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PubMed1997

A prospective randomized comparison between long and discontinuous-long protocols of gonadotropin-releasing hormone agonist for in vitro fertilization.

OBJECTIVE: To investigate the efficacy of a discontinuous-long protocol in an IVF program. DESIGN: Prospective randomized study. SETTING: University hospital. PATIENT(S): One hundred thirty-seven IVF cycles of 92 patients in an outpatient IVF program from April 1995 to December 1995. INTERVENTION(S): In the discontinuous-long protocol group (n = 68), GnRH agonist (GnRH-a) was administered from the luteal phase until cycle day 7, when pure FSH administration was begun. In the long protocol group (n = 69), GnRH-a was administered until the day before hCG administration. MAIN OUTCOME MEASURE(S): Serum LH and ovarian steroid hormone levels, and IVF outcome. RESULT(S): The period and the total dosage of hMG were increased in the discontinuous-long protocol group. Although the fertilization rate was similar under both protocols, the number of embryos transferred was smaller and the cancellation rate was higher in the discontinuous-long protocol group because of the greater failure of oocyte retrieval and fertilization. Serum E2 levels in the late follicular phase were lower in the discontinuous-long protocol group. CONCLUSION(S): Early discontinuation of GnRH-a is not beneficial because of its adverse effects on follicular development.

Adult↗
PubMed1999

Prognostic factors in patients continuing in vitro fertilization or intracytoplasmic sperm injection treatment and dropouts.

OBJECTIVE: To investigate whether cumulative pregnancy rates using life table analysis but without considering dropouts are representative of the whole population of patients entering an in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) program. DESIGN: Retrospective study. SETTING: University hospital-based infertility center. PATIENT(S): One thousand one hundred sixty-nine patients entering our IVF/ICSI program from January 1993 to December 1996. INTERVENTION(S): Comparison of prognostic factors between pregnant and nonpregnant patients, and between patients continuing IVF/ICSI treatment and dropouts. MAIN OUTCOME MEASURE(S): Prognostic factors, such as patient age, cancellation of oocyte retrieval because of poor response to ovarian stimulation, number of oocytes retrieved, fertilization rate, number and quality of embryos transferred. RESULT(S): No statistical differences in prognostic factors were found between patients continuing IVF/ICSI treatment and dropouts. CONCLUSION(S): Cumulative pregnancy rates using life table analysis can be considered representative of the whole population of patients for at least the first three treatment cycles.

Adult↗
PubMed1999

Changing acute pain management to improve patient outcomes: an educational approach.

The United States Agency for Health Care Policy and Research (AHCPR) Acute Pain Management Guidelines were written to provide a scientific basis for practice. Educational programs designed to promote use of the guidelines may change practice in community hospitals. This article describes the development and implementation of an education program for nurses, physicians, and pharmacists in six community hospitals. Program content addressing the use of continuous quality improvement (CQI) teams, detailed pain histories, application of algorithms and dose calculation is described; direct and indirect outcome measures are reviewed. Six months after the program, all three experimental sites reported use of the AHCPR Guidelines in practice. Nurses reported that assessment and documentation of patients' duration of pain were perceived to be the most important caregiver behaviors providing benefit to patients: Across all respondents' reports of regularly performed activities, the activity performed by the largest proportion was assessing and documenting pain using a 0-10 rating scale.

Acute Disease↗
PubMed2001

Long-term weight-loss maintenance: a meta-analysis of US studies.

BACKGROUND: Current perception is that participants of a structured weight-loss program regain all of their weight loss within 5 y. OBJECTIVE: The objective was to examine the long-term weight-loss maintenance of individuals completing a structured weight-loss program. DESIGN: Studies were required to 1) have been conducted in the United States, 2) have included participants in a structured weight-loss program, 3) have provided follow-up data with variance estimates for > or =2 y. Primary outcome variables were weight-loss maintenance in kilograms, weight-loss maintenance as a percentage of initial weight loss, and weight loss as a percentage of initial body weight (reduced weight). RESULTS: Twenty-nine studies met the inclusion criteria. Successful very-low-energy diets (VLEDs) were associated with significantly greater weight-loss maintenance than were successful hypoenergetic balanced diets (HBDs) at all years of follow-up. The percentage of individuals at 4 or 5 y of follow-up for VLEDs and HBDs were 55.4% and 79.7%, respectively. The results for VLEDs and HBDs, respectively, were as follows: weight-loss maintenance, 7.1 kg (95% CI: 6.1, 8.1 kg) and 2.0 (1.5, 2.5) kg; percentage weight-loss maintenance, 29% (25%, 33%) and 17% (13%, 22%); and reduced weight, 6.6% (5.7%, 7.5%) and 2.1% (1.6%, 2.7%). Weight-loss maintenance did not differ significantly between women and men. Six studies reported that groups who exercised more had significantly greater weight-loss maintenance than did those who exercised less. CONCLUSIONS: Five years after completing structured weight-loss programs, the average individual maintained a weight loss of >3 kg and a reduced weight of >3% of initial body weight. After VLEDs or weight loss of > or =20 kg, individuals maintained significantly more weight loss than after HBDs or weight losses of <10 kg.

