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PubMed2001

House dust mite avoidance measures for perennial allergic rhinitis.

BACKGROUND: In developed countries, it is estimated that 15% of the general population suffer from one or more allergic disorders, of which allergic rhinitis is the most common. Perennial rhinitis is most often due to allergy to the house dust mite. In such patients, house dust mite avoidance is logical, but there is considerable uncertainty regarding the efficacy and effectiveness of interventions designed to reduce dust mite exposure. OBJECTIVES: To assess the benefit (and harm) of measures designed to reduce house dust mite exposure in the management of house dust mite sensitive allergic rhinitis. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, Central, MEDLINE and EMBASE. No restrictions on the language of publication were employed. The bibliography of each paper and other published reviews were checked for further references. We wrote to first authors of all included trials in an attempt to identify further published and unpublished trials. SELECTION CRITERIA: Randomised controlled trial (with or without blinding), in which house dust mite control measures have been evaluated in comparison with placebo or other dust mite avoidance measures, in patients with clinician diagnosed allergic rhinitis and confirmed allergy to dust mite. DATA COLLECTION AND ANALYSIS: Two reviewers independently checked titles and abstracts identified by the searches and full text copies of all papers of potential relevance were considered. Trials were graded for methodological quality using the Cochrane approach. Data extraction was performed in a standardised manner. Meta-analysis was neither possible, nor considered appropriate, because of the heterogeneity of the patient groups studied; a narrative overview of the results is therefore presented. MAIN RESULTS: Four trials satisfied the inclusion criteria, all of which were small and of poor quality. Two trials investigated the efficacy of acaricides, a third investigated the role of high-efficiency particulate air (HEPA) filters, whilst a fourth investigated the efficacy of a bedroom environmental control program that comprised use of a barrier mattress cover, fortnightly washing of bed covers, removal of soft furnishings and daily cleaning. Each of the four trials showed the interventions to result in significant reductions in house dust mite load when compared with control. Trial results suggest that the interventions may be effective in reducing some rhinitis symptoms, though it is not possible to provide a reliable summary estimate about the magnitude of such symptom reduction. No serious adverse effects were reported from the interventions. REVIEWER'S CONCLUSIONS: Trials to date have been small and of poor methodological quality making it difficult to offer any definitive recommendations on the role, if any, of house dust mite avoidance measures in the management of house dust mite sensitive perennial allergic rhinitis. The results of these studies suggest that interventions designed to reduce house dust mite exposure in patients with house dust mite allergic perennial rhinitis may be of some benefit in reducing rhinitis symptoms. Data at present is only available for acaricides, HEPA filters and a bedroom-based environmental control program; therefore, if considered appropriate, these should be the interventions of choice.

Animals↗
PubMed1996

Eastern barred bandicoot recovery: the role of the veterinarian in the management of endangered species.

The eastern barred bandicoot, Perameles gunnii, formerly widespread on the volcanic plains of western Victoria, has been reduced to a single, rapidly-declining, remnant population at Hamilton. Recovery of this critically endangered species has included local management, in an attempt to stabilise the wild population, captive breeding and reintroduction to selected sites. Veterinary advice and assistance have been an integral part of the investigation, planning and implementation phases of the program. The development of appropriate, standardised techniques has enabled successful treatment of problems in the captive colony. Husbandry, including the hand-rearing of pouch young has been refined. Parasitism, identified as a contributor to poor health or death, has been investigated. Experimental development of techniques for the attachment of radio-transmitters to bandicoots has enabled improved field research to take place. Fox predation, a major limiting factor in the recovery program, has been studied in detail, in order to refine control protocols.

Animal Husbandry↗
PubMed1996

Postgraduate training for rural family practice. Goals and opportunities.

