Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Program Design”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,225 records · Page 68Linked to original sources
PubMed2007

An evaluation of venous thromboembolic risk in acutely ill medical patients immobilized at home: the AT-HOME Study.

Many risk factors for venous thromboembolism (VTE) in hospitalized medical patients are also present in medical outpatients. VTE prevention represents an important challenge for physicians treating patients at home. The AT-HOME study was a prospective cross-sectional observational study designed to assess awareness of the risk of VTE in immobilized acutely ill medical outpatients among German physicians, many of whom were participating in a national Continuing Medical Education (CME) program designed to raise awareness of VTE. The study involved 1210 medical patients who were acutely confined to bed at home. Physicians performed a subjective assessment of VTE risk, which was rated on a 10-point scale (1 = very low risk; 10 = very high risk). The risk of VTE was also assessed retrospectively by using a scorecard developed for use in hospitalized medical patients. Of the 1210 patients, 198 (16%) had risk scores of 0-4, 319 (26%) had scores of 5 or 6, and 693 (57%) had scores > or =7. Overall, 966 patients (80%) received thromboprophylaxis. The proportion of patients receiving thromboprophylaxis was 0% to 47% in risk score groups 0-4, 76% to 85% in groups 5 and 6, and 90% to 100% in risk score groups 7-10. In the retrospective assessment of VTE risk, 74% of patients were at high risk, 15% were at intermediate risk, and 11% were at low risk. The proportions of patients receiving thromboprophylaxis in these groups were 87%, 61%, and 55%, respectively. The involvement of physicians in educational activities focusing on VTE awareness appeared to create awareness of the risks of VTE in acutely ill medical outpatients.

Acute Disease↗
PubMed1991

Enhancing blood glucose awareness in adolescents and young adults with IDDM.

OBJECTIVE: To determine the effectiveness of an intervention program designed to improve blood glucose awareness. RESEARCH DESIGN AND METHODS: Eight young-adult outpatients (mean age 22 yr) and six adolescent inpatients (mean age 14.5 yr) with insulin-dependent diabetes mellitus participated in the intervention program. Nine adolescent inpatients (mean age 13.9 yr) served as an untreated comparison group. One adult outpatient with unreliable data was removed. Before treatment, each patient completed a minimum of 40 blood glucose estimations, blood glucose tests, and symptom-rating checklists. Symptoms of hypo- or hyperglycemia were identified for each patient. The three-session intervention focused on internal (e.g., personal symptoms) and external (e.g., timing and amount of insulin, food, and exercise) cues that could be used to enhance blood glucose awareness. At postintervention, patients completed a minimum of 40 additional blood glucose estimates and tests. Comparison subjects completed the pre-postassessments but did not receive the intervention. RESULTS: Blood glucose estimation accuracy was evaluated with error grid analysis. All estimated-actual blood glucose values were plotted into one of five zones: accurate estimates (zone A), benign errors (zone B), and clinically dangerous errors (zones C, D, and E). An overall accuracy index (AI) was calculated by subtracting the summed percentage of clinically dangerous estimates (zones C, D, and E) from the percentage of accurate estimates (zone A). At study entry, the adolescent inpatients' mean AI of 7% was significantly poorer than the 32% mean AI exhibited by the outpatient young-adult sample (P less than 0.02). At postintervention, the adolescents' mean AI improved to 30% (P less than 0.02) and the young adults' mean outpatient AI improved to 45% (P less than 0.06). The treated sample as a whole exhibited increased sensitivity to both hypo- (P less than 0.005) and hyperglycemia (P less than 0.05). Similar improvements did not occur in the untreated comparison sample. CONCLUSIONS: Adolescents may exhibit poorer blood glucose awareness than adults. Although this intervention program improved blood glucose awareness in both adolescent and adult patients, postintervention blood glucose estimation accuracy remained far from ideal.

Adolescent↗
PubMedDate not supplied

Outcomes of a pilot occupational therapy wellness program for older adults.

