Computer-Aided Learning in Insulin Pump Training
|
|
- Veronica Martin
- 6 years ago
- Views:
Transcription
1 Journl of Dibetes Science nd Technology Volume 4, Issue 4, July 2010 Dibetes Technology Society TECHNOLOGY REPORTS Computer-Aided Lerning in Insulin Pump Trining Sergey V., M.Sc., 1 nd Chrles J. George, M.S. 2 Abstrct This technicl report concerns novel, computer-ided lerning tool for ptients with dibetes. The gol of the tool is to mke trining in the use of n insulin pump pinless, prcticl, effective, nd eductionlly rewrding. This lerning tool (or ppliction) is unique becuse it uses virtul pump to fcilitte lerning nd llow the ptient to prctice pump opertion, presents trining tsks in stndrdized formt, nd provides corrective feedbck to help ptients better understnd nd mnge their dibetes. The ppliction s cceptbility ws surveyed by 126 helth cre professionls who re experienced in dibetes eduction nd certified in pump trining. Results suggest tht use of Insulet s OmniPod Interctive Trining is ssocited with incresed trining efficiency nd promotes positive ttitude towrd insulin pump therpy. J Dibetes Sci Technol 2010;4(4): Introduction Advnces in insulin infusion technology hve provided new therpeutic options for ptients with type 1 dibetes. Along with dvnces in insulin pumps come new chllenges in educting ptients bout the use of these devices for mximum benefit nd sfety. Insulin pump trining involves lerning bout specific brnd fetures to mster pump opertion nd cquiring dvnced dibetes self-mngement skills to successfully mnge dibetes with pump therpy. 1,2 Beginning insulin pump therpy requires significnt time commitment from the ptient nd medicl prctitioner for eduction nd trining ctivities. Historiclly, this process my tke from two to six months in some complicted cses. 2 Intensive trining requirements contribute to the cost of therpy nd often become brrier to the efficient introduction of new technology in dibetes cre. Trditionlly, pump mnufcturers hve been the primry sources of informtion bout their devices vi mrketing brochures nd user mnuls nd hve provided generl dibetes mngement informtion s well. However, none of these sources is bsed on principles derived from eductionl curriculum development nd lerning theories, nor do they present opportunities for interctive prctice. In this technicl report, we describe novel, interctive, computer-ided ppliction clled Insulet s OmniPod Interctive Trining (trining CD), nd we present survey study of its unique fetures nd benefits. In ddition to its unique pump simultion component, the ppliction orgnizes bsic nd dvnced self-mngement concepts, stndrdizes the delivery of trining tsks, nd provides users with corrective feedbck s they lern pump opertion. Author Affilitions: 1 dbz inc., Pittsburgh, Pennsylvni; nd 2 University of Pittsburgh Medicl Center, Pittsburgh, Pennsylvni Abbrevitions: (CAL) computer-ided lerning, (PDM) Personl Dibetes Mnger, (trining CD) OmniPod Interctive Trining ppliction Keywords: computer-ided lerning, insulin pump trining Corresponding Author: Sergey, dbz inc., 5001 Bum Boulevrd, Suite 625, Pittsburgh, PA 15213; emil ddress ssirotinin@dbz.com 1022
2 Methods To develop the trining CD, we relied on principles of interctive computer-ided lerning (CAL). Computer-ided lerning is estblished s cost-effective djunct to conventionl eduction; specificlly, CAL cn contribute to the efficiency of trining, reduce trining time nd ssocited costs, nd eliminte eductionl brriers. 3 5 Product Design A computer-bsed interctive trining environment ws designed to guide ptients through the key res of dibetes mngement nd the use of the OmniPod Insulin Mngement System (OmniPod System, Insulet Corportion, Bedford, MA; Figure 1). Building on Ggne s theory, the trining frmework included three essentil ingredients of teching: 6,7 1. Knowledge presenttion nd skill demonstrtion 2. Prctice opportunity with feedbck 3. User guidnce Specificlly, users were guided in their interction with the virtul OmniPod System, OmniPod System fetures were demonstrted vi simultion of insulin mngement tsks, nd corrective feedbck ws provided (if needed) t ech step in skill lerning. In ddition, the trining Figure 1. The user interfce of the OmniPod trining CD. 1023
3 mteril ws ppropritely structured for new nd dvnced pump users in stndrdized lerning trcks. In summry, the trining CD fetures the following unique elements: dvnced self-mngement concepts (such s bsl rtes nd progrms, bolus doses nd presets, nd insulin correction nd djustment) re presented in brief reviews longside the OmniPod fetures; multimedi tutorils provide step-by-step illustrtions on how to use the OmniPod System fetures; split-screen presenttions reinforce step-by-step instructions with guidnce on the virtul Personl Dibetes Mnger (PDM) screen; Try It Now interctive tutorils llow ptients to prctice dibetes mngement scenrios; Living Well with Dibetes section presents bsic informtion bout nutrition nd exercise, voiding low nd high blood glucose levels, nd