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PubMed1985

Job satisfaction, prestige, and the aftercare clinician.

Few would disagree that programs designed to assist deinstitutionalized mental-health patients have been seen as the step-children of community mental health. Many community mental-health programs were built quickly to rise to the challenge of the flood emerging from the hospitals. Unfortunately, this resulted in programs being poorly defined and reactive rather than responsive in nature. One of the issues that emerges as crucial is the status afforded to the aftercare clinician by other mental-health professionals. Personal experiences shared by community mental-health personnel suggest that clinicians who work with aftercare patients or who work in aftercare settings are attributed less prestige than their outpatient counterparts. The authors review the pertinent literature and reveal the results of a survey suggesting that aftercare clinicians view themselves as expert, but the rest of the system does not, leading to the inconsistent status profile. The problem then emerges that the aftercare clinician must "market" his or her expertise and specialized skills so that other clinicians recognize the unique therapeutic contribution of aftercare. The authors offer recommendations.

Aftercare↗
PubMed2003

[The quality of medication orders--can it be improved?].

Medication errors are a common cause of morbidity and mortality among patients. Medication administration in hospitals is a complicated procedure with the possibility of error at each step. Errors are most commonly found at the prescription and transcription stages, although it is known that most errors can easily be avoided through strict adherence to standardized procedure guidelines. In examination of medication errors reported in the hospital in the year 2000, we found that 38% reported to have resulted from transcription errors. In the year 2001, the hospital initiated a program designed to identify faulty process of orders in an effort to improve the quality and effectiveness of the medication administration process. As part of this program, it was decided to check and evaluate the quality of the written doctor's orders and the transcription of those orders to the nursing cadre, in various hospital units. The study was conducted using a questionnaire which checked compliance to hospital standards with regard to the medication administration process, as applied to 6 units over the course of 8 weeks. Results of the survey showed poor compliance to guidelines on the part of doctors and nurses. Only 18% of doctors' orders in the study and 37% of the nurses' transcriptions were written according to standards. The Emergency Department showed an even lower compliance with only 3% of doctors' orders and 25% of nurses' transcriptions complying to standards. As a result of this study, it was decided to initiate an intensive in-service teaching course to refresh the staff's knowledge of medication administration guidelines. In the future it is recommended that hand-written orders be replaced by computerized orders in an effort to limit the chance of error.

Drug Prescriptions↗
PubMed2004

[Infection with Chlamydophila pneumoniae as a cause of female infertility of tubal origin?].

OBJECTIVE: A contribution to the role of Chlamydophila pneumoniae in women from the IVF program. DESIGN: A serological study proving the antibodies against the antigens of Chlamydophila pneumoniae (C. pneumoniae) and Chlamydia trachomatis (C. trachomatis) in women from the IVF program suffering from different factor of infertility. SETTING: Veterinary Research Institute, Brno. METHODS: The complement fixation test with chlamydial antigen and ELISA tests proving IgA and IgG antibodies against genus-specific antigen (cLPS) and species-specific chlamydial major outer membrane protein (cMOMP) of C. trachomatis and C. pneumoniae in the blood serum of 32 females being in the fertilization program due the tubal factor infertility have been estimated and the results compared with those obtained in 26 females being in the fertilization program due the ovarian factor and in 42 female with andrological factor, respectively. RESULTS: The frequency of positive complement fixation test proved in the group of women with tubal factor infertility was significantly higher than in the groups with ovarial and andrological factor, respectively. The number of the strongly positive reactions (with high titres) in the group with tubal factor infertility was higher than in two remaining groups. The occurrence of species-specific IgG antibodies (anti-C. trachomatis) and chlamydia genus-specific IgA antibodies proved by means of ELISA in the group with tubal factor was statistically more frequent. The difference of the species-specific anti-C. pneumoniae antibodies in all three groups examined was not significant. The simultaneous occurrence of species-specific antibodies against anti-C. pneumoniae and C. trachomatis in the group with tubal factor was higher than in other groups (in comparing with the group with andrological factor statistically significant). CONCLUSION: The opinion of the authors being in agreement with the view of most specialists is that the most important agent in the pathogenesis of tubal factor fertility is C. trachomatis. C. pneumoniae is above all a respiratory pathogen with a high prevalence and its impact for fertility disorders may be in the synergismus with C. trachomatis. The serological examination of both chlamydial infections should be a standard part of diagnostic algorithm.

