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PubMed1997

Chromium picolinate supplementation and resistive training by older men: effects on iron-status and hematologic indexes.

Chromium competes with iron for binding to transferrin, and high-dose chromium supplementation has been hypothesized to adversely affect iron status. This study examined the effects of chromium picolinate supplementation on hematologic indexes and selected indexes of iron status in 18 men aged 56-69 y who participated in an introductory resistive training program. The men were randomly assigned (double-blind design) to groups (n = 9) that consumed either 17.8 mumol Cr/d (924 micrograms Cr/d) as chromium picolinate or a low-chromium placebo for 12 wk while engaging in resistive training twice weekly (3 sets of 8-12 repetitions at 80% of one repetition maximum for 5 exercises). Hematocrit, hemoglobin, red blood cell (erythrocyte) count, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, red blood cell distribution width, platelet count, and mean platelet volume were within normal clinical ranges and were unchanged by either chromium picolinate supplementation or resistive training. Resistive training decreased total-iron-binding capacity from 38.4 +/- 9.3 to 27.3 +/- 5.6 mumol/L (P < 0.0001) and increased transferrin saturation from 35.7 +/- 16.3% to 45.4 +/- 16.9% (P = 0.050). Chromium picolinate supplementation did not influence these responses. Serum iron concentrations and serum ferritin concentrations were unchanged by either resistive training or chromium picolinate supplementation. These data suggest that high-dose chromium picolinate supplementation for 12 wk did not influence hematologic indexes or indexes of iron metabolism or status in older men. The decrease in total-iron-binding capacity and increase in transferrin saturation (%) with resistive training are largely opposite to changes associated with iron depletion and suggest a novel effect of resistive training on iron transport.

Aged↗
PubMed1986

Oral biology and the early introduction of clinical dentistry in the dental curriculum.

For the past nine years students entering the Dental School in the University of Western Australia have participated in an introductory clinical dentistry program closely integrated with oral biology. This paper outlines the content of the program and discusses its educational advantages. Changing attitudes in Australian universities toward the appointment of full professors in clinical disciplines also are discussed, and reference is made to the way in which these appointments are helping to achieve a closer correlation between basic science and clinical dentistry.

Anatomy↗
PubMed1997

Quality management for health care in the Middle East and north Africa: professional cooperation as part of the peace process.

BACKGROUND: In 1993, as the peace process opened up new possibilities for professional cooperation, the Quality Management (QM) Program for Health Care Organizations in the Middle East and North Africa was born of a shared perception that there is a high-priority need to improve the quality of health care and to cope with increasing costs and financial pressures. To date 22 health care organizations--including hospitals, primary care centers, health maintenance organizations, and ministries of health--are members of the QM Program and are actively implementing QM projects. DEVELOPMENT OF THE PROGRAM: The QM Program began with an introductory conference, followed by an intensive training course. During the current phase of the program (1996-1999), a variety of facilitation activities--including training visits to the region by international experts, consultation support to member organizations by volunteer mentors in the United States, professional-exchange seminars, and site visits--are being conducted at the regional and national levels. Since the training course, the QM Program member organizations have implemented more than 40 model QM projects to improve both clinical and nonclinical processes. Projects consistent with national and organizational priorities were selected, with an emphasis on fast-paced improvements that reduce costs and enhance patient satisfaction. FUTURE PLANS: The regional QM Program is envisioned to grow in size and strength through a four-year building process. By the year 2000, a cadre of local leaders should be prepared to carry the program forward into the new millennium.

Africa, Northern↗
PubMed2001

Status of pediatric perfusion education: 2000 survey.

