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Results for “Program Appropriateness”

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PubMed2004

[Impact of a program to improve appropriate prescribing of medications in residential facilities for older persons. Results after one year].

OBJECTIVE: To evaluate the impact after one year of a program to improve appropriate prescribing of medications, medical care products and supplies at a group of residential centers for older persons. DESIGN: Multicenter, controlled, quasi-experimental, before-after study of all outpatient prescriptions charged from each center to the Catalonian Health Service during the study period (reference year 2001, monitoring year 2002). SETTING: A total of 107 residential centers in the Barcelonés Norte y Maresme (Barcelona) health region. PARTICIPANTS: After situation analysis the centers were divided into two groups: intervention (n=21) and control (n=86). A total of 4789 older persons were residents at participating centers during the study. Interventions. The actions carried out in the intervention group were: a). letter describing the program; b). face-to-face interview to provide information; c). distribution of printed information about the study's aims and the indicators recorded, and d). monitoring with several follow-up interviews. MAIN MEASURES: We recorded quantitative indicators (general, specific and urinary incontinence products), qualitative indicators (use of medications with high intrinsic pharmacological value and generic pharmaceutical specialties) and relative drug use. The data were analyzed with a program written for Microsoft Access. RESULTS: In the intervention group we found that pharmaceutical costs were contained, a result we attributed to the greater efficiency achieved with the intervention (interannual increase of 0.7% in the reference period to 16.2% in the monitoring period; P=.000). The contribution of urinary incontinence supplies to cost reductions was noteworthy. Total costs in terms of numbers of packages dispensed for all therapeutic subgroups decreased by 4.8% (P=.000). The use of generic pharmaceutical specialties increased by from 7.9% to 13.1%, and the results for qualitative indictors for antiasthmatics and recommended NSAIDs also revealed improvements in prescribing quality. CONCLUSIONS: The preliminary results of the program show it to be effective in improving the efficiency of drug prescribing at participating nursing homes. The research method was useful in promoting the rational use of medications and improving the quality of prescribing practices.

Aged↗
PubMed1980

Department of Energy--appropriate technology small grants program: final rule.

This rule prescribes amendments to the Program Guidelines for the Appropriate Technology Small Grants Program which were issued pursuant to the Energy Research and Development Administration Appropriation Authorization of 1977. The full text of Part 470, as amended, is set forth in this final rule.

Conservation of Energy Resources↗
PubMedDate not supplied

Developing a culturally appropriate family planning program for the Navrongo experiment.

This article describes the first six months of the strategic planning process to develop a culturally appropriate community health and family planning program for a traditional community in a district of northern Ghana, served by the Navrongo Health Research Centre. To explain the context within which fertility decisions are made, this article describes the district's severe ecological, social, economic, and health constraints to family planning. It discusses related programmatic obstacles and presents the strategies developed to respond to them. A system of care has been developed that is closely coordinated with traditional leaders and communication networks. Management systems support outreach workers by emphasizing the importance of peer leadership, supervisory support, and community liaison in the implementation of village-based services. A large-scale experiment will be fielded to test the demographic impact of this approach.

Community Participation↗
PubMedDate not supplied

Getting it right: appropriate therapeutic recreation programs for community based consumers of mental health services.

Over the last two decades in Australia, the deinstitutionalization process, which began with the intent of moving consumers of mental health services from in-patient facilities and then seeking to integrate these same individuals into the community, has served to highlight a wide range of consumer needs that have remained largely unfulfilled throughout the process. One such need has been the provision of appropriate therapeutic recreation programs for the community based consumers of the various state co-ordinated mental health services. This paper argues a case for a change in the approach which professional staff provide and lead therapeutic recreation based programs to enable participants to be empowered, rather than disempowered, through their involvement. Further, this paper contends that there is a need for health care staff, more generally, to accept the concept of such programs for the community based consumers of various mental health services as a valued one.

Australia↗
PubMed1995

The "low intensity treadmill exercise" protocol for appropriate rate adaptive programming of minute ventilation controlled pacemakers.

