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PubMed2005

Strategies for acquiring affordable medications for seniors.

While Congress continues to debate issues related to Medicaredrug benefits, senior citizens grow increasingly frustrated withtheir monthly medication bills. Many seniors are unable to affordall of their medications, and therefore find that they must choosebetween those that are the most helpful and those that have thegreatest potential for severe medical consequences if missed. Op-tions are available for helping senior citizens with this financialburden, but many seniors are either unaware or unable to availthemselves of the existing programs. Several pharmaceutical com-panies have developed programs for the medically needy based onincome levels. Generic medications as opposed to trade names re-present substantial cost savings. Many pills can be split, thus pro-viding twice the dose for half the cost. Some community healthcenters offer access to prescriptions at decreased costs through fed-eral programs. This article explores the various options availableto senior citizens so that nurses may act as advocates for thesepatients.

Aged↗
PubMedDate not supplied

Outcomes of scholarly inquiry: an analysis of Master's of Nursing students' projects/theses.

This study examined the first scholarly projects/theses of 112 graduates of a newly formed Master of Nursing (MN) program. The purpose of the analysis was to determine whether MN graduates' scholarly projects/theses addressed the American Association Colleges of Nursing's (1996) Essentials of Master's Education for Advanced Practice Nursing, met program outcomes, and adhered to campus and program values. Other specific questions were formulated to ascertain the method of inquiry most used, the population group most examined, and the outcomes of the inquiry. The sample of 106 scholarly projects and six theses were categorized according to method of inquiry, population group, population type, and scholarly outcomes and then entered into a database software program. The findings showed the method of inquiry most used was literature review, followed by program critique, community assessment, and secondary analysis. The community was the most frequently examined population group, with patient, children, provider, minority, and elderly the most used population type. The most frequent scholarly outcomes were recommendations, study reports, educational materials, and program development. Findings supported the campus's and program's mission statement that values community partnership and diversity, improved health care outcomes, as well as an outcome objective of master's-level proficiencies in research competencies.

Academic Dissertations as Topic↗
PubMed2002

Improving medication use in newly admitted home healthcare patients: a randomized controlled trial.

OBJECTIVES: To test the efficacy of a medication use improvement program developed specifically for home health agencies. The program addressed four medication problems identified by an expert panel: unnecessary therapeutic duplication, cardiovascular medication problems, use of psychotropic drugs in patients with possible adverse psychomotor or adrenergic effects, and use of nonsteroidal antiinflammatory drugs (NSAIDs) in patients at high risk of peptic ulcer complications. It used a structured collaboration between a specially trained clinical pharmacist and the patients' home-care nurses to improve medication use. DESIGN: Parallel-group, randomized controlled trial. SETTING: Two of the largest home health agencies in the United States. PARTICIPANTS: Study subjects were consenting Medicare patients aged 65 and older admitted to participating agency offices from October 1996 through September 1998, with a projected home healthcare duration of at least 4 weeks and at least one study medication problem. INTERVENTION: Qualifying patients were randomized to usual care or usual care with the medication improvement program. MEASUREMENTS: Medication use was measured during an in-home interview, with container inspection at baseline and at follow-up (between 6 and 12 weeks) by interviewers unaware of treatment assignment. The trial endpoint was the proportion of patients with medication use improvement according to predefined criteria at follow-up. RESULTS: There were 259 randomized patients with completed follow-up interviews: 130 in the intervention group and 129 with usual care. Medication use improved for 50% of intervention patients and 38% of control patients, an attributable improvement of 12 patients per 100 (95% confidence interval (CI) = 0.0-24.0, P =.051). The intervention effect was greatest for therapeutic duplication, with improvement for 71% of intervention and 24% of control patients, an attributable improvement of 47 patients per 100 (95% CI = 20-74, P =.003). Use of cardiovascular medications also improved more frequently in intervention patients: 55% vs 18%, attributable improvement 37 patients per 100 (95% CI = 9-66, P =.017). There were no significant improvements for the psychotropic medication or NSAID problems. There was no evidence of adverse intervention effects: new medication problems, more agency nurse visits, or increased duration of home health care. CONCLUSIONS: A program congruent with existing personnel and practices of home health agencies improved medication use in a vulnerable population and was particularly effective in reducing therapeutic duplication.

