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Results for “Program Appropriateness”

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At least 883 records · Page 49Linked to original sources
PubMed2006

The impact of an intensive antimicrobial control program in a Taiwanese medical center.

OBJECTIVE: The study evaluates the short term impacts of an intensive control program for the appropriate us of antimicrobials, and to provide a novel strategy for antimicrobial control in inpatient wards in Taiwan. METHOD: In September 2002, a dual intensive antimicrobial control program was implemented within a 921-bed medical center in Taiwan. The study sample included all patients admitted to the medical center during the basal period (October-December 2001) and the intervention period (October-December 2002), where at least one type of parenteral antimicrobial was administered. The sample comprised of 5046 patients during the basal period and 5054 patients during the intervention period. MAIN OUTCOME MEASURE: Analysis of the impact of the intensive antimicrobial control program was undertaken by comparing clinical outcomes, parenteral antimicrobial consumption and bacterial susceptibilities, before and after the establishment of the intensive antimicrobial control program. RESULTS: No statistical differences were found between the basal and intervention periods with regard to either the demographic variables, such as age and gender, or the incidence of nosocomial infections. The clinical outcomes, including length of stay in the medical center, mortality and readmission rates, were also similar for both periods. As compared to the basal period, the consumption of parenteral antimicrobials--in defined daily doses (DDDs) per 100 patient days (PDs)--declined by 13.2% during the intervention period (71.2 vs. 61.8). There were significant increases in the susceptibilities of Pseudomonas aeruginosa to both amikacin and ciprofloxacin, and Serratia spp. to ciprofloxacin (P < 0.05), while all others remained stable. CONCLUSION: This study reports positive responses to intensive antimicrobial control measures among health professionals within a Taiwanese medical center. Following the implementation of the intensive control program, both prescriptions and consumption levels of parenteral antimicrobials were reduced without compromising the clinical outcomes of patients, while the susceptibility patterns of bacterial organisms mostly remained stable. Long-term control of parenteral antimicrobials under such a program may well produce significant benefits for inpatients through the overall rationalization of antimicrobial usage, leading to potential reductions in both the incidence of adverse effects and the burden of resistant organisms. A method of incorporating this intensive control program into a computerized prescription order system is currently under construction.

Adult↗
PubMedDate not supplied

Continuing-education needs of public health educators: their perspectives.

The objective of the study described in this article was to determine the perceived continuing-education needs of employed public health educators. A three-wave mailing of a questionnaire was sent to a national sample of 500 public health educators who were asked to rate their preparation on 41 subcompetencies. Of 299 returned surveys (63%), 149 indicated that they were not currently practicing public health educators. Thus, analysis was based on 150 respondents. Six subcompetencies were perceived by 25% or more of the respondents as topics in which they needed more training. Health educators reported a need for continuing education, focused primarily on administration and evaluation of programs and applying appropriate research principles. Furthermore, the public health educators overwhelmingly preferred to attend a conference or workshop (85%) as their method of obtaining further continuing education. Health education programs and professional organizations need to take note of the identified continuing-education needs when developing future educational programs to adequately update health educators.

Adult↗
PubMed1981

Dental school capitation - an historical perspective.

The Health Professions Capitation Grant program was in existence for nine years. At its inception the capitation grant program was intended principally to be an incentive program for various health professions schools, dental schools among them, to increase the output of manpower. In recent years, the program had changed its emphasis for dental schools to curricular modifications designed to improve the geographic and specialty distribution of dental graduates. All the same time the appropriations for the program had steadily declined since 1972. These developments and the legislative actions that led to the termination of the capitation program are reviewed.

Government↗
PubMed1981

The appropriateness evaluation protocol: a technique for assessing unnecessary days of hospital care.

