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Therapeutic exercise in general practice.

Newer techniques of exercise which rely on a static or isometric muscle contraction of six seconds' duration once daily offer great possibilities in the treatment of patients incapacitated by low cardiac reserve, joints that are painful on movement or debility too severe to permit a conventional exercise program for general conditioning. Increments of strength of up to two per cent per day can be thus achieved in normal muscles. Muscles deconditioned by immobilization respond at a faster rate. However, no significant muscle hypertrophy can be achieved by this technique. This form of exercise can also be used by persons who are "too busy to exercise" but who may be willing to give two minutes a day to an exercise program designed to increase and maintain muscle tone and strength.A considerable number of medical conditions could be treated more effectively and with less resultant disability if therapeutic exercises-passive, active and progressive-were accurately prescribed and supervised by a physician as part of the treatment program. Among the many conditions to be considered are poliomyelitis, peripheral nerve injuries, the neuritides, postural defects and cardiac diseases.

Exercise↗

Neuromuscular Changes in Female Collegiate Athletes Resulting From a Plyometric Jump-Training Program.

OBJECTIVE: To assess performance changes induced by a 6- week plyometric jump-training program. DESIGN AND SETTING: We used a quasiexperimental design to compare groups formed on the basis of team membership. Testing was conducted in an athletic training research laboratory, both before and after a 6-week period of preseason basketball conditioning. SUBJECTS: Nineteen female collegiate basketball players from a National Collegiate Athletic Association Division I program (8 subjects) and a National Association of Intercollegiate Athletics Division II program (11 subjects) who had no history of anterior cruciate ligament injury and who had no history of any lower extremity injury during the preceding 6 months. MEASUREMENTS: The variables of primary interest were hamstrings and quadriceps isokinetic peak torque. Of secondary interest were 5 variables derived from step-down and lunging maneuvers performed on a computerized forceplate system and 4 variables derived from tracking the position of the body core during performance of a T-pattern agility drill with a computerized infrared tracking system. RESULTS: A significant group x trial interaction was found for hamstrings peak torque at 60 degrees.s(-1) (F(1,17) = 9.16, P =.008.), and the proportion of total variance attributable to the treatment effect produced by the jump-training program was relatively large (eta(2) =.35, omega(2) =.30). None of the other variables demonstrated statistically significant changes. CONCLUSIONS: Our primary results support plyometric jump training as a strategy for improving neuromuscular attributes that are believed to reduce the risk of anterior cruciate ligament injury in female college basketball players. They also provide the basis for reasonable isokinetic strength goals.

Journal Article↗

Developing an AIDS prevention education program for persons with developmental disabilities.

The AIDS epidemic poses a serious threat to people with developmental disabilities, the magnitude of which has not yet been fully realized by many professionals working with this population. Models for effective AIDS prevention education have been developed, however, within other populations. Key principles utilized in existing models were discussed and recommendations presented on how to adapt these models when designing programs for people who have developmental disabilities, most specifically, those in the mild/moderate range of mental retardation.

Acquired Immunodeficiency Syndrome↗

The effects of two different incentives on recruitment rates of families into a prevention program.

This study experimentally manipulated two incentives for participation (monetary: paid participation for sessions and setting: group vs. individual) in a child behavior problem prevention program to analyze their effects on recruitment and retention of families. A population of 690 eligible families from 15 preschools located in socially disadvantaged neighborhoods was invited to participate in a parent training (PT) program. The study recruited parents by using advertisements that had information describing only the indicated condition (i.e., PT in group-unpaid, or PT individual-unpaid, or PT in group-paid, or PT individual-paid). Results demonstrate significant impact of payment on recruitment and initial attendance. Training setting alone (individual or group) did not significantly influence these rates. Editors' Strategic Implications: A compelling case is made for the utility of monetary incentives to increase proportions of low-income families in prevention research and programs. Evaluators and program designers should note the impressive use of the experimental design and hierarchical linear modeling to test the effects on recruitment.

Adolescent↗

Outreach childbirth education classes for low-income families: a strategy for program development.

Childbirth and parenting education programs are coming to the forefront of public health initiatives aimed at the reduction of infant mortality and low birth-weight in high-risk groups in the United States. Childbirth education programs have proven effective in helping parents make positive life style changes and can play an important role in the reduction of risks associated with poor pregnancy outcomes. Childbirth education gives parents the knowledge, desire, and confidence they need to change their health behaviors. The Florida Outreach Childbirth Education Project offers an example of a statewide program designed to serve a high risk population: low-income, low-literacy families.

