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PubMed1992

Health needs of a suburban community: a nursing assessment approach.

Community health nursing can play an important role in conducting community needs assessments that provide critical data upon which programming, planning, and evaluation should be based. The community health services developed for any given community should be planned with the specific needs of the community residents in mind. A community needs survey is one method that should be periodically employed to ascertain the specific needs and concerns of community residents. Nursing conceptual models developed by CHNs are very appropriate to the assessment of all aspects of community life related to health and well-being. Comprehensive community needs surveys should include assessment of environmental, psychosocial, and physiological aspects of health as well as indicators of health-related behaviors in the population. The Omaha classification system adapted for this study provides a broad conceptual framework that facilitates the development of comprehensive programs of assessment. Public health services are in a state of crisis in many states. Traditional program offerings may no longer be the key to providing the types of services most needed by some communities. Analysis of data on problems related to personal and family well-being in one upper middle class suburban community indicate a need for health promotion and services focused on many of the psychosocial aspects of health. The stress experienced by younger community residents appears to be related to issues of parenting and balancing the dual roles required at work and home. Families of elders are also confronted by issues concerning the decreasing independence of these individuals and the need to find additional support services for them. Community health services must be designed that take these factors into account. Professional nurses can provide the leadership necessary to assess health needs and current public health practices in these communities and to recommend and implement programs appropriate to the needs of the present and the goals of the future.

Adult↗
PubMed1996

Evaluating the appropriateness of red blood cell transfusions: the limitations of retrospective medical record reviews.

OBJECTIVE: Several studies have looked at the appropriateness of red blood cell transfusions, using retrospective chart reviews to assess compliance with guidelines. The goal of this study was to determine the quality of medical chart documentation, and assess the validity and the feasibility of using retrospective chart review data as part of a quality improvement (QI) program, to evaluate the appropriateness of peri-operative transfusions. DESIGN: The charts of 188 patients admitted for elective orthopedic surgery were reviewed. Both intra-operative and post-operative transfusion events (n = 353) were analyzed. RESULTS: Only 68% of post-operative transfusion events on the day of surgery and 35% of transfusion events on days after surgery were accompanied by documentation of blood loss and/or change in vital signs. Symptoms were recorded in only 10% of post-operative transfusion events. The rationale for transfusion was recorded in only 16% of post-operative transfusion events on the day of surgery, in 27% on post-operative days and in 95% of intra-operative transfusions. The documentation of rationale was not different for transfusion events involving autologous blood (31%) or allogeneic blood (32%). This study provided information on transfusion practices. Single unit transfusions occurred in only 47 and 34% of patients receiving autologous and allogeneic blood, respectively. Only 19% of patients transfused with more than one allogeneic blood units, were clinically reassessed between blood units, compared to 34% of patients receiving more than one autologous blood unit. We conclude that retrospective chart reviews are limited by inadequate documentation and may not be the optimal source of information to determine the appropriateness of a transfusion. Improved methods (e.g. prospective reviews, or other system-level data collection methods) are needed for QI programs to influence practice. Despite its limitations, the information obtained suggests that current practice could be improved.

Adult↗
PubMed2005

Promoting health for transgender women: Transgender Resources and Neighborhood Space (TRANS) program in San Francisco.

Transgender women are at high risk for HIV, substance abuse, and mental health problems. We describe a health promotion intervention program tailored to transgender women in San Francisco. The program creates a safe space for providing transgender-sensitive education about HIV risk reduction, substance abuse prevention, and general health promotion. Transgender health educators conduct workshops and make referrals to appropriate substance abuse treatment programs and other services in the community. Evaluation findings indicate that this community-tailored intervention may be an effective way to reach transgender women and reduce sexual risk behaviors, depression, and perceived barriers to substance abuse treatment.

Attitude to Health↗
PubMed1992

Green Spring criteria for medical necessity of outpatient treatment and its use in a mental health utilization review program.

The authors have developed a two-tiered method for utilization review of outpatient mental health services. The methodology looks at initial and continued treatment evaluation and uses diagnosis, symptoms, plan of treatment, and the Global Assessment Scale (GAS) among other indicators to determine appropriateness of treatment. Preliminary program experience has been positive and is included.