hndling specil occsions such s illness or trvel, nd sfe environment for ptients to prctice their OmniPod skills in stndrdized formt. Survey Study Mesures After reviewing results from pilot online survey, we designed 59-item questionnire tht covered prticipnts experience in dibetes eduction nd pump trining; their fmilirity with the trining CD, Web-bsed trining, or both; stisfction with content; efficcy of the eductionl mteril; nd impct of the trining CD on the trining process. Prticipnts Instructions for the online survey were sent vi emil to 1381 helth cre professionls involved with ptients pump eduction nd registered with Insulet Corportion. Ten dys were given to respond to the survey, with no incentives nd no follow-up. From the pool of potentil prticipnts, 126 completed the survey. In ddition, 36 prticipnts who responded to fewer thn five survey questions were eliminted from the finl nlysis. Sttisticl Methods Simple frequency nlysis ws used to exmine respondents experience nd expertise in trining with vrious brnds of pumps. Group t-tests were used to compre continuous vribles. Results Chrcteristics of the 126 respondents re shown in Tble 1. Ninety-six percent re involved with trining ptients to use their pumps. In ddition, 94% re certified on the OmniPod brnd, 84% on the Medtronic MiniMed, 72% on Anims, 39% on Accu-Chek, nd 6% on Nipro. Over the three-month period, the respondents trined 1244 ptients. Both those who lredy use the trining CD nd non-users lened towrd greement (on scle of 2 = strongly disgree to +2 = strongly gree; men rtings = 0.7, stndrd devition = 1.1) tht the OmniPod System fetures led to incresed recommendtion or utiliztion of pump therpy (Tble 2). Notbly, those lredy using the trining CD more strongly greed tht ese of trining, ese of use, nd ese of lerning increse pump therpy utiliztion. Trining CD users elevted greement bout the impct of the OmniPod System design, probbility of ptient complince, nd simplifiction of insulin pump therpy did not sttisticlly differ from tht of the trining CD non-users. The trining CD users were stisfied with overll content, qulity, orgniztion, nd ese of use. Regrding ness of specific ppliction fetures, the mjority of respondents rted ech feture s or very. Overll, 80% of pump triners reported their pprovl of the teching methods used in the trining CD (Tble 3). Regrding efficiency of trining, 81% of the triners confirmed tht their pump trining is more efficient when ptient views the trining CD before beginning trining with them (dt not tbulted). Moreover, the pump triners were unnimous in recognizing the vlue nd ppropriteness of the trining CD for ptients new to insulin pump therpy. They ll greed tht the trining CD helped ptients new to insulin pump therpy gin positive ttitude towrd it. Limittions This study included response rte lower thn typicl emil-requested prticiption. 8 Respondents in this study were the pump triners, not the ptients. Although dt 1024
4 provided by triners reflect their experience with other devices nd trining progrms something tht is not vilble from ptient surveys future studies will need to focus on ptient perspective nd outcomes. Finlly, it is not cler how mny medicl devices would benefit from this eductionl pproch. However, the device in question ws prticulrly well suited to computer-bsed trining. Tble 1. Chrcteristics of OmniPod Triners All Triners (n = 126) Trining CD Non-users (n = 79) Users (n = 47) Amount of job involved in trining n % n % n % Rrely involved Sometimes involved Regulrly involved One of primry responsibilities Led responsibility Other device certifictions (ctegories my overlp) n % n % n % Accu-Chek Anims Medtronic MiniMed Nipro OmniPod Time needed to trin on the OmniPod System n % n % n % 1 h h h h h Stisfction with the current OmniPod trining process n % n % n % Very disstisfied Disstisfied Stisfied Very stisfied Yers of experience in dibetes eduction Hours/week providing pump or pod trining Number of ptients trined in pst three months 12.7 ± ± ± ± ± ± 6.5 Accu-Chek 0.6 ± ± ± 4.5 Anims 2.1 ± ± ± 3.4 Medtronic MiniMed 6.0 ± ± ± 8.9 Nipro 0.0 ± ± ± 0.0 OmniPod 2.5 ± ± ± 6.0 p <.05 compring triners who use the trining CD versus those who do not. 1025
5 Tble 2. Extent of Agreement with Sttements Regrding the OmniPod System Item Ese of trining motivtes to recommend pump therpy to more ptients Ese of use motivtes to recommend pump therpy to more ptients Ese of lerning enbles more ptients to use pump therpy Wireless, tube-free design motivtes more ptients to use pump therpy Ptients re more likely to be more complint with their pump therpy The OmniPod simplifies insulin pump therpy Men (± stndrd devition) Trining CD Non-users (n = 79) Users (n = 47) 0.5 ± ± 1.1 b 0.7 ± ± 0.8 c 0.7 ± ± 0.9 b 1.2 ± ± ± ± ± ± 0.8 Rtings were on five-point scle centered on zero ( 2 = strongly disgree,, +2 = strongly gree). b p < 0.05 c p < 0.01 Tble 3. User Rtings of the Trining CD Fetures (n = 47) Trining CD fetures Overview of dvnced self-mngement concepts