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PubMed1992

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↗
PubMed1986

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↗
PubMedDate not supplied

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↗
PubMed1975

[The Caceres-USPHS (version HP-3) computer program. Evaluation of automatic analysis of 40,000 ECG (author's transl)].

The main features of Caceres-USPHS (version HP-3) program for automatic analysis of the ECG are reviewed. Our experience at the Ospedale Regionale di Udine has now reached a total of 40,000 tracings analyzed by such a program and with an HP 1530-A computer system. In a detailed study of 1,000 consecutive computer-analyzed tracings reviewed by three experienced cardiologists, 534 were normal and 466 abnormal. A high degree of specificity was detected in the normal group (only 1.5% of false negatives) while the sensivity was rather low. In the abnormal group there were 18.1% of false positives and while the agreement was 100% in complete bundle branch block and some types of infarction, it was 56% in atrial fibrillation and 47% in incomplete right bundle branch block. Program errors were more common in measurements and pattern recognition; they were unusual in the program logic (0.3%). A significant improvement over comparable data obtained one year previously was attributed to a better quality control in data recording and to increase physician acceptance of the program diagnostic criteria. On the current and past figures of accuracy, it is concluded that the version HP-3 of Caceres-USPHS program represents a step forward in computer-derived ECG interpretation. However more progress is still needed for a larger and more profitable clinical application of this ECG computer program.

Computers↗
PubMed1975

The international postpartum family planning program: eight years of experience.

The International Postpartum Program was begun in 1966 in order to demonstrate the feasibility of providing efficient and effective family planning services in the context of the obstetrical care provided by hospitals. The project included 138 institutions in 21 countries. Over an eight-year period, 1.14 million women were recruited, representing 33 acceptors per 100 obstetrical/abortion patients in these hospitals. Relying primarily on modern methods of contraception, the pill, the IUD, and sterilization, the program provided about 124 years of contraceptive protection for each 100 obstetrical/abortion patients, or somewhat more than four years' protection per acceptor. Predischarge insertion of IUDs was found to be safe and effective. In all countries, the program acceptors experienced important changes in fertility over and above the effects of aging. The demonstration showed that basing a program on activities in the obstetrical wards permits a rapid buildup of services, without great cost for construction. Whether using specially trained additional staff to provide family planning education and information or relying on the existing staff, hospitals were able to recruit a substantial proportion of women on the maternity wards as acceptors. Cost per acceptor averaged about US$5.00 during the eight-year period--considerably below the cost per acceptor in the majority of national programs. Such economy arose because acceptance ratios for the International Postpartum Program were higher than ratios for national programs where the target population is more dispersed, and because only direct costs for the services needed to be considered. The idea of uniting family planning information and services with the maternity services of hospitals has been seized upon and replicated outside the International Postpartum Program. The governments of India, Pakistan, Indonesia, Colombia, Thailand, and the Philippines, among others, now operate such systems. Postpartum programs still do not reach substantial segments of the urban population in the developing world, but the expansion of such services is continuing. Also, adaptations of maternity-centered family planning programs are now being tested in rural areas in the world, where most children are born.

Abortion, Induced↗
PubMed2006

Fidelity of implementation in Project Towards No Drug Abuse (TND): a comparison of classroom teachers and program specialists.

This paper presents the results of an effectiveness trial of Project Towards No Drug Abuse [TND], in which we compared program delivery by regular classroom teachers and program specialists within the same high schools. Within 18 schools that were randomly assigned to the program or control conditions, health classrooms were assigned to program delivery by teachers or (outside) specialists. Classroom sessions were observed by pairs of observers to assess three domains of implementation fidelity: adherence, classroom process, and perceived student acceptance of the program. Pre- and immediate posttest survey data were collected from 2331 students. Of the four composite indexes of implementation fidelity that were examined, only one (quality of delivery) showed a difference between specialists and teachers, with marginally higher ratings of specialists (p < .10). Both teachers and program specialists achieved effects on three of the five immediate outcome measures, including program-specific knowledge, addiction concern, and social self-control. Students' posttest ratings of the program overall and the quality of program delivery failed to reveal differences between the teacher- and specialist-led classrooms. These results suggest that motivated, trained classroom teachers can implement evidence-based prevention programs with fidelity and achieve immediate effects.

Adult↗
PubMedDate not supplied

The provision and evaluation of a neonatal resuscitation program.

