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Ergonomics: CTD management evaluation tool.

Cumulative trauma disorder (CTD) occurrences peaked in number in 1994 and although decreasing in 1995, still accounted for 62% of all illness cases reported. A CTD Management Evaluation Tool was developed to assist Occupational Safety and Health Compliance Officers (CSHOs) in program evaluation and documentation of the occupational health management component and the need for an ergonomics program. Occupational and environmental health nurses may use the tool not only to reduce and prevent CTD occurrences, but also as a benchmark for program evaluation.

Cold Temperature↗

Web-based, virtual course units as a didactic concept for medical teaching.

The objective was to develop a web-based, virtual series of lectures for evidence-based, standardized knowledge transfer independent of location and time with possibilities for interactive participation and a concluding web-based online examination. Within the framework of a research project, specific Intranet and Internet capable course modules were developed together with a concluding examination. The concept of integrating digital and analogue course units supported by sound was based on FlashCam (Nexus Concepts), Flash MX (Macromedia), HTML and JavaScript. A Web server/SGI Indigo Unix server was used as a platform by the course provider. A variety of independent formats (swf, avi, mpeg, DivX, etc.) were integrated in the individual swf modules. An online examination was developed to monitor the learning effect. The examination papers are automatically forwarded by email after completion. The results are also returned to the user automatically after they have been processed by a key program and an evaluation program. The system requirements for the user PC have deliberately been kept low (Internet Explorer 5.0, Flash-Player 6, 56 kbit/s modem, 200 MHz PC). Navigation is intuitive. Users were provided with a technical online introduction and a FAQ list. Eighty-two students of dentistry in their 3rd to 5th years of study completed a questionnaire to assess the course content and the user friendliness (SPSS V11) with grades 1 to 6 (1 = 'excellent' and 6 = 'unsatisfactory'). The course units can be viewed under the URL: http://giga.rrze.uni-erlangen.de/movies/MKG/trailer and URL: http://giga.rrze.uni-erlangen.de/movies/MKG/demo/index. Some 89% of the students gave grades 1 (excellent) and 2 (good) for accessibility independent of time and 83% for access independent of location. Grades 1 and 2 were allocated for an objectivization of the knowledge transfer by 67% of the students and for the use of video sequences for demonstrating surgical techniques by 91% of the students. The course units were used as an optional method of studying by 87% of the students; 76% of the students made use of this facility from home; 83% of the students used Internet Explorer as a browser; 60% used online streaming and 35% downloading as the preferred method for data transfer. The course units contribute to an evidence-based objectivization of multimedia knowledge transfer independent of time and location. Online examinations permit automatic monitoring and evaluation of the learning effect. The modular structure permits easy updating of course contents. Hyperlinks with literature sources facilitate study.

Computer-Assisted Instruction↗

Educating medical students for work in culturally diverse societies.

CONTEXT: Recent attention has focused on whether government health service institutions, particularly in the United Kingdom, reflect cultural sensitivity and competence and whether medical students receive proper guidance in this area. OBJECTIVE: To systematically identify educational programs for medical students on cultural diversity, in particular, racial and ethnic diversity. DATA SOURCES: The following databases were searched: MEDLINE (1963-August 1998); Bath International Data Service (BIDS) Institute for Scientific Information science and social science citation indexes (1981-August 1998); BIDS International Bibliography for the Social Sciences (1981-August 1998); and the Educational Resources Information Centre (1981-August 1998). In addition, the following online data sets were searched: Kings Fund; Centre for Ethnic Relations, University of Warwick; Health Education Authority; European Research Centre on Migration and Ethnic Relations, University of Utrecht; International Centre for Intercultural Studies, University of London; the Refugee Studies Programme, University of Oxford. Medical education and academic medicine journals (1994-1998) were searched manually and experts in medical education were contacted. STUDY SELECTION: Studies included in the analysis were articles published in English before August 1998 that described specific programs for medical students on racial and ethnic diversity. Of 1456 studies identified by the literature search, 17 met the criteria. Two of the authors performed the study selection independently. DATA EXTRACTION: The following data were extracted: publication year, program setting, student year, whether a program was required or optional, the teaching staff and involvement of minority racial and ethnic communities, program length, content and teaching methods, student assessment, and nature of program evaluation. DATA SYNTHESIS: Of the 17 selected programs, 13 were conducted in North America. Eleven programs were exclusively for students in years 1 or 2. Fewer than half (n = 7) the programs were part of core teaching. Only 1 required program reported that the students were assessed on the session in cultural diversity. CONCLUSIONS: Our study suggests that there is limited information available on an increasingly important subject in medical education. Further research is needed to identify effective components of educational programs on cultural diversity and valid methods of student assessment and program evaluation.

Cultural Diversity↗

Simple measures of case mix in mental health services.

The concept of Case Mix in community mental health service program evaluation can be useful in mental health program evaluation if the definition of case mix is expanded beyond Diagnostic Related Groups (DRG), where DRG is solely based upon diagnosis and length of hospitalization stay. A case mix definition based upon two principal characteristics is offered. One characteristic is clinical status defined in terms of diagnostic signs and symptoms, level of functioning, and age. The other characteristic is typical treatment strategy for a given period of time (e.g., 13 weeks). Two cases mixes typical of services designed for the chronically mentally ill are discussed.

Chronic Disease↗

Fifty years of general anesthesia in California oral and maxillofacial surgery.