Step-by-step illustrtion of how to use the OmniPod System functions Guided interctions on the virtul PDM screen Virtul prctice of dibetes mngement scenrios Informtion bout bsic dibetes mngement res Sfe environment to prctice the OmniPod skills Very Helpful Rting Somewht Not 62% 26% 0% 0% 62% 23% 0% 0% 55% 28% 2% 0% 62% 19% 0% 4% 43% 40% 4% 0% 62% 19% 2% 0% Due to missing responses, percentges do not dd up to 100%. Conclusion OmniPod triners who use the trining CD ssocite it with positive ttitude towrd insulin pump therpy mong ptients s well s n increse in the efficiency of trining. The trining CD users did not report spending less time in ptient trining, but they did more strongly gree tht ese of use, trining, nd lerning contribute to incresed cceptnce of the therpy. Helth cre professionls who use the trining CD with their ptients re very stisfied with the overll trining process. Such interctive trining tools fcilitte the efficient nd cost-effective introduction of new technology for ptients with dibetes. Funding: This study ws supported by dbz inc. Acknowledgments: The uthors thnk Dr. Mri Kovcs for vluble suggestions. Disclosures: Sergey V. is full-time employee of dbz inc. nd holds shres of Insulet Corportion. Chrles J. George is full-time employee of the University of Pittsburgh Medicl Center. References: 1. Skyler JS, Ponder S, Kruger DF, Mtheson D, Prkin CG. Is there plce for insulin pump therpy in your prctice? Clin Dib. 2007;25(2): Boyd LC, Boyd ST. Insulin pump therpy trining nd mngement: n opportunity for community phrmcists. J Mng Cre Phrm. 2008;14(8): Lo R, Lo B, Wells E, Chrd M, Hthwy J. The development nd evlution of computer-ided dibetes eduction progrm. Aust J Adv Nurs. 1996;13(4): Berridge E, Roudsri A, Tylor S, Crey S. Computer-ided lerning for the eduction of ptients nd fmily prctice professionls in the personl cre of dibetes. Comput Methods Progrms Biomed. 2000;62(3): Dy JL, Rymn G, Hll L, Dvies P. Lerning dibetes: multimedi lerning pckge for ptients, crers nd professionls to improve chronic disese mngement. Med Inform (Lond). 1997;22(1): Ggne RM, Driscoll MP. Essentils of lerning for instruction. 2nd ed. Englewood Cliffs: Prentice-Hll; Ggne RM, Briggs LJ, Wger WW. Principles of instructionl design. 4th ed. Fort Worth: HBJ College Publishers; Finchm JE. Response rtes nd responsiveness for surveys, stndrds, nd the Journl. Am J Phrm Educ. 2008;72(2):
XII. HIV/AIDS. Knowledge about HIV Transmission and Misconceptions about HIV
XII. HIV/AIDS Knowledge bout HIV Trnsmission nd Misconceptions bout HIV One of the most importnt prerequisites for reducing the rte of HIV infection is ccurte knowledge of how HIV is trnsmitted nd strtegies
More informationReducing the Risk. Logic Model
Reducing the Risk Logic Model ETR (Eduction, Trining nd Reserch) is nonprofit orgniztion committed to providing science-bsed innovtive solutions in helth nd eduction designed to chieve trnsformtive chnge
More informationWORKSHOP FOR SYRIA. A SHORT TERM PROJECT A Collaborative Map proposal Al Moadamyeh, Syria
Al Modmyeh is city locted south-west Dmscus, in Syri. It is fcing post-conflict sitution, fter yers of siege nd displcement of its inhbitnts. Now, the popultion is coming bck, s lso new incomers. Therefore,
More informationHealth Coaching: A Preliminary Report on the Effects in Traumatic Brain Injury/Polytrauma Patients
ORIGINAL RESEARCH Helth Coching: A Preliminry Report on the Effects in Trumtic Brin Injury/Polytrum Ptients Esmerld Mdrigl, MSW; Mx Gry, BA; Molly A. Timmermn, DO; Ttin Orozco, PhD; Dine Cowper Ripley,
More informationAssessment of Depression in Multiple Sclerosis. Validity of Including Somatic Items on the Beck Depression Inventory II
Assessment of Depression in Multiple Sclerosis Vlidity of Including Somtic Items on the Beck Depression Inventory II Peggy Crwford, PhD; Noh J. Webster, MA Signs nd symptoms of multiple sclerosis (MS)
More informationJOB DESCRIPTION. Volunteer Student Teacher. Warwick in Africa Programme. Warwick in Africa Programme Director
JOB DSCRIPTION POST TITL: DPARTMNT: POST RSPONSIBL TO: SALARY: Volunteer Student Techer Wrwick in Afric Progrmme Wrwick in Afric Progrmme Director Voluntry position, ll your costs will be covered (flights,
More informationUtilization of dental services in Southern China. Lo, ECM; Lin, HC; Wang, ZJ; Wong, MCM; Schwarz, E
Title Utiliztion of dentl services in Southern Chin Author(s) Lo, ECM; Lin, HC; Wng, ZJ; Wong, MCM; Schwrz, E Cittion Journl Of Dentl Reserch, 2001, v. 80 n. 5, p. 1471-1474 Issued Dte 2001 URL http://hdl.hndle.net/10722/53200
More informationFactors influencing help seeking in mentally distressed young adults: a cross-sectional survey
L Biddle, D Gunnell, D Shrp nd J L Donovn Fctors influencing help seeking in mentlly distressed young dults: cross-sectionl survey Lucy Biddle, Dvid Gunnell, Debbie Shrp nd Jenny L Donovn SUMMARY Bckground:
More informationResearch Article Patterns of Cancer Genetic Testing: A Randomized Survey of Oregon Clinicians
