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PubMedDate not supplied

The development of a clinical skills centre.

Guidelines produced by the General Medical Council of Great Britain have emphasised the importance of the development of the skills and attitudes appropriate for a junior doctor. Medical schools are in the process of reforming their curricula accordingly. The development of these skills is made increasingly difficult by changes such as short admissions to hospital, increased care in the community, and reduced resources. This article outlines the development of a clinical skills centre as a multidisciplinary unit to improve clinical skills teaching with the aid of up-to-date technology and educational practices. By sharing our experience we aim to provide a practical guide for the development of such units in other medical and nursing colleges.

Clinical Clerkship↗

PubMedDate not supplied

Educating nursing students about quality care and safe practices in the AIDS epidemic.

Nursing students, as future health care providers, need comprehensive instruction about AIDS--the many manifestations of both the disease itself and the pandemic. As health educators and practitioners, nurses play a major role in safeguarding the health care setting and the community by their efforts in preventing transmission of the AIDS virus. Nurses are and will continue to be responsible for administering the major portion of the direct health care that AIDS patients require and for teaching basic nursing skills to other care givers. According to a 1987 survey of 461 nursing programs conducted by the American Association of Colleges of Nursing, AIDS content is being incorporated into the curriculums of the majority of programs that responded. Students require an in-depth knowledge of AIDS to enable them to address effectively the needs of AIDS patients and their families. Because of the complex psychosocial, ethical, and legal issues, careful attention must be given to the development of students' skills in making clinical decisions that will promote effective nursing intervention when addressing problems in nursing care. Curriculums should also include assessment of the special needs of members of minority groups that are disproportionately affected by AIDS. Schools of nursing in colleges and universities can serve as key resources for developing curriculums, policies, and practice patterns that will assist the nursing community and the public in responding to the AIDS epidemic.

Acquired Immunodeficiency Syndrome↗

PubMed1993

Comparison of AIDS knowledge and HIV-related sexual risk behaviors among adolescents in low and high AIDS prevalence communities.

Data were collected from students attending high school in a rural, low acquired immunodeficiency syndrome (AIDS) prevalence community in Northern California, and compared with students in an inner-city AIDS epicenter (San Francisco). The findings demonstrate that rural adolescents have higher levels of human immunodeficiency virus (HIV) knowledge, especially about risk-reduction strategies. However, rural adolescents also report higher rates of HIV-related sexual risk behaviors. Rural adolescents may not perceive the personal salience of practicing HIV risk-reduction behaviors thus increasing their risk for exposure to sexually-transmitted diseases, including HIV infection. School-based HIV prevention programs developed for rural communities will need to enhance the personal salience of HIV for adolescents' and discourage their discounting of personal risk attributable to a lower prevalence of AIDS in the community. Physicians must become more actively involved in HIV prevention efforts by routinely assessing adolescent patient's sexual behavior and utilizing their clinical interaction to provide HIV education and promote the adoption of HIV risk-reduction behaviors.

Acquired Immunodeficiency Syndrome↗

PubMed1991

Cryptosporidiosis.

Before 1982, only eight case reports of human cryptosporidiosis and fewer than 30 papers on Cryptosporidium spp. appeared in the biomedical literature. At that time, cryptosporidiosis was thought to be an infrequent infection in animals and rarely an opportunistic infection in humans. The concept of Cryptosporidium spp. as pathogens has changed dramatically within the past 8 years because of improved diagnostic techniques, increased awareness within the biomedical community, and the development of basic research programs in numerous laboratories. Presently, greater than 1,000 publications including over 400 case reports in the biomedical literature address Cryptosporidium spp. and cryptosporidiosis. Cryptosporidium parvum is now thought to be one of the three most common enteropathogens causing diarrheal illness in humans worldwide, especially in developing countries. It is likely that cryptosporidiosis was previously included in the 25 to 35% of diarrheal illness with unknown etiology. Because of the severity and length of diarrheal illness and because no effective therapy has been identified, cryptosporidiosis is one of the most ominous infections associated with AIDS. The role of C. parvum as an enteropathogen is well established; documentation of its role as a cause of hepatobiliary and respiratory diseases is now appearing in the literature. Our present understanding of the natural history, epidemiology, biology, and immunology of Cryptosporidium spp. as well as the clinical features, pathogenicity, and treatment of cryptosporidiosis are reviewed here.

Animals↗

PubMed1993

Assessment of street outreach for HIV prevention--selected sites, 1991-1993.