PROBLEM BEING ADDRESSED: The continuing shortage of rural family physicians in Canada. PURPOSE OF PROGRAM: To further develop training for rural family practice so that adequate numbers of rural family physicians will be appropriately prepared. MAIN COMPONENTS OF PROGRAM: All family medicine residents should have the opportunity to experience the joys and challenges of rural family practice. Rural family medicine training streams provide the best education for family medicine residents who are planning a career in rural family medicine. Integrated training for rural family practice should be high-quality, academically sound, needs-driven, evidence-based, learner-centered, and outcome-measured. This involves comprehensive development of curricula that provide specific skills and appropriate core subjects in rural practice as well as a solid family medicine foundation. contextual and experiential learning in areas similar to or in actual areas where there is a need for rural physicians, and appropriate hospital rotations to learn skills for the hospital role of many rural family doctors, are important components of rural family medicine training. CONCLUSIONS: Postgraduate rural family medicine training programs can be further focused and developed to train more physicians with the knowledge, skills, and attitudes required for rural practice.

Canada↗
PubMed1999

Quality assurance and standardization: summary of the satellite meeting, Turku, Finland, 11-12 June 1999.

The Quality Assurance (QA) and Standardization satellite meeting addressed five major issues in newborn screening: (i) Pre- and post-analytical phases are important in the overall quality of screening, and quality assurance programs should include these aspects. (ii) It is possible to run a single screening program using laboratories on more than one site, as is done in Europe, California and Cuba. Special quality assurance procedures are necessary for success. (iii) It is possible to achieve improved analytical quality and international comparison of results by use of common reference materials such as the amino acid materials developed in Europe and the US. It will be important to use tested paper with defined performance characteristics. (iv) It is appropriate for newborn screening programs to be accredited, but it will also be important to develop criteria for pre- and post-analytic phases of screening. (v) A new QA program is being developed for Latin America. The Australasian QA program now includes amino acids and acylcarnitines in a form suitable for tandem mass spectrometry blind QA. The European Society for Paediatric Endocrinology has developed guidelines for CAH screening.

Accreditation↗
PubMed1998

Pay-for-performance compensation: moving beyond capitation.

Although capitation has been instrumental in lowering healthcare costs, it also has generated growing concern about quality of and access to healthcare services. Shifting to pay-for-performance compensation programs, however, allows health plans and physicians to balance economic incentives and operational outcomes, which in turn encourages improved performance and benefits providers, payers, and patients alike. A successful pay-for-performance program requires selection of appropriate performance criteria, accurate assessment of the financial impact, development of an effective means of communication between the health plan and physicians, and gradual implementation of the plan.

Capitation Fee↗
PubMed2005

Southeast Asian refugee children: a school-based mental health intervention.

One particular focus of refugee studies in the United States has been the violence experience of Southeast Asian (S.E.A.) refugee children and its impact on mental health and school adaptation. Although virtually all researchers have found that the children have high rates of depression and/or post-traumatic stress disorder, findings concerning successful school adaptation have been inconclusive. Even so, concern has been generated on how to best meet the children's mental health needs. The purpose of our study was to provide an eight-week school-based program that was designed to reduce depression symptoms of S.E.A. refugee children. Specifically, this collaborative program addressed refugee adaptation issues, children's culture and the development of coping skills. All of the children were screened for depression using the Children's Depression Inventory (CDI). Analysis of CDI data revealed that children's depression scores had a significant decrease between screening times 1 (approximately one month before the intervention) and 2 (fourth week of the intervention), 1 and 3 (eighth week of the intervention) and 1 and 4 (one month following the intervention). Globally, culturally sensitive mental health school-based programs may be an appropriate intervention to assist immigrant and refugee children in making a successful adaptation to host countries.

Adaptation, Psychological↗
PubMed1995

Design and analysis of community trials: lessons from the Minnesota Heart Health Program.

