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PubMedDate not supplied

The efficacy of an educational program to improve direct caregiver knowledge regarding fall prevention.

One hundred seventy-one (N = 171) direct caregivers were tested to determine their baseline knowledge about patient falls and fall prevention and to determine the impact of a fall prevention education program on their knowledge. Following the pretesting of participants for baseline knowledge a 20-minute educational videotape was viewed. Identical posttesting of knowledge followed. Mean posttest scores (M = 14.01) were significantly higher (t = 17.883; p < 0.001) than the pretest scores, supporting the effectiveness of the educational program in increasing direct caregivers' knowledge related to fall prevention.

Accident Prevention↗
PubMedDate not supplied

Comparison of two methods of instruction for the prevention of workplace violence.

The purpose of this study was to compare the effect of the poster session format (PSF) with the traditional film discussion format (FDF) on posttest scores using the Violence in the Workplace Knowledge Test (VWKT) for hospital staff. The 25-item VWKT was developed by the authors. Both groups took this test as the pretest and posttest to determine whether there was a difference in ovrall test scores or a difference in score according to type of violence. The control group included a sample of newly hired staff (n = 51) in general hospital orientation who received training via the FDF method and took the posttest after the program. The experimental group included current staff (n = 84) who received training via the PSF. They "walked through" a poster session at their own pace, completing the posttest as they went along. The comparison of mean pretest scores on the VWKT for the two groups was not significantly different. However, the PSF group had greater improvement in test scores than the FDF group. Further analysis determined that the PSF group significantly improved in both types of violence compared to the FDF group. For this study, using an alternative teaching-learning strategy was more effective than the traditional method. Implications for staff development educators include the need to explore different methods of enhancing learning.

Adult↗
PubMed2005

Quantitative evaluation of "Can It Happen in Kansas: Response to Terrorism and Emerging Infections".

PURPOSE: This study describes the evaluation of a 2-year plan to train 10 percent of Kansas' multidisciplinary health professionals for response to terrorism and emerging infections. This project was part of a national effort covering 19 states funded by the Health Resources and Services Administration in 2003. METHODS: The initial training occurred in six 2-day workshops. A terrorism preparedness questionnaire was developed to assess Health Resources and Services Administration terrorism response competencies/learning objectives. These were measured before, after, and 3 months after training in a hybrid cross-sectional and cohort follow-up design. RESULTS: Health professionals' mean scores significantly improved on all four Health Resources and Services Administration terrorism self-reported competencies from pretest to posttest. Three months posttraining, health professionals' mean scores decreased slightly but remained significantly higher than their pretest scores. CONCLUSIONS: This project prepared healthcare professionals to respond to the medical consequences of terrorism. The integration of core competencies into the evaluation plan allowed for trainees to evaluate their confidence and abilities. The evaluation plan and curriculum may serve as useful tools for preparation of healthcare workers nationwide, with the potential to rebuild the public health infrastructure to assume preparedness responsibilities.

Adult↗
PubMedDate not supplied

Burn pain and anxiety: the use of music relaxation during rehabilitation.

Pain and anxiety are well-documented problems during the rehabilitation of patients with burns. This study examined the effect of music on anxiety and pain during range of motion. Eleven subjects with partial-thickness or deeper burns were randomly assigned to a control group (without music intervention) or experimental group (with music intervention). Vital signs, pain, and anxiety were recorded before and after treatments. There was no difference in pretest and posttest anxiety across the groups; however, there was a difference in anxiety between the groups. Conversely, there was a difference in pretest and posttest pain across the groups but no difference in pain between the groups. Results showed no significant reduction in anxiety and pain during therapy with music relaxation. Limitations included nonhomogenous groups, small sample size, potentially unrepresentative sample, variation in exercise protocol, and small musical selection. Further research is recommended.

Adult↗
PubMed2004

Relevance of aerobic capacity measurements in the treatment of chronic work-related spinal disorders.

