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PubMed2002

Introducing domestic violence assessment in a postpartum clinical setting.

OBJECTIVES: Attempts to introduce assessment for exposure to domestic violence in health care settings have met with limited success, in spite of widespread knowledge of the prevalence of spousal abuse and its implications for women's health. We assessed the utility of Rogers' model of institutional change for the implementation of a universal screening program for domestic violence in postpartum clinical settings. METHODS: We adapted Rogers' innovation-diffusion model to develop and implement a protocol for domestic violence assessment among 300 nurses working in two hospitals that together provide obstetrical care to the City of Vancouver, British Columbia, Canada. Our education sessions introduced new knowledge and addressed attitudes and beliefs. They were followed by "hands-on" demonstration and supervision of assessments. Our "Let's Talk" visual aids program added visibility to our initiative and provided cues as to how to undertake screening and response. Screening rates were monitored along with a process evaluation based on anecdotal reporting by nursing staff. RESULTS: Following the initiation of educational sessions and supervision of assessment, the screening rate was 42%. Within 6 months, the screening rate had climbed to 60% and was sustained at that level. Major barriers to screening include difficulty in finding the opportunity to screen in privacy and overcoming language barriers. CONCLUSIONS: Application of Rogers' principles of diffusion of innovation in the implementation of a universal program for a domestic violence in two obstetrical care settings resulted in a screening rate of 60% which has been sustained for the first 18 months of the program.

British Columbia↗
PubMed2005

How shall we train?

The prosecution of modern war and the competing missions of peacekeeping, humanitarian missions, and beneficiary care place great demands on the military medical system. Meeting the military medical training challenges of the new millennium requires the best trained and most experienced medical personnel possible. Various strategies for initial and sustainment (continuing) medical training are available to ensure that the medical force is ready for the next mission. Accredited programs both in and out of the military are the mainstay of training for both enlisted personnel and officers, with professional certification serving as the standard for competency. Clinical sustainment training can take place in military medical treatment facilities, civilian institutions, or a combination of the two. When direct patient care opportunities cannot provide the proper mixture of experiences to maintain certain skills, short courses, distance education, and patient simulators can play important roles. Because each training strategy offers certain advantages in different settings, it is likely that military medical departments will need to use all of them. An optimal training environment benefits from all strategies used, in combination or separately.

Accreditation↗
PubMed2005

Detection of programmed cell death in cells exposed to genotoxic agents using a caspase activation assay.

Many environmental toxins cause DNA damage. Cells that have sustained significant DNA damage must attempt to repair the damage prior to replication, in which aberrant base incorporation can result in an irreversible mutation. If a cell cannot repair the damage, however, it may commit suicide through a genetically regulated programmed cell death (PCD) pathway. Crucial to the ultimate execution of PCD is a family of cysteine proteases called caspases. Activation of these enzymes occurs late in the PCD pathway, when a cell can no longer avoid cell death, but earlier than other PCD markers, such as morphological changes or DNA fragmentation. This protocol details a method for using fluorochrome-conjugated caspase inhibitors for the detection of activated caspases in intact cells using fluorescent microscopy.

Animals↗
PubMed1980

Sustained ventricular tachycardia in recent canine myocardial infarction.

To study recurrent ventricular tachycardia in the late phase or myocardial infarction (MI), transmural anteroapical infarcts were created by ligation of the left anterior descending (LAD) coronary artery in 25 dogs. Twenty dogs survived LAD ligation and underwent an open-chest electrophysiologic study an average of 20 days after MI. Programmed electrical stimulation was carried out using the extrastimulus technique and short bursts of rapid ventricular pacing via bipolar electrodes positioned at multiple left ventricular endocardial sites. Sixteen dogs had electrically induced ventricular tachycardia, and in 11, sustained ventricular tachycardia was reproducibly initiated and terminated by programmed ventricular stimulation. Short bursts of rapid left ventricular pacing from areas in periinfarct zone was the most effective technique for initiating ventricular tachycardia. The electrophysiologic phenomena in this model of sustained ventricular tachycardia in 3-week-old MI included electrically induced changes in rate and morphology and biventricular capture without termination during tachycardia.

Animals↗
PubMed2004

The School Health Portfolio System: a new tool for planning and evaluating coordinated school health programs.

