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PubMed1994

Impact of treatment efficacy and professional affiliation on ratings of treatment acceptability.

Vignette methodology was used to assess factors associated with decisions regarding the acceptability of behavior modification programs. Members (N = 198) of the American Association on Mental Retardation (AAMR) reviewed two vignettes describing proposed treatment plans for individuals who were either aggressive or self-injurious. Nine descriptor variables were nested within each vignette; no two vignettes were exactly the same. The strongest predictor of treatment acceptability was the respondents' own estimates of probable treatment success. Secondary predictors included the restrictiveness of the proposed procedure and whether other procedures had been previously tried. Members of the AAMR Psychology Division tended to be slightly more accepting of behavioral treatments than were members of other divisions.

Adolescent↗
PubMed1980

Do cancer patients really want counseling?

Newly diagnosed cancer patients who were screened as being "at risk" for future psychosocial distress were offered a counseling program, covering the period from hospital discharge to resumption of regular activity. More than two-thirds of "at risk" patients accepted. Those who refused the program tended to be more antagonistic or apprehensive than those who accepted. Refusers denied difficulties, minimized problems, and in certain instances were truculent and suspicious. Some refusers did not wish to be interviewed, for fear that social and emotional equilibrium would be disturbed; they rejected counseling, which was felt to be either an immediate threat or an omen of disaster. Accepters, while as much "at risk," did not deny, but felt more hopeless. Differences in cancer site, stage, symptoms, treatment, availability of significant others, age, sex, social status, and so forth were not significant.

Attitude to Health↗
PubMed1976

A comparative study to evaluate three separate computer programs for electrocardiographic interpretation.

To compare the efficiency and accuracy of three separate computer programs for interpreting electrocardiograms, 50 EKGs run on patients hospitalized in our institution were transmitted to each of the three participating computer programs. The EKGs were then inspected individually by three cardiologists who later correlated and compared their results with the interpretations provided by the computer. The computer program used by Telemed Corporation provided the greatest frequency of totally correct and clinically acceptable interpretations as well as the least number of unacceptable or incorrect interpretations. The Bonner program was an acceptable second. The Mayo-Smith program had a much larger number of disagreements with the clinical cardiologists, and was far less acceptable for clinical use in their opinion.

Diagnosis, Computer-Assisted↗
PubMed1978

A preprocessor for less basic BASIC.

BASIC, originally developed primarily as a teaching tool, has many extensions to allow its application to regular production programming. Naming restrictions of variables and line number references, however, are less satisfactory for longer programs making a program more difficult to read and maintain. The solution described is a program code preprocessor which accepts, long, meaningful variable names and line labels and converts the code to executable BASIC code. In addition, automatic library inclusions and a means of isolating sections of code for variable and label resolution facilitate creation and use of general purpose routines. Use of the preprocessor does not interfere with the capability to debug programs interactively which is one of the most helpful characteristics of interpretive implementations of BASIC.

Computers↗
PubMed1990

Follow-up services in newborn hearing screening programs.

Newborn hearing screening programs have gained wide acceptance as a means of identifying infants at risk for hearing loss. For the most part, the auditory brainstem response (ABR) technique has been the measurement tool universally adopted in the evaluation of high-risk infants. Over the years, the ABR has been used successfully with a negligible false-negative rate. Unfortunately, program follow-up services have not received similar attention, and there is a lack in program development. This article describes a series of follow-up measures that include the use of a questionnaire sent to the parents/caregivers of 401 infants who pass either the initial or retest ABR screen. A total of 262 (65%) response questionnaires were returned. The results of the questionnaire and recommendations regarding follow-up services are discussed.

Child Health Services↗
PubMed1998

Prenatal diagnosis of thalassemia in Songklanagarind Hospital in southern Thailand.

A thalassemia screening program for pregnant women has been established in Songklanagarind Hospital since 1992. After genetic counseling, a total of 5078 pregnant women accepted entry into a screening program for thalassemia. Couples at risk who should receive prenatal diagnosis were 2.8%. Total cases who accepted prenatal diagnosis were 135. Total clinical cases were 40 (29.6%) with achievement by prenatal diagnosis of 33 cases (82.5%). Genetic amniocentesis is the most acceptable method for prenatal diagnosis. Five cases (12.5%) were misdiagnosed due to contamination of maternal blood cells in amniotic fluid cases. Questionable results were reported in 2 cases (5%). Abortion occurred in one case (0.7%). Improvement of surgical technic in prenatal diagnosis reduced the complications and contamination of maternal cells. This program shows the feasibility of prevention and control of thalassemia disease in southern Thailand.

Adult↗
PubMed1997

Patients' acceptance of waiting for cataract surgery: what makes a wait too long?

The patient's perspective about waiting for elective surgery is an important consideration in the management of waiting lists, yet it has received little attention to date. This study was undertaken to assess the acceptability of personal waiting times from the perspective of patients, and to examine waiting time and patient characteristics associated with the perception that a wait for cataract surgery is too long. The international prospective study was conducted in three sites with explicit waiting systems: Manitoba, Canada; Denmark; and Barcelona, Spain. Patients over the age of 50 years were recruited consecutively from ophthalmologists' practices at the time of their enlistment for first-eye cataract surgery. Anticipated waiting time, opinions about personal waiting time, and patients' visual and health characteristics were identified by means of telephone interviews. The 550 patients interviewed at the time of enlistment for surgery anticipated waits varying from < 1 to 24 months. Clinical visual acuity measures were obtained from patients' ophthalmologists/cataract surgeons. Results indicated that anticipated waiting time was the strongest predictor of patients' tolerance of waiting for cataract surgery. Patient dissatisfaction increased with the duration of the anticipated wait. Patients in all three sites were accepting of waits of three months or less, and considered waits exceeding six months to be excessive. Response to waits between three and six months varied across study sites. Patients with low tolerance for waiting had greater self-reported difficulty with vision, as assessed by a Cataract Symptom Score and expressed trouble with vision. Patients' acceptance of waiting was not associated with clinical visual acuity measures or socio-demographic characteristics. The patient perspective on acceptability of waiting times for cataract surgery suggests that restricting waiting times to less than six months and preferably less than three months and utilizing self-reported measures of visual difficulty in prioritizing patients may contribute to improved management of waiting systems. Patients are more tolerant of their personal waiting times than responses to questions about waiting for elective surgery in general would indicate, and appear to accept waiting times that are longer than those identified as reasonable by specialists.

Aged↗
PubMed2004

The cumulative risk of a false-positive recall in the Norwegian Breast Cancer Screening Program.

BACKGROUND: Biennial breast cancer screening for women ages 50-69 years is recommended by the World Health Organization. It has been claimed that the cumulative risk of a false-positive recall is a significant disadvantage in breast cancer screening programs. The primary objective of this study was to estimate the cumulative risk of a false-positive recall during a screening period of 20 years in women ages 50-51 years who are screened biennially in a population-based screening program. A secondary objective was to estimate the cumulative risk of undergoing fine-needle aspiration cytology, core needle biopsy, and open biopsy with benign morphology in the same group of women. METHODS: The Norwegian Breast Cancer Screening Program invites all women ages 50-69 years who reside in the country to a 2-view mammography biennially. A nationwide data base that covers all of the invited women includes individual information about all screening activity. Results from three screening rounds in four counties were the basis for this study. False-positive recalls due to abnormal mammograms among 83,416 women who participated all the 3 screening rounds were the basis for the estimations. RESULTS: It was calculated that women ages 50-51 years who participate in biennial screening run a cumulative risk of 20.8% for a false-positive recall during a screening period of 2 decades. The cumulative risk of undergoing fine-needle aspiration cytology was estimated at 3.9%, and the risk of undergoing core needle biopsy or open biopsy with benign morphology was 1.5% and 0.9%, respectively. CONCLUSIONS: False-positive recalls are a disadvantage in a breast cancer screening programs, but the cumulative risk seemed to be acceptable in the Norwegian Breast Cancer Screening Program. It is important to communicate the existence and extent of this risk to the target group.

