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PubMed1998

The impact of special programs for kidney transplantation of highly sensitized patients in Eurotransplant.

Highly immunized patients will continue to accumulate on the waiting list of many registries unless special allocation programs are introduced. In Eurotransplant such patients can benefit from 2 programs, the Acceptable Mismatch (AM) and the Highly Immunized Tray (HIT) programs. Kidney exchange is mandatory in these programs. In addition, highly immunized patients who do not participate in these programs profit from additional points in the allocation procedure (ET-HI). In the past 18 months the 3 programs have run in parallel. Here, we show that the AM and HIT programs are highly effective with respect to increasing the patient's chance of finding a crossmatch negative donor in an adequate time course. Furthermore, the transplantation results of AM and HIT are at least comparable to those of the ET-HI. The main gain at present seems to be the significantly shorter waiting time in the AM and HIT programs.

Europe↗

PubMed1993

Enrichment programs to create a pipeline to biomedical science careers.

The Student Educational Enrichment Programs at the Medical College of Georgia in the School of Medicine were created to increase underrepresented minorities in the pipeline to biomedical science careers. Eight-week summer programs are conducted for high school, research apprentice, and intermediate and advanced college students. There is a prematriculation program for accepted medical, dental, and graduate students. Between 1979 and 1990, 245 high school students attended 12 summer programs. Of these, 240 (98%) entered college 1 year later. In 1986, after eight programs, 162 (68%) high school participants graduated from college with a baccalaureate degree, and 127 responded to a follow-up survey. Sixty-two (49%) of the college graduates attended health science schools, and 23 (18%) of these matriculated to medical school. Of college students, 504 participated in 13 summer programs. Four hundred (79%) of these students responded to a questionnaire, which indicated that 348 (87%) of the 400 entered health science occupations and/or professional schools; 179 (45%) of these students matriculated to medical school. Minority students participating in enrichment programs have greater success in gaining acceptance to college and professional school. These data suggest that early enrichment initiatives increase the number of underrepresented minorities in the biomedical science pipeline.

Education, Premedical↗

PubMed1985

A university-based incentive program to increase safety belt use: Toward cost-effective institutionalization.

A cost-effective incentive program to increase safety belt use was implemented by the campus police of a large university. For each of the 3-week intervention periods during three consecutive academic quarters, the 22 campus police officers recorded the license plate numbers of vehicles with drivers wearing a shoulder belt. From these numbers, 10 raffle winners were drawn who received gift certificates donated by community merchants. Faculty and staff increased their belt usage markedly as a result of the "Seatbelt Sweepstakes," whereas students increased their belt use only slightly. A cost-effectiveness analysis indicated that the sweepstakes cost an average of $0.98 per each newly buckled driver. During each sweepstakes intervention, officers' belt usage increased significantly, but diminished to initial baseline levels after the final withdrawal of the program. Surveys of officers' opinions indicated that the police would accept the program demands as a regular task requirement. This result and the fact that program promotion and coordination were eventually taken over by two student organizations suggest that institutionalization of the "Seatbelt Sweepstakes" is feasible.

Journal Article↗

PubMed1983

Grade animals in Canadian dairy cattle improvement.

Grade dairy animals in Canada are an important resource in genetic evaluations of the populations. A program was established in 1972 to provide accurate identification of grade animals. This paper describes Canada's National Identification Program, its acceptance, and its procedures and use in Canada. National Identification Program has proven to be an excellent program to identify grade animals on milk recording programs in Canada.

Animals↗

PubMed2005

"Kids Choice" school lunch program increases children's fruit and vegetable acceptance.

The "Kids Choice" school lunch program used token reinforcement, food choice, and peer participation to increase children's fruit and vegetable consumption without later drops in food preference sometimes found in past research and often called 'overjustification effects.' Participants included 188 school children (92 boys, 96 girls; mean age = 8.0; 95% Caucasian). After four baseline meals, children were randomly assigned for 12 meals to receive token reinforcement for eating either fruits or vegetables. Observers recorded fruit and vegetable consumption and provided token reinforcement by punching holes into nametags each day children ate their assigned foods, then once a week children could trade these tokens for small prizes. Fruit and vegetable preference ratings were gathered with child interviews during baseline, and during follow-up conditions two weeks and seven months after the token reinforcement program. Consumption increased for fruit and for vegetables and the increases lasted throughout reinforcement conditions. Two weeks after the program, preference ratings showed increases for fruit and for vegetables. Seven months later, fruit and vegetable preferences had returned to baseline levels, suggesting the need for an ongoing school lunch program to keep preferences high, but also showing no signs of "overjustification effects" from the token reinforcement used in the "Kids Choice" school lunch program.

