Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Program Acceptability”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 829 records · Page 46Linked to original sources
PubMed1995

Triage of patients to angiography for detection of aortic rupture after blunt chest trauma: cost-effectiveness analysis of using CT.

OBJECTIVE: The purpose of this study was to evaluate the cost-effectiveness of dynamic chest CT, compared with plain chest radiography and immediate angiography, in deciding when angiography should be performed in hemodynamically stable patients with suspected aortic rupture after blunt chest trauma. The use of CT was evaluated in relation to the prior probability of aortic rupture. MATERIALS AND METHODS: A cost-effectiveness analysis comparing six diagnostic strategies combining chest radiography, CT, and angiography in various sequences was performed. Effectiveness was expressed as survival to hospital discharge, and costs were those incurred to society. Estimates for the variables in the analysis were derived from published reports. The model was evaluated for two cohorts of patients: those undergoing and those not undergoing CT for the evaluation of other injuries. Sensitivity analysis was performed for all variables in the model with emphasis on the prior probability of aortic rupture. RESULTS: Selecting patients for triage to angiography based on the CT findings yielded higher effectiveness at a lower cost-effectiveness ratio than doing so based on the chest radiograph, and the incremental cost-effectiveness ratio was less than $500,000 per life saved. For the cohort undergoing CT for the evaluation of other injuries, triage to angiography based on the CT findings yielded equivalent survival chances compared with immediate angiography and cost less ($1468 per patient evaluated compared with $2508). For the cohort not undergoing CT for other injuries, immediate angiography yielded the highest survival chances but was expensive, with an incremental cost-effectiveness ratio of $2 million per life saved compared with triage based on CT. In the latter cohort, immediate angiography yielded higher survival chances and had a cost-effectiveness ratio of less than $500,000 compared with the triage by CT if the prior probability of aortic rupture was 5% or more. CONCLUSION: Selecting hemodynamically stable patients after blunt chest trauma with suspected aortic rupture for angiography on the basis of CT findings is more effective than doing so based on the findings on chest radiography and is cost-effective compared with other accepted health care programs. Immediate angiography has a high incremental cost-effectiveness ratio compared with triage by CT and is warranted only in patients not undergoing CT for the evaluation of other injuries who have a prior probability of aortic rupture of 5% or more.

Angiography↗
PubMed1999

Computerized realistic simulation: a teaching module for crisis management in radiology.

OBJECTIVE: Computerized realistic simulation technology has been used as a training tool in fields such as aviation and military training and in the nuclear power industry. More recently, it has been adapted for use in anesthesia crisis resource management. We describe the effectiveness of a simulation program like that used by anesthesiology departments that we developed to teach radiologists the principles of crisis management. MATERIALS AND METHODS: A mock CT scanner and patient simulator were used to simulate the environment in which radiologists encounter crises. Twenty-four residents attended the training program, four at each half-day session. Two responded to and two observed an initial crisis, after which they attended a lecture and watched a videotape review. The second pair then participated in a different crisis scenario. The scenario order was randomized. All scenarios were videotaped and randomly reviewed by two physicians not involved with the course. The following behavioral qualities of the participating residents were evaluated using a five-point scale, ranging from poor (1) to excellent (5): global assessment, communication skills, use of support personnel, use of resources, and role clarity. Residents then rated the course on a five-point scale using the following criteria: overall course usefulness, attainment of course goals, realism of scenarios, quality of lecture, and quality of videotape review. RESULTS: The trainees who had attended the lecture and watched the videotape review before participating in a scenario consistently scored higher than those who had not in the following areas (score after training/score before training): global assessment, 4.08/2.50; communication skills, 4.09/2.67; use of support personnel, 4.17/3.00; use of resources, 4.00/2.92; and role clarity, 4.17/2.67. Moreover, the participants gave the course the following average ratings: overall usefulness, 4.93; attainment of course goals, 4.78; realism of scenarios, 4.63; quality of lecture, 4.63; and quality of videotape review, 4.85. CONCLUSION: Although the critical assessment of a teaching method is difficult and subjective by nature, the improvement in behavioral performance scores suggests that simulation technology effectively conveyed the principles of crisis management. The course ratings show that the program was well accepted by participants.

Clinical Competence↗
PubMedDate not supplied

[Validation of the Italian versions of the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index (DFI) in patients with ankylosing spondylitis].

