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PubMed2001

Wellness perception in persons with traumatic brain injury and its relation to functional independence.

OBJECTIVES: To test the reliability and validity of a perceptual wellness measure in persons after traumatic brain injury (TBI) and to determine whether a relation exists between functional independence and wellness perceptions in the same population. DESIGN: Survey research. SETTING: A private, residential brain injury program. PARTICIPANTS: A convenience sample of 49 patients (43 men, 6 women) with TBI whose mean age was 32.1 years (range, 18-61yr) and mean time since injury was 10.47 years (range, 1-21yr). MAIN OUTCOME MEASURES: The Perceived Wellness Survey (PWS) assessed wellness. The PWS has 6 subscales measuring physical, psychologic, emotional, intellectual, spiritual, and social wellness. The FIM instrument was used to measure functional status. RESULTS: The mean PWS score (15.99) for the sample was comparable to published samples of adults (mean, 15.31-16.51); however, the reliability of the composite score (alpha = .58) and the subscales (alpha = .32-.64) was less than that obtained in previous samples (composite alpha = 0.91; subscale alpha = .64-.81). The correlations between the PWS and the FIM scores were not significant. CONCLUSIONS: The PWS in its composite form is a reliable measure for use with persons with TBI. The finding that perceived wellness and functional independence were not related suggests that these constructs are unique and thus should both be measured. The measurement of perceptions will enable the provider to consider a client holistically and to develop programs that address quality of life issues. Further, because perceptions influence behaviors, understanding a person's perceptions in multiple dimensions may provide a useful and necessary framework for developing intervention programs that address behavioral and cognitive issues that are important to that person.

Activities of Daily Living↗
PubMed1995

Older people's responses to education about advance directives.

As advances in medical technology increase the life span, social workers committed to quality of life for elderly people are faced with practice challenges. Preserving the autonomy and civil rights of elderly people in guiding their own health care even if they are unable to articulate preferences has become an important area of social work intervention. This article evaluates a social work program in a rural New England community designed to promote autonomous decision making by educating elderly people about advance directives. Results revealed a continuum of willingness among elderly people to address future decision making. Interventions to promote autonomy in health care decision making need to address the diversity of elderly people. The primacy of the family emerged throughout the study, suggesting that advance directives may be a family issue rather than solely an individual one. Further needs assessment research is needed to guide program development in this essential area of social work practice.

Advance Directives↗
PubMedDate not supplied

Nosocomial infection control: an overview.

Nosocomial infections are one of the most important public health problems in the world today. Although a great deal of attention is being directed toward the control and prevention of these infections, old problems continue to occur and new problems are constantly arising. The approximately 5% rate of nosocomial infections among patients admitted to acute-care hospitals has a significant impact on patients morbidity and morality and on the financial concerns of the patient, hospital, and community. An effective, efficient, and sensitive surveillance program developed to meet the needs of the individual hospital is absolutely necessary to obtain data on nosocomial infections from which controls and prevention programs can be developed. At the same time, lessons can be learned from the experience of other hospitals. The nosocomial infection control and prevention program must be under the general direction of a representative, interested, effective infection control committee. One area of importance under the committee's responsibility is that of an appropriate isolation program practiced by all persons within the hospital.

Centers for Disease Control and Prevention, U.S.↗
PubMed1983

Social networks and work/nonwork life: action-research with nurse managers.

An action-research project with hospital nurses is reported which explores the utility of social network analysis for understanding and enhancing the quality of work life. Based on a framework for conceptualizing work stressors, we present a rationale for developing resource-support groups. These groups combine emotional support, group problem-solving, and participatory decision-making within the context of developing programs and policies to enhance the quality of working life. A workshop help for nurse managers focused on the potential for using these groups to achieve specific, prioritized goals. To study the ecology of work/nonwork life, we obtained data from workshop participants on both their work and nonwork social networks. We found these to be almost totally segmented. Personal, organizational, and sociocultural variables that may account for this pattern are examined. Implications are also discussed for developing support programs and for empowering nursing as a profession.

Humans↗
PubMed1994

Community participation in vector control: lessons from Chagas' disease.

