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PubMed1992

Battling AIDS through home care in Uganda and Zambia.

Innovative home care programs, providing a variety of services to persons with HIV infection and their families and reflecting different health, political, cultural, social, and philosophical concepts, have been developed in Africa, starting in 1987. In 1989 the World Health Organization (WHO) Global Programme on AIDS conducted a descriptive study of some of these programs. It is hoped that these experiences will assist planners and health care providers in their decision making and thereby benefit persons with HIV infection and their families. The lessons learned about the context, backgrounds, structure, process, and outcome of the six selected home care programs can be used and adapted by policymakers and program planners in their own settings when deciding on "their" model of home care.

Acquired Immunodeficiency Syndrome↗

PubMed1994

Experience with not offering dialysis to patients with a poor prognosis.

Despite ongoing discussion of dialysis rationing in the nephrology community, there are little available data describing current practice in treatment selection for very ill renal patients with a poor prognosis. We report a prospective survey of end-stage renal patients referred to our Canadian regional dialysis center who were not accepted to the dialysis program on the grounds of poor prognosis and low quality of life. One quarter of patients referred during 1992 were not accepted to the program, with a mean age of 74 +/- 11 years. Patients were predominantly female and most suffered from a combination of renovascular and cardiovascular disease, with very poor functional capacity as determined by the Karnofsky scale. Nonacceptance to the dialysis program did not create legal difficulties or requests for second opinions. Based on our experience, we propose guidelines for nonacceptance of patients to dialysis programs.

Adult↗

PubMedDate not supplied

Innovative technology for secondary students with learning disabilities.

During the 1980s, innovative use of technology was equated with microcomputer instruction. In the 1990s, a different kind of technology--videodisc instruction--has great potential for application in secondary special education. By examining its day-to-day use in naturalistic settings, this study builds on previous research with a specific videodisc program in fractions. Participants were seven secondary teachers of students with learning disabilities. Researchers measured the program's level of implementation, teacher reactions, and student achievement. Results were generally positive in all areas, with a surprisingly high acceptance of the program by the seven teachers.

Adolescent↗

PubMed1996

Establishing a community network for recruitment of African Americans into a clinical trial. The African-American antiplatelet stroke Prevention Study (AAASPS) experience.

A major aspect of a clinical trial is the ability to successfully recruit patients. There is a paucity of information concerning the nuances of recruiting study patients, especially those from minority communities. As minorities generally have been underrepresented in the health-care system, they may be less likely to participate in clinical trials or other studies. Thus, a strategy is needed to overcome this potential shortfall. One of our solutions has been the development of a community network to help disseminate information about our program. We believe that a key aspect has been the involvement of community members during pre-trial planning, community awareness programs, and our Community Advisory Panel. We also believe that it may be a major error to bring a health-care initiative unannounced into a targeted community without extensive pre-program planning in cooperation with that community. As our community awareness scheme suggests (Figure), there are many possible avenues to heighten awareness about a health-care program. While the church remains an important institution for religious and cultural activities in the African-American community, we have found that the news, television, and radio media also can be a powerful source for spreading awareness. Thus, we recommend creating awareness about an initiative through a "grassroots" approach of church and community organizations, along with a global approach through news, television, and radio media. As part of the awareness promotion campaign, it must be emphasized that the study is safe and provides benefits to enrollees. The success of health programs is largely dependent on community acceptance, which must be established in the pre-program planning stages of the initiative. This concept of obtaining community approval and acceptance prior to program initiation is not a new one, nor does it exclusively apply to the African-American community. Community leaders and members need to have a vested interest in such a program and a sense of empowerment. Through this type of communication, patient enrollment and community satisfaction can be substantial. Such success can serve as a springboard for other targeted health-care studies or programs in high-risk communities.

Black or African American↗

PubMed1996

An adolescent hepatitis B immunisation program. The Preston experience.

An adolescent hepatitis B immunisation program was conducted in all post primary schools in the City of Preston, Melbourne, Victoria, in 1993. The program was funded entirely by the City of Preston using SmithKline Beecham, Engerix B Adult Vaccine. A total of 857 Year 9 students in 8 schools were offered a three-dose course of Hepatitis B vaccine; 85% of all students elected to enter the program; 78% of all students completed the program; 95% of students who started the program completed the three-dose schedule. No side effects from the 2041 doses were reported. The program was well accepted and tolerated by the students with minimum side effects at a total cost of $34 per completed course.

