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PubMedDate not supplied

A clinical laboratory program to improve performance of resident physicians.

In summary residents entering our program lacked many basic clinical laboratory skills. Without an organized curriculum in this area, residents make marginal or no gains in competence. A clinical laboratory program which is accessible and clinically relevant does influence residents' knowledge and skills. Whether supervised performance of tests or didactic teaching was responsible for improved test results in our residents remains to be determined. This is important to determine because of the financial restraints of most programs and the demands already present on most residents' time.

Clinical Laboratory Techniques↗
PubMed1990

Effect of response programming on hemispheric differences in lexical decision.

A lateralized tachistoscopic lexical decision task with concrete nouns and orthographically regular nonwords was administered to normal subjects in three conditions using unimanual responses: Yes-No, Go-NoGo with nonword targets, and Go-NoGo with word targets. There was an overall right visual field advantage in accuracy and sensitivity, an interaction between visual hemifield and wordness in latency, and an overall "word" bias. No effect interacted with experimental conditions, showing that response programming did not affect hemispheric asymmetries. The data suggest independent lexical access and similar response programming in each hemisphere. These results are examined in light of three psycholinguistic models of lexical access and are interpreted to support instead a fourth one which posits separate and parallel computations for word decisions and for nonword decisions in each hemisphere.

Adolescent↗
PubMed2005

Knowledge and attitudes about treatment for hepatitis C virus infection and barriers to treatment among current injection drug users in Australia.

Despite recent improvements in outcomes of treatment for infection with hepatitis C virus (HCV), very few current injection drug users (IDUs) have access to treatment programs. We examined the natural history of and treatment knowledge about HCV infection and barriers and willingness to seek treatment for HCV infection. A convenience sample of current IDUs (n=100) with self-reported HCV-positive status drawn from a primary health facility and methadone clinic in inner Sydney completed an interviewer-administered questionnaire. Participants had a reasonable knowledge of the natural history of HCV infection but poorer knowledge of treatment for HCV infection. Most believed that being a current IDU was an exclusion criterion for treatment. Despite this, 70%-80% of IDUs reported that they would consider treatment under current scenarios in Australia: requirement for liver biopsy, subcutaneous injections, common adverse effects, and 40% efficacy. Study participants at the methadone clinic had higher levels of consideration of treatment. These findings support the development of specific education programs regarding treatment for HCV infection for current IDUs.

Adolescent↗
PubMedDate not supplied

Assessment of patient and provider satisfaction scales for project access.

OBJECTIVE: This study examined the underlying variables that contribute to patient and provider satisfaction with Project Access, a physician-driven program that connects low-income, uninsured adults (aged 18-64) to denoted specialty care and hospital services. SUBJECTS AND METHODS: Of the 550 physicians and 1400 patients participating per year, 125 physicians and 164 patients completed and returned the 14- and 15-item satisfaction questionnaires, respectively. The data from both surveys were factor analyzed. RESULTS: Patient satisfaction data factored into 4 dimensions: respect from program implementation staff, respect from pre-Project Access enrollment staff, practical health-related issues, and the level of understanding of Project Access guidelines and expectations. Provider satisfaction data factored into 3 dimensions: external services available to patients, receiving recognition and respect, and the administration of Project Access. CONCLUSIONS: Patients' feelings of respect seemed to be closely associated with their satisfaction with Project Access, in addition to the helpfulness of the program. Providers also considered respect and recognition an important factor contributing to their satisfaction, in addition to ease of administrative duties and services available to patients.

Adolescent↗
PubMed1998

Hemodialysis access failure: a call to action.

Recent evidence suggests that the cost as well as the morbidity associated with the maintenance of hemodialysis access is increasing rapidly; currently, the cost exceeds 1 billion dollars and access related hospitalization accounts for 25% of all hospital admissions in the U.S.A. This increase in cost and morbidity has been associated with several epidemiological trends that may contribute to access failure. These include late patient referral to nephrologists and surgeons, late planning of vascular access as well as a shift from A-V fistulaes to PTFE grafts and temporary catheters, which have a higher failure rate. The reasons for this shift in the types of access is multifactorial and is not explained by changes in the co-morbidities of patients presenting to dialysis. Surgical preference and training also appear to play an important role in the large regional variation and patency rate of these PTFE grafts. We propose a program for early placement of A-V fistulae, a continuous quality improvement, multidisciplinary program to monitor access outcome, the development of new biomaterials, and a research plan to investigate pharmacological intervention to reduce development of stenosis and clinical interventions to treat those that do develop, prior to thrombosis.

