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Delivery Methods (delivery + methods)
Selected AbstractsA Systematic Review of the Effectiveness of Breastfeeding Intervention Delivery MethodsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2009Barbara Pate ABSTRACT Objective: To analyze breastfeeding intervention delivery methods to determine the likelihood of successful breastfeeding outcomes of e-based interventions compared to provider-based interventions. Data Sources: Eligible studies were identified by searching MEDLINE, CINAHL, Academic Search Elite, Health Source: Nursing/Academic Edition, SOC INDEX, and PsycINFO. Study Selection: Studies were included if they were conducted in a developed country, published between the years 2004 and 2008, included a concurrent control group, and reported frequency data on breastfeeding initiation or duration. The suitability of design and quality of execution were evaluated using the Centers for Disease Control procedure for systematic reviews. Twenty-one articles met the criteria for inclusion. Data Extraction: Study design, demographics, intervention/control conditions, settings, sampling strategies, potential threats to validity, and breastfeeding outcomes were abstracted and entered into a database for analysis and synthesis. Data Synthesis: Odds ratios were calculated for each individual study, and studies were stratified into 2 groups by intervention delivery type. The pooled results indicated that studies using e-based interventions had a moderate effect on breastfeeding (odds ratio=2.2 [1.9-2.7], d=0.5); whereas provider-based interventions had very little to no effect (odds ratio=1.1 [1.0-1.2], d=0.03). Conclusions: Results indicate that breastfeeding promotion programs delivered via the Internet may be an appealing alternative to time-consuming and expensive provider-based breastfeeding education and support. [source] How necessary are universities?ECONOMIC AFFAIRS, Issue 3 2001Sir Alan Peacock The paper discusses whether universities can continue to be the ,template for the extension and transmission of knowledge.' Technical and social changes are already undermining the universities' previous near-monopoly of delivery of higher education. Alternative delivery methods ought to be considered on their own merits and barriers to entry should be removed. The ideal form of higher education is not necessarily residence combined with traditional teaching and associated research. [source] A Systematic Review of the Effectiveness of Breastfeeding Intervention Delivery MethodsJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 6 2009Barbara Pate ABSTRACT Objective: To analyze breastfeeding intervention delivery methods to determine the likelihood of successful breastfeeding outcomes of e-based interventions compared to provider-based interventions. Data Sources: Eligible studies were identified by searching MEDLINE, CINAHL, Academic Search Elite, Health Source: Nursing/Academic Edition, SOC INDEX, and PsycINFO. Study Selection: Studies were included if they were conducted in a developed country, published between the years 2004 and 2008, included a concurrent control group, and reported frequency data on breastfeeding initiation or duration. The suitability of design and quality of execution were evaluated using the Centers for Disease Control procedure for systematic reviews. Twenty-one articles met the criteria for inclusion. Data Extraction: Study design, demographics, intervention/control conditions, settings, sampling strategies, potential threats to validity, and breastfeeding outcomes were abstracted and entered into a database for analysis and synthesis. Data Synthesis: Odds ratios were calculated for each individual study, and studies were stratified into 2 groups by intervention delivery type. The pooled results indicated that studies using e-based interventions had a moderate effect on breastfeeding (odds ratio=2.2 [1.9-2.7], d=0.5); whereas provider-based interventions had very little to no effect (odds ratio=1.1 [1.0-1.2], d=0.03). Conclusions: Results indicate that breastfeeding promotion programs delivered via the Internet may be an appealing alternative to time-consuming and expensive provider-based breastfeeding education and support. [source] The Efficacy of Metered-Dose Inhalers with a Spacer Device in the Pediatric SettingJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 9 2002APRN, Lance J. Buxton MSN Purpose To systematically review the published research and report on the efficacy of using a metereddose inhaler with a spacer (MDI-S) device in a pediatric setting to treat acute exacerbations of asthma. Data sources A literature search was conducted on the CINAHL, Medline, and Cochrane databases; additional searches were made by hand from the reference lists in each study retrieved from databases and from review articles written on the same topic. Conclusion This