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At least 1,135 records · Page 63Linked to original sources
PubMed1992

Improving dietitians' teaching skills.

Many health professionals lack important teaching skills, perhaps adding to patient difficulties in understanding and adopting therapeutic diets. Research suggests that teaching skills improved after dietitians took a continuing education course entitled "Effective Patient Teaching." Our study tested whether dietitians' new skills would persist in the field and whether selected patient outcomes would differ as a result. Thirty staff dietitians from six urban hospitals were videotaped teaching patients, then randomly assigned to take the Effective Patient Teaching course or not (control group). Follow-up videotapes were made after 1 week, 1 month, and 3 months. After each teaching session, patient satisfaction and recall were assessed. Two judges rated 20 teaching skills, which were divided into four subsets for analysis. Repeated measures analyses of variance showed overall gains only for the group that took the Effective Patient Teaching course, which scored higher than the control group at 1 week and 1 month, but not at baseline or 3 months. Gains occurred in presentation skills and essential teaching functions. Throughout the study, interpersonal skills were high and adherence promotion skills were low for dietitians in both groups. Groups did not differ on patient satisfaction or recall. Improvements in dietitians' teaching skills translated to the field immediately after they completed the continuing education program, but not all gains were sustained after 3 months. We recommend that dietitians assess their teaching and adherence promotion skills, obtain training where warranted, and periodically reassess the application of those skills during patient teaching sessions.

Adult↗
PubMed2003

Palliative care in Kenya: report of the International Association of Hospice and Palliative Care Traveling Fellowship.

In August and September 2001, Dr. David Allbrook from Perth, Western Australia, traveled to Maua Methodist Hospital, North Meru District, Kenya, on an International Association for Hospice and Palliative Care Traveling Fellowship. The visit of Professor Allbrook provided a valuable opportunity that enabled Dr. Dietmar Ziegler, and the staff at Maua Methodist Hospital to put together a workable proposal for a sustainable community-based palliative care program.

Community Health Services↗
PubMed2004

Technology. Island hopping.

Rural communities rely heavily on federal and state grants to build their telemedicine programs. But finding the funds to sustain the initiatives can sometimes be tricky.

Hawaii↗
PubMed1990

[Signal averaged ECG and mechanisms of sudden death].

The aim of signal averaged electrocardiography is to detect late potentials (LP) which are markers of ventricular tachycardia. As sudden death is often due to ventricular fibrillation which can complicate ventricular tachycardia, some workers have suggested that the presence of LP may increase the risk of sudden death. We analysed the results of signal averaged ECG in 17 subjects who died suddenly and compared them with 8 patients who died from ventricular tachycardia. These two groups of patients were part of a general population of 450 subjects who underwent programmed ventricular stimulation and signal averaged ECG by Simson's method (25 Hz filter). Three parameters of this ECG were analysed: total QRS duration (Dur QRS), amplitude of the signal 40 ms before its termination (V 40), and the duration of the terminal activity less than 40 microV (Dur LP). The criteria of diagnosis of Lp were: Dur QRS greater than or equal to 120 ms, V 40 less than or equal to 20 microV, Dur LP greater than or equal to 40 ms. The results of signal averaged ECG of patients who died suddenly were different to those of patients who died from VT: Dur QRS 116 +/- 40 vs 140 +/- 25 ms, V 40 27 +/- 24 vs 7 +/- 8 microV, Dur LP 39 +/- 27 vs 59 +/- 14 ms. Only 8 patients who died suddenly had LP (47%) whereas all patients who died of VT had LP. A correlation was observed between the presence of LP and 2 factors: the LV ejection fraction which was significantly lower in patients with LP (28 +/- 8 vs 46 +/- 19%) and the results of programmed ventricular stimulation: patients with induced sustained VT less than 270/mn usually had LP (15/16). LP were usually absent (4/6) in cases of ventricular flutter (VT greater than or equal to 270/mn) or induced VF. The presence of LP in 2 patients could signify a risk of developing VT later on. In conclusion, 9/17 patients who died suddenly did not have LP. The risk of sudden death due to primary VF or V flutter cannot be predicted. Other causes of VF are even harder to identify.

Adult↗
PubMed1988

Follow-up study of an urban family medicine home visit program.

A home visit program was established by a large urban family practice in an academic setting. At the program's inception, 198 patients were randomly assigned to either an experimental group, to be eligible for home visits, or a control group, to continue receiving only office-based care. Two years after this randomization, follow-up data were obtained on 194 of the 198 subjects to assess the program's effectiveness. Fifty-one of the subjects had died. There were an increased number of deaths in the experimental group (30 percent) compared with the control group (21 percent), although this difference was not statistically significant. No statistically significant differences were found between the remaining 143 experimental and control group patients in function or well-being. Patients in the experimental group had a significantly higher number of hospitalizations, although there was no difference in the number of days spent in the hospital. Although methodologic considerations limit the ability to draw policy conclusions from this follow-up study, this home visit program did not have a measurable sustained impact on health outcomes or utilization of health services.

