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PubMed1983

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↗
PubMed1991

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↗
PubMed1990

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↗
PubMed1980

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↗
PubMed1990

The procurement of kidneys for transplantation in Scandinavia.

In countries with active renal transplant programs and wide acceptance criteria for transplant patients, the number of cadaveric donors is not, and probably never will be, sufficient to meet the demand for renal allografts. In general between 15 and 20 cadaveric donors PMP per year (maximum 23.7 in Denmark in 1986) have been available in the Scandinavian countries in the 1980s. In most other countries fewer donors are available, but there are regions where higher figures have been reached. Continuous registrations of potential cadaveric donors in Sweden have shown that the number of donors could increase by 40% to 60% if relatives of all medically suitable patients had given consent to organ donation. Since a public survey has shown that factual information on cadaveric organ donation and transplantation had a positive effect on the public's attitude, more public awareness programs are needed. Donor acceptance criteria are already broadly based, particularly with respect to age, and could probably not be further broadened without risking results after transplantation. A varying proportion of renal allografts from living donors are used in the Scandinavian countries. An increased use of living donors, related and unrelated, in the countries where few currently are used might help meet demand in the future. At present the need for nonrenal organs can be met, but as the programs for liver and heart transplantations are developed to reach their predicted levels, the current number of donors will most likely prove insufficient.

Cadaver↗
PubMedDate not supplied

DIABLOG: a simulation program of insulin-glucose dynamics for education of diabetics.

This paper presents a dialogue computer program, DIABLOG, for the education of diabetic patients with insulin therapy. Through mathematical modelling of glucose-insulin dynamics this program is able to simulate glucose and insulin profiles of a 24 h period and display them graphically as curves. The subjects could vary the carbohydrate content of meals, the injection time and dose of short-acting and intermediate-acting insulin and could switch to insulin pump therapy. For a first evaluation 22 patients with insulin-dependent diabetes mellitus tested the program and their comments were recorded by a questionnaire. The results indicate a good acceptance of the program even by patients with no previous computer experience. Further suggestions by the patients will be discussed as well.

Blood Glucose↗
PubMed1990

Assistant programming software: a new tool for an improved programming of pacemakers.

Programming the new DDD pacemakers is becoming increasingly difficult. One must take into account the pacemaker's complexity, the fact that some parameters are linked to others, and the clinical profile of the patient. This difficult problem will lead to the design of software to assist programming, which will help the implanting physicians in choosing adequate programmed settings adapted to the functioning of the device and to the physiology and pathology of the patient. These programming aides should meet certain basic requirements to make them safe, efficient, and easy to use. One such system designed by ELA Médical, "Programming Assistant" is herein described. The preliminary results of an initial study on the acceptance of this programming aide among physicians involved in cardiac pacing are given and discussed.

Adult↗
PubMed1980

Automobile inspection and maintenance programs: their role in reducing air pollution.

The development of Inspection and Maintenance Programs to control automobile emissions are one component of a comprehensive strategy to reduce automobile related air pollutants such as CO, NOX, and HC. Since the efficiency at which most motored vehicles are designed to limit pollutant emissions deteriorate with prolonged driving, an Inspection and Maintenance system is needed to restore the ability of the automobile to achieve its designed emission standards. Several types of approaches toward developing Inspection and Maintenance Programs in the U.S. including city, county, and state levels of organization and their effectiveness have been described. However, information on the efficiency of these approaches in achieving reductions in pollutant levels remain to be documented, as well as the cost effectiveness of such programs, and their acceptance by the public. In light of the important role that Inspection and Maintenance Programs have been projected to have in the U.S. in reducing automobile related air pollution, it is recommended that interdisciplinary research projects evaluating the multiple dimensions of Inspection and Maintenance Programs be initiated.

Air Pollution↗
PubMed1976

Planning for meaningful change in libraries and library networks: a first step.

The Program Planning Model (PPM) is a planning and management tool that facilitates development and acceptance of significant programs. PPM assists program planning by systematically involving consumer or user groups in the development and review of new programs. While user participitation is important throughout PPM, this involvement is especially important during the problem exploration phase, when the problems or needs of these users are surveyed. The Nominal Group Technique (NGT), a variation of the "brainstorming" process, is a structured but flexible group process used in the problem exploration phase to generate a high number of useful responses concerning problem areas. NGT ensures maximum contribution of ideas by all participtants. NGT and its application in the planning and management efforts of several libraries and library networks are described in detail.

Group Processes↗
PubMed1990

Arm exercise training in the rehabilitation of patients with impaired ventricular function and heart failure.