OBJECTIVES: The Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index (DFI) are the most commonly used instruments to measure functioning in ankylosing spondylitis (AS). The aim of this study was to translate, adapt and validate these instruments into the Italian language. METHODS: The BASFI and DFI questionnaires were translated into Italian by two independent bilingual physicians who were familiar with the medical aspects of AS and by one professional translator. Two rheumatologists familiar with instrument validation, and who were aware of the purpose of the study, examined semantic, idiomatic and conceptual issues and produced by consensus unified versions of each instrument. English back-translations from the Italian were done by a professional translator unaware of the original version. Both English versions were compared, and where needed, modifications to the Italian versions were made. RESULTS: A total of 95 patients were included: 77 males, age (mean+/-SD) 47.9+/-9.3years, and disease duration 12.4+/-6.6 years, and 18 females, age 45.9+/-8.7 years, and disease duration 11.3+/-8.2 years. Reliability, measured in 23 patients participating a physiotherapy program, showed an acceptable one-week test-retest intraclass correlation coefficient (ICC)--BASFI ICC: 0.91, 95% CI: 0,87-0.94 and DFI ICC: 0.86, 95% CI: 0.83-0.90. The internal consistency was 0.90 (Cronbach's alpha) for the BASFI and 0.87 for the DFI. For validity the functional indices were correlated with the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Patient Global Score (BAS-G), modified Health Assesment Questionnaire (HAQ-S), SF-36 physical component summary (SF-36 PCS), stiffness, pain, physician's assessment of disease activity, Bath AS Radiology Index-total (BASRI-t), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). The functional indices (BASFI and DFI) were correlated with each other (p<0.0001) and with activity variables. There was no significant relationship between functional indices and BASRI-t and acute phase reactants. The receiver operating characteristic (ROC) curve analysis indicated that the BASFI ranked superior compared to HAQ-S, (p = 0.019) and SF36 PCS (p = 0.002), but not respect to DFI (p = NS), in distinguishing between patients with high and low disease activity. CONCLUSIONS: The Italian versions of the BASFI and DFI showed adequate reliability and validity in patients with AS. Because of psychometric advantages, the BASFI may be preferred in clinical trial settings. However, sensitivity to changes due to drug therapy and/or rehabilitation remains to be determined.

Activities of Daily Living↗
PubMed2006

A system for improving vitamin D nutrition in residential care.

OBJECTIVE: To assess the feasibility of administering an inexpensive preparation of vitamin D(3) 100 000 IU orally 3 monthly to aged-care residents. DESIGN: Prospective, controlled open-label implementation trial. SETTING: Residential aged care, November 2003 to May 2004 (primary study). PARTICIPANTS: 137 ambulant residents: 107 treated (mean age, 85 years; 79 were women), 30 untreated controls (mean age, 87 years; 22 were women). INTERVENTIONS: Lactose microencapsulated vitamin D(3) 100 000 IU orally at baseline, then 3 monthly (three or more doses); untreated subjects were observed contemporaneously. MAIN OUTCOME MEASURES: Serum levels of 25-hydroxyvitamin D [25(OH)D] at 6 months compared with baseline; acceptability of the program to residents and staff. RESULTS: At baseline, 95% of residents assessed (n = 137) had serum 25(OH)D levels below the desirable range of 60-160 nmol/L. At 6 months, all treated residents (n = 98) achieved desired levels, with the mean (+/- SD) 25(OH)D level increasing from 36.4 +/- 12.6 nmol/L (range, 12-75 nmol/L) at baseline to 124.0 +/- 27.9 nmol/L (range, 68-244 nmol/L). In no resident did 25(OH)D approach toxic levels. The mean serum 25(OH)D level remained low in the control group (n = 27): 42.8 +/- 18.3 nmol/L (range, 18-98 nmol/L). The difference between the mean 25(OH)D levels of treatment and control groups at 6 months was 81.2 nmol/L (95% CI, 69.7-92.0 nmol/L). The cost of the supplement was $4 per resident per annum. Substudies showed mean trough serum 25(OH)D levels in the desired range at 3 months (n = 31), but below the desired range at 6 months (n = 50). Subjects given 3-monthly doses for up to 2 years maintained serum 25(OH)D levels within the desired range, with no trend toward undesirable accumulation (n = 11). CONCLUSIONS: Vitamin D(3) 100 000 IU given orally 3 monthly is a practical, safe, effective and inexpensive way to meet the vitamin D(3) requirements of aged-care residents.

