Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Program Appropriateness”

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 1,351 records · Page 75Linked to original sources
PubMed1976

Ventilatory muscle strength and endurance training.

We studied respiratory mechanics in young volunteers before and after 5-wk training programs limited to the ventilatory muscles. Four strength trainers (S) performed repeated static maximum inspiratory and expiratory maneuvers against obstructed airways. Four endurance trainers (E) performed voluntary normocarbic hyperpnea to exhaustion. Subjects spent 30-45 min each day in these exercises, 5 days a week. Four control subjects (C) did no training. We attempted to minimize the effect of learning. S increased pressure maximums by about 55%, but vital capacity and total lung capacity by only about 4%. Initially all subjects could sustain hyperpnea at about 81% of their control 15-s maximum voluntary ventilation (MVV) for 15 min; E increased this to about 96% and increased their MVV by 14% as well. No other statistically significant changes were recognized in any group. We conclude that ventilatory muscle strength or endurance can be specifically increased by appropriate ventilatory muscle training programs.

Adult↗
PubMedDate not supplied

The family health and rural improvement program in Tari.

The Family Health and Rural Improvement Program (FHRIP) grew out of 25 years of research activity in Tari. Between 1995 and 2000 FHRIP assisted over 300 families in 20 communities in Tari to acquire a water supply, sanitation, nutritional gardens and small livestock, and provided health education. The program demonstrated that with appropriate assistance local people could improve their health and start small projects that promise real development in their communities. The extension of this experience is occurring under Community-Based Health Care in several highlands provinces. However, FHRIP had to overcome many internal and external obstacles, and more commitment from the public sector, together with long-term assistance from aid agencies, is required if such initiatives are to grow and flourish.

Agriculture↗
PubMed2003

Clinical course and short-term outcome of hospitalized adolescents with eating disorders: the success of combining adolescents and adults on an eating disorders unit.

Although significant controversy exists regarding the appropriate setting for treating adolescents with eating disorders, empirical studies have been lacking. This study aimed to evaluate, and compare with adults, the clinical course and short-term outcome of adolescents with eating disorders hospitalized on an adult eating disorders unit. One hundred forty-four consecutive inpatient admissions on a weight gain protocol (28% minors and 72% adults) completed psychometric measures and were assessed on clinical indices. No differences between minors and adults were demonstrated for weight gain per week on either inpatient or partial hospitalization admissions. Whereas inpatient length of stay was equivalent, adolescents stayed significantly longer in partial hospitalization than adults. Minors did not differ from adults on the presence of problematic eating disordered behaviors or most psychometric measures, although they had less functional interference due to their eating disorders. Results suggest that an adult eating disorders specialty program can be an appropriate and efficacious setting for adolescents.

Adolescent↗
PubMed1983

Low-Income Energy Assistance Program.

In fiscal year 1981, Congress appropriated $1.85 billion for home heating assistance to help low-income households meet rapidly rising energy costs. Eligibility for payments was based on income and energy-cost criteria. This procedure represented a departure from the earlier Federal focus of assisting households facing emergency hardships. Funds for the Low-Income Energy Assistance Program were allocated to the 50 States and District of Columbia, six territories, and 55 Indian tribal organizations. This article presents program data and information on the characteristics of the more than 17 million persons who received aid under this program.

Air Conditioning↗
PubMed1983

Monitoring and assessment in maternal and child health: recommendations for action at the state level.

Recent administration-sponsored changes in federal health policy and funding may harbor adverse effects for the health of mothers and children, and for the capabilities of state-level programs to serve them appropriately. Careful monitoring is required to assess the nature, extent, and impact of those changes. This paper examines several monitoring efforts in maternal and child health and recommends additional action at the state level to meet urgent information requirements.

Child↗
PubMed1991

Lipopolysaccharide, tumor necrosis factor-alpha, and IL-1 beta prevent programmed cell death (apoptosis) in human peripheral blood monocytes.

