Developing a disease management program to improve outcomes and efficiencies.
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Data Collection↗
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[Cancer screening in Hungary: World Bank supported model programs].
Since 1995, a model cancer screening program has been in operation in Hungary, the overall purpose of which is to promote the establishment of effective and efficient screening programs by means of adapting the internationally agreed principles of organized screening to the needs and opportunities in Hungary. The establishment and operation of a national population-based cancer registration system is an other aim of the Program. The model program--financed partly from a loan from the World Bank, partly from local funds provided by the Government of Hungary--is to develop standard procedure for cervical, breast and colorectal screening and to end up with tested recommendations for introduction of organized screening of proved effectiveness, integrated into the health care system, on country-wide service bases in Hungary.
Female↗
A computer program to estimate power and relative efficiency to assess multiplicative interactions in flexibly matched case-control studies.
Matching on one of two possibly interacting exposures can increase power and efficiency to estimate multiplicative interactions in case-control studies. We recently introduced the concept of flexible matching strategies with varying proportions of a dichotomous matching factor among controls to further increase power and efficiency. In order to facilitate the application of this concept, we developed a computer program which provides estimates of power and efficiency varying the proportion of the matching factor in controls over all possible values from 1 to 99%. The program allows one to estimate the effect of frequency matching on power and efficiency to study multiplicative interactions and to assess the optimal prevalence of the matching factor in selected controls for a given scenario which often differs from the prevalence in cases (aimed at in traditional 'fixed' frequency matching). Our program will strongly facilitate assessing the benefits of matching and flexible matching strategies in case-control studies addressing multiplicative interactions, including gene-environment interactions.
Case-Control Studies↗
Program outcome and QA: a new approach to evaluation.
Health care providers and managers are familiar with the limitations of current quality assurance (QA) practices, which do little to indicate the overall effectiveness of health care programs. This article discusses a comprehensive method of evaluating program effectiveness, efficiency, cost, client satisfaction, and adherence to standards. The authors present the Brockville Psychiatric Hospital's experience in evaluating a new program with data collected from a multi-faceted QA perspective, and suggest that combining program evaluation with QA could become the standard for future program assessments.
Community Mental Health Services↗
A computer program to estimate power and relative efficiency of flexibly matched case-control studies.
OBJECTIVES: We recently introduced the concept of flexible matching strategies with varying proportions of a dichotomous matching factor among controls to increase power and efficiency of case-control studies. We now present a method and a computer program to calculate power and relative efficiency compared to an unmatched design varying the proportion of the matching factor in controls over all possible values from 0 to 100 percent. METHODS: For all these values, the program calculates the expected variance of the combined Mantel-Haenszel odds ratio and determines the power using the standard error of the expected combined Mantel-Haenszel odds ratio under the null hypothesis as derived from the Mantel-Haenszel test statistic without continuity correction. RESULTS: Thereby, the program allows estimating the optimal prevalence of the matching factor in selected controls for a given scenario which often differs from the prevalence in cases. It furthermore allows to estimate loss in power and efficiency compared to optimal matching by suboptimal matching. CONCLUSIONS: Estimations like these are helpful with respect to the decision when to stop efforts to optimize the degree of matching during the recruitment of controls. Our program will strongly facilitate assessing the benefits of flexible matching strategies.
Case-Control Studies↗
Value adding through regional coordination of rural placements for all health disciplines: The Broken Hill experience.
OBJECTIVE: To describe the experience of the University of Sydney's Broken Hill Department of Rural Health (BHUDRH) delivering a regional program in far western NSW. DESIGN: Case Study Setting: The Australian Government's University Departments of Rural Health Program, established in 1997, has been responsible for setting up regionally coordinated rural placement programs for students from all health disciplines in each state and territory. RESULTS: Over nine years the BHUDRH has harnessed both academic and administrative resources to achieve greater efficiency in program delivery, increased support for students during their placement, and enhanced educational opportunities that draw on regional issues. The Broken Hill program accepts students from 22 Australian universities and places more students in the region, for longer periods than previously (271 students in 2005 compared with 140 students in 1998). CONCLUSION: Regional coordination, linked to investments in rural-based infrastructure and support systems can provide a sustainable platform from which to provide quality rural placements for students from all health disciplines, while at the same time increasing regional capacity to take students.
Allied Health Occupations↗
Prosthetic relining and dietary counselling in elderly women.