OBJECTIVE: The purpose of this study was to evaluate a pilot occupational therapy wellness program designed to teach elders the importance of participation in meaningful social and community occupations to their quality of life. METHOD: Sixty-five older adults participated in this pilot wellness program held at each of three senior apartment complexes. Measures of health-related quality of life using the SF-36 Health Survey and frequencies of social and community participation from a program-specific intake form were completed by 39 participants before and after the 6-month program. Participants also evaluated components of the program through a satisfaction survey. RESULTS: Scores on the SF-36 Health Survey were significantly higher in vitality, social functioning, and the mental health summary scores following participation in the program. Participants reported an increased frequency of socialization and community participation with an average of 55% participating in at least three or more activities per week before the program to an average of 66% participating after the program. Participants who benefited the most attended more classes, were older, and were nondrivers. Eighty percent of those polled rated the pilot program as good or excellent. CONCLUSION: This pilot study provides additional support for prevention efforts for elders in the community. Wellness programs for seniors may be most effective if targeted to those who are older and nondrivers.

Aged↗
PubMed1985

Chemotherapy administration precheck verification.

Inappropriate administration of antineoplastics can result in severe adverse reactions or potential therapeutic failure. This article reports the formation and evaluation of a program designed to assure appropriate antineoplastic administration and the creation of a continuous teaching document. The primary goal was to achieve and document safe and appropriate administration of antineoplastic medications. The program was organized, initiated, and evaluated by the clinical pharmacist and assistant director of nursing. Use of available resources allowed program development without additional cost to hospital departments. A teaching series and provision of reference data were made available, and completion of a chemotherapy verification form was required before the nurse administered the antineoplastic. Over 1,500 forms have been completed in a little more than 2 years. Nurses report a high level of compliance with form completion. One chemotherapy error report has been filed in the last 28 months, compared with three error reports in the 8 weeks prior to initiation of the program. Use of the chemotherapy verification form has achieved a high standard of correct administration without errors as defined by our institution and fostered continually conscientious and acceptable antineoplastic administration.

Antineoplastic Agents↗
PubMed1983

Arizona's newest frontier: health care cost containment.

Fear of cost overruns, fraud and red tape had kept Arizona out of the Medicaid program, the only state to reject it. Financial pressures on the counties finally forced a statewide approach to subsidized health care for the poor. But Arizona still did not embrace Medicaid. Instead it enacted a demonstration program designed not only to serve the poor but to attract the private sector by dint of lower health care costs achieved through competition and a number of other mechanisms. The program became operable on Oct. 1, 1982 and, depending upon its success, may serve as a model of programs to come in other states.

Arizona↗
PubMed2003

[Environmental intervention in sites contaminated by lead: the United States of America experience].

For a decade, state and federal agencies have worked jointly with communities throughout the USA, with the objective of measuring the health-risk from lead pollution in residential zones. Often these communities have been linked with facilities previously associated with activities like mining and metallurgy; nevertheless, there are other industries like paint manufacturing and battery recycling, that have also been identified as lead pollution sources. The vast experience in cleaning up the contaminated sites has shown that ample programs designed to identify and handle the exposure routes can help, in an effective manner, to diminish blood lead levels (BLL) in susceptible populations, such as in young children. Environmental intervention programs are more effective when the affected communities carry out health education/intervention programs, geared towards the development of individualized strategies for handling the risk implied by the presence of lead in the atmosphere. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Environmental Exposure↗
PubMedDate not supplied

Tobacco-related attitudes and counseling practices of Iowa dentists.

Evidence suggests that dentists' efforts to encourage their patients to stop tobacco use can significantly decrease tobacco-related morbidity and mortality. This study identified attitudes and counseling practices of 1116 Iowa dentists and compared results of a subgroup (N = 55) surveyed in both 1983 and 1989 to note changes in their tobacco-related attitudes and practices. Although only 9% of the dentists from the statewide survey felt counseling their patients on tobacco use was inappropriate, 56% reported they did not routinely ask their new patients about tobacco use. With some frequency 90% of the dentists discussed negative health effects of tobacco, whereas only 64% advised their smokers to quit. In addition, fewer than half made special efforts with pregnant patients or those at high risk for heart disease. The vast majority reported seldom if ever using intervention tools such as pamphlets or referral to cessation programs. Data from the subgroup surveyed in 1983 and 1989 indicated few substantial changes in attitudes and counseling practices. Substantial discrepancies exist between dentists' attitudes and counseling practices. Well-designed programs are needed to help dentists select and implement appropriate interventions.

Attitude to Health↗
PubMed2004

Acceleration risk in student fighter pilots: preliminary analysis of a management program.