The need to train perinatal staff in neonatal resuscitation is widely accepted; however, standardized educational programs have not been available. This study used a randomized control trial to evaluate a one-day neonatal resuscitation education program with 190 nurses. Experimental subjects receiving the program had significantly improved knowledge and skill performance. Knowledge, but not skill performance, was maintained at six months for the experimental group. There was a significant relationship between subjects' self-rating of knowledge and performance, suggesting that this method could be used to prioritize staff for basic or refresher training. An effective format and evaluation instruments for neonatal resuscitation training have been developed. Strategies to maintain skills should be addressed in future research.

Adult↗
PubMed1995

In search of effective programs to address students' emotional distress and behavioral problems. Part II: Critique of school- and community-based programs.

Part I of this article discussed the dimensions of students' emotional distress and behavioral problems and proposed school programs to address it. This section evaluates the school- and community-based programs advocated in educational, psychological, and psychiatric journals over the past five years. Twenty-nine articles were selected, and the programs classified by location, focus, and format. Their merits and limitations based on their results are discussed. This review found that (1) some programs poorly defined the study populations; (2) emotional distress was not included as a criterion; (3) a strictly behavioral approach or narrow focus on specific populations or issues prevailed. Only four programs used emotional expression and social support; (4) outcome measures focused on specific behaviors with only one study evaluating the emotional outcome; (5) none addressed the student's acceptance of the program; (6) only five measured the outcome beyond the immediate termination of the intervention, and only to a limited degree. While the programs reviewed support the likelihood that such interventions may be helpful, definitive conclusions which can be generalized to average high school students are still lacking. Recommendations for future school-based programs are proposed.

Adolescent↗
PubMed2001

Qmol: a program for molecular visualization on Windows-based PCs.

With the advent of powerful, inexpensive graphics hardware, a variety of molecular modelling tools are now available for personal computers (PCs). While a host of high-quality, free visualization programs exist for Unix-like operating systems, there are relatively few available for Microsoft Windows. Most programs that do run under Windows are designed to interactively visualize experimental data and cannot read binary trajectory data generated by molecular simulations. In addition, many of these programs do not accept command line arguments, limiting their ability to serve as a "helper" application to be run by other applications. To fill this gap in functionality, we present Qmol--a program designed for viewing the output of simulations and theoretical calculations of peptides and small molecules.

Chemistry Techniques, Analytical↗
PubMed2005

Prospective evaluation of remote, interactive videoconferencing to enhance urology resident education: the genitourinary teleteaching initiative.

PURPOSE: Changes in referral patterns and resource allocation into Centers of Excellence affect the educational experience of urology trainees by altering resident exposure to patients and clinicians, especially at sites where subspecialty deficiencies exist. Access to educators at Centers of Excellence using interactive videoconferencing technology may facilitate residency training objectives and enhance trainees' overall educational experience. We prospectively evaluated the implementation of this technology at tertiary care teaching centers to enhance urology resident education. MATERIALS AND METHODS: Using videoconferencing technology, urology residents at the University of Western Ontario (London, Canada) participated in a series of didactic, interactive pediatric urology teleteaching seminars. These were presented by an expert pediatric urologist from the Hospital for Sick Children, Toronto, Canada. Using a 5-point Likert scale (1-strongly disagree, 5-strongly agree), participants responded to statements pertaining to seminar content, technology and ease of use at the completion of each session. The results were subsequently tabulated and evaluated to determine the effectiveness and accessibility of the program in providing expert pediatric urological education to residents at a remote urology training program. RESULTS: The entire urology resident staff from postgraduate year 1 to 5 participated in the seminar program. The overall acceptance of this medium was high (mean score 4.5). The quality of presentation, as well as picture and sound quality, all received mean scores greater than 4. Participants indicated that their ability to interact with the presenter was not inhibited by using this medium. All participants agreed that they would use this technology in the future (mean score 4.5) and that the presentation would not be improved if the presenter were on-site. Due to preexisting technology at both centers, no direct cost was incurred throughout the study. CONCLUSIONS: Our experience suggests that interactive teleteaching using readily available, existing technology, is a cost-effective and accepted method of providing trainees with an appropriate educational experience. In centers where subspecialty deficiencies exist, this medium may provide residents with the necessary education requirements of their respective programs without the need for costly teacher (or student) travel. Continual improvements in technology as well as the addition of multiple sites will increased this medium's impact in the future.

Adult↗
PubMed1996

Attitudes regarding advance directives among patients in pulmonary rehabilitation.