Adolescent↗
PubMedDate not supplied

Influenza vaccination of healthcare workers: institutional strategies for improving rates.

The nosocomial transmission of influenza has been well documented since the 1970s with both direct and indirect effects of outbreaks in healthcare settings. Outbreaks can directly increase morbidity among patients and residents of long-term care facilities. Indirect effects include disruption of normal operations of healthcare institutions, shortages of healthcare workers (HCWs), fewer elective admissions, and income loss due to absenteeism. Influenza vaccination of United States HCWs remains below 40% despite the availability of a safe, effective vaccine and a long-standing recommendation for vaccination of HCWs. New strategies to improve the rate of influenza vaccination among HCWs are needed as the percentage of those receiving yearly vaccination has changed little in the past 20 years. Increasing HCW influenza vaccination coverage calls for a paradigm shift, institutions should view vaccination of HCWs as a crucial part of a comprehensive infection control program designed to protect patients and staff. Administrators of hospitals, long-term care facilities, and other health agencies should respond to this challenge by developing programs to improve yearly influenza vaccination of their staff Such efforts would put these employees into compliance with national recommendations and also benefit the institution by reducing absenteeism, nosocomial influenza transmission, and the associated economic losses and disruption of routine operations.

Cross Infection↗
PubMed2005

Education for life: the evaluation of an innovative approach to facilitate ongoing learning for nurses.

There is general consensus within the nursing profession that life-long learning is crucial for all nurses irrespective of their educational backgrounds. There currently is a paucity of literature addressing both the problems experienced in accessing and utilising continuing education or innovative programs designed to overcome these problems, despite widespread acknowledgement of the problems encountered. In this paper the findings from the evaluation of the Clinician-Trainer Program, developed by the Centre for Psychiatric Nursing Research and Practice (CPNRP) are presented. This includes an evaluation of the course itself and of its impact on clinical practice. The findings suggest a high level of satisfaction with the course, but more importantly, it appears to be assisting trained clinicians to deliver professional development sessions within their workplace.

Consumer Behavior↗
PubMed1979

Resource for managing sleep disorders.

To enhance physicians' knowledge of the prevalent problem of sleep disorders, a 50-minute videotape program designed as a learning and self-assessment experience in evaluating and treating these disorders was coproduced with the Network for Continuing Medical Education. The program has been presented nationally to about 25,000 medical professionals. The mean correct score was 50% for the pretest, 69% for the instructional section, and 79% for the posttest; the composite score on the posttest was 59% higher than that on the pretest. Physicians' responses indicated strengths and weaknesses in their knowledge of sleep disorders, thus delineating future directions for medical education in insomnia, narcolepsy/cataplexy, nightmares, night terrors, sleepwalking, and enuresis. All of these sleep disorders can be best evaluated and treated by the general physician.

Audiovisual Aids↗
PubMed2005

The Breathmobile Program: structure, implementation, and evolution of a large-scale, urban, pediatric asthma disease management program.

Despite more than a decade of education and research-oriented intervention programs, inner city children with asthma continue to engage in episodic "rescue" patterns of healthcare and experience a disproportionate level of morbidity. The aim of this study was to establish and evaluate a sustainable community-wide pediatric asthma disease management program designed to shift inner city children in Los Angeles from acute episodic care to regular preventive care in accordance with national standards. In 1995 the Southern California Chapter of the Asthma and Allergy Foundation of America (AAFA), the Los Angeles County Department of Health Services (LAC DHS), and the Los Angeles Unified School District (LAUSD) established an agreement to initiate and sustain the Breathmobile Program. This program includes automated case identification, mobile school-based clinics, and highly structured clinical encounters supported by an advanced information technology solution. Interdisciplinary teams of asthma care specialists provide regular and ongoing care to children at school and county clinic sites over a wide geographic area of urban Los Angeles. Each team operates in a specially equipped mobile clinic (Breathmobile), efficiently moving a structured healthcare process to school and county clinic sites with large numbers of children. Demographic, clinical, and participation data is tracked carefully in an electronic medical record system. Program operations, clinical oversight, and patient tracking are centralized at a care coordination center. Clinical operations and methods have been replicated in fixed specialty clinic sites at the Los Angeles County + University of Southern California Medical Center. Clinical and process measures are regularly evaluated to assure quality, plan iterative improvement, and support evidence-based care. Four Breathmobiles deliver ongoing care at more than 90 school sites. The program has engaged over five thousand patients and their families in a continuity care model that has demonstrated efficacy over usual episodic care. More than 90% of patients in all asthma severity categories achieved clinical control of asthma with significant reductions in inpatient (IP) and emergency department (ED) use. On February 14, 2002, the program became the first program in the United States to receive the award of disease-specific care certification by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Proper design and resource allocation can sustain a school-based community-wide pediatric asthma disease management program and shift a population of inner city children from acute episodic care to routine preventive care in accordance with national standards. An evidence-based approach to evaluating and maintaining quality, coupled with stratified care delivery, can assure the efficient use of safety net healthcare resources.