The objective of rate adaptive pacemakers that measure minute ventilation by transthoracic impedance is to simulate the physiological relationship of the sensed signal to the sinus node response during exercise, thus achieving an appropriate matching of heart rate with patient effort. The purpose of this study was to determine the physiological relationship between heart rate and minute ventilation (HR/VE) during peak exercise testing in order to develop a database for appropriate rate adaptive slope programming of minute ventilation controlled pacemakers. Due to several clinical limitations of peak exercise testing, it was additionally determined whether the 35-watt "low intensity treadmill exercise" (LITE) protocol can be used as a substitute for peak exercise test using the "ramping incremental treadmill exercise" (RITE) protocol in order to assess the correct HR/VE slope below the anaerobic threshold. The stress tests were performed on a treadmill with the collection of breath-by-breath gas exchange. Linear regression analysis was used to determine the HR/VE slope below and above the anaerobic threshold and during the early, dynamic phase of low intensity exercise with the RITE and LITE protocols, respectively. The results of this testing in 41 healthy subjects demonstrated that the HR/VE relationship throughout treadmill exercise using the RITE protocol was not linear but curvilinear in nature, with a steeper HR/VE slope of 1.54 +/- 0.51 below versus 1.15 +/- 0.37 above the anaerobic threshold (P < 0.005). The HR/VE slope determined during the early, dynamic phase of the LITE protocol (1.58 +/- 0.88) did not differ from the HR/VE slope from rest to anaerobic threshold obtained using the peak exercise RITE test (1.54 +/- 0.51; P = 0.79). Rate adaptive pacing should simulate the curvilinear relationship between heart rate and minute ventilation from rest to peak exercise. The HR/VE slope determined during the early, dynamic phase of low intensity exercise represents the HR/VE slope derived from the RITE protocol below the anaerobic threshold. According to the peak exercise database, the slope above anaerobic threshold can easily be calculated as a percentage of the slope below the anaerobic threshold. The LITE protocol can, therefore, be effectively performed as a substitute for peak exercise stress tests to determine the correct pacemaker rate response factor in order to obtain a physiological heart rate to minute ventilation relationship for the appropriate matching of paced heart rate with patient effort.

Anaerobic Threshold↗
PubMed1988

Statutory prohibition on use of appropriated funds in programs where abortion is a method of family planning; standard of compliance for family planning services projects--PHS. Final rules.

The Public Health Service (PHS) amends the regulations governing the use of funds for family planning services under Title X of the Public Health Service Act in order to set specific standards for compliance with the statutory requirement that none of the funds appropriated under Title X may be used in programs where abortion is a method of family planning. It is expected that the amendments will improve compliance by grantees with the statute and facilitate monitoring of compliance by PHS.

Abortion, Induced↗
PubMedDate not supplied

Tomando Control: a culturally appropriate diabetes education program for Spanish-speaking individuals with type 2 diabetes mellitus--evaluation of a pilot project.

PURPOSE: The purpose of this study was to pilot test the feasibility, acceptability, and efficacy of a culturally appropriate and culturally relevant Spanish-language cognitive-behavioral diabetes self-care educational intervention for Hispanic Americans with type 2 diabetes mellitus. METHODS: The study site was an urban community health center in the Northeast, at which 16 Latino patients with type 2 diabetes mellitus were recruited. This was a 1-group pretest-posttest pilot study, during which qualitative and quantitative data were collected on demographic, physiologic (HbA1c, body mass index, lipids), psychosocial (diabetes-related distress and health beliefs), knowledge, and language-based acculturation variables at baseline, 3 months, and 6 months. Data were collected using questionnaires, laboratory data, and chart review. The intervention was culturally appropriate in terms of language, social emphasis, nutritional guidance, and acknowledgment of cultural health beliefs. Descriptive and inferential statistical analysis was used to evaluate response variables of glycemic control, lipid levels, and psychosocial and knowledge outcomes. The intervention acceptability process was evaluated by attendance and attrition. RESULTS: This pilot study demonstrated excellent acceptance for and feasibility of this intervention. Most study participants (9 women, 7 men) were middle-aged married individuals who had had diabetes mellitus for an average of 8 years; English was a second language for all of them. Most were overweight and had suboptimal glycemic control and lipid profiles and moderate levels of knowledge at the outset of the study. Most had received a one-on-one diabetes educational session prior to the intervention. Over the 6 months of the study, most of both men and women showed an increase in knowledge scores, improvement in lipid profiles, and reduction in HbA1c levels. Men demonstrated a temporary increase in emotional distress much greater than that reported by women during the first 3 months of the study. CONCLUSIONS: The findings suggest that a culturally relevant type 2 diabetes mellitus educational program, particularly one that addresses different learning needs and styles of men and women, can have a positive impact on Hispanic Americans with diabetes. Implications for practice include awareness of gender-based differences in response to self-management education, the importance of providing realistic samples of meals prepared in a manner consistent with American Diabetes Association principles, and the rationale for offering a brief and focused refresher course 6 to 9 months following this type of intervention.

