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PubMed1981

[National research program on the economy and efficacy of the health system in Switzerland: scientific objective and practical aspects].

Scientific and policy targets of the National Research Program on Health Care Efficiency. Following a brief review of the general background, the specific goals of the program are presented: the realization of a solid scientific and interdisciplinary basis in the field of systematic health-system-research in Switzerland. After a review of the criteria which were employed to select out of one hundred offers some twenty research projects, a summary of these projects permits to illustrate the architecture of the whole program.

Cost-Benefit Analysis↗
PubMed2005

CaSPredictor: a new computer-based tool for caspase substrate prediction.

MOTIVATION: In vitro studies have shown that the most remarkable catalytic features of caspases, a family of cysteineproteases, are their stringent specificity to Asp (D) in the S1 subsite and at least four amino acids to the left of scissile bound. However, there is little information about the substrate recognition patterns in vivo. The prediction and characterization of proteolytic cleavage sites in natural substrates could be useful for uncovering these structural relationships. RESULTS: PEST-like sequences rich in the amino acids Ser (S), Thr (T), Pro (P), Glu or Asp (E/D), including Asn (N) and Gln (Q) are adjacent structural/sequential elements in the majority of cleavage site regions of the natural caspase substrates described in the literature, supporting its possible implication in the substrate selection by caspases. We developed CaSPredictor, a software which incorporated a PEST-like index and the position-dependent amino acid matrices for prediction of caspase cleavage sites in individual proteins and protein datasets. The program predicted successfully 81% (111/137) of the cleavage sites in experimentally verified caspase substrates not annotated in its internal data file. Its accuracy and confidence was estimated as 80% using ROC methodology. The program was much more efficient in predicting caspase substrates when compared with PeptideCutter and PEPS software. Finally, the program detected potential cleavage sites in the primary sequences of 1644 proteins in a dataset containing 9986 protein entries. AVAILABILITY: Requests for software should be made to Dr José E. Belizário SUPPLEMENTARY INFORMATION: Supplementary information is available for academic users at site http://icb.usp.br/~farmaco/Jose/CaSpredictorfiles.

Algorithms↗
PubMedDate not supplied

Use of the Critical Thinking Disposition Inventory in critical care orientation.

In the current health care environment it is imperative that orientation programs be effective and efficient in the preparation of nurses entering critical care nursing. Institutions strive to develop orientation programs that use the least amount of resources necessary to achieve the desired outcome. The desired outcome of the critical care orientation process is for nurses to use critical thinking skills to make sound clinical judgments based on scientific knowledge of critical care nursing. Identifying areas of strengths and deficits in critical thinking could prove beneficial in assisting educators to individualize nursing orientation programs using critical thinking skills in practice. The purpose of this article is to describe a method used to measure nurses' dispositions toward critical thinking and the application of the California Critical Thinking Disposition Inventory (CCTDI) in critical care orientation programs.

Adult↗
PubMed2000

[Estimating cost functions of cancer screening programs provided by municipalities].

OBJECTIVE: To estimate cost functions of cancer screening programs for stomach, lung, colorectal, cervical, and breast cancers provided by municipalities and to describe the relationship between the costs and the scale of cancer screening programs. METHODS: Subjects were all the municipalities in Japan. Questionnaires were sent to 3,182 subjects and 1,860 responses were received. Data obtained from questionnaires were the number of persons screened and the total cost of each program in the 1998 fiscal year. A cost function of each program was specified as a linear model, a power model, and a cubic model, and the fitness of each model was estimated. RESULTS: Long-run cost functions of all the cancer screening programs allowed better explanation of the relationship between the number of persons screened and the total cost than short-run cost functions. The average costs of stomach, colorectal, and cervical cancer screening programs increased and the average cost of the lung cancer screening program decreased, as the number of persons screened increased. The cost function of the breast cancer screening program could not be identified. CONCLUSIONS: It is necessary to estimate not only cost functions but also production functions of cancer screening programs using the data related to products, costs, and factors of production to evaluate the efficiency of cancer screening programs.

Cities↗
PubMed1991

Efficient computation of three-dimensional protein structures in solution from nuclear magnetic resonance data using the program DIANA and the supporting programs CALIBA, HABAS and GLOMSA.