In recent years, studies have raised questions about pediatric perfusion training, minimum proficiency requirements, and specialization. To understand these questions better, a survey was undertaken to investigate the status of pediatric/neonatal perfusion training in the United States. Three groups were surveyed: program directors (PD), recent graduates of perfusion programs (RG), and pediatric cardiac anesthesiologists (PCA). Program directors and recent graduates were queried about didactic curriculum and clinical experiences. All three groups were asked core questions regarding minimum proficiency, specialization, and need for a postgraduate style program. Didactically, 65% of program directors believed that perfusion programs provided a solid introductory knowledge base in infant perfusion. Clinically, students performed an average of 124 +/- 42.5 adult and 17 +/- 12.9 pediatric cases during their education. Program directors cited numerous limitations to clinical pediatric education, including access to pediatric cases and allocation of resources. The PD (69%) and RG (96%) both believed graduates were less prepared to perform infant/pediatric cardio-pulmonary bypass (CPB) at graduation as compared to adult CPB. The opinions of all three groups were divided when asked whether the essentials and guidelines requirement for minimum pediatric caseload is too low (yes response: PD 52%, RG 73%, PCA 47%). The PD and RG were against pediatric subspecialization/certification (87%, 57% respectively); whereas, the PCA were unanimously in favor (100%) of pediatric subspecialization/certification for perfusionist. All three groups felt a postgraduate-style program in infant perfusion would benefit the community (78%, 82%, 100%). Finally, 64% of RG said that, if available, they would have considered entering a training program in pediatric/neonatal perfusion after graduation. Our results indicate that there are still limitations to pediatric perfusion education. A postgraduate-style program in infant perfusion is one possible solution to this problem.

Attitude of Health Personnel↗
PubMed2006

Evaluating the California Hospital Initiative in Palliative Services.

BACKGROUND: Inpatient palliative care programs can improve care of patients with serious illness. We developed the California Hospital Initiative in Palliative Services (CHIPS) program to assist hospitals in establishing these programs. CHIPS included an introductory conference followed by 10 months of mentoring with telephone calls, e-mails, on-site consultation at the hospital, and a reunion conference. METHODS: To evaluate CHIPS and the factors associated with establishing inpatient palliative care programs, we conducted a cross-sectional telephone survey of leaders from the 38 hospitals that participated in CHIPS. We assessed the number of inpatient palliative care consultation services established by hospitals that participated in CHIPS (success) and hospital characteristics associated with success. RESULTS: Participants gave CHIPS high ratings. Six hospitals (16%) had a palliative care consultation service at enrollment in CHIPS and 19 hospitals (60%) established one after participation in CHIPS (P<.001). In bivariable comparisons, successful hospitals were more likely to have a hospitalist program (P = .003) or to be located in an urban setting (P = .03). CONCLUSIONS: CHIPS seemed to help many hospitals establish inpatient palliative care programs. Hospitals with hospitalists and those in an urban setting were more likely to succeed in developing palliative care programs. Future studies should focus on the quantity and quality of care provided by these programs.

California↗
PubMed1999

Violence prevention in the primary care setting: a program for pediatric residents.

OBJECTIVE: To measure the effect of a violence prevention program on pediatric residents' violence prevention guidance during well-child visits. DESIGN: Prospective study of an educational intervention. SETTING: Inner-city tertiary care hospital and satellite site. PARTICIPANTS: Pediatric residents. INTERVENTIONS: A 2(1/2)-hour violence prevention program, consisting of an introductory talk, role playing, a printed resident guide, and supplemental reading materials. MAIN OUTCOME MEASURES: Parent or guardian report of violence prevention guidance offered during the well-child visit, using a postvisit survey. RESULTS: Three hundred eight patient encounters were included in the survey: 93 prior to the program, 106 just afterward, and 109 after 6 months. Before the program, guns or violence was discussed at 9.7% of visits; this increased to 19.1% of visits after the program (odds ratio, 2.20; 95% confidence interval, 1.02-4.74). The improvement was sustained 6 months after the program. More than 80% of residents felt the program increased their fund of knowledge and taught them skills, and 93% stated that they would use these skills in the future. CONCLUSION: This one-time educational intervention significantly increased the amount of violence prevention guidance provided by pediatric residents to their patients and families. The effect was sustained after 6 months. Residents regarded the program as a successful method of providing the skills and knowledge needed to address the issue of interpersonal violence in their primary care encounters.

