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PubMed1997

National Delphi study to determine competencies for nursing leadership in public health.

PURPOSE: To identify competencies needed by nurse leaders in public health programs. DESIGN: Five-round national Delphi. SAMPLE: Convenience sample of members of major public health nursing associations and nurse and non-nurse public health leaders in the USA. METHODS: Mailed survey in 1994-1995 using a modified snowball technique based on a modification of the Pew Foundation health professions' competencies for Round 1. Four additional rounds produced consensus. FINDINGS: Initially, 62 competencies were identified. Factor analysis resulted in four factors: political competencies, business acumen, program leadership, and management capabilities; 57 competencies were clustered in the four groupings and accounted for 91.4% of the variance. CONCLUSIONS: Graduate schools in nursing and public health must prepare students with broad-based competencies from a variety of disciplines. Findings of this national survey provide a database for curriculum development and evaluation of programs to prepare nurse leaders for roles in public health-based delivery systems.

Curriculum↗
PubMed1991

Quality assurance of Leksell gamma units.

A Leksell Gamma Unit was commissioned and a Lars Leksell Center for Radiosurgery was established at the University of Virginia Health Sciences Center in March 1989. At that time a formal quality assurance program designed for the Leksell Gamma Unit was put into effect. This paper will review the components of suggested daily, monthly, semiannual and annual quality assurance reviews of United States Nuclear Regulatory Commission regulatory as well as nonregulatory items for Leksell Gamma Units. The acceptance criterion for each quality assurance test has been established based on federal requirements and the recommendations of national scientific organizations as well as the practical experience gained from this quality assurance program.

Calibration↗
PubMed2001

Lipid-lowering efficacy, safety, and costs of a large-scale therapeutic statin formulary conversion program.

STUDY OBJECTIVE: To assess the lipid-lowering efficacy, safety, and costs of a large-scale statin formulary conversion program. DESIGN: Prospective, observational study. SETTING: Tertiary academic medical center. PATIENTS: A total of 980 patients consented to participate; 942 patients completed the study. INTERVENTION: Patients were converted from their current statin therapy to either cerivastatin 0.4 or 0.8 mg/day, or simvastatin 80 mg/day, using a conversion algorithm. MEASUREMENTS AND MAIN RESULTS: Efficacy and safety were evaluated at baseline and after 6 weeks of therapy; costs were also measured. Overall attainment of the National Cholesterol Education Program (NCEP) goal for low-density lipoprotein cholesterol (LDL) increased from 64.8% to 74.5% of patients (p<0.001); mean LDL decreased from 115+/-30 mg/dl to 106+/-25 mg/dl (p<0.001). Adverse events occurred in 3% of patients, and included myositis (0.6%) and increased hepatic transaminases (0.1%). Overall costs were reduced by $115/patient treatment-year. CONCLUSION: Statin therapeutic interchange can improve lipid control at reduced costs. The possibility of uncommon but potentially serious adverse effects suggests that these programs require appropriate monitoring.

Aged↗
PubMed1999

Teaching video effect on renal transplant patient outcomes.

A study was undertaken to test the effect of a teaching video on renal transplant recipient outcomes. A quasi-experimental, pretest/posttest design was used. Fifty-nine adults undergoing renal transplantation were studied. Subjects were randomly assigned to either an experimental group, which received discharge preparatory teaching with the use of a teaching video, or to a control group, which received standard teaching. Subjects in the experimental group had significantly greater improvements in knowledge scores postteaching. No other differences were seen. Findings suggest the use of a teaching video can be a useful adjunct to educational programs designed for renal transplant patients and their families.

Adult↗
PubMed1999

A population-based study of school scoliosis screening.

