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PubMedDate not supplied

Compliance education through participational QA programs.

Attaining and sustaining an acceptable level of compliance to regulations, guidelines, or directives presents a challenge to every company. Compliance education programs usually combine in-house tailored programs with extramural courses, both of which are very valuable. It is recommended that two motivational participational Quality Assurance programs be added to your compliance education: (1) Deputy Quality Assurance monitoring program and (2) Quality Assurance group auditing. Both programs provide the researcher active involvement, on an ad hoc basis, in the compliance assessment process, and an increased awareness of the practical application of compliance principles. Through self-discovery and team building, both the researcher and Quality Assurance gain a mutual trust and respect for their respective expertise. Motivation is enhanced through this environment and provides a self-perpetuating impetus for proactive improvements in the compliance process. From a Quality Assurance perspective, effective compliance education combines in-house tailored compliance programs and extramural courses or meetings with these two participational Quality Assurance programs. The combination has the potential for going beyond our basic understanding of compliance and creating a compliance consciousness that can successfully translate into continually improving our compliance programs.

Humans↗
PubMed1995

The role of program quality in producing early childhood program benefits.

It is widely accepted by the field of early childhood education and by the public that high-quality preschool programs for young children from low-income families can have long-term benefits, although studies of early childhood programs in typical communities have often failed to find similar long-term effects. Some argue that variations in the quality or developmental appropriateness of programs can account for differences in effectiveness. This article reviews studies designed to define and measure the effects of quality in early care and education, and it analyzes the programs provided in successful long-term studies to look for common elements that may be critical to the long-term effectiveness of preschool. The conclusions of the analysis are that effective programs were characterized by combinations of most of the following elements: (1) small class sizes with low ratios of children to teachers; (2) teachers who received support to reflect on and improve their teaching practices; (3) a concentrated or long-lasting intervention; (4) ongoing, child-focused communication between home and school; and (5) use of some curriculum content and classroom processes that are similar to what children encounter in traditional schooling. Recommendations for policy, practice, and research are offered to promote the adoption of these effective practices in all types of early childhood programs.

Adolescent↗
PubMed1989

An educational program on depressive disorders for general practitioners on Gotland: background and evaluation.

General practitioners are the psychiatrists' most important coworkers in the treatment of depressive disorders. A high degree of knowledge about this illness in this group of doctors is of decisive importance. However, the value of postgraduate educational programs for general practitioners has been questioned. The Swedish Committee for the Prevention and Treatment of Depression (PTD) offered an educational program on symptoms, etiology, diagnosis, prevention and treatment of depression to all general practitioners on the Swedish island of Gotland. Lectures on suicide, depressive illness in childhood and in old age and psychotherapy of depressive states were also given. In several control periods data were collected on suicides, referrals to the local psychiatric department, emergency admissions, the quantity of sick leave used and the quantity of inpatient care due to depression. Even the prescription of psychopharmacological drugs on the island was investigated. Overall, the results indicated that general practitioners gratefully accepted the educational program and achieved increasing competence and stringency in treating and preventing depressive states. The program was associated with decreases in the use of psychiatric inpatient care and the sick leave frequency of depressed patients. The possibility of preventing suicides was positively influenced.

Curriculum↗
PubMed2005

Effects of strength training on body composition and bone mineral content in children who are obese.

The purpose of this study was to test the hypothesis that strength training benefits diet-controlled obese children with respect to lean mass and bone mineral acquisition. Eighty-two Hong Kong school children (aged 10.4 +/- 1.0 years, 70 in Tanner stage 1, 12 in stage 2) who were obese/overweight were randomly assigned to receive either a balanced low-energy (900-1200 cal) diet plus strength training (n = 41) (training group) or the diet alone (n = 41) (control group). The training group attended a 75-minute strength exercise program 3 times/week for 6 weeks (phase 1), after which they were offered and 22 children opted to continue a once-weekly program for a further 28 weeks (phase 2). All children were evaluated at baseline, after 6 weeks, and at the end of the 36-week study (including an intervening 2-week introduction to phase 2). Body composition and bone mineral content were measured by dual-energy X-ray absorptiometry, and diet was assessed by food-frequency questionnaire. The results showed that the exercise programs were well accepted, with good attendance at the exercise classes. After 6 weeks, the children in the training group showed significantly larger increases in lean body mass (+ 0.8 kg [2.4%] vs. +0.3 kg [1.0%], p < 0.05) and total bone mineral content (+46.9 g [3.9%] vs. +33.6 g [2.9%], p < 0.05) than those in the control group. At the end of the study, these trends were maintained in the continued-training subgroup, though no longer reaching statistical significance. We conclude that in diet-controlled prepubertal obese/overweight children, participation in an exercise program with emphasis on strength training resulted in improved lean mass and bone mineral accrual.

