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At least 343 records · Page 19Linked to original sources

PubMed2005

Knowledge, perceptions, and attitudes of advanced practice nursing students regarding medical genetics.

PURPOSE: To describe the current medical genetic knowledge and perceptions of graduate advanced practice nursing (advanced practice nurse [APN]/nurse practitioner and nurse anesthetist) students using survey data for future integration of genetic topics, principles, and healthcare issues into curriculum. DATA SOURCES: Survey data of APNs' perceived knowledge of genetics and a review of the literature from past research studies of students and current articles from professional journals and organizations. Web sites were those of the National Coalition of Health Professions for Education in Genetics and National Institutes of Health, Human Genome Research Institute; professional organizations; and the authors' professional, clinical, and educational experiences. CONCLUSIONS: Most APN students perceived they had minimum knowledge and prior training regarding medical genetics. There is a need to integrate genetic concepts, principles, and medical conditions into advanced practice nursing curriculum and to provide clinical experiences in genetic conditions across the life span and throughout the health and illness spectrum. APN students have positive attitudes toward integrating genetics into graduate curricula. Potential methods for program integration include readings, small group discussion, standardized patients, and role-play as measures to increase information. IMPLICATIONS FOR PRACTICE: The National Coalition for Health Profession Education in Genetics, the American Nursing Association, and the American College of Nursing Education have recommended integration of genetics knowledge and skills into routine health care to provide effective interventions for individuals and families. However, previous research and data from this study have revealed that many nurses have minimal training in genetics. Advanced practice nurses must be knowledgeable on genetic principles, topics, and the ethical, legal, and social implications related to medical genetics to increase the ability to diagnose, prevent, and treat diseases and to provide effective care for individuals and families.

Adult↗

PubMed2004

Strengthening community-based programming for juvenile sexual offenders: key concepts and paradigm shifts.

The past decade has been witness to a sharp increase in residential placement of adjudicated delinquent youth, including juvenile sexual offenders. It is argued that this trend has fiscal implications and may be clinically contraindicated for less characterologically disturbed and dangerous youth. The authors advocate greater investment of public funds in the development and refinement of community-based intervention programs. It is believed that clinically and legally integrated programming, using newer social-ecological methodologies and supports, offers promise of reducing the number of youth who require residential placement, shortening residential lengths of stay and improving the transition of residentially treated youth back into community settings. Key concepts relevant to bolstering community-based programming for juvenile sexual offenders are identified and discussed. Two programs are described, and program evaluation data reviewed, in support of the viability of innovative community-based approaches to the management of this population.

Community Mental Health Services↗

PubMed1998

Health care programs: fraud and abuse; revised OIG exclusion authorities resulting from Public Law 104-191; correction--Office of Inspector General (OIG). HHS. Final rule; correcting amendment.

This document contains corrections to the final regulations which were published in the Federal Register of Wednesday, September 2, 1998 (63 FR 46676). The regulations addressed revisions to the OIG's administrative sanction authorities resulting from the Health Insurance Portability and Accountability Act of 1996, along with technical and conforming changes to the OIG exclusion authorities. A number of inadvertent errors appeared in the text of the regulations relating to program integrity for the Medicare and State health care programs. As a result, we are making corrections to two sections addressing the length of exclusion and notice of intent to exclude in order to assure the technical correctness of these regulations.

Fraud↗

PubMed2004

Evolution of the postabortion care program in Nepal: the contribution of a national Safe Motherhood Project.

The objective of this review is to present the findings and lessons learned over the first 4 years (1999-2002) of implementation of postabortion care (PAC) services outside of major urban centers in Nepal, where a significant proportion of services are provided by nurses. The contributions made by a national Safe Motherhood project to the establishment of the National Postabortion Care Program including the promotion of nurse providers within an integrated program of emergency obstetric care services are highlighted. Clinical competency assessments and service utilization data from three district hospital-based postabortion service sites supported by the Nepal Safer Motherhood Project are analyzed. The relationship between the findings of this assessment and two previous assessments, one covering two districts and one nationwide, are discussed. This review found that nurses are at least as competent as physicians in providing postabortion care services. The inclusion of postabortion care into the emergency treatment of obstetric complications provided the environment needed for successful introduction of nurse-led PAC services. Competency-based training of nurse providers is the key to making life-saving postabortion care services accessible and affordable in Nepal. Ensuring that these nurse providers are able to implement services requires strategic planning, careful advocacy and support from physician colleagues as well as the presence of adequate infrastructure and equipment. The successful introduction of postabortion care services into three district hospitals also offering emergency obstetric care provides an example of how a nurse-led service can be integrated into an emergency obstetric care support project. The project's learning has influenced national policy on the expansion of the postabortion care program throughout Nepal.

Abortion, Induced↗

PubMed1987

PEDA: a microcomputer program for parameter estimation and dosage adjustment in clinical practice.

