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Biomedical subjects

C Manfredi

Publications and source records attributed to C Manfredi.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Prescribe for health. Improving cancer screening in physician practices serving low-income and minority populations.

OBJECTIVE: To evaluate a health maintenance organization (HMO)-sponsored intervention to improve cancer screening in private physician practices serving low-income, minority populations. DESIGN: A randomized controlled trial with preintervention and postintervention measurements. Measurements were obtained by abstracting information from independent random samples of medical charts (N = 2316 at preintervention and 2238 at postintervention). SETTING: Forty-seven primary care physician practices located in low-income and minority urban neighborhoods in Chicago, Ill. INTERVENTION: Practices were encouraged to adopt an office chart reminder system and to use a patient health maintenance card. Activities to facilitate the adoption of these items and for compliance with cancer screening guidelines included on-site training and start-up assistance visits, a physician continuing medical education seminar, and quality assurance visits with feedback to physicians. MAIN OUTCOME MEASURES: The proportions of patients with a chart-documented mammogram, clinical breast examination, Papanicolaou smear, or fecal occult blood slide test in the 2 years before preintervention and postintervention chart abstractions. RESULTS: Between baseline and postintervention, there was a net increase in the proportion of HMO members in the intervention, compared with the control practices, who received in the preceding 2 years a Papanicolaou smear (11.9%) and a fecal occult blood slide test (14.1%). There was a net increase in the proportion of non-HMO patients in the intervention compared with the control practices who received a clinical breast examination (15.3%) and a fecal occult blood slide test (20.2%). CONCLUSIONS: Implementation of an HMO-mediated, multicomponent intervention to improve cancer screening was feasible and effective for the Papanicolaou smear, fecal occult blood slide test, and the clinical breast examination, but not for mammography.

Adult↗
PubMedDate not supplied

Measuring readiness and motivation to quit smoking among women in public health clinics.

We conducted a pilot test of an instrument to assess stage of readiness and level of motivation to change smoking behavior among 495 women smokers in public health clinics. The stages of readiness were based on those proposed by Prochaska and DiClemente but with finer discrimination within the precontemplation stage, where a substantial minority (41%) of the target smokers were situated. Subdividing this earliest group, we found that 8% of the total sample planned no change in smoking ever; 8% were seriously thinking of cutting down; and 25% were seriously thinking of quitting but not within 6 months. Scales in the questionnaire included general motivation to change smoking behavior and confidence in one's ability to do so. The women's scores differed on these scales and on action toward quitting across the five stages of readiness, except that the lowest two groups did not differ on confidence. Pregnancy enhanced readiness to quit. The instrument accommodates the brevity and low literacy requirements for use in these applied settings and is suitable for use in either self-administered questionnaire or interview format.

Adolescent↗
PubMedDate not supplied

Doctoral programs in nursing: philosophy, curricula, and program requirements.

This study examined the philosophy, curricula, and program requirements of doctoral nursing programs in the United States. Forty-four doctoral nursing programs were solicited by mail and information about doctoral nursing programs was obtained. Of the programs, 31 offer the doctor of philosophy degree, 11 the doctor of nursing science degree, and 1 the doctor of education degree. Program philosophies could not be distinguished from one another. Eighteen doctoral programs offered advanced clinical courses and 22 programs focused on role preparation; 16 offered both clinical and role preparation. There was much variation in credit requirements, but the standard program was 60 credits in length, with 48 credits in nursing and 12 credits in cognates and electives. Approximately half the required credits focused on research. The similarity in the curricula of doctoral programs is striking. Discipline-specific values may be strong and account for the congruence in the types of curricula found in this study. Continued focus on research preparation, with varying degrees of emphasis on clinical or role development, is expected. The dominance of the doctoral degree as the terminal degree for nursing is likely to continue.

Curriculum↗
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Measuring readiness and motivation to quit smoking among women in public health clinics: predictive validity.

We conducted an independent pilot test of the internal consistency, stability, and predictive validity of the instrument presented by Crittenden, Manfredi, Lacey, Warnecke, and Parsons (1994) using a two-wave panel of female smokers in 12 public health clinics. This instrument subdivides the precontemplation stage proposed by Prochaska and DiClemente into three more distinct stages: not contemplating quitting or cutting down, not contemplating quitting, and not contemplating quitting within 6 months. Findings confirm that the instrument is useful for evaluating movement toward quitting for populations that are largely concentrated in the precontemplative stage. The concurrent and predictive validity of the elaborated stages and the reliability and stability of smoking motivation and confidence indicate that the instrument is sensitive enough to track changes in readiness and motivation across the full readiness continuum.

Adult↗
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Noise reduction for vocal pathologies.