Although exercise training is an accepted part of comprehensive coronary care programs in patients with coronary artery disease, it still remains to be demonstrated whether or not exercise training should also be applied to patients with impaired ventricular function. Circumstantial evidence exists that patients with impaired ventricular function may eventually benefit from an individually adapted exercise training program provided that contraindications for acceptance of cardiac patients to such a program are well observed. Our study is based on 22 patients with impaired ventricular function, of which 18 were at least 6 months after a Q-wave myocardial infarction and the remaining 4 after coronary artery bypass grafting. Eleven patients with impaired left ventricular function performing upper extremity (arm) ergometry were followed up for 36 months. These patients were trained twice weekly with exercise periods of 30 min duration. The reason for choosing arm ergometry training was that the peak heart rate obtained in arm ergometry is higher when compared to leg ergometry. Rate-pressure product and heart rate were higher for given submaximal work tasks in arm ergometry, while maximal work aerobic capacity was found to be lower in comparison to leg work. The assessment of our patients was based on cardiopulmonary testing, continuous electrocardiographic monitoring (48 h), two-dimensional echocardiography and equilibrium multigated radionuclide ventriculography (99mTc). Group 1, consisting of 11 patients with left ventricular ejection fraction (LVEF) 30.1 +/- 9.5%, were trained by arm exercise for 3 years with a significant increase in work capacity and LVEF. Group 2 consisted of 11 patients with LVEF 25.5 +/- 6.8% who underwent a 12 months' calisthenic program. Peak work capacity and LVEF remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1990

Diethylcarbamazine in the control of bancroftian filariasis in the highly endemic Ok Tedi area of Papua New Guinea: phase 1.

The effects of a well-spaced diethylcarbamazine (DEC) mass drug application in areas highly endemic for Wuchereria bancrofti in Papua New Guinea are not known. In 1986 a semi-annual single-dose 6 mg/kg body weight administration of DEC was initiated in the Ok Tedi area of Western Province, Papua New Guinea. The rate of bancroftian filariasis in the area was 39%. Within two years the rate of detectable microfilaraemia was reduced from 31% to 11% in the treated group. The mean blood density of the parasite was reduced from 79 to 19 microfilariae per 20 microliters. A survey of untreated villages in the immediate area (not surveyed before 1988) showed a filariasis rate of 39%. A 14-fold difference in the total microfilaraemia count was noted between the two groups when 1988 data were compared. A reduction in the annual rate of filariasis may be monitored through a well-established passive case detection program for malaria. The DEC treatment program was well accepted despite side-effects encountered in 20% of the treated population early on in the program. The success of the 2-year Phase 1 program has expanded into an annual single-dose administration of DEC over a larger area.

Adult↗
PubMed1994

Content of continuing education courses in obstetrics and gynecology.

The objective of this study was to determine the emphases of continuing medical education courses in obstetrics and gynecology. Eighty programs for obstetricians and gynecologists were evaluated for location, accreditation, sponsorship, cost, faculty composition, teaching methods, and curriculum content. The programs' curricula were compared through classification of courses and individual topic presentations as emphasizing primary care, maternal-fetal medicine, gynecologic oncology, reproductive endocrinology and infertility, introduction of new technology, or general review. All 80 programs were in acceptable locations and had valid accreditation. Universities, hospitals, industrial corporations, and professional organizations were among the programs' sponsors. Tuition costs per credit hour averaged $46.48 and ranged from $4.64-238.09; programs emphasizing new technology cost the most. Ninety percent of the programs' 880 faculty had medical school affiliations. Of the teaching methods, lectures accounted for 77.9%, laboratory instruction 9.1%, panel discussions 7.0%, workshops 4.9%, and other methods 1.0%. The total 1592 credit hours consisted of 563 in primary care, 181 in maternal-fetal medicine, 99.5 in gynecologic oncology, 122.5 in reproductive endocrinology and infertility, and 626 in introduction of new technology. Although these programs were diversified, many emphasized the introduction of new technology, which does not enhance the designation of the specialty as "primary care."

Curriculum↗
PubMed1996

American Indian women's talking circle. A cervical cancer screening and prevention project.

BACKGROUND: Cervical cancer is important to American Indian women due to high mortality and low survival rates compared with other ethnic groups. This article describes the development and implementation of a culturally acceptable cervical cancer screening program in urban and rural American Indian health clinics in California. METHODS: A team of researchers used social learning theory, research data, and focus groups to design a cervical cancer screening program. The major component of the program was the adaptation of a culturally acceptable mode of communication called Talking Circles. The American Indian Talking Circle project used the Talking Circle format, coupled with traditional Indian stories, as a vehicle to provide cancer education and to improve adherence to cancer screening. Eight American Indian clinics were randomly assigned into intervention and control sites (n = 400 women). The intervention was administered to 200 Indian women 18 years and older in four American Indian clinics; four additional American Indian clinics (n = 200 women) served as control sites. RESULTS: Preliminary results from the research show that American Indian women responded favorably to a culturally framed education project. Initial reports indicate that health-related information is accepted and acted on when it is coupled with cultural information that is presented in a sensitive manner. Final evaluation of the project is forthcoming. CONCLUSIONS: Utilizing a culturally acceptable intervention has the potential to improve the health status of American Indian Women.

