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At least 1,099 records · Page 61Linked to original sources
PubMed1998

Knowledge and attitudes of health-care providers toward cancer pain management: a comparison of physicians, nurses, and pharmacists in the state of New Hampshire.

The knowledge and attitudes toward cancer pain management of physicians, nurses, and pharmacists in the state of New Hampshire were examined through the use of a statewide survey. Many of the providers who completed the survey, and thus indicated that they treated patients with cancer pain on a regular basis, were not pain or oncology specialists. Most of these providers were quite well informed about the fundamentals of cancer pain management. Approximately 90% of providers in all three groups were not concerned about addiction among cancer patients. Yet, there was a small percentage of providers who responded in less than optimal ways to items dealing with opioid pharmacology, pain assessment, and the importance of pain relief. Comparison of responses among provider groups indicated that nurses were the most knowledgeable and pharmacists the least knowledgeable about pain assessment. Physicians were the most knowledgeable regarding opioid pharmacology but seemed the least committed to providing optimal pain relief. Further analysis identified a small group of physicians that included a disproportionately high percentage of family practitioners and surgeons who consistently responded in less than optimal ways to items dealing with the importance of pain relief. The results of this study indicate a continuing need for broad-based educational programs in cancer pain management and for new initiatives focused on practitioners who see relatively few cancer patients and may have difficulty accessing traditional educational programs.

Attitude of Health Personnel↗
PubMed2000

Assistance programs available for medications commonly used in transplant patients.

Pharmaceutical manufacturers have programs available to supply medications to indigent patients at little or no cost. Enrolling needy patients into these programs should increase patient compliance to medications, minimize patient and institution financial burdens, and decrease adverse events associated with medication noncompliance. However, access to assistance programs by patients in need is limited if physicians and other health care providers are unaware of the existence of such programs or not informed of each program's enrollment process. The literature is void of a manuscript describing assistance programs available for commonly prescribed medications used in transplant patients. This article offers a concise summary of medication assistance programs available through the pharmaceutical industry to assist in the procurement of medications that are commonly prescribed for the transplant population, including immunosuppressants, antibacterials, gastrointestinal, cardiovascular, and hypoglycemic agents. This article should be used by health care professionals as a guide to the availability and requirements of medication assistance programs.

Anti-Bacterial Agents↗
PubMed2002

Cancer screening promotion among medically underserved Asian American women: integration of research and practice.

Mammography and Pap smear tests are known to be effective early detection measures for breast and cervical cancers, respectively, but Asian Americans are reluctant to make visits for routine preventive care. Quantitative and qualitative research conducted by the Healthy Asian Americans Project (HAAP) between 1996 and 1999 indicated that Asian residents in southeastern Michigan, like the general Asian population in the US, underutilized early cancer screening programs due to cultural, psychosocial, linguistic, and economic barriers. This article reports how the HAAP's research findings guided the Michigan Breast and Cervical Cancer Control Program (BCCCP) promotion (conducted from 2000 to 2001 among medically underserved Asian women residing in southeastern Michigan), and how evaluation of the HAAP's BCCCP promotion will direct future research and health promotion programs. The article presents strategies used to improve access to cancer screening programs for diverse Asian sub-groups as well as outcomes of the 2-year HAAP's BCCCP promotion among the target population. Discussion regarding lessons and experiences gained from integration of research and practice has implications on design and implementation of the cancer screening promotion for the rapidly increasing Asian American population as well as other medically underserved minority populations in the US.

Adult↗
PubMed1994

The concept of the Second Generation program in the treatment of post-traumatic stress disorder among Vietnam veterans.

The concepts of First and Second Generation treatment programs for Vietnam veterans with post-traumatic stress disorder are presented, based on a developmental theoretical model of adaptation. First Generation programs focus on accessing and then working through the effects of the war trauma and aim to diminish the intensity of core PTSD symptoms. Second Generation programs focus on reintegrating veterans into the social context of family and work, and aim to improve their ability to function in society. Both types of treatment may be required in order to help veterans resume their psychological and social development. The need to develop sophisticated models of comprehensive inpatient treatment in order to support scholarly discourse and outcome research is emphasized.

Adaptation, Psychological↗
PubMedDate not supplied

Is Internet-based support for dyspnea self-management in patients with chronic obstructive pulmonary disease possible? Results of a pilot study.