In summary, the advances of the last half of the 20th century in general anesthesia delivery by oral and maxillofacial surgeons are the following: 1. Oral and maxillofacial surgeons in training are exposed to significantly more hospital general anesthesia training and in addition spent much of their residency training performing general anesthesia on outpatient dental patients undergoing dentoalveolar surgery. Training programs increased from one year to three years, then to four years and finally, many six-year programs were developed that award the MD degree during or following completion of the residency program. 2. Self-evaluation programs were initiated in the late 1960s and evolved into mandatory in-office evaluation by peer practitioners and later into state-regulated evaluation. These programs began in Southern California and spread to encompass the entire United States. 3. Intravenous ultra-fast acting barbiturate office anesthesia became very refined and several combination drug "balanced" techniques developed. 4. Benzodiazepines, first diazepam then midazolam were introduced and gained wide acceptance by the dental profession. 5. New synthetic narcotic agents were introduced, which give the oral surgeon another pain control and anesthesia supplement. The new agents were short acting but very effective for the period necessary to complete most office surgical procedures. Fentanyl is the prototype for these agents. 6. Monitoring devices were incorporated into practice, and currently all oral surgeons use the pulse oximeter, the electrocardiograph, and blood pressure monitoring devices. All of these monitors are required by the California general anesthesia regulations. 7. Propofol, an entirely new type of intravenous agent, was introduced and is used by more than half of oral surgeons reporting in a survey of drugs used in 2003. Propofol may be used by incremental injection or by continuous infusion incorporating an automatic infusion pump. 8. Sevoflurane, a potent inhalation anesthetic that has many properties of an ideal agent - rapid onset, potent, easily delivered by calibrated vaporizers, rapid emergence, infrequent postoperative nausea, and favorable acceptance by almost all patients about to undergo general anesthesia - is gaining acceptance and use by oral and maxillofacial surgeons.

Anesthesia, General↗

Guidelines for evaluating intervention programs for children with autism.

It is now well recognized that early diagnosis and intervention improves the prognosis for children with autism. It is crucial that professionals be aware and sensitive to the needs of autistic persons and their families. We must never lose sight of the long-term goal of treatment and must not become so infatuated with any one treatment that we fail to provide the education parents need. It is incumbent upon us, as professionals, to educate parents and help them evaluate the myriad of information with which they are bombarded. In this article a framework for thinking about autism and principles of evaluation are reviewed. Components of appropriate early intervention programs are then described and guidelines for evaluating alternative treatments are provided.

Autistic Disorder↗

The expanded criteria donor policy: an evaluation of program objectives and indirect ramifications.

The expanded criteria donor (ECD) policy was formalized in 2002, which defined higher-risk deceased donor kidneys recovered for transplantation. There has not been a comprehensive examination of the impact of policy on the allocation of ECD kidneys, waiting times for transplant, center listing patterns or human leukocyte antigen (HLA) matching. We examined transplant candidates from 1998 to 2004 utilizing a national database. We constructed models to assess alterations in recipient characteristics of ECD kidneys and trends in waiting time and cold ischemia time (CIT) associated with policy. We also evaluated the impact of the proportion of center candidate listings for ECD kidneys on waiting times. Elderly recipients were more likely to receive ECDs following policy (odds ratio = 1.36, p < 0.01). There was no association of decreased CIT or pretransplant dialysis time while increasing HLA mismatching with policy inception. Over one quarter of centers listed < 20% of candidates for ECDs, while an additional quarter of centers listed > 90%. Only centers with selective listing for ECDs offered reduced waiting times to ECD recipients. The ECD policy demonstrates potential to achieve certain ascribed goals; however, the full impact of the program, reaching all transplant candidates, may only be achieved once ECD listing patterns are recommended and adopted accordingly.

Adolescent↗

Evaluating a program to build data capacity for core public health functions in local maternal child and adolescent health programs in california.

OBJECTIVES: To improve local Maternal and Child Health programs' capacity to collect and analyze data to support core public health functions, the California Maternal and Child Health Branch (CAMCHB) and the University of California San Francisco Family Health Outcomes project (FHOP) entered into a cooperative agreement. FHOP utilizes a 6-pronged strategy: face-to-face training, telephone technical assistance, on-site consultation, development of automated analytic tools, development of written guidelines, and web dissemination of data and materials. We evaluated the acceptability and effectiveness of these approaches. METHODS: Local Health Jurisdiction (LHJ) staff completed a self-administered questionnaire on use of and satisfaction with FHOP's services. A 34-item assessment tool was used to independently evaluate each 5-year community assessment plan submitted by LHJs to the CAMCHB. Administrative data on the use of FHOP's service was also considered. Correlational analyses were done to determine if use of FHOP services and materials was related to more adequate plans. RESULTS: LHJs with higher overall adequacy scores on their plans had an overall higher level of use of FHOP's products and services. LHJs with higher adequacy scores reported calling FHOP for technical assistance more frequently, using FHOP's book - "Developing an Effective Planning Process: A Guide for Local MCH Programs," and using FHOP's automated tools including EpiBC, an EpiINFO based program for birth certificate analysis, and Microsoft Excel data analysis templates. CONCLUSION: This 6-pronged strategy is well utilized and accepted by local MCH staff and appears to have some degree of association with better quality of local MCH plan documents.

Adolescent↗

A day care program and evaluation of animal-assisted therapy (AAT) for the elderly with senile dementia.

We conducted a survey to clarify the evaluation methods of animal-assisted therapy (AAT) for the elderly with senile dementia in an adult day care center. AAT was implemented for a total of six biweekly sessions. The AAT group consisted of seven subjects and the control group numbered 20 subjects. In a comparison between Mini-Mental State Exam (MMSE) scores at baseline and those measured three months later, the average MMSE score before AAT (baseline) was 11.43 (+/- 9.00), and three months later it was 12.29(+/- 9.69). In the AAT group, the average score on Nishimura's Activities of Daily Living (N-ADL) at baseline was 28.43(+/- 14.00), and after ATT it was 29.57(+/- 14.47). In the AAT group, the average baseline score on behavioral pathology of Alzheimer's disease (Behave-AