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At least 199 records · Page 11Linked to original sources

PubMed2002

Bioinformatics and reanalysis of subtracted expressed sequence tags from the human ciliary body: Identification of novel biological functions.

PURPOSE: The ciliary body is largely known for its major roles in the regulation of aqueous humor secretion, intraocular pressure, and accommodation of the lens. In this review article we applied bioinformatics to re-examine hundreds of expressed sequence tags (ESTs) previously isolated by subtractive hybridization from a human ciliary body library [1]. The DNA sequences of these clones have been recently added to the web site of NEIBank. METHODS: DNA sequence comparisons of subtracted ESTs were performed against all entries in the last available release of the non-redundant database containing GenBank, EMBL, DDBJ and PDB sequences using the BlastN program accessed through NCBI's BLAST services on the internet (NCBI). Sequences were also compared and mapped using the Blast search program provided through the Internet by the Human Genome Project (UCSC). RESULTS: A total number of 284 independent ESTs were classified in 17 functional groups. Analysis of their relationships allowed to define the expression of five major groups of known genes: (i) protein synthesis, folding, secretion and degradation (20%); (ii) energy supply and biosynthesis (12%); (iii) contractility and cytoskeleton structure (6%); (iv) cellular signaling and cell cycle regulation (7%); and (v) nerve cell related tasks (2%), including neuropeptide processing and putative non-visual phototransduction and circadian rhythm control. The largest group contain unidentified sequences, a total of 105 sequences, accounting for 37% of ESTs. The unidentified sequences show similarity to genomic non-coding regions, or genes of unknown function. CONCLUSIONS: The most highly represented EST, correspond to myocilin, a gene involved in glaucoma. The data also confirms the secretory functions of the ciliary epithelium, and its high metabolism; the presence of a neuroendocrine peptidergic system presumably involved in the regulation of the intraocular pressure and/or aqueous humor secretion. Additional genes may be related to a non-visual phototransduction cascade and/or to circadian rhythms. Overall this initial group of subtracted ESTs can lead to uncover novel physiological functions of the ciliary body in normal and in disease, as well as novel candidate genes for ocular diseases.

Ciliary Body↗

PubMed2005

Antiretroviral adherence in a resource-poor setting.

Adherence is key to successful antiretroviral therapy (ART). Many countries with increased HIV prevalence and the greatest need for ART have limited health resources. Recent assumptions that the adherence required for successful ART will not be achieved in resource-poor settings have led to calls for caution in expanded access programs. New studies from Africa refute this, showing excellent adherence and virologic outcomes. Major factors contributing to adherence or nonadherence are whether the drug is accessed for free or is self-funded, patient preparedness for use of ART, stigmatization related to being HIV-positive, and ease of use of regimen.

Africa↗

PubMed1998

Measuring the success of the Arkansas Health Care Access Foundation.

This report is an attempt to measure the effectiveness of the Health Care Access Program and to study the demographic elements of the patient population served. The study involved a two-pronged approach. By polling both physicians and patients regarding their experiences with AHCAF, we can form conclusions about its effectiveness. In addition, demographic information regarding patient make-up and physician participation in regional areas can serve as a resource for strategic management of the program.

Adult↗

PubMed1996

Multicultural maternal and child health outreach: Washington State strategies to assure access for Asian and Pacific Islander women and children.

This article outlines some of the barriers to health care experienced by Asian and Pacific Islander Communities. The authors then describe a number of strategies the Washington State Department of Health has used to reduce cultural and linguistic barriers to health care. As a state health agency, the Department has promoted accessible programs through mechanisms such as improved data collection, culturally competent staff, targeted outreach, and development of partnerships with community organizations and other agencies to promote culturally accessible health care delivery.

Adolescent↗

PubMed2001

The registered nurse as a first assistant: the "downunder" experience.

In 1996, Bernadette Brennan, RN, was awarded a fellowship from the Australian Confederation of Operating Room Nurses (now known as the Australian College of Operating Room Nurses Ltd.) to travel to the United States to study the role of the Advanced Nurse Practitioner, with an emphasis on the role of the registered nurse first assistant (RNFA). As part of this study, she undertook an RNFA course at Delaware County Community College. This article provides a description of her work to develop an educational program for RNFAs in Australia. Because of the size of the country and the many rural areas needing to be served, her challenge was to devise an accessible program that was also academically rigorous. Her trials as well as her triumphs are presented here.

Certification↗

PubMed2000

Client-case manager racial matching in a program for homeless persons with serious mental illness.

