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PubMed1990

[Development of a computer program for early diagnosis of acute myocardial infarction].

A standardised case history was obtained for 1,163 patients admitted to the Central Hospital of Akershus due to suspected acute myocardial infarction. From this database, a computer program was developed for establishing early diagnosis of acute myocardial infarction. In a given patient the program calculates the probabilities of the different conditions giving rise to the particular chest pain history by applying Baye's conditional probability approach. The program proved valuable as a supportive clinical tool of decision in patients admitted with acute chest pain.

Diagnosis, Computer-Assisted↗
PubMed1976

Thirteenth Annual Lenna Frances Cooper Memorial Lecture: Nutrition education-what comes next?

Education for normal nutrition must include preventive measures against the principal health problems of the day, namely cardiovascular and gastrointestinal diseases. Preventive nutrition denotes a sufficiency of all nutrients for normal metabolic processes and the avoidance of excesses of calories, salurated fat, cholesterol, simple carbohydrates, and refined foods. The dietitian is uniquely qualified to interpret nutritional science and to apply it to daily food choices by people and must assume leadership in all program development for nutrition education, including nutrition education programs in the nation's schools. For effective, preventive nutrition education, new perspectives are needed to overcome the limitations of the simplistic, traditional approach.

Adolescent↗
PubMed1996

The role of nephrology nurses in training hemodialysis patient care technicians.

This article describes a hemodialysis patient care technician training program developed after a need was identified. The program may serve as a model for nephrology nurses who are interested in nephrology technician education. The course has been very popular with those seeking career directions or changes. The course was evaluated by graduate survey.

Allied Health Personnel↗
PubMed1993

Developing a resident assistance program. Beyond the support group model.

BACKGROUND: A program designed to identify and address specific evolving needs of residents throughout their first year has been implemented in our department of medicine. The average annual participation is 55 residents. The program includes a detailed and structured curriculum with topics and activities aimed at improving nonclinical skills that help residents function effectively during residency. METHODS: The program was developed based on a careful analysis of problems reported by graduating residents. It consists of 12 sessions in which the residents are presented with typical difficult situations they are likely to encounter during the year. At the end of each session they are provided with strategies to help them deal with the problems or even prevent problems in some cases. An important aspect of the program is the training and utilization of senior residents as group leaders. RESULTS: Eighty-five percent of the first-year residents have actively participated in the program since July 1989 despite its voluntary nature. Participants reported that the program greatly accelerated their adaptation and helped them function more effectively in the system. Senior residents recognized benefits for their professional development as well. CONCLUSIONS: The collective wisdom of past generations is often not effectively communicated to post-graduate year 1 residents. They are left to reinvent the wheel, not always with the best results. As a consequence, a great deal of stress that can be minimized is introduced into the training process. This program shows promise as an effective mechanism to deal with these challenges.

Adaptation, Psychological↗
PubMedDate not supplied

Collaborative speech and language services for students with learning disabilities.

Fueled by educational reforms such as the Regular Education Initiative, the inclusion movement, and Goals 2000, speech and language pathologists (SLPs) have explored the use of collaborative consultation in providing integrated service delivery. The implications of classroom-based services are discussed, along with models that have been adopted by SLPs, learning disabilities specialists (LDSs), and classroom teachers. The characteristics of students served, and the areas of speech and language (i.e., language, articulation, fluency, voice) targeted in the classroom, are reviewed. Ways in which SLPs, LDSs, and classroom teachers can collaborate, including collaborative assessment; Individualized Education Program development; teaching listening, speaking, reading, and writing skills; and teaching students the language of the classroom, are described.

Cooperative Behavior↗
PubMedDate not supplied

IGF-I triple helix strategy in hepatoma treatment.