Human peripheral blood monocytes progressively lose viability when cultured in the absence of serum, cytokines, or other stimuli. In this study, we investigated whether monocyte death results from membrane damage (i.e., necrosis) or internally regulated processes [i.e., programmed cell death (PCD) or apoptosis]. Our results clearly indicated that monocytes die by PCD when cultured without stimulation. Death was associated with fragmentation of DNA into integer multiples of approximately 200 bp, a decrease in cell size, condensation of the nucleus and cytoplasmic organelles, and membrane blebbing, all of which are cardinal features of PCD. Monocytes exposed to nonphysiologic conditions such as acidic media (pH 4.2), 56 degrees C for 30 min, or freezing and thawing were killed without concomitant DNA fragmentation, indicating that DNA fragmentation was not a result of cell death per se. Addition of Escherichia coli LPS, a potent monocyte activating agent, in concentrations as low as 0.1 ng/ml caused a marked increase in monocyte survival and prevented DNA fragmentation. Moreover, exogenous human rTNF-alpha or IL-1 beta also prevented PCD, suggesting that PCD is regulated by certain cytokines released from LPS-stimulated monocytes. The results indicate that in the absence of appropriate stimulation, monocytes are programmed to undergo a sequence of molecular events leading to cell death. Regulation of PCD may be an important homeostatic mechanism for controlling the number of monocytes available to respond to infection, wound healing, and tumor growth.

Cell Survival↗
PubMed2002

Ventricular rate stabilization for the prevention of pause dependent ventricular tachyarrhythmias: results from a prospective study in 309 ICD recipients.

Reviews of stored electrograms from ICDs revealed a 5-30% incidence of short-long-short intervals preceding the onset of recurrent ventricular tachyarrhythmias. Rate stabilization by dedicated antibradycardia pacing algorithms has, therefore, been suggested to prevent onset of pause dependent tachyarrhythmias. However, the clinical efficacy of this approach has not been studied systematically. In a prospective multicenter crossover study, patients were randomized to activation or deactivation of an implemented ventricular rate stabilization algorithm (VRS) after first implant of a dual chamber ICD. After 3 months, all patients were crossed over to the alternate programming. The rate of appropriate spontaneous VA episodes was compared between VRS On and VRS Off. Stored electrograms were reviewed for evaluation of the mode of onset of tachyarrhythmias. Overall efficacy analysis was based on 309 patients enrolled in the study. Forty percent (124/309) of the patients experienced 4,973 VA episodes. Based on an intention-to-treat analysis, VRS Off and On arrhythmia incidence was 10.2 and 6.6 normalized to 3 months, respectively (risk reduction 35%; P = 0.18) On an on-treatment basis, a reduction from 9.0 episodes to 8.1 episodes (10% risk reduction, P = 0.24) was seen. In an extended Cox model adjusting for confounding variables, the relative risk for recurrent episodes was 0.92 during VRS On compared to Off (95% CI: 0.58-1.48; P = 0.74). During VRS Off, pause dependent onset was documented in only 36 (8%) of 427 visually analyzed episodes. There was no significant reduction in the incidence of recurrent ventricular tachyarrhythmias with VRS On compared to the Off programming in this prospective study.

Algorithms↗
PubMed1996

Adapting EcoCyc for use on the World Wide Web.

