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Results for “Medical Supervision”

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At least 19 recordsLinked to original sources
PubMed1984

Safety of outpatient cardiac exercise programs. Issues regarding medical supervision.

Medical supervision of cardiac exercise programs should be individualized to each patient's needs. In order for this to be done, several factors must be considered, including the nature of increased risk during exercise due to coronary heart disease, ways to minimize the risk of cardiovascular complications during exercise, the types of medical supervision available and their contributions to safety, and the other factors that are influenced by medical supervision, such as program availability and cost and patient reactivity and compliance.

Ambulatory Care↗
PubMed2002

Could American women use mifepristone-misoprostol pills safely with less medical supervision?

Medical methods of early abortion differ from surgical methods in that women themselves can potentially administer the regimens. As currently researched and offered, however, the main regimen used for medical abortion, mifepristone-misoprostol, is highly medicalized, involving several clinic visits and extensive physician involvement. We re-examined the role of clinical supervision in each step of the abortion process, using data collected during a large clinical trial of mifepristone-misoprostol abortions in the US, fielded during 1994-1995. The trial was carried out in 17 geographically diverse centers, including private, public, and nongovernmental organization clinics, and enrolled 2121 women, aged 18-45 years, seeking early abortion (< or =63 days since last menstrual period). Women received 600 mg oral mifepristone, followed 48 h later by 400 microg oral misoprostol. Evidence suggests that most women can handle most steps of the medical abortion process themselves, effectively and safely. The utility of clinic visits to ingest mifepristone and misoprostol is questionable. For many women, even the follow-up visit could perhaps be replaced by telephone follow-up, combined with home pregnancy tests. Alternatives to the present protocol might allow greater control, comfort, and convenience at lower cost. Where clinician involvement might be useful, mid-level health care providers typically possess the skills necessary to offer the method safely, implying that physicians might be necessary only as complications arise. Future research useful for determining the optimal amount of medical involvement to provide mifepristone-misoprostol safely and effectively should include self-screening tests, label comprehension tests, calendars to aid in calculating gestational age, and the development of special pregnancy tests with telephone follow-up.

Abortion, Induced↗
PubMed2006

Summary of findings from the evaluation of a pilot medically supervised safer injecting facility.

In many cities, infectious disease and overdose epidemics are occurring among illicit injection drug users (IDUs). To reduce these concerns, Vancouver opened a supervised safer injecting facility in September 2003. Within the facility, people inject pre-obtained illicit drugs under the supervision of medical staff. The program was granted a legal exemption by the Canadian government on the condition that a 3-year scientific evaluation of its impacts be conducted. In this review, we summarize the findings from evaluations in those 3 years, including characteristics of IDUs at the facility, public injection drug use and publicly discarded syringes, HIV risk behaviour, use of addiction treatment services and other community resources, and drug-related crime rates. Vancouver's safer injecting facility has been associated with an array of community and public health benefits without evidence of adverse impacts. These findings should be useful to other cities considering supervised injecting facilities and to governments considering regulating their use.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Medically supervised water-only fasting in the treatment of hypertension.

BACKGROUND: Hypertension-related diseases are the leading cause of morbidity and mortality in industrially developed societies. Although antihypertensive drugs are extensively used, dietary and lifestyle modifications also are effective in the treatment of patients with hypertension. One such lifestyle intervention is the use of medically supervised, water-only fasting as a safe and effective means of normalizing blood pressure and initiating health-promoting behavioral changes. METHODS: One hundred seventy-four consecutive hypertensive patients with blood pressure in excess of 140 mm Hg systolic, 90 mm Hg diastolic (140/90 mm Hg), or both were treated in an inpatient setting under medical supervision. The treatment program consisted of a short prefasting period (approximately 2 to 3 days on average) during which food consumption was limited to fruits and vegetables, followed by medically supervised water-only fasting (approximately 10 to 11 days on average) and a refeeding period (approximately 6 to 7 days on average) introducing a low-fat, low-sodium, vegan diet. RESULTS: Almost 90% of the subjects achieved blood pressure less than 140/90 mm Hg by the end of the treatment program. The average reduction in blood pressure was 37/13 mm Hg, with the greatest decrease being observed for subjects with the most severe hypertension. Patients with stage 3 hypertension (those with systolic blood pressure greater than 180 mg Hg, diastolic blood pressure greater than 110 mg Hg, or both) had an average reduction of 60/17 mm Hg at the conclusion of treatment. All of the subjects who were taking antihypertensive medication at entry (6.3% of the total sample) successfully discontinued the use of medication. CONCLUSION: Medically supervised water-only fasting appears to be a safe and effective means of normalizing blood pressure and may assist in motivating health-promoting diet and lifestyle changes.