A novel procedure for efficient computation of three-dimensional protein structures from nuclear magnetic resonance (n.m.r.) data in solution is described, which is based on using the program DIANA in combination with the supporting programs CALIBA, HABAS and GLOMSA. The first part of this paper describes the new programs DIANA. CALIBA and GLOMSA. DIANA is a new, fully vectorized implementation of the variable target function algorithm for the computation of protein structures from n.m.r. data. Its main advantages, when compared to previously available programs using the variable target function algorithm, are a significant reduction of the computation time, and a novel treatment of experimental distance constraints involving diastereotopic groups of hydrogen atoms that were not individually assigned. CALIBA converts the measured nuclear Overhauser effects into upper distance limits and thus prepares the input for the previously described program HABAS and for DIANA. GLOMSA is used for obtaining individual assignments for pairs of diastereotopic substituents by comparison of the experimental constraints with preliminary results of the structure calculations. With its general outlay, the presently used combination of the four programs is particularly user-friendly. In the second part of the paper, initial results are presented on the influence of the novel DIANA treatment of diastereotopic protons on the quality of the structures obtained, and a systematic study of the central processing unit times needed for the same protein structure calculation on a range of different, commonly available computers is described.

Algorithms↗
PubMed2004

Efficient two-trait-locus linkage analysis through program optimization and parallelization: application to hypercholesterolemia.

We have optimized and parallelized the GENEHUNTER-TWOLOCUS program that allows to perform linkage analysis with two trait loci in the multimarker context. The optimization of the serial program, before parallelization, results in a speedup of a factor of more than 10. The parallelization affects the two-locus-score calculation, which is predominant in terms of computation time. We obtain perfect speedup, that is, the computation time decreases exactly by a factor of the number of processors. In addition, two-locus LOD and NPL scores are now calculated for varying genetic positions of both disease loci, not just one locus varied and the position of the other disease locus fixed, as before. This results in easily interpretable 3-D plots. We have reanalyzed a pedigree with hypercholesterolemia using our new version of GENEHUNTER-TWOLOCUS. Whereas originally, two individuals had to be discarded due to excessive computation-time demands, the entire 17-bit pedigree could now be analyzed as a whole. We obtain a two-trait-locus LOD score of 5.49 under a multiplicative model, compared to LOD scores of 3.08 and 2.87 under a heterogeneity and additive model, respectively. This further increases evidence for linkage to both 1p36.1-p35 and 13q22-q32 regions, and corroborates the hypothesis that the two genes act in a multiplicative way on LDL cholesterol level. Furthermore, we compare the computation times for two-trait-locus analysis needed by the programs GENEHUNTER-TWOLOCUS, TLINKAGE, and SUPERLINK. Altogether, our algorithmic improvements of GENEHUNTER-TWOLOCUS allow researchers to analyze complex diseases under realistic two-trait-locus models with pedigrees of reasonable size and using many markers.

Computer Simulation↗
PubMed1978

Efficiency of traditional chewing sticks in oral hygiene programs among Ethiopian schoolchildren.

The effect of oral hygiene programs was studied in 248 children from five schoolclasses in Asella, Ethiopia. All children received professional toothcleaning after an initial clinical examination, and were again examined after a trial period of 3 months. The classes were assigned to the following procedures: one class received information and instruction in the use of the toothbrush, and a second class in the use of the mefaka, a wooden chewing stick traditionally used for oral cleaning. The children were advised to clean their teeth daily. Two other classes received similar information and instruction with regard to the toothbrush and the mefaka. Oral cleaning was then performed daily under direction and supervision, in one class with the toothbrush and in the other class with the mefaka. The fifth class was used as control. Instruction only was found to have no effect on the amount of oral deposits. Supervised oral cleaning, on the other hand, improved the oral hygiene of the schoolchildren significantly. The mefaka was found to be as effective as the toothbrush in removing oral deposits. It was concluded that the mefaka should be recommended for use in preventive dental programs in Ethiopia since it is effective, inexpensive, and familiar to the population.

Adolescent↗
PubMedDate not supplied

Review of cost efficiency and efficacy of delivering a diabetes education program in a southwest rural healthcare facility.

The purpose of this study was to evaluate the effect of redesigning the education program from individual instructional sessions to a format where the majority of instruction was provided through small group classes. Patient outcomes of lifestyle changes as evidenced by weight loss, improved glycemic control, adoption of a consistent pattern of blood glucose monitoring, and increased physical activity were evaluated using a physician satisfaction survey and a patient satisfaction and lifestyle change survey. The findings indicate that the changes in the education program accommodated a variety of needs; facilitated cost-effectiveness; were convenient for the patients, educators, and physicians; and still promoted adaptive lifestyle changes in behavior leading to improved glycemic control, increased levels of physical activity, and weight loss in persons with type 2 diabetes.

