Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Program Appropriateness”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 55 records · Page 3Linked to original sources
PubMed1989

Issues in the economic evaluation of community water fluoridation.

Community water fluoridation has long been recognized as an effective public health intervention in the prevention of dental caries. The recently documented secular decline in dental caries, however, presents for policy makers the challenge of appropriately allocating limited health care resources between a variety of health care programs. Appropriate economic assessment of these alternatives becomes critical for rational distribution of such resources. Cost-benefit and cost-effectiveness analyses are techniques that, when used correctly, can guide policy makers facing such decisions. This paper reviews and critiques the published literature assessing the cost effectiveness and cost benefit of community water fluoridation using criteria developed for economic evaluation. Eight papers met the criteria for inclusion in the present study. In general, the articles failed to incorporate the declining prevalence of dental caries into their analyses and to fully document costs associated with water fluoridation. Treatment savings from dental care averted secondary to water fluoridation were not appropriately incorporated into the cost-effectiveness analyses, thereby overestimating the marginal cost associated with fluoridation. Specification of outcome measures to assess the consequences of water fluoridation failed to incorporate the dynamic nature of dental disease. Suggestions for improving the generalizability and usefulness of future cost-benefit and cost-effectiveness analyses are made.

Bias↗
PubMed1983

Increased effectiveness of substance abuse treatment. A prospective study of patient-treatment "matching".

An earlier study retrospectively evaluated the effectiveness of six separate substance abuse treatment programs and generated a set of hypotheses for matching patients to the most appropriate programs. In the present study, these predictors and the matching strategy were tested in a prospective design, using the same treatment programs and a new sample of 130 alcohol- and 256 drug-dependent patients. The new group of patients who were treated in their predicted program (matched patients) were compared with those patients from the same sample who were not treated in their predicted program (mismatched patients). Treatment staff were not apprised of the matching criteria or which patients were matched, thus permitting an experimental test of the predictions. Results indicated superior performance during treatment and an average of 19 per cent better 6-month outcomes for the matched patients than for their mismatched counterparts. The matching effect was seen in both the alcohol- and drug-dependent samples and in all treatment programs. The authors discuss the application of these findings to other types of patients and treatments in substance abuse and other fields of psychiatry.

Alcoholism↗
PubMed1987

Chronotropic response of an activity detecting pacemaker compared with the normal sinus node.

We compared the rate responsiveness of an activity-detecting multiprogrammable, single chamber pacemaker (Medtronic Activitrax) to rate responsiveness of the normal sinus node. This pacemaker changes its basic pacing rate in response to physical activity. The rate responsiveness is programmable by selecting one of three activity thresholds, and one of 10 rate response settings. The study included a group of six normal volunteers and 12 patients implanted with Activitrax to examine the similarity of the pacemaker rate to normal sinus rhythm during acceleration and deceleration. The pacemaker was set to Activity mode, at a basic rate of 60 bpm. In volunteers, the device was externally secured on the chest wall and tested at two programmed settings. When programmed at a high threshold of activity and high rate response in volunteers, there was no significant difference in maximum normal sinus rates and pacemaker rates during arm waving, jumping in place, and walking during stress testing. At a medium activity threshold, the only significant difference occurred during submaximal stress testing, when the maximum sinus rate achieved was 141 +/- 19 bpm and the maximum pacing rate was 105 +/- 8 bpm (p less than .02). The pacemaker behaved in a similar manner in patients, successfully simulating the typical fast acceleration and slow deceleration of a normal sinus node in exercise testing. There was no difference in pacer response when implanted in abdominal or infraclavicular locations. The implanted units have functioned normally over a follow-up period of nine to 22 months. Activitrax can be programmed to achieve physiologic pacing rates in response to normal daily activities with appropriate programming.

Abdomen↗
PubMed1989

Problems of sensing tachyarrhythmias by an antitachycardia pacemaker (Symbios 7008).

Atrial burst pacing is an effective method of terminating supraventricular tachycardia. In the patient presented in this report, a Symbios 7008 pacemaker (Medtronic Inc., Minneapolis, MN, USA) was implanted for two reasons: (1) severe AV conduction defect (AH, 230 msec; HV, 150 msec) and bifascicular block following anterior myocardial infarction; and (2) paroxysmal atrial flutter. The conduction defect ruled out programming other than atrial burst in DDD mode. Activation of burst pacing required appropriate programming of the "tachycardia detection window" on the basis of the cycle length of the flutter waves. In the case reviewed, episodes of atrial flutter with variable cycle lengths of 230 to 280 msec necessitated reprogramming of the AV interval, the refractory period, and the upper rate interval. The use of an antitachycardia device in automatic mode may be limited by variations in tachycardia cycle length.

