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PubMed1993

A computer program to aid in calculating similarity indexes from DNA fingerprints.

DNA SIMDEX is a DOS-based computer program designed to assist in the visual scoring of DNA fingerprint assays. DNA SIMDEX uses the migration distances of the individual DNA bands to generate lists of probable matching and nonmatching bands and automatically calculates a probable similarity index between DNA fingerprints based on these initial predictions. After comparisons are edited by the user, the final similarity index, along with accompanying data, can be saved on a floppy disk or hard drive for easy storage and retrieval or can be printed directly on a laser or line printer. The program has been developed to function with or without an image-analysis system, thus making it an inexpensive alternative for small laboratories.

DNA Fingerprinting↗
PubMed2001

Cost-effectiveness of syringe exchange as an HIV prevention strategy.

OBJECTIVE: To analyze the cost-effectiveness of New York State-approved syringe exchange programs (SEPs) and estimate the cost-saving potential of these programs. DESIGN AND METHODS: The cost-effectiveness analysis used cost and process data provided by seven SEPs for the calendar year 1996 or the most recent 12-month period available at the time of the study. Alternative estimates of the number of HIV infections prevented were calculated using published data and a simplified circulation model. HIV treatment costs were taken from the literature. RESULTS: A cost-effectiveness ratio of $20,947 per HIV infection averted was calculated based on an estimated 87 HIV infections averted across the seven programs and total program costs of $1.82 million (all amounts given in US dollars). Sensitivity analyses were also performed. Using imputed costs for donated services and estimates of lifetime costs to treat an HIV infection, syringe exchange was demonstrated to be a cost-saving strategy from a societal perspective. CONCLUSIONS: This research demonstrates that syringe exchange is a cost-effective and cost-saving strategy for reducing HIV transmission.

Cost-Benefit Analysis↗
PubMed1986

Radiation therapy in the elderly patient.

In the management of cancer in the older patient, the treatment program designed should be based on careful analysis of the patient's problem and a decision made as to whether the patient can be cured by the radiation therapy technique for what is primarily a limited local regional disease process or palliated by virtue of the fact that the patient has more widespread disseminated disease. In both instances, careful attention must be given to proper, continuous and careful support of all the problems the older patient has. The patient's status may dictate a major change in the radiation therapy program by virtue of fractionation, protraction, total dose being delivered or even the volume being treated. The response to treatment in terms of normal tissue effects require careful medical management in order to minimize those effects. Interruptions of treatment should be allowed only if appropriate deliberate management of side effects are not effective. The basic principle in the management of the older patient with cancer is to allow for cure of those patients in which that is a reasonable possibility with the minimum in terms of complication as a consequence of the treatment program. Palliative radiation therapy programs are directed toward improvement in the quality of life by diminishing symptoms and hastening rehabilitation. When two definitive treatment programs, surgery or radiation therapy, have equal probability for long-term survival, the radiation therapy curatively administered would allow for the preservation of anatomy and function. The maximum potential for management in the older patient with cancer is achieved best in the circumstances of an integrated multimodal team for management including those specialists that are appropriate to the disease process being treated. These would include the surgeon, the radiation oncologist, the medical oncologist, the pathologist, the diagnostic radiologist, as well as other specialists such as anesthesiology, rehabilitation medicine, etc., along with paramedical support members of the team. It is within this environment that the maximum potentials of treatment can be achieved.

Aged↗
PubMed1982

The good toothbrushing game: a school-based dental hygiene program for increasing the toothbrushing effectiveness of children.

There has been a serious lack of experimentally verified, effective dental hygiene programs in the schools. In and of themselves, the instruction-alone programs which comprise children's dental education do not produce proper toothbrushing skills. In the present study, a school-based contingency dental hygiene program designed to increase the effectiveness of children's toothbrushing skills at home was implemented with grade one and two classes. Each class was divided into teams and participated in the "Good Toothbrushing Game." Each day four children fron each team had the cleanliness of their teeth assessed according to the Simplified Oral Hygiene Index (Greene & Vermillion, 1964). The team with the lowest mean oral hygiene score was declared the daily winner. Winning teams received stickers and had their names posted. A multiple baseline across classrooms single-subject group design. (Hersen & Barlow, 1976, pp. 228-229) established that the good toothbrushing game greatly increased the effectiveness of children's oral hygiene skills. the treatment terminal levels for the grade one scores was 2.0 as compared to a baseline terminal level of 5.0 and for the grade two's was 2.3 compared to 5.7 at the end of baseline. A 9-mo follow-up indicated that these results were maintained. The data strongly suggest that proper implementation of behavioral principles is essential to the success of oral hygiene programs.