A reduced consumption of hard-textured fibrous foods may promote the development of digestive disturbances in more susceptible elderly people who wear prostheses having deficient masticatory function. The purpose of this study was to evaluate the effects of a program combining denture relining and dietary counselling on the masticatory performance, fibre intake, and prevalence of digestive symptoms in elderly women with low chewing efficiency. This program was provided to 55 women between 55 and 74 years of age. Chewing ability was assessed quantitatively with the Swallowing Threshold Test Index (STTI), and qualitatively according to the participants' experience in chewing five specific foods. Nutritional data were collected using a food frequency questionnaire. The mean value of the STTI was significantly increased at three weeks and at six to nine months after completion of relining by 37 and 31 per cent, respectively. Subjects included one more food in their diet at the end of the six- to nine-month period only. Fibre intake from vegetables was significantly increased by 18 per cent, while colonic and gastrointestinal symptoms were both reduced. Prosthetic relining increased the masticatory performance of elderly women, but not to a functional level. In addition, dietary counselling stimulated subjects to eat foods that had previously been avoided. These observations suggest that the improvement of chewing efficiency, combined with dietary counselling, could reduce the presence of digestive symptoms.
Aged↗
Compliance in dietary management of hypertension.
Relapse is a problem common to all behavior-change programs, including weight-reduction and salt-restriction programs. The process of relapse can be understood in the context of the way that emotional, social, and environmental forces impinge upon the individual's behavior. The data on compliance suggest that behavior modification programs are moderately efficient in producing changes in eating behavior. Relapse prevention programs are recommended as part of a dietary approach to the treatment of hypertension to increase treatment efficiency. If these programs are implemented using a group format, then these services can be delivered to patients at a reasonable cost.
Behavior Therapy↗
Evolution of dental school clinics as patient care delivery centers.
Dental school clinics, originally envisioned as closely similar to private practice, evolved instead as teaching clinics. In the former, graduate and licensed dentists perform the treatment while undergraduate dental students are assigned treatment within their capabilities. In the latter, dental students provide the treatment under faculty supervision. It is generally recognized that the care provided by the teaching clinics is inefficient. However, in the last quarter of the twentieth century, dental school clinics began to pay much more attention to how treatment is rendered. The comprehensive care movement and quality assurance systems are leading towards more efficient patient-centered care. Case studies at the University of Maryland, Columbia University, and University of Louisville describe activities to make their clinic programs more efficient and patient-friendly. This article explores whether the potential exists for faculty to take a direct patient care delivery role in dental clinics in order for those clinics to become efficient patient care delivery systems as originally envisioned in the early part of the twentieth century.
Comprehensive Dental Care↗
Neural network programming in bioprocess variable estimation and state prediction.
A neural network program with efficient learning ability for bioprocess variable estimation and state prediction was developed. A 3 layer, feed-forward neural network architecture was used, and the program was written in Quick C ver 2.5 for an IBM compatible computer with a 80486/33 MHz processor. A back propagation training algorithm was used based on learning by pattern and momentum in a combination as used to adjust the connection of weights of the neurons in adjacent layers. The delta rule was applied in a gradient descent search technique to minimize a cost function equal to the mean square difference between the target and the network output. A non-linear, sigmoidal logistic transfer function was used in squashing the weighted sum of the inputs of each neuron to a limited range output. A good neural network prediction model was obtained by training with a sequence of past time course data of a typical bioprocess. The well trained neural network estimated accurately and rapidly the state variables with or without noise even under varying process dynamics.
Algorithms↗
PANSYM: a symbolic equation generator for mathematical modelling, analysis and control of metabolic and pharmacokinetic systems.
Software is presented for automatic generation of first-order ordinary differential equations (ODE) that arise from lumped parameter representations of metabolic and pharmacokinetic systems. The definition of system structures is accomplished by fractional transfer rates between state variables, together with input/output equations and initial conditions of state variables. General non-linear mathematical expressions can be assigned to all structure definition items. The software parses and interprets the system definitions and generates symbolically the mathematical expression of the model's set of ODE. In addition, symbolic derivatives of state equations are determined with respect to model parameters, state variables and external inputs. These derivatives represent the constituents of systems of sensitivity-differential and adjoint-differential equations that arise in identification and optimal control problems. Finally, output routines generate source code that, once compiled and linked to simulation programs, allows efficient numerical integration of the system of ODE. This software has been developed in PROLOG on Macintosh computers and has been extensively used with the programming environment MATLAB. Possible applications of this software include model building, sensitivity analysis, identification, optimal experiment design and numerical solution of optimal control problems.
Computer Simulation↗
[Evaluation of the reduction of the visible plaque index and of the gum bleeding index in a program of oral health promotion for children].