Aged↗
PubMed2002

Correlates of hypertension among Chippewa and Menominee Indians, the Inter-Tribal Heart Project.

OBJECTIVE: The objective of this study was to document the prevalence and control of hypertension among Chippewa and Menominee Indians who participated in the Inter-Tribal Heart Project (ITHP), and to identify the covariates of controlled hypertension in this population. DESIGN: Participants responded to an interviewer-administered questionnaire and underwent a physical examination and laboratory screening. SETTING/PARTICIPANTS: A random sample of 1376 individuals aged > or = 25 years who were active users of the Indian Health Service clinics on the Chippewa and Menominee Reservations and participated in the ITHP. RESULTS: The prevalence of hypertension (systolic blood pressure [SBP] > or = 140 mm Hg and/ or diastolic blood pressure [DBP] > or = 90 mm Hg and/or currently taking anti-hypertension medications) was 31%. Approximately 25% of individuals with hypertension were unaware of their hypertensive status. Among hypertensives, 58% reported currently using anti-hypertension medications, and only 28% had blood pressures below the recommended levels (SBP < 140 mm Hg or DBP < 90 mm Hg). CONCLUSIONS: The high prevalence of hypertension coupled with the low prevalence of controlled hypertension suggests the need to enhance and strengthen programs that target hypertension prevention and control. These programs should include pharmacologic and non-pharmacologic approaches, as well as culturally appropriate programs that incorporate beliefs held by American Indians about hypertension causation, manifestations and treatment, in an attempt to reduce this group's burden of hypertension.

Adult↗
PubMed2001

Indications and patient selection for mechanical ventricular assistance.

Cardiac assist devices have become an important component of transplantation programs as they successfully bridge unsalvageable patients who would otherwise die. The indications for a device can still be classified into short-term and long-term situations. The short-term indications have expanded into areas such as postcardiotomy failure, high-risk cardiac operations, and acute myocardial infarction with results that were not previously possible in the absence of a well-established mechanical assistance program. Appropriate patient selection remains challenging and perhaps the most important attribute of a successful ventricular assist program. Although few exact criteria can define patients who are not eligible, several considerations and screening scales can help determine a particular patient's suitability. Specific attention must be given to right heart function, neurologic status, existing infections, renal function, and transplantation suitability. The future of this field will not only be in technological advances with devices but in optimization of patient selection and expanding indications such as permanent replacement therapy.

Algorithms↗
PubMed1985

Atrial pacing bigeminy: a manifestation of crosstalk.

Atrial pacing bigeminy, defined as atrial pacing with alternating short and long cycle lengths, was recorded in two out of five DDD-pacemaker implants. Another fascinating feature, the lowering of the effective pacing rate after programming to a higher rate, occurred in one patient. Both phenomena can be explained by crosstalk; appropriate programming resulted in normal DDD-function in all cases. These observations in our patients have led to some interesting conclusions regarding multiprogrammability and nominal settings.

Aged↗
PubMed1983

Graduate education in food service systems management: clarifying the focus.

Administrators of dietetic services and educators in food service systems management identified levels of education and degree of experience needed to develop competencies in food service systems management. Master's level competencies that emerged from the analysis provide a framework for design and evaluation of graduate programs. Also, the differentiation of bachelor's and master's level competencies should assist in clarifying appropriate program focuses. The data on experience levels indicate performance areas for which the educational institution is primarily responsible and those for which responsibility should be shared by educators and employers.

Data Collection↗
PubMed1981

The effect of insulin upon the influx of tryptophan into the brain of the rabbit.