STUDY DESIGN: Prospective cohort study of rehab program completers, comparing aerobic capacity data of chronic lumbar spinal disorder patients (CLSD) to that of chronic cervical spinal disorder (CCSD), collected from a tertiary care facility. OBJECTIVE: We evaluated whether CLSD is associated with different pre- and postrehabilitation aerobic capacity deficits than CCSD, and whether such deficits affect functional restoration outcomes. SUMMARY OF BACKGROUND DATA: Chronic spinal disorder patients are thought to lose aerobic fitness as a component of the deconditioning syndrome. Patients with CLSD often restrict aerobic activities because of back or leg pain, while CCSD patients generally do so to a lesser degree. We hypothesized that those with CLSD would have greater deficits in tests of aerobic fitness than patients with CCSD both before and after treatment. METHODS: From a consecutive cohort of 683 patients with work-related spinal disorders, two groups were identified: patients with CLSD (n = 504; age 40.1 years; 68% male); and patients with CCSD (n = 179; 41.3 years; 43% male). All patients completed an intensive, medically supervised functional restoration program. Before and after the program, patients completed a submaximal bicycle ergometer aerobic capacity test and a psychosocial test battery. A structured clinical interview to determine socioeconomic outcomes was conducted 1 year after the program completion. RESULTS: Of CLSD patients 33% and 11% of CCSD patients (P < 0.001) either failed to produce any torque or could not complete at least 2 stages on the bicycle on preprogram tests (invalid tests). However, all patients had valid bicycle tests at program completion. Nearly two-thirds of the subjects with initially invalid tests in the lumbar group failed to develop any torque, while only one-third of subjects with invalid tests of the cervical group had a similar result. Thus, CLSD is associated with greater prerehabiliation aerobic fitness deficits than CCSD. Overall, there was no significant change in pre to postrehab aerobic capacities for the initially valid test subjects. The initially invalid test subjects achieved similar postrehabilitation scores compared to the valid test subjects, although CLSD patients with initially valid tests performed slightly better at the posttest. Socioeconomic outcomes were the same one year after the program for valid and invalid test subjects. CLSD patients had higher preprogram self reports of disability. The subgroup of the initially invalid test subjects that produced no torque whatsoever (19.3% of CLSD and 3.9% of CCSD) did not differ from the subgroup that failed to complete 2 stages in the pretest of aerobic performance on depression. They had higher pretest self-reported disability. CONCLUSIONS: Although mean aerobic fitness levels for all patients improved during rehabilitation, the improvement is almost entirely accounted for by initially invalid tests becoming valid. Aerobic capacity testing measured with submaximal bicycle ergometry may frequently be invalid when fear-avoidance limits effort, particularly in CLSD. Psychosocial fear-avoidance, as it applies to bicycle ergometry, can be overcome in virtually all patients motivated to complete a tertiary rehabilitation program. As such, prerehabilitation aerobic capacity testing is a poor differentiator of postrehabilitation outcomes.

Adult↗
PubMedDate not supplied

Role of the 12-lead electrocardiogram in diagnosing pulmonary embolism.

We investigated the role of the standard 12-lead electrocardiogram (ECG) to improve the pretest probability of pulmonary embolism before performing computed tomographic (CT) pulmonary angiography. A retrospective chart analysis was performed on patients who underwent CT pulmonary angiography at a tertiary care hospital during a 30-month period. Comparison of 15 ECG parameters was made between those with CT pulmonary angiograms positive for pulmonary embolism and a matched control group with negative CT pulmonary angiograms. Data were analyzed by chi-squared tests and logistic regression. Sinus tachycardia (39% vs. 24%, P <0.01), an S1 Q3 T3 pattern (12% vs. 3%, P <0.01), atrial tachyarrhythmias (15% vs. 4%, P <0.005), a Q wave in lead III (40% vs. 26%, P <0.02), and a Q3 T3 pattern (8% vs. 1%, P <0.02) were the findings significantly associated with pulmonary embolism. We conclude that 1) standard 12-lead ECG findings can increase the pretest probability of pulmonary embolism before performing CT pulmonary angiography; and that 2) the ECG findings have relatively low likelihood ratios to have clinical use.

Acute Disease↗
PubMed2006

Attitudes toward prenatal screening and testing for Fragile X.

