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Acceptance of physical therapist assistant course work by programs preparing physical therapists.

I developed and sent a questionnaire to the directors of entry-level physical therapy programs to determine if course work taken in an associate degree program could be credited toward requirements leading to a higher degree or certificate in physical therapy. I sent 86 questionnaires; 45 were returned. Results of the survey revealed that basic science courses taken by the physical therapist assistant (PTA) students are more likely to be credited (up to half of the respondents replied positively) toward a higher degree or certificate than are technical courses like therapeutic exercise, fundamentals of physical therapy, or physical modalities. Moreover, as many as 79 percent of the respondents reported that PTAs would not be granted transfer credit for their technical courses. Of those respondents whose programs do give credit for the technical courses, the courses are usually considered as elective hours. Although the concept of upward mobility appears to remain viable in the educational philosophy of the American Physical Therapy Association, students who view the associate degree program as an entry point into a physical therapy program must be aware of the problems of acceptance of PTA credits in an entry-level physical therapy program.

Allied Health Personnel↗

Substance abuse and intimate partner violence: treatment considerations.

Given the increased use of marital- and family-based treatments as part of treatment for alcoholism and other drug disorders, providers are increasingly faced with the challenge of addressing intimate partner violence among their patients and their intimate partners. Yet, effective options for clinicians who confront this issue are extremely limited. While the typical response of providers is to refer these cases to some form of batterers' treatment, three fundamental concerns make this strategy problematic: (1) most of the agencies that provide batterers' treatment only accept individuals who are legally mandated to complete their programs; (2) among programs that do accept nonmandated patients, most substance-abusing patients do not accept such referrals or drop out early in the treatment process; and (3) available evidence suggests these programs may not be effective in reducing intimate partner violence. Given these very significant concerns with the current referral approach, coupled with the high incidence of IPV among individuals entering substance abuse treatment, providers need to develop strategies for addressing IPV that can be incorporated and integrated into their base intervention packages.

Comorbidity↗

Wingecarribee Health Service model for transitional care.

The Wingecarribee Health Service (WHS) has developed a program of ambulatory care different from the commonly accepted models. The program provides a "whole service" approach to care, with integration of hospital, allied health and community services in partnership with other key stakeholders such as general practitioners (GPs) and non-government organisations (NGOs). It departs from the medical model and embraces the health service's commitment to a wellness approach to care. The program is focused on providing the most appropriate care, in the most appropriate location by the most appropriate provider.

Ambulatory Care↗

Training, utilization and motivation of pharmacy technicians--a five-year analysis.

A 600-hour-on-the-job training program for hospital pharmacy technicians is described. Qualified applicants who successfully pass a written examination are admitted to the program. Trainees receive both didactic and practical experience in all service areas of the pharmacy department. Opportunity for advancement through a technician specialist training program is available. Eighty percent of all applicant accepted into the program graduated, and 39% are currently employed by the pharmacy department with an average of 42 months work experience each. It is recommended that national guidelines are established for hospital-based pharmacy technician training program.

Education, Pharmacy↗

Reflections on the three-year program.

Dental education has twice altered curriculum length from four- to three-year programs. The first switch from four to three years came during World War II to meet the need for additional dentists, but schools rapidly returned to four-year programs after the war. During the early 1970s, 14 dental schools converted to three-year programs; however, by 1976 several of these schools had returned to the four-year programs. At the New Jersey Dental School, one of the first schools to adopt a three-year program in 1970, a return to a four-year program in 1977 was the result of poor acceptance of the program by the faculty, a lack of flexibility in the schedule, and an undiminishing negative attitude by the profession toward the graduates. The experience derived from the three-year curriculum has reenforced the need for designing variable length programs, because a significant number of students can successfully complete the traditional program in three years.

Attitude↗

The use and acceptability of a one-on-one peer support program for Australian women with early breast cancer.

A population-based survey of Australian women diagnosed with early breast cancer examined the uptake and acceptability of a peer support program, the Breast Cancer Support Service (BCSS). We examined the characteristics and perceptions of women who did and did not use the BCSS. More than one-third (36%) had used the BCSS, most of whom first heard of it from hospital staff (36%) or clinicians (16%). Women perceived meeting someone else with similar experiences (53%) as the most beneficial aspect of the program and 89% said they would definitely recommend it to others. The findings suggest that uptake is related to provision of information about the BCSS. Peer support programs appear to be acceptable to both women who do and do not use the BCSS. To ensure that women can choose whether to participate in peer support programs requires strategies that encourage health professionals to provide comprehensive supportive care information.

Adult↗

Promotion of healthy weights at preschool public health vaccination clinics in Calgary: an obesity surveillance program.

OBJECTIVE: To evaluate the acceptability and feasibility of a surveillance program of overweight and obesity in preschool children in Calgary, and to provide advice for families to promote healthy weights. PARTICIPANTS AND SETTING: Children (mean age 4.9+/-0.6 years) attending pilot-site clinics in September 2002 and all clinics in Calgary between February 2003-December 2003 (n=7048). INTERVENTION: The growth assessment protocol and resources supported a three-pronged approach to promote healthy weights (healthy eating, active living and positive body image). Public health nurses were trained in standardized measurement techniques and information resources. Links with physicians were made to facilitate continuity of care. Children's weight and height measurements were plotted on the Weight-for-Stature growth chart and used to identify children as obese (> or =95th percentile), healthy weight (> or =5th, <95th) or underweight (<5th). Subsequent analysis calculated the Body Mass Index (BMI)-for-Age to identify overweight children (> or =85th, <95th percentile). The protocol was pilot tested and subsequently implemented in all Calgary public health clinics. OUTCOMES: The majority (98%) of parents were either very happy or happy with information received during the visit. Public health nurse counselling confidence significantly improved after the pilot (p<0.001). Data indicated that 9% of children were obese, 15% were overweight and 3% were underweight. INTERPRETATION: This approach to identifying children's weight status appeared satisfactory to stakeholders, maximized use of existing resources to establish a surveillance program for Calgary, and provided an opportunity to give parents health-promoting advice on healthy weights.

Alberta↗

Social implications of behavioral interventions for persons with mental retardation.

The influence of type of behavioral program and program outcome on university students' perceptions of a hypothetical 17-year-old boy with mental retardation who exhibited severe self-injury was examined. A positive program was viewed as more acceptable and effective than were other programs (extremely aversive, mildly aversive, positive combined with extremely aversive, and control). Successful programs were also judged more acceptable and effective than were unsuccessful ones. When a program succeeded the individual was also seen as more likable, competent, adjusted, capable of learning, responsible, and problem-free. These preliminary findings point to the merits of considering the individual's social image in evaluating treatment acceptability.

Adult↗

Recent trends in psychiatry residency workforce with special reference to international medical graduates.

OBJECTIVE: This study examines trends in the supply, distribution, and demographics of psychiatry residents during the 1990s. It evaluates the extent to which the predicted downsizing of psychiatry residency training programs actually occurred and how it affected training programs of different sizes and locations. METHOD: Data for this study were obtained from the American Medical Association's (AMA) Annual Survey of Graduate Medical Education (GME) Programs, the AMA GME directory, and the APA Graduate Medical Census. The study compares the roles played by international medical graduates (IMGs) in contrast to U.S. medical graduates (USMGs) in these trends. RESULTS: There was a significant decline in the number of residents during the years studied. The median training program size also decreased. International medical graduates found broad acceptance in training programs of all locations and sizes, including medical school based programs. Implications of the findings are discussed regarding the impact of current graduate medical education (GME) and immigration policies on future workforce patterns. CONCLUSION: The field will have to decide whether it can afford anymore residency downsizing in light of emerging evidence of a shortage of psychiatrists.

Data Collection↗

Computer-based smoking cessation interventions in adolescents: description, feasibility, and six-month follow-up findings.

The impact of adolescent smoking cessation clinics has been disappointing due to low participation rates, high attrition, and low quit rates. This paper describes two computerized self-help adolescent smoking cessation intervention programs: 1) a program utilizing the expert system which is based on the transtheoretical model of change and 2) a popular action-oriented smoking cessation clinic program for teens which was modified for computer presentation. High participation rates in the program among 132 smokers demonstrate the high feasibility and acceptability of the programs. Quit rates of up to 20% were observed during the intervention, and an additional 30% made unsuccessful quit attempt(s). The 6-month follow-up findings indicated that adolescents were poorly prepared to maintain abstinence.

Adolescent↗

[Evaluation of the determination of total cholesterol in Chilean clinical laboratories].

The precise and accurate measurement of total cholesterol is necessary to correctly identify hypercholesterolemia. The aim of this study was to assess the measurement of serum cholesterol in clinical laboratories using as acceptability criteria the recommendations of the "National Cholesterol Education Program" (that consider acceptable a deviation < 5% from the real value and ideal a deviation < or = 3%). In each of three assessments, three pools of lyophilized sera with different levels of cholesterol were used method. Twenty nine to 42.3% of laboratories had results within the ideal interval and 49.5 to 60% within the acceptable range of deviation. In the last assessment, only 17% of laboratories had their three values within the ideal range. Only 39.4% of laboratories use 200 mg/dl as the cut off point to diagnose hypercholesterolemia. It is concluded that the standardization of cholesterol measurement and the use of a common cut off point to diagnose hypercholesterolemia must be emphasized.

