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At least 415 records · Page 23Linked to original sources

Response of general practitioners to a national dental office evaluation program. Office of Quality Assurance.

The methods used and the results achieved in an effort to solicit 300 volunteers to test the feasibility of a dental office assessment instrument have been described. In response to personal letters to general practitioners in 14 states, 13.9% returned a card indicating a willingness to consider participation. The response rate from different states ranged from 8% to 21.7% with the response being more favorable from states with fewer dentists. Year of graduation from dental school had little effect on the rate of response. Rural dentists responded at a slightly more favorable rate. Of dentists responding, 71% did so within 2 weeks and 90% within the first month after receiving the solicitation. Mail solicitation can be used successfully in recruiting private practitioners for participation in an in-office practice assessment program.

Adult↗

[A conceptual framework for the evaluation of health programs].

Evaluation can have three distinct goals: to help plan and develop programs, to provide information which will improve programs and to determine the outcomes and impact of programs. Evaluation questions flow from each of these goals. Described in this paper are different types of evaluation useful in answering these questions. Whatever type of evaluation is chosen, the evaluator must attempt to assess its validity. This validity concerns the equivalence between answers to evaluation questions and the "true value" of the program. It is just as concerned with measurement strategy and instruments as it is with the designs and techniques of analysis used, and the population studied.

Evaluation Studies as Topic↗

Children's self-selection into prevention programs: evaluation of an innovative recruitment strategy for children of alcoholics.

Systematically evaluated the efficacy of a self-selection strategy to recruit elementary-aged children into a school-based prevention program for children of alcoholics. Recruitment involved: a film about parental alcoholism, a follow-up meeting, and an invitation to participate in a prevention program. Of the 844 4th-6th graders exposed to recruitment, 67% showed no interest in the program, 26% attended the follow-up meeting, and 11% obtained parental permission. Analyses focused on group differences according to selection classification on measures of symptomatology and resources available to the child. Significant differences were noted on level of concern about parents' drinking, depression, conduct disorder, and self-worth. Children interested in the program tended to score higher on measures of symptomatology. The potential of a self-selection model for identifying children at risk and areas for future research are discussed.

Alcohol Drinking↗

The Challenge Project: a treatment program evaluation for perpetrators of child sexual abuse.

OBJECTIVE: Research on treatment outcome for sex offenders has been poorly designed, with biased sampling, lack of controls, and a failure to define treatment programs, subjects, and outcome measures. This research aimed to compare group and individual treatment outcomes, with particular reference to program compliance and reoffending. METHOD: The Challenge Project assessed all 80 convicted perpetrators of child sexual abuse in S.E. London over a 2-year period, and followed them up 1 and 2 years later. The 43 perpetrators who were diverted into the community program received weekly standardized cognitive-behavioral treatment over a 1-year period. Subjects were matched on key variables and entered either group or individual therapy. RESULTS: Some treatment effects could be demonstrated in both group and individual therapy, particularly if individual changes in test scores were examined. Two variables were significantly associated with poor treatment compliance: A history of sexual and/or violent offending, and a history of childhood sexual victimization. However, only one subject had been convicted of a further sexual offense--possession of child pornography--at follow-up. CONCLUSION: The findings may support professionals in deciding how best to allocate scarce resources; and it is intended to extend the outcome study to at least a 5-year follow-up period, to see whether compliance and shifts in psychological measures are a valid predictor of outcome.

Adult↗

Clinicians, the Mount Sinai program and the Veterans' Administration program evaluated against clinico-pathological data derived independently of the electrocardiogram.

221 electrocardiograms (ECGs) recorded from adult subjects with cardiac symptomatology were interpreted by clinicians and the Mount Sinai (MS) and Veterans' Administration (VA) computer programs. After the clinicians had eliminated their interobserver variability, their interpretations and those of the computer programs were compared with the corresponding clinico-pathological data that had been derived independently of the ECG. A measure of overall diagnostic accuracy was used which showed that the performance of the 2 computer programs was similar and somewhat worse than that of the clinicians. The clinicians and the computer programs were not as good at diagnosing the ECGs of women as at diagnosing those of men. As the VA program's interpretations may be altered by including information about the patient's provisional diagnosis, 6 different sets of these prior probabilities were used to analyse 141 of the original 221 ECGs. Different fixed sets of prior probabilities made only a small difference to overall diagnostic accuracy but a marked difference to the VA program's ability to differentiate Normal from Abnormal. Optimizing the prior probabilities for the individual subjects increased the VA program's overall diagnostic accuracy up to that of the clinicians. Both computer programs correctly diagnosed sinus rhythm as the dominant rhythm in 165 out of 177 subjects. The MS program diagnosed the dominant rhythm as Atrial Fibrillation in 35 out of 41 subjects and the VA program in 27 (X(2) = 3.24; not significant). ECG interpretation; Mount Sinai program; Veterans' Administration program; independent clinico-pathological data; sex differences in the ECG; prior probabilities.

