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Acceptance of physical therapist assistant course work by programs preparing physical therapists.

I developed and sent a questionnaire to the directors of entry-level physical therapy programs to determine if course work taken in an associate degree program could be credited toward requirements leading to a higher degree or certificate in physical therapy. I sent 86 questionnaires; 45 were returned. Results of the survey revealed that basic science courses taken by the physical therapist assistant (PTA) students are more likely to be credited (up to half of the respondents replied positively) toward a higher degree or certificate than are technical courses like therapeutic exercise, fundamentals of physical therapy, or physical modalities. Moreover, as many as 79 percent of the respondents reported that PTAs would not be granted transfer credit for their technical courses. Of those respondents whose programs do give credit for the technical courses, the courses are usually considered as elective hours. Although the concept of upward mobility appears to remain viable in the educational philosophy of the American Physical Therapy Association, students who view the associate degree program as an entry point into a physical therapy program must be aware of the problems of acceptance of PTA credits in an entry-level physical therapy program.

Allied Health Personnel

Training, utilization and motivation of pharmacy technicians--a five-year analysis.

A 600-hour-on-the-job training program for hospital pharmacy technicians is described. Qualified applicants who successfully pass a written examination are admitted to the program. Trainees receive both didactic and practical experience in all service areas of the pharmacy department. Opportunity for advancement through a technician specialist training program is available. Eighty percent of all applicant accepted into the program graduated, and 39% are currently employed by the pharmacy department with an average of 42 months work experience each. It is recommended that national guidelines are established for hospital-based pharmacy technician training program.

Education, Pharmacy

Reflections on the three-year program.

Dental education has twice altered curriculum length from four- to three-year programs. The first switch from four to three years came during World War II to meet the need for additional dentists, but schools rapidly returned to four-year programs after the war. During the early 1970s, 14 dental schools converted to three-year programs; however, by 1976 several of these schools had returned to the four-year programs. At the New Jersey Dental School, one of the first schools to adopt a three-year program in 1970, a return to a four-year program in 1977 was the result of poor acceptance of the program by the faculty, a lack of flexibility in the schedule, and an undiminishing negative attitude by the profession toward the graduates. The experience derived from the three-year curriculum has reenforced the need for designing variable length programs, because a significant number of students can successfully complete the traditional program in three years.

Attitude

Physician acceptance of a computerized health maintenance prompting program.

Computer prompting systems remind physicians to perform health promotion/disease prevention (HP/DP) procedures on their patients, but it is unclear how willingly physicians accept these systems. Because acceptance is critical to long-term system success, we assessed attitudes toward a computerized health maintenance program (HMP) prompting system. We surveyed 23 faculty and 52 residents in a general medicine teaching hospital group practice after the HMP had been in use for three years. Sixty-four physicians (85 percent) responded. Almost all (91 percent) agreed that all ongoing-care patients should receive periodic screening--a significant (p less than .001) increase compared to 1979, when prior to the HMP 56 percent agreed. On average, the physicians believed that 87 percent of their ongoing-care patients over 50 years of age should be enrolled in the HMP. About half (55 percent) felt that losing the HMP would limit their ability to care for their patients, and almost all (97 percent) said they would include a prompting system in any future private practice, with most (87 percent) preferring a computer-based system. A majority (65 percent) said that they liked being reminded. Prompting systems improve physician performance of HP/DP procedures. The HMP received a high level of acceptance and was associated with improved attitudes toward HP/PD activities, suggesting that computerized prompting systems should be more widespread.

Attitude of Health Personnel

An individualized educational model for the remediation of physicians.

OBJECTIVE: To design and implement an individualized program of evaluation and education to provide remedial experiences to physicians. DESIGN AND SETTING: An evaluation and educational program for physicians practicing in New York State. PARTICIPANTS: Physicians referred for evaluation and possible remedial educational experiences from the New York State Office of Professional Medical Conduct, from the New York State Committee on Physicians' Health, or self-referred. MAIN OUTCOME MEASURES: Educational programs designed to meet the individually identified educational needs of physicians and placement of physicians in educational settings that facilitate their meeting the program goals and issues raised by the Office of Professional Medical Conduct. RESULTS: Of the 28 physicians who have undergone evaluation activities, at the time of this report, five (18%) had completed their educational programs, five (18%) were participating in directed educational programs, five (18%) had approved educational programs and were awaiting placement, and 10 (36%) were awaiting acceptance of their program by the Office of Professional Medical Conduct. CONCLUSIONS: A comprehensive evaluation program can identify areas amenable to education and target individualized remedial educational experiences that may enable physicians to become contributing members of the medical community.

Clinical Competence

[Exercise tests in spirometry].

