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PubMed2000

Creating a hospital-based nursing research fellowship program for staff nurses.

Staff nurses are expected to participate in nursing research and to use study findings. Insufficient institutional support and uncertainties about how to participate in the research process can prevent staff nurses from meeting these expectations. We describe a newly developed nursing research fellowship program designed for staff nurses who practice in an acute care setting. An overview of the entire curriculum and the outcomes of the first year of the program are described.

Curriculum↗

PubMed1986

Populations, practices, and problems in forensic psychiatric facilities.

This is a study of the public facilities to which mentally disordered offenders are committed or transferred so that they may be securely confined while simultaneously participating in programs designed for treatment of their mental disorders. The study focuses principally on the nature and characteristics of these facilities: their patient populations, staff, security conditions, treatment programs, and operational programs. We identified and surveyed 231 facilities. The information from the survey, legal research, and site visits to 11 programs has been integrated and used to address four major issues: the types of facilities mentally disordered offenders are institutionalized in for treatment of their mental disorders; the legal, diagnostic, and demographic characteristics of the residents of these facilities; the forms of treatment and levels of staffing available in these facilities; and the common problems faced by facility administrators with respect to facility management, treatment, and release decisions.

Adolescent↗

PubMed1997

Developing capacities of youth as lay health advisors: a case study with high school students.

Youth lay health advising, a form of support or helping, is an important potential resource for preventive intervention. This article describes a case study of a youth lay health advising program designed to provide high school students with support and guidance to handle challenges and concerns related to their health and quality of life. First, the planning, program development, and implementation of the approach are described. Second, a rapid formative evaluation presents quantitative and qualitative information on adolescent issues faced, the types and content of interactions, and peer helper satisfaction with the program. Third, the strengths and challenges of the peer helping program and the role of youth as lay health advisors are discussed. The article concludes with a discussion of the implications for practitioners on this approach to building the capacity of adolescents as lay advisors for community health.

Adolescent↗

PubMed2006

Weight management program for treatment-emergent weight gain in olanzapine-treated patients with schizophrenia or schizoaffective disorder: A 12-week randomized controlled clinical trial.

BACKGROUND: The main objective was to assess the efficacy of a weight management program designed for outpatients taking olanzapine for schizophrenia or schizoaffective disorder and to compare these patients with a randomized control group. The effects of the weight management program were also assessed with regard to safety and quality of life. METHOD: Forty-eight patients were enrolled in a 12-week, randomized, multicenter weight management study. Thirty-three patients were randomly allocated to an intervention group in which they received olanzapine within a weight management program. Fifteen patients were allocated to a control group in which they were given olanzapine treatment as usual outpatients. Weight, body mass index (BMI), and measurements of safety and quality of life were evaluated. The study was conducted from January 7, 2003, to September 16, 2003. RESULTS: Thirty-six patients (75%) completed this study. We found significant differences in weight (-3.94 +/- 3.63 kg vs. -1.48 +/- 1.88 kg, p = .006) and BMI (-1.50 +/- 1.34 vs. -0.59 +/- 0.73, p = .007) change from baseline to endpoint between the intervention and control groups, respectively. Significant differences in weight reduction were initially observed at week 8 (p = .040). No significant differences were found with regard to the safety outcomes. When the ratio of low-density lipoproteins to high-density lipoproteins was calculated, change from baseline was greater in the intervention group than the control group (-0.19 vs. -0.04), but the difference was not statistically significant (p = .556). After the completion of the weight management program, there was a trend toward statistical difference in the physical health score changes between the weight management and control groups (1.12 in the intervention group vs. -0.93 in the control group, p = .067). CONCLUSION: The weight management program was effective in terms of weight reduction in patients with schizophrenia or schizoaffective disorder taking olanzapine and was also found to be safe in terms of psychiatric symptoms, vital signs, and laboratory data. In addition, such a weight management program might improve quality of life in patients with schizophrenia or schizoaffective disorder with respect to their physical well-being.

Adult↗

PubMed1987

A bridge over troubled waters: an innovative day-treatment program for older adolescents.

An innovative day-treatment program designed to reduce the likelihood that severely disturbed, older adolescents will become chronically ill young adults is described and clinical vignettes are presented which illustrate the program's effectiveness in facilitating educational achievement and enhanced social functioning among patients with significant histories of hospitalization and substance abuse.

Adolescent↗

PubMed2003

Increasing compliance with stretch breaks in computer users through reminder software.

In order for a repetitive strain injury (RSI) prevention program to be effective, it is important to implement strategies to maintain a client's compliance with the program. This quantitative study explored the effectiveness of computer reminder software in increasing compliance with a stretching program designed to prevent RSI associated with prolonged computer use. Data were collected from a convenience sample of 26 participants who were instructed in a preventative stretching program and assigned to either a treatment group with the computer reminder software, or a control group without the software. To measure compliance, all participants recorded the number of times per day they stretched. Although a statistically significant difference was not found in the mean number of stretch breaks taken by the two groups (p = 0.09), further analysis suggested a type II error may have occurred. The effect size, d, revealed a large effect suggesting that the computer software had an impact on the frequency of stretch breaks, with the mean number of breaks per hour of work greater for the treatment group. Results strongly suggest that further research is warranted in this area.

Adult↗

PubMed2004

OPENWIDE: an innovative oral health program for non-dental health and human services providers.

Emerging awareness of the nature and severity of oral diseases and disorders and their serious impact on overall health and well-being, combined with a nationwide crisis in access to oral health care for populations with the most and worst disease, makes it imperative that non-dental health and childcare professionals engage more fully in oral health promotion and disease prevention. OPENWIDE is a comprehensive training program designed to help achieve this goal. The Connecticut Department of Public Health has trained more than 2,000 individuals during the first year of the OPENWIDE program. This article reports on successes and impediments to training and implementation encountered in the early stages of OPENWIDE and makes recommendations to improve the curriculum and its delivery to families and children.

Caregivers↗

PubMed1980

"Guardians of the patient's pocketbook".

Underway in Virginia is a cost-conscious program designed by Blue Shield to discourage the use of inhospital procedures deemed by national specialty societies to be relatively ineffective or outmoded. The author describes the program and its early influence.

Blue Cross Blue Shield Insurance Plans↗

PubMed1996

A quality improvement project to increase the use of postmenopausal hormonal replacement therapy (HRT)

Many medical institutions are initiating quality improvement and disease prevention programs. In this paper, we report the results of a program designed to increase the rate of hormonal replacement therapy (HRT) in a postmenopausal population. After initially assessing the rate of HRT use, we instituted an educational program directed at both physicians and patients. Reassessment two years later indicated the rate of HRT had increased from 31% to 48.4%. Further educational efforts were followed by a reassessment three years later that showed a further improvement in prescription rate to 64%. We conclude that our educational program directed at physicians and patients dramatically increased the rate of HRT prescription of postmenopausal women.

Education, Medical, Continuing↗

PubMed2002

Center-based care for young children: examining predictors of quality.

The authors collected information from caregivers, trained observers, and parents to investigate quality elements in child-care programs designed for young children in center-based settings. Participants were 75 parents of children aged 15 to 36 months and their caregivers from 13 child-care centers in a southeastern state. Observers collected indicators of program quality and process and structural quality indicators, including adult-child ratio, group size, use of planned activities, use of child-designated space, housekeeping activities, and caregiver-child interactions. Participants responded to questions regarding their child-rearing beliefs, social support networks, perceived stress levels, and demographic characteristics. The best predictors of higher quality care and sensitive caregiver-child interaction in centers were specialized caregiver training, higher adult-child ratios, use of planned activities, and less perceived stress by caregivers. Implications of these findings are discussed.

Adult↗

PubMed1999

Using cluster random assignment to measure program impacts. Statistical implications for the evaluation of education programs.