The World Wide Web (WWW) offers the potential to deliver specialized information to an audience of unprecedented size. Along with this exciting new opportunity comes a challenge for software developers: instead of rewriting our software applications to operate over the WWW, how can we maximize software reuse by retrofitting existing applications? We have developed a Web server tool, written in Common Lisp, that allows existing graphical user interface applications written using the Common Lisp Interface Manager (CLIM) to hook easily into the WWW. This tool-CWEST (CLIM-WEb Server Tool, pronounced "quest")-was developed to operate with EcoCyc, an electronic encyclopedia of the genes and metabolism of the bacterium E. coli. EcoCyc consists of a database of objects relevant to E. coli biochemistry and a user interface, implemented in CLIM, that runs on the X-window system and generates graphical displays appropriate to biological objects. Each query to the EcoCyc WWW server is treated as a command to the EcoCyc program, which dynamically generates an appropriate CLIM drawing. CWEST translates that drawing, which can be a mixture of text and graphics, into the HyperText Markup Language (HTML) and/or the Graphics Interchange Format (GIF), which are returned to the client. Sensitive regions embedded in the CLIM drawing are converted to hyperlinks with Universal Resource Locators (URLs) that generate further EcoCyc queries. This tight coupling of CLIM output with Web output makes CLIM a powerful high-level programming tool for Web applications. The flexibility of Common Lisp and CLIM made implementation of the server tool surprisingly easy, requiring few changes to the existing EcoCyc program. The results can be seen at URL http: @www.ai.sri.com/ecocyc/browser.html. We have made CWEST available to the CLIM community at large, with the hope that it will spur other software developers to make their CLIM applications available over the WWW.

Computer Communication Networks↗
PubMed1994

Predictors of patient refusal to participate in ambulatory-based comprehensive geriatric assessment.

BACKGROUND: Comprehensive Geriatric Assessment (CGA) in ambulatory settings can be effective only if patients who need this intervention are willing to participate in the evaluation and follow the indicated therapy. METHODS: To learn whether older persons' health beliefs and perceptions influence participation in ambulatory-based CGA, we studied subjects who failed a screening assessment offered through a community-based outreach program and were deemed appropriate for CGA. All subjects were interviewed in person following a structured sequence including questions from the RAND Current Health (CH) and Health Worry/Concern (HWC) scales, the Health Locus of Control Scale (HLC), and scales developed to measure health risks and perceived benefits of geriatric assessment. RESULTS: In univariate analysis, the following variables were associated with refusal to participate in CGA status at the p < .05 level: increased worry on HWC and higher scores on three new scales constructed to measure Global Health Risk (GHR), Perceived Global Health Benefits (PGHB), and Perceived Specific Health Benefits (PSHB). For GHR, higher scores indicate greater risk; for PGHB and PSHB, higher scores indicate greater perceived benefit. In multivariate analysis, only educational level, GHR, PGHB, and PSHB scores were independently predictive of refuser status. Correlations with other established health perceptions scales provided support that global health risk and perceived global and specific health benefits are unique constructs. Furthermore, high scores on these scales predicted participation in health improvement programs. CONCLUSIONS: Patients' beliefs about perceived risk and benefit can be measured and predict willingness to participate in ambulatory-based CGA.

Aged↗
PubMed1992

Comparison of electrocardiogram interpretations by family physicians, a computer, and a cardiology service.

BACKGROUND: Some family physicians may be under pressure to relinquish the interpretation of outpatient electrocardiograms to cardiologists. The purpose of this study was to determine whether the quality of electrocardiogram (ECG) interpretations by family physicians justifies this pressure, and whether an immediately available computerized ECG interpretation program could serve as an appropriate backup for the family physician. METHODS: Family practice faculty and residents at a university-based residency program provided written interpretations of 301 ECGs ordered over an 11-month period. Their ECG findings were compared with those from a computerized interpretation program and the readings of the cardiology service. All interpretations were then compared with those of a fellowship-trained electrocardiographer, whose readings served as the reference standard. RESULTS: Discrepancy was found between the family physician and the electrocardiographer on 33% of those items that had any potential clinical significance. The computer interpretation and the cardiologist's interpretation agreed with that of the electrocardiographer on 63% and 71% of these discrepancies, respectively (not statistically different). CONCLUSIONS: Family physicians reached a level of agreement with the reference standard in ECG interpretation that was comparable to previously published reports for expert interrater agreement. In this study, however, the quality of ECG readings by family physicians was further improved by expert review. The quality of computer-assisted ECG interpretation was comparable to that of review provided by a cardiology service. Furthermore, computerized interpretation may be clinically more useful because it is immediately available.

