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At least 1,603 records · Page 89Linked to original sources
PubMed2000

Strategies for implementing lipid-lowering therapy: pharmacy-based approach.

A multidisciplinary program was designed to improve patient outcomes after an acute coronary event. The primary objective of the program was that lipid-lowering therapy be prescribed at the time of discharge for acute myocardial infarction (AMI) and percutaneous transluminal coronary angioplasty (PTCA) patients. Secondary objectives for this program were (1) a baseline lipid panel within the first 24 hours of admission and (2) documentation of discharge counseling for lipid-lowering therapy in the patient medical record. Improvements were reported for all 3 objectives. For the primary indicator, lipid-lowering therapy prescribed at discharge, the baseline value increased from 40% to 72-81%. The percentage of patients with a lipid panel within 24 hours of admission improved from a baseline of 13% to 38-71%. Overall, 28-77% of patient records contained documentation of lipid-lowering medication counseling after initiation of the program. This information should provide the necessary benchmarking data to maintain competitiveness in the dynamic healthcare environment. Overall, this program provides high-quality, cost-effective health care for the patient with established coronary artery disease.

Angioplasty, Balloon, Coronary↗
PubMed2002

The neuronal basis of bimanual coordination: recent neurophysiological evidence and functional models.

Recent physiological studies of the neuronal processes underlying bimanual movements provide new tests for earlier functional models of bimanual coordination. The recently acquired data address three conceptual areas: the generalized motor program (GMP), intermanual crosstalk and dynamic systems models. To varying degrees, each of these concepts has aspects that can be reconciled with experimental evidence. The idea of a GMP is supported by the demonstration of abstract neuronal motor codes, e.g. bimanual-specific activity in motor cortex. The crosstalk model is consistent with the facts that hand-specific coding also exists and that interactions occur between the motor commands for each arm. Uncrossed efferent projections may underlie crosstalk on an executional level. Dynamic interhemispheric interactions through the corpus callosum may provide a high-level link at the parametric programming level, allowing flexible coupling and de-coupling. Flexible neuronal interactions could also underlie adaptive large-scale systems dynamics that can be formalized within the dynamic systems theory approach. The correspondence of identified neuronal processes with functions of abstract models encourages the development of realistic computational models that can predict bimanual behavior on the basis of neuronal activity.

Arm↗
PubMed1990

Prenatal education outcomes for pregnant adolescents and their infants using trained volunteers.

This study evaluated the effects of lessons taught by trained nonprofessional volunteers in community prenatal clinics. Project participants (n = 210) and comparison subjects (n = 189) were pregnant women, aged 18 years or younger. Participants were divided according to those who attended eight or more lessons (high treatment, n = 94) and those who attended fewer lessons (n = 116). A system of rewards for attendance was used. The number of prenatal visits was significantly different between the three groups (p less than 0.001), with the high-treatment participants having a significantly greater number of visits than the other groups. The groups differed on gestational age at delivery (p less than 0.006), favoring the infants of high-treatment participants; however, only 8% of gestational age variance was attributable to prenatal visits. A significantly greater proportion of high-treatment participants returned for postpartum care (p less than 0.011 vs. low-treatment participants, p less than 0.002 vs. comparison subjects). Postpartum return was not improved by a hospital visit by a volunteer. Regardless of treatment, most (99%) accepted a contraceptive method at their postpartum visit. The groups did not differ on their return for method check at 3 months. However, a significantly greater proportion of the high-treatment participants returned for an annual family planning evaluation (p less than 0.015 vs. low-treatment participants, p less than 0.005 vs. comparison subjects). Both the high- and low-treatment participants differed significantly from the comparison subjects on having taken their infants for at least one well-child visit during the first year (p less than 0.001 for both tests).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Family planning issues relating to maternal and infant mortality in the United States.