This article explores the possibility of randomly assigning groups (or clusters) of individuals to a program or a control group to estimate the impacts of programs designed to affect whole groups. This cluster assignment approach maintains the primary strength of random assignment--the provision of unbiased impact estimates--but has less statistical power than random assignment of individuals, which usually is not possible for programs focused on whole groups. To explore the statistical implications of cluster assignment, the authors (a) outline the issues involved, (b) present an analytic framework for studying these issues, and (c) apply this framework to assess the potential for using the approach to evaluate education programs targeted on whole schools. The findings suggest that cluster assignment of schools holds some promise for estimating the impacts of education programs when it is possible to control for the average performance of past student cohorts or the past performance of individual students.

Bias↗

PubMed1980

Income and illness.

Little research has been directed toward an examination of the health needs of low-income Americans in relation to major governmental medical care programs designed originally to narrow the health gap between "poor" and "nonpoor." Analysis of unpublished data from the 1977 Health Interview Survey of the National Center for Health Statistics shows that about 75 per cent of the gap in restricted activity days and bed disability days--two common measures of the impact of ill-health--between "poor" and "nonpoor" populations is attributable to greater prevalence and severity of activity-limiting chronic conditions among low-income people. Although both income groups report similar types of chronic conditions resulting in activity limitation, the prevalence of all major chronic conditions is greater in the low-income population. Approximately 25 per cent of the low-income population bears the burden of these conditions; the majority of the "poor" report disability day levels similar to the "nonpoor." The substantial impact of chronic conditions should be an important consideration in meeting the health needs of the low-income population. Current government programs, such as Medicare and medicaid, however, are designed primarily to pay for acute care received in hospitals and in physicians' offices.

Activities of Daily Living↗

PubMed1982

Legal implications of monitoring workers for carcinogenic and mutagenic risk.

Many industries have initiated testing programs designed to identify workers who are especially vulnerable to workplace assaults by carcinogenic or mutagenic agents. This paper examines a number of legal issues attendant on such programs, including disclosure and consent, confidentiality, and other potential liability-producing factors. This paper also briefly looks at the legal issues that might arise if the federal government were to mandate similar programs. Finally, the basic rationale of industrial monitoring programs is discussed within the context of the emerging legal issues.

Carcinogens, Environmental↗

PubMed1990

School-based prevention of teen-age pregnancy and school dropout: process evaluation of the national replication of the Teen Outreach Program.

Examined a program designed to prevent adolescent pregnancy, school failure, and dropout using a process model of evaluation to assess with which groups of participants and under what conditions the program was most effective. Students in the Teen Outreach Program of the Association of Junior Leagues and matched comparison students in 35 schools nationwide participated. Sites that highly utilized a volunteer service component, and sites that primarily served older students reported lower levels of student problem behaviors at program exit, after controlling for problem behaviors at entry. These findings occurred only for program youths and not for comparison youths. The connection of volunteer service to reductions in adolescent problem behaviors is interpreted in terms of helper-therapy and empowerment theories. Limitations of the analytic strategy used in this study, as well as techniques for addressing the limitations, are also discussed.

Adolescent↗

PubMed1997

Lower-fat menu items in restaurants satisfy customers.

OBJECTIVE: To evaluate a restaurant-based nutrition program by measuring customer satisfaction with lower-fat menu items and assessing patrons' reactions to the program. DESIGN AND SETTING: Questionnaires to assess satisfaction with menu items were administered to patrons in eight of the nine restaurants that volunteered to participate in the nutrition program. One patron from each participating restaurant was randomly selected for a semistructured interview about nutrition programming in restaurants. SUBJECTS: Persons dining in eight participating restaurants over a 1-week period (n = 686). STATISTICAL ANALYSES PERFORMED: Independent samples t tests were used to compare respondents' satisfaction with lower-fat and regular menu items. Two-way analysis of variance tests were completed using overall satisfaction as the dependent variable and menu-item classification (ie, lower fat or regular) and one of eight other menu item and respondent characteristics as independent variables. Qualitative methods were used to analyze interview transcripts. RESULTS: Of 1,127 menu items rated for satisfaction, 205 were lower fat, 878 were regular, and 44 were of unknown classification. Customers were significantly more satisfied with lower-fat than with regular menu items (P < .001). Overall satisfaction did not vary by any of the other independent variables. Interview results indicate the importance of restaurant during as an indulgent experience. CONCLUSIONS: High satisfaction with lower-fat menu items suggests that customers will support restaurant providing such choices. Dietitians can use these findings to encourage restaurateurs to include lower-fat choices on their menus, and to assure clients that their expectations of being indulged are not incompatible with these choices.

