crimes.

This study examined what factors were predictive of who volunteers for sex offender treatment (self-selection) as well as who enters treatment after volunteering (administration selection). Research participants included 404 treatment volunteers and 387 nonvolunteers to treatment who were convicted of a sexual offense involving minors within the federal prison system. Maximum likelihood probit estimation procedures indicated that when compared with nonvolunteers, treatment volunteers were more likely to be recommended by a judge to receive treatment at the time of sentencing, had received prior treatment for sexually deviant behavior, reported higher levels of motivation to change their sexually deviant behavior, and had lower rates of a substance use disorder in the year prior to incarceration. Of those persons who initially volunteered, 62% were accepted and entered treatment, 16% were denied entry to treatment by program staff, and 22% refused treatment after being accepted to the waiting list. When compared with those who were accepted and entered treatment, motivation was the only predictor of being denied admission into treatment by program staff and for refusal of treatment once accepted. The findings emphasize the need to control for selection bias in treatment outcome studies and the importance of examining the role of motivation in treatment volunteerism and treatment entry for sexual offenders.

Child↗
PubMed2002

Using performance standards to evaluate social programs with incomplete outcome data. General issues and application to a higher education block grant program.

The idea of program evaluation is both simple and appealing. Program outcomes are measured and compared to some minimum performance standard or threshold. In practice, however, evaluation is difficult. Two fundamental problems of outcome measurement must be addressed. The first, which we call the problem of auxiliary outcomes, is that we do not observe outcome of interest. The second, which we call the problem of counterfactual outcomes, is that we do not observe the threshold standard. This article examines how performance standard should be set and applied in the face of these problems in measuring outcomes. The central message is that the proper way to implement standards varies with the prior information an evaluator can credibly bring to bear to compensate for incomplete outcome data. By combining available data with credible assumptions on treatments and outcomes, the performance of a program may be deemed acceptable, unacceptable, or indeterminate.

Data Collection↗
PubMed1992

Resident research in obstetrics and gynecology: development of a program with comparison to a national survey of residency programs.

OBJECTIVE: The objective of this report is to describe our recently established resident research program and to compare this program with those of other obstetrics and gynecology residency training programs in the United States. STUDY DESIGN: The components of our program are described. Data for comparison from other programs were obtained from questionnaires, phone follow-up and the Directory of Obstetrics and Gynecology Residency Programs of the Council on Resident Education in Obstetrics and Gynecology. RESULTS: We initiated a residency research program in 1987 with acceptable projects defined, a time for completion of manuscripts established, and a Resident Research Day organized with presentation of articles, critique by a guest speaker, and an awards banquet. Nationally, less than 60% of residency programs have research requirements. Of the 208 programs responding to the written questionnaire 86% of programs associated with a university required research compared with 10% of community-based residency programs. CONCLUSION: While more than a third of residency programs in obstetrics and gynecology do not have resident research programs, the trend is for programs to establish research as a required portion of training. An outline of a recently established program is provided.

Data Collection↗
PubMed1999

An introductory hospice experience for third-year medical students.

BACKGROUND: An organized and distinct curriculum in hospice and palliative care education is lacking in most United States medical school programs. Because of this knowledge deficit, physicians are often not able to meet the needs of their terminally ill patients and their families. METHODS: A five-day combined didactic and clinical rotation in hospice and palliative care for third-year medical students was developed and is presented. The program is run through a home-based hospice in conjunction with the state's medical school. RESULTS: The pilot program has been well accepted by the participating students as a valuable learning experience. Although brief, it has also been successful in changing some of their attitudes about death and the care of the dying. CONCLUSIONS: This one-week program is an effective means to provide an intense course in hospice education. It should be easily transportable to other health care curricula.

Attitude to Death↗
PubMed2004

A syringe prescription program to prevent infectious disease and improve health of injection drug users.

Injection drug users (IDUs) are at increased risk for many health problems, including acquisition of human immunodeficiency virus (HIV) and hepatitis B and C. These risks are compounded by barriers in obtaining legal, sterile syringes and in accessing necessary medical care. In 1999, we established the first-ever syringe prescription program in Providence, Rhode Island, to provide legal access to sterile syringes, reduce HIV risk behaviors, and encourage entry into medical care. Physicians provided free medical care, counseling, disease testing, vaccination, community referrals, and prescriptions for sterile syringes for patients who were not ready to stop injecting. We recruited 327 actively injecting people. Enrolled participants had limited stable contact with the health care system at baseline; 45% were homeless, 59% were uninsured, and 63% did not have a primary care physician. Many reported high-risk injection behaviors such as sharing syringes (43% in the last 30 days), reusing syringes (median of eight times), and obtaining syringes from unreliable sources (80%). This program demonstrates the feasibility, acceptability, and unique features of syringe prescription for IDUs. The fact that drug use is acknowledged allows an open and frank discussion of risk behaviors and other issues often not disclosed to physicians. The syringe prescription program in Providence represents a promising and innovative approach to disease prevention and treatment for IDUs.

Adult↗
PubMed2006

Cyberball: a program for use in research on interpersonal ostracism and acceptance.

Since the mid-1990s, research on interpersonal acceptance and exclusion has proliferated, and several paradigms have evolved that vary in their efficiency, context specificity, and strength. This article describes one such paradigm, Cyberball, which is an ostensibly online ball-tossing game that participants believe they are playing with two or three others. In fact, the "others" are controlled by the programmer. The course and speed of the game, the frequency of inclusion, player information, and iconic representation are all options the researcher can regulate. The game was designed to manipulate independent variables (e.g., ostracism) but can also be used as a dependent measure of prejudice and discrimination. The game works on both PC and Macintosh (OS X) platforms and is freely available.

Behavioral Research↗