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PubMed1998

Recommended components of health care provider training programs on intimate partner violence.

Programs that are effective in training health care providers to recognize and meet the needs of victims of intimate partner violence must be identified and replicated. The Centers for Disease Control and Prevention (CDC) has developed criteria for use in developing, enhancing, and evaluating such programs. CDC developed these criteria as a result of continuing efforts to provide useful products for constituents through literature reviews and consultations with experts in the field; evaluations of training programs; creation of an inventory and annotated bibliography of health care provider training programs in the United States and Canada; and development of a framework to assist hospitals and health centers in evaluating their training programs. Training should begin while providers are in professional school and continue in the health care setting. Curricula should be multidisciplinary and should provide information, promote clinical skills, and effectively link providers with resources. Evaluation should assist programs in determining providers' needs and identifying appropriate materials, trainers, and training strategies. CDC is working to establish scientific evidence that provider training programs are effective and to share successful models with others. Providers have an important role in stopping and ultimately preventing intimate partner violence, but they are not alone in this effort. They need to know how to access the growing network of assistance including women's advocates, the criminal justice system, and other members of increasingly dynamic community coalitions.

Canada↗

PubMedDate not supplied

Choosing the appropriate habilitative track for the newly identified hearing-impaired child.

Based on prospective longitudinal data collected on 38 hearing-impaired infants, this study addresses the question, "What constitutes adequate progress in habilitation of the young deaf child?" The components of the newly developed Diagnostic Early Intervention Program aimed at selecting the most appropriate habilitative-educational track for the hearing-impaired infant will be described, together with data from the first 15 children who have completed the 6-month program. The results of a multidisciplinary medical evaluation completed on these children, including audiology, otolaryngology, aural rehabilitation, pediatrics, neurology, radiology, and genetics, will illustrate the important assistance these findings provide to the decision-making process of the habilitative-educational team.

Age Factors↗

PubMedDate not supplied

New communications tools expand educational options.

Administrators must make well-informed decisions regarding new communications technology to disseminate information to diverse constituencies in the facility and its service area. For example, communicating and using information about rapidly changing regulations is important in today's competitive environment. Administrators are faced with choosing from among such electronic media as satellite programming, telephone systems, cable television, and microwave radio to meet their institutions' needs. Teleconferences and closed-circuit educational programming also offer cost-efficient choices. Consultants can assist the management team in developing an appropriate system, whether sharing in an existing program or private network or installing an independent satellite-receiving dish, or "downlink." The team, including medical personnel, must choose the hardware that the institution can use most effectively in accomplishing its objectives. Studying other facilities' systems, such as St. Joseph Hospital, Providence, RI, with its independent receiving dish, shows the practical applications of the often confusing technology. Administrators should not be put off by "'technology frenzy." About 600 U.S. institutions have receiving stations or access to them; most will have them in the future. Even smaller facilities can become leaders with this cost-effective technology. Administrations must lead in accepting the challenge to improve health care communications.

Decision Making↗

PubMed1994

Real-time sleep-wake scoring in the rat using a single EEG channel.

A new method of analysis of sleep in the rat based on the electrocorticogram (ECoG) is described. Three states, awake (W), nonrapid eye movement (NREM) and rapid eye movement (REM) sleep are automatically classified by the system. After amplification of the ECoG over a restricted bandwidth (3.18-25 Hz) and sampling at 512 Hz, the data are processed in 8-second epochs by a microcomputer, which generates three statistical and two harmonic variables. Each 8-second epoch is thus compressed into five numerical values occupying 10 bytes of memory. Epochs for each state of vigilance are identified by an expert observer to produce three reference models. The program classifies each epoch into the appropriate state by the least quadratic distance. The system was validated by comparing the results with a visual analysis of polygraph recordings. The agreement between the program and the two independent scorers for 24-hour tracings of six rats was 83% for REM sleep, 96% for W and 97% for NREM sleep.

Animals↗

PubMed1980

Health Care Financing Administration--Medicare program; schedules of guidelines for respiratory therapy services. Notice.

This notice establishes schedules of salary equivalency guidelines for Medicare program reimbursement for the reasonable costs of respiratory therapy services furnished under an arrangement with a hospital or other institution. These schedules update the schedule of guidelines that was published in the Federal Register on October 6, 1978 (43 FR 46378) with respect to registered therapists and certified therapists. These schedules also include, for the first time, salary equivalency amounts calculated for respiratory therapists who are neither registered nor certified. These schedules are to be used by the Medicare program's fiscal intermediaries to determine the maximum hourly amount that the Medicare program will pay to a hospital or other institution for covered respiratory therapy services furnished under an arrangement. In addition, these guidelines would also apply, where appropriate, to reimbursement under the Medicaid program as specified in 42 CFR 447.250 et seq. of the regulations.