A noise reduction scheme, particularly suited for the correction of vocal pathologies, is proposed. The filter makes use of concepts originated within the theory of dynamical systems and deterministic chaos. In particular, the idea of embedding scalar data in order to reconstruct a phase space is of fundamental importance here. Furthermore, the concept of an attractor as a result of dynamical constraints is exploited. In order to perform noise reduction one needs redundancy and the human voice provides it even within a phoneme, namely the smallest structural unit of speech. Due to several repetitions of a pattern called pitch inside a phoneme, separation between the pure voice signal and the noise is possible, provided the latter is uncorrelated with the former. With a proper parameter tuning, different kinds of noise can be removed. We describe the idea behind the noise reduction algorithm and present applications to vocal pathologies.

Algorithms↗
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Developmental aspects of infant's cry melody and formants.

This paper deals with the analysis of cry melodies (time variations of the fundamental frequency) as well as vocal tract resonance frequencies (formants) from infant cry signals. The increase of complexity of cry melodies is a good indicator for neuro-muscular maturation as well as for the evaluation of pre-speech development. The variation of formant frequencies allows an estimation of articulatory activity during pre-speech vocalization. Subjects are three pairs of healthy identical twins (monocygozity determined by DNA-fingerprint). Spontaneous cries of these six children were recorded at different ages: 8th-9th week, 15th-17th week and 23rd-24th week. Analysis of 136 cry melodies and intensity contours was made using KAY-CSL 4300/MDVP. For formant estimation a spectral parametric technique was applied, which was based on autoregressive models (Digital spectral analysis with applications, 1987) whose order is adaptively estimated on subsequent signal frames by means of a new method (Med. Eng. Phys. 20 (1998) 432; Utras. Med. Biol. 21 (1995) 793). Cry melodies exhibited an increasing complexity during the observation period. Beginning with the second observation period (15th-17th week) an increasing coupling and tuning between melody and resonance frequencies was observed, which was interpreted as "intentional" articulatory activity. Possible applications are in cry diagnosis as well as in the evaluation of pre-speech development.

Crying↗
PubMedDate not supplied

Non-linear prediction for oesophageal voice analysis.

Herein, non-linear prediction methods are applied to oesophageal voice analysis. The research aims to investigate normal and pathological subjects, in order to improve knowledge of the oesophageal voice behaviour. Analysis is performed in the reconstructed phase space, using both non-linear prediction with local linear approximation and the S-Map method. Preliminary results seem to confirm that in normal subjects a non-linear stable deterministic behaviour takes place, while in pathological subjects the non-linear contribution reduces while the time series becomes unstable.

Adult↗
PubMedDate not supplied

Single-agent ifosfamide in the treatment of anthracycline-refractory adult sarcomas.

OBJECTIVE: The objective of this trial was to assess the therapeutic activity and toxicity of ifosfamide (IFO) with mesna uroprotection as salvage therapy in patients (pts) with soft tissue sarcomas (STS) who had failed high-dose epirubicin treatment. PATIENTS AND METHODS: IFO was administered at a dose of 2.0 g/m2 daily for 5 consecutive days by a 2-h i.v. infusion every 3 weeks. RESULTS: Partial responses were observed in 5/31 (16%) evaluable patients, whereas in other 5 pts the disease remained stable. The median duration of response was 8 months. The median overall survival was 6.5 months. The most common toxicity was hematologic with grade 3 or 4 neutropenia occurring in 47% of the pts. Neurologic toxicity was infrequent, but in 1 patient treatment discontinuation was needed because of severe mental confusion and disorientation. CONCLUSIONS: Although IFO can be of value in a minority of pts with anthracycline-refractory STS, more active agents and new salvage cytotoxic regimens should be investigated in this disease.

Adult↗
PubMedDate not supplied

[Gemcitabine in advanced stage soft tissue sarcoma: a phase II study].

PURPOSE: To assess the activity and toxicity of gemcitabine in locally advanced or metastatic soft tissue sarcoma patients (pts). PATIENTS AND METHODS: Gemcitabine was administered on days 1, 8, 15 every 4 weeks at a dose of 1.000/1.250 mg/m2, respectively, in pretreated or not pretreated pts. RESULTS: Eighteen pts entered this phase II trial; sixteen had been previously treated with anthracyclines and ifosfamide. A partial response was observed in a woman with fibrous malignant istocytoma, whereas in 7 pts the disease remained stable. Median time to progression was 4 months. The treatment was well tolerated. Grade 4 toxicity was not observed. CONCLUSIONS: These results do not suggest that gemcitabine, in the dose and schedule used in this trial, may be of value in the treatment of soft tissue sarcomas.

Antimetabolites, Antineoplastic↗