Adult↗
PubMed2002

Medically supervised water-only fasting in the treatment of borderline hypertension.

BACKGROUND: Hypertension-related diseases are the leading causes of morbidity and mortality in industrially developed societies. Surprisingly, 68% of all mortality attributed to high blood pressure (BP) occurs with systolic BP between 120 and 140 mm Hg and diastolic BP below 90 mm Hg. Dietary and lifestyle modifications are effective in the treatment of borderline hypertension. One such lifestyle intervention is the use of medically supervised water-only fasting as a safe and effective means of normalizing BP and initiating health-promoting behavioral changes. METHODS: Sixty-eight (68) consecutive patients with borderline hypertension with systolic BP in excess of 119 mm Hg and diastolic BP less than 91 mm Hg were treated in an inpatient setting under medical supervision. The treatment program consisted of a short prefasting period (approximately 1-2 days on average) during which food consumption was limited to fruits and vegetables followed by medically supervised water-only fasting (approximately 13.6 days on average). Fasting was followed by a refeeding period (approximately 6.0 days on average). The refeeding program consisted of a low-fat, low-sodium, plant-based, vegan diet. RESULTS: Approximately 82% of the subjects achieved BP at or below 120/80 mm Hg by the end of the treatment program. The mean BP reduction was 20/7 mm Hg, with the greatest decrease being observed for subjects with the highest baseline BP. A linear regression of BP decrease against baseline BP showed that the estimated BP below which no further decrease would be expected was 96.0/67.0 mm Hg at the end of the fast and 99.2/67.3 mm Hg at the end of refeeding. These levels are in agreement with other estimates of the BP below which stroke events are eliminated, thus suggesting that these levels could be regarded as the "ideal" BP values. CONCLUSION: Medically supervised water-only fasting appears to be a safe and effective means of normalizing BP and may assist in motivating health-promoting diet and lifestyle changes.

Adult↗
PubMed1977

Medical supervision for contraception: too little or too much?

The need to provide medical supervision in contraceptive services is reviewed in the context of the situation existing in developing nations. The author contends that less rather than more medical supervision can be justified if one compares the relatively low incidence of complications from modern contraception with the inordinately high maternal death rates from pregnancy and its complications in these same countries.

Allied Health Personnel↗
PubMed1996

Safety of medically supervised exercise in a cardiac rehabilitation center.

Medically supervised exercise continues to have a low major cardiovascular complication rate. Direct gym supervision by a physician does not appear necessary for safety. The currently proposed cardiac rehabilitation risk stratification criteria do not appear to identify patients at risk for these major complications. The safety of exercise programs with less supervision and electrocardiographic telemetry monitoring is unknown.

Angina Pectoris↗
PubMed1977

Ventricular fibrillation in a medically supervised cardiac exercise program. Clinical, angiographic, and surgical correlations.

Five patients with ischemic heart disease were resuscitated after experiencing ventricular fibrillation in a medically supervised exercise program. Four subsequently had successful myocardial revascularization (three prior to hospital discharge), and three have returned to an exercise prescription of reduced intensity. Multivessel operative coronary disease is common in patients experiencing ventricular fibrillation. Ventricular fibrillation may occur unpredictably (two to 48 months) in duration of exercise. Exercise fitness centers for such patients should be medically supervised and equipped with a defibrillator and appropriate drugs.

Adult↗
PubMed2005

Prevalence and correlates of hepatitis C infection among users of North America's first medically supervised safer injection facility.