Adult↗

PubMed1997

An outcomes management program in gynecologic oncology.

OBJECTIVE: To evaluate the effectiveness of an outcomes-management program designed to provide high-quality patient care, generate data for outcomes research, and decrease costs in a managed-care environment. METHODS: An outcomes-management program was launched in June 1994, based on the elimination of wasteful or ineffective therapies through the systematic development of practice guidelines and collaborative care paths, with concomitant definition of desired outcomes. Over 3 months, care paths were developed for our most common surgical procedures. A matched control outcomes study was undertaken for the most commonly performed gynecologic oncology procedure: total abdominal hysterectomy and oophorectomy with pelvic and para-aortic node sampling for endometrial cancer. Thirty consecutive women treated on the care path were compared with 29 matched controls accrued during the period of care-path planning and with 73 controls from the period preceding care-path planning. Patient satisfaction with care-path treatment was assessed by a survey sent 2 weeks after discharge. RESULTS: Median length of hospital stay decreased significantly, from 6 days before care-path planning to 4 days after care-path implementation (P < .001). Median laboratory costs decreased by 74% (P < .001), medication costs by 35% (P < .001), room costs by 29% (P < .001), and total hospital costs by 20% (P < .002). Incremental improvements were observed during care-path planning. There were no readmissions for complications in the care-path group. According to the survey results, patient satisfaction with care was very high among care-path patients. CONCLUSIONS: A physician-driven outcomes-management program in an academic setting permits the delivery of high-quality care and supports outcomes research while decreasing costs.

Cancer Care Facilities↗

PubMed1982

Prevention of behavioral problems in young children.

Behavioral problems in young children are quite common and arise from a complex interaction between child and environmental characteristics. Many are transient disorders related to situational family stresses and will respond to a number of brief intervention approaches or simply the passage of time. As yet we have no accurate way of predicting which children are likely to develop more serious problems in the future. Because of this, systematic screening and treatment of individual children and families does not seem as effective an approach to prevention as a community-wide program designed to improve the support systems available to all families. Examples are quality day care centers, family planning facilities and guidance, parenting resource centers, and home visitor programs. The pediatrician can be an influential person supporting the development of these kinds of programs in his or her community. For families in the pediatrician's own practice he or she can help parents cope with troublesome behaviors through education and brief intervention techniques such as behavior modification and link them with community services for more complex problems. In addition the physician can help to promote "competence" by teaching parents how to interact with their children in more affectionate and cognitively stimulating ways.

Brain Damage, Chronic↗

PubMed2004

The practice and process of healthy exercise: an investigation of the treatment of exercise abuse in women with eating disorders.

This study investigates the effectiveness of an exercise program designed to reduce exercise abuse in women who are in residential treatment for eating disorders. One hundred and twenty-seven women who participated in the exercise program were compared to 127 non-participants on weight gain and self-reported obligatory attitudes and beliefs about exercise. The exercise participants were women who were medically cleared and attended at least two exercise groups during treatment. The control group were women who were medically cleared, but did not attend any exercise groups during treatment. Significant group x diagnosis interactions revealed that women in the exercise group who were diagnosed with anorexia nervosa gained more than one-third as much weight as those in the control group. Also, women in the exercise group demonstrated significantly reduced obligatory attitudes toward exercise compared to the control group. These findings suggest that the use of an exercise program that targets exercise abuse in women with eating disorders is feasible during residential treatment and results in positive change without interfering with weight gain. Limitations that result from the lack of random assignment to the exercise and control group are discussed.

Journal Article↗