Adult↗
PubMed2005

Effectiveness of a graduate medical education program for improving medical event reporting attitude and behavior.

OBJECTIVES: To evaluate the effectiveness of an educational program for improving medical event reporting attitude and behavior in the ambulatory care setting among graduate medical trainees. DESIGN: One group pre- and post-test study. SETTING: The University of Texas Southwestern Medical Center at Dallas Family Medicine Residency Program. PARTICIPANTS: All family practice residents (n = 30). INTERVENTION: Patient safety educational program implemented through an introductory lecture and 6 monthly conferences, June to December 2002, involving medical events that occurred in the ambulatory care setting. OUTCOME MEASURES: Medical event reporting attitude and behavior at baseline and at 6 month follow up, and barriers to medical event reporting at the 6 month follow up. RESULTS: Program attendance was significantly correlated with medical event reporting attitude and behavior change (rho = 0.525, p = 0.003). The median change in medical event reporting attitude and behavior was zero and not statistically significant (p = 0.566). Major barriers to medical event reporting were lack of time, extra paper work, and concern about career and personal reputation. CONCLUSIONS: Attending the patient safety educational program was key for promoting a positive medical event reporting attitude and behavior change among graduate trainees. Major barriers to medical event reporting were lack of time, extra paper work, and concern about career and personal reputation. Future research will need to focus on reducing these barriers and to evaluate the effectiveness of such a program over longer periods of time, since making a positive change in medical event reporting attitude and behavior must be made at the individual and organizational levels.

Adult↗
PubMed1986

Increasing the use of meatless meals: a nutrition intervention substudy in the Multiple Risk Factor Intervention Trial (MRFIT).

Forty-seven participants from six MRFIT clinical centers were involved in a 3-month intensive dietary intervention program to determine the feasibility of increasing the use of meatless meals. The substudy was conducted late in the trial, and many dietary changes had already been made. The purpose, therefore, was to initiate ways to continue the maintenance of achieved serum cholesterol reductions and possibly effect additional decreases. The program consisted of an introductory session and three follow-up visits. Preplanning, contracting, self-monitoring, regular follow-up, and homemaker involvement were among techniques used to help participants incorporate meatless meals into routine dietary practices. Data collection included scores from a knowledge test administered at the introductory and final visits, number of meatless meals consumed per week as contracted at the first three visits and as reported at the last three visits, and serum cholesterol and weight determinations made at each visit. Knowledge related to meatless meal concepts, such as complementary proteins, appeared to improve as the majority of substudy participants scored higher on the post-test than on the pretest. Over the substudy duration, the mean number of contracted and reported weekly meatless meals in addition to breakfast was approximately four and five, respectively. Mean serum cholesterol drop was 2.6%, and mean weight loss was about 3 lb over the 3-month period. The approach was one of the intervention techniques used to maintain serum cholesterol reductions on a long-term basis, which has not been achieved in any other clinical trial with similar objectives. The described meatless meals program may prove useful to dietetic practitioners who counsel individuals in fat-modified food patterns.

Blood Pressure↗
PubMed2002

Protected clinical teaching time and a bedside clinical evaluation instrument in an emergency medicine training program.

In a process that has evolved over the last four years, the Emory University Emergency Medicine Education Committee has developed an "academic attending" teaching shift incorporating a formatted lecture series with a clinical evaluation exercise (CEE). The program structures the approach to clinical teaching at the bedside, provides an objective clinical evaluation tool specific to emergency medicine residents, and provides targeted learning for medical students and residents rotating in the emergency department (ED). The CEE instrument was designed to be quick and efficient, satisfy requirements of assessment of the Accreditation Council for Graduate Medical Education (ACGME) general competencies, and incorporate the language of the "Model of the Clinical Practice of Emergency Medicine." The original program called for unstructured bedside teaching three days a week, by faculty freed from clinical duties, combined with a limited series of introductory emergency medicine lectures. The program proved more successful when concentrated in a once weekly structured educational program. The prepared, repeating lecture series has been expanded to include many of the most common ED presenting chief complaints and has significantly advanced a curriculum for medical students and visiting interns. A CEE was developed to evaluate and provide immediate feedback to residents on many of the core ACGME competencies. The CEE has been successfully used to structure the bedside educational encounter. This dedicated non-clinical "teaching" shift appears effective in meeting the educational goals of the authors' academic ED. This is a description of the program and its evolution; the program has not been formally evaluated.