BACKGROUND: As of 2003, approximately 67% of US adults have Internet access. The purpose of this study was to determine the feasibility and preliminary efficacy of an Internet-based dyspnea self-management program (iDSMP) for people with chronic obstructive pulmonary disease. A related aim was to compare the differential effects of the iDSMP on 2 different groups: (1) to test a "booster" effect and (2) to evaluate the program as a primary intervention. METHODS: Two groups (n = 16) were evaluated at baseline and at 3 months after completing the iDSMP, which included education, exercise, self-monitoring, and support. Dyspnea, self-efficacy, perception of available support, and exercise behavior were measured. Paired, independent t tests and Mann-Whitney U tests were used. RESULTS: Most subjects (87%) reported that the program increased their access to information and resources for managing dyspnea. Dyspnea with activities of daily living and self-efficacy for managing the symptom showed significant improvements (both P < .01), whereas more modest changes were noted in perceived support and exercise behavior in the overall sample. There were no differences between the 2 groups on these outcomes. CONCLUSIONS: The findings suggest that additional investigations of Internet-based interventions to promote self-management in patients with chronic obstructive pulmonary disease are warranted.

Access to Information↗
PubMed1995

[Description of the development of a new model of primary care in the community of Valencia].

OBJECTIVE: The aim of this study was to determine to what extent the new model of primary care (NMPC) had been introduced and developed in the Community of Valencia by means of an assessment of the structure, procedures and results attained by the primary care teams (PCT). DESIGN: An observation study of a crossover type. SETTING: Primary health care. PATIENTS AND OTHER PARTICIPANTS: 70 health centres in the Valencia Community were studied. The criteria for inclusion in the study were that the centre should have been open for at least two years on March 1st 1991 and/or had the accreditation (or had requested it) to teach family and community medicine. MEASUREMENTS AND MAIN RESULTS: 51 indicators were applied. These evaluated the seven fundamental attributes which make up the theoretical model: accessibility, integrated care, programmed performance, ongoing care, team work, community involvement and research and teaching. Of these seven primary care attributes, the highest valued were geographical accessibility and ongoing care; and those which needed to be strengthened, non-geographical accessibility and integrated care. CONCLUSIONS: The analysis of the results obtained makes us reflect on the model of primary care which can be developed in our environment, with peoples' real needs and the resources available being borne in mind.

Cross-Over Studies↗
PubMed1992

An evaluation of substance misuse treatment providers used by an employee assistance program.

Structural measures of access, continuity, and quality of substance misuse treatment services were compared in 30 fee-for-service (FFS) facilities and nine health maintenance organizations (HMOs). Probit models related effects of the provider system (FFS or HMO) and the system's structural characteristics to 243 employees' access to and outcomes from treatment. Access was decreased in Independent Practice Association (IPA)/network HMOs and in all facilities which did not employ an addictionologist or provide coordinated treatment services. When bivariate correlations were examined, both use of copayments and imposing limits to the levels of treatment covered were negatively related to access, while a facility's provision of ongoing professional development was positively associated with access. These correlations did not remain significant in the multivariate probits. Receiving treatment in a staff model HMO and facing limits to the levels of treatment covered were negatively associated with attaining sufficient progress, while receiving treatment in a facility which provided ongoing professional development was positively related to progress: these effects did not remain significant in multivariate analyses. Implications for employee assistance program (EAP) staff in their role as case managers and for EAP staff and employers in their shared role as purchasers of treatment are discussed.

Adult↗
PubMed1986

State Data Centers: improving access to census information.

"The U.S. Bureau of the Census created the State Data Center program in 1978 to improve public access to census information. This article discusses the background, structure, and services of that program; the role of libraries in the program; and future directions in State Data Center/library relationships. The appendix lists contact person names, as well as addresses and telephone numbers for State Data Center lead agencies."

Americas↗
PubMedDate not supplied

A Windows software package to record from voltage-clamped Xenopus oocytes.