Absorptiometry, Photon↗
PubMed1996

Rooming-in: an alternative to involuntary detention.

OBJECTIVE: To provide, via 'rooming-in', a local, less coercive and less frightening alternative to involuntary detention. Rooming in is the voluntary participation of so-called 'confidants', who may be chosen family members or trusted friends, in the management of acute, severe psychiatric disturbance by their providing a 24 hour vigil with the patient in a single, safe hospital room. METHOD: There were 73 admissions to the rooming-in program at the Manning Base Hospital, Taree, New South Wales (NSW), Australia between 5 August 1986 and 21 September 1992. During the same period 78 patients were remitted from the hospital on an involuntary basis to urban detention centres: 'scheduled' under the NSW Mental Health Act. Demographic and diagnostic characteristics of the two populations, both of whom met identical criteria for involuntary detention, are compared in this retrospective, case report study. These two groups constituted only 6% of total psychiatric consults carried out at the hospital over the same 6 year period and those roomed-in represented only 12% of the psychiatric admissions. A quality assurance study evaluated the acceptability of the program. RESULTS: The scheduled patients were more likely to be single, of no fixed abode and without a local family. They were more likely to have a schizophrenic disorder, compounded by polysubstance abuse, than a mood disorder. The average inpatient stay for those roomed-in was 10 days. Seventy per cent of confidants were required for 4 days or less. The rooming-in program was valued highly by nursing staff, patients and their families. CONCLUSION: A search of the world literature would suggest that rooming-in, as a model of care, is unique, at least in the developed world. It allows some seriously disturbed patients to be provided with a local and less restrictive general hospital alternative.

Adolescent↗
PubMed2005

Comparison of home versus physical therapy-supervised rehabilitation programs after anterior cruciate ligament reconstruction: a randomized clinical trial.

BACKGROUND: Because of health care funding and policy changes, there is a need to examine the effects of an evolution toward patient-directed (ie, home-based) rehabilitation programs on clinical outcomes of patients undergoing anterior cruciate ligament reconstruction. HYPOTHESIS: There will be no difference in the effectiveness of a home-based rehabilitation program and a standard physical therapy-supervised rehabilitation program in patients 3 months after nonacute anterior cruciate ligament reconstruction with bone-patellar tendon-bone grafts. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: There were 145 patients (16-59 years) who attended a presurgery education class. Home-based patients attended 4 physical therapy sessions, and physical therapy-supervised patients attended 17 physical therapy sessions over the first 12 weeks after surgery. All patients followed the same standardized rehabilitation program. Study outcome measures included active-assisted knee flexion and passive knee extension range of motion, knee range of motion during walking, KT computerized arthrometer results, and isokinetic quadriceps and hamstrings strength. Patient outcomes were dichotomized as either clinically acceptable or unacceptable. Rehabilitation programs were compared by the proportion of acceptable patients in each group. RESULTS: The home-based group had a significantly higher percentage of patients with acceptable flexion and extension range of motion compared to the standard physical therapy group (flexion, 67% vs 47%; extension, 97% vs 83%). There were no significant differences between the groups in range of motion during walking, ligament laxity, and strength. CONCLUSION: A structured, minimally supervised rehabilitation program was more effective in achieving acceptable knee range of motion in the first 3 months after anterior cruciate ligament reconstruction than a standard physical therapy-based program. CLINICAL RELEVANCE: Recreational athletes undergoing nonacute anterior cruciate ligament reconstruction can successfully reach acceptable rehabilitation goals in the first 3 months after surgery with a limited number of purposeful physical therapy education sessions, allowing recreational athletes more flexibility when integrating the necessary postoperative rehabilitation into their daily activities.

Adolescent↗
PubMed2003

Designing an HIV counseling and testing program for bathhouses: the Seattle experience with strategies to improve acceptability.