Adult↗
PubMed2006

School-based smoking prevention programs for adolescents in South Korea: a systematic review.

The number of research papers evaluating programs designed to prevent adolescent smoking have increased in the last 13 years in Korea. The purpose of this study was to evaluate these programs, to review the features of the studies and to systemically assess the results on the knowledge about, and attitude to, smoking and smoking behavior. Database searched were national digital library (NDL) and the Research Information Service System, which are major literature search systems for all academic fields in South Korea, and the Research Information Center for Health, which is a database for health field. A total of 11 papers were included. Program contents are described under five categories and the mode of delivery is described. Methodological features were investigated and effect of the size of the study on variables investigated was computed. Knowledge was the main content of the program in most of the studies. Most studies delivered classroom-based instructions that were mainly didactic presentations. School-based smoking programs have not influenced adolescent smoking behavior as much as anticipated. Methodological problems were discussed. Several recommendations are made to improve effectiveness of smoking prevention programs and reduce methodological flaws in future studies.

Adolescent↗
PubMed2005

Awareness of heart attack symptoms and lifesaving actions among New York City area residents.

The American Heart Association has a national network of community-based programs designed to reduce response times to cardiac emergencies by improving access to automatic external defibrillators (AEDs) among laypersons. Success of these Operation Heartbeat programs depends in part on the public's knowledge of the warning signs of a myocardial infarction (MI) and appropriate response to cardiac arrest victims. In May 2000, a 7-minute telephone survey was administered to a random sample of adults residing within the American Heart Association affiliate territories of New York, New Jersey, and Connecticut to determine the knowledge of MI symptoms, confidence in cardiopulmonary resuscitation (CPR) use, and the awareness of AEDs. Of the respondents, 60% were women (n=1,128), 83% were Caucasians (n=1,558), 15.2% were non-whites (African American, Asian, or Hispanic), and 38.5% had at least a college degree (n=724). Women were significantly more likely than men to know that sex differences exist in the warning signs for an MI (63% vs. 30.7%, respectively; P< .001). Whites had above-average confidence in MI recognition compared with non-whites (39.2% vs. 27.4%, respectively; P< .001) and were more cognizant of the public availability of AEDs (54.5% vs. 33.2%, respectively; P< .001). Our findings suggest that racial/ethnic and sex disparities exist in the awareness of AEDs and in the knowledge of atypical MI symptoms in women, respectively. Innovative CPR outreach programs might be needed in New York area communities to increase CPR training among all adults, to increase AED awareness in vulnerable populations, and to improve knowledge and confidence in the recognition of acute MI symptoms.

Adolescent↗
PubMed1984

Simplified computer programs for search of homology within nucleotide sequences.

Four new computer programs for search of homology within nucleotide sequences are presented. The main scope of the program design is flexibility, independence of sequence length and the capability to be used by any molecular biologist without any prior computer experience. The programs offer a linear search, a search for maximal identity, an alignment along a given sequence and a search based on homology within the amino acid coding capacity of nucleotide sequences. The language is Fortran V. Copies are available on request.

Amino Acid Sequence↗
PubMed2000

The path to professionalism: cultivating humanistic values and attitudes in residency training.

Though few question the importance of incorporating professionalism and humanism in the training of physicians, traditional residency programs have given little direct attention to the processes by which professional and humanistic values, attitudes, and behaviors are cultivated. The authors discuss the underlying philosophy of their primary care internal medicine residency program, in which the development of professionalism and humanism is an explicit educational goal. They also describe the specific components of the program designed to create a learner-centered environment that supports the acquisition of professional values; these components include a communication-skills training program, challenging-case conferences, home visits with patients, a resident support group, and a mentoring program. The successful ten-year history of the program shows how a residency program can enable its trainees to develop not only the requisite excellent diagnostic and technical tools and skills but also the humane and professional attributes of the fully competent physician.

Attitude of Health Personnel↗
PubMedDate not supplied

African American community health advisors trained as research partners: recruitment and training.

The African American community has played an influential role in generating change. Grass-roots organizations and concerned individuals can be included in programs designed to increase cancer awareness and cancer early detection practices to ultimately eliminate cancer disparities. The utilization of a formalized Community Health Advisors program can be an infrastructure by which effective cancer prevention and control programs can be conducted in underserved African American communities. The purpose of this article is to outline the steps necessary to develop an infrastructure for recruitment and training of grass-root African Americans to serve as Community Health Advisors trained as Research Partners.

Black or African American↗
PubMedDate not supplied

A discharge planning program in orthopaedics: experiences in implementation and evaluation.

The acute care orthopaedic registered nurse plays a key role in assessing and communicating the continuing care needs of patient's and their families, coordinating community resources, and formulating a timely discharge plan to maximize rehabilitation and recovery. Developing and maintaining a staff nurse's discharge planning knowledge and skills can be a challenging endeavor. Discharge Planning Coordinators at a tertiary medical center developed and implemented a Discharge Planning Mentorship Program, an educational pilot program designed to enhance the knowledge and skill level of select nurses in the orthopaedic specialty practice, thus maximizing expert resources at the bedside. Program implementation and evaluation of role preparation, practice changes, and actualization challenges are discussed in this article. Overall, participants demonstrated increased skill in articulating and problem solving a patient's postdischarge needs, devised creative strategies to enhance communication between multiple levels of care, and developed a greater knowledge of community resources and reimbursement mechanisms for continuing care.

Clinical Competence↗
PubMed1995

Controversies of early discharge of infants from the well-newborn nursery.

A reduced hospital length of stay for normal newborns has become common, largely in an attempt to reduce hospital costs. Although evidence in the literature suggests that this is a safe practice, the overall quality of the studies is weak, and controversy exists regarding the advisability of this practice. A review of the rather modest literature and experience with shortened hospital stays lead us to conclude that early discharge of newborns is safe if it is but one component of a larger program designed to transfer portions of care traditionally provided in the hospital to pre- and postnatal care provided outside the hospital. The early discharge program developed at the Harvard Community Health Plan is presented as an example of such a program, with the hope that this model will provide a useful framework to those who are involved with shortened hospital maternity lengths of stay.

Community Health Services↗
PubMed2003

Infectious pancreatic necrosis virus in Scottish Atlantic salmon farms, 1996-2001.

The rapid growth of aquaculture has provided opportunities for the emergence of diseases. Programs designed to monitor these pathogens are useful for analysis of regional variation and trends, provided methods are standardized. Data from an official monitoring program were used to analyze the emergence of infectious pancreatic necrosis virus in Scottish salmon farms from 1996 to 2001. An annual increase in the prevalence of this virus was found in saltwater (10%) and freshwater sites (2% to 3%), with a much faster increase (6.5%) in Shetland's freshwater sites. No significant increase in the virus was detected in the marine farms of southern mainland Scotland. However, the virus had become very prevalent at marine sites and was almost ubiquitous in Shetland by 2001. The prevalence of this virus at marine sites may be underestimated. Because several diseases have emerged or are emerging in fish farming, aquaculture surveillance programs represent a rich potential source of data on emerging diseases.

Animals↗
PubMed1999

Effectiveness of a writing improvement intervention program on the readability of the research informed consent document.

BACKGROUND: Problems with the comprehensibility of human research informed consent have been documented since the 1970s, and efforts aimed at rewriting consents have not been successful in consistently producing more readable consents. This study employed researched principles of reading comprehension research to create writing intervention program designed to help the research writer produce more comprehensible informed consent documents. The purpose of this study was to determine if this intervention program was effective. METHOD: The key component of the writing improvement intervention packet was a newly formatted consent form that contained annotated instructions for researchers on how to write each section for optimum comprehension. The resulting consent forms were evaluated using a Readability and Processability Form (RPF). The RPF is based on reading research and includes the Fry Scale, which yields an approximate grade reading level. The RPF assigned points to each of the 20 areas of comprehension analysis according to strict scoring criteria, and target scores were established by the authors in consultation with the hospital institutional review board. RESULTS: We evaluated 66 post-intervention informed consents. The mean readability and processability score was 62, resulting in the RPF classification of "good." The established readability and processability target range was good to excellent or 61-100 points; 66% of the forms scored in this range. In our 1995 pre-intervention study, the corresponding score was 12%. The target range for grade reading level was 8th grade: 53% scored in that range as compared with 4% in 1995. A question-by-question analysis of each of the 20 checklist items on the RPF identified important aspects of the consent writing that improved and others that were still weak and needed improvement. CONCLUSIONS: The Hartford Hospital writing improvement intervention program was associated with the production of more comprehensible informed consent documents. Using the intervention materials, investigators from a variety of departments could function independently to produce readable consent forms. This program may help others who wish to assist their research departments in creating consents that are written for optimal reading comprehension.

