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PubMed2003

Use of hepatitis B core antibody-positive donors in recipients without evidence of hepatitis B infection: a survey of current practice in the United States.

Because of the current organ shortage, some liver transplant programs have begun to accept marginal organs that previously would have been rejected. An example is the use of donors with evidence of past hepatitis B virus (HBV) infection. To gain insight into the use of hepatitis B core antibody-positive (anti-HBc(+)) donor livers in recipients without evidence of HBV infection, we conducted a survey. Surveys consisting of 12 multiple-choice questions were sent to all 110 liver transplant programs across the United States in mid-2001, and 56 of 110 surveys (51%) could be evaluated. Overall, 32 of 56 programs (57%) indicated they would transplant an anti-HBc(+) liver into a recipient without serological evidence of HBV infection. Of those who would accept an anti-HBc(+) liver, 16 of 27 respondents (59%) indicated knowledge of HBV DNA status would change their protocol; 46% of these respondents would decrease prophylaxis if HBV DNA was negative, 27% would increase prophylaxis if HBV DNA was positive, and 27% would not accept the liver if HBV DNA was positive. Conversely, 9 of 28 respondents (32%) who would not accept an anti-HBc(+) liver stated that knowing HBV DNA status would change their protocol in that they might consider accepting livers if HBV DNA was negative. In conclusion, as of mid-2001, of transplant medical directors in the United States who responded to our survey, 57% would accept an anti-HBc(+) donor liver for an HBV-naïve recipient. Treatment protocols for using these organs varied. Knowledge about HBV DNA status of the donor and/or liver would greatly influence prophylaxis for those accepting anti-HBc(+) donor livers.

Clinical Protocols↗

PubMed1994

Reliability of a utilization review instrument in a large field study.

One important question for a utilization management program is whether the utilization review instrument is consistent or stable when used on many occasions by the same abstractor (intrarater reliability) or by several abstractors (inter-rater reliability). As part of a nationwide study of inappropriate utilization of inpatient services by the Department of Veterans Affairs, we conducted a thorough investigation of the inter-rater reliability of a widely used utilization review instrument by 27 nurse abstractors. All abstractors were extensively trained, both by the developers of the instrument and by use of practice medical records. A standard protocol for resolving questions was implemented, with immediate communication of decisions to abstractors. The results of three reliability assessments, conducted immediately after formal training, after several weeks of reviewing practice records, and midway through review of the study records, demonstrated good to excellent reliability, both when comparing the nurse abstractors with a physician gold standard and among themselves. Therefore, with appropriate training and monitoring, utilization management programs in large hospitals, multihospital systems, and other health care organizations needing to examine inpatient utilization should feel confident that they can achieve reviews that would be in close agreement with physician and other nurse abstractors. Such confidence should increase the acceptability of utilization management programs.

Abstracting and Indexing↗

PubMed2006

Group tele-exercise for improving balance in elders.

This study was to assess the level of acceptance and efficacy of a group tele-exercise program designed for balance impaired elders to improve balance and reduce fear of falling. The program would allow a group of elderly subjects to participate in a structured, interactive, and supervised exercise class from their own homes through a videoconferencing system. A total of 17 independent living elderly subjects (mean age, 81 +/- 8 years) participated in the study. An Internet-based videoconferencing device (VCD) was installed in each subject's home, allowing real-time video and audio communication with the exercise instructor and all other participants. The exercise was in the form of Tai Chi Quan, three times per week for 15 weeks. The main study measures included exercise compliance, level of acceptance and satisfaction, and the effectiveness of the exercise program on balance, fear of falling, and general health. Three subjects dropped out of the study. For those remaining, the average compliance was 78% (range, 51% to 98%). All subjects were able to operate the VCD independently, and expressed earnest interest in continuing tele-exercise programs in the future. There were significant improvement (p < 0.05) postexercise in fear of falling score (18%), single leg stance time (43%), Up-and-Go time (21%), and body sway during quiet stance (>8%). This study has demonstrated that the group tele-exercise program is acceptable and welcomed by elders, and is effective for improving balance and reducing fear of falling.

Accidental Falls↗

PubMed1995

Hepatitis B vaccine acceptance among adolescents and their parents.