CONTEXT: Although school-based screening programs for adolescent idiopathic scoliosis are mandated in 26 states in the United States, few program outcomes data exist regarding the effectiveness of such programs. OBJECTIVE: To determine the effectiveness of a community-based school scoliosis screening program. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of children who attended kindergarten or first grade at public or private schools in Rochester, Minn, during 1979-1982. Children were followed up until age 19 years or until they left the school district. MAIN OUTCOME MEASURES: Number of children diagnosed and treated for scoliosis, based on results from scoliosis screenings performed annually in grades 5 through 9, linked to community medical records data; performance characteristics of the screening program. RESULTS: Of the 2242 children screened, 92 (4.1 %) were referred for further evaluation. Of these, 68 (74%) had documented medical or chiropractic evaluation of scoliosis. School screening identified 5 of the 9 children treated for scoliosis but resulted in referrals for another 87 children who were not treated. The cumulative incidence of diagnosed scoliosis in this population was 1.8% (95% confidence interval [CI], 1.2%-2.3%) for curves of more than 10 degrees, 1.0% (95% CI, 0.6%-1.5%) for curves of at least 20 degrees, and 0.4% (95% CI, 0.1 %-0.6%) for curves of 40 degrees or more; 0.4% (0.5% of girls and 0.3% of boys) were treated for scoliosis. The positive predictive value of the school screening program for the identification of treated scoliosis was 0.05 (95% CI, 0.048-0.052), with 448 children needed to screen to identify 1 child who subsequently received treatment. The percent positive agreement across consecutive years of screening varied from 7% to 30%. CONCLUSION: In this population, school scoliosis screening identified some children who went on to receive treatment but referred many more who did not. These data should be considered in making decisions regarding school scoliosis screening.

Adolescent↗
PubMed2006

Engineering a de novo internal disulfide bridge to improve the thermal stability of xylanase from Bacillus stearothermophilus No. 236.

Improvement of thermal stability of the Bacillus stearthermophilus No. 236 endo-beta-1,4-xylanase (XynA) was tried by engineering a de novo designed disulfide bridge. Disulfide design was performed firstly using the disulfide bond design program (Disulfide by Designtrade mark) to identify residue pairs having the favorable geometric characteristics for disulfide formation. Subsequently, the selected 25 amino acid pairs were filtered with the evolutionarily conserved Cys residues identified by alignment of 34 family 11 mesophilic and thermophilic xylanases, and also by doing inspection of the molecular model of the xylanases. Only one pair (Ser100 and Asn150) was finally chosen, and the respective amino acids were substituted with cysteine residues. The newly designed disulfide bridge increased thermostability of the XynA about 5 degrees C. This improved thermal stability was supported by the increase in the energy barrier for inactivation. As expected, the mutant XynA SNC demonstrated its better use in the hydrolysis of xylan at substantially higher temperatures than permitted by its native counterpart. The mutation had little influence on the catalytic efficiency and other functional properties of the XynA. In conclusion, it is evident that the strategically placed disulfide bridge has made the XynA be more effective in resisting thermal inactivation.

Amino Acid Sequence↗
PubMed2005

Educational and health services innovation to improve care for rural Hispanic communities in the US.

BACKGROUND: Access to comprehensive and quality health care services is difficult for socioeconomically disadvantaged groups in rural regions. Barriers to health care for rural Latinos include lack of insurance, language barriers and cultural differences. For the Latino immigrant population in rural areas, barriers to access are compounded. HEALTH NEEDS OF RURAL AREAS: THE CASE OF WALHALLA, SC: The town of Walhalla, South Carolina is a rural community located in Oconee County, the northwest corner of the state. Disparities exist between rural and urban residents in several health categories, and these disparities illustrate the need to provide competent, appropriate and affordable healthcare to rural populations. The Hispanic population of Oconee has dramatically increased in the past decade, and the majority of these immigrants have no health insurance and have limited access to health services. DESIGNING A PROGRAM TO FIT THE COMMUNITY--THE "WALHALLA EXPERIENCE": The purpose of the Accessible and Culturally Competent Health Care Project (ACCHCP) is to provide care for underserved populations in Oconee County, South Carolina while providing rural educational opportunities for health services students. Funded by the Health Resources and Services Administration of DHHS, the program is designed to offer culturally appropriate, sensitive, accessible, affordable and compassionate care in a mobile clinic setting. In this interdisciplinary program, nurse practitioners, health educators, bilingual interpreters, medical residents and Clemson University students and professors all played key roles. Women in the community also serve as Promotoras or lay health advisors. The program is unique in using educational initiatives and innovative strategies for bringing health care to this underserved community and offers important information for rural health care initiatives targeting minority groups. This paper reports on the challenges and successes in the development and implementation of the ACCHCP program in Walhalla, South Carolina.

Adult↗
PubMed2005

Rational inhibitor design and iterative screening in the identification of selective plasmodial cyclin dependent kinase inhibitors.

