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PubMed1989

Sexual counseling standards for the spinal cord-injured.

Spinal cord injury is one of the most prevalent disabilities in the United States today. The disability invariably affects sexual functioning challenging the usual ways one thinks about sexuality. Rehabilitation and development of standards of care for sexual counseling in this population are essential. Outlined in this article are proposed standards of care for sexual counseling of the spinal cord-injured (SCI) client. Theoretical approaches, provision of counseling and nurse-client objectives which support development of these standards are identified. Also included is a discussion of the preparation and role of the nurse in providing sexual counseling.

Persons with Disabilities↗
PubMed2002

Tobacco intervention training: current efforts and gaps in US medical schools.

CONTEXT: Research has documented that US medical schools inadequately teach tobacco intervention skills. OBJECTIVE: To examine effective training methods for tobacco intervention in undergraduate medical education. DATA SOURCES: Using indexing terms related to tobacco intervention and medical education, we searched MEDLINE (1966-June 2002) and the Cochrane Database of Systematic Reviews (through issue 2, 2002). Reference lists of relevant articles were also read to identify additional articles. Because of their importance to tobacco intervention, we also reviewed Ockene and colleagues' tobacco education research and the tobacco treatment guidelines of the United States Public Health Service and the United States Preventive Services Task Force. STUDY SELECTION: All study designs that incorporated process or outcome evaluation of tobacco intervention educational methods for medical students were included in this review. Of an initial 1241 articles retrieved, 82 included medical students. Reviewing abstracts and references of these articles identified 13 pertinent studies. DATA EXTRACTION: Quality criteria for inclusion consisted of explicit evaluation of the educational methods used. Data extraction identified all evaluations and any problems in program implementation. DATA SYNTHESIS: Enhanced instructional methods (eg, the use of patient-centered counseling, standardized patient instructors, role playing, or a combination of these) are more effective for teaching tobacco intervention than are traditional didactic methods alone and can be effectively inserted into medical school curricula. CONCLUSIONS: Various educational methods have been used to train medical students in tobacco intervention. Nonetheless, gaps still exist within undergraduate medical education, including a lack of integration of tobacco dependence information throughout all 4 years of medical school curricula, specific training in smokeless tobacco intervention, tobacco intervention training that addresses cultural issues, and long-term studies showing that such training is retained.

Counseling↗
PubMed1990

A hospital quit-smoking consult service: clinical report and intervention guidelines.

A minimal-contact quit-smoking consult service was established to treat hospital inpatients and outpatients referred for behavioral smoking cessation treatment. Sixty-two consecutively referred patients were evaluated and triaged to one of three standardized quitting protocols: motivational counseling; standard behavioral abstinence counseling; or abstinence counseling plus nicotine fading. Consultations included personalized self-quit materials and planned telephone follow-up to enhance compliance. Triage differentiated patients with different levels of quitting readiness and nicotine dependence. Six months after treatment, 27% of patients had quit smoking (informant-verified). Predictors of quit attempts were shorter smoking history and lower nicotine dependence. Variables predicting cessation or substantial reductions in estimated daily nicotine intake included higher educational level, stronger beliefs in smoking health harms, higher trait anxiety, a greater desire to quit and quitting self-efficacy, and the recall of direct quitting advice from the referring physician. Results compare favorably with those of more intensive treatments with similar patient groups. Recommendations are presented for controlled follow-up research to explore promising findings in this clinical report.

Adult↗
PubMed2002

Efficacy of Eye Movement Desensitization in the treatment of cognitive intrusions related to a past stressful event.