Despite advances in G-protection, F-16 student pilots continue to demonstrate G-performance inadequacies. The G-Risk Indicator Management (GRIM) Program was introduced at Luke Air Force Base in 2000 to facilitate early detection of G-related problems and to aid in the establishment of tailored ground training programs designed to enhance a student's performance under G. Assessment of anthropomorphic data, previous G-performance, anaerobic fitness, and centrifuge qualification scores comprise the initial assessment in the GRIM Program. Observations from these assessments are used to qualitatively determine the level of risk for the student. In the absence of any historical controls, no conclusions could be drawn with regards to the overall efficiency of the GRIM program. Significant differences were found between groups for anaerobic test scores, centrifuge scores, and gradebook comments. The results from this non-experimental study suggest the need for future studies to better determine the validity of G-risk indicators.

Adult↗
PubMed1993

Developing a resident assistance program. Beyond the support group model.

BACKGROUND: A program designed to identify and address specific evolving needs of residents throughout their first year has been implemented in our department of medicine. The average annual participation is 55 residents. The program includes a detailed and structured curriculum with topics and activities aimed at improving nonclinical skills that help residents function effectively during residency. METHODS: The program was developed based on a careful analysis of problems reported by graduating residents. It consists of 12 sessions in which the residents are presented with typical difficult situations they are likely to encounter during the year. At the end of each session they are provided with strategies to help them deal with the problems or even prevent problems in some cases. An important aspect of the program is the training and utilization of senior residents as group leaders. RESULTS: Eighty-five percent of the first-year residents have actively participated in the program since July 1989 despite its voluntary nature. Participants reported that the program greatly accelerated their adaptation and helped them function more effectively in the system. Senior residents recognized benefits for their professional development as well. CONCLUSIONS: The collective wisdom of past generations is often not effectively communicated to post-graduate year 1 residents. They are left to reinvent the wheel, not always with the best results. As a consequence, a great deal of stress that can be minimized is introduced into the training process. This program shows promise as an effective mechanism to deal with these challenges.

Adaptation, Psychological↗
PubMed1993

Using a network menu and the UMLS Information Sources Map to facilitate access to online reference materials.

As computer technology advances, clinicians and biomedical researchers are becoming more dependent upon information from online databases and information systems. By using specially configured computer workstations and high-speed computer networks, it is now possible to access this information in a rapid and straightforward manner. To empower users by providing these capabilities, the authors are assembling a variety of network workstations to be located throughout Yale-New Haven Medical Center. At the heart of the workstation is NetMenu, a program designed to help users connect to a number of important online information systems, including a hospital order entry and results reporting system, a drug reference, bibliographic retrieval systems, and educational programs. In addition, as part of the National Library of Medicine's Unified Medical Language System (UMLS) project, the authors have developed a local prototype of the UMLS Information Sources Map (ISM) and a companion query assistant program to complement the NetMenu in helping users select and connect automatically to information services relevant to a particular question. The ISM query assistant draws from a listing of many online information sources accessible via local and international networks.

Computer Communication Networks↗
PubMed1993

The treatment of posterior subluxation in athletes.

Posterior instability in athletes is a diagnostic and therapeutic challenge. Athletes have recurrent posterior subluxations rather than true dislocations, and they have pain rather than instability, which makes the diagnosis difficult. The pathology is usually capsular laxity rather than a true reverse Bankart lesion. There is not one diagnostic test, including computed tomography (CT) arthrogram, magnetic resonance imaging (MRI), or arthroscopy, that will always help with the diagnosis. Most athletes respond to conservative care with an exercise program designed to strengthen the posterior deltoid, the infraspinatus, and the teres minor; but, there is still a select group of athletes that cannot perform their sport after an extensive rehabilitation program. The surgical options for these athletes are varied, and the results in most cases are less than ideal. A posterior capsulorrhaphy was performed to treat this problem. This was initially performed with a staple, but this technique has been abandoned for a suture capsulorrhaphy to avoid staple problems. The 40 athletes treated operatively that had adequate follow-up evaluation reflected a 40% failure rate. Most of the failures were related to ligamentous laxity and unrecognized multidirectional instability not treated at the time of surgery. There may be subtle differences between a patient with posterior subluxation and multidirectional instability; these must be differentiated before operation. Also, the higher the competitive level of athlete, the worse the overall results. The high-level athlete must be informed that even if his or her shoulder is stabilized, the functional results may not allow him or her to continue at the same competitive level.

Adolescent↗
PubMed2002

The usefulness of a daily pain management diary for outpatients with cancer-related pain.