Ambulatory Care↗
PubMed1993

Prenatal alcohol education for low-income women with interactive multimedia.

Prenatal alcohol use is a major cause of birth defects and other adverse outcomes of pregnancy. Educating expectant mothers concerning the need to limit alcohol consumption has been advocated as a method to decrease alcohol-related birth problems, however providing this service for low-income women is increasingly difficult due to ongoing changes in obstetrical practice patterns. The purpose of this work was to develop and test a computer-based multimedia prenatal alcohol education program which would be appropriate for use in a poor rural patient population. We first review the effect of alcohol consumption during pregnancy and previously employed intervention strategies. Then the design, development, and evaluation of the program is described. The content of the program reflects user beliefs and attitudes and takes advantage of a computer-based multimedia approach. This format provides numerous opportunities for user interaction, requires little reading ability and offers the potential to increase levels of health education efforts with no increase in staff. The program was found to be well accepted, to provide new information and to demonstrate potential for effecting change in behavioral intention. Possible uses of this technology for educating similar populations and the use of computers for health screening are discussed.

Alcohol Drinking↗
PubMed1999

Feast or famine? Supplemental food programs and their impacts on two American Indian communities in California.

This article examines the use of supplemental food programs by two Native American populations and assesses some of the health and cultural impacts of these programs. A cross-sectional survey of 80 American Indian families, 40 families residing on the Round Valley Indian Reservation and 40 in Sacramento, California was conducted to determine access, use and appropriateness of supplemental feeding programs. Respondents at both the rural and urban geographic location showed considerable familiarity with available supplemental feeding programs. USDA Food Commodities were utilized most at Round Valley, raising the concern that provided staples which were highly processed and contained significant amounts of sodium, sucrose, and fat, could contribute to the problems of obesity and diabetes. Native Americans in Sacramento used food banks and food closets as their primary source of supplemental foods, and some expressed concern that the foods provided were highly sweetened and high in fat. While some nutrition advising was available at both geographical localities, access was inadequate. The study found that the foods provided by the supplemental food programs varied considerably in their nutritional quality and healthier foods such as fresh fruits, vegetables, and meats were either completely lacking or in short supply. In addition, culturally sensitive nutritional counseling and the development of education modules to instruct program recipients in the preparation of healthy meals and how to manage obesity and diabetes were needed and requested within the California Native American communities surveyed.

Adult↗
PubMed1985

Computer-assisted concurrent antibiotic review in a community hospital.

A computer-assisted program that monitors the appropriateness of antibiotic prescribing by matching microbiology reports and patient drug profiles is described. An antibiotic review committee in conjunction with the quality assurance department developed the computer-assisted antibiotic review program. An antibiotic order sheet was incorporated into the physicians' order form. Automatic stop dates were assigned according to the reason the antibiotic was ordered, e.g., surgical prophylaxis or documented infection. Numerous reports are generated from the data gathered from the physicians' order form. A drug/microbiology report is used to match patients' antibiotic drug profiles with their microbiology culture and sensitivity results. This report identifies all patients who have been receiving antibiotics for 72 hours or longer with sensitivities on file and mismatched sensitivity results. All mismatches that are considered important are investigated. Any actions taken are reported to the antibiotic review committee for peer review. The computer-assisted program has helped this hospital screen large populations of inpatients receiving antibiotics. The concurrent review of the drug/microbiology report has made it possible to detect within 24 hours, patients who are receiving antibiotics inappropriately. A computer can be used to perform daily concurrent antibiotic use review as a by-product of order entry by both the pharmacy and laboratory.

Anti-Bacterial Agents↗
PubMed2002

National MOTTEP: educating to prevent the need for transplantation. Minority Organ Tissue Transplant Education Program.