We performed a cross-sectional, descriptive questionnaire study in two pulmonary rehabilitation programs to assess: (1) attitudes of 105 subjects with chronic lung conditions about end-of-life decision-making; (2) the determinants of these attitudes; and (3) patient acceptance of rehabilitation programs as foci for education about advance directives (ADs). We found that 99 of the 105 subjects (94.3%) had health worries, the most common of which was fear of increasing dyspnea (33.3%). Although 93.8% had opinions about intubation, less than 42% had completed an AD. Most subjects wanted information about ADs (88.6%) and life-support (68.6%); pulmonary rehabilitation programs, lawyers, and physicians were preferred sources for AD information. Although 98.9% of the patients wanted patient-physician AD discussions, only 19.0% had such discussions, only 15.2% had discussed life-support, and only 14.3% thought that their physicians understood their end-of-life wishes. Subject willingness to undergo intubation varied with baseline health, likelihood of survival, and anticipated health following extubation. We conclude that patients in pulmonary rehabilitation programs desire more information about end-of-life issues than is currently provided by physicians. They regard pulmonary rehabilitation educators as valuable sources of AD education.

Aged↗
PubMed1995

Cost-efficient radical prostatectomy.

Radical retropubic prostatectomy is an easily standardized procedure with reproducible outcomes. Care has been standardized at our institution through the use of a collaborative care approach that defines the optimal care and outcomes for the ideal patient on a daily basis. This approach is based on an objective evaluation of the available medical literature. With this program, hospital charges have been reduced by 41% and hospital stay has been reduced to 2.9 days. Surgical outcomes have been excellent with low morbidity rates and excellent patient acceptance. Collaborative care programs for health care provide a comprehensive approach that allows for the delivery of cost-efficient care, which is supportive of the patient and allows continual refinement in care based on objective analysis of outcomes.

Cost Control↗
PubMed1997

Findings from a statewide program of respite care: a comparison of service users, stoppers, and nonusers.

This study compared respite users with stoppers and nonusers in the Health Resources and Services Administration-funded Alzheimer's disease demonstration grant in the State of Maryland. Of those accepted into the program, only 54% participated for at least 6 months. The primary reasons for stopping were the death or institutionalization of the relative, while those not using respite services felt they didn't really need them. Determinants of program use included the poorer cognitive status of the relative and less anxiety and greater burden among the caregivers. After 6 months, users reported fewer hours of informal assistance, less burden, and that the relative had fewer behavioral problems although cognitive status and activities of daily living (ADLs) had deteriorated.

Aged↗
PubMed2003

Evaluation of the National Resident Matching Program (NRMP) radiation oncology data (1993-2003).

PURPOSE: Radiation oncology continues to evolve as a specialty. In the early 1990s, issues of manpower oversupply, resource allocation, development of academic radiation oncology, and residency training curricula were fervently considered and evaluated. Much of this effort continues. This communication endeavors to examine the National Residency Matching Program (NRMP) results as they pertain to radiation oncology to identify and document applicant trends over the last decade. METHODS AND MATERIALS: The NRMP database tables for inclusive dates 1993-2003 were evaluated. The database figures were supplied directly from the executive staff at the AAMC/NRMP. Data were reviewed for radiation oncology, and the following variables were evaluated for the study period (1993-2003): Training program participation, positions offered, applicant totals, proportion of US senior applicants, US seniors as a percentage of those who successfully matched, ratio of applicants to positions, and percentage of training program positions filled. Trends over the study period were analyzed. Data were also analyzed for all specialties collectively as a comparison group. RESULTS: The number of training programs has remained relatively stable between 1993 and 2003. In 2003, each radiation oncology program in the NRMP on average accepted two new candidates. The number of positions offered has fluctuated over time. There appeared to be a downward trend until 2003, during which 107 positions were offered. The number of applicants continues to rise with totals of 209 and 214 in 2003 and 2001, respectively. Percentage of US senior applicants compared with the total pool has remained relatively stable, but raw numbers are rising. The number of US seniors as a percentage of those who successfully matched escalated during 2001 compared with previous years. This value has been consistent over the past 3 years, at a level of approximately 94%. The ratio of applicants to positions, which is a broad indicator of level of competition for entrance, began to rise significantly in 2000 to a level of 1.9. It peaked at 2.6 in 2001, and the ratio for 2003 was approximately 2.0. For the first time, all positions offered were filled (100%) through the NRMP match process in 2003. Such positive trends have not been realized to the same degree for all specialties analyzed as a cohort. CONCLUSION: Acceptance into radiation oncology training programs through the NRMP has become very competitive. The explanation for this trend is likely complex with many variables. These data may be helpful in training program development and will certainly be of service to advisors of medical students seeking entrance into the field in the near future.