Community trials remain the only design appropriate for the evaluation of lifestyle interventions that cannot be allocated to individuals. The Minnesota Heart Health Program, conducted in Minnesota and the Dakotas between 1980 and 1993, is one of the largest community trials ever conducted in the United States. That study suggests several lessons that should guide future community trials. Planners should 1) carefully assess the secular trends for their outcomes and be confident that they can demonstrate an intervention effect against those trends; 2) be confident that they have effective programs than can be delivered to a sufficiently large fraction of their target population; 3) avoid differences between study conditions in levels and trends for their outcomes through random allocation of a sufficient number of communities to each condition; 4) develop good estimates of community-level standard errors prior to launching future trials; and 5) take steps to ensure that power will be sufficient to test the hypotheses of interest.

Adult↗
PubMed2002

Effects of regular exercise on anxiety, depression, and quality of life in maintenance hemodialysis patients.

BACKGROUND: Psychological problems such as depression and anxiety are common in hemodialysis patients. In several studies, exercise programs were effective in relieving depression or anxiety in these patients, although not all agree. PURPOSE: In this study, we evaluated the effects of an exercise program on exercise capacity, anxiety, depression and quality of life in maintenance hemodialysis patients. METHODS: Twenty hemodialysis patients were enrolled in the study. Six patients were later excluded; two due to anemia, one due to nausea with vomiting during exercise, one due to a neurologic problem, and the other two due to noncompliance. Thus, fourteen patients, 3 men and 11 women, aged 42 +/- 10 years, completed the study. The exercise program composed of bicycle ergometer, treadmill or upper limb ergometer, 60 min per session, 3 times per week, for 12 weeks. At the beginning and the end of the exercise program, the exercise capacity was determined by measuring the maximal oxygen consumption and exercise duration. In addition, psychological tests for the assessment of depression, anxiety and quality of life were performed. RESULTS: Maximal oxygen consumption was increased from 26.3 +/- 4.6 mL/kg/min to 29.8 +/- 4.9 mL/kg/min (p = 0.013). Exercise duration was 483 +/- 138 s at the start. At the end of the exercise program it was increased to 607 +/-119s (p = 0.002). The score of anxiety was significantly improved from 47.9 +/- 5.9 to 42.8 +/- 6.3 after exercise (p = 0.004). Though it did not reach statistical significance there was a trend of improvement in depression (from 44.8 +/- 8.4 to 39.7 +/- 6.4, p = 0.073). The score of quality of life also showed a significant improvement (from 124.5 +/- 16.5 to 133.6 +/- 19.3, p = 0.031). CONCLUSION: The results of this study indicate that an appropriate application of exercise program would improve the psychological status in long-term maintenance hemodialysis patients.

Adult↗
PubMed1984

KLONER; a computer program to simulate recombinant DNA strategies by restriction map manipulation.

A computer program is described which allows for the manipulation of restriction maps of various DNA fragments to demonstrate techniques used in DNA cloning and to predict and/or confirm experimental results. This program is capable of reading in restriction enzyme cleavage sites for several different DNA molecules of interest. This information is then compiled in order to form restriction maps which can then be processed by digestion with restriction endonucleases and treatment with other common DNA modifying enzymes. Ligation can then be simulated by joining fragments with complementary ends in all possible orientations, producing restriction maps of the products. The resulting recombinants can then be further analyzed by physical mapping with appropriate restriction endonucleases. This program was written in Pascal on an Apple II computer.

Base Sequence↗
PubMed1976

Attitudes toward aging as a function of in-service training and practitioner age.

Age differences in attitudes toward aging were investigated as a function of a 3-hour training program with 322 women (18-74 years) from various geriatric health care and social service contexts. Using a quasi-experimental pre- and posttest design, sites were randomly divided into initial experimental and control groups, with all control participants receiving training following the research program. Results indicated few instances of unfavorable attitudes toward aging in any age group, with younger women evidencing less cynicism toward aging, less social distance from the aged, and slightly less stereotyping. Training appeared to result in less cynicism, stronger endorsements of family and public responsibility, and slightly greater anxiety. No Age X Pretest/Posttest interactions were found. The results are discussed in terms of their implications for service provider-client interaction, the correspondence of attitudinal and behavioral change, and appropriate instruments for assessing program impact.