The School Health Portfolio System (SHPS), developed originally to evaluate the Florida Coordinated School Health Program Pilot Schools Project, offers a new and innovative system for planning and evaluating a coordinated school health program at the individual school level. The SHPS provides practitioners a detailed but easy-to-use system that enables schools to create new programs or modify existing programs across all eight components of the CSHP model, as well as administrative support critical to sustainability. The System comes packaged as a self-contained, notebook-style manual divided into 15 sections. It includes electronic templates of key documents to guide school teams in creating a customized portfolio, and a list of sample goals and artifacts that confirm achievement of a goal related to the school's coordinated school health program. An evaluation rubric provides a structured method to assess a program portfolio's contents, and the extent to which the contents document achievement of program goals. The rubric produces both a qualitative assessment, such as a narrative summary of program strengths and areas for improvement, and a quantitative assessment, such as a numerical score (0-100), letter grade (A-F), or 5-star system (*-*****). The physical structure, function, and scoring of the rubric depend on the method of assessment. The SHPS enables schools to set goals based on individual school needs, and incorporate CSHP goals into school improvement plans--a critical factor in sustainability and accountability. The System also offers teams the option of coordinating their efforts with CDC's School Health Index as a companion assessment measure. This article outlines the process a team would follow in developing a portfolio, and includes a sample assessment for the area of School Health Education.

Florida↗
PubMed1985

[Treatment of recurrent ventricular tachycardias using oral propafenone].

The effect of oral propafenone on prevention of pacing-induced ventricular tachycardia (VT) was studied in 11 patients. All patients experienced documented sustained VT refractory to 4.1 +/- 2 antiarrhythmic agents per patient including amiodarone in 8. Programmed electrical stimulation was performed before and 48-72 hours after oral propafenone (900 mg/day) 2-3 hours after the last dose. Two patients developed spontaneous incessant VT before the scheduled date of the study on propafenone, and were classified as aggravation. Propafenone prevented pacing-induced VT in 2 patients (successful results). In 3 additional patients the results were partial, as non-sustained VT was induced on propafenone whereas sustained VT could be provoked during the control study. In the remaining 4 patients, oral propafenone failed to prevent pacing-induced VT. Tachycardia cycle length increased in 3 (C = 284 +/- 129 P = 450 +/- 202 ms) and was shorter in 1 aggravation. The 5 patients with successful or partial results (45.4 p. cent), underwent long-term therapy with a mean follow up of 5.6 +/- 4 months. Recurrence of VT occurred in 2. The remaining 3 are well controlled. This study demonstrates that propafenone is able to prevent pacing-induced VT in a limited number of patients. Stimulation techniques are useful in order to detect patients with potential pro-arrhythmic effect.

Administration, Oral↗
PubMed1990

Comparative evaluation of American Cancer Society and American Lung Association smoking cessation clinics.

We compared the effectiveness of American Cancer Society, FreshStart, American Lung Association, Freedom from Smoking, and laboratory clinic methods in subjects (N = 1041) from three communities. Three-month follow-up results favored the laboratory method over the two public service approaches on both a prevalence and a sustained abstinence measure. At one-year follow-up, treatment effects for smoking prevalence were no longer significant. However, sustained abstinence results at one-year remained highly significant and favored the more intensive laboratory and Freedom from Smoking clinics over the FreshStart method. FreshStart fared less well than the other interventions both in producing initial quit attempts and in sustaining abstinence among initial quitters. It should be noted, however, that FreshStart requires considerably less facilitator contact than do the other approaches. Unexpected outcome effects occurred for treatment location. Future clinic programs should include a specific target date for quitting and should place more emphasis upon recycling participants who fail to sustain abstinence.

Adult↗
PubMed2003

Cost-effectiveness of a prework screening program for the University of Illinois at Chicago physical plant.

A post-offer screening program jointly developed by the Occupational and Physical Therapy Departments (University of Illinois at Chicago) was first implemented in March 1998. A total of 712 screens were completed from 3-01-98 through 2-28-01. A quasi-experimental design was utilized to analyze changes in Workers' Compensation costs between the three-year period prior to, and the three-year period following program inception. Additionally, injury rates and mean cost per injury were compared between injuries sustained between 3-98 and 3-01 which were incurred by workers who had passed screening and those that had not been screened. Finally, the tabulated cost per screen and reduction in Workers' Compensation costs allowed derivation of a dollar spent/ dollar saved ratio. Dramatic declines in number of injuries, total costs and mean cost per case occurred in the three-year period following program inception. Mean cost per case also dramatically declined comparing injured workers who had passed screening versus those who had never been screened. Cost savings were over US dollars 18 per dollar spent on the program. While a number of mitigating variables may have accounted for some of the profound effects noted, decrease in average cost per case (indicating possible reduction in severity of injury) was consistent with existing literature.

