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PubMed1989

Chemical dependence treatment review guidelines.

During the last decade, there has been an explosive increase in the development of chemical dependence (CD) inpatient/freestanding units (Yahr: J Stud Alcohol 49:233-239, 1988) to the point that fully one third of all mental health admissions reviewed involve chemical dependence (L. Goldstein, personal communication; APA, Office of Quality Assurance, unpublished data). This dramatic increase has raised serious concerns among clinicians about the quality and appropriateness of treatment programs and among third-party payors about the cost of care. Five major categories should be considered when reviewing CD cases: (1) patient characteristics, including age, gender, severity of illness, course, past treatments, and impact of an intervention; (2) level of care, including outpatient, day treatment, freestanding units, hospital, and detoxification units; (3) match of services appropriate to patient's needs; (4) treatment program, including level of staff involvement, program elements, and planning for patient transition; and (5) peer review, including reviewing with a peer, being a patient advocate, and being a consultant. If these elements in these five categories are considered, a competent review is accomplished.

Health Services Needs and Demand↗
PubMed1993

Obesity. Workshop III. AHA Prevention Conference III. Behavior change and compliance: keys to improving cardiovascular health.

The workshop provided the opportunity to discuss issues and develop and integrate ideas. The following recommendations for public policies, education programs, and high-priority research initiatives were developed: Recommendations for Public Policies: Focus on prevention by requiring school programs to emphasize appropriate diet, physical activity, and general health guidance to promote cardiovascular health and prevent disease through federal funding. Provide better access to exercise (city planning, work-site interventions). Influence food availability and accessibility. Influence reimbursement policies for effective early intervention and prevention strategies for obesity. Reevaluate policies for use of drugs in the treatment of obesity. Recommendations for Education Programs: Sponsor scientific workshop to: Define the most appropriate weight standards for prevention and treatment. Identify who should lose weight and why, when, and how. Promote the fact that obesity is an important health risk factor, even at moderate levels, and that excess visceral fat is particularly hazardous. Target health care professionals, consumers, and the media for education about: Nature of obesity as a heterogeneous syndrome. Recommendations for diet, exercise, behavioral interventions, drugs, and surgery. Recognition of special needs of populations of different ethnicity, gender, age, etc. State-of-the-art treatment and treatment programs. High-Priority Research Initiatives: Build better bridges between basic research and treatment/prevention practices. Acknowledge that obesity is a heterogeneous syndrome that may best be characterized as different obesities. Research on defining subtypes. Implications for etiology and treatment. Better characterization of genotypes and phenotypes. Study the effects of weight loss, weight gain,and weight cycling on medical and psychosocial outcomes and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

Suicide prevention programs: issues of design, implementation, feasibility, and developmental appropriateness.

Emerging models of prevention focus on population-level risk reduction through enumerating antecedent conditions that are linked to subsequent expressions of disorder and dysfunction. The authors discuss the essential ingredients for successful prevention programs--comprehensiveness, fidelity, and intensity. The authors describe how to mount prevention programs to increase feasibility, access, and effectiveness. Suicide is an epidemic of low frequency in the general population and therefore does not receive appropriate attention in public health prevention campaigns. They argue for nesting suicide prevention programs within existing public health preventive intervention programs and provide some examples of how to reduce vulnerabilities and risk conditions for subsequent suicidal behaviors.

Comorbidity↗
PubMed2005

Methods and criteria used in evidence-based decisions in public health.

A workshop entitled, "The Impact of Maternal Thyroid Diseases on the Developing Fetus: Implications for Diagnosis, Treatment, and Screening," was held in Atlanta, Georgia, January 12-13, 2004. This paper reports on the session that examined methods and criteria used for decisions in public health. For this session the following papers were presented: "Methods to Evaluate Scientific Evidence," "Criteria for Screening," and "Public Health Considerations." Development of evidence-based guidelines, strengthened by rigorous systematic reviews, will improve the quality, efficiency, and cost effectiveness of management of thyroid dysfunction among reproductive-age women. Maternal and fetal benefits that have been hypothesized to result from screening pregnant and pre-pregnant women for hypothyroidism include reduced incidences of peripartum maternal complications and fetal loss and optimization of fetal and neonatal neuropsychological development. Screening should be considered as the initial step in a comprehensive program that includes appropriate diagnostic and therapeutic interventions. The actual benefits and potential risks (i.e., iatrogenic thyrotoxicosis) of implementing a thyroid function screening program have not been demonstrated in a prospective randomized clinical trial or prospective cohort study. Consequently, it is difficult to develop consensus and secure resources for a comprehensive thyroid function screening and therapeutic intervention program in women who are or anticipate becoming pregnant. Marshalling support for performance of both a clinical trial and high-quality observational studies should be a high priority.