PURPOSE: To employ theoretic health decision models to determine strategies that may facilitate acceptance of hepatitis vaccination programs among adolescents and their parents/guardians. METHODS: The research was conducted in a hospital-based adolescent clinic between January and September 1994. Eighty adolescents and 65 parents participated in a survey that was administered to new patients. Two groups (those who accepted the vaccine and those who rejected it) were compared for each variable and potential predictor. RESULTS: The majority of adolescents and parents indicated that their clinic care provider was the initial contact to initiate discussion about the vaccine. Significant predictors for parents' acceptance of the vaccination were their perceptions of the vaccine's importance to the care provider and concern about the general risk of the disease. Predictors for adolescents' acceptance of the vaccine was their perception that their parents felt it was important and the extent to which they believed it was for "everyone" to be vaccinated. CONCLUSIONS: Providers should be aware that adolescents are influenced by their parent's opinions and that the care provider's endorsement of the vaccine may be a key factor in parental acceptance of the vaccine. Results of this study have potential implications for public health approaches to facilitate vaccine acceptance.

Adolescent↗

PubMed1989

A tool for multiple sequence alignment.

Multiple sequence alignment can be a useful technique for studying molecular evolution and analyzing sequence-structure relationships. Until recently, it has been impractical to apply dynamic programming, the most widely accepted method for producing pairwise alignments, to comparisons of more than three sequences. We describe the design and application of a tool for multiple alignment of amino acid sequences that implements a new algorithm that greatly reduces the computational demands of dynamic programming. This tool is able to align in reasonable time as many as eight sequences the length of an average protein.

Algorithms↗

PubMed1998

Study to validate the outcome goal, competencies and educational objectives for use in intensive care orientation programs.

Intensive care orientation programs have become an accepted component of intensive care education. To date, however, there have been no Australian-based standards defining the appropriate level of competence to be attained upon completion of orientation. The aim of this study was to validate a set of aims, competencies and educational objectives that could form the basis of intensive care orientation and which would ensure an outcome standard of safe and effective practice. An initial document containing a statement of the desired outcome goal, six competency statements and 182 educational objectives was developed through a review of the orientation programs developed by the investigators. The Delphi technique was used to gain consensus among 13 nurses recognised for their expertise in intensive care education. The expert group rated the acceptability of each of the study items and provided suggestions for objectives to be included. An approval rating of 80 per cent was required to retain each of the study items, with the document refined through three Delphi rounds. The final document contains a validated statement of outcome goal, competencies and educational objectives for intensive care orientation programs.

Australia↗

PubMed2002

Evaluation of a computer based interactive diabetes education program designed to train the estimation of the energy or carbohydrate contents of foods.

The objective of this study was to evaluate a computer based interactive diabetes education program designed to train patients with diabetes to correctly estimate the energy or carbohydrate contents of foods. The acceptance and the operator convenience of the program were evaluated with an integrated program and written questionnaires. The training success was calculated for each user from the data sets after multiple repetitions of the same exercise. Age, weight, type of diabetes, previous training and computer experience of 126 patients with type 1 or 2 diabetes from three different German diabetes centres were documented. The evaluation of the computer program indicated a good acceptance and operator convenience. Moreover, there was a significant training success in patients who have never used a structured diabetes education program before. Therefore, the potential impact of the program is to support but not to replace structured diabetes education programs and to further motivate and attract patients to diabetes education programs.

Computer-Assisted Instruction↗

PubMed1999

Producer quality assurance programs.

Essentially all animal commodity organizations have established quality assurance programs designed to ensure food safety and quality. Most of these programs were originally implemented to address problems with veterinary drug residues. Many of the current programs have or plan to include food safety critical control points with specific guidelines on how to control or reduce pathogen load. The continued focus placed on food safety by today's consumer demands that American producers ensure that their commodities are wholesome, safe, and of high quality in order to remain competitive in the global marketplace. Veterinarians should recognize that it is important to encourage food animal producers to participate in quality assurance programs for their clients' economic health and for food safety and protection of public health. Commodities certified as being produced under good production practices or by producers certified as following a recognized and validated quality assurance program often bring a premium price. Also, some slaughter establishments are beginning to require producers to be certified as practicing under a recognized quality assurance program before animals are accepted for processing. This practice is being driven partially by the demands placed on slaughter establishments by the US Department of Agriculture's implementation of the Pathogen Reduction, Hazard Analysis and Critical Control Point Systems regulation. Regardless of why producer trade association quality assurance programs have come into existence, veterinarians should promote the programs as an excellent mechanism to help ensure everyone's goal of a safe, wholesome food supply.

