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PubMed1999

Preexisting medical conditions in adult day services: an examination of nonmetropolitan and metropolitan admissions.

BACKGROUND: It is not known what health conditions are being managed by day services staff because, to date, there is virtually no research on the types of preexisting medical conditions that clients bring to these community-based settings. Furthermore, it is not known whether or how nonmetropolitan clients differ from their metropolitan counterparts. METHODS: Census data for 1,448 individuals who were admitted to adult day services in Maryland during 1993 were examined. Variables were included for client characteristics, medical diagnoses at admission (based upon ICD-9-CM categories), and adult day center location (metropolitan vs. nonmetropolitan). RESULTS: Persons admitted to nonmetropolitan centers were more likely than those entering metropolitan centers to be diagnosed as having musculoskeletal, respiratory, cardiovascular, and endocrine conditions and as having a malignant neoplasm. Admissions to metropolitan centers were significantly more likely to be diagnosed with Alzheimer's disease. After using multiple logistic regression to control for a number of client characteristics, location of the facility remained significantly associated with all listed admission diagnoses except musculoskeletal conditions. CONCLUSION: Nonmetropolitan centers are caring for a distinctly different type of long-term care client than metropolitan centers, perhaps because few other long-term care options are available to families in sparsely populated settings. The differences in the medical conditions of their clients should affect most aspects of the day services program, including budgets for appropriate professional staff, staff qualifications, resources for client/family education and counseling, and expected outcomes.

Adult↗
PubMed2000

Cardiovascular stress associated with concentric and eccentric isokinetic exercise in young and older adults.

Heart rate (HR), mean arterial blood pressure (MAP), and rate-pressure product (RPP) responses to submaximal isokinetic concentric (CON) and eccentric (ECC) knee extension exercise were compared at the same absolute torque output in 20 young (mean+/-SD=23.2+/-1.7 years) and 20 older (mean+/-SD=75.2+/-4.6 years) adults. After determination of peak CON and ECC torques, subjects performed separate, randomly ordered, 2-minute bouts of isokinetic CON and ECC exercise (90 degrees/s, exercise intensity: 50% of CON peak torque). CON exercise elicited greater changes in HR, MAP, and RPP than ECC exercise (p<.001) for both age groups. There were no age-related differences in HR, MAP, or RPP responses for either CON or ECC exercise. At the same absolute torque output, isokinetic CON knee extension exercise elicited significantly greater increases in cardiovascular stress than ECC exercise in both young and older adults. This result has implications for determining appropriate fitness and rehabilitation programs.

Adult↗
PubMed2003

Poverty among elderly women: assessing SSI options to strengthen Social Security reform.

OBJECTIVES: We explore the potential of the Supplemental Security Income (SSI) program to reduce poverty among elderly women. We develop a methodological framework that compares how well various reform proposals are targeted to reducing poverty among elderly women. METHODS: Using a microsimulation model and survey data matched to SSI administrative records, we model the effects of eight alternative policies on current and potential SSI recipients. We develop an evaluation methodology that systematically compares poverty outcomes, using multiple measures of effectiveness, at given levels of program expansion. RESULTS: All but two of the SSI reforms are clearly more target efficient at various degrees of simulated program expansion than popular proposals to reform Social Security. For a given cost increase, modifying the SSI asset test is the most effective option for reducing severe poverty among elderly women, but several reforms of the SSI income test are also highly effective. DISCUSSION: The SSI program is target efficient in providing a broad safety net to economically vulnerable elderly women. The relationship between SSI and Social Security and the relationship between the SSI asset and income tests have to be reevaluated to make the program more effective and appropriate to changing household structure and work patterns among the elderly population.

Aged↗
PubMed2002

Using an explicit guideline-based criterion and implicit review to assess antipsychotic dosing performance for schizophrenia.

