Evaluating social marketing programs.
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Contraception Behavior↗
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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↗
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↗
Evaluation of a minimal-contact smoking cessation program in a health care setting.
A controlled evaluation of a minimal-contact smoking cessation intervention was conducted with 213 inpatients and outpatients at a Veterans Administration Medical Center (VAMC). The intervention had three components: Brief consultation from a health practitioner; administration of a self-help smoking cessation manual; and provision of an incentive to adhere to recommendations in the manual. Enrollment procedures differed from those of many other smoking-intervention trials in that, instead of enrolling only smokers who were motivated to quit, all patients who smoked and who would normally be considered eligible for a smoking-cessation intervention were included. The evaluation examined acceptability of the program to patients who smoked, overall effectiveness of the intervention, and efficacy of the intervention for specific patient demographic, social status, and health status groups. The program had a high degree of acceptance by patients who smoked, with over 60% agreeing to participate and take home the self-help smoking-cessation manual. The program was effective in getting patients to reduce their daily smoking, and marginally effective in influencing smoking cessation, with some patient groups exhibiting higher cessation rates than others. Special problems to be considered when attempting to influence groups of smokers at high levels of psychological stress and with low levels of education and income--factors normally associated with high rates of smoking and failure in traditional smoking-cessation programs--are discussed in light of the results obtained.
Hospitals, Veterans↗
Developing an ethylene oxide quality assurance program.
Regulations concerning the acceptable levels of Ethylene Oxide (EtO) in the hospital work environment have been tightened. The need has increased for both monitoring equipment and for programs to evaluate the results obtained. Development of a program at a community hospital is discussed, with a consideration of equipment cost-effectiveness, availability, and ease of use. The program developed includes both installation of equipment to reduce the levels of EtO in the work area, and purchase of equipment to monitor the EtO levels in the air, and to monitor EtO levels in the "breathing zone" for individual employees. This program also includes the establishment and review of policies concerning the purposes and procedures for EtO use in the hospital. An inservice education program is described, which includes documentation of employee attendance and comprehension, with follow-up to assure compliance with procedures. Monitoring the personnel for exposure to EtO can support the value of instituting such policies.
Central Supply, Hospital↗
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↗
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↗
Preimplantation diagnosis of single disorders.
Preimplantation diagnosis of inherited and chromosomal diseases provides an option for couples at risk for conceiving genetically abnormal fetus to avoid a birth of an affected child without the need for a prenatal diagnosis and selective abortion of affected fetus (1-3). In some countries this might be the only way to the prevention of genetic disease, as abortion is not acceptable procedure. Even in those countries where prenatal diagnosis is practiced for many years, there is also concern that existing genetic programs based on prenatal screening will lead to increasing number of abortions. On the other hand, the possibilities for genotyping oocytes and cleaving embryos open a new prospect for genetic diagnosis before pregnancy, making genetic programs more ethically acceptable in any social setting. This will make preimplantation diagnosis the method of choice in the community based programs for prevention of genetic disease in the future, as well as a useful addition to assisted reproduction technologies, at least for IVF patients of advanced maternal age.
Female↗
Overview of Medicaid capitation and case-management initiatives.
Case-management programs have grown in number and in acceptance in the Medicaid program since 1981. In this article, we review their structure and incentives as well as what is known about their impact on cost and use. These programs also have been difficult to implement, posing myriad management challenges for prepaid program managers and State administrators. We highlight the problems in the following areas: eligibility, enrollment, rate setting, and management information systems.
Aged↗
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↗
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↗
Surveillance issues in inflammatory bowel disease: ulcerative colitis.
This review article on the surveillance of patients with ulcerative colitis provides an overview of the criteria for evaluating screening and surveillance programs and applies the criteria to the available evidence to determine the effectiveness of the surveillance of patients with ulcerative colitis. We examine the clinical outcomes associated with surveillance, the additional clinical time required to confirm the diagnosis of dysplasia and cancer, compliance with surveillance and follow-up, and the effectiveness of the individual components of a surveillance program, including colonoscopy and pathologist's interpretation. The disability associated with colectomy is considered, as are the cost and acceptability of surveillance programs. Patients with long-standing ulcerative colitis are at risk for developing colorectal cancer. Recommended surveillance colonoscopy should be supported. New endoscopic and histopathologic techniques to improve the identification of high-risk patients may enhance the effectiveness and cost-effectiveness of surveillance practices.
