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PubMed1996

Effect of integrated research programs on health care systems and costs.

We examined the effect of research program size on clinical costs (current dollars/work unit) and productivity (work units/ employee) in Department of Veterans Affairs (DVA) hospitals. Our data demonstrate that research programs have a small, almost negligible effect on clinical costs. The data also show that average acute medical service length-of-stay was inversely related to research program size. The indirect cost of research may have been almost entirely offset by an increased efficiency, as reflected in the shortened length of stay. This unexpected benefit of research may be due to the influence of research opportunities on the recruitment and retention of highly trained clinicians, including medical specialists. In the past, recruitment and retention was part of the justification for the DVA research program. Although this justification no longer appears to be considered politically acceptable, our data strongly support the notion that research programs can and do enhance the efficiency of medical care. Furthermore, research activities help professional staff maintain their critical thinking and analytic skills. We discuss the implications of these observations on cost containment in health care systems.

Cost Control↗
PubMed1993

PROBE: a computer program employing an integrated neural network approach to protein structure prediction.

A computer program, PROBE, has been designed for the prediction of protein structural features from amino acid sequence. This program integrates a variety of computer-simulated neural networks, each predicting an aspect of protein structure, into a single, easy-to-use package. The surface accessibility of each residue, the presence of disulfide bonds, the overall secondary structure composition and the residue secondary structures, including beta-turn type, are predicted. In addition, the overall amino acid composition and relative hydrophobicity are used to determine whether a protein belongs to one of four common folding motifs. PROBE is able to compare and synergistically improve the predictions by allowing communication between the different networks.

Amino Acid Sequence↗
PubMedDate not supplied

A review and analysis of the clinical- and cost-effectiveness studies of comprehensive health promotion and disease management programs at the worksite: 1998-2000 update.

PURPOSE: This article is the fifth in a series of critical reviews of the clinical effectiveness and cost-effectiveness studies of comprehensive, multifactorial health promotion and disease management programs conducted in worksites. As with the previous reviews, the purpose of this article is to review and assess the randomized control trials that have focused on both clinical and cost outcomes of worksite health promotion and disease management programs. For this current review, a new category of quasi-experimental studies has been added because this represents a major new trend in such interventions over the last 2 years. Comprehensive worksite programs are those that provide an ongoing, integrated program of health promotion and disease prevention that integrates specific components into a coherent, ongoing program that is consistent with corporate objectives and includes program evaluations of both clinical and cost outcomes. DATA SOURCES: A comprehensive search was conducted using a multistage process that included MEDLINE, ERIC, ADI, EDGAR, CARL, Inform, and Lexis-Nexis databases and direct inquiries to worksite researchers. INCLUSION AND EXCLUSION CRITERIA: The search identified 27 new studies to which the following inclusion criteria were applied: research conducted in the United States; results published in English; methodological quality of nonexperimental (pre- and postmeasures but no comparison group); quasi-experimental to randomized control trials; and both clinical and cost outcomes. Exclusion criteria were studies outside of the United States; non-English publications; and clinical or cost outcomes only. Fifteen studies remained for this review. FINDINGS EXTRACTION METHODS: Findings extraction and analysis of the 15 studies was done by extracting the relevant population, intervention design, clinical results, and cost outcomes from the published article. As in previous reviews, findings are summarized in a table format that extracts and describes each study by the following: (1) study author(s); (2) corporate site; (3) purpose of the evaluation; (4) employee population; (5) percentage of program participants; (6) number of employees included in the evaluation; (7) brief description of the intervention; (8) evaluation design; (9) evaluation period; (10) outcomes; (11) research rating; and (12) findings. FINDINGS SYNTHESIS: Based on these 15 studies, a methodological critique was conducted with brief reference to appropriate prior studies. Conclusions regarding study quality and new trends over the time period of 1998 to 2000 are discussed. MAJOR CONCLUSIONS: Results from randomized clinical trials and quasi-experimental designs suggest that providing individualized risk reduction for high risk employees within the context of comprehensive programming is the critical element of worksite interventions. Despite the many limitations of the current methodologies of the 15 new studies, the vast majority of the research to date indicates positive clinical and cost outcomes.