We have written a software package to record, display and analyze membrane currents elicited by neurotransmitter receptors or voltage-activated channels in voltage-clamped Xenopus oocytes. This suite, which consists of 4 applications, runs on IBM-PC compatible microcomputers under Windows 3.1. The recording programs use Direct Memory Access (DMA) to access the analog-digital board. The first program, NicPulse, is aimed at studying voltage-activated channels. It delivers voltage steps to the voltage-clamp and records the resulting membrane current. The second program, NicScope, emulates a dual-trace digital oscilloscope. It operates either in continuous or triggered mode, and is used chiefly to display neurotransmitter-induced responses in oocytes. The third recording program, VRamp, automatically determines the voltage-current relationship of drug-activated responses (I/V curve), by applying a voltage ramp and recording the subsequent clamping current. The last program, NicView, is designed to analyze records taken with NicScope and NicPulse. The present paper will discuss several issues regarding the design of these programs, and will give a brief description of each application.

Animals↗
PubMed1998

Treatment-seeking patterns of chronic recidivists.

Many substance abusers return to substance abuse treatment. This article uses the life-history interview method to explore why chronic substance abuse recidivists, from their perspective, repeatedly access substance abuse treatment programs. This approach reveals that their intentions for accessing treatment are not based on abstinence but rather in response to other, more immediate needs. Therefore, relapsing and returning to treatment is normative for chronic recidivists and patterned by their differential social and institutional associations.

Adult↗
PubMed1999

Preventable hospitalization and avoidable maternity outcomes: implications for access to health services for Medicaid recipients.

This study demonstrates how readily available hospital discharge data and small area methods can be used to identify potential problems of access to primary and prenatal outpatient health services for Medicaid populations. We examine whether rates of preventable hospitalization and avoidable maternity outcomes differ across geographic areas by their concentration of Medicaid recipients. Five county and twenty-four intra-county areas in Upstate New York are examined. Individuals living in Medicaid intra-county areas had significantly higher rates of these hospitalizations than persons living in non-Medicaid areas. Public health managers can use these methods to identify and compare areas in which access problems exist and to target and evaluate programs designed to improve access.

Adolescent↗
PubMed1999

Impact of improved diagnosis and treatment on prevalence of gonorrhoea and chlamydial infection in remote aboriginal communities on Anangu Pitjantjatjara Lands.

OBJECTIVE: To evaluate the impact of a program to improve access to, and delivery of, diagnosis and treatment on prevalence of gonorrhoea and chlamydial infection in remote Aboriginal communities. DESIGN: Analysis of cross-sectional data from annual age-based screening. SETTING: Six remote Aboriginal communities and three homelands on the Anangu Pitjantjatjara Lands in the far north-west of South Australia, 1996-1998. PARTICIPANTS: All Aboriginal people aged 12-40 years listed on the Nganampa Health Council population register as resident on the Anangu Pitjantjatjara Lands. MAIN OUTCOME MEASURES: Prevalence of gonorrhoea and chlamydial infection, determined by urine polymerase chain reaction tests. RESULTS: The prevalence of gonorrhoea in people aged 12-40 years almost halved, from 14.3% in 1996 to 7.7% in 1998 (test for trend: P < 0.001). The fall in prevalence of gonorrhoea was comparable and statistically significant in both men and women. Prevalence of chlamydial infection also fell, from 8.8% in men and 9.1% in women in 1996 to 7.2% in both men and women in 1998, but this decline was not statistically significant (test for trend: P = 0.174). CONCLUSION: This study documents a rapid reduction in prevalence of gonorrhoea, probably reflecting reduced duration of infectiousness due to advances in diagnosis, increased testing activity and reduced interval to treatment rather than behaviour change. These results demonstrate that, in remote communities, even with a highly mobile population, it is possible to implement effective control activities for sexually transmitted diseases.

Adolescent↗
PubMed1997

A monumental task.

President Clinton is hoping to secure a place in history by balancing the federal budget, a prospect that has many in the healthcare industry worried. With Medicare and Medicaid eating up major portions of federal spending, any move to trim the deficit will require painful cuts in provider payments. And funds for programs like children's access to healthcare are likely to be scarce.

Budgets↗
PubMed2003

Nonstigmatizing ways to engage HIV-positive African-American teens in mental health and support services: a commentary.

