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PubMedDate not supplied

The knowledge and practices of registered nurse, certified diabetes educators: teaching elderly clients about exercise.

This study identified the knowledge base and practices of Registered Nurse, Certified Diabetes Educators (RN, CDEs) regarding their exercise teaching programs for elderly clients who have non-insulin-dependent diabetes mellitus (NIDDM). The random sample of 197 AADE members surveyed by questionnaire was a highly educated and experienced group. RN, CDEs who worked 30 or more hours per week in diabetes education or attended four or more continuing education (CE) programs per year had significantly more comprehensive exercise teaching program designs and instructional techniques to enhance elderly NIDDM clients' learning (P < .05). However, many CDEs do not teach their elderly clients about exercise due to lack of resources, lack of specific knowledge to prescribe exercise,and negative stereotypes of elderly clients' ability to exercise. Greater availability of educational programs for CDEs to explore curriculum development, program planning, evaluation, and exercise prescription for elderly clients with multisystem disease is recommended.

Adult↗
PubMedDate not supplied

Counseling women who request sterilization: psychodynamic issues and interventions.

With large numbers of women seeking sterilization each year, including over half a million in 1983 alone, the problem of regretted sterilization and efforts to prevent regret have become matters of concern to health care providers. This paper describes a sterilization counseling program designed to reduce the likelihood of regretted sterilization. Discussed are factors which help predict satisfaction or regret following sterilization. A psychodynamic approach to sterilization counseling informed by these factors is described. Case vignettes are included, as is a retrospective analysis of candidates counseled during one year of the program.

Adaptation, Psychological↗
PubMed2002

Paradoxical Vocal-Cord Dysfunction: Management in Athletes.

OBJECTIVE: To describe a treatment strategy for paradoxical vocal-cord dysfunction (PVCD) as it applies to an athletic population. BACKGROUND: Paradoxical vocal-cord dysfunction has been identified as a cause of dyspnea and stridor in athletes. The basic element of PVCD is an inappropriate closure of the vocal cords during respiration, resulting in airway obstruction. This condition is familiar to speech-language pathologists and otolaryngologists yet remains poorly understood in the sports medicine community. Treatment strategies are even less understood. A therapeutic exercise program designed to promote diaphragmatic breathing may allow an athlete to gain control during episodes of dyspnea. Elimination of contributing or concomitant conditions is critical to resolution of the condition. DESCRIPTION: The treatment of PVCD requires an understanding of the pathoanatomy of the condition. The focus of the exercise program is on relaxation of the larynx and conscious activation of the diaphragm and abdominal muscles during respiration. The athlete must have a sense of laryngeal control while performing the exercises. In addition, the patient and practitioner must realize the amount of neuromuscular reeducation required to change breathing patterns. CLINICAL ADVANTAGES: This therapy may allow the athlete to gain control over episodic dyspnea, participate in athletic activities with fewer complications, and, perhaps, reduce or eliminate medications prescribed to treat suspected bronchospasm.

Journal Article↗
PubMedDate not supplied

Prevention of skin colonization and subsequent bacteremia with CDC-JK organisms in patients with cancer.

A 10-year experience with a program designed to reduce the incidence of bacteremias in the cancer patient, specifically those caused by Corynebacterium CDC-JK, is presented. Retrospective chart reviews identified patients at risk and generated the hypothesis that special attention to body hygiene may play a significant role. Implementation of a skin hygiene program resulted in a significant decrease in the incidence of CDC-JK bacteremias in Memorial Hospital patients.

Bacteremia↗
PubMed1996

The IPSOC project: integrating prevention strategies into ongoing care.

Each primary care clinical visit can be an opportunity to promote health and provide primary prevention and screening. An innovative prompting and reminder system (IPSOC), using computer technology as an enabler, has been developed to facilitate integration of disease prevention and health promotion into ongoing clinical care for an unemployed and working poor population. In addition, the prompting system is being converted to a database program designed to prompt providers and educate consumers about the value of health promotion, screening, and disease prevention.

Ambulatory Care↗
PubMed1994

The termination of a randomized clinical trial for poor Hispanic children.

OBJECTIVE: To conduct a randomized clinical trial of the Spanish version of an educational program designed to be an adjuvant to adequate medical care of children with asthma. DESIGN: Randomized, clinical trial. SETTING: Los Angeles County, Calif. PARTICIPANTS: One hundred thirty-eight Hispanic children, ages 7 to 12 years, from disadvantaged families. All had used emergency facilities of major local hospitals in the previous year. MEASUREMENT/MAIN RESULTS: As the study proceeded, it became apparent that subjects were receiving inadequate medical and nursing care and had numerous barriers to applying knowledge and self-care skills gained from the program. Realizing this, we considered it unethical to allow the control children to suffer for the duration of the trial (1 year). Therefore, all children received "adequate" care from the research staff, and the randomized clinical trial, as originally designed, was ended. The emergency department/hospital use by both groups was significantly reduced compared with previous experience. CONCLUSION: Those researchers conducting randomized trials involving poor children should be aware of the potential ethical problems inherent in such ventures.

Asthma↗
PubMed1998

Improved birth outcomes associated with enhanced Medicaid prenatal care in drug-using women infected with the human immunodeficiency virus.

OBJECTIVE: To evaluate the effectiveness of an intervention designed to enhance Medicaid prenatal care in improving birth outcomes of drug-using women infected with the human immunodeficiency virus (HIV). METHODS: Medicaid and vital statistics records were linked for 353 HIV-infected drug-using women delivering in 1993 and 1994 while enrolled in New York State Medicaid. Of these, 68% were treated by providers participating in the Prenatal Care Assistance Program, designed to provide case management, improved continuity, referral services, and behavioral risk reduction counseling. In a series of logistic models, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of low birth weight (less than 2500 g) and preterm delivery (before 37 weeks), comparing women using and not using the program. RESULTS: Women using the Prenatal Care Assistance Program were significantly less likely, after adjustments were made for maternal characteristics, to have low birth weight infants and preterm deliveries (OR 0.52, 95% CI 0.31, 0.89; and OR 0.57, 95% CI 0.34, 0.97, respectively). Adding measures of greater adequacy and continuity of prenatal care to the models explained just over 20% of the Prenatal Care Assistance Program's protective effect. The addition of maternal high-risk behavior, HIV-focused care, and drug use treatment variables altered program effect estimates less profoundly (together accounting for 4 and 9% of the program's protection against low birth weight and preterm delivery, respectively). CONCLUSION: The Prenatal Care Assistance Program appeared to be successful in reducing the incidence of low birth weight and preterm delivery in this high-risk population. The program's success can be attributed, in part, to increased adequacy and continuity of prenatal care and, to a lesser extent, to more frequent receipt of special services and reduced maternal high-risk behaviors.

Adult↗
PubMed1991

Community-based approach to weight loss: the Pawtucket "weigh-in".

The Pawtucket Heart Health Program (PHHP), in its attempt to treat obesity in the community, has delivered many traditional group and self-help weight loss programs. However, in order to reach a sufficient number of people to produce a public health impact in Pawtucket, PHHP devised a monthly city-wide "weigh-in." This program, designed to be delivered by volunteers, allowed individuals to set a weight loss goal and pledge a monetary incentive toward this goal. Self-help materials and the opportunity to join weight loss groups were provided. In the pilot study, 129 (61%) of 213 enrollees completed the 10-week program with a mean weight loss of 8.2 lb (p less than .001). A large decrease in total serum cholesterol was also observed. Nonpersonnel costs, including the total costs of the cholesterol measurement, were $1.30 per pound lost. Moreover, success is also evident by continued availability of the program and the increasing number of new participants "referred" to the weigh-in by members.

Adult↗
PubMed2004

Wheelchair skills training program: A randomized clinical trial of wheelchair users undergoing initial rehabilitation.

OBJECTIVE: To test the hypothesis that a brief, formalized period of additional wheelchair skills training is safe and results in significantly greater improvements in wheelchair skills performance than a standard rehabilitation program. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center. PARTICIPANTS: Thirty-five wheelchair users (20 with musculoskeletal disorders, 15 with neurologic disorders) admitted for initial rehabilitation. Subjects' mean age +/- standard deviation (SD) was 59+/-18.3 years. INTERVENTION: Subjects randomly allocated to the treatment group participated in the Wheelchair Skills Training Program (WSTP), averaging 4.5+/-1.5 training sessions, each 30 minutes long. Subjects in the control group did not receive any wheelchair skills training beyond that given in a typical rehabilitation stay. MAIN OUTCOME MEASURES: Wheelchair Skills Test (WST), version 2.4, before and after training. Changes in total percentage WST score and individual skill scores were examined. RESULTS: There were no adverse incidents. The control group's mean percentage score +/- SD increased from 60.1%+/-14.4% to 64.9%+/-13.3%, an 8% improvement of the posttest relative to the pretest (P=.01). The WSTP group's mean score increased from 64.9%+/-9.4% to 80.9%+/-5.6%, a 25% improvement of the posttest relative to the pretest (P<.000). The WSTP group showed significantly greater improvements than the control group (P<.000). Among the specific skills, significantly greater improvements were seen in the WSTP group for the gravel and high-curb descent skills (P<.001). CONCLUSIONS: The WSTP is safe and practical and has a clinically significant effect on the independent wheeled mobility of new wheelchair users. These findings have implications for the standards of care in rehabilitation programs.