Adolescent↗
PubMed2005

Optimal H infinity insulin injection control for blood glucose regulation in diabetic patients.

The theory of H infinity optimal control has the feature of minimizing the worst-case gain of an unknown disturbance input. When appropriately modified, the theory can be used to design a "switching" controller that can be applied to insulin injection for blood glucose (BG) regulation. The "switching" controller is defined by a collection of basic insulin rates and a rule that switches the insulin rates from one value to another. The rule employed an estimation of BG from noisy measurements, and the subsequent optimization of a performance index that involves the solution of a "jump" Riccati differential equation and a discrete-time dynamic programming equation. With an appropriate patient model, simulation studies have shown that the controller could correct BG deviation using clinically acceptable insulin delivery rates.

Algorithms↗
PubMed1980

Multi-test screening and the chances of being normal.

Screening programs involve responsibility for appropriate action on abnormal test results. When multiple-test screening batteries are used, a simple probability formula is commonly used to predict the proportion of healthy individuals who will have one or more abnormal test results occur by chance alone. This formula is valid only when the assumptions upon which it rests are met in the population being tested. In many situations the assumptions are not met and the formula overestimates the occurrence of abnormal results in healthy populations. Data for three screening programs involving blood chemistry test batteries on 769 patients document this overestimate and its magnitude. Clinical judgment, not misapplied probability theory, should guide the physician's strategy in evaluating abnormal results of screening tests.

Blood Chemical Analysis↗
PubMed2003

Determinants of appropriate lipid management in patients with ischaemic heart disease. Cracovian Program for Secondary Prevention of Ischaemic Heart Disease.

UNLABELLED: Although several randomised clinical trials have documented the efficacy of lipid-lowering therapy in improving clinical outcomes in hyperlipidemic subjects with ischaemic heart disease (IHD), such therapy is underutilized worldwide. Not much is known about the effects of the hospital setting (university vs. community) on lipid management in patients after hospitalization due to ischaemic heart disease. The combined effect of age, sex, education, risk factors, hospital as well as practice setting in the post-discharge period on lipid management in IHD patients is also unknown. Therefore the aim of this study was to evaluate factors influencing lipid management during and after hospitalization due to IHD. The primary outcome measure was "appropriate lipid management", defined as: (a) being discharged on lipid-lowering medication or having a documented LDL cholesterol level <3.4 microM/l within the first 24 h of hospitalization, and (b) (for patients with hypercholesterolemia) being prescribed a lipid-lowering drug at the time of the interview 6-18 months after discharge. METHODS AND RESULTS: We reviewed the hospital records of 1051 consecutive patients with a discharge diagnosis of acute myocardial infarction (N=290), unstable angina (N=247), percutaneous coronary intervention (N=259) or coronary artery bypass surgery (N=255) who were hospitalized at three university (N=533) or three community (N=518) cardiac departments. Overall, 42.2% of the study population met the criteria for appropriate lipid management during hospitalization. Admission to the university hospital, percutaneous coronary intervention, a history of myocardial infarction, the presence of hypertension, the absence of diabetes mellitus, and younger age were all associated with an increased probability of receiving proper treatment during hospitalization. During the follow-up interview (6-18 months after discharge), 10.4% patients had a LDL cholesterol level of <2.6 microM/l. The use of lipid-lowering agents in the group with hypercholesterolemia was 40.8%. Patients who met the criteria for appropriate lipid management during hospitalization were more often prescribed a lipid-lowering drug at the time of interview compared with persons who did not meet those criteria (62.5% vs. 23.5%; P<0.0001). Patients undergoing percutaneous coronary interventions, treated in hospital outpatient clinics, obese patients as well as those better educated were more likely to be treated appropriately than the other groups. CONCLUSIONS: Proper lipid management during hospitalization is the most important factor related to lipid management in the post-discharge period. There is the potential for a further reduction of coronary risk, especially in patients hospitalized in community hospitals, not undergoing coronary interventions and those being under the care of general practitioners.

