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PubMed1988

Spontaneous pregnancies and pregnancies as a result of treatment on an in vitro fertilization program terminating in ectopic pregnancies or spontaneous abortions.

Five hundred three patients were accepted for the in vitro fertilization (IVF) program from 1983 to 1986. Two hundred ninety-nine patients had a total of 678 IVF treatment cycles during this period. Eighty-one clinical pregnancies resulted, of which 8 were ectopic pregnancies and 19 spontaneous abortions (group A). During this period 82 patients accepted for IVF became pregnant spontaneously: 44 before treatment and 38 after a failed IVF treatment cycle (group B). Of these, 14 were ectopic pregnancies and 8 were miscarriages. The main indications for acceptance on the IVF program were similar in the two groups if those patients who had a bilateral salpingectomy are excluded from group A. Causative factors for the high ectopic pregnancy rate are discussed. The authors suggest that after embryo transfer, migration of the embryo or embryos into the fallopian tubes occurs more frequently than realized, and the diseased tube is less likely than a normal tube to propel the embryo back into the uterus. The abortion rate in group B was similar to the rate in the general population.

Abortion, Spontaneous↗
PubMed2003

Program to enhance health literacy and treatment adherence in low-income HIV-infected Latino men and women.

This paper reports the initial results of a pilot study to evaluate the acceptability and effectiveness of a program to enhance health literacy in low-income HIV-infected Latino men and women receiving antiretroviral therapy. Participants rated the program highly on measures of satisfaction, providing evidence of its acceptability. The effectiveness of the program was assessed in comparisons of the intervention (n = 41) and standard care only (n = 40) groups at baseline and 6-week intervals. Program participants showed significant improvement over comparison group participants on measures of HIV/AIDS and treatment-related knowledge and recognition and understanding of HIV terms. Although there were no significant changes in adherence mastery and behaviors during the 6-week follow up period, there were significant changes in program participants' knowledge about medication adherence. Future steps to examine the sustainability of the program in the medical management of patients are planned in addition to determining its long-range relative impact.

Adult↗
PubMed1983

The helper-therapy principle applied to weight management specialists.

One hundred twenty applicants to a weight management specialist training program were studied over a 33-month period. Following a nine-month training period, Specialists (N = 29; those leading at least one posttraining weight management group) were compared to Contact Controls (N = 31; persons participating in the weight management program, but not in the helper role) and No Contact Controls (N = 60; those not accepted into the training program and whose only contact with the program was for data collection purposes) in a test of the helper-therapy principle. The major question was, "What are the long-term physical, psychological, and behavioral effects on overweight and formerly overweight individuals involved in helping other persons manage their weight?" Data gathered at 12 and 24 months post-training revealed few differences between the total group of specialists and persons in the two control groups. However, when the data were analyzed by the amount of commitment to the specialist role, it was found that the Higher Involved Specialists (N = 16; those who led two or more weight management groups in the year posttraining) were significantly more likely to lose additional weight (or maintain earlier weight losses), to be more consistent in their adherence to the eating and activity levels advocated by the program, to feel better about themselves and their bodies, and to maintain their levels of general well-being than control subjects or the Lesser Involved Specialists. These latter individuals (N = 13) were significantly the worse for having gone through specialist training, but not fully carrying out the specialist role.

Adult↗
PubMed2004

HEALTH C.H.I.P.s: opportunistic community use of computerized health information programs.

Computerized health information programs have been shown to have potential to improve knowledge, attitudes and behavior. However, relatively little is known regarding their capacity to engage the public for opportunistic, spontaneous use in community settings. Two studies were undertaken to provide insight to this practical issue. An intercept survey of adults from a shopping center where a computer kiosk had been located for 7 months was undertaken to investigate exposure to, attention to, use and acceptability of kiosks. A total of 99.7% of participants were exposed to the kiosk, 77.4% of these noticed it and 20.8% of these used it. Program acceptability was high; the most common barriers to use related to time constraints and disinterest. A utilization study was then undertaken to describe program utilization in greater detail, with kiosks installed in 18 community settings over 1 year. These were used 57,064 times (19.4 uses per kiosk per day). Additional data described demography of users, preferred topics selected, preferred formats and presentation styles, and a comparison of use across different community settings. Both studies provide insight to practical application of this health education strategy, indicating that is has substantial capacity to engage people for opportunistic use in community settings.