Behavior Therapy↗
PubMed1969

The NLM current catalog.

When the National Library of Medicine acquired a computer to augment its publication program, the intent was to present in one medium an index to journal articles and a catalog of books and new serial titles. The computer programs designed for indexing were unsatisfactory for cataloging, however; so two publications were issued, the Index Medicus and the NLM Current Catalog. The Current Catalog features separate name and subject sections, added volumes, and technical reports. The Express Cataloging Service was one of the first attempts to increase the speed and coverage of the Catalog. Shared cataloging with the Library of Congress, the Countway Library at Harvard, and the Upstate Medical Library in Syracuse, New York, have also contributed to the efforts toward improving this library service. An additional shared cataloging program, this time with the National Medical Audiovisual Center, is expected to be implemented shortly.

Catalogs, Library↗
PubMed1994

Quality of care in public and private primary health care facilities: structural comparisons in Jamaica.

This article examines the quality of care provided by Jamaican primary health care clinics by comparing various structural quality indexes derived from a nationwide 1990 survey of 366 public clinics and 189 private clinics. This comparison points up important differences in the quality of care being provided by public versus private and urban versus rural facilities that might not have been anticipated. Among other things, the study found that the public clinics provided better prenatal diagnosis and counseling and more family planning services than the private clinics. However, the private clinics tended to be better condition, better equipped and supplied, and better able to provide certain laboratory test results in a timely manner. Comparison of urban and rural public clinics indicated that the urban clinics were somewhat better provisioned with equipment, supplies, and pharmaceuticals. However, the rural clinics appeared to be in better repair. Comparison of basic and higher-level public clinics showed the basic clinics to be in better condition and more fully staffed than the higher-level clinics while having similar perinatal diagnostic capabilities. However, the higher-level public clinics tended to have an overall profile more resembling that of the private clinics, being better equipped and supplied than the basic clinics. While structural measures of quality such as those employed here tend to poorly estimate health outcomes, they do serve as good indicators of access to services where resources are severely constrained. For policy-makers, the results presented here could prove useful in guiding concrete interventions, summarizing the structural elements of health care quality at different types of facilities, and providing a method for less costly evaluation of programs designed to improve services at primary health care clinics.

Ambulatory Care Facilities↗
PubMed2003

Cultivating a disease management partnership: a value-chain model.

Disease management (DM) is one of the health care industry's more innovative value-chain models, whereby multiple relationships are created to bring complex and time-sensitive services to market. The very nature of comprehensive, seamless DM provided through an outsourced arrangement necessitates a level of cooperation, trust, and synergy that may be lacking from more traditional vendor-customer relationships. This discussion highlights the experience of one health plan and its vendor partner and their approach to the development and delivery of an outsourced heart failure (HF) DM program. The program design and rollout are discussed within principles adapted from the theoretical framework of a value-chain model. Within the value-chain model, added value is created by the convergence and synergistic integration of the partners' discrete strengths. Although each partner brings unique attributes to the relationship, those attributes are significantly enhanced by the value-chain model, thus allowing each party to bring the added value of the relationship to their respective customers. This partnership increases innovation, leverages critical capabilities, and improves market responsiveness. Implementing a comprehensive, outsourced DM program is no small task. DM programs incorporate a broad array of services affecting nearly every department in a health plan's organization. When true seamless integration between multiple organizations with multiple stakeholders is the objective, implementation and ongoing operations can become even more complex. To effectively address the complexities presented by an HF DM program, the parties in this case moved beyond a typical purchaser-vendor relationship to one that is more closely akin to a strategic partnership. This discussion highlights the development of this partnership from the perspective of both organizations, as revealed through contracting and implementation activities. It is intended to provide insight into the program development and rollout processes that one health plan and its partner have adopted to advance a DM model that integrates appropriately within the local environment. This discussion also highlights how an organizational culture can shift from an emphasis on cost, growth, and control to an emphasis on quality, innovation, and service within a value-chain model.

Cooperative Behavior↗
PubMed2002

A model-based evaluation of a cultural mediator outreach program for HIV+ Ethiopian immigrants in Israel.