Arteriovenous Shunt, Surgical↗
PubMed2007

SChiSM2: creating interactive web page annotations of molecular structure models using Jmol.

UNLABELLED: SChiSM2 is a web server-based program for creating web pages that include interactive molecular graphics using the freely-available applet, Jmol, for illustration. The program works with Internet Explorer and Firefox on Windows, Safari and Firefox on Mac OSX and Firefox on Linux. AVAILABILITY: The program can be accessed at the following address: http://ci.vbi.vt.edu/cammer/schism2.html.

Algorithms↗
PubMed2001

Ruptured appendicitis among children as an indicator of access to care.

OBJECTIVE: To determine factors associated with ruptured appendicitis among children, using administrative databases. Insurance-related differences in the risk of ruptured appendix among adults in California have previously been described (Braveman, Schaaf, Egerter, et al. 1994). DATA SOURCES/STUDY SETTING: State of Maryland Medicaid claims data for children < or = 18 years of age from 1989 to 1993 and hospital discharge data for children < or = 19 years of age from 1989 to 1994 were analyzed. STUDY DESIGN: Administrative data analysis pre- and post-implementation of a Medicaid managed care program called Maryland Access to Care. DATA COLLECTION/EXTRACTION METHODS: Medicaid claims and hospital discharge ICD-9-CM codes were used to define hospitalization for ruptured and nonruptured appendicitis. Linear regression was used to model trends. Logistic regression was used to model the probability of ruptured appendicitis. PRINCIPAL FINDINGS: Among the 374 Medicaid inpatient claims for appendicitis, 37 percent were for ruptured appendicitis. Among the 5,141 hospital discharges for appendicitis, 30 percent were for ruptured appendicitis. Using Medicaid claims data, the probability of ruptured appendicitis was inversely related to age (OR = 0.86, 95% CI 0.81-0.91), white race (OR = 0.35, 95% CI 0.17-0.71) and preventive care visits (OR = 0.19, 95% CI 0.05-0.77). Using hospital discharge data, age (OR = 0.91, 95% CI 0.90-0.93) and female gender (OR = 0.87, 95% CI 0.77-0.99) were significant covariates. Insurance-related covariates were not significant in multivariate models addressing the probability of ruptured appendicitis. CONCLUSIONS: During a period of rapid managed care growth, insurance type was not associated with an increased risk of ruptured appendicitis among children in this geographic area. Age, female gender, and the number of preventive care visits are inversely related to the risk of ruptured appendix among children. The protective effect of preventive care visits suggests that a primary care relationship facilitates access to care, thus reducing delay in the management of appendicitis.

Adolescent↗
PubMedDate not supplied

State efforts to measure the health care safety net.

This article describes the role states could play in a national effort to measure and monitor the public health safety net. The authors developed a data collection framework using information from five states on two components of the safety net: structure and demand. Because states are the primary vehicle for access expansions and programs to care for the poor, the authors suggest that they be the primary coordinating mechanism for data collection on the safety net. Because the necessary mechanisms for more uniform standards or criteria to evaluate state data collection activities and capacity remain undeveloped, they recommend using existing data to begin building state capacity to measure and monitor the safety net.

Adult↗
PubMed2004

Digital stereoscopic analysis of the optic disc: evaluation of a teaching program.