Street outreach programs for human immunodeficiency virus (HIV) prevention are designed to deliver HIV prevention messages, materials, and referral services to high-risk persons outside of traditional health-care and drug-treatment clinics. The Acquired Immunodeficiency Syndrome (AIDS) Evaluation of Street Outreach Projects (AESOP) is an eight-site study designed by CDC in collaboration with researchers in each of the sites to better understand client characteristics, service delivery, and the impact of street outreach programs on the risk behaviors of high-risk populations. The populations studied are injecting-drug users (IDUs) in five of the eight sites and youth in high-risk situations (YHRS) (i.e., youths aged 12-23 years who are homeless or runaway or who support themselves through the "street economy" of drugs, prostitution, pan-handling, and crime) in three sites. This report summarizes information collected during the first 2 years of the project.

Adolescent↗

PubMed2004

Design of a case management approach to enhance cancer screening trial retention among older African American men.

PURPOSE: The purpose of this study was to enhance retention among African American men enrolled in a cancer screening trial. DESIGN: A telephone-based, randomized trial design was used. The intervention group included 352 African American men aged 55+. Case managers contacted participants at least monthly and provided information and referral services to participants and their relatives. RESULTS: The mean age of participants was 65.7 years. A total of 14,978 calls were made resulting in 780 referrals. The 10 most frequent referrals were for scheduling medical appointments, health information, insurance information, legal aid, transportation, cancer screening information, information technology/computer information, employment, housekeeping/chore services, and food programs. CONCLUSIONS: The case managers served as links between participants and community-based resources. The types of referrals made could be associated with the age-related needs of the participants.

Black or African American↗

PubMed1990

Staffing patterns of American methadone maintenance programs.

Methadone maintenance is the most frequently utilized treatment for heroin addiction and also represents one of the best AIDS-prevention tools for the IV drug using population. Despite these important roles, very little has been reported about how methadone maintenance clinics are staffed. Surveys covering various aspects of program operations, including staffing, were sent to all clinics (N = 557) listed in the 1984 National Directory of Drug Abuse and Alcohol Treatment Programs. Using ANOVA, staffing patterns were compared across programs as a function of clinic size, city size, region of the country, and funding resources. While few differences were found based on city or clinic size, staffing patterns varied as a function of regional location as well as the sources of a clinic's funding.

Community Mental Health Centers↗

PubMed1988

A program using medical students to teach high school students about AIDS.

In the spring of 1987, 20 medical students from the Eastern Virginia Medical School of the Medical College of Hampton Roads were involved in a pilot program to teach about the acquired immune deficiency syndrome (AIDS) to high school senior students in Norfolk, Virginia. The medical students received instruction about AIDS from basic science and clinical faculty members at the medical school in preparation for the project. All participating high school seniors completed a 15-item knowledge test about AIDS prior to the intervention and an equivalent posttest one week after the program was completed. T-test analysis revealed a significant increase in knowledge by students at all five high schools. Responses to 10 subjective posttest questions indicated that the high school students were interested in learning about AIDS and having medical students as their teachers. This program provides an example of how medical institutions can develop a collaborative community education project that contributes to the education of medical students.

Acquired Immunodeficiency Syndrome↗

PubMed1976

Anaerobic infections in children: a prospective study.

The prevalence and significance of anaerobic infections in patients at St. Louis Children's Hospital were studied prospectively for a one-year period. Blood, selected body fluids, and aspirates obtained from abscesses or areas of cellulitis were cultured using special anaerobic collection and processing techniques. Infected peritoneal fluid from patients with gastrointestinal disease yielded a large proportion of all anaerobic isolates. The types of organisms isolated were common inhabitants of the intestinal tract. Anaerobic organisms were recovered from only 0.75% of all blood cultures; anaerobic bacteremia accounted for 5.8% of all clinically significant bacteremic episodes (8.7% in the neonatal period and 4.8% in children over 1 month of age). Serious anaerobic infections occurred more frequently in the compromised host or in newborn infants than in otherwise healthy children. Since anaerobic organisms cause a small proportion of infectious diseases in a general pediatric population, the cost of refined bacteriologic techniques for the isolation and identification of these organisms is not warranted in most community hospitals. However, such a program should be available in selected tertiary care centers to aid in the management of certain high-risk patients.

Anti-Bacterial Agents↗

PubMedDate not supplied

Impact of HIV risk and infection and the role of prevention services.

Blood-borne infection associated with injection drug use is a significant cause of morbidity and mortality. Over the last decade, HIV infection and its clinical sequelae have had a significant impact on research and interventions involving injecting drug users (IDUs) in the United States and elsewhere. Discussed are some of the major intervention options for reducing blood-borne infections in general and HIV in particular. The use of multiple interventions is considered within the community context in which both IDUs and service providers operate. Intervention options discussed include treatment for drug dependence; voluntary and confidential HIV testing and counseling; community health outreach; bleach distribution; and easy, legal access to needles and syringes through pharmacy sales and needle exchange programs. Many surveillance and evaluative studies have examined multiple intervention efforts that include all or some of these program components and suggest positive outcomes. However, these studies tend to be limited by experimental designs that restrict attribution of causal inference. Examples of such programs in the United States and abroad are examined in terms of their potential for reducing HIV risk behaviors and averting new infections. The article concludes that diversity among AIDS prevention programs, rapid deployment (at earlier stages of epidemics), and effective coordination (minimization of interagency conflicts) are important factors in successful AIDS prevention programming and attaining disease prevention objectives.

