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At least 1,333 records · Page 74Linked to original sources
PubMed2001

Measurement of comfort levels by means of electrical stapedial reflex in children.

BACKGROUND: Patient success and satisfaction with a cochlear implant largely depend on the adequacy of the speech-processing program. The program is generated by means of behaviorally determined threshold and comfort levels for each electrode. As the minimum age for implantation continues to decrease, behavioral methods of measuring comfort levels have become more problematic, and so the need for objective ways to program speech processors has become more important. OBJECTIVES: To evaluate the use of electrically evoked stapedial reflexes (ESRs) to measure comfort levels for children and compare these results with behavioral measurements, and to report the results of a questionnaire assessing the acceptability and general performance of program before and after adjustment of comfort levels measured with ESRs. DESIGN AND SETTING: Before-after trial in the cochlear implant unit of a tertiary hospital. PATIENTS AND METHODS: Programming with the ESR technique was successfully completed in 20 of a consecutive sample of 26 children undergoing programming of their cochlear implants. OUTCOME MEASURES: Programming units as measured by the 2 programming techniques and numerical score of questionnaire. RESULTS: Comfort levels with the ESR method were found to be consistently lower than those obtained with behavioral techniques. Children using programs set with ESRs wore their implants longer and had fewer episodes of discomfort to environmental sounds. CONCLUSION: Comfort level estimation by means of ESRs is reliable and objective and hence a valuable programming tool in the pediatric population.

Child↗
PubMed1994

Evaluating a school-based intervention for STD/AIDS prevention in Peru.

PURPOSE: In a context of increasing HIV/STD risks among adolescents in Latin America, new conceptions of sequential "sex education" are needed. However, older adolescents must be reached through shorter programs. A quasi-experimental study was conducted to evaluate the impact of a short school-based STD/AIDS prevention program on knowledge, attitudes, and intended behavior among secondary students in Lima. METHODS: Aimed at empowering adolescents regarding their sexuality, improving knowledge and attitudes, and developing skills and prevention-oriented behavioral intentions, the program consisted of seven weekly two-hour sessions. Cost exclusive of research expenses was $3 per student reached. RESULTS: 1213 students from 14 schools participated in either the intervention or control groups. Significant changes in knowledge on sexuality and AIDS, erotophilia, acceptance of contraception, machismo, and discrimination against persons with HIV/AIDS were found in the intervention group, as compared to the control group. Self-efficacy and prevention-oriented behavioral intentions were significantly better in the intervention group. CONCLUSIONS: Owing to its effectiveness, acceptability, and low cost, this program may become useful in reaching adolescents unable to participate in longer-term sex education programs in Peru and elsewhere.

Acquired Immunodeficiency Syndrome↗
PubMed1978

Regional planning for allied health education.

The tremendous proliferation of new programs in allied health education is contrasted with the situation which existed in the pre-Flexner era of medical education. Some similarities to the present state of allied health education and cautionary signs are noted. Allied health educators are urged to accept their responsibility for objective program planning. Several examples of successful regional planning approaches are noted as examples worthy of further investigation, with special attention focused on the State of Virginia, which appears to have developed some of the most comprehensive approaches to planning.

Allied Health Personnel↗
PubMed2006

Trained standardized patients can train their peers to provide well-rated, cost-effective physical exam skills training to first-year medical students.

BACKGROUND AND OBJECTIVES: Teaching physical examination skills effectively, consistently, and cost-effectively is challenging. Faculty time is the most expensive resource. One solution is to train medical students using lay physical examination teaching associates. In this study, we investigated the feasibility, acceptability, and cost-effectiveness of training medical students using teaching associates trained by a lay expert instead of a clinician. METHODS: We used teaching associates to instruct students about techniques of physical examination. We measured students' satisfaction with this teaching approach. We also monitored the financial cost of this approach compared to the previously used approach in which faculty physicians taught physical examination skills. RESULTS: Our program proved practical to accomplish and acceptable to students. Students rated the program highly, and we saved approximately $9,100, compared with our previous faculty-intensive teaching program. CONCLUSIONS: We believe that our program is popular with students, cost-effective, and generalizable to other institutions.

Clinical Competence↗
PubMed1998

Dietetic Internship: Evaluation of an Integrated Model.