Both maternal and infant death rates in the United States are much higher than in many developed countries. The interrelationships between abortions and maternal and infant mortality have been analyzed on the basis of data from the 1970s and 1980s. The legalization of abortions in 1973 resulted in a marked increase in legal abortions and marked reductions in maternal and infant mortality over the course of the 1970s. However, a wide variation in abortion rates and in the number of abortion facilities indicates that such facilities were not readily available to all segments of the population in some areas. This probably accounts in part for higher maternal and infant death rates in such areas. Smoking, small weight gain, use of alcohol and drugs in pregnancy, and excessive maternal youth or age affected the outcome of pregnancy and contributed to high rates of infant death. Infant death rates were especially high among newborns of teenagers and young adult mothers; relatively high proportions of these newborns had low birthweights; a large share of the pregnancies involved were unintended; and slightly over half of the unintended pregnancies in teenagers and young women resulted in abortion. Comparisons with findings in Sweden reveal that the rates of unplanned pregnancy, abortion, and infant mortality were all much higher in the United States than in Sweden. The differences are attributed to better contraceptive services, which were made available free or very inexpensively in Sweden. Also, the frequency of low weight births was much lower in Sweden.

Abortion, Legal↗
PubMedDate not supplied

"Supersplint": a new dynamic combination splint for the burned hand.

Dynamic splinting for the burned hand is used worldwide. We previously presented a home hand therapy program. This program included a series of dynamic splints made by the occupational therapist for daily use by the patient. The "supersplint" evolved from the need to reduce the time required to manufacture the splints for the home therapy program; it also reduced patient-therapist sessions in the occupational therapy unit. The supersplint provides active-resistive movements of the fingers and thumb. As range of motion progresses, resistance can be increased to strengthen muscles and tendons. The supersplint provides tendon gliding, helps control edema, prevents muscle disuse, prevents skin and capsular contracture, minimizes complications, and helps prevent deformities. The patient uses the supersplint daily as part of an occupational therapy program that includes activities of daily living, prevention of shoulder hand syndrome, and scar therapy (including pressure garments).

Activities of Daily Living↗
PubMed1993

The nutritional status of children of displaced families in Beirut.

The nutritional status of children of displaced families in Greater Beirut was investigated in 1986 (a sample of 146 households) and in 1991 (137 households). Data on demographic variables, nutrient intake (calories, protein, and iron), and anthropometric measurements were collected. Iron intake was only 50-57% of the RDA for the 1-3 age group, and 35.6% and 32.0% of all children consumed < 60% of the RDA for iron in 1986 and 1991, respectively. Main sources of protein were dairy products, milk and eggs. The lower nutrient intake in 1991 compared to 1986 was negatively related to social class. Anthropometric measurements showed an increased past and recent undernutrition of the children in 1991 as compared to both the 1986 child sample and the NCHS standard child population. Severe inflation and marked increase in food prices were reflected in dietary intake and growth of the children. Food aid programmes, government subsidy of bread, and partial wage correction were possible stabilizing factors for the most destitute groups but not for the total population of displaced children.

Anthropometry↗
PubMed1996

Linking reengineering to revitalization.

A health care organization that embarks on reengineering without a strategy for revitalizing is courting disaster. What does it take to get reengineering right? It takes vision, unflinching commitment, new kinds of leadership and business strategies, and new behaviors to challenge the old manager-physician power dynamic. A low-cost health care provider must be able to promote trust, partnerships, and competencies that are specifically linked to accessible, cost-effective patient care.

Career Mobility↗
PubMed1993

Urologic management of spinal cord injury in children.

This overview of the management of children with spinal cord injury has focused on a program based on bladder dynamics. The bladder is modulated pharmacologically and surgically, if necessary, to create a reservoir that stores urine at low pressure, and emptying is achieved by clean intermittent catheterization. The parent assumes the responsibility for bladder emptying when the child is unable to perform catheterization. Reflex voiding in a balanced fashion is not advocated. The program described not only avoids the deleterious effects of high voiding pressures, it also obviates the wearing of a urinary collection device, which is impractical for most prepubertal boys, and it provides for emptying at predictable intervals in order to make the child more socially acceptable. This approach seems to improve the child's self-image, and it should increase the chances of useful participation in society and a fulfilling life.

Adolescent↗
PubMed2006

Generation and reshaping of sequences in neural systems.