BACKGROUND: North America's first medically supervised safer injection facility (SIF) for illicit drug users was opened in Vancouver, Canada on 22 September 2003. We examined the prevalence and correlates of hepatitis C (HCV) infection among a representative cohort of SIF users. METHODS: Users of the Vancouver SIF were selected at random and asked to enrol in the Scientific Evaluation of Supervised Injecting (SEOSI) cohort. At baseline, venous blood samples were collected and an interviewer-administered questionnaire was performed. Participants who were HCV-positive were compared with HCV-negative subjects using bivariate and logistic regression analyses. RESULTS: Between 1 December 2003 and 30 July 2004, 691 participants were enrolled into the SEOSI cohort, among whom 605 (87.6%) were HCV-positive at baseline. Factors independently associated with HCV infection in logistic regression analyses included: involvement with the sex trade [adjusted odds ratio (AOR) 3.7, 95% confidence interval (CI) 2.1-6.1], history of borrowing syringes (AOR 1.8, 95%CI 1.1-2.9), and history of incarceration (AOR 2.6, 95%CI 1.5-4.4). Daily heroin use was protective against HCV infection (AOR 0.6, 95%CI 0.3-0.9). CONCLUSION: The SIF has attracted injection drug users with a high burden of HCV infection and a substantial proportion of uninfected individuals. Although cross-sectional, this study provides some insight into historical risks for HCV infection among this population, and prospective follow-up of this cohort will be useful to determine if use of the SIF is associated with reduced risk behaviour and HCV incidence.

Canada↗
PubMed1993

Comparison of medically supervised and unsupervised approaches to weight loss and control.

The rising incidence of obesity in the United States has given physicians an increased role in its treatment. Although unsupervised programs can produce significant weight losses, the lack of medical supervision increases the potential for health problems. As with other lifestyle changes (for example, smoking cessation and blood pressure control), even minimal physician involvement may enhance outcome. In published clinical trials, the absence of contact with health professionals among control group participants may account in part for their poor success at weight loss or for their weight gain. Smaller trials examining the value of physician advice and encouragement among dieting patients have shown promising results. Physicians should monitor the health of obese and overweight patients during and after weight loss as is appropriate for the patient, depending on caloric levels, rate of weight loss, weight-loss goals, and intercurrent health events. Medical supervision is necessary for patients on very-low-calorie diets, for severely obese patients (body mass index > 35), and for patients with other health problems.

Clinical Trials as Topic↗
PubMed2004

Rationale for evaluating North America's first medically supervised safer-injecting facility.

Many cities throughout the world are experiencing ongoing infectious disease and overdose epidemics among illicit injection drug users (IDUs). In particular, HIV and hepatitis C virus (HCV) have become endemic in many settings and bacterial infections, such as endocarditis, have become extremely common among this population. In an effort to reduce these public health concerns, in September 2003, Vancouver, Canada, opened a pilot medically supervised safer- injecting facility (SIF), where IDUs can inject pre-obtained illicit drugs under the supervision of medical staff. Before and since the facility's opening, there has been a substantial misunderstanding about the rationale for evaluating SIF as a public-health strategy. This article outlines the evidence and rationale in support of the Canadian initiative. This rationale involves limitations in conventionally applied drug-control efforts, and gaps in current public-health policies in controlling the spread of infectious diseases, and the incidence of overdose among IDUs.

British Columbia↗
PubMed1997

Roles of mental health professionals in multidisciplinary medically supervised treatment programs for obesity.

Excess weight is a major medical problem for more than one third of Americans and, after cigarette smoking, is the second largest cause of death. However, obesity treatments remain controversial, and only surgical therapies have patient volume and appropriate follow-up adequate to prove effectiveness. National Institutes of Health conferences on obesity treatments and the Institute of Medicine have suggested that all obesity treatment programs, including those which are medically supervised, should be multidisciplinary, involving professionals from the behavioral, nutritional, and exercise fields to facilitate delivery of a patient-treatment matching strategy. There are no models to suggest how these recommendations should be accomplished or whether they are financially feasible. We present a case management model that includes psychotherapists in a multidisciplinary obesity treatment program. More data are needed to show whether these suggestions improve cost-effectiveness of obesity treatments.

Behavior Therapy↗
PubMed2004

Methodology for evaluating Insite: Canada's first medically supervised safer injection facility for injection drug users.