As applied to vector-borne disease control, the term community participation has been broadly interpreted. Community-based vector control projects have been described as having both active and passive components. Recently, community participation in organized efforts to control Chagas' disease has become more dynamic, with increasingly active involvement by local community members. Chagas' disease is a particularly significant vector-borne disease problem in the South American countries of Brazil, Venezuela, and Bolivia, and health officials there are beginning to emphasize horizontal or decentralized approaches to control of triatomine vectors. Experience suggests that vector control programs using community participation have significant and sustainable impact on vector density, appear to be more cost-effective than purely vertically structured programs, are readily integrated with other health or development programs, promote an enduring sense of pride in home and community, and are politically viable vector control strategies. Community participation per se has inherent value because of its positive effect on social relationships and community solidarity. Moreover, it is a dynamic process that results in accrued benefits for public health that exceed most vector control program goals and persist well beyond program termination.

Animals↗
PubMedDate not supplied

Using a focus group to design a diabetes education program for an African American population.

PURPOSE: The purpose of this project was to determine what factors need to be considered in planning a diabetes education program to better meet the needs of African Americans with diabetes in a community served by a suburban community hospital. METHODS: Two focus group sessions were conducted. The sessions were recorded, transcribed, and analyzed by members of the research team. RESULTS: Four themes emerged that had bearing on program development: (1) a sense of personal powerlessness, (2) fear related to complications, (3) recognition of knowledge deficits accompanied by an inability to link behavior to outcomes, and (4) a clear vision of what kind of educational setting would interest and benefit the group. CONCLUSIONS: There were significant differences between what was being offered for diabetes education at the facility and what was desired according to the focus group, including factors of cost and leadership. Recommendations for future program planning are given.

Adult↗
PubMed2006

Multisectoral responses to HIV/AIDS: applying research to policy and practice.

The KwaZulu-Natal Enhancing Care Initiative is a program developed by a consortium of members who represent 4 sectors: academia, government, nongovernmental and community-based organizations, and the business sector. The Initiative was formed to develop a plan for improved care and support for people with HIV/AIDS and who live in resource-constrained settings in the province of KwaZulu-Natal, South Africa. A needs analysis helped to determine the following priorities in prevention, treatment, care, and support: training, grant-seeking, prevention, and care and treatment, including provision of antiretroviral therapy. A partnership approach resulted in better access to a wider community of people, information, and resources, and facilitated rapid program implementation. Creative approaches promptly translated research into policy and practice.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Narrative means to humanistic ends.

BACKGROUND: Efforts to "rehumanize" medical education through curriculum reform and program development have been numerous and ongoing in recent years. One particularly intriguing contribution has come from the area of narrative studies. It is now common to use literature in general, and physician--patient narratives in particular, both to expand students' understanding of the clinical encounter and to sensitize them to the humanistic aspects of medicine. DESCRIPTION: In this article, we describe the process by which we have introduced key insights from and elements of narrative theory into our 1st-year clinical skills program. Rather than limiting our efforts to the use of literature and to the description of individual narrative encounters, however, we have framed our entire course as an exercise in narrative construction. We refer to this process as "narrative structuring." EVALUATION: A combination of short essays on topics related to the various literary materials utilized in the course, written reports on ethical aspects of the clinical cases presented in the clinical skills sessions, and student journaling are integral components of the evaluation of this course. CONCLUSION: Characterizing our course in terms of narrative structuring serves both to integrate the various elements of our complex curriculum around a common theme and to remind both students and faculty alike of the privileges and responsibilities we share as we participate in the writing of one another's stories.

Altruism↗
PubMedDate not supplied

[Memory training in old age: theoretical background and development of an intervention program for nursing home residents].

A survey of the literature reveals that studies providing hard evidence of the effects of training on improvement of cognitive skills in old age focus on highly specialized training measures. To date there are hardly any suitable procedures for memory training that have a broad effect on the consciousness of impaired individuals which would nurture a different attitude towards the entire complex of learning and memory. For this reason a memory training program was developed, aimed at conserving, reactivating, and fostering the cognitive skills of non-demented residents of old people's homes. The training program, carried out over a 3-month period, consists of a total of 24, 45-min training units. The first half of the memory training program prompts participants to use as many channels of perception as possible, and thereby, also to employ compensation possibilities. In addition, there are exercises for improving observation and concentration and for understanding the functions of memory on the basis of a simplified model of information processing. The second half of the memory training program focuses on exercises to improve short-term and medium-range retention. The exercises are oriented in content to the daily situations relevant to the residents in which memory performance is expected. The memory training program was used for the first time in a geriatric facility in Mannheim, FRG. Continued use of the program, coupled with an evaluation, is planned as part of a research project in several homes for the elderly in that greater metropolitan area.