Aged↗
PubMed2003

Activation of Notch signaling pathway precedes heart regeneration in zebrafish.

Several vertebrates display the ability to regenerate parts of their body after amputation. During this process, differentiated cells reenter the cell cycle and proliferate to generate a mass of undifferentiated cells. Repatterning mechanisms act on these cells to eventually shape a regenerated tissue or organ that replaces the amputated one. Experiments with regenerating limbs/fins in newts and zebrafish have shown that members of the Msx family of homeodomain-containing transcription factors play key roles during blastema formation and patterning. Here we show that adult zebrafish have a remarkable capacity to regenerate the heart in a process that involves up-regulation of msxB and msxC genes. We present evidence indicating that heart regeneration involves the execution of a specific genetic program, rather than redeployment of a cardiac development program. Preceding Msx activation, there is a marked increase in the expression of notch1b and deltaC, which we show are also up-regulated during fin regeneration. These data suggest a role for the Notch pathway in the activation of the regenerative response. Taken together, our results underscore the use of zebrafish as a model for investigating the process of regeneration in particular and the biology of stem cells in general. Advances in these fields will undoubtedly aid in the implementation of strategies for regenerative medicine.

Animals↗
PubMed2002

Effective approaches to reducing adolescent unprotected sex, pregnancy, and childbearing.

In the United States, there exist a multitude of different approaches to reducing adolescent sexual risk-taking, unintended pregnancy, childbearing, and sexually transmitted disease, including HIV. While many of these approaches have some positive effects upon some outcomes (such as greater knowledge), only some of these programs actually delay the initiation of sex, increase condom or contraceptive use, and reduce unprotected sex among youth. This article summarizes a review of 73 studies and their respective programs, and describes four groups of programs which have reasonably strong evidence that they delay sex, increase condom or contraceptive use, or reduce teen pregnancy or childbearing. These four groups of programs include (a) sex and HIV education curricula with specified characteristics, (b) one-on-one clinician-patient protocols in health settings with some common qualities, (c) service learning programs, and (d) a particular intensive youth development program with multiple components.

Adolescent↗
PubMed1996

A consumer-oriented model for evaluating computer-assisted instructional materials for medical education.

Computer-assisted instruction (CAI) can enhance medical education, but course directors and curriculum designers need thorough, credible evaluative data to make sound decisions about procuring and implementing CAI programs. There has been extensive research on the merits of CAI in general (although much of it is flawed by methodologic shortcomings), but sufficient evaluative data on specific programs are rarely available. The author proposes that a consumer-oriented model would be useful for evaluating CAI programs, and he discusses one published, consumer-oriented evaluation of a multimedia CAI program for ophthalmology students. The author contends that if CAI programs were routinely evaluated using the consumer-oriented model, and if CAI program developers used this model to evaluate their programs during the developmental phase, medical educators would be better able to choose and implement the programs that would best serve their needs.

Computer-Assisted Instruction↗
PubMed1993

Evaluating the Mount Sinai Leadership Enhancement Program: a developmental perspective.

The principal evaluators of the Mount Sinai Leadership Exchange program used a developmental approach to evaluating the program, applying qualitative and quantitative data within the program as the program developed. Over the course of its development, evaluation, and refinement, the leadership enhancement program emerged as a vehicle for true international exchange of ideas, skills, resources, and collegiality.

Academic Medical Centers↗
PubMed2001

Developing standards in behavioral surveillance for HIV/STD prevention.

HIV/STD prevention programs are increasingly guided by behavioral rather than by disease indicators. Relevant HIV/STD-related behavioral information is currently available from a variety of surveys and surveillance systems at three levels: general population, infected populations, and high-risk populations. However, the utility of these systems for local program development is limited due to lack of standardization. In 1997 a Centers for Disease Control and Prevention working group was formed to develop a core set of items for HIV/STD behavioral surveillance for use across surveys. Core items were chosen on the basis of existing surveys and surveillance systems, relevant literature, testing in a cognitive laboratory, and field pilot-testing. A draft of the core set of sexual behavior questions is available on the web at http://www.cdc.gov/nchstp/od/core-workgroup for review and feedback. Questions on drug use, including drug injection practices, as well as questions on HIV testing and sexually transmitted diseases are in preparation and will also be posted on the web site for review.