Hindwi Publishing Corportion Journl of Cncer Epidemiology Volume 2012, Article ID 294730, 11 pges doi:10.1155/2012/294730 Reserch Article Ptterns of Cncer Genetic Testing: A Rndomized Survey of Oregon
More informationPhysicians prescribing a new medication often fail to discuss basic. Intervention to Enhance Communication About Newly Prescribed Medications
to Enhnce Communiction About Newly Prescribed Medictions Derjung M. Trn, MD, PhD 1 Debor A. Pterniti, PhD 2 Deborh K. Orosz, BA 3 Chi-Hong Tseng, PhD 4 Neil S. Wenger, MD, MPH 4 1 Deprtment of Fmily Medicine,
More informationSummary. Effect evaluation of the Rehabilitation of Drug-Addicted Offenders Act (SOV)
Summry Effect evlution of the Rehbilittion of Drug-Addicted Offenders Act (SOV) The Rehbilittion of Drug-Addicted Offenders Act (SOV) ws lunched on April first 2001. This lw permitted the compulsory plcement
More informationThe Acute Time Course of Concurrent Activation Potentiation
Mrquette University e-publictions@mrquette Exercise Science Fculty Reserch nd Publictions Exercise Science, Deprtment of 1-1-2010 The Acute Time Course of Concurrent Activtion Potentition Luke Grceu Mrquette
More informationReview TEACHING FOR GENERALIZATION & MAINTENANCE
Gols By the end of clss, you should be ble to: Explin wht generliztion is, why it is criticl for techers to know how to tech so tht it occurs, nd give n exmple of it from your own experience in the clssroom
More informationEffect on Glycemic, Blood Pressure, and Lipid Control according to Education Types
Originl Article http://dx.doi.org/10.4093/dmj.2011.35.6.580 pissn 2233-6079 eissn 2233-6087 D I A B E T E S & M E T A B O L I S M J O U R N A L Effect on Glycemic, Blood Pressure, nd Lipid Control ccording
More informationImpact of Pharmacist Intervention on Diabetes Patients in an Ambulatory Setting
Impct of Phrmcist Intervention on Dibetes Ptients in n Ambultory Setting Julie Stding, PhrmD, CDE, Jmie Herrmnn, PhrmD, Ryn Wlters, MS, Chris Destche, PhrmD, nd Aln Chock, PhrmD Dibetes is the seventh-leding
More informationFactors affecting orthodontists management of the retention phase
Originl Article Fctors ffecting orthodontists mngement of the retention phse Kevin Bibon ; Bhvn Shroff b ; Al M. Best c ; Steven J. Linduer d ABSTRACT Objective: To test the null hypothesis tht orthodontist
More informationDeveloping Performance Standards for Teacher Assessment by Policy Capturing
Assessment & Evlution in Higher Eduction, Vol. 28, No. 4, 2003 Developing Performnce Stndrds for Techer Assessment by Policy Cpturing MARIEKE F. VAN DER SCHAAF, KAREL M. STOKKING, Deprtment of Eductionl
More informationPNEUMOVAX 23 is recommended by the CDC for all your appropriate adult patients at increased risk for pneumococcal disease 1,2 :
PNEUMOVAX 23 is recommended y the CDC for ll your pproprite dult ptients t incresed risk for pneumococcl disese 1,2 : Adults ged
More informationWork-related musculoskeletal disorders (WMSDs) among nursing personnel
Work-Relted Musculoskeletl Injuries nd Disorders Among Occuptionl nd Physicl Therpists Amy R. Drrgh, Wendy Huddleston, Phyllis King KEY WORDS ccidents, occuptionl moving nd lifting ptients musculoskeletl
More informationThe Effects of Diet Particle Size on Animal Performance
MF-2050 Feed Mnufcturing Feed Mnufcturing Cerel grins re the primry energy source in swine nd poultry diets. Therefore, not only must producers be concerned bout the composition of the grin, but lso how
More informationJ Arab Soc Med Res 9: The Arab Society for Medical Research
6 Originl rticle Assessment of complince to stndrd precutions mong surgeons in Zgzig University Hospitls, Egypt, using the Helth Belief Model Emn M. Mortd, Mrw M. Zlt b Deprtments of C ommunity Medicine
More informationMetabolic Syndrome and Health-related Quality of Life in Obese Individuals Seeking Weight Reduction
Metbolic Syndrome nd Helth-relted Qulity of Life in Obese Individuls Seeking Weight Reduction Adm Gilden Tsi 1, Thoms A. Wdden 1, Dvid B. Srwer 1, Robert I. Berkowitz 1, Leslie G. Womble 1, Louise A. Hesson
More informationMaximize Your Genetic Return. Find your Genetic Solution with Boviteq West
Mximize Your Genetic Return. Find your Genetic Solution with Boviteq West Boviteq West is comprehensive reproductive solutions provider, imed t finding the right genetic solution for every niml nd every
More informationSummary of Package Insert 1
Summry of Pckge Insert 1 For Sttes with Non-Published Policies Indictions Non-infected prtil nd full-thickness skin ulcers due to VSU 2 of greter thn 1 month durtion nd which hve not dequtely responded
More informationDiabetes affects 29 million Americans, imposing a substantial
CLINICAL Comprtive Effectiveness nd Costs of Insulin Pump Therpy for Dibetes Ronld T. Ackermnn, MD, MPH; Amish Wlli, MD, MS; Rymond Kng, MA; Andrew Cooper, MPH; Theodore A. Prospect, FSA, MAAA; Lewis G.
More informationCEO MESSAGE STEPHANIE HARVEY. As we take these first steps into the New Year, it s a good time to reflect upon our journey.
