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PubMedDate not supplied

A simple and efficacious criterion based on serum LH levels to time hCG administration for human in vitro fertilization.

OBJECTIVE: To test the efficacy of a simple criterion--LH level--for administration of hCG in an IVF program. DESIGN: Prospective, with retrospective analysis of other criteria for hCG administration. SETTING: University hospital IVF program. PATIENTS AND INTERVENTIONS: Eighty-four patients, in 110 cycles, were given 150-300 IU at 10-11 A.M. daily beginning on day 3 of the cycle. Serum LH measured daily 8:30-9:30 A.M., hCG administered on night of day LH level first exceeded J, defined as minimum value + (day 3 value-minimum) x 1/3. OUTCOME MEASURES: Pregnancy (after IVF + ET); serum concentrations of estradiol and LH. RESULTS: Total and ongoing pregnancy per cycle: 35% and 27% respectively. If hCG is administered one day early or late by the J criterion, the pregnancy rate is reduced. CONCLUSIONS: Pregnancies occurred over wide follicle diameter (14-21 mm) and estradiol level (229-2,050 pg/mL) ranges. LH is recommended for timing hCG administration.

Chorionic Gonadotropin↗

PubMedDate not supplied

[Description of a computer program and results of its application to the follow up of enteral nutrition].

Computerization has been introduced little by little in the different activities which take place in a department of pharmacy, due to the fact that it means an increased agility of the tasks to be performed as well as an improvement of the care and managerial quality. In our hospital, the department of pharmacy makes up enteral nutrition units, and it participates in the follow up and control of the patients with this type of nutrition through a computer program designed for this purpose. The objective of the present study is to describe this computerized program as well as the results obtained by its application. The enteral nutrition computer program is made up of two data bases which are indexed between each other: that of daily follow up of the enteral nutrition prescriptions, and that of the follow up of the patients who have been given this nutritional support. In this way it allows us to obtain identification labels and consumption listings. During a two year period a total of 632 enteral nutrition treatments were given. The department with the greatest number of prescriptions was internal medicine (187, 29.5%). The polymeric diets were the most frequently used (435, 68.7%). The have mainly been used as a supplement to a hospital kitchen diet (149, 41.8%). The oral administration was the most frequent route of administration (331, 52.4%). The main reason for not implementing the nutrition was refusal by the patient (114, 38%). The computer program allows greater agility of the circuit which in our hospital generates the preparation of the enteral nutrition formulations, which are made up in the Department of Pharmacy, and given the large number of variables which this implies, this means a quality guarantee in the preparation and follow up of the patients with enteral nutrition.

Enteral Nutrition↗

PubMed1997

Needle exchange programs: an economic evaluation of a local experience.

OBJECTIVE: To determine whether providing a needle exchange program to prevent HIV transmission among injection drug users would cost less than the health care consequences of not having such a program. DESIGN: Incidence outcome model to estimate the number of cases of HIV infection that this program would prevent over 5 years, assuming that the HIV incidence rate would be 2% with the program and 4% without it, and that an estimated 275 injection drug users would use the service over this time. SETTING: Hamilton, Ont. OUTCOME MEASURES: Estimated number of cases of HIV infection expected to be prevented with and without the program over 5 years; estimated lifetime health care costs of treating an AIDS patient. The indirect costs of AIDS to society (e.g., lost productivity and informal caregiving) were not included. Projected costs were adjusted (discounted) to reflect their present value. In a sensitivity analysis, 3 parameters were varied: the estimate of the HIV transmission rate if no needle exchange program were provided, the number of injection drug users participating in the program, and the discount rate. RESULTS: With very conservative estimates, it was predicted that the Hamilton needle exchange program will prevent 24 cases of HIV infection over 5 years, thereby providing cost savings of $1.3 million after the program costs are taken into account. This translates into a ratio of cost savings to costs of 4:1. The sensitivity analysis confirmed that these findings are robust. CONCLUSION: Needle exchange programs are an efficient use of financial resources.

Canada↗

PubMedDate not supplied

Population-based growth stunting.