PURPOSE/OBJECTIVES: To describe the usefulness of daily pain management diaries to outpatients with cancer who participated in a randomized clinical trial of the PRO-SELF Pain Control Program. DESIGN: Randomized clinical trial in which a daily pain management diary was used for data collection in the control group and for data collection and nurse coaching regarding the pain management program in the intervention group. SETTING: Seven outpatient oncology settings. SAMPLE: 155 patients with pain from bone metastases and 90 family caregivers. METHODS: Content and statistical analysis of audiotaped answers to a semistructured questionnaire. MAIN RESEARCH VARIABLES: Patients' and family caregivers' perceptions of the usefulness of a daily pain management diary; specific ways in which the diary was used. FINDINGS: Patients in both the intervention (75%) and control groups (73%) found the diary useful. The diary was used to heighten awareness of pain, guide pain management behavior, enhance a sense of control, and facilitate communication. Family caregivers in both groups also reported that the diary was useful. CONCLUSIONS: The completion of a daily pain management diary is useful to patients and family caregivers and may function as an intervention for self-care. IMPLICATIONS FOR NURSING: Research-based evidence supports the importance of using a daily pain management diary in clinical practice.

Adult↗
PubMed2000

Project Hope: changing care delivery for the substance abuse patient.

Project Hope is a program designed to assist healthcare providers in the assessment, care, referral, and follow-up of the hospitalized substance abuse patient. First implemented in 1990 at what is now called University Hospital in San Antonio, Texas, the program has influenced care in a positive way through change in the attitude and knowledge of personnel, administrators, and community. In this paper, the authors provide an overview of the approaches utilized, improvement process, and outcomes obtained from this project. To formally evaluate the effectiveness of Project Hope, a quasi-experimental, Solomon-Four design study was conducted. Eighty nurses from various educational backgrounds and experience with alcohol were divided into groups by nursing unit. A normative-reeducative intervention was applied as described by Chin and Benne. Test of cognition showed significant change (p < .01) in the experimental group; no significance was found for attitudes change. Reasons for these findings and lessons learned from the process are described.

Attitude of Health Personnel↗
PubMed1993

An evaluation of an AIDS risk reduction education and skills training (ARREST) program.

PURPOSE: With the increasing rate of HIV infection among adolescents, there is an urgent need for interventions that will provide teenagers with information, the ability to make decisions, and the assertiveness and communication skills required for effective prevention and risk reduction. This study evaluated an AIDS Risk Reduction Education and Skills Training (ARREST) program designed for adolescents, ages 12-16 years. METHODS: Eighty-seven inner-city, African-American (36%) and Latino (55%) adolescents were recruited from community-based after-school programs, and randomly assigned to either the ARREST intervention or a wait-list control group. Adolescents assigned to the ARREST intervention participated in three 90-minute intervention sessions. ARREST was evaluated by comparing pre- and post-test scores on a battery of self-report measures and videotaped role-play simulations. RESULTS: Analyses revealed significant post-test differences between the ARREST and wait-list control groups, with teens in the ARREST group demonstrating significant changes in knowledge and negative attitudes about HIV/AIDS, perception of risk, and appropriate concern about contracting AIDS. Most importantly, adolescents in the ARREST group demonstrated a significant increase in behavioral skills for negotiating prevention and risk reduction, and resisting peer pressures to engage in risk-related sexual and drug-use behaviors. CONCLUSIONS: ARREST was effective in meeting its short-term objectives for changes in knowledge and behavioral skills, which are important prerequisites for behavior change. Replication with long-term follow-up assessment is needed, however, to determine this intervention's effectiveness at changing risk-related sexual and drug-use behaviors.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Effects of partner smoking status and gender on long term abstinence rates of patients receiving smoking cessation treatment.

AIMS: To assess the effect of partner smoking status on the success of a cessation program. DESIGN: Prospective cohort. SETTING: Smoking Cessation Unit in Hospital of Bellvitge (Hospitalet de Llobregat, Barcelona). PARTICIPANTS: A total of 1516 smokers of 10 or more cigarettes who started a smoking cessation program between January 1995 and December 2001 were included. MEASUREMENTS: All patients gave information about smoking history and smoking partner status. Abstinence was determined by carbon monoxide exhaled. FINDINGS: Significant differences were found in the abstinence rates at 12 months by smoking partner status: abstinence was achieved by 28.3% of patients with smoking partner, and by 46.5% of patients without smoking partner (p<0.001). Subjects whose partner was smoking at the beginning of the program appear to be more likely to relapse than subjects without smoking partners (p<0.001) and this is more pronounced in women than in men. However no significant gender differences were found in any group of smoking partner status. CONCLUSIONS: Having a smoking partner is a determinant of relapse 1 year after the beginning of the cessation program. Interacting not just with the smoker, but also with his or her partner, could neutralize interpersonal influences making smokers more accessible to behavioural and pharmacological techniques.