Clinical Competence↗
PubMed2005

Implementation of a family intervention to increase fruit and vegetable intake: the Hi5+ experience.

Family is an important, yet challenging, target for dietary intervention. This article describes the implementation of Hi5+, a family fruit and vegetable (FV) promotion program. Complementing a fourth-grade school curriculum, the seven weekly Family Fun Nites were at-home family meal sharing and game evenings. A sample of families (N = 575; 69% consented) from schools in a southeastern U.S. urban area received tailored intervention materials based on their FV attitudes and family interaction styles. A pyramidal organizational design, using peer leaders, facilitated 71% of families to complete all seven sessions, whereas 84% completed at least one session. Significant independent predictors of program completion were attending an introductory Kick-Off Nite, interactive family style, additional adults in the household, married parents, being African American, earning more than 60,000 dollars, and additional children in the household. Family-specific issues and initial program experience are important considerations for implementing a family intervention.

Adult↗
PubMed2001

Determinants of acceptance of a community-based program for the prevention of falls and fractures among the elderly.

BACKGROUND: Low-energy fractures among the elderly may be prevented by measures aimed at reducing the risk of falling or increasing the strength of the skeleton. Acceptance of these interventions in the target population is necessary for their success. METHODS: The total elderly population in a Danish municipality 7,543 community-dwelling persons aged 66+ years, were offered participation in one of three intervention programs: 2,550 persons were offered a home safety inspection, evaluation of prescribed medicine, and identification of possible health and food problems (Program I); 2,445 persons were offered 1000 mg of elemental calcium and 400 IU (10 microg) of vitamin D(3) per day in combination with evaluation of prescribed medicine (Program II); and 2,548 persons were offered a combination of the two programs (Program III). Acceptance was defined as willingness to receive an introductory visit by a nurse. RESULTS: Acceptance of Program I was 50%; of Program II, 56% (P < 0.00005 as contrasted with Program I); and of Program III, 46% (P < 0.005). Acceptance was associated with gender (females, 53%; males, 47%) and did not change from ages 66 to 84 but decreased significantly after the age of 85. Widows aged 66-84 had the highest acceptance (57%) and never married males aged 66-84 the lowest (30%). An important determinant, however, was the individual social service center that communicated the specific program. Acceptance varied from 39 to 66% between the social centers. CONCLUSIONS: Acceptance of a fall and fracture prevention program varies with intervention type; with gender, age, and social status of the target population; and with the motivation and attitude of the health workers involved in the implementation of the program.

Accidental Falls↗
PubMed1994

Credentialing of crossover privileges in fluoroscopy for nonradiologists.

PURPOSE: To comply with federal and state guidelines, a credentialing process was developed for nonradiologist medical users of fluoroscopy. MATERIALS AND METHODS: Seventy-three nonradiologist physicians participated in a program consisting of (a) an introductory 1-hour lecture; (b) a 10-page booklet providing basic information on radiation physics, radiobiology, and radiation safety; and (c) successful completion of a 15-question self-study quiz on fluoroscopy RESULTS: Mean fluoroscopy times per surgical case were compared for a 7-month period before (7.01 minutes in 201 cases) and after (4.39 minutes in 396 cases) the program and showed a 37.4% decrease (P < .05). Participating physician attitudes were surveyed at the completion of the program and showed an average physician time investment of 2 1/2 hours and a 4.1 approval rating for the credentialing program on a 5-point Likert scale. CONCLUSION: This fluoroscopic credentialing process for nonradiologist medical users (a) achieved a statistically significant reduction in fluoroscopic time per surgical case, (b) required a minimal investment of physician time, and (c) was well received by the medical staff.

