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PubMedDate not supplied

Exercise prescription when the guidelines do not work.

Because the current medical environment encourages a more conservative approach to resource use, "clinically unnecessary" exercise tests are being scrutinized and refused. This article's intent is not to debate the appropriateness of exercise tests for prescription purposes or suggest that programs should accept patients who have not been tested. These decisions are institutional specific. The intent is only to suggest an approach for those programs who feel it is safe and appropriate to accept patients who have not had an entry exercise test.

Exercise Test↗
PubMed1991

Factors related to medical school application and acceptance in minority summer enrichment program students.

Baylor College of Medicine has conducted a summer enrichment program for minority/disadvantaged premedical students since 1969. Follow-up data on medical school application and acceptance for participants from 1980 through 1984 were analyzed in relation to selected preprogram variables--cumulative college grade point average, total Scholastic Aptitude Test score, competitiveness of undergraduate college, sex, and ethnicity. Results of univariate and multivariate analyses indicated that: 1) females were significantly less likely to apply to medical school than males, 2) females had significantly lower mean MCAT scores (5.9 vs 7.2) even though their preprogram academic performance was comparable to that of the males, and 3) after controlling for MCAT scores, none of the preprogram variables were significant in predicting medical school acceptance. These findings suggest the need for research to explain the discrepancy between male and female MCAT performance and frequency of medical school application in summer program participants. The findings also have implications for the type of counseling provided to female participants in summer enrichment programs.

College Admission Test↗
PubMed1986

Computer applications in thermoregulatory research.

Thermoregulatory information is a frequently used parameter in both physiological and psychophysiological research. Specific software programs using accepted formulae are not readily available to the scientist as is the hardware. The program described here uses the well-established physiological model by Burton, calculating mean skin temperature and mean body temperature. The primary goal of this microsoft Basic program is to aid the researcher through speed of execution and quantitative reliability. A few command alterations will allow this program to be used with most microcomputer systems currently available. The time saved using this program will greatly enhance the efficiency of the researcher's thermoregulatory data analyses.

Body Temperature↗
PubMed1983

Calculator programs to deal with non-steady state, multiple dosage regimen clinical pharmacokinetics.

Serum drug levels have become a useful tool in the optimization of dosage requirements for several therapeutically important drugs. In the acute care situation the interpretation of these levels is complicated by multiple dosage regimens and inadequate time to achieve steady-state serum drug levels. Mathematical equations describing first order single compartment pharmacokinetics have been compiled. An alpha-numeric programmable calculator has been programmed to accept information regarding up to seven different serial dosage regimens. The calculator is also programmed to predict concentrations at any time during a complex set of dosage regimens or peak, trough, and average concentrations given a maintenance dosage regimen. Examples are given to demonstrate the usefulness of the programs in the clinical setting.

Aged↗
PubMed2006

How will the introduction of primary certificate training programs change vascular surgery training programs?

New requirements for vascular surgery training allow several routes to Board eligibility in the specialty. Individuals can enter vascular residency directly from medical school, after 3 years of surgical residency, or after completion of the traditional 5 years of surgery training. Vascular surgery program directors will be faced with the challenges of obtaining institutional support, designing an acceptable educational program, and working closely with the general surgery program director to ensure both programs are successful. Faculty in the vascular program may find working with residents right out of medical school or after only 3 years of surgery training to be a challenge, especially in terms of developing the requisite technical skills. Residents must be able to demonstrate mastery of the six competencies in addition to the skills of vascular surgery. Because, in some ways, this new vascular training scheme is an experiment in redesigning all surgical education, the vascular community will need to carefully evaluate the results by monitoring the practices of those who graduate from these programs.

Accreditation↗
PubMedDate not supplied

Evaluation of a HACCP pilot program for the food service industry.

OBJECTIVE: To evaluate the efficacy and applicability of a HACCP-based program for use in restaurants. PARTICIPANTS: A randomly selected sample of 16 intervention and 42 control full service, "stand-alone" restaurants with a minimum of 3 full-time food handling staff on duty per shift. SETTING: Six communities in Central West Ontario. INTERVENTION: The Critical Approach, a HACCP-based program for use in restaurants, was designed in consultation with health inspectors and restaurant operators. It focusses on generic risk factors (Critical Control Points, CCPs) for food handlers rather than assessing specific menu items or foods; offers appropriate training of both management and staff; and encourages self-monitoring of CCPs by operators without extensive record keeping or retention. OUTCOMES: Outcome indicators measured changes in three areas: the environment, knowledge, and behaviour. CONCLUSION: Results suggest that among a subpopulation of restaurants, the program is acceptable to operators and capable of producing tangible results. Principles and methods of the program (i.e., an initial assessment of the site, working with the operator to identify and suggest improvements, and return visits to monitor compliance) may be transferable to other types of food service operations.

Food Contamination↗
PubMed1987

The role of exercise therapy in patients with impaired ventricular function and chronic heart failure.

Physical training as a part of a comprehensive cardiac care program is accepted as an effective therapeutic modality. The physiological and psychological benefits of such a program have definitely been demonstrated in selected patients with coronary artery disease, but there is still some doubt about the influence of exercise therapy on morbidity and mortality. Recently, exercise training has also been instituted as part of the therapeutic regimen of groups of coronary patients who have impaired cardiac function or who suffer from chronic heart failure. If patients have been selected properly, taking into account absolute and relative contraindications, no deteriorating effect as a consequence of training has been observed in a follow-up period of 14 months. In some selected patients, an increased ejection fraction was found during the training. The results of our preliminary studies are reported and discussed, as is a special training method based on arm ergometry and applied to patients with impaired ventricular function. Clinicians are often concerned with the quality of life of their patients who have chronic cardiac conditions. In our experience, exercise therapy has beneficial effects on various psychological factors and determinants of the "quality of survival" in these patients. It still remains to be demonstrated whether a prolonged and effective exercise therapy can preserve or maintain patterns of an adaptive mechanism to exercise in patients with left ventricular dysfunction or chronic heart failure, or both.

Chronic Disease↗
PubMed1982

PCS-I--a point counting stereology program for cell biology.

PCS-I is a versatile BASIC program designed to collect and process stereological point counting data from electron micrographs of cells. The program can accept the point counts from three sources: (i) a set of user-definable keys programmed as counters; (ii) a numeric pad that enters counts line by line; and (iii) a data tape cartridge. The program calls for all the information needed to solve stereological equations and then helps the user to interpret the suitability of the sample size by drawing error curves. The coefficients of the stereological equations and the output headings can be readily modified to accommodate a new set of experimental parameters, which gives a substantial amount of flexibility to the program. PCS-I is easy to use and offers a practical solution to the problem of data management for biological stereology.

Cell Biology↗
PubMed1995

Client interests in premarital counseling: a further analysis.

A survey was conducted of over 150 college students concerning their attitudes toward premarital preparation. In general, the students valued brief, high-quality, low-cost, voluntary programs led by well-trained clergy or mental health professionals. However, females, students with more supportive family backgrounds, and religious students were more willing to participate in longer-than-average programs. Students with more supportive family backgrounds were also willing to pay more for such programs and to participate earlier in their relationship's development and were more willing to accept mandatory programs. Religious students were more interested in those led by clergy and less interested in those led by mental health or social workers. Female students were more interested in in-depth programs that focus on awareness and skill-building.

Adolescent↗
PubMed2002

Application of a falls prevention program for older people to primary health care practice.

BACKGROUND: Our research group has established the effectiveness of an individually tailored home exercise program to prevent falls and fall injuries in older people in four controlled trials. In one of these trials we evaluated the applicability of the exercise program to routine primary health care practice and the feasibility of nurses implementing the program. METHODS: People aged 80 years and older, registered with general practices in three exercise (n = 330 participants) and four control centers (n = 120 participants) in New Zealand, were invited to take part by their doctor. We investigated program reach, uptake, and compliance. We carried out physical assessments at baseline and after 1 year to assess the impact of the program. RESULTS: Most (85%) doctors agreed to take part and they approved 71% of patients to undertake the exercise program. Overall 47% of people invited agreed to participate and 70% of the exercise participants remained exercising at 1 year. Balance score and chair stand time improved by a similar amount in each exercise center compared with the control centers. CONCLUSIONS: This falls prevention program is acceptable to older people and their doctors. Nurses trained by a physiotherapist can deliver the home exercise program effectively in routine primary health care practice.

Accidental Falls↗
PubMed1989

Giving credit where money is due. How to get a charge out of patients.

It took a while, but hospitals are finally catching on to what major retailers discovered more than 30 years ago: Americans love to charge. When presented with a bill for socks at Bloomingdale's or lunch at Lutece, they pull out the plastic. Now, many can do roughly the same thing when presented with a hospital bill for treatment of a herniated disk. To shore up financial reserves, reduce bad debt, and increase cash flow, hospitals are turning to revolving consumer credit plans to help patients pay the self-pay portions of their hospital bills. Consumers like it because it gives them an affordable monthly payment over a long term, a good credit report reference, and a means to satisfy the self-pay obligation in a dignified, responsible way. And it seems to be working. A study of a 43-hospital chain that used a revolving charge plan for patients for a 23-month period showed that finance charges to patients more than covered the cost of the program; bad debts for receivables financed were cut to 29 percent, a 44.2 percent reduction; and consumers accepted the program because it was familiar, legal, binding, and, most important, affordable.

Accounting↗
PubMed1996

Acceptance of moderate drinking by alcoholism treatment services in Canada.

OBJECTIVE: The present study was conducted to provide a nationwide survey of acceptance of nonabstinence goals and related alcoholism treatment practices by Canadian alcoholism treatment services. METHOD: A random sample of 335 Canadian alcoholism treatment service agencies were mailed a 4-page questionnaire designed to assess acceptance of moderate drinking as a drinking goal and related alcoholism treatment practices. RESULTS: Acceptance varied by type of service, with considerably more acceptance by outpatient programs (62%) and mixed inpatient/outpatient programs (43%) than inpatient/detoxification/ correctional facilities (27%) and halfway houses (16%). Two-thirds of the respondents who reported moderate drinking as unacceptable in their own agencies categorically rejected moderation for all alcoholism clients. CONCLUSIONS: Individuals seeking services in Canadian alcoholism treatment agencies are more likely to have a choice of drinking goals if they present to an outpatient program than a residential institution, and Canadian agencies appear more accepting of moderation goals than American programs, but less accepting than British and Norwegian service agencies.

Alcohol Drinking↗
PubMed1998

[R. N. Braun diagnostic programs: what prevents the general practitioner from using them? Results of a 1-year-study of indications, acceptance and failure to apply diagnostic programs].

In General Practice, a global measure for quality control has not yet been established. Procedures in this field of health care are usually not evidence based but rely on personal experience. In 1976, the "Diagnostic Protocols" (DP) had been introduced by Robert N. Braun to cover the most frequent and most important uncharacteristic complaints presented to the General Practitioner by the patient. In this study, the authors are showing how often the usage of DP may be useful in the management of cases in General Practice. Additionally, reasons are demonstrated that may lead the Family Physician not to apply DP in certain cases. In 2,084 new cases presented to a General Practitioner within one year (1-12/1994), 19 of 82 existing protocols were used. In every sixth new case (16%), the patient's history and physical examination were analyzed with the help of Diagnostic Protocols. However, their usage would have been beneficial in one of four cases (24.6%). Reasons for declining DP included "No need for further diagnostic investigation" and "Other diagnostic strategy chosen". Shortness of time only played a minor role.

Attitude of Health Personnel↗
PubMed1994

The Italian fight against world hunger. A critical analysis of Italian aid for development in the 1980s.

During the 1980s, Italy expanded its development assistance, soon becoming the fifth largest donor. Italian development cooperation directed much effort to alleviate hunger, malnutrition and their health consequences. This paper provides an evaluation of Italy's fight against world hunger considering the political environment in which the policy was conceived and implemented, the organizational structure behind the policy, and the available quantitative indicators of outcome. The analysis shows how powerful humanitarian drives, supported by inchoate thinking about development problems and priorities, and by institutional and technical confusion, gave rise to development programs below accepted standards. Poor financial planning and the absence of proper mechanisms for project appraisal facilitated the capture of some programs by domestic political and commercial interests. In 1992, Italian magistrates began investigations into the extent of corruption in development assistance; preliminary reports documented widespread waste and ineffectiveness in major aid projects. Substantial changes in organization and priorities are needed in order to control past practices of corruption, improve the effectiveness of projects, and redirect Italian aid towards development goals.

Efficiency, Organizational↗
PubMed1998

Learning at the computer: evaluation of an intelligent tutoring system.

The aim of the study was to test the efficacy of a new courseware. In a pre and post test frame, students were given the software to be used during one semester. A significant increase in the students' general study motivation was shown at the end of the semester. A change in the use and attitudes towards computers could not be observed. In a follow-up survey at the end of the semester, the students stated that the program was indeed helpful and useful but that they have had difficulties with the program's technical aspects and the general use. Furthermore, the results show that the majority of the participating students accepted the program's content, the general study motivation was high and the students showed a significant increase in learning gains, determined by the differences from pre and post test values. Especially students with low pre test values seemed to profit from the additional use of learning material, resp. the presented courseware. At the end of the semester the students with low and middle pre test results showed an increase in performance as well as an alignment in the performance for diagnosing rheumatological diseases to the students of the upper third pre test results.

Cardiology↗
PubMedDate not supplied

The health interview: automated assessment in a multidisciplinary outpatient hypertension treatment program.

We studied patients' acceptance of a computer-administered health assessment and educational program at an outpatient hypertension clinic. The program was designed to be user-friendly and minimized the need for keyboard skills. Thirty patients > or = 50 years of age participated. The computer assessment took an average of 39 minutes to complete. Completion time was related to age but not to other demographic factors such as sex, education, or previous computer use. The program was well accepted by patients. Its personalized risk-factor summary and life style advice were particularly well received. We conclude that automated history-taking and educational programs can be used in this health care setting.

Aged↗
PubMed1987

Kappa Delta Award paper. Osteoregulatory nature of mechanical stimuli: function as a determinant for adaptive remodeling in bone.

The capacity for functional adaptation within the skeleton was studied using the functionally isolated turkey ulna preparation. The results of this study would suggest that adaptive bone remodeling is extremely sensitive to alterations in both the magnitude and distribution of the strain generated within the bone tissue. At present, it appears that a loading regime can only influence bone remodeling when it is dynamic in nature. The full osteogenic potential of its influence is then achieved after only an extremely short exposure to this stimulus. The potency of the stimulus appears to be proportional to the magnitude of the strain engendered. As strain levels that are acceptable in one location induce adaptive remodeling in others, it would appear that each region of each bone is "genetically programmed" to accept a particular amount and pattern of intermittent strain as "normal." Deviation from this "optimal strain environment" will stimulate changes in the bone's remodeling balance, resulting in adaptive increases or decreases in its mass.

Adaptation, Physiological↗