Aged↗
PubMed2006

Brief screening for co-occurring disorders among women entering substance abuse treatment.

BACKGROUND: Despite the importance of identifying co-occurring psychiatric disorders in substance abuse treatment programs, there are few appropriate and validated instruments available to substance abuse treatment staff to conduct brief screen for these conditions. This paper describes the development, implementation and validation of a brief screening instrument for mental health diagnoses and trauma among a diverse sample of Black, Hispanic and White women in substance abuse treatment. With input from clinicians and consumers, we adapted longer existing validated instruments into a 14 question screen covering demographics, mental health symptoms and physical and sexual violence exposure. All women entering treatment (methadone, residential and out-patient) at five treatment sites were screened at intake (N = 374). RESULTS: Eighty nine percent reported a history of interpersonal violence, and 70% reported a history of sexual assault. Eighty-eight percent reported mental health symptoms in the last 30 days. The screening questions administered to 88 female clients were validated against in-depth psychiatric diagnostic assessments by trained mental health clinicians. We estimated measures of predictive validity, including sensitivity, specificity and predictive values positive and negative. Screening items were examined multiple ways to assess utility. The screen is a useful and valid proxy for PTSD but not for other mental illness. CONCLUSION: Substance abuse treatment programs should incorporate violence exposure questions into clinical use as a matter of policy. More work is needed to develop brief screening tools measures for front-line treatment staff to accurately assess other mental health needs of women entering substance abuse treatment.

Adolescent↗
PubMed2000

Prevalence of cytomegalovirus infection among health care workers in pediatric and immunosuppressed adult units.

The prevalence of cytomegalovirus (CMV) infection varies not only from one country to another, but also with social, economic, and environmental conditions and with professional activity. Health care workers in contact with the main vectors of the CMV (i.e., children and immunosuppressed patients) are particularly exposed to the infection. We assessed the prevalence of the virus among health care personnel in light of CMV epidemiology and the recent shift in living conditions and family size. Our study was included in a broader program evaluating the risk of infection among female hospital workers of childbearing age. The goal of the program was to implement appropriate preventive measures for personnel who were not immune to the infection. Consequently, we included only female caregivers who worked with children or immunosuppressed patients. The study was based on a clinical examination, a medical and occupational questionnaire, the assessment of tasks performed; and CMV serologic testing. The overall seroprevalence was 44.25% in our population (n = 400) and was comparable regardless of the place of work. Prevalence differed significantly with age and parity, and we also found that it was higher among personnel who worked in closer contact with the patients (nurse's aides, pediatric nurse's aides) than among those whose tasks required more technical skills (nurses, pediatric nurses) (57.3% vs 34.5%, P < 0.01). The logistic regression analysis between prevalence of CMV antibodies, age, parity, and type of job showed that "contact job" was as significant a factor as parity to explain immunization in our population (odds ratio, 2.2). We also determined a correlation between the prevalence of CMV antibodies and tasks performed. In addition, we found a non-negligible group of non-immune personnel (55.75%) and young workers (mean age: 33.4) who were potentially exposed to infection. This points to the need to establish a prevention program.

Adult↗
PubMed2006

Intention to register as organ donors: a survey of adolescents.