PURPOSE: To determine if a computer-based stereoscopic teaching program could improve optic cup/disc ratio (CDR) agreement between student observers and an expert. DESIGN: Experimental study. PARTICIPANTS: Six student observers (A-F) assessed at least 30 digital stereoscopic optic disc images using a digital stereoscopic analysis program. All observers made 36 CDR measurements (every 10 degrees ) for each disc image that they assessed. METHODS: Disc images were divided into 3 sets of 10 images (image sets 1, 2, and 3). Observers A, B, and C determined CDRs for all 3 image sets. Set 1 was examined without access to a teaching program, set 2 using a teaching program that allowed the observer to view an expert assessment of the optic disc, and set 3 after using the teaching program. Observers D, E, and F evaluated image sets 1 and 3 only and did not have access to the teaching program. Ten months later, these same observers (D-F) viewed image set 2 using the teaching program and then reassessed image set 3. MAIN OUTCOME MEASURES: Standard deviation (SD) of CDR differences between observers and an expert, the percentage of CDR observations differing > or =0.20 from those of the expert, and intraclass correlation coefficients (ICCs) between observers. RESULTS: Before teaching, the average SD of differences between all observers and the expert was 0.10. After teaching, the average SD of differences between all observers and the expert was 0.057. For observers D, E, and F, the average SD of differences for image set 3 without teaching was 0.074. The percentage of all observer measurements that differed > or =0.20 from those of the expert for image set 1 was 16.7%; for set 3 after teaching, 1.7%; and for set 3 for observers D, E, and F without teaching, 10%. Interobserver ICC values for all observers were 0.37 before teaching and 0.76 after. For observers D, E, and F, the ICC value for set 3 without access to teaching was 0.69. CONCLUSIONS: This study suggests that an interactive digital stereoscopic teaching program improves agreement between observers and an expert when assessing CDRs.

Diagnostic Techniques, Ophthalmological↗
PubMed1999

The impact of personal problems on accessing prenatal care in low-income urban African American women.

OBJECTIVE: The purpose of this study was to investigate the nature and contribution of personal factors related to the use of prenatal care in a sample of high-risk women residing in an urban environment where care was accessible and free. STUDY DESIGN: The sample consisted of 297 African American women with low socioeconomic status and a high school education or less who were newly delivered of neonates. The level of prenatal care was classified according to the Kessner 3 Parameter Index (adequate, intermediate, inadequate). Women who received no prenatal care made up a fourth group. Subjects responded to the "Ten-Item Checklist" of Richwald. Rhodes, and Kersey and an in-person interview that queried their reasons for obtaining different levels of prenatal care. RESULTS: Both personal and structural reasons were described by women for not obtaining care earlier in pregnancy or at all. The mean number of personal and structural problems reported per subject was inversely correlated to the level of prenatal care obtained. However, personal problems were the single most important reason cited by these women. Personal problems that were statistically significant different among the groups were drug use and desire for an abortion. The structural barriers that exhibited statistically significant differences among the groups were trouble scheduling an appointment, access totransportation, dislike of health care professionals and institutions, access to child care, and not knowing where to go. CONCLUSION: Both personal and structural problems were cited as reasons for not obtaining adequate prenatal care. Structural barriers to prenatal care have been identified and extensively studied. These barriers to care continue to persist, despite innovations in program delivery and access. This study demonstrates that the significance of personal problems has not been adequately considered as a major factor associated with insufficient prenatal care.

Adult↗
PubMed2000

Clustalnet: the joining of Clustal and CORBA.

MOTIVATION: Performing sequence alignment operations from a different program than the original sequence alignment code, and/or through a network connection, is often required. Interactive alignment editors and large-scale biological data analysis are common examples where such a flexibility is important. Interoperability between the alignment engine and the client should be obtained regardless of the architectures and programming languages of the server and client. RESULTS: Clustalnet, a Clustal alignment CORBA server is described, which was developed on the basis of Clustalw. This server brings the robustness of the algorithms and implementations of Clustal to a new level of reuse. A Clustalnet server object can be accessed from a program, transparently through the network. We present interfaces to perform the alignment operations and to control these operations via immutable contexts. The interfaces that select the contexts do not depend on the nature of the operation to be performed, making the design modular. The IDL interfaces presented here are not specific to Clustal and can be implemented on top of different sequence alignment algorithm implementations.

Sequence Alignment↗
PubMed1992

Transportation as outreach, driver as mental health worker.

Case finding and early detection and referral of elderly persons with mental problems can be accomplished by trained and supervised drivers as part of a transportation service. Increased access to community programs and services as a result of provided transportation helped clients maintain their independence and self-esteem.

Aged↗
PubMedDate not supplied

Implementation of garlic cryopreservation techniques in the national plant germplasm system.

