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Receptivity of a worksite breast cancer screening education program.

A breast cancer screening education program was offered to 97 major worksites in Forsyth County, North Carolina. Worksites could design a program by choosing components that consisted of (1) brochures, (2) breast cancer education classes taught by program staff or (3) sending company nurses to be trained by program staff to then teach employees at the worksite. A total of 63 out of the original 97 companies (65%) accepted and offered a program to their employees. Worksites that chose to sponsor a program were more likely to have already sponsored breast cancer education programs at their worksites (P = 0.027) or to have a medical department (P = 0.006). The type of component selected was significantly associated with a history of sponsoring other health education programs (P < 0.001). Fourteen worksites chose the more intensive component, the training of a company nurse. More than half of the worksites that had never sponsored and had no plans to sponsor worksite breast education programs were receptive to our program (43 of 73, 59%). The majority of these sites (67%) chose the brochure. These results indicate that worksites are receptive to offering breast cancer educational programs if varying types of components can be selected.

Adult↗

Hepatitis B vaccination for injection drug users--Pierce County, Washington, 2000.

Hepatitis B vaccination has been recommended for injection drug users (IDUs) since 1982, but vaccination coverage of IDUs remains low (1), and outbreaks of hepatitis B among IDUs continue to occur. An outbreak of hepatitis B primarily among IDUs in Pierce County, Washington, detected in April 2000, included 60 cases and resulted in three deaths among IDUs co-infected with hepatitis delta virus. A program to administer hepatitis B vaccine to IDUs was implemented to control the outbreak, and the number of cases identified decreased from 13 per month in May to two cases since November. This report describes a vaccination program during which IDUs accepted hepatitis B vaccination provided free of charge in community-based settings and illustrates how effective hepatitis B vaccination programs targeted at IDUs can be implemented through collaborations between departments of health and corrections and community organizations.

Adolescent↗

Costs of training drug-administration technicians.

The costs associated with training drug-administration pharmacy technicians in a 1000-bed university teaching hospital were determined. Data were collected between January 1 and December 31, 1983, for the personnel acquisition phase and four training phases of the technician training program. The study phases were further divided into direct and indirect costs. The pharmacy department interviewed 56 applicants for the training program, of which 19 were accepted; 15 of the 19 (79%) trainees successfully completed the program and were hired. Four nine-week training sessions were conducted. The cost per training hour was $15.69, the cost per trainee was $5,683, and the total training cost of the program was $85,245. Although these cost data are specific to this hospital, they may assist other hospitals in the financial management of pharmacy technician training programs.

Costs and Cost Analysis↗

Evolution of liver transplantation at the University of Heidelberg: interventions influencing patient referral.

In Heidelberg, liver transplantation was first performed in 1987. In this article, we report our experience with an interdisciplinary approach (intervention) to improve the internal and external acceptance of the liver transplantation program. Formation of a transplant team and interdisciplinary standard setting of pre-, peri-, and postoperative protocols significantly stimulated this process. Involvement of the referring doctors in patient's treatment by transferring competencies enhanced patients referral to our center and increased the numbers of patients on the waiting list, an indispensable factor for organ allocation by Eurotransplant and transplantation. Involvement of patient organizations increased patient acceptance in the program.

Germany↗

Nursing staff knowledge of the hepatitis B virus including attitudes and acceptance of hepatitis B vaccination: development of an effective program.

Data for this study in a large tertiary referral teaching hospital in Dublin, Ireland were collected by anonymous self administered questionnaires. A total of 137 questionnaires were distributed to nurses working in five wards with a response rate of 88% (120). Objectives included identifying levels of awareness of the infectivity of the hepatitis B virus, ascertaining levels of knowledge of hepatitis B vaccination, and identifying attitudes resulting in acceptance of hepatitis B vaccine. Ninety seven respondents (82%) knew hepatitis B was 100 times more infective than HIV. Ninety eight respondents (83%) had completed a full course of hepatitis B immunizations. Ninety six respondents (93%) reported a hepatitis B antibody level on completion of the immunizations, 13 (14%) knew their actual titer, and 49 of 63 respondents (78%) reported immunity. Factors influencing decisions to accept vaccination included information related to the benefits of the vaccine from an occupational health physician or nurse and the vaccine being provided free of charge. Nurses in this study had an understanding of the hepatitis B infection. The number of nurses choosing to be vaccinated and having an antibody level test performed postvaccination was high in this group. Most nurses in this study believed they were immune to hepatitis B even though a significant number did not know their hepatitis B antibody level.

Adult↗

The outcome of research training during surgical residency.