Cognition↗
PubMed1985

Teenage mothers and their infants.

The outcomes of the IS/MT pilot project and the expanded services program as well as program replications in other geographic areas suggest that efforts to support the teenage mother in the care of her firstborn infant can have a demonstrable effect. Completing school, securing employment, going off welfare, and acting on a decision to prevent subsequent unwanted pregnancies were all secondary effects of a 20-week postnatal mother-infant class program designed to positively influence infant development. Similar treatment effects have been reported by IS/MT replications in St. Louis and Genesee County, Michigan. Other program innovations, however, lacking the funds and/or the expertise to conduct adequate evaluations, are nonetheless significant because they provide a groundswell capable of establishing a climate for social change. At the community level, this is expressed in the creation of new service paradigms, as in Norfolk and Memphis, where individuals and agencies are transformed and experiment with new solutions to thorny problems. At the national level, it is expressed in coalitions and political alliances around a single issue, as with the Children's Defense Fund and adolescent and single-parent families. As one who has spent almost 20 years addressing the consequences of teenage parenthood, it is heartening to know that the time is near to address the prevention of the problem. Let us hope that the Children's Defense Fund agenda accurately reflects the beliefs and feelings of the majority of our citizenry and that our national priorities will change to include the reduction of teen pregnancy and teen parenthood.

Adolescent↗
PubMedDate not supplied

Medical education's role in primary care/community health: a model from Kumasi, Ghana.

Providing primary care for the medically underserved is an international problem. In the developing world the problem is accentuated by the disparity between resources and needs. Although during the past few decades much has been accomplished worldwide to improve primary care, medical educators have not adequately responded to the challenge of preparing students to participate in community health services, education, and research. This paper describes a medical school program from the Department of Community Health, School of Medical Sciences, Ghana. It is a program designed to prepare medical students for primary care by making community health a curriculum component of all three years of medical education. The program has potential for replication in the industrial as well as the developing world.

Community Health Services↗
PubMed1987

Patient education program to teach energy conservation behaviors to patients with rheumatoid arthritis: a pilot study.

We report a prospective, randomized pilot study comparing a new workbook-based program, designed to teach patients with rheumatoid arthritis (RA) energy conservation behaviors, with standard occupational therapy (OT). Sixteen patients took part in the new program and nine received the standard therapy. Data on the number of tender or swollen joints, grip strength, walk time, activities of daily living, psychologic adjustment to illness, and daily activity log, were measured before and three months after intervention. Eleven percent of those who received standard therapy and 50% of those who received the workbook increased their amount of physically active time (p = .10). Twenty-two percent of the control group and 50% of those in the workbook group achieved a better balance of rest and physical activity (p = .07). We conclude that the adoption of energy conservation behaviors is different in the two groups. This initial study suggests that interrupting physical activity with rest periods may result in increased physical activity in patients with RA.

Arthritis, Rheumatoid↗
PubMedDate not supplied

[Results of a deafness screening program for infants: a pilot project].

This article describes a screening program for hearing loss among infants. The program, designed according to ASHA recommendations, was implemented in a public health district of the province of Quebec. In the first stage of the program all infants born between April 1, 1990 and March 30, 1992 were assessed for risk factors for deafness. In the second stage, those infants considered at risk were given an audiological examination at six months of age. There were 3,944 births during the study period and of these, 8.4% of the infants had at least one risk factor for hearing impairment, the most frequent of which was a family history of hearing impairment at an early age, followed by: hyperbilirubinemia, admission to a high risk neonatal unit, consumption of ototoxic medications, anatomical malformations, perinatal infections and insufficient birthweight. Of the infants at risk, 54.2% were given the audiological examination at six months and one case of deafness was diagnosed.

Deafness↗
PubMedDate not supplied

Preventing child placement in substance-abusing families: research-informed practice.

The authors present finding from their study of a placement prevention program designed to facilitate addiction treatment for substance-abusing mothers and other primary caregivers reported for child maltreatment. Relationships between involvement in the program, the status of addiction treatment, and the variety of outcomes for caregivers and their children were tested. Findings indicate that nearly half of the participants were able to complete addiction treatment and achieve sobriety. Those who used the program's child day care component were three times more likely to complete treatment. Implications for confronting the problem of substance-abusing caregivers in the child welfare system are drawn.

Adult↗