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 847 records · Page 47Linked to original sources
PubMed1990

Blood products: optimal use, conservation, and safety.

A review of our experience in total joint arthroplasty revealed that the cell saver was not cost-effective in the case of routine primary hip or knee replacement. Its use should be restricted to cases of revision hip and knee surgery in which infection has been ruled out. Preoperative aspiration remains the most reliable method for accomplishing this. However, if the aspiration is negative and the intra-articular fluid obtained at the time of surgery is suspicious for infection, either in appearance or on Gram stain or cell count, it is best to abandon use of the cell saver. Predonation should be routine for all hip replacement cases unless there are specific contraindications. In general, there is good acceptance of this program by patients, although a few have specifically indicated they would prefer to run the risk of homologous transfusion. Two units available for primary replacement are more than ample. In cases of revisions, a first revision justifies a minimum of 3 units. For complex revision cases involving patients with three or more previous procedures on the hip, or those requiring significant bone resection or large segment grafting, the maximum possible number of units should be obtained. Autologous blood reinfusion should be done for essentially the same indications as homologous transfusion even though risks are sharply reduced. The local source for autologous collection will then follow its own specific protocol for the disposition of remaining units. In every case, the surgical technique should be careful and directed toward limiting intraoperative blood loss.

Blood Transfusion, Autologous↗
PubMed1989

Bayesian regression analysis of non-steady-state phenytoin concentrations: evaluation of predictive performance.

Michaelis-Menten saturable pharmacokinetics confound the determination of appropriate phenytoin maintenance doses. This study retrospectively evaluated the performance of an IBM-PC/XT computer program applying Bayesian regression to the "explicit solution to the Michaelis-Menten equation." Zero to five non-steady-state phenytoin serum concentrations were used to predict either non-steady-state concentrations at least 10 days in the future (n = 49) or steady-state concentrations (n = 20). Non-steady-state concentration prediction precision (% mean absolute error) using 0-5 non-steady-state feedbacks was 137%, 62%, 39%, 31%, 25%, and 15%, respectively, and steady-state concentration prediction precision was 446%, 47%, 50%, 44%, 21%, and 13%, respectively. Elimination of subjects receiving concurrent drugs known to induce phenytoin metabolism significantly improved predictions based on population priors; however, performance improvements were not apparent after two serum level feedbacks. The program provided clinically acceptable predictions with four or more feedbacks. Refinement of population parameters and optimal sampling times should further improve performance.

Aged↗
PubMed1989

Extended donor age in cardiac transplantation.

Approximately one third of brain-dead organ donors are above the age of 35 years. These donors have been used routinely for heart transplantation because the risks of compromised early graft function and potentially accelerated graft atherosclerosis remained nuclear. The increasing length of the waiting list and a 30% death rate of those on the waiting list for donor organs in our heart transplant program led to acceptance of donor hearts up to 54 years of age. Of a total number of 233 donor hearts, 74 were between 36 and 54 years old (group 2). These hearts were compared for early and chronic graft function with a group of 159 patients who received hearts from donors aged 1-35 years (group 1). All but three group 2 hearts were accepted without coronary angiography. Early postoperative graft function was sufficient in all 72 group 2 patients, whereas in group 1, early graft failure in nine (5.7%) patients led to death or required retransplantation. Forty-one patients in group 2 and 79 patients in group 1 were restudied at annual intervals between 1 and 4 years postoperatively by complete cardiac angiography. Mean late postoperative left and right ventricular ejection fractions were normal in both groups. Graft atherosclerosis was found in seven (8.9%) patients in group 1 and in four (9.8%) patients in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Evaluation of surgical training in Belgium. Survey carried out within 2 French-speaking universities].

An inquiry among surgical residents and recently formed surgeons was set up at two major university centers. The information was gathered from 72 departments with an officially accepted surgical training program. Major shortcomings were noted at both the theoretical and practice levels. The global impression of the recently trained surgeons shows moderate enthusiasm. The pedagogic value of several accredited surgical training programs must be questioned. A global evaluation at the end of the training program is also deemed indispensible. The strictly surgical curriculum of the surgeons recently trained in Belgium is totally insufficient when compared to that of those trained abroad. Suggestions to improve the surgical training program as a whole are given in detail.

