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PubMed1998

A blueprint for linking academic oncology and the community.

The processes by which academic medicine will train the next generation of physicians and develop new knowledge have brought to the forefront the relationship between academic medical centers and community hospitals and practitioners. Over the past thirteen years, the Harvard Medical School Joint Center for Radiation Therapy (JCRT) has developed an integrated radiation oncology program designed to serve simultaneously the needs of the community, teaching hospitals, medical schools, and faculty. The structure and function of this program are described here, as are the challenges posed by the highly competitive health care marketplace. We believe that long-term vision should guide short-term goals. The success of academic-community collaborative programs depends not only on the good will and vision of the participants but also on the medical administration, academic leadership, policy makers, and politicians who define the principles and rules by which cooperation within the health care industry occurs.

Academic Medical Centers↗
PubMed2003

Sexually transmitted diseases surveillance among incarcerated men who have sex with men--an opportunity for HIV prevention.

There is an urgent need for behavioral surveillance and prevention strategies specifically designed for men who have sex with men (MSM) who exhibit high-risk behavior. This report describes a sentinel screening program designed to identify sexually transmitted infections among incarcerated MSM. Approximately 2,200 inmates were screened for HIV, syphilis, gonorrhea, and chlamydia from a segregated unit of men who have sex with men in Los Angeles County Men's Central Jail. A convenience sample of 217 participants was offered a survey to assess risk behaviors. Screening activities yielded a 12.4% HIV, 3.1% chlamydia, 1.5% gonorrhea, and 0.3% early syphilis prevalence. The high HIV prevalence found in this population indicates the opportunity for HIV prevention within sexually transmitted disease (STD) screening of incarcerated MSM. Bridging HIV prevention into STD screening will require the integration of primary and secondary prevention services within the jail including case management, early treatment, and referral services.

Adult↗
PubMed1987

Expanding the impact of behavioral staff management: a large-scale, long-term application in schools serving severely handicapped students.

Experimental evaluations of behavioral staff management procedures usually have been limited to relatively small-scale demonstration studies. We evaluated a large-scale, long-term application of a staff management program designed to improve the functional utility of educational services for severely handicapped persons. The intervention, involving a brief in-service program followed by supervisory prompts and feedback, was implemented by three principals in four schools involving 21 classrooms. Implementation of the management procedures was consistently accompanied by increases in student involvement in functional educational tasks in each classroom. Further, the improved services continued throughout a 2-year follow-up period. Staff responses to a questionnaire indicated a high degree of staff acceptance of the management program. Results are discussed in terms of expanding the use of behavioral supervisory procedures from experimental demonstrations to actual adoption by existing human service agencies.

Activities of Daily Living↗
PubMed2003

Modeling the interaction of paclitaxel with beta-tubulin.

The natural product cytotoxic agent, paclitaxel, partly induces cell death through its ability to disrupt mitosis by binding to the microtubule protein beta-tubulin. Structural characterization of the paclitaxel-beta-tubulin complex, a first stage in the design of new antimitotics, has been complicated by contradictory observations obtained from different experimental techniques [electron crystallography, fluorescence resonance energy transfer (FRET), and photo-affinity labeling (PAL)] used to examine the complex. In this study we have used a range of molecular modeling techniques including restrained conformational searching and computer-assisted docking to propose that these contradictions may be resolved by the hypothesis that the nature of the interaction of paclitaxel with beta-tubulin depends on the physical form of the tubulin examined. In particular, our analysis identified a binding mode that is consistent with available data for the interaction of paclitaxel with beta-tubulin in polymerized tubulin or microtubules. This orientation is characterized by an alternate conformation (inverted orientation of side chains) and inverted orientation of the taxane core of paclitaxel within its tubulin binding site compared with the electron crystallographic structure. The proposed structure, however, is only marginally consistent with electron crystallographic data for the interaction of paclitaxel with beta-tubulin in Zn-induced tubulin sheets. Similarly, the electron crystallographic structure shows poor correlation with FRET, solid-state NMR, and some observed SAR relationships for paclitaxel interacting with polymerized tubulin or microtubules. These observations suggest to us that the interaction of paclitaxel with Zn-induced tubulin sheets may not reflect paclitaxel's interaction with tubulin in microtubules and hence may not be an appropriate guide for rational drug design programs.

Antineoplastic Agents, Phytogenic↗
PubMedDate not supplied

Helping physicians manage challenging patient encounters. Part II.

In the Nov.-Dec. 1990 issue of Physician Executive, the author discussed some of the problems and effects of poor physician-patient interactions and described a program designed to develop physician skills in dealing with challenging patients. In this issue, the author details a method for implementing this program in a health care provider organization.