OBJECTIVE: Using structured implicit review as the gold standard, this study assessed the sensitivity and specificity of an explicit antipsychotic dose criterion derived from schizophrenia guidelines. DESIGN: Two psychiatrists reviewed medical records and made consensus-structured implicit review ratings of the appropriateness of discharge antipsychotic dosages for hospitalized patients who participated in a schizophrenia outcomes study. Structured implicit review ratings were compared with the explicit criterion: whether antipsychotic dose was within the guideline-recommended range of 300-1000 chlorpromazine milligram equivalents (CPZE). In addition, reasons for deviation from guideline dose recommendations were examined. SETTING AND STUDY PARTICIPANTS: A total of 66 patients hospitalized for acute schizophrenia at a Veterans Affairs medical center or state hospital in the southeastern US. MAIN OUTCOME MEASURES: The sensitivity and specificity of the explicit dose criterion at hospital discharge were determined in comparison with the gold standard of structured implicit review. RESULTS: At hospital discharge, 61% of patients (n = 40) were receiving doses within the guideline-recommended range. According to structured implicit review ratings, antipsychotic dose management was appropriate for 80% (n = 53) of patients. When the 300-1000 CPZE dose criterion (dosage within or outside the recommended range) was compared with structured implicit review, it demonstrated 84.6% sensitivity and 71.7% specificity for detecting inappropriate antipsychotic dose. CONCLUSIONS: The explicit antipsychotic dose criterion may provide a useful and efficient screen to identify patients at significant risk for quality of care problems; however, the relatively low specificity suggests that the measure may not be appropriate for quality measurement programs that compare performance among health plans.

Adult↗
PubMed1998

Physical therapy for a patient through six stages of amyotrophic lateral sclerosis.

BACKGROUND AND PURPOSE: This case report describes the use of Sinaki and Mulder's approach to staging amyotrophic lateral sclerosis (ALS) and functional outcome measures in designing a treatment program for a 59-year-old woman with ALS. CASE DESCRIPTION AND OUTCOMES: As the patient progressed from stage I through stage VI, over 12 months, the physical therapy goals changed from optimizing remaining function, to maintaining functional mobility, and finally to maximizing quality of life. DISCUSSION: Disease staging and the use of functional outcome measures provide a framework for physical therapy evaluation and treatment of patients with ALS throughout the disease process. Physical therapists can assist patients with ALS through the provision of education, psychological support, rehabilitation programs, and recommendations for appropriate equipment and community resources.

Activities of Daily Living↗
PubMed1998

Changes in services for students with learning disabilities in U.S. and Canadian medical schools, 1991 to 1997.

PURPOSE: To determine the changes between 1991 and 1997 in the admission policies of and services offered by U.S. and Canadian medical schools to students with learning disabilities. METHOD: Between June 1 and August 31, 1997, the author surveyed 144 medical schools in the United States and Canada regarding their services and programs for learning-disabled medical students. The questionnaire was the same one as used in a 1991 study. RESULTS: Of the medical schools contacted, 106 responded (one Canadian school sent a letter but did not complete the questionnaire). Ninety-four of 96 U.S. schools and seven of the remaining nine Canadian schools said that they accept students with learning disabilities. All of the respondents that accept such students claimed to make some academic accommodations. Most indicated that they would administer non-standard (e.g., untimed) licensing examinations, and many reported that their affiliated postgraduate medical training programs would also make appropriate accommodations for students with learning disabilities. CONCLUSION: When compared with the results from the 1991 survey, the new data suggest that medical schools have improved their services for learning-disabled students in response to the Americans with Disabilities Act.

Canada↗
PubMed1990

Autologous transfusion.

Autologous transfusion is but one component of the comprehensive blood conservation program. It is often appropriate to employ more than one method of autologous transfusion. In addition, use of pharmacological measures to decrease blood loss, meticulous attention to surgical hemostasis, acceptance of lower hemoglobin levels during the perioperative period, and seeking the advice of transfusion medicine experts in assessing the need for administration of blood components are also important. Finally, the risks of homologous blood transfusion should not overshadow the life-saving benefits of transfusion.

