"Disabled people aren't interested in sex...".
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Attitude of Health Personnel↗
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Evaluating needle exchange: a description of client characteristics, health status, program utilization, and HIV risk behavior.
This study was designed to describe demographic and drug use characteristics, health status, and HIV-related risk behavior among clients attending the San Francisco needle exchange program (NEP), and to assess the relationship between NEP utilization and risk behavior. Randomly selected clients were interviewed when they visited the NEP. Participants were of diverse ethnicity, had a mean age of 38.2, and 72% were male. Many reported being homeless (25%), unemployed (34%), uninsured (52%), and having an episode of infectious disease in the past 2 years (36%). Clients who received a higher proportion of their needles from the exchange were less likely to report sharing of needles or rinse water. Clients who attended the exchange more frequently were more likely to clean their skin prior to injecting and less likely to use the same needle repeatedly. Frequency of visiting the NEP was not associated with the likelihood of sharing needles or rinse water. Efforts to evaluate needle exchange in the United States will benefit from descriptive reports from other NEP programs, and the use of nonexchange comparison groups.
Adult↗
[Evaluation and renewal of vaccination program].
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Communicable Disease Control↗
Jelly alone vs. diaphragm and jelly.
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Contraception↗
Success of in vitro fertilization and embryo transfer in relation to the causes of infertility.
In 1984 163 patients were treated in our in vitro fertilization program, including 4 patients accepting embryos from the oocyte and embryo donation program. Twenty pregnancies were achieved with an average chance per transfer of 16,6%. The final success of IVF strongly depends on the cause of infertility. The best results were obtained for patients with tubal infertility, with a pregnancy rate of 15% per laparoscopy and 19% per transfer. There is a significant decrease in oocyte cleavage rate from tubal (61%) to male infertility (13%). Once the barrier of embryo formation is taken, there is no marked difference in the mean number of embryos transferred on the pregnancy rate after transfer, among the different patient groups. In patients with tubal infertility the pregnancy rate per cycle remains constant, resulting in a cumulative pregnancy rate of 40% after 3 cycles.
Antibodies↗
Obstetrical caudal anesthesia in a community hospital. A satisfactory plan.
The development of a program to provide complete anesthesia coverage for obstetrics in a community hospital was undertaken as a prospective project which emphasized continuous caudal techniques. Mutually acceptable guidelines were formulated by a group of anesthesiologists and the Department of Obstetrics and Gynecology. A computerized study involving 3,500 labor patients was carried out to thoroughly evaluate the experience over 16 months. The data confirmed the feasibility, safety and wide acceptance of the program. Major complications were few and the anesthesia service to patients was excellent.
Anesthesia, Epidural↗
Evaluation of adverse events after influenza vaccination in hospital personnel.
Reactogenicity of trivalent influenza vaccine prepared for the 1988-89 season was assessed as part of a first-time voluntary influenza prevention program among hospital staff. Of approximately 500 full-time workers in areas with the highest concentrations of patients at high risk for influenza complications offered the vaccine 288 accepted. Of these, 266 (92%) returned a questionnaire regarding any symptoms experienced within 48 hours after vaccination; 238 (90%) of the respondents reported adverse effects. Soreness at the injection site was described by 229 subjects, 58 (25%) of whom had constant aching and 123 (54%) soreness with arm movement. Symptoms resolved in 1 to 2 days, and only 21 (9%) of those who reported symptoms said they took analgesic medication. Systemic adverse effects were described by 130 subjects (49%). Intercurrent illness accounted for some of these complaints, but 65 people (24%) described at least two of the following symptoms: generalized aching, tiredness, nausea, chills or onset of fever within 12 hours after vaccination (a symptom complex previously attributed to influenza vaccine). Systemic symptoms resolved within 0.5 to 2 days. Thirteen subjects (5%) reported missing work because of arm soreness (1 subject) or systemic symptoms (12). Adverse effects were encountered more often than expected, probably because most of the workers were young and lacked immunity to influenza. Acceptability of the program could likely be improved by using a split-virus vaccine.