Medical Staff, Hospital↗
PubMedDate not supplied

Empowerment: the emperor's new clothes.

Everyone talks about empowerment, but it's not working. CEOs subtly undermine empowerment. Employees are often unprepared or unwilling to assume the new responsibilities it entails. Even change professionals stifle it. When empowerment is used as the ultimate criteria of success in organizations, it covers up many of the deeper problems that they must overcome. To understand this apparent contradiction, the author explores two kinds of commitment: external and internal. External commitment--or contractual compliance--is what employees display when they have little control over their destinies and are accustomed to working under the command-and-control model. Internal commitment occurs when employees are committed to a particular project, person, or program for their own individual reasons or motivations. Internal commitment is very closely allied with empowerment. The problem with change programs designed to encourage empowerment is that they actually end up creating more external than internal commitment. One reason is that these programs are rife with inner contradictions and send out mixed messages like "do your own thing--the way we tell you." The result is that employees feel little responsibility for the change program, and people throughout the organization feel less empowered. What can be done? Companies would do well to recognize potential inconsistencies in their change programs; to understand that empowerment has its limits; to establish working conditions that encourage employees' internal commitment; and to realize that morale and even empowerment are penultimate criteria in organizations. The ultimate goal is performance.

Administrative Personnel↗
PubMed1987

The SmartChart program.

After briefly reviewing the evolution of clinical programs designed to handle the types of information needed for day-to-day decisions regarding patients, the authors discuss their SmartChart program, which is suited specifically to the maintenance of patient records in a private practice or a teaching hospital.

Internship and Residency↗
PubMed1995

Addressing domestic violence in the African American community.

This paper focuses on the problem of spouse abuse in the African American community and discusses intervention programs designed to reduce domestic violence. The problem of domestic violence is not new. However, there is increased concern about it, such that the criminal justice system has changed its policy toward this act. This policy considers domestic violence a crime, and arrest the most efficient way to prevent it. Further, providing counseling programs to men is one of the efforts some criminal justice departments are now using. The two programs discussed in this paper are programs used by the criminal justice system. They are designed to prevent repeated domestic violence by focusing on the education of conflict resolution to deal with anger, denial, and jealousy, and the development of interpersonal skills that assist in channeling anger and poor interpersonal communication into positive modes of conduct. Some characteristics of batterers are noted.

Adult↗
PubMedDate not supplied

Psychologic effects of cardiovascular conditioning: a controlled experiment.

Although there have been numerous studies documenting a relationship between physical fitness and psychologic functioning, few have employed the type of experimental design that would allow conclusions to be drawn regarding cause and effect. In the present study, college students were randomly assigned to a cardiovascular conditioning program or to a control program designed to give the appearance of physical training while minimizing cardiovascular benefits. Both groups were tested for cardiovascular fitness as well as on a number of self-rating scales before and after the 6-week program. The cardiovascular group demonstrated a significantly greater improvement in cardiovascular fitness than the control group and also tended to show a greater reduction in anxiety and greater increase in measures of general psychologic well-being.

Adult↗
PubMedDate not supplied

Using the stages of change model to increase the adoption of physical activity among community participants.

PURPOSE: This study examined the use of the stages of change model to design an exercise intervention for community volunteers. DESIGN: The "Imagine Action" campaign was a community-wide event incorporating the involvement of local worksites and community agencies. Community members registering for the campaign were enrolled in a six-week intervention program designed to encourage participation in physical activity. SUBJECTS: Six hundred and ten adults aged 18 to 82 years old enrolled in the program. Seventy-seven percent of the participants were female and the average age was 41.8 years (SD = 13.8). SETTING: The campaign was conducted in a city with a population of approximately 72,000 and was promoted throughout community worksites, area schools, organizations, and local media channels. MEASURES: One question designed to assess current stage of exercise adoption was included on the campaign registration form as were questions about subject name, address, telephone number, birthdate, and gender. INTERVENTION: The intervention included written materials designed to encourage participants to initiate or increase physical activity, a resource manual describing activity options in the community, and weekly "fun walks" and "activity nights." RESULTS: A Stuart-Maxwell test for correlated proportions revealed that subjects were significantly more active after the six-week intervention. Sixty-two percent of participants in Contemplation became more active while 61% in Preparation became more active. CONCLUSIONS: Most participants increased their stage of exercise adoption during the six-week intervention. This study provides preliminary support for use of the stages of change model in designing exercise interventions.