Belgium↗
PubMed1987

Dislocation of the acromioclavicular joint. An end-result study.

The cases of 127 patients who had an acute dislocation of the acromioclavicular joint were studied. Fifty-two patients, with an average follow-up of 10.8 years, were managed operatively, and seventy-five patients, with an average follow-up of 9.5 years, were managed non-operatively. Using a rating system that included subjective, objective, and roentgenographic criteria, it did not appear that reduction of the acromioclavicular joint was necessary to obtain consistently good results. Operative management, using either coracoclavicular or acromioclavicular fixation, was associated with a higher rate of complications than non-operative treatment. The use of a sling for four weeks without reduction of the joint, followed by a graduated exercise program, led to acceptable clinical results. In patients who had persistent pain and stiffness of the acromioclavicular joint, or in whom symptomatic post-traumatic arthritis developed, resection of the distal part of the clavicle reliably produced significant improvement.

Acromioclavicular Joint↗
PubMed1986

Allied health and the dilemma of nontraditional doctorates.

Opportunities to acquire doctoral degrees through nontraditional means have proliferated in recent years. These opportunities offer master-level allied health professionals a chance to obtain doctoral degrees without major interruptions in their careers or the need to leave their place of employment. However, many question the comparability of these degrees to those obtained through traditional programs. This report examines various types of nontraditional programs and attempts to assess their acceptance by deans of allied health programs based in academic health centers. Of ten deans surveyed, eight stated that they would consider candidates with nontraditional doctorates for faculty appointment. Two had nontraditional doctoral faculty on staff and have had no problems with promotion or tenure of those individuals. Only one indicated that promotion and tenure would not be possible for faculty possessing nontraditional degrees. The implications for allied health faculty possessing nontraditional degrees are explored in light of official and unofficial university policies, and an approach is suggested for junior faculty considering the nontraditional doctoral option.

Costs and Cost Analysis↗
PubMedDate not supplied

A program to help asthmatic students reach their potential.

Asthma is the most common chronic disease of childhood, affecting 15 percent of Americans under the age of 15. It ranks first among the chronic disease in causing school absenteeism, and it has been linked to lowered academic performance. An educational program for elementary school teachers has been developed to assist the asthmatic student in reaching his or her potential. The program addresses needs expressed by members of the Montgomery, Ala., chapter of Parents of Asthmatic Kids (PAK). These parents voiced concern regarding the inadequate preparation of teachers for dealing with the needs of the asthmatic student. Results of a survey of teachers in local elementary schools confirmed their need for asthma education. The program, consisting of an audiovisual presentation, an informative brochure, and an instructional packet to use with first to sixth graders, is designed to be presented in faculty meetings throughout the school system. To evaluate the effectiveness of the module, a simple test is administered before and after the program. The program has been accepted by the American Lung Association of Alabama and is under consideration by the American Lung Association at the national level.

Alabama↗
PubMed1981

Management overview of osteogenesis imperfecta.

The treatment of osteogenesis imperfecta varies with the age of the patients and the severity of disease. Patients with mild disease rarely develop significant deformities; therefore, the care required is mainly limited to periodic fractures or to associated problems, such as erosion of the teeth, decreased hearing, and difficulties in adjustment. It is the patient with severe disease who often requires an unusual amount of attention. Regardless of the immediate problem, the treatment program should be geared toward the long-term function of the patient; in most cases this will be best served by the prevention and/or correction of long bone deformities, and by encouraging maximum intellectual and academic development. The latter requires contact of the child with normal children by placement in regular school classes. The primary basis of a successful treatment program to maintain acceptable skeletal alignment consists of properly timed operations for insertion of extensible intramedullary rods, together with supportive splints and braces. No other method of treatment, such as the use of systemic medications, has yet been shown to benefit the patient clinically. Progressive improvement in bone strength during childhood permits better eventual function for those patients in whom good skeletal alignment has been maintained. Most patients will become productive members of society, so the combination of optimum physical and optimum academic development will offer maximum opportunity to those who enter the competitive job market.

Age Factors↗
PubMedDate not supplied

Efficacy of cyclosporine to reduce steroids in patients with idiopathic pulmonary fibrosis before lung transplantation.