Adolescent↗
PubMedDate not supplied

Selective primary health care: strategies for control of disease in the developing world. XXI. Acute respiratory infections.

Acute respiratory infections represent an important cause of mortality in developing countries, especially among malnourished infants. The microbial etiologies are numerous and complex. Since vaccines effective against the likely major pathogens in the youngest children are not available, the acute respiratory infection control programs designed by the World Health Organization are based on simple schemes to classify illness according to severity and to treat bacterial infections early, thus preventing severe complications. These programs require careful planning to anticipate and circumvent local problems, and their efficacy should be monitored with care. In addition, research is needed in many areas: definition of the spectrum of organisms involved and the pathogenesis of severe infection; delineation of markers that will accurately identify patients needing antibiotics or hospitalization; performance of controlled trials of intervention strategies that will unequivocally identify effective methods; design and production of new, simple, and inexpensive diagnostic tools; and development of vaccines that will be effective in the target populations.

Adolescent↗
PubMed2003

CELT: a computerised evaluative learning tool for continuing professional development.

OBJECTIVES: To evaluate a computerised, evaluative learning tool (CELT) designed to encourage self-directed learning and help users make changes in practice following learning. The study aimed to evaluate how CELT was used and to ascertain user perceptions of the program. DESIGN: Qualitative analysis of interviews and quantitative analysis of entries made using the software. SETTING AND SUBJECTS: West of Scotland region, comprising six Health Board areas with a total of 2176 general practitioners (GPs), 39 of whom took part in the study. RESULTS: Of the 39 GPs who started on the project, 34 used CELT. Of these 34, 28 GPs sent in files and six did not. Of the 28 GPs who sent in files, 25 entered data and 76% (22/29) considered the program easy to use. The program was used 7 days a week during the day and night. It raised participants' awareness of the educational value of everyday experiences and led to increased thought about learning. In 41% (45/111) of entries there was evidence that some action had been initiated by users as a result of learning. CONCLUSIONS: CELT was designed to encourage self-directed learning and help users make changes in practice following learning. The study has shown that it can be used to deliver individual continuing professional development. It encourages a disciplined approach to learning, promotes thought about learning needs and increases the ability of GPs to learn from everyday experiences. In some instances, users were able to apply what had been learned.

Adult↗
PubMedDate not supplied

Designing and testing telehealth interventions to improve outcomes for cardiovascular patients.

This article presents considerations for the design and testing of electronic interventions to improve recovery outcomes in cardiac patients. A brief description of the design and testing of 2 telehealth interventions for cardiac patients is provided: HeartCare and E-CHANGE. The HeartCare project was a randomized trial of a home support program for patients after coronary artery bypass graft surgery. E-CHANGE is an Internet-based home support program designed to increase lifestyle exercise after a cardiac event. Lessons learned from these 2 projects regarding design considerations, system use, effectiveness, and research challenges are discussed. Methods to promote the preservation of nursing values in electronic systems are described, as well nursing roles in the use of computer-assisted care.

Coronary Artery Bypass↗
PubMed1989

Therapy: state-of-the-art assessment of quality. The National Cancer Institute perspective.