Administration, Oral↗
PubMed1978

Intravenous antibiotic therapy at home.

During a 12-month period, 23 patients aged 12 to 78 years were treated for 8 to 40 days (mean, 23 days) at home with intravenous (i.v.) antibiotics. Diseases treated included bone and joint infection (14 patients), blastomycosis (two), actinomycosis (two), staphylococcal bacteremia (two), endocarditis (two), and candidal pyelonephritis (one). After initial in-hospital training, patients self-administered their drugs through a heparin-lock i.v. cannula, which was changed regularly by a visiting home care nurse. Antibiotics administered included cloxacillin, penicillin G, cephalosporins, gentamicin, carbenicillin, and amphotericin B. Patient and family acceptance of the program was good, the program was therapeutically effective, and, apart from a decreased prevalence of phlebitis with the heparin lock at home, side effects were no different from those of in-hospital-treated patients. The cost of home therapy was $ 40 per patient-day compared with an estimated $ 137 had the patients remained in hospital. Most patients were able to resume normal activities while receiving home i.v. therapy.

Actinomycosis↗
PubMed1992

Medicare program; offset of Medicare payments to individuals to collect past-due obligations arising from breach of scholarship and loan contracts--HCFA. Final rule.

This final rule sets forth the procedures to be followed for collection of past-due amounts owed by individuals who breached contracts under certain scholarship and loan programs. The programs that would be affected are the National Health Service Corps Scholarship, the Physician Shortage Area Scholarship, and the Health Education Assistance Loan. These procedures would apply to those individuals who breached contracts under the scholarship and loan programs and who-- Accept Medicare assignment for services; Are employed by or affiliated with a provider, Health Maintenance Organization, or Competitive Medical Plan that receives Medicare payment for services; or Are members of a group practice that receives Medicare payment for services. This regulation implements section 1892 of the Social Security Act, as added by section 4052 of the Omnibus Budget Reconciliation Act of 1987.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1987

Steam sterilization trends in the U.S.A.

Steam sterilization practices, standards, and products in the United States are changing as the U.S. health care system continues to undergo dramatic restructuring. The causes of this restructuring are hospital consolidations, implementation of diagnostic-related-group reimbursement, cost-containment programs, and increasing acceptance of disposable packs.

Central Supply, Hospital↗
PubMed1984

Impact analysis and medical manpower planning.

The impact analysis at St. Joseph's Hospital forms a integral part of the long range financial planning perspective and reflects the hospital's commitment to the provision of quality patient care and to the mandate of ensuring that resources are employed in an effective and efficient manner. Medical staff acceptance of the program indicates that they recognize the value and the necessity of the impact analysis as an important part of medical manpower planning, even though it impinges on the historical role of the chief of the department in the recruitment of new medical staff. Although the process described is of particular relevance to teaching hospitals, the implications are also important to any community hospital which is trying to use its scarce resources to provide the best possible service to its community.

Financial Management↗
PubMed1976

Acupuncture effect on neurosensory deafness.

Bilateral neurosensory deafness offers a unique opportunity to study the effects of acupuncture objectively. By treating only one ear, and using audiometric evaluation techniques instead of subjective evaluations of hearing, an analysis of any achieved improvement seemed feasible. Only patients with well documented bilateral nerve deafness were accepted into the program. A baseline audiogram with speech discrimination and puretone air and bone conduction thresholds was obtained prior to treatment. Thirty-eight patients underwent ten consecutive acupuncture treatments on one ear only, with the other ear serving as a control. After the course of acupuncture, the audiometrics were repeated by the same audiologist. There was no significant increase in hearing after acupuncture therapy.

Acupuncture Therapy↗
PubMed2000

Risk factors that may adversely modify the natural history of the pediatric pronated foot.