critical appraisal of the research demonstrates the MDI-S is as effective as the nebulizer, faster in the delivery of medication, and cost-effective. Implications for Practice No significant difference between the MDI-S and nebulizer in delivering medication in an acute exacerbation of asthma was found in this analysis. The practitioner's choice of delivery methods should reflect the family's preference, the practice situation, and economic considerations. [source] Intermittent and Continuous Enteral Nutrition in Critically Ill Dogs: A Prospective Randomized TrialJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2010M. Holahan Background: Malnutrition is a common problem in critically ill dogs and is associated with increased morbidity and mortality in human medicine. Enteral nutrition (EN) delivery methods have been evaluated in humans to determine which is most effective in achieving caloric goals. Objectives: To compare continuous infusion and intermittent bolus feeding of EN in dogs admitted to a critical care unit. Animals: Fifty-four dogs admitted to the critical care unit and requiring nutritional support with a nasoenteric feeding tube. Methods: Prospective randomized clinical trial. Dogs were randomized to receive either continuous infusion (Group C) or intermittent bolus feeding (Group I) of liquid EN. The percentage of prescribed nutrition delivered (PPND) was calculated every 24 hours. Frequencies of gastrointestinal (GI), mechanical, and technical complications were recorded and gastric residual volumes (GRVs) were measured. Results: PPND was significantly lower in Group C (98.4%) than Group I (100%). There was no significant difference in GI or mechanical complications, although Group C had a significantly higher rate of technical complications. GRVs did not differ significantly between Group C (3.1 mL/kg) and Group I (6.3 mL/kg) and were not correlated with the incidence of vomiting or regurgitation. Conclusions and Clinical Importance: There was a statistically significant difference in the PPND between continuously and intermittently fed dogs, but this difference is unlikely to be clinically relevant. Critically ill dogs can be successfully supported with either continuous infusion or intermittent bolus feeding of EN with few complications. Increased GRVs may not warrant termination of enteral feeding. [source] Genotype and viral load as prognostic indicators in the treatment of hepatitis CJOURNAL OF VIRAL HEPATITIS, Issue 4 2000Trepo Interferon-, (IFN-,), either alone or in combination with ribavirin, is the standard treatment for patients with hepatitis C. However, most patients do not achieve a sustained remission with this treatment regimen. A number of studies have demonstrated that genotype, baseline viral load and/or a decrease in viral load early after treatment induction are the major predictive factors for response to treatment with IFN. Patients with hepatitis C virus (HCV) genotype 1 are more resistant to treatment with IFN, whereas low viral load at baseline and a marked decline in the HCV RNA level during the first 2,12 weeks of IFN therapy are associated with enhanced treatment efficacy. These variables could potentially be used to develop treatment algorithms that tailor therapies for specific clinical situations. Continued development and refinement of such algorithms would facilitate both the selection of patients who are most likely to benefit from therapy and the development of optimal treatment regimens for different patient groups. Predictive factors will also enable clinicians to identify subsets of patients who are not expected to respond well to current treatment. The development of new delivery methods for IFN that produce sustained antiviral pressure may provide a means of treating these previously difficult-to-treat patient groups. [source] Control of phlebotomine sandfliesMEDICAL AND VETERINARY ENTOMOLOGY, Issue 1 2003B. Alexander Abstract. Phlebotomine sandflies (Diptera: Psychodidae) transmit many zoonotic diseases (arboviruses, bartonelloses and especially leishmaniases) of importance to human health in at least 80 countries. Measures used to control adult sandflies (Lutzomyia and Phlebotomus) include the use of insecticides (mostly pyrethroids) for residual spraying of dwellings and animal shelters, space-spraying, insecticide-treated nets, impregnated dog-collars and personal protection through application of repellents/insecticides to skin or fabrics. Because the breeding-sites of sandflies are generally unknown, control measures that act specifically against immatures are not feasible, although the effectiveness of a few biological and chemical agents has been demonstrated in laboratory evaluations. Reports of insecticide-resistance refer to only three sandfly species (P. papatasi, P. argentipes and S. shorttii) against DDT in one country (India), although there are reports of DDT-tolerance in