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PubMed1995

Retraining in endoscopy.

This article outlines a program developed by the American Society for Gastrointestinal Endoscopy (ASGE) for training gastroenterologists in endoscopy techniques that had not been introduced at the time of their fellowships. Discussed are prerequisites for students, criteria for teachers, elements for the teaching program, and methods for documenting the experience. Problems to be anticipated are highlighted and include liability, justification of an attenuated training experience, and the acceptability of such a program for purposes of obtaining privileges. Also considered is ASGE's experience with this program and the potential for its use in other nontraditional teaching situation, for example, managed care.

Education, Professional, Retraining↗
PubMedDate not supplied

Survey of behavior management teaching in predoctoral pediatric dentistry programs.

PURPOSE: The purpose of this study was to survey directors of predoctoral pediatric dentistry programs regarding the teaching of behavior management techniques. METHODS: Surveys were mailed to all 56 dental schools in the United States. Follow-up mailings were sent to nonrespondents. The survey contained items on program demographics and the program's teaching of communicative and pharmacologic techniques. Information was also obtained on informed consent and parental presence in the operatory. RESULTS: Surveys were returned by 48 schools. Two schools declined to respond because they had not yet accepted or graduated students. The final response rate was 89%. The mean (+/-SD) percentage of total didactic time devoted to behavior management was 12% (+/-6). Communicative techniques were taught as "acceptable" by 96% to 100% of programs, with the exception of the hand-over-mouth exercise (HOME). HOME was taught as "unacceptable" by 62% of programs. Active and passive immobilization of sedated and nonsedated children was taught as "acceptable" by 69% to 85% of programs. Sixty-seven percent to 98% of programs taught that pharmacologic techniques (nitrous oxide, conscious sedation, general anesthesia) are "acceptable." There was little evidence that the teaching of behavior management techniques had changed over the previous 5 years, nor that they were likely to change in the near future. Parental presence in the operatory was common for some procedures, particularly among younger children. CONCLUSIONS: Predoctoral programs teach as acceptable communicative and pharmacologic management techniques, with the exception of HOME. Predoctoral program directors report they are not likely to increase the amount of curricular time devoted to behavior management in the near future.

Anesthesia, Dental↗
PubMed1992

Modifying diets to satisfy nutritional requirements using linear programming.

A computational method for constructing individually acceptable diets by modifying a chosen diet to meet nutritional requirements is described. The effects on food quantities of imposing different nutrient requirements on a sample diet are demonstrated and techniques which can ensure the acceptability to the individual of the modified diet are described. The starting point in the calculation is the person's current dietary intake. This is modified using linear programming methods which make the smallest changes to the food quantities to meet specific targets. Sequential modification can be used to identify changes that are acceptable to the individual. The computer program has been developed in collaboration with practising dietitians and is in use in some leading UK hospitals.

Dietetics↗
PubMed1990

Findings from the Medicaid Competition Demonstrations: a guide for states.

The Medicaid Competition Demonstrations were initiated in 1983-84 in six States (California, Florida, Minnesota, Missouri, New Jersey, and New York). State experiences in implementing the demonstrations are presented in this article. Although problems of enrolling Medicaid recipients in prepaid plans or with primary care case managers under these demonstrations proved challenging to States, lessons were learned in three key areas: program design and administration, health plan and provider relations, and beneficiary acceptance. Therefore, States considering similar programs in the future could benefit from these findings.

Cost Control↗
PubMed1993

[General practice: a theme in search of clarity].

Specialization is a consequence of the progress in knowledge and technology, and is essential to increase medical knowledge. Culturally, the population increasingly aspires to be attended by a specialist. On the other hand, generalism is necessary to protect the unitary focus on the sick patient, to mitigate the increasing cost of medicine and to avoid the increasing dehumanization of medical practice. The condition of generalist is not synonym of general practitioner and may be applied to internists or pediatricians with ample knowledge and diagnostic skills based more in medical interview and physical examination than in the sophisticated laboratory. Specialties have clearly defined fields of knowledge and action, have well established training programs and are culturally accepted, not so general medicine. In Chile, a significant number of trained general practitioners has not been attained, in spite of the existence of training programs since more than 20 years. Outpatient care (primary care in the language of health planners) may be undertaken by general practitioners but also, and perhaps with better efficiency, by general internists and pediatricians. The use of ones or others will depend on the geographic location (urban, suburban or rural), on the available physicians and the communication facilities with better developed medical centers. Within this line of thinking, the Faculty of Medicine of the University of Chile is studying a reform of medical curriculum, rotating internship and residency programs.

Education, Medical↗
PubMed1982

Effects of structured interactions with severely handicapped peers on children's attitudes.

