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PubMedDate not supplied

Addressing the issue of cataloging and making accessible chiropractic literature: Part II. Pilot software development program.

Health science journals are a principle source of new knowledge for chiropractors, chiropractic faculty, and students. Regrettably, clinically or educationally relevant articles (appearing in the nearly 20,000 journals annually) are often overlooked due to access difficulties. Innovations are needed to assist the reader to select articles relevant to chiropractic and reduce the time spent sorting through the volumes of literature. A solution to those problems of accessing, obtaining, and storing article citations from the chiropractic literature come from a pilot computerized program developed for use on the Los Angeles College of Chiropractic (LACC) campus. The Chiropractic Literature Archive and Search Program (CLASP) is dedicated to chiropractic literature. It provides rapid access to the literature and directs the user to one of the participating chiropractic campuses where the article can be found. Because of its ease of operation, the program is a useful tool for nearly all areas of chiropractic, ranging from education and research to clinical patient management. The program would be inexpensive to fully implement, and the hardware needed is minimal. Important protocols have been developed for database input, use and maintenance. Testing of this program on the LACC campus reveals that such a program is capable of making citations of the chiropractic literature available within days of their publication.

Abstracting and Indexing↗
PubMed2002

Mycology at a distance.

GermWare Mycology is an image-rich, CD-ROM-based instruction divided into tutorial and reference programs. The tutorial program, designed for new students, provides only for sequential progress through each of the subject modules, so that each page of information is seen. In contrast, the reference program allows the more experienced learner with random and direct access to each facet of information. The aspergilli, the agents of chromomycosis, the dermatophytes, the dimorphic fungi, the hyaline molds, the dematiaceous molds, the yeasts, and the zygomyces are divided into separate modules. The tutorial program also includes an opening 'isolation procedures' module, in which details of specimen collection, culture media, and microscopic techniques are presented. The random access program includes system maps separating out each of the fungal species, and flow diagrams allowing an algorithm approach to species identifications. A global map is also included through which each fungal species can be directly accessed by the simple click of the mouse. Random access to information on the ecology, clinical presentations, pathology and therapy of the various mycotic diseases is also a feature of the reference program. A series of self-assessment exercises is included at the end of each module, with immediate 'pop-up' feedback to both correct and incorrect answers. The entire program includes over 2500 screens and over 700 color images and diagrams. GermWare Mycology is available through the Colorado Association for Continuing Medical Laboratory Education (CACMLE), who also can provide continuing education credits for individuals who complete a separate examination. For more information contact CACMLE at (303) 321-1734 or info@cacmle.org.

Adult↗
PubMed2000

Managing the lifeline: preemptive access management for better outcomes for hemodialysis patients and programs. Medical Review Board of The Renal Network, Inc.

Problems with vascular access for hemodialysis patients contribute substantially to the morbidity, mortality, and high costs associated with renal replacement therapy. Data from the Network 9/10 Regional Hemodialysis Vascular Access Quality Improvement Project show evidence of incremental improvements, with more native vein fistulae and fewer grafts. However, increased numbers of catheters were observed, and still fully 32% of the catheters in place were associated with no internal access created after more than 90 days on dialysis. This article reviews recent contributions to understanding patterns of access-related care, pathophysiology of vascular access complications, and new approaches to achieving the preferred native vein arteriovenous fistulae. A financial analysis shows that dialysis units that employ dedicated access management personnel can expect bottom-line benefits that will easily cover the added expense. These benefits will be in addition to improvements in morbidity and mortality for patients.

Arteriovenous Shunt, Surgical↗
PubMed1992

A PC program for performing multigroup longitudinal comparisons using the Potthoff-Roy analysis and orthogonal polynomials.

A PC-program performing the Potthoff-Roy (PR) multigroup (G-sample) analysis of longtidinal data is described and illustrated. This program and the underlying statistical model are useful in the comparison of several longitudinal samples. Applications include the study of growth, development, adaptation, aging, and treatment effects (in short, any phenomenon in which the passage of time is important) for which serial data are available. Specifically, this method fits polynomials to the average growth curves in the samples, and tests hypotheses concerning the curves themselves and the individual coefficients of the polynomials. The program features the utilization of orthogonal polynomial regression coefficients (OPRCs) and is written in GAUSS, a relatively inexpensive yet comprehensive matrix programming language. It is documented that using OPRCs to comprise the within-individual or time design matrix has several advantages over the more usual choice of the successive-powers-of-t form of this matrix and an example of one important such advantage is provided. GAUSS was employed to make the program readily-accessible (i.e., executable code) to biomedical investigators. The GAUSS compiler is not required to run this program. Information regarding the availability of the program is provided in the Appendix.