Adolescent↗

PubMed1990

Attitudes of staff members toward a sex education program for hospitalized adolescents.

Problems encountered when introducing sex education programs into institutions are frequently attributed to adult resistance related to the anxiety of staff members about their sexuality and that of their charges. The author examines the process by which a sex education program was introduced into a psychiatric hospital for adolescents and the attitudes of staff members toward the course. He suggests that the acceptance of such programs is determined as much by the social dynamics of initiating change in institutions as by the particular content or form of the new program.

Adolescent↗

PubMed1985

Description of a faculty-student group practice.

Dental schools are facing budgetary constraints, decreasing clinic patient populations, and increasing competition. At the same time, there is a need to provide students a realistic educational environment. The Dental Practice Systems (DPS) Program is a partially self-supported student-faculty group practice designed to address these issues. All individuals appearing for care are accepted into the program. Services are delivered by vertical teams of faculty preceptors, in-house specialty consultants, dental and dental hygiene students, and appropriate auxiliaries. All third- and fourth-year students rotate through the program providing clinical services. In addition, fourth-year students are assigned specific managerial responsibilities. The DPS Program maximizes the use of auxiliaries and students, allowing each to function as autonomously as is consistent with good patient care.

Behavioral Sciences↗

PubMed1983

Evaluating aseptic technique of pharmacy personnel.

A procedure for validating the effectiveness of a training program in aseptic technique for admixture personnel and for monitoring the aseptic technique of those trained is described. Double-strength soybean casein digest broth was prepared as the culture media. Technicians were instructed to prepare 50 sample i.v. admixtures after the structured one-week orientation and training period. The sample admixtures were cultured for sterility by a total-culturing method. An ongoing random-sampling plan was implemented to monitor the technique of the trained technicians. Six technicians completed the orientation program, and five compounded the validation admixtures aseptically. The ongoing monitoring revealed that the technicians who were validated have continued to perform at acceptable levels. This program validated that the personnel had adequate training in aseptic technique and the necessary skills for performing the aseptic manipulations required in i.v. admixture compounding.

Antisepsis↗

PubMed1976

Role vs. entry-level competencies in competency-based education.

The real strength of the competency-based education effort lies in its emphasis on the total program. No longer can we, as educators, ask ourselves merely: "What do I want students to learn in my course?" The studies and learning opportunities of students must meet specific objectives developed on assessed needs in the profession. The resulting output can then be evaluated against standards or a set of criteria. Since implementation of a competency-based education program requires "adaptation rather than adoption," both the role-competency and entry-level approaches are valuable. Few professionals are willing to accept totally a program or syllabus developed by someone else. However, effective adaptation requires understanding of the total concept of competency-based education. In fact, the search for totality is the heart of the competency-based movement. By viewing the framework of competency-based education and thoroughly understanding all of the components of the program, professionals should be able to utilize the ideas of others, even though they are presented in varying formats with constantly changing semantics.

Behavior↗

PubMed1998

Acceptance by Swedish users of a multimedia program for primary and secondary prevention of malignant melanoma.

BACKGROUND: In Sweden, the incidence of malignant melanoma of the skin is rapidly increasing, and the disease is now one of the ten most common tumor types. The objectives were to apply multimedia techniques to increase public knowledge about malignant melanoma and its risk factors, to increase awareness of preventive measures, and to make people more disposed to change their sunbathing habits. METHODS: A trilingual (Swedish, English, and German) multimedia program was developed for two target groups, health care personnel and the general public, with a total of >500 "pages" in each language. User reactions were studied on-site at a municipal pharmacy and library, where the program was available in a kiosk with touch-screen. RESULTS: Practically all 274 users interviewed found the program easy to use and understand. 92% identified one or more of the recommendations given. 66% found the program information "worrying," and 29%--mainly young women-instantly declared that they were going to change their sun-exposure behaviors. No correlation to skin type was found. CONCLUSIONS: A multimedia program of the present design seems to be a useful tool for health promotion.

Adult↗

PubMed1986

Programming for the DNA analysis of FCM data on an IBM microcomputer.