Blood Glucose↗
PubMedDate not supplied

Rural and urban family planning services in the United States.

Family planning programs have become more efficient. It cost $66 per patient in 1976 to provide services in both rural and urban programs--the same cost reported in 1971, despite a 40 percent increase in prices since that time. Rural programs are dominated by health departments, lack health professionals, are more likely to insist teenagers have parental consent.

Adolescent↗
PubMed2000

[The efficiency of mass media utilization in preventive health programs and mental health promotion].

This paper reviews articles pertaining to mental health prevention and promotion programs that have used mass media as a component of their program. The programs are analyzed according to four roles that media can play in health promotion programs: promotion, education, complementarity, and support. The relationship between the function assigned to the media and the effects of the programs in changing knowledge, attitudes, or behaviour is explored. When mass media are used alone, they seem to be powerful in recruiting people into groups or social services and in enhancing knowledge and changing attitudes. But when it comes to changing behaviour, mass media by themselves have limited impact. This type of change is more likely to occur when media are combined with face-to-face intervention. Finally, some issues involved in improving the use of mass media in mental health are discussed.

Humans↗
PubMed2002

[Progress and efficiency of implementation of the purpose-oriented program "Urgent Tuberculosis Control Measures in Russia in 1998-2004" in the Urals Federal Region].

The paper analyzes the tuberculosis epidemic situation in the areas of the Urals Federal Okrug, which is regarded to be very serious. Recent years are marked by a rise in basic epidemiological indices, such as incidence, prevalence, spread of cases with bacterial isolation, mortality due to tuberculosis. There is a direct, close, and significant relationship of positive tuberculin tests and morbidity in children to the spread of tuberculosis with bacterial isolation. The effectiveness of tuberculosis controlling measures within the federal special program Urgent Tuberculosis Controlling Measures in Russia in 1998-2004 was evaluated and guidelines for its enhancement are stated.

Adult↗
PubMed1998

Teaching clinical decision-making to pediatric residents in an era of managed care.

The growth of managed care has brought a new focus on physician competency in the appropriate use of resources to help patients. The community of pediatric educators must improve residency curricula and teaching methodologies to ensure that graduates of their programs can effectively and efficiently meet the needs of children and their families. The educational approach in many pediatric residency programs is an implicit apprenticeship model, with which the residents follow the actions of attending physicians with little attention to scrutiny of the clinical evidence for and against diagnostic and treatment strategies. Evidence-based medicine stresses to the trainee the importance of the evaluation of evidence from clinical research and cautions against the use of intuition, unsystematic clinical experience, and untested pathophysiologic reasoning as sufficient for medical decision-making. Managed care also has helped to create a heightened awareness of the need to educate residents to incorporate the preferences of patients and families into diagnostic and treatment decisions. Trainees must know how to balance their duty to maximize the health of populations at the lowest resource use with their duty to each individual patient and family. Changes in the residency curriculum will bring change in educational settings and the structure of rotations. Potential barriers to implementation will include the need for faculty development and financial resources for information technology.

Cost-Benefit Analysis↗
PubMed1996

Self-paced learning stations for tuberculosis respirator training: report of a pilot program.

BACKGROUND: In response to the Centers for Disease Control and Prevention's recently issued "Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Facilities, 1994," during May 1994 we implemented and evaluated a pilot tuberculosis respirator training program that used four self-directed learning stations, through which participants proceeded at their own pace. Employee tuberculin skin testing was included in the training program. METHODS: The time required to train each employee was recorded. At the completion of the training program, all participants were asked to assess their ability to attain the learning objectives and whether they believed the program format was an effective and efficient use of their time. Two weeks later, a convenience sample of 100 employees completed an 11-question test designed to measure knowledge retention. RESULTS: One hundred seventy-six employees completed training during the pilot period. The average time necessary to train each employee was 19.5 minutes. Overall 97.1% of participants stated that they were able to fully meet the course objectives. Test scores among the convenience sample averaged 88% 2 weeks after training. CONCLUSIONS: The use of self-paced stations for tuberculosis respirator training and employee tuberculosis skin test screening was both effective and time-efficient for employees. We have expanded this program to include all of our approximately 500 employees who may be exposed to tuberculosis.

Educational Measurement↗