The generation of informational sequences and their reorganization or reshaping is one of the most intriguing subjects for both neuroscience and the theory of autonomous intelligent systems. In spite of the diversity of sequential activities of sensory, motor, and cognitive neural systems, they have many similarities from the dynamical point of view. In this review we discus the ideas, models, and mathematical image of sequence generation and reshaping on different levels of the neural hierarchy, i.e., the role of a sensory network dynamics in the generation of a motor program (hunting swimming of marine mollusk Clione), olfactory dynamical coding, and sequential learning and decision making. Analysis of these phenomena is based on the winnerless competition principle. The considered models can be a basis for the design of biologically inspired autonomous intelligent systems.

Animals↗
PubMed1982

Needs assessment in continuing medical education: a practical guide.

The identification and assessment of learning needs and the setting of priorities are the foundation of successful program planning in continuing medical education (CME). The present report includes recommendations concerning optimal procedures for the assessment of the learning needs of individual physicians, small groups, and large groups. The vital role of learners and their perceived needs in emphasized. Appropriate and accurate needs assessment contributes greatly to the success of CME programs. The most effective needs assessment involves the dynamic interaction of teachers, learners, and experienced program planners. The recommendations in this report are based on studies and interviews conducted in several major academic health centers in the United States and Europe over a period of one year. Research efforts to improve needs assessment techniques are greatly needed. As improved methods of needs assessment are adopted, CME planners may be assured that their programs will become more attractive and effective.

Clinical Competence↗
PubMed1988

Use-effectiveness of the ovulation method initiated during postpartum breastfeeding.

Between April 1981 to March 1984, 419 urban middle class postpartum women entered the Natural Family Planning (NFP) program of the Pontificia Universidad Catolica de Chile. This NFP program teaches the Ovulation Method (Billings). Only 1.9% of the women did not learn how to recognize the mucus pattern of fertility awareness. The sample of 378 women who were practicing the method to avoid a pregnancy completed 4,935 months of use of the OM. The cumulative life table unplanned pregnancy rate at the 12th postpartum month was 11.1 +/- 1.9 and the Pearl Rate was 12.1 per 100 woman-years. The Pearl Rate calculation of method-related failure was only 2.1 pregnancies per 100 woman-years. The breastfeeding group showed a significantly lower rate of unplanned pregnancies than the nonbreastfeeding group and there was no significant increase in unplanned pregnancy at the time of menstruation among previously amenorrheic women as compared to later intervals. The protection against unplanned pregnancy shown in this study should be viewed as the combination of two factors: breastfeeding and the Ovulation Method (OM) of NFP.

Adult↗
PubMed1985

The transition stages between the main aphasic syndromes.

One of the basic features of most aphasic patients is their clinical dynamics, i.e. the continuous change in language function. The functional Dynamic Approach on which our rehabilitation program is based, can be expressed as a model of dynamic movement in which a patient's progress from one syndrome to another can be documented quantitatively. In this study we have concentrated on the initial emergence of patients out of the major syndrome categories. Our language test "I.L.A.T." provides for the evaluation of changes in the four language functions. Relative changes are charted by establishing a theoretical maximum performance to be expected in an aphasic population and noting improvements from the initial condition towards that point. Quantification of the proposed transitional stages are currently being developed to document our clinical insights.

Anomia↗
PubMed1986

What is the relationship between postpartum withdrawal from school and repeat pregnancy among adolescent mothers?

An association between the failure of teenage mothers to return to school postpartum and rapid repeat pregnancy (recidivism) has been described. We report the postpartum education pursuits and contraceptive practices of 29 teenage mothers. Our data, together with the literature, suggest that with close postpartum follow-up, young mothers who are not motivated to return to school following delivery can effectively postpone pregnancy.

Adolescent↗
PubMed2005

Knowledge discovery and system biology in molecular medicine: an application on neurodegenerative diseases.