New chemical classes of compounds must be introduced into the malaria drug development pipeline in an effort to develop new chemotherapy options for the fight against malaria. In this review we describe an iterative approach designed to identify potent inhibitors of a kinase family that collectively functions as key regulators of the cell cycle. Cyclin-dependent protein kinases (CDKs) are attractive drug targets in numerous diseases and, most recently, they have become the focus of rational drug design programs for the development of new antimalarial agents. Our approach uses experimental and virtual screening methodologies to identify and refine chemical inhibitors and increase the success rate of discovering potent and selective inhibitors. The active pockets of the plasmodial CDKs are unique in terms of size, shape and amino acid composition compared with those of the mammalian orthologues. These differences exemplified through the use of screening assays, molecular modeling, and crystallography can be exploited for inhibitor design. To date, several classes of compounds including quinolines and oxindoles have been identified as selective inhibitors of the plasmodial CDK7 homologue, Pfmrk. From these initial studies and through the iterative rational drug design process, more potent, selective, and most importantly, chemically unique compound classes have been identified as effective inhibitors of the plasmodial CDKs and the malarial parasite.

Amino Acid Sequence↗
PubMed2002

A randomized clinical trial to assess the benefit of offering on-site mobile mammography in addition to health education for older women.

OBJECTIVE: We conducted a cluster randomized clinical trial to compare the benefit of offering on-site mobile mammography in addition to an outreach program designed to increase mammography use by educating patients. SUBJECTS AND METHODS: We recruited a consecutive volunteer sample of 499 women ranging in age from 60 to 84 years who had not undergone mammography in the previous year to participate in a cluster randomized clinical trial about the benefit of on-site mobile mammography. Subjects were recruited from 60 community-based sites where seniors gather. The intervention included a structured on-site multicomponent educational program with or without available on-site mobile mammography. The primary outcome measure was self-reported receipt of mammography within 3 months of the intervention. RESULTS: Women in the group offered access to on-site mammography and health education were significantly more likely than those in the group offered health education only to undergo mammography within 3 months (55% vs 40%, p = 0.001; adjusted [for clustering] odds ratio, 1.83; 95% confidence interval, 1.22-2.74). Gains from offering on-site mammography were shown for several ethnic and sociodemographic subgroups and were especially large for Asian American women. CONCLUSION: Offering on-site mammography at community-based sites where older women gather is an effective method for increasing breast cancer screening rates among older women and may be particularly effective for some subgroups of women who traditionally have had low screening rates.

Aged↗
PubMed1984

Computer skills enhance a hospital pharmacy residency training program.

Hospital pharmacy residents participated in a program designed to introduce them to computer systems useful in pharmacy practice and to provide them with access to a variety of computer resources that could be helpful in completing their residency projects. Using existing computer facilities, various short courses and individual tutorials were employed to train residents in a variety of computer skills. These courses provided a useful vehicle for recent pharmacist graduates to acquire necessary computer skills not obtained during their academic training. Because the program provided residents with the tools needed for the management and analysis of large data sets, a marked increase occurred in the number of residency projects acceptable for publication in peer-reviewed pharmacy journals. Thus, residency projects improved in quality and faculty preceptors were more motivated to get involved in such projects.

Computers↗
PubMed2005

Educational and health services innovation to improve care for rural Hispanic communities in the USA.

BACKGROUND: Access to comprehensive and quality healthcare services is difficult for socioeonomically disadvantaged groups in rural regions. Barriers to health care for rural Latinos include lack of insurance, language barriers and cultural differences. For the Latino immigrant population in rural areas, barriers to access are compounded. HEALTH NEEDS OF RURAL AREAS: THE CASE OF WALHALLA, SC: The town of Walhalla, South Carolina, USA, is a rural community located in Oconee County, the northwest corner of the state. Disparities exist between rural and urban residents in several health categories, and these disparities illustrate the need to provide competent, appropriate and affordable healthcare to rural populations. The Hispanic population of Oconee has dramatically increased in the past decade, and the majority of these immigrants have no health insurance and have limited access to health services. DESIGNING A PROGRAM TO FIT THE COMMUNITY--THE "WALHALLA EXPERIENCE": The purpose of the Accessible and Culturally Competent Health Care Project (ACCHCP) is to provide care for underserved populations, in Oconee County, South Carolina while providing rural educational opportunities for health services students. Funded by the Health Resources and Services Administration of DHHS, the program is designed to offer culturally appropriate, sensitive, accessible, affordable and compassionate care in a mobile clinic setting. In this interdisplinary program, nurse practitioners, health educators, bilingual interpreters, medical residents and Clemson University students and professors all played key roles. Women in the community also serve as promotoras or lay health advisors. The program is unique in using educational initiatives and innovative strategies for bringing health care to this underserved community and offers important information for rural healthcare initiatives targeting minority groups. This article reports on the challenges and successes in the development and implementation of the ACCHCP program in Walhalla, South Carolina.

