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1.
Creat Nurs ; 25(1): 17-24, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30808781

RESUMO

In response to the merger of our 248-bed community hospital with a new health system, a multidisciplinary team began a journey of holistic transformation via the evolution of a new rounding process called Leadership, Ownership, Transformation, Unity, and Sustainability (LOTUS) in the 20-bed ICU. Morphing from a hierarchical practice structure with limited engagement of multidisciplinary members, the LOTUS initiative (named for the blossom whose petals surround its core, the patient) afforded each discipline (petal) an equal voice and allowed a once-fragmented team to work cohesively, collaboratively, and at the highest level of the scope of practice for each discipline, thus affording expert guidance during care planning while providing a method to collect quality metrics. LOTUS allows us to view our patients in a new way as we refocused goal determination on patients and their families. The restructuring and evolution into a high-functioning team was targeted with the goal of enhancing quality critical care for patients, which, in the literature, has correlated with improved patient safety and decreased mortality and ICU length of stay.


Assuntos
Unidades de Terapia Intensiva/organização & administração , Assistência Centrada no Paciente/organização & administração , Instituições Associadas de Saúde , Hospitais Comunitários , Humanos , New Jersey , Qualidade da Assistência à Saúde
4.
J Immunol ; 186(7): 4474-80, 2011 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-21335491

RESUMO

Dermatitis herpetiformis (DH) is characterized by deposition of IgA in the papillary dermis. However, indirect immunofluorescence is routinely negative, raising the question of the mechanism of formation of these immune deposits. Sárdy et al. (2002. J. Exp. Med. 195: 747-757) reported that transglutaminase-3 (TG3) colocalizes with the IgA. We sought to create such deposits using passive transfer of Ab to SCID mice bearing human skin grafts. IgG fraction of goat anti-TG3 or control IgG were administered i.p. to 20 mice. Separately, sera from seven DH patients and seven controls were injected intradermally. Biopsies were removed and processed for routine histology as well as direct immunofluorescence. All mice that received goat anti-TG3 produced papillary dermal immune deposits, and these deposits reacted with both rabbit anti-TG3 and DH patient sera. Three DH sera high in IgA anti-TG3 also produced deposits of granular IgA and TG3. We hypothesize that the IgA class anti-TG3 Abs are directly responsible for the immune deposits and that the TG3 is from human epidermis, as this is its only source in our model. These deposits seem to form over weeks in a process similar to an Ouchterlony immunodiffusion precipitate. This process of deposition explains the negative indirect immunofluorescence results with DH serum.


Assuntos
Dermatite Herpetiforme/imunologia , Dermatite Herpetiforme/patologia , Modelos Animais de Doenças , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Transplante de Pele/imunologia , Transplante de Pele/patologia , Transglutaminases/imunologia , Animais , Complexo Antígeno-Anticorpo/metabolismo , Sítios de Ligação de Anticorpos/imunologia , Tecido Conjuntivo/enzimologia , Tecido Conjuntivo/imunologia , Reações Cruzadas/imunologia , Dermatite Herpetiforme/enzimologia , Derme/imunologia , Derme/metabolismo , Cabras , Humanos , Imunização Passiva/métodos , Imunoglobulina A/administração & dosagem , Imunoglobulina A/biossíntese , Imunoglobulina G/administração & dosagem , Imunoglobulina G/biossíntese , Injeções Intradérmicas , Masculino , Camundongos , Camundongos SCID , Coelhos , Transglutaminases/sangue
5.
Cogn Behav Ther ; 37(4): 233-46, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18803072

RESUMO

Increases in personal computer ownership and Internet use patterns provide a potential avenue for dissemination of evidence-based prevention and treatment interventions. The authors describe the implementation of a psychoeducational intervention (the Incredible Years parenting program, which is designed to promote behavioral change in parents and children) using a hybrid model combining computer- and web-based delivery with professional intervention via phone calls, electronic messages, and home visits. The model attempted to simulate many of the parent training methods shown to be successful in the original program. The intervention was implemented with 90 Head Start families who reported elevated levels of child behavior problems. Of the 45 families offered the intervention in the final year of the project, 37 (82%) completed at least half the program and 34 (76%) completed the entire intervention using procedures refined in light of the initial year's experience. These participants reported high achievement of their self-determined goals and were highly satisfied with the intervention. The combination of technology with professional coaching represents a potential model for adapting and disseminating evidence-based interventions.


