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PubMed2005

Understanding participation in an asthma self-management program.

STUDY OBJECTIVE: Asthma education programs improve asthma treatment results significantly. Low participation rate is a recurrent problem that impedes the efficiency of those programs. The purpose of this study was to investigate social cognitive determinants of the intention to participate in an asthma self-management program. DESIGN: Structured interview. SETTING: Outpatient clinic, University Hospital Gasthuisberg, Leuven, Belgium. PATIENTS: One hundred seven asthmatic outpatients (mean age 42 years; 35% male). INTERVENTIONS: Patients received a standard explanation about the asthma program, were invited to participate, and were questioned about their beliefs about the program offered. MEASUREMENTS AND RESULTS: A social cognitive framework (attitude, social influence, and self-efficacy model) was used to compose a structured interview that was administered to assess the patients' attitude toward the program (perceived benefits), their social influence, and self-efficacy expectations to participate (perceived barriers). Asthma-related health behavior and clinical and demographic characteristics were evaluated by means of questionnaires. Fifty-nine percent of the patients expressed the intention to participate. Logistic regression analysis resulted in a model explaining 72% of the variance of intentions (Nagelkerke R(2) = 0.72). Having few structural barriers to participate was a significant predictor of participation (odds ratio [OR], 12.5; 95% confidence interval, 5.2 to 19.3), next to believing in the personal benefits of the program (OR, 7.6; 95% confidence interval, 2.4 to 12.5), social influence (OR, 3.3; 95% confidence interval, 1.3 to 8.4), and education level (OR, 2.7; 95% confidence interval, 1.3 to 5.6). CONCLUSIONS: Recruitment of patients with asthma for an educational program should emphasize personal benefits of the program, should include patients' social network, and should consider the impact of structural barriers on participation behavior.

Adult↗
PubMed1990

Structured approach in PLC (programmable logic controller) programming for water/wastewater applications.

This paper describes a methodology for efficient implementation of PLC programming for water/wastewater applications. The PLC was interfaced with a supervisory host computer which used touch screen equipped color monitors as operator interfaces. PLC ladder logic had to be designed to process real-world hardwired I/O as well as the I/O received from the host computer and/or touch screens, via a communications link. Standard "templates" of PLC networks were developed for (a) pump controls including provision for touch screen I/O; (b) PID control; (c) alarms; (d) motor run times; (e) square root extraction; (f) signal conversion, and (g) flow totalization. All logic was implemented using the standard templates. This structured approach led to efficient implementation, easy debugging/start-up, and easy to read uniform ladder logic.

Computer Systems↗
PubMed1983

Shaping bladder and bowel continence in developmentally retarded preschool children.

A program to improve bladder and bowel continence was evaluated in a preschool with four developmentally retarded children. During baseline, the children were taken to the toilet on a regular schedule, once an hour. The training program increased this frequency to once every 15 minutes for the 1st week, every 30 minutes the 2nd week, every hour the 3rd week, and every 2 hours in the 4th week. Using the toilet appropriately was reinforced with social praise and liquids. Accidents resulted in a brief verbal reprimand and simple correction (i.e., going to the bathroom, changing clothes, and sitting on the toilet). All four children showed improvement in their bladder and bowel continence. Results of the program are discussed in terms of improved efficiency of toilet training programs and their use with developmentally retarded preschool children.

Behavior Therapy↗
PubMed1978

An integrated set of computer programs for processing electron micrographs of biological structures.

A set of computer programs is described which has been developed for processing electron micrographs of biological structures. The programs provide facilities for efficient image storage, enhancement and display. Extensive programs are available for analysis of images of structures with translational, rotational and helical symmetry, and for performing 3-dimensional reconstruction. The considerations which went into the design of the system are listed. A description is provided of the means of control of the main program, which performs the majority of the image processing operations, and an example is given to illustrate its use. These programs are compared with other program systems also developed for micrograph image processing.

Computers↗
PubMed1997

Age differences in using precued information to preprogram interception of a ball.