1. The effect of hyperinsulinaemia upon the influx of tryptophan into the brain was determined. A raised level of insulin was maintained in the circulation of rabbits for periods of up to 120 min by means of a continuous, programmed intravenous injection of the hormone, given by an electronically controlled variable-drive syringe. A similar, appropriately programmed, intravenous injection of glucose, given simultaneously with the insulin, maintained the concentration of the blood glucose within normal limits throughout each experiment, so that the results were not vitiated by the development of hypoglycaemia. 2. Raised levels of insulin in the blood affect the supply of tryptophan to the brain in two opposing ways: (a) by increasing the binding of tryptophan to the albumin in the blood, thereby reducing the level of the free tryptophan in the circulation by about a half, which would decrease the influx of tryptophan into the brain; (b) by simultaneously reducing the levels in the blood of six or more of the amino acids which compete with tryptophan for transport carriers into the brain, which would increase the influx of tryptophan. The net result of these two opposing effects is that insulin causes only a slight increase in the influx of tryptophan into the brain. 3. To account in quantitative terms for the effect of insulin upon the influx of tryptophan into the brain it proved necessary to make one assumption. This assumption was that a predictable proportion of the tryptophan which is loosely bound to blood albumin is being stripped off this protein by the transport carrier located on the luminal surface membranes of the endothelial cells during the passage of the blood through the cerebral capillaries. If this assumption is accepted the work reported here explains adequately the effect of insulin on the influx of tryptophan into the brain.

Amino Acids↗
PubMed1986

Self-injurious behavior: a state-wide prevalence survey of the extent and circumstances.

A state-wide prevalence survey was conducted to determine the extent and circumstances of self-injurious behavior (SIB) among institutionalized mentally retarded individuals with 13.6% of the population (1,352 individuals) identified as being self-injurious from the approximately 10,000 clients in Texas' 13 residential facilities serving the mentally retarded. It was found that: (a) 89.8% of the clients were severely and profoundly mentally retarded; (b) differential therapeutic treatment modalities may have occurred according to the sex of the client; (c) 58.4% of the clients engaged in more than one SIB response topography; (d) 57% of the clients emitted SIB at least once per day; (e) 55% of all clients were aggressive toward others, with a higher incidence of aggression, property destruction, and sleep disturbances among clients who received psychoactive medication; and (f) 33.1% of the clients were on formalized positive treatment programs and 6.8% of the clients were on formalized aversive programs. Discussion highlights the extent and circumstances to which SIB exists and the need to implement effective and appropriate programming.

Aggression↗
PubMed1999

Beliefs about smoking cessation among out-of-school youth.

Although the majority of adolescents in the 13-18 age range are at school, there is a need to target specific groups of young smokers such as unemployed youth. For those young people who are not at school, few directed programs are available in either prevention or cessation and information is needed about the design and delivery of appropriate programs for this population. This report presents the results from a survey of unemployed youth and students at vocational colleges about various aspects of smoking cessation. The majority of out-of-school youth smokers had not tried to quit, but 52% were contemplating action to quit. Only a quarter of the smokers had quit for more than a week. Few young smokers would use a recognised program though more females would change to a lower nicotine brand, quit with the help of a friend or participate in a group quit program. The method of quitting most would recommend to peers is 'use of will power'. Incentives to quit were attractive to only a third of the smokers, and many enhancing and inhibiting factors for participation in programs were identified. In particular, efforts to quit increased their confidence in quitting, supporting the need to assist those who are contemplating action to quit. Programs need to incorporate input from youth and be tailored for them but not necessarily for different groups such as non-secondary school students and unemployed youth.

Adolescent↗
PubMed1989

Exercise in the elderly.

Regular physical activity in the elderly delays decline in physical abilities, improves quality of life, and enhances functional capacity. As medical costs rise, preventive measures such as exercise are attaining great importance. Physicians should encourage their patients to participate in routine exercise and assist them in selecting an appropriate program. Preexercise evaluation is mandatory and should include a history and physical examination, an exercise stress test, and appropriate laboratory tests.

Aged↗
PubMedDate not supplied

A computerized method for the measurement of conspicuity. Comparison of film and digital nephrograms.

We have designed a computer program appropriate for comparing the conspicuity of an object of interest portrayed on film-based and photoelectronic images. To test this program, we evaluated nephrograms generated by exposing matched film tomograms and digital images of rabbit kidneys following contrast administration. We then evaluated their conspicuity--a measure of how well an object can be distinguished from its surround--by a computer program which automatically traced a concentric and equal area of surrounding background around operator-defined nephrograms. Computerized evaluation of these areas provides the formula elements (mean object and background density and variance values and the number of pixels) from which conspicuity is automatically calculated. Nephrogram conspicuity was greatest for digital subtraction images. This approach is useful for comparing film and digital techniques.

Analog-Digital Conversion↗
PubMed2001

The enculturation of our nursing graduates.

