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PubMed1993

Preventing marital distress through communication and conflict management training: a 4- and 5-year follow-up.

This article reports the 4- and 5-year follow-up results of evaluating the effects of a marital distress prevention program. The program, Prevention and Relationship Enhancement Program (PREP), is a 5-session program designed to teach couples effective communication and conflict management skills. At the 5-year follow-up, intervention, as compared with control, couples had higher levels of positive and lower levels of negative communication skills and lower levels of marital violence. Data are also presented on couples who declined the program. Issues are discussed concerning selection effects, change mechanisms, and future directions for prevention research.

Adolescent↗
PubMed1999

The adolescent parenting program: improving outcomes through mentorship.

Adolescent parents and their infants are a population at risk. Infant mortality, low-birthweight, and child maltreatment are inordinately higher within this population than within slightly older cohorts. The purpose of this one group pretest-posttest intervention study was to analyze the efficacy of a program designed to improve infant outcomes through the enhancement of health practices and parenting skills in a sample of 137 low-income, pregnant and parenting adolescents who reside in an urban area and who screened positive for risk of child maltreatment. Based on theories of mentorship and social support, the program provided intensive home visitation by nursing paraprofessionals, indigenous to the community, for the 2 year study period. Program outcomes were compared to local and national data. Findings revealed only 4.6% of program infants were low-birthweight compared to local and national percentages of 13.5% and 9.42%. The mean length of gestation was 39.27 weeks (SD = 1.55). The incidence of infant mortality was zero, comparing favorably with national data as well as the local infant mortality rate (almost twice the state average). There were only four cases of child neglect, representing only 2.91% of the sample. This finding also compares favorably with national data.

Adolescent↗
PubMed2001

Improved care for diabetes in underserved populations.

UNLABELLED: Diabetes mellitus (DM) is a common chronic health condition among the adult population in the United States. DM is more prevalent and complications higher in Latinos, possibly due to inadequate medical and self-care as well as inaccurate culture-bound beliefs. Project Dulce is a nurse-managed DM educational and treatment program designed to measure the effect on clinical outcomes, adherence to American Diabetes Association and American Heart Association standards of care, and cultural beliefs in 210 high risk (HbA1c > 9.5%) and 346 lower risk (HbA1c < 9.5%) indigent Latinos with DM. METHODS: All patients were given a 12-week culturally sensitive educational program. Nurse manager/certified diabetes educators working together with primary care providers treated high-risk patients using protocols from Staged Diabetes Management. Physical exam and biochemical markers of DM were followed. Pre- and post-program questionnaires measured changes in diabetes knowledge, cultural beliefs practices, treatment satisfaction, and health locus of control. Chart reviews of Latinos with diabetes (n = 311) not enrolled in Project Dulce provided the case controls. RESULTS: After 1 year, the high-risk group showed significant improvements in HbA1c (11.5% to 8.3%, p < 0.0001), total cholesterol (219 to 181 mg/dL, p < 0.00001), SBP (129 to 122 mmHg, p < 0.03), and DBP (79 to 75 mmHg, p < 0.006). Pre- and post-test evaluations showed improved diabetes knowledge (p = .024), treatment satisfaction (p = .001) and internal locus of control (p = 0.04), and fewer inaccurate culture-bound beliefs (p = 0.001). Compliance was 100% in the high-risk group in obtaining HbAlc, lipids, urine microalbumin, and foot exams and 47% in obtaining eye exams, while the case controls had 28%, 46%, 31%, 14%, and 6% respectively. Mean TC and LDL values improved in Project Dulce patients compared to case controls (181 vs 221 Img/dL, p < 0.0001 and 99 vs 1241 mg/dL, p < 0.0004). CONCLUSION: Patients enrolled in Project Dulce had significantly improved clinical outcomes, adherence to standards of care, and culture bound beliefs. Nurse managed diabetes management programs that are culturally sensitive may decrease the incidence of complications of diabetes and improve health outcomes.

California↗
PubMed2002

Stroke awareness and knowledge retention in children: The Brain Child Project.

BACKGROUND AND PURPOSE: Efforts at public education to improve adults' response to stroke symptoms continue to be disappointing, and very little has been developed to improve the knowledge base of children regarding brain attacks. Children may be able to exert a positive influence on adult behavior and to learn positive healthcare habits, which will also influence their own health. METHODS: A total of 561 children enrolled in grades kindergarten through eighth (K-8), participated in The Brain Child Project, which included (1) assessment of their knowledge of stroke awareness (including initiation of the emergency medical system [EMS]) using a multiple-choice questionnaire, (2) attendance at a multimedia educational program designed to increase stroke knowledge, followed by (3) immediate administration of the same questionnaire, and (4) a final administration of the same questionnaire 10 days later to measure retention of acquired learning. RESULTS: The results showed that these children had a limited understanding of stroke, but with a brief educational program, all grades significantly increased their scores on the average from 64% to 82%. The loss of knowledge between the posttest and the retention test was negligible. CONCLUSIONS: The results of this study indicate that through brief education, children show significant improvement in their knowledge of and response to brain attacks. Future efforts in this direction may positively affect stroke prevention, response and outcomes. A national program could be implemented in the school systems much like heart disease programs, with the ultimate goal of greater public awareness and prevention of stroke.

Child↗
PubMed2004

Using telemedicine to provide pediatric subspecialty care to children with special health care needs in an underserved rural community.

OBJECTIVE: For children with special health care needs (CSHCN) that live in rural, medically underserved communities, obtaining subspecialty care is a challenge. Telemedicine is a means of improving access to these children by addressing rural physician shortages and geographic barriers. This article reports a medical-needs assessment of parents/guardians with CSHCN and the status of a telemedicine program for CSHCN as well as the results of parent/guardian and local provider satisfaction with the telemedicine program. DESIGN: We report the results of a pretelemedicine medical-needs survey conducted in March 1999 by using a convenience sample of CSHCN living in a rural, medically underserved community located 90 miles north of the University of California Davis Children's Hospital (Davis, CA). In April 1999, a telemedicine program was initiated to provide consultations to CSHCN and has continued since. We also report the parent/guardian's perceptions of the appropriateness and quality of telemedicine consultations and the local provider's satisfaction with telemedicine consultations completed from April 1999 to April 2002. RESULTS: The pretelemedicine medical-needs assessment demonstrated several barriers in access to subspecialty care including traveling >1 hour for appointments (86% of parents/guardians), missing work for appointments (96% of working parents/guardians), and frequently relying on emergency department services and/or self-regulation of their child's medications. From April 1999 to April 2002, 130 telemedicine consultations were completed on 55 CSHCN. Overall, satisfaction was very high. All the parents/guardians rated satisfaction with telemedicine care as either "excellent" or "very good," and all but 2 of the rural providers' surveys reported satisfaction with telemedicine as "excellent" or "very good." The frequency of telemedicine consultations has increased with time. CONCLUSIONS: Pediatric subspecialty telemedicine consultations can be provided to CSHCN living in a rural, medically underserved community with high satisfaction among local providers and parents/guardians. Telemedicine should be considered as a means of facilitating care to CSHCN that, relative to the customary delivery of health care, is more accessible, family-centered, and coordinated among patients and their health care providers.

Adolescent↗
PubMed1988

Effect of a targeted antibiotic advisory consult program on hospital antibiotic costs.

The purpose of this 3-year study was to determine whether or not an antibiotic control program, designed by the P & T Committee, would affect the cost of antibiotics to this 473-bed general medical-surgical teaching hospital. Physician consultants from different clinical departments discussed each use of targeted antibiotics with prescribing physicians. Compared with the preprogram year, cost savings of $46,869 during the first program year, and $73,212 during the second program year were achieved. Many factors were taken into account before arriving at these figures, including cost analysis of both targeted and nontargeted antibiotics, impact of price changes, administration costs, and changes in hospital census. The authors conclude that in the absence of cost inflation, antibiotic costs would have risen considerably due to price escalation, but in the face of antibiotic controls, a modest cost savings over the 2 years analyzed was actually realized.

Anti-Bacterial Agents↗
PubMed1985

Evaluating RECONSIDER. A computer program for diagnostic prompting.