The purpose of this study was to utilize graduate and employer perceptions of outcomes of the Mount Saint Vincent University (MSVU) Co-operative Education (Co-op) Dietetics program to determine if an integrated model was an acceptable alternate method of dietetic education. Acceptable alternate was defined as: "facilitating achievement of entry level competence for dietetic practice". A self-administered, validated and piloted questionnaire was utilized to collect qualitative and quantitative information concerning employability, professional preparedness and program outcomes. Surveys were mailed to all program graduates (1989-1993) (n=24) and their first employers (n=19). Response rates were 96% and 89% respectively. Close-ended questions were analyzed quantitatively by determining frequency distributions. Data were also subjected to Chi-square to identify dependent factors. Qualitative responses to open-ended questions were analyzed by thematic content analysis. Results revealed all graduates were employed by six months after graduation. Competency development, a component of professional preparedness, was rated as average or above average by the majority of graduates and employers. Analysis of open-ended responses indicated that the introduction of experience while students were establishing theoretical foundations was perceived as beneficial. An integration of qualitative findings led to the development of a model depicting how professional competency development, readiness for practice, a realistic approach to dietetic practice and a high standard of practice were developed within an evolving personal and contextual framework. Socialization and mentoring opportunities, evaluation processes and the integration of theory and practice influenced professional development. In conclusion, both employer and graduate responses indicated overall program satisfaction suggesting that the Co-op program is an acceptable alternate method of dietetic education.

Journal Article↗
PubMed1976

Perinatal care of low-risk mothers and infants. Early discharge with home care.

A family-centered perinatal-care program featuring collaboration by nurse practitioners, obstetricians, pediatricians, and paramedical personnel was developed to enhance family participation and achieve a shorter but safe hospital stay. Discharge from the hospital was permitted as early as 12 hours after delivery. A perinatal nurse practitioner made daily home visits. The program's safety, feasibility, and acceptability to patients was studied by comparison of 44 patients so treated (study group) with 44 receiving traditional care (controls). Twenty-one study families, but no controls, went home within 24 hours. The study and control groups had no significant differences or trends in numbers of types of morbidity during hospitalization or the six-week post-partum period. The expense of the program is approximately equaled by hospital costs saved through early discharge. The results indicate that early discharge with home-care follow-up observation as described is safe, economically feasible, and well accepted by patients.

Adult↗
PubMed1990

Principles of bladder cancer screening in an intervention trial.

Screening for preclinical disease in asymptomatic people is an accepted activity in occupational health programs, public health programs, and physicians' offices. Yet, only diseases with high morbidity and mortality, a detectable, prolonged preclinical phase, and treatment that can improve survival if applied before the onset of clinical manifestations are suitable for screening. Furthermore, the screening test must be simple to perform, acceptable to providers and recipients, safe, reasonably pain-free, low-cost, and a valid estimator of the true disease state. Even so, screening will succeed only if the condition has a high prevalence in the population being screened, in order that enough persons with disease are identified and treated to justify the cost and the stress experienced by screen-positive, disease-negative subjects. The ultimate goal of screening is to reduce disease-specific mortality. The one recognized study design that can demonstrate a reduction in mortality from cancer of the urinary bladder is a randomized, controlled clinical trial of a screening modality, eg, urinary cytology, in a population previously exposed to occupational carcinogens.

Bias↗
PubMedDate not supplied

Exploring social cognitive theory constructs for promoting exercise among breast cancer patients.

Physical activity during breast cancer treatment can significantly reduce treatment-related fatigue and improve quality of life. Unfortunately, the majority of women with breast cancer either do not exercise at all or exercise below recommended levels. Little is known about how to enhance physical activity among breast cancer patients. The social cognitive theory, a useful framework for the design of physical activity interventions, has not been studied among breast cancer patients. Our study purpose was to explore physical activity knowledge, attitudes, and behaviors among breast cancer patients during adjuvant therapy utilizing social cognitive theory constructs in preparation for a larger, survey study and future intervention research. Twelve breast cancer patients attended 1 of 3 focus group sessions. Focus group questions were based on the social cognitive theory constructs of self-efficacy, environment, behavioral capability, expectations, expectancies, self-control and performance, observational learning, and reinforcement. The focus group participants generally felt confident in their ability to exercise during treatment if fatigue, time management, and social networking were addressed. The majority of participants had not been given information related to exercise by their physicians during treatment. The participants felt that exercise was more beneficial than harmful during treatment, with the 2 most important benefits identified as reduced fatigue and the potential for improved survival. The use of reinforcements by participants was minimal. The participants consistently expressed the desire for education and guidance by knowledgeable staff during an exercise program. Walking was the most acceptable exercise modality. Social cognitive theory may be a useful framework for future study of exercise behavior among breast cancer patients and measurement of constructs related to this theory should be included in such studies. Future exercise intervention studies should consider the unique barriers and program preferences of breast cancer patients while focusing on self-efficacy, outcome expectations/ expectancies, observational learning, and reinforcements.

