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PubMed2003

The relationship of residency performance to match status and US versus international graduate status.

BACKGROUND AND OBJECTIVES: This study compared the performance of family practice residents selected through the National Resident Matching Program (NRMP) with those selected outside the NRMP and that of US medical graduates (USMGs) versus international medical graduates (IMGs). METHODS: Surveys were mailed to all 470 US family practice residencies asking Match status and USMG versus IMG status of graduates accepted into their programs from 1994-1996. RESULTS: Of 3,222 residents, 2,815 (87.4%) were accepted through the Match, 159 (4.9%) before the Match, and 248 (7.7%) after the Match; 2,874 (89.2%) were USMGs, and 348 (10.8%) were IMGs. Residents accepted after the Match versus residents selected through the Match were more likely to leave their programs early (14.5% versus 4.8%), score in the lower 10% of their In-training Assessment Examination (ITE) (11.7% versus 2.2%), and require remedial programs (12.9% versus 2.6%). A lower proportion of residents accepted after the Match scored in the top 10% on the ITE examination (5.6% versus 15.2%). IMGs were more likely than USMGs to leave the program be fore graduating (8.0% versus 5.2%), to score within the lower 10% on the ITE examination (7.8% versus 2.5%), and to require remedial programs (7.8% versus 3.2%). CONCLUSIONS: Although a large majority of the residents studied here performed well, somewhat less-favorable performance was seen among residents accepted after the Match and among those with international medical degrees.

Chi-Square Distribution↗
PubMed1998

A holistic approach to the economic evaluation of health programs using institutionalist methodology.

The paper examines possibilities for employing more holistic approaches to the evaluation of health care programs. It is argued that the reductionism of conventional forms of economic evaluation, where value (or benefit) is seen in terms of either health consequences or individuals' utility, can cause a number of aspects of such programs to be overlooked. As such, this imposes fairly strict limits on the capacity of economic evaluation to inform public policy. In contrast, institutionalist economic theory in common with the community development approach to health promotion is an area of research which acknowledges that change to the broader socio-political environment can be a source of value. It is suggested that this idea has, for instance, significance for the evaluation of indigenous health programs where notions of "cultural appropriateness" have strong influence over the effectiveness and acceptability of such programs. It is concluded that no one evaluative approach is appropriate in all situations and that a greater receptiveness to broader sources of social value can help to improve the way evaluations are conducted.

Evaluation Studies as Topic↗
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↗
PubMed2002

Managing change during an information systems transition.

This article examines the social forces underlying computer technology diffusion into nursing. It also explores the benefits of computerized perioperative patient documentation and suggests methods that can used to persuade nurses to embrace and master computer technology as a tool of their trade. Options are examined that offer nurses opportunities to overcome their reluctance to accept responsibility for accurate computer documentation and appreciate the added value offered by information technology. Implementing an adequate computer technical skills training program affects nurses' acceptance of computerized documentation, but having the best training program available does not replace the need to ensure that organizational and individual practitioners are receptive to change.

Communication↗
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↗
PubMed2001

The frequency of Tay-Sachs disease causing mutations in the Brazilian Jewish population justifies a carrier screening program.

CONTEXT: Tay-Sachs disease is an autosomal recessive disease characterized by progressive neurologic degeneration, fatal in early childhood. In the Ashkenazi Jewish population the disease incidence is about 1 in every 3,500 newborns and the carrier frequency is 1 in every 29 individuals. Carrier screening programs for Tay-Sachs disease have reduced disease incidence by 90% in high-risk populations in several countries. The Brazilian Jewish population is estimated at 90,000 individuals. Currently, there is no screening program for Tay-Sachs disease in this population. OBJECTIVE: To evaluate the importance of a Tay-Sachs disease carrier screening program in the Brazilian Jewish population by determining the frequency of heterozygotes and the acceptance of the program by the community. SETTING: Laboratory of Molecular Genetics--Institute of Biosciences--Universidade de São Paulo. PARTICIPANTS: 581 senior students from selected Jewish high schools. PROCEDURE: Molecular analysis of Tay-Sachs disease causing mutations by PCR amplification of genomic DNA, followed by restriction enzyme digestion. RESULTS: Among 581 students that attended educational classes, 404 (70%) elected to be tested for Tay-Sachs disease mutations. Of these, approximately 65% were of Ashkenazi Jewish origin. Eight carriers were detected corresponding to a carrier frequency of 1 in every 33 individuals in the Ashkenazi Jewish fraction of the sample. CONCLUSION: The frequency of Tay-Sachs disease carriers among the Ashkenazi Jewish population of Brazil is similar to that of other countries where carrier screening programs have led to a significant decrease in disease incidence. Therefore, it is justifiable to implement a Tay-Sachs disease carrier screening program for the Brazilian Jewish population.

Adolescent↗
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↗
PubMed1999

Recent information about hip dysplasia.

Dogs suffering from HD have a genetic background, but the releasing factors are many. Two of the most important are overnutrition and overexercising, especially in the young puppy. Radiography can give an estimate of the degree of secondary OA, and by evaluating the laxity in the hip joints at an early age, it seems to be possible to predict the chances for later development of OA. The eradication program has to be instituted in such a way that only the best dogs are accepted into breeding programs. It seems to be more efficient to eradicate the genetic part of the etiology by creating a breeding index by means of evaluating the offspring of the male dogs.

Animals↗
PubMed2001

Asthma patient education: current utilization in pulmonary training programs.

The national guidelines for the diagnosis and management of asthma published in April of 1997 emphasized patient education in asthma management. It is unclear how often patient education is included in asthma management clinics. We sought to determine how often education programs are available by surveying teaching hospitals with training programs in pulmonary and critical care medicine. Using this survey, we also determined the reason programs are not offered and whether computer resources are routinely available to utilize computer-delivered patient educational materials. We sent mail questionnaires to 163 training programs in the United States. We had a response rate of 72% (117 of 163). Of the 117 programs responding, 75 (64%) reported having a formal asthma patient education program. Most (72%) were in university teaching hospitals. A majority of respondents (84%) believed that compensation for their efforts was inadequate, and those hospitals with no formal asthma education program reported that financial cost and time requirements were the primary reasons for not having such a program. Despite the fact that many programs did not have a patient education component, 96% (72 of 75) of respondents with an educational program viewed patient education as an effective patient self-management tool. Of all programs surveyed, 85% reported they would use a high-quality computer-based asthma education program if one was available. Implementation of such a program is feasible, with 69% of programs surveyed having a personal computer in their clinic and 60% having Internet access. We conclude that most training directors believe that patient asthma education is important and effective; however, cost and time issues remain barriers to its implementation. Computer-based educational programs delivered over the Internet are feasible, could address some of these limitations, and are acceptable to most programs.

Asthma↗