Adult↗
PubMed2000

Effectiveness of an Internet-based program for reducing risk factors for eating disorders.

This study evaluated an Internet-delivered computer-assisted health education (CAHE) program designed to improve body satisfaction and reduce weight/shape concerns--concerns that have been shown to be risk factors for the development of eating disorders in young women. Participants were 60 women at a public university randomly assigned to either an intervention or control condition. Intervention participants completed the CAHE program Student Bodies. Measures of body image and disordered eating attitudes were assessed at baseline, postintervention, and 3-month follow-up. At follow-up, intervention participants, compared with controls, reported a significant improvement in body image and a decrease in drive for thinness. This program provides evidence for the feasibility and effectiveness of providing health education by means of the Internet.

Adolescent↗
PubMed1998

Preventing and reducing alcohol and other drug use among high-risk youths by increasing family resilience.

This study examines the effects of a community-based program designed to delay onset and reduce the frequency of alcohol and other drug (AOD) use among high-risk youths, ages 12 to 14, through strengthening family resilience. It is part of a larger five-year demonstration project funded by the Center for Substance Abuse Prevention (CSAP). The program was implemented in multiple church communities in rural, suburban, and inner-city settings. Program components of this study included parent or guardian and youth training, early intervention services, and follow-up case management services. The results show that the program produced positive direct effects on family resilience. The evaluation also found positive moderating effects on delayed onset of alcohol and other drug use and frequency of alcohol and other drug use among youths in the form of conditional relationships with changes in those family resilience factors that were targeted by the program.

Adolescent↗
PubMed2004

Using a mentorship program to recruit and retain student nurses.

The authors present a student nurse mentorship program designed to provide an experience that assists nursing students to transition more easily into competent nursing professionals. The outcomes to date have been encouraging, showing a decrease in turnover among mentorship participants. At little cost and with great benefit to the student, the mentor, and the hospital, the mentorship program is presented as a successful way to recruit and retain the brightest graduate nurses.

Attitude of Health Personnel↗
PubMed2002

The role of postsecondary education in welfare reform. Ohio's JOBS Student Retention Program.

The 1996 federal welfare reform legislation encourages quick employment over education and training for the nation's welfare recipients. However, some argue that a one-size-fits-all approach ignores the heterogeneity of this population. This article presents findings from a net impact evaluation of Ohio's JOBS Student Retention Program (JSRP), a program designed to facilitate success for public assistance recipients at 2-year community or technical colleges. The authors evaluate this policy using state administrative data sets. The analyses consist of unadjusted and regression-adjusted comparisons of means for the JSRP group and a constructed comparison group. Outcomes examined include program completion, employment, earnings, and welfare recipiency. Focusing on the most recent 11 of 16 quarters of data available, the average increase in quarterly earnings was 8.45% for program participants and 12.91% for program completers. The results indicate that encouraging postsecondary education for some welfare recipients will boost earnings capacity and therefore long-term self-sufficiency.

Adult↗
PubMed1999

Where need meets opportunity: youth development programs for early teens.

Early adolescence is a time of burgeoning independence, autonomy, and focus on peers. It is also a time when individual interests, skills, and preferences become salient to young people. Not surprisingly, out-of-school programs designed to capture the interest of early teens are diverse in focus and varied in structure, ranging from sports teams to drop-in recreation centers, from museum apprenticeships to mentoring relationships between an individual teen and an adult. This article describes the array of various organizations that offer programs and services for youths in their early teens. It explains the philosophy of positive youth development that has emerged as a unifying theme in this long-standing but newly self-conscious field. Principles of best practice are reviewed, as are five key implementation challenges: increasing participation by youths; expanding access to programs, especially in low-income communities; improving funding; evaluating program effectiveness; and coordination with other youth services. The article closes with a discussion anticipating the new opportunities that accompany the attention and funding now going toward positive youth development programs that enrich the lives of young people through informal learning.

Adolescent↗
PubMed1992

[Care and prevention of drug dependence in primary care].