Career Choice↗
PubMed1982

Development of a quality assurance program as an integral part of the physical therapy system.

The purposes of this article are to describe the conditions that must be met and the process that must be carried out to develop, implement, and evaluate a quality assurance program. The conditions to be met are administrative support for the program; knowledge of quality assurance theories and components (including structure, process, and outcome standards); and a commitment of the department members to quality assurance. The participative approach to program development is essential to the acceptance and implementation of the program. The process is cyclical in nature with the actual program design based on the needs of the people to be served. The department's policies and procedures manual provides the appropriate place for the documentation of the program standards so they are easily accessible to all staff and are an integral part of the delivery system. External peer review is used in measuring the potential for success of the program's structure.

Activities of Daily Living↗
PubMedDate not supplied

Medical students' attitudes toward the use of an endoscopic sinus surgery simulator as a training tool.

BACKGROUND: Modern adult learning theory characterizes self-directed learning as most effective. While studying the effectiveness of an endoscopic sinus surgery simulator (ES3) as a training tool and acknowledging that its successful integration into a training program is dependent on its acceptance and self-driven use by trainees, we sought to determine our study subjects' attitudes toward the simulator. METHODS: Twenty-six medical students were enrolled and trained in our ES3 study. Each student was asked to complete a 28-item questionnaire on completion of training. This questionnaire contained 10-point Likert scale instruments, yes/no questions, and one open-ended question. RESULTS: All but four subjects responded to the questionnaire; 90.9% of the respondents rated the training benefit derived from the simulator's novice mode as 6 or greater on a 10-point scale; the mean was 7.82 (+/- 2.22). The training benefit of the intermediate mode also was scored highly, with a mean score in the 7-9 range for all but one component-heart rate response to actions performed. Trainees appreciated the simulator's ability to help them adapt to a three-dimensional space on a two-dimensional display. They also noted its strengths in elucidating intranasal anatomy. CONCLUSION: Medical students who enrolled in our study, as a group,felt that the ES3 provided them with significant training benefits. Although subjective, these attitudes, coupled with objective data indicating that there is a measurable benefit from use of the ES3, will ensure itsfull acceptance and use in otolaryngology training programs.

Adult↗
PubMed2006

Antenatal herpes serologic screening: an appraisal of the evidence.

OBJECTIVE: Calls for universal antenatal type-specific herpes simplex virus (HSV) screening to prevent neonatal herpes have recently increased and would affect the four million pregnant women and their partners annually in the United States. We undertook this review to assess the appropriateness of such screening, making relevant comparisons to established antenatal human immunodeficiency virus (HIV) and hepatitis B virus (HBV) screening programs. DATA SOURCES: We conducted a full PubMed and bibliographic search for relevant literature in English available from 1966 through February 2006, using the terms "genital herpes," "neonatal herpes," "decision analysis" or "cost-effectiveness analysis," and "herpes and pregnancy" or "antenatal herpes screening." Comparison literature was obtained by replacing "herpes" with "HBV" or "HIV". METHODS OF STUDY SELECTION: We appraised antenatal type-specific HSV screening using well-established criteria for a good screening program, which we articulated as questions. Of 455 articles we selected those that addressed at least one of the questions and were pertinent to the U.S. population. TABULATION, INTEGRATION, AND RESULTS: We found that neonatal HSV is rare and its incidence is imprecisely defined. There is a lack of evidence supporting the effectiveness of interventions to prevent maternal acquisition of new infection in late pregnancy, which accounts for 60-80% of neonatal herpes. The consequences of universal screening are incompletely understood but include the potential for unnecessary cesarean deliveries and medical treatment, maternal psychosocial stress, and discord among partners. The available evidence indicates universal screening is not cost-effective. In contrast, antenatal HIV and HBV screening programs better satisfy accepted criteria for screening. CONCLUSION: On the basis of this appraisal, universal antenatal type-specific HSV screening to prevent neonatal herpes does not adequately satisfy criteria of a good screening program, and we recommend against its adoption.

Cost-Benefit Analysis↗