BACKGROUND/AIMS: To investigate the effect of gene therapy for hepatocellular carcinoma based on inhibition of cellular IGF-I expression, the technique of IGF-I triple helix was investigated in mice developing programmed hepatoma. METHODOLOGY: mhAT1F1 mouse hepatoma cell line was transfected in vitro with IGF-I triple helix expression vector (pMT-AG-TH) or with IGF-I antisense expression vector (pMT-Anti-IGF-I). 10 x 10(6) transfected cells of either triple helix or antisense type were inoculated intraperitonealy into transgenic ATIIITB6 mice developing genetically programmed hepatoma (mice die between the age of 6 and 7 months). In parallel, human cell cultures established from surgically removed hepatomas were investigated. RESULTS: mhAT1F1 and human primary cell cultures, transfected with pMT-AG-TH or pMT-Anti-IGF-I vectors resulted in total inhibition of IGF-I demonstrated by immunocytochemical and Northern blot techniques. Transfected cells changed their phenotype and recovered major histocompatibility complex I expression showed by fluorescence-activated cell sorting analysis and Western blot. Moreover, two phenomena were observed in IGF-I "antisense" or "triple helix" transfected cells: 1) the apoptosis, demonstrated by TUNEL technique; 2) the presence of IL-6 simultaneously with disappearance of tumor necrosis factor-alpha and IL-10, investigated by reverse transcriptase-polymerase chain reaction technique. In in vivo experiments, injection of murine transfected cells into mice in terminal-phase prolonged their survival 3-4 months in 100% of cases, as well in "antisense" group (8/8) as in "triple helix" group (10/10). CONCLUSIONS: Injection of hepatoma cells transfected with IGF-I triple helix expression vector, and showing immunogenic and apoptotic characteristics, can constitute an effective cellular therapy against hepatocellular carcinoma.

Animals↗
PubMed1999

Sharpening the focus on populations: an intentional community health nursing approach. Part II.

An interpretive study conducted in a Midwestern metropolitan area was designed to examine expertise in everyday community health nursing (CHN) practice. Twenty-five nurses from three practice areas (traditional, nontraditional, and program development) participated in group and individual interviews and field observations, sharing stories of their practice. Transcribed interviews and field observation notes were analyzed as a text. One of the major findings of the study focused on experiences of the nurses as they developed the population aspects of their everyday practice. Part I describes the natural development of a population focus of CHN generalists whose care most often targeted individuals and families. The stories of how their practices evolved and were supported by their institutions provided insights into how nurses develop a broad population-focused practice perspective. Part II examines the practice of those CHN specialists who nurse their target populations from an intentional perspective. Their population-focused practice, in which they repeatedly displayed what the research team terms multilingual and multiperspectival skills, was solidly based in their prior individual and family-focused experience and expertise in program planning and evaluation.

Attitude of Health Personnel↗
PubMed2006

A collaborative rehabilitation approach to the improvement of inpatient treatment for persons with a psychiatric disability.

With the growth of community support programs the role of the state psychiatric hospital has changed. Reduced funding levels have resulted in overcrowding, inadequate staffing and ineffective programming. In order to improve the quality of care and introduce more psychiatric rehabilitation-oriented activities into hospital programming, a large state hospital and a state health sciences university have entered into a time-limited collaborative partnership. This paper describes that partnership and its attempt to improve staff competencies, enhance service delivery and integrate a more rehabilitation-oriented philosophy of care into the hospital through undergraduate education, in-service training, program development, staff mentoring and organizational change activities.

Adult↗
PubMed1992

USAR Nurse Referral and Retention Program.

In 1987, the 804th Hospital Center made alleviating the shortfall of registered nurses in the Command a priority. The Command had only 79% of its registered nurse positions filled at the time. Using the recruitment strategies of an employee referral program and a mailing list, the Command reached 100% fill in 2 years and maintained those gains for an additional year. Retention strategies were also implemented which lowered the attrition rate. This paper describes the Army Nurse Referral and Retention Program developed and implemented at the 804th Hospital Center that relieved the shortfall of registered nurses in the United States Army Reserve in New England.

Female↗
PubMedDate not supplied

Reaching the hard to reach: innovative housing for homeless youth through strategic partnerships.