Evaluate the assistencial drug-dependence program. DESIGN. Transversal retrospective study. Primary care (Unitat de Prevenció i Seguiment de Drogodependéncies). PATIENTS OR OTHER PARTICIPANTS. Sixty patients treated from 23.02.90 to 31.06.91. MEASUREMENTS AND MAIN RESULTS. It was made 165 interviews. Sixty patients were treated: 2 (3.3%) with methadone substitution and 58 (96.6%) started the "drug free program". In this program, 7 (12%) patients accomplished hospital desintoxication and 51 (88%) home desintoxication. At the end of the period control, 48 patients were in "drug free program". At the beginning of treatment 32 (53.3%) patients were 22-27 years old. The most usual illegal drugs at consultation were: cannabis 57 (95%), cocaine 53 (88.3%), heroine 51 (85%) and benzodiazepines 50 (83.3%). Twenty-five patients (41.6%) needed derivation to another health services. From 51 patients addicted to intravenous heroin, only ten (19.6%) were positive to HIV antibodies. CONCLUSIONS. The increase of patients number who started and remained the "drug free program" and the low percent of patients who stopped treatment show that the assistant program in primary care is working. This program has been appropriate to know the characteristics of this group in our area: low age at initiation, progressive use of more than one drug and low prevalence of HIV positivity.

Adolescent↗
PubMed2005

Development of a school-wide behavior program in a public middle school: an illustration of deployment-focused intervention development, stage 1.

School-wide behavior management systems can improve academic performance and behavior in middle schools, and they should have positive effects on students with ADHD. Unfortunately, evidence-based, school-wide behavior management systems have not been widely adopted because of problems with feasibility, acceptability, and sustainability. The Deployment-Focused Model of Intervention Development and Testing has been proposed as a promising method of bridging the gap between research and practice settings. A key aspect of the model is to involve the persons most likely to deliver the service (e.g., teachers) in the intervention development process from the very beginning. To illustrate this process, the authors describe the planning and implementation of a school-wide program designed to improve behavior in a public middle school.

Adolescent↗
PubMed2004

Manipulation and arthroscopy under general anesthesia and early rehabilitative treatment for frozen shoulders.

OBJECTIVE: To evaluate the efficacy of manipulation followed by arthroscopic release of the glenohumeral joint in conjunction with an immediate and intensive rehabilitation program. DESIGN: Retrospective, descriptive study. SETTING: A free-standing, university-affiliated orthopedics and rehabilitation hospital. PARTICIPANTS: Forty patients with a clinical diagnosis of adhesive capsulitis resistant to pharmacologic and physical therapy (PT). INTERVENTIONS: Patients underwent manipulation and arthroscopic release of the capsular joint and were given an intensive PT program on the first postoperative day. MAIN OUTCOME MEASURES: All patients were evaluated pre- and postoperatively at follow-up at an average of 42 months by using the Simple Shoulder Test (SST), the Constant-Murley system score, and passive (PROM) and active (AROM) range of motion. RESULTS: The SST, which showed a mean preoperative score of 2.2+/-0.7, was 10.8+/-0.7 (P<.001) after surgery. Preoperatively, the mean Constant-Murley score was 33.2%+/-1.9%; postoperatively, the mean score was 91.7%+/-2.9% (P<.001). PROM increased from 90 degrees to 165 degrees for anterior elevation, from 85 degrees to 160 degrees for abduction, from 20 degrees to 60 degrees for external rotation, and from 10 degrees to 40 degrees for internal rotation. AROM improved for anterior elevation from 82 degrees to 155 degrees; for abduction from 77 degrees to 143 degrees, and for external rotation, with the arm along the patient's side, from 5 degrees to 50 degrees. CONCLUSIONS: Results support the efficacy of manipulation follow by arthroscopic release and rehabilitative treatment for patients with resistant adhesive capsulitis of the shoulder.

Adult↗
PubMed1985

An approach to prevention of recurrent diabetic ketoacidosis in the pediatric population.

In 1982 we introduced a program designed to prevent recurrent diabetic ketoacidosis (RDKA), based on the assumption that diabetes education in conjunction with appropriate use of and adherence to insulin therapy should eliminate all RDKA. A hierarchical set of medical, educational, and psychosocial interventions was used. The rate of RDKA was lower after initiation of the program even though patients seen during this period came from lower socioeconomic and more one-parent families (each independently associated with RDKA) than patients seen prior to intervention. In 44 patients with a history of RDKA, insulin omission was documented in 31, inadequate education in 13. Overall, the rate of RDKA decreased from a prereferral mean of 25.2 episodes to a postreferral mean of 2.6 episodes per 100 patient-months (P less than 0.0001). Metabolic control improved after intervention as documented by a decrease in mean hemoglobin A1 from 14.1% to 10.7% (P less than 0.0001). RDKA ceased whether or not psychotherapy was used. Although RDKA is causally related to a variety of social, economic, and family dysfunctions, its prevention requires recognition that its proximate cause is omission of insulin and assurance that a support system exists to ensure adherence.

Adolescent↗