A major national health policy objective is to improve the efficiency of hospital utilization. To evaluate programmatic interventions with this objective, such as the Professional Standards Review Organization program, measures of appropriate use are a fundamental need. This report represents the results of two developmental trials of a new technique, labeled the Appropriateness Evaluation Protocol (AEP), for assessing potentially unnecessary hospital days of care. Twenty-seven objective criteria items related to medical services, nursing/life support services and patient condition factors were incorporated in the protocol. If any one of the criteria was met, the day was deemed "appropriate," and if none was met, the day was deemed "inappropriate" at an acute hospital level of care. A reviewer could override the objective criteria in either direction in reaching a final judgment. Three reviewers, two nurses and one physician each reviewed 200 charts at a teaching hospital. After correcting for a small number of abstracting errors, overall agreement rates between pairs of reviewers ranged from 92 to 94 per cent, levels significant p less than 0.0001. Of all cases judged inappropriate by at least one of the reviewers, specific agreement rates for the reviewer pairs on which days were inappropriate ranged from 73 to 79 per cent. These overall agreement rates and specific agreement rates on days of care judged as inappropriate are higher than those of any previously reported assessment methods. A parallel study of the appropriateness of admissions in these same cases, using purely subjective reviewer judgments, found overall agreement rates averaging 90 per cent, but rates of specific agreement on inappropriate admissions were less than 40 per cent between pairs of reviewers. Along with comparisons to other, more subjective, assessment techniques, this finding suggests that objective criteria are a vital element in developing methodologically sound techniques for assessing appropriate hospital use.

Health Services Misuse↗
PubMed1989

A critique of therapeutic intervention programming with reference to an alternative approach based on motor learning theory.

As an alternative to current therapeutic intervention programming for developmentally delayed children, a rationale for intervention programming based on theories of motor control and learning is presented. The authors believe that the keys to successful motor training programs are repetition, correctly performed practice of functional skills, and sufficient learning time to facilitate skill retention and transfer. In order for therapists to construct and implement the most appropriate motor training programs for developmentally delayed children, they must be knowledgeable of the sensory-motor basis of motor skill acquisition. Some of the more important concepts of motor control and learning are presented.

Journal Article↗
PubMedDate not supplied

Culturally tailored diabetes education program for Chinese Americans: a pilot study.

BACKGROUND: The prevalence of type 2 diabetes among Chinese Americans is rising, and cultural and socioeconomic factors prevent this population from achieving optimal diabetes management. OBJECTIVES: To assess the feasibility and acceptability of a culturally appropriate diabetes management program tailored to Chinese Americans with type 2 diabetes and the preliminary outcomes of the intervention. METHOD: Forty eligible subjects were recruited from the community to participate in this 10-session program developed by integrating Chinese cultural values into an established Western diabetes management program. Feasibility and acceptability of the program were evaluated by the percentage of participants meeting the course objectives and satisfaction with the program. Outcomes measures included the Diabetes Quality-of-Life (DQOL) survey, body weight, blood pressure, and HbA1c levels measured before, after, and 3 months after the intervention. RESULTS: Thirty-three participants completed all 10 sessions and the outcome measurements. Attrition rate was 17.5%. The majority of the participants understood the course content (75%) and identified and demonstrated various diabetes management skills (70% and 82.5%, respectively). All participants who completed the program were "very satisfied" with the program. With regard to the outcome variables, 43.6% of the participants lost more than 5 pounds and most had a reduction in blood pressure at 3 months after completion of the program. Mean HbA1c decreased from 7.11 to 6.12 postintervention. Significant improvements on the DQOL also were reported. DISCUSSION: Culturally tailored diabetes management may be effective in Chinese Americans with type 2 diabetes. Further study, with a larger sample size and a control group, is recommended.

Adult↗
PubMed2002

Evaluation of Legs For Life National Screening and Awareness Program for Peripheral Vascular Disease: results of a follow-up survey of screening participants.