The USDA-ARS National Plant Germplasm System (NPGS) maintains more than 200 Allium sativum (garlic) accessions at the Western Regional Plant Introduction Station in Pullman, WA. All accessions must be grown out in the field annually since garlic plants from these accessions do not reliably produce seeds and bulbs do not store well. Shoot tips excised from garlic cloves can be successfully cryopreserved using either Plant Vitrification Solution 2 (PVS2; 15 percent v/v DMSO, 15 percent v/v ethylene glycol, 30 percent v/w glycerol, 0.4 M sucrose) or Plant Vitrification Solution 3 (PVS3; 50 percent v/w sucrose, 50 percent v/w glycerol). We compared regrowth of shoot tips representing diverse garlic germplasm after exposure to either PVS2 or PVS3 during the cryopreservation procedure. At the USDA-ARS National Center for Genetic Resources Preservation, a component of the NPGS, we consider accessions successfully preserved if a minimum of 40 percent of explants exhibit regrowth after liquid nitrogen exposure and at least 60 viable shoot tips remain in long-term storage. Ten of twelve diverse garlic accessions were successfully cryopreserved using either PVS2 or PVS3 as cryoprotectants. Five genotypes had the best post liquid nitrogen regrowth after exposure to PVS2, four genotypes had the best regrowth after exposure to PVS3, and three genotypes performed equally well using either cryoprotectant solution. This project is part of an ongoing program to cryopreserve accessions of NPGS clonal crop collections.

Cryopreservation↗
PubMed2006

Analysis of a mammography teaching program based on an affordance design model.

RATIONALE AND OBJECTIVES: The wide use of computer technology in education, particularly in mammogram reading, asks for e-learning evaluation. The existing media comparative studies, learner attitude evaluations, and performance tests are problematic. Based on an affordance design model, this study examined an existing e-learning program on mammogram reading. MATERIALS AND METHODS: The selection criteria include content relatedness, representativeness, e-learning orientation, image quality, program completeness, and accessibility. A case study was conducted to examine the affordance features, functions, and presentations of the selected software. Data collection and analysis methods include interviews, protocol-based document analysis, and usability tests and inspection. Also some statistics were calculated. RESULTS: The examination of PBE identified that this educational software designed and programmed some tools. The learner can use these tools in the process of optimizing displays, scanning images, comparing different projections, marking the region of interests, constructing a descriptive report, assessing one's learning outcomes, and comparing one's decisions with the experts' decisions. Further, PBE provides some resources for the learner to construct one's knowledge and skills, including a categorized image library, a term-searching function, and some teaching links. Besides, users found it easy to navigate and carry out tasks. The users also reacted positively toward PBE's navigation system, instructional aids, layout, pace and flow of information, graphics, and other presentation design. CONCLUSION: The software provides learners with some cognitive tools, supporting their perceptual problem-solving processes and extending their capabilities. Learners can internalize the mental models in mammogram reading through multiple perceptual triangulations, sensitization of related features, semantic description of mammogram findings, and expert-guided semantic report construction. The design of these cognitive tools and the software interface matches the findings and principles in human learning and instructional design. Working with PBE's case-based simulations and categorized gallery, learners can enrich and transfer their experience to their jobs.

Breast Neoplasms↗
PubMed2004

A systematic review of the effectiveness of community-based mental health outreach services for older adults.

OBJECTIVES: Psychiatric outreach services that provide mental health assessment and treatment to older adults in their homes or communities are widely promoted as improving access and outcomes for older adults. However, a systematic review of the efficacy of these services has not been done. This review evaluates the evidence base for the effectiveness of outreach services for older adults with mental illness in noninstitutional community settings. End points of interest include the ability of the outreach program to increase access to mental health services and improve psychiatric outcomes. METHODS: MEDLINE, CINAHL, PsycINFO, and Web-of-Science databases were searched for articles in English that were indexed through May 2004. Studies were included if they evaluated face-to-face psychiatric services provided to adults aged 65 and older with mental illness and if they were randomized controlled trials, quasi-experimental outcome studies, uncontrolled cohort studies, or comparisons of two or more interventions. Articles were excluded that evaluated interventions that were provided in institutional settings or that focused on persons with dementia or their caregivers. RESULTS: Fourteen studies matched all the inclusion criteria. Two studies (one controlled prospective study and one study that used a comparison group) found support for the use of gatekeepers-nontraditional referral sources-in identifying socially isolated older adults with mental illness. Twelve studies (five randomized controlled trials, one quasi-experimental study, and six uncontrolled cohort studies) found that home and community-based treatment of psychiatric symptoms were associated with improved or maintained psychiatric status. All randomized controlled trials reported improved depressive symptoms, and one reported improved overall psychiatric symptoms. CONCLUSIONS: Limited data supported the effectiveness of outreach services in identifying isolated older adults with mental illness. A more substantial evidence base indicated that home-based mental health treatment is effective in improving psychiatric symptoms. Studies are needed that apply more rigorous methods evaluating the efficacy of case identification models and subsequent treatment for older persons with a variety of psychiatric diagnoses.