OBJECTIVE: This study evaluated the relationship between client-case manager racial matching and both service use and clinical outcomes in a case management program for homeless persons with serious mental illness. METHODS: The study focused on 1,785 clients from the first cohorts that entered the Center for Mental Health Services' Access to Community Care and Effective Services and Supports (ACCESS) program, a five-year demonstration program for homeless persons with mental illness established at 18 sites between 1994 and 1996. A series of two-way analyses of variance was used to assess the effect of client and case manager race and their interaction on changes in outcomes and service use over a 12-month period. RESULTS: Although African Americans had more severe problems on several measures and higher levels of service use at baseline, no differences in service use at 12 months or in the changes in client outcomes as measured by nine variables were associated with the different pairings of African-American and white clients and case managers. White clients had a greater reduction in psychotic symptoms than did African-American clients, regardless of client- case manager racial pairing. No differences were found between white and African-American clients on the amount of services received over time. CONCLUSIONS: This study found virtually no evidence of a relationship between client race, case manager race, or client-case manager racial matching on either outcomes or service use.

Black or African American↗

PubMedDate not supplied

RT-PCR comparative study of viral load levels in the HIV positive population in Puerto Rico before and after protease inhibitor regimen implanted.

Ponce School of Medicine AIDS Research Program conducted a large scale viral load assessment of Puerto Ricans who are infected by human immunodeficiency virus type 1 (HIV-1) during the summer of 1996 through the Roche ACCESS program before general implementation of combination therapy. Since January 1997, it has monitored those HIV-1 patients who are under treatments at most HIV-1 health care clinics, including both public and private. The present study was conducted to evaluate how the new treatment has generally impacted on the HIV-1 disease status of HIV-1 infected population in the eight Immunology Clinics. Assessment was made by consecutively monitoring the changes in HIV-1 viral load profiles of the population from January to September, 1997. A large majority of samples were delivered for viral load assessment without information of their treatment status, and only a small number of samples were identifiable either as baseline or followup. Despite the paucity of individual information, remarkable improvements of HIV-1 (+) population at large were evident. For example, in the summer of 1996 (ACCESS), population median viral load was 51,842; only 9% of the population had viral load less than 500 viral RNA copies/ml plasma and 72% had over 10,000 copies/ml. By July-September, 1997, the population median dropped to 8,679 (83%); 23% were below 500 copies/ml (+156%) and the proportion of patients who had over 10,000 copies/ml was reduced to 48% (-33%). The group of individuals who were positively identified as "follow-up" (i.e., under active treatment) had a median of 37128 copies/ml (-94%); 28% were below 500 copies/ml (+211%) and only 40% had more than 10,000 copies/ml (-44%). It is obvious that the implementation of triple combination therapy by PASET in 1997, has very markedly improve the HIV-1 disease status of HIV-1 (+) population in Puerto Rico.

HIV Infections↗

PubMed2000

Accessing patient assistance programs to meet clients' medication needs.

The high cost of medication is a barrier to patient compliance. Nurse practitioners can access patient assistance programs to assist low-income clients to obtain medications, empowering them to take action to improve their health. At Health Care Access, a primary care clinic serving low-income, uninsured persons, approximately $150,000 worth of medications were obtained through patient assistance programs in 1997, compared to the total clinic budget of $189,000. Processes for obtaining prescription drugs vary between pharmaceutical companies. An understanding of these types of programs provides nurse practitioners access to these resources for their clients.

Drug Costs↗

PubMed2002

Development and initial testing of a multimedia program for computer-assisted cognitive therapy.

A multimedia program for computer-assisted psychotherapy has been developed to help patients learn cognitive therapy skills. The program is designed to provide psychoeducation, teach self-help methods, and give information to clinicians on the patient's progress in using the software. Multimedia technology is utilized to engage users in the learning process and to make the program accessible for persons who do not have computer or keyboard skills. A preliminary study with 96 subjects who used the software along with treatment as usual found that 75 (78.1%) completed the entire program. Users indicated a high rate of acceptance of this form of computer-assisted therapy, and mean scores on a measure of cognitive therapy knowledge were significantly improved.

Adult↗

PubMed2006

The National Access to Antiretroviral Program for PHA (NAPHA) in Thailand.