Adolescent↗
PubMed1996

A culturally appropriate cancer education program for African-American adolescents in an urban middle school.

This article describes an innovative transfer of cancer prevention information from a Comprehensive Cancer Center to the community and school setting. A cancer control curriculum, developmentally and culturally appropriate for middle school, African-American children, was taught to seventh grade students in a public middle school in a large, northeastern city. By building partnerships among a university, an academic medical center, a public school district, and a non-profit arts organization, students learned cancer control concepts in the context of their daily lives. Students increased their knowledge of cancer risk and demonstrated a positive attitude about their ability to affect their own health. Experience with this project enabled staff to identify additional education and support needs that exist among students who have family members with cancer.

Adolescent↗
PubMed2005

Impact of statewide program to promote appropriate antimicrobial drug use.

The Wisconsin Antibiotic Resistance Network (WARN) was launched in 1999 to educate physicians and the public about judicious antimicrobial drug use. Public education included radio and television advertisements, posters, pamphlets, and presentations at childcare centers. Physician education included mailings, susceptibility reports, practice guidelines, satellite conferences, and presentations. We analyzed antimicrobial prescribing data for primary care physicians in Wisconsin and Minnesota (control state). Antimicrobial prescribing declined 19.8% in Minnesota and 20.4% in Wisconsin from 1998 to 2003. Prescribing by internists declined significantly more in Wisconsin than Minnesota, but the opposite was true for pediatricians. We conclude that the secular trend of declining antimicrobial drug use continued through 2003, but a large-scale educational program did not generate greater reductions in Wisconsin despite improved knowledge. State and local organizations should consider a balanced approach that includes limited statewide educational activities with increasing emphasis on local, provider-level interventions and policy development to promote careful antimicrobial drug use.

Anti-Bacterial Agents↗
PubMed1997

Long GnRH-agonist protocol in an IVF program. Is it appropriate for women with normal FSH levels and high FSH/LH ratios?

OBJECTIVE: To determine whether subjects with an elevated ratio of follicle-stimulating hormone (FSH) to luteinizing hormone (LH) but normal basal FSH levels should be regarded as poor responders to controlled ovarian hyperstimulation. STUDY DESIGN: One hundred twenty-five women undergoing in vitro fertilization (IVF) for the first time were recruited in this retrospective cohort study. Women over 40 years old or having serum basal FSH > 10 mIU/mL were excluded. RESULTS: Various cutoff values for the FSH/LH ratio were chosen, and the ratio demonstrated that pregnancy rates were apparently higher in patients with the long protocol than with the short one if they had an FSH/LH ratio < 3.0 (48.5% vs. 25.8%, P = .034), < 2.5 (53.3% vs. 28.6%, P = .030) or < 2.0 (57.8% vs. 21.7%, P = .005). Pregnancy rates were similar with the long and short protocols in patients with FSH/LH > or = 3.0 (57.1% vs. 70%, P = .521), FSH/LH > or = 2.5 (40% vs. 53.8%, P = .435) or FSH/LH > or = 2.0 (40% vs. 55.6%, P = .281). CONCLUSION: This study failed to demonstrate that FSH/LH was a useful parameter for predicting reproductive outcome in IVF programs and for patient selection for the long or short gonadotropin-releasing hormone agonist protocol.

