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PubMedDate not supplied

Iterative design and evaluation of new prone carts for individuals with SCDs: a technical note.

This paper summarizes a series of projects funded since 1992 to address the compelling need to improve the quality of life for persons with spinal cord dysfunctions who use prone carts. Specifically, Veterans Services Organization, National Institute on Disability and Rehabilitation Research (NIDRR), and the VA Rehabilitation Research and Development funded studies to develop new consumer-driven designs for prone carts. Using an iterative approach, this team of clinicians and designers (1) evaluated existing prone carts; (2) designed a new manual prone cart; (3) designed a new motorized prone cart, including a standing model; and (4) are collaborating with manufacturers to market and commercialize the new prone carts. Prototypes were developed at the Milwaukee Institute of Art and Design with the assistance of Ortho-Kinetics, Inc., and Everest & Jennings and were clinically evaluated at two Veterans Affairs Medical Centers (Tampa and Milwaukee) with patients and caregivers and for compliance with applicable ISO (International Organization for Standardization) for electric wheelchair standards.

Activities of Daily Living↗
PubMed2004

Improved tolerance to missing data in myocardial perfusion SPET using OSEM reconstruction.

When projection data are incomplete for various technical reasons, artefacts may occur in the reconstructed images. This study examines whether an iterative reconstruction method, the ordered subsets implementation of the EM algorithm (OSEM), can improve reconstruction and minimise the artefacts compared to filtered back-projection (FBP). We varied the number and location of projections removed to investigate when significant artefacts occur, and whether diagnosis is affected. Phantom studies were analysed with sequential orthogonal pairs of projection angles removed (as would typically occur when either data loss or severe motion is detected during acquisition with a right-angled, dual-head cardiac single-photon emission tomography system) and reconstructed with both FBP and OSEM. Twelve normal myocardial perfusion studies were also assessed to study the effect of missing projections on clinical diagnosis. Differences between reconstructions with intact versus missing data were measured. Also, reconstructed images were clinically assessed and scored on a five-point scale based on whether the artefacts would alter clinical interpretation. Although both reconstruction methods showed artefacts, the absolute differences between reconstructed phantom data with intact and missing projection sets were significantly greater (P<0.005) for FBP than for OSEM for all numbers of missing projections. The clinical data showed similar differences between FBP and OSEM reconstructions. The three observers noted superiority of OSEM compared to FBP, with reduced incidence of clinically significant artefacts. However, neither reconstruction method could tolerate six or more missing pairs from 32 projections. There was no significant dependence on the angular location of missing projections. In the absence of any attempt to correct for missing projections, OSEM reduced the influence of artefacts compared to FBP.

Algorithms↗
PubMed2006

Cultivating systemic capacity: the Rhode Island tobacco control enhancement project.

This paper describes the Rhode Island Tobacco Control Enhancement Project (TCEP), a state-university-community technical assistance system. TCEP was developed under the auspices of the Rhode Island Department of Health's Tobacco Control program and was designed to build capacity among nine community-based organizations to mount comprehensive tobacco control interventions in five diverse communities within the state. This paper: (1) provides a description of community mobilization; (2) presents a logic model for planning and decision making used by state-university-community partners; (3) describes training, technical assistance services and implementation; and, (4) describes the evaluation and program improvement activities used to support on-going project development.

Comprehensive Health Care↗
PubMedDate not supplied

EVATS: a proactive solution to improve surgical education and maintain flexibility in the new training era.

OBJECTIVE: To describe the development of the EVATS rotation. DESIGN: Descriptive document. SETTING: University teaching hospital. PARTICIPANTS: Faculty and residents of the University of Washington. METHODS: In July 2003 we identified the need for a new, independent, educational module within our residency training. Requirements for this rotation included dedicated time for technical skills training on simulators, independent competency learning modules, academic research project time, vacation time and coverage, and flexibility for unplanned leave (eg, interview travel, m/paternity leave). RESULTS: An EVATS rotation was created in July 2003 that is provided at each training level and lasts from 4 to 8 weeks depending on R-level. EVATS meets the following challenges: Emergency coverage (EVATS residents available for last-minute service coverage), vacation time/vacation coverage (2 weeks vacation + 1 week vacation coverage; this maintains vacations for all residents every 6 months), academic time (residents now must complete 1 academic project for graduation) and ACGME competency learning and assessment, and technical skills training (includes simulator work for open/lap skills). Initial implementation indices are high and include resident satisfaction, 80-hour work week compliance, academic productivity, and patient continuity of care. CONCLUSIONS: The 21st century brought new challenges for surgical training. Increased societal demands for skills training in a laboratory setting using simulators and the 6 ACGME competencies all require classroom-type training periods. Paradoxically, the 80-hour work week restricted the time available for these educational activities and made it more difficult for programs to accommodate resident vacations and emergencies. These challenges provided an opportunity to enhance the educational experience for our residency program. The product was the EVATS rotation. Early data after implementation are favorable.