Adult↗
PubMed1998

Effect of an intensive educational program for minority college students and recent graduates on the probability of acceptance to medical school.

CONTEXT: Increasing the number of minority physicians is a long-standing goal of professional associations and government. OBJECTIVE: To determine the effectiveness of an intensive summer educational program for minority college students and recent graduates on the probability of acceptance to medical school. DESIGN: Nonconcurrent prospective cohort study based on data from medical school applications, Medical College Admission Tests, and the Association of American Medical Colleges Student and Applicant Information Management System. SETTING: Eight US medical schools or consortia of medical schools. PARTICIPANTS: Underrepresented minority (black, Mexican American, mainland Puerto Rican, and American Indian) applicants to US allopathic medical schools in 1997 (N =3830), 1996 (N = 4654), and 1992 (N =3447). INTERVENTION: The Minority Medical Education Program (MMEP), a 6-week, residential summer educational program focused on training in the sciences and improvement of writing, verbal reasoning, studying, test taking, and presentation skills. MAIN OUTCOME MEASURE: Probability of acceptance to at least 1 medical school. RESULTS: In the 1997 medical school application cohort, 223 (49.3%) of 452 MMEP participants were accepted compared with 1406 (41.6%) of 3378 minority nonparticipants (P= .002). Positive and significant program effects were also found in the 1996 (P=.01) and 1992 (P=.005) cohorts and in multivariate analysis after adjusting for nonprogrammatic factors likely to influence acceptance (P<.001). Program effects were also observed in students who participated in the MMEP early in college as well as those who participated later and among those with relatively high as well as low grades and test scores. CONCLUSIONS: The MMEP enhanced the probability of medical school acceptance among its participants. Intensive summer education is a strategy that may help improve diversity in the physician workforce.

Data Collection↗
PubMed2006

Proposed program guidelines for pregnant radiology residents: a project supported by the American Association for Women Radiologists and the Association of Program Directors in Radiology.

RATIONALE AND OBJECTIVES: Written institutional policies governing radiation exposure and work responsibilities for pregnant radiology residents are not uniform and often are nonexistent. Standardized program guidelines would allow residents and program directors alike to prepare for a resident pregnancy with objectivity and consistency. MATERIALS AND METHODS: The American Association for Women Radiologists (AAWR) launched a task force to revisit guidelines for the protection of pregnant residents from radiation exposure during training. We conducted two surveys of the Association of Program Directors in Radiology (APDR) membership. Survey 1 was designed to learn about existing program and institutional policies and to assess the need for and interest in standardized guidelines that would address radiation exposure and work responsibilities for pregnant radiology residents. Based on those responses, we drafted a set of program guidelines incorporating policies contributed by responding program directors. Our follow-up APDR survey, survey 2, was conducted to determine opinions and acceptance of the drafted program guidelines. Each survey was analyzed by using a proportion of means test. RESULTS: Fifty-five of 156 program director APDR members (35%) responded to survey 1. Only half the respondents had formal written policies at their respective institutions. Review of submitted policies showed widely divergent opinions about appropriate policies for pregnant radiology residents. Most (34/52; 75%) supported the development of standardized guidelines. In survey 2, 38/73 responding APDR members (53%) offered their opinions and comments on our drafted guidelines. Approximately 90% agreement was catalogued on 13 of 18 items (72%); a majority (>60%) agreed on all points, even the most controversial points concerning fluoroscopy. CONCLUSION: A minority of radiology residency programs have written policies addressing pregnancy during training. With expressed support from a majority of responding program directors, we have developed and present here proposed program guidelines for pregnant radiology residents to serve as a framework for radiology residents and program directors alike.