2 CEO MESSAGE STEPHANIE HARVEY As we tke these first steps into the New Yer, it s good time to reflect upon our journey. At ICV we re guided by the knowledge tht Aboriginl nd Torres Strit Islnder communities
More informationClinical Study Report Synopsis Drug Substance Naloxegol Study Code D3820C00018 Edition Number 1 Date 01 February 2013 EudraCT Number
EudrCT Number 2012-001531-31 A Phse I, Rndomised, Open-lbel, 3-wy Cross-over Study in Helthy Volunteers to Demonstrte the Bioequivlence of the Nloxegol 25 mg Commercil nd Phse III Formultions nd to Assess
More informationp Coaches j i k n A B m Recruitment Dimensions Report Name Sample Person Date of Report: 05/07/2016 Trait Profile 3 Narrative Report 5
Report Nme Smple Person Dte of Report: 05/07/2016 Trit Profile 3 Nrrtive Report 5 Also Recommended: Trit nd Indictor Profile Who could use components of this report: p Coches j i k HR professionls Trined
More informationGraduate medical education in
Simultion Trining Improves Surgicl Proficiency nd Sfety During Dignostic Shoulder Arthroscopy Performed by Residents Brin R. Wtermn, MD; Kevin D. Mrtin, DO; Kenneth L. Cmeron, PhD, MPH, ATC; Brett D. Owens,
More informationKnowledge, Attitude, and Concussion-Reporting Behaviors Among High School Athletes: A Preliminary Study
Journl of Athletic Trining 2013;48(5):645 653 doi: 10.4085/1062-6050-48.3.20 Ó y the Ntionl Athletic Triners Assocition, Inc www.ntjournls.org originl reserch Knowledge, Attitude, nd Concussion-Reporting
More informationTeacher motivational strategies and student self-determination in physical education
Loughborough University Institutionl Repository Techer motivtionl strtegies nd student self-determintion in physicl eduction This item ws submitted to Loughborough University's Institutionl Repository
More informationAnalysis of Regulatory of Interrelated Activity of Hepatocyte and Hepatitis B Viruses
Interntionl Journl of Biomedicl Mterils Reserch 8 6(): -7 http://www.sciencepublishinggroup.com/j/ijbmr doi:.648/j.ijbmr.86. ISSN: 33-756 (Print) ISSN: 33-7579 (Online) Anlysis of Regultory of Interrelted
More informationCheckMate 153: Randomized Results of Continuous vs 1-Year Fixed-Duration Nivolumab in Patients With Advanced Non-Small Cell Lung Cancer
CheckMte 53: Rndomized Results of Continuous vs -Yer Fixed-Durtion Nivolumb in Ptients With Advnced Non-Smll Cell Lung Cncer Abstrct 297O Spigel DR, McCleod M, Hussein MA, Wterhouse DM, Einhorn L, Horn
More informationMETHOD 4010 SCREENING FOR PENTACHLOROPHENOL BY IMMUNOASSAY
METHOD 4010 SCREENING FOR PENTACHLOROPHENOL BY IMMUNOASSAY 1.0 SCOPE AND APPLICATION 1.1 Method 4010 is procedure for screening solids such s soils, sludges, nd queous medi such s wste wter nd lechtes
More informationImpact of Short Message Service (SMS) Education Based on a Health Promotion Model on the Physical Activity of Patients with Type II Diabetes
Originl Article Impct of Short Messge Service (SMS) Eduction Bsed on Helth Promotion Model on the Physicl Activity of Ptients with Type II Dibetes Hmideh Lri 1, Azit Noroozi 1,2, Rhim Thmsebi 2,3 Submitted:
More informationMultiple sclerosis (MS) affects approximately. Triaging Patients with Multiple Sclerosis in the Emergency Department. Room for Improvement
Systemtic Review of Tools for Anxiety in MS MS CARE DELIVERY: CHALLENGES AND INVATIONS Triging Ptients with Multiple Sclerosis in the Emergency Deprtment Room for Improvement Heshm Abboud, MD, PhD; Krin
More informationMay 28, Congressional Requesters
United Sttes Government Accountbility Office Wshington, DC 20548 My 28, 2010 Congressionl Requesters Subject: Federl Funds: Fiscl Yers 2002-2009 Obligtions, Disbursements, nd Expenditures for Selected
More informationURINARY incontinence is an important and common
Urinry incontinence in older people in the community: neglected problem? Helen Stoddrt, Jenny Donovn, Elise Whitley, Deborh Shrp nd In Hrvey SUMMARY Bckground: The prevlence nd impct of urinry incontinence
More informationThe Association of Gender With Quality of Health in Peripheral Arterial Disease Following Peripheral Vascular Intervention
The Assocition of Gender With Qulity of Helth in Peripherl Arteril Disese Following Peripherl Vsculr Intervention Sudrshn Pudel, MD 1 ; Anwr Zitoun, MD 1 ; Sif Al-Njfi, MD 2 ; Ther Mus, MD 3 ; Susn Szpunr,
More informationJudges and other legal personnel, understandably, have a
Mentl Helth Review Tribunls in the UK: Applying Therpeutic Jurisprudence Perspective Nicol Ferencz nd Jmes McGuire Judges nd other legl personnel, understndbly, hve profound interest in the impct of their
More informationEvaluation of a task-oriented client-centered upper extremity skilled performance training module in persons with tetraplegia
(2011) 49, 1049 1054 & 2011 Interntionl Society All rights reserved 1362-4393/11 $32.00 www.nture.com/sc ORIGINAL ARTICLE Evlution of tsk-oriented client-centered upper extremity skilled performnce trining
More informationThe Quality and Outcomes Framework (QOF) is a pay-for-performance
Effect of UK Py-for-Performnce Progrm on Ethnic Disprities in Dibetes Outcomes: Interrupted Time Series Anlysis Riydh Alshmsn, MSc John Tyu Lee, MSc Azeem Mjeed, MD Goplkrishnn Netuveli, PhD Christopher
More informationSupplementary Online Content
Supplementry Online Content Zulmn DM, Pl Chee C, Ezeji-Okoye SC, et l. Effect of n intensive outptient progrm to ugment primry cre for high-need Veterns Affirs ptients: rndomized clinicl tril. JAMA Intern
More informationEVALUATION OF DIFFERENT COPPER SOURCES AS A GROWTH PROMOTER IN SWINE FINISHING DIETS 1
Swine Dy 2001 Contents EVALUATION OF DIFFERENT COPPER SOURCES AS A GROWTH PROMOTER IN SWINE FINISHING DIETS 1 C. W. Hstd, S. S. Dritz 2, J. L. Nelssen, M. D. Tokch, nd R. D. Goodbnd Summry Two trils were
More informationUniversity of Texas Health Science Center, San Antonio, San Antonio, Texas, USA
Lung Cncer Chemotherpy Given Ner the End of Life by Community Oncologists for Advnced Non-Smll Cell Lung Cncer Jose R. Murillo, Jr., Jim Koeller b,c Methodist Hospitl, Houston, Texs, USA; b University
More informationNovel AHP-based QoE Factors Selection Approach
Novel AHP-bsed QoE Fctors Selection Approch Yosr Ben Youssef, Mériem Afif, Smi Tbbne MEDIATRON: Reserch Unit on Rdio Communiction nd Multimedi Networks Higher School of communiction of Tunisi (SupCom)
More informationRESEARCH Design and Implementation of an Elective on the Ethnopharmacology of Appalachia for the PharmD Curriculum
RESEARCH Design nd Implementtion of n Elective on the Ethnophrmcology of Applchi for the PhrmD Curriculum Rebecc S. Linger, PhD Americn Journl of Phrmceuticl Eduction 2017; 81 (10) Article 6100. University
More informationInput from external experts and manufacturer on the 2 nd draft project plan Stool DNA testing for early detection of colorectal cancer
Input externl experts nd mnufcturer on the 2 nd drft project pln Stool DNA testing for erly detection of colorectl cncer (Project ID:OTJA10) All s nd uthor s replies on the 2nd drft project pln Stool DNA
More informationAbstract. Background. Aim. Patients and Methods. Patients. Study Design
Impct of the Use of Drugs nd Substitution Tretments on the Antivirl Tretment of Chronic Heptitis C: Anlysis of Complince, Virologicl Response nd Qulity of Life (CHEOBS). Melin, 1 J.-. Lng, D. Ouzn, 3 M.