Credentialing↗
PubMedDate not supplied

If you feed them, will they come? The use of social marketing to increase interest in attending a college alcohol program.

The authors used social marketing to design and test advertisement components aimed at increasing students' interest in attending an alcohol program focused on reaching students who drink heavily, although the authors offered no such program. Participants were undergraduate students in introductory psychology courses (N = 551). Questionnaires included measures assessing demographic information, alcohol use and negative consequences, and interest in attending an alcohol program in response to exposure to 1 of 12 systematically varied advertisements. The authors found that approximately 20% of participants across all ad types indicated some level of interest in attending the alcohol program. Students who use alcohol reported more interest in attending when an informational message was used. Of the participants offered food, 41.9% indicated the food offered in the advertisement impacted their interest in attending. Results suggest market segmentation plays a role in developing effective advertisements to recruit different groups of students based on their reported drinking behavior.

Adolescent↗
PubMed1983

[Udder health care as part of a veterinary care program for dairy farms. I. Objectives and materials and methodology in the introductory phase].

Udder health plays an essential role in herd health and production control programmes both from the technical and economic point of view. A model of udder health control practicable on dairy farms is introduced in three papers. The present paper is concerned with the objectives of udder health control, as well as with the materials and methods required during the introductory phase of the programme. During the introductory phase of the programme, the current udder health status is assessed by an extensive farm interview and analysis of the records already available on the farm. The system of recording by the control programme is introduced. The model of this udder health control programme consists of five interrelated key factors.

Animals↗
PubMed1997

The Derogatis Interview for Sexual Functioning (DISF/DISF-SR): an introductory report.

The current report describes a program of research designed to demonstrate the psychometric characteristics and validity of the Derogatis Interview for Sexual Functioning (DISF/DISF-SR), a set of brief, gender-keyed, multidimensional outcome measures designed to measure quality of sexual functioning. The primary goals of the development of the DISF/DISF-SR are outlined within the context of the principal measurement parameters involved in human sexual functioning. The development and rationale for both interview (DISF) and matching self-report (DISF-SR) versions of the instrument are presented, as is the rationale for developing distinct male and female forms. The studies described evaluate the reliabilities of both modalities of the DISF/DISF-SR and demonstrate confirmation for the hypothesized internal structure of the test. Research is provided that demonstrates dimensional uniqueness in subtest-total score relationships, and several studies are reviewed that show high discriminative validity for the DISF/DISF-SR in medical and community cohorts. The initial norms for the DISF/DISF-SR are also reviewed and described.

Adult↗
PubMed2003

Radiology as a tool for teaching veterinary anatomy.

Instructors at the Ontario Veterinary College (OVC) have a long-standing commitment to the use of radiographic films in teaching introductory anatomy in the DVM program. The imaging component of the course has evolved from being heavily instructor-dependent, with small group teaching in each laboratory session, to being almost self-taught. The manner in which recognition of structures in radiographic images is examined has also changed. In 2001 a novel examination process was introduced. Here we report the approach to the teaching and examining of anatomy by use of radiographic images implemented for phase 1 of the new DVM curriculum at the University of Guelph.

Anatomy↗
PubMed1989

Inter-university collaboration in the development of a distance education course in community health nursing.

Collaboration between faculty members from two university nursing programs has successfully produced an introductory community health nursing course for RN-BScN distance education students. The course has integrated theoretical and clinical components organized into a coherent whole via a detailed course manual. The course is designed to be flexible so that individual units of the course manual can be reorganized as needed to fit the curriculum requirements of the co-authoring university. The process of collaboration was both frustrating and satisfying. The frustrations included unavoidable difficulties as well as problems that, now that they have been identified, could be avoided in future. The greatest satisfaction, of course, was that of actually achieving a worthwhile goal despite the obstacles that presented themselves during the course development process.

Community Health Nursing↗