Assuntos
Transtornos do Comportamento Infantil/prevenção & controle , Instrução por Computador , Internet , Poder Familiar , Grupos de Autoajuda , Adulto , Pré-Escolar , Comportamento do Consumidor , Intervenção Educacional Precoce , Feminino , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Motivação , Oregon , Ensaios Clínicos Controlados Aleatórios como Assunto , Desempenho de Papéis
6.
Early Child Res Q ; 23(4): 527-546, 2008 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-19802343

RESUMO

The quality of the child care environment and caregiver practices can potentially have significant, lasting impact on children's social development. This study involves the development and a small-scale efficacy trial of the Carescapes program, a video-based training program that focuses on promoting positive social development in young children attending family child care. Fifty-seven caregivers who provided child care in their homes were randomly assigned to immediate intervention or waitlist control groups. Random coefficients analyses showed significant increased use of effective behavior management practices and decreased overall children's problem behavior for the intervention group. A mediation model demonstrated that increases in effective behavior management practices were associated with decreases in problem behavior. A medium intervention effect was found for caregiver's monitoring and a small effect for use of positive attention. These effects declined 5 months following the intervention. Implications for future efficacy and effectiveness studies in family child care settings that involve strategies to facilitate maintenance are discussed.

7.
Am J Community Psychol ; 40(1-2): 64-81, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17592769

RESUMO

The economic evaluation of psychosocial interventions is a growing area of research. Though time costs are central to the economist's understanding of social costs, these costs generally have been ignored by prevention scientists. This article highlights the need to measure such costs and then reviews the principles economists use in valuing time. It then considers the specific time costs that often arise in interventions designed to reduce behavior problems among children and youth. These include classroom time devoted to program activities, the time of parents or other caregivers, the time of teachers (outside of the classroom), and the time of volunteers. We consider the economic principles that govern how economists value these inputs and then apply these principles to data from an evaluation of a prominent intervention in the field, the Incredible Years Program. We find that the time costs are potentially rather large and consider the implications for public policy of ignoring them.


Assuntos
Transtornos do Comportamento Infantil/prevenção & controle , Educação/economia , Criança , Custos e Análise de Custo , Educação/organização & administração , Humanos , Fatores de Tempo , Estados Unidos
8.
Psychol Sch ; 44(4): 333-350, 2007 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-17372623

RESUMO

School discipline referrals (SDRs) may be useful in the early detection and monitoring of disruptive behavior problems to inform prevention efforts in the school setting, yet little is known about the nature and validity of SDRs in the early grades. For this descriptive study, SDR data were collected on a sample of first grade students who were at risk for developing disruptive behavior problems (n = 186) and a universal sample (n = 531) from 20 schools. Most SDRs were given for physical aggression and the predominant consequence was time out. As expected, boys and at-risk students were more likely to receive an SDR and to have more SDRs than were girls and the universal sample. A large difference between schools regarding the delivery of SDRs was found. A zero-inflated Poisson model clustered by school tested the prediction of school-level variables. Students in schools that had a systematic way of tracking SDRs were more likely to receive one. Also, schools with more low-income students and larger class sizes gave fewer SDRs. SDRs predicted teacher ratings, and to a lesser extent, parent ratings of disruptive behavior at the end of first grade. Practitioners and researchers must examine school-level influences whenever first grade discipline referrals are used to measure problem behavior for the purpose of planning and evaluating interventions.

10.
J Invest Dermatol ; 127(5): 1167-74, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17235329

RESUMO

Bullous pemphigoid (BP) is characterized by the deposition of IgG in the basement membrane zone, infiltration of eosinophils, and blister formation. The purpose of this study was to evaluate a potential role of IgE basement membrane antibodies in the histological findings of BP. LABD97 is a component of the shed ectodomain of bullous pemphigoid antigen 2. We have developed an IgE hybridoma to LABD97 antigen. This hybridoma was injected subcutaneously in SCID mice with engrafted human skin. A subcutaneous hybridoma secreting IgE antibodies developed. An IgE mouse hybridoma to trinitrophenyl was used as a control. Human grafts and mouse skin were examined grossly over 21 days, histologically, and immunopathologically at day 21 after injection of the hybridoma. A visible subcutaneous tumor developed in 10-14 days. Erythema and intense scratching developed 2-3 days before the tumor in test mice, but not in controls. At day 21, 16/16 test mice developed intense eosinophil infiltration and degranulation of the human mast cells within the grafts and 13/16 developed histological, but not clinically visible, basement membrane blisters. Human skin grafts of control mice and normal mouse skin on the test mice and control mice did not develop any histological abnormalities. IgE antibodies to LABD97 recapitulate the histological inflammatory process seen in BP.