Adult↗
PubMed1991

Evaluation of a Computerized Clinical Information System (Micromedex).

This paper summarizes data collected as part of a project designed to identify and assess the technical and organizational problems associated with the implementation and evaluation of a Computerized Clinical Information System (CCIS), Micromedex, in three U.S. Department of Veterans Affairs Medical Centers (VAMCs). The study began in 1987 as a national effort to implement decision support technologies in the Veterans Administration Decentralized Hospital Computer Program (DHCP). The specific objectives of this project were to (1) examine one particular decision support technology, (2) identify the technical and organizational barriers to the implementation of a CCIS in the VA host environment, (3) assess the possible benefits of this system to VA clinicians in terms of therapeutic decision making, and (4) develop new methods for identifying the clinical utility of a computer program designed to provide clinicians with a new information tool. The project was conducted intermittently over a three-year period at three VA medical centers chosen as implementation and evaluation test sites for Micromedex. Findings from the Kansas City Medical Center in Missouri are presented to illustrate some of the technical problems associated with the implementation of a commercial database program in the DHCP host environment, the organizational factors influencing clinical use of the system, and the methods used to evaluate its use. Data from 4581 provider encounters with the CCIS are summarized. Usage statistics are presented to illustrate the methodological possibilities for assessing the "benefits and burdens" of a computerized information system by using an automated collection of user demographics and program audit trails that allow evaluators to monitor user interactions with different segments of the database.

Computer Systems↗
PubMed1996

Rapid KABP survey for evaluation of NGO HIV/AIDS prevention projects.

The Johns Hopkins University HAPA Support Program (HSP) provided technical assistance to Save the Children (SC), a U.S.-based nongovernmental organization, to conduct a survey of knowledge, attitudes, beliefs, and practices (KABP) related to AIDS among rural Zimbabweans. The objectives of the HSP technical assistance were to field test a rapid KABP survey methodology and to assist SC to provide data that would contribute to their final project evaluation. The entire process of planning, implementation, preliminary data analysis, and preparation of a draft report of survey results was completed in a four-week period. A total of 660 respondents, aged 18-45 years, selected by a modified 30-cluster sampling method, were interviewed in two SC project areas. Although knowledge about HIV/AIDS was high, a number of misconceptions about HIV transmission and unfavorable attitudes to people with AIDS were noted. Of five knowledge and attitude variables that could be compared with the baseline survey results, 4 showed favorable changes and 1 showed an unfavorable trend. Comparing responses from those who were educated by SC with those who had other sources of information about HIV/AIDS, higher levels of knowledge were seen in the SC-educated group and, in one area, somewhat greater willingness to care for family members with AIDS. However, there were no differences seen in other attitudes, beliefs, or in practices regarding condom use. The rapid KABP survey approach was successful in providing, with a relatively modest investment of resources, quantitative data useful for project evaluation, and for developing HIV/AIDS-intervention strategies.

Acquired Immunodeficiency Syndrome↗
PubMed1979

The effect of supplemental lecture, evaluation method and instructional type on student performance in a preclinical technique project.

This study examined two types of instruction, two methods of evaluation, and the effects of a supplemental lecture in teaching a laboratory technique exercise. Students were randomly assigned to one of four groups: (1) self-instruction, self-evaluation; (2) self-instruction, teacher-evaluation; (3) teacher-aided instruction, self evaluation; and (4) teacher-aided instruction, teacher-evaluation. In addition, half of the students in each of the four groups received a supplemental lecture. Ratings of technical performance, a didactic posttest, and project completion time, were used as outcome measures. Of 27 main treatment effects tested, 25 demonstrated no significant differences. This study fails to demonstrate any major advantage of using self versus traditional forms of instruction and evaluation when student performance is the primary consideration.

Composite Resins↗
PubMedDate not supplied

Trials and tribulations: a small pilot telehealth home care program for medicare patients.

This article describes a home care agency's experience initiating the technology of a telehealth program for a selected view of its home care patients. The goal of the telehealth program was to improve patient outcomes by augmenting patients' regularly scheduled in-home skilled nursing visits with video-conferencing encounters. Patient selection, costs, projected savings, patient satisfaction, and the technical, clinical, and patient problems with the telehealth system are discussed.

Aged↗
PubMed2006

Translating visions into realities.

The overall vision and the building concept. The overall vision with individual buildings that have focal points for the related medical treatment may seem to increase both investment and operational cost, especially in the period until the total hospital is finished (2014). The slogan "Better services at lower cost" is probably a vision that will prove to be hard to fulfil. But the patients will probably be the long-term winners with single rooms with bathroom, high standards of service, good architecture and a pleasant environment. The challenge will be to get the necessary funding for running the hospital. The planning process and project management Many interviewees indicate how difficult it is to combine many functions and requirements in one building concept. Different architectural, technical, functional and economic interests will often cause conflict. The project organisation HBMN was organised outside the administration of both STOLAV and HMN. A closer connection and better co-operation with STOLAV may have resulted in more influence from the medical employees. It is probably fair to anticipate that the medical employees would have felt more ownership of the process and thus be more satisfied with the concept and the result. On the other hand the organisation of the project outside the hospital administration may have contributed to better control and more professional management of the construction project. The management for planning and building (technical programme, environmental programme, aesthetical The need for control on site was probably underestimated. For STOLAV technical department (TD) the building process has been time-consuming by giving support, making controls and preparing the take-over phase. But during this process they have become better trained to run and operate the new centres. The commissioning phase has been a challenging time. There were generally more changes, supplementation and claims than anticipated. The investment costs are nearly on budget, but the concept will have a negative effect on the running costs of the hospital. The budgets for running both the old and new hospital until phase 2 is finished have not been calculated properly and can reduce the level of ambition in the further process. The moving in phase was a little postponed for some of the centres. Only the laboratory centre has moved in on time. It was realised immediately that the buildings services had not been tested out and adjusted properly. In addition it was acknowledged that there should have been a better training programme for the new organisation before moving in. This situation was extremely challenging for the medical employees. With experience from building phase 1, HBMN decided to change the contract model for building phase 2 to a partnering process. That means higher involvement of suppliers and subcontractors with a goal to improve both quality and efficiency. A greater involvement of all participants is needed to share the risk but also reduce costs.

Efficiency, Organizational↗
PubMed2006

The diffusion of effective behavioral interventions project: development, implementation, and lessons learned.

Implementation of evidence-based HIV/STD prevention interventions can play an important role in reducing HIV and sexually transmitted diseases. This article describes the development, implementation, and lessons learned of the Diffusion of Effective Behavioral Interventions (DEBI) project, a strategy funded by the Centers for Disease Control and Prevention to diffuse evidence-based, group- and community-level HIV/STD prevention interventions to health departments and community-based organizations nationwide. The article specifically provides an overview of the rationale, description, and theoretical foundation of the project; a review of marketing efforts, including assessment of interests, needs, and capacities relative to the project; a description of project products, their purpose, approach employed to develop them, and their use by implementers; a description of the project's training coordination functions and activities; technical assistance issues; an overview of process and outcome evaluation components; new developments in response to feedback; and a discussion of future directions for DEBI. Project successes and challenges are addressed to inform future efforts to diffuse prevention interventions.

Diffusion of Innovation↗
PubMed2005

Implementation of the European protocol for quality control of the technical aspects of mammography screening in Bulgaria.

The results from the national pilot project on implementation of the European protocol for the quality control (QC) of the technical aspects of mammography screening as well as the European protocol for dosimetry in mammography in Bulgaria are presented. A QC programme for mammography equipment and a standardised measurement protocol were created. The full QC programme was tested on four mammography units of different types and ages. A national survey was performed for entrance surface air kerma (ESAK) on 20 units using a 45 mm PMMA standard phantom. Average glandular dose (AGD) was calculated using the conversion coefficients from the European dosimetry protocol. The survey demonstrated considerable differences in the technical condition of the mammography units that resulted in varying image quality. The measured values of ESAK showed significant variations. Doses for approximately 45% of the units were found to be below the European reference level. The values for AGD ranged from 0.35 to 3.47 mGy. The main problems found were film processing, optical density (OD) control settings and AEC adjustment. The results showed the importance of film OD measurements parallel to dose measurements. The X-ray mammography in the country needs optimisation. Comprehensive quality assurance programme should be adopted in all departments covering permanent QC of the equipment, image quality and breast dose.

Breast↗