Accidents, Occupational↗
PubMed1991

Safety of a preadolescent basketball program.

A preadolescent youth basketball program was prospectively studied to determine injury rates and the kinds of injuries sustained. The overall injury rate was 7.6% (39 injuries among the 510 children aged 5 to 12 years). Girls had a higher injury rate than boys (P less than .02). Only 12 children (2.4%) suffered significant injuries as defined by the inability to play for at least one session. Most injuries were contusions (35.9%), followed by strains or sprains (28.2%), epistaxis (12.8%), lacerations (5.1%), and one finger fracture (2.6%), the most significant injury. Games were more likely to produce injuries than practice sessions; most injuries occurred in the second half of game play. This study documents a low injury rate in an organized preadolescent basketball program.

Basketball↗
PubMed2003

On a happier note: validation of musical exercise for older persons in long-term care settings.

This paper describes a quasi-experimental study of a musical exercise intervention to improve the physical, cognitive, behavioral status and life satisfaction of older residents in a long-term care facility in the United Kingdom. Twenty long-term care residents from three different units (n=60) were recruited and assigned to one of three groups: a control (C) group (no intervention), an occupational therapy (OT) group (comparison group) and a music exercise group (intervention group). Assessments of physical and cognitive status were made pre-intervention and repeated at the end of the 10-week exercise program and again 10 weeks after the completion of the program. The results show that both OT and exercise participation is associated with improvement in physical and cognitive function. However, the exercise group showed significant improvement in more areas than the OT group. The functional benefits from OT and exercise were not sustainable after these activities ceased and showed significant decline 10 weeks after the end of the programs.

Activities of Daily Living↗
PubMed1987

[Complex ventricular extrasystole. Value of technics of programmed electric stimulation].

The incidence and significance of ventricular arrhythmia induced by programmed electrical stimulation in subjects with complex ventricular ectopy were studied in 46 consecutive subjects: 34 with heart disease, 12 with an apparently normal heart. The procedure consisted of delivering on one spontaneous and 2 imposed rhythms one, two, then three extrastimuli. Significant arrhythmia with more than 6 ventricular complexes was induced in 17 patients (37%), including 6 (13%) with sustained ventricular tachycardia and 11 with unsustained ventricular tachycardia. Induction of ventricular arrhythmia was observed in 12 of the 14 patients with a history of myocardial infarction. At the end of a mean follow-up period of 12 +/- 4 months, there were 2 sudden deaths, and 3 patients had clinically sustained ventricular tachycardia. Clinical ventricular tachycardia occurred in the group of 17 patients inducible during programmed electrical stimulation. The patients who died suddenly belonged to the group of 29 patients without induced ventricular arrhythmia. This study shows a high proportion of significant stimulation-induced arrhythmia in patients who had suffered from myocardial infarction more than 3 months previously and who had complex ventricular ectopy. Owing to the good condition of this group of patients after a mean follow-up of 12 months, we were unable to determine the influence of stimulation-induced arrhythmia on mortality. However, it must be noted that spontaneous sustained tachycardia occurred in the group of patients with significant induced ventricular arrhythmia.

Adult↗
PubMed1989

Recurrent injuries in schoolchildren.

Past work identifying "accident-prone" children with disproportionate rates of injury has been based on clinical data gathered in office, clinic, or emergency department settings. To avoid the biases inherent in such designs, we studied recurrent injuries in a school district population, utilizing a prospective surveillance system to identify injuries meeting standardized criteria. During three school years we observed 54,874 students, ranging in age from 6 to 18 years, for recurrent injuries, which were defined as those occurring in a year in which two or more injuries were reported for the child. Five hundred seventy-three recurrently injured children (1% of the school district population) sustained 1405 injuries (17% of the overall injury experience), a proportion significantly but only slightly greater than that expected on the basis of chance alone (14%). Most recurrently injured children were injured in only a single year, with only 15 children sustaining injuries in all three study years. Age, sex, and type of school were significant correlates of recurrent injury rates, with junior high school students, boys, and students attending schools with alternative educational programs having the highest rates of injury recurrence. The findings indicate that (1) a small group of schoolchildren sustain a disproportionate share of the overall injury experience, (2) the majority of recurrently injured children experience only transient periods of enhanced injury risk, and (3) preventive strategies may benefit from investigation of developmental and social environmental factors that alter such risk.