This article presents a model-based evaluation of a program designed to reduce HIV transmission from HIV-infected Ethiopian immigrants in Israel. Rather than rely on self-reported variables such as condom use, this study's approach focuses on pregnancy rate reduction, estimated from administrative periodic reporting data, as a measure of unprotected sexual exposure. The models show that among both HIV+ women and the female sex partners of HIV+ men, the ongoing pregnancy rates estimated during the intervention were significantly lower than the estimated baseline pregnancy rates, suggesting reductions in unprotected sexual exposures among those participating in the program.

Community-Institutional Relations↗
PubMed1990

The effect of compliance with treatment on survival among patients with hematologic malignancies.

Ninety-four newly diagnosed patients with hematologic malignancies were monitored for compliance with oral medication and scheduled clinic appointments over a 6-month treatment period. They were assigned at entry either to a control condition or an intervention condition designed to improve compliance. Compliance with medication was assessed objectively with serial serum drug and metabolite levels, as well as with self-report indices obtained on a monthly basis. Medical records were abstracted to obtain data on the number of appointments kept, treatment given, disease characteristics, and survival. On univariate analyses using the log-rank test, five variables were found to be significantly related to survival. These included compliance with allopurinol (probably acting as a surrogate for self-medication with other chemotherapeutic agents) (P = .007), control versus educational program cohort (P less than .001), disease severity (P = .009), Karnofsky at diagnosis (P = .011), sex (P = .084), and clinic appointments kept (P = .043). In hierarchical proportional hazards models, the following variables were associated with decreased risk of death: disease severity (P less than .025), keeping over 60% of appointments (P less than .05), allopurinol/oxipurinol compliance (P less than .01), and educational program cohort (P less than .05). After controlling for all other variables, three variables were associated with increased survival: high disease severity (relative risk [RR] = 2.48), high compliance with allopurinol (RR = .45), and educational program cohort (RR = .39). We conclude that compliance with oral medication has a significant effect on patient survival. In addition, the use of special educational and supportive programs designed to improve patient compliance are associated with significant prolongation of patient survival due to, as well as independent of their effects on compliance.

Adolescent↗
PubMed1981

Cost containment through restriction of cephalosporins.

The effect of a program designed to reduce hospital drug costs by limiting the selection of injectable cephalosporins and promoting the rational use of the selected agents was studied. Cefazolin sodium was chosen as the primary injectable cephalosporin, and guidelines for proper dosing were approved. Strict guidelines for the use of cephapirin sodium, cefamandole nafate, and cefoxitin sodium were also adopted; cephalothin sodium was deleted from the formulary. Clinical pharmacists reviewed all cephalosporin orders and consulted with prescribers whose orders did not conform to the guidelines. Total cephalosporin purchases for the first fiscal year of the program were $64,914, a decrease of $55,715 or 46.2% from the previous year's total of $120,629. Cost per patient day for cephalosporins decreased from $0.921 to $0.519 (43.6%) over the same period. The number of milligrams of cephalosporins used per patient day decreased from 398.16 to 178.77 (55.1%), while the number of patient days decreased by only 4.45% during the same interval. The estimated annual cost of monitoring the program was $1500. This program demonstrates that substantial cost savings can be achieved if guidelines for the use of injectable cephalosporins are clearly outlined and strictly enforced.

Cefazolin↗
PubMed2004

Effect of a selection and postoperative care protocol on survival of infants with hypoplastic left heart syndrome.

BACKGROUND: We report the development and implementation of a program designed to assign patients preoperatively to either transplant or Norwood procedure based on a score derived from known risk factors and to enhance postoperative care of infants undergoing the Norwood procedure. METHODS: A weighted score for each of six variables comprised the scoring system: ventricular function, tricuspid regurgitation, ascending aortic diameter, atrial septal defect blood flow characteristics, blood type, and age. The scoring system was used to prospectively assign mortality risk and lead to recommendation of either Norwood procedure or transplantation. RESULTS: Survival following the Norwood procedure significantly improved after the management program was implemented (88% versus 40% at 48 hours, 57% versus 10% at 30 days, and 50% versus 10% at 1 year, p < 0.0001 at each time point). The survival of the group that received a score of 7 or less (high risk) who underwent the Norwood procedure was 78% at 48 hours, 44% at 30 days, and 33% at 1 year; survival rates among patients considered lower risk (greater than 7) were 100% at 48 hours and 80% at 30 days and 1 year. Transplant outcomes remained unchanged. CONCLUSIONS: We report improved survival following the Norwood procedure after the implementation of an institutional management approach aimed at improving the outcome of infants with hypoplastic left heart syndrome and may help neutralize historical biases toward Norwood procedure or transplantation.