Blood Transfusion, Autologous↗
PubMed1987

A segmentational analysis of prescription drug information seeking.

Drug information-seeking proclivities were examined using data from a telephone survey of 835 individuals who had obtained new outpatient prescriptions within the previous 4 weeks. Factor analytic and clustering techniques were used to segment patients based on the source and nature of drug information received in conjunction with the prescription. A four-cluster solution appeared to represent the most stable, distinct, yet homogeneous solution for the data. The groups were named "physician reliant" (40%), "pharmacist reliant" (19%), "questioners" (7%), and "uniformed" (34%). The four groups were compared for demographic, situational, and attitudinal differences. The physician-reliant group appeared most satisfied with the direct counseling of the doctor. Although this group may have sought additional information, the information appeared to reinforce the physician's directions. The pharmacist-reliant group often obtained prescriptions at independent pharmacies and tended not to rely on magazines or reference books for additional information. The questioners were often taking multiple medications. This group tended to seek out reference information from nonprofessional sources and reported several barriers to seeking information from professionals. The uninformed group was the oldest, tended to receive little information, and was more likely than the other groups to agree that one need not ask questions if one trusts the doctor. Different types of patient education programs were recommended as appropriate for each of the four groups. Motivational messages directed to the uninformed segment appeared to be the largest unmet need in patient-oriented prescription drug education.

Adult↗
PubMed1998

Quantitative intramuscular myoelectric activity of lumbar portions of psoas and the abdominal wall during a wide variety of tasks.

PURPOSE: Since most previous reports of EMG activation profiles from psoas and the abdominal wall have been qualitative, the objective of this work was to document myoelectric activity from these deep muscles. This knowledge is required to assist in choosing specific training exercises and for making rehabilitation decisions that require knowledge of normalized and calibrated muscle activation levels in different tasks. METHODS: Intramuscular EMG was collected from five men and three women, in whom amplitudes were normalized to maximum contraction efforts and reported over a wide variety of clinical and rehabilitation tasks. Electrodes were inserted into vertebral portions of psoas and the three layers of the abdominal wall. Normalized signal amplitudes were reported as peak levels and time histories. RESULTS: All forms of sit-ups activated psoas (15-35% MVC) more than the curl-up (<10%); psoas was not highly activated during barbell lifting of loads up to 100 kg (< 16% MVC); psoas was most active during maximal hip flexion efforts; push-ups activated psoas up to 25% MVC. Several isometric abdominal exercises were evaluated using the criteria of maximizing abdominal activation while minimizing psoas activity: the side (bridge) support exercise proved the best training method for the abdominal wall. CONCLUSIONS: Consideration of deep muscle activity, provided in this report, is important for choosing the most appropriate rehabilitation and training program for an individual. Specific guidance is provided for choosing the best abdominal exercise, together with activation profiles during lifting, during twisting, and during hip rotation.

Abdominal Muscles↗
PubMed1989

No clinical effect of back schools in an HMO. A randomized prospective trial.

In a prospective trial, 222 adults with low-back pain of at least 2 weeks' duration in a Health Maintenance Organization (HMO) were randomly assigned to usual care (UC), a 4-hour back school psychoeducational session (LBS), or the same back school plus a 1-year "compliance package" program designed to encourage appropriate self-management for back pain (CP). Sixty-four percent of LBS and CP subjects attended their back school sessions. Follow-up measurement of pain level (using the Visual Analogue Scale), functional status (using the Sickness Impact Profile), and various other indicators of health status showed no measurable effect of either treatment condition (LBS or CP) compared with UC at 3, 6, 12, and 18 months after entry into the study. Initial disability resolved by 3 months in most patients, and a minority of subjects (10-15%) showed residual or recurrent functional impairment 1 year after entry. Health care utilization tended to be slightly higher after intervention in the CP group. With or without follow-up encouragement, back school instructions given in a single 4-hour session had no measurable impact on the comfort or functional status of the majority of patients with new onset back pain in this HMO.