PURPOSE: Currently, the American Colleges of Medical Genetics and Obstetrics and Gynecology recommend screening in the prenatal setting only for individuals with specific family history indicators. Our aims were to study patient attitudes and psychologic impact of offering widespread screening for Fragile X in a prenatal setting. METHODS: Participants were recruited from pregnant women referred for "Prenatal Diagnosis Options" counseling by their primary provider in the first trimester of pregnancy. RESULTS: Pretest knowledge about Fragile X was limited; 33% had heard of Fragile X syndrome before enrollment. Postcounseling knowledge was similarly limited; only 30% accurately understood the 50% risk for girls. Participants were strongly in favor of being tested or screened, and did not experience undue anxiety related to Fragile X testing. Respondents hoped that knowledge of Fragile X in the general population would increase, and recommended that screening be offered during routine prenatal care. CONCLUSION: Fragile X screening in this setting was a favorable testing experience for the participants. Limited pretest knowledge and posttest retention of specific genetic information on Fragile X suggest that widespread screening will pose significant counseling and educational challenges, which should be addressed in such programs.

Adult↗
PubMed2005

Evaluating the program of a smoking cessation support group for adult smokers: a longitudinal pilot study.

Tobacco use is the leading cause of preventable death in Taiwan. In order to increase cessation rates among adult smokers, the Department of Health in Taiwan has begun providing financial support for nicotine replacement therapy (NRT). However, therapies based on multiple interventions can lead to significantly higher cessation rates than NRT alone. This study develops and evaluates the outcomes of a smoking cessation program that provides a combination of physiological and psychological treatment in the context of a short-term support group. In this study, ten adult smokers were recruited by means of advertisements broadcast on local television over a seven-day period and one thousand flyers that advertised free assistance with quitting smoking. The smoking cessation support group was carried in Tainan County, in southern Taiwan. The three-month program consisted of three, monthly group sessions, free nicotine patches, telephone counseling by public health nurses, and telephone interviews by community health volunteers. Those participating in the group were encouraged to keep a record of all smoking behavior and its "triggers" in a diary, list the personal benefits of quitting, draw up a quitting contract, and enlist significant family members to monitor their quitting behavior. Participants were also trained in behavioral strategies to avoid smoking, including imagery rehearsal, relaxation techniques, exercise, and distraction. The outcome of the project was assessed by the following two criteria: (1) carbon monoxide (CO) level in the breath before and after the three-month program, as measured by percentage of carboxyhemoglobin (%COHB), and (2) the self-reported number of cigarettes smoked per month, taken at the outset of the three-month program, at the conclusion of the program, and six months after the termination of the program. The Wilcoxon signed-rank and Friedman tests respectively revealed that there were significant decreases both in the subjects' %COHB level at the 3-month data-point, and in the number of cigarettes smoked at one month from the pretest, at the 3-month test and at the 9-month follow-up test. At the 9-month follow-up, five of the ten participants (50%) were abstinent, and three (30%) had decreased cigarette consumption by at least 49% of their pretest levels. Eighty percent of participants had, therefore, changed their smoking behavior. These results demonstrate the promise of integrated smoking cessation therapy in a group support context and indicate the need to pursue implementation and evaluation of this type of therapy on a larger scale.

Administration, Cutaneous↗
PubMed2004

Management strategies for the solitary pulmonary nodule.

PURPOSE OF REVIEW: The challenge of diagnosis and management of solitary pulmonary nodules is among the most common yet most important areas of pulmonary medicine. Ideally, the goal of diagnosis and management is to promptly bring to surgery all patients with operable malignant nodules while avoiding unnecessary thoracotomy in patients with benign disease. RECENT FINDINGS: Effective management of the solitary pulmonary nodule depends upon an understanding of decision analysis principles so that diverse technologies can be integrated into a systematic approach. SUMMARY: In almost all patients computed tomography (CT) is the best first step. Three key questions can then help guide the workup of the SPN. These are what is the pretest probability of cancer, what is the risk of surgical complications, and does the appearance of the nodule on CT scan suggest a benign or malignant etiology. In patients with average surgical risk, positron emission tomography (PET) scan is warranted when there is discordance between pretest probability of cancer and the appearance of the nodule on CT scan. Thus, when either the patient has a low risk of cancer and the CT suggests a malignant origin, or when there is high risk of cancer and the CT appears benign, PET scan will be cost effective. In most other situations, PET scanning is only marginally more effective than CT and fine needle aspiration strategies but costs much more.