Lung transplantation today is considered an effective option for patients with severe idiopathic pulmonary fibrosis. The standard medical treatment for this disease consists of high-dose steroids alone or combined with other immunosuppressive drugs. Unfortunately, pretransplantation administration of steroids may jeopardize the healing of the airway anastomosis and cause other complications; therefore it is considered a relative contraindication to lung transplantation. For this reason we try to reduce the dose of prednisone to 15 to 20 mg/day or less before the transplantation, but this creates many difficulties and is sometimes impossible in severely ill patients. Therefore we used cyclosporine (4 to 7 mg/kg/day) in 10 patients who were receiving high-dose prednisone (> or = 50 mg/day) therapy, but who were otherwise suitable candidates for lung transplantation. In seven cases prednisone could be tapered to 20 mg/day or less, allowing acceptance in our program. These patients had a CRP score of 60 or more before entering our trial and remained stable at this level after conversion to cyclosporine. The 6-minute walk test showed a mild improvement in five cases (71.5%). Three patients underwent single lung transplantation; two patients are on our waiting list after 3.5 and 4 months of treatment with cyclosporine and prednisone (10 mg/day), and two patients died while awaiting a suitable organ 6 and 7.5 months after starting cyclosporine therapy. Combined administration of cyclosporine and prednisone may extend the waiting time while receiving low-dose steroids and allow more patients with idiopathic pulmonary fibrosis to qualify for lung transplantation while reducing the risk of steroid-induced complications.

Adult↗
PubMedDate not supplied

Health education for the Ethiopian community in the Negev.

The importance of health education as part of health enhancement programs is well accepted. The encounter with the Ethiopian Jews introduced a new set of problems, requiring a novel approach to old concepts. A project that was carried out during the last decade is presented. Three target populations were identified: the Ethiopian population with 851 participants, medical and community teams with 843 participants, and 138 Ethiopian instructors. An effort was made to make the interaction between these groups more coherent. The project included 65 series of activities: lectures, workshops, staff meetings and conferences. The major topics included medical, emotional, anthropological and behavioral issues. The project was initiated for immigrants of Operation Moses (1984-85), and reinforced in Operation Solomon (1991). A follow-up is presently underway to aid in the absorption of this unique community.

Community Health Workers↗
PubMed1993

Prenatal behavioral risk screening by computer among Native Americans.

BACKGROUND AND OBJECTIVES: Computer interviews have potential value in screening pregnant patients for substance abuse and other behavioral risk factors linked to adverse pregnancy outcomes. The focus of this study was to determine whether a patient-interactive computerized assessment and education program was an acceptable and valid means of obtaining behavioral risk data. METHODS: Study participants completed a computer interview, and computer-generated reports of substance use and physical abuse within the past year were compared with information in the participants' prenatal records. The accuracy of computer interview reports of substance use was evaluated by performing urine drug screens. RESULTS: More than 95% of the 265 women who completed the computer interview rated it favorably. Drug use and physical abuse were reported significantly more often during the computer interview, compared with information obtained from the patients' medical records. Results of urine drug screens demonstrated a high concurrence rate between self-reports of drug use and the results of urine analyses. CONCLUSIONS: Results indicated that the computerized assessment was well received by patients and yielded valid information regarding risk factors for adverse pregnancy outcomes.

Adult↗
PubMed1977

Experience with an adolescent pregnancy program. A preliminary report.

A program has been designed to give comprehensive health care services to pregnant adolescents. The program components include community liason, patient education, counseling and social services, a nurse "on call" program for labor and delivery, and pediatric nurse-practitioner followup. In addition, a drug use identification component screens the patients by interview and urinalysis. Hypertensive disorders of pregnancy occurred in 10% of the first 202 patients. Forty-three percent had anemia (hematocrit less than 35%), and screening cervical cultures for gonorrhea were positive in 3.5%. Cigarettes, alcohol, and marijuana constituted the most common nonmedical drugs used, and aspirin the most common medical drug. Eighty-one percent of the patients attended 7 or more antenatal visits, one-half did not miss a single clinic appointment, and 95% completed a post-partum visit, indicating that the program was well accepted by the adolescents.

Adolescent↗
PubMed1997

Predicting who will choose a family medicine residency.