Aged↗
PubMedDate not supplied

More women use prenatal services.

Growing numbers of women understand the importance of prenatal care and are acting to improve their own health and that of their babies, according to a report from the Aga Khan Foundation. In 8 of the foundation's primary health care program areas in Kenya, Bangladesh, India and Pakistan, more women receive prenatal care, more are immunized against tetanus, and more give birth in the presence of a trained attendant than a few years ago. Statistics of improvement vary considerably between programs, not least because of differing levels of acceptance and availability of services when the programs began. However, the overall trend in the 4 countries is towards greater knowledge of health issues and greater readiness to act upon that knowledge. In Mombasa, Kenya, 81% of pregnant women received prenatal care at least once in 1986, and this has since risen to 87%. In Vur, Bangladesh, where only 27% of pregnant women received prenatal care in 1986, this has now risen to 75%.

Behavior↗
PubMed1992

A randomized trial to evaluate a computer-based learning program in occupational lung disease.

Computer based learning (CBL) is a recent educational innovation that may supplement the limited formal education typically offered to medical students in occupational health-related issues. The authors conducted a randomized trial among sophomores to evaluate a Macintosh-based application on occupational lung disease (OH-CBL). The program emphasizes interactive learning and skills practice through a case-based approach. Students taking an OH block in the Preventive Medicine course were assigned either to the OH-CBL or to the lecture group. 35 students completed the OH-CBL; 45 attended the lecture. Of four study-relevant multiple-choice questions, substantial differences were found in favor of the OH-CBL group over the lecture group on one question as well as on the study-relevant multiple choice total score. There was no difference on mean overall grade or on the three study-relevant essay items. The grade on study-relevant questions exhibited a weak relationship with microcomputer experience (r = .29, P = .04). Students' ratings of the CBL program using Likert scales were generally favorable. These findings suggest that CBL programs can be designed to be both acceptable to students and educationally effective. Each new program needs to be individually assessed to meet these standards. The authors identify several components of CBL that are necessary for successful implementation into a medical curriculum.

Computer-Assisted Instruction↗
PubMedDate not supplied

Evaluation of safety, efficacy, and acceptability of NORPLANT implants in Sri Lanka.

This paper presents findings based on a one-year pre-introductory clinical investigation concerning safety, efficacy, and acceptability of the new contraceptive NORPLANT implants in Sri Lanka. The study is based on 400 acceptors of the implants at two clinics in Sri Lanka. Acceptors' mean age was 27 years, mean number of children was about two, and average educational attainment was eight years. Nearly half of the acceptors did not want to have another child. Follow-up was conducted at one, three, six, and twelve months. The one-year termination rate due to medical problems was very low, and the one-year life-table pregnancy rate was 0.5. Menstrual pattern disruption was the most frequently reported complaint with the implants. Amenorrhea increased in the first three months of use, and intermenstrual bleeding was common among those menstruating. In spite of these changes and some significant variations between the acceptors in the two study center, the overall degree of satisfaction with the implants was very high. The features most important to the acceptability of the implants were low risk of pregnancy, the long duration of action, and the convenience of use. The results of the study suggest that NORPLANT implants are safe, effective, and highly acceptable to Sri Lankan women.

Adolescent↗
PubMed1998

Quality improvement and the integrated management of childhood illness: lessons from developed countries.