Data Collection↗
PubMed1994

Increasing physician acceptance of technology assessment through a focused training program.

This paper presents the framework for a one-semester course to give physicians a better understanding of the core concepts of technology assessment, using medical instrumentation technology as a vehicle to stimulate the discussion of technology assessment and its applications. An assessment matrix has been developed as an organizational tool to identify issues in assessment to be addressed under each topic and to identify those issues that are of key importance to particular technologies. At the end of the class, the physician-student should be able to identify major types of medical instrumentation and the instrument's principal application(s), to identify the techniques of technology assessment, and to analyze the economic, ethical, and legal issues that are applicable to instrumentation.

Curriculum↗
PubMed1999

[The results of an active screening program for tuberculosis in immigrants from the Maghreb: acceptability and adherence].

OBJECTIVE: To assess acceptability and adherence to a tuberculosis screening programme (TSP) in Maghrebi immigrants (MI). DESIGN: A descriptive crossover study. SETTING: Primary health care service. INDIVIDUALS: MI residing in a periurban health district. All people who attended clinic for consultation at a primary care center were systematically recommended to be screened for tuberculosis. INTERVENTION: Individuals accomplished a questionnaire in arabic (with interpreter assistance) and were subjected to tuberculosis infection/illness screening tests till they were assigned one of the definitive diagnostic classes of the American Thoracic Society. RESULTS: 219 individuals were offered the TSP (sex ratio 6.2:1). 166 individuals (76.1%) accepted the test and kept their first appointment: 147 males (78.2%) versus 19 females (63.3%); difference in acceptance by gender was not significant (chi 2 = 3.14; p = 0.07). Fourteen individuals did not complete the study (8.6%): one did not attend clinic for Mantoux reading, four did not have the chest X-ray, three did not present themselves on their Mantoux reading, nor did they have the chest X-ray and, six did not deliver sputum samples (11.1% of the required samples). Six cases of TB were diagnosed. CONCLUSIONS: Given the special features of the MI (communication difficulties, illegal status, no fixed abode ...) acceptance and adherence to TSP are considered to be high. The diagnostic effectiveness, though considerable, was affected by the high number of individuals which did not deliver sputum samples. TSP directed to MI must have a specific design in order to facilitate acceptance and adherence.

Adult↗
PubMed1998

Demand management: another marketing tool or a way to quality care?

Demand management tools are population-based strategies used to control costs and improve utilization of services by assisting health consumers in maintaining their health and seeking appropriate health care. These tools are increasingly used by health care delivery systems and, in the US, by fiscal intermediaries, such as insurance companies. If these tools are not properly applied, there is a clear possibility that their use may lead a reduction of health care services with no improvement in clinical, humanistic, or economic outcomes. Demand management effectiveness has not been rigorously examined by the medical industry or academia. Before adopting or purchasing demand management technologies, health care systems should examine them carefully to determine how the tools were developed and who they were intended to serve. Once implemented, careful tracking of population outcomes is as necessary with these technologies as with any other technologies that can affect health care.

Cost Control↗
PubMed2006

Modeling the problem-based learning preferences of McMaster University undergraduate medical students using a discrete choice conjoint experiment.

OBJECTIVES: To use methods from the field of marketing research to involve students in the redesign of McMaster University's small group, problem-based undergraduate medical education program. METHODS: We used themes from a focus group conducted in an electronic decision support lab to compose 14 four-level educational attributes. Undergraduate medical students completed a discrete choice experiment composed of 15 web-administered, partial-profile, conjoint-choice tasks. RESULTS: Latent class analysis revealed two segments with different preferences. Segment 1, (86% of students), preferred a problem-based approach with more small group tutorial sessions led by expert tutors who facilitated the tutorial process without teaching didactically. Segment 2, (14% of students), preferred more large group lectures, explicit learning objectives, expert tutors who taught didactically, and streaming options based on learning preferences. Although Segment 1 preferred smaller tutorial groups, simulations predicted these students would trade increases in tutorial group size for a conceptually integrated program that included tutorial problems based on core curriculum concepts, greater integration of the content of clinical skills training sessions and the tutorial curriculum, and a link between clerkship patient selection and the program's curriculum. A majority of both segments would accept a more conceptually integrated program if the savings associated with increases in tutorial group size was reinvested in web-enhanced tutorial processes and computer-simulated health care problems. CONCLUSIONS: Most students preferred a small group, web-supported, problem-based learning approach led by content experts who facilitated group process. Students favored a program in which tutorial group problems, clinical skills training sessions and the patients selected for clerkship activities were more closely linked to core curriculum concepts.