Adult↗
PubMed1990

Multiscreen serum analysis of highly sensitized renal dialysis patients for antibodies toward public and private class I HLA determinants. Implications for computer-predicted acceptable and unacceptable donor mismatches in kidney transplantation.

A multiscreen serum analysis program has been developed that permits a determination of antibody specificity for the vast majority of highly sensitized patients awaiting transplantation. This program is based on a 2 x 2 table analysis of correlations between serum reactivity with an HLA-typed cell panel and incorporates two modifications. One implements the concept of public HLA determinants based on the serologic crossreactivity among class I HLA antigens. The other modification derives from the premise that most highly sensitized patients maintain the same PRA and antibody profiles over many months and even years. Monthly screening results for patients with persistent PRA values can therefore be combined for analysis. For 132 of 150 highly sensitized patients with greater than 50% PRA, this multiscreen serum analysis program yielded information about antibody specificity toward public and private class I HLA determinants. The vast majority of patients (108 of 112) with PRA values between 50 and 89% showed antibody specificity generally toward one, two, or three public markers and/or the more common private HLA-A,B antigens. For 24 of 38 patients with greater than 90% PRA, it was possible to define one or few HLA-specific antibodies. The primary objective of the multiscreen program was to develop an algorithm about computer-predicted acceptable and unacceptable donor HLA-A,B antigens for patients with preformed antibodies. A retrospective analysis of kidney transplants into 89 highly sensitized patients has demonstrated that allografts with unacceptable HLA-A,B mismatches had significantly lower actuarial survival rates than those with acceptable mismatches (P = 0.01). This was shown for both groups of 32 primary transplants (44% vs. 67% after 1 year) and 60 retransplants (50% vs. 68%). Also, serum creatinine levels were significantly higher in patients with unacceptable class I mismatches (3.0 vs. 8.4 mg% [P = 0.007] after 2 weeks; 3.9 vs. 9.1 mg% [P = 0.014] after 4 weeks). Histopathologic analysis of allograft tissue specimens from 47 transplant recipients revealed a significantly higher incidence of humoral rejection (P = 0.02), but not cellular rejection, in the unacceptable mismatch group. These results suggest that the multiscreen program can establish which donor HLA-A,B mismatches must be avoided in kidney transplantation for most highly sensitized patients. For 18 of 150 high PRA renal dialysis patients, the multiscreen program could not define HLA-specific antibody. Most patients had greater than 90% PRA, and many of their sera appeared to contain IgM type nonspecific lymphocytotoxins that could be inactivated by dithioerythreitol (DTE).(ABSTRACT TRUNCATED AT 400 WORDS)

Antibodies↗
PubMedDate not supplied

Four-week multidisciplinary cardiac rehabilitation produces similar improvements in exercise capacity and quality of life to a 10-week program.

BACKGROUND: Cardiac rehabilitation (CR) is widely accepted as beneficial for patients with myocardial infarction (MI) and coronary artery bypass graft (CABG). A need exists to evaluate how different formats of delivery can best meet CR service demands. METHODS AND RESULTS: Cardiac patients (n = 60) were randomly assigned to either a standard 10-week (30 sessions) or a 4-week (20 sessions) multifactorial rehabilitation program. Patients underwent exercise testing using the Bruce protocol before, immediately after, and then 6 months after CR. Patients also completed the SF-36 quality of life questionnaire and the Hospital Anxiety and Depression scale at each time point. Compared with pre-CR, exercise time and metabolic equivalents attained were significantly increased, and heart rate significantly decreased both immediately (P<.05) and 6 months after CR (P<.05) in both groups, with no between-group differences. Significant improvements (P<.05) in energy, pain, and general health were reported after CR, and in energy and emotional and social well-being at 6 months after CR. No differences were seen between the groups. CONCLUSIONS: Cardiac rehabilitation after MI and CABG significantly improved exercise capacity and general health and well-being. No significant differences were detected between groups undergoing a 10-week or 4-week course. These preliminary data suggest that shortened courses of CR may be beneficial to cardiac patients and such courses may also facilitate more widespread use of CR.