Adolescent↗
PubMed1987

Effect of clinical pharmacists on drug prescribing in a primary-care clinic.

The effect of clinical pharmacy services on prescribing patterns and drug costs for nonsteroidal anti-inflammatory drugs (NSAIDs) and salicylates in a primary-care clinic operated by a health-maintenance organization (HMO) was studied. Two pharmacists provided clinical services to a randomly selected cluster of family practice physicians in the HMO for six months. A second family practice cluster served as a control group. The pharmacists alerted prescribers to the availability of low-cost alternatives (such as ibuprofen and salicylates) and reviewed the medication profiles of patients receiving high-cost NSAIDs. Data were collected for both physician clusters for nine months before and six months after the pharmacists' intervention. Changes in the mean numbers of prescriptions for ibuprofen and piroxicam per 1000 enrollees per physician in the baseline and evaluation periods were not significantly different between the two groups. Significantly more prescriptions for salicylates were written by physicians in the intervention group than in the control group during the evaluation period. Annualized mean drug ingredient costs per enrollee and per prescription for NSAIDS and salicylates decreased during the evaluation period in both groups, but these differences were not significant. In relatively unstructured interactions with physicians and nurses, clinical pharmacists were not able to reduce the costs associated with NSAIDs but did have a modest effect on altering salicylate prescribing patterns. This clinical pharmacy program was not economically self-sustaining during the first six months of operation, since operating costs exceeded anticipated savings.

Ambulatory Care↗
PubMed1984

[Surgical possibilities in the treatment of ventricular tachycardia].

Medical therapy for recurrent sustained ventricular tachycardia is often disappointing. We report on the direct i.e. electrophysiologically guided surgical approach to 44 patients with sustained ventricular tachycardia. 43 patients had previous myocardial infarction, one patient had arrhythmogenic right ventricular dysplasia. During preoperative electrophysiologic study, sustained ventricular tachycardia was induced in 41 patients, three patients had an incessant sustained ventricular tachycardia. 30 patients underwent endocardial catheter mapping. In 28 of 30 cases, the earliest endocardial activation during ventricular tachycardia was detected. Intraoperative mapping was performed in 42 patients, in two cases surgical approach was guided by the result of endocardial catheter mapping. In 34 patients endocardial mapping revealed the earliest site of ventricular tachycardia, in eight patients the arrhythmogenic area was identified by mapping during sinus rhythm. An encircling endocardial ventriculotomy was performed in 14 patients, whereas 29 patients underwent a circumscribed endocardial resection. A cryosurgical technique was performed in the patient with arrhythmogenic right ventricular dysplasia. The hospital mortality rate was 16% (seven of 42 patients), in one patient the cause of death was ventricular fibrillation. The late mortality rate is 14% (five of 37 patients), one patient had sudden cardiac death. Two patients had a recurrence of ventricular tachycardia postoperatively. In one of these an antitachycardia pacemaker was implanted, the other was successfully reoperated with endocardial resection. Postoperatively, a sustained ventricular tachycardia was inducible by programmed stimulation in three patients. Complex ventricular ectopic activity was found in ten patients, all of these were administered antiarrhythmic drugs. With respect to the poor prognosis of medically refractory ventricular tachycardia, we conclude that the electrophysiologically guided surgical approach has become an acceptable therapeutical alternative.

Adult↗
PubMed1982

The treatment of sickle cell anemia with induced hyponatremia.

Since the rate of polymerization of sickle hemoglobin is exquisitely dependent on its concentration, a small reduction in intracellular hemoglobin concentration should cause a significant inhibition of sickling. In three patients with homozygous sickle cell anemia, sustained hyponatremia was induced by a program consisting of a high fluid intake, a low salt diet and a vasopressin analog, DDAVP. During periods of hyponatremia, mean corpuscular hemoglobin concentration (MCHC) fell 13% and in vitro sickling was reduced as assessed by morphology and oxygen affinity. The frequency and duration of sickle cell crises appeared to be decreased during periods when patients were hyponatremic. These preliminary results indicate that reduction in intracellular hemoglobin concentration is an effective approach to the treatment of sickle cell anemia.

Anemia, Sickle Cell↗
PubMed1980

Persistence: the role of partial reinforcement in psychotherapy.