The possibility to study an organism in terms of system theory has been proposed in the past, but only the advancement of molecular biology techniques allow us to investigate the dynamical properties of a biological system in a more quantitative and rational way than before . These new techniques can gave only the basic level view of an organisms functionality. The comprehension of its dynamical behaviour depends on the possibility to perform a multiple level analysis. Functional genomics has stimulated the interest in the investigation the dynamical behaviour of an organism as a whole. These activities are commonly known as System Biology, and its interests ranges from molecules to organs. One of the more promising applications is the 'disease modeling'. The use of experimental models is a common procedure in pharmacological and clinical researches; today this approach is supported by 'in silico' predictive methods. This investigation can be improved by a combination of experimental and computational tools. The Machine Learning (ML) tools are able to process different heterogeneous data sources, taking into account this peculiarity, they could be fruitfully applied to support a multilevel data processing (molecular, cellular and morphological) that is the prerequisite for the formal model design; these techniques can allow us to extract the knowledge for mathematical model development. The aim of our work is the development and implementation of a system that combines ML and dynamical models simulations. The program is addressed to the virtual analysis of the pathways involved in neurodegenerative diseases. These pathologies are multifactorial diseases and the relevance of the different factors has not yet been well elucidated. This is a very complex task; in order to test the integrative approach our program has been limited to the analysis of the effects of a specific protein, the Cyclin dependent kinase 5 (CDK5) which relies on the induction of neuronal apoptosis. The system has a modular structure centred on a textual knowledge discovery approach. The text mining is the only way to enhance the capability to extract ,from multiple data sources, the information required for the dynamical simulator. The user may access the publically available modules through the following site: http://biocomp.ge.ismac.cnr.it.

Biomedical Research↗
PubMed2005

Neighborhood poverty and public policy: a 5-year follow-up of children's educational outcomes in the New York City moving to opportunity demonstration.

Data from the Moving to Opportunity Program, a randomized mobility experiment in which a subset of low-income minority families living in public housing in high-poverty neighborhoods were given vouchers to move to low-poverty neighborhoods, were used to evaluate 1 policy approach for improving children's educational outcomes. Four hundred twenty-five New York City children were seen 2 1/2 and 5 years following relocation (mean age=14.64 years, SD=3.21 years). Analyses examining program effects on 5-year educational outcomes, accounting for 2 1/2-year outcomes, revealed that program effects on adolescent boys' achievement found at 2 1/2 years were not sustained at 5 years. Rather, male and female youths 14-20 years of age in low-poverty neighborhoods reported lower school grades and engagement relative to youths in high-poverty neighborhoods. From a policy standpoint, the complexity of enhancing low-income minority children's educational outcomes is underscored by the multiple dynamics involved--family, neighborhood, housing, and school.

Adolescent↗
PubMed2006

Internal bulge and tetraloop of the catalytic domain 5 of a group II intron ribozyme are flexible: implications for catalysis.

RNA molecules have an inherent flexibility that enables recognition of other interacting partners through potential disorder-order transitions, yet studies to quantify such motional dynamics remain few. With an increasing database of three-dimensional structures of biologically important RNA molecules, quantifying such motions becomes important to link structural deformations with function. One such system studied intensely is domain 5 (D5) from the self-splicing group II introns, which is at the heart of its catalytic machinery. We report the dynamics of a 36 nucleotide D5 from the Pylaiella littoralis group II intron in the presence and absence of magnesium ions, and at a range of temperatures (298K-318 K). Using high-resolution NMR experiments of heteronuclear nuclear Overhauser enhancement (NOE), spin-lattice (R(1)), and spin-spin (R(2)) (13)C relaxation rates, we determined the rotational diffusion tensor of D5 using the ROTDIF program modified for RNA dynamic analysis (ROTDIF_RNA). The D5 rotational diffusion tensor has an axial symmetric ratio (D(||)/D(perpendicular)) of 1.7+/-0.3, consistent with an estimated overall rotational correlation time of tau(m)=(2D(||)+4D(perpendicular))(-1) of 6.1(+/-0.3) ns at 298 K and 4.1(+/-0.2) ns at 318 K. The measured relaxation data were analyzed with the reduced spectral density mapping formalism using assumed values of the chemical shift anisotropy of the (13)C spins. Both the relaxation data and the values of the spectral density function reveal that the functional groups in D5 implicated in magnesium ion binding and catalysis (catalytic triad, internal bulge, and tetraloop regions) exhibit thermally induced motion on a wide variety of timescales. Because these motions parallel those observed in the intramolecular stem-loop of the U6 element within the spliceosome, we hypothesize that such extensive dynamic disorder likely facilitates D5 engaging both binding and catalytic regions of the ribozyme, and these may be a conserved feature of the catalytic machinery essential for catalysis.

Anisotropy↗