Growth stunting, defined as height for age below the fifth percentile on a reference growth curve, is traditionally used as an indicator of nutritional status in children. Growth stunting is a population-based indicator and can indicate the prevalence of malnutrition or nutrition-related disorders among an identified population of children. Among certain segments of the U.S. child population, most notably poor children, growth stunting occurs more often than expected, suggesting that inadequate nutrition may be a problem for these children. Available general population data are not recent enough to allow for an assessment of the impact of several major public programs designed to address the risk of inadequate nutrition among children. Analysis of data from these programs does show, however, a higher-than-expected-albeit-declining level of stunting among program participants. The serious consequences of growth stunting and malnutrition-particularly impaired cognitive development-suggest that careful consideration of the growth stunting indicator should remain an important part of policy discussions on public nutrition programs.

Adolescent↗

PubMed2000

Methods for evaluating a mature substance abuse prevention/early intervention program.

The authors describe methods for work in progress to evaluate four workplace prevention and/or early intervention programs designed to change occupational norms and reduce substance abuse at a major U.S. transportation company. The four programs are an employee assistance program, random drug testing, managed behavioral health care, and a peer-led intervention program. An elaborate mixed-methods evaluation combines data collection and analysis techniques from several traditions. A process-improvement evaluation focuses on the peer-led component to describe its evolution, document the implementation process for those interested in replicating it, and provide information for program improvement. An outcome-assessment evaluation examines impacts of the four programs on job performance measures (e.g., absenteeism, turnover, injury, and disability rates) and includes a cost-offset and employer cost-savings analysis. Issues related to using archival data, combining qualitative and quantitative designs, and working in a corporate environment are discussed.

Absenteeism↗

PubMed1996

Safer Choices: a multicomponent school-based HIV/STD and pregnancy prevention program for adolescents.

Given the serious consequences of HIV infection, other STDs, and pregnancy among teens, professionals must develop and evaluate new approaches to reduce risks associated with adolescent sexual behavior. The Safer Choices intervention is a comprehensive, theoretically based program designed to reduce risk behaviors and increase protective behaviors to prevent HIV, other STDs, and pregnancy among high school adolescents. The program includes five components: a School Health Promotion Council involving administrators, school staff, students, parents, and community members; curriculum and staff development activities; school environment activities designed and implemented by a team of peer educators; parent education activities; and school-community linkage activities. The School Health Promotion Council is responsible for planning and overseeing program implementation. This article describes the theoretical framework, process for intervention development, and key intervention strategies used in Safer Choices.

Adolescent↗

PubMedDate not supplied

Identifying program preferences through conjoint analysis: illustrative results from a parent sample.

PURPOSE: The purpose of this article is to illustrate the application of conjoint analysis, a consumer research technique, using data from a survey of parents' preferences for prevention programs. DESIGN: This study utilized a one-time, cross-sectional telephone survey. SETTING: Data were collected from subjects living in economically disadvantaged rural midwestern counties. SUBJECTS: Subjects were 202 randomly selected parents with preadolescents who indicated interest in family-focused prevention programs. MEASURES: Conjoint analysis software was employed in computer-assisted telephone interviews to evaluate relative preferences for 39 individual features of family-focused prevention programs falling under 11 categories (e.g., program meeting time, facilitator background). The software also guided computer simulations of parent choices among four types of programs. RESULTS: Findings indicated that meeting time was the most important category of program features. Strongly preferred individual features included meetings scheduled on weekday evenings, instruction by child development specialists, and programs based on extensive research. Two multiple-session programs evaluated via computer simulations incorporated several preferred features and received higher ratings than did single-session programs. Estimated variance z-tests indicated limited differences in perceived importance of program feature categories across sociodemographic subgroups. CONCLUSIONS: Findings highlight a) differences in the relative value parents place on various features of prevention programs in the surveyed population and b) the importance of practical aspects of program delivery.

Adolescent↗

PubMed2005

Balance, aging, and osteoporosis: effects of cognitive exercises combined with physiotherapy.

