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PubMed1996

[Clinical examinations in Usher's syndrome].

In this paper we are showing the results of clinical examinations in the family in which three siblings had the following symptoms: congenital deafness and nyctalopia. Clinical examinations including genetic counseling, audiometry, caloric test, Flash ERG, perimetry, computer tomography revealed total deafness, no vestibular function, and an advanced stage of retinitis pigmentosa. On the basis of clinical results, we determined the correct diagnosis: autosomal recessive Usher's syndrome-type 1. Diagnosis of the syndrome enables qualification of prognosis, complications, possibility of treatment and the risk of having the disease in the next generations. Early identification of the presence of Usher's syndrome can help in the formulation of an appropriate educational and training program. It seems purposeful that all patients with hearing loss should be examined by ophthalmologists.

Abnormalities, Multiple↗
PubMedDate not supplied

The cigarette smoking experience of pregnant Latinas in the United States.

Cigarette smoking is harmful to pregnant women and their babies. Although there is a considerable body of knowledge about cigarette smoking and smoking cessation behavior, Latinas in the United States have been included in only a few studies. This research was conducted to explore the smoking and smoking cessation experiences of pregnant Latinas. Sixteen English-speaking pregnant Latina smokers participated in 1 of 4 focus group discussions of smoking-related experiences. Thematic content analysis of data resulted in the elaboration of 3 processes inherent in smoking and smoking cessation for participants: how these Latinas used smoking in their daily lives, how pregnancy influenced their smoking, and what quitting was like for them. Strong family influences were evident in all themes. Recommendations include the development of culturally appropriate, tailored tobacco control programs that engage family members in the smoking cessation process.

Adult↗
PubMed1997

Reducing the complications of type II diabetes: a patient-centered approach.

Diabetes mellitus is responsible for 12 percent of health care expenditures in the United States, and much of the cost can be attributed to the treatment of complications. Morbidity, particularly the development of microvascular complications, has been linked to poor glycemic control in type 1 diabetes. Evidence strongly suggests that improved glycemic control may reduce the morbidity, mortality and treatment costs of type II diabetes. To prevent cardiovascular complications, physicians and patients must work together to address risk factors such as dyslipidemia, hypertension and smoking. Effective care of type II diabetes requires an appropriate diet, an exercise program and, if needed, a carefully monitored drug regimen. In addition, physicians and patients need to cooperate in setting goals and making tradeoffs related to the potential benefits and adverse effects of therapy. Individualized patient education and support groups also can be very useful.

Clinical Trials as Topic↗
PubMedDate not supplied

Feasibility of obtaining sexual risk and STD history in the context of a drinking drivers' program.

OBJECTIVES: This study was designed (a) to assess the feasibility of obtaining data about sexually transmitted diseases and sexual risk behavior in an alternative-to-incarceration program for convicted drinking drivers and (b) to determine whether asking health history and sexual risk questions using an anonymous questionnaire, anonymous interviews, or confidential interviews affected the willingness of people to participate. METHODS: The same survey instrument was used across three data collection modes to collect information on sexually transmitted diseases and sexual risk behavior. RESULTS: Overall, there were no differences across modes in self-reports of STDs and details of sexual history. Although the difference in refusal rates between the anonymous questionnaire and the anonymous interview was not significant, the refusal rate for the anonymous questionnaire was significantly higher than the rate for the confidential interview. Those answering the self-administered questionnaire were more likely than those receiving face-to-face interviews to refuse to answer questions about having sex while high and condom use. CONCLUSIONS: A drinking driver intervention program may be an appropriate site for health screenings and prevention activities for an at-risk population.

Adult↗
PubMed1998

[17-KS sulfate as a biomarker in health and disease].