The purpose of this research was to evaluate the reduction of the VPI (visible plaque index) and of the GBI (gum bleeding index) in children seen at a unit of SUS, in the state of Rio de Janeiro. A comparative and statistical procedure (t-test, by means of the GMC program) was employed in order to assess the variation between initial and final mean VPI and GBI values. Initial values were registered in the beginning of the assistance program, and final values were registered after the children had participated in health promotion activities, which included weekly supervised brushing sessions, individual dietary guidance, collective instructive activities in which parents were present, adjusting of the oral environment, as well as restorative and surgical dental care, during an average period of six months. The studied sample comprised fourty-two children, with an average age of nine years, who presented an average of four teeth affected by caries. The technique of indirect documentation, by means of documental research, was employed. The following results were obtained: initial VPI = 29%; final VPI = 11%; initial GBI = 13% and final GBI = 5%. The observed variations were statistically significant at the level of 1%, which was revealed by the applied statistical test. The program proved efficient as to plaque control, reducing VPI to a more acceptable level. Although GBI presented considerable reduction, the presence of bleeding at the end of the program calls for a better approach in motivating patients as to regular oral hygiene.
Adolescent↗
Screening for diabetic retinopathy. Initiation and frequency.
A screening program for diabetic eye disease was established in Iceland in 1980. Diabetics involved in the screening program have a low prevalence of blindness, 1% in type 1 and 1.6% in type 2. We examined ways to make the screening program more efficient by identifying subgroups at low risk of developing eye disease that require treatment and therefore need less frequent screening. We studied whether diabetic eye disease screening programs may be trimmed by excluding children and examining diabetics without retinopathy biannually. Our results indicate that diabetic children under the age of 12 years do not need regular screening for eye disease. Biannual examinations seem to suffice in type 1 and 2 diabetic patients without retinopathy. However, in a setting where the eye clinic is located apart from the diabetes clinics, biannual examinations present practical problems which could result in a less effective screening for diabetic eye disease.
Adolescent↗
Diabetic retinopathy. Screening and prevention of blindness. A doctoral thesis.
Diabetic eye disease is a major cause of blindness in the Western World and remains one of the most serious complications of diabetes mellitus. Retinopathy is the ocular complication of diabetes that most often leads to impaired vision. In recent years laser treatment has been introduced that can significantly decrease the likelihood of blindness in diabetic patients, if the eyes are treated at the appropriate stage of the disease. It remains a public health problem to make sure that each patient is treated at the optimal time in the development of the eye disease. Several types of screening programs have been designed throughout the world to meet this problem. We now report on our active screening program for diabetic eye disease and describe the sight and eye condition of the diabetic patients who have been involved in this program. In 1980, regular eye screening for diabetic retinopathy was initiated at Department of Ophthalmology, Landakot Hospital. The number of diabetic patients seen regularly has increased considerably since then, with 70-80% of type 1 diabetic patients in the country participating in the program in 1990, increasing to over 90% in 1994. About a fifth of type 2 diabetics in the country participated in the program in 1990. The patients have undergone annual eye examinations and fundus photography. Laser treatment is administered for proliferative retinopathy and diabetic macular edema according to the Diabetic Retinopathy Study and Early Treatment Diabetic Retinopathy Study criteria. In 1990, we embarked on a cross-sectional study to evaluate the prevalence of retinopathy and visual impairment of the type 1 and type 2 patients participating in our program. At the time of study, 205 insulin-taking patients, with age at diagnosis of less than 30 years, participated in our screening program. Out of those, retinopathy was present in 106 (52%), patients proliferative retinopathy in 26 (13%) and macular edema in 19 (9%). Visual acuity of 196 patients (96%) was equal or better than 6/12 in their better eye, 6 patients (3%) had 6/18-6/36 in their better eye, and 2 patients (1%) had equal or worse than 6/60 in their better eye, or legally blind. We concluded that the prevalence of retinopathy and visual impairment in type 1 diabetic patients in the country was low compared with other countries. In 1990, out of 245 diabetic patients with Type 2 diabetes, retinopathy was present in 100 patients (41%), proliferative retinopathy had been present in 17 (7%) and 24 (10%) had diabetic macular edema. A total of 224 patients (91%) had visual acuity equal or better than 6/12 in their better eye, 17 patients (7%) with 6/18-6/36 in their better eye, and 4 patients (1.6%) equal or worse than 6/60 in their better eye, or legally blind. We concluded that the prevalence of visual impairment of those type 2 diabetic patients participating in our screening program at the time of study was low compared with population-based studies from other countries. In 1992 we examined ways to make the screening program more efficient by identifying subgroups at low risk for developing eye disease that required treatment and therefore needed less frequent screening. We studied whether diabetic eye disease screening programs could be trimmed by excluding children and examining diabetic patients without retinopathy every other year. We examined all children under the age of 15 at the time of study and went through the files of all patients under age 15 examined from 1980 to 1992 at our diabetic eye screening program. We also followed for two years the type 1 and type 2 diabetic patients found to have no retinopathy in 1990, establishing their retinopathy stage two years later. Our results indicated that diabetic children under the age of 12 do not need regular screening for eye disease. Biannual examinations seemed to suffice in type 1 and 2 diabetic patients without retinopathy. (ABSTRACT TRUNCATED)
Adolescent↗
How to select a satisfying typing program for paternity testing.