Assuntos
Membrana Basal/imunologia , Movimento Celular/imunologia , Eosinófilos/patologia , Imunoglobulina E/imunologia , Penfigoide Bolhoso/patologia , Transplante Heterólogo/patologia , Animais , Autoantígenos/imunologia , Proteínas de Transporte , Proteínas do Citoesqueleto , Modelos Animais de Doenças , Distonina , Humanos , Hibridomas/imunologia , Hibridomas/patologia , Imunoglobulina A/imunologia , Imunoglobulina G/imunologia , Injeções Subcutâneas , Masculino , Camundongos , Camundongos SCID , Proteínas do Tecido Nervoso , Colágenos não Fibrilares/imunologia , Penfigoide Bolhoso/induzido quimicamente , Pele/imunologia , Pele/patologia , Transplante de Pele/imunologia , Transplante de Pele/patologia , Transplante Heterólogo/imunologia
11.
Prev Sci ; 8(2): 133-40, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17180473

RESUMO

Maximizing the response rate to surveys involves thoughtful choices about survey design, sampling and collection methods. This paper describes an innovative survey method, to provide immediate reinforcement for responding and to minimize the response cost. This method involves using a questionnaire printed as checks on security (anti-fraud) paper with questions and responses separated using a perforated tear off section. Once a participant completes the survey, the response area is detached from the questions, thus protecting the confidentiality of the subject, and the check is returned via the banking system. This report describes the survey-check methodology, the survey flow process, and the results from four research studies which have used this method. These studies include (1) a technology accessibility survey of parents with children enrolled in a low-income preschool program; (2) a parent report of their child's behavior used as screening criteria for inclusion in a computer-mediated parent education project; (3) a follow-up questionnaire as part of a longitudinal study of child behavior, covering home and classroom interventions, and service utilization, and; (4) a survey of dentists in support of efforts to recruit them to participate in a randomized control trial of tobacco cessation in dental offices. The results of using this method show great improvement in response rates over traditionally administered surveys for three of the four reported studies. Results are discussed in terms of future applications of this method, limitations, and potential cost savings.


Assuntos
Análise Custo-Benefício , Coleta de Dados/métodos , Difusão de Inovações , Coleta de Dados/normas , Humanos , Seleção de Pacientes , Estados Unidos
12.
Psychol Assess ; 18(4): 439-43, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17154765

RESUMO

Confirmatory factor analysis of 25 items on the Child and Adolescent Disruptive Behavior Inventory (CADBI, Version 2.3; G. L. Burns, T. K. Taylor, & J. C. Rusby, 2001) was conducted on teacher ratings of 824 kindergarten children and replicated on 534 children. Model fit was improved when correcting for 2 method effects: (a) adjacent items and (b) identical behaviors (e.g., argues with adults, argues with peers). The results show that the 25 items loaded on 3 distinct but correlated factors: Hyperactivity, Oppositional to Adults, and Oppositional to Peers. These more refined constructs from the CADBI may be useful for practitioners in identifying children who are at risk and for helping define appropriate contexts in which to intervene. The CADBI and analytic procedures also may contribute to future psychoeducational research on the development of problem behavior.


Assuntos
Transtornos de Deficit da Atenção e do Comportamento Disruptivo/diagnóstico , Transtornos de Deficit da Atenção e do Comportamento Disruptivo/psicologia , Docentes , Grupo Associado , Pré-Escolar , Estudos de Coortes , Análise Fatorial , Feminino , Humanos , Estudos Longitudinais , Masculino , Psicometria/métodos
13.
Prev Sci ; 6(2): 113-25, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15889626

RESUMO

This paper reports a randomized controlled trial of the effects of behavioral parenting skills training, social skills training, and supplemental reading instruction on the social behavior of early elementary school children (K through 3). We selected children based on teacher-rated aggressive behavior or reading-skill deficits, delivered the intervention over a 2-year period, and obtained follow-up data for two additional years. The intervention affected only two of eight measures of child functioning--parent daily reports of antisocial behavior and parent ratings of coercive behavior. There was evidence that parents of boys in the intervention condition displayed significantly greater declines in their rated use of coercive discipline than did parents of boys in the control condition.