Much of the Eye Movement Desensitization and Reprocessing (EMDR) efficacy research has been widely criticized, limiting scientific understanding of its therapeutic components. The present investigation of Eye Movement Desensitization (EMD) effectiveness included undergraduate students reporting current intrusive cognitions conceming a traumatic event. Forty-five participants received a single treatment session of either: (a) EMD, as described by Shapiro [J. Behav. Ther. Exp. Psychiatry 20 (1989b) 211], (b) an identical procedure which employed eye fixation on a stationary target, or (c) non-directive counseling. Standardized self-report, subjective rating, Daily Diary, and intrusive thought sampling measures were collected before and after treatment. Results indicated that participants in the eye fixation group reported marginally (p < .052) fewer cognitive intrusions than the non-directive group 1 week following treatment. No significant differences between the EMD and non-directive conditions or between the EMD and eye fixation conditions on this measure were found. During the treatment session, both desensitization groups were superior to the non-directive group in reducing reported vividness of the mental image of the original event. However, the non-directive group improved to the level of the two other groups by the following week. Rapid saccadic eye movements were therefore unrelated to immediate treatment effects for this sub-clinical sample, and non-directive treatment largely yielded eventual outcomes equivalent to the two desensitization conditions.

Arousal↗
PubMed2000

Surveillance, social risk, and symbolism: framing the analysis for research and policy.

Name-based surveillance for HIV, considered alone, is a useful public health measure; its benefits outweigh its direct costs. There is little evidence that name-based surveillance directly deters individuals at risk of HIV from being tested, or exposes them to significant social risks. Yet such surveillance is chronically controversial. Understood in a broader context of the social risks and symbolic politics of HIV, as subjectively experienced by people at risk, this opposition is both rational and instructive. Although often discussed, the social risks of HIV infection are poorly understood. To the extent these risks have been addressed by privacy and antidiscrimination laws, the solution has been less complete than many public health professionals appear to believe: developments in law and policy, including the increasing prevalence of criminal HIV transmission laws and proposed changes in HIV testing and counseling standards, are contextual factors that help explain the opposition to name-based surveillance. Rather than focusing piecemeal on specific "barriers" to testing and care, an appreciation of the surveillance debate in context suggests a positive undertaking in public health policy to provide the conditions of opportunity, information, motivation and confidence that people with HIV need to accept an effective program of early intervention.

Confidentiality↗
PubMed2004

Preparing residents to counsel about smoking.

The objective of this study was to evaluate the effects of an innovative, multicomponent, theory-based educational intervention for pediatric residents on prevention of tobacco use counseling for cessation. Before and 3 months after intervention residents in a large urban midwestern pediatric residency program completed a self-assessment of measures of their attitudes and counseling behaviors. The intervention was a 3-hour multicomponent program including presentations, case discussions, role-plays and support material based on concepts from Motivational Interviewing (MI). Participants reported increased confidence in their ability to counsel, as well as greater frequency of counseling (standardized effect size (d) = 0.57). Residents also reported an increased use of principal components of MI, assessing how important quitting is to patients (d = .66), and how confident patients are in their ability to quit (d = .78). This brief educational intervention taught theory-based counseling techniques to pediatric residents. After the study, participants reported significant increases in their frequency of counseling as well as greater use of the MI principles.

Adult↗
PubMed1994

Medicaid program; drug use review program and electronic claims management system for outpatient drug claims--HCFA. Final rule.

This final rule revises some of the regulatory requirements for the drug use review (DUR) program for covered outpatient drugs furnished to recipients under the Medicaid program. The regulatory requirements became effective on January 2, 1993, as a result of an interim final rule with comment period that we published on November 2, 1992. Specifically, these revisions-- Clarify the definitions of overutilization, underutilization, consensus process, peer-reviewed literature, adverse medical result, adverse drug-drug interaction, appropriate and medically necessary, and individual medical history; Change the requirements for licensure of DUR board members, and telephone counseling arrangements for mail order pharmacies; Include non-prescription drugs in the consideration of alteration of therapeutic effect; Require hospitals to give assurances that they have met the requirements of the statute before claiming the hospital exemption from DUR; Specify the issues that State agencies must address when formulating counseling standards; Clarify the bases for DUR board recommendations; Clarify the distinction between DUR and surveillance and utilization review (SUR); and Make certain technical and editorial corrections. The November 1992 interim final rule with comment period incorporated and interpreted certain provisions of section 4401 of the Omnibus Budget Reconciliation Act of 1990.

Centers for Medicare and Medicaid Services, U.S.↗