The analysis of data generated on a flow cytometer (FCM) is often performed on a computer obtained especially for dedicated use with the flow cytometer. This computer component can be expensive and also presents the FCM user with the added burden of mastering specialized programming language or of accepting the secret analytical processes of protected proprietary program routines. We believe that the evolution of more accurate and efficient FCM analyses that have the power to consider complex signal distributions can be assisted by the availability of analysis programs written in languages common to many users. DNA analysis routines written for a relatively inexpensive microcomputer (IBM PC/XT) in Basic and Pascal are described here. The routines can automatically process multiple FCM data files and can provide high-resolution graphic hardcopy. A foreground/background utilization is also described that allows the computer to be available for other uses in the laboratory.

Animals↗

PubMed1992

National TV smoking cessation program and contest in Finland.

BACKGROUND: In the fall of 1986 the North Karelia Project in cooperation with Finnish TV 2 arranged an eight-part nationwide smoking cessation TV program. The Project, also arranged a smoking cessation contest coinciding with the TV program in cooperation with four major voluntary public health organizations and the national health service. The TV program featured two studio groups of local volunteers: one from Turku (southwestern Finland) and the other from North Karelia, where there was more intensive community support for the activity. RESULTS: Based on a national survey of a representative population sample, the reported viewing rates (at least one part) of the working-age population (15-64 years, smokers and nonsmokers) were 64% in North Karelia, 45% in Turku, and 46% nationally (P less than 0.001). Among smokers who had watched at least one session of the TV program, 7.7% reported to have tried to quit smoking in North Karelia, 4.1% in Turku, and 7.5% nationally. Altogether, 16,089 smokers participated in the contest; again the highest participation rate was in North Karelia. The 6-month success rate among the smokers who participated in the contest was 22% in North Karelia, 18% in Turku, and 17% nationally (P less than 0.05). Men were more likely to succeed in quitting: among men the 6-month success rate was 22% and among women 15% (P less than 0.001). CONCLUSIONS: The results and experiences indicate high viewing and participation and a beneficial cost-effect ratio. They also stress the importance of community support activities in enhancing the effects of a media-based health promotion program.

Adolescent↗

PubMed1999

The social security scheme in Thailand: what lessons can be drawn?

The Social Security Scheme was launched in 1990, covering formal sector private employees for non-work related sickness, maternity and invalidity including cash benefits and funeral grants. The scheme is financed by tripartite contributions from government, employers and employees, each of 1.5% of payroll (total of 4.5%). The scheme decided to pay health care providers, whether public or private, on a flat rate capitation basis to cover both ambulatory and inpatient care. Registration of the insured with a contractor hospital was a necessary consequence of the chosen capitation payment system. The aim of this paper is to review the operation of the scheme, and to explore the implications of capitation payment and registration for utilisation levels and provider behaviour. A key weakness of the scheme's design is suggested to be the initial decision to give employers not employees the responsibility for choosing the registered hospitals. This was done for administrative reasons, but it contributed to low levels of use of the contractor hospitals. In addition, low levels of use were also probably the result of the potential for cream skimming, cost shifting from inpatient to ambulatory care and under-provision of patient care, though since monitoring mechanisms by the Social Security Office were weak, these effects are difficult to detect conclusively. Mechanisms to improve utilisation levels were gradually introduced, such as employee choice of registered hospitals and the formation of sub-contractor networks to improve access to care. A beneficial effect of the capitation payment system was that the Social Security Fund generated substantial reserves and expenditures on sickness benefits were well stabilised. The paper ends by recommending that future policy amendments should be guided by research and empirical findings and that tougher monitoring and enforcement of quality of care standards are required.

Capitation Fee↗

PubMed1984

Evaluation of industrial hearing conservation programs: a review and analysis.

In 1981, a large scale reviews of the literature concerning the effects of noise on hearing was initiated by the National Institute of Neurological and Communicative Diseases and Stroke. This review concentrated on the information published in the decade of the 1970's and underscored the importance of evaluating the effectiveness of industrial hearing conservation programs. Published information on this topic was scanty prior to 1970. Investigations of the application and utility of methods for this evaluation have only recently begun to appear in the literature. The status of evaluating hearing conservation programs is the subject of the present review. Three evaluation methods are considered in detail: use of various proposed criteria for significant threshold shift; methods used by Pell at DuPont; and more recent methods developed by Royster. The condition and availability of data do not permit selection of the optimum evaluation procedure. Systematic collection and analysis of data from industrial programs are necessary if acceptable standardized procedures for evaluation of hearing conservation programs are to be developed.