Aged↗
PubMed2000

Atiprimod (AnorMED).

Atiprimod is a macrophage-targeting oral cytokine inhibitor which is being developed by AnorMED as a potential treatment for rheumatoid arthritis and other autoimmune diseases. Phase I trials have been successfully completed and phase II multicenter trials have been approved by the FDA [303260]. The compound was discovered in a joint research and development program with SmithKline and French (now SmithKline Beecham, SB) but following acceptance of the phase II protocol by the FDA, SB decided not to proceed with further development of atiprimod as a result of an internal restructuring program [350042]. All rights to atiprimod and other azaspiranes developed in this program have reverted to AnorMED, which is seeking corporate partners for further development of the compound [303260,337657]. The compound was originally disclosed in European patent, EP-00310321, entitled 'Preparation of N-aminoalkyl-2-azaspiro[4.5]decanes and analogs as immunosuppresants', while a cost-effective, efficacious pilot plant synthesis has also been described [298722].

Journal Article↗
PubMed2005

Staff development planning in an academic health sciences library.

OBJECTIVE: A staff development committee (SDC) was convened to implement staff development opportunities for an academic health sciences library system comprised of three separate facilities. The charge for the SDC was to: (1) develop programs to enhance workplace skills and personal growth, (2) communicate the availability of existing programs at the university and medical center, and (3) encourage the staff to participate in these opportunities. PROGRAM: The committee created goals and objectives and developed a survey designed to give staff the opportunity to provide input for this initiative. With an 80% response rate, the survey results were used to plan 15 events based on staff needs and preferences. First-year attendance for SDC-sponsored events was 459. Committee members served as liaisons for each event. Two forms were developed to facilitate event planning. A monthly announcement sheet, email reminders, and the library's local area network are used to communicate upcoming SDC events and encourage attendance. CONCLUSION: This approach can serve as a useful model for similar program planning in any organization.

Academies and Institutes↗
PubMed2003

Coastal seas as a context for science teaching: a lesson from Chesapeake Bay.

Lessons that employ authentic environmental data can enhance the ability of students to understand fundamental science concepts. This differs from traditional "environmental education" in that school curricula need not set aside time for educators to teach only environmental topics. Rather, the "environment" is used to advance student learning in science and technology. The success of this approach depends on programs that encourage scientists to communicate more effectively with teachers at all education levels. The expanding diversity of research and monitoring activities on the world's marine waters constitutes an outstanding potential education resource. Many of these projects involve remote sensing with sophisticated instrumentation and employ Internet technology to compile measurements, interpret data using graphs and satellite imagery, and share the results among scientific colleagues and the general public alike. Unfortunately, these resources, which constitute a much shortened path between research findings and textbook presentation, are seldom interpreted for use by K-12 educators. We have developed an example that uses the Chesapeake Bay as a paradigm to demonstrate how such interpretation can assist educators in teaching important principles in physical oceanography and marine ecology. We present this example using PowerPoint to conduct a virtual tour of selected Internet sources. Our example begins with the conceptual "salt wedge" circulation model of Chesapeake Bay as a partially mixed estuary. Teachers have the opportunity to explore this model using salinity, temperature, and dissolved oxygen data taken from a research vessel platform during summer professional development programs. This source of authentic data, originally obtained by teachers themselves, clearly demonstrates the presence of a picnocline and deep-water anoxia. Our lesson plan proceeds to interpret these data using additional Internet-based resources at increasing scales of time and space. The "salt wedge," picnocline, and anoxia are examined using graphics derived from data taken by researchers using "ScanFish," a towed instrument that samples temperature, salinity, and dissolved oxygen at a resolution of only a few meters vertically and horizontally. The seasonal dynamics of these parameters at a given location are interpreted using biweekly monitoring data obtained as part of the state-federal Chesapeake Bay Program. The influence of annual variations in freshwater input is examined using stream flow data from US. Geological Survey gauging stations. Satellite remote sensing images from the TOPEX/Poseidon project are used to show how El Niño and La Niña events in the mid-Pacific affect the Chesapeake Bay system via rainfall on its watershed. Finally, the life cycle of the blue crab (Callinectes sapidus) is presented to show how an estuarine organism has adapted to this truly unique and dynamic coastal environment.

