Biomedical subjects

J T Fullerton

Publications and source records attributed to J T Fullerton.

At least 19 recordsLinked to original sources

PubMed2001

Promoting screening and early detection of cancer in men.

Gender is a factor in the risk assessment for many diseases. It may also impact on the way in which men assess their personal health or illness status and take action to prevent illness or promote well-being. This paper is focused on three objectives: (i) to foster an understanding of gender differences in health promoting behaviors; (ii) to review three health issues affecting males for which dissemination of health education, increased personal awareness and early detection may be beneficial in the reduction of morbidity and mortality; and (iii) to offer suggestions for nurses and other health care professionals to promote positive patient-provider interactions within a health-care framework for action.

Attitude to Health↗

PubMed2001

Effective strategies that enhance adherence to breast cancer screening guidelines.

Mammography has long been recognized as the most effective cancer screening modality. Nevertheless, substantial numbers of women either do not utilize mammography or do not do so in compliance with recommended screening guidelines. A substantial body of literature has been published that discusses strategies likely to be effective in increasing mammography screening. Health care provider recommendation for a mammogram is the single most effective intervention. This paper reviews the more recent literature to highlight a selection of the additional strategies that are most likely to be effective among all women, and among women of various vulnerable cultural and population subgroups. African American, Hispanic, Pacific Asian, and Native American communities are included in the discussion. The paper also addresses other communities with special needs, such as those who are lesbians, elderly, low users of health services, and those who are physically or mentally challenged.

Journal Article↗

PubMed1999

The measurement of stress in pregnancy.

Stress is thought to be one of the biopsychosocial factors that contribute to adverse pregnancy outcomes, such as preterm labor and low birthweight. Identification of these factors (as in total number), and measurement of their individually perceived importance (severity) could lead to opportunities for intervention, and improved pregnancy outcome. A pilot study of the Daily Hassles Scale, was conducted in order to determine the appropriateness of its use among pregnant women. Daily hassles were thought to be a valid proxy for prenatal stress. Content and construct validity were determined among a sample of four content experts and 30 pregnant women. The Daily Hassles Scale proved to be a reliable (internally consistent) measure of stress (alpha reliability coefficient of 0.90). Further adaptation of the scale to include hassles specific to pregnancy and further testing of its usefulness among diverse multicultural and ethnic populations is warranted.

Activities of Daily Living↗

PubMed1999

Surgery during pregnancy.

The anatomic and physiologic changes of pregnancy complicate a woman's response to elective or emergency surgical intervention. Alterations related to perioperative positioning, fluid volume replacement, effects of medicinal and anesthetic agents, and maternal/fetal assessment are discussed. Emotional and ethical/legal concerns are considered. A postoperative assessment guideline is presented.

Female↗

PubMed1998

Incorporating electronic-based and computer-based strategies: graduate nursing courses in administration.

The use of electronic technology allows faculty to improve their course offerings. Four graduate courses in nursing administration were contemporized to incorporate fundamental computer-based skills that would be expected of graduates in the work setting. Principles of adult learning offered a philosophical foundation that guided course development and revision. Course delivery strategies included computer-assisted instructional modules, e-mail interactive discussion groups, and use of the electronic classroom. Classroom seminar discussions and two-way interactive video conferencing focused on group resolution of problems derived from employment settings and assigned readings. Using these electronic technologies, a variety of courses can be revised to accommodate the learners' needs.

Computer Literacy↗

PubMed1997

Breast cancer among men: raising awareness for primary prevention.

The American Cancer Society estimated that in 1993 1,000 new cases of male breast cancer would be diagnosed in the United States and 300 men would die from the disease. The clinical picture of breast cancer among men resembles that seen in women, and the development of the disease among men has been attributed to similar hormonal and genetic causes. The mortality rate from breast cancer is also similar, when corrected for chronological age and stage of the disease at the time of diagnosis and treatment. Guidelines for patient education, health screening, and patient support are presented.

Breast Neoplasms, Male↗

PubMed1996

Maternity care for Hispanic women who cross to the United States side of the Mexico border.

Medical chart abstracts and interviews were conducted among 587 Hispanic women within the first 72 hours following childbirth in any of five hospitals in San Diego County in 1991-1992. Demographic and maternal/infant obstetrical outcome data from 83 women who admitted that they had crossed the US/ Mexico Border to receive reproductive health services were compared with data from women who did not cross the Border. Border crossers were younger, less conversant in English, and more financially vulnerable. Several barriers existed for women in both groups that prevented entering and remaining within prenatal care programmes. Outcome data were favorable despite these adverse risk factors.

Adolescent↗

PubMed1995

Vaginal bleeding in pregnancy.