OBJECTIVE: To evaluate whether performing cognitive tasks while exercising influenced the effects of an exercise program designed to reduce the risk of falling in elderly women with osteoporosis. METHODS: We included 68 osteoporotic women older than 70 years of age (mean age, 73.5 years+/-1.6) who followed a program of 12 sessions of balance, coordination, and ambulation exercises designed to lessen the risk of falling. The patients were divided into two groups based on proximity to the study centers. The groups were randomly allocated to the exercise program alone (N=31, single-task group) or to the same program combined with cognitive tasks performed while exercising (N=37, dual-task group). Timed up-and-go tests and one-leg balance (OLB) tests were done at baseline, at the end of the exercise program, and 3 months after the end of the exercise program. RESULTS: In both groups, the exercise program produced significant improvements in up-and-go and OLB times. Additional improvements occurred over the first 3 months following the program. Adding cognitive exercises did not provide added efficacy. CONCLUSIONS: Balance was improved after the exercise sessions. The improvements were clinically significant and increased over time.

Accidental Falls↗

PubMed1989

Management preparation for nurse executives: the dual degree option.

Nurses have the clinical expertise that enables them to better understand the complex issues inherent in management of the delivery of health care. Yet without adequate preparation in management, as well as training of higher levels of nursing theory and research, nurses will be less prepared to compete at higher levels as the system continues to change. The University of Colorado offers a program designed to meet these needs, which serves as a national model for other schools of nursing considering such a curricular change. Further research needs to be conducted to identify the specific components of a graduate program that will enable the nurse executive to develop advanced nursing practice skills while developing the management skills necessary to achieve effectiveness in the practice setting. Because the long-term outcome of the dual degree model is still unknown, the effectiveness of the program in the health care system over time will be evaluated in relation to three outcomes: first, the effectiveness of program goals and objectives for producing successful nurse executives; second, the effectiveness of the curriculum design in preparing successful nurse executives; and third, satisfaction of graduates with the program and with their preparation. Participants in the dual degree program look forward to meeting this challenge.

Administrative Personnel↗

PubMedDate not supplied

Mathematical programming assisted drug design for nonclassical antifolates.

A concept from optimization theory, specifically, mathematical programming, is proposed for designing drugs with desired properties. The mathematical programming formulation is solved to obtain the optimal descriptor values, which are employed in the Cerius(2) modeling environment to infer the optimal lead candidates, in the sense that they exhibit both high selectivity and activity while ensuring low toxicity. It has been observed that unique substituent groups and their molecular conformations are responsible for attaining the goal of simultaneous high selectivity and activity. Both linear and nonlinear quantitative structure activity relationships (QSARs) have been developed for use in the proposed approach. A comparative study of these models is done, and it is shown that the QSARs are well represented by nonlinear models. The proposed mathematical programming strategy has been demonstrated for a class of nonclassical antifolates for Pneumocistis carinii and Toxoplasma gondii dihydofolate reductase. Some of the potential leads found in this study have biological properties similar to those in the open literature. We believe the technique proposed is general and can be applied to other structure based drug design.

Algorithms↗

PubMedDate not supplied

Maintaining reliability in a long-term psychiatric study: an ongoing inter-rater reliability monitoring program using the longitudinal interval follow-up evaluation.

The Longitudinal Interval Follow-up Evaluation (LIFE), has been shown to be a valid and reliable instrument for characterizing the week-by-week course of anxiety disorders examined retrospectively over the period of 1 year. Due to the chronic nature of these disorders, there is a need for reliable, valid instruments for measuring course over periods of several years if we are to learn more about the natural history of these disorders. This paper describes a rater-monitoring program designed to ensure long-term inter-rater reliability and prevent "rater drift". In this program, clinical interviewers score taped interviews and are required to maintain a median intra-class correlation coefficient (ICC) of at least 0.80 with the other raters. Raters also assess tapes from previous years, to ensure that they are using the same diagnostic criteria as earlier generations of interviewers. A reliability study was conducted to compare psychiatric status ratings (PSRs) collected using biweekly telephone interviews with the semi-annual interviews. The ICCs for panic, agoraphobia, social phobia, and generalized anxiety disorder were very good to excellent. Another reliability study examined the PSRs of subjects who had been previously lost to follow-up. ICCs for panic, agoraphobia, generalized anxiety disorder and depression were good to excellent. These results show that the LIFE, when used in conjunction with an intensive training and rater monitoring system, is a reliable instrument for use in longitudinal studies of the course of anxiety disorders.