Buserelin↗
PubMed2005

Clinician knowledge and beliefs after statewide program to promote appropriate antimicrobial drug use.

In 1999, Wisconsin initiated an educational campaign for primary care clinicians and the public to promote judicious antimicrobial drug use. We evaluated its impact on clinician knowledge and beliefs; Minnesota served as a control state. Results of pre- (1999) and post- (2002) campaign questionnaires indicated that Wisconsin clinicians perceived a significant decline in the proportion of patients requesting antimicrobial drugs (50% in 1999 to 30% in 2002; p<0.001) and in antimicrobial drug requests from parents for children (25% in 1999 to 20% in 2002; p = 0.004). Wisconsin clinicians were less influenced by nonpredictive clinical findings (purulent nasal discharge [p = 0.044], productive cough [p = 0.010]) in terms of antimicrobial drug prescribing. In 2002, clinicians from both states were less likely to recommend antimicrobial agent treatment for the adult case scenarios of viral respiratory illness. For the comparable pediatric case scenarios, only Wisconsin clinicians improved significantly from 1999 to 2002. Although clinicians in both states improved on several survey responses, greater overall improvement occurred in Wisconsin.

Adult↗
PubMed2004

Development of a culturally appropriate smoking cessation program for Chinese-American youth.

PURPOSE: To identify potential cultural factors to enhance the efficacy of smoking cessation curricula for Asian-American adolescents, Chinese-Americans, and to present the process and challenges of implementing a culturally specific curriculum. METHODS: Chinese-American male (n = 17) youth smokers, aged 14-19 years, were recruited from community-based Asian-American organizations in the Delaware Valley Region of Pennsylvania and New Jersey. A 36-item questionnaire was developed to measure smoking behavior, attitudes, and culturally related factors. Focus groups were conducted. Cultural themes were addressed, such as interdependency and collective orientation of the Asian culture, importance of harmony in Asian families, and culturally related factors for smoking initiation and maintenance. A pre-post quasi-experimental research design was used. Data were analyzed using the Mann-Whitney U test to determine differences in the intervention and control groups in smoking behavior and the Chi-square test for differences in program characteristics. RESULTS: Participants almost never read their native language, they disagreed that their friends would accept them more if they were nonsmokers, and they thought they smoked because of high parental expectations. Asian teens perceived that a high percentage of their Asian-American peers smoke. The most important facilitator characteristics, program processes, relevant cultural factors and topics were identified for the program. Two groups were compared, a standard smoking cessation curriculum (SC) and a culturally modified program (ACT) for Asian adolescents. A 23.1% quit rate for the SC program and an 18.2% quit rate for the ACT program at 3-month follow-up was achieved. Among participants who continued to smoke, there was a larger reduction in reported weekend and weekday cigarette use among ACT participants, than the Standard (SC) group. There was a reduction of 6.7 cigarettes on a typical weekday and 6 cigarettes on a typical weekend day for ongoing smokers of the ACT group. CONCLUSIONS: Given the positive results among a high-risk population, the ACT program needs to be tested among a larger population of Chinese-Americans.

Adolescent↗
PubMedDate not supplied

Participant satisfaction with a culturally appropriate diabetes education program: the Native American Diabetes Project.

PURPOSE: The purpose of this paper is to report on participant satisfaction with the Native American Diabetes Project diabetes education program. METHODS: A questionnaire was designed to measure satisfaction among participants in the diabetes education program, which consisted of five sessions designed according to the Transtheoretical Model of Change and Social Action Theory with input from community members. Eight pueblo communities participated in the program. Sessions were taught by community mentors in three sites in New Mexico. One site taught sessions in a one-on-one format, and two sites taught sessions in a group format. RESULTS: The results showed that participant satisfaction did not vary based on session delivery type or by session site. Overall, participants responded positively to sessions designed according to Social Action Theory and with cultural competency. Retention rates for the sessions were 81% for group sessions and 91% for one-one-one sessions. CONCLUSIONS: Using a strong theoretical framework and community input to design diabetes education sessions may be important factors in participant satisfaction and retention in diabetes lifestyle education sessions.

Diabetes Mellitus↗