Fee Schedules↗

PubMed2002

Mixed-methods resistance training increases power and strength of young and older men.

PURPOSE: This study examined the effects of mixed-methods resistance training on young and older men to determine whether similar increases in muscle power were elicited. METHODS: Effects of 10 wk of a periodized resistance-training program designed to increase muscle size, strength, and maximal power on isometric squat strength, time course of force development, muscle fiber characteristics, and muscle activation (iEMG), as well as force and power output during squat jumps, were compared in young (YM, 30 +/- 5 yr, N = 8) and older men (OM, 61 +/- 4 yr, N = 10). RESULTS: Isometric squat strength was higher in the YM compared with OM at all testing occasions and increased over the training period by 23 +/- 15% and 40 +/- 42% for the YM and OM, respectively. The early phase of the force-time curve was shifted upward in both groups over the course of the training. During the squat jumps, the YM produced higher force and power at all test occasions and at all loads tested compared with the OM. The YM increased power output by 15 +/- 14%, 33 +/- 16%, and 26 +/- 12%, and the OM by 7 +/- 5%, 36 +/- 23%, and 25 +/- 16% for the 17 kg, and 30% and 60% 1RM loads, respectively. CONCLUSION: Although the results of this study confirm age-related reductions in muscle strength and power, the older men did demonstrate similar capacity to young men for increases in these variables via an appropriate periodized resistance-training program that includes rapid, high-power exercises.

Adult↗

PubMed2006

Using Ciona to study developmental programmed cell death.

Ciona intestinalis, a member of Tunicates, the closest group to vertebrates, has emerged as an appropriate organism for the study of developmentally regulated programmed cell death. First, because massive phases of apoptosis occur all along embryogenesis. Second, because the lecithotrophic mode of development is associated with autophagic process occurring during juvenile formation. Third, because the biochemical cell death machinery is close to that found in mammals. Altogether, the Ciona system contributes to identify new specific regulatory pathways and to explain how molecular mechanisms of programmed cell death evolved from invertebrates to vertebrates.

Animals↗

PubMed2001

Age-predicted maximal heart rate revisited.

OBJECTIVES: We sought to determine a generalized equation for predicting maximal heart rate (HRmax) in healthy adults. BACKGROUND: The age-predicted HRmax equation (i.e., 220 - age) is commonly used as a basis for prescribing exercise programs, as a criterion for achieving maximal exertion and as a clinical guide during diagnostic exercise testing. Despite its importance and widespread use, the validity of the HRmax equation has never been established in a sample that included a sufficient number of older adults. METHODS: First, a meta-analytic approach was used to collect group mean HRmax values from 351 studies involving 492 groups and 18,712 subjects. Subsequently, the new equation was cross-validated in a well-controlled, laboratory-based study in which HRmax was measured in 514 healthy subjects. RESULTS: In the meta-analysis, HRmax was strongly related to age (r = -0.90), using the equation of 208 - 0.7 x age. The regression equation obtained in the laboratory-based study (209 - 0.7 x age) was virtually identical to that obtained from the meta-analysis. The regression line was not different between men and women, nor was it influenced by wide variations in habitual physical activity levels. CONCLUSIONS: 1) A regression equation to predict HRmax is 208 - 0.7 x age in healthy adults. 2) HRmax is predicted, to a large extent, by age alone and is independent of gender and habitual physical activity status. Our findings suggest that the currently used equation underestimates HRmax in older adults. This would have the effect of underestimating the true level of physical stress imposed during exercise testing and the appropriate intensity of prescribed exercise programs.

Adult↗

PubMed2006

Evaluation and management of patients after implantable cardioverter-defibrillator shock.

CONTEXT: There has been a tremendous increase in the use of implantable cardioverter-defibrillators (ICDs) after several large clinical trials demonstrated their ability to effectively reduce mortality in selected populations of patients with cardiac disease. Thus, the nonelectrophysiologist will often encounter patients who have received an ICD shock. OBJECTIVE: To assess options for the evaluation and management of patients who have received an ICD shock. EVIDENCE ACQUISITION: Literature search using the PubMed and MEDLINE databases to identify articles published from January 1990 to September 2006, using the Medical Subject Headings defibrillators, implantable; defibrillators, implantable/adverse effects; anti-arrhythmic agents; electric countershock; quality of life; tachycardia therapy; algorithm; ventricular tachycardia/diagnosis; and supraventricular tachycardia/diagnosis. Case reports were excluded and articles were limited to those published in English. Scientific statements and guidelines from the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society were also reviewed, as were the reference lists of retrieved articles, to identify any additional articles for inclusion. EVIDENCE SYNTHESIS: There are multiple causes of both appropriate and inappropriate ICD shocks. Irrespective of appropriateness, receiving ICD shocks substantially impairs a patient's quality of life. A variety of techniques are available using ICD programming to reliably limit the occurrence of appropriate or inappropriate ICD shocks. Antiarrhythmic medications can also effectively reduce the occurrence of shocks. CONCLUSIONS: Through the use of effective ICD programming and antiarrhythmic medications, the occurrence of ICD shocks can be reduced while maintaining the lifesaving ability of the ICD. A basic understanding of the range of available options is fundamental for evaluation and management of the patient who has received an ICD shock.