We attempted to determine compounds in human urine which, differing from 17-OHCS, show high values in healthy individuals, decrease with failing health, clearly decline with advancing disease and finally reach very low values in severe disease. We have initially established that 17-ketosteroid sulfates (17-KS-S) are the compound we were searching for. Hans Selye regarded stress as the rate of wear and tear and 17-OHCS as its indicator, but we considered that, differing from inanimate objects, living organisms consume energy to cope with stress and "repair" "wear and tear" of the tissue "and recover" its function. This concept led us to determine the organism's requirements for two mechanisms: "Wear and tear" which could be represented by the secretion of 17-OHCS (Selye), and "repair and recovery", which could be determined by the amounts of 17-KS-S (Nishikaze) derived from dehydroepiandrosterone sulfate (DHEA-S), a product of the adrenal cortex, which enhances neuronal survival, long-term memory, maintains the function of peripheral tissues (skin, bone-muscle, gastro-intestinal and vascular system etc.), increases lipid metabolism, protein anabolism (antiobesity, antiatherosclerosis etc.) and stimulates the immune system. We hold that the stress response is a series of biological processes, beginning with CRH.ACTH and Catecholamines, Cortisol (17-OHCS), followed by Insulin, acting as an anabolic agent and finally DHEA-S (17-KS-S) induces tissue repair utilizing the energy produced. Low levels of urinary 17-KS-S are observed not only in cases of low cortisol or catecholamines secretion, but also when these are elevated. Normalization of these levels is followed by an increase in 17-KS-S excretion. Balanced changes of hormones, such as 17-KS-S, 17-OHCS, Cortisol, Catecholamines and Insulin are seen in a normal organism under healthy lifestyles and disruption of the balance induces an apparent reduction in 17-KS-S. From this perspective, we hope to research the interrelations between biologically antagonistic 17-KS-S and 17-OHCS as well as other agents, focusing particularly on 17-KS-S, which represents a contact point for mind and body, which is kept in healthy balance by appropriate sleeping and exercise programs along with adequate food intake.

17-Ketosteroids↗
PubMed2000

Regulation of programmed cell death in maize endosperm by abscisic acid.

Cereal endosperm undergoes programmed cell death (PCD) during its development, a process that is controlled, in part, by ethylene. Whether other hormones influence endosperm PCD has not been investigated. Abscisic acid (ABA) plays an essential role during late seed development that enables an embryo to survive desiccation. To examine whether ABA is also involved in regulating the onset of PCD during endosperm development, we have used genetic and biochemical means to disrupt ABA biosynthesis or perception during maize kernel development. The onset and progression of cell death, as determined by viability staining and the appearance of internucleosomal DNA fragmentation, was accelerated in developing endosperm of ABA-insensitive vp1 and ABA-deficient vp9 mutants. Ethylene was synthesized in vp1 and vp9 mutant kernels at levels that were 2-4-fold higher than in wild-type kernels. Moreover, the increase and timing of ethylene production correlated with the premature onset and accelerated progression of internucleosomal fragmentation in these mutants. Treatment of developing wild-type endosperm with fluridone, an inhibitor of ABA biosynthesis, recapitulated the increase in ethylene production and accelerated execution of the PCD program that was observed in the ABA mutant kernels. These data suggest that a balance between ABA and ethylene establishes the appropriate onset and progression of programmed cell death during maize endosperm development.

Abscisic Acid↗
PubMed2001

Using student writing assignments to assess critical thinking skills: a holistic approach.

This work offers an example of one school's holistic approach to the evaluation of critical thinking by using student writing assignments. Faculty developed tools to assess achievement of critical thinking competencies, such as analysis, synthesis, insight, reflection, open mindedness, and depth, breadth, and appropriateness of clinical interventions. Faculty created a model for the development of program-specific critical thinking competencies, selected appropriate writing assignments that demonstrate critical thinking, and implemented a holistic assessment plan for data collection and analysis. Holistic assessment involves the identification of shared values and practices, and the use of concepts and language important to nursing.

Clinical Competence↗
PubMed1989

A program for oriented treatment of essential hypertension.

Treatment of essential hypertension is often a complex task and needs appropriate methodology. A newly developed computer program can help physicians to choose the best pharmacological approach to the treatment of essential hypertension. Based on an oriented clinical history, the program asks the user to give the physiological, pathological and pharmacological antecedents of the patient to be treated. Taking into account these characteristics, 19 antihypertensive drugs are ordered according to their indications and contraindications in the patient. Diet advice based on body weight and the patient's habits are considered as well. The program is designed to explain why decisions are made, so it can be useful in teaching medical students or postgraduates.

Antihypertensive Agents↗
PubMed1998

Appropriate training for northern physicians.

It remains difficult to find appropriately trained physicians to work in isolated northern areas. Urban-based family medicine programs have not been able to provide appropriate training. The Northern Family Medicine Education (NorFam) Program of Memorial University of Newfoundland was created to fill this need. This paper reviews the NorFam Program and discusses current practice locations and the relevance of the program as reported by its graduates. From 1993 to 1995, the NorFam Program trained 14 residents. The residents participate in a variety of educational and training activities--all chosen to be as relevant to northern practice as possible. When the graduates were surveyed, nine had remained in northern/remote or rural practice and three were doing further medical training. All respondents reported that the NorFam Program gave them more relevant training for northern practice than they would have received in an urban-based family medicine program.

Arctic Regions↗
PubMed2001

Steroid-triggered death by autophagy.

Programmed cell death is a critical part of normal development, removing obsolete tissues or cells and sculpting body parts to assume their appropriate form and function. Most programmed cell death occurs by apoptosis of individual cells or autophagy of groups of cells. Although these pathways have distinct morphological characteristics, they also have a number of features in common, suggesting some overlap in their regulation. A recent paper by Lee and Baehrecke provides further support for this proposal.(1) These authors present, for the first time, a genetic analysis of autophagy, using the steroid-triggered metamorphosis of Drosophila as a model system. They demonstrate a remarkable degree of overlap between the control of apoptosis and autophagy as well as a key role for the steroid-inducible gene E93 in directing the autophagic death response. This paper also shows that E93 can direct cell death independently from the known death-inducer genes, defining a novel death pathway in Drosophila.

Animals↗
PubMedDate not supplied

The impact of HIV infection on medical services in drug abuse treatment programs.

The HIV/AIDS epidemic has had a profound impact on the organization and delivery of clinical services in drug abuse treatment programs. The need for emphasis on HIV prevention vs. treatment services has varied with the geographic distribution of HIV infection among drug injectors. On-site primary medical care services have been developed in some treatment programs, whereas other programs have had to formalize arrangements for referral or contractual care with outside medical providers. No single model of care is necessarily appropriate for all drug treatment programs, and, along with the potential benefit, each may pose structural challenges that need to be addressed. The advent of the AIDS epidemic may have served, in an inadvertently positive way, to draw attention to the increasingly illogical separation between drug abuse treatment and the larger medical care system. This review will examine the epidemiologic, clinical, organizational, and policy issues generated by the increased medical needs of drug users with HIV infection in treatment program settings.

Combined Modality Therapy↗
PubMed1995

To use dialysis appropriately: the emerging consensus on patient selection guidelines.

When the United States Congress established the Medicare End-Stage Renal Disease (ESRD) Program in 1972, they did not specify patients for whom dialysis would be appropriate. The ESRD program has grown beyond expectation in patient numbers and in costs, partly because patients who were not initially considered by the dialysis community to be candidates are now routinely accepted. The appropriateness of dialysis for some of these patients has been questioned. Recognizing that practice guidelines are a means to promote appropriate health care, the Institute of Medicine Committee to Study the Medicare ESRD Program recommended the development of practice guidelines for ESRD patient selection. This article reviews the arguments for and against guideline development for dialysis patient selection and the guidelines that have been proposed. It describes what appears to be an emerging consensus on the appropriate use of dialysis and recommends a process for the establishment of dialysis patient selection guidelines based on this consensus.

Humans↗
PubMed2003

Tailoring nutrition education intervention programs to meet needs and interests of older adults.