Absenteeism↗
A preschool program for safety and injury prevention delivered by home visitors.
OBJECTIVE: To evaluate the feasibility, acceptability, and effectiveness of an injury prevention program delivered by school based home visitors to the families of low income children attending preschool enrichment programs in Washington State. STUDY SAMPLE: The families of children attending preschool Head Start programs in two regions were eligible. A total of 213 families (77.8% of those eligible) from intervention sites, and 149 families (71.9% of those eligible) from concurrent comparison sites, agreed to participate and completed the trial. INTERVENTION: Trained school personnel conducted home safety inspections as part of a planned home visit. Intervention families were offered educational materials as well as smoke detectors, batteries, ipecac, and age appropriate car safety restraints based on results of the home inspection. EVALUATION METHODS: At a repeat home visit three months later, the proportion of families with a positive change in injury prevention knowledge or behavior among those in the intervention group was compared with the proportion in the comparison group. Smoke detector presence and function were observed. RESULTS: Among families without a working smoke detector at baseline, the intervention was associated with an increased probability of having a working detector at follow up (relative risk (RR) 3.3, 95% confidence interval (CI) 1.3 to 8.6). Intervention families were also more likely to report the presence of ipecac in the home (RR 4.7, 95% CI 3.0 to 7.3) at follow up and to have obtained an age appropriate booster seat (RR 4.1, 95% CI 1.9 to 8.8). The program was acceptable to client families and to the home visitors who conducted the intervention. CONCLUSIONS: Among the families of low income children enrolled in preschool enrichment programs, home safety inspections and the distribution of safety supplies by school based home visitors appears to improve knowledge and behavior related to poisoning, smoke detector installation, and car safety seat use over three months of follow up.
Accidents, Home↗
Efficacy of a one-month training block in psychosocial medicine for residents: a controlled study.
STUDY OBJECTIVE: To determine the efficacy of a comprehensive, one-month psychosocial training program for first-year medical residents. DESIGN: Nonrandomized, controlled study with immediate pre/post evaluation. Limited evaluation of some residents was also conducted an average of 15 months after teaching. SETTING: Community-based, primary care-oriented residency program at Michigan State University (MSU). SUBJECTS: All 28 interns from the single-track MSU residency program during 1986/87-88/89 participated in this required rotation; there was no dropout or instance of noncompliance with the study. In the follow-up study in 1989, all 13 available trainees participated. Of 20 untrained, volunteer controls, ten were second/third-year residents in the same program during 1986/87 and ten were interns from a similar MSU program in Kalamazoo, MI, during 1988/89. TEACHING INTERVENTION: An experiential, skill-oriented, and learner-centered rotation with competency-based objects focused on communication and relationship-building skills and on the diagnosis and management of psychologically disturbed medical patients. MEASUREMENTS AND MAIN RESULTS: The two subsets of the control group were combined because residents and training programs were similar and because means and standard deviations for the subsets were similar on all measures. By two-way analyses of variance (group x gender), the trainee group showed significantly greater gains (p less than 0.001) on questionnaires addressing knowledge, self-assessment, and attitudes; a mean of 15 months following training, there was no significant deterioration of attitude scores. All trainees were also able to identify previously unrecognized, potentially deleterious personal responses using a systematic rating procedure. Residents' acceptance of the program was high. CONCLUSIONS: Intensive, comprehensive psychosocial training was well accepted by residents. It improved their knowledge, self-awareness, self-assessment, and attitudes, the latter improvement persisting well beyond training.
Adult↗
Clinical preventive services efficacy and adolescents' risky behaviors.