PURPOSE: The Legs For Life(R) National Screening and Awareness Program for Peripheral Vascular Disease (PVD) was launched in 1999. A critical component of the screening program was an independent evaluation to provide additional information about the results of the program. This evaluation considers the health education impacts of the screening program; participants' knowledge about appropriate providers; and some of the outcomes associated with the program. MATERIALS AND METHODS: The evaluation is based on a representative sample of 700 individuals who participated in the screening program and responded to a six-page closed-ended mail questionnaire 6 months after the screening. The sample was drawn in a two-stage cluster. A sample of 1,000 individuals was drawn using random selection of low-risk participants and oversampling of all high- and medium-risk participants from 22 sites. RESULTS: More than 80% of the respondents remembered the name of the test (ankle-brachial index) given during the screening program. More than half the respondents reported being informed during the screening that leg pain when walking was a symptom of PVD, and 40% reported being told that numbness in the leg was a symptom. The majority of respondents were able to identify ways to prevent or slow the progression of PVD, whereas just under 50% were able to identify those individuals that would be at higher risk for PVD. Respondents most frequently identified vascular surgeons (42%), family or primary care physicians (22%), and cardiologists (19%) as the type of doctor to see for PVD treatment, whereas only 4.8% of screening participants recognized interventional radiologists as specialists appropriate to dealing with PVD. CONCLUSION: Evidence from participants in the Legs For Life(R) National Screening Program suggests that the program has met its initial goals of education, identification, and treatment for those identified with PVD. While many specialties manage this condition, the evaluation indicates there is much to be done in increasing the awareness of interventional radiologists and their role in the diagnosis and treatment of PVD.

Aged↗
PubMed2004

Assessment of persistent toxic substances in the environment of Egypt.

The objective of this review is to provide a comprehensive assessment of the threats posed by persistent toxic substances (PTS) to the environment and human health in Egypt and to identify priorities, data gaps and recommendations for future intervention to control, reduce or eliminate releases of PTS. Data on available concentrations of persistent toxic substances in the different environmental compartments and their impacts on the ecosystem, and humans have been assembled and summarized. Despite extensive studies, most of the data available deal with limited studies or hot spot situations. Localized inputs of PTS have been identified from freshwater discharges in coastal areas (e.g., Nile estuaries and coastal lakes) and near sewage outfalls from highly industrialized and populated cities. Data are often missing for certain contaminants and in some compartments and geographical areas. The lack of standardized methodologies makes it difficult to compare and use existing data to provide exact conclusions on spatial and temporal trends. In spite of these restrictions, available data indicate that it is unlikely that present levels of cyclodiene pesticides would adversely affect marine organisms. Compounds which are proven to be of concern are DDT, PCBs, gamma-HCH, PAHs, HCB and organotin compounds. Other compounds are suspected to be ubiquitous but data are lacking. Based on few recent data, the reported levels of organochlorine pesticides in fish and human milk samples suggest a concentration decline during the 1990s consistent with the regulatory restrictions on the use of these compounds. It is essential to activate monitoring programs to fill data gaps in appropriate abiotic and biotic. Monitoring programs should be follow standard procedures and include improved QA/QC protocols.

Egypt↗
PubMed2005

E3LSI research: an essential element of biodefense.

The threat of bioterrorism has prompted the U.S. to undertake a vast biodefense initiative, including funding biodefense-related scientific research at unprecedented levels. Unfortunately, the many ethical, economic, environmental, legal, and social implications (E(3)LSI) of biodefense research and activities are not yet receiving the attention they warrant. Previously, in laudable demonstrations of foresight and responsibility, the federal government has funded research into the E(3)LSI of other recent scientific endeavors--namely, the Human Genome Project and the nanotechnology research program--through directed appropriations from their respective research budgets. This article advocates and proposes a model for a portion of biodefense funding to be similarly set aside for an E(3)LSI research program to complement biodefense research, to ensure that bioterror preparedness does not give rise to harmful or otherwise undesirable unintended consequences.

Bioterrorism↗
PubMed1997

Teaching personal safety skills to young children: an investigation of age and gender across five studies.

OBJECTIVE: To determine the extent to which preschool-aged boys and girls can benefit from instruction in personal safety. METHOD: Data compiled from five previous studies were employed. Four hundred and six preschoolers were pretested and participated in either the Behavioral Skills Training program (BST; Wurtele, 1986) or a control program. Children were posttested on skill and knowledge gains. RESULTS: Preschoolers who had participated in the BST program demonstrated greater knowledge and higher levels of personal safety skills compared with controls. Boys and girls reacted similarly to the program, as did children from younger and older age groups. CONCLUSIONS: These results provide support for the assertion that most preschool-aged children can benefit from participating in a developmentally appropriate personal safety program. Suggestions for expanding the efforts to prevent child sexual abuse are offered, so that children do not shoulder the full responsibility for prevention.