RECONSIDER, a computer program designed to perform as a diagnostic prompting aid, was evaluated for its ability to include the correct diagnosis in an ordered computed list of candidate diseases. The study was performed using 100 consecutive first admissions to the medical service of a university hospital, where the individuals entering the data into the program were blind to all but a limited set of findings known at time of admission. Each person entering the data created one or more lists of diagnostic possibilities (versions) using the program. The program suggested the correct diagnosis within the first 40 on its list 61% (498/797) of the time; the correct diagnosis was present with the first 40 in at least one version 93% (98/105) of the time. Performance was found to be best with cases having a single diagnosis and when more terms were entered into the program.

Computers↗
PubMed2000

Programs for the promotion of family wellness and the prevention of child maltreatment: a meta-analytic review.

OBJECTIVE: The objectives were to determine the effectiveness of programs in promoting family wellness and preventing child maltreatment and to identify factors that moderate program success. METHOD: Meta-analysis, employing a 3-step model testing procedure, was used to review 56 programs designed to promote family wellness and prevent child maltreatment. RESULTS: The effect sizes for proactive interventions were larger at follow-up than at post-assessment, while the effect sizes for reactive interventions were higher at post-assessment than follow-up. The lowest effect sizes for home visitation programs on child maltreatment were for programs with 12 or fewer visits and less than a 6-month duration. Intensive family preservation programs with high levels of participant involvement, an empowerment/strengths-based approach, and a component of social support had higher effect sizes than programs without those elements. Also, both home visitation and intensive family preservation interventions achieved higher effect sizes with participants of mixed socioeconomic status (SES) than participants with low SES. CONCLUSIONS: The total mean weighted effect size was .41, indicating that outcomes for the intervention group exceed 66% of those in control/comparison groups. The findings from this review demonstrated that child maltreatment can be prevented and that family wellness can be promoted.

Adult↗
PubMed1977

A sophomore physical diagnosis course in an outpatient setting.

A program designed to teach sophomore medical students physical diagnosis in an outpatient setting was evaluated as an alternative to an inpatient-oriented course. A comparison of the ability of 12 students trained in an outpatient setting to examine hospitalized patients with that of students trained in the traditional inpatient-oriented program revealed no difference between the two groups. These results are consistent with the hypothesis that the clinical status of the patient and the clinical setting have little impact on students' acquisition of physical diagnosis skills. Thus, the ambulatory care setting can provide an effective alternative for inpatient-oriented physical diagnosis programs. This finding has implications for curriculum planners who are seeking ways to restructure fundamental courses that emphasize development of primary care skills.

Ambulatory Care↗
PubMedDate not supplied

The application of laparoscopic bariatric surgery for treatment of severe obesity in adolescents using a multidisciplinary adolescent bariatric program.

The evolution of laparoscopic surgery has made bariatric surgery acceptable for weight loss; however, much controversy exists about its appropriateness for adolescents. Despite the controversial issues, the growing epidemic in adolescent obesity has resulted in rising numbers of applications for bariatric surgery. There are few bariatric surgical programs designed for adolescents. Pediatric settings face high start-up costs and poor reimbursement and lack established bariatric surgeons. Even so, bariatric surgery is increasingly being performed on adolescents in alarming numbers. To avoid adverse physical and psychosocial outcomes, the application of the principles of growth and development is essential. The program should be established as a multidisciplinary approach to management of adolescents and should be in institutions capable of meeting the guidelines for surgical treatment outlined by the American Society of Bariatric Surgery. To prevent postoperative complication, a multidisciplinary team of experienced medical and surgical specialists is needed for optimal preoperative decision making and postoperative management and long-term follow-up. Laparoscopic Roux-en-Y gastric bypass is a safe procedure and an effective means to treat obesity-related morbidity in the adolescent. Results have been excellent and justify a clinical trial to confirm the safety and efficacy of bariatric surgery in the adolescent population.

Adolescent↗
PubMed1983

Analytic procedures for evaluating health care. Statistical control charts.