The present experiment examined the development of programming interception of a ball's movement across three groups of children ages 6, 8, and 10 years, who were compared with adults. In an interception task we manipulated the subjects' preparation by using Rosenbaum's 1980 precuing procedure. Two levels of precued information were used concerning the effector specified (right or left arm) and the direction of the arm projection (outside or inside). We focused particularly on RT and response errors. Analysis indicated RT decreased across the age groups and errors decreased mainly in the nonprecued condition. A critical period in improvement might be at age 8 as children use precue information to program their movements as efficiently as adults. The duration of effector programming was similar for children and adults but was more precise for the older subjects. For children as well as for adults, the specification of direction occurs after movement initiation and not before.

Adult↗
PubMed2005

[Possibilities and perspectives of home-based exercise training in patients with chronic obstructive pulmonary diseases].

In Germany there is a long tradition of rehabilitation and exercise training programs to improve the clinical state and physical function of patients with chronic obstructive pulmonary diseases. This is particularly true regarding inpatient rehabilitation. Based on experiences gained in other countries, outpatient and home-based programs are currently getting more attention. One of the key components of pulmonary rehabilitation is exercise training which can be expected to exert direct and indirect beneficial effects on physical performance, health-related quality of life and even the progress of the disease. Most of the available experience refers to patients with COPD -- besides those with bronchial asthma. The data available so far suggest that exercise training programs can reduce exacerbation rates and that this effect is achievable by minimal personal assistance. Thus the most important aim of future studies seems to be the development and evaluation of training programs which are efficient but also easy to implement and minimally expensive. Furthermore it needs to be studied whether such programs can be transferred to pulmonary disorders other than obstructive airway diseases.

Disease Progression↗
PubMed2003

Frail elderly patients. New model for integrated service delivery.

PROBLEM BEING ADDRESSED: Given the complex needs of frail older people and the multiplicity of care providers and services, care for this clientele lacks continuity. OBJECTIVE OF PROGRAM: Integrated service delivery (ISD) systems have been developed to improve continuity and increase the efficacy and efficiency of services. PROGRAM DESCRIPTION: The Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) is an innovative ISD model based on coordination. It includes coordination between decision makers and managers of different organizations and services; a single entry point; a case-management process; individualized service plans; a single assessment instrument based on clients' functional autonomy, coupled with a case-mix classification system; and a computerized clinical chart for communicating between institutions and professionals for client monitoring. CONCLUSION: Preliminary results on the efficacy of this model showed a decreased incidence of functional decline, a decreased burden for caregivers, and a smaller proportion of older people wishing to enter institutions.

Aged↗
PubMed1995

Referral rates and cost efficiency in a universal newborn hearing screening program using transient evoked otoacoustic emissions.

Recently, a National Institutes of Health Consensus Statement recommended that all infants be screened for hearing prior leaving the birthing hospital using a two-stage screening process based on transient evoked otoacoustic emissions (TEOAEs). Although the value of identifying hearing loss before 1 year of age is widely recognized, the feasibility of universal newborn hearing screening using TEOAE is sometimes questioned because it is presumed that the technique has a high false positive rate and is not cost efficient. This paper presents new data for 4253 infants from an operational universal newborn hearing screening program using a TEOAE procedure that answers those arguments.

Acoustic Stimulation↗
PubMed1997

Using profiling for cost and quality management in the emergency department.

Overutilization and underutilization of resources are inappropriate and may result in unacceptable quality of care and increased morbidity. Current data are needed to monitor the use of clinical resources and help identify physicians with appropriate cost/quality outcomes and those who may have utilization or quality problems. Profiling is an analytical tool that uses epidemiological method to compare cost, service use, and quality of various physician practice patterns for a large number of patient encounters. To develop a profiling program, standards of care must be established and information systems must be instituted to measure resource utilization and care efficiency. Such a program can be especially valuable in the emergency department of hospitals, where wide variation in practice patterns may occur because of the episodic nature of patient encounters. A reduction in practice variations saves time and increase patient throughput in many cases.

Ancillary Services, Hospital↗
PubMed1996

Tuberculosis screening in medical students.

