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PubMed2001

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↗

PubMed1995

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↗

PubMed1992

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↗

PubMed1998

[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↗

PubMed1979

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↗

PubMed1997

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↗

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

The child and the medication: education software on administering medication in pediatrics.

Computer science is being introduced in education at an accelerated pace, thus forcing educators and students to become familiar with the technology. The objective of this project was aimed at the development and evaluation of the education software, The Child and the Medication. The program uses multimedia resources in four topics: the child, the medication, who administers it, and medication administration. The evaluation showed good acceptance of the program, with most of the items receiving excellent approval. The emphasis in this report is on the importance of teaching strategy development using computational means to teach nursing, thus capacitating the nurses of the next millennium.

Child↗

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↗

PubMed2002

Web-based training in occupational medicine.

OBJECTIVES: The aim of our project was to develop and evaluate an interactive computer-based approach to teach medical students in occupational medicine. To enhance interest in occupational medicine the major focus was on clinical and practical aspects of occupational medicine. METHODS: The computer program was designed in HTML and JavaScript. It presents a guided tour of the patient's case history followed by information on practice and theory of occupational medicine. The program was integrated into the curriculum during the summer term of 1999 and the following winter term. To assess the effectiveness and acceptability of the program we asked students to rate the program on an 18-item questionnaire. RESULTS: Overall, 287 students participated in the evaluation of the program. The participants highly recommended the program structure and had no difficulties in handling the program. This was independent of the computer experience of the students. The evaluation showed that it was possible to enhance interest in occupational medicine by using "virtual patients". CONCLUSION: The program represents a student-orientated learning tool that points out clinical and practical aspects of occupational medicine. The availability via the Internet allows the application as a self-learning tool as well as a teaching tool for the medical curriculum.

Humans↗

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↗

PubMedDate not supplied

[Development and evaluation of an educational software for pediatric nursing education].

Computer Science is being introduced in education at an accelerated pace, thus forcing educators and students to become familiarized with such technology. This study aimed at the development and evaluation of the educational software "Children and medication". The program utilizes multimedia resources in four topics: the child, medication, the person who administers and administration of medication. The evaluation showed a large acceptance of the program, with most of the items being rated as excellent. We emphasize the importance of the development of teaching strategies utilizing computer resources in nursing education and in the development of nurses for the new millenium.

Evaluation Studies as Topic↗

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↗