The purpose of this study was to determine whether participation in culturally appropriate, community-developed, health education programs addressing organ/tissue donation and preventing the need for transplantation, is an effective strategy for contributing to sustained behavior change among members of minority population groups. Within 15 target cities, 800 (40%) minority participants consented to a 2-3 month telephone follow-up survey. The 5-item questionnaire using items extracted from the pre- and post-survey instrument, addressed: 1) knowledge and beliefs; 2) willingness to sign donor cards and have family discussions; and 3) prevention/health behaviors. The preliminary findings based on telephone interviews with 253 participants indicate the following: [table: see text] The conclusions indicate that the community-based, culturally appropriate health education strategies used contributed to and sustained behavior changes.

Attitude to Health↗
PubMed2000

Educational program for children with peanut allergy.

The best approach to managing peanut allergy is to educate patient and family. We developed specific consultation for children with peanut allergy. We follow a structurized program in a pedagogical manner. The objectives of this program are to encourage appropriate understanding, recognition of the signs of allergy, and if it is necessary, to teach how to inject oneself with an epinephrine injection. The aim of these sessions is to improve knowledge on basic allergy, recognition of hidden foods, on reading labelling, on recognition of earliest signs and finally on use of epinephrine as a rescue treatment. Behaviour in restaurant and most of all at school is also precised. The interview began with the parents and children, followed by discussions and pedagogical games. Our subjects experiences, described below, suggest that these educational programs are beneficial. As the others chronic pathologies, patients with this program seem to have less allergic reactions, and are able to respond with the appropriate behaviour when symptoms appear. Three months later, we conduct the efficiency of the treaning.

Adolescent↗
PubMedDate not supplied

Emergency medical services assessment and treatment of children with special health care needs before and after specialized paramedic training.

INTRODUCTION: This study evaluates whether a continuing education program for paramedics, focusing on Children with Special Health Care Needs, improved paramedics' assessment and management. METHODS: Emergency Medical Services responses for children, 21 years of age or younger, with a congenital or acquired condition or a chronic physical or mental illness, were identified. The responses before and after the specialized education program were reviewed by a multidisciplinary team to evaluate assessment and management of the children. Interreviewer agreement between the nurses on the team and between the physicians on the team was assessed. We also evaluated whether there was an improvement in assessment and care by paramedics completing our education program. RESULTS: Significant improvement was seen in appropriate assessment and overall care by paramedics who completed our specialized education program. Reviewers also noted an appropriate rating for the initial assessment category more often for responses involving paramedics who had the training. Agreement on whether assessment and treatment was appropriate for all five reviewers varied considerably, ranging from 32% to 93%. Overall there was a high percentage of agreement (>70%) between the nurses and between the physicians on most items. However, kappa statistics did not generally reflect good agreement except for most of the focused assessment items and some treatment and procedure items. CONCLUSION: Most of the documentation on the EMS records indicated appropriate assessment and treatment during all responses for Children with Special Health Care Needs. Nevertheless, the results indicate that paramedics may improve their assessment and management of these children after specialized continuing education.

Arizona↗
PubMed2004

Asthma education: the adolescent experience.

Recent studies show that prevalence of asthma is higher among adolescents than children. Adolescents have poor asthma self-management skills resulting in a significant increase in the severity of asthma exacerbations and a reduction in their quality of life. Despite this, few self-management programs have been developed for adolescents. Adolescents experience developmental transitions that both hinder and facilitate asthma self-management. In this paper we discuss developmental transitions in cognition, knowledge, autonomy, identity development, and peer relations in terms of their influence on adolescents' management of asthma. Next, we describe the Asthma Self-Management for Adolescents (ASMA) program that incorporates developmental characteristics into an age-appropriate school-based asthma education program. Preliminary data is presented indicating that the program is successful in enrolling and engaging the interest of adolescents with persistent asthma.

Adolescent↗
PubMedDate not supplied

The importance of a successful Quality Assurance (QA) program from a research manager's perspective.