Adult↗
PubMed2005

Long-term maintenance of exercise and healthy eating behaviors in overweight adults.

BACKGROUND: Most people experience weight regain following the termination of a weight management program. The failure to maintain changes in diet and exercise patterns is a major factor. This study presents 24-month outcomes of a healthy-lifestyle weight management program designed to promote long-term changes in diet and exercise behaviors. METHODS: Overweight and obese adults (n = 144; BMI = 32.5 +/- 3.8) completed a 6-month clinic-based weight management program and were followed for an additional 18 months. Assessments completed at baseline, 6, 12, and 24 months included weight, body composition, dietary recalls, self-reported physical activity, and mediator variables based on Transtheoretical Model of Health Behavior Change. RESULTS: At 24 months, subjects maintained decreases in weight, % body fat, caloric intake, % kcal saturated fat, and increases in weekly exercise minutes (P < 0.05). Individuals who maintained regular exercise at 24 months had higher confidence scores and higher use of experiential and behavioral processes. Individuals who maintained a healthy diet at 24 months had lower temptation scores and higher use of experiential and behavioral processes. CONCLUSIONS: A healthy-lifestyle weight management program is successful at promoting long-term changes in exercise and dietary behaviors. Individuals who actively engage in the maintenance process are more likely to succeed.

Adult↗
PubMed2003

Characteristics of effective school-based substance abuse prevention.

This study summarizes, using meta-analytic techniques, results from 94 studies of school-based prevention activities that examined alcohol or other drug use outcomes. It set out to determine what features of school-based substance abuse prevention programs are related to variability in the size of program effects, It asked (1) Which populations (e.g., high risk vs. general population) should be targeted for prevention services? (2) What is the best age or developmental stage for prevention programming? (3) Does program duration matter? and (4) Does the role of the person delivering the service (e.g., teacher, law enforcement officer, peer) matter? The results suggest that targeting middle school aged children and designing programs that can be delivered primarily by peer leaders will increase the effectiveness of school-based substance use prevention programs. The results also imply that such programs need not be lengthy. The evidence related to the targeting issue is sparse, but suggests that, at least for programs teaching social competency skills, targeting higher risk youths may yield stronger effects than targeting the general population. Suggestions for future research are offered.

Adolescent↗
PubMed2002

Life satisfaction and adverse effects in renal transplant recipients: a longitudinal analysis.

INTRODUCTION: Previous cross-sectional analyses have identified significant associations between quality of life (QOL), comorbidities and adverse effects in renal transplant recipients. This report examines the longitudinal relationship between adverse effects and QOL, with particular attention to the relative impact of adverse effects associated with immunosuppression. METHODS: The Transplant Learning Center (TLC) is a program designed to improve QOL and preserve graft function in transplant recipients. Self-selected enrollees filled out questionnaires at roughly 3-month intervals. Each questionnaire included QOL scales developed for the program. Repeated measures multiple regression analysis was used to examine the relationship between the QOL scales, comorbidities, adverse effects, adjusting for other factors. RESULTS: A total of 4247 TLC enrollees were included in the analysis, with a mean time since transplant of 5.1 yr. Comorbidities and adverse effects were common, with high blood pressure reported by 87% of respondents and unusual hair growth reported by 69.6%. In bivariate analysis, emotional/psychological problems and headaches had the largest impact on QOL. In multivariate analysis, emotional/psychological problems decreased sexual interest or ability, and headache had the largest adverse QOL effect. CONCLUSIONS: We have identified QOL issues that have been previously underemphasized in transplant recipients. These findings open new areas of research to further explore and define these issues. They provide new opportunities for interventions to address factors adversely impacting QOL and to develop strategies to improve QOL in these patients. Clinicians should actively solicit information about adverse effects of medications, particularly information about sexual and relationship issues, when evaluating renal recipients. These issues should be taken into account when making therapeutic decisions.

Comorbidity↗