OBJECTIVE/BACKGROUND: To analyze the value of studying or implementing office-based clinical preventive services for adolescents. Most adolescent mortality and morbidity is attributable to risky behaviors, yet clinical preventive services to reduce risky behaviors are often challenged because their efficacy has not been demonstrated. DESIGN: A cost-effectiveness model of adolescents' risky behaviors that compares standard practice with a program of screening visits for all adolescents and counseling visits for youth identified as high risk. We considered two risky behaviors, alcohol abuse and unsafe sexual activity, and five outcomes. MAIN OUTCOME MEASURES: Baseline cost-effectiveness of the program, minimum efficacy at which the program would be cost-effective, and sample sizes required for a trial of the program. RESULTS: Assuming that the program is 5% effective at preventing risky behaviors, it would cost $3035 to prevent any one adverse outcome and $471,000 to prevent a death from an automobile crash or from human immunodeficiency virus infection. Assuming society were willing to pay $600,000 to prevent a death (a generally accepted figure), the program would be cost-effective only if it were 5.6% effective at changing behavior. At this efficacy, the program would have a cost per year of life saved comparable to or better than many other accepted medical interventions. However, to demonstrate changes in outcomes at this efficacy would require a clinical trial with between 4000 and 95 million adolescents in each treatment group, depending on the outcome measured. CONCLUSIONS: Studying the ability of clinical preventive services to prevent outcomes of adolescents' risky behaviors would be impractical. The decision to implement these programs should be made based on current knowledge and beliefs; their efficacy can probably be studied only as part of widespread implementation.
Adolescent↗
Perinatal outreach education. A continuation strategy for a basic program.
The Perinatal Continuing Education Program consists of a nine-month intervention with community hospital nurses, physicians, and support personnel. Components include a hospital self-inventory of resources, coordination by community hospital staff, a skills workshop, and self-instructional books. This article outlines a follow-up strategy to the basic program and describes changes in community hospital knowledge and care practices that occur between programs. The follow-up program presented includes a modified coordinators' workshop, identification of updated self-instructional materials for careful study by past participants, and a self-survey of "recommended routines" intended to facilitate change in hospital policies. Otherwise, except for the deletion of the resources inventory, the follow-up program is similar to the basic program. Testing of participants and detailed review of 1435 hospital charts at sequential time periods revealed a decline in mean knowledge scores between programs, higher scores by new participants before follow-up when compared to pre-basic program, a plateau of patient care quality between programs, and a further improvement in patient care quality after the follow-up program. We conclude that a follow-up program is best accepted after three years but that timing is not critical. Evaluation measures suggest that new knowledge and care practices become institutionalized as a result of this program and that altered care practices are not simply a result of improved performance by individuals.
Education, Medical, Continuing↗
Tuberculosis in the workplace: OSHA's compliance experience.
OBJECTIVE: Inspections of 272 facilities were performed between May 1992 and October 1994 to determine compliance with applicable Occupational Safety and Health Administration (OSHA) requirements for prevention of tuberculosis (TB) transmission. DESIGN: Retrospective record review of two data sources: (1) OSHA's Computerized Integrated Management Information System and (2) an inspector-completed questionnaire on inspection results. SETTING/PARTICIPANTS: Inspections of five types of facilities: healthcare institutions, correctional facilities, homeless shelters, long-term-care facilities for the elderly, and others, including drug treatment centers that the Centers for Disease Control and Prevention (CDC) identified as having a higher than expected rate of TB. METHODS: The OSHA Compliance Memorandum, based on the 1990 CDC Guidelines, which outlined elements of a TB prevention program, was used in performing 272 inspections of facilities between May 1992 and October 1994. Elements of compliance were recorded and reviewed from the IMIS database and inspectors' questionnaires. RESULTS: Regulated facilities were not fully compliant with OSHA guidance. Generally, healthcare facilities performed better than other facilities. Most facilities (79%) were compliant with administrative elements of a comprehensive TB control program, such as early identification of known or suspected infectious TB patients and skin testing of workers. Only 29% of inspected facilities were found to have acceptable respiratory protection programs for the prevention of occupational TB. CONCLUSION: Facilities have not been fully compliant with the OSHA memorandum describing protection of workers from TB. Facility compliance was better with some traditionally recognized TB infection control elements, but was weaker in the area of respiratory protection programs. This may reflect a lack of familiarity with the latter type of hazard protection.
Facility Regulation and Control↗
A graduate program designed for medical and other doctoral degree applicants.