several countries. Current knowledge of sandfly susceptibility to various insecticides is summarized. Constraints and advantages of different compounds, formulations and delivery methods for sandfly control under different environmental conditions are discussed. [source] Lessons Learned from Teaching Web-Based Courses: The 7-Year ItchNURSING FORUM, Issue 1 2005Cynthia G. Johnson RN TOPIC.,Lessons Learned from Teaching Web-Based Courses: The 7-Year Itch SOURCES OF INFORMATION.,Increased sophisticated technological communications are rapidly changing the teaching and learning environment. Nursing educators must respond by developing new ways of teaching. Because of these changes, new ways of teaching, course delivery methods, and classroom environments are being discovered. The Internet and the cyberspace environment allow students from all over the nation to sit in the same virtual classroom and ,attend lecture' with one instructor. This article describes lessons learned from seven years of teaching on the web on both undergraduate and graduate levels. CONCLUSION.,The major challenges for faculty relate to the creation of a stimulated learning environment for communication and interaction among the students, course preparation, workload, time management. Additional challenges are the methods of classroom discussions, teaching methods, responding to students, and teaching a 2-unit clinical component on-line. For students, issues of learning styles, motivation, and class participation are discussed. Results of the students' responses to a 10-item Likert,type course evaluation tool as well as issues for future web educators are presented. [source] Comparative efficacy of the Schistosoma mansoni nucleic acid vaccine, Sm23, following microseeding or gene gun deliveryPARASITE IMMUNOLOGY, Issue 4 2002Akram A. Da'dara Summary Sm23 is an integral membrane protein expressed widely in the human parasitic worm Schistosoma mansoni. Sm23 has already been shown to elicit protective immune responses following immunization with peptides or DNA constructs. In this study, we evaluated the immunogenicity and the protective efficacy of the Sm23 DNA vaccine using two different intradermal DNA delivery methods: microseeding and gene gun. Using both techniques, all mice immunized with the Sm23-pcDNA construct generated Sm23-specific immunoglobulin (Ig)G antibody, while mice immunized with the control plasmid, pcDNA, did not. Antibody isotypes analysis revealed that microseeding elicited mainly IgG2a and IgG2b antibodies, with relatively low levels of IgG1 and IgG3. The relative IgG1/IgG2a ratio was 0·03, indicative of a Th1 type immune response. In contrast, gene gun immunization resulted in significantly higher levels of IgG1 and IgG3. The relative IgG1/IgG2a ratio in this case was 11, indicative of a Th2 type immune response. No significant difference in the levels of IgG2b was observed. Coimmunization with plasmid DNA encoding either interleukin (IL)-12 or IL-4 by microseeding did not affect the levels of IgG1, while the levels of IgG2a and IgG2b were reduced. On the other hand, the levels of IgG3 were significantly increased by IL-4, but unchanged by IL-12. Importantly, in all experiments, the Sm23-pcDNA vaccine provided statistically significant levels of protection against challenge infection. Microseeding immunizations resulted in higher levels of protection (31,34% protection) than gene gun immunization (18% protection). This suggests that the Th1 type immune response elicited by microseeding immunization was responsible for the higher protection levels. However, the protective effect of the vaccine was not affected by coadministering plasmids encoding either IL-12 or IL-4 using the microseeding technique. [source] Angiogenesis Therapy for the Treatment of Erectile DysfunctionTHE JOURNAL OF SEXUAL MEDICINE, Issue 7 2010Jeffrey J. Lysiak PhD ABSTRACT Introduction., Over the past 15 years, significant advances have been made in the treatment of erectile dysfunction (ED). The most significant of these advances has been pharmacological treatment of ED with phosphodiesterase type 5 (PDE5) inhibitors. This therapy greatly increased the awareness of ED and has helped stimulate research into the underlying causes of ED. While treatment with PDE5 inhibitors continues to be the current therapy of choice, approximately 40% of men treated with PDE5 inhibitors fail to have significant improvement in erectile function and PDE5 inhibitors do not reverse the vasculopathic processes associated with ED. With this in mind, new therapies must be developed. The treatment with angiogenic growth factors such as vascular endothelial cell growth factor (VEGF) may be one such therapy. Aim., This review will focus on defining key terms in the angiogenic process, angiogenic growth factors, and different delivery methods, and summarize results from angiogenic therapies for the treatment of