Child↗

PubMedDate not supplied

Effects of advance care education in cardiovascular rehabilitation programs: a prospective randomized study.

PURPOSE: To determine the effect of advance care education provided to patients enrolled in cardiovascular rehabilitation (CVR) programs and assess patients' acceptance of the educational program. METHODS: In a multicenter, prospective, randomized study, the authors administered two questionnaires 6 months apart to 284 patients enrolled in 14 CVR programs in 11 states. An educational group (99 subjects) participated in educational programs related to advance care planning and received advance directive forms after completing the first questionnaires; 185 subjects served as controls. Primary outcomes were completion of patient-physician discussions of end-of-life issues and patient confidence that their end-of-life wishes were understood by their physicians. Secondary outcomes were completion of formal advance directives and patient acceptance of the educational program. RESULTS: Both the educational and control groups demonstrated a larger proportion of patients at the end of the study, compared with the amount at the beginning of the study, who had completed living wills, durable powers of attorney for healthcare, and discussions with their physicians about advance directives and life support care. These outcomes were not observed more commonly after the educational intervention. Neither groups gained confidence, however, that their physicians understood their end-of-life wishes. Only 8.6% of patients had a negative response to the educational program. CONCLUSIONS: Advance care education is well received by patients enrolled in CVR programs. Enrollment in CVR promotes advance care planning to a small but measurable degree CVR rehabilitation programs appear to be acceptable sites for advance care planning but further research is needed to develop effective educational interventions.

Adult↗

PubMedDate not supplied

Feasibility and acceptability of a telephone psychotherapy program for depressed adults treated in primary care.

OBJECTIVE: Telephone psychotherapy is an emerging model of care that appears feasible for extending the reach of evidence-based psychotherapy treatment without accruing the full costs of traditional office-based, mental health care. This manuscript describes the development, implementation and acceptance of a 12-month telephone psychotherapy program (TPP) for depressed adults not fully responding to standard antidepressant treatment in primary care. METHOD: The TPP combined a population-based medication monitoring and information system with a structured cognitive-behavioral treatment (CBT) program. The TPP included 8-12 telephone sessions (eight core CBT sessions and three to four clinical booster sessions) delivered by a master-level therapist working in tandem with each patient's primary care physician (PCP). RESULTS: The TPP was well accepted (i.e., 80% completed the core program) by a population-based sample of adult primary care patients initiating antidepressant treatment. The mean duration of core telephone psychotherapy sessions was approximately 31 min during acute-phase treatment (0-6 months). Eighty-two percent of TPP patients maintained contact with their therapist during maintenance-phase treatment (6-12 months). CONCLUSIONS: The practical and efficient nature of this TPP appears to sidestep many of the treatment barriers encountered in traditional office-based care. Implementation of this TPP program in other primary care settings may be valuable for enhancing standard pharmacotherapy treatment of adult depression, especially among populations facing greater barriers of care.

Adult↗

PubMed2000

Incorporating critical care oncology nursing in a baccalaureate of science in nursing curriculum.

Undergraduate nursing curricula traditionally provide a superficial overview of oncology with only a passing mention of critical care oncology concepts. With an unprecedented nursing shortage predicted in the coming decade and acute care facilities likely to overflow with an elderly, chronically ill patient population, nursing education programs must strive to assure that nursing curriculum remains relevant in the face of these future challenges and changes in health care. Rather than require employers to provide the oncology education needed by the nursing staff during the orientation period, undergraduate nursing programs must accept the commitment to provide a stronger oncology and critical care nursing knowledge base in the basic nursing curriculum. This article describes how the baccalaureate degree nursing program at Houston Baptist University accepted this challenge and incorporated content on the management of oncologic emergencies within an existing critical care nursing course. Discussion of the development of the oncology content and the benefits of incorporating the content within a critical care nursing framework are also provided.