Adult↗

PubMed2004

Developments in the CCP4 molecular-graphics project.

Progress towards structure determination that is both high-throughput and high-value is dependent on the development of integrated and automatic tools for electron-density map interpretation and for the analysis of the resulting atomic models. Advances in map-interpretation algorithms are extending the resolution regime in which fully automatic tools can work reliably, but at present human intervention is required to interpret poor regions of macromolecular electron density, particularly where crystallographic data is only available to modest resolution [for example, I/sigma(I) < 2.0 for minimum resolution 2.5 A]. In such cases, a set of manual and semi-manual model-building molecular-graphics tools is needed. At the same time, converting the knowledge encapsulated in a molecular structure into understanding is dependent upon visualization tools, which must be able to communicate that understanding to others by means of both static and dynamic representations. CCP4 mg is a program designed to meet these needs in a way that is closely integrated with the ongoing development of CCP4 as a program suite suitable for both low- and high-intervention computational structural biology. As well as providing a carefully designed user interface to advanced algorithms of model building and analysis, CCP4 mg is intended to present a graphical toolkit to developers of novel algorithms in these fields.

Algorithms↗

PubMed1999

Who goes to the ICU postoperatively?

OBJECTIVE: To describe changes in ICU postoperative management strategies utilized for patients undergoing cardiac surgery. The treatment of these patients serves as a useful illustration of the changing patterns of ICU utilization and care associated with contemporary surgery. DESIGN: Evidence-based review of the clinical literature following a MEDLINE search, direct observation of rapid recovery programs following surgery, and informal inquiry of others utilizing similar approaches to postoperative cardiac surgery care. SETTING AND PATIENTS: The reports reviewed are from a diverse set of hospitals providing cardiac surgery services in both Europe and the United States. Most reports focus efforts on patients undergoing coronary artery revascularization. MEASUREMENTS: Outcome measures used to gauge the effectiveness of postoperative ICU care typically include time to extubation, ICU and hospital length of stay, postoperative complications including reintubation and ICU readmission, patient satisfaction, and health resource savings. MAIN RESULTS: The literature regarding current practice for postoperative ICU management in cardiac surgery consists primarily of grade 2 and 3 literature. CONCLUSIONS: Despite the paucity of controlled data, rapid recovery, extubation, and discharge from the ICU following cardiac surgery is an approach to care that is growing in acceptance. The goals include reduction in the utilization of resources and costs associated with cardiac surgery and maintenance of quality of care and patient satisfaction. Assessment of outcomes requires a program to monitor outcomes. Success does not appear to be linked to preoperative risk for most patients but does relate directly to the anesthetic management delivered in the operating room. Few adverse consequences from this approach have been reported. Experience to date suggests that programs designed to truncate ICU admission following cardiac surgery can be implemented with the cooperation between the health delivery team including surgeon, anesthesiologist, intensivist where available, nursing, respiratory care, and patient and family. These programs can serve as useful models for reassessing the utilization and role of the ICU in the postoperative treatment of routine surgical patients.

Cardiac Surgical Procedures↗

PubMed1978

Interdisciplinary health education: a case study of fact and fancy.

Meeting the health needs of patients and providing comphrehensive health care services require the integration and coordination of several professional health services. Traditional methods for training students in the health professions independently are being challenged by the need for future practitioners to understand and to utilize effectively the skills offered by the other disciplines. However, the movement of educational institutions toward interdisciplinary training programs entails the careful assessment of program design, content, and basic philosophy. Two and one-half years of experience with such a program at one academic health center are reviewed.

Adult↗

PubMedDate not supplied

Workplace health promotion and utilization of health services: follow-up data findings.

This article reports findings from a workplace substance abuse prevention program designed to investigate best practices. The study sought to assess the effects of the worksite wellness program and employee assistance program (EAP) on healthcare utilization and costs, identify predictors of outpatient costs and visits, and assess the effect of the intervention on health attitudes, behaviors, and behavioral health-related costs and visits. Results indicated that visits to the EAP increased as did overall healthcare visits, that utilization of healthcare services and costs were higher in the population receiving substance abuse prevention intervention, and that employees in the substance abuse prevention intervention reported lower heavy drinking and binge drinking. Data suggest that substance abuse prevention may result in higher healthcare costs and utilization in the short term, but a reduction in health risk behaviors such as heavy drinking may result in lower healthcare costs and utilization in the long term.