Child↗
PubMedDate not supplied

Access flow measurement as a predictor of hemodialysis graft thrombosis: making clinical decisions.

Since the introduction of dilution methods for measurement of vascular access blood flow during hemodialysis, more than 170 publications addressing the accuracy, prognostic value, and economic impact of the technology have been presented. Recently researchers (Paulson et al.) have raised concerns about the accuracy of access flow measurements in predicting thrombosis. Our first objective was to address the inadequacies of the analysis by these authors. The second objective was to apply a statistically accepted three-step approach for clinical decision making to assess the utility of access flow surveillance (similar to the K/DOQI guidelines) in the prediction of thrombosis. These steps included 1) estimation of treatment thresholds based on harm-benefit analysis of fistulography-angioplasty versus thrombosis, 2) estimation of prior probability of thrombosis based on patient demographic and clinical characteristics, and 3) application of Bayes' theorem to evaluate whether flow test results provided information that could move patients across the treatment threshold, thus discriminating between patients who should be referred for fistulography-angioplasty and those who should not. These data and an analysis of recent publications show that the implementation of an access flow surveillance program decreases thrombosis rates in hemodialysis units and can significantly reduce the costs associated with hemodialysis access maintenance. We conclude that access flow monitoring (K/DOQI flow thresholds) is useful in the clinical decision-making process for thrombosis prediction across a wide range of demographic categories.

Blood Flow Velocity↗
PubMed2006

Universal influenza vaccination: the time to act is now.

Annual influenza epidemics create a significant public health burden each year in the United States. That influenza continues to pose a public health threat despite being largely preventable through vaccination is indicative of continuing weaknesses in the U.S.'s public health system. Moreover, the burden of annual influenza epidemics and the fragility and instability of the capacity to respond to them underscore the U.S.'s ongoing vulnerability to pandemic influenza and highlights gaps in bioterrorism preparedness and response efforts. This article examines the burden of annual influenza epidemics in the U.S., efforts to combat that burden with vaccination, shortcomings of influenza vaccination efforts, and how those shortcomings exemplify weaknesses in pandemic influenza and bioterrorism preparedness efforts. We make the case for establishing an annual universal influenza vaccination program to assure access to influenza vaccination to anyone who can safely receive vaccination and desires it. Such a program could greatly reduce the annual burden of influenza while advancing and maintaining U.S. pandemic influenza and bioterrorism preparedness and response efforts.

Bioterrorism↗
PubMed1976

Brain architecture and mechanisms that underlie language: an information-processing analysis.

A neural network model for naming visual objects and their attributes, and understanding certain simple types of sentences has been presented. The model is based on neural processes rather than linguistic or symbolic constructs. The following are the major structural features of the model: 1. Memory stores are associative networks that perform an analysis of their inputs in real time. This analysis converts the input pattern into a "recognition pattern" that depends on the specific stored information and its location in the store. 2. The naming store is an analyzer network that converts the sensory encoding of a sentence into a "sentence pattern". The sentence pattern is obtained by averaging the recognition signals from several memory locations in the naming store. Because of the organization of words in the naming store, sentence patterns are an encoding of the structure of the sentences. 3. The sentence store is an associative memory store that recognizes sentence patterns and associates with each one an "instruction sequence" or "program" that specifies how the system should respond to the sentence. It is the enabling of access to this "program" that constitutes "understanding." Sentences are understood in real time, without the explicit grammatical analysis that is usual in sentence-understanding systems. Understanding a sentence involves two functionally distinct processes: (1) associating with its sentence pattern an instruction sequence that specifices what to do in order to generate an appropriate response to the sentence matching that pattern: for example, to look in the visual field for an object, determine its location, and so on, and (2) analysis of the tokens in the sentence that indicate specific attributes or entities to look for or determine.

