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At least 1,801 records · Page 100Linked to original sources
PubMed1990

[Evaluation of quality assurance program in high dose rate remote after-loading brachytherapy].

In the past 9 years, we have routinely used high-dose-rate remote afterloading systems, a Toshiba RAL-302-2 remote afterloading system and a self-fabricated Ir-192 system, for radiation therapy of various cancers, particularly cancers of the uterine cervix and nasopharynx. The frequency of using these two systems is more than 30 times per week. These machines can deliver high-dose radiation (300-1000 cGy) to a specifically planned target on the patient in a few minutes, therefore, the performance of the systems requires well planned dosimetry and quality control assurance in order to achieve effective therapeutic results and ensure safety of the patient under treatment. Any malfunction of the machines may cause over-radiation that exceeds a planned dose to the patient, and any distortion in the distribution of a planned dose may give an unexpected high dose of radiation to the therapist operating the machines. Hence, a quality assurance program must be enforced regularly to avoid or minimize any possible accidents. Based on information and recommendations reported in the literature, as well as from our own experience, we set up a program of routine checks to correct and adjust the machinery conditions and to ensure the optimum operational status of the equipment on a weekly, monthly, semiannual and annual basis. In checking the Co-60 machine, we found that the rate of occurrence for abnormal source position was 3.9% and that for the timer was 2.8%. In the Ir-192 machine checks, abnormal conditions were found only in the source position at the rate of 7.8%.

Brachytherapy↗
PubMed1991

Knowledge about AIDS among intravenous drug users: an evaluation of an education program.

Increasing intravenous drug users' (IVDUs) knowledge about the etiology and symptoms of the human immunodeficiency virus is a first step in controlling the spread of the virus to the general population. A comparison of pretest and posttest measures of knowledge of acquired immune deficiency syndrome among IVDUs participating in an AIDS education program reveals significant increases in knowledge after a basic one-hour education session. Additional analyses indicate that IVDUs are more ignorant of certain aspects of AIDS than others, and frequently less amenable to education efforts related to these aspects. Finally, the analyses show that the knowledge among IVDUs about AIDS is independent of the IVDU's demographic characteristics and risk-profile.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Family of origin genograms: evaluation of a teaching program for medical students.

BACKGROUND: The use of family genograms is an important component in family practice, yet little has been written about curriculum for teaching genograms in medical school. Since 1981, the Department of Family and Community Medicine at the University of California, San Francisco, has conducted a behavioral science seminar for fourth-year students on their required 8-week ambulatory care clerkship. At one site, this seminar includes presentation of the students' personal genograms. This report describes the curriculum and a study to determine whether students understood genograms or used them in clinical settings. METHODS: We compared students' perceptions of the usefulness of genograms and genogram documentation in new patient assessments. Students at two sites were given pre- and postclerkship questionnaires, and a random sample of charts was reviewed for documentation of genograms. RESULTS: Students in the genogram demonstration group increased significantly in their stated use of genograms. Surprisingly, the group of students not exposed to the genogram curriculum were more likely to have genograms with more details recorded in the patients' charts. CONCLUSION: These results imply that there were initial differences in the two groups and that didactic teaching must be complemented with clinical supervision. Also, the results have implications for specific areas in need of faculty development.

Adult↗
PubMed1993

Evaluation of a new program: pediatric parental visitation in the postanesthesia care unit.

PACU staff members have long resisted the implementation of parental visitation in the PACU despite its apparent psychological benefit to pediatric patients. This resistance can be attributed to the belief that parents would interfere with care, that they would reduce other patient's privacy, and that their presence would increase nursing work load. After 3 months' experience with pediatric parental visitation, the nurses and physicians at Coral Springs Medical Center discovered these beliefs to be groundless. Indeed, 95% of staff felt the program should continue, 100% of adult patients felt their privacy was well maintained, and 89% of staff stated that parental visitation had made their job easier. An audit of patient records showed that need for narcotics and length of stay was unaffected by visitation and that pediatric patient discomfort as measured by frequency of patient crying decreased by 54%.

Child↗
PubMedDate not supplied

[An evaluation of the new program of Master of Sciences in Environmental Health].

Our country is presently undergoing a historical, environmental and economic transition, along with an intense industrial expansion. As the rapid industrialization has not run parallel with the strengthening of environmental sanitary infrastructure, metropolitan cities have grown anarchically, turning over excessive amounts of air, water and soil pollutants. The harmonic combination of development, environment and health requires the supervision of trained human resources. The scarcity of such resources is a major restriction to overcome. In response to the lack of human resources devoted to environmental issues, the School of Public Health of Mexico established the Specialty of Environmental Health. In coordination with experts and decision makers from the health services, this specialty was reorganized in a Master of Science Degree in Environmental Health. Several institutions participated in this program actively, either with financial support or with human resources. The major obstacle to the continuity of the Program has been the lack of institutional financial support for students to devote fully to the programs. Nevertheless this Master's Degree is expected to undergo intense development in coming years. In the future, this program will have to reduce its epidemiologic focus and adopt a more general one. Efforts will be directed toward a wider national and international projection.