PURPOSE: To create and evaluate a screening instrument and a revised interview format for use in the selection of family medicine residents at the McGill University Faculty of Medicine. METHOD: The screening tool consisted of two sections an assessment of academic performance (the TASS) and an evaluation of applicants' generalist versus specialist orientation (the GSSS); each applicant's file was assessed by two raters. The revised interview included specific questions and scenarios related to family medicine. All three parts were tested on 143 applicants from outside the region of Quebec in 1994-95. The results on both parts of the screening tool and the interview were compared with the students' first choices of residency and then were compared with the performances of the 24 accepted into the program as reflected in their first six-month summative evaluation forms. Data were analyzed through several statistical methods. RESULTS: Only the GSSS accurately predicted the applicants' first choices (for agreement between both raters: sensitivity, 81%; specificity, 70%; accuracy, 78%). No significant association was found when comparing matching applicants' scores obtained during the selection process with their scores on the six-month evaluation forms. CONCLUSION: The GSSS may prove useful as a tool in the review of applicants' files. More studies are needed to reevaluate the use of the interview in the selection process and to help determine whether any selection instrument can accurately predict applicants' subsequent performances in a residency.

Career Choice↗
PubMed1998

Results of intermediate measures from a population-based, randomized trial of mammographic screening prevalence and detection of breast carcinoma among Asian women: the Singapore Breast Screening Project.

BACKGROUND: Although increasing rates of breast carcinoma incidence have been observed in Asian countries, appropriate strategies for detecting early stage breast carcinoma in such communities have been difficult to formulate, particularly because no large population screening trial specifically involving Asian women has been reported. The objective of this study was to evaluate the effectiveness and quality of mammography as a screening technique for Singaporean women, who are predominantly Chinese. METHODS: In this prospective study, 166,600 women in Singapore ages 50-64 years were randomized to either 2-view mammography without physical examination (67,656) or observation (97,294, controls) over 2 years. RESULTS: Of these women, 28,231 (41.7%) responded and were screened; they were more likely to be married, have more formal education, be working, be Chinese, and be in a higher socioeconomic group (P < 0.001 for all variables). To assess for response bias that could affect outcome, results were also evaluated for nonrespondents (n = 39,425). The incidence rate of cancers among nonrespondents (1 per 1000 woman-years) was less than the 1.3 in women not invited to have screening (P = 0.03, relative risk [RR], 1.3; 95% confidence interval [CI], 1.0-1.7). However, cancers arising from nonrespondents did not differ significantly in stage distribution when compared with cancers within the control group. For every 1000 women screened, 4.8 cancers were detected. The prevalence ratio (the number of cancers detected per 1000 women at first screening divided by the corresponding incidence rate in controls per year) was 3.6 for screened women and 2.4 for women invited to have screening. The majority of cancers detected through screening were early stage, with 64% as either ductal carcinoma in situ (26%) or Stage I disease (38%) and was significantly more than the corresponding 26% in women not invited to have screening (P < 0.001). When only invasive cancers were considered, screened women still had more early cancers, with 65% having no lymph node involvement, compared with 47% in the group not invited to have screening (P = 0.001; RR, 1.4; 95% CI, 1.2-1.7). Women who were screened had half the risk of having Stage II or later cancers (P < 0.0001; RR, 0.5; 95% CI, 0.4-0.7) when compared with women not invited to have screening. This higher detection rate of early cancers through screening was accomplished with acceptable recall rates of 8% for further mammographic films or physical examination and a biopsy rate of 1.0% (10 per 1000 women screened). The interval cancer rate was 2.1 per 10,000 women screened in the first year of follow-up. CONCLUSIONS: These positive results of intermediate measures suggest that, in Asian communities, screening mammography could be an important modality for detecting early stage breast carcinoma. However, the low compliance rates suggest that health education efforts must focus on issues related to acceptability if such programs are to succeed.

Aged↗
PubMed2001

Heart failure and community-acquired pneumonia: cases for home hospital?