Bathhouses are important venues for providing HIV counseling and testing to high-risk men who have sex with men (MSM), yet relatively few bathhouses routinely provide this service, and few data are available to guide program design. We examine numerous logistic considerations that had been identified in the HIV Alternative Testing Strategies study and that influenced the initiation, effectiveness, and maintenance of HIV testing programs in bathhouses for MSM. Key programmatic considerations in the design of a bathhouse HIV counseling and testing program included building alliances with community agencies, hiring and training staff, developing techniques for offering testing, and providing options for counseling, testing, and disclosure of results. The design included ways to provide client support and follow-up for partner notification and treatment counseling and to maintain relationships with bathhouse management for support of prevention activities. Early detection of HIV infection and HIV prevention can be achieved for some high-risk MSM through an accessible and acceptable HIV counseling and testing program in bathhouses. Keys to success include establishing community prevention collaborations between bathhouse personnel and testing agencies, ensuring that testing staff are supported in their work, and offering anonymous rapid HIV testing. Use of FDA approved, new rapid tests that do not require venipuncture, centrifugation, or laboratory oversight will further decrease barriers to testing and facilitate implementation of bathhouse testing programs in other communities.

AIDS Serodiagnosis↗
PubMed1983

Evaluation of a testing program for aflatoxin in corn.

A computer model that accounts for sampling and analytical variability was developed to simulate the aflatoxin testing program administered by the North Carolina Department of Agriculture (NCDA) to regulate aflatoxin in corn meal. Monte Carlo solution techniques were employed to account for conditional probabilities that rise from multiple samples being used in the testing program. The NCDA testing program was then evaluated by applying the computer model to a hypothetical group of 1000 corn meal lots with the same distribution of aflatoxin concentrations as was observed among aflatoxin assays made by NCDA on commercial lots of corn meal from 1977 to 1980. The average of the 1000 lots assayed was 17.7 parts per billion (ppb). The model predicted that 79.5% of the lots would be accepted and 20.5% of the lots would be rejected by the NCDA testing program. The accepted and rejected lots contained an average of 5.7 and 64.2 ppb aflatoxin, respectively. The testing program accepted 7.3% of the lots with more than 20 ppb aflatoxin (consumers' risk) and rejected 1.0% of the lots with 20 ppb or less (processors' risk). A correct decision was made 94% of the time.

Aflatoxins↗
PubMed1995

[Life style changes in patients with myocardial infarct in the framework of intramural and ambulatory rehabilitation--results of a German pilot study].

To assess whether German patients would make comprehensive lifestyle changes as designed and successfully tested in the San Francisco Lifestyle Heart Trial, we recruited 25 patients who received usual care, and 15 patients who made lifestyle changes during a 6-week in-hospital rehabilitation program followed by a 3-month ambulatory period. The intervention program consisted of a low-fat vegetarian diet, stress management techniques, aerobic exercises, and group support meetings. The program was well accepted, and high compliance resulted in significant changes in the patients' diet, stress management, and exercise activity. For instance, fat intake dropped from 36% to 9% of total calories. As patients in both groups received 20 mg/day of Pravastatin, a lipid-lowering drug, lipid levels dropped significantly in both groups (30% in the intervention group and 27% in the control group). Thus, the combined effect of behavioral and drug treatment did not result in a substantial additional lipid-lowering effect. Within the intervention group significant improvement in quality of life occurred. In conclusion, the lifestyle heart program can be successfully implemented in a German rehabilitation setting which combines in-hospital and out-patient activities. However, participation in the current program is limited to highly motivated, well educated coronary patients.

Adult↗
PubMed1982

The impact of an educational program on gentamicin use in a teaching hospital.

We evaluated the effectiveness of a structured educational program in improving the gentamicin prescribing pattern of physicians in the hospital. Predetermined criteria for acceptable use were based upon the specific indications for initiating the drug therapy, the dosage regimen, and the precautions taken to avoid toxicity. In the preeducation review period, 57 of 109 courses of gentamicin (52 percent) were found acceptable. Following the educational program, 93 of 120 courses (78 percent; p less than 0.001) were acceptable; indications for gentamicin use that were found unacceptable decreased from 11 percent to 5 percent (p less than 0.005) and the incidence of excessive doses declined from 21 to 7 percent (p less than 0.005). We conclude that a structured educational program may improve the prescribing pattern of physicians.

Adolescent↗
PubMed1994

Preoperative autologous donation: surgery clinic staff knowledge/attitudes. Preoperative Autologous Blood Donation Study Group.

Preoperative autologous blood donation (PABD) is both under- and overused. Although the decision to order PABD lies with the surgeon, it is quite likely that other surgery clinic personnel influence patient acceptance and enrollment into PABD programs. Accordingly, we measured knowledge, attitudes, and the referral practice of clinic personnel pertaining to PABD. We administered a questionnaire to 102 nurses and 33 clerks working in surgery clinics at three university medical centers--one center in an area with a high incidence of AIDS and two centers in areas of low incidence of AIDS. Knowledge of PABD was poor when assessed by six questions. Only 6% each of nurses and clerks answered all questions correctly; 55% of nurses and 54% clerks missed three or more of the six questions. Surprisingly, no differences (P > .05) in knowledge deficits were noted when personnel from high and low AIDS areas were compared--indicating an overall need for education about PABD. In general, attitudes about PABD were positive, as most respondents (63%) gave favorable answers. Clinic personnel from the high AIDS area had even more favorable attitudes (P = .02). Because of these favorable attitudes, it seems likely that educational programs dealing with PABD would be readily accepted by clinic personnel. Greater knowledge should enhance the effectiveness of clinic staff in identifying, counseling, and referring eligible patients for this service.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Case-oriented computer-based-training in radiology: concept, implementation and evaluation.