Female↗

Automated interpretation of high-energy collision-induced dissociation spectra of singly protonated peptides by 'SeqMS', a software aid for de novo sequencing by tandem mass spectrometry.

SeqMS, a software program designed for the automated interpretation of high-energy collision-induced dissociation (CID) mass spectra of singly protonated peptides ionized by fast atom bombardment, has been developed. The software is capable of probing the sequence of an unknown peptide, and even of certain modified peptides. The program, compiled for WINDOWS95 or NT, also permits the retrieval of raw data and the reconstruction of the spectra on a user-friendly graphical interface with the aid of several tools for processing the spectra, which include setting multiple threshold levels and automatic peak detection. SeqMS is capable of generating candidate sequences, based on the detected peaks, and of displaying the resulting assignments for each candidate in a spectrum or in tabular form. The software has the following capabilities: 1) the ions derived from backbone and side-chain fragmentations, internal and immonium ions, and side-chain loss ions can be used for calculation; 2) 18O-labeling of a peptide at the C terminus, a methodology which was developed to differentiate N-terminal from C-terminal ions, is applicable as an optional setting; 3) modified amino acids and N- or C-terminal blocking groups are taken into account for calculation according to the user's setting in a library; 4) amino acid composition and partial or complete amino acid sequence of a peptide can be used as input for calculation; 5) the assignments of signal output in a spectrum can be graphically edited, and then re-calculated based on the edited peaks. The efficacy of the program is demonstrated by testing 74 high-energy CID spectra, obtained using a four-sector instrument, of synthetic, proteolytic, and biologically active peptides, some of which contain modified groups.

Algorithms↗

Life in recovery: rebuilding from trauma.

Trauma can cause visible, often profound physical injuries for patients. The emotional and social drain that families and health care providers experience can also be life-altering. REBUILD is a program designed by a level 1 trauma center that incorporates former patients and their families in a support group to aid previous and new patients, their families, and care providers by sharing mutual experiences and learning from each other. Health care providers have found that participating in the program has been personally gratifying and professionally beneficial by preventing burn-out.

Group Processes↗

Brief report: parents of children undergoing bone marrow transplantation: documenting stress and piloting a psychological intervention program.

OBJECTIVE: To document levels of stress in parents of children undergoing bone marrow transplantation (BMT) over the course of hospitalization and to pilot a psychological intervention program designed to teach parents techniques for managing stress associated with their child's illness and hospitalization. METHODS: Twenty-two mothers of children (ages 2-16) undergoing BMT were followed prospectively from preadmission to three weeks posttransplant. Eleven mothers, randomly assigned to participate in a pilot intervention program, were compared with 11 control mothers receiving standard care preparation of their child's BMT. RESULTS: Repeated measures ANOVAs detected significant changes in stress over time, with most stress reported preadmission. Mothers in the intervention condition reported using more stress management techniques than mothers in the standard care condition, though the majority of analyses revealed no significant differences in stress between groups. CONCLUSIONS: Increased levels of parenting distress may occur pretransplant, suggesting the need for additional psychological intervention at that time.

Adolescent↗

Reducing trauma payment denials with computerized collaborative billing.

BACKGROUND: Trauma care demands constant physician availability, resulting in rotational coverage systems. Third-party payors consider separate trauma surgeon bills as originating from the same individual. Trauma surgeons may be unaware of their colleagues' billing history on jointly managed patients. Not all postoperative procedures and evaluation and management services are denied by global surgical package rules. We investigated whether a networked billing program designed to crosscheck for global package coding concerns would reduce payment denials. METHODS: A networked relational database was created for trauma surgeons to enter billable encounters, displaying global periods and operative diagnoses while prompting for postoperative modifiers. Denials were compared for equivalent time periods before and after program initiation. RESULTS: Payment denials fell from 361 to 16 for "bundled" evaluation and management services and from 55 to 13 for bundled postoperative procedures. Time spent on billing decreased and legibility improved. Overall savings totaled $183,404. CONCLUSION: Collaborative billing can improve payments for professional trauma care.