Many Canadian cities are experiencing ongoing infectious disease and overdose epidemics among injection drug users (IDUs). In particular, Human Immunodeficiency Virus (HIV) and hepatitis C Virus (HCV) have become endemic in many settings and bacterial and viral infections, such as endocarditis and cellulitis, have become extremely common among this population. In an effort to reduce these public health concerns and the public order problems associated with public injection drug use, in September 2003, Vancouver, Canada opened a pilot medically supervised safer injecting facility (SIF), where IDUs can inject pre-obtained illicit drugs under the supervision of medical staff. The SIF was granted a legal exemption to operate on the condition that its impacts be rigorously evaluated. In order to ensure that the evaluation is appropriately open to scrutiny among the public health community, the present article was prepared to outline the methodology for evaluating the SIF and report on some preliminary observations. The evaluation is primarily structured around a prospective cohort of SIF users, that will examine risk behavior, blood-borne infection transmission, overdose, and health service use. These analyses will be augmented with process data from within the SIF, as well as survey's of local residents and qualitative interviews with users, staff, and key stakeholders, and standardised evaluations of public order changes. Preliminary observations suggest that the site has been successful in attracting IDUs into its programs and in turn helped to reduce public drug use. However, each of the indicators described above is the subject of a rigorous scientific evaluation that is attempting to quantify the overall impacts of the site and identify both benefits and potentially harmful consequences and it will take several years before the SIF's impacts can be appropriately examined.

Journal Article↗
PubMed2005

Safety of cardiac rehabilitation in a medically supervised, community-based program.

The time to occurrence of cardiovascular complications after the beginning of an exercise rehabilitation program is variable. It is not clear whether such complications are related to the duration in the program. The aim of the present study was to assess the timing of cardiovascular events occurring during the activity and the long-term safety of a medically supervised cardiac rehabilitation program performed in the community, in a large cohort. We retrospectively evaluated 3,511 patients with a history of myocardial infarction, coronary artery bypass grafting and risk factors for coronary artery disease, participating in exercise training, for 69 months. The total number of patient-hours was 338,688 with an event rate of 1/58,902 patient-hours/year (0.02%). Non-fatal events occurred in 11 patients and fatal cardiovascular events in 2 patients; 1 was successfully resuscitated. Most of the non-fatal events (62%) occurred during the first 4 weeks from the beginning of the exercise program. One third of the patients who experienced cardiovascular events, resumed the exercise program with no further complications. Medically supervised cardiac rehabilitation program is accompanied by a very low incidence of cardiovascular events. Nevertheless, special caution should be undertaken during the first sessions of the program.

Aged↗
PubMed2001

Medication supervision and adherence of persons with psychotic disorders in residential treatment settings: a pilot study.

BACKGROUND: Little is known about risk factors for and predictors of medication nonadherence within residential facilities. This pilot study examined the association between medication adherence and level of supervision and other environmental and clinical variables among patients with schizophrenia and related psychotic disorders living in supported housing. METHOD: A convenience sample of 74 adult residents with schizophrenia and related psychotic disorders (DSM-IV criteria) living in 4 supported housing facilities in New York City were assessed by their treating psychiatrist for medication cessation during the previous month. Demographic characteristics, medications, supervision, global function as measured by the Global Assessment of Functioning (GAF), and substance abuse were also assessed. A priori hypotheses were that regimen complexity would be directly and medication supervision would be inversely related to medication nonadherence. RESULTS: In multivariate models, lack of direct medication supervision, negative medication attitude, and lower GAF score were associated with increased medication nonadherence in the recent past. CONCLUSION: This pilot study suggests that direct supervision of medication is associated with better adherence in residential treatment settings. This finding is relevant for mental health service planners and clinicians working in these settings.

Adult↗
PubMed2002

[Piercing--a problem of medical supervision].

Piercing constitutes a medical problem due to infections originating from contamination at the penetration of the different tissues. Lack of clear guidelines adjusted to piercing activities interferes with the quality of supervision and makes it differ between municipalities. The National Board of Health and Welfare exercise the overall responsibilities for public health problems related to piercing. A training programme for persons performing piercing should be established in order to reduce the risk of infections.

Cosmetic Techniques↗