The efficiency of a typing program for paternity testing concerns three specific aspects: first, what is the percentage of non-fathers that cannot be excluded from paternity; second, what is the percentage of true fathers that cannot be recognized as probable fathers, and third, what is the percentage of non-fathers that will be assigned as probable fathers. When extensive materials for observation with any specific typing program are not directly available, only the chance of non-exclusion of non-fathers can be calculated in a relatively simple way. The aim of the present study was to find a relationship between this and the other two criteria. It was found that the variance of the distribution of natural logarithms of paternity index values is approximated rather well by the formula var. ln I = 0.65 X (n(ln 1/ne)2) (n = the number of genetic systems of the typing program and ne = the chance of non-exclusion of non-fathers). This allows the estimation of the two other critical percentages: the percentage of true fathers that cannot be assigned, and the percentage of non-fathers that will be assigned as probably true fathers.
Genetic Techniques↗
A new approach for assessment of IT programs in health care.
The efficiency of health care programs, on the level of a community, results not only from reducing hospitalization or drugs costs but also from the number of days of health and life gained. This gain can be estimated in monetary terms if we accept that, at least partially, the Gross Domestic Product results from the human activity. In the Center for Health Information and Statistics, Ministry of Health Bucharest. Romania, a methodology based on these premises was developed and non-officially used in assessment of several health programs. In this paper, the core of this methodology, as well as some applications are shown.
Ambulances↗
Cost effectiveness of three arbovirus surveillance methods in northern California.
We compared the cost effectiveness of enzootic arbovirus surveillance in northern California by antibody detection in sentinel chickens, virus isolation from mosquitoes, and antibody detection in wild avian hosts. Total and annual recurring costs were determined for each method based on estimated personnel and actual material and travel costs for biweekly surveillance at 3 sites in the Sacramento Valley from May 1 through mid-October 1997 and 1998. Serologic detection of antibodies in wild birds was the most expensive method. Total costs associated with sentinel chickens and mosquitoes combined were less than half of those for the wild bird program. Recurring annual costs for the wild bird and mosquito methods were only slightly less than expenses for those methods during the 1st year of operation, which included nonrecurring setup costs. Recurring costs for sentinel chickens were reduced approximately 40% from total costs during the 1st year of the program and were <14% of recurring costs for wild bird serology. Exceptions and caveats of our analysis are discussed. When considering data from a companion paper on detection of enzootic virus transmission using the 3 methods, we concluded that the current system that combines sentinel chickens and virus isolation from mosquitoes is the most cost-effective and efficient surveillance program and should be retained. Future research efforts should investigate the costs and surveillance efficiency of modifications in the frequency of specimen collection and the placement of chicken flocks and mosquito traps.
Animals↗
Fitting methods for constructing energy-dependent efficiency curves and their application to ionization chamber measurements.
An ionization chamber without and with an iron liner (absorber) was calibrated by a set of radionuclide activity standards of the Physikalisch-Technische Bundesanstalt (PTB). The ionization chamber is used as a secondary standard measuring system for activity at the Slovak Institute of Metrology (SMU). Energy-dependent photon-efficiency curves were established for the ionization chamber in defined measurement geometry without and with the liner, and radionuclide efficiencies were calculated. Programmed calculation with an analytical efficiency function and a nonlinear regression algorithm of Microsoft (MS) Excel for fitting was used. Efficiencies from bremsstrahlung of pure beta-particle emitters were calibrated achieving a 10% accuracy level. Such efficiency components are added to obtain the total radionuclide efficiency of photon emitters after beta decay. The method yields differences of experimental and calculated radionuclide efficiencies for most of the photon-emitting radionuclides in the order of a few percent.
Journal Article↗