Adolescent↗
PubMed1993

Comparison of two hypocaloric diets in obese children.

OBJECTIVE: To examine whether a protein-sparing modified fast diet and a hypocaloric balanced diet are safe and effective for children in an outpatient weight reduction program. DESIGN: Randomization of two groups to either diet, with follow-up at 14.5 months. SETTING: Physician or parent referral to outpatient program at Children's Hospital of New Orleans, La. PARTICIPANTS: Nineteen children, ranging in age from 7.5 to 16.9 years, weighing 45% to 131% more than the mean weight for age, sex, and height. INTERVENTION: During the first 10 weeks, 10 children were placed on a protein-sparing modified fast diet (2520 to 3360 J), and nine children and adolescents were placed on a hypocaloric balanced diet (3360 to 4200 J). Subsequently, all participants were placed on a hypocaloric diet; calories were increased from 4200 to 5040 J in a 3-month period and maintained for 1 year. SELECTION PROCEDURES: Children were assigned to one of two diets for the first 10 weeks according to their time of enrollment. MEASUREMENTS/MAIN RESULTS: Both diets produced significant weight loss during the first 6 months. However, the protein-sparing modified fast diet produced significantly greater changes in the percentage of overweight at 10 weeks (-30% vs -14%) and at 6 months (-32% vs -18%). At 10 weeks, a significant loss of adipose tissue with preservation of lean body mass occurred in the protein-sparing modified fast group. A transient slowing of growth velocity was noted at 6 months in both dietary groups compared with values at 14.5 months. Growth velocity approached normal levels at 14.5 months compared with standards for North American children. When dietary groups were combined, the initial mean blood pressure decreased significantly at all points in the study. The initial mean serum cholesterol value also decreased significantly at 10 weeks. No biochemical or clinical complications were observed. CONCLUSIONS: These hypocaloric diets appear to be safe and effective in the short-term management of pediatric obesity. However, these diets should not be used without close medical supervision.

Adolescent↗
PubMed1994

The Modified Barium Swallow Database.

Every center that carries out the modified barium swallow (MBS) has a potential storehouse of useful clinical and radiological information filed away in the patient's files and in the center's video library. The modified barium swallow database automates the recording, storage, and analysis of this information. This project utilizes a standardized clinical and radiological data form which provides a consistent approach to the reporting of the MBS results. The information on the data form is entered into the MBS database software program for decoding and permanent storage. This database program, designed for the computer novice, is menu driven to simplify operation. Once the patient information is verified on the computer screen, the program can generate different types of reports for clinical and research purposes. The program has routines to search for patients with any clinical or radiological findings of interest. The ability to group and recall patients with specific findings has been an aid in teaching, peer review, and research. The program has been modified based upon feedback and experience at three centers in Toronto that have used it for 9 months.

Barium Sulfate↗
PubMed1986

Adolescent suicidal and self-destructive behavior. Results of an intervention study.

This study evaluates an intervention program designed to reduce suicidal, self-destructive behavior among high-risk adolescents aged 13- to 17 years. The intervention combined a program of community education and direct service to youth who had required emergency care for self-inflicted injuries. The intervention program was effective in increasing subjects' compliance with medical regimen. To a lesser degree, the intervention also facilitated early help seeking among adolescents with suicidal thoughts and appeared to diminish slightly the overall occurrence of emergency room admissions for suicidal behaviors. However, the intervention program had no demonstrable effect on the occurrence of repeat suicidal episodes.

Adolescent↗
PubMedDate not supplied

Violence, trauma and substance abuse.

A review of the relevant literature concerning posttraumatic stress disorder, violence, domestic violence suggests that violence behavior, trauma, and substance abuse have a substantial connection; it also suggests that shame is a powerful agent for rage. Shame permeates many levels of society: the individual, the family, institutions and the community. The policies of the criminal justice system are directed towards promoting more shame in a population that has been saturated with shame in the many levels of the culture. Attention is focused on the role of alcohol and other drug use in the cycle of violence. Violent behavior, violent individuals, and victims of violence are deeply affected--emotionally, physically, politically, and spiritually--by drug use. This suggests that any program designed to promote healing violent behavior, for victims and/or perpetrators, should include attention to each of these spheres. This article describes a program that I have developed in the San Francisco City and County Jails. The program includes three groups: a Stress Reduction Group, a Personal Writing Group, a Partner Abuse Group, and an Anger and Conflict Management Group. The milieu is described, as well as the components, methods and rationale for each group.

Domestic Violence↗
PubMed1992

Atmospheric concentrations of PCDDs/PCDFs in southern California.