Persistence, which refers to the ability of a learned behavior to survive protracted nonreinforcement (extinction), has been an overlooked dimension of clinical intervention. While persistence of newly acquired coping behavior is desired (and possibly assumed) by all psychotherapeutic procedures, few treatment programs possess features that operate to sustain responding in the face of a nonsupportive, nonreinforcing environment. The present article presents a treatment strategy designed to foster persistence based on the laboratory findings that partial reinforcement schedules produce greater resistance to extinction than continuous reinforcement schedules--a phenomenon referred to as the partial reinforcement extinction effect. The two major theories of persistence (Amsel's general theory of persistence and Capaldi's sequential theory) are discussed, and the basic principles of these models are extended to a number of therapeutic modalities including depression therapies, systemic desensitization, assertiveness training, and aversion therapy. In addition, procedural considerations including generalized and discriminated persistence are discussed.

Adaptation, Psychological↗
PubMed1995

[Role of intracellular calcium in the programmed cell death of prostatic cancer cells].

The growth of any tissue depends on the quantitative relationship between the rate of cell proliferation and cell death. In normal adults tissues, this steady-state balance is regulated by a series of both systemic hormones and local growth factors. Programmed cell death, also called apoptosis, is one of the two pathways for cell death. In programmed cell death, specific intracellular signals induce the cell to undergo an active, energy-dependent process leading to a cascade of biochemical and morphologic events that result in the irreversible fragmentation of genomic DNA and then of the cell itself. Biochemical and morphological studies have demonstrated that the involution of the normal, hyperplastic and cancerous prostate after castration is the result of programmed cell death. Numerous group have studied the role of calcium in programmed cell death's triggering. In androgen-independent prostatic cell it had been proved that it was possible to trigger programmed cell death by inducing a sustained elevation of the intracellular calcium. Actually, some features tend to explain more precisely the exact role of calcium in apoptosis of prostatic cells.

Apoptosis↗
PubMed1993

Interleukin-1-inducible expression of gro-beta via NF-kappa B activation is dependent upon tyrosine kinase signaling.

Interleukin-1 (IL-1) induces programmed growth arrest in human melanoma cells, A375-C6. IL-1 action in these cells is associated with induction of a cell type-specific immediate-early (IE) gene expression program characterized by strong, rapid, and sustained induction of gro-alpha and gro-beta, but transient induction of c-jun, IRG-9, and NAK-1, and lack of induction of c-myc. With the exception of gro-alpha and gro-beta, these IE genes are also associated with growth-stimulatory responses in the melanoma cells, suggesting that the gro-genes may play key roles in the growth arrest action of the cytokine. To elucidate the early intracellular signals associated with IL-1 action, we are studying the second messenger signals and transcription factors required for induction of gro-genes. Here, we present evidence that IL-1-inducible gro-gene expression is dependent on tyrosine kinase signaling. Using gel retardation and transient expression assays, we show that IL-1 causes protein tyrosine phosphorylation-dependent activation of NF-kappa B enhancer binding protein, which then induces transcription of the gro-genes via an NF-kappa B site located 76 base pairs upstream from the cap site. IL-1-activated protein tyrosine phosphorylation is also required for gro-gene induction in human cervical carcinoma cells, HeLa; human fibroblast cells, WI-38; and mouse fibroblast cells, L929. Thus, in diverse cell types, IL-1 induces gro-genes via tyrosine kinase-dependent signals.

1-Methyl-3-isobutylxanthine↗
PubMed1995

[Frequency versus time domain analysis in signal-averaged ECG: reproducibility and differences in predicting high risk patients with myocardial infarction].

Frequency domain analysis (FDA) and time domain analysis (TDA) are techniques for the diagnostic interpretation of signal averaged ECG. To overcome the limitations of TDA, such as noise and conduction disturbances, FDA has been developed. But the reproducibility of FDA, especially spectral temporal mapping analysis, results are significantly lower than that of TDA. We examine the difference of two methods, and the role in high risk patients with myocardial infarction. Low amplitude signal (LAS) and area ratio (AR) are independent predictors of inducible sustained monomorphic ventricular tachycardia (SMVT) by programmed ventricular stimulation. The combined use of TDA and FDA enhanced the accuracy in predicting inducible SMVT.

Body Surface Potential Mapping↗
PubMedDate not supplied

[The response of ventricular tachycardia to adenosine administration].

Ten patients with ventricular tachycardia were studied. Two groups were formed. Group A included 5 patients with idiopathic ventricular tachycardia and group B included 5 patients with coronary heart disease. In all patients an electrophysiologic study was performed and monomorphic sustained ventricular tachycardia was induced through programmed stimulation. All patients received 12 mg of intravenous adenosine. The response was satisfactory in 3 of 5 patients in group A, with the presence of sinus rhythm. No response was seen in the other 2 patients. None of the patients in group B responded to the administration of intravenous adenosine. We concluded that adenosine may be useful in patients with cyclic AMP-mediated triggered activity ventricular tachycardia, in contrast to the coronary heart disease patients in which the mechanism is reentry. This interpretation is supported by results obtained in 15 experiments in canine heart.