Association↗
PubMedDate not supplied

Effects of training in patient education on attitudes and behaviors of family practice residents.

The attitudes of 24 family practice residents toward patient education and perceptions of their own efficacy as patient educators were measured before and after they underwent a special patient education training program. Their scores were compared to those of 34 family practice residents who did not have access to the program. Study group residents showed positive changes in attitudes, reported behaviors, and problems, while the comparison group showed no changes in any of the categories. The differences were statistically significant for the behaviors and problems but not for the attitudes data.

Analysis of Variance↗
PubMed1998

Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness.

OBJECTIVES: This study evaluated the hypothesis that greater integration and coordination between agencies within service systems is associated with greater accessibility of services and improved client housing outcomes. METHODS: As part of the Access to Community Care and Effective Services and Supports program, data were obtained on baseline client characteristics, service use, and 3-month and 12-month outcomes from 1832 clients seen at 18 sites during the first year of program operation. Data on interorganizational relationships were obtained from structured interviews with key informants from relevant organizations in each community (n = 32-82 at each site). RESULTS: Complete follow-up data were obtained from 1340 clients (73%). After control for baseline characteristics, service system integration was associated with superior housing outcomes at 12 months, and this relationship was mediated through greater access to housing agencies. CONCLUSIONS: Service system integration is related to improved access to housing services and better housing outcomes among homeless people with mental illness.

Adult↗
PubMed2005

Public dental health care program for persons with disability.

The objectives of the study were (1) to describe the organization and content of the Danish public oral health care program for persons with disability, and (2) to analyse possible variations in relation to the goals and requirements set by the health authorities. Data were collected by means of self-administered questionnaires completed by the person responsible locally for the program in each municipality. The response rate was 84%. The following topics were included: (1) Number of persons attending the program, (2) procedure for identification of persons eligible for the program, (3) payment of service, (4) providers of oral health care, (5) special training of staff, 6) dental services delivered, (7) ethical issues, and (8) patient rights. Less than one-third of persons estimated by the health authorities were enrolled in the program. On average, 0.4% of the municipal population attended the program, ranging from 0.03% to 1.53%. In large municipalities, and where internal providers delivered oral health care, relatively more persons were enrolled in the program (p < 0.001). Overall, more than 20 categories of personnel were involved in the selection procedure; attitude and lack of knowledge of oral health and oral health care for persons with disability were barriers to equal access to the program. Preventive dental services were the most frequent services delivered, although relatively few oral hygienists were involved in the program. Special training was most frequent in large municipalities. To secure equal access for persons with disability, it is recommended that joint collaboration between smaller municipalities should be made regarding procedures of such programs. Special training of dental personnel and of the staff responsible for selecting persons for the program should be systematically organized at a higher administrative level. The pattern of dental services delivered justifies further involvement of oral hygienists in the program.

Aged↗
PubMed1999

Rural Health Support, Education and Training Program (RHSET): where to now?

The Rural Health Support Education and Training (RHSET) Program is a Commonwealth Government grants program established in 1990 to enhance the access to rural communities to effective health services. The emphasis has been on professional workforce issues. Up until December 1997, 431 applications for funding had been approved and close to $37 million allocated. This article considers the grants awarded in that period according to their main topic of interest within three broad groupings: policy and tertiary service provision; health discipline-specific groups; and special interest groups such as Aboriginal and Torres Strait Islanders and community organisations. Each subgroup is introduced and its contents outlined. It also suggests that despite heightened government interest in rural and remote health, a niche can still be found for RHSET. It further argues that the time has come for a major evaluation of project activity to ensure non-duplication and to develop performance indicators for evaluating projects addressing rural and remote area workforce issues.

Australia↗
PubMed2005

Electronic strategies for information and research: cyberNephrology/cyberMedicine in the emerging world.