BACKGROUND: Little is known about factors that influence the intention of adolescents to register as organ donors. The identification of such factors has important implications for the development and implementation of educational programs and subsequent donor registration rates. OBJECTIVE: To determine whether adolescents with an expressed commitment to becoming organ donor registrants differ significantly from nondonors on sociodemographic characteristics and factors influencing their decision. PARTICIPANTS: Four hundred forty-five adolescents visiting a Department of Motor Vehicles office for a permit or license (n=153) or attending a driver's education course (n=292) completed a semistructured interview and questionnaire. RESULTS: Female (52.6%) and white (55.8%) adolescents were more likely to have favorable donation intentions relative to male (45.6%) and nonwhite (39.0%) adolescents (chi2 = 7.5, P = .02, and chi2 = 19.7, P = .003, respectively). Those with favorable donation intentions also endorsed significantly more positive factors (benevolence, need awareness, existentialism) as being more important in their decision. Adolescents who did not want to donate (58.7%) and those who were undecided (23.1%) were less likely to have discussed their decision with parents than were those who wanted to donate (67.7%, chi2 = 63.6, P = .0001). Finally, providing adolescents with a free driver's license in exchange for organ donor registration would have the greatest impact on registering undecided adolescents (29.8%, chi2 = 33.2, P = .0001). CONCLUSIONS: There is a pressing need for more systematic and culturally sensitive organ donation education directed toward adolescents, and the Department of Motor Vehicles and driver's education courses may be appropriate venues. An educational program from the U.S. Department of Health and Human Services, Decision: Donation, could be used in this context.

Adolescent↗
PubMed1987

Automatic postural responses in the cat: responses of distal hindlimb muscles to paired vertical perturbations of stance.

The active components of the quadrupedal diagonal stance response to rapid removal of the support from beneath a single limb were studied in cats to further define the mechanisms that trigger and generate the response. We recorded EMG activity from lateral gastrocnemius and tibialis anterior muscles in awake, behaving cats while they stood on an hydraulic posture platform. By dropping the support from beneath a single limb, we evoked the diagonal stance response, with its characteristic changes in vertical force and EMG patterns. As the animal responded to this drop, a second perturbation of posture was then presented at intervals of 10 to 100 ms following the first. The second perturbation, which consisted of dropping the support from beneath the two limbs that were loaded as a result of the initial limb drop, made the first response biomechanically inappropriate. The EMG responses observed in both muscles during paired perturbations were triggered by the somatosensory events related to the perturbations. Muscle responses that were appropriate for the first perturbation always occurred with amplitudes and latencies similar to control trials. This was true even when the second perturbation occurred 10-20 ms after the first, that is, when this perturbation either preceded or was coincident with the response to the initial limb drop. The EMG responses that were normally associated with the second perturbation were delayed and/or reduced in amplitude when the time interval between perturbations was short. As the inter-perturbation interval was lengthened beyond 60-100 ms, however, EMG responses to the second perturbation were unaffected by the occurrence of the first perturbation. When the hindlimb containing the recording electrodes was dropped as part of the second perturbation, a myotatic latency response was observed in tibialis anterior. The amplitude of this response to the second perturbation was greater than controls when this displacement was presented during the period between initiation of the first perturbation and execution of the response to it. When the second displacement was presented after execution of the first response began, the amplitude of the myotatic response was reduced below control levels. While the results do not preclude the possibility that these "automatic" postural responses are segmental or suprasegmental reflexes, they support the hypothesis that the active component of the response to drop of the support beneath a single limb is centrally programmed and that the appropriate response can be triggered very rapidly by the somatosensory information signalling the perturbation.

Animals↗
PubMed1991

The use of LIS for blood usage review. Experience in a children's hospital.

To comply with the requirements of the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO) and to facilitate the review process, the authors designed a program to screen for the appropriateness of packed red cell (PRC) and platelet concentrate (PLT) transfusions. The purpose of this report is to describe the methodology of the review process. A quality assurance (QA) monitor was created in the Laboratory Information System (LIS) to screen indicators: hemoglobin for PRCs and platelet count for PLTs. Numerical value limits were defined to determine acceptable ranges. Each week, the LIS compiles a list of all patients who received transfusions and for whom the QA monitor determined that the values of the screened indicators were outside the defined appropriate limits. A detailed transfusion record is generated for each patient identified. During a six-month evaluation of this program, a total of 1,788 PRC and 3,109 PLT units were transfused. Of these, 582 PRC (32.5%) and 2,219 PLT (71.4%) units were within the acceptable guidelines. Lists for the remaining 1,206 PRCs and 890 PLTs were generated. Review of the transfusion record and other laboratory values from the LIS established the appropriateness of 1,052 PRC and 782 PLT transfusions. At the conclusion of the six-month period, the medical charts for 181 (11%) PRC and 108 (4.5%) PLT transfusions required chart review. This method provided major reduction in time of the transfusion review process. Similar guidelines may be used to monitor other transfusion products such as fresh frozen plasma.