Blood-Borne Pathogens↗

PubMed2000

Organizational predictors of prenatal HIV counseling and testing.

OBJECTIVES: Efforts to prevent perinatal transmission of HIV include implementation of prenatal counseling and testing programs. The objective of this study was to assess organizational predictors of HIV counseling and testing. METHODS: Surveillance records were collected on 5900 prenatal patients from 9 hospital and community clinics in Connecticut. RESULTS: Some organizational factors (e.g., type of clinic, dedicated staff) that enhanced counseling rates had the opposite effect on test acceptance. For instance, patients were more likely to be counseled when counseling was conducted by providers; however, test acceptance was more likely when dedicated counselors were available. CONCLUSIONS: These results provide important information concerning clinic resources needed as HIV counseling and testing services continue to be incorporated into prenatal care.

AIDS Serodiagnosis↗

PubMed2005

Gender, age, and ethnicity in HIV vaccine-related research and clinical trials: report from a WHO-UNAIDS consultation, 26-28 August 2004. Lausanne, Switzerland.

This report summarizes the presentations and recommendations from a consultation held in Lausanne, Switzerland (26-28 August 2004) organized by the joint World Health Organization (WHO) - United Nations Programme on HIV/AIDS (UNAIDS) HIV Vaccine Initiative. The consultation discussed issues related to gender, ethnicity, and age in HIV vaccine research and clinical trial recruitment. A special focus of the meeting was the participation of women and adolescents in clinical trials. Also discussed were the experiences and lessons from various research programs, trials, and studies in different countries. Implementing the recommendations from this meeting will require prioritization and active participation from the research community, funders of research, local and national governments, non-governmental organizations, and industry, as well as the individuals and communities participating in clinical trials. This report contains the collective views of an international group of experts, and does not necessarily represent the decisions or the stated policy of the WHO. The contribution of the co-chairs (R. Macklin and F. Mhalu) and the rapporteurs (H. Lasher, M. Klein, M. Ackers, N. Barsdorf, A. Smith Rogers, E. Levendal, T. Villafana and M. Warren) during the consultation and in the preparation of this report is much appreciated. S. Labelle and J. Otani are also acknowledged and thanked for their efficient assistance in the preparation of the consultation and the report.

AIDS Vaccines↗

PubMedDate not supplied

Community syringe collection and disposal policies in 16 states.

OBJECTIVE: To review laws, regulations, and guidelines that affect the collection and disposal of hypodermic needles, syringes, and lancets used outside of professional health care settings (hereafter referred to as "community syringes"). DESIGN: Law and policy analysis. SETTING: Alabama, California, Florida, Georgia, Hawaii, Massachusetts, Michigan, Minnesota, New Jersey, New York, Ohio, Oregon, Rhode Island, South Carolina, Washington, and Wisconsin. INTERVENTION: Information on syringe collection and disposal in the community was gathered from federal and state records and state agency personnel. MAIN OUTCOME MEASURES: Legally permissible means of syringe collection and disposal available to persons in the community injecting medical treatments and injection drug users. RESULTS: Laws, regulations, or guidelines in 13 states allowed community syringes to be legally discarded in household trash; guidelines for in-trash disposal varied among the states. Only 6 states had laws or regulations that specifically addressed community syringe collection. In 10 states, infectious waste laws and regulations that apply to medical facilities such as clinics would also apply to community syringe collection sites. CONCLUSION: In the 16 states studied, laws, regulations, and guidelines relating to community syringe collection and disposal were somewhat inconsistent and confusing and presented potential barriers to safe disposal. States should consider amending laws, regulations, and guidelines to promote community syringe collection programs. A national effort is needed to achieve consistent community syringe collection and disposal laws and guidelines for all states. Pharmacists can aid in safe syringe disposal by counseling their patients about safe disposal, providing or selling sharps containers, and accepting used syringes for safe disposal. Pharmacists can join other interested groups in advocating clarification of disposal laws and regulations that favor community programs designed to keep syringes out of the trash so that they can be disposed of as infectious waste.

Blood-Borne Pathogens↗

PubMed1978

Influence of a nutrition education program (EFNEP) on infant nutrition in East Harlem.