Adenosine↗
PubMed1993

[Transvenous ablation of recurrent ventricular tachycardia in arrhythmogenic right ventricular dysplasia].

Catheter ablation was used to cure refractory ventricular tachycardias (VT) in a 20-years old lady with arrhythmogenic right ventricular dysplasia. Antiarrhythmic drugs (procainamide, amiodarone, gilurytmal, flecainide and beta-blockers) used in monotherapy or combination didn't prevent recurrence of sustained VT. During electrophysiological study 3 different morphologies of tachycardia were induced, indicating multiple sites of arrhythmia. One of them was typical for right ventricular outflow tract and similar to the VT recorded in clinical conditions. Endocardial mapping in that region showed pathological low amplitude, fragmented potentials. They preceded by 35 ms the onset of QRS complexes during VT. This area was suggested as a presumed origin of the VT and chosen for transvenous ablation. 11 direct current shock of 200-250 joules (total energy 2400 j) were delivered. No complications were seen during and after ablation. The procedure was terminated when only non sustained VT can be induced by programmed stimulation. The same results were obtained during the control study one month later. However, the patient was taking sotalol and mexiletine. During 6 months period of ambulatory observation the patient was doing well, free of arrhythmias.

Adult↗
PubMed1977

Injuries in amateur ice hockey: a two-year analysis.

A compilation of injuires sustained in an amateur ice hockey program over a tw0-year period revealed that the majority of those injuires were facial lacerations. The number of injuries increased with the level of players' skill and with the intensity of the games. Youth players who were required to wear head and total face protection had fewer injuries than either the adult league or semi-professional players. Injuries were greatest to the semi-professional players who wore little or not head protection, and no facial protection. Physicians have a duty to urge all hockey players to wear adequate head and face protection to prevent such injuries. Equipment which is currently available is illustrated.

Adolescent↗
PubMed1990

Parent involvement in cigarette smoking prevention: two pilot evaluations of the "Unpuffables Program".

Efforts to prevent the onset of cigarette smoking with young adolescents have been primarily successful in delaying onset, particularly with classroom curricula that emphasize social competencies. Maintenance of these reductions has been difficult to sustain into later adolescence, suggesting the need for programs to complement and supplement curricula. Since one group of adolescents more difficult to influence are those whose parents smoke, parental involvement in smoking prevention may be a powerful enhancer. This paper describes the "Unpuffables Program," an activity package program around smoking, for preadolescents and their parents. Two pilot evaluation studies in Minnesota and Massachusetts focus on the feasibility of and receptivity to the "Unpuffables Program." High awareness and participation rates were found in both settings. The program appears to provide an opportunity for smoking to be discussed at home, motivating smokers to consider cessation, and reinforcing nonsmoking parents' attitudes and behaviors.

Adult↗
PubMed1999

Implementing and sustaining evidence-based clinical practice in Australia: the Evidence Based Clinical Practice Research Initiative.

Evidence-based medicine is a process by which clinicians translate clinical information needs into answerable questions, track down answers to those needs as efficiently and effectively as possible using the best evidence available, apply the information to patients and evaluate their performance. Implementing evidence-based medicine is fragmented and variable. The National Health and Medical Research Council of Australia has implemented a research program to determine successful strategies for implementation and sustaining of evidence-based clinical practice. In addition this research program will help to answer whether evidence-based practice improves patient outcomes. This paper describes this program and other strategies that improve the application of evidence-based practice in clinical settings.

Australia↗
PubMedDate not supplied

Correlates of the sustainability of community-based heart health promotion interventions.

OBJECTIVES: This study investigated factors related to the perceived sustainability of 189 heart health promotion interventions initiated by a public health department or research initiative and implemented in a variety of organizations across Canada. METHODS: Data were collected in a telephone survey of key informants from schools, restaurants, grocery stores, health care facilities, and sports facilities that had implemented a heart health promotion intervention (risk factor screening, courses for smoking cessation, healthy eating or physical activity, support groups to promote healthy lifestyles, environmental modification, dissemination of information) in the past 8 years. RESULTS: Overall, 43.6% of 189 interventions were perceived to be very permanent, 34.8% were somewhat permanent, and 21.5% were not permanent. Independent correlates of perceived sustainability included intervention used no paid staff (odds ratio (OR) 95% confidence interval (95% Cl) = 3.7 (1.8, 7.5)), intervention was modified during implementation (OR (95% Cl) = 2.7 (1.4, 5.0)), there was a good fit between the local provider and the intervention (OR (95% Cl) = 2.4 (1.2, 5.0)), and there was the presence of a program champion (OR (95% Cl) = 2.3 (1.2, 4.4)). CONCLUSION: Consideration of these factors by health promotion program planners could increase the potential for sustainability of health promotion interventions implemented in the community.

Adult↗