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PubMed2004

An approach to simulation program development.

Simulation education is becoming increasingly popular. Many institutions and programs find themselves in a situation where they have an identified need for the simulation education but few resources to reference. Most programs purchase first and ask questions later, leaving faculty with equipment with which they are unfamiliar and few, if any, resources to contact. Developing a simulation program involves more steps than one would think. Developing a vision and business plan are paramount. Only with a well-developed business plan will decision maker buy-in occur. Consideration must also be given to facility construction or renovation, equipment purchase, faculty development and training, and most important, curriculum development. These steps are not intuitive. This article describes these steps in a concise and manageable way and is intended to serve as a template that hopefully will increase the likelihood of developing successful and efficient simulation education programs.

Computer Simulation↗
PubMed2006

Parameter estimation in stochastic mammogram model by heuristic optimization techniques.

The appearance of disproportionately large amounts of high-density breast parenchyma in mammograms has been found to be a strong indicator of the risk of developing breast cancer. Hence, the breast density model is popular for risk estimation or for monitoring breast density change in prevention or intervention programs. However, the efficiency of such a stochastic model depends on the accuracy of estimation of the model's parameter set. We propose a new approach-heuristic optimization-to estimate more accurately the model parameter set as compared to the conventional and popular expectation-maximization (EM) algorithm. After initial segmentation of a given mammogram, the finite generalized Gaussian mixture (FGGM) model is constructed by computing the statistics associated with different image regions. The model parameter set thus obtained is estimated by particle swarm optimization (PSO) and evolutionary programming (EP) techniques, where the objective function to be minimized is the relative entropy between the image histogram and the estimated density distributions. When our heuristic approach was applied to different categories of mammograms from the Mini-MIAS database, it yielded lower floor of estimation error in 109 out of 112 cases (97.3 %), and 101 out of 102 cases (99.0%), for the number of image regions being five and eight, respectively, with the added advantage of faster convergence rate, when compared to the EM approach. Besides, the estimated density model preserves the number of regions specified by the information-theoretic criteria in all the test cases, and the assessment of the segmentation results by radiologists is promising.

Algorithms↗
PubMedDate not supplied

A computer-aided system for the diagnosis of hepato-biliary diseases. A comparison with the performance of physicians.

A computer-aided system has been developed for the diagnosis of disease of the liver and biliary system. The program is based on the use of 30 indicants, all of which are available within six hours after patient's admission: 18 of them are clinical signs, 12 are laboratory parameters including routine liver-function tests. To date, the program concerns 52 hepato-biliary diseases. From the analysis of the 30 items collected in any patient, the diagnoses are computed according to Bayes' theorem and printed by decreasing order of probability. The performance of the program was tested using records of patients with fully proven diagnosis. The first diagnosis given by the computer was correct in 57 per cent of the cases. In 80 per cent, the right diagnosis was among the first four proposed. When the performance of the model was compared to that of physicians, the number of correct answers was roughly the same for the computer and for the specialists in hepatology; in contrast, the computer's responses were far better than those of general practitioners. These results demonstrate the efficiency of the program for the diagnosis of hepato-bilitary diseases and its potential interest for helping clinicians in decision-making.

Adult↗
PubMed1975

[ECG evaluation by the computer using the USPHS program (author's transl)].

The efficiency of ECG evaluation by the computer has definitely increased owing to the current improvement of the program. Applying the USPHS program in our material, a wrong diagnosis was made in 14% of the pathological tracings and in 25% of the normal tracings under investigation. These results are certainly encouraging, considering that dissimilar diagnoses are established by different cardiologists in about 20% of the cases. However, we deem the number of wrong diagnoses both in pathological and in normal cases still too high and, therefore, further improvement should be made before applying ECG diagnosis by the computer in practice.

Arrhythmias, Cardiac↗
PubMed1993

Cost effectiveness and efficiency in assistive technology service delivery.

In order to develop and maintain a viable service delivery program, the realities of cost effectiveness and cost efficiency in providing assistive technology must be addressed. Cost effectiveness relates to value of the outcome compared to the expenditures. Cost efficiency analyzes how a provider uses available resources to supply goods and services. This paper describes how basic business principles of benefit/cost analysis can be used to determine cost effectiveness. In addition, basic accounting principles are used to illustrate methods of evaluating a program's cost efficiency. Service providers are encouraged to measure their own program's effectiveness and efficiency (and potential viability) in light of current trends. This paper is meant to serve as a catalyst for continued dialogue on this topic.

Cost-Benefit Analysis↗
PubMed2000

Acquisition strategies for critical care technology.