Centers for Disease Control and Prevention, U.S.↗
PubMed2005

Ideologies of aid, practices of power: lessons for Medicaid managed care.

The articles in this special issue teach valuable lessons based on what happened in New Mexico with the shift to Medicaid managed care. By reframing these lessons in broader historical and cultural terms with reference to aid programs, we have the opportunity to learn a great deal more about the relationship between poverty, public policy, and ideology. Medicaid as a state and federal aid program in the United States and economic development programs as foreign aid provide useful analogies specifically because they exhibit a variety of parallel patterns. The increasing concatenation of corporate interests with state and nongovernmental interests in aid programs is ultimately producing a less centralized system of power and responsibility. This process of decentralization, however, is not undermining the sources of power behind aid efforts, although it does make the connections between intent, planning, and outcome less direct. Ultimately, the devolution of power produces many unintended consequences for aid policy. But it also reinforces the perspective that aid and the need for it are nonpolitical issues.

Altruism↗
PubMed1975

Training mentally retarded adolescents to brush their teeth.

The need for self-care by retarded individuals in behaviors such as brushing teeth led to the development and evaluation of a comprehensive toothbrushing program that included a task analysis and training procedure specific to each component of the task analysis. Eight mentally retarded adolescents, in two groups, individually received acquisition training that included scheduled opportunities for independent performances, verbal instruction, modelling, demonstration, and physical assistance. The first group of four subjects received token plus social reinforcement; the second received only social reinforcement. All eight subjects showed improved toothbrushing behaviors when compared to baseline. Six of the eight subjects correctly performed all toothbrushing steps in two of three consecutive sessions. The study emphasizes the need for systematic program development and evaluation.

Adolescent↗
PubMed2001

The evolution of the Fenway Community Health model.

Fenway Community Health was founded by community activists in 1971 in the Fenway neighborhood of Boston, Mass, and within a decade had rapidly expanded its medical services for gay men in response to the AIDS epidemic. Increased expertise and cultural competence in lesbian, gay, bisexual, and transgender (LGBT) care led to expansion of medical services to address broader community concerns, ranging from substance use to parenting issues to domestic and homophobic violence, as well as specialized programs for lesbians, bisexuals, and transgendered individuals. Fenway began as a grassroots neighborhood clinic. In 1975, the center recorded 5000 patient care visits; in 2000, Fenway's clinical departments recorded 50,850 visits by 8361 individuals, including more than 1100 individuals receiving HIV-associated care. The center now has more than 170 staff people responsible for clinical programs, community education, research, administration, planning, and development. Over the past few years, Fenway's annual budget has exceeded $10 million. Fenway has established standards for improved cultural competence about LGBT health issues for other health providers and has developed programs to educate the general community about specific LGBT health concerns. This health center may provide a model of comprehensive LGBT health services that have a local impact.

Acquired Immunodeficiency Syndrome↗
PubMed2003

A problem-based learning trial on the Internet involving undergraduate nursing students.

This article describes the application of a nursing educational program developed on the basis of problem-based learning (PBL) and Internet technology, and reports student satisfaction and perceived learning effectiveness. This study was conducted in two phases-the development of a Web-based educational program and the application of this program using PBL strategies to teach undergraduate nursing students. The results showed this program was an effective method of delivering PBL to nursing students and the interaction between tutors and students influenced student satisfaction and learning effectiveness.

Adult↗
PubMed1992

Providing more than just care to neighborhoods.

The riots in Los Angeles focused new attention on the needs of inner cities. Many urban hospitals have played an active role in responding to and attempting to alleviate the woes afflicting cities. They've volunteered personnel and helped to develop programs ranging from job creation to property development to neighborhood beautification. Hospitals' efforts have benefited both neighborhoods and facilities.