Choice Behavior↗
PubMed1998

Barriers to acceptance of medical error: the case for a teaching program (695).

There is need for a teaching programme aiming to impart a tolerance of error to undergraduate medical students. The implementation of such a programme may have to challenge the institutional norms that encourage authoritarianism, intolerance of uncertainty and denial of error. Acceptance of error is a prerequisite for its candid reporting, and reporting of errors is a prerequisite for their analysis with a view to their prevention. A curriculum on medical error may, therefore, not only help medical students cope with their future mistakes, but also reduce their frequency. Teaching intervention aiming to promote an acceptance of medical error as both inevitable and reducible may also encourage students' epistemological development by making them realize that their doubts and uncertainties are shared by their peers and instructors.

Curriculum↗
PubMedDate not supplied

Recidivism among offenders with developmental disabilities participating in a case management program.

This study examined recidivism, defined as arrests, among 252 clients who were accepted into a case management program for offenders with developmental disabilities. Overall, 40% of clients were arrested while participating in the program, and 34% were arrested within 6 months after case closure. The crimes for which clients were arrested tended to be minor: 21% were for probation or parole violations not associated with new criminal acts, 39% were for misdemeanors, 27% were nonviolent felonies, and 12% were for felonies against persons. Clients who completed the program (N=115) were less likely to be arrested after case closure than those who dropped out of the program (N=112), 25 and 43%, respectively. Other factors associated with arrests after case closure included having a developmental disability other than mental retardation, living in an urban area, being referred to the program by a criminal justice agency or through a private referral rather than a social service agency, and being arrested while in the program. Implications are discussed for service provision and evaluation of programs that work with offenders with developmental disabilities.

Adolescent↗
PubMed2002

[Training and educational measures in severe chronic heart failure. Experiences and application to general practice].

OBJECTIVES: Prognosis and course of severe left ventricular dysfunction have been shown to be influenced positively by exercise training. Yet, physicians have been reluctant to include exercise into therapeutic concepts due to widespread uncertainty about the acceptable intensity of cardiac stress. Standardized exercise programs with proven safety may promote acceptance of this approach. PATIENTS AND METHODS: 25 patients with severe heart failure were enrolled in a PC-controlled interval exercise training on cycle ergometer, lasting 21 minutes five times a week for a 4-week inpatient period. After discharge patients performed incremental daily walking for 3 months. Associated educational measures concerned life-style changing and self-controls. RESULTS: None of the patients had to interrupt the training because of side effects. 3 weeks and 3 months after starting exercise training there was an increase of peak VO2 from 13.4 +/- 2.8 to 14.5 +/- 3.8 (p < 0.05) and 15.3 +/- 3.2 ml/kg/min (p < 0.01), respectively, and an increase of ventilatory anaerobic threshold (VAT) from 9.3 +/- 1.9 to 10.0 +/- 2.3 (p < 0.05) and 11.3 +/- 2.2 ml/kg/min (p < 0.001), respectively. The improved aerobic capacity corresponded to a 9.3% increase in the results of the 6-minute walk test in the 4th week (n.s.). During out-patient period, the walking could be increased from 37 to 58 minutes daily. The physical quality of life was significantly improved after 3 months. There was no hospital admission due to heart failure. CONCLUSION: Exercise training in the therapy of severe heart failure is safe and increases the aerobic capacity. Associated educational measures may be able to minimize the danger of wrong exercise techniques and to reduce the rate of hospital readmissions.

Adult↗