One responsibility of an EPA research manager is to ensure that data from research projects are acquired, processed, and reported in accordance with Quality Assurance (QA) requirements established by the Agency. To meet this responsibility, the research manager should understand Agency QA requirements, require an appropriate, effective Quality Assurance program to ensure that data are of known and acceptable quality for the intended use of the data, and provide support, guidance, and oversight to principal investigators in meeting QA requirements. In addition, the effectiveness of the QA effort can be enhanced if the research manager 1) ensures that principal investigators and other managers are aware that QA is viewed as an essential, integrated component of the research programs; 2) provides adequate resources (people and money) to support an effective Quality Assurance program; 3) encourages cooperative, productive interactions between researchers and Quality Assurance professionals; and 4) maintains oversight so that issues that have the potential for adversely affecting research and Quality Assurance objectives can be negotiated and corrected quickly. This presentation will discuss the Air Pollution Prevention and Control Division's Quality Assurance program and the approaches used to meet Quality Assurance requirements in the Division. The presentation will be a technical manager's perspective of the Division's requirements for and approach to Quality Assurance in its research programs. The presentation will include the design of the QA Team, the roles of members of the QA Team, training and technical aids provided by the QA Team to promote understanding of and adherence to Agency QA requirements, the interactions of the QA Team members with principal investigators, and examples of effective conflict resolution.

Air Pollution↗
PubMed1994

Prognosis of patients with severe congestive heart failure referred to the cardiac transplant program. Osaka University Cardiac Transplant Program.

In any program for cardiac transplantation, appropriate recipient selection is critically important. The purpose of this study is to evaluate the prognosis of 42 patients with severe cardiac dysfunction who were referred to the Patient Referral Committee of the Osaka University Cardiac Transplant Program from August 1990 to July 1993. All of the patient profiles and clinical data were presented and discussed in the Committee Conference. The Committee classified the patients into three groups according to the following criteria: Class A; 14 patients judged to have a medical indication for heart transplantation, Class B; 7 patients with possible indications which required reevaluation for a definite indication after further intensive medical treatments, and Class C; 21 patients who did not have indications for heart transplantation or who required further clinical examinations and/or medical treatments before a final judgment. Twelve of the 14 Class A patients had a history of NYHA functional class IV and ejection fractions were 25% or less in all of the patients but one (18.5 +/- 1.7%). Six patients in Class A had a history of ventricular tachycardia. The one-year survival rate of Class A patients was 60%, and only 28% survived for 28 months. One patient underwent successful heart transplantation in the United States. If we assume that this patient would have died within a year without heart transplantation, the estimated one-year survival rate would fall to 48%, which is comparable to the survival rate of patients who have been accepted for transplant, but are being treated medically, in Western countries.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed2004

Development of an opinion leader-led HIV prevention intervention among alcohol users in Chennai, India.

In 1999, we began a community-based randomized controlled prevention trial in Chennai, which aims to test the efficacy of HIV prevention messages disseminated through members of an individual's social group called community popular opinion leaders, or CPOLs. We targeted patrons of 100 bars or wine shops in the city of Chennai, India. In this article we report on the process of development of an HIV prevention intervention for wine shop patrons. First, we conducted detailed ethnography to understand social norms and CPOL and social network characteristics, including 41 in-depth interviews among wine shop patrons and gatekeepers. Second, we tailored a generic HIV education training manual to appropriately address the needs of Chennai wine shop patrons. Field-testing involved 16 focus groups with wine shop patrons and 12 sessions of participant observations in wine shops. Finally, we piloted the intervention to determine the appropriateness of the training program and its content among wine shop patrons. Our ethnographic data indicated that wine shops are a common meeting place for men. We were able to identify CPOLs influential in these settings and train them to deliver appropriate prevention messages to their close friends and associates. We found that HIV prevention messages in this population need to dispel misperceptions about HIV transmission, provide strategies and skills to adopt and sustain condom use, and target the role of alcohol in sexual behavior. We outline specific lessons we learned in intervention development in this population.

Alcohol Drinking↗
PubMed1997

Guidelines for school and community programs to promote lifelong physical activity among young people. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and prevention.