Adolescent↗
PubMedDate not supplied

Abstinence trajectories among treated crack cocaine users.

This article reports findings from a study that investigated treatment outcomes among crack/cocaine users over a 18-month period. From a cohort of 229 subjects, three groups emerged: (1) those who had reported ongoing, stable abstinence from crack/cocaine; (2) those who had consistently used during the period; and (3) those who reported cycling between abstinence and use during the follow-up period. Analyses of variance (ANOVA) were conducted to compare the three groups in terms of intake characteristics, including demographic profile, previous treatment, motivational factors, and functioning in seven Addiction Severity Index (ASI) domains. Length of time involved in aftercare and Twelve Step participation after treatment were also contrasted among the three groups. Results showed that subjects who achieved sustained abstinence from crack/cocaine also did better in other domains such as employment, family, legal, and psychiatric than others. Stable abstinence was also significantly associated with a longer period of aftercare and frequent attendance at Twelve Step programs. Logistic regression analyses further estimated the significant impact of the posttreatment factors on the achievement of sustained abstinence. The implications of these findings for treatment services research are discussed.

Adult↗
PubMed1999

[Long-term follow up of 115 patients with ischemic heart disease and ventricular flutter induced by programmed ventricular stimulation in the absence of ventricular arrhythmia].

The clinical significance of rapid monomorphic ventricular tachycardia (VT) (> 270 beats/min), also called ventricular flutter, remains controversial in patients without documented spontaneous sustained VT. The aim of this study was to evaluate the outcome of 115 patients with ischaemic heart disease, aged 58 +/- 10 years, without spontaneous ventricular arrhythmias, but who had inducible ventricular flutter during programmed ventricular stimulation. The patients underwent stimulation to evaluate the prognosis after myocardial infarction or to investigate a malaise with or without loss of consciousness. Sustained ventricular flutter was the only inducible arrhythmia in all patients. The mean left ventricular ejection fraction (LVEF) was 42 +/- 14%. During an average follow-up period of 66 +/- 43 months, 31 deaths, including 27 of cardiac causes, were observed. The 1, 5, and 11 year survival of the whole population was 94, 79 and 64% respectively. In univariate analysis, anterior wall myocardial infarction, a low LVEF, the presence of non-sustained ventricular tachycardia (NSVT) on 24 hour Holter monitoring and Class III antiarrhythmic treatment, were poor prognostic factors (p 0.05). In multivariate analysis, the only independent predictive factors of mortality were low LVEF (p = 0.006), the presence of NSVT on Holter monitoring (p = 0.003) and the absence of betablocker therapy (p = 0.015). Medical therapy with betablockers or the implantation of an automatic defibrillator may be indicated in these patients at higher risk.

Arrhythmias, Cardiac↗
PubMed1986

Long-term reproducibility and significance of provokable ventricular arrhythmias after myocardial infarction.

The long-term reproducibility and significance of inducible ventricular arrhythmias were assessed in 21 survivors of a myocardial infarction. Programmed ventricular stimulation performed a mean of 12 +/- 2 days (range 8 to 18) after infarction provoked ventricular fibrillation in 2 patients, sustained monomorphic ventricular tachycardia in 8 and nonsustained ventricular tachycardia in 11. Patients were restudied using the same protocol a mean of 8 +/- 2 months (range 4 to 11) after infarction. All patients underwent programmed ventricular stimulation studies in the absence of antiarrhythmic drug treatment. Ventricular tachyarrhythmias could be reinitiated in 16 patients (76%): ventricular fibrillation in 2, sustained ventricular tachycardia in 5 (monomorphic in 4) and nonsustained ventricular tachycardia in 9. A preponderance of inferior infarction was observed among patients with reinducible tachycardias (9 of 16 patients versus 0 of 5 with noninducible tachycardias) (p less than 0.05). No significant difference existed between patients with and without reinducible arrhythmias with respect to severity of coronary artery disease, degree of left ventricular dysfunction, occurrence of ventricular fibrillation in the acute phase of infarction and ventricular arrhythmias detected by 24 hour ambulatory electrocardiographic (Holter) monitoring. There was no significant difference between patients with and without a positive late study in stimulation thresholds, ventricular refractory periods, time interval between initial and repeat testing and use of beta-adrenergic blocking agents. During a mean follow-up period of 17 months (range 10 to 23) one patient with inducible sustained monomorphic ventricular tachycardia at both studies died suddenly. The remaining patients have survived follow-up without experiencing an arrhythmic event.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

A continuum of rehabilitative care. A day hospital extends patients' lifeline to the medical center.