Cost-Benefit Analysis↗
PubMed2000

A model to simulate the effect of vaccination against Boophilus ticks on cattle.

This paper describes a vaccination model to simulate the effect of cattle vaccination with concealed antigens on Boophilus tick spp. The model considers the vaccination effect in three parts: antibody titer, accumulation of damaging vaccination effects by parasite stages, and the effect of accumulated damage on all tick life stages. Biological parameters for ticks and hosts, as well as parameters describing tick-host interaction, were included. The validity of this model, integrated with the TICKSIM simulation program, was demonstrated for the Bm86-containing vaccine Gavac by comparing simulated and real data for several geographic locations in the Americas. All model parameters were estimated using field data collected in the different geographic locations. The model sensitivity to changes in antibody titer level and titer half-life was studied, and the impact on tick population density of changes in these parameters was evaluated. Simulation results showed that to achieve a higher level of tick control, an increase in the maximum antibody titer levels was more important than extending titer half-life in geographical locations with short seasonal peaks of tick infestation. The TICKSIM program, integrated with the new vaccination model, proved to be a framework for designing and evaluating tick control strategies, including vaccination with GavacTM.

Animals↗
PubMed2002

Evaluation of a computer based interactive diabetes education program designed to train the estimation of the energy or carbohydrate contents of foods.

The objective of this study was to evaluate a computer based interactive diabetes education program designed to train patients with diabetes to correctly estimate the energy or carbohydrate contents of foods. The acceptance and the operator convenience of the program were evaluated with an integrated program and written questionnaires. The training success was calculated for each user from the data sets after multiple repetitions of the same exercise. Age, weight, type of diabetes, previous training and computer experience of 126 patients with type 1 or 2 diabetes from three different German diabetes centres were documented. The evaluation of the computer program indicated a good acceptance and operator convenience. Moreover, there was a significant training success in patients who have never used a structured diabetes education program before. Therefore, the potential impact of the program is to support but not to replace structured diabetes education programs and to further motivate and attract patients to diabetes education programs.

Computer-Assisted Instruction↗
PubMed2002

The impact of an integrated family planning program in Russia.

In 1995, the U.S. Agency for International Development implemented an integrated program of family planning education and services in six Russian cities to increase physicians' and women's contraceptive knowledge and change current contraceptive use. Large population-based surveys of women ages 15-44 were carried out at the beginning of project implementation (in 1996) and 3 years later in two project sites and a comparison site. Results from these surveys indicate that project activities affected women's knowledge of family planning methods, and caused women to have more favorable attitudes toward modern contraception. In addition, abortion rates decreased in project sites while remaining virtually unchanged in the comparison site. Because of uneven implementation of project interventions in the demonstration sites, however, the intervention's actual impact on abortion rates remains unclear.

Abortion, Legal↗
PubMed2002

Measuring integrated pest management programs for public buildings.

Integrated pest management (IPM) tends to be perceived by different stakeholder groups either as a methodology for effective pest control or as an ideology of responsible environmental stewardship. The IPM process has never been subjected to a rigorous empirical test as a control methodology in buildings; published studies have either tested isolated program components or have presented uncontrolled, sequential descriptions of IPM replacing traditional pest control service procedures. Because ideological measurement is simpler, cheaper, and more relevant than methodological testing to evaluate structural IPM performance in the public sector, data on pesticide use/risk and customer satisfaction, rather than control efficacy, are used by the General Services Administration (GSA) IPM program to demonstrate success compatible with Government Performance and Results Act (GPRA) guidelines. Implementation of IPM in 1989 resulted in significant decreases both in quantities of insecticide applied indoors and requests for pest control service by building occupants throughout the first decade of the program. Although these results do not provide an empirical test of structural IPM methodological superiority as a means of reducing pest populations, they indicate that replacing sprayed insecticide formulations with baits and using client reporting as the primary pest surveillance method can successfully achieve the policy goals of a large-scale IPM program for public buildings.

