Retranslations of expectations technique was used to develop behaviorally anchored scales for evaluating dentists' utilization of expanded duty dental auxiliaries. To enhance the reliability and validity of such instruments the project focused on specific acts and decisions of the dentist which are either effective or ineffective in accomplishing the health team's tasks.

Behavior↗

PubMedDate not supplied

Development of scales to measure provider attitudes toward expanded duty dental auxiliaries.

Much of the research on attitudes toward utilizing EDDAs has been rather haphazard in its measurement aspects. Examining responses to single items or summing across a series of items without any empirical rationale for such summing cannot be justified given current knowledge about measuring attitudes. The scales developed here are appreciably better from a psychometric point of view than scales reported in the dental literature to date. The use of standardized measuring instruments would facilitate cross-study comparisons. Such a process is presently not feasible because each researcher is using his own idiosyncratic scales of unknown psychometric characteristics. The three scales developed here to measure (1) the value of expanding auxiliary functions, (2) patient reaction to the use of EDDAs, and (3) satisfaction with changed dentist role may permit more standardized measurement of at least some aspects of provider and future provider attitudes toward the utilization of expanded duty dental auxiliaries.

Attitude↗

PubMedDate not supplied

Reengineering managed behavioral healthcare.

Reengineering is an industrial method for rethinking and redesigning basic business processes in order to improve performance and lower cost. Just as many of the corporate clients of managed behavioral healthcare companies go through reengineering initiatives, behavioral healthcare needs to streamline its production processes, in order to deliver services that are high quality but affordable. Traditional, cumbersome, bureaucratic and labor-intensive work processes must be reexamined. This article reviews basic principles of reengineering in the context of the evolving managed behavioral healthcare industry, defines ten core processes for managed behavioral healthcare companies and then illustrates how reengineering methods can be applied to two intermediate processes: "manage access" and "manage network."

Clinical Protocols↗

PubMedDate not supplied

Symptomatology, pulmonary function and response, and T lymphocyte beta 2-receptors during smoking cessation in patients with chronic obstructive pulmonary disease.

STUDY OBJECTIVES: To characterize the effect of smoking cessation and nicotine replacement on pulmonary symptomatology, baseline pulmonary function and response to terbutaline, and purified T lymphocyte beta 2-receptor regulation; and the relationship between T lymphocyte beta 2-receptor density and pulmonary function. DESIGN: Open-label, longitudinal, 28-week study. SETTING: A university clinical research center. PATIENTS: Eighteen long-term smokers with mild to moderate chronic obstructive pulmonary disease (COPD) were enrolled and seven completed the study. INTERVENTIONS: Subjects stopped smoking with the aid of nicotine substitution and behavioral counseling. Pulmonary response (FEV1) to subcutaneous terbutaline and T lymphocyte beta 2-receptor density (Bmax) and function (cAMP) were measured prior to smoking cessation (week 0), during nicotine replacement (week 8), and after nicotine cessation (week 28). MEASUREMENTS AND MAIN RESULTS: Serum cotinine concentrations, plasma epinephrine concentrations, and day and night cough decreased significantly after smoking cessation, whereas basal cAMP concentrations increased (p < 0.05). No significant change was seen in baseline FEV1, pulmonary response to terbutaline, or Bmax over the 28 weeks; however, intrasubject changes in Bmax between visits correlated significantly (p < 0.05) with intrasubject changes in pulmonary response between visits. CONCLUSIONS: Our data indicate that smoking cessation is associated with a significant decrease in the symptomatology of COPD, and that change in T lymphocyte beta 2-receptor density is a good marker of change in pulmonary response to beta 2-agonists.

Adult↗