Technological advances in critical care will undoubtedly find their way into the ICU of the 21st century. The challenge for critical care practitioners is to meticulously assess these innovations and adopt the most appropriate and efficient technologies that will improve unit function and staff efficiencies, support educational programs, and most importantly, enhance patient outcome at a reasonable cost. Hospital-based intensivists have excellent opportunities to establish leadership roles in the technology evaluation process by cultivating relationships with administrators, and through active participation in the hospital-based Technology Committee and the ICU-based multidisciplinary committee. The authors' experience has left them with the lasting impression that the evaluation and introduction of new technology is time consuming and requires perseverance and patience. Ultimately, it is hoped that technological breakthroughs coupled with a standardized approach to delivery of ICU services in the coming decades will ensure better and more efficient care to critically ill patients.

Cost-Benefit Analysis↗
PubMed2004

Surface dust contamination and perceived indoor environment in office buildings.

UNLABELLED: The purpose of the study was to evaluate the impact of cleaning on indoor environment quality. Surface dust contamination and occupants' perception of the work environment factors and symptoms were the parameters studied. Six multi-floor office buildings were selected. Dust contamination on surfaces was sampled with gelatine foils and quantified using a BM-Dustdetector. Occupants' perceptions of the environment were assessed with modified MM-40 questionnaires. The results indicated that each building had its own surface dust contamination profile. Weekly cleaning maintained the surface dust contamination at the highest acceptable level for indoor environments. The occupants and their activities have a major effect on the level of dust particle contamination on desks. The correlation between the perceived surface dust contamination and the level of satisfaction with cleaning was as expected. Furthermore, surface dust contamination appeared not to be associated with work-related symptoms. PRACTICAL IMPLICATIONS: The results provide information about current program for contractors and clients, e.g. appropriate cleaning intervals of different surfaces, and the influence of disorder on result. After the evaluation of surface dust contamination levels, it will be possible for cleaning companies to focus on the most important surfaces to clean in order to enhance the quality of the indoor environment in office buildings. This should lead to future development work, which will require cooperation between contractors, clients, and research scientists. In office environments where high cleanliness is required, objective measurements (with instruments) are needed in addition to subjective measurements (the perceptions of occupants). It is essential to evaluate the efficiency of cleaning programs regularly with effective and appropriate quality-monitoring methods.

Analysis of Variance↗
PubMedDate not supplied

[The results of school health exams in Montcada y Reixac (Barcelona). The 1991-92 school year].

BACKGROUND: The results of the school health examinations (SHE) carried out in school children attending P4 and 1st of EGB (aged between 4 and 8 years) from the public schools of Montcada y Reixac (Barcelona) during the academic year 1991-92 were evaluated. METHODS: 310 school children (157 boys and 153 girls) were studied. The following variables were analysed: weight and height by percentiles (using Tanner's standards): the percentage of vaccinations administered: and the prevalence of anomalies according to the current SHE program in Catalonia. RESULTS: From a general point of view, the weight and height values were higher than expected. The administering of vaccinations was poor (66%: 95% confidence interval (CI) = 61.5%-70.4%). A high prevalence of squinted vision (6.2%: 95% CI = 4.1%-8.2%) and a good absence of caries index (76.7%: 95% CI = 71.1%-82.2%) were observed. During the examination of male genital organs, a higher percentage of non-palpable testicles in the scrotum amongst boys aged 6-8 years versus boys aged 4-5 years was observed (14.9% vs 9.8%). CONCLUSIONS: The weight-and-height standards used and the efficiency of the program for caries prevention were discussed. It was recommended that the reasons for some of the anomalies found be investigated and that more control over routine vaccination certificates be implemented.

Anthropometry↗
PubMed2001

The public health impact of obesity.

The increase in obesity worldwide will have an important impact on the global incidence of cardiovascular disease, type 2 diabetes mellitus, cancer, osteoarthritis, work disability, and sleep apnea. Obesity has a more pronounced impact on morbidity than on mortality. Disability due to obesity-related cardiovascular diseases will increase particularly in industrialized countries, as patients survive cardiovascular diseases in these countries more often than in nonindustrialized countries. Disability due to obesity-related type 2 diabetes will increase particularly in industrializing countries, as insulin supply is usually insufficient in these countries. As a result, in these countries, an increase in disabling nephropathy, arteriosclerosis, neuropathy, and retinopathy is expected. Increases in the prevalence of obesity will potentially lead to an increase in the number of years that subjects suffer from obesity-related morbidity and disability. A 1% increase in the prevalence of obesity in such countries as India and China leads to 20 million additional cases of obesity. Prevention programs will stem the obesity epidemic more efficiently than weight-loss programs. However, only a few prevention programs have been developed or implemented, and the success rates reported to date have been low. Obesity prevention programs should be high on the scientific and political agenda in both industrialized and industrializing countries.

Adolescent↗
PubMedDate not supplied

Transition to program management.