Attitude to Health↗
PubMedDate not supplied

A randomized trial of medical quality assurance. Improving physicians' use of pelvimetry.

The capacity of educational programs to improve physician performance remains doubtful despite many evaluative efforts. This is especially true for programs sponsored by the federal government. We tested the efficacy of an educational program conducted by Professional Standards Review Organizations in reducing the inappropriate use of x-ray pelvimetry. This procedure may cause harm to the fetus, and there is little evidence that it is efficacious. We randomly assigned 120 hospitals in six Professional Standards Review Organizations to study and control groups. Physicians with delivery privileges at each study hospital participated in an educational program that discussed acceptable indications for x-ray pelvimetry. Pelvimetry use was similar in study and control hospitals before the program. However, after the program, pelvimetry was performed by physicians at study hospitals less than one third as often as by physicians at control hospitals. We conclude that educational programs can improve physician performance substantially and that such programs can be effectively conducted by federally sponsored physician organizations.

Education, Medical, Continuing↗
PubMed1995

Dosing adjustment of 10 antimicrobials for patients with renal impairment.

OBJECTIVE: To describe a program of creatinine clearance-based dosage adjustment of 10 renally eliminated antimicrobial agents and to discuss the utility of such a program in a hospital as a method of quality assurance (by ensuring that patients with renal impairment receive generally accepted dosage adjustments), based on pharmacodynamic principles. METHODS: Consecutive patients prescribed any of 10 targeted renally eliminated antibiotics were included. Recommendations for dosage adjustment were made to the prescriber based on a calculated creatinine clearance. Additional adjustments in drug therapy were performed, including dosage recommendations of nontargeted drugs, simplification of antibiotic regimens, and conversion of intravenous to oral therapy. A cost analysis was performed. RESULTS: During a 6-month study period, 160 dosage changes (7.6% of total number screened) were recommended in 137 patients receiving the targeted antimicrobial agents. Prescribers accepted 147 recommendations (91.9%). A dosage change recommendation was necessary more than 12% of the time for acyclovir, ceftazidime, and imipenem/cilastatin. A cost avoidance of $11,702.08 was realized. Ancillary drug recommendations that were offered and accepted during the program realized a cost avoidance of $6613.75. CONCLUSIONS: This dosage adjustment program using pharmacodynamic principles was successful in optimization of dosing, potential minimization of morbidity caused by excessive dosing, and demonstration of direct and potentially indirect cost avoidance. A dosing program for patients with renal impairment would be of benefit to other clinicians and institutions seeking to optimize patient care.

Adult↗
PubMed1992

A researcher's view.

The Food and Drug Administration (FDA), by ensuring that the health care products used by Americans are both safe and effective, provides an essential regulatory function. With respect to the regulation of dental drug products, this researcher perceives that the FDA has not changed or modified its position on a number of issues to reflect new scientific information. Reasons for this inflexibility include the size and ponderousness of the agency, inadequate staff with dental expertise, and a failure to keep current with new dental research findings. The FDA must solve these problems if it wishes to regulate intelligently. The acceptance and certification programs of the American Dental Association ensure that products offered to the profession and the public that bear its seal of acceptance are safe and effective. The ADA's Council on Dental Therapeutics has a long history of staying current on issues in dental research and public health and regularly seeks consultation from eminently qualified experts. Overall, it has done an excellent job over the years in conducting an important voluntary regulatory program. Both the FDA and the ADA benefit and help protect the oral health of the public.

American Dental Association↗
PubMed1979

Structured educational program for staff development.

The development of a mandatory continuing education program for the pharmacy staff of a 675-bed hospital with 10 decentralized pharmacy satellites is described. The therapeutic topics selected for presentation were antibiotics, immunology and adverse drug reactions, diabetes mellitus and acid-base disorders. The format for each subject included a pretest of basic knowledge, a comprehensive lecture, a tape recording, supplemental handout material and readings, and a posttest. Posttests were scheduled three to four weeks following lectures to allow preparation time. Questionnaires were used to evaluate acceptance of the program. Posttest scores for each of the four topics were significantly better than pretest scores (p less than or equal to 0.0001). Questionnaire responses indicated that 97% of the participants believed the program to be worthwhile, and 94% voted to continue the series. The success and acceptance of this approach to continuing education support its application to a comprehensive program of staff development.

Chicago↗