California↗
PubMed1996

[Detection of rapid eye movement with rapidly adapting neuronal fuzzy systems in imprecise REM syntax].

Both living beings and artificial neuronal networks are capable of 'learning' and behavioural adaptation. But also the fuzzy program designed to detect rapid eye movements (REM) during sleep and described here, can be provided with a self-learning option that provides important information about REM sleep. The algorithm computes REM on the basis of horizontal and vertical EOG. EEG, EMG and actiography signals are employed to optimize the method and eliminate artefacts. In a second step, the fuzzy system learns to detect REM with the aid of a sample data set and a minimal set of syntax rules. From sample data and the actions and reactions of visual scorers, the program extracts additional rules and information, which are then used to build a complete fuzzy structure. Thereafter, the REM detection program optimizes the fuzzy logic structure, independently of visual monitoring, on its own. A direct comparison of the results of the algorithm in a 10-night analysis with those of two experienced visual scorers revealed a better than 95% agreement. Re-analysis with the algorithm showed a 100% concurrence. Complete visual measurement of the eye movements occurring in a single night requires several hours; this compares with only 15 minutes required by the algorithm.

Algorithms↗
PubMedDate not supplied

Promoting healthy bladder habits for seniors.

Urinary incontinence (UI) effects people of all ages, but is especially prevalent in the elderly population. Also significant is a lack of knowledge about UI. A health promotion project was developed and implemented in six ethnically diverse, predominantly minority, inner city senior centers, a program designed to address an elder population, as they are very likely to be experiencing UI and lacking knowledge concerning healthy bladder habits. The project consisted of three phases: orientation/training of key staff members/peer educators at the six senior centers; educating elder consumers through four one-hour weekly sessions involving visual aids and completion of bladder records and quizzes, and follow-up sessions with senior staff/peer educators to reinforce previous training. One result was that training of peer educators needed further refinement to allow for a more significant role throughout the program. The program was very well received by the participants and roughly 80 percent felt they had more control over their bladder by the end of the last session. This project will continue into 1997 and in addition to information on UI, the project will include prostate health for men and gynecological health for women, as this need became evident throughout the program.

Aged↗
PubMed1995

Description and results of a needs assessment in preparation for the "Surgeons as educators" course.

BACKGROUND: In August 1993 the American College of Surgeons sponsored a course entitled "Surgeons as Educators" (SAE) aimed at equipping academic surgeons with the knowledge and skills necessary to enhance surgical education administration, curriculum, teaching, and evaluation. METHODS: The instructional design model used to construct the course called for a formal needs assessment to determine the importance, current skill level, and priority of what needed to be learned to be an effective educator. The needs assessment was accomplished using a job analysis and questionnaire approach. The 68-item questionnaire was mailed to 320 academic surgeons representing eight medical schools. RESULTS: A 62% response rate was achieved. Results indicated the education-related tasks or activities that faculty felt were important to their careers, as well as their perceived level of development in each area. Descriptive statistics were used to summarize the responses that were critical to the SAE faculty in helping prioritize, sequence, and time ration course content. Collective results became the foundation for developing the SAE curriculum by the course's five faculty members. CONCLUSIONS: A well-done needs assessment does not necessarily guarantee course success; however, it is the first and critical step to planning an educationally sound faculty development course or program designed for adult learners.

Adult↗
PubMed1998

The effects of a physical training program on patients with osteoarthritis of the knees.

OBJECTIVE: To investigate physical function in patients with severe osteoarthritis (OA) of the knees during and after a general physical training program. DESIGN: Randomized control trial, blinded observer, follow-up at 3 months and 1 year. SETTING: Outpatient clinic. PATIENTS: Consecutive sample of 25 patients (3 men, 22 women) with OA of the knees according to the criteria of the American College of Rheumatology (ACR). Two patients (8%) failed to complete the study. There were no withdrawals for adverse effects. INTERVENTION: Twelve patients received training in groups of 6, twice a week for 3 months. Training focused on general fitness, balance, coordination, stretching, and lower extremity muscle strength, and included a daily home exercise program. MAIN OUTCOME MEASURES: Muscle strength across the knee (extension and flexion), Algofunctional Index (AFI), pain (0 to 10 point scale), walking speed, clinical findings. RESULTS: Patients participated in 96 of 96 assessments (100%) and in 218 of 280 training sessions (77.9%). From baseline to 3 months, isokinetic quadriceps strength (30 degrees/sec) improved 20% (confidence interval [CI] 2alpha = .05, 8% to 50%) in the least affected leg; isometric strength improved 21%. By 1 year, AFI had decreased 3.8 points (CI2alpha = .05, 1.0 to 7.0), pain had decreased 2.0 points (CI2alpha = 05, 0.0 to 4.0), and walking speed had increased 13% (CI2alpha = .05, 4% to 23%). There was an increase in the frequency of palpable joint effusions (p < .01) on the most affected side. Frequency of crepitus decreased on the least affected side (p < .01). CONCLUSIONS: General physical training appears to be beneficial to patients with OA of the knee. As shown by the high compliance and low dropout frequency, such a program is feasible even in patients with severe OA of the knee.

Aged↗
PubMedDate not supplied

Pregnant inmates: risk factors and pregnancy outcomes.

OBJECTIVE: To document the risk factors and outcomes of pregnant women incarcerated in a maximum-security prison. DESIGN: Descriptive correlational study. SETTING: Women's correctional facility. PARTICIPANTS: Eighty-nine pregnant women incarcerated during the third trimester of pregnancy. MAIN OUTCOME MEASURES: Medical, obstetric, life-style, and psychologic risk factors during pregnancy; birth weight; weeks of gestation at delivery; and presence of congenital anomalies in the newborn. RESULTS: Numerous risk factors during pregnancy, including chemical dependency, poor nutritional status, poor obstetric histories, high levels of anxiety and depression, and inadequate prenatal care. CONCLUSIONS: There is a need for intensive prenatal education for incarcerated women and for chemical dependency treatment programs designed specifically for incarcerated pregnant women. Interventions that address psychologic distress also are needed.

Adolescent↗
PubMed1990

Intensive insulin therapy for treatment of type I diabetes.

Intensive insulin therapy is best defined as a comprehensive system of diabetes management with the patient and management team as partners. The system is directed at improvement of glycemia and patient well-being. Glycemic targets should be individually defined. Frequent self-monitoring of blood glucose, probably at least four times per day, is essential for meticulous control. The benefits include improved psychosocial functioning and the potential of lessening the risks of chronic complications of diabetes. The risks relate to problems associated with hypoglycemia, which are increased if meticulous glycemic control is sought. One of the important elements of intensive therapy is a multiple-component insulin program designed to provide effective insulinemia coinciding with each major meal and continuous basal insulinemia throughout the 24-h day. This may be achieved with continuous subcutaneous insulin infusion (CSII) or multiple injections with various insulin regimens, although CSII may offer real advantages in terms of the pharmacokinetics of insulin delivery. Other pharmacokinetic issues to be considered involve selection of injection sites, timing of premeal insulin, and mixing insulins. Many studies have shown that, albeit with effort, excellent glycemic control can be achieved by various intensive insulin-therapy regimens. The implementation of a program of intensive therapy involves patient self-management in terms of altering insulin dosages, food intake, and/or activity in an attempt to achieve the target level of glycemia selected. In motivated patients willing to embark on such a course of therapy, intensive insulin therapy can be worthwhile. It should be considered for all patients with type I (insulin-dependent) diabetes mellitus.

Diabetes Mellitus, Type 1↗
PubMed2001

The Kentucky Homeplace Project: family health care advisers in underserved rural communities.

The Kentucky Homeplace Project (KHP) is a state-legislated program designed to address well-documented deficits in the health status of and health resources available to many of Kentucky's rural residents. Since its inception in 1994, the KHP has served approximately 80,000 clients, primarily through home visits by trained, locally residing paraprofessionals known as family health care advisers. These family health care advisers employ culturally appropriate strategies to meet immediate needs as well as to foster long-term client empowerment and the adoption of health prevention strategies. This descriptive examination of KHP provides information regarding (a) the advantages of the program, with specific attention to its orientation toward provision of culturally appropriate health services; (b) the disadvantages of KHP, including competing budgetary priorities and its vulnerability to local economic and political trends; and (c) the potential application of similar programs for other rural, difficult-to-reach populations.

Family Health↗

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