The concern for quality of health care motivates evaluation programs designed to monitor the health care system, patient outcome, and provider expertise. An array of audit methods and instruments for evaluating professional and institutional performance has been developed. Although evaluation is viewed by many as the basis for accountability and improvement of health care, few are aware that most existing evaluation programs are really data-collecting systems. Very little if any, analysis of the data is done with the objective of optimizing the system. The "sampling with intervention" procedures often used to monitor the health care delivery system are primarily directed toward the individual patient while the system and provider continue to operate in the established mode. This article outlines analytic procedures for interpreting evaluation data generated by quality control and audit systems. Five common univariate statistical quality control charts are described.

Data Collection↗
PubMed2003

Reducing acute adverse outcomes in youths with type 1 diabetes: a randomized, controlled trial.

OBJECTIVE: Both acute and chronic complications of diabetes account for a disproportionate percentage of US health care expenditures. Despite improvements in diabetes care, the incidence of adverse events in children with type 1 diabetes remains high, particularly for youths with poor glycemic control. Cost-effective intervention programs designed to reduce complications are needed. This study evaluated a low-intensity, nonmedical intervention using a case manager (called a "Care Ambassador"), with and without the supplementation of psychoeducational modules, designed to monitor and encourage routine diabetes care visits to reduce short-term adverse outcomes and improve glycemic control in youths with type 1 diabetes. METHODS: We performed a 2-year prospective, randomized clinical trial in 299 youths with type 1 diabetes, aged 7 to 16 years, comparing 3 treatment programs (Care Ambassador [CA], Care Ambassador plus psychoeducational modules [CA+], and standard multidisciplinary diabetes care [SC]). The study was conducted in a large metropolitan US city from April 1997 through April 2000. Number of medical visits, frequency of hypoglycemic events, hospital/emergency department (ED) utilization, and glycosylated hemoglobin A1c were assessed during follow-up. RESULTS: During the 2-year study period, both the CA and CA+ groups had significantly more routine visits (mean [standard deviation]: 7.3 [2.06] and 7.5 [2.02], respectively) compared with the SC group (5.4 [2.62]). The CA+ intervention group had significantly reduced rates of short-term adverse outcomes compared with the other 2 groups; 25% fewer total hypoglycemic events, 60% fewer severe hypoglycemic events, and 40% fewer hospitalizations and ED visits. "High-risk" youths in the CA+ group (baseline glycosylated hemoglobin A1c > or =8.7%) were 3.4-fold (1.57-7.41) more likely to improve their glycemic control compared with those at high risk in the other 2 groups. CONCLUSIONS: For youths with type 1 diabetes, the CA and CA+ interventions increased visit frequency. Youths in the CA+ intervention had reduced rates of hypoglycemia and hospital/ED utilization with estimated annual cost savings of 80 000 dollars to 90 000 dollars. The CA+ intervention compared with the other 2 groups improved glycemic control in "high-risk" youths. Nonmedical case management incorporating psychoeducational modules seems to be a cost-effective approach to improving outcomes in youths with diabetes.

Adolescent↗
PubMed2000

A model for a managed care education approach to increase hepatitis awareness: Part I.

Morbidity and mortality associated with viral hepatitis, especially hepatitis C, are expected to increase rapidly over the next 2 decades. Many MCOs view hepatitis as a high-cost disease with a relatively low incidence; the incentive to develop education or awareness programs for hepatitis is correspondingly low. The American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy, and the American Association for the Study of Liver Diseases have, through the American Digestive Health Foundation, developed a unique, proactive, and flexible educational initiative for managed care. After providing an overview of hepatitis, this paper describes the four phases of this program designed to increase hepatitis awareness among managed care providers and members.

Awareness↗
PubMed2005

Expanding the range of free calcium regulation in biological solutions.