Curriculum↗
PubMed1993

[Perinatal Streptococcus agalactiae infections. Clinical epidemiological study and evaluation of a prevention program].

BACKGROUND: To prove both the importance of SGB (group B streptococci) as a cause of perinatal infection and the efficacy of a prophylactic treatment in pregnant women with cervicovaginal colonization by SGB. METHODS: Retrospective study of 197 third trimester pregnant women who were carriers of SGB (155 received intrapartum prophylaxis) and of 44 patients with SGB infections during pregnancy, post-partum and neonatal periods. RESULTS: No neonatal sepsis was detected in the group of SGB carrier mothers who received antibiotic prophylaxis. In carrier pregnant women who did not receive prophylaxis, one case of neonatal sepsis by SGB was detected and a greater prevalence of intrapartum fever, and neonatal infection with negative cultures was observed. SGB was frequently isolated as a cause of early sepsis and neonatal meningitis (13 cases), intraamniotic infection (12 cases) and puerperal endometritis (8 cases). In 45% of the patients with perinatal infections by SGB, the cervicovaginal culture performed in the third trimester of pregnancy did not detect the presence of SGB. CONCLUSIONS: The administration of intrapartum ampicillin to pregnant SGB carriers permits the prevention of perinatal infections by this microorganism in a great number of patients, although the possibility of late colonization, which may not be detected during pregnancy, stil remains.

Ampicillin↗
PubMed1996

Maternal serum screening for birth defects: results of a Connecticut regional program.

Second trimester maternal serum screening provides a method to identify pregnancies at high risk for fetal Down's syndrome, trisomy 18, open neural tube defects, and a variety of other chromosomal and nonchromosomal fetal anomalies. Results are presented for a regional program to identify high-risk pregnancies using alpha feto-protein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol (uE3) analyses (triple marker testing). A total of 27,140 women received screening. Using a midtrimester Down's syndrome risk of 1:270 to define the high-risk group, 5.26% of women of all ages were screen-positive for Down's syndrome resulting in the eventual detection of approximately 72% of the affected fetuses. The detection rate for patients under 35 at estimated date of delivery was 61% and for women 35, or older, the detection rate was 100%. A separate protocol to screen for trisomy 18 identified 0.2% of pregnancies, with 38% of the trisomy 18 cases present in this group. Over 3% of women screen-positive for Down's syndrome or trisomy 18 had a serious fetal chromosome anomaly. In addition, 2.89% of women had an elevated AFP (greater or equal to 2.0 multiples of median). This component of the screening resulted in the identification of 86% of the neural tube defects, 75% of the ventral wall defects, and also some of the other various fetal anomalies present in the screened population. Since both laboratory and clinical data are combined to generate patient-specific risks, there is a need for quality control elements that go beyond that normally required for a clinical laboratory alone. We stress the need for comprehensive follow-up programs to evaluate screening programs and maintain high quality.

Biomarkers↗
PubMedDate not supplied

[Evaluation of a supervision program of health centers at the district level in Madagascar].

Poor supervision and follow-up have long been recognized as major weaknesses in the development of primary health care in many countries. A program has therefore been specifically developed to strengthen the supervision activities of 18 rural health centers in Madagascar. District health officers were appropriately trained and then conducted two-monthly supervision visits. The emphasis of the training program was on problem solving, program integration and on-site training. The effects of the supervision program was assessed quantitatively and objectively. Various activities of each health center were scored before intervention, and one year after implementation of the supervision program. The improvement in most health centers was substantial, both in quantitative coverage and qualitative practice. Nevertheless, some centers appear to have been resistant to change.

Diarrhea↗
PubMed1985

The use of swing beds in rural hospitals.

The national program under which rural hospitals are currently providing swing-bed care is the result of a HCFA-sponsored demonstration and evaluation program involving more than 100 rural hospitals in four states. We summarize herein the larger of two evaluation studies of the program. The experimental hospitals averaged approximately two fully occupied swing beds, experienced a 5% increase in total occupancy owing to swing-bed care, and may have reduced acute care length of stay slightly. A strong negative correlation between acute care occupancy and use of swing beds was observed, but no evidence was found to support the hypothesis that swing-bed care decreases nursing home occupancy in rural communities.

Bed Conversion↗
PubMed1996

Evaluation strategies for CNSs: application of an evaluation model.

Program development has become an essential role function for today's CNS, who must be able to evaluate programs to determine their efficacy. A useful evaluation guide is Stufflebeam's CIPP (context, input, process, and product) model, which includes a framework to evaluate indirect care measures directly affecting cost-effectiveness and accountability. The model's core consists of (1) context evaluation leading to informed, contemplated decisions; (2) input evaluation directing structured decisions; (3) process evaluation guiding implemented decisions; and (4) product evaluation serving to recycle decisions. Strategies for using Stufflebeam's CIPP model are described.

Cost-Benefit Analysis↗

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