To describe the development, components, initial results and lessons learned from Thailand's National Access to Antiretroviral Program for People living with HIV/AIDS (NAPHA), a historical review was conducted and program monitoring was analyzed. The national antiretroviral therapy program at different levels of the public health system was implemented with all major program components; ARV protocol development, health care professional training, drug supply chain management, laboratory network formation, monitoring and evaluation, and multi-sector and PHA involvement since 2001, which was based on elements of research, pilot projects, training, national guideline development, experiences and policy making. A national monitoring system was developed to monitor the progress of the program. From February 2001 to December 2004, the monitoring reports received from implementing hospitals showed that 58,133 cases had received antiretroviral therapy (ART), and 85% (49,477) of them were continuing to take ARV drugs. In conclusion, the NAPHA was implemented nationwide with comprehensive systems. The reports indicate achievement of expansion of the ART program. Lessons learned from the program initiation and scaling up show local leadership, comprehensive training, adherence, and coordination are essential to program effectiveness and sustainability.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Planning and implementing an anesthesia crisis resource management course for student nurse anesthetists.

Development of Anesthesia Crisis Resource Management (ACRM) skills is a highly desirable outcome of a nurse anesthesia educational program. Access to an ACRM course is limited by a variety of factors including cost, availability of a center, time constraints, and the lack of adequately prepared CRNA faculty. The authors describe a Nurse Anesthesia Program's planning and implementation of an ACRM course by using a high fidelity human simulator. Key supportive and logistical elements necessary to implement an ACRM course are described. The authors address administrative concerns, faculty preparation needs, and explain the process of course design. Strengths of the course and problems encountered during the implementation of the experience are described. Feedback from participating students, faculty perceptions, and lessons learned from the experience are shared.

Clinical Competence↗

PubMed1997

Service system performance and integration: a baseline profile of the ACCESS demonstration sites. Access to Community Care and Effective Services and Supports.

OBJECTIVE: Networks of agencies at the 18 demonstration sites in the Access to Community Care and Effective Services and Supports (ACCESS) program for homeless persons with serious mental illness were surveyed to profile baseline levels of systems performance and integration as part of a longitudinal evaluation of systems change and client outcomes. METHODS: Interviews were conducted with a representative from each of 875 agencies in the 18 service networks. Information was obtained about the perceived performance of the service system and the extent of systems integration as measured by client referrals, funds exchanges, and information sharing between agencies. Measures consisted of two multi-item scales assessing the accessibility and coordination of services for the target population in each community and four indexes of interagency relationships. RESULTS: Services at baseline for homeless mentally ill persons at the program sites were rated as relatively inaccessible, and the coordination of services between agencies was rated as even more problematic. Interagency ties were largely based on client referrals and information exchanges, with very few instances of funding transfers in the form of contracts or grants. On average, at baseline agencies that had received an ACCESS grant were better connected to their local service network than were other agencies. CONCLUSIONS: Consistent with the premise of the ACCESS demonstration, services for persons who are homeless and mentally ill in urban America are fragmented and not very accessible. The longitudinal design of the evaluation will allow for an assessment of efforts to improve services and systems integration and of the effects of these improvements on client outcomes.

Adult↗

PubMed1997

Client and site characteristics as barriers to service use by homeless persons with serious mental illness.

Clients entering the Access to Community Care and Effective Services and Supports (ACCESS) program for homeless mentally ill persons in 18 U.S. communities identified barriers to service use. The most frequent barrier was not knowing where to go for a service (encountered by 32.4 percent of the 1,828 clients). It was followed by not being able to afford it (29.5 percent); experiencing too much confusion, hassle, or waiting to obtain it (27.1 percent); and having been previously denied the service (16.5 percent). Differences in the program site (that is, the 18 communities) explained two to three times more of the variance in encountering barriers use than did individual client characteristics.

Adult↗

PubMed1996

Occupational safety & health administration. Building partnerships.

1. The Office of Occupational Health Nursing, within the Occupational Safety & Health Administration (OSHA), actively advocates for workers and occupational health nurses. 2. Although an enforcement agency by law, OSHA has and is in the process of building bridges to the regulated community through its cooperative development of programs intended to enhance employer efforts for improving and maintaining employee health and workplace safety. 3. OSHA's service of consultation is geared toward the small employer seeking assistance in the recognition and correction of workplace hazards, while improving worksite health and safety programs. Voluntary Protection Programs participation, the recognition of exemplary larger employers, often leads to improvements in employee safety motivation while improving product quality, worker productivity, and corporate profits. 4. OSHA produces a wealth of publications, pamphlets, audiovisual, computer access programs and other documents designed to ease compliance while providing a foundation to the understanding of workplace health and safety.