This article features three housing programs designed to target the needs of youth aging out of child welfare. One program combines housing and treatment to move substance-dependent youth off the streets; one combines the resources of Urban Peak, the only licensed homeless and runaway youth shelter in Colorado, with the Denver Department of Human Services to prevent youth in child welfare from discharging to the streets; and one addresses the intense mental health needs of this population. It costs Colorado 53,655 dollars to place a young person in youth corrections for one year and 53,527 dollars for residential treatment. It costs Urban Peak 5378 dollars to move a young person off of the streets. This article describes how data have driven program development and discusses how policy implications and relationships with the public and private sector can leverage additional resources.

Adolescent↗
PubMed1994

How economic development and family planning programs combined to reduce Indonesian fertility.

This paper examines the contributions of family planning programs, economic development, and women's status to Indonesian fertility decline from 1982 to 1987. Methodologically we unify seemingly conflicting demographic and economic frameworks into a single "structural" proximate-cause model as well as controlling statistically for the targeted (nonrandom) placement of family planning program inputs. The results are consistent with both frameworks: 75% of the fertility decline resulted from increased contraceptive use, but was induced primarily through economic development and improved education and economic opportunities for females. Even so, the dramatic impact of the changes in demand-side factors (education and economic development) on contraceptive use was possible only because there already existed a highly responsive contraceptive supply delivery system.

Adolescent↗
PubMed1995

Residency training--the profession's forge for leadership development.

The concept of leadership may be the most widely studied and least understood topic in the domain of social services. Leadership has been described as a major force in the profession's transition to pharmaceutical care and effective program development. Pharmacy practice residency programs are a major means of developing and sustaining leadership for the growth of the profession. Three concepts that are explored include: (1) some insight into noncognitive elements of residency training that are critical to the development of professional practice, (2) analysis of leadership perceived to be critical for pharmacists, and (3) a definition of how residency training can develop professional leaders to meet the challenges for pharmacy.

Competency-Based Education↗
PubMed2001

The continuing professional development of the Canadian Society of Clinical Chemists and the Canadian Academy of Clinical Biochemists.

The Canadian Society of Clinical Chemists (CSCC) and the Canadian Academy of Clinical Biochemistry (CACB) have recently implemented a new professional development program for its 400 members. The program's goals are: to evaluate and recognize professional development based on self-determined needs, interests, and learning preferences; and to ensure that qualified professionals directing clinical biochemistry laboratories have adequate basic and current knowledge to function competently in their profession. Involvement in the program is currently voluntary and based on a 3-year cycle during which time participants must earn a minimum of 150 credits from at least 3 of 8 categories' learning activities. Of these activities: four are related to updating knowledge (Formal Group Learning related to Laboratory Medicine, Other Formal Group Learning, Self-Directed Learning, Self-Assessment); three are related to the maintenance and implementation of practice skills (Service Associated Learning, Teaching, Change in Practice); and one is related to the advancement of knowledge (Publications and Presentations). One credit is defined as one hour of continuing professional development activity. At the end of each year, members document their activities by submitting a 4 page Annual Summary of Activities (ASA) form. The cost of coordinating the program is minimal as it is administered by a steering committee and smaller working committees, all of whom are voluntary. A basic assumption of our program is that self-management of professional development (PD) is an important prerequisite and indicator of maintenance of competence. By recognizing learning through a number of activities and outcomes, it is anticipated that our program will promote an overall improvement in the quality of Laboratory Medicine throughout Canada.

Canada↗
PubMed1999

Peer review of teaching: instituting a program in a college of nursing.

Institutions of higher education can lose sight of the importance of teaching. Teaching, in some settings, needs to be restored to its place of primacy in the faculty role and its quality needs to be evaluated. The American Association for Higher Education (AAHE) national project, "From Idea to Prototype: The Peer Review of Teaching," is an attempt to accomplish that purpose. Involvement in the AAHE national peer review project has been the impetus for the Kent State University College of Nursing to initiate a faculty-developed program of peer review. The program has been well received primarily because it was owned and controlled by the faculty. Its voluntary nature, administrative sanction, and strong support have contributed to its success. Faculty explored many possible methods to accomplish peer review. However, the use of a task force, classroom and clinical observations, and teaching circles have been the approaches best suited to this particular departmental culture.