Regular-education children in Grades 4 through 6 participated in structured social interactions with severely handicapped children, and an attitude survey was administered to measure the effects of the intensive contact upon them and their classroom peer group. Results over two semesters of the program revealed significantly higher acceptance of individual differences on three attitudinal dimensions by children at an experimental school (n = 241) in comparison to children from schools where no severely handicapped children were enrolled (n = 288) and schools with severely handicapped children enrolled but without the interaction program (n = 288). Results support the development of personalized, peer-interaction interventions to facilitate social acceptance of child variance in integrated school settings.

Analysis of Variance↗
PubMedDate not supplied

Assessing the quality of health promotion and patient education programs.

Quality assessment for health promotion and patient education programs helps ensure that these services are efficient and effective, and represent professional standards of practice. It also helps ensure that they are beneficial, accessible, and acceptable to members. Three program characteristics should be considered in defining the objectives of an assessment--the degree of existing knowledge regarding the effectiveness of the program, the degree of risk posed by the program, and the cost of the program. A menu of objective is presented, including assessment of the structure of the program; comparison of the program with state-of-the-art models; assessment of program implementation and coverage; measurement of member/patient response; evaluation of program outcome; and evaluation of cost-effectiveness, opportunity costs, and broad benefits to the organization. Major methods for assessment and evaluation are discussed briefly in relationship to the objectives they address--review of professional staff performance; comparison with models, standards, and other criteria; documentation and management information systems; focus groups and other small-scale qualitative methods; participation in plan monitoring and quality assurance activities; and controlled evaluation studies.

Cost-Benefit Analysis↗
PubMedDate not supplied

Family-based, in-home services for the severely emotionally disturbed child.

FBS was not conceived as a substitute for a residential treatment program. It was instead established to provide a greater array of services in the center's continuum of care and another treatment alternative. Although children were accepted into the FBS program when residential treatment was indicated, it was not because the program was considered an equal to residential treatment. Rather, we felt the child and family could receive greater benefits from an in-home approach [Willner et al. 1972]. The results of intensive family-based services speak for themselves in terms of cost-effectiveness, placement prevention, and family reunification [Bryce and Lloyd 1980a]. It has been the center's experience that the most vulnerable children are those who have been removed for extended periods of time to an institutional setting. Results of table 1 indicate that 68% of the children receiving FBS aftercare remained in their homes, while children who were served before any placement remained in their homes 97% of the time. In spite of major behavioral changes experienced by the child and family during the residential course of treatment, the staff reports the following obstacles to successful reunification: Child "identified" as the problem is often expected to return home as a different human being without needs or problems. Temporary expulsion of the identified child often immediately relieves family stress, yet begins a process of homeostatic adjustment whereby the system closes, excluding the child.(ABSTRACT TRUNCATED AT 250 WORDS)

Affective Symptoms↗
PubMed1994

Centralized automated quality assurance for large scale health care systems. A pilot method for some aspects of dental radiography.

President Clinton's Health Security Act proposes the formation of large scale health plans with improved quality assurance. Dental radiography consumes 4% ($1.2 billion in 1990) of total dental expenditure yet regular systematic office quality assurance is not performed. A pilot automated method is described for assessing density of exposed film and fogging of unexposed processed film. A workstation and camera were used to input intraoral radiographs. Test images were produced from a phantom jaw with increasing exposure times. Two radiologists subjectively classified the images as too light, acceptable, or too dark. A computer program automatically classified global grey level histograms from the test images as too light, acceptable, or too dark. The program correctly classified 95% of 88 clinical films. Optical density of unexposed film in the range 0.15 to 0.52 measured by computer was reliable to better than 0.01. Further work is needed to see if comprehensive centralized automated radiographic quality assurance systems with feedback to dentists are feasible, are able to improve quality, and are significantly cheaper than conventional clerical methods.

Absorptiometry, Photon↗
PubMedDate not supplied

[Should we apply assisted reproduction technology to women without limitations of age?].

The decline of female fertility with increasing age is due to a physiological diminution of the ovarian reserve of follicles. Hence, a reliable evaluation of the ovarian reserve before performing assisted reproductive technology in aged women provides them and the physician with information about the actual probabilities of pregnancy. Patients aged over 38 years should be accepted in assisted reproduction programs only after confirmation of a healthy ovarian reserve. Patients aged more than 42 years, even in case of a normal ovarian reserve assessment, should be only accepted in selected cases. After 42 years until 46 of age, techniques of in vitro fertilization with oocyte donation may represent an alternative chance of pregnancy to aged women.

Adult↗
PubMed1986

The impaired dentist. Recognition and treatment of the alcoholic and drug-dependent professional.

An attempt has been made to focus on the gravity of the consequences of alcoholism and/or drug dependence within the dental profession. The dentist who suffers from these illnesses can be identified through a pattern of behaviors and personal, vocational, and social consequences that are progressive and potentially fatal. When denial by colleagues, family, friends, professionals, and office personnel is overcome, enabling no longer perpetuates the illness and help is forthcoming. Programs can be developed in constituent societies that are based on the widely accepted and effective employee assistance programs found in the work world today. Voluntary and nonvoluntary approaches are employed to direct the sick person to professional help. The sophistication of today's alcoholism treatment provides us with the tools to initiate recovery. The dentist and his or her family has an excellent chance for recovery and everyone gains--the victim, the family, the dental profession, the dental patient, and society. It is time we recognized our own denial and enabling and accept our responsibilities to help our suffering colleagues. Dentists are just as susceptible to disease as other humans, and the tragedy of a wasted life as a result of alcoholism is inexcusable with our level of knowledge of alcoholism programs today.

Alcoholism↗
PubMed1994

The Lactational Amenorrhea Method (LAM): a postpartum introductory family planning method with policy and program implications.

It is well accepted that breastfeeding contributes significantly to child survival and child nutrition. Healthful child spacing is associated with improved birth outcomes and maternal recovery. On a population basis, breastfeeding may contribute more to birth spacing than all family planning use combined in many countries. However, while breastfeeding does provide a period of infertility, until recently, there was no reliable way for an individual woman to capitalize on this lactational infertility for her own efficacious child spacing. The Lactational Amenorrhea Method (LAM) is a new introductory family planning method that simultaneously promotes child spacing and breastfeeding, with its optimal nutrition and disease preventive benefits for the infant. LAM, as it is called, is based on the utilization of lactational infertility for protection from pregnancy and indicates the time for the introduction of a complementary family planning method. LAM is recommended for up to six months postpartum for women who are fully or nearly fully breastfeeding and amenorrheic, and relies on the maintenance of appropriate breastfeeding practices to prolong lactational infertility, with the concomitant delay in menses return. A recent clinical trial confirmed the theoretical 98% or higher effectiveness of the method and field trials are demonstrating its acceptability. Nonetheless, some demographers and family planning organizations continue to debate its value. The development, efficacy, and sequelae of the method are presented using data from several studies by the authors.

Amenorrhea↗
PubMed1993

Donation and retrieval of cadaveric organs in Australia. Accepting the challenge.

Most transplant programs in this country are significantly restricted by a chronic shortage of donor organs. This article examines the sources of transplantable organs, the concept of brain death, reasons why potential donors may be missed in hospitals, the often perceived difficulty in approaching next-of-kin, and the medical requirements and logistics of organ retrieval. The lives of many people are affected by organ donation and transplantation. For those receiving a transplant it can be a gift of incalculable value; for those who agree to donation it may represent one positive outcome from an otherwise tragic situation. These unique circumstances provoke a wide range of emotions and reactions. Health care professionals need to act responsibly towards both donor families and potential transplant recipients. Their involvement in the process of organ donation is an important part of their role in the care of critically ill or injured patients.

Adolescent↗
PubMedDate not supplied

[Use of the computer for management of a vaccination program].

The surveillance of vaccine acceptance was carried out in 3 French towns. The cost was minimal as the necessary equipment and personnel were available in the town-halls. This arrangement was utilized to monitor the increasing percentage of children vaccinated in the 3 towns. The increase was particularly significant for diphteria, tetanus and poliomyelitis.

Child↗
PubMed1999

Assessment of quality of life in the younger child: the use of an animated computer program.

BACKGROUND: In the past, quality of life was primarily assessed using objective measurements of the condition of the patient. Today, most quality-of-life measurements include several aspects regarding the patient's opinions and feelings. There has been an extensive development of quality-of-life instruments particularly in adults, including those for people with inflammatory bowel disease (IBD). However, only a few instruments, mostly questionnaires, have been developed for the pediatric population. It has been noted, even in young patients with IBD, that there is reduced self-esteem and more anxiety and depression. Altogether, these are important aspects for early measurement of psychosocial functioning and possibly intervention during the treatment of children with IBD. METHODS: For the current study, an instrument was developed for young children aged 5 years or more in which a computer-based animated program was used to measure quality of life in children with inflammatory bowel disease. The instrument was designed to be similar for boys and girls with no reference to racial identity. In addition, it was culturally acceptable for all Dutch children. The program was in the form of a story of a bear and a clown playing in an attic of an old house where they come across many objects with which they play and where many adventures occur. All 35 questions were interwoven in this story. RESULTS: The animated computer program was well accepted and easily used by 16 children between the ages of 5 and 12 in a small pilot study. In those older than 11 years, another approach is probably necessary, using an age-appropriate animated program. CONCLUSIONS: The computer program can easily be used in an outpatient setting and thus ensures that quality-of-life measurement will become a routine part of a medical visit.

Child↗
PubMed2006

The fate of organs refused locally and transplanted elsewhere.

UNLABELLED: The number of kidney allografts procured from deceased donors has been fairly constant in the past few years, while organs from living donors steadily increase. In our program, existing protocols refused some kidneys which were subsequently accepted and transplanted at other hospitals. Thus, a review of our criteria to accept kidneys became necessary. METHODS: We studied the outcome of all kidneys refused by us but transplanted in other programs between 2002 and 2004. The data analyzed included ID no. donor, transplant center, procurement date, donor age, ischemic times, recipient alive or dead, creatinine level (when it was offered), initial function, hypertension, diabetes mellitus, biopsy, reason why the kidney was not accepted in our program, kidney functioning or lost, and cause of graft failure. The chi-square, Fisher, and t tests were used to analyze our data; P values of <.05 were regarded as significant. RESULTS: Originally 137, we excluded kidneys exported due to mandatory sharing (26 of 137 = 18.97%) and multiorgan placement (10 of 137 = 7.3%). Thus, 101 kidneys were not accepted by us because they did not meet the existing criteria of our program, but were accepted elsewhere. Reasons for nonacceptance were divided into donor quality, donor social history, donor age, donor size/weight, positive serological test, as well as organ preservation time, organ anatomical damage, elevated creatinine, abnormal urinalysis, abnormal biopsy, and decreased urine output. Donor issues were 66 of 101 (65.3%) with a graft loss of 13.6%, and organ issues were 35 of 101 (34.7%) with a graft loss of 66.6%. Donor quality totaled 24 of 66 (36.4%) and donor social history totaled 20 of 66 (30.3%); these were the most common causes for kidney nonacceptance related to donor issues. Reasons related to organ quality included elevated creatinine (15 of 35 = 42.9%; graft loss, 46.6%), and abnormal biopsy (9 of 35 = 25.7%; graft loss, 11.1%) and organ anatomical damage (4 of 35 = 11.4%; graft loss, 75%) (P = .42). Graft loss was more frequent with creatinine levels above 2.4 mg/dL (P < .001, RR gf = 1.5). Long-term fate of these 101 kidneys transplanted elsewhere: 82 (81.2%) were still working while 19 (18.8%) were lost. The causes of graft loss were renal artery thrombosis (42.1%), renal venous thrombosis (26.3%), death for other reasons (15.8%), graft never worked (10.5%), and ESRD (5.7%). The results suggest that the criteria for refusal related to donor issues, including hypertension, diabetes mellitus, donor age and donor size, should be revised owing to the low percentage of graft loss. Other donor issues such as positive serological test and donor social history (drug use, alcoholism) represent a serious potential risk for the health of recipients; for this reason, considering these persons as possible donors is very difficult irrespective of the graft outcome. Kidney refusals related to organ issues (especially elevated creatinine and anatomical damage) due to the very high percentage of graft loss should be considered high risk and probably be excluded. The increase in the demand of kidneys to be transplanted is a very important reason for a continuous and systematic review of donor exclusion criteria in every transplant program. The results presented here have helped us to improve both our outcomes and utilizations based on scientific evidence.

Cadaver↗
PubMed2006

[What determines the time-lag for publications in Revista Médica de Chile?].

The number of manuscripts submitted for publication in Revista Médica de Chile has increased steadily. Consequently, the number of external experts that generously contribute in the peer review process has also been enlarged. When the manuscripts return to the authors with specific requests to be improved, according to the criticisms raised by their reviewers or the editors, more time is added until a corrected version is received and accepted. After acceptance, the manuscripts are programmed by the editors to be included in future monthly issues of the Revista. The number of manuscripts that can be included in an issue is limited by the number of pages accorded between the publishers and the owner institution. Therefore, an additional time-lag occurs: research articles and case reports may be published 6-8 months after they were finally accepted, while reviews and special articles have to wait even more. As experienced in prestigious journals worldwide, a computational program to handle the editorial process through the Internet is needed, but it is not yet available in Spanish language. Although it should fasten communications and facilitate the authors a rapid insight in the stages of the editorial process where their manuscripts are, the increasing number of submissions, the current acceptance rate and the limitation in space will still retard the publications once they are accepted.

Chile↗