The transition from undergraduate nursing student to employment as a registered nurse is fraught with difficulties for a neophyte. This qualitative study used interviews and focus groups with graduate nurses from the Flinders University of South Australia in their first year of practice to ascertain their experiences as new graduates. The results reveal an enculturation of graduates not conducive to ongoing learning, consolidation of skills and application to practice. A rushed environment that was unpredictable, together with a lack of support, were recurrent themes from the graduates' perspective. Graduate nurse programs are run by institutions focused on outcomes and expenditure. There is little or no collaboration with the tertiary sector in providing appropriate programs according to graduates' needs. The graduates, as beginning practitioners, focused on not having the time to nurse holistically, an unrealistic workload, and the need for backup and continuous support on an individual basis. The wards, although possibly efficient and effective in providing health care, provided a culture where the graduates felt inadequate, rushed, overworked and unsupported, which is contrary to the aims and objectives of the graduate nurse programs. The nursing profession as a whole needs to develop a culture that is nurturing, enabling, supportive and protective of our young.

Education, Nursing, Baccalaureate↗
PubMed1977

Affecting the supply of rural physicians.

A model describing physician supply and distribution is described. Two surveys obtained information to examine elements of the model. The first survey identified a group of primary care physicians that had considered rural locations but ultimately selected an urban location. This sub-group, 29 per cent of the primary care supply pool, received a follow-up survey to provide more information about how they made their choice. About one-half of them finally chose on the basis of factors other than metropolitan/non-metropolitan considerations. For this half, some of the factors that entered into the decision were the availability of physician specialists, nearby hospital facilities, and access to medical school programs. Such factors could be affected by future policy decisions, but the cost is unknown. Even if such policy decisions were made, and appropriate programs instituted, the results would probably not solve the problem of disproportionate physician distribution. The most likely-to-succeed approach to increasing the number of rural physicians remains that of increasing the number of entrants to medical school with a rural background.

Career Choice↗
PubMedDate not supplied

The role of dental hygienists in state public health programs.

The role and personnel status of dental hygienists in state public health programs have not been documented. In October 1987, a 13-page questionnaire was mailed to the 55 state and territorial dental directors around the country, requesting information on dental hygienists who are employed by the state in public health positions. The questionnaire was divided into three categories: educational services; clinical services; and hygienists who divide their time between clinical and oral health educational services. Questions in each category requested information on job title, educational requirements, salary, benefits, and programmatic areas of responsibility. The purpose of this survey was to document the role and extent of participation by dental hygienists in state public health programs. Forty-eight states responded to the questionnaire, with 37 states employing dental hygienists in state public health programs. Twelve percent of the educational services and seven percent of the clinical services employing hygienists are in supervisory or management-level positions, with advanced degree requirements not necessarily a factor. Only 61% have dental hygienists involved with water fluoridation educational programs which, considering the known benefits of community water fluoridation, is surprisingly low. The survey results may be used to assist administrators in developing appropriate programs utilizing dental hygienists.

Adult↗
PubMedDate not supplied

A new curriculum for fitness education.

Regular exercise is important in a preventive approach to health care because it exerts a beneficial effect on many risk factors in the development of coronary heart disease. However, many Americans lack the skills required to devise and carry out a safe and effective exercise program appropriate for a life-time of fitness. This inability is partly due to the lack of fitness education during their school years. School programs in physical education tend to neglect training in the health-related aspects of fitness. Therefore, a new curriculum for fitness education is proposed that would provide seventh, eighth, and ninth grade students with (a) a basic knowledge of their physiological response to exercise, (b) the means to develop their own safe and effective physical fitness program, and (c) the motivation to incorporate regular exercise into their lifestyle. This special 4-week segment of primarily academic study is designed to be inserted into the physical education curriculum. Daily lessons cover health-related fitness, cardiovascular fitness, body fitness, and care of the back. A final written examination covering major areas of information is given to emphasize this academic approach to exercise. Competition in athletic ability is deemphasized, and motivational awards are given based on health-related achievements. The public's present lack of knowledge about physical fitness, coupled with the numerous anatomical and physiological benefits derived from regular, vigorous exercise, mandate an intensified curriculum of fitness education for school children.

Curriculum↗
PubMedDate not supplied

Medical surveillance in the biotechnology industry.

A medical program appropriate for employees in biomedical laboratories should be based upon specific understanding of the risks and hazards associated with the work activities. Components of a medical program might include: preplacement examinations, periodic monitoring evaluations, tracking of prolonged or unusual illness, specific illness or exposure-related evaluations, epidemiological studies, immunization programs, and exit (or termination) evaluations.

Accident Prevention↗