Adult↗

Client participation in CMHC program evaluation: increasing incidence, inadequate involvement.

Client satisfaction surveys and client complaint systems are used by more CMHCs since the Amendments of 1975 required centers to evaluate "acceptability of service," but clients are seldom actively involved in designing or administering these evaluations. The authors argue that greater control by clients is merited on technical and political grounds, and would increase the likelihood that program improvements would result from assessments of acceptability.

Community Mental Health Centers↗

Cost savings for a preferred provider organization population with multi-condition disease management: evaluating program impact using predictive modeling with a control group.

Disease management programs have historically had difficulty demonstrating the financial value of their programs using statistically rigorous methods. This preliminary study utilized a predictive model built from a control group that consisted of individual employer groups whose benefits managers did not purchase disease management. The purpose of this evaluation was to examine the cost savings associated with Health Management Corporation's disease management program for asthma, diabetes, and coronary artery disease. Study and control group members were identified with exactly the same selection criteria as self-insured employer groups (n = 76,194) with preferred provider organization health plans that offered the disease management program. The study group consisted of members (n = 1,009) who were identified as having any of the three conditions and were eligible for the disease management program, regardless of the extent of their participation. The control group included members (n = 2,491) who were identified as having any of the same three conditions. The control group data were used to develop a predictive model designed to calculate expected medical claims costs for the study group. The gross savings of the disease management program was measured by calculating the difference between the expected medical claims costs predicted by the model and the actual medical claims costs for the study group. Preliminary analyses indicate that Health Management Corporation's disease management program produced a return on investment of $2.84: $1.00 and $1.45 gross savings per member per month.

Adolescent↗

Cerebrospinal fluid analysis: disease-related data patterns and evaluation programs.

Cerebrospinal fluid (CSF) analysis is a basic tool for diagnosis of neurological diseases. Knowledge regarding blood-CSF barrier function (molecular flux/CSF flow theory) and neuroimmunology is reviewed to aid understanding and evaluation of CSF data. Disease-related immunoglobulin patterns (IgG, IgA, IgM with reference to albumin) are described in CSF/serum quotient diagrams with the hyperbolic reference range for blood-derived protein fractions in CSF. Clinical relevance of complementary analyses (cytology, PCR, oligoclonal IgG, antibody detection and brain-derived proteins) is briefly discussed. Integrated CSF data reports are shown with numerical and graphical data representation, reference range-related interpretation and diagnosis-related comments. The principles and rationale of general CSF analysis reported in this review should enable the reader to accurately interpret CSF data profiles, and to plan a proper evaluation of new brain- or blood-derived analytes in CSF.

Albumins↗

Development and implementation of a safety evaluation program for chemical fibers.

Polyester and acrylic fibers often have prolonged contact with human skin: the sucking of childrens' toys may lead to ingestion. During manufacture, occupational exposure to fiber components may occur. An evaluation of these possible hazards was undertaken by data appraisal, chemical analyses, and animal plus human testing. Occupational exposure limits have already been set for the chemicals used in polymer manufacture. Finishing agents (applied to the fibers) were examined in bacterial mutation and rat acute oral toxicity tests. Finished fibers were tested for acute toxicity and then for sensitizing potential (on guinea pig skin). Human volunteer trials for skin irritance and sensitization followed. No adverse reactions were seen. Only when fibers were burnt was toxicity seen: smoke from acrylic fiber proved more toxic than that from polyester fiber (due principally to hydrogen cyanide release). Migration tests showed that little material leached out from the fibers: < 1 mg/dm2 surface area in saline, 0.4 mg/dm2 from acrylic fibers in methanol, 3.6 mg/dm2 from polyester fibers in chloroform. Analysis showed only fiber polymer components and finish in saline and methanol leachates. Whilst further testing may be required for areas of special concern, since only a limited range of biological endpoints have been addressed, it is concluded that current and foreseeable future uses of these chemical fibers pose little or no toxicological hazard.

Acrylonitrile↗

The National Pork Producers Council Maternal Line National Genetic Evaluation Program: a comparison of six maternal genetic lines for female productivity measures over four parities.

