Management and union health programs; the coordination of care and public understanding and acceptance of health services.
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Disease Management↗
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Results for “Program Acceptability”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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How to get community acceptance and participation through the Veterans Administration voluntary services program.
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Humans↗
Use of community analysis methods in community-wide intervention programs.
Successful implementation of large scale health intervention programs aimed at heart disease or cancer prevention require prior analysis and understanding of community structure, organization and influence networks. Systematic sociological analysis facilitates the health program entry process. Survey results are used to build acceptance, participation and to design educational programs. Specific methods used to assess the community's social configuration, organizational resources, and leadership patterns are described. Local leader identification process and participation in community advisory boards is presented. Approaches to the study of community are reviewed in the context of the Minnesota Heart Health Project, a ten year research and demonstration program to reduce risk of cardiovascular disease in three U.S.A. cities.
Cardiovascular Diseases↗
Issues impacting on acceptance and compliance in a community based colorectal screening program.
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Adult↗
[Value of preoperative autotransfusion in elective urologic surgery].
Over a period of 5 months, 50 patients were entered into the preoperative autologous blood donation program of our Service. Two patients were excluded; one had previously had an acute myocardial infarction and the other had epilepsy. The remaining 48 patients, which accounted for one third of our elective surgery procedures, all accepted to enter the program. These patients were not more severely anemic than the other patients not in the program and who underwent the same surgical procedures. No patients required homologous blood transfusion and no complications ascribable to the procedure were observed. Although it is not utilized widely to date, predeposited autologous blood transfusion is a safe and efficient method, with no remarkable morbidity, even in patients aged over 65 years, the age group of one half of our patients. Autologous blood transfusion programs are necessary. The indications, the exclusion criteria for patients at high risk and the objective parameters for evaluating its success must be established.
Adult↗
Mindfulness-based stress reduction and health benefits. A meta-analysis.
OBJECTIVE: Mindfulness-based stress reduction (MBSR) is a structured group program that employs mindfulness meditation to alleviate suffering associated with physical, psychosomatic and psychiatric disorders. The program, nonreligious and nonesoteric, is based upon a systematic procedure to develop enhanced awareness of moment-to-moment experience of perceptible mental processes. The approach assumes that greater awareness will provide more veridical perception, reduce negative affect and improve vitality and coping. In the last two decades, a number of research reports appeared that seem to support many of these claims. We performed a comprehensive review and meta-analysis of published and unpublished studies of health-related studies related to MBSR. METHODS: Sixty-four empirical studies were found, but only 20 reports met criteria of acceptable quality or relevance to be included in the meta-analysis. Reports were excluded due to (1) insufficient information about interventions, (2) poor quantitative health evaluation, (3) inadequate statistical analysis, (4) mindfulness not being the central component of intervention, or (5) the setting of intervention or sample composition deviating too widely from the health-related MBSR program. Acceptable studies covered a wide spectrum of clinical populations (e.g., pain, cancer, heart disease, depression, and anxiety), as well as stressed nonclinical groups. Both controlled and observational investigations were included. Standardized measures of physical and mental well-being constituted the dependent variables of the analysis. RESULTS: Overall, both controlled and uncontrolled studies showed similar effect sizes of approximately 0.5 (P<.0001) with homogeneity of distribution. CONCLUSION: Although derived from a relatively small number of studies, these results suggest that MBSR may help a broad range of individuals to cope with their clinical and nonclinical problems.
Adaptation, Psychological↗
The multiple layers of prevention science research.
A systematic framework for prevention science clinical research is described that explicitly links the identification of prevention needs to the implementation of research results in public health programs. The framework integrates five elements: advocacy and policy, community participation, prevention research, acceptability research, and operations and program development. These five elements are often viewed as disparate agendas, but an effective prevention science research enterprise requires that they be coordinated and integrated through all research stages--from the conceptual, to the experimental, and ultimately to the applied. Examples are provided of how this integration can be achieved from our experience in reproductive health and HIV prevention.
Biomedical Research↗
Bloodless surgery: establishment of a program for the special medical needs of the Jehovah's witness community--the gynecologic surgery experience at a community hospital.
OBJECTIVE: My purpose was to describe the rationale behind the establishment of a hospital-based program instituted to enhance the health of the Jehovah's Witness community and to evaluate patient profiles and outcomes of gynecologic patients treated surgically at our institution, during the past 5 years, whose intake was through the Bloodless Surgery Program and who were not accepting of blood or most blood products. I further describe how a coordinated program dedicated to serving this particular population might improve outcomes and patient satisfaction. STUDY DESIGN: A retrospective review of the charts of 89 patients, all Jehovah's Witnesses, who were enrolled through the Bloodless Surgery Program and underwent gynecologic surgery involving at least 1 night's hospitalization at our institution between January 1, 1993, and December 31, 1997, was performed. A comparison of patient length of stay, hospital charges, and surgical blood loss, in a subset of 41 patients who underwent abdominal hysterectomy, with a cohort of patients not affiliated with the Jehovah's Witnesses or the Bloodless Surgery Program was performed. Data regarding patient satisfaction were obtained through surveys and are presented. RESULTS: Patients enrolled through the Bloodless Surgery Program and undergoing abdominal hysterectomy were significantly younger (average age 43.4 vs 47.7 years) and incurred significantly lower hospital charges (average cost $8754 vs $9539). No significant difference between the group studied and the control group could be found in average length of stay or the average change between preoperative and postoperative hemoglobin levels. Data from patient satisfaction surveys suggest a high level of satisfaction with the Bloodless Surgery Program. CONCLUSION: A program dedicated to the special needs of the Jehovah's Witness community can be instituted in a community-based hospital with no evidence of increased morbidity, as evidenced by length of stay, hospital charges, and surgical blood loss, in a gynecologic patient population. Development of such programs is associated with a high level of patient satisfaction and the potential for improved patient care.
Adult↗
[Aphasia: debates].
Quarrels over aphasia are no recent phenomena and have not always been explicit. Lordat and Gall can be cited in this respect as well as Dax and Bouillaud. Reference is also made to Broca-Dax and Trousseau-Lordat. The creation of the Chair in honour of Charcot, which contributed so greatly (thanks to Charcot himself, the others Masters and their students) to the birth of neurology, then to that of the neurological sciences and eventually to that of the neurocognitive sciences. Next, the most explicit of quarrels on aphasia is dealt with, namely that in which, during three meetings of the French Society of Neurology in 1908, Joseph Jules Dejerine and Pierre Marie crossed swords. Their duel in the Bois de Boulogne in 1893 having fortunately been cancelled, it was in 1908 merely a battle of words. Fulgence Raymond was soon to retire. Dejerine and Pierre Marie each put forward their proposal to the Society for a discussion program and Dejerine's was accepted following a vote. The meeting on 11th June, in accordance with the program proposed by Dejerine, was largely restricted to clinical facts. Fulgence Raymond was not present. Dejerine always spoke first, but some of the replies from Pierre Marie received a degree of approval from the audience. It was during this meeting that Achille Souques, the future founder of the history of neurology, cleverly defended the ideas of Pierre Marie. A little later, Dejerine went on the defensive and agreed to a change in the program along the lines suggested by Pierre Marie: he then presented his ideas on the manifest clinical difference between Broca's aphasia and that of Wernicke. After Souques, Edouard Brissaud also came to the rescue of Pierre Marie by mentioning the Leborgne case published by Broca in the spring 1861. Matters were unresolved and André-Thomas, the future founder of neuropaediatrics, produced a highly intelligent deference of his Master Dejerine. Gilbert Ballet and Ernest Dupré also came down largely on his side. The meeting of 9th July (27th anniversary of the Charcot Chair) was dedicated to cerebral anatomy and the "quadrilateral". The subject of Dejerine's questionnaire was again raised. Accompanied by Georges Guillain, Fulgence Raymond was present on this occasion (but refrained from speaking). This time the star was Augusta Dejerine Klumpke, born on a Spanish sand dune now known as San Francisco, U.S.A. Mrs Dejerine contested the "lenticular zone" and gave it a quite different dimension by proving that its anterodorsal part included associative axons originating in or projecting to Broca's area, the remainder of the "Pierre Marie quadrilateral" being called into question. Brissaud was impressed by the performance of Madame Dejerine, and Pierre Marie found himself in an awkward position. His student François Moutier, present at his request, discussed his own clinical cases and then, on the subject of "Lelong's" brain' (autumn 1861), let it be known that Broca had scratched it with his finger nails while removing the meninges. André-Thomas and Georges Guillain took part in the discussion. At the last meeting, on 23rd July, Brissaud was absent. Fulgence Raymond was again present but remained silent. The only subject on the agenda was "physiological pathology", but several points that had not been resolved on the 9th July were brought up again. On this occasion, Pierre Marie opened the debate and adopted a very cautious approach. However, his patience eventually ran out and he replied sharply to the comments of Dejerine on "images of language" and those of Dupré on "mental representations". Metaphorically speaking, it might be said that the gold medal was not awarded, Augusta Dejerine Klumpke took the silver, Dupré and André-Thomas shared the bronze, and Souques and Moutier each deserved a special mention. It might also be suggested that in 1908 the Society sketched out to a large extent the programme for research on aphasia for the century to come. (ABSTRACT TRUNCATE
Aphasia↗
Marketing cardiovascular disease risk reduction programs at the workplace. The Pawtucket Heart Health Program experience.