Flatfoot is one of the most common conditions seen in pediatric podiatry practice. There is no universally accepted definition for flatfoot. Flatfoot is a term used to describe a recognizable clinical deformity created by malalignment at several adjacent joints. Clinically, a flatfoot is one that has a low or absent longitudinal arch. Determining flexibility (physiologic) or rigidity (pathologic) is the first step in management. A flexible flat foot will have an arch that is present in open kinetic chain (off weight-bearing) and lost in closed kinetic chain (weight-bearing). A rigid flatfoot has loss of the longitudinal arch height in open and closed kinetic chain. According to Mosca, "The anatomic characteristics of a flatfoot are excessive eversion of the subtalar complex during weight-bearing with plantarflexion of the talus, plantarflexion of the calcaneus in relation to the tibia, a dorsiflexed and abducted navicular and a supinated forefoot." Normally developing infants have a flexible flatfoot and gradually develop a normal arch during the first decade of life. When evaluating an infant for a pronated condition, the examiner must also consider other risk factors that may affect the foot in its overall development. These contributing factors will play a role in the development of a treatment plan. The risk factors include ligamentous laxity, obesity, rotational deformities, tibial influence, pathological tibia varum, equinus, presence of an os tibiale externum, and tarsal coalitions. The authors realize other less significant factors exist but are not as detrimental to the foot as the primary ones discussed in depth. The primary risk factors that affect the pronated foot have been outlined. The clinician should always examine for these conditions when presented with a child exhibiting pronatory changes. A thorough explanation to the parents as to the consequential effects of these risk factors and their effects on the pediatric pronated foot is paramount to providing an acceptable comprehensive treatment program. Children often are noncompliant with such treatments as stretching and orthotic maintenance. The support of the parents is crucial to maintaining an effective treatment program continued at home.

Child↗
PubMed1984

[Endometrial curettage in abnormal vaginal bleedings in 1964 and 1983 at the Panti Rapih Hospital, Yogyakarta, and family planning].

This study was undertaken to compare the causes of abnormal vaginal bleedings in 1964 before the family planning program in Indonesia was introduced and in 1983 when this program was widely accepted. The samples were taken from the files of the Department of Pathology, Gadjah Mada University Medical Faculty, during the period of July 1-December 31 in the years 1964 and 1983. The results suggested that in 1964 these bleedings were mainly caused by conception (52.9%), while in 1983 only 19.7% were caused by conception. In 1964 most dysfunctional bleedings were found in the perimenopause groups and in 1983 in the child bearing groups. Extended studies utilizing larger samples could provide further information about the role of estrogen hormones for contraception and therapy or hormones for cosmetic purposes, and also about endogenic factors. It would be necessary to work together with other specialists as well as psychologists.

Asia↗
PubMedDate not supplied

Interactive peer review: an innovative resident evaluation tool.

BACKGROUND AND OBJECTIVES: We designed an interactive peer review process for our inpatient family practice residents using a faculty-facilitated group format. This paper describes and evaluates the method. METHODS: During inpatient rotations, first-year residents evaluate second- and third-year residents, second-year residents evaluate first- and third-year residents, and third-year residents evaluate first- and second-year residents. Evaluations are conducted in discussion format, led by a faculty facilitator. Results are shared with the resident being evaluated. We surveyed residents and faculty regarding the usefulness of this review method and their comfort with the process using a 15-question survey. RESULTS: A total of 90% of residents and 100% of faculty responded to the survey; 82% of residents and 100% of faculty felt that the peer-review process was useful. All faculty felt that peer comments correlated well with their own impressions of resident performance. Only 4% of residents felt uncomfortable knowing that peers were evaluating their performance, and 93% of residents and 100% of faculty felt that the peer-review process had supported the team environment. CONCLUSIONS: Interactive peer review is an excellent tool to obtain timely, specific, and useful information regarding resident performance and has been well accepted in our program.

Data Collection↗
PubMedDate not supplied

Somatization, anxiety and depression in a drug-free residential therapeutic community.

This study aims to assess the nature and prevalence of somatization and related psychiatric symptoms among residents in Daytop Village, a drug-free residential therapeutic community (TC). Three hundred and twenty two residents at Daytop were surveyed, and when compared with a normal, non-patient reference group, residents at Daytop exhibited higher levels of somatization, depression, and anxiety as measured with the Brief Symptom Inventory. Multiple linear regression analysis showed that being widowed or divorced, having marijuana/hallucinogens as greatest drug problem, and the importance of a religious figure in entering Daytop were associated with higher levels of somatization. A length of stay of 3-6 months and acceptance of Daytop program philosophy was inversely correlated with somatization scores. These findings are discussed with particular attention focused on the role of somatization among TC residents.

Adult↗
PubMed2002

Quality assessment program in histopathology: a pilot study from Maharashtra.