In their continuing pursuit of quality, effectiveness and efficiency, Canadian hospitals are adopting program management as an organizational model. West Park Hospital, a 406-bed continuing care and rehabilitation facility in Toronto, has recently introduced a comprehensive and decentralized program-management structure. This article describes West Park's five-year transition from a traditional administrative structure to program management.

Hospital Bed Capacity, 300 to 499↗
PubMed2006

PSI-DOCK: towards highly efficient and accurate flexible ligand docking.

We have developed a new docking method, Pose-Sensitive Inclined (PSI)-DOCK, for flexible ligand docking. An improved SCORE function has been developed and used in PSI-DOCK for binding free energy evaluation. The improved SCORE function was able to reproduce the absolute binding free energies of a training set of 200 protein-ligand complexes with a correlation coefficient of 0.788 and a standard error of 8.13 kJ/mol. For ligand binding pose exploration, a unique searching strategy was designed in PSI-DOCK. In the first step, a tabu-enhanced genetic algorithm with a rapid shape-complementary scoring function is used to roughly explore and store potential binding poses of the ligand. Then, these predicted binding poses are optimized and compete against each other by using a genetic algorithm with the accurate SCORE function to determine the binding pose with the lowest docking energy. The PSI-DOCK 1.0 program is highly efficient in identifying the experimental binding pose. For a test dataset of 194 complexes, PSI-DOCK 1.0 achieved a 67% success rate (RMSD < 2.0 A) for only one run and a 74% success rate for 10 runs. PSI-DOCK can also predict the docking binding free energy with high accuracy. For a test set of 64 complexes, the correlation between the experimentally observed binding free energies and the docking binding free energies for 64 complexes is r = 0.777 with a standard deviation of 7.96 kJ/mol. Moreover, compared with other docking methods, PSI-DOCK 1.0 is extremely easy to use and requires minimum docking preparations. There is no requirement for the users to add hydrogen atoms to proteins because all protein hydrogen atoms and the flexibility of the terminal protein atoms are intrinsically taken into account in PSI-DOCK. There is also no requirement for the users to calculate partial atomic charges because PSI-DOCK does not calculate an electrostatic energy term. These features are not only convenient for the users but also help to avoid the influence of different preparation methods.

Algorithms↗
PubMedDate not supplied

Regional orientation program for the department of clinical neurosciences.

A regional orientation program increases the efficient and effective use of resources such as classroom, equipment, and educator time. It provides consistent information to all new nurses and maintains standards of nursing practice throughout the Department of Clinical Neurosciences.

Alberta↗
PubMed2000

Six-year experience of caring for forty-four patients with a left ventricular assist device at home: safe, economical, necessary.

OBJECTIVE: With increasing numbers of implantations, left ventricular assist device programs can put a financial strain on a hospital unless an efficient and safe outpatient program is developed. However, the left ventricular assist device is not widely recognized in the medical community as being reliable enough to support a patient at home. We reviewed our experience with these patients at home to assess the safety and the benefits of such a program. METHODS: Our institutional 6-year experience with 90 consecutive recipients of a wearable left ventricular assist device was analyzed. RESULTS: Forty-four (49%) of the 90 patients who received TCI vented-electric left ventricular assist devices (Thermo Cardiosystems, Inc, Woburn, Mass) were discharged, spending a total of 4546 days (12.5 years) at home with an average of 103 +/- 16 days of outpatient support (range 9-436 days). Of these 44 patients, all were successfully bridged to transplantation (42 patients, 96%) or planned explantation (2 patients, 4%). None of the outpatients died. The cumulative events per outpatient month were 0.020 for bleeding, 0.053 for device infection, 0.0068 for thromboembolus, and 0.020 for major malfunctions. Our estimated average cost to bridge a patient to transplantation or explantation once discharged is $13,200 and as an inpatient over the same length of time, including only room and board, is $165,200. Thirty percent of outpatients were able to return to work or school, 33% to sexual activity, and 44% to driving. All outpatients performed activities of daily living. CONCLUSION: Current left ventricular assist device technology provides effective and economical outpatient support and is associated with limited morbidity and a satisfactory quality of life.

Ambulatory Care↗
PubMed2006

Developing an institution-based assessment of resident communication and interpersonal skills.