Assuntos
Comportamento Cooperativo , Educação , Leitura , Instituições Acadêmicas , Comportamento Social , Agressão , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde
14.
J Med Internet Res ; 7(5): e57, 2005 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-16403721

RESUMO

BACKGROUND: Children with type 1 diabetes and their parents face rigorous procedures for blood glucose monitoring and regulation. Mobile telecommunication systems show potential as an aid for families' self-management of diabetes. OBJECTIVE: A prototype designed to automatically transfer readings from a child's blood glucose monitor to their parent's mobile phone was tested. In this formative stage of development, we sought insights into the appropriateness of the concept, feasibility of use, and ideas for further development and research. METHODS: During four months, a self-selected sample of 15 children (aged 9 to 15 years) with type 1 diabetes and their parents (n = 30) used the prototype approximately three times daily. Parent and child experiences were collected through questionnaires and through interviews with 9 of the parents. RESULTS: System use was easily integrated into everyday life, and parents valued the sense of reassurance offered by the system. Parents' ongoing struggle to balance control of their children with allowing independence was evident. For children who measured regularly, use appeared to reduce parental intrusions. For those who measured irregularly, however, parental reminders (eg, "nagging") appeared to increase. Although increased reminders could be considered a positive outcome, they can potentially increase parent-child conflict and thus also undermine proper metabolic control. Parents felt that system appropriateness tapered off with the onset of adolescence, partly due to a potential sense of surveillance from the child's perspective that could fuel oppositional behavior. Parental suggestions for further developments included similar alerts of irregular insulin dosages and automatically generated dietary and insulin dosage advice. CONCLUSIONS: User enthusiasm suggests that such systems might find a consumer market regardless of whether or not they ultimately improve health outcomes. Thus, more rigorous studies are warranted to inform guidelines for appropriate use. Potentially fruitful approaches include integrating such systems with theory-based parenting interventions and approaches that can aid in interpreting and responding to experiences of surveillance, virtual presence, and balances of power in e-mediated relationships.


Assuntos
Automonitorização da Glicemia/métodos , Telefone Celular , Diabetes Mellitus Tipo 1/sangue , Monitorização Fisiológica/métodos , Relações Pais-Filho , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Relações Mãe-Filho , Autocuidado , Responsabilidade Social
15.
J Investig Dermatol Symp Proc ; 9(1): 47-51, 2004 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-14870985

RESUMO

IgA is present in the skin in several dermatoses, including dermatitis herpetiformis, linear IgA bullous dermatosis, and Henoch-Schoenlein purpura. The neutrophilic infiltration in the area of the IgA deposition suggests that IgA is responsible for the associated inflammatory events. The mechanism for this process is unproven, but is likely to involve IgA-mediated neutrophil chemotaxis with inhibition of chemotaxis by dapsone. Elucidation of the mechanism of IgA-mediated inflammation will require an animal model. We have established a model for linear IgA bullous dermatosis as a prototype disease to be studied. IgA mouse monoclonal antibodies against a linear IgA bullous dermatosis antigen have been passively transferred to SCID mice with human skin grafts. This has produced neutrophil infiltration and basement membrane vesiculation in 4 of 12 mice tested. We conclude that an animal model for the pathogenesis of IgA dermatoses with IgA deposition and inflammation can be produced by passive transfer of mouse IgA antibodies against a linear IgA antigen.


Assuntos
Doenças Autoimunes/imunologia , Modelos Animais de Doenças , Imunoglobulina A/imunologia , Camundongos , Dermatopatias/imunologia , Animais , Doenças Autoimunes/patologia , Imunização Passiva , Dermatopatias/patologia
16.
Prev Sci ; 3(2): 83-94, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12088139

RESUMO

Children's aggressive behavior and reading difficulties during early elementary school years are risk factors for adolescent problem behaviors such as delinquency, academic failure, and substance use. This study determined if a comprehensive intervention that was designed to address both of these risk factors could affect teacher, parent, and observer measures of internalizing and externalizing problems. European American (n = 116) and Hispanic (n = 168) children from 3 communities who were selected for aggressiveness or reading difficulties were randomly assigned to an intervention or no-intervention control condition. Intervention families received parent training, and their children received social behavior interventions and supplementary reading instruction over a 2-year period. At the end of intervention, playground observations showed that treated children displayed less negative social behavior than controls. At the end of a 1-year follow-up, treated children showed less teacher-rated internalizing and less parent-rated coercive and antisocial behavior than controls. The study's limitations and implications for prevention are discussed.


Assuntos
Transtorno da Conduta/etnologia , Transtorno da Conduta/prevenção & controle , Dislexia/prevenção & controle , Intervenção Educacional Precoce , Hispano-Americanos/psicologia , Criança , Comportamento Infantil/etnologia , Comportamento Infantil/psicologia , Dislexia/etnologia , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Humanos , Delinquência Juvenil/prevenção & controle , Masculino , Fatores de Risco , Socialização , Estados Unidos
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