A comprehensive air toxics measurements program designed to establish baseline concentrations of atmospheric polychlorinated dioxins and dibenzofurans (PCDDs/PCDFs) in the South Coast Air Basin has been completed. The program utilized state-of-the-art air sampling and laboratory analysis techniques (HRGC/HRMS) to quantify the fifteen 2,3,7,8-substituted PCDDs/PCDFs congeners of primary toxicological significance. This study, which included nine discrete sampling sessions between December 1987 and March 1989, provides the first systematic assessment of ambient PCDDs/PCDFs concentrations in the state of California. The highest PCDDs/PCDFs concentrations noted during this study occurred in December 1987. This period was dominated by off-shore air flows, suggesting a regional air mass and transport phenomena. Concentrations of the PCDDs/PCDFs were diminished markedly in subsequent sampling sessions where air flow patterns were primarily of on-shore or of coastal origin. Ambient PCDDs/PCDFs concentrations, expressed as toxic equivalents, were highest during the December 1987 sampling period. The El Toro monitoring site, located approximately 40 miles southeast of Los Angeles, consistently showed the lowest measured ambient PCDDs/PCDFs concentrations and toxic equivalents values. In the majority of the sessions and samples examined the PCDDs/PCDFs congener profiles strongly suggest combustion source influences. Typical of combustion source profiles, 1,2,3,4,6,7,8-HpCDD was the predominant 2,3,7,8-substituted species and most prevalent PCDD after OCDD. The congener of highest toxicological significance, 2,3,7,8-TCDD, was reported below the 10-20 fg/m3 detection limit for most of the ambient air samples selected for analysis.

Air Pollutants, Occupational↗
PubMed2006

Comparing effects of auricular acupressure with and without an internet-assisted program on smoking cessation and self-efficacy of adolescents.

OBJECTIVES: This study aimed to develop an Internet-assisted smoking cessation program accompanied with auricular acupressure, and compare the quit rate and self-efficacy of youth smokers receiving auricular acupressure with and without the Internet-assisted smoking cessation program. DESIGN: A Website was constructed on IBM Websphere 5.0 and DB2 database using HTML, Javascript, and JSP. A quasiexperimental research design was adopted. Subjects were assigned nonrandomly to two groups. Group 1 received auricular acupressure plus the Internet-assisted smoking cessation program, whereas group 2 received auricular acupressure only. MEASUREMENTS: The data of demographic factors, serum cotinine, quitting rate, nicotine dependence, and self-efficacy of subjects were collected before and after a 4-week intervention. RESULTS: After intervention, the quit rate was 15.78% in group 1 and 2.56% in group 2. Nicotine dependence was significantly lowered in group 1, but remained unchanged in group 2. The improvement of self-efficacy between groups 1 and 2 was significantly different. CONCLUSIONS: The combination of auricular acupressure and Internet-assisted smoking cessation program was more efficacious than auricular acupressure alone in terms of quit rate.

Acupuncture Points↗
PubMed1990

Development of indicators to assess hunger.

Despite widespread concern about hunger in America, efforts to monitor and assess the extent of hunger have been hampered by lack of consensus on an appropriate meaning for the term hunger and by the lack of valid indicators to assess it. The first phase of the research used qualitative methods to derive a socially-appropriate definition of hunger. Thirty-two women in Upstate New York were interviewed regarding their experience with food problems and hunger. The interviews were analyzed using the constant comparative method. Results indicated that women had a narrow and a broad concept of hunger. The narrow concept focused on going without food for a specified period of time and the physical sensation of hunger. The broad one included two dimensions: household and individual hunger. Each had quantitative, qualitative, psychological, and social components. The second phase of the research used survey methodology to examine the validity and reliability of items designed to measure the conceptual definition of hunger. The survey was administered to 189 women in Upstate New York who participated in programs designed for low-income households or households in need of food. The second phase confirmed the conceptualization of hunger developed in the first phase. A subset of valid and reliable items that represented each of the major dimensions and components of hunger was identified as being useful for monitoring and assessing hunger.

Adult↗
PubMed1997

Improving care givers' satisfaction with information received during hospitalization.

As competition for patient volume escalates among hospital providers, administrators must identify ways to attract new patients and maintain or increase patient volume. Family care givers are known to greatly influence individuals' choices in these matters of selection of healthcare services and providers. The results of a successful nurse-initiated daily phone calls program, designed to improve family care giver satisfaction by enhancing the provision of patient-specific information, are presented. The components of the program, associated costs, and implications on delivery of care are discussed.

Aged↗