Many biological systems use ethylene glycol bis (beta-aminoethylether)-N,N,N',N'-tetraacetic acid (EGTA) to regulate the free calcium concentration ([Ca(2+)](free)) in the presence of physiological levels of free Mg(2+) ([Mg(2+)](free)). Frequently, it is necessary to work at [Ca(2+)](free) beyond EGTA's buffering capabilities. Therefore, we have developed methods to extend the buffering range by adding nitrilotriacetic acid (NTA) to solutions containing EGTA. This extension results from NTA having a lower K'(dCa) than EGTA. Such equilibria are solved by pCa Calculator, a computer program designed to aid in the study of Ca(2+)-dependent physiological processes while accounting for the effects of pH, temperature, and ionic strength. With multiple chelators and pH buffers from which to choose, pCa Calculator calculates the total concentration of each species required to achieve specified free concentrations of Ca(2+), ATP, and Mg(2+). The program is intuitive, user-friendly, and flexible enough to fix or vary the [Mg-ATP(2-)] and ionic strength. Moreover, it can account for increases in experimental volume from calcium addition. A comparative analysis is reported for testing solutions in the presence and absence of NTA by measuring the calcium binding affinity of fluorescent cardiac troponin C. These findings demonstrate that EGTA, when used in conjunction with NTA, improves and expands the regulation of free calcium in solution.

Adenosine Triphosphate↗
PubMed1983

Preparing low-income hispanic, black, and white patients for psychotherapy: evaluation of a new orientation program.

Examined the effectiveness of a new orientation program designed to prepare low-income white and ethnic minority outpatients for psychotherapy. Sixty-two Hispanic, 51 black, and 60 white psychiatric outpatients in a large public psychiatric clinic participated prior to their first psychotherapy interview. Patients were presented with one of two experimental conditions; the oriented patients saw an audiovisual program that instructed them about psychotherapy, and the control patients saw a program that was neutral with regard to psychotherapy. The patients' knowledge and attitudes toward psychotherapy were assessed with two questionnaires. Results indicated that patients who were oriented were more knowledgeable about psychotherapy and more positive in their attitudes toward psychotherapy than were patients who had not been oriented. The role and utility of brief orientation programs for low-income and ethnic minority outpatients in public mental health facilities are discussed.

Adult↗
PubMed2004

Compact program resolves overlapping voltammetric peaks.

A simple self-contained program designed to separate overlapping peaks from electrochemical analyses is presented. Combining an original interactive way to define initial parameter estimates with nonlinear curve fitting based on the simplex method of optimization, it allows the user to resolve voltammograms consisting of 2 to 5 analytical peaks raised on a straight base line. The program provides highly intuitive interface, easy operation, and straightforward result documentation. A free package including the program, three data files and user instructions is available on request.

Journal Article↗
PubMed1986

A generic computer program for systematic desensitization: description, construction and case study.

A computer program designed to provide systematic desensitization for phobias is described. Clients are taught by computer-aided instruction to develop their own personalized phobic hierarchy which is then used by the computer as the phobic stimulus in desensitization proper. The results of a pilot trial with an agoraphobic client indicate that the computer program was successful.

Adult↗
PubMed2000

Evaluation of a particle-enhanced turbidimetric immunoassay for the measurement of ferritin: application to patients participating in an autologous blood transfusion program.

OBJECTIVES: To evaluate a turbidimetric immunoassay for the measurement of ferritin, and to assay this method in a group of patients undergoing an autologous blood transfusion program. DESIGN AND METHODS: We used an ILab 900 analyzer. This instrument automates a particle-enhanced immunoturbidimetric assay with an analysis time of 9 min. This technique was compared with a microparticle immunoassay. The turbidimetric assay was used to measure ferritin in a group of 30 patients undergoing an autologous blood transfusion program. RESULTS: The assay was linear in the range 3-1400 microg/L (r = 0.9999). The intra- and inter-assay imprecision (CV) at 20, 97 and 469 microg/L were <3.0 and <5.0%, respectively. Recovery was 88. 7 to 97.4%. The detection limit was 3 microg/L. Hemoglobin (</=4 g/L), mild hyperbilirubilinemia (bilirubin </=50 micromol/L), triglycerides (</=10 mmol/L) and myeloma paraproteins did not interfere with the assay. The assay showed good correlation with a microparticle enzymoimmunoassay (r = 0.994) with a mean difference between methods of -6 +/- 16 microg/L. This method was sensitive, accurate, and fast enough for an efficient follow-up of autologous blood transfusion patients. CONCLUSIONS: The new automated serum assay for ferritin is an attractive alternative that avoids the need for dedicated instrumentation.

Adult↗