The data collected during the evaluation of the natural science program at Roswell Park revealed a high rate of success in preparing students to enter health and science related careers. An average of 50 percent of the entering students each year had been unsuccessful medical school applicants or students preparing to enter Ph.D. programs following an initial research experience. The program assists students in admission to medical and research programs and encourages research participation. Many graduate programs will not accept or find difficulty dealing with students who have career goals in medicine and are not necessarily in research. This is understandable, especially in Ph.D. granting programs with substantial investments of faculty time and funding. The philosophy of the program reported here is to assist the students to enter the career of their choice; however, at the same time, the faculty members insist on a high level of scholarship in course work and research during the program. With this philosophy, the program continues to be successful in attracting students of high quality.
Education, Graduate↗
Modular group therapy in a community mental health center.
To use staff resources more efficiently, a community mental health center in South Carolina initiated an eight-session modular psychoeducational and group therapy program with a classroom format. Groups were composed of three to 12 patients with the same or similar diagnoses. Each session in the series constituted a complete module and included didactic presentations and group discussion about the material. At follow-up two years after the program started, the program was well accepted by staff and patients. The proportion of patient contacts for group therapy and revenue generated by group contacts had increased. Although an aim of the program was to reduce the frequency of contacts for individual therapy, these contacts did not decline over the follow-up period.
Case Management↗
Vocational rehabilitation for psychiatric inpatient Vietnam combat veterans.
A Department of Veterans Affairs (DVA) inpatient psychiatry program treating Vietnam veterans for symptoms of posttraumatic stress disorder provided day and evening treatment programs. The evening program, besides treating psychiatric trauma, incorporated the DVA mission of assisting patients with vocational rehabilitation and work force reentry. Although initially opposed to employment, Vietnam veterans accepted a treatment program with an emphasis on working and job training. Both programs were compared using the Ward Atmosphere Scale (WAS). No significant differences between the two programs were found. The results support the DVA's position that employment is a valuable component of psychiatric treatment.
Adult↗
Developing shared decision-making programs to improve the quality of health care.
We strongly believe in the importance of patient involvement in a medical decision. The interactive SDPs appear to be an effective way to facilitate this involvement. One key to the acceptance of these programs by patients and physicians is that they be--and be perceived as--fair, accurate, and balanced. Herein we have described the well-defined protocol for developing, evaluating, and updating SDPs. The first of the foundation's programs dealing with benign prostatic hyperplasia has been well received by patients and clinicians and has been demonstrated to have an impact on practice patterns. Efforts are under way to evaluate four additional programs, leading to widespread availability of the first five SDPs by fall of 1992.
Decision Making↗
PROBFIND: a computer program for selecting oligonucleotide probes from peptide sequences.
Synthetic oligonucleotides have proven to be extremely useful probes for screening cDNA and genomic libraries. Selection of the appropriate probe can be more easily and accurately achieved with the use of the computer program PROBFIND. The user enters the amino acid sequence from a file or from the keyboard, selects the minimum length allowed for the probe and the maximum allowable degeneracy. The computer prints a list of the sequences of potential probes which meet these minimum specifications and the location of the corresponding sequence in the protein to the screen and to a file. The user may modify the specifications for length and degeneracy at any time during the output of data, which allows for rapid selection of the desired probe. The program is interactive, accepts any file format with only a single modification of the file, is written in BASIC, and requires less than 6 kbytes of memory. This makes the program easy to use and adaptable even to unsophisticated microcomputers.
Amino Acid Sequence↗
Program accreditation and correctional treatment.
In the correctional field, treatment program accreditation requires the support of correctional administrators and program providers for successful introduction. How accreditation criteria are developed and a support structure for the process in corrections is achieved is in itself an interesting story. Her Majesty's Prison Service has, in 3.5 years, accelerated the effectiveness of correctional treatment programming, established a platform for program integrity, obtained acceptance by the institutional leadership, and increased pride and morale among prison officers. In this article we describe the development, structure, content, and benefits of correctional treatment program accreditation as it has occurred in England and Wales.
Accreditation↗