Education, Nursing↗
PubMed1998

Community collaboration. The nursing administrator's role in implementing a child abuse prevention program.

The increasing incidence of child abuse is a national disaster. One proposed intervention is prevention through a public health nurse home visitation program developed and extensively researched by David Olds. Selected components of the conceptual model of community collaboration developed by Polivka are applied to the implementation process. The role of the public health nursing administrator in collaboration, human resource management, and delegation is discussed.

Child Abuse↗
PubMed1988

Preliminary report of an identification mission for safe motherhood, Senegal: putting the M back in M.C.H.

The Government of Senegal, in keeping with the priority given to women and children in its health programs, requested the assistance of the United Nations Development Program (UNDP) in identifying and executing a program to diminish maternal mortality in that country. A UNDP "Mission of Identification" was carried out in response to this initiative. The preliminary results of this mission confirm that the issue of maternal safety is of primary concern not only to the government but also to women in the Republic of Senegal. The methodology employed during this mission allowed the team of national and international experts to confirm the level of this concern and to identify four major potential areas of intervention. Quantitative goals for the program have been set and estimates for the efficacy of each of the intervention areas indicate that intervention through the timely provision of access to emergency surgical services and appropriate prenatal care will yield the largest reduction. The feasibility of providing interventions in each of the four areas was also addressed during the mission. This methodology will be applicable to other settings as Third World countries begin to address the problem of excessive maternal mortality.

Abortion, Illegal↗
PubMed2006

Improving comfort and communication in the ICU: a practical new tool for palliative care performance measurement and feedback.

OBJECTIVE: To develop a practical set of measures for routine monitoring, performance feedback, and improvement in the quality of palliative care in the intensive care unit (ICU). DESIGN: Use of an interdisciplinary iterative process to create a prototype "bundle" of indicators within previously established domains of ICU palliative care quality; operationalization of indicators as specified measures; and pilot implementation to evaluate feasibility and baseline ICU performance. SETTING: The national Transformation of the Intensive Care Unit program developed in the United States by VHA Inc. PATIENTS: Critically ill patients in ICUs for 1, > 3, and > 5 days. MEASUREMENTS AND MAIN RESULTS: Palliative care processes including identification of patient preferences and decision making surrogates, communication between clinicians and patients/families, social and spiritual support, and pain assessment and management, as documented in medical records. Application is triggered by specified lengths of ICU stay. Pilot testing in 19 ICUs (review of > 100 patients' records) documented feasibility, while revealing opportunities for quality improvement in clinician-patient/family communication and other key components of ICU palliative care. CONCLUSIONS: The new bundle of measures is a prototype for routine measurement of the quality of palliative care in the ICU. Further investigation is needed to confirm associations between measured processes and outcomes of importance to patients and families, as well as other aspects of validity.

Communication↗
PubMed1999

A medical school-based program to encourage native Hawaiians to choose medical careers.

Native Hawaiians are highly underrepresented in the field of medicine, both nationally and in Hawaii. Since 1991, the Native Hawaiian Center of Excellence (funded by the Bureau of Health Professions) at the John A. Burns School of Medicine in Honolulu has developed programs to encourage Native Hawaiians to enter and complete medical school. In this article, the authors focus on a revised version of a six-week summer enrichment program for high school students developed by the Center in 1995 and funded by the Hawaii State Department of Education and the federal government. The authors trace the difficulties in attracting Native Hawaiian students and how these difficulties were overcome. They show that once Native Hawaiians have entered the academically rigorous, culturally rich program, their academic and career ambitions have been kindled, and some are planning careers in medicine. The history of the program illustrates that a committed medical school and dedicated individuals in the community, with the support of the federal and state governments, can increase interest among underrepresented students in medical and other health professions careers. Eventually, when such students graduate, there is a likelihood that some of them will go back to serve the health needs of their communities.

Career Choice↗