The National Cancer Institute (NCI) has a broad spectrum of responsibilities that range from support of basic laboratory research to the clinical testing of new therapeutics and, finally, the dissemination of results of this research to the practicing physician and the public. The reduction of cancer mortality is largely dependent on the responsibility for widespread application of state-of-the-art cancer treatments. A major cancer control focus of the NCI over the last decade has been the development and implementation of programs designed to improve awareness, access and application of state-of-the-art cancer treatment. In addition to the computerized Physician Data Query system, three targeted programs, the Cooperative Group Outreach Program (CGOP), the Community Hospital Oncology Program (CHOP), and the Community Clinical Oncology Program (CCOP) have all been aimed at establishing mechanisms to facilitate the transfer of new patient care technology; and, thereby, provide the highest quality cancer treatment in the community setting. An evaluation was conducted to determine if patterns and outcomes of cancer care management changed over time, and whether this could be related to the presence of CGOP, CHOP, and CCOP. Measurement of required program implementation was relatively straightforward. However, measurement of resultant changes in "quality of care" and the factors that influence physician performance are complex and controversial. Critical elements in the treatment of breast, colon, rectum, and small cell lung cancer were used as tracers to measure changes in the patterns of care in communities where programs were implemented. Results from this study highlight issues in state-of-the-art assessment of quality, such as the difficulty in defining quality cancer care, relationships between process and outcome indicators, and the problems of documentation and missing data. Assurance of quality cancer care requires the interaction of health care professionals with knowledge of the most up-to-date cancer research results working in a health care delivery system that encourages and rewards application of these results.

Clinical Trials as Topic↗
PubMed2001

Modification of eating attitudes and behavior in adolescent girls: A controlled study.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a school-based eating disorder prevention program designed to reduce dietary restraint and concern about shape and weight among adolescent girls. METHOD: A total of 474 girls aged 13-14 years received the program as part of their normal school curriculum. An assessment-only control group included 386 pupils. Measures of eating disorder features, self-esteem, and knowledge were administered before and after the intervention and at 6-month follow-up. RESULTS: Immediately following the intervention, there was a small reduction in dietary restraint and attitudes to shape and weight in the index group, whereas there was no change in the control group. This reduction was not maintained at 6-month follow-up although the dietary restraint scores of the index group remained lower than those of the control group. DISCUSSION: This prevention program achieved change in eating attitudes and behavior, although the change was modest in size and not sustained. Focusing on a high-risk subgroup of dieters might be a more fruitful primary prevention strategy.

Adolescent↗
PubMed1986

Computerized model for evaluating the kinetics of in vitro release of valpromide from controlled-release tablets under nonsink conditions.

A general mathematical model was developed to describe a dissolution system for tablets that have undergone attrition and maintained their geometric shape as concentration changed, i.e., starting with sink and ending with nonsink conditions. A computer program, designed for the microcomputer, was used to test the goodness of fit of the experimental data to the theoretical data by the chi 2 test. This program is more significant than a previous published program that relates to the more specific kinetic analysis of multidispersed powders undergoing dissolution under sink conditions. Concentration data obtained after dissolution tests of valpromide (2-propylvaleramide) controlled-release tablets performed under changing concentration conditions were checked in the two computerized models, which showed a better fit to the general model.

Biotransformation↗
PubMed1980

Software development for the management of cephalometric radiographic data.

This paper presents the details and logic of a set of three IBM System 370 Assembler Language programs designed to manage a data bank, of ever increasing magnitude, which contains coordinate data obtained from cephalometric radiographs. The data from the radiographs, and consequently, the programs, are primarily intended for use by the orthodontist who is engaged in clinical research, and are especially useful in studies related to changes within the facial and dental complexes which occur as a result of growth and orthodontic treatment.

Cephalometry↗
PubMedDate not supplied

Qualitative study of spirituality in a weight loss program: contribution to self-efficacy and locus of control.