Regular physical activity is linked to enhanced health and to reduced risk for all-cause mortality and the development of many chronic diseases in adults. However, many U.S. adults are either sedentary of less physically active than recommended. Children and adolescents are more physically active than adults, but participation in physical activity declines in adolescence. School and community programs have the potential to help children and adolescents establish lifelong, healthy physical activity patterns. This report summarizes recommendations for encouraging physical activity among young people so that they will continue to engage in physical activity in adulthood and obtain the benefits of physical activity throughout life. These guidelines were developed by CDC in collaboration with experts from universities and from national, federal, and voluntary agencies and organizations. They are based on an in-depth review of research, theory, and current practice in physical education, exercise science, health education, and public health. The guidelines include recommendations about 10 aspects of school and community programs to promote lifelong physical activity among young people policies that promote enjoyable physical activity and social environments that encourage and enable physical activity; physical education curricula and instruction; health education curricula and instruction; extracurricular physical activity programs that meet the needs and interests of students; involvement of parents and guardians on physical activity instruction and programs for young people; personnel training; health services for children and adolescents; developmentally appropriate community sports and recreation programs that are attractive to young people; and regular evaluation of physical activity instruction, programs, and facilities.

Adolescent↗
PubMed2003

A comparison of model performance for six quantitative structure-activity relationship packages that predict acute toxicity to fish.

Some regulatory programs rely on quantitative structure-activity relationship (QSAR) models to predict toxic effects to biota. Many currently existing QSAR models can predict the effects of a wide range of substances to biota, particularly aquatic biota. The difficulty for regulatory programs is in choosing the appropriate QSAR model or models for application in their new and existing substances programs. We evaluated model performance of six QSAR modeling packages: Ecological Structure Activity Relationship (ECOSAR), TOPKAT, a Probabilistic Neural Network (PNN), a Computational Neural Network (CNN), the QSAR components of the Assessment Tools for the Evaluation of Risk (ASTER) system, and the Optimized Approach Based on Structural Indices Set (OASIS) system. Using a testing data set of 130 substances that had not been included in the training data sets of the QSAR models under consideration, we compared model predictions for 96-h median lethal concentrations (LC50s) to fathead minnows to the corresponding measured toxicity values available in the AQUIRE database. The testing data set was heavily weighted with neutral organics of low molecular weight and functionality. Many of the testing data set substances also had a nonpolar narcosis mode of action and/or were chlorinated. A variety of statistical measures (correlation coefficient, slope and intercept from a linear regression analysis, mean absolute and squared difference between log prediction and log measured toxicity, and the percentage of predictions within factors of 2, 5, 10, 100, and 1,000 of measured toxicity values) indicated that the PNN model had the best model performance for the full testing data set of 130 substances. The rank order of the remainder of the models depended on the statistical measure employed. TOPKAT also had excellent model performance for substances within its optimum prediction space. Only 37% of the substances in the testing data set, however, fell within this optimum prediction space.

Animals↗
PubMed1987

Attention-deficit disorder in children: the role of the nurse practitioner.

Attention-deficit disorder is a relatively common syndrome; it is probably the behavior disorder of childhood that primary care practitioners most frequently see. This article describes 1) the clinical picture, subtypes and possible etiologic factors involved in the disorder; 2) the diagnostic evaluation of the child who presents with symptoms suggestive of this syndrome; 3) the natural history of the disorder and its relationship to other disorders of childhood, adolescence and adult life; and 4) the management of the disorder. The nurse practitioner can play a major role in evaluating these children, in designing a proper multimodality treatment program, in making referrals for appropriate types of intervention and in monitoring the results of this multimodality therapeutic program over time.

Attention Deficit Disorder with Hyperactivity↗
PubMed1995

Interactive computer program for the analysis of cardiovascular polysomnographic recordings.

A computer program for the analysis of blood pressure, heart rate, oxygen saturation and some other polysomnographic signals is presented. The program analyzes the signals, digitized by using a 100 Hz sampling frequency, in one second resolution. The analysis and calibration periods can be entered to the program by pointing at the appropriate positions of the displayed signal with a mouse. As analysis results the program can produce statistical tables or graphical representations of the measured variables as a function of time. The program can be used in routine polysomnographic cardiovascular analysis and due to its flexibility also in experimental studies.

Blood Pressure↗