Alexian Brothers Medical Center in Elk Grove Village, IL, carries out its commitment to a continuum of care through the Alexian Brothers Rehabilitation Center and its Physical Rehabilitation Day Hospital. The day hospital treats patients who need rehabilitation but do not need around-the-clock hospitalization. The day hospital individualizes its intensive comprehensive, pulmonary, and arthritis programs. An important component of these outpatient programs is education and preventive techniques to reduce the need for repeat treatment. Only medically stable patients are transferred to the rehabilitation center, where an interdisciplinary team helps them achieve the maximum function possible within the limits imposed by their disabilities. The rehabilitation center sponsors a community support group for young adults who have sustained head injuries and a group for alumni of the center. Through its home healthcare program and its adult day care program, the medical center offers a variety of treatment delivery methods that enhance the center's continuum of care.

Catholicism↗
PubMedDate not supplied

New hybrid online graduate program in medical imaging graduates its first class of students.

According to the American Registry of Radiologic Technologists (ARRT), the current shortage of radiologic technologists (RTs) will continue to grow and by 2010, when many RTs are expected to retire from the profession, there will be an estimated 24,000 vacancies. In response to the shortage of RTs, The MGH Institute of Health Professions has developed a fast-track hybrid online graduate program in medical imaging (MI) which is geared toward bachelor degree prepared students who are seeking to make a career change. By targeting bachelor prepared students, the Institute seeks to attract academically mature students who will make a sustaining contribution to the field of radiologic science. The first class of students in this new online program just graduated. Measured results of this first group are very encouraging with all results exceeding the goals initially set for the program. Except for one student who has visa issues precluding employment, all of the students from the class have passed their registry exam and are employed in the field. The format of this new online MI program eases constraints on growth and viability and it bridges the gap between entry-level and advanced practice. This hybrid online program is a model that could be implemented with healthcare systems nationwide.

Diagnostic Imaging↗
PubMed2001

QT interval dispersion in ventricular beats: a noninvasive marker of susceptibility to sustained ventricular arrhythmias.

Increased QT dispersion (QTd) calculated from sinus beats has been shown to identify patients prone to sustained VT. However, predictive accuracy of this parameter is limited. Electrophysiological properties of the myocardium may be altered by a premature ventricular beats, which is a well-established trigger for sustained VT. Therefore, the author hypothesised that QTd in spontaneous or paced ventricular beats may improve identification of patients with inducible sustained VT. In 28 consecutive patients (men, mean age 61 +/- 13 years) who underwent programmed ventricular stimulation, the values of QTd calculated in sinus and ventricular beats were compared between inducible and noninducible patients. The mean QTd values obtained using three different methods differed significantly, QTd in paced ventricular beats being the highest, QTd in spontaneous ventricular beats was intermediate, and QTd in sinus beats was the lowest (83.9 +/- 30 vs 63.0 +/- 29 ms vs 53.9 +/- 27 ms, P < 0.0001 and P < 0.004, respectively). In 13 (46%) patients sustained VT was induced. QTd values were significantly higher in inducible than noninducible patients (QTd sinus beats: 67.5 +/- 31 vs 42.1 +/- 11 ms, P = 0.02; QTd spontaneous ventricular beats: 79.3 +/- 35 vs 46.7 +/- 13 ms, P = 0.008, and QTd-paced ventricular beats: 104.8 +/- 32 vs 65.9 +/- 9 ms, P = 0.0009). The receiver operator characteristic curves showed that at a sensitivity level of 100%, the highest specificity for identification of inducible patients had QTd measured in paced ventricular beats (87%) followed by QTd in spontaneous ventricular beats (45%), and QTd in sinus beats (40%). In conclusion, (1) QTd in ventricular beats is greater than in sinus beats, and (2) QTd calculated from paced ventricular beats identifies patients with inducible sustained VT better than QTd measured during sinus rhythm.

Electrocardiography↗