OBJECTIVE: The purpose of this qualitative study was to examine how spirituality affects intrapersonal characteristics associated with a weight loss program. DESIGN: A series of 5 focus group interviews was conducted with women who were past participants of the Weigh Down Workshop, a spiritually based weight loss program. SETTING: Three churches in the Minneapolis/St. Paul, Minnesota, metropolitan area. PARTICIPANTS: Focus group participants (N = 32) were white, fairly well educated, with moderate income levels. Their mean age was 50 years. PHENOMENA OF INTEREST: Behavior changes, factors affecting self-efficacy for performing the behaviors, and locus of control. ANALYSIS: Sessions were audiotaped and transcribed. Transcribed text was coded and analyzed using qualitative data analysis procedures. RESULTS: Major changes in self-reported eating behaviors included eating only when experiencing true physiological hunger and stopping when sensing a feeling of fullness. Self-efficacy for these behaviors was reported to be enhanced by observing weight loss for themselves or others. Support from other group members, the simplicity of the program, and spiritual benefits through prayer and scripture reading were also reported to enhance confidence. Women indicated that they relied on an internal locus of control based on a sense of self-discipline. CONCLUSIONS AND IMPLICATIONS: Traditional means to enhance self-efficacy were important for all women; however, for some women, spirituality was also an important aspect of adhering to program principles.

Adult↗
PubMed2003

Bringing assisted living services into congregate housing: residents' perspectives.

PURPOSE: Bringing state-subsidized assisted living services (ALS) into congregate housing (CH) is a strategy for reducing rates of nursing home placement. This article discusses CH residents' reactions as a new ALS program was introduced in their housing, and it provides recommendations for others who are considering the implementation of similar programs. DESIGN AND METHODS: Focus groups and face-to-face interviews with residents in a CH facility explored their experiences over time with the new ALS program. Residents were interviewed before the program was initiated and 6 months later as a way to better understand their knowledge of and feelings about the program. RESULTS: A qualitative analysis of the interview data revealed several patterns of complex attitudes and emotions linked to the program. Although the overwhelming majority of residents endorsed the program as a way to avoid nursing home placement, few understood the features of the program (e.g., cost and eligibility requirements). ALS participants' accounts of services suggested the presence of a highly "medicalized" approach. IMPLICATIONS: When new community-based models are implemented for elders, policy makers need to evaluate how these programs affect quality of life. Further, program guidelines for bringing ALS into existing housing have to address how the program complements the home-like nature of the housing.

Aged↗
PubMed2006

Data withholding and the next generation of scientists: results of a national survey.

PURPOSE: To provide the first national data on the nature, extent, and consequences of withholding among life science trainees. METHOD: In 2003, the authors surveyed 1,077 second-year doctoral students and postdoctoral fellows in life sciences at 50 U.S. universities, with a comparison group of trainees in computer science and chemical engineering. The study variables examined trainees' exposure to and the consequences of data withholding. RESULTS: Two hundred forty-six trainees (23.0%) reported that they had asked for and been denied access to information, data, materials, or programming associated with published research and 221 (20.6%) to unpublished research. Eighty-five trainees (7.9%) reported that they had denied another academic scientist's request(s) related to their own published research. Five hundred thirty-three trainees (50.8%) reported that withholding had had a negative effect on the progress of their research, 508 (48.5%) on the rate of discovery in their lab/research group, 472 (45.0%) on the quality of their relationships with academic scientists, 346 (33.0%) on the quality of their education, and 299 (28.5%) on the level of communication in their lab/research group. Trainees denied access to research were significantly more likely to report that data withholding had had a negative effect on several aspects of the educational experience. CONCLUSIONS: Data withholding had demonstrated negative effects on trainees. The life sciences, more so than chemical engineering or computer science, will have to address this issue among its trainees. Failure to do so could result in delayed research, inefficient training, and a culture of withholding among future life scientists.

Access to Information↗
PubMed1995

Evaluation of a nurse-based hypertension management program: screening, management, and outcomes.

This article reports the experience of patients with elevated blood pressure scheduled to be seen in a nurse-based hypertension management program in a large multispecialty group practice. The hypertension management program is a screening and follow-up program designed to improve the measurement and management of patients' blood pressure with standardized protocols. The cohort for this study of the effectiveness of the hypertension management program consisted of 200 patients with elevated blood pressure (140 referred directly for management and counseling, 60 entered through screening). At entry, only 17% of the patients had blood pressure within controlled limits (< 140/90 mm Hg). One year after entry in the management phase of the program, systolic pressure had decreased an average of 6.20 mm Hg (P < 0.01), and 44% of patients had blood pressure within controlled limits (P < 0.001). These results suggest that the use of standardized screening techniques using multiple measurements helps to ensure that patients will not be unnecessarily treated. Furthermore, patients who entered the program successfully lowered their blood pressure and maintained the reduction over time.

Blood Pressure↗