Communication and medicine have evolved together. Internet resources now provide an unprecedented opportunity to provide health assistance to the developing world. The International Society of Nephrology Informatics Commission and National Kidney Foundation cyberNephrology initiative (http://www.cybernephrology.org) have created e-mail discussion groups (e.g., NEPHROL, NEPHKIDS, and so forth) and online texts and web resources (e.g., the Schrier Atlas: http://www.kidneyatlas.org) that are, in many respects, ahead of other areas of medicine. On the other hand, nephrology is quite behind in its embrace of some specific communications initiatives that could benefit emerging nations: the Health InterNetwork Access to Research Initiative program, which provides free full-text access to medical journals and books in poorer countries; the Global Health Network Supercourse, which provides specially designed online lectures for the developing world; and Internet2/Abilene and similar research networks around the world, which provide reliable, guaranteed bandwidth for high-quality Internet videoconferencing as an alternative to face-to-face lectures and meetings. The intent of many educational ventures in nephrology, particularly in the clinical practice guideline realm (National Kidney Foundation Kidney Disease Outcomes Quality Initiative, Kidney Disease Improving Global Outcomes, and so forth), is not just to disseminate information but to change human behavior: physician practice and referral patterns, patient compliance, and so forth. Concepts from the worlds of marketing and entertainment, where the science of changing human behavior is highly evolved, can be used to create high-impact, educational offerings to promote health. They can also be highly beneficial to share Internet educational innovations and future vision across boundaries of medical specialties, which is part of the intent of the cyberMedicine joint venture (http://www.cyber-medicine.org).

Humans↗
PubMed2006

Limited opportunities for paramedic student endotracheal intubation training in the operating room.

BACKGROUND: Paramedics, who often are the first to provide emergency care to critically ill patients, must be proficient in endotracheal intubation (ETI). Training in the controlled operating room (OR) setting is a common method for learning basic ETI technique. OBJECTIVES: To determine the quantity and nature of OR ETI training currently provided to paramedic students. METHODS: The authors surveyed directors of paramedic training programs accredited by the Commission on Accreditation of Allied Health Education Programs. An anonymous 12-question, structured, closed-response survey instrument was used that requested information regarding the duration and nature of OR training provided to paramedic students. The results were analyzed by using descriptive statistics. RESULTS: From 192 programs, 161 completed surveys were received (response rate, 85%). OR training was used at 156 programs (97%) but generally was limited (median, 17-32 hours per student). Half of the programs provided fewer than 16 OR hours per student. Students attempted a limited number of OR ETI (median, 6-10 ETI). Most respondents (61%) reported competition from other health care students for OR ETI. Other identified hindering factors included the increasing OR use of laryngeal mask airways and physicians' medicolegal concerns. Respondents from 52 (33%) programs reported a recent reduction in OR access, and 56 (36%) programs expected future OR opportunities to decrease. CONCLUSIONS: Despite its key role in airway management education, the quantity and nature of OR ETI training that is available to paramedic students is limited in comparison to that available to other ETI providers.

Emergency Medical Technicians↗
PubMed1989

The weight loss profile: a biopsychosocial approach to weight loss.

Obesity is a common complicating condition in a variety of medical problems. Often effective consultation liaison involves recommendations to overweight patients involving lifestyle and health risk modification. Factors that need to be addressed include exercise, nutritional counseling/caloric restriction, and attitude and behavioral change regarding eating. Patients requiring weight loss typically seek various commercial programs that are readily accessible. One major problem associated with such programs is the high attrition rate within the first six weeks of initiation. Therefore, attempts to facilitate longer-term retention and associated weight loss are warranted. One approach is the identification of factors associated with problems in short-term retention and weight loss followed by the implementation of brief interventions to potentially reverse the influence of these factors on retention and weight loss. The present investigation was conducted to determine the effects of such a strategy on short-term retention and weight loss in a commercial weight loss program. Two groups (n = 66 per group) of female participants with a mean age of thirty-eight years, mean initial weight of 184.6 lbs, mean height of 64.3 inches, mean goal weight of 147.3 lbs, mean Body Mass Index of 31.4 kg/m2 were recruited for the study. Groups were matched for age, initial weight, height, goal weight, and body mass index. One group (controls) received a standard thirteen-week group cognitive-behavioral intervention that emphasized the teaching of self-management strategies for weight reduction. The second group (personalized intervention) received the same thirteen-week cognitive-behavioral intervention. This group also completed a questionnaire (Weight Loss Profile) that identifies factors associated with poor retention and minimal weight loss. Targeted interventions were implemented to modify specific problem areas identified on the Weight Loss Profile. The problem areas were based upon previous research which identified predictors of retention and weight loss. The problem areas included job stress, social comfort, self-consciousness regarding weight and eating behaviors, concern with physical appearance, Type A behavior pattern, social support, motivation, and expectation of success. Both groups also received 1,000 calorie/day prepackaged foods, instruction in mild exercise, and nutritional counseling. Weekly weights and attendance were recorded across the thirteen consecutive week period. The group receiving the personalized intervention lost significantly more weight than the control group (30 lbs vs. 11 lbs, respectively).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2000