Analysis of Variance↗
PubMed2003

Models of standard and intensive outpatient care in substance abuse and psychiatric treatment.

Intensive outpatient mental health programs are proliferating rapidly. However, findings suggest that intensive treatment may be no more effective than standard treatment. This study compared standard to intensive outpatient programs, within both the psychiatric and substance abuse systems of care, on organization, staffing, and treatment orientation; clinical management practices; and services. A total of 723 (95% of those eligible) Department of Veterans Affairs programs were surveyed nationwide. Psychiatric intensive programs have responded appropriately to their more severely ill patients in terms of the amount and orientation of care, and having a rehabilitation focus. However, the relative lack of basic psychiatric services in psychiatric intensive programs, and the overall similarity of substance abuse standard and intensive programs, may explain why intensive programs have not yielded patient outcomes that are superior to those of standard programs. Mental health system planners should consider differentiating intensive programs using broader criteria and methods.

Ambulatory Care↗
PubMed2006

[Evaluation of visiting nursing care using geographical information system (GIS) technology].

PURPOSE: Previous evaluation studies of the visiting nursing program explained an average change of the participants' health status, without considering socio-ecological characteristics and their impacts. However, these factors must affect individual health problems and lifestyles. For effective and appropriate community based programs, the Geographical Information System (GIS) can be utilized. GIS is a computer-based tool for mapping and analyzing things that happen on earth, and integrates statistical analysis with unique visualization. The purpose of this study was to evaluate visiting nursing care and to advocate the usefulness of planning and evaluating visiting nursing programs using Exploratory Spatial Data Analysis (ESDA) with GIS technology. METHODS: One hundred eighty-four elderly participants with cerebrovascular risk factors who lived in 13 areas of one community received visiting nursing care. The data analyzed characteristics of pre-post change and autocorrelation by ESDA using GIS technology. RESULTS: Visiting nursing care showed an improvement in the participants' lifestyle habits, and family management ability and stress level, while the improvements were different depending on the regions. The change of family management ability and stress level correlated with neighborhoods (Morgan's I= 0.1841, 0.1675). CONCLUSIONS: Community health providers need to consider the individual participant's health status as well as socio-ecological factors. Analysis using GIS technology will contribute to the effective monitoring, evaluation and design of a visiting nursing program.

Aged↗
PubMed1982

How do psychiatrists think? Clinical reasoning in the psychiatric interview: a research and education project.

This paper describes a model of the clinical process in psychiatry. Research into the clinical reasoning of physicians is reviewed. Experimental work at the University of Vermont has demonstrated systematic differences between medical students and psychiatrists of different levels of experience, in regard to the logical order and complexity of clinical reasoning. A psychiatric educational program which objectifies cue recognition, clinical inference, hypothesis generation and systematic enquiry has been associated with changes in reasoning. This suggests that the acquisition of efficient diagnostic reasoning strategies could be accelerated by appropriately designed educational programs.

Curriculum↗
PubMed1997

Designing a successful investment program.

Healthcare organizations have various asset pool funds that can be invested to increase nonoperating revenues. In order to maximize the long-term success of investment efforts, healthcare organizations need to develop comprehensive investment management programs. Such programs identify the assets that can be invested, establish the level of risk each asset type can be exposed to, and match long-term and short-term investment opportunities to the appropriate asset pool. Programs can be managed internally or outsourced to investment management firms with objectives and procedures that are compatible with those of the healthcare organizations' investment policies and guidelines. These policies and guidelines must address asset allocation. Oversight committees must be established to monitor investment performance and reallocate assets, as needed, to take advantage of market movements.

Depreciation↗
PubMed1992

Living with recurrent ventricular dysrhythmias.