Biopsy, Needle↗
PubMed2004

Effects of brief cognitive-behavioral interventions on confidence to resist the urges to use heroin and methamphetamine in relapse-related situations.

The aim of this study was to examine the effect of brief cognitive-behavioral (C-B) intervention on improving confidence in managing situations related to heroin and methamphetamine (MAMP) use in drug users. The subjects in the intervention group received a five-session C-B intervention, which focused on the acquisition of skills aimed at helping the subject to reduce drug use. The subjects in the intervention and control groups completed pretest and posttest assessments to determine the changes of confidence in managing situations related to drug use. A total of 70 subjects (40 heroin and 30 MAMP users) and 75 subjects (38 heroin and 37 MAMP users) in the control group completed pretest and posttest assessments. The results revealed that among heroin users, the intervention group had greater improvement in confidence to manage interpersonal situations related to heroin use than did the control group, but there was no difference in the improvement in confidence to manage intrapersonal situations between the two groups. Furthermore, MAMP users in the intervention group showed greater improvement in confidence to manage both intrapersonal and interpersonal situations related to MAMP use than the control group. The present study confirmed the efficacy of brief C-B interventions in improving confidence in ability to resist urges to use heroin and MAMP in stressful interpersonal situations and to use MAMP in intrapersonal situations. The possible explanations for the ineffectiveness of brief C-B interventions to improve confidence in managing intrapersonal situations related to heroin use are discussed.

Adaptation, Psychological↗
PubMed2005

Physicians' ability to diagnose sepsis in newborns and critically ill children.

OBJECTIVE: To elucidate physicians' ability to correctly diagnose infection in critically ill children in three different situations: 1) post hoc adjudication (e.g., ward rounds, outcome determination in surveillance studies or controlled trials), 2) when decisions must be made (e.g., sepsis workup in suspected infection), c) and applying suggested adult consensus conference definitions in children. METHOD: Appraisal of two previously published studies and a data simulation model. SETTING: Data of the reviewed studies were obtained from a multidisciplinary neonatal and a pediatric intensive care unit in tertiary hospitals. INTERVENTIONS: None. MAIN RESULTS: In the first study reviewed, the post hoc adjudication of 167 consecutive cases of suspected infection was carried out by a fifth-year medical student and three senior consultants. The agreement of the three experts beyond chance in the 119 episodes not classifiable unanimously by a priori defined criteria into proven sepsis or no infection was poor. In the second study reviewed, the physicians provided daily predictions of the likelihood of infection (pretest probability) in premature infants and critically ill children (2567 hospitalization days). Estimated pretest probabilities provided at the time of sepsis workup showed a remarkable predictive accuracy (area under the receiver operating characteristic curve, 0.85). In the simulation model, in which catheter-related sepsis was assumed, correct classification of patients from a central and a peripheral culture decreased to 56% when a sensitivity of 70%-80% was assumed for blood cultures and amounted to 15% only when a sensitivity of 30%-50% was imputed. CONCLUSION: Misclassification is a serious threat in post hoc adjudication of episodes or when consensus definitions rely on the application of criteria with imperfect sensitivity (e.g., the positivity of blood cultures in premature infants or children). This underscores the need to use probability-based categorizations such as probable and possible infection.

Biomarkers↗
PubMedDate not supplied

Vagal and sympathetic activity in burnouts during a mentally demanding workday.

OBJECTIVE: We study differences in task performance and related sympathetic-vagal reaction patterns between burnouts and controls during a mentally demanding workday. METHOD: Thirty-nine adults with burnout and 40 healthy controls performed mental tasks during a simulated workday. At pretest, just before lunch (lunch test) and at the end of the day (posttest), a Stroop color word task was administered as a probe task. Efficiency (the relation between performance and effort during the probe task), performance (reaction time and errors), and effort (self-report) were measured, as well as cardiovascular indices of sympathetic (blood pressure) and vagal (respiratory sinus arrhythmia) activity. RESULTS: Performance and effort investment of both burnouts and controls did not differ during pretest. As the day progressed the performance of controls improved more than the performance of burnouts. Moreover, the control group showed a decrease of blood pressure in response to mental task demands, a decrease in respiratory sinus arrhythmia activity, and no change in experienced effort. In the burnout group, no change could be demonstrated in blood pressure, suggesting a sympathetic predominance in the sympathetic-vagal balance. Burnouts experienced an increase in effort and were more tired at the end of the workday. CONCLUSION: Burnouts and healthy controls differ in their pattern of sympathetic-vagal activity only after long-lasting work demands. Findings give limited support to Porges's view that in healthy subjects, the vagal system is more responsive to challenging task situations than in chronically stressed individuals. The distinction between two phases in the burnout on the basis of behavioral and physiological characteristics is discussed.

Adult↗
PubMed2006

Predictors of failure to return for HIV test results among pregnant women in Moshi, Tanzania.

Identification of HIV-infected women is a prerequisite in HIV perinatal prevention programs. The aim of this study was to determine the predictors of failure to return for HIV posttest results among pregnant women (N=2654) receiving antenatal care at primary health clinics in Moshi urban district, Tanzania. Consenting pregnant women, who were in the third trimester of pregnancy, received individual pretest counseling, followed by interview and screening for HIV. Posttest counseling and results were given after 1 week. A total of 182 (7%) failed to return for their HIV test results. Women were less likely to return for test results if their partners did not come for testing (adjusted odds ratio [AOR], 12.6; 95% CI, 3.1-51.4), if their partners consumed alcohol (AOR, 1.8; 95% CI, 1.3-2.7), and if they had never discussed reproductive health matters with their partners (AOR, 1.7; 95% CI, 1.1-2.7). Additionally, the site of recruitment, age, alcohol consumption, and advanced gestation age predicted failure to return for HIV test results. These results indicate that male partner factors were important in determining whether women returned for results. We therefore recommend promotion of antenatal couple counseling and strengthening of community awareness of the availability of perinatal interventions, with special efforts targeting men. Furthermore, the predictors for failure to collect test-results need to be addressed during pretest counseling.

Adolescent↗
PubMed2003

Internet-based intervention to promote organ donor registry participation and family notification.

BACKGROUND: Little is known regarding the potential of Internet-based educational interventions to increase organ donor registry participation and family notification of donation wishes. We studied the effects of an Internet-based multimedia intervention (www.journey.transweb.org) on donor registry participation and family notification. METHODS: Visitors to a specially designed web site were studied between December 14, 2000, and March 31, 2002. Demographic characteristics were requested, and a pretest was administered to one half of the participants (selected randomly) before web site content exposure. All visitors were offered a posttest. Eight knowledge questions (true/false), three attitude questions (7-point scale), and three behaviors (yes/no) were assessed. RESULTS: A total of 10,884 visitors provided demographic data. Correct answers to knowledge questions increased from 85.1% to 87.0% overall (pretest vs. posttest; P<0.001) and from 80.6% to 82.0% for teenagers (P<0.001). Willingness to donate increased (scores of 6.34 vs. 6.39; P<0.001), as did willingness to join a donor registry (scores of 5.53 vs. 5.67; P<0.001). Willingness measures were less positive among teenagers but increased significantly after exposure to the intervention. Almost 10% of visitors directly linked to an online registry and 2,489 (23%) used the web site facilities to communicate donation wishes. Increases in knowledge were not associated with changes in attitudes, but an increase in pro-donation attitude was a significant predictor of donor registry participation (P<0.001). CONCLUSIONS: Increases in donation attitudes among visitors to an organ donation web site resulted in positive behaviors, such as enrollment in a donor registry and family notification. Future efforts should focus on using Internet-based interventions to improve attitudes toward donation and to facilitate pro-donation behaviors.

Adolescent↗
PubMedDate not supplied

Heart rate-defined phases of attention, look duration, and infant performance in the paired-comparison paradigm.