The process of identifying and evaluating the common causes of vaginal bleeding during pregnancy changes as the pregnancy progresses to term. The most common identifiable causes of vaginal bleeding during early pregnancy include spontaneous abortion and ectopic pregnancy. Pelvic ultrasound and quantitative beta-human chorionic gonadotropin measurements are used in the evaluation of early-stage bleeding in pregnancy. During the middle and late stages of pregnancy, placental abnormalities become important in the differential diagnosis of vaginal bleeding. Placenta previa classically presents as painless bleeding and is evaluated with ultrasound. Patients with placental abruption may present with abdominal pain and bleeding. As pregnancy progresses to term, bloody show must be considered as a common source of bleeding. Vaginal and cervical lesions can cause vaginal bleeding in any stage of pregnancy.

Female↗

PubMed1995

Advancing the status of nursing in Egypt: the project to promote the development of the High Institutes of Nursing.

This paper discusses the successes and the challenges of a 3-year project to improve the image and status of nursing in Egypt. Several strategies were developed and tested. These activities focused on transforming nurse-training and the nursing role to the status of professional education and practice. These activities have a broad applicability for other countries engaged in similar efforts. Successful interventions included the following: (1) A board composed of health professionals, health policy-makers, and the nursing trade union was established, providing opportunity for interprofessional dialogue; (2) criteria that would enable the High Institutes of Nursing (HINs) to quality for university faculty status were identified; (3) HINs shared their resources in order to enable lesser developed HINs to strengthen their academic curricula, initiate graduate degree programs and provide for faculty development; (4) a set of standards for nursing clinical practice was developed; and (5) Demonstration Clinical Units were established as model settings for improving nursing clinical skills. Project trajectories that remain to be accomplished include final development and promulgation of a set of nursing standards, development of a nursing organization that can speak for professional as well as trade issues and upgrading the educational pathway to the nursing profession.

Education, Nursing↗

PubMed1995

Attitudes of beginning medical students toward older persons: a five-campus study. The University of California Academic Geriatric Resource Program Student Survey Research Group.

OBJECTIVE: To examine the attitudes of beginning medical students toward older persons and their medical care. DESIGN: Cross-sectional survey. SETTING: Five University of California medical schools. PARTICIPANTS: Beginning medical school students from the Class of 1994. MEASUREMENTS: Demographic characteristics, personal contacts with older persons, and previous coursework or research experience with older persons were assessed. Knowledge with regard to aging was measured with a group of 10 questions, which were modified from the Facts on Aging Quiz. The attitudes of students toward older persons were assessed using the Aging Semantic Differential (ASD), the Maxwell-Sullivan Attitude Scale (MSAS), and two case scenarios. RESULTS: Ninety-two percent of the participants (554 of 603) responded; 93% of these responses were usable. Students were much less likely to admit an acutely ill 85-year-old woman to an intensive care unit, intubate her, and treat her aggressively than they were to treat an acutely ill 10-year-old girl with underlying chronic leukemia. In multivariate models, male gender and younger student age were both independently predictive of less favorable attitudes regarding a 70-year-old person on the ASD Instrumental-Ineffective subscale. Asian-Americans and males had less favorable attitudes on the Autonomous-Dependent and the Personal Acceptability-Unacceptability subscales. More knowledge with regard to aging was predictive of more favorable attitudes on the Autonomous-Dependent and Personal Acceptability-Unacceptability subscales. Male gender and Asian-American ethnicity were significantly associated with less favorable attitudes on the two scales derived from the MSASs. Students who had previously visited a long-term care facility were more likely to disagree that it takes too much time to care for older persons. CONCLUSION: Beginning medical students have already formed some unfavorable attitudes about older persons. Few independent predictors (either sociodemographic or students' previous experiences) of student attitudes could be identified that would help in the selection of students who had more favorable attitudes toward older persons. Hence, attempts to generate physicians with good attitudes must rely on curricular efforts during medical school and residency training.

Adult↗

PubMed1994

Task analysis in education and evaluation: an application among midwives in the Republic of Yemen.

The political union between the countries of North and South Yemen prompted nurse-midwife educators to re-examine the midwifery curricula of both countries and define the roles midwives play as members of the health team, based on the unique circumstance in which Yemeni midwives operate within the health care system. The faculty of the Health and Manpower Institute (HMI), the main educational institution for the education of midwives, recognised that the delineation of tasks attributed to the practice of midwifery varied widely within Yemen, and between Yemen and other countries, despite the existing international definition of the role. In 1992, the Agency for International Development (AID) funded a workshop for the HMI faculty. Nineteen midwives, nurses and other health care professionals used task analysis techniques to define key knowledge, skills and attitudes that a midwife should be taught in Yemen. Task analysis, a psychometric (test development) technique, is a process that can be used to develop specific role delineations. This article describes in detail the process of task analysis in identifying key skills, knowledge and attitudes to be taught to student midwives in Yemen, clarifying the role of midwives and identifying the usefulness of a derived task listing in educational development and student evaluations.