Adult↗
PubMed1976

Rentran. An on-line computer-based regional kidney transplant matching system.

An interactive on-line computerized renal transplant matching system called RENTRAN which serves the Southwest Kidney Transplant Region is described. The region consists of one transplant center in Arkansas, two in Oklahoma, and six in Texas. The computer used is the DECsystem-10 located in the Medical Computing Resources Center at Dallas. RENTRAN participants have remotely located standard interactive computer terminals and gain access to the computer by dialing over normal telephone lines. Functions provided by RENTRAN include obtaining instructions, performing a donor-recipient match, obtaining a list of potential recipients, making a user comment or adding, updating or deleting a potential recipient record. Either long or short formats for dialog with the computer system are available for inexperienced and experienced and users, respectively. In the time period from August 1,1973, when the system went into production on February 1, 1976, there have been in excess of 232 matches attempted and approximately 142 kidneys have been transplanted according to RENTRAN results. There are about 361 recipients currently on the data base. The system was developed with funds provided by the Texas Regional Medical Program. Expenses of maintaining the system as well as occasional programmed improvements as deemed appropriate by the Southwest Kidney Transplant Region Registry Committee on the basis of user comments are provided through a $25 per year charge to patients for being listed on the data base.

ABO Blood-Group System↗
PubMed1998

Non-fatal workplace violence workers' compensation claims (1993-1996).

More is known about fatal workplace violence than non-fatal workplace violence (NFWV). This study provides descriptive information on the number and cost of NFWV claims filed with a large workers' compensation carrier. NFWV claims from 51 US jurisdictions were selected either by cause codes or by word search from the accident-description narrative. Claims reported in 1993 through 1996 were analyzed to report the frequency, cost, gender, age, industry, and nature of injury. An analysis of a random sample of 600 claims provided information on perpetrator type, cause of events, and injury mechanism. A total of 28,692 NFWV claims were filed during the study period. No cost was incurred for 32.5% of the claims, and 15.5% received payments for lost work. As a percentage of all claims filed by industry, schools had the highest percentage (11.4%) of NFWV claims, and banking had the highest percentage (11.5%) of cost. The majority of claims in the banking random sample group (93%) were due to stress. In the random sample, 90.3% of claims were caused by criminals (51.8%) or by patients, clients, or customers (38.5%). Only 9.7% were caused by an employee (9.2%) or a personal acquaintance of the employee (0.5%). Employers should acknowledge that NFWV incidents occur, recognize that the majority of perpetrators are criminals or clients rather than employees, and develop appropriate prevention and intervention programs.

Adult↗
PubMed2002

Automated external defibrillation in the occupational setting.

ACOEM supports ongoing efforts to enhance emergency response to medical emergencies in the occupational environment. The development of training and use of AEDs is a reasonable and appropriate aspect of such programs for managing sudden cardiac arrest, an important cause of morbidity and mortality among working age adults. The implementation of such an AED program, which should be a component of a more general worksite emergency response plan, requires clearly defined medical direction and medical control.

Cardiovascular Diseases↗
PubMedDate not supplied

The relationship between death-related experiences, death anxiety, and patient care attitudes among AIDS nursing staff.

A questionnaire was completed by 197 nurses working in AIDS care facilities to examine the experiences and attitudes of AIDS nursing staff. Correlations (Pearson r) showed a statistically significant relationship between personal death-related experience and death anxiety and attitudes toward dying patients. CNAs reported higher death anxiety scores and rated the negative aspects of caring for dying patients higher than did licensed practical nurses and registered nurses. The evidence supports the development of appropriate training and support programs in death and dying issues that are tailored to meet the needs of different levels of nursing staff in AIDS care facilities.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Promoting minority access to health careers through health profession-public school partnerships: a review of the literature.