Four-month-old infants (N = 68) were tested in a paired-comparison familiarization-novelty recognition task in which the length of choice trials was systematically manipulated. Peak look duration during pretest and familiarization periods significantly predicted a dichotomous measure of recognition performance, but recognition was unaffected by choice-trial length. Heart rate (HR) was simultaneously assessed during the task, and the amount of time infants spent in various HR-defined phases of attention was assessed. Longer durations of looking during pretest and familiarization were significantly associated with more time spent in both sustained attention (SA) and attention termination (AT). Of these two variables, only individual differences in AT accounted for significant variance in recognition memory performance. A final analysis addressed the possibility that individual differences in AT mediated the relation between look duration and recognition performance. These findings provide support for the hypothesis that individual differences in the disengagement of attention underlie the relation between look duration and cognitive performance in early to midinfancy.

Attention↗
PubMed2004

Changes in values cognition after rating values-associated feelings.

This study investigated values change as an outcome of assessing feelings elicited by contemplating the actualization of the same values. The subjects were divided into an experimental and a control group. They completed three tests in a single session. In the pretest, all subjects were asked to rate the importance of 20 values items on a 4-point scale. Subjects in the experimental group were then asked to rate the degree of pleasure they would feel in actualizing each of the values, while those in the control group rated the degree of inequality they considered women suffer in the actualization of each of the values. The post-test consisted of the same items as the pretest. The subjects in the experimental group completed a second post-test 3 months later. It was found that the experimental procedure produced significant change in the ratings of 15 values at the post-test, whereas the control procedure produced change in only five. The results suggest that rating one's emotional response to a value-related situation can change one's cognition of that value. At the post-test 3 months later, only 3-value ratings remained changed.

Journal Article↗
PubMedDate not supplied

Effectiveness of home visit falls prevention strategy for Taiwanese community-dwelling elders: randomized trial.

The purpose of this research was to examine the effect of a multifactorial intervention to prevent falls by increasing self-efficacy to prevent falls, improving the knowledge of medication safety, and decreasing the number of environmental risks in older persons dwelling in the community. A sample of 120 cognitively intact residents of this community who were 65 years of age and older were recruited into a two-group pretest-post-test experimental design and randomly assigned to an experimental group and a comparison group (60 in each group). The intervention was delivered, and data were collected during three home visits in a 4-month period. (1) Experimental subjects improved their fall self-efficacy, environmental safety, and knowledge of medication safety significantly (p < 0.01) as compared with those in the comparison group at post-test; (2) the incidence of falls was reduced at post-test in both groups compared to pretest scores, and the falling was more serious in the comparison group at post-test compared to that in the experimental group. The results can help community health professionals to individualize their interventions to the specific needs of the elderly, thus helping to prevent falls among community-dwelling elders.

Accident Prevention↗
PubMed2006

Systematic review: the use of serology to exclude or diagnose coeliac disease (a comparison of the endomysial and tissue transglutaminase antibody tests).

BACKGROUND: With the appreciation of the high prevalence of coeliac disease there is increasing use of serology in screening asymptomatic people and testing those with suggestive features. AIM: To compare the sensitivities and specificities of the endomysial antibody and the tissue transglutaminase antibody tests. METHODS: Using electronic databases a search was made for relevant papers using the terms tissue transglutaminase and endomysial antibody. RESULTS: Both the endomysial antibody and tissue transglutaminase antibody have very high sensitivities (93% for both) and specificities (>99% and >98% respectively) for the diagnosis of typical coeliac disease with villous atrophy. Human recombinant tissue transglutaminase performs much better than guinea pig tissue transglutaminase. Review of studies comparing endomysial antibody with human recombinant tissue transglutaminase antibody shows that endomysial antibody more often has a higher specificity and human recombinant tissue transglutaminase antibody more often has a higher sensitivity. CONCLUSION: The human recombinant tissue transglutaminase antibody is the preferred test for screening asymptomatic people and for excluding coeliac disease in symptomatic individuals with a low pretest probability (i.e. <25%) for coeliac disease. Furthermore, it has a number of practical and financial advantages. If the pretest probability is >25%, biopsy is preferred as the post-test probability of coeliac disease with a negative test is still >2%.

Antibodies↗