Decision Trees↗
PubMed2005

Outcomes of Project Dulce: a culturally specific diabetes management program.

BACKGROUND: Diabetes mellitus is a common and costly chronic disease that increasingly affects minority populations; however, there is little evidence regarding the clinical effectiveness and costs of culturally appropriate disease management programs. OBJECTIVE: To determine the clinical outcomes and costs of Project Dulce, a combined stepped-care diabetes nurse case management program and culturally oriented peer-led self-empowerment training program. METHODS: Pre-post clinical outcome and cost analysis of Project Dulce participants were compared with a cohort of historical controls over a one-year period. Subjects included 348 persons with diabetes with coverage under County Medical Services who were receiving services in community health centers in San Diego, CA. Generalized regression models were used to estimate changes in clinical outcomes (hemoglobin [Hb] A1c, blood pressure, cholesterol level) and costs associated with participation in Project Dulce. RESULTS: Project Dulce participants had significant reductions in HbA1c (0.8%; p < 0.001), systolic (5.4 mm Hg; p = 0.001) and diastolic (8.0 mm Hg; p < 0.001) blood pressure, total cholesterol (28.1 mg/dL; p < 0.001), and low-density-lipoprotein cholesterol (15.6 mg/dL; p < 0.001). Expenditures for pharmacy ($3157 Dulce vs $1618 control) and disease management ($507 Dulce) increased. Total costs were higher during the first year of disease management ($5711 Dulce vs $4365 control; p < 0.001). CONCLUSIONS: Project Dulce was effective in improving clinical outcomes for control of diabetes and related conditions in a medically indigent, culturally diverse population. Our finding of reduced hospital expenditures, although statistically insignificant, is clinically and economically important and suggests that intervention might provide an immediate benefit to a high-risk population.

Antihypertensive Agents↗
PubMed2006

Women's use of force: voices of women arrested for domestic violence.

Following changes in law enforcement policies that encourage or mandate arrest of domestic violence offenders, a concomitant increase in women arrested and mandated to batterer treatment programs has resulted. Most research findings, however, suggest that heterosexual intimate violence is gendered, with abuse, power, and control wielded by men over their female partners, and that when women use violence, it is typically in self defense or for nonaggressive reasons. However, few studies have investigated the female batterer treatment programs and the context of the women's use of violence. Using qualitative data collected from observations of three female domestic violence offender programs, this article examines women's interpretations of their violent experiences. In addition, the findings raise policy-level questions about the appropriateness of such programs, weighing the costs and benefits of a criminal justice approach to women's use of force in intimate relationships.

Adult↗
PubMed1990

The purchase of specialized radiologic software: estimation of investment. Part II.

For the most part, specialized radiologic software addresses narrow vertical markets that are not large enough to attract the larger software firms. This can work to the benefit of the user, for smaller companies tend to be more flexible and are better able to respond to the user's needs and to tailor their product to meet specific requirements. However, because the companies are small and often relatively young, some do not have the stability associated with larger, well-established firms. As a result, it may be more risky to commit to one of their programs. Nevertheless, with appropriate cautions regarding the company and its product, with proper training of departmental personnel and with adequate safeguards to protect data, these programs can represent a secure and prudent investment.

Capital Expenditures↗
PubMed1978

Use of a programmable calculator in processing and interpreting serum cholinesterase phenotypes.

Cholinesterase phenotyping is done at 25 degrees C with use of benzoylcholine as substrate and dibucaine, fluoride, chloride, and succinyldicholine as inhibitors. We wrote a diagnostic program in modified BASIC language for the processing and interpretation of these cholinesterase phenotypes. We used the HP 9830A calculator. The diagnostic aspect of the program uses 646 words, a further 86 words being used to run this program. The traditional and the programmed reporting procedures were duplicated for 296 consecutive patients, with no case of disagreement between the two reporting methods as to the appropriate phenotype. The programmed system requested nine repeat analyses more than did the traditional method. Seven of these were due to the tight limits set in the program for the fluoride inhibitor numbers. These tight limits were set to ensure that there was as limited an overlap as possible between the phenotypes E1uE1u and E1uE1f. The remaining two repeats were due to the restrictions placed on the succinyldicholine inhibitor numbers that would be acceptable before a patient was designated as having the relatively rare phenotype, E1aE1f.

Cholinesterases↗
PubMed1970

Birth of a foundation.