Forms and Records Control↗

Evaluation of a program to reduce back pain in nursing personnel.

OBJECTIVE: To evaluate the effectiveness of a program designed to reduce back pain in nursing aides. METHODS: Female nursing aides from a university hospital who had suffered episodes of back pain for at least six months were included in the study. Participants were randomly divided into a control group and an intervention group. The intervention program involved a set of exercises and an educational component stressing the ergonomic aspect, administered twice a week during working hours for four months. All subjects answered a structured questionnaire and the intensity of pain was assessed before and after the program using a visual analogue scale (VAS). Student's t-test or the Wilcoxon Rank Sum Test for independent samples, and Chi-square test or the Exact Fisher test for categorical analysis, were used. The McNemar test and the Wilcoxon matched pairs test were used to compare the periods before and after the program. RESULTS: There was a statistically significant decrease in the frequency of cervical pain in the last two months and in the last seven days in the intervention group. There was also a reduction in cervical pain intensity in the two periods (2 months, 7 days) and lumbar pain intensity in the last 7 days. CONCLUSIONS: The results suggest that a program of regular exercise with an emphasis on ergonomics can reduce musculoskeletal symptoms in nursing personnel.

Adult↗

Developing helping relationships in dietetic counseling.

Counseling involves (a) the development of rapport between conselor and conselee and (b) the use by the counselor of strategies to create behavior change in the counselee. Dietetic educational programs have apparently focused on the latter, action-oriented procedures, with little attention being given to training in the development of helping relationships. A training program, designed to build such skills in human resource workers, is described. Listed are six steps considered essential, all of which involve an understanding of self by the counselor, some knowledge of the helping skills, and experience in practicing them. Steps in skill training are also enumerated. The program merits inclusion in dietetic education programs.

Behavior Therapy↗

Population growth and economic growth: any connection?

The author examines the current evidence concerning the relationship between population growth and economic growth, with particular reference to the justification for U.S. assistance to programs designed to slow rates of population growth in developing countries. It is concluded that "the results of economic theory and research do not support the oft-repeated claims that population growth inhibits economic growth." The author suggests that the reason for continued U.S. support for population programs is the effectiveness of a population lobby that has a vested interest in the continuation of such assistance.

Americas↗

[Ten-year surveillance of nosocomial surgical site infections in an orthopedic surgery department].

PURPOSE OF THE STUDY: Surveillance of nosocomial surgical site infections was instituted in our department in June 1991. We report our first nine years experience. MATERIAL AND METHODS: This study concerned the first 9 years (June 1991-June 2000) of a surveillance program designed to monitor nosocomial surgical site infections in our orthopedic surgery department. During this period 9,696 patients underwent surgery, including 2745 for hip replacements and 1016 for knee replacements. The diagnosis of infection was based on the Centers of Disease Control criteria. Beginning in 1997, the program was widened to include all indications for prophylactic antibiotics, being limited before that time to indications for arthroplasty and spinal surgery. RESULTS: The overall rate of infection was 1.25%; 0.55% for hip arthroplasty and 1.77% for knee arthroplasty. The rate of infection among hip surgery patients over the last 5 years was much higher for prosthesis revision (2.37%) than for first-intention implantations (0.16%). The majority of the isolated strains were Gram-positive (84%) including Staphylococcus sp. found in 65% of the cases. Multiple-strains were found in 23% of the infections. The rate of infection improved very significantly over the last five years both for knee arthroplasty and spinal surgery. The rate remained unchanged for hip arthroplasty. DISCUSSION: This 10-year survey enabled us to analyze the difficulties encountered and pinpoint errors or insufficiencies in data recording. We were also able to identify measures to be taken concerning patient follow-up. The improvement in the rate of infection over time appears to be multifactorial, undoubtedly related to wider use of prophylactic antibiotics, progress in hygiene and sterilization methods with institution of a quality assurance program, and team awareness. CONCLUSION: Surveillance of nosocomial infections is a recommended practice. We have found that the information provided can be beneficial if the data is statistically sound, pointing out the need for progress in patient follow-up.

Arthroplasty, Replacement↗

Factors associated with receipt of pension and compensation benefits for homeless veterans in the VBA/VHA Homeless Outreach Initiative.