PEDA, an integrated program in BASIC for implementation on microcomputers, has been developed for use in clinical practice to assist dosage adjustment for individual patients. A parameter optimization for individual patients is based on the principle of Bayes' theory and Maximum Likelihood Estimation, and utilizes a prior information on the distribution of population pharmacokinetic parameters, means and variances, as well as serum drug concentrations. The program can accommodate a one-compartment open linear model and a non-linear model at steady state (Michaelis-Menten model) and handle both uniform and non-uniform multiple dosage regimens mostly arising from clinical settings. Clinical examples which demonstrate the ability and the flexibility of the program are provided. The program may also be used as an aid for instruction in clinical pharmacokinetics.

Adult↗

PubMed2002

Informatics training in pathology residency programs.

Information management is crucial in pathology, and previous reports have stressed the needfor improved informatics training in pathology residency programs. We surveyed 150 US programs to assess informatics training with respect to types of training, proficiency expectations, and computing infrastructure. Seventy-two programs (48.0%) responded. Of the respondents, 67 (93%) reported offering informatics training; of these, 52 (78%) required it. Most programs integrated informatics into another rotation, usually management. In 37 programs (55%), the amount of informatics training has increased during the last 3 to 5 years. The most common instructional methods were hands-on training and self-study; 61 programs (91%) used multiple methods. In all but 2 programs, computers were designated for residents; 9 programs offered individual computers to residents. All programs provided productivity software. These data suggest progress in informatics training but that considerable room for improvement exists. Our data also document for the first time detailed computing resources available to residents.

Internet↗

PubMedDate not supplied

Educating students with mild disabilities in general education classrooms: Minnesota alternatives.

This article reports two major data collection efforts conducted during successive years. Study 1 examined the relationship between the school effectiveness variables identified in the Minnesota Educational Effectiveness Project (MEEP), and the attitudes and achievement of students in 31 MEEP schools. Study 2, which focused on 11 of the Study 1 schools, compared the instructional programs provided to students with mild disabilities in three integrated programs in these 11 schools, with those provided by conventional resource "pull-out" programs in three other schools. We not only contrasted program characteristics, but analyzed differences between program characteristics and cognitive and affective outcomes. Results do not provide a strong basis for concluding that general efforts at school improvement will provide the framework for improved outcomes among low-achieving students.

Achievement↗

PubMed1992

Moving Out Services for Education and Support (MOSES): a model program for individuals with spinal cord injury.

A comprehensive educational, social, and community integrated program for individuals with spinal cord injury (SCI) was established at Mount Sinai Medical Center. The need for this program was evident from patients' responses to mailed questionnaires and staff's direct observations of the difficulties encountered by SCI patients when they left the hospital's protected environment and began to cope with living in their communities. The program, Moving Out Services for Education and Support (MOSES), provides relevant information and support to individuals with spinal cord injury as they make the transition from patient to community member. The goal of the program is to foster independence and initiative and to develop leadership skills which enhance successful community reintegration. This article describes the program development, content and training requirements for implementation of these services.

Activities of Daily Living↗

PubMed2000

Behavioral medicine in medical education: report of a survey.

Behavioral medicine has become increasingly important in medical education over the past two decades, but adoption of its principles and methods has been slow. Behavioral medicine stresses the effects of human behavior on health and illness using a biopsychosocial approach. It also focuses on the use of the doctor-patient relationship, which, if developed using appropriate communication skills, can result in greater patient satisfaction and increased compliance. The authors surveyed all 124 American medical schools to assess both national trends and specific efforts in the teaching of behavioral medicine principles and methods. A review of the types of behavioral medicine programs offered reveals that eight percent of U.S. medical schools had integrated programs of behavioral medicine. Several successful and effective programs were identified, as were a number of specific curricular components. There are several options available to medical schools to integrate behavioral medicine into medical education. The authors conclude that medical education must include behavioral medicine in order to improve the health of the public and to meet the demands of a changing health care system.

Behavioral Medicine↗

PubMedDate not supplied

Policy issues for learning disability computer integration.

With the current expansion and development of educational computing in public and private schools across the country, policy issues for computer integration can be extremely important for educators. In the present article, research on a 3-year computer integration program at a private school for students with learning disabilities is used to illustrate integration issues. Problems and limitations in the computer program, ranging from lack of direction, support, and leadership from the administration to the lack of funds for maintenance or development, are identified and discussed. Policies and implications for the future of educational computing for students with learning disabilities as well as for private schools are examined.

Adolescent↗

PubMed1986

Patterns of otolaryngologic surgery utilization in Syracuse, NY.

Utilization of otolaryngologic surgical procedures performed in Syracuse, NY, during 1983 and 1984 was evaluated. Both inpatient and outpatient procedures were included; classification was according to diagnosis related groups. The system-wide portion of the analysis demonstrated that 62.5% of otolaryngologic operations carried out during the study were performed in outpatient settings. Total utilization was highest for myringotomies, tonsillectomies, and adenoidectomies, over 80% of which were performed on an outpatient basis. The program-specific portion of the analysis indicated that the highest volumes for these procedures were produced by a free-standing ambulatory surgery program with dedicated facilities and staff. However, a hospital-integrated program, which made use of inpatient resources, also served a majority of total hospital cases for several types of procedures.

