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PubMedDate not supplied

Deploying the chronic care model to implement and sustain diabetes self-management training programs.

PURPOSE: The purpose of this project was to evaluate the utility of using the 6 elements of the chronic care model (CCM; health system, community, decision support, self-management support, clinical information systems, and delivery system design) to implement and financially sustain an effective diabetes self-management training (DSMT) program. METHODS: The University of Pittsburgh Medical Center (UPMC) uses all elements of the CCM. Partnerships were formed between UPMC and western Pennsylvanian community hospitals and practices; the American Diabetes Association DSMT recognition program provided decision support. A clinical data repository and reorganization of primary care practices aided in supporting DSMT. The following process and patient outcomes were measured: number of recognized programs, reimbursement, patient hemoglobin A1C levels, and the proportion of patients who received DSMT in primary care practices versus hospital-based programs. RESULTS: Using elements of the CCM, the researchers were able to gain administrative support; expand the number of recognized programs from 3 to 21; cover costs through increased reimbursement; reduce hemoglobin A1C levels (P < .0001), and increase the proportion of patients receiving DSMT through delivery in primary care (26.4% suburban; 19.8% urban) versus hospital-based practices (8.3%; P < .0001). CONCLUSIONS: The CCM serves as an effective model for implementing and sustaining DSMT programs.

Chronic Disease↗
PubMed1989

MEDTUTOR: a microcomputer-based training program for MEDLINE.

MEDTUTOR is an interactive, microcomputer-based training package designed to teach medical and health professionals, as well as librarians and information specialists, how to use MEDLINE effectively. The objective of MEDTUTOR is to provide a comprehensive package for teaching the various commands and search techniques required for utilizing the MEDLINE database through the MEDLARS system. MEDTUTOR's menu-driven design allows novice users to learn about the content and use of MEDLINE, such as author searching, text word searching, MeSH indexing, etc., at their own pace and with considerable program feedback. In addition, MEDTUTOR provides the skilled searcher with a way to reinforce or recall previously-learned search techniques without incurring online charges. MEDTUTOR may be used in place of formal training, as a precursor to or as a refresher following formal training, or for review of a particular concept. It provides inexpensive and easily accessible instruction for searching MEDLINE.

Computer User Training↗
PubMed1997

Do training programs help AFDC recipients leave the welfare rolls? An evaluation of New York City's BEGIN (Begin Employment Gain Independence Now) program.

Guided by the Federal Family Support Act of 1988 and the Job Opportunity and Basic Skills Program (JOBS), welfare reform initiatives on state and local levels were designed to foster employability among the public assistance population. Reform has focused on enhancing the supply of labor rather than the demand for labor as a route to labor force participation for the public assistance population. Program reforms assume that, by providing job training, educational services, and training-related expenses, labor market entry of the participating clientele would be facilitated while caseloads and public expenditures would decline. To date, analysis of similar programs in many states indicates that the impact of such programs in reducing public assistance caseloads is marginal. In New York City, despite the large investment of public funds in such programs, prior to this study the outcome of program implementation remained largely unknown. This study evaluates New York City's BEGIN program outcome target defined as the ability of the program to move welfare clients off public assistance and into the labor market. While the results of the study indicate that New York City's BEGIN program does not improve client's odds of leaving welfare, when compared to the odds of a non-participation client, there are several significant findings. The impact of program participation can be distinguished among distinct age groups. While older clients responded positively to BEGIN participation, access to day care was the only factor that significantly improved the probability that clients younger than 36 years of age would leave the welfare rolls within a two-year period. In response to the findings, the researchers suggest that future welfare reform efforts should grant localities broader flexibility to determine their own target population so that resources can be allocated to those groups that are most likely to benefit from specific programs.

Adolescent↗
PubMed1999

Prestige of training programs and experience of bypass surgeons as factors in adjusted patient mortality rates.