BACKGROUND: Home hospital is advocated in many western countries in spite of limited evidence of its economic advantage over usual hospital care. Heart failure and community-acquired pneumonia are two medical conditions which are frequently targeted by home hospital programs. While recent trials were devoted to comparisons of safety and costs, the acceptance of home hospital for patients with these conditions remains poorly described. OBJECTIVE: To document the medical eligibility and final transfer decision to home hospital for patients hospitalized with a primary diagnosis of heart failure or community-acquired pneumonia. DESIGN: Longitudinal study of patients admitted to the medical ward of acute care hospitals, up to the final decision concerning their transfer. SETTING: Medical departments of one university hospital and two regional teaching Swiss hospitals. PATIENTS: All patients admitted over a 9 month period to the three settings with a primary diagnosis of heart failure (n= 301) or pneumonia (n=441). MEASUREMENTS: Presence of permanent exclusion criteria on admission; final decision of (in)eligibility based on medical criteria; final decision regarding the transfer, taking into account the opinions of the family physician, the patient and informal caregivers. RESULTS: While 27.9% of heart failure and 37.6% of pneumonia patients were considered to be eligible from a medical point of view, the program acceptance by family physicians, patients and informal caregivers was low and a transfer to home hospital was ultimately chosen for just 3.8% of heart failure and 9.6% of pneumonia patients. There were no major differences between the three settings. CONCLUSIONS: In the case of these two conditions, the potential economic advantage of home hospital over usual inpatient care is compromised by the low proportion of patients ultimately transferred.

Aged↗
PubMed2002

Promoting the social acceptance of young children with moderate-severe intellectual disabilities using cooperative-learning techniques.

The effects of a cooperative-learning program on the social acceptance of children with moderate to severe intellectual disabilities by young children without disabilities were examined. Children without disabilities were assigned to a cooperative-learning program or a social-contact program involved with the special class children or to a control (no classroom contact) condition. Significant pretest-posttest changes over a 10-week period in the cooperative-learning context indicated that children without disabilities gave the special class children higher peer acceptance ratings, greater popularity indices, and lower social-distance ratings. There were also more frequent interactions with the children without disabilities. These changes did not occur in either the social-contact or the control groups.

Child↗
PubMed1993

[Physics, dosimetry, and quality control in mammography].

The diagnostic value of mammography, especially in the early diagnosis of breast cancer, is closely related to examination optimization in terms of high-quality images with the lowest possible dose to the organ. Currently, "optimal" beams are produced by X-ray tubes with a Molybdenum anode, their voltage reaching 35 kV, using the K fluorescence line at 17.48 keV and absorption of photons with > 20 keV energy, through Mo filtration. The dose delivered with a mammographic examination is expressed differently in the literature reports on the subject: air exposure, skin exposure, dose at the midplane and mean dose; currently, it is recommended to specify the dose as "average glandular tissue dose", considering beam quality and the ratio between transmissions in perspex and tissues respectively. Threshold values for the average dose to the glandular tissue range 1.8 to 3 mGy with a grid and 0.9 to 1.5 mGy without the grid. The high quality standard of mammography requires quality assurance programs including the mammographic unit and the image acquisition and treatment systems. In Italy the "Dose and Quality in Mammography" program is in progress. According to the acceptance quality criteria established in the program and on the basis of the investigation of 272 centers, an acceptable dose-quality ratio was seen in 37.5% of the centers, low quality was found in 24.5%, high dose in 23.7% and high dose plus low quality in 14.1% of the whole of centers.

Breast Neoplasms↗
PubMed1997

Young people considering nursing as a career: starters vs. non-starters.

This study focused on applicants who were accepted to a nursing education program but did not begin their studies, thus wasting time, effort and money. Of 953 accepted applicants, 27% did not enter the program. Significant variables differentiating starters from non-starters were higher psychometric score, higher paternal education, lower priority for nursing studies, older age, non-Israeli country of birth and not completed army service. The study relating to starters vs. non-starters is one aspect of a large study (Ehrenfeld, Rotenberg, Sharon, & Bergman, 1995). In most nursing education programs the number of applicants exceed the faculty's capacity, and suitable candidates must be rejected. It is therefore both wasteful and disappointing when accepted applicants change their mind and do not actually begin in the program. In light of the costs and complexities involved in the student screening process and the continuous efforts extended today all over the world to raise the standards of nursing education and care, the factors differentiating starters from non-starters may have important implications. The aim of the present study was to evaluate the screening process at the Tel Aviv University baccalaureate nursing program and determine which variables were predictive of starters and non-starters among accepted applicants.

Discriminant Analysis↗