Adolescent↗
PubMed1997

The strategic model for the PMM Network.

The projects of the PMM Network are based on a strategic model that focuses sharply on the interval between the obvious onset of a serious obstetric complication and the provision of emergency obstetric care (EmOC). The reason for this is that most of these complications cannot be predicted or prevented, but they can be successfully treated. The implications of this model for program design are profound. The emphasis is on improving the accessibility, quality and utilization of EmOC for women who develop such complications, rather than on having contact with all pregnant women.

Africa, Western↗
PubMed2002

Implementing a national hospital accreditation program: the Zambian experience.

OBJECTIVES: This study describes the development of the Zambia Hospital Accreditation Program from 1997 to 2000. Ten major milestones are presented and discussed, as are challenges to the program. DESIGN: Data were collected through a review of written documents, interviews with major stakeholders, hospital visits, and discussions with implementers. MAIN OUTCOME MEASURES: Zambia has successfully developed hospital standards that are relevant and potentially achievable by its hospitals. Half of Zambia's 79 hospitals have received educational surveys, and 12 have also received the full accreditation survey. Significant improvement in compliance with standards occurred in overall scores, and in seven out of 13 functional areas. However, the program has stalled due to lack of sufficient funds, lack of legal standing for the Zambia Health Accreditation Council, difficulties in retaining qualified surveyors, and indecision on how to handle accreditation results. In addition, serious resource constraints in hospitals and the need for ongoing facilitation have hindered their full participation in the program. It is estimated that the program costs about 10000 dollars US per hospital to complete the cycle. CONCLUSIONS: Having a developing country sustain an accreditation program requires dedicated funds, government and donor commitment, continual adaptation, ongoing technical assistance to hospitals, and a functioning accreditation body. In Zambia, the accrediting Council was stymied by a heavy workload, lack of legitimacy and budget authority, and the government's indecision on incentives and feedback. Long delays arose between accreditation surveys and feedback of written results. Zambia has now begun to include some accreditation standards in performance audits and is considering decentralizing survey functions.

Accreditation↗
PubMed2004

[Evidence of antibodies against the chlamydial heat shock protein (cHSP60) in women from "in vitro" fertilization program].

OBJECTIVE: A contribution to the role of chlamydial heat shock protein in women from the IVF program. DESIGN: A serological study proving the antibodies against the chlamydial heat shock protein. SETTING: Veterinary Research Institute, Brno, Department of Clinical Microbiology, and Centrum of Reproductive Medicine, Faculty Hospital Brno. METHODS: The IgG antibodies against the chlamydial heat shock protein (cHSP60) and the IgA and IgG antibodies against species specific chlamydial major outer membrane protein (cMOMP) of Chlamydia trachomatis (C. trachomatis) and Chlamydophila pneumoniae (C. pneumoniae) in the blood serum of 70 females being in the fertilization program due to fertility disorders (Group 1) have been estimated and the results compared with those obtained in 50 females suffering from pelvic inflammation disease (PID) (Group 2) and in 51 female blood donors (Group 3) respectively. RESULTS: The anti-cHSP60 antibodies have been ascertained as follows: in 26 women from the first group (37.1%), in 16 of the second group (32.0%) and in 12 (23.5%) of female blood donors. The anti cHSP60-antibody-occurrence and mean index of positivity as well, found in the groups examined, was statistically insignificant. Similarly no difference has been found in the occurrence of the species specific anti-cMOMP antibodies C. trachomatis and C. pneumoniae in the groups examined. The anti-cMOMP antibodies against C. trachomatis and simultaneously against C. pneumoniae have been detected in 21 from 171 women of all groups (12.3%), only against C. trachomatis in 9 (5.3%) and against C. pneumoniae in 73 of them (42.7%). There was considerably higher occurrence of the specific antibodies against C. trachomatis in women with a positive finding of antibodies against the cHSP60, especially in women suffering from gynecological disorders, than in women without such antibodies. CONCLUSION: C. trachomatis has a significant impact on the production of antibodies against the cHSP60. This fact can be documented by considerably higher occurrence of the specific antibodies against C. trachomatis in women with a positive finding of antibodies against the cHSP60, than in women without such antibodies. Preceding infection C. trachomatis and following sensitization with chlamydial heat shock protein indicate an unfavourable prognosis of the reproductive outcome and impairs the perspective of a successful in vitro fertilization. The proof of antibodies against the chlamydial HSP60 can be recommended as a further auxiliary criterion in women suffering from fertility disorders.