Adenoidectomy↗

PubMedDate not supplied

A combined community strategy to reduce cholesterol and other risk factors.

Our primary objective was to conduct an integrated program to reduce coronary risk factors in the population of an Israeli kibbutz. The population-based objective was to reduce the mean community total cholesterol level. The individual-based objective was to provide counseling and treatment for individuals at high risk and to reduce individual total and low-density lipoprotein cholesterol levels. The intervention included food policy changes in the central kibbutz kitchen, health education programs aimed at all age groups, and health counseling for individuals at risk. Evaluation was by questionnaire at baseline and at the end of two years, blood lipoproteins, and monitoring of all food purchased by the kibbutz. Fifty-three percent of the adult population (100 of 187) had borderline to high baseline total cholesterol levels. At one year, 27% of these were in the normal category. Egg consumption dropped by 6%, liquid oil by 7%, and red meat by close to 19%. Consumption of fish, chicken meat, and vegetarian patties increased. Consumption of 1% milk increased by almost 300%. We conclude that an integrated health education program targeting individuals and the community together can be effective in reducing risk factors for coronary artery disease.

Adult↗

PubMed1986

Clinical oral medicine. An exciting facet of postdoctoral periodontic training.

This paper briefly reviews the historical relationship between oral medicine and periodontics. The reasons for including structured clinical oral medicine in a postdoctoral program in periodontics are discussed. Problems and solutions to such an integrated program are outlined. Guidelines for broadening the base of the field of periodontics by expanding the specialty more vigorously into the area of clinical oral medicine are provided.

Curriculum↗

PubMed2003

Breaks in continuity of care and the rural senior transferred for medical care under regionalisation.

Continuity of care, defined as the patient experiencing coherent care over time and place, is challenged when a rural senior with multiple medical problems is transferred to a regional hospital for acute care. From an illustrative case of an older patient with pneumonia and atrial fibrillation, we catalogue potential breaks in continuity of care. Optimal continuity of care is characterised not only by regular contact with the providers who establish collaboration with patients and their caregivers, but also by communication, co-ordination, contingency, convenience, and consistency. Because it is not possible to have the same providers continuously available (relational continuity), for continuity of care, there is a need for integrative system approaches, such as: (1) policy and standards, disease management programs, integrated clinical pathways (management continuity), (2) electronic health information systems and telecommunications technology (communication continuity). The evaluation of these approaches requires measures that account for the multi-faceted nature of continuity of care.

Journal Article↗

PubMedDate not supplied

The benefits and challenges of a fitness and lifestyle enhancement program for correctional officers.

This paper documents the benefits and difficulties encountered in the development of an on-site exercise and lifestyle enhancement program for correctional officers. 25 male correctional officers participated in a 6.5-week strength and aerobic training program integrated with penitentiary duties. 21 officers were available for retesting. The program was associated with decreases in body weight, skinfold thickness, cholesterol levels and increases in HDL-cholesterol, chest girth, strength scores and muscular endurance. Resting heart rates and systolic blood pressures were reduced but there was no significant change in maximal oxygen consumption. Furthermore, there were favourable changes in smoking and alcohol consumption, sleeping patterns, nutritional habits and tolerance of stress. These results are probably typical of what can be expected from a program of this type. We conclude that a brief at-work exercise and health enhancement program can exert positive but modest influences on the fitness, health and lifestyle of correctional officers, without undermining security of the institution. However, if this type of program is to achieve beneficial effects on health and fitness, a number of difficulties must be addressed.

Adult↗

PubMed1987

Modeling: a method for program development.

Successful program development is crucial for nursing. The methodology of modeling systematically integrates program development strategies recommended in the nursing literature. In addition to guiding program planning and design, the series of diagrams which modeling generates can be used to guide program implementation, evaluation, refinement, and reformulation. The diagramming also facilitates communication with others about the program.

Health Services Needs and Demand↗

PubMedDate not supplied

[Evaluation of a supervision program of health centers at the district level in Madagascar].

Poor supervision and follow-up have long been recognized as major weaknesses in the development of primary health care in many countries. A program has therefore been specifically developed to strengthen the supervision activities of 18 rural health centers in Madagascar. District health officers were appropriately trained and then conducted two-monthly supervision visits. The emphasis of the training program was on problem solving, program integration and on-site training. The effects of the supervision program was assessed quantitatively and objectively. Various activities of each health center were scored before intervention, and one year after implementation of the supervision program. The improvement in most health centers was substantial, both in quantitative coverage and qualitative practice. Nevertheless, some centers appear to have been resistant to change.

Diarrhea↗

PubMed2004

Low back pain: an economic assessment in the United States.

Although it is clear that LBP imposes a grave economic cost on society, the lack of consensus on causes and appropriate treatments makes it difficult to develop explicit guidelines and best practices. To gain a greater understanding of the economic impact of the condition and to reduce the unnecessary procedures that patients undergo, a series of cost-effectiveness analyses on established treatment options and on proposed integrated programs of prevention, treatment, and counseling, would be not only informative but integral to the progress of LBP disease management.

Cost of Illness↗