Animals↗
PubMed2003

Integrated care in schizophrenia: a 2-year randomized controlled study of two community-based treatment programs.

OBJECTIVE: To evaluate the efficacy of two community-based programs that combined antipsychotic medication, family interventions and social skills training. METHOD: A randomized controlled trial with 2 years follow-up. The study included 84 patients with schizophrenic disorders, continuously managed in terms of care and treatment, and regularly assessed. Analysis was by intention-to-treat. RESULTS: Between-program comparisons showed significantly improved social function and consumer satisfaction in favour of the program 'Integrated Care' (IC) at the 2-year follow-up. The main clinically important differences between the two treatment programs studied were the procedures for shared decision making and patient empowerment in IC. CONCLUSION: The implementation of IC in clinical practice can improve social recovery and increase consumer satisfaction for patients with schizophrenic disorders. We identified specific procedures that might be added to improve the effectiveness of any program for severely mental ill people.

Adult↗
PubMed2001

Safety makes sense: a program to prevent unintentional injuries in New York City public schools.

Estimates suggesting that 10% to 25% of unintentional injuries to school-aged children occur in and around American schools are alarming. Information from the National Health Information Survey indicates as many as 3.7 million children are injured in schools annually. To address these concerns, The New York Academy of Medicine and the Board of Education of the City of New York in 1998 launched Safety Makes Sense, a multidimensional school-based, injury prevention initiative. The Safety Makes Sense program integrates unintentional injury prevention into comprehensive school health education in elementary and middle school classrooms and is implemented by interdisciplinary teams within a coordinated school health program. The multifaceted program also integrates safety and music education, and includes development of a handbook for teachers and staff, student booklets, staff development training workshops, and evaluation.

Accident Prevention↗
PubMed1997

Research and practice in an academic community nursing center.

PURPOSE: To identify issues and describe strategies used in developing a successful program of clinical research focused on the vulnerable populations served by one urban academic nursing center. Academic community nursing centers provide ideal settings to implement programs of research. Understanding the challenges when integrating research into these practices and the strategies used is important. SETTING AND SCOPE: The University of Wisconsin-Milwaukee Silver Spring Community Nursing Center has provided primary health care services to a low-income urban population since 1987. A team of advanced practice nurse clinicians, community health nurses, and other health care professionals and community residents implemented a broad range of innovative, community-focused, clinical interventions that are routinely studied through an integrated program of nursing research. Their strategies for research implementation are analyzed. CONCLUSIONS AND IMPLICATIONS: Factors affecting the integration of research into the center include (a) community mistrust, (b) the need for participatory recruitment strategies, and (c) the need for multiple data collection methods. Meeting these challenges requires that research agendas and methods are consonant with community goals. The inclusion of clinicians, other providers, and community residents as active members of research teams is critical to success. Reframing research and practice role in terms of team effort that incorporates the community can strengthen research and practice-and benefit professionals and the populations they serve.

Academic Medical Centers↗
PubMed1996

[Evaluation of occupational programs in the city of Zurich].

Occupational and job integration programs are components of low threshold drug policies. Since the mid-eighties many such projects have been realized not least to counteract the increasing pauperization of drug addicts and the spreading of AIDS. Two of these occupational programs, the "job-Bus" and the "Förderband (Conveyor Belt)", were evaluated by the means of two quantitative cross-sectional studies and by a qualitative topic oriented interview in the second phase. The results presented refer to the second phase of the evaluation. The proportion of women in the programs is low with only 10%. The average age of 38.4 is higher than in other institutions for drug users. The work program is well accepted among the participants, and there is a high demand for such programs in the target group. Non-material aspects such as structuring of days, contact opportunities and fulfillment give the institution an additional significance. The author therefore recommends expansion of these programs under occupational and socio-pedagogical aspects in doing so, the underrepresented women and young adults ought to be reached. Furthermore it should be examined whether stable users can be employed permanently.

Adult↗
PubMed1995

Treatment of commercial broiler chickens with a characterized culture of cecal bacteria to reduce salmonellae colonization.