BACKGROUND AND OBJECTIVES: The Liaison Committee on Medical Education and the Association of American Medical Colleges have issued recommendations for screening medical students for tuberculosis. This report describes the initiation of a tuberculosis screening program at the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences (USUHS). METHODS: A screening program was instituted in 1993 that included intradermal purified protein derivative, the "booster phenomenon," inter-reader variability, risk factor analysis, and administrative policy to improve compliance. RESULTS: There were 501 students screened (classes of 1996-1998). Initially, 19 (3.8%) students' tests were classified as positive, and 14 additional students tested positive when tested again 2 months later, due to the booster phenomenon. The subsequent conversion rate was 2.5% for those students who were followed for the next 3 years of medical school. All these students were placed on prevention therapy with isoniazid. No active cases of tuberculosis have been identified since the inception of the screening program. DISCUSSION: Only recently has the importance of screening medical students been emphasized. The USUHS program was designed to address the factors for a successful screening program, such as increased compliance, standardization, and documentation. With modifications according to resources, medical schools can offer an efficient tuberculosis screening program to students, faculty, and staff.

Humans↗
PubMed1986

Antitachycardia pacing: a comparison of burst overdrive, self-searching and adaptive table scanning programs.

Eight patients with the Siemens Elema "Tachylog" generator implanted for management of paroxysmal reentrant tachycardia were studied to assess the safety and efficiency of three antitachycardia programs. The programs investigated were burst overdrive, self-searching, and adaptive table scanning. There were five males and three females aged 19-62 years. Seven had Wolff-Parkinson-White syndrome, and one had dual atrioventricular nodal pathways. Four had right atrial electrodes and four had right ventricular electrodes. Patients were studied lying, standing, and exercising in all three modes, and the appropriate long-term programs were chosen. The generator remained in a program for 1 month, it was interrogated and the memory was read, and then it was reprogrammed to a different antitachycardia mode. Burst overdrive was unsuitable for long-term use in four patients, producing atrial fibrillation in one and ventricular arrhythmias in three. In this group, self-searching and adaptive table scanning were safe and equally effective (mean number of attempts/tachycardia 6.97 and 6.3, respectively). In the four patients in whom all three programs could be used, burst overdrive proved to be most efficient, the mean number of attempts/tachycardia were 2.4 (cf 9.6 and 9.0 for self-searching and adaptive table scanning). Thus, burst overdrive was only suitable for long-term use in 50% of our patients, but when safe it was more efficient than the other two programs, especially in those with narrow termination windows on exercise.

Adult↗
PubMed1985

Improving agency productivity.

The home care industry is being challenged by many changes, most notably an abrupt reorientation in HCFA reimbursement policy. One way agencies can combat the dwindling flow of funds is to improve labor productivity by performing more home visits with the same staff. Health care professionals have not traditionally embraced this concept, but the emphasis on cost containment makes "productivity-mindedness" a requirement. A sensitive, open process will help staff realize that quality of care and and cost-consciousness are not mutually exclusive. Carefully structured productivity tools can help provide agencies with the information they need to make better plans and decisions. A productivity improvement program, carefully planned and implemented by enlightened, enthusiastic management in cooperation with staff, can provide agencies with the benefits of improved efficiency. Such a program also provides agency leaders with the means to turn the challenge of providing quality care with fewer resources into new agency opportunities.

Efficiency↗
PubMed2005

Self-reported barriers to quality physical education by physical education specialists in Texas.

School-based programs offer an efficient means of promoting the health of a large number of children. The Coordinated Approach to Child Health (CATCH) program was designed to decrease risk factors for chronic disease in elementary school children and includes separate coordinated interventions for child nutrition services, physical education (PE), classroom instruction, and family education. Physical education specialists who attended CATCH training during school years 2000-2003 were surveyed about CATCH PE at their respective schools. The survey included items pertaining to PE barriers, implementation and satisfaction of CATCH PE, and demographic characteristics. A serial cross-sectional study design was used; response rates were 58.6% in 2000, 20.9% in 2001, 38.7% in 2002, and 57.7% in 2003. The top two rank order barriers to quality PE were large class size and low academic value. Future research should focus on determining characteristics of schools that are achieving quality PE programs.