Aged↗
PubMed1992

Estimating viral concentrations from dilution counts: an improved HP48SX version of the 'MLE2' program.

The recent withdrawal of the HP41C* calculator from the market necessitated a translation of the HP41C* 'MLE2' program published earlier (Roussel and Husson, 1991) into a version for its successor, the HP48SX. The existence of the HP41CV emulator module for the HP48SX offers no solution for continued support of the 'MLE2' program, because it does not accept synthetic HP41C instructions (cf. 'Warning' paragraph in (Roussel and Husson, 1991)). Moreover, the built-in HP48SX upper-tail probability functions (UTPC UTPF UTPN) are more accurate than the corresponding HP41C subprograms. The easy interfacing capabilities of the HP48SX with PC or Macintosh make transfer of the program itself, and its output (e.g. for reporting) straight-forward. This calls for a specific HP48SX implementation with ASCII text output of the algorithm presented by Roberts and Coote (1965), and extended by Roussel and Husson (1991). Finally, the probability distribution of the particle concentration lambda as a function of a given set of counts is shown to be chi 2, so that exact confidence bounds for lambda can be computed using the HP48SX UTPC and ROOT commands.

Probability↗
PubMed1989

A national health program for the United States. A physicians' proposal.

Our health care system is failing. Tens of millions of people are uninsured, costs are skyrocketing, and the bureaucracy is expanding. Patchwork reforms succeed only in exchanging old problems for new ones. It is time for basic change in American medicine. We propose a national health program that would (1) fully cover everyone under a single, comprehensive public insurance program; (2) pay hospitals and nursing homes a total (global) annual amount to cover all operating expenses; (3) fund capital costs through separate appropriations; (4) pay for physicians' services and ambulatory services in any of three ways: through fee-for-service payments with a simplified fee schedule and mandatory acceptance of the national health program payment as the total payment for a service or procedure (assignment), through global budgets for hospitals and clinics employing salaried physicians, or on a per capita basis (capitation); (5) be funded, at least initially, from the same sources as at present, but with all payments disbursed from a single pool; and (6) contain costs through savings on billing and bureaucracy, improved health planning, and the ability of the national health program, as the single payer for services, to establish overall spending limits. Through this proposal, we hope to provide a pragmatic framework for public debate of fundamental health-policy reform.

Budgets↗
PubMed1983

Full and limited medicaid participation among pediatricians.

Participation in Medicaid by pediatricians is an important element in the access of low income children to health care. Factors that influence whether participating pediatricians choose to participate fully in the program or to limit their acceptance of Medicaid patients are identified and analyzed. Data were derived from interviews conducted with 814 pediatricians in 13 states. A multivariate analysis examining physician, practice, service area, and Medicaid policy characteristics indicates that policy factors are most influential in the physician's decision whether to participate fully in medicaid programs. Factors found to foster the willingness of pediatricians to participate fully in state Medicaid programs included more competitive levels of reimbursement, minimal delays in reimbursement, and eligibility and benefit policies that minimize interference with the exercise of medical judgment.

Fees and Charges↗
PubMedDate not supplied

Perceived barriers to holistic nursing in undergraduate nursing programs.

This descriptive essay summarizes the recommendations rendered by 40 holistic nurse educators attending the 22nd American Holistic Nurses' Association Annual Gathering of Holistic Nurses regarding perceived barriers to integrating concepts of holistic nursing into undergraduate nursing education programs. This paper also presents proposed strategies for promoting more positive attitudes and acceptance of holistic nursing in undergraduate nursing programs.

Congresses as Topic↗
PubMed1998

Careseeking for illness in young infants in an urban slum in India.

Illness in infants in the first two months of life can take a precipitous life-threatening course, and requires timely and appropriate medical assessment and management. We conducted a focused ethnographic study of illness in young infants and associated careseeking practices in an urban slum in New Delhi, India, in order to identify the constraints in securing effective care for severe illness in this age group. The findings suggest that maternal recognition of illness is not a limiting factor in the use of health care services for sick young infants in this setting. Mothers respond to a number of important signs of illness, including changes in the young infant's sleeping or feeding behavior, and they are usually prompt in seeking care outside the home. They are not able, however, to discriminate among the many sources of health care available in this setting, and give preference to local unqualified private practitioners. Most practitioners, including qualified medical practitioners, display critical failures in the assessment and management of sick young infants. The continuity and effectiveness of care is further compromised by the caretakers' expectations of rapid cure, which result in discontinued treatment courses and frequent changes in practitioners, and by their reluctance to seek hospital care. The implications of these findings for the design of programs to reduce young infant mortality are discussed. In particular, the feasibility and acceptability of hospital referrals according to current program guidelines are called into question.