Chile↗

Addressing issues for early detection and screening in ethnic populations.

PURPOSE/OBJECTIVES: To describe how multicultural knowledge and skills are applied in culturally competent practice to develop and deliver available, accessible, acceptable, and appropriate programs in early cancer detection and screening programs in ethnic communities. DATA SOURCES: Literature and clinical community practice reports. DATA SYNTHESIS: Successful community screening programs can be conducted within ethnic minority populations. Practitioners must tailor care based on salient cultural differences of the population of focus. Culturally based practice results in the (a) increased ability to think critically in community and individual assessments, (b) development of more accurate program plans and designs, and (c) increased likelihood that appropriate outcomes will be used in the evaluation of care. CONCLUSIONS: Greater cultural competence increases the accuracy of care and thereby its effectiveness, efficiency, and success in providing acceptable and optimal programs. IMPLICATIONS FOR NURSING PRACTICE: The first step in a cultural assessment is to know one's own beliefs and attitudes. The second step, conducted in parallel, requires knowledge about the groups that make up the patient and staff populations within the practice setting and then integrating those perspectives into practice. Practitioners then can begin the third step of negotiation of all stages of the project with members of the various communities on an equal basis that recognizes the expertise and integrity of all parties.

Culture↗

[Work-related disabilities and workers' difficulties in rejoining the labor market].

This cross-sectional study was conducted on permanently disabled workers assisted by the Center for Occupational Rehabilitation (CRP) in Belo Horizonte, Minas Gerais, Brazil, to evaluate factors associated with their chances of readmission into the labor market. A logistic model was used to investigate workers' acceptance into the professional rehabilitation program and their return into the market. The most decisive factors for their acceptance were age, presence of repetitive strain injury (RSI), and educational level. The most favorable situation was that of workers with RSI under 40 years of age and with average schooling (75.6%). Results showed that young male workers with high educational levels were the ones with the best chances of rejoining the market (90.9%). A controversial issue relates to workers' acceptance and program results. In order to be accepted, the worker had to display a given age and educational profile. Workers with RSI had this profile, but once accepted they were the ones with the greatest difficulty in rejoining the work force. In addition, discrimination against female workers was observed, despite their characteristics being similar to those of males.

Accidents, Occupational↗

Short and long-term impact of a structured educational program on the patient's knowledge of hypertension.

BACKGROUND: It has been generally accepted that educational programs can be beneficial in the treatment of a number of chronic diseases such as diabetes mellitus as well as of cardiovascular risk factors and hypertension. We organized a structured educational intervention aimed at 1) assessing the patient's baseline knowledge of hypertension, 2) verifying the short and long-term impact of this initiative on patient's education. METHODS: We invited 174 consecutive patients referred to our hypertension outpatient clinic to participate in an educational meeting on hypertension. For organizational reasons, patients were divided into two groups, each attending a single meeting. Each meeting included four sessions: 1) in the first session a multiple choice questionnaire (nine questions, with answers collected by an interactive electronic system) was administered in order to evaluate patients' baseline knowledge of hypertension, 2) a traditional teaching session, 3) an interactive phase aimed at assessing the improvement of knowledge in which the same questions as in the first session were assessed again, 4) a general discussion session. At the end of the meeting a booklet on principal issues related to hypertension was given to each patient. In order to evaluate the long-term impact of this initiative on the patient's knowledge, 6 months later we invited the patients to answer to the same questions in a questionnaire sent to their home address. RESULTS: One hundred thirty-three patients of the 174 invited attended the meeting and 111 (57 males, 54 females, mean age 53 +/- 13 years) completed the questionnaire after 6 months. The answers to the questions in the initial session were correct in a percentage ranging from 60 to 80% (mean 68%) and immediately after the teaching session this rate increased significantly (range 75-98%, mean 90%, p < 0.05 at least, in all questions). A similar good level of knowledge was maintained in the long term (percentage of exact answers ranging from 78 to 97%, mean 88%, p < 0.05 or p < 0.01 compared to baseline). CONCLUSIONS: The findings of the present study show a positive short and long-term impact of a structured educational intervention on the patient's knowledge of issues related to arterial hypertension. The beneficial role on clinical outcomes such as blood pressure control and cardiovascular events will need future controlled trials.

Adult↗

Survey of behavior management teaching in pediatric dentistry advanced education programs.