BACKGROUND/PURPOSE: Graduates of a university surgical residency program were surveyed to identify the timing of specialty selection and the impact that studying in a research laboratory had on subsequent acceptance into a fellowship program. METHODS: Between 1975 and 1990, 86 residents completed general surgery training at UCLA Medical Center. A survey was sent to all graduates to determine the focus of their previous laboratory research and when they selected their eventual surgical specialty. Responses were received from 67 of the 86 graduates (78%). RESULTS: Forty-eight of the sixty-seven respondents (72%) took one or more years of surgical research during residency. Postresidency fellowship training was selected by 55 of 67 (82%); 50 applied to fewer than five programs; 49 of 55 (89%) received one of their top three choices. Twenty-seven of the sixty-seven residents pursued an academic career (40%). Residents who performed at least 2 years of research were more likely to become academicians (53%) than residents who did 1 year or less of research (22%). Only 39 of 67 residents (58%) had selected a specialty after 2 years of clinical training; 28 more made the selection after the third clinical year. All residents interested in cardiac surgery (n = 18) or plastic surgery (n = 4) prior to research were accepted into fellowships in those specialities, whereas only 37% of those who had an interest in other fields pursued the same specialty (P < 0.0001). Residents performing research in general surgery (n = 9), surgical oncology (n = 18), cardiac surgery (n = 14), and plastic surgery (n = 3) were more likely to practice in that specialty than those doing research in other specialty laboratories. CONCLUSIONS: General surgery residents performing research in a specialty laboratory are likely to pursue fellowship training relating to that field. Those who select a career in cardiac or plastic surgery prior to research are most likely to enter into these fields as their eventual specialty. Residents who perform 2 or more years of laboratory research publish more papers and often pursue an academic career.

General Surgery↗

Effectiveness of an infection control programmed unit of instruction in nursing education.

To determine whether programmed instruction is an acceptable, cost-effective alternative to classroom lectures for teaching the basic principles of infection control to nursing students, a 46-frame programmed unit of instruction (PUI), with a pretest and posttest, was developed, piloted, and tested for reliability and validity. The instruments were developed on the basis of current knowledge of the epidemiology of infectious diseases and the 1983 revised Centers for Disease Control guideline for category-specific isolation precautions. A study was undertaken to test the hypothesis: Student nurses who take a PUI in the basic principles of infection control will score higher on posttests than those who do not take the PUI. A sample of 40 subjects was selected from the senior class in a baccalaureate nursing program at a public university. The subjects were randomly assigned to four groups of 10. A Solomon four-group design was used for data analysis, and a two-way analysis of variance was performed on the posttest means. Results indicated that the treatment (PUI) effect was significant (p less than 0.001). Therefore, it was concluded that the PUI in the basic principles of infection control is an effective instrument for nursing education.

Analysis of Variance↗

CHOICES: promoting early access to end-of-life care through home-based transition management.

CHOICES is a comprehensive home-based care coordination program designed to bridge the gap between home health and hospice for Medicare + Choice enrollees with advanced chronic illness in San Francisco's East Bay region. Key elements of the program include physician education, enrollment of patients with high disease burden who may not be terminally ill, co-management of care with the primary physician, and an advanced practice clinical team that provides comprehensive in-home assessments, a flexible mix of life-prolonging and palliative care that evolves with disease progression, focused education and advance planning, and caregiver support. During a 42-month demonstration, 208 patients were enrolled in the program. Eighty percent had a non-cancer diagnosis; 40% were people of color. After an 8-month follow-up, 44% of the study cohort had died in the program or after transfer to hospice, 51% had been discharged, and 5% remained active. Median length of stay for decedents was 260 days. Preliminary evidence supports the program's feasibility and acceptability to patients, families, physicians, and agency partners. However, the uncertain future of Medicare + Choice and of managed care may jeopardize the program's sustainability. Policymakers and taxpayers will need to determine how to care for the growing number of chronically ill elderly who wish to remain at home as illness advances. The care needs of these patients and their families may overwhelm a health system organized around hospital treatment of acute illness.

Advance Care Planning↗

Collaborative governance in the postanesthesia care unit.

The administration at Schumpert Medical Center, Shreveport, LA, is committed to empowering the nursing staff. Due to this commitment, the postanesthesia nurses developed a collaborative governance program that is based on empowerment. This article discusses how to begin the development and implementation process, address staff concerns, and facilitate acceptance of the finished program by the staff. This program has become a successful model for the collaborative governance program at the author's hospital and has resulted in a stimulating and caring working environment for the professional.

Humans↗

Combating the stress of residency: one school's approach.

Residency is a time of stress and turmoil for many residents. The stresses are varied and great, often involving both personal and professional issues. One institutional mechanism that has been shown to help residents cope with stress is the use of residents' wellness, or assistance, programs. The University of South Florida (USF) College of Medicine developed the USF Residency Assistance Program (RAP) in 1997, modeled after business employee assistance programs but tailored to enhance the well-being of residents. The program was developed in an organized, thoughtful manner starting with a Request for Proposals to all local employee assistance programs and the selection of one of these to run the program. The RAP is broad-based, readily available, easily accessible, totally voluntary and confidential, and not reportable to the state board of medicine. It is well integrated into all residency programs and has had excellent acceptance from the administration; information about access to the RAP is available to all residents through multiple venues. The cost is minimal, at only seven cents a day per resident. The authors present data from the eight years the RAP has been operating, including information on program use, referral rates, acceptance, and types of problems encountered. One suicide occurred during this time period, and the RAP provided a significant role in grief counseling. Assistance programs are critical to the well-being of residents. The USF program presents a model that can be used by other programs around the country.

Academic Medical Centers↗

[New educational strategies: evaluation of the Jury Trial technique for training council members in women's health in Santa Catarina, Brazil].

This article describes and evaluates the Jury Trial technique, an innovative educational instrument used in a pilot workshop on Social Control and Gender by health council members in Greater Metropolitan Florian polis, Santa Catarina, Brazil. The reliability and validity were studied based on the participants' opinions, complemented by qualitative observation of the work. There was consensus in acceptance of the technique based on "acquisition of knowledge" and the fact that it was participatory, democratic, and dynamic. The positive evaluation agrees with a previous study that interviewed municipal health secretaries, with a smaller preference of formal cognitive activities that were also part of the workshop. The article concludes by emphasizing the importance of this innovative technique in training programs, since it is accepted by different target publics, allows for designing the program contents, and is useful in relation to new and controversial issues since it favors practical and reflexive experiences.

Adult↗

Acceptance of moderate drinking by alcohol treatment services in the United States.

This study was designed to survey the acceptance of moderate drinking as an outcome goal by alcohol treatment services in the United States. Of a sample of 330 randomly selected services, there were 312 potential respondents of whom 196 (63%) returned surveys that were usable. Three-quarters of respondents reported that nonabstinence was not an acceptable outcome goal for patients in their program; however, 17% of these respondents endorsed the statement that nonabstinence was acceptable for patients in other alcohol programs or for their own patients after discharge. Of the remaining one-quarter of respondents who found moderate drinking acceptable for their patients, 80% worked in outpatient programs and 70% reported moderate drinking as appropriate for only 1-25% of their clientele. Respondents endorsing moderate drinking rated the following factors as important when selecting outcome goals: severity of physiological dependence, drinking history, psychological dependence, previous treatment, criminal behavior and liver function test results.

Adolescent↗

Attitudes of family practice residency program directors toward mandatory preemployment drug testing.

BACKGROUND AND OBJECTIVES: As health care institutions adopt policies on substance use and abuse and mandatory substance abuse testing in the workplace, applicants for house staff positions may become the subjects of testing as a requirement for acceptance into a residency program. This study attempted to learn what directors of family practice residency programs feel about mandatory preemployment drug testing and its effect on house staff recruitment. METHODS: We surveyed the directors of 420 US family practice residency programs, as listed by the American Academy of Family Physicians, in November 1994. All programs (community based, university affiliated, university based, and military) were included in the survey. RESULTS: A total of 308 (73%) program directors responded. Of these, almost half disagreed with mandatory substance abuse testing and felt it should not be a condition of acceptance for a house staff position. Eighty-eight percent believed that the existence of a policy did not hinder recruitment. None felt it was an enhancement. CONCLUSIONS: Preemployment drug testing for potential house staff remains a controversial issue, and it is unlikely that it will be universally implemented in the near future.

Attitude of Health Personnel↗

Principles for assessing disease management outcomes.

Disease management (DM) is rapidly becoming an important force in the late 20th and early 21st century as a strategy for managing the chronic illness of large populations. Given the increasing visibility of DM programs, the clinical, economic and financial impact of this support are vital to DM program accountability and its acceptance as a solution to the twin challenges of achieving affordable, quality health care. Measuring and reporting outcomes in DM is difficult. DM programs must adapt to local market conditions and customer desires, which in turn limits generalizability, and still account for the overlapping/interlocking/multifaceted nature of the interventions included in any DM program. The Disease Management Association of America convened a Steering Committee to suggest a preferred approach, not a mandated or standardized approach for DM program evaluation. This paper presents the Steering Committee's "Consensus Statement" and "Guiding Principles" for robust evaluation.

Disease Management↗

Parents of elementary school students weigh in on height, weight, and body mass index screening at school.

School-based body mass index (BMI) screening and parent notification programs have been recommended as a childhood overweight prevention strategy. However, there are little empirical data available to guide decision making about the acceptability and safety of programs. A pilot study was conducted using a quasiexperimental research design. In fall 2004, children in 4 suburban elementary schools (kindergarten to sixth grade) in the St Paul/Minneapolis, MN, metropolitan area completed height/weight screening. The following spring, parents in 2 schools received letters containing height/weight and BMI results. A self-administered post-only survey examined parents' opinions and beliefs regarding school-based BMI screening and parent notification programs (response rate: 790/1133 = 70%). The chi2 test of significance was used to examine differences in program support by treatment condition, child's weight status, and sociodemographic characteristics. Among all parents, 78% believed it was important for schools to assess student's height/weight annually and wanted to receive height, weight, and BMI information yearly. Among parents receiving the letter, 95% read most/all of the letter. Most parents (80%) and children (83%) reported comfort with the information in the letter. Parents of overweight children were more likely to report parental discomfort as well as child discomfort with letter content. There was considerable parental support for school-based BMI screening and parent notification programs. Programs may be a useful overweight prevention tool for children. However, continued attention to how best to support parents and children affected by overweight is required.

Body Height↗

Evaluation of motivating factors for selecting optometric residency education.

There are now more than 50 accredited optometric residency programs. We sought to learn the primary motivating factors for selecting residency education beyond the traditional 4-year professional program. Questionnaires addressing this issue were sent in May 1990 to directors of all Council on Optometric Education (COE)-accredited residency programs for distribution to currently participating residents. Of the 81 existing residency positions, 61 questionnaires (75 percent) were returned. Three residents (5 percent) accepted positions in residency programs because they had no definite practice plans following graduation. One resident (2 percent) could not take state board examinations and elected to enter a residency program until licensure could be obtained. Fifty-three (85 percent) selected residency education to enhance their clinical skills, and five residents (8 percent) cited other reasons, such as to prepare for a career in optometric education, to enhance long-term career objectives, and to mature. For 50 (83 percent) of the respondents, residency education was their first choice following graduation from optometry school. We conclude that optometric residency education is highly valued as a source of enrichment of clinical skills.

Career Choice↗

Long-term abstinence from alcohol in patients receiving aversion therapy as part of a multimodal inpatient program.

A sample of 200 patients who had been treated for alcoholism in a multimodal inpatient program that used aversion therapy as a treatment component was selected for outcome evaluation. One hundred sixty (80%) were located. A minimum of 13 months had elapsed since treatment (mean 20.5 months) collateral reports were used to verify self-reports in 36% of the cases. Abstinence status was determined for the first 12 months since treatment, the entire elapsed time since treatment (range 13 to 25 months, mean 20.5 months), and "current abstinence" (last 6 months). The abstinence rate for the first 12 months was 71.3%; for the total period since treatment, the rate was 65% (mean 20.5 months); the current abstinence rate was 78.1%. The data was also viewed from other perspectives. The findings of this study suggest that a multimodal alcoholism treatment program utilizing aversion conditioning is at least as acceptable to patients as counseling centered programs and can be expected to yield favorable abstinence rates.

Adult↗

Key criteria for selection of radiology residents: results of a national survey.

RATIONALE AND OBJECTIVES: We sought to identify the criteria that academic radiology departments in the United States consider for selecting their residents. MATERIALS AND METHODS: In a cross-sectional study, a validated survey was sent to all the program directors of radiology residency programs. A total of 25 variables were studied. Descriptive statistics and correlations were calculated by the chi2 test. Nonparametric correlations were calculated with the Kruskal-Wallis rank test. Statistical significance was set at 5% alpha-error level (P<.05). RESULTS: We had a response rate of 53.1% (77 of 145). All responders participate in the National Resident Matching Program (NRMP), and 93.5% fill all their positions through NRMP. The preinterview selection criteria showed no significant difference by size, region, or affiliation with a medical school. An "interviewing body" carries out the interview process in 87.3% of the cases. Residents and fellows are part of the interviewing body in 76.5% of the programs, the body has the final word in accepting candidates in 62.9% of the programs, 55.4% of the programs use score sheets during interviews with candidates, and only 6.5% of the programs perform panel interviews. Programs associated with a medical school are significantly more likely to have more members in their interviewing body and to use score sheets when evaluating candidates, and panel interviews (more than one candidate or interviewer) are significantly more common among programs in the northeast region. CONCLUSION: All preinterview selection criteria and some interview structural characteristics are independent of the program's size, region, or affiliation with a medical school. More research regarding optimal preselection and interview processes is needed, and closer attention should be paid to the NRMP process if current practices are to be maintained.

Data Collection↗