The number of patients who live with recurrent ventricular dysrhythmias is increasing as medical advances such as pharmacologic and electrical therapies decrease mortality rates in this population. As a result, nurses frequently encounter patients who are trying to learn to live with chronic aspects of recurrent life-threatening dysrhythmias. The findings of this study provide an important beginning description of strategies used by patients to address their concerns. The RVD patients in this study reported using a variety of strategies to manage their physiologic and psychosocial concerns. Their responses described a continuum of strategies to handle concerns that ranged from "compensate for the concern" to "unable to handle the concern." These findings suggest several implications for nursing. Careful assessment of all patients with RVD is appropriate to detect areas where patients perceive a need for additional strategies to manage their concerns, require support for existing self-reliance strategies, and need identification of additional nursing interventions. Individualized or group programs may be appropriate interventions to assist some patients. Strategies to support patients who report an inability to manage specific concerns need clarification. Ideally, as further research defines the processes patients with RVD use to manage their concerns, high-risk patients can be discovered and provided with interventions to promote their adjustment to living with life-threatening dysrhythmias.

Adaptation, Psychological↗
PubMed2000

Interval cancers as an indicator of performance in breast screening.

BACKGROUND: The literature shows that breast screening performance varies between centers. Those who monitor the performance of screening programs must use appropriate methods to demonstrate quality. Analysis of interval cancer rates provides one such measure. This study analyses interval cancers over a ten-year period in a single center of the UK National Breast Screening Program, offering screening to a population of 45,000 women. METHODS: 108,948 screening examinations were undertaken between 1987 and 1996. Sequential interval cancer rates were studied and compared with the results of the Swedish Two-County trial. More detailed analysis of the first prevalence round was undertaken. RESULTS: Improvement in rates occurred after three years. Two-year time bands show some fluctuation in rates, indicating variation in performance. For one time period, rates equivalent to the Two County Trial were achieved, but this was not consistently maintained. Overall rates equate to performance reported elsewhere in the UK (25% in the first year after screening, 48% in the second year after screening and 48% in the third year after screening, equivalent Two County rates are 17%, 32% and 57%). The prevalence round analysis shows that undiagnosed cancers arose after the film reading stage in 88% of interval cases. The team was able to distinguish minor signs from significant lesions effectively. Assessment procedures were effective once the patient had been recalled. CONCLUSION: Interval cancer rates fell initially but reached a plateau. Recall procedures were effective in making the diagnosis, and cases were missed at the film reading stage. Consistency of performance may be important in achieving low rates.

Breast Neoplasms↗
PubMedDate not supplied

Effectiveness of an emergency preparedness training program for public health nurses in New York City.

A public health workforce that is competent to respond to emergencies is extremely important. We report on the impact of a training program designed to prepare public health nurses to respond appropriately to emergencies. The program focused on the basic public health emergency preparedness competencies and the emergency response role of public health workers employed by the New York City School Department of Health and Mental Hygiene School Health Program. The evaluation methods included pre/post-testing followed by a repeat post-test one month after the program. The program resulted in positive shifts in both knowledge and emergency response attitudes.

Attitude of Health Personnel↗
PubMed1986

Cocaine treatment outcome: cocaine use following inpatient, outpatient, and no treatment.

Based upon a sample of 83 cocaine users self-selected into one of 3 programs, several conclusions seem possible. There seems to be little difference in Ss populations who choose hospital, outpatient or self-help/no treatment. Current hospital aftercare programs may not be appropriately oriented for cocaine users. It appears the hospital program in this study retained fewer than 30% of the Ss in aftercare. Outpatient treatment for cocaine dependency is a viable form of treatment which Ss will participate in for up to 6 months on a fee for service basis. Only about 20% of the Ss who were referred to self-help groups attended more than one meeting. Preliminary outcome data suggest that outpatient treatment may result in a lower relapse rate to cocaine than hospital or no treatment. However, this conclusion is extremely guarded due to a large number of methodological issues and the short follow-up period. Relapse to cocaine use is higher among Ss who returned to alcohol or marijuana.

Cannabis↗