In order to attract competent students with backgrounds in biology to the field of medical librarianship, the Medical Library Group of Southern California decided to expand their scholarship program. Funds were appropriated to establish a nonprofit, tax exempt foundation whose objective is to provide two full annual scholarships for the Master's degree program in librarianship. Details of the procedure followed in establishing the foundation are described along with criteria for selecting students.

California↗
PubMed1991

Traumatic brain injury rehabilitation.

Improved survival from severe traumatic brain injury has prompted the development of dedicated rehabilitation programs. Ideally, rehabilitation should begin during acute care in order to prevent later complications. Medically stable patients should be referred from acute care to acute rehabilitation programs for evaluation and then treatment or transfer as appropriate. Dedicated brain injury rehabilitation programs follow a method in which treatment is adapted to the major physical and cognitive impairments at each stage of recovery. Specialized treatment protocols have been developed for unconscious or agitated patients, partly on the basis of advances in neuropharmacology. Because of the long recovery course after severe brain injury, many patients are appropriate for postacute rehabilitation programs directed at community reentry, including return to work. Newer program models for patients with traumatic brain injuries, especially programs using cognitive rehabilitation techniques, are controversial because of inadequate research support and uncertain cost-effectiveness.

Brain Damage, Chronic↗
PubMedDate not supplied

Returning to school: an alternative to 'traditional' education.

To remain current within the changing health care system, health care professionals must continuously develop and sharpen skills to provide effective care. Advancement within the profession may be dependent upon the attainment of additional degrees. "Traditional" education methodologies do not fit easily into busy schedules. Many nurses are finding that distance learning programs provide a practical alternative for degree completion. This article presents a basic introduction to distance learning. Specific strategies and resources for finding appropriate distance learning programs are discussed in detail.

Accreditation↗
PubMed1998

Has the California tobacco control program reduced smoking?

CONTEXT: Comprehensive community-wide tobacco control programs are considered appropriate public health approaches to reduce population smoking prevalence. OBJECTIVE: To examine trends in smoking behavior before, during, and after the California Tobacco Control Program. DESIGN: Per capita cigarette consumption data (1983-1997) were derived from tobacco industry sales figures. Adult (> or =18 years) smoking prevalence data were obtained from the National Health Interview Surveys (1978-1994), the California Tobacco Surveys (1990-1996), the Current Population Surveys (1992-1996), and the California Behavioral Risk Factor Survey and its supplement (1991-1997). Trends were compared before and after introduction of the program, with the period after the program being divided into 2 parts (early, 1989-1993; late, 1994-1996). MAIN OUTCOME MEASURES: Change in cigarette consumption and smoking prevalence in California compared with the rest of the United States. RESULTS: Per capita cigarette consumption declined 52% faster in California in the early period than previously (from 9.7 packs per person per month at the beginning of the program to 6.5 packs per person per month in 1993), and the decline was significantly greater in California than in the rest of the United States (P<.001). In the late period, the decline in California slowed to 28% of the early program so that in 1996 an average of 6.0 packs per person per month were consumed. No decline occurred in the rest of the United States, and in 1996, 10.5 packs per person per month were consumed. Smoking prevalence showed a similar pattern, but in the late period, there was no significant decline in prevalence in either California or the rest of the United States. In 1996, smoking prevalence was 18.0% in California and 22.4% in the rest of the United States. CONCLUSIONS: The initial effect of the program to reduce smoking in California did not persist. Possible reasons include reduced program funding, increased tobacco industry expenditures for advertising and promotion, and industry pricing and political activities. The question remains how the public health community can modify the program to regain its original momentum.

California↗
PubMedDate not supplied

Marketing health care programs to older adults: strategies for success.

Sensitivity to older adults as consumers will ensure the development of programs that are targeted appropriately to fill a need in the marketplace. Programs should be designed on the basis of information gained in the programmatic needs assessment. Health professionals who assume they know the needs, wants, and desires of older consumers because they treat so many ill elderly people risk program failure. By contrast, those that listen to older consumers and heed the signals from the geriatric marketplace are most likely to succeed.

Aged↗
PubMed1996

Design and results of a group counter-detailing DUR educational program.