Adult↗
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↗
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↗
[Continuing education as an instrument of medical quality management].
A rheumatologic educational program for general practitioners (GPs), based on andragogic principles, has been developed by the study group for Continuing Education and Quality Control of the Association of Cooperative Centers of Rheumatology in the DGRh. The educational program has been tested and evaluated by a study group supported by the German Ministry of Health (FB 2-43346-8/63) as an possible tool for quality assurance in rheumatology. Evaluation was carried out in 2 audit circles each of the KV Hessen and KV Lower Saxony. In the 4 audit circles 39 GPs and 3 trained rheumatologists, acting as "experts", participated. Using didactic materials provided by the study group, the topic "shoulder-neck pain" was discussed in all 4 audit circles. Questionnaires and case records according to the topic were used as evaluation tools. The evaluation was supported scientifically by the Scientific Institute of the German Medical Association (WIAD). Of patients with shoulder-neck pain (1193 pre- and 958 post-education) 2151 records were documented by the participating GPs for the evaluation of outcome in respect of changes of diagnostic and therapeutic attitude. Additionally pre- and postintervention, 10 MC questions related to the topic were used to measure changes in specific knowledge, and at the end of the audit circles participants were asked by questionnaire for acceptance of the educational program. An index of acceptance of 9.6 points (best: 7.0 points, worst: 31.0 points) indicating an excellent acceptance of the educational program by the participating GPs was recorded. The increase in specific knowledge amounted to about 30% in all 4 audit circles. Changes in diagnostic and therapeutic attitudes showed a better specification within the spectrum of diagnoses, a reduction of expensive and not indicated diagnostic procedures (e.g., CT), as well as a reduction in the use of non-adequate therapeutic modalities (e.g., massage, fango, unguenta, and gels) in favor of physiotherapy and mobilisation or local and systemic use of corticosteroids. The results of the evaluation project demonstrate that interactive learning in small groups (audit circles) based on andragogic principles can contribute to a better quality of care of patients with rheumatic diseases. The innovative concept seems to be a well-accepted alternative to formal lectures in postgraduate medical education.
Curriculum↗
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↗
Initial employment status of resident physicians completing training in 1995.
OBJECTIVE: To assess the degree and type of difficulty encountered by resident physicians attempting to enter the workforce in 1995. DESIGN: Employment information derived from a 1-page descriptive survey completed by residency program directors from January 1, 1996, to June 15,1996, is described and compared with the results of a similar survey completed 1 year earlier. SETTING: Directors of 4568 residency programs in 31 specialties and subspecialties accredited by the Accreditation Council for Graduate Medical Education. MAIN OUTCOME MEASURE: The number of 1995 program graduates, their current professional status, and program directors' characterization of the experience of graduates who entered clinical practice, including the number who experienced major difficulties securing an acceptable practice position. Program directors reported actual and anticipated decreases in the number of residency positions and the likely availability of future professional opportunities. RESULTS: The 3819 program directors (83.6%) who completed the survey reported that 20065 resident physicians completed a residency program during 1995. Of those seeking employment (n = 13215), most entered clinical practice (80.1%) or took an academic position (15.6%); 2.2% were unemployed or had taken a position in a specialty or subspecialty different from the one in which they were last trained. A portion (6.3%) of graduates who entered clinical practice in their specialty or subspecialty experienced difficulty finding a suitable position; the percentage was lowest among graduates of general surgery, psychiatry, and primary care specialties. CONCLUSIONS: Survey results regarding the 1995 graduates are consistent with those obtained regarding the 1994 graduates and suggest that the market for physician services in some disciplines continues to be restrictive. We found that graduates of the specialties of anesthesiology and plastic surgery, whom we reported had the greatest difficulty finding acceptable positions in 1994, had less difficulty in 1995, suggesting a possible improvement in the market, less competition, a change in the respondents' perception of "acceptable," or a change in the resident physicians' willingness to pursue different opportunities. The general consistency of our results and their congruence with other published data suggest that this method is useful to identify and monitor trends in the physician market.
Employment↗
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↗