More informationInterproximal reduction of teeth: Differences in perspective between orthodontists and dentists
Originl Article Interproximl reduction of teeth: Differences in perspective between orthodontists nd dentists Elvi Brcom ; Bhvn Shroff b ; Al M. Best c ; Michel C. Shoff d ; Steven J. Linduer e ABSTRACT
More informationInadequate health literacy is a
Testing the BRIEF Helth Litercy Screening Tool Jolie Hun, PhD, Virgini Nolnd-Dodd, PhD, MPH, Jill Vrnes, EdD, John Grhm-Pole, MD, Brbr Rienzo, PhD, nd Ptrici Donldson, RN Due to the oppressive strins lid
More informationChapter II. THE PREVALENCE METHOD John Bongaarts*
Chpter II THE PREVALENCE METHOD John Bongrts* This chpter describes nd pplies new methodology for estimting the fertility impct of contrception obtined through fmily plnning progrmme. This pproch is clled
More informationEffect of linear and random non-linear programming on environmental pollution caused by broiler production
Journl of Novel Applied Sciences Aville online t www.jnsci.org 24 JNAS Journl-24-3-/43-434 ISSN 2322-549 24 JNAS Effect of liner nd rndom non-liner progrmming on environmentl pollution cused y roiler production
More informationSandra Kus, MPH 1,2, Martin Müller, RGN, Dipl. Nurs. Mngt. 1,2, Ralf Strobl, Dipl. Stat. 1,2 and Eva Grill, DrPH, PhD 1,2
J Rehbil Med 2011; 43: 156 161 ORIGINAL REPORT Ptient gols in post-cute geritric rehbilittion: gol ttinment is n indictor for improved functioning Sndr Kus, MPH 1,2, Mrtin Müller, RGN, Dipl. Nurs. Mngt.
More informationENERGY CONTENT OF BARLEY
ENERGY CONTENT OF BARLEY VARIATION IN THE DIETARY ENERGY CONTENT OF BARLEY Shwn Firbirn, John Ptience, Hnk Clssen nd Ruurd Zijlstr SUMMARY Formultion of commercil pig diets requires n incresing degree
More informationThe potential future of targeted radionuclide therapy: implications for occupational exposure? P. Covens
The potentil future of trgeted rdionuclide therpy: implictions for occuptionl exposure? Introduction: Trgeted Rdionuclide Therpy (TRT) Systemic tretment Molecule lbelled with rdionuclide delivers toxic
More informationPreliminary Findings of a Randomized Controlled Trial of an Interdisciplinary Military Pain Program
MILITARY MEDICINE, 174, 3:270, 2009 Preliminry Findings of Rndomized Controlled Tril of n Interdisciplinry Militry Pin Progrm Robert J. Gtchel, PhD * ; Donld D. McGery, PhD ; Aln Peterson, PhD ; Mysti
More informationAppendix J Environmental Justice Populations
Appendix J Environmentl Justice s [This pge intentionlly left blnk] Tble of Contents REFERENCES...J-2 Pge LIST OF TABLES Pge Tble J-1: Demogrphic Overview of Bruinsburg Site Project Are... J-3 Tble J-2:
More informationGoal: Evaluate plant health effects while suppressing dollar spot and brown patch
Newer Fungicide Products Alone nd In Rottion on Chicgo Golf Green Reserchers: Chicgo District Golf Assoc. Derek Settle, Tim Sibicky, nd Nick DeVries Gol: Evlute plnt helth effects while suppressing dollr
More informationCommunication practices and preferences between orthodontists and general dentists
Originl rticle ommuniction prctices nd preferences between orthodontists nd generl dentists Kevin ibon ; hvn Shroff b ; l M. est c ; Steven J. Linduer d STRT Objective: To evlute similrities nd differences
More informationAnalytic hierarchy process-based recreational sports events development strategy research
ISSN : 0974-7435 Volume 0 Issue 6 An Indin Journl Anlytic hierrchy process-bsed recretionl sports events development strtegy reserch Weihu Yo School of hysicl Eduction, Luoyng Norml University, Luoyng
More informationTHE 2017 GENENTECH ONCOLOGY TREND REPORT
THE 2017 GEETECH OCOLOGY TRED REPORT Perspectives From: Mnged Cre Orgniztions, Specilty Phrmcies, Oncologists, Prctice Mngers, nd Employers 9 th Edition THE 2017 GEETECH OCOLOGY TRED REPORT Editoril Bord
More informationClinical statistics analysis on the characteristics of pneumoconiosis of Chinese miner population
Originl Article Clinicl sttistics nlysis on the chrcteristics of pneumoconiosis of Chinese miner popultion Mei-Fng Wng 1 *, Run-Ze Li 2 *, Ying Li 2, Xue-Qin Cheng 1, Jun Yng 1, Wen Chen 3, Xing-Xing Fn
More informationEffect of Preoperative Intravenous Methocarbamol and Intravenous Acetaminophen on Opioid Use After Primary Total Hip and Knee Replacement
Feture Article Effect of Preopertive Intrvenous Methocrbmol nd Intrvenous Acetminophen on Opioid Use After Primry Totl Hip nd Knee Replcement THOMAS D. LOOKE, MD, PHD; CAMERON T. KLUTH, MBA bstrct Between
More informationChecks on inadvertently modified BAS-funseeking scale from BIS-BAS. Modified scale excluded 2 of the original 4 items: bisbas10, bisbas20.