[Undergraduate medical education. Students' perspective and medical school policy].

OBJECTIVES: Student attendance to lectures in French medical schools is often poor. We surveyed undergraduate medical students in our medical school, repeating a similar survey conducted ten years earlier. The results are presented with the conclusions of the faculty seminar that followed this survey. METHODS: A closed item questionnaire was distributed in June, 1998, through the hospital wards where the students were posted. After two reminders, the final response rate was 71% (247/348). RESULTS: Overall, 71% of the students declared that they never, or only occasionally, attended lectures in the medical school. Reasons included lack of time (75%), the curriculum diverging from the program of the selective examination that gives access to graduate specialization programs (59%), or insufficient practical clinical content (36%); 46% believed that this teaching prepared them to practice family medicine (11% some specially), and 92% that the way it was organized was not compatible with preparing for the selective examination. On the other hand, 75% of the students in the final two years of the curriculum declared that attending regularly special preparation seminars for the selective examination, to succeed at this test (91%), but also to prepare for family practice (25%). Respectively, 75%, 68% and 66% declared that undergraduate medical courses should, ideally, prepare them for the selective examination, but also for the practice of family medicine, and for graduate medical education. CONCLUSIONS: These results echoed the difficulties of the faculty of the medical school to reconcile preparing students both for their future medical practice and for the selective examination. Two working groups were asked to identify independently appropriate educational objectives according to each perspective: their conclusions appeared to be quite compatible. Based on these conclusions, institutional objectives were ratified to guide the educational policy of our medical school, including the following: to reinforce the consistency and progressiveness of the curriculum; to promote active and autonomous student learning approaches; to develop faculty teaching skills, curriculum evaluation and recognition of teaching activities.

Curriculum↗
PubMed2006

A marketing perspective on disseminating evidence-based approaches to disease prevention and health promotion.

Evidence-based disease prevention practice guidelines can provide a rationale for health programming decisions, which should, in turn, lead to improved public health outcomes. This logic has stimulated the creation of a growing number of evidence-based prevention practice guidelines, including the Guide to Community Preventive Services. Few systematic efforts have been made to document the degree of adoption and implementation of these approaches, although the evidence on translation of research into practice in other health fields indicates that the adoption and implementation rate is low. Drawing on the marketing literature, we suggest three approaches to enhance the adoption and implementation of evidence-based approaches: 1) conducting consumer research with prospective adopters to identify their perspectives on how evidence-based prevention programs can advance their organization's mission, 2) building sustainable distribution channels to promote and deliver evidence-based programs to prospective adopters, and 3) improving access to easily implemented programs that are consistent with evidence-based guidelines. Newly emerging paradigms of prevention research (e.g., RE-AIM) that are more attuned to the needs of the marketplace will likely yield a new generation of evidence-based preventive approaches that can be more effectively disseminated. We suggest that the public health community prioritize the dissemination of evidence-based prevention approaches, because doing so is a potent environmental change strategy for enhancing health.

Evidence-Based Medicine↗
PubMed1997

[The bases and indications for the staged combined treatment of heroin addicts as outpatients].

Combined and staged treatment is a new clinical methodology for the orientation of drug addiction cases within families. This methodology resorts to several techniques in a combined way, such as: family therapy and counselling; the use of psychopharmacology and opioide antagonists; as well as individual and group psycho-therapeutics. These are all linked to a personal psycho-social rehabilitation program. This treatment is based on family accessibility and therapeutic community programs. The authors review different contributions and the evolution of different therapeutic modalities. Finally they propose a list for inductions and another for the formal contra-indications for this kind of treatment.

Ambulatory Care↗