OBJECTIVES: The relation of physician performance to physician training and experience is not well understood. The aim of this study was to examine whether indicators of physician background and experience were associated with an objective measure of physician performance. METHODS: Physician background information obtained from the Directory of Board-Certified Medical Specialists was linked to physician risk-adjusted mortality rates obtained from three statewide data bases of coronary artery bypass surgeons. Subjects were 275 surgeons who performed CABG surgery on 83,547 patients during the years 1989 to 1992. Surgical performance was measured by the mortality ratio (MR), the ratio of the observed to the predicted patient mortality rate as determined by detailed clinical information. Training institutions and physicians were characterized as prestigious if they were listed as outstanding in published articles. RESULTS: Surgical performance was not associated with graduation from an American medical school; attendance at a prestigious medical school, residency, or fellowship program; or an academic appointment. Mortality ratios decreased with increased volume and increased with years of experience, age, and academic rank. Surgeons were more likely to be considered a "best doctor" if they had more years experience and trained at a prestigious residency or fellowship program. CONCLUSIONS: Training at a prestigious institution was associated with identification as a "best" doctor but not with lower mortality ratios.

Adult↗
PubMedDate not supplied

A comparison of recruiting strategies for increasing older adults' initial entry and compliance in a memory training program.

Older adults in highrise buildings were recruited for memory training using positive ("build your memory power"), neutral ("learn memory skills"), or negative ("avoid memory failures") content approaches which were: printed on a poster mounted in a prominent place (CSA), presented orally at a building meeting (PC), and, finally, printed on flyers distributed to the residents (DC). There were more volunteers after PC with neutral or positive content, but the CSA respondents were more likely to complete the training. Negative content was most likely to attract persons concerned about age-related memory decline. The discussion focused on the appropriate recruitment methods for particular intervention programs.

Aged↗
PubMed1989

Aerobic exercise training programs for the upper body.

Sufficient data are available to support the inclusion of upper body or combined arm-leg training in a comprehensive physical conditioning program. There is now evidence to suggest that initial fitness, as well as the intensity, frequency, and duration of training, may be important variables in determining the extent of cross-training benefits from the legs to the arms, and vice versa. Nevertheless, the limited degree of transfer of training benefits from one set of limbs to another appears to discount the practice of emphasizing leg training alone. Aerobic exercise programs for the upper body may yield significant central (Q and SV) and peripheral (a-vO2 difference) adaptations to support improvements in peak oxygen uptake (VO2peak) during arm and leg work, especially in subjects who are initially unfit, with the more dominant effects specific to the upper extremities. Finally, an arm exercise prescription that is based on the maximal heart rate derived from leg testing may result in an inappropriately high target heart rate for arm training. Workloads (kg.m.min-1) considered appropriate for leg training will generally need to be reduced by 50-60% for arm training.

Adult↗
PubMed2006

Exploring the feasibility of a community-based strength training program for older people with depressive symptoms and its impact on depressive symptoms.

BACKGROUND: Depression is a disabling, prevalent condition. Physical activity programs may assist depression management in older people, ameliorate co-morbid conditions and reduce the need for antidepressants. The UPLIFT pilot study assessed the feasibility of older depressed people attending a community-based progressive resistance training (PRT) program. The study also aimed to determine whether PRT improves depressive status in older depressed patients. METHODS: A randomised controlled trial was conducted. People aged > or = 65 years with depressive symptoms were recruited via general practices. Following baseline assessment, subjects were randomly allocated to attend a local PRT program three times per week for 10 weeks or a brief advice control group. Follow-up assessment of depressive status, physical and psychological health, functional and quality of life status occurred post intervention and at six months. RESULTS: Three hundred and forty six people responded to the study invitation, of whom 22% had depressive symptoms (Geriatric Depression Scale, GDS-30 score > or = 11). Thirty two people entered the trial. There were no significant group differences on the GDS at follow-up. At six months there was a trend for the PRT intervention group to have lower GDS scores than the comparison group, but this finding did not reach significance (p = 0.08). More of the PRT group (57%) had a reduction in depressive symptoms post program, compared to 44% of the control group. It was not possible to discern which specific components of the program influenced its impact, but in post hoc analyses, improvement in depressive status appeared to be associated with the number of exercise sessions completed (r = -0.8, p < 0.01). CONCLUSION: The UPLIFT pilot study confirmed that older people with depression can be successfully recruited to a community based PRT program. The program can be offered by existing community-based facilities, enabling its ongoing implementation for the potential benefit of other older people.