Public support payments may facilitate exit from homelessness for persons with mental illness. We examined data from 10,641 homeless veterans contacted from October 1, 1995 to September 30, 2002 in a collaborative outreach program designed to facilitate access to Department of Veterans Affairs (VA) disability benefits. Those who were awarded benefits (22% of contacted veterans) were more likely to report disability, poor to fair self-rated health, and were more likely to have used VA services in the past. Thus, this program achieved only modest success and was most successful with veterans who were already receiving VA services and who might have received benefits even without the outreach effort.

Adult↗

Perioperative nursing orientation. A primer for designing your own program.

The orientation program for OR nurses at Mount Sinai Medical Center has been in place for more than two years. Orientees have given consistently favorable evaluations of the program, and many of them have commented that this was the first real OR orientation that they had received in their careers. Staff acceptance of new employees has improved, and our retention rate of new employees is promising. New nurses who have been through the orientation program now can provide staffing in the OR so that more experienced nurses can participate in the RN first assistant training program that we have introduced. A structured orientation program ensures consistency in the information given to new employees. We continue to revise and improve the program based on changes in the workplace and orientees' evaluations. We believe that the time spent designing our program has paid off well in employee satisfaction and retention--in management terms, the return on investment has been good.

Clinical Competence↗

The prevention of depressive symptoms in children and adolescents: A meta-analytic review.

Research on the prevention of depressive symptoms in children and adolescents was reviewed and synthesized with meta-analysis. When all 30 studies were included, selective prevention programs were found to be more effective than universal programs immediately following intervention. Both selective and indicated prevention programs were more effective than universal programs at follow-up, even when the 2 studies with college students were excluded. Effect sizes for selective and indicated prevention programs tended to be small to moderate, both immediately postintervention and at an average follow-up of 6 months. Most effective interventions are more accurately described as treatment rather than prevention. Suggestions for future research include testing potential moderators (e.g., age, gender, anxiety, parental depression) and mechanisms, designing programs that are developmentally appropriate and gender and culturally sensitive, including longer follow-ups, and using multiple measures and methods to assess both symptoms and diagnoses.

Adolescent↗

Reduction in recidivism of incarcerated women through primary care, peer counseling, and discharge planning.

Prior to release from the Rhode Island state prison, women at the highest risk for reincarceration and HIV infection are assigned to the Women's HIV/Prison Prevention Program (WHPPP), a discharge program designed to reduce the likelihood of reincarceration and HIV infection. Candidates for the WHPPP must meet at least one of three criteria: intravenous drug use or crack use, commercial sex work, or a history of prison recidivism with poor educational history and poor employment prospects. While incarcerated, the program participant develops a relationship with a physician and a social worker and establishes an individualized discharge plan. After release, the same physician and social worker continue to work with the client and assist an outreach worker in implementing the discharge plan. Data were collected from questionnaires administered to 78 women enrolled in the WHPPP between 1992 and 1995. The population in this program was primarily composed of ethnic minorities (55%), 25-35 years of age (55%), unmarried (90%), had children (72%), and displayed a variety of HIV risk behaviors. The WHPPP recidivism rates were compared with those of a mostly white (65%), similarly aged (51% were between 25 and 35 years of age) historical control group of all women incarcerated in Rhode Island in 1992. The intervention group demonstrated lower recidivism rates than the historical control group at 3 months (5% versus 18.5%, p = 0.0036) and at 12 months (33% versus 45%, p = 0.06). Assuming that recidivism is a marker for high-risk behavior, participation in the WHPPP was associated with a reduction in recidivism and in the risk of HIV disease in this very high risk group of women.

Adult↗

Effectiveness of the MASTER program for teaching special children multiplication and division.

In this study, the utility of a MAthematics Strategy Training for Educational Remediation (MASTER) program, (Van Luit, Kaskens, & Van der Krol, 1993) was examined. The effectiveness of the program, designed to encourage strategy utilization with multiplication and division problems, was investigated for 84 students with poor mathematics skills, some of whom had learning disabilities (n = 42) and others with mild levels of mental retardation (n = 42). The results showed that the use of the self-instruction program resulted in significant improvement over the general instruction program. Furthermore, far transfer was found for the children with learning disabilities in the experimental group when they used effective problem-solving strategies on nontrained tasks. The results are consistent with previous findings suggesting the importance of self-instruction in mathematics training programs.

Adolescent↗