BACKGROUND: The World Health Organization (WHO) and the United Nations Children's Fund have launched a global initiative to reform the health care received by sick children in developing countries. The core of this initiative, known as Integrated Management of Childhood Illness (IMCI), is a clinical practice guideline. The guideline addresses the case management of clinically ill children under the conditions typical of peripheral facilities, focusing on the most common serious conditions, such as pneumonia and malaria. WHO estimates that up to 70% of childhood deaths in developing countries are attributable to conditions addressed by IMCI. About 40 developing countries have made commitments to implementing IMCI in public-sector programs. QI STRATEGIES AND GUIDELINES IN DEVELOPING COUNTRIES: Like other clinical guidelines, which are increasingly accepted in developing countries' health programs, IMCI raises difficult quality issues. High levels of guideline compliance are needed for IMCI to be effective. However, many developing countries have achieved relatively low levels of compliance with far simpler guidelines, such as those for diarrhea case management. Despite obvious differences, the experience of developed countries in quality improvement (QI) offers a wide range of promising strategies for IMCI, including (1) developing standards, (2) communicating those standards to providers, (3) monitoring quality and providing feedback, (4) team-based QI problem solving, (5) designing processes conducive to high levels of quality, and (6) regulating providers and institutions. MORE LESSONS FROM DEVELOPED COUNTRIES FOR IMCI: Only recently have QI strategies been adapted for use in developing countries, and virtually none of the early experience has dealt with IMCI. Indirect evidence suggests that a wide range of QI approaches will prove suitable for IMCI. However, it will be important to carefully evaluate the cost-effectiveness of early applications. The experience of developed countries also provides useful models for important issues that have not yet been addressed by the IMCI initiative. These issues include (1) the review and possible modification of the current guideline, (2) extending IMCI into the private sector through regulatory strategies, and (3) institutionalizing QI.

Case Management↗
PubMed2005

Improving clinic- and neighborhood-based smoking cessation services within federally qualified health centers serving low-income, minority neighborhoods.

Within federally qualified health centers serving low-income, African American audiences, participatory approaches to system changes were organized through multidisciplinary committees that (a) drew on evidence-based guidelines, (b) guided system changes including the requirement of documenting smoking status and readiness to quit in encounter forms, (c) tested and refined practice improvements prior to their general adoption, and (d) guided development of neighborhood-based resources and supports for smoking cessation that were linked to clinic-based services. Documentation of smoking status or readiness to quit increased from 2% of encounter forms in the first 3 months to 94.3% in the last 3 months of the 24-month program. This rate remained over 90% throughout the following year. Exit interviews also indicated increased key clinic-based services, including "explained importance of quitting" (to 78% and 82% of interview respondents in the two intervention clinics in year 2), "tell you that you should quit" (to 80% in each), "tell you about nicotine gum...or other medications" (to 69% and 58%), "offer to help you quit" (to 61% and 64%), and "tell you about programs or help in your neighborhood" (to 51% and 56%). These rates exceeded those in one comparison clinic and equaled those in a second that also had launched a smoking cessation initiative. From exit interviews, improvements in neighborhood resources and support (e.g., people and activities that encourage nonsmoking) also exceeded those in comparison clinics. Thus, participatory approaches to system changes and quality improvement can enhance clinic- and neighborhood-based smoking cessation services within health centers serving low-income, minority populations.

Adult↗
PubMed1996

Research curricula in critical care fellowships--a survey.

OBJECTIVES: To determine curriculum requirements and educational methods used by Critical Care fellowship training programs in fulfilling Residency Review Committee requirements for a research experience during Critical Care subspecialty training. DATA SOURCE: Responses from 163 (67%) of the 245 directors of accredited Anesthesiology, Medicine, Pediatric, and Surgical Critical Care fellowship training programs listed in the American Medical Association Graduate Medical Education Directory. DATA EXTRACTION: Survey information accepted as valid for each program was tabulated to answer study questions. DATA SYNTHESIS: Most (89%) Critical Care programs with 2- or 3-yr curricula meet Residency Review Committee requirements and provide nonclinical time for research. Only 63% of 1-yr curricula from Anesthesiology and Medicine provide a required research experience. Formal instruction in research topics is provided by lecture, journal club, or research conference in approximately 90% of fellowships. Academic productivity from fellowship programs is high, but not correlated with a program's requirement for research. CONCLUSION: Compliance with current Residency Review Committee requirements for active participation in research is poor for 1-yr fellowship curricula. Reasons for this failure are discussed and a modified requirement is proposed.