PATH 20 24 Wve 3. Checks on indvertently modified BAS-funseeking scle from BIS-BAS Modified scle excluded 2 of the originl 4 items: bisbs0, bisbs20. Check correltions mong BAS-fun items in 20-24 yer olds
More informationCharacteristics of zero-absenteeism in hospital care
Occuptionl Medicine 2013;63:266 273 Advnce Access publiction 17 April 2013 doi:10.1093/occmed/kqt033 Chrcteristics of zero-bsenteeism in hospitl cre J. A. H. Schreuder 1, C. A. M. Roelen 2, J. J. L. vn
More informationEfficacy of Pembrolizumab in Patients With Advanced Melanoma With Stable Brain Metastases at Baseline: A Pooled Retrospective Analysis
Efficcy of Pembrolizumb in Ptients With Advnced Melnom With Stble Brin Metstses t Bseline: A Pooled Retrospective Anlysis Abstrct 1248PD Hmid O, Ribs A, Dud A, Butler MO, Crlino MS, Hwu WJ, Long GV, Ancell
More informationWill All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic
nture publishing group rticles Will All s Become Overweight or Obese? Estimting the Progression nd Cost of the US Obesity Epidemic Youf Wng 1, My A. Beydoun 1, Ln Ling 2, Benjmin Cbllero 1 nd Shiriki K.
More informationCommunity. Profile Powell County. Public Health and Safety Division
Community Helth Profile 2015 Powell County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12 Behviorl Risk
More informationOpioid Use and Survival at the End of Life: A Survey of a Hospice Population
532 Journl of Pin nd Symptom Mngement Vol. 32 No. 6 December 2006 NHPCO Originl Article Opioid Use nd Survivl t the End of Life: A Survey of Hospice Popultion Russell K. Portenoy, MD, Un Sibircev, BA,
More informationCommunity. Profile Big Horn County. Public Health and Safety Division
Community Helth Profile 2015 Big Horn County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12 Behviorl
More informationCommunity. Profile Yellowstone County. Public Health and Safety Division
Community Helth Profile 2015 Yellowstone County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12 Behviorl
More informationCommunity. Profile Lewis & Clark County. Public Health and Safety Division
Community Helth Profile 2015 Lewis & Clrk County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12 Behviorl
More informationCommunity. Profile Missoula County. Public Health and Safety Division
Community Helth Profile 2015 Missoul County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12 Behviorl Risk
More informationEstimating the Cost to U.S. Health Departments to Conduct HIV Surveillance
Reserch Articles Estimting the Cost to U.S. Helth Deprtments to Conduct HIV Surveillnce Rm K. Shresth, PhD Stephnie L. Snsom, PhD, MPP, MPH Benjmin T. Lffoon, BS Pul G. Frnhm, PhD R. Luke Shouse, MD Kren
More informationCommunity. Profile Anaconda- Deer Lodge County. Public Health and Safety Division
Community Helth Profile 2015 Ancond- Deer Lodge County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12
More informationHuman Immunodeficiency Virus / Acquired Immunodeficiency Syndrome Knowledge and Risk Factors in Ethiopian Military Personnel
MILITARY MEDICINE, 169, 3:221, 2004 Humn Immunodeficiency Virus / Acquired Immunodeficiency Syndrome Knowledge nd Risk Fctors in Ethiopin Militry Personnel Gurntor: Ludmil N. Bkhirev, MD MPH Contributors:
More informationQuantifying perceived impact of scientific publications
Quntifying perceived impct of scientific publictions Filippo Rdicchi, Alexnder Weissmn, nd John Bollen Center for Complex Networks nd Systems Reserch, School of Informtics nd Computing, Indin University,
More informationCommunity. Profile Carter County. Public Health and Safety Division
Community Helth Profile 2015 Crter County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12 Behviorl Risk
More informationThe Effects of Small Sized Rice Bowl on Carbohydrate Intake and Dietary Patterns in Women with Type 2 Diabetes
Originl Article doi: 10.4093/kdj.2010.34.3.166 pissn 1976-9180 eissn 2093-2650 The Effects of Smll Sized Rice Bowl on Crbohydrte Intke nd Dietry Ptterns in Women with Type 2 Dibetes Hee-Jung Ahn 1, *,
More informationOriginal Article. T Akter 1, N Islam 2, MA Hoque 3, S Khanam 4, HA khan 5, BK Saha 6. Abstract:
Fridpur Med. Coll. J. 214;9(2):61-67 Originl Article Nebuliztion by Isotonic Mgnesium Sulphte Solution with Provide Erly nd Better Response s Compred to Conventionl Approch ( Plus Norml Sline) in Acute
More informationMany authors have recognized the lack of continuity in cancer
Fmily Physicin Involvement in Cncer Cre Follow-up: The Experience of Cohort of Ptients With Lung Cncer Michèle Aubin, MD, PhD, CCFP, FCFP 1,2,3,4 Lucie Vézin, MA 4 René Verreult, MD, PhD, FCFP, CCFP 1,5
More informationORIGINAL ARTICLE. A Survey of Treatment Modalities for Convergence Insufficiency
1040-5488/02/7903-0151/0 VOL. 79, NO. 3, PP. 151 157 OPTOMETRY AND VISION SCIENCE Copyright 2002 Americn Acdemy of Optometry ORIGINAL ARTICLE A Survey of Modlities for Convergence Insufficiency MITCHELL
More informationKaiser Permanente Georgia s Experience with Operation Zero: A Group Medical Appointment to Address Pediatric Overweight
CME helth systems Kiser Permnente Georgi s Experience with Opertion Zero: A Group Medicl Appointment to Address Peditric Overweight By Josephine Hinchmn, MPH Luke Beno, MD Adrienne Mims, MD, MPH Astrct
More informationPsychological distress in Australian case managers working with the unemployed
Psychologicl distress in Austrlin cse mngers working with the unemployed Author Goddrd, Richrd, Ptton, Wendy, Creed, Peter Published 2001 Journl Title Journl of Employment Counseling Copyright Sttement
More informationA series of recent studies and meta-analyses confirm
Originl Reserch Clinicl Medicine & Reserch Volume 11, Number 4: 210-218 2013 Mrshfield Clinic clinmedres.org Brest nd Prostte Cncer Survivors in Dibetic Cohort: Results from the Living With Dibetes Study
More informationStaffing Model for Dental Wellness and Readiness
MILITARY MEDICINE, 169, 8:604, 2004 Stffing Model for Dentl Wellness nd Rediness Gurntor: LTC Jeffrey Chffin, DC USA Contributors: COL Lrry G. Rothfuss, DC USA* ; LCDR Scott A. Johnson, NC USN* ; MAJ Stephen
More informationManagement and Outcomes of Binge-Eating Disorder in Adults: Current State of the Evidence
Clinicin Summry Mentl Helth Eting Disorders Mngement nd Outcomes of Binge-Eting Disorder in Adults: Current Stte of the Evidence Focus of This Summry This is summry of systemtic review evluting the evidence
More informationResidency Curriculum Improves Breastfeeding Care
Residency Curriculum Improves Brestfeeding Cre Lori Feldmn-Winter, Luren Brone, Brry Milcrek, Krystl Hunter, Jon Meek, Jne Morton, Tr Willims, Audrey Nylor nd Ruth A. Lwrence Peditrics 2010;126;289-297;
More informationThe Self in Adolescence
INVITED SYMPOSIUM EARA 2018 The Self in Adolescence Chir: Snder Thomes, Utrecht University, the Netherlnds Discussnt: Jp Denissen, Tilburg University, the Netherlnds Thursdy September 13 th, 13.30-15.00,
More informationThe RUTHERFORD-2 trial in heterozygous FH: Results and implications
The RUTHERFORD-2 tril in heterozygous FH: Results nd implictions Slide deck kindly supplied s n eductionl resource by Professor Derick Rl MD PhD Crbohydrte & Lipid Metbolism Reserch Unit University of
More informationThe diagnosis of autism and Asperger syndrome: findings from a survey of 770 families
The dignosis of utism nd Asperger syndrome: findings from survey of 770 fmilies Ptrici Howlin*, Deprtment of Psychology, St George s Hospitl Medicl School, London; Ann Asghrin, Deprtment of Psychology,
More informationTHE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS
THE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS THE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS John F. Ptience nd Doug Gillis SUMMARY
More informationSeasonal influenza vaccination programme country profile: Ireland
Sesonl influenz vccintion progrmme country profile: Irelnd 2012 13 Seson Bckground informtion Influenz immunistion policy nd generl fcts bout Irelnd Volume indices of GDP per cpit in 2011 nd 2013 (EU-
More informationCost-Effectiveness of Finding New HIV Diagnoses Using Rapid HIV Testing in Community-Based Organizations
Reserch Articles Cost-Effectiveness of Finding New HIV Dignoses Using Rpid HIV Testing in Community-Bsed Orgniztions Rm K. Shresth, PhD Hollie A. Clrk, MPH Stephnie L. Snsom, PhD, MPP, MPH Binwei Song,
More informationBreast-Conserving Surgery Under Local Anesthesia in Elderly Patients with Severe Cardiorespiratory Comorbidities: A Hospital-Based Case-Control Study
Originl Article Brest Cre 2017;12:29 33 DOI: 10.1159/000455003 Published online: Februry 8, 2017 Brest-Conserving Surgery Under Locl in Elderly Ptients with Severe Crdiorespirtory Comorbidities: A Hospitl-Bsed
More informationPEOPLE HAVE SHOWN considerable creativity in discovering
358 ORIGINAL ARTICLE Exercisers Achieve Greter Acute Exercise-Induced Mood Enhncement Thn Nonexercisers Mrtin D. Hoffmn, MD, Debi Rufi Hoffmn, MA ABSTRACT. Hoffmn MD, Hoffmn DR. Exercisers chieve greter
More informationImpact of Positive Nodal Metastases in Patients with Thymic Carcinoma and Thymic Neuroendocrine Tumors
Originl Article Impct of Positive Nodl Metstses in Ptients with Thymic Crcinom nd Thymic Neuroendocrine Tumors Benny Weksler, MD, Anthony Holden, MD, nd Jennifer L. Sullivn, MD Introduction: Thymic crcinoms
More information