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At least 919 records · Page 51Linked to original sources

Teaching severely multihandicapped students to put on their own hearing aids.

Two experiments were conducted with six severely multihandicapped students with hearing impairments to: (a) train the six students to put on their own hearing aids independently, and (b) provide an empirical evaluation of a comprehensive instructional program for putting on a hearing aid by assessing acquisition, maintenance, and generalization of that skill across environments. All six students acquired the skill rapidly, with two students requiring remedial training on one step of the program. Because for two of the original three students the newly learned skill failed initially to generalize to other environments, a second experiment was initiated to assess generalization across environments as well as to replicate the efficiency of the acquisition program. When a variation of the multiple-probe baseline technique was used, the behavior of three additional students generalized to other settings without direct training in those settings.

Adolescent↗

An input and process evaluation of Internet-based distance learning education for hospital managers in Indonesia.

An evaluation study was carried out to describe the input and process of internet-based distance learning graduate education program for hospital managers in indonesia. The main research question addressed in the study was whether the program supported quality learning among students who were working full time and could not leave their jobs for the whole study period. The results of the study indicated that the program benefited those who lived in remote areas and women who could not leave their family for long period of time. The study suggests that interactions between students and their peers or tutors motivated better learning processes. Variability of performances were observed among students who were not equally supported by technological helps and with different learning motivations. It needs another year to evaluate whether the internet-based program is no less effective and efficient or even better than the in-class programs.

Adult↗

[The comparison of efficiency of supplement of the second phase in the program IVF-ET by dydrogesterone and progesterone].

The retrospective study was carried out to compare effectiveness of progesteron and dydrogesteron luetal phase support following in vitro fertilisation and embryo transfer. Two hundred and fifty eight patients undergoing IVF ET received progesteron in itramuscular injections. Two hundred sixty patients received dydrogesteron three times daily p.o. There were no differences in stimulation protocols, indications for IVF and IVF procedures. Pregnancy rate, implantation rate and spontaneous abortion rate were similar in both groups. The effectiveness of luteal phase support in patients undergoing IVF ET program by dydrogesteron and progesteron is similar with significantly lower costs for the last one.

Adult↗

No programming required. Mobile PCs can help physicians work more efficiently, especially when the application is designed to fit the practice.

UNLABELLED: The Jacobson Medical Group San Antonio PROBLEM: Jacobson Medical Group (JMG) needed a way to effectively and efficiently coordinate referral information between their hospitalist physicians and specialists. SOLUTION: JMG decided to replace paper-based binders with something more convenient and easily updated. The organization chose to implement a mobile solution that would provide its physicians with convenient access to a database of information via a hand-held computer. RESULTS: The hand-held solution provides physicians with full demographic profiles of primary care givers for each area where the group operates. The database includes multiple profiles based on different healthcare plans, along with details about preferred and authorized specialists. KEYS TO SUCCESS: JMG adopted a user-friendly solution that the hospitalists and specialists would embrace and actually use.

Attitude to Computers↗

Complications of laparoscopic procedures after concentrated training in urological laparoscopy.

PURPOSE: To increase the safety and efficiency of laparoscopic surgery clinical training programs have been developed to increase the skill and efficiency of urological trainees. We evaluated the impact of dedicated laparoscopy training on the rate and type of complications after trainees entered clinical practice. MATERIALS AND METHODS: Data were obtained from 13 centers where laparoscopy was performed by a single surgeon with at least 12 months of training in urological laparoscopy before clinical practice. Data included training experience, laparoscopic procedures performed after commencing clinical practice and associated complications. Procedures were classified as easy, moderate and difficult. RESULTS: During training each surgeon participated in a mean of 71 cases. In clinical practice a total of 738 laparoscopic cases were performed with the group reporting an overall complication rate of 11.9%. The rate was unchanged when the initial 20, 30 and 40 cases per surgeon were compared with all subsequent cases (12%, 11.9% and 12% versus 11.8 to 12%, respectively). The re-intervention rate was 1.1%. The complication rate increased with case difficulty. Overall and early complication rates attributable to laparoscopic technique in the initial 20, 30 and 40 cases were identical. The most common complications were neuropathy in 13 patients, urine leakage/urinoma in 9, transfusion in 7 and ileus in 5. CONCLUSIONS: The complication rate of surgeons who completed at least 12 months of laparoscopy training did not differ according to initial versus subsequent surgical experience. Intensive training seems to decrease the impact of the learning curve for laparoscopy.

Humans↗

Health center streamlines use of audiovisual aids.

Audiovisual aids and programs can be used to help provide effective and efficient in-hospital continuing education programs. The cost of audiovisual equipment can be minimized and use can be maximized by implementing standardization policies that identify and simplify the number and types of equipment to be purchased.

Audiovisual Aids↗

[Digital multi-filter auditory prosthesis: study of its efficiency in function of number of filters and their programming].