Aged↗
PubMed2003

Assessing evidence-based dermatology and evidence-based internal medicine curricula in US residency training programs: a national survey.

OBJECTIVES: To examine attitudes toward evidence-based medicine and evidence-based dermatology and to assess evidence-based training in US internal medicine and dermatology residency programs. METHODS: A 1-page self-administered questionnaire was mailed to residency training directors and chief residents at 104 dermatology and 103 internal medicine residency programs from the same or affiliated medical centers. RESULTS: Questionnaires were returned by respondents from 70 (68%) of 103 internal medicine programs and 86 (83%) of 104 dermatology programs. Most respondents (91% internal medicine and 70% dermatology) strongly agreed or agreed that evidence-based internal medicine/dermatology is valuable and should be included in residency training (93% internal medicine and 70% dermatology). Respondents from internal medicine programs agreed more strongly with both statements than respondents from dermatology programs (P =.001). Dedicated evidence-based curricula were in place at significantly more internal medicine programs (50 [71%] of 70) than dermatology programs (20 [23%] of 86) (P<.001). Curricula at internal medicine programs offered significantly more evidence-based medicine training sessions (24 vs 6; P<.001) and biostatistics sessions (10 vs 2.3; P =.03), and internal medicine programs more frequently evaluated the curricula using clinical question applications (56% vs 30%; P =.04). CONCLUSION: Despite favorable attitudes toward evidence-based dermatology, compared with internal medicine programs, dedicated evidence-based training is underdeveloped in dermatology programs.

Attitude of Health Personnel↗
PubMed1976

Physical training program for rehabilitating extremely obese patients.

Performance records of 22 extremely obese adult patients undergoing physical rehabilitation in a multi-disciplinary program were used to devise three progressive training protocols to which patients can be individually assigned. These protocols include "fastest pace" walking and jogging and are designed to rehabilitate patients to a two-mile continuous walk within three, five or seven weeks. Specific definition of progressions in distance/work session units are given and criteria for assigning patients to each protocol are discussed. The program allows time for psychological as well as physiological adaptation and improves the rehabilitative process by eliminating much of the variability and regression previously attributed to patient manipulation.

Adolescent↗
PubMed2000

Project SOAR: a training program to increase school counselors' knowledge and confidence regarding suicide prevention and intervention.

School counselors are often the lead individuals in school suicide prevention programs. All school counselors in Dallas, Texas, receive training through Project SOAR (Suicide, Options, Awareness, and Relief), a suicide prevention program. This study assessed Dallas school counselors' knowledge of suicidal risk factors and perceived ability to initiate appropriate steps when confronted with a suicidal student. A two-page, 44-item survey was distributed to all Dallas school counselors attending a mandatory meeting in spring 1999. A total of 186 school counselors (75%) responded. Most had been a school counselor for less than 10 years and one-half received initial SOAR training less than four years ago. The majority strongly agreed that they could recognize suicidal warning signs, assess a student's risk for suicide, and offer support to a suicidal student. In addition, most knew the intervention steps to take when a student assessed at high suicidal risk. When compared to school counselors nationwide, these counselors reported increased confidence in identifying students at suicidal risk.

Adolescent↗
PubMed1991

Exercise training programs and cardiorespiratory adaptation.