Aged↗
PubMed2005

Storing, linking, and mining microarray databases using SRS.

BACKGROUND: SRS (Sequence Retrieval System) has proven to be a valuable platform for storing, linking, and querying biological databases. Due to the availability of a broad range of different scientific databases in SRS, it has become a useful platform to incorporate and mine microarray data to facilitate the analyses of biological questions and non-hypothesis driven quests. Here we report various solutions and tools for integrating and mining annotated expression data in SRS. RESULTS: We devised an Auto-Upload Tool by which microarray data can be automatically imported into SRS. The dataset can be linked to other databases and user access can be set. The linkage comprehensiveness of microarray platforms to other platforms and biological databases was examined in a network of scientific databases. The stored microarray data can also be made accessible to external programs for further processing. For example, we built an interface to a program called Venn Mapper, which collects its microarray data from SRS, processes the data by creating Venn diagrams, and saves the data for interpretation. CONCLUSION: SRS is a useful database system to store, link and query various scientific datasets, including microarray data. The user-friendly Auto-Upload Tool makes SRS accessible to biologists for linking and mining user-owned databases.

Computational Biology↗
PubMed2003

Pilot study: access to fitness facility and exercise levels in olanzapine-treated patients.

BACKGROUND: Increasingly alarmed by the health risks (that is, weight gain, elevated lipids, and poor glucose tolerance) posed by novel antipsychotic medications, clinicians who treat schizophrenia are attempting to help patients improve lifestyle factors. Unfortunately, schizophrenia research has neglected exercise as a legitimate adjunctive treatment for schizophrenia. OBJECTIVE: To assess the extent to which stable patients with schizophrenia would adhere to an exercise program if offered access to a fitness facility. METHODS: Ten of 20 stable patients with schizophrenia or schizoaffective disorder who were treated with olanzapine for at least 4 weeks had the opportunity to receive access to a Young Men's Christian Association (YMCA) fitness facility, based on random allocation. The intervention included a free membership to the YMCA for 6 months, with access to all the fitness amenities and equipment. The mean dosage of olanzapine was 11.5 mg daily for the YMCA group. RESULTS: Of the 10 subjects, 2 did not attend at all. One subject met criteria for full attendance for each of the 6 months and lost 15 Kg. Dropout rates were as follows: 90% at 6 months, 70% at 5 months, and 40% at 4 months. The main reason they gave for poor attendance was lack of motivation. The mean weight gain was 2 kg in the YMCA group. CONCLUSION: Most subjects did not regularly exercise or attend. They cited poor motivation as the main reason. The subject who exercised regularly lost a significant amount of weight.

Adolescent↗
PubMed2004

Computer-assisted learning in human and dental medicine.

This article describes the development and application of new didactic methods for use in computer-assisted teaching and learning systems for training doctors and dentists. Taking the Meducase project as an example, didactic models and their technological implementation are explained, together with the limitations of imparting knowledge with the "new media". In addition, legal concepts for a progressive, pragmatic, and innovative distribution of knowledge to undergraduate students are presented. In conclusion, potential and visions for the wide use of electronic learning in the German and European universities in the future are discussed. Self-directed learning (SDL) is a key component in both undergraduate education and lifelong learning for medical practitioners. E-learning can already be used to promote SDL at undergraduate level. The Meducase project uses self-directed, constructive, case- and problem-oriented learning within a learning platform for medical and dental students. In the long run, e-learning programs can only be successful in education if there is consistent analysis and implementation of value-added factors and the development and use of media-didactic concepts matched to electronic learning. The use of innovative forms of licensing - open source licenses for software and similar licenses for content - facilitates continuous, free access to these programs for all students and teachers. These legal concepts offer the possibility of innovative knowledge distribution, quality assurance and standardization across specializations, university departments, and possibly even national borders.

Computer-Assisted Instruction↗