Methods for determining appropriate content of older adult nutrition education intervention programs and strategies for effectively delivering nutrition messages to older learners are presented. Educators can determine the nutrition education needs and interests of their older learners by using results of food intake surveys and assessment screening tools, written surveys, interviews and group discussions. Findings of recent reports using these methods are summarized. Additionally, published experiences with and suggestions for tailoring education intervention programs for older adult audiences, including those of particular racial/ethnic groups, are reviewed. The need for research in this area is presented. This article is one of a series of literature reviews of topics related to nutrition education for older adults.

Aged↗
PubMed1977

Health manpower-planning without objectives.

Health manpower developments of the past decade have resulted in an absolute increase in the number of health personnel, the expansion of the roles of some traditional categories of personnel, and the introduction of new professional categories. Inherent in these developments has been the acceptance of the principal that the relative and absolute increase in manpower would result in an increased availability of health services. Unfortunately, in the last decade, the correlation between increased numbers and increased services is not a strong one. The failure to link manpower needs to specific service objectives and to identify appropriate rates of substitution among professional types has resulted in a wastage of funds and energies.A framework for future planning must now be developed which (1) defines service priorities, (2) delineates the functions required to deliver those services, and (3) defines appropriate manpower categories with their rates of substitution to perform those functions. Training programs must be coordinated to allow appropriate linkages among categorical types of personnel. The maldistribution of health care service must be viewed as a result of the demographic maldistribution among the health professions as well as the maldistribution of organizational and financial incentives for provision of priority services as well as utilization of priority services.

Health Occupations↗
PubMed1982

The use of management by objectives in medical education enrichment programs.

Since numerous medical education enrichment programs have been established throughout the United States, their effectiveness must eventually be evaluated. It is difficult to evaluate the goals of these programs. The programs do have goals, yet most program managers do not have a simple tool for transforming these broad statements into measurable performance standards. No program can be properly prepared for evaluation unless a goal clarification process is initiated. The authors maintain that "management by objectives" is an appropriate process for refining a program's goals and enables the enrichment programs to be fairly evaluated.

Education, Premedical↗
PubMed1986

Rapid computation with the personal computer of the percent cholesterol saturation of bile samples.

A microcomputer program to calculate the cholesterol saturation of bile is described. The program is designed to accept most of the conventional concentration units for bile salts, phospholipid, and cholesterol. The calculated cholesterol saturation can be corrected for the presence of ursodeoxycholic acid conjugates in bile. The program is designed to make appropriate statements when the input data produce results that are out of range of the solubility data available in the published literature. The program makes possible not only a very rapid calculation of the cholesterol saturation of bile, but eliminates arithmetical errors that are occasionally encountered during conventional calculations.

Animals↗
PubMed1997

[Clinical significance of the guidelines for appropriate management of transfusion therapy and aim of introduction of inspection and accreditation program].

For these ten years we have had several guidelines and manuals published by Ministry of Health and Welfares (MOHW) and other organizations. In 1989 MOHW put a guideline for appropriate management of blood transfusions into effect. Some medicolegal scholars have made an evaluation of this guideline in the descriptions to consider what blood transfusion therapy should be and how to make up the control system of blood services in hospitals, but the guideline would be a double-edged sword to medical staffs. In this paper some main topics in the guideline were presented, on the background how to decide the expressions of the contents. Why inspection and accreditation programs should be introduced in hospital blood transfusion services in near future, promoting proper use of blood products by audits, was discussed.

Accreditation↗
PubMed1998

A graduate school curriculum in clinical hypnosis.

The literature suggests a growing interest in hypnosis training. With this growing interest, there has been an increase in training opportunities for the interested clinician. However, much of that training is in the form of a single course or workshop, or a series of single workshops. Many programs only offer hypnosis courses when the appropriate faculty is interested in offering such a course. Other programs offer a minimal exposure to hypnosis, less than a minimal degree of training as suggested by ASCH. This paper describes a formal, integrated curriculum in clinical hypnosis that is offered through a psychology graduate school. An integrated program offers students and practicing professionals the opportunity to learn hypnosis in an environment that offers ongoing supervision and support of their long term development.

Curriculum↗