Curriculum↗

PubMed1993

A community strategic planning process for elder services.

Dynamic changes in population, patient demographics, and healthcare financing mechanisms create shifting service priorities. Strategic planning has become a vitally important skill for nurse executives, who must extend their efforts and influence beyond traditional agency boundaries. The authors present an application of the strategic planning process as it was used to develop recommendations for eldercare services in one southwestern, urban community.

Adult↗

PubMed1992

Scoring and setting pass/fail standards for an essay certification examination in nurse-midwifery.

Examination for certification or licensure of health professionals (credentialing) in the United States is almost exclusively of the multiple choice format. The certification examination for entry into the practice of the profession of nurse-midwifery has, however, used a modified essay format throughout its twenty-year history. The examination has recently undergone a revision in the method for score interpretation and for pass/fail decision-making. The revised method, described in this paper, has important implications for all health professional credentialing agencies which use modified essay, oral or practical methods of competency assessment. This paper describes criterion-referenced scoring, the process of constructing the essay items, the methods for assuring validity and reliability for the examination, and the manner of standard setting. In addition, two alternative methods for increasing the validity of the pass/fail decision are evaluated, and the rationale for decision-making about marginal candidates is described.

Certification↗

PubMed1992

The level and focus of geriatric nursing content in ADN and BSN programs.

The didactic and clinical focus of geriatric curriculum content within both associate (ADN) and baccalaureate (BSN) schools of nursing in California was reviewed. Geriatric nursing content experts confirmed the detail of a geriatric nursing curriculum, then determined which of the content items were basic to both educational levels, and which might be appropriately deferred to programs of baccalaureate preparation. Nurse educators may use the results of this study to guide curriculum development in both depth and breadth of content.

California↗

PubMed1991

Nurse-midwifery services in one multi-ethnic, underserved community.

Through a nurse-midwifery service in a mixed urban and rural agricultural community, we compared maternal risk factors, prenatal care, labor and delivery, and adverse birth outcomes in low-income Mexican-American Hispanic, white (Caucasian), and Southeast Asian women--a three-way analysis rarely reported in the literature. Southeast Asian women were older and had more children. Hispanic women bore children at a younger age. Both Southeast Asians and Hispanics made fewer prenatal visits than did Caucasian women, and used less analgesia and anesthesia during delivery. The incidence of Cesarean section (7.7 percent) and low birthweight (5.9 percent) was compared to local, state, and national reference statistics. Prospective case-controlled studies and cost/benefit analyses of nurse-midwifery services could yield more definitive information. But until more precise data are collected for birth certificates, these studies will be difficult.

Adolescent↗

PubMed1990

Effect of normal MSAFP screening on maternal age for genetic amniocentesis.

Routine maternal serum alpha-fetoprotein (MSAFP) screening for neural tube defects is considered by many to be standard obstetrical care, and recently many have encouraged this test to screen for Trisomy-21 (Down's syndrome). We questioned whether, after a normal MSAFP screen, the risk of Trisomy-21 decreases enough to warrant modifying the recommended age for genetic amniocentesis for Down's syndrome. A logistic regression was developed which, using reported values for sensitivity and specificity for MSAFP detection of Trisomy-21 and assuming a constant threshold risk in opting for amniocentesis, indicates that genetic amniocentesis for Trisomy-21 may be deferred in some women who have a normal MSAFP screening. Sensitivity analysis of varying thresholds for a normal MSAFP demonstrates that a 37 year old woman with a median MSAFP level has the same risk for Trisomy-21 as an unscreened women who is 4.5 years younger. An abnormal MSAFP is useful in screening for neural tube defects and possibly for Trisomy-21. A normal MSAFP may allow for delaying the potentially risky amniocentesis in otherwise low-risk pregnancies.

Adult↗

PubMed1990

Methodological problems in the assessment of nurse-midwifery practice.

Through a review of the past 30 years' literature that addresses the structure, process, and outcomes of nurse-midwifery care, the limitations inherent to the study of nurse-midwifery are identified. The need for a prospective study that represents the diversity of nurse-midwifery practice patterns and incorporates an appropriate control group is acknowledged. Difficulties inherent in the design and statistical analysis of such a study are discussed.

Humans↗

PubMed1989

Provision of comprehensive perinatal services through rural outreach: a model program.

A university-based program of perinatal care was extended to serve a spectrum of underserved populations through both urban and rural outreach. The program centered on the use of a multidisciplinary health care team comprised of a physician, nurse-midwife, health educator, social worker, nutritionist, pediatric nurse-practitioner, and patient case manager for health service delivery. It emphasized a decentralized service model with central referral and management of high-risk problems. The program has become a model for perinatal access and is reflected in current state legislation. The implementation of this program in four geographically rural communities is presented. Selected indices of perinatal outcome are presented, with San Diego County, CA, and national statistics as comparisons.

California↗