The effect of treatment with a newly developed characterized continuous-flow (CCF) culture composed of 29 strains of cecal bacteria on salmonellae colonization was evaluated in commercially reared broiler chickens. Newly hatched chicks in three flocks were sprayed with CCF culture as they were placed in rearing houses and compared with untreated flocks on the same farm. Hatchery transport tray liners and rearing house feed, water, and little samples were cultured for the presence of salmonellae. Cecal samples were cultured after 3- and 6-wk growout. Skin-feather samples were cultured at 6-wk growout. Fifty-five percent of the transport tray liners were contaminated with salmonellae on the day of chick placement. At 3 wk, salmonellae serotypes present on the tray liners were widely distributed in the litter of the rearing houses. The results indicated that exposure to salmonellae occurred before culture treatment and continued in the rearing houses during the 6-wk growout period. Salmonellae cecal colonization was decreased (P < .05) in two of the treated flocks at 3 wk and diminished (P < .07) in the third treated flock compared with control flocks. At 6 wk, skin-feather contamination and cecal colonization were decreased (P < .05) in one of the treated flocks whereas no treatment effect occurred in two of the treated flocks compared with controls. The results clearly indicate the necessity of implementing integrated programs to control salmonellae in both the hatchery and rearing house environments. The CCF culture served to enhance salmonellae colonization resistance and may serve as a useful component of an integrated control program.

Animals↗
PubMed1993

Community responses to violence.

Community level efforts are effective in the reduction of violence. Community-level interventions have three goals: to prevent the escalation of risk for violence among the families in the community, to assist families at risk of or using violence, and to protect victims of abuse. To prevent violence or reduce its prevalence, community groups need to collaborate to reduce the community-level risk factors. Assisting families and protecting victims of violence requires coordination of community services, including law enforcement, schools, therapists, courts, child care, and social services. All of these goals can best be achieved through the efforts of a community level, multidisciplinary council or board that directs the programs. A community process to establish an integrated program involves several steps. The leaders that are identified need to represent all the disciplines and the entire geographic area involved in the project. Once the leaders start meeting, the baseline information and plan can be developed. Then the project itself can be undertaken, with the support of the media and other appropriate organizations. Several examples of effective projects document this process and its success; the best efforts involve coalitions of private and governmental agencies working together. Physicians are integral to this process. The practice of medicine provides opportunities every day to prevent and intervene in potential cases of abuse and violence. Also, by participating actively in the community, physicians can be effective leaders to change attitudes and behaviors and institute programs toward reducing violence.

Adult↗
PubMed1994

The evolution of the end-stage renal disease program in Australia.

Australia was an early pioneer of national integrated programs for the management of end-stage renal disease (ESRD). From being a leader in numbers of patients per population treated, it is now in the top 15. The Australian program has a high proportion of living patients with functioning transplants and a high proportion of out-of-hospital dialysis. The proportion of elderly patients is increasing but lower than expected. A particular problem is the treatment of Aboriginal people. The ANZ Data surveys give accurate complete data for the national program. Unique features of the Australian patients are the high incidence of analgesic nephropathy and the low incidence of primary hypertension as a cause of renal failure. Surveys show that it is possible to improve transplantation rates 2 to 3 times. Analysis of Australian data raises the question of whether dialysis and transplantation should be offered to all potential patients regardless of comorbidity or quality of life when health resources are inevitably finite.

Adult↗
PubMed1995

Health care programs: fraud and abuse; technical revision to the scope and effect of the OIG exclusion regulations--HHS. Final rule.

This document sets forth a technical revision to OIG regulations on program integrity for Medicare and State Health Care programs, concerning the scope and effect of the OIG's program exclusion regulations. Prior to this revision, the regulations provided that a program exclusion imposed under title XI of the Social Security Act was to affect future participation in all Federal non-procurement programs. This revision specifically amends the language in the existing regulations to clarify that the scope of an exclusion is now applicable to all Executive Branch procurement and non-procurement programs and activities. This rule is consistent with the Federal Acquisition Streamlining Act, and the Department's Common Rule on debarment and suspension which is also being amended and published elsewhere in this issue of the Federal Register.

Fraud↗