Adolescent↗
PubMed1987

The management of work-related back pain.

This paper describes the Spinal Treatment Program at Columbia Hospital in Milwaukee. The primary goal of the program is to efficiently return the employee with a work-related back injury to the work setting. The two-phase program has been developed to provide treatment of acute injury, patient education, work hardening, and an assessment of the patient's ability to perform job tasks. Preliminary evaluative data are presented for patients treated from 1982 to 1984. The patient's discharge status (returned or did not return to work) was examined as a function of sex, age, educational level, employment category, duration of pain, or worker's compensation status. Results indicated that discharge status was significantly related to sex, employment category, duration of pain, and worker's compensation status.

Adult↗
PubMedDate not supplied

Development of a program logic model to measure the processes and outcomes of a nurse-managed community health clinic.

Evaluation is an essential process that permits assessing the effectiveness and efficiency of planned programs. In implementing a new nurse-managed Community Health Clinic targeting services for the homeless and underserved, the stakeholders considered an evaluation process integral to the planning stage of the clinic as a whole as well as of all the different programs being offered. The program logic model was chosen and modified to guide evaluation. Work to develop the evaluation model and its components began before the clinic opened. This article describes the development of the modified program logic model, how it was modified, and the rationale for its modifications. We highlight the process of developing the evaluation model because we found limited descriptions of the process in the literature. The evaluation process itself will be evaluated on an ongoing basis to determine if it is capturing the evaluation needs of the clinic project accurately.

Community Health Services↗
PubMed2005

[Social support and emergence of a feeling of parental efficiency: a pilot study on the contribution of the EcoFamille program].

This article presents the contribution of the support program EcoFamille in the emergence of a feeling of efficiency among parents of young children. The practical suggestions of the program are set in terms of illustrations and analyses of the dynamic diversity rather than in terms of solutions to problems. Following participation in the program, non-parametric analyses of the results using the Parents' Social Provisions Scale showed a significant increase in the level of social integration, and reinforcement on the self-perception of their educative skills, as well as in the areas of guidance, and the feeling of confidence as parents. Conclusion emphasizes the importance of focusing on adaptive potential, individual and collective, rather than simply offering limited and specific solutions to problems.

Adult↗
PubMedDate not supplied

Evaluating the impact of a theory-based sexuality and contraceptive education program.

A controlled field study involving 1,444 adolescent males and females 13-19 years of age was performed to compare a sexuality education program based on the health belief model and social learning theory with several publicly funded community-based and school-based interventions. Among males who had never had intercourse prior to participating in the study, those in the experimental program were more likely than those in the comparison programs to maintain abstinence over the next year; there was no program effect, however, among females. Among female adolescents who initiated intercourse after the start of the study, attendees of the comparison programs were more likely to have used an effective contraceptive at most recent intercourse and to have used an effective method more consistently than were those who attended the experimental program; no such association was seen among comparable young men. Both experimental and comparison programs significantly increased the consistent use of effective methods among teenagers who had been coitally active before attending the programs. Among males, however, when preintervention contraceptive efficiency was held constant, the experimental program led to significantly greater contraceptive efficiency during the follow-up year than did the comparison programs; among females, the two approaches produced an equivalent degree of improvement. Finally, prior exposure to sexuality education was associated with greater contraceptive efficiency at the one-year follow-up among almost all sexual-experience and gender groups, regardless of the type of intervention program attended.

Adolescent↗
PubMed1984

Delila system tools.

We introduce three new computer programs and associated tools of the Delila nucleic-acid sequence analysis system. The first program, Module, allows rapid transportation of new sequence analysis tools between scientists using different computers. The second program, DBpull, allows efficient access to the large nucleic-acid sequence databases being collected in the United States and Europe. The third program, Encode, provides a flexible way to process sequence data for analysis by other programs.

Base Sequence↗