PURPOSE: The study objectives were to (1) design, (2) implement and (3) evaluate a multi-step educational program as an integral component of a healthcare system's activities to improve medication use quality and control drug costs. Design and implementation of the educational program were based upon established principles of changing prescriber behavior. Two classes of oral medications, antihistamines and antibiotics, were targeted. METHODS: A before-after nonequivalent comparison group design with 2 comparison groups was used for evaluation. Medication claims data from the same time period one year previously were used as historical controls. Prescribing rates, net savings and prescribers' attitudes were assessed. RESULTS: Prescribing trends in the treatment group but not comparison groups generally reflected changes consistent with the educational message. A net savings of $84 was achieved in the antihistamine program. A net loss of ($2722) was seen in the antibiotic program. Over 75 percent of prescribers agreed or strongly agreed that the educational program was an appropriate mechanism to optimize medication use. Level of exposure and practice years affected perceived knowledge gains. CONCLUSION: The group counter-detailing DUR educational program was effective in improving prescribing rates. Prescribing rate changes and economic impacts differed by therapeutic category. The entire program was well accepted among prescribers including physicians and nurse practitioners.

Drug Prescriptions↗
PubMed1976

Program for cardiac patients: stress testing and training.

Dynamic exercise stress testing had become a widely accepted technique in the diagnosis of cardiac patients. The results of standardized exercise testing may be used to evaluate a patient's functional capacity and to derive an exercise prescription to assist him in improving his state of cardiovascular fitness. Because the physical therapist has special training and skill in exercise-related techniques, a stress testing laboratory and an exercise-based cardiac rehabilitation program may be appropriately established in a hospital's physical therapy department. Results are presented of a diagnostic exercise testing and an exercise-based cardiac rehabilitation program organized and supervised by physical therapists in a 300-bed private hospital.

Coronary Disease↗
PubMed2003

College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement.

This position paper from the College on Problems of Drug Dependence addresses the issues related to non-medical use and abuse of prescription opioids. A central theme throughout is the need to strike a balance between risk management strategies to prevent and deter prescription opioid abuse and the need for physicians and patients to have appropriate access to opioid pharmaceuticals for the treatment of pain. The epidemiology of prescription opioid use and abuse is reviewed. Non-medical use and abuse of prescription opioids are on the rise in the United States, illicit use of several widely prescribed opioids has increased disproportionately more than illicit use, and the prevalence of prescription opioid abuse appears to be similar to that of heroin and cocaine abuse. There is a paucity of abuse liability testing of prescription opioids, and methods should be developed to fill critical gaps in our knowledge in this area. The role of regulatory agencies in preventing diversion of prescription opioids and identifying potential sources of diversion are discussed. More research is needed to identify those populations most at risk for abusing prescription opioids, and then to develop appropriately targeted prevention programs. Treatment options are discussed; these depend on whether or not an abuser is in pain. Prescription opioid abuse has harmful ramifications for the legitimate and appropriate use of opioids, including stigmatization, opiophobia, and undertreatment of pain. Recommended steps to take include further epidemiological research, laboratory testing of prescription opioids to determine abuse liability, and clinical trials to determine the efficacy of different approaches to the prevention and treatment of prescription opioid abuse.

Analgesics, Opioid↗
PubMed1990

A bereavement program: good care, quality assurance, and risk management.

Oregon Health Sciences University Hospital implemented a proactive bereavement program based on a faculty research project demonstrating poor sensitivity to the families of deceased patients, their subsequent postdeath adjustment, and feelings about interactions at the hospital. The program has improved support to families at the time of death and established a follow-up system that refers families with adjustment difficulties to an appropriate provider. Educational programs have improved the skills and sensitivity of trainees and staff in responding to stressful patient-family situations concerning death and bereavement. Beyond providing optimal care, a bereavement program benefits quality assurance, risk management, and the community image of any hospital.

Attitude to Death↗
PubMed1992

Prolongation of survival of human polymorphonuclear neutrophils by granulocyte-macrophage colony-stimulating factor is caused by inhibition of programmed cell death.

In the absence of appropriate stimuli, polymorphonuclear neutrophils (PMN) undergo programmed cell death (PCD), also termed apoptosis. We show that granulocyte-macrophage colony-stimulating factor (GM-CSF), but not the chemotactic factors formyl-methionyl-leucyl-phenylalanine (FMLP), recombinant human (rh) C5a, transforming growth factor (TGF)-beta, and interleukin-8 (IL-8), or other cytokines including IL-3, IL-4, IL-6, and G-CSF, maintains viability of PMN in culture by preventing these cells from undergoing PCD. Prevention from PCD by GM-CSF was associated with induction of RNA and protein synthesis in PMN. Inhibition of RNA and protein synthesis by actinomycin-D and cycloheximide impeded the protection of apoptosis by GM-CSF. Similarly, neutralization of GM-CSF biologic activity by a specific antiserum abrogated GM-CSF-mediated inhibition of PCD.

Apoptosis↗