Community-Institutional Relations↗
PubMed1986

The Canadian hospital pharmacy workload measurement study.

"One pharmacist for every 100 beds" has been the traditional rule of thumb used in determining hospital pharmacy staffing requirements in North America. Hospital pharmacy practice has undergone profound changes over the past 20 years. Staffing requirements for contemporary hospital pharmacy practice determined by the traditional guideline are outdated and of limited value. The Canadian government, through its National Health Research and Development Program, funded a $225,000 study to develop a Canadian Hospital Pharmacy Workload Measurement System which would provide a data base for a more accurate determination of staffing requirements for hospital pharmacies. Time studies were carried out to measure the personnel time required to perform defined activities that collectively formed a pharmacy service or function.

Canada↗
PubMedDate not supplied

RN-MSN admission practices and curricula in the mid-Atlantic region.

Nurse educators are increasingly sensitive to the differences in learning needs of adult students in comparison to the traditional generic student and to the demand for advanced practice nurses. For these reasons, the number and type of accelerated programs has increased. There is very little in the literature related to RN-MSN programs. To determine the state of RN-MSN education, a descriptive exploratory study was conducted to examine admission and curricular requirements for RN-MSN nursing programs in the mid-Atlantic region. The findings reveal a wide variety of educational practices. Over 74 percent of responding programs indicated that challenge exams are used to accelerate students' progress; 59 percent reported participating in statewide articulation agreements. Credit requirements for core and major courses were found to vary dramatically, as do credits required to earn the BSN-MSN credential; the average number of credits for program completion was 127. GPA requirements for admission ranged from 2.5 to 3.5. Findings from this study can assist existing programs to assess their comparability and help developing programs understand emerging patterns in RN-MSN education.

Curriculum↗
PubMedDate not supplied

The nature and effectiveness of program models for adolescents at risk of entering the formal child protection system.

This article compares rationales and outcome research for five areas of programming for adolescents: adolescent competence and skill development programs, family- and parent-focused programs, social integration programs, multiple component programs, and neighborhood transformation programs. The article examines program evidence for maltreated teens as well as teens coping with a variety of other challenges. The study uses a framework based on common developmental challenges and risk factors for adolescents to select and review programs.

Adolescent↗
PubMed2004

[Prevalence of HTLV-I/II infection among blood donors in Santa Fe Province, Argentina].

Subsequent to the National Epidemiologic Surveillance Program developed in 1997 by the National AIDS Program, anti-HTLV-I/II antibodies among blood donors in Santa Fe Province started to be detected. On the basis of this initial finding, it was regarded of interest to evaluate the true HTLV-I/II seroprevalence in this population during a four-year survey. Thus, from 1997 up to 2002, 9425 samples were studied from 17 out of the 19 provincial departments. Out of the total sampling, 38 proved reactive by agglutination techniques, 18 of which were confirmed by western blot (WB). Out of the latter, 10 were HTLV-I/II seropositive with a final prevalence of 0.1% (10/9425), whereas 7 were indeterminate and 1 negative. Among these 10 confirmed sera, 2 (0.02%) were HTLV, 3 (0.03%) HTLV-I and 5 (0.05%) HTLV-II. It should be highlighted that the presence of HTLV-I/II infection in blood donors in Santa Fe Province was demonstrated for the first time, with a prevalence greater than that reported for blood donors in non-endemic Argentine areas. Such findings confirm the need of corresponding systematic screening through regulatory blood bank norms in Santa Fe Province.

Argentina↗
PubMed2006

[Standard precautions: are these known? Are they applied?].

A study carried out among postgraduate nurses detected a high degree of confusion regarding standard precautions. This led to the formation of a multidisciplinary group from various sections of the health system to investigate this topic in greater detail. Our study observed a high degree of conceptual confusion and a lack of knowledge about standard precautions and the new recommendations regarding decontamination and hand washing in diverse health collectives. It is worrisome to detect at risk habits in relation to self-protective measures among one-third of those surveyed. Knowledge of standard precautions should be integrated with greater efficiency in the medical study programs as well as in continuing professional development programs for health professionals.

Guideline Adherence↗