Animals↗

PubMed1981

Multidisciplinary centers of gerontology program: long term care gerontology centers--Office of Human Development Services. Announcement of availability of financial assistance for the long term care gerontology centers program.

The Administration on Aging (AoA)announces that applications are being accepted for the Multidisciplinary Centers of Gerontology Program authorized by Title IV, Part E of the Older Americans Act of 1965, as amended (42 U.S.C. sec. 3036) to support Stage II, Operational Long Term Care Gerontology Centers only. Eligibility for these awards is limited to institutions which have received a planning award from the Administration on Aging for the development of Long Term Care Gerontology Centers.

Aged↗

PubMed1991

Improved efficiency of protein structure calculations from NMR data using the program DIANA with redundant dihedral angle constraints.

A new strategy for NMR structure calculations of proteins with the variable target function method (Braun, W. and Go, N. (1985) J. Mol. Biol., 186, 611) is described, which makes use of redundant dihedral angle constraints (REDAC) derived from preliminary calculations of the complete structure. The REDAC approach reduces the computation time for obtaining a group of acceptable conformers with the program DIANA 5-100-fold, depending on the complexity of the protein structure, and retains good sampling of conformation space.

Amino Acid Sequence↗

PubMed1986

Cardiac rehabilitation exercise program: outcome assessment.

Medically supervised exercise programs have increasingly gained acceptance in management of the coronary patient. Beneficial postexercise results published include: Improved exercise and work tolerance, a decrease in frequency and severity of angina, and earlier return to work. The present retrospective study evaluates the outcome of a three-month cardiac rehabilitation exercise program with changes in exercise performance, compliance with postdischarge exercise routine, and return to work pattern. The study group included 38 patients with documented coronary artery disease and two participants free of ischemic heart disease. Thirty patients were treated with beta blocker medications, ten were not. Time of follow-up ranged from six months to two years. Pre- and postexercise performance expressed in VO2 ml/kg/min was assessed at target heart rate using a modified exercise protocol. Training resulted in statistically significant increases in median exercise performance in both patient groups: 2.38 ml O2/kg/min (range 1.33, 7.18; p 0.0068, one-tail) in the untreated group, and 3.45 ml O2/kg/min (range 2.63, 11.48; p 0.001, one-tail) in the beta blocker treated group. Fifty-seven percent of the participants complied with a postdischarge exercise routine while 7/12 (58%) patients unemployed at time of referral resumed work during or following completion of the exercise program. Such programs appear to be a valuable component in the management of the coronary patient. Further studies involving larger numbers of patients are indicated to document cost effectiveness of such programs.

Adrenergic beta-Antagonists↗

PubMed1994

Personality characteristics of condom users.

The California Psychological Inventory (CPI) and a survey of sexual behavior and condom use specifically developed for this descriptive study were administered to 132 sexually active, heterosexual male university students (mean age = 19.2 years; 75% Caucasian). Condom "users" (44% of this sample) were defined as those who reported using a condom in their last sexual encounter to ejaculation. "Sexually active" men were defined as those who reported some form of intercourse with a partner to ejaculation within the past 3 months. On the CPI, the condom users scored significantly higher than nonusers on the Achievement via Independence scale and marginally higher on the Socialization and the Social Presence scales. The mean CPI profile for the condom users yielded the Gamma personality type which denotes an externally-oriented, norm questioning personality. Gammas tended to be uninhibited, clever, witty, pleasure-seeking risk takers. Those men who did not use a condom in their last sexual encounter offered their reasons for not doing so. The most common reasons were not expecting intercourse to occur and they were not available. In terms of perceived risk for HIV-infection, only 12.3% of the men had taken the antibody test and 75% considered themselves to be at zero or low risk. Several suggestions were made for counseling strategies in promoting condom use in college-age populations.

Americas↗

PubMed1975

The Mayo Lung Project for early detection and localization of bronchogenic carcinoma: a status report.

The Mayo Lung Project (MLP) is a screening program designed to detect bronchogenic carcinoma at a curable stage. Screening tests include chest roentgenograms, three-day "pooled" sputum cytology studies, and lung-health questionnaires. These are being applied every four months to a study population of outpatients who have a high probability of developing lung cancer. Initial patient acceptance of the screening program has been excellent. Small asymptomatic lung cancers have been detected both roentgenographically and cytologically. The two procedures have complemented each other with little overlap. Chest roentgenography has proved most useful in diagnosing peripherally situated cancers, whereas sputum cytology studies have been most effective in identifying early squamous cancer involving major airways. At present, more cancers have been detected roentgenographically than cytologically, but the cytologically detected cases appear to have a better prognosis. Roentgenographically occult cancers have been localized with regularity, although the localization process is complicated. Theoretically, vigorous application of radiologic and cytologic screening, combined with optimum use of localizing procedures and treatment, could increase the five-year survival rate among lung cancer patients to nearly 50 percent. However, the actual survivorship attained will ultimately be determined by currently imponderable factors such as patient acceptance of longterm screening, frequency of multicentric respiratory cancers, and incidence of noncancerous smoking-related diseases, especially chronic obstructive pulmonary disease and ischemic heart disease.

Aged↗

PubMed2006

Feasibility, acceptability, and cost of tuberculosis testing by whole-blood interferon-gamma assay.

BACKGROUND: The whole-blood interferon-gamma release assay (IGRA) is recommended in some settings as an alternative to the tuberculin skin test (TST). Outcomes from field implementation of the IGRA for routine tuberculosis (TB) testing have not been reported. We evaluated feasibility, acceptability, and costs after 1.5 years of IGRA use in San Francisco under routine program conditions. METHODS: Patients seen at six community clinics serving homeless, immigrant, or injection-drug user (IDU) populations were routinely offered IGRA (Quantiferon-TB). Per guidelines, we excluded patients who were <17 years old, HIV-infected, immunocompromised, or pregnant. We reviewed medical records for IGRA results and completion of medical evaluation for TB, and at two clinics reviewed TB screening logs for instances of IGRA refusal or phlebotomy failure. RESULTS: Between November 1, 2003 and February 28, 2005, 4143 persons were evaluated by IGRA. 225(5%) specimens were not tested, and 89 (2%) were IGRA-indeterminate. Positive or negative IGRA results were available for 3829 (92%). Of 819 patients with positive IGRA results, 524 (64%) completed diagnostic evaluation within 30 days of their IGRA test date. Among 503 patients eligible for IGRA testing at two clinics, phlebotomy was refused by 33 (7%) and failed in 40 (8%). Including phlebotomy, laboratory, and personnel costs, IGRA use cost $33.67 per patient tested. CONCLUSION: IGRA implementation in a routine TB control program setting was feasible and acceptable among homeless, IDU, and immigrant patients in San Francisco, with results more frequently available than the historically described performance of TST. Laboratory-based diagnosis and surveillance for M. tuberculosis infection is now possible.

Adolescent↗

PubMed2004

Participation in the academic associate program: effect on medical school admission rate.

OBJECTIVES: Several emergency medicine programs are using premedical students as research assistants for clinical research in the emergency department (ED). These programs have been shown to enhance faculty research productivity, but the effects of these programs on the students' goals have not been assessed. The authors evaluated the effect of the Academic Associate Program (AAP) on medical school acceptance rates. METHODS: From 1997 to 2002, premedical students who attended informational sessions about the AAP completed a 28-item survey including demographic information, educational experiences, career goals, grade point average (GPA), and prior research participation. Premedical students who had a career goal of becoming a physician were included in the study if they matriculated into medical school or changed their career plans by the fall of 2003. Medical school acceptance was determined by contacting students or their parents via telephone and e-mail. Students enrolled in the AAP were compared with Association of American Medical Colleges (AAMC) data to determine whether they were more or less likely to be accepted into medical school. RESULTS: During the study period, 198 students enrolled in the AAP had attained a final disposition with respect to medical school matriculation. Students were a mean age of 22.4 +/- 3.0 years, 55% female, and 43% nonwhite. Most students (91%) were junior year or later with respect to educational level. Prior research experience included being an author on an abstract (25%), being an author on a manuscript (17%), and presenting research at a scientific meeting (14%). The mean GPA ( +/- standard deviation) for Academic Associates was 3.38 ( +/- 0.31). Medical school acceptance rates were 79% for students in the AAP (95% confidence interval [95% CI] = 73.1 to 84.5). This is higher than expected based on AAMC published data with a 49% (95% CI = 48.5 to 49.5) acceptance rate for students with a mean GPA of 3.46. CONCLUSIONS: Compared with AAMC data, students in the AAP have a higher medical school acceptance rate despite a slightly lower GPA. This finding suggests that participation in the program enhances a student's likelihood of matriculating in medical school.

Adult↗

PubMed1991

[Data registration of postoperative complications in connection with orthopedic surgery. A review of 4,346 surgical wounds].

A personal computer program to monitor surgical wound infections and other complications in orthopedics was developed. Internationally accepted definitions were used. The program was tested in four Danish orthopedic wards. The test period was from 1 January 1988 to 30 June 1989. Results from four wards consisting of 4,346 wounds in 3,570 patients are presented. The overall superficial wound infection rate was 2.4%, deep wound infection rate was 0.9%, other infection rate was 3.1%, and other complications were developed in 4.3% of the cases. In contrast to previous computer systems presented, this system also registers other nosocomial infections, and other complications. We found the system easy to use, and during the period, the overall registration rate was over ninety percent. If a registration system is introduced in the ward, a combined system which registers all infections and complications is preferable, instead of a simple wound infection system.

Adolescent↗

PubMed2001

Integrating the methadone patient in the traditional addiction inpatient rehabilitation program--problems and solutions.

Physicians have reported alcoholism and opioid addiction as co-morbid conditions since the 19th century. From the inception of methadone maintenance treatment, heroin addicts with serious alcohol conditions have enrolled in methadone maintenance programs. Programs that treat alcoholism, including the traditional addiction inpatient rehabilitation programs of the Addiction Treatment Centers (ATCs) operated by New York State, have based their treatment regimen on 12-step abstinence models. Methadone maintenance was considered antithetical to this philosophy. It was regarded as simply substituting one drug for another and not a legitimate treatment for opiate dependence. Therefore, methadone patients were often not accepted into alcohol treatment programs, since they were perceived as active addicts taking a mood-altering drug. Alcohol-related conditions among methadone patients are major causes of liver disease and death, and behavior problems associated with excessive drinking are major reasons for discharging patients. To address these issues and the lack of treatment facilities, the administration of the New York State Office of Alcoholism and Substance Abuse Services (OASAS), which licenses both methadone programs and the ATCs in New York State, realized that many of the methadone patients with alcohol problems are in need of the services provided at the ATCs. They instituted, therefore, a rigorous educational effort for the medical and counseling staffs of the ATCs, designed to integrate methadone treatment into the ATC treatment framework. Eighty percent of the 220 methadone patients who entered the ATCs in a demonstration project during the 1997/1998 state fiscal year have been compliant with the treatment regimen. These results have led to acceptance of methadone patients into the ATCs.

Alcoholism↗

PubMed1991

Different rates of acceptance of health examination among the people under 2 separate health insurance programs in Japan.

The entire population in Japan is covered by either workplace-based health insurance program or region-based health insurance program. While both programs were originally for curative medical care, only the former program has recently extended its financial support to preventive health examination. The attitude of the people toward health examination was studied in Miyagi prefecture in north-east Japan by questionnaires with more than 32,000 respondents to examine whether the difference in health insurance reflect on the rates of acceptance of 4 health examination items (i.e., blood pressure measurement, chest x-ray taking, and 2 screening tests for stomach and cervical cancer). Throughout the 4 items, the rate of acceptance was higher among those who were covered by workplace-based health insurance than among those covered by regional health insurance. The difference is large for the insured and less so for the family dependents of the insured. Further analysis for the preferred opportunities for health examination such as personal examination at clinics in contrast to region-based mass examination showed that the weight of clinics was quite large for the insured of national health insurance and their family dependents (i.e., 50% or even larger) but it was less so for the people covered by workplace-based insurance.

Blood Pressure Determination↗