Adolescent↗
PubMed2006

Diurnal variability in concentrations and sources of Escherichia coli in three streams.

Microbial contamination is a major concern for drinking water worldwide. Many monitoring protocols that use one or very few samples are inadequate and introduce a very large margin of error. An intensive sampling program needs to be conducted to characterize the Escherichia coli concentrations of a source water stream prior to establishing a monitoring program so that the sample frequency can be determined statistically, based on an acceptable margin of error. Developing meaningful monitoring programs for managing bacterial water quality is dependant on scientific data that determine the bacterial sources. In this study, three streams from drinking water watersheds were sampled every 15 min over a 24 h period on three different days to determine the concentrations of E. coli and to identify their sources, using ribosomal RNA finger printing (ribotyping). The concentrations of E. coli varied throughout the day in each of the three streams. Ribotyping identified many different animal sources of E. coli in the samples. The sources of E. coli varied significantly with stream (P < 0.001, df = 16). The development of monitoring programs for watersheds needs to consider the watershed, and care needs to be taken in selecting appropriate sample sites, sampling regime, and number of samples taken during each sampling period. This note provides a prescription for the development of monitoring programs for watersheds.

Animals↗
PubMed2001

[Rehabilitation after anterior cruciate ligament reconstruction: inpatient or outpatient rehabilitation? A series of 103 patients].

PURPOSE OF THE STUDY: The goal of this work was to evaluate outpatient rehabilitation after anterior curciate ligament reconstruction using the bone-tendon technique. MATERIAL AND METHODS: This was a prospective non-randomized study of 103 consecutive patients participating in the same rehabilitation program, excepting for the first month. During the first postoperative month, 55 patients (group A) attended a physical therapy outpatient clinic near their home and 48 patients (group B) followed the same rehabilitation protocol at an inpatient facility of their choice. We recorded preoperative data for age, sex, weight, height and function (sports, occupational activities). Surgery data concerned delay between severe sprain and surgery, and the exact surgical procedure used (meniscal tear, associated procedure). Clinical assessment (mobility, effusion, clinical and radiological laxity) and functional scores (Tegner, Lysholm, Arpege, IKDC) as well as delay to recovery of gait and to renewed physical activity were recorded at 3 and 6 weeks and 4, 6 and 12 months postoperatively. Two isokinetic tests were done 4 and 6 months postoperatively. RESULTS: There was no statistical difference for the pre and peroperative data between the two groups, with the exception of meniscal tears that were more frequent in group A (p<0.05). Postoperative outcome and complications were not significantly different between the 2 groups except for greater flexion at 3 weeks in group B (related to difference in measurement date). Fifteen complications were observed in each group: 4 reflex dystrophies and 2 cyclope syndromes in each group, 5 patellar syndromes in group A and 1 in group B; 3 painful surgical wound sites in group A and 8 in group B (including one requiring revision). In group A there was one early failure due to a surgical error requiring revision. At 1 year, there were 2 cases of persistent femoropatellar syndromes, one of which occurred after reflex dystrophy. A high percentage of the patients were lost to follow-up (45% in group A and 50% in group B) and lack of randomization should also be considered when interpreting the results. DISCUSSION: This is the first report comparing inpatient and outpatient rehabilitation protocols after anterior cruciate ligament reconstruction. The only reports in the literature have compared different ambulatory rehabilitation programs that appear to be internationally accepted as the routine procedure. The current trend towards short hospital stays for surgery is compatible with outpatient rehabilitation programs if dependent patients receive proper support from an ambulatory medical unit, a physical therapist or a home assistant. Our study demonstrated that the bone-tendon technique for anterior cruciate ligament reconstruction is compatible with an outpatient rehabilitation program if quality medical and surgical follow-up is ensured. This type of rehabilitation program gives results comparable with those obtained after inpatient programs conducted in a rehabilitation facility during the first postoperative month.

Activities of Daily Living↗