Litter (n = 8,424) and female performance records were collected in two breed-to-wean production units in order to evaluate genetic line differences for sow longevity and maternal performance over four parities. Lines evaluated were American Diamond Genetics, Danbred North America, Dekalb-Monsanto DK44, Dekalb-Monsanto GPK347, Newsham Hybrids, and National Swine Registry. Females within a line were derived from a minimum of 65 sires, 197 dams (three dams per sire), and a maximum of three daughters per dam, except in the GPK347, which were produced using semen from 12 Nebraska Index boars mated with Dekalb-Monsanto Line 34 females. All lines expressed 100% maternal heterosis. Mixed model statistical procedures were used with fixed effects including genetic line, parity, production unit, and two-way interactions. Random effects included a contemporary week of production and female for repeated records. Lactation length (average 15 d) was included as a linear covariate where appropriate. In total, 3,599 females entered as early-weaned pigs, 3,283 entered the breeding herd, 2,592 farrowed at least a single litter, and 1,656 and completed four parities. Line (P < 0.001) and parity (P < 0.001) effects were observed for virtually all traits measured. Ranges of genetic line differences averaged across parities were 1.76 pigs for total born, 1.45 pigs born alive, and 0.31 stillborn pigs per litter. Ranges of line differences in total and live litter weight were 1.4 and 1.3 kg, respectively. Ranges among lines, within Parities 1 through 4, for litter size at weaning were 0.56, 1.08, 0.91, and 0.64 pigs per litter, respectively. Line differences for weight (33.8 kg) and backfat depth (6.4 mm) at farrowing, lactation feed intake (8.7 kg), weight loss (5.0 kg), and backfat loss (0.87 mm) were observed. Extended wean-to-estrus interval was related to variation in weight, feed intake, and backfat loss in all lines except the GPK347. The GPK347 females farrowed and weaned the largest number of pigs, ate less feed in lactation, and lost more backfat and weight during lactation, yet they had the largest litters and the shortest wean-to-estrus intervals. Line x parity interactions existed for many traits due to small rank changes, but in general, the high- and low-ranked lines did not change. Genetic line differences in reproductive efficiency through four parities exist and must be recognized when choosing a female line.

Adipose Tissue↗

ICWU cancer control education and evaluation program: research design and needs assessment.

The International Chemical Workers Union is implementing a 3-year nationwide field experiment in cancer prevention education. The educational program includes three stages: generalized cancer control education, education tailored to each local union, and an interactive monitoring system designed to provide ongoing communication and reinforcement for desired cancer control behaviors among local unions and their members. These alternative educational approaches will be systematically evaluated using a randomized factorial study design involving more than 120 local unions. The need for such a program is demonstrated by the results of a needs assessment survey of 690 union members. Respondents expressed strong concern regarding possible carcinogen exposures at the work site, combined with generally low ratings of co-worker knowledge of and adherence to appropriate cancer control behaviors. Engineering controls and personal protective equipment were reported to be inadequate in many work sites.

Attitude to Health↗

Signs, symptoms, and ill-defined conditions in Persian Gulf War veterans: findings from the Comprehensive Clinical Evaluation Program.

OBJECTIVE: The purpose of this study was to analyze the type and frequency of signs, symptoms, and ill-defined conditions (SSID; International Classification of Diseases-9th Revision, Clinical Modification (ICD-9-CM) codes 780-799) identified by physicians evaluating Persian Gulf War veterans; to determine the influence of the extent of evaluation on the type and frequency of SSID diagnoses; and to search for evidence for a new illness, or illness related to wartime exposures, in veterans with ill-defined conditions. METHOD: Comprehensive examinations were provided for 21,579 consecutive Persian Gulf War veterans with symptoms or health concerns after the war. Data recorded on all individuals includes demographics, self-reported exposures, symptoms, and physician-assigned ICD-9-CM primary and secondary diagnoses. A detailed psychosocial history, including a multidisciplinary discussion, was incorporated for a subset of participants. RESULTS: SSID conditions were primary diagnoses for 17.2% of veterans, and either primary or secondary diagnoses for 41.8%. Although some SSIDs were objective conditions (eg, sleep apnea), most were simply symptoms. More comprehensive evaluation, especially the multidisciplinary discussion of findings, decreased the frequency of symptoms as diagnoses and increased the number of DSM-IV psychiatric diagnoses. Ill-defined conditions were not associated with particular self-reported exposures or demographic variables. CONCLUSIONS: Ill-defined conditions identified by physicians in Gulf War veterans are most often symptoms. More definitive, often psychological, diagnoses can be made by increasing the intensity of the evaluation and by multidisciplinary input. Evidence for a new or unique illness related to wartime exposures did not emerge from this analysis.

Adult↗