We designed a prototype of a 7-filter digital auditory prosthesis table prototype. For each of these filters frequency band width, amplification and compression were programmable in order to adapt these parameters to the deaf patient's audiometric particularities. We compared the hearing improvement it was possible to obtain either with the 3-analogue-filter auditory prosthesis Triton 3004 from Siemens, or with our prototype as a function of the number of filters (3, 4 or 7) and their frequency band width programmability. We tested 21 patients suffering from middle or severe neurosensory hearing loss. This study allows to demonstrate that to overpass the present analogue T004 device a 7 programmable-width-filter strategy seems to be the most appropriate. Further studies benefiting with material improvement of our prototype and finer audiometric adjustment of filter strategies as well as long term clinical studies have to be carried out.

Acoustic Stimulation↗

Gastric cancer screening of a high-risk population in Japan using serum pepsinogen and barium digital radiography.

With the aim of developing more efficient gastric cancer screening programs for use in Japan, we studied a new screening program that combines serum pepsinogen (PG) testing and barium digital radiography (DR). A total of 17 647 middle-aged male subjects underwent workplace screening over a 7-year period using a combination of PG testing and DR. This program's effectiveness, as well as other characteristics of the program, was analyzed. Forty-nine cases of gastric cancer were detected (comprising 88% early cancer cases). The detection rate was 0.28%, and the positive predictive value was 0.85%. The PG test detected 63.3% of cases, DR detected 69.4% of cases, and both tests were positive in 32.7% of cancer cases. The two methods were almost equally effective, and were considerably more effective than conventional screening using photofluorography. Each screening method detected a distinct gastric cancer subgroup; the PG test efficiently detected asymptomatic small early cancer with intestinal type histology, while DR was efficient at detecting cancers with depressed or ulcerated morphology and diffuse type histology. The cost for the detection of a single cancer was much less than that for conventional screening. In fact, it is possible to further reduce the cost of detecting a single cancer to a cost comparable to that of surgically resecting a single gastric cancer. Thus, it is probable that a highly efficient gastric cancer screening system can be implemented by combining the two screening methods. Such a screening program would be beneficial in a population at high risk for gastric cancer.

Barium↗

Program budgeting and marginal analysis: a case study in chronic airflow limitation.

Program budgeting and marginal analysis is a method of priority-setting in health care. This article describes how this method was applied to the management of a disease-specific group, chronic airflow limitation. A sub-program flow chart clarified the major cost drivers. After assessment of the technical efficiency of the sub-programs and careful and detailed analysis, incremental and decremental wish lists of activities were established. Program budgeting and marginal analysis provides a framework for rational resource allocation. The nurturing of a vigorous program management group, with members representing all participants in the process (including patients/consumers), is the key to a successful outcome.

Budgets↗

24-hour care programs.

Twenty-four-hour care programs, which combine group health programs with workers' compensation and disability benefits, hold considerable potential for cost savings and greater efficiency. This article explains these programs and uses a care history to show the savings they can achieve.

Cost Savings↗

Medicaid program; MMIS system performance review revisions--HCFA. Final notice.

This notice revises the system performance review standards, procedures and methodologies previously published in the Federal Register on June 30, 1981 (46 FR 33653) that we have used to evaluate State Medicaid Management Information Systems. These revisions are intended to improve the economy, effectiveness and efficiency of the Medicaid program.

Centers for Medicare and Medicaid Services, U.S.↗

Relative efficiency in rural primary health care: an application of data envelopment analysis.

This study applied data envelopment analysis (DEA) to the evaluation of rural primary health care programs, which are known to be very heterogeneous. DEA is a mathematical programming technique that optimizes the relative efficiency ratio of current inputs over current outputs for each decision-making unit (DMU). It produces a summary scalar efficiency ratio for each DMU and identifies the amount of inefficiency. The data came from the National Evaluation of Rural Primary Health Care Programs. Despite the demands of the software used for homogeneous units and nonzero values, the efficiency analysis was useful to the evaluation. It assessed multiple inputs and multiple outputs simultaneously, and identified directly those units that are performing efficiently or inefficiently when compared to specific peer programs. This then allowed us to compare this efficient-inefficient classification with other data, first, to verify the classification and, second, to assist with the evaluation. DEA can contribute to the evaluation of heterogeneous health programs, especially when used in conjunction with other methods of analysis.

Evaluation Studies as Topic↗

[Use of PGF2alpha and GnRH for estrus synchronization in cattle].

Estrus detection has a tremendous impact on the reproductive efficiency in dairy farms. Recently the systematic use of hormones for synchronization of estrus and ovulation has been propagated. These programs are designed to facilitate estrus detection and/or increase its efficiency. Prostaglandin programs are used to improve estrus detection and reproductive management in dairy operations. All cows are treated up to three times in weekly or biweekly intervals at the end of the voluntary waiting period. This should lead to groups of cows in estrus within two to four days after PG treatment. Since PG programs cannot completely eliminate the need for estrus detection procedures for fixed time artificial insemination (AI) were developed. Fixed time AI not only requires control of the luteal phase of the cow but also synchronization of the follicular development. Treatment with GnRH will induce a new follicular wave and provide a dominant follicle in a defined growth phase at the time of PG administration seven days later. A second injection of GnRH given 48 hours after PG results in ovulation approximately 24 to 32 hours after GnRH (OvSynch-procedure). The pros and cons of hormone programs in dairy farming are discussed in the light of field trials and experiments performed in our department.

Animals↗