Comorbidity↗
PubMed1991

An MS-DOS program for certain computations for the Wechsler Adult Intelligence Scale--Revised.

A compiled program for MS-DOS computers is described. The program computes four useful measures for the Wechsler Adult Intelligence Scale--Revised (WAIS-R). It will estimate the subject's premorbid Verbal, Performance, and Full-Scale IQs from demographic data. It will prorate the sum of the Verbal or Performance scaled scores when less than the full number of subtests are administered. It will compute the deviation of each age-scaled score from either the Verbal or Performance mean, indicating the reliability and abnormality of all differences. For those subtests which differ significantly from the appropriate mean score, the program briefly describes the subject's relative strengths and weaknesses. Finally, the program will compute the difference between the Verbal and Performance IQs, indicating the reliability and abnormality of the difference.

Mathematical Computing↗
PubMed1992

HIV/AIDS education and prevention among African-Americans: a focus on culture.

African-Americans have emerged as the "second wave" of the AIDS epidemic. Epidemiologic evidence indicates that African-Americans adults as well as adolescents have a disproportionately higher risk of AIDS and human immunodeficiency virus (HIV) infection. While programs designed to increase self-protective behaviors are urgently needed to avert a further increase in HIV infection among this population, there is little understanding of African-American sociocultural factors that may influence the acceptance of HIV information and the adoption of HIV-preventive behaviors. This paper describes African-American cultural values and mores which may be related to risk-taking behavior. Barriers to the effective dissemination of HIV prevention education are identified and strategies that may be effective in surmounting these barriers and implementing culturally-appropriate HIV behavioral modification programs are described.

Black or African American↗
PubMed2006

Promovision: designing a capacity-building program to strengthen and expand the role of promotores in HIV prevention.

This article describes the development of Promovisión, a program based on the utilization of promotores in community-based organizations (CBOs) to improve the provision of HIV prevention services to recent immigrants and Latinos who are less acculturated. Promovisión aims to demonstrate the contribution of promotores as a cost-effective strategy in HIV prevention efforts, and how promotores facilitate the formation of community, regional, and national CBO networks working collaboratively to prevent the spread of HIV in Latino communities. In addition, this article examines the interpersonal, organizational, community, and sociocultural dimensions that facilitate or hinder community mobilization, and coalition formation and growth, and how these findings shaped the final design of the program. Finally, the Promovisión program seeks to demonstrate that a promotor-based program is a culturally appropriate model for HIV prevention and care, which can be successfully implemented in community and clinical settings among ethnic populations with limited English proficiency.

Acculturation↗
PubMed2005

The American Board of Radiology Maintenance of Certification (MOC) Program in Radiologic Physics.

Maintenance of Certification (MOC) recognizes that in addition to medical knowledge, several essential elements involved in delivering quality care must be developed and maintained throughout one's career. The MOC process is designed to facilitate and document the professional development of each diplomate of The American Board of Radiology (ABR) through its focus on the essential elements of quality care in Diagnostic Radiology and its subspecialties, and in the specialties of Radiation Oncology and Radiologic Physics. The initial elements of the ABR-MOC have been developed in accord with guidelines of The American Board of Medical Specialties. All diplomates with a ten-year, time-limited primary certificate in Diagnostic Radiologic Physics, Therapeutic Radiologic Physics, or Medical Nuclear Physics who wish to maintain certification must successfully complete the requirements of the appropriate ABR-MOC program for their specialty. Holders of multiple certificates must meet ABR-MOC requirements specific to the certificates held. Diplomates with lifelong certificates are not required to participate in the MOC, but are strongly encouraged to do so. MOC is based on documentation of individual participation in the four components of MOC: (1) professional standing, (2) lifelong learning and self-assessment, (3) cognitive expertise, and (4) performance in practice. Within these components, MOC addresses six competencies: medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.

Certification↗