Blood Transfusion↗
PubMed2005

[Effects of a drug misuse and abuse prevention program on knowledge, attitude, and preventive behaviors related to drug misuse and abuse, and depression in low-income elderly women].

PURPOSE: This study was conducted to determine the effects of a drug misuse and abuse prevention program on knowledge, attitude, and preventive behaviors related to drug misuse and abuse, and depression in low-income elderly women in the urban area. METHOD: The design of this study was a nonequivalent control group pretest-posttest design. The subjects consisted of 26 in the experimental group and 23 in the control group. The program was performed for about 1 hour, once a week for 5 weeks. Data was analyzed by the SAS(ver.8.02) computer program, and it included descriptive statistics, Fisher's exact test, Mann-Whitney U test, Wilcoxon signed ranks test, and ANCOVA. RESULT: There were statistically significant differences in knowledge, attitude, and preventive behaviors related to drug misuse and abuse, and depression between the experimental group and the control group. CONCLUSION: This study showed that this prevention program of drug misuse and abuse is appropriate for low-income elderly women, Therefore this program is recommended as a nursing intervention strategy for the elderly.

Aged↗
PubMed1997

The successful implementation of pharmaceutical practice guidelines. Analysis of associated outcomes and cost savings. SWiPE Group. Systematic Withdrawal of Perioperative Expenses.

BACKGROUND: Although approximately 2,000 medical practice guidelines have been proposed, few have been successfully implemented and sustained. We hypothesized that we could develop and institute practice guidelines to promote more appropriate use of costly anesthetics, to generate and sustain widespread compliance from a large physician group, and to decrease costs without adversely affecting clinical outcomes. METHODS: A prospective before and after comparison study was performed at a tertiary care medical center. Clinical outcomes data and times indicative of perioperative patient flow were collected on the first of two sets of patients 1 month before discussion of practice guidelines. Practice guidelines were developed by the physicians and their associated care team for the intraoperative use of anesthetic drugs. A drug distribution process was developed to aid compliance. Clinical outcomes data and times indicative of perioperative patient flow were collected on the second set of patients 1 month after institution of practice guidelines. Hospital drug costs and adherence to guidelines were noted throughout the study period and for each of the following 9 months by querying the database of an automated anesthesia record keeper. RESULTS: A total of 1,744 patients were studied. Drug costs decreased from 56 dollars per case to 32 dollars per case as a result of adherence to practice guidelines. Perioperative patient flow was minimally affected. Time (mean +/- SD) from end of surgery to arrival in the post-anesthesia care unit (PACU) increased from 11 +/- 7 min before the authors instituted practice guidelines to 14 +/- 8 min after practice guidelines (P < 0.0001). Admission of inpatients to the PACU receiving monitored anesthesia care increased from 6.5 to 12.9% (P < 0.02). Perioperative patient flow and clinical outcomes were not otherwise adversely affected. Compliance and cost savings have been sustained. CONCLUSIONS: This study is an example of a successful physician-directed program to promote more appropriate utilization of health care resources. Cost savings were obtained without any substantial changes in clinical outcomes. Institution of similar practice guidelines should result in pharmaceutical savings in the range of 50% at tertiary care centers around the country, with a slightly smaller degree of savings expected at institutions with more ambulatory surgery.

Anesthesiology↗