Partnerships between health profession schools and public schools provide a framework for developing comprehensive, creative solutions to the problem of minority underrepresentation in health careers. This review examines the functioning of partner relationships, focusing on elements of the social context that determine success or failure, and stages of partnership development. Influential aspects of the social context include cultural differences between personnel in higher education and K-12 institutions, the resources available to the partnership, and constraints on partnership activity. Stages of the process that partner institutions must negotiate include initiation, ongoing management, and institutionalization. Strategies to improve minority student achievement are reviewed, including specific types of programmatic interventions and best practices. Strategies available to partnerships for improving minority achievement include academic enhancement, science or math instructional enrichment, career awareness and motivation, mentoring, research apprenticeship, reward incentives, and parental involvement. Of these, academic enhancement and instructional enrichment have the greatest potential for improving minority student outcomes. Partnerships need to take a sustained multipronged approach, providing intensive interventions that target students, teachers, and curricula at appropriate educational stages. Documenting program impact is critical for attracting more resources to increase minority access to health careers: sponsoring organizations should dedicate funds for assessment of the partnership's functioning and for rigorous evaluation of interventions.

Health Occupations↗
PubMed2004

The benefits and costs of disclosing information about risks: what do we know about right-to-know?

Following the attacks of September 11, 2001, the Environmental Protection Agency and other government agencies removed information from their web sites that they feared could invite attacks on critical public and private infrastructure. Accordingly, the benefits and costs of environmental information disclosure programs have come under increasing scrutiny. This article describes a framework for examining these benefits and costs and illustrates the framework through brief case studies of two information disclosure programs: risk management planning and materials accounting. The article outlines what we know and still need to find out about information disclosure programs in order to appropriately balance benefits and costs.

Cost-Benefit Analysis↗
PubMed1981

'Voices of concern'-a study of verbal communication about patients in a psychiatric day unit.

In this study, the author employs observations from a psychiatric day unit in an analysis of regularly occurring forms of 'professional talk'. Considerable staff time is scheduled for such talk, which must be considered as part of the health professional's work. Much of the talk which occurs may be analysed as having 'technical' significance in programming staff to behave appropriately towards different patients, so as to maximize the effectiveness of hospital treatment. Very much more time than is technically necessary, however, is devoted to talking about patients. Rather than seeing this 'superfluity' of talk as an indication of inefficiency within the system, the author examines its functions in maintaining the social structure of the unit and meeting the personal needs of the staff. This appears to be of particular importance against the background (common to many psychiatric settings) of staff-patient and interdisciplinary role ambiguity, high patient chronicity, and the absence of many of the structural and symbolic 'props' of a conventional hospital. This 'excess talk' is expensive in terms of professional time, and takes time away from direct patient contact. None the less, it may be a necessary cost if staff are to continue to pursue therapeutic goals within a deliberately 'informal' psychiatric setting.

Communication↗
PubMed1979

Electronic data processing in the Danish cytogenetic central register and EDP problems of registers in general.

A brief introduction to the Danish Cytogenetic Central Register (DCCR) is given, and possibilities, principles and problems concerning the establishment and maintenance of a national cytogenetic register are presented. Various data carrier media for registers in general are discussed, of which the magnetic disc is considered most appropriate. General principles for programs capable of performing insertions, deletions and other modifications in the data base are outlined as well as the principles for the programs in the DCCR. The individual records should preferably be identified by aid of a central person registration number (CPR) rather than by name. The data should be stored and sorted by this identification in order to facilitate retrieval of a desired record. The structure of the records is discussed with regard to prevention of the occurrence of certain errors as well as the optimization of processing. Flexibility and economy of space are achieved by using programs able to handle records of unequal length, and problems occurring in connection with this are discussed. The question of how to protect sensitive data is dealt with, and two different methods used in the DCCR are outlined. Programs capable of analyzing karyotypes with the purpose of recognizing various cytogenetic syndromes have been developed for use in the DCCR. Various examples of computing times of typical program runs are presented.

Chromosome Aberrations↗