Attitude of Health Personnel↗

PubMed1980

Feasibility of maintaining normal glucose profiles in insulin-dependent pregnant diabetic women.

This study was designed to test the feasibility of a patient-monitored glucose determination program to establish and maintain normal blood glucose levels. Ten pregnant women, who were insulin-dependent diabetics prior to becoming pregnant and who were in their eighth week or less of pregnancy, were offered the program. All 10 accepted and continued the program for the duration of their pregnancy. Normal plasma glucose (60 to 140; mean = 80 mg/dl) levels were achieved after one week of the program and were maintained throughout the pregnancy as documented by 5 to 8 blood glucose determinations a day. The hemoglobin A1c level, which was elevated in all 10 patients at the start (9.4 +/- 1.6 per cent) of the program, fell into the normal range (2 to 5.0 per cent) five weeks after glucose values became normal. Serum estradiol (0.8 +/- 0.6 ng/ml), serum prolactin (10 +/- 9 ng/ml) and serum human chorionic gonadotropin (5,500 +/- 1,700 ng/ml), although all abnormal at the start of the program, became normal after glucose control was achieved (program weeks 4, 5 and 6, respectively). The infants showed no signs of macrosomnia (2,988 +/- 959 g), hypoglycemia, hyperbilirubinemia, hypocalcemia, erythremia or respiratory distress. Therefore, a program to maintain normal blood glucose levels during a diabetic patient's pregnancy is not only possible but may also improve the pregnancy and the outcome.

Adult↗

PubMed1992

Ten-year experience with an exercise-based outpatient life-style modification program in the treatment of diabetes mellitus.

Exercise is frequently recommended in the treatment of diabetes mellitus. Nevertheless, its use has been limited in clinical practice, and concerns about safety and efficacy persist. We have reviewed a 10-yr experience with 255 patients enrolled in a comprehensive diabetes program that emphasized physical training. A low maximal oxygen uptake (VO2max) was found in patients with non-insulin-dependent diabetes mellitus compared with sedentary control subjects. This was not accounted for by autonomic neuropathy and is unlikely to be due to subtle differences in life-style. Exercise-related proteinuria was common and occurred in 29% of patients and was associated with higher blood pressure levels at rest and during exercise, impaired VO2max, and decreased R-R interval variation. Regular exercise was associated with a modest decrease in resting and exercise blood pressure. Glycosylated hemoglobin levels and plasma triglycerides improved only in patients with non-insulin-dependent diabetes mellitus. Insulin requirements were significantly reduced in patients with insulin-dependent diabetes mellitus. Compliance for up to 3 mo in the program was acceptable but longer-term compliance was poor. Serious complications during the program were rare. Our experience suggests a program of regular aerobic training can be safely and effectively used in an outpatient population with diabetes mellitus for up to 3 mo.

Adult↗

PubMedDate not supplied

Treatment of homebound mentally ill elderly patients: the multidisciplinary psychiatric mobile team.

Authors evaluated the general feasibility of using a multidisciplinary psychiatric mobile team model for homebound elderly patients. Information was collected with a semistructured interview on 235 homebound elderly patient referrals over a 2.5-year period. Ninety-three subjects were accepted into the program; 12.9% of those accepted required psychiatric hospitalization during the follow-up. Maintaining individuals in the community was achieved with intense case management and significant increases in home-care hours. The multidisciplinary team approach appeared to lessen psychiatric disability in homebound mentally ill elderly patients.

Aged↗

PubMed1977

Practical mastitis control in the field.

Research has shown the effectiveness of teat dipping and medically treating all nonlactating cows to control mastitis. However, there is a problem of getting dairy-men to accept the program. Improved educational programs might be helpful. Some means of visual evaluation is essential to acceptance. Use of indirect tests for estimating cell content can be helpful in evaluating control efforts and in demonstrating results. More intense coordinated effort by professional persons advising dairy-men is necessary.

Animals↗

PubMed1998

The feasibility of a syringe-needle-exchange program in Vietnam.