BACKGROUND: Providing high-quality clinical cases is important for teaching radiology. We developed, implemented and evaluated a program for a university hospital to support this task. METHODS: The system was built with Intranet technology and connected to the Picture Archiving and Communications System (PACS). It contains cases for every user group from students to attendants and is structured according to the ACR-code (American College of Radiology) 2. Each department member was given an individual account, could gather his teaching cases and put the completed cases into the common database. RESULTS: During 18 months 583 cases containing 4136 images involving all radiological techniques were compiled and 350 cases put into the common case repository. Workflow integration as well as individual interest influenced the personal efforts to participate but an increasing number of cases and minor modifications of the program improved user acceptance continuously. 101 students went through an evaluation which showed a high level of acceptance and a special interest in elaborate documentation. CONCLUSION: Electronic access to reference cases for all department members anytime anywhere is feasible. Critical success factors are workflow integration, reliability, efficient retrieval strategies and incentives for case authoring.

Computer Communication Networks↗
PubMed2006

Universal perinatal depression screening in an Academic Medical Center.

OBJECTIVE: To develop a department-based program to identify and treat women at risk for perinatal depression. METHODS: Private and employed physician groups were engaged to conduct antepartum maternal depression screening using the Edinburgh Postnatal Depression Scale. A comprehensive program was established to ensure that patients identified as being at risk would receive appropriate care. The program 1) developed a network of existing community mental health providers to accommodate screen-positive referrals, 2) created a 24/7 hotline staffed by mental health workers to respond to urgent/emergent patient needs, 3) provided nursing and physician education via a comprehensive curriculum on perinatal depression, and 4) facilitated outpatient depression screening that included a centralized scoring and referral system. RESULTS: A total of 4,322 women completed 4,558 screens during the initial 24 months (June 2003-May 2005). Although initial uptake of the screening program was gradual, all 20 departmental obstetric practices were screening their patients at the end of the first year. Depression screening was accomplished between 28-32 weeks of gestation, and postpartum screening (during the 6-week postpartum visit) was subsequently added. Overall, 11.1% of women screened positive in the antenatal period, and 7.3% screened positive in the postnatal period. Three hundred three women were referred for evaluation and care. CONCLUSION: Department-based, perinatal depression screening was feasible when individual physician practices were not required to develop the infrastructure necessary to respond to at-risk patients. We believe that the provision of clinical safety nets (mental health provider network and the hotline) were essential to the universal acceptance of this program by practitioners. LEVEL OF EVIDENCE: III.

Adult↗
PubMed1991

Can physician education lower the cost of prescription drugs? A prospective, controlled trial.

OBJECTIVE: To determine whether an educational program featuring a drug cost manual can assist physicians in reducing their patients' out-of-pocket prescription drug expenses. DESIGN: Prospective controlled trial. SETTING: A general internal medicine-teaching clinic in a university hospital. PARTICIPANTS: Fifty-one medical interns. INTERVENTION: Thirty-one interns received a manual of comparative drug prices annotated with prescribing advice, two feedback reports, and weekly cost-oriented prescribing reminders. A control group concurrently participated in a manual-based educational program on cholesterol management. MEASUREMENTS: Copies of 3012 prescriptions written over 8 months were analyzed. MAIN RESULTS: Intervention group physicians prescribed less expensive drugs within classes of drugs. The change in drug price score per prescription was -0.15 (95% Cl, -0.27 to -0.04; P = 0.01). A score of 3 was assigned to the most expensive, 2 was assigned to intermediate-priced, and 1 was assigned to the least expensive drug or drugs in the class. An increase of 0.74 months' (Cl, 0.49 to 0.98; P less than 0.001) supply of medication was dispensed per prescription, reducing dispensing fees. The program was well accepted by the physicians. CONCLUSION: This relatively simple educational intervention can help physicians to reduce their patients' drug expenses and may serve as a model for incorporating cost information into the routine practice of medicine.

Cost Control↗
PubMed1992

Clinical privileges program for pharmacists.