PURPOSE: The authors describe the development and validation of an institution-wide, cross-specialty assessment of residents' communication and interpersonal skills, including related components of patient care and professionalism. METHOD: Residency program faculty, the department of medical education, and the Clinical Performance Center at the University of Illinois at Chicago College of Medicine collaborated to develop six standardized patient-based clinical simulations. The standardized patients rated the residents' performance. The assessment was piloted in 2003 for internal medicine and family medicine and was subsequently adapted for other specialties, including surgery, pediatrics, obstetrics-gynecology, and neurology. We present validity evidence based on the content, internal structure, relationship to other variables, feasibility, acceptability, and impact of the 2003 assessment. RESULTS: Seventy-nine internal medicine and family medicine residents participated in the initial administration of the assessment. A factor analysis of the 18 communication scale items resulted in two factors interpretable as "communication" and "interpersonal skills." Median internal consistency of the scale (coefficient alpha) was 0.91. Generalizability of the assessment ranged from 0.57 to 0.82 across specialties. Case-specific items provided information about group-level deficiencies. Cost of the assessment was about $250 per resident. Once the initial cases had been developed and piloted, they could be adapted for other specialties with minimal additional effort, at a cost saving of about $1,000 per program. CONCLUSION: Centrally developed, institution-wide competency assessment uses resources efficiently to relieve individual programs of the need to "reinvent the wheel" and provides program directors and residents with useful information for individual and programmatic review.

Clinical Competence↗
PubMed1999

Hearing screening--aspects of epidemiology and identification of hearing impaired children.

Mass screening of hearing in children is based on the concept of secondary prevention. In recognition of the importance of an early identification and intervention in children with congenital or early-acquired (i.e. neonatal period) hearing disability, numerous hearing screening programs have been introduced throughout the world. The devastating consequences of a congenital/early acquired hearing disability upon the speech, language, and social development of a child, and the estimated prevalence rates of at least 1-1.5/1000 live births of congenital permanent hearing impairment, represent an important health problem. The increase in the estimated prevalence of permanent hearing impairment in childhood, reaching at least 3.6-8.2% of live births at 5-9 years of age further emphasizes the importance of the problem. The delayed identification of children with congenital/early acquired hearing disability should result in the implementation of universal neonatal hearing screening, and the negative impact on the learning processes during school age from hearing impairment acquired throughout childhood seems to justify the introduction or maintenance of a hearing screening at school entrance. Implementation of efficient hearing screening programs throughout the neonatal period, infancy, or childhood should result in secondary prevention of this important health problem.

Child↗
PubMedDate not supplied

[Aspects of left ventricular function in children with chronic renal failure].

OBJECTIVE: To present the main morphological and functional cardiac modifications in children with chronic renal failure (CRF) and the effect of hemodialysis on systolic function of the left ventricle (LV). METHODS: 22 patients (5-19 years) with CRF of different degrees of severity. 16 of them were included in a hemodialysis (HD) program and they were followed-up for at least 1 year. The systolic and diastolic function of the LV were investigated by echocardiography (echo) 2D and Doppler. RESULTS: Although the clinical signs of cardiac suffering were rare, echo detected concentric hypertrophy (9 cases), dilated cardiomyopathy (4 cases), mitral and tricuspidian regurgitation and pulmonary hypertension (3 cases) and pericardial effusion (10 cases). Systolic function was normal in most of the cases, but the diastolic function (evaluated by E/A ratio, isovolumic relaxation and deceleration time) was modified in 10 cases. The HD session induced the improvement of the LV systolic function parameters and the decrease of right ventricle dimensions. CONCLUSIONS: Echocardiography has a higher sensitivity compared to ECG and chest X-ray in evaluation of the LV function, mainly in the cases without cardiac symptoms. An efficient chronic HD program and also a complex antihypertensive treatment contribute to the alleviation of the LV function. For the HD session, echo is useful in monitoring the systolic LV function.

Adolescent↗
PubMed1993

The evaluation of targeted outreach in an adolescent HIV/AIDS program.

PURPOSE: Most HIV infected youth are unaware of their serostatus. Among adolescents who know they are HIV positive, only a small percentage are currently receiving care in age-specific programs. Establishing effective links between prevention and service programs is critical in reaching this group of young people. METHODS: A specific outreach strategy was designed to develop more referrals from a wider variety of agencies to better serve youth at risk for HIV. A needs assessment of community-based agencies was the basis for: 1. overcoming barriers to care, 2. specifying the target population, 3. assessing existing referrals, and 4. selecting agencies for different levels of intensity of outreach. RESULTS: Six barriers faced by potential referring agencies were identified and corresponding solutions created which were incorporated into the outreach strategy. A comparison was made of referrals in the years before, during and after the outreach strategy was instituted. A significant difference by (chi 2 analysis) was noted in the number of agencies (p < 0.05), number of individuals (p < 0.01), number of appointments kept (p < 0.01), and the number of HIV+ youth enrolled (p < 0.01) during the year when the plan was fully implemented compared to previous and subsequent years. CONCLUSIONS: Systematic targeted outreach programs are an efficient way to maximize the time and effort of outreach staff. The result was an increase in the number and diversifity of referrals. This strategy could be used by groups caring for adults or younger children who want to expand services to include adolescents or by groups providing HIV/AIDS care who want to specifically serve adolescents.

Adolescent↗