Since the beginning of the HIV/AIDS epidemic, syringe-exchange programs have been established in a number of developed countries and have proven effective in reducing the transmission of HIV. Very few similar programs have been established in developing countries. This study reports on the feasibility of establishing a syringe-exchange program in Vietnam. Process data collected since the beginning of the program indicate the feasibility of establishing such a program as well as highlight a number of important issues. These issues are: 1) Acceptability of the program in the community which has been achieved through workshops with key community people including the local police; 2) training and recruitment of ex-user outreach workers; 3) the distribution of clean syringes and needles through outreach services rather than at established exchange sites; 4) the establishment of appropriate methods for the collection of used injection equipment. Further research is needed to examine the efficacy of the program in reducing risks and acceptability of the program in the larger society.

Adult↗

PubMed2002

Leadership Opportunities with Communities, the Medically Underserved, and Special Populations (LOCUS).

OBJECTIVES: The Leadership Opportunities with Communities, the Underserved, and Special Populations (LOCUS) Program aims to improve medical students' leadership knowledge and skills, to improve self-awareness and motivation for community service, and to provide models for students to integrate community service into their medical careers. DESCRIPTION: The LOCUS program was established as a longitudinal, extracurricular student opportunity at the University of Wisconsin Medical School in the fall of 1998. Up to 15 new students each year are selected for the program through an application and interview process during their first or second year of medical school. Students remain in the program from acceptance until graduation from medical school. Nearly 50 students have enrolled in the program to date. LOCUS fellows are matched with a physician mentor, participate in core curriculum activities, and complete a longitudinal community service project. Mentors are community generalist physicians who have integrated community service into their own careers. Students participate in their mentors' clinical practices one afternoon a month during the first two years, and mentors serve as role models and provide guidance for students' projects and career development. The program administration and staff are supported through federal predoctoral training and Area Health Education Centers (AHEC) grants. The LOCUS core curriculum is delivered through a series of retreats, workshops, and seminars that emphasize active learning methods and include approximately 20 hours of scheduled activities per academic year. The curriculum addresses concepts of leadership in relation to one's self and in relation to others. Students are introduced to methods of self-reflection and develop their own vision and mission statements. Students also discuss the importance of compassion, self-care, striving for balance, avoiding burnout, and being realistic about what they can accomplish. Students practice strategies for working with teams, organizing meetings, working with media, taking political action, and resolving conflicts. They acquire community health skills such as assessing the health needs of a defined population; engaging community members' participation in health program development; and selecting priorities, designing interventions, and measuring the progress of community health care. Working in small teams, LOCUS fellows apply and refine their leadership skills through design and completion of a community health service project. Students can design their own projects or work on projects designed by community partners. The projects have addressed a variety of community health needs, such as parenting support for teen mothers, teaching health education for residents of group homes, and providing free sports physical exams for uninsured youth. DISCUSSION: This pilot program demonstrates that motivated students can develop leadership skills and address unmet community health needs while they progress through medical school. LOCUS students, staff, and physicians provide a social network that includes opportunities, encouragement, reflection, and problem solving. Student and mentor satisfaction with the program has been high. Future challenges include securing long-term funding, refining the core curriculum, assessing the impact of the program on participants, and improving the quality of projects through community partnerships. LOCUS strives to kindle the fires of altruism and community service so they are not extinguished as students progress through medical training.

Community Health Services↗

PubMed1991

Serum ferritin and stool occult blood and colon cancer screening.

A group of 531 participants age 50 years or older were evaluated for colonic polyps and malignancy with stool occult blood testing, hemoglobin, hematocrit, serum ferritin, flexible fiberoptic sigmoidoscopy, and colonoscopy. Screening revealed 1 colorectal cancer, 2 malignant polyps, 30 hyperplastic polyps, 69 adenomatous polyps, 4 villous adenomas, and 2 villous components. Low serum ferritin, an indicator of iron deficiency without anemia, improved the detection of colonic malignancies and polyps when used in combination with stool occult blood testing. The program was acceptable to participants and attrition was low; the attrition rate for the screening program at 1 year was 14.5%.

Anemia↗

PubMedDate not supplied

Environmental agricultural tractor cab filter efficiency and field evaluation.

To evaluate filter efficiency and performance of environmental enclosures for tractors, 3- to 4-year-old tractor enclosure combinations (cabs retrofitted to tractors after manufacturing) were studied at a custom pesticide applicators facility. Optical particle counters were used to measure the aerosol number concentration inside and outside the cab. The ratio of these concentrations multiplied by 100 is termed percentage penetration, the amount of the aerosol that penetrates into the enclosure. For particles in the 0.3 to 0.4 microm range, penetration into the cab was reduced from 11 to 0.4% in the following sequential steps. First, manufacturing mistakes were corrected by fixing a bowed flange and inappropriate sealing of the sheet metal used to separate incoming air from air that had passed through the filter. This reduced aerosol penetration from 11 to 4.8%. Replacing gasket material on the used filter reduced penetration from 4.8 to 0.65%. This suggests that the filter gaskets are deforming and allowing leakage. Also, the filter media were evaluated for aerosol penetration as a function of particle size and were tested per the criteria stipulated in 42 CFR 84 for negative pressure air-purifying particulate respirators. These results showed penetration through the filter media of less than 0.03%, indicating that filter media were not a major source of aerosol leakage into the cab. The results suggest that the manufacturer should implement a quality control program to ensure that minimal aerosol penetration criteria into the cabs are met and an acceptable maintenance program exists to ensure compliance. Furthermore, the degradation of filter gasket material over time needs to be minimized to ensure that the environmental cabs continue to provide acceptable performance.

Agriculture↗

PubMed1985

A multi-hospital hepatitis B vaccine program: prevalence of antibody and acceptance of vaccination among high-risk hospital employees.

In July 1982, five Hartford hospitals embarked on a joint hospital-sponsored program to immunize high-risk employees against hepatitis B virus (HBV). The program included a questionnaire to characterize relative risk, serology for anti-HBs, vaccination and a follow-up survey of vaccine non-recipients. Of 2,065 employees who were considered to be at high-risk for infection with HBV, 1,894 (91.7%) responded to the screening questionnaire and 1,279 (67.5%) were tested for anti-HBs serology. The prevalence of antibody varied from hospital to hospital; the highest prevalence (10.9%) was observed at one of the urban university-affiliated community hospitals and the lowest prevalence (4.1%) was reported from the smaller, rural hospital. The prevalence of antibody also varied greatly within the high-risk groups; the highest prevalence of antibody was seen among surgical house officers (15%). The rate of acceptance of vaccine among hospitals ranged from 57.5% to 23.7%. Reasons for vaccine non-acceptance included fear of as yet unknown side effects, perceived low risk of hepatitis acquisition and possible effects on present or future pregnancies. Our experience illustrates some of the epidemiologic and practical aspects that must be addressed in administering a hospital-based HBV vaccine program. Among the five hospitals, we saw marked inter- and intra-hospital variations in the prevalence of anti-HBs among high-risk employees. More significantly, we observed unexpectedly low rates of vaccine acceptance among high-risk personnel.

Attitude of Health Personnel↗

PubMed2004

Programmed cell death is not a necessary prerequisite for fusion of the fetal mouse palate.

It has been widely accepted that programmed cell death (PCD) is an essential event in palatogenesis and that its failure can result in cleft palate, one of the most common birth defects in the human. However, some conflicting results have been reported concerning the timing of cell death occurring in the fusing palate and therefore the role of PCD in palatal fusion is controversial. In order to clarify whether cell death is indispensable for mammalian palatogenesis, we cultivated the palates of day-13 mouse fetuses in vitro and prevented cell death by treating them with the inhibitors of caspases-1 and -3 or with aurintricarboxylic acid which inhibits the activity of caspase-activated DNase. Even when cell death was almost completely inhibited, palatal fusion took place successfully. Histological examination revealed that in the absence of apoptotic cell death, the medial edge epithelia of opposing palatal shelves adhered to each other and subsequently, the midline epithelial seam was disrupted and disappeared to bring about mesenchymal confluence across the palate. It seems that cell death is not a necessary prerequisite for palatal fusion but it may help to efficiently eliminate unnecessary cells which failed to migrate or differentiate properly.

Animals↗