Adult↗
PubMed1981

A university-staffed, private hospital-based air transport service. The initial two-year experience.

During the first two years of a cooperative effort between the University of Texas Medical School at Houston and Hermann Hospital, Houston, a program designed to extend the emergency center to the patient by helicopter treated and moved 1,702 patients. A physician and flight nurse attended patients on each mission. Of all flights, 68.3% were because of major multiple trauma and 28.8% were to the scene of an accident. The magnitude of these injuries was reflected by a mortality of 11% at the scene of the accident and 7% in the emergency room of those transported. The primary purpose of the program is to minimize the time between the catastrophic event and the institution of appropriate medical therapy. Our experience with this program of early stabilization and rapid transport has led to the following observations: (1) single-organ injury is virtually nonexistent in the patient with multiple trauma; (2) clotting abnormalities, even disseminated intravascular coagulopathy, are seen regularly in patients with apparently isolated head injuries; and (3) patients with apparently isolated head injuries often have serious pulmonary function abnormalities.

Academic Medical Centers↗
PubMed1987

Teen contraception: a review of perspectives on compliance.

National attention has been drawn to the near epidemic rates of teen-age pregnancy in this country, with greater psychological understanding of this problem cited as a research need. This paper reviews available literature on teen contraceptive compliance with particular focus on the development of self-regulation. In this first section, programs designed to enhance teens' choice and use of birth control are reviewed, with specific attention given to emerging issues and methodological concerns. In the second section, studies that examine factors predictive of contraceptive use in teen-age girls are discussed. This literature is grouped according to three conceptual systems: medical perspectives, behavioral theory, and self-regulation and self-control approaches. A summary is presented, specifying ways in which conceptually based research findings can assist in program development to address the problem of teen pregnancy.

Adolescent↗
PubMed1993

The Mount Sinai cesarean section reduction program: an update after 6 years.

A six year follow-up evaluation of our original cesarean section reduction program is presented. While establishing obstetric practice guidelines was accomplished, two prerequisites remain critical: lowering cesarean utilization was to be accomplished without harm to mother or fetus, and a target rate was prospectively determined. The results after 6 years indicate that total cesarean rates of 10-12% can consistently be achieved without adverse outcome. Additionally, operative vaginal procedures were employed less that 3% of cases. Separate analysis of 580 breech deliveries failed to show an effect of route of delivery on mortality. This effort indicates that long-term reductions and cesarean utilization are possible with a comprehensive departmental program designed to accomplish achieving a target rate of 11%.

Breech Presentation↗
PubMed2005

GeneMark: web software for gene finding in prokaryotes, eukaryotes and viruses.

The task of gene identification frequently confronting researchers working with both novel and well studied genomes can be conveniently and reliably solved with the help of the GeneMark web software (http://opal.biology.gatech.edu/GeneMark/). The website provides interfaces to the GeneMark family of programs designed and tuned for gene prediction in prokaryotic, eukaryotic and viral genomic sequences. Currently, the server allows the analysis of nearly 200 prokaryotic and >10 eukaryotic genomes using species-specific versions of the software and pre-computed gene models. In addition, genes in prokaryotic sequences from novel genomes can be identified using models derived on the spot upon sequence submission, either by a relatively simple heuristic approach or by the full-fledged self-training program GeneMarkS. A database of reannotations of >1000 viral genomes by the GeneMarkS program is also available from the web site. The GeneMark website is frequently updated to provide the latest versions of the software and gene models.

Algorithms↗