Evaluation Studies as Topic↗

PubMed1998

Evaluating needle exchange: a description of client characteristics, health status, program utilization, and HIV risk behavior.

This study was designed to describe demographic and drug use characteristics, health status, and HIV-related risk behavior among clients attending the San Francisco needle exchange program (NEP), and to assess the relationship between NEP utilization and risk behavior. Randomly selected clients were interviewed when they visited the NEP. Participants were of diverse ethnicity, had a mean age of 38.2, and 72% were male. Many reported being homeless (25%), unemployed (34%), uninsured (52%), and having an episode of infectious disease in the past 2 years (36%). Clients who received a higher proportion of their needles from the exchange were less likely to report sharing of needles or rinse water. Clients who attended the exchange more frequently were more likely to clean their skin prior to injecting and less likely to use the same needle repeatedly. Frequency of visiting the NEP was not associated with the likelihood of sharing needles or rinse water. Efforts to evaluate needle exchange in the United States will benefit from descriptive reports from other NEP programs, and the use of nonexchange comparison groups.

Adult↗

PubMedDate not supplied

Success of in vitro fertilization and embryo transfer in relation to the causes of infertility.

In 1984 163 patients were treated in our in vitro fertilization program, including 4 patients accepting embryos from the oocyte and embryo donation program. Twenty pregnancies were achieved with an average chance per transfer of 16,6%. The final success of IVF strongly depends on the cause of infertility. The best results were obtained for patients with tubal infertility, with a pregnancy rate of 15% per laparoscopy and 19% per transfer. There is a significant decrease in oocyte cleavage rate from tubal (61%) to male infertility (13%). Once the barrier of embryo formation is taken, there is no marked difference in the mean number of embryos transferred on the pregnancy rate after transfer, among the different patient groups. In patients with tubal infertility the pregnancy rate per cycle remains constant, resulting in a cumulative pregnancy rate of 40% after 3 cycles.

Antibodies↗

PubMed1974

Obstetrical caudal anesthesia in a community hospital. A satisfactory plan.

The development of a program to provide complete anesthesia coverage for obstetrics in a community hospital was undertaken as a prospective project which emphasized continuous caudal techniques. Mutually acceptable guidelines were formulated by a group of anesthesiologists and the Department of Obstetrics and Gynecology. A computerized study involving 3,500 labor patients was carried out to thoroughly evaluate the experience over 16 months. The data confirmed the feasibility, safety and wide acceptance of the program. Major complications were few and the anesthesia service to patients was excellent.

Anesthesia, Epidural↗

PubMed1990

Evaluation of adverse events after influenza vaccination in hospital personnel.

Reactogenicity of trivalent influenza vaccine prepared for the 1988-89 season was assessed as part of a first-time voluntary influenza prevention program among hospital staff. Of approximately 500 full-time workers in areas with the highest concentrations of patients at high risk for influenza complications offered the vaccine 288 accepted. Of these, 266 (92%) returned a questionnaire regarding any symptoms experienced within 48 hours after vaccination; 238 (90%) of the respondents reported adverse effects. Soreness at the injection site was described by 229 subjects, 58 (25%) of whom had constant aching and 123 (54%) soreness with arm movement. Symptoms resolved in 1 to 2 days, and only 21 (9%) of those who reported symptoms said they took analgesic medication. Systemic adverse effects were described by 130 subjects (49%). Intercurrent illness accounted for some of these complaints, but 65 people (24%) described at least two of the following symptoms: generalized aching, tiredness, nausea, chills or onset of fever within 12 hours after vaccination (a symptom complex previously attributed to influenza vaccine). Systemic symptoms resolved within 0.5 to 2 days. Thirteen subjects (5%) reported missing work because of arm soreness (1 subject) or systemic symptoms (12). Adverse effects were encountered more often than expected, probably because most of the workers were young and lacked immunity to influenza. Acceptability of the program could likely be improved by using a split-virus vaccine.

Absenteeism↗