The workplace offers a unique setting in which to offer CVD risk reduction programs. Marketing these programs involves at least two distinct processes. First, a corporation must agree to accept and support workplace health programming. Second, workplace programs must be effectively marketed to eligible employees, dependents, and retirees. After identifying critical barriers to the effective marketing of workplace programs, a stepwise approach used by the Pawtucket Heart Health Program to successfully overcome these obstacles is used. Using real world examples and practical tips, a discussion of implications for marketing future programs to the corporate and employee audience is shared.
Cardiovascular Diseases↗
Use of computer modeling to predict the magnitude of intralaboratory error tolerated by proposed CDC interlaboratory proficiency testing performance criteria.
In December 1987, the Centers for Disease Control (CDC) proposed to the Health Care Financing Administration revised criteria for evaluating participating laboratories' performance in proficiency-testing programs. If these criteria are accepted, they will become the minimum standard for all regulatory proficiency-testing programs. To evaluate a laboratory's performance in a clinical chemistry proficiency-testing program, the CDC proposed a combination of the use of fixed limits, multiples of the interlaboratory group standard deviations, and absolute values. In addition, laboratories would be required to meet 70% of the most recent proficiency-testing challenges. Because the purpose of regulatory proficiency testing is to identify poorly performing laboratories, it is essential that regulators be aware of the relationship between the regulatory criteria and the actual magnitude of intralaboratory error they tolerate. Through computer simulation, we determined for 21 chemistry analytes the amount of intralaboratory error tolerated by the CDC-proposed criteria. We evaluated the effectiveness of the proposed criteria by comparing the levels of total intralaboratory error permitted by a proficiency-testing program by using the CDC criteria with actual currently achievable levels of performance and defined medical usefulness needs. The proposed CDC criteria were too lenient for six analytes, about correct for seven, and too stringent on two; no medical usefulness limits were available for six.
Blood Chemical Analysis↗
[Computer-based training--a new method in surgical education and continuing education].
Computer-based training (CBT) programs teach the material of a specific field and at the same time offer various ways of objectively checking the knowledge gained. The interactive use of multimedia components, such as text, graphics, animation, sound, digital slide shows, videos and quizzes, facilitates the learning process. The aim of this study was the development and evaluation of a CBT program for use by surgeons teaching students. Using SuperCard, a teaching module for distal radius fracture (DRF) was developed, containing detailed clinical information. Video clips and vivid animation combine theoretical knowledge with practical experience. Fourth-year medical students (n = 103) were tested after using the module for 90 min. Other students (n = 47) served as the control group. In a 90-min lecture, DRF was discussed. In all evaluated criteria (distinctness, detailed description, presentation of materials, structure, motivation to learn, time saved while learning and memory retention), CBT gained 15-20% better scores than the lecture. Although 87% of the students stated that their experience with computers was limited or insufficient, 100% found the use of CBT systems helpful in student teaching. Most of them suggested the use of such programs as a exam preparation/self study method (90%) or as a supplement to a lecture (40%). Based on these evaluations, it is clear that CBT modules are an appropriate future teaching and learning system that will be well accepted. In conclusion, CBT programs should be integrated into medical education as a valuable supplement. With this aim, CBT systems should be developed and used at universities as an information system for the surgical residency program.
Achievement↗
How did we get here? Where are we going? Hopes and gaps in access to oral health care.
This article reviews the history and future good of acceptance ethics and helps frame the publication of papers presented at the workshop on Professional Promises: Hopes and Gaps in Access to Oral Health Care. Discovery and development of Universal Patient Acceptance (UPA), a practical application of acceptance ethics, is key to systematizing access to oral health; UPA expands partnerships among professional volunteerism, culture, and economic structures. A Veterans' Administration health services preventive dentistry research project and a West Virginia school children's preventive dental program raised awareness of acceptance. A state insurance crisis revealed an underlying systems ethics problem that was not purely legal, political, educational, economic, or scientific in nature. Key players were identified for dialogue, and questions were ranked. UPA was articulated and proposed as a unique, practical, and positive professional promise. The experience involved PEDNET, a dental ethics education group. An intensive applied dental ethics course for practicing dentists was developed; it attracted the American College of Dentists (ACD) and American Dental Association (ADA). Annual ACD LeaderSkills helped expand continuing education of ethics; several dental ethics summits were initiated. Concepts like discourse, adequate care, and viewing organizations as both persons and machines motivated further exploration of acceptance. Separating acceptance from diagnosis, treatment, and payment improves discourse on the various philosophical notions and practical applications that dominate each area.
Child↗
Predictors of acceptance of a postpartum public health nurse home visit: findings from an Ontario survey.
OBJECTIVES: To determine 1) rates of offer and uptake of a home visit provided through Ontario's universal Hospital Stay and Postpartum Home Visiting Program, and 2) predictors of acceptance of a home visit. METHODS: Women were eligible to participate if they had given birth vaginally to a live singleton infant, were being discharged with the infant to their care, were competent to give consent, and could communicate in one of the four study languages. A self-report questionnaire was used to collect data from 1,250 women recruited from five hospitals across the province; 890 (71.2%) women completed a structured telephone interview 4 weeks following discharge. RESULTS: Most women (81.4% to 97.8%) reported having received a telephone call from a public health nurse, although not necessarily within 48 hours of discharge. While the offer of a home visit reportedly was high across sites, there were statistically significant differences in rates of acceptance (40.8% to 76.2%). Important predictors of acceptance were first live birth, lower social support, lower maternal rating of services in labour and delivery, poorer maternal self-reported health, probable postpartum depression, lower maternal rating of services on the postpartum unit, and breastfeeding initiation. CONCLUSION: The home visiting component of the universal program is reaching most women through telephone follow-up. However, rates of acceptance of a home visit differed greatly across study sites. The findings suggest that it is women with specific problems or needs who are accepting a visit. Further research is necessary to guide the development of evidence-based programs and policies regarding postpartum nurse home visits.
Adult↗
Teaching teachers about childhood cancer: the effects of a web-based training program.
The purpose of this study was to examine the utility and acceptability of a modular computer-based training program on childhood cancer (eg, acute and late effects of treatment, intervention strategies) for teachers. A within-subjects design was implemented with 41 teachers and teachers in training. Participants completed tests of childhood cancer knowledge and application skills both before and after completing the web-based training. An acceptability questionnaire was completed after the training. Results indicated significant gains in knowledge and in case application, as well as high levels of acceptability of the training. It seems that a web-based training program can be accessed by teachers and in 2 to 4 hours can significantly increase cancer knowledge in an acceptable manner.
Child↗
Patient as volunteer: an assault on chronicity.
By integrating selected former patients into its regular volunteer program, a South Australian state hospital reduced the hospital stays and the readmissions of a large number of the participants who had previously been seen as failures of the community mental health movement. The author describes the program, its benefits, and some limitations and problems, such as an occasional extra burden on ward personnel. The former patients' new roles as volunteers enabled them to get the support they needed from the hospital but through means more acceptable to them. The program also improved their self-esteem and enabled them to engage in more normalizing social relationships.
Adult↗
Trends in dental hygiene applicant pool size and characteristics of students upon entry over three decades.
A survey was conducted to determine trends that have occurred in the dental hygiene applicant pool and characteristics of entering dental hygiene students between 1957 and 1987. A two page, 46-item questionnaire with a cover letter and stamped pre-addressed envelope was mailed to each dental hygiene program director in the United States. A second mailing was sent one month later to directors who had not responded to the first mailing. A total of 106 usable questionnaires were returned, for a 54 percent response rate for 1987 programs. Response rates for programs existing in 1977, 1967, and 1957 were 51 percent, 45 percent, and 45 percent, respectively. For associate degree/certificate and baccalaureate degree programs, results suggest trends toward (1) a dramatic decline in dental hygiene applicants over the past ten years, (2) a decrease in dental hygiene class size, (3) an increase in age of applicants and length of education prior to acceptance into dental hygiene programs, and (4) a slight decrease in applicants' overall grade point average and science grade point average in the past decade. In addition, findings indicate that dental hygiene remains predominantly a Caucasian woman's profession. Implications of these findings for recruitment efforts and the numbers of dental hygienists for the future are discussed.
Adolescent↗
Physician participation in state Medicaid programs.
Medicaid requires that physicians who accept Medicaid reimbursement for treating a patient agree to accept its payment as payment in full. Policy instruments under Medicaid's control are both levels of reimbursement and various administrative burdens imposed on physicians by the program. A model depicting the physician's participation decision is developed, and predictions from the comparative statics analysis are discussed. Data came from a 1975--76 survey of fee-for-service physicians. The results indicate that high fee schedules and low administrative burdens are ways to stimulate physician involvement with Medicaid patients. Results on the Medicaid policy instruments and other explanatory variables on the whole lend support to the model of physician behavior proposed earlier in the paper.
Economics, Medical↗