ED. Methods., A review of the literature was performed on all angiogenic therapies for the treatment of ED. A brief review on the angiogenic factors was also performed Results., Angiogenic therapies for the treatment of ED are possible and promising; however, further investigation is needed to advance clinically. Conclusions., Although numerous studies have now employed angiogenic factors for the possible treatment of ED in several animal models, we are still not at the point to begin human investigations. Future studies need to examine proper dosage of the angiogenic agent, route of delivery, time course for delivery, and combination therapies. Lysiak JJ, Kavoussi PK, Ellati RT, Steers WD, and Annex BH. Angiogenesis therapy for the treatment of erectile dysfunction. J Sex Med 2010;7:2554,2563. [source] Alcohol, Tobacco, and Other Drugs: Future Directions for Screening and Intervention in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 11 2009Rebecca M. Cunningham MD Abstract This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on "Public Health in the ED: Screening, Surveillance, and Intervention." The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening,develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention,conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups,conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategies,a) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and follow-up; and d) examine alternatives to specialized treatment referral. 5) Translation,conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice. [source] Efficacy of systemic morpholino exon-skipping in duchenne dystrophy dogs,ANNALS OF NEUROLOGY, Issue 6 2009Toshifumi Yokota PhD Objective Duchenne muscular dystrophy (DMD) is caused by the inability to produce dystrophin protein at the myofiber membrane. A method to rescue dystrophin production by antisense oligonucleotides, termed exon-skipping, has been reported for the mdx mouse and in four DMD patients by local intramuscular injection. We sought to test efficacy and toxicity of intravenous oligonucleotide (morpholino)-induced exon skipping in the DMD dog model. Methods We tested a series of antisense drugs singly and as cocktails, both in primary cell culture, and two in vivo delivery methods (intramuscular injection and systemic intravenous injection). The efficiency and efficacy of multiexon skipping (exons 6,9) were tested at the messenger RNA, protein, histological, and clinical levels. Results Weekly or biweekly systemic intravenous injections with a three-morpholino cocktail over the course of 5 to 22 weeks induced therapeutic levels of dystrophin expression throughout the body, with an average of about 26% normal levels. This was accompanied by reduced inflammatory signals examined by magnetic resonance imaging and histology, improved or stabilized timed running tests, and clinical symptoms. Blood tests indicated no evidence of toxicity. Interpretation This is the first report of widespread rescue of dystrophin expression to therapeutic levels in the dog model of DMD. This study also provides a proof of concept for systemic multiexon-skipping therapy. Use of cocktails of morpholino, as shown here, allows broader application of this approach to a greater proportion of DMD patients (90%) and also offers the prospect of selecting deletions that optimize the functionality of the dystrophin protein. Ann Neurol 2009 [source] The promise of the Internet for disability: a study of on-line services and web site accessibility at Centers for Independent Living,BEHAVIORAL SCIENCES & THE LAW, Issue 1 2003Heather Ritchie M.S.W. The Internet provides individuals with disabilities numerous tools to live independently. In the convenience of the home, a person can access an abundance of information, an electronic community, updates on the latest disability advocacy news, education through distance-learning classes, and on-line shopping for books, clothes, assistive technology, and a host of other consumer goods. Centers for Independent Living (CILs) are consumer-run, non-profit grassroots disability service organizations at the forefront of the disability rights movement. Providing services to individuals across the range of disabilities, CILs have begun to use the Internet as a complement to their traditional service delivery methods. This article examines the emerging trend of independent living services on the web. The investigation examines 200 CIL Internet sites across the United States during the period of April to August 2001. Information is collected and analyzed about how CILs are using the Internet to provide their services and programs. In addition, the article examines the technological accessibility of their web sites. Implications of the findings for CILs, consumers with disabilities, and disability policy are examined. Copyright © 2003 John Wiley & Sons, Ltd. [source] | ||||||||||