Adult↗

PubMedDate not supplied

Teaching humanistic and psychosocial aspects of care: current practices and attitudes.

OBJECTIVE: To assess current practices and attitudes toward teaching humanistic and psychosocial aspects of care in internal medicine residency programs. DESIGN AND PARTICIPANTS: Survey questionnaires were sent to residency directors at all 434 internal medicine residency programs accredited in 1985-1986. Response rate for two mailings was 71%. MEASUREMENTS AND MAIN RESULTS: 78% OF RESIDENCY DIRECTORS and 70% of department chairpersons had high or moderately high levels of commitment to teaching humanistic/psychosocial aspects of care, but only 44% of responding programs offered mandatory training, and only 18% offered elective training in these areas. Obstacles to expanded teaching of the humanistic/psychosocial aspects rated high or moderately high by residency directors included insufficient curriculum time (51%), lack of trained faculty (44%), and pressures to reduce both training costs (40%) and patient-care costs (37%). CONCLUSIONS: Most of the training that does occur in the humanistic/psychosocial aspects of care probably happens informally via mentoring and role modeling. Appeals to expand teaching in these areas raise questions regarding what to include in medical training and the proper scope of internal medicine. Sustainable change will depend on the politics of resource distribution and the influence of general internal medicine and primary care on traditional training.

Clinical Competence↗

PubMed1994

Effectiveness of two training methods to improve the quality of foodservice in small facilities for adult care.

OBJECTIVE: Community-based adult-care facilities (ACFs) with fewer than 25 beds provide homes for persons with disabilities who cannot live independently. The staff in these facilities are not required to have any formal foodservice training, yet they provide meals for the residents. The objective of this study was to evaluate the quality of foodservices before and after a foodservice training program. DESIGN: Forty-six ACFs from six health-unit areas throughout the province of British Columbia were enrolled in the study, which involved a pretest-posttest design over a 5-month period. The health units were randomly assigned to one of three programs. INTERVENTION: The ACFs received either a training workshop plus foodservice manual developed specifically for ACFs, the manual only, or no intervention. MAIN OUTCOME MEASURES: Facilities were audited on performance in food purchasing, menu planning, food safety, and food storage. These areas were rated according to established minimum government regulations and other foodservice standards. Differences between the two audit scores (postintervention score minus preintervention score) were analyzed for each program section. Group comparisons were done using analysis of covariance procedures, with the initial score being the covariable. RESULTS: No treatment effect was found on performance for food purchasing and food storage. Training via workshop plus manual resulted in a significant improvement in audit scores for menu planning and food safety compared with training via the manual alone. APPLICATION: Dietitians should consider providing foodservice training workshops for similar types of facilities. The benefits of providing a manual alone are negligible.

Adult↗

PubMed1995

A simple approach to intracytoplasmic sperm injection.

OBJECTIVE: To describe a simple injection apparatus and method for performing intracytoplasmic sperm injection in a clinical IVF program. DESIGN: A prospective clinical trial of intracytoplasmic sperm injection. SETTING: A private office-based fertility program. PATIENTS: Five couples undergoing IVF-ET with intracytoplasmic sperm injection as a treatment for male factor infertility. INTERVENTIONS: Intracytoplasmic sperm injection was performed at room temperature (23.5 to 24.5 degrees C) in a simple zwitterion-buffered medium. MAIN OUTCOME MEASURES: Fertilization rates, cleavage rates, clinical pregnancy rates, implantation rates. RESULTS: Intracytoplasmic sperm injection was performed on 44 fresh oocytes from five patients. Twenty-three oocytes fertilized (52.3%) and 22 zygotes cleaved (95.7%). Three of five patients became pregnant (60%), resulting in the live birth of one normal male infant, one continuing singleton pregnancy, and one continuing twin gestation (46XX, 46XY). The implantation rate was 23.5%. CONCLUSION: Intracytoplasmic sperm injection can be performed successfully in a simple medium at room temperature using commercially available microtools.

Cytoplasm↗