PURPOSE: The purpose of this study was to survey pediatric dentistry advanced education program directors regarding the teaching of behavior management techniques. METHODS: Surveys were mailed to all (65) advanced education programs in the United States. Follow-up mailings were sent to nonrespondents. The survey contained items on program demographics and the program's teaching of communicative and pharmacologic techniques. Information was also obtained on informed consent and parental presence in the operatory. RESULTS: Surveys were returned by 54 programs. Two programs declined to respond because they had not yet accepted or certified residents. The final response rate was 86%. The mean percentage (+/- SD) of total didactic time devoted to behavior management was 13% (+/-9.5). Communicative techniques were taught as "acceptable" by 98% of programs, with the exception of the hand-over-mouth exercise (HOME), which was taught as "unacceptable" by 54% of programs. Active and passive immobilization of sedated and nonsedated children was taught as "acceptable" by 76% to 98% of programs. All programs taught that pharmacologic techniques (nitrous oxide, conscious sedation, general anesthesia) are "acceptable." There was little evidence that the teaching of behavior management techniques had changed over the previous 5 years, nor that it is likely to change in the near future. Parental presence in the operatory was common for some procedures, particularly among younger children. CONCLUSIONS: Most programs do not teach HOME as an acceptable behavior management technique. The amount of curricular time devoted to behavior management is not likely to change appreciably in the near future.

Anesthesia, Dental↗

Acceptance and relationship context: a model of substance use disorder treatment outcome.

AIMS: This study presented and tested a model of behavior change in long-term substance use disorder recovery, the acceptance and relationship context (ARC) model. The model specifies that acceptance-based behavior and constructive social relationships lead to recovery, and that treatment programs with supportive, involved relationships facilitate the development of these factors. DESIGN: This study used a prospective longitudinal naturalistic design and controlled for baseline levels of study variables. SETTING AND PARTICIPANTS: The model was tested on a sample of 2549 patients in 15 residential substance use disorder treatment programs. MEASUREMENTS: Acceptance-based responding (ABR), social relationship quality (SRQ), treatment program alliance (TPA) and substance use-related impairment were assessed using interviews and self-report questionnaires. FINDINGS: TPA predicted ABR and SRQ and, in turn, ABR predicted better 2-year and 5-year treatment outcomes. The baseline-controlled model accounted for 41% of the variance in outcome at 2-year follow-up and 28% of the variance in outcome at 5-year follow-up. CONCLUSIONS Patients from treatment programs with an affiliative relationship network are more likely to respond adaptively to internal states associated previously with substance use, develop constructive social relationships and achieve long-term treatment benefits.

Adaptation, Physiological↗

Process evaluation of an on-site water testing program in remote Aboriginal communities in Western Australia.

A unique public health intervention introduced on-site water test kits into 19 communities in Western Australia in order to improve the frequency of water testing in remote Aboriginal communities. Resources, training and support were provided by the Health Department of Western Australia to enable the communities to conduct fortnightly water testing over a 12-month period. This study assesses how effective and appropriate the training and support strategies were, and the extent of acceptance of the program by the community 'water samplers'. A written survey of the participants (community water samplers), enabled their knowledge of the principles and the application of the test regime, and their satisfaction with both the training strategies and the resources to be evaluated. A structured phone survey was conducted mid-trial to re-assess participant knowledge, to ascertain the use of training resources and to identify barriers to regular testing. Details of the support that was provided, was documented systematically during the trial by the Health Department. The participants were satisfied with the format and content of the training workshops. Support services documentation disclosed that contact with the participants throughout the trial was limited. The acceptance of the program by the water samplers varied. Those who participated in the trial expressed the need for more feedback and support. A major reason for not participating in the trial was due to the water sampler leaving the community. The specific outcomes of the program and directions for future programs are discussed.

Adult↗

Physician acceptance of a computerized health maintenance prompting program.

Computer prompting systems remind physicians to perform health promotion/disease prevention (HP/DP) procedures on their patients, but it is unclear how willingly physicians accept these systems. Because acceptance is critical to long-term system success, we assessed attitudes toward a computerized health maintenance program (HMP) prompting system. We surveyed 23 faculty and 52 residents in a general medicine teaching hospital group practice after the HMP had been in use for three years. Sixty-four physicians (85 percent) responded. Almost all (91 percent) agreed that all ongoing-care patients should receive periodic screening--a significant (p less than .001) increase compared to 1979, when prior to the HMP 56 percent agreed. On average, the physicians believed that 87 percent of their ongoing-care patients over 50 years of age should be enrolled in the HMP. About half (55 percent) felt that losing the HMP would limit their ability to care for their patients, and almost all (97 percent) said they would include a prompting system in any future private practice, with most (87 percent) preferring a computer-based system. A majority (65 percent) said that they liked being reminded. Prompting systems improve physician performance of HP/DP procedures. The HMP received a high level of acceptance and was associated with improved attitudes toward HP/PD activities, suggesting that computerized prompting systems should be more widespread.

Attitude of Health Personnel↗