Histopathology reports are important quality assurance tools and evaluation of pathological diagnoses described in them is an integral part of total quality control and quality improvement program. We describe a program based on slide circulation which was aimed at both continuing education to upgrade knowledge and proficiency testing of histopathologists. The performance of the participating pathologists was analyzed and the degree of agreement was also studied. The results showed improvement indicated by rising level of performance in 35.3% of consistent participants and increasing trend in the average score. The degree of agreement was comparatively low (65.29%). The practicability of this program and its acceptability as an EQAS was also investigated.

Education, Medical, Continuing↗
PubMed2004

Childbearing practices in anadier Mennonite women.

Cross-cultural nursing practices call for attention to be paid to the unique beliefs and practices of the groups with which nurses come in contact. The Kanadier Mennonites are a conservative religious group who live in Alberta, Manitoba and Ontario. An exploratory, descriptive study was conducted with this group in southern Alberta to generate information about their health and illness beliefs. This article focuses on their knowledge, beliefs and practices in relation to childbearing. Interviews were conducted with 45 women, the majority of whom were married and had been born in Mexico. Among the sample there had been a range of one to 16 pregnancies. The participants noted that childbearing is not a topic openly discussed with others. Women learn about childbearing from their mothers and other women but also from physicians and books. During pregnancy there are particular activities to be avoided including the use of strong cleaning fluids and hand milking of cows. Foods such as milk need to be ingested to ensure a healthy pregnancy Prenatal care was not emphasized in Mexico nor has it become a customary practice in Canada but deliveries in hospital are the norm in both these countries. During the postpartum the women receive support from their immediate and extended family in order to recuperate. Nurses need to explore individual Kanadier Mennonite beliefs regarding childbearing and work with this group in developing acceptable health promotion programs to help ensure healthy pregnancy outcomes. The blending of nursing practice knowledge in a non-intrusive manner with a group of people with differing belief systems is a necessary and achievable goal.

Adult↗
PubMed2006

The impact of quality assurance programming: a comparison of two canadian dental hygienist programs.

Quality assurance (QA) and continuing competence (CC) programs aim to ensure acceptable levels of health care provider competence, but it is unknown which program methods most successfully achieve this goal. The objectives of the study reported in this article were to compare two distinct QA/CC programs of Canadian dental hygienists and assess the impact of these two programs on practice behavior change, a proxy measure for quality. British Columbia (BC) and Ontario (ON) were compared because the former mandates continuing education (CE) time requirements. A two-group comparison survey design using a self-administered questionnaire was implemented in randomly selected samples from two jurisdictions. No statistical differences were found in total activity, change opportunities, or change implementation, but ON study subjects participated in significantly more activities that yielded change opportunities and more activities that generated appropriate change implementation, meaning positive and correct approaches to providing care, than BC dental hygienists. Both groups reported implementing change to a similarly high degree. The findings suggest that ON dental hygienists participated in more learning activities that had relevancy to their practice and learning needs than did BC subjects. The findings indicate that the QA program in ON may allow for greater efficiency in professional learning.

Behavior↗
PubMed1991

[Intracavernous injections of prostaglandin E1 in the treatment of erection disorders].

Vasoactive drugs have been widely used for the treatment of impotence in the last years. Recently Prostaglandin E1 has been employed with success as a therapy in erection problems. The Authors have treated with Prostaglandin E1 209 patients complaining erection failure. Positive results were obtained in 155 patients (74,16%). No complications or side effects occurred. 129 patients of the 155 in which the test resulted positive were proposed a self-injection program and 115 accepted. Until now no side effects or complications occurred.

Adult↗
PubMed1991

[Cost-effectiveness of lowering of blood cholesterol using simvastatin and cholestyramine].

With use of a model of the costs and effects of cholesterol lowering therapy in the primary prevention of coronary heart disease, the cost-effectiveness of simvastatin and cholestyramine in the Netherlands have been estimated. Costs per year of life saved by cholestyramine therapy are several times greater than those of simvastatin therapy and compared unfavorably with those of generally accepted health care programs in the Netherlands. Cholesterol-lowering with simvastatin in men can be cost-effective when therapy is initiated at an early age. At cholesterol levels between 6.5 and 8 mmol/l, however, therapy should be restricted to men with at least one, preferably two additional risk factors such as hypertension or diabetes mellitus. Among women, cholesterol lowering can only be cost-effective when therapy is limited to women with diabetes mellitus or severely elevated serum cholesterol levels.

Adult↗