Prudent, proper, and progressive aerobic exercise can improve the efficiency of the cardiorespiratory system. Several physiologic mechanisms interact to enhance the body's functional capabilities. Central cardiac adaptations such as improved pump efficiency and peripheral adjustments related to efficient energy transfer are the principle manifestations of proper exercise training. Related benefits of physical activity include reduction in risk from life style-related diseases, increased energy reserves for the activities of everyday living, and an improved quality of life. Functional exercise testing when administered properly can be used to establish safe exercise prescriptions, evaluate patients at risk, and determine program efficacy. The method of choice is a maximal exercise stress test with direct determination of oxygen uptake. Results from such evaluations help to accurately and safely determine the appropriate exercise prescriptions and establish a patient's physiologic profile. The exercise prescription should encompass an approach that denotes the proper application of frequency, intensity, duration, and mode of exercise. For the noncompetitive athlete, training programs should begin with a gentle progression of low-level intensity activities that encourages compliance and reduces risk. Short-term reachable goals documenting gradual increases in activity have been shown to be successful in terms of compliance and desired benefits. Although intense exercise training may be an ambitious goal for many persons, moderate levels of habitual physical activity are a more realistic goal. The clinician should realize that habitual physical activity is an integral part of a healthy life style. Lack of fitness has been strongly associated with all-cause morbidity and mortality. Obviously, the health potential of exercise cannot be realized if a society remains inactive. It is estimated that 40% of Americans are completely sedentary and another 40% are active at levels well below a threshold that would produce gains in cardiovascular fitness and health. This situation exists even though the US Public Health Service has prioritized the importance of physical fitness and habitual physical activity in maintaining preventive health measures and population health status.

Adaptation, Physiological↗
PubMed1985

A postgraduate dental training program for treatment of persons with disabilities.

Educational aspects of a five-year project of postgraduate training in dentistry for patients with severe disabilities are described. Courses consisted of two weeks of didactic and up to six weeks of clinical instruction. Participating dentists, dental hygienists, and assistants demonstrated significant post-course gains in cognitive knowledge and confidence. Follow-up evaluations indicated that more than 75 percent actively apply their training, particularly those in academic dentistry. The nationwide response to the program indicates a demand for advanced training of this type.

Clinical Competence↗
PubMed1986

Development and evaluation of an infant-care training program with first-time fathers.

We evaluated the effectiveness of a multicomponent package in training infant-care skills to first-time fathers. After developing and socially validating a set of infant-care skills, we assessed the effects of training in a hospital-based program with expectant fathers (Experiment 1) and in a home-based program with fathers having varied degrees of experience with their infants (Experiment 2). In both experiments, a multiple probe design demonstrated that the training package was responsible for producing criterion performance by the expectant and first-time fathers. A 1-month generalization probe in Experiment 1 showed that the effects transferred across training conditions (training doll to human infant) and settings (hospital to home). An increase in the number of infant-stimulation activities performed by fathers was also observed in both experiments.

Adaptation, Psychological↗
PubMed2003

Training of residents for their role as flight physicians: a survey of emergency medicine training programs.

OBJECTIVE: To determine the number of emergency medicine (EM) residency programs in which residents serve as helicopter emergency medical services (HEMS) crew, the extent of training provided for this role, and how HEMS residents are evaluated. METHODS: Accredited EM residency programs were contacted by telephone to determine which programs had residents serving as HEMS physicians. A self-administered survey was then mailed to the medical directors of the HEMS programs. Descriptive statistics were determined for each question. RESULTS: Surveys were returned by 18 of the 20 residency programs (90%) where residents served as HEMS physicians. In the majority (94%), residents work with one other crew member, typically a nurse or paramedic. The amount of flight hours for a resident ranged from 25 to 500. The number of flights ranged from five to 225. The amount of HEMS training was highly variable. Four programs (22%) did not require any orientation flights with patients; 12 (67%) did not require any proficiency testing; direct attending supervision was rare (6%); and written feedback occurred in only 28% of programs. CONCLUSIONS: The training of residents for their role as flight physicians is highly variable, considering the amount of air transport time they perform. Direct faculty supervision, proficiency testing, and written feedback are rarely utilized.

Air Ambulances↗