Humans↗

PubMed2006

Leveraging the benefits of Health Information Technology to support healthcare delivery model redesign.

Uninsured and low income underinsured patients create substantial challenges for local healthcare systems, yet their providers are not always included in community-wide implementations of health information technology. To address this deficit, prototypes of the recently proposed National Health Information Network must include providers who care for underserved populations. In 2003, a consortium of providers founded the Waterbury Health Access Program (WHAP) to implement an electronic medical record (EMR) system that would first address the needs of the region's vulnerable underserved patients. It was anticipated that lessons learned would be applicable to other patient populations as well. The WHAP consortium of competing hospitals and outpatient clinics developed a broad-based community-wide initiative to include implementing a common EMR system to share clinical information across all locations. The design includes 11 outpatient clinic locations linked to a common data-sharing tool that is accessible by each clinic, emergency department and community practitioner participating in a local, coordinated charity care program. The collaboration required to support community-wide implementations of health information technology also can be leveraged to facilitate additional quality improvement initiatives.

Ambulatory Care↗

PubMed2006

Setting up chronic disease programs: perspectives from Aboriginal Australia.

OBJECTIVE: To share some perspectives on setting up programs to improve management of hypertension, renal disease, and diabetes in high-risk populations, derived from experience in remote Australian Aboriginal settings. PRINCIPLES: Regular integrated checks for chronic disease and their risk factors and appropriate treatment are essential elements of regular adult health care. Programs should be run by local health workers, following algorithms for testing and treatment, with back up from nurses. Constant evaluation is essential. COMPONENTS: Theses include testing, treatment, education for individuals and communities, skills and career development for staff, ongoing evaluation, program modification, and advocacy. Target groups, elements, and frequency of testing, as well as the reagents and treatment modalities must be designed for local circumstances, which include disease burden and impact, competing priorities, and available resources. Pilot surveys or record reviews can define target groups and conditions. Opportunistic testing will suffice if people are seen with some regularity for other conditions; otherwise, systematic screening is needed, preferably embedded in primary care streams. The chief goal of treatment is to lower blood pressure, and if the patient is diabetic, to control hyperglycemia. Many people will need multiple drugs for many years. CHALLENGES: Challenges include lack of resources, competing demands of acute care, the burden of treatment when disease rates are high, problems with information systems, and in our setting, health worker absenteeism. FUNDING: Businesses, altruistic organizations, and pharmaceutical and biotechnology companies might fund feasibility studies. Where governments or insurance companies already support health services, they must ultimately commit to chronic disease services over the long- term. Effective advocacy requires the presentation of an integrated view of chronic disease and a single cross-disciplinary program for its containment. Arguments based on preserving the economic base of societies by preventing or delaying premature death will carry most weight, as will the costs of dialysis avoided in countries that already support open-access programs.

Adult↗

PubMed2006

Testing the potential for computational chemistry to quantify biophysical properties of the non-proteinaceous amino acids.

Although most proteins of most living organisms are constructed from the same set of 20 amino acids, all indications are that this standard alphabet represents a mere subset of what was available to life during early evolution. However, we currently lack an appropriate quantitative framework with which to test the qualitative hypotheses that have been offered to date as explanations for nature's "choices." Specifically, although many indices have been developed to describe the 20 standard amino acids, few or no comparable data extend to prebiotically plausible alternatives because of the costly and time-consuming bench experiments that would be required. Computational chemistry (specifically quantitative structure property relationship methods) offers a potentially fast, cost-effective remedy for this knowledge gap by predicting such molecular properties in silico. Thus, we investigated the use of various freely accessible programs to predict three key amino acid properties (hydrophobicity, charge, and size). We assessed the accuracy of these predictions by comparisons with experimentally determined counterparts for appropriate test data sets. In light of these results, and factors of software accessibility and transparency, we suggest a method for further computational assessments of prebiotically plausible amino acids. The results serve as a starting point for future quantitative analysis of amino acid alphabet evolution.

Amino Acids↗

PubMed1994

Expanded distribution of an investigational drug in parallel with ongoing controlled clinical trials: the didanosine model.

The purpose of the didanosine Expanded Access Program was to provide a needed antiretroviral agent to individuals who were unable to tolerate other therapy for human immunodeficiency virus infection or in whom such therapy was failing. The logistics of establishing this program are described, and the results of on-site auditing that confirmed the validity of the data obtained through this program are presented.

Didanosine↗