Arrhythmias, Cardiac↗

PubMed1992

Dental students' self-assessed competence in geriatric dentistry.

This study measured the self-assessed confidence levels of four classes of dental students (n = 172) exposed to both didactic and clinical training regarding geriatric patients. It was found that after completing a two-term (20-week) didactic course in their junior year, and a five-week clinical course with geriatric patients in their senior year, dental students graduating from this university between 1987 and 1990 perceived significant improvements in their abilities to manage geriatric patients in all areas assessed, most notably in their treatment planning skills, in coordinating preventive dentistry programs, in referring patients to appropriate community resources, and in providing dental care in alternative settings. Greatest self-assessed improvements were exhibited between pre-didactic and post-didactic assessments, with a tendency to stabilize rather than improve after the clinical experience. Interestingly, this study found that the students' self-assessed changes between post-didactic training and post-clinical training were significant in only one area--their ability to manage the medical emergencies of elderly patients, including a patient's death in the dental chair. No differences were found between students who completed the clinical course early in their senior year with those who took it later; nor did differences emerge among the four classes. Clinical teaching in geriatrics may be an opportunity to practice skills and reinforce knowledge that has been gained in didactic courses, not necessarily a place to enhance perceived competence.

Analysis of Variance↗

PubMed2004

Preparing the singing voice specialist revisited.

In review of singing voice specialist preparation, discussion can be chronicled prior to the establishment of Arts Medicine in 1987. Although discussion began in 1984 (and earlier), no formal academic program currently exists to train the singing voice specialist. The need now is greater than ever for a formal program of study to prepare a person who seeks to be a singing voice specialist. The question of adequate preparation continues to be in need of an appropriate answer because no formal training programs or fellowships are available. It is essential to first define the role of singing voice specialists and the populations that they will encounter. To meet the needs of a diverse population, care of the professional voice demands cross-disciplinary training. Knowledge from the fields of music, science, medicine and communication disorders and experience/observation, clinical preparation, and research would provide for optimal preparation. To meet this need, development of a Masters degree program seems highly desirable. The structure of such a program is proposed, along with specific requirements outlined from the music and singing voice pathology components for a Masters Degree in Arts Medicine with a concentration in voice.

Curriculum↗

PubMed2000

Preventive service use and Medicaid managed care in New York City.

OBJECTIVE: To examine the effect of managed care enrollment on the use of preventive services among New York City's Medicaid population. STUDY DESIGN: An analysis of survey results from a sample of Medicaid beneficiaries in managed care plans and in traditional Medicaid. METHODS: This study is based on a 1994 survey of 1038 Medicaid beneficiaries enrolled in any of 5 managed care plans and a comparison group of 410 beneficiaries in traditional Medicaid in New York City. The survey data are used to examine the effect of managed care on the self-reported use of Pap smears, mammograms, and infant immunizations. We performed bivariate analysis to compare the use of preventive services between managed care enrollees and beneficiaries in traditional Medicaid. We also used multivariate logistic analysis to explore this comparison, controlling for factors that may confound the relationship. RESULTS: Medicaid beneficiaries in managed care were no more or less likely to receive infant immunizations, Pap smears, or mammograms than those in the traditional Medicaid program. CONCLUSIONS: Our analysis suggests that Medicaid managed care and the traditional program performed the same in getting appropriate preventive services to beneficiaries.

Adolescent↗

PubMed1995

China. FP education at the grassroots level.