Actual situation: There is a great variety of exercise programs (formerly called protocols) used in daily routine and general practice. Exercise programs vary with increments, step-duration, speed and grade, although standard recommendations have been published recently. In the USA, the Bruce program is widely accepted, although some criticism has been published. Comparing different exercise programs it is obvious, that maximal values (VO2, heart rate etc.) are only moderately affected by the program, but submaximal values are strongly influenced by the methodological procedure. Advantages and disadvantages of the different exercise testing procedures will be presented. As we need some standardized exercise programs to avoid "free-style ergometry", recommendations may be based on the following assumptions: Exercise testing should not be too short nor too long (10-12 min total test time), work rate increments should be intermediate (adapted to physical fitness), work rate steps should be about 2 min or an individualized ramp test should be used. Exercise test programs have to be selected according to the patient's fitness, to the disease or function to be studied, and to the laboratory setting. Standardization is strongly recommended.

Exercise Test

A case for social marketing and education for acceptance and implementation of preventive health and occupational safety measure programs for rural communities.

The environment in which acceptance and implementation of preventive health and occupational safety occurs is not conducive to the message being heard, nor are people acting upon the message. Diffusion of innovation and community development models are explored for possible approaches to health education in the rural community. In particular, the community-oriented primary care approach to medical practice is discussed. In addition, the responsibility of the rural community is outlined.

Agriculture

AIDS contact notification: initial program results in New Jersey.

As part of an 1988-89 evaluation of New Jersey's newly established HIV Notification Assistance Program (NAP), data were collected concerning number of HIV+ persons providing contact names; contact characteristics; reactions to NAP of HIV counselors, their clients, and of notified contacts; and program costs. There was initial resistance to the program both from HIV counselors and their clients. By mid-1989, acceptance of the program by referring HIV counselors had increased. The proportion of HIV+ clients who referred contacts was still low, but had increased to 10%. 160 contacts were notified: 72% sexual contacts and 28% needle sharing contacts, 59% male and 41% female, 58% black, 29% white, 13% Hispanic. 67% considered themselves at moderate or high risk for HIV; 31% stated that they had already been tested for HIV, with 7% having tested positive. Cost per notified contact was $2,260; cost per contact not previously tested HIV+ and unaware of risk was $3,014. Findings suggest that persuading counselors at HIV counseling and testing sites of the program's value is a key prerequisite for success, in situations where notification is carried out by a separate agency. Once the program has been in place for a time and has established credibility, the opportunity exists for initial resistance to be overcome.

AIDS Serodiagnosis

[Care of tuberculosis patients at the community level in the state of Chiapas, Mexico].

From August 1989 to August 1990 in the municipio of Chicomuselo, State of Chiapas--an area with a high incidence of tuberculosis--health promoters were trained to carry out priority actions as part of the National Campaign Against Tuberculosis. A program to provide training, semi-monthly evaluation of the work carried out, detection of new cases, treatment supervision, and contact tracing was established utilizing the structure and resources of the Campaign. The health promoters were assigned the following functions: searching for patients with respiratory symptoms and conducting sputum smear examinations, examining postvaccination scars in persons under 15 years of age, and tracing tuberculosis patient contacts. In total, 1,778 doses of BCG vaccine were administered to individuals under 15 years of age in 35 communities; 144 patients with respiratory symptoms were studied; 257 sputum smear examinations were carried out; and 26 cases of tuberculosis were diagnosed. The most affected age group consisted of those 15 to 45 years old. Patients were monitored during treatment through sputum smear examinations. Twenty-nine persons started the treatment and 24 completed it; 24 were cured, five did not complete the treatment, two abandoned it, and three died. There were no treatment failures. The efficiency of the program was 82% and its effectiveness, 100%. The results show that it is possible to utilize the human resources in a community to carry out health programs. The community members' acceptance of and support for the program was due in part to that fact that their interests were taken into account in its implementation.

Adolescent

OSHA's voluntary protection programs. The benefits to occupational health nurses and their companies.

The Voluntary Protection Programs (VPP) consist of three different programs: Star, Merit, and Demonstration. Each is designed with different criteria to allow the opportunity for a wide range of safety and health programs to be recognized. To be accepted into the Star program it is necessary to have statistics that indicate the program is effective and to have the following six elements incorporated into a comprehensive safety and health program: management commitment; established methods of worksite analysis; established methods of hazard prevention and control; quality safety and health training; employee participation; and annual self evaluation. Because occupational health nurses have daily experience and formal training in hazard prevention and control, safety and health training, and employee health, they are invaluable resources in the VPP application process and in the maintenance of Star level protection. Decreased workers' compensation costs, decreased injury rates, and development of a positive attitude toward OSHA are benefits of the VPP for management, employees, and OSHA.