A clinical privileges program for pharmacists is described. In 1985 and 1989 the Department of Veterans Affairs (VA) issued circulars defining policy on clinical privileges for pharmacists at its medical centers. Pharmacists at one large VA medical center responded by developing a clinical privileges program. Bylaws under which medical staff members are granted clinical privileges were used as a model for the pharmacist program. A pharmacist seeking privileges prepares an application detailing his or her background and the practice areas involved in the request; the applicant also drafts a quality assurance protocol. The application is reviewed by a pharmacist clinical privileges review board (PCPRB). The PCPRB uses the quality assurance plan to verify that adequate measures are in place to meet standards of care. If a question of patient safety arises, the board meets to review the pharmacist's activities. Each pharmacist who is granted privileges must have a physician sponsor. Since the first meeting of the PCPRB in 1990, clinical privileges have been requested by all 24 clinical pharmacy specialists at the center. No pharmacist has been denied privileges, although the board has required additional training or improved quality assurance protocols for many. Acceptance of the program by the medical staff has been good. A clinical privileges program at a VA medical center offers pharmacists the opportunity to practice pharmaceutical care.

Medical Staff Privileges↗
PubMed1980

Anti-rabies treatments in New Mexico: impact of a comprehensive consultation-biologics system.

Fewer than 20% of the 30,000 anti-rabies treatments administered in the United States each year are necessary. New Mexico established a comprehensive consultation-biologics program to assist physicians in making appropriate and systematic rabies treatment decisions. In 1978, 32 individuals received anti-rabies treatments as the result of 144 physician consultation requests. Dog and cat exposures accounted for 70 per cent of consultations and 63 per cent of the treatments. A seasonal peak of both consultations and treatments was observed in the summer and early autumn. The cost of biologics was $212 per treatment. Coordinated use of laboratory diagnostic services and animal control resources obviated the need for treatment in over 60 per cent of the 112 consultations not resulting in treatment. Experience in 1978 suggested that the system was probably responsible for a greater than five-fold reduction in the annual rate of anti-rabies treatments in New Mexico. Efficient physician utilization and high acceptability of the program may be attributed to maximization of private sector input into design and implementation of this public health program.

Adult↗
PubMed2004

Modified directly observed therapy for the treatment of HIV-seropositive substance users: lessons learned from a pilot study.

Highly active antiretroviral therapy (HAART) can dramatically decrease human immunodeficiency virus (HIV) load in plasma, increase CD4+ cell counts, and prolong life for HIV-seropositive persons. However, the need for optimal adherence has been recognized. We implemented a pilot community-based program of directly observed therapy (DOT) with HAART among persons with substance use disorders and a history of failure of HAART. A near-peer outreach worker initially delivered and observed once-daily HAART doses on up to 7 days per week. Many participants tapered the frequency of visits. Participants were assessed by a brief questionnaire and determination of their CD4+ cell count and plasma HIV load. Twenty-five HIV-seropositive persons were enrolled and followed-up for a mean of 6.6 months (standard deviation, 3.9 months). We found that once-daily dosing of HAART by DOT is feasible in this population; in addition to observation of the majority of doses, most participants achieved virus suppression and felt favorably about the intervention. Tapering the intensity of visits with maximum flexibility was necessary to enhance the acceptability of the program to participants.

Adult↗
PubMed2000

Agency-based tracking of difficult-to-follow populations: runaway and homeless youth programs in St. Louis, Missouri.

OBJECTIVES: This study explored agency-based tracking methods for one of the most difficult-to-follow populations: runaway and homeless youth. METHODS: A total of 118 program discharges from three federally funded agencies serving runaway/ homeless youth in St. Louis, Missouri were tracked for a follow-up study of this population. Agency staff attempted to locate and interview program participants three months post-discharge using a protocol that systematically varied times and location of contact attempts. Separate analyses were conducted to compare the group of subjects whose locations were ascertained with those who were not, and who were successfully interviewed with those who were not. Variables related to the tracking protocol and individual descriptive and service use variables were examined in these analyses. RESULTS: Sixty-nine percent of the sample was successfully located and fifty-nine percent interviewed. Significant findings included: fewer contact attempts over fewer days were made for individuals successfully interviewed, individuals tracked through Division of Family Services were less likely to be both located and interviewed, and individuals successfully located were significantly younger. CONCLUSIONS: This report provides encouraging evidence that even relatively unsophisticated protocols for tracking agency clients developed in collaboration with community agencies can--with consistent implementation--yield follow-up samples that are acceptably representative of program participants.

Adolescent↗