In order to reach the grassroots level with family planning information, the Publicity and Education Department of State Family Planning Commission (SFPC) established a network of FP and communication centers in 29 provinces to undertake FP publicity and disseminate educational materials. However, these mechanisms were not far-reaching enough to cover the rural and more remote areas of the counties where information was most needed and have direct access to grassroot FP service providers, fieldworkers, and end-users. Thus, the SFPC decided to further set up 180 pilot county stations under the project CPR/90/P17 (Strengthening Rural Grassroots Family Planning Publicity and Education). These pilot county stations provided training and guided village/township FP workers and service providers on how to communicate FP to the target groups effectively. They also strengthened the existing 29 Provincial Publicity and Education Sub-Centers through training programs, production and distribution of appropriate IEC materials. The project was recently evaluated with the assistance of UNESCO CST Population Communication Adviser, who reported a number of weaknesses as well as successes in the implementation of the project. Based on the findings, the evaluation report recommended the improvement of the training in various aspects to suit the Chinese culture. It proposed that the training curriculum should be "need-based" and developed through participatory approach, with specific behavioral objectives, using participatory training methodologies and competency-based evaluation. It also recommended that the content of future IEC materials should be updated on a regular basis, using survey findings in the local area where possible in response to the finding that most IEC materials had taken on urban, mass-media bias. It further added that the materials should include new messages on how to combat rumors and misconceptions on various FP methods, on responsible sexual behavior, on teenage pregnancy and prevention and on reproductive health needs of adolescents.

Asia↗

PubMed1975

Evaluating health programs: Where do we find the data?

This paper examines the data requirements for impact evaluation in the light of recent federal efforts to improve the evaluation of health programs. Typically, new health programs are launched before there is sufficient time or administrative interest in devising appropriate evaluation methodology. Therefore, any evaluation of such a program must be designed retrospectively. We argue that the best and typically only sources of data appropriate for such evaluations are pre-existing administrative statistics and archival records. The potential and limitations of these data sources are reviewed.

American Medical Association↗

PubMed1988

Measurement quality assurance.

The quality of a radiation protection program can be no better than the quality of the measurements made to support it. In many cases, that quality is unknown and is merely implied on the basis of a calibration of a measuring instrument. If that calibration is inappropriate or is performed improperly, the measurement result will be inaccurate and misleading. Assurance of measurement quality can be achieved if appropriate procedures are followed, including periodic quality control actions that demonstrate adequate performance. Several national measurement quality assurance (MQA) programs are operational or under development in specific areas. They employ secondary standards laboratories that provide a high-quality link between the National Bureau of Standards and measurements made at the field use level. The procedures followed by these secondary laboratories to achieve MQA will be described, as well as plans for similar future programs. A growing general national interest in quality assurance, combined with strong specific motivations for MQA in the area of ionizing radiation, will provide continued demand for appropriate national programs. Such programs must, however, employ procedures that are cost effective and must be developed with participation by all affected parties.

Government Agencies↗

PubMedDate not supplied

Method for ascertaining denominators for evaluation of population coverage with pneumococcal vaccine.

BACKGROUND: Immunization programs may collect numerator data for the estimation of pneumococcal vaccine coverage, but program evaluators do not have appropriate denominator data for estimation of pneumococcal vaccine coverage, particularly among those eligible for vaccine on the grounds of having chronic health conditions. METHODS: We partitioned the Alberta population into 6 mutually exclusive groups, all but one of which met Canadian recommendations for pneumococcal vaccination. Age-sex specific prevalence rates for each group were estimated using data on chronic health conditions from the Alberta over-sample of the 1996 Household component of the National Population Health Survey, from Alberta Health and Wellness rosters of nursing home residents, and from the Alberta Health Care Insurance Plan Stakeholder Registry. We applied these to Alberta Population Projections to estimate the numbers of persons who should be vaccinated. RESULTS: The proportion of persons recommended for vaccination on the grounds of chronic health condition ranged from 1.5% among those aged less than 12 years to 36% among persons aged 80 years or older. The total number of persons recommended for vaccination at mid-year 2000 is estimated to be 638,561 (21.5% of the Alberta population). INTERPRETATION: This methodology provides denominators for the estimation of pneumococcal vaccine coverage and permits monitoring of local and regional progress towards national goals.

Adolescent↗

PubMed1990

Indigent health care plan for Tennessee.

The author describes the development of an Indigent Health Care Program for the State of Tennessee from the campaign pledge of the Governor, through the development of an Indigent Care Cabinet Council, to the development and enactment of appropriate legislation required to implement this program. The program deals with availability of health care services, accessibility to health care services and funding mechanisms. The backbone of the program is the involvement of the local community and the coordinating and networking of the existing private, community and state health care providers.

Community Health Centers↗

PubMed1985

Ethical and legal issues related to the use of computer programs in clinical medicine.

As computer programs are used with increasing frequency in the clinical setting, ethicists, lawyers, computer scientists, clinicians, and patients must confront a group of problems: In what situations is it appropriate to use a medical computer program? Who should use these programs and how should they be used? What is the legal status of a computer program that provides medical advice? Can a proper balance be achieved between confidentiality of patient information and shared access to records by health care personnel? How can regulatory agencies, physicians, and patients determine if a program is safe for human use? Will programs be able to communicate with users well enough to prevent clinically harmful misunderstandings? Because few if any definitive answers are yet available, these questions remain the subject of much discussion.

Computers↗