Animals↗
PubMedDate not supplied

Building healthy public policy.

Policies in literacy and health need to address two perspectives: how basic literacy skills influence the health of populations and individuals; and health literacy--the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. There are three potential areas for action to improve literacy and health literacy: the health system, the education system, and within the broader sphere of culture and society. Despite some increasing attention in the last 20 years, low literacy levels remain a major problem in Canada. Policies need to be sensitive to culture, especially among Aboriginal peoples, Francophones and new Canadians. Public policies are needed to: Improve literacy outcomes (for example, support for a pan-Canadian literacy strategy, early childhood education and family literacy programs, and efforts to reduce high school drop out). Improve health literacy (for example, support integrated policy and program development across sectors, integrated research and knowledge translation initiatives, and efforts to build links between literacy and health networks). Reduce disparities by strengthening levels of literacy and health literacy among vulnerable groups.

Adolescent↗
PubMed1998

Adapting living environments for persons with Alzheimer's disease.

Skilled nursing facilities, assisted living facilities, and specialized housing can be enhanced by incorporating dementia-oriented adaptations that better match the environment to the capabilities of individuals at different stages of dementia. Environmental adaptations can be made through architectural, interior, and landscape design specifications. New models of care for Alzheimer's disease are emerging all along the long-term care continuum. This trend has been accompanied by a gradual growth in the knowledge base about designing and delivering specialized dementia care. Three components of care are critical: (1) environmental design, (2) program development, and (3) staff development. Six different models of dementia care were identified based on an analysis of care attributes that represent the critical components of care. These models differed in terms of caregiver satisfaction and resident characteristics (ADL scores, cognition, stage of dementia, agitation, and antipsychotic drug use).

Alzheimer Disease↗
PubMed1994

An individualized, comprehensive asthma care treatment program.

In the conclusion of a three-part series on patient-centered asthma care, the authors describe the program developed at National Jewish Center for Immunology and Respiratory Medicine. Beginning at the time of diagnosis, the interdisciplinary intervention team works in tandem with the patient and family to build confidence, skill, and motivation in self-management.

Asthma↗
PubMed2005

The multiple layers of prevention science research.

A systematic framework for prevention science clinical research is described that explicitly links the identification of prevention needs to the implementation of research results in public health programs. The framework integrates five elements: advocacy and policy, community participation, prevention research, acceptability research, and operations and program development. These five elements are often viewed as disparate agendas, but an effective prevention science research enterprise requires that they be coordinated and integrated through all research stages--from the conceptual, to the experimental, and ultimately to the applied. Examples are provided of how this integration can be achieved from our experience in reproductive health and HIV prevention.

Biomedical Research↗
PubMed1993

A pressure ulcer prevention program.

The prevention and management of pressure ulcers often creates challenging situations requiring specialized knowledge and expert, consistent nursing care. In order to promote pressure ulcer prevention and control costs at a 350-bed community hospital, a "Pressure Ulcer Prevention Program" was developed. This program was developed upon completion of a baseline audit determining the extent of skin problems, equipment in use, and nursing documentation regarding skin care. Five months after initiation of the program, a second audit was conducted to evaluate the effectiveness of the program. An overall decrease in pressure ulcer incidence was found and the documentation of pressure ulcer prevention was improved.

Adolescent↗
PubMed1982

Citizen participation in neighborhood health centers for the poor: the politics of reform organizational change, 1965-77.

Through a longitudinal study of neighborhood health centers for the poor in the United States, this paper presents an analysis of the political economy of change within reform organizations. In the final accounting, we seek to explain the shift in the role of poor people participating in health care decision making from that of program developer and change agent to the role of program restrictor. We conceptualize the neighborhood health center (NHC) as a reform organization whose initial objective was to use health care as a tool for achieving political and economic development within low-income rural and urban communities. The analysis, based on a prospective study of NHCs between 1965 and 1977, using interviews with citizen board members, NHC project administrators, NHC physicians, HEW decision elites, and oral history interviews with former Office of Economic Opportunity (OEO) administrators and directors, exemplifies the generic social organizational problem of how social, political, economic, and ideological forces shape the emergence and performance of a new reform organization.

Community Health Centers↗