Accidents, Occupational

Behavior therapy for autistic children: a study of acceptability and outcome.

An inpatient program for autistic children which used behavior modification methods is described, and a follow-up study of the first 15 children discharged from the program is reported. In general, the outcome results appear to be comparable to those of other treatment methods. A second main purpose of the study was to assess the acceptability of this program to parents and to document their impressions regarding their child's period of inpatient care. Overall, a high level of acceptability was found.

Autistic Disorder

Hospital counseling in Khartoum: a study of factors affecting contraceptive acceptance after abortion.

This study examines the impact of contraceptive counseling on 3 263 women hospitalized in Khartoum for treatment of incomplete abortion. The analysis which focused on education and parity/child desire, revealed that the counseling program produced contraceptive acceptance among 47.0% of those followed up. In spite of the counseling efforts, half of the women in this study did not accept contraception following the abortion-regardless of education or parity/child desire. It is difficult to determine why 50% of those who had recently undergone an incomplete abortion were willing to put themselves at risk again. Apparently, future efforts to increase the impact of counseling programs must also examine patients' motivation to accept (or not to accept) contraception.

Abortion, Incomplete

The industrial hygiene audit: purposes and implementation.

The increased implementation of industrial hygiene programs in industry, with the associated increase in funds allocated to safety and health programs, has introduced the concept of evaluative measures for program performance. The audit is a frequently used and valuable tool for the safety specialist, but it has been infrequently used by the hygienist. We differentiate the audit from 1) program guidelines and 2) program evaluation. The latter implies relating program activities to articulated measures of effectiveness. The audit, in contrast, utilizes widely accepted industrial hygiene program structural elements. In an audit a qualitative or numerical rating scale is assigned each audit program element to indicate the extent to which the element is present. The audit is an essential tool for the manager of an industrial hygiene program. Audits are not a substitute for program evaluation, but program evaluation is a very uncertain matter because the industrial hygiene profession has yet to focus on measures of program progress in terms similar to those of the safety field, i.e. accident frequencies and severities. Program elements and qualitative and quantitative rating scales are described. Preparation, conduct and reporting of the audit are discussed.

Accident Prevention

Physician opinion of pharmacist-initiated change from injectable to oral administration of histamine H2-receptor antagonists.

Physicians' knowledge of dosage and cost differences between injectable and oral histamine H2-receptor antagonists (HRAs) and attitudes toward pharmacist-initiated route conversion of HRAs were assessed. A questionnaire was mailed to 491 physicians two months before implementation of a hospital program that allowed pharmacists to use preapproved guidelines to directly change the route of HRA administration. A similar questionnaire was sent to 488 physicians after five months of program operation. The response rate was 36.0% and 37.5% for the first and second surveys, respectively. In both surveys, almost half of the respondents gave incorrect answers or did not know whether dosage should be altered when HRA route is changed, and about 60% underestimated the relative cost of injectable HRAs. Among respondents who were aware of the program, 28% preferred direct pharmacist intervention; 15% of respondents who were unaware of the program had the same preference. Physicians generally responded positively to statements regarding the acceptability of the program and thought that the pharmacist's role in route conversion was appropriate. Many physicians were ignorant of differences in dosage and cost between injectable and oral HRAs. They generally supported allowing pharmacists to change the route of HRA administration from injectable to oral.

Administration, Oral

Diversion programs for impaired physicians.

Nine states have legislated impaired physician programs administered by state medical boards (2), by independent agencies (4), or by medical societies through contracts with medical boards (3). All other state programs are administered by medical societies. California's diversion program has been in effect for more than 10 years. It was the first program for alcohol- and drug-addicted physicians in the country administered by the state agency that also disciplines physicians. Of the physicians who enrolled in this program, 72% have completed it successfully. A total of 618 physicians have been accepted into the program since its inception, with 247 physicians currently participating.

California

The first 10 years of the dialysis-transplantation program at The Hospital for Sick Children, Toronto. 1: Predialysis and dialysis.

Renal dialysis and transplantation have been used for many years for adults with kidney failure but only recently for children. In May 1967 a renal-dialysis-transplantation program was established at The Hospital for Sick Children, Toronto for patients aged 6 to 18 years living within 240 km of Toronto. In 1973, children aged 1 to 5 years began to be accepted into the program, and by August 1977, 90 children (mean age 11 years) from all parts of Canada had been admitted to the program. The creation of vascular access in very small patients is difficult; the most successful types of access have been central shunts (established above the knee or the elbow) and bovine grafts. Specially made dialysis equipment is necessary for young patients. Young children should only be accepted in a dialysis-transplantation program that has a medical staff expert in meeting the specific needs of such children.

Adolescent