An assessment of the effectiveness of aides working in the Expanded Food and Nutrition Education Program (EFNEP) to improve the nutritional status of infants was conducted with a group of 118 infants attending a well-baby clinic in a low-income area of New York City. In addition to clinic care, the fifty-seven study infants received home visits from a nutrition aide whose role was to reinforce nutritional advice received at the clinic. The sixty-one control infants received only regular clinic care. The benefits of having an aide were suggested by three observations: Reduction in the practice of introducing whole cow's milk to young infants, familiarizing older infants with a variety of foods, and reducing the prevalence of iron-deficiency anemia. Few of the differences between study and control infants achieved statistical significance, although trends consistently indicated that the presence of aides was beneficial. The problems of assessing the effectiveness of nutrition education programs with healthy infants are discussed.

Black or African American↗

PubMed1999

The experience of relapse to unsafe sexual behavior among HIV-positive, heterosexual, minority men.

The purpose of this qualitative study was to examine the phenomenon of relapse to unsafe sexual behavior in human immunodeficiency virus (HIV)-positive, heterosexual, minority men. In-depth interviews were conducted by using a purposive sample of 18 HIV-positive, heterosexual, minority men who were recruited from an outpatient acquired immunodeficiency syndrome (AIDS) clinic in upstate New York and a community-based HIV/AIDS service organization in New York City. All participants expressed concern about the seriousness and health threat of unsafe sexual behaviors. The perceived benefits and barriers to unsafe sexual practices were identified. Content analysis revealed the following themes related to relapse to unsafe sexual behavior: drug and alcohol use, state of mind, "looking good" and "helping" fallacies, male-female relationship issues, influence of friends, weighing the risks, sexual preparation, uncontrollable sexual urges, and the symbolic meaning of condoms. Clinical implications related to health assessment, interventions, and health education and prevention programs for HIV-positive heterosexual, minority men and their sexual partners are presented.

Adult↗

PubMed2004

Factors influencing the retention and attrition of community health aides/practitioners in Alaska.

CONTEXT: The Community Health Aide Program (CHAP) is a unique program employing local, indigenous peoples as primary care nonphysician providers in extremely remote frontier, tribal Alaskan communities. With attrition rates up to 20%, recommendations for improving retention are necessary to maintain access to health services for Alaska Natives in these communities. PURPOSE: The purpose of this study was to identify factors contributing to retention in Alaska's CHAP program. METHODS: Key informant interviews were conducted with 41 community health aides/practitioners (CHA/Ps) in 15 villages statewide. Efforts were made to ensure the sample included a mix of villages with high retention of health aides and villages with lower retention. Geographic and ethnic diversity were also considered. Transcripts were coded using NUD*IST software, and data were analyzed for differences between high retention and low retention villages and between more experienced and less experienced CHA/Ps. FINDINGS: Five fundamental needs of health aides were identified as crucial for retention of personnel. These needs include strong co-worker support, access to basic training, a fully staffed clinic, good community support, and supportive families. CONCLUSIONS: For 35 years, the CHAP program has worked to diminish health disparities for Alaska Natives. Though unique challenges associated with the job have factored into low retention of CHA/Ps, improved retention is possible with easier access to basic training, increased support from colleagues and community, enhanced team-building skills, and better on-call schedules.

Adult↗

PubMed1997

Delivering health information services and technologies to urban community health centers: the Chicago AIDS Outreach Project.

Health professionals cannot address public health issues effectively unless they have immediate access to current biomedical information. This paper reports on one mode of access, the Chicago AIDS Outreach Project, which was supported by the National Library of Medicine through outreach awards in 1995 and 1996. The three-year project is an effort to link the programs and services of the University of Illinois at Chicago Library of the Health Sciences and the Midwest AIDS Training and Education Center with the clinic services of community-based organizations in Chicago. The project was designed to provide electronic access to AIDS-related information for AIDS patients, the affected community, and their care givers. The project also provided Internet access and training and continued access to library resources. The successful initiative suggests a working model for outreach to health professionals in an urban setting.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Bridging the gap. Community partnerships in nursing education: advancing primary health care in practice.

An innovative approach to nursing education was piloted by the School of Nursing at Flinders University and Noarlunga Health Services, a generic community health service, in Adelaide, South Australia. The approach, encapsulated in the four-year Community Enrichment Project (CEP), focused on Primary Health Care (PHC) and nursing practice. The CEP developed curriculum and organised student placements, which promoted understanding of PHC in a way that integrated acute and community sectors. This paper considers the impact of splitting the students' third year final practicum, of seven weeks, between acute and community placements. Integral to the overall outcome of the project was the community agencies' cooperation in accepting students for longer clinical placements than had previously been the norm. This resulted in students being engaged in activities and projects in diverse areas. The students were aided in linking PHC theory to practice by the CEP team members who mentored them throughout these placements. Outcomes demonstrated the ability of students to integrate PHC theory to practice, across a variety of health settings. Students moved from a position of little knowledge or understanding of PHC, to an integrated knowledge of PHC principles and the relationship to enhanced nursing practice.

Attitude of Health Personnel↗