This commentary illustrates a hospital/adolescent-clinic based model for providing support services and for increasing medical adherence among HIV positive inner city African-American adolescents. This commentary reviews the racial/ethnic disparities in HIV disease among adolescents and describes a successful program model for overcoming stigma. Traditional support groups were rejected by youth with HIV/AIDS. Seven elements common to successful programs were identified. Successful programs built on designs described in the research literature. Focus groups composed of HIV-positive adolescents identified what they wanted and needed. Stigmatizing labels were avoided in naming programs. Practical barriers to access, such as transportation and childcare, were eliminated. Programs were skills oriented, culturally sensitive, and life affirming, focusing on healthy living. HIV-positive inner city African-American youth can be successfully recruited and engaged in hospital based programs. Although these programs were qualitatively evaluated by youth as successful and attrition was low and attendance averaged 50%, rigorous quantitative research is needed to evaluate the effectiveness of such programs. We need quantitative research to successfully advocate for government funding. Stigma needs to be addressed openly in public health. Future research is needed to evaluate interventions to overcome the health consequences of stigma on utilization of available medical and mental health services.

Adolescent↗
PubMed1993

Realistic outcomes: lessons from community-based research and demonstration programs for the prevention of cardiovascular diseases.

Public health departments nation-wide are implementing community-based cardiovascular disease (CVD) prevention programs. Many such programs are turning for guidance to three research and demonstration projects: the Stanford Five City Project, the Pawtucket Heart Health Program, and the Minnesota Heart Health Program. This article summarizes some of the lessons learned in these projects and recommends strategies for the new generation of CVD prevention programs. The core of a successful program is the community organization process. This involves identification and activation of key community leaders, stimulation of citizens and organizations to volunteer time and offer resources to CVD prevention, and the promotion of prevention as a community theme. A wide range of intervention settings are available for health promotion. As is true for the workplace, places of worship are receptive to health promotion programs and have access to large numbers of people. Mass media are effective when used in conjunction with complementary messages delivered through other channels, such as school programs, adult education programs, and self-help programs. Community health professionals play a vital role in providing program endorsement and stimulating the participation of other community leaders. School-based programs promote long-term behavior change and reach beyond the school to actively involve parents. Innovative health promotion contests have widespread appeal and promote participation in other community interventions. In the area of evaluation, health program participation rates are appropriate primary outcome measures in most community-oriented prevention programs. Other program evaluation priorities include community analysis and formative evaluation, providing data to fine-tune interventions and define the needs and preferences of the community. It is premature to comment conclusively on the effectiveness of community-based CVD prevention programs in reducing population risk factor levels. However, it has been demonstrated that a broad range of intervention strategies can favorably modify the health behaviors of specific groups in communities such as employees and school children.

Cardiovascular Diseases↗
PubMed1993

Characteristics of completed suicides: implications of differences among methods.

Approximately 30% of suicides in New York City are the result of jumping from a height. After describing jumping suicides and jumping sites, we used polychotomous logistic regression to compare the characteristics of suicides by jumping to those of individuals committing suicide by hanging, ingestion, or shooting. Method used was significantly associated with sociodemographics, occupation, and mental health status, even after adjustment for individual access to the means of committing suicide. Our finding of an independent association between personal characteristics and method used provides strong evidence for the hypothesis that controlling access to an agent of suicide can influence overall suicide rates, at least in the short term. Study results support the introduction of preventive programs to control access to commonly employed agents of suicide.

Adolescent↗
PubMedDate not supplied

Internet-based asthma education - a novel approach to compliance: a case report.

Asthma costs Canadians over 1.2 billion dollars per annum and, despite advances, many asthmatic patients still have poor control. An action plan, symptom diary and measurement of peak expiratory flow have been shown to improve clinical outcomes. Effective educational interventions are an important component of good care. However, many rural sites lack not only access to education but physician care as well. It is reasonable, therefore, that an Internet-based asthma management program may be used as an approach. In the present case report, a novel approach that may increase access in these poorly serviced areas is presented. In an Internet-based asthma management program, patients are reviewed by a physician, receive education and are given a unique password that provides program access. Patients record symptoms and peak expiratory flow rates. The present case report shows that a patient can be assisted through an exacerbation, thus averting emergency intervention and stabilizing control, even when travelling on another continent.

Aged↗
PubMedDate not supplied

The personal digital assistant, a new medical instrument for the exchange of clinical information at the point of care.

Personal digital assistants can provide a portable, integrated platform for point-of-care clinical reference, patient management and data communication. Clinical reference programs allow the user to access information from the Internet and guidelines. Patient management programs allow doctors to access and store clinical information. Wireless technologies have potential for rapid exchange of clinical laboratory results and efficient "electronic patient handovers". Thus, these devices provide the potential for true continuity of care across the healthcare system.

Communication↗