Critical Care↗
PubMed2001

Suicide prevention in Aboriginal communities: application of community gatekeeper training.

OBJECTIVE: Concern over the high rate of suicide among Aboriginal people on the south coast of NSW led to the development of a project aimed at preventing youth suicide in the Aboriginal communities of the Shoalhaven. This paper describes the development, implementation and evaluation of the project. METHOD: Following extensive consultation with the Aboriginal community, a range of culturally appropriate interventions were developed. The main focus was a series of community gatekeeper training workshops, which aimed to increase the potential of members of the Aboriginal community to identify and support people at risk of suicide and to facilitate their access to helping services. RESULTS: Evaluation of the workshops demonstrated an increase in participants' knowledge about suicide, greater confidence in identification of people who are suicidal, and high levels of intentions to provide help. Attitudes, subjective norms and barriers predicted intentions to help. CONCLUSIONS: The project indicated community members could be successfully trained in the recognition of individuals at risk of suicidal behaviour. Gatekeepers' attitudes and perceived barriers to helping predicted intentions to help those in need. There is a need for longer-term follow-up to assess the extent to which new knowledge and skills are used in practice. IMPLICATIONS: Suicide awareness and skills training have been demonstrated to be an effective early intervention strategy. Gatekeeper training empowers Aboriginal communities and is generally accepted. There is demand for such programs outside the Shoalhaven. The project has a methodological framework that can be easily adapted by other communities.

Adult↗
PubMed1992

Designing computer assisted instruction programs for diabetic patients: how can we make them really useful?

Despite the increasing potential of computers for educational use, experience shows that few Computer Assisted Instruction (CAI) programs for patient education have been accepted into routine use by health care providers. A CAI program on hypoglycemia for insulin dependent diabetics, which was developed by the authors and has been widely used in Europe for over 6 years, is described and is used to illustrate some specific difficulties and possible solutions when using computers for patient education. We hope to show that patients suffering from a chronic disease, such as diabetes, require specific skills which are very different in nature from the theoretic knowledge they usually receive from different sources, including health care providers. In order to be really useful, a CAI program for patients must help them to cope with their disease and take into account patients' concerns, fears, and misconceptions as far as possible. Far beyond a detailed knowledge of the domain, a deep experience in patient education is mandatory to understand patients' needs.

Artificial Intelligence↗
PubMed2005

HIV risk perception and prevalence in a program for prevention of mother-to-child HIV transmission: comparison of women who accept voluntary counseling and testing and those tested anonymously.

OBJECTIVE: To determine whether data from voluntary counseling and testing (VCT)/prevention of mother-to-child transmission (PMTCT) programs can be used for HIV surveillance. METHODS: Women attending an antenatal clinic at the district hospital in Entebbe, Uganda, from May 2002 to April 2003 were offered counseling and HIV testing with same-day results (VCT) and nevirapine for PMTCT was provided for HIV-positive women and their babies. Those who declined VCT were tested for HIV anonymously. RESULTS: Overall, 2635 women accepted VCT; 883 were tested anonymously. HIV prevalence was higher in VCT than in anonymously tested women in the first month of the program (20% vs. 11%, P=0.05) and in months with <70% VCT uptake (17% vs. 8%, P<0.001) but was similar in months with high uptake. Uptake of VCT was higher in women who had risk factors for HIV, especially those who believed themselves to have been exposed (84% vs. 73%, P<0.001). CONCLUSION: There was a bias to accepting VCT in women with HIV, or risk factors for HIV infection, the former most apparent when there was low coverage. Data from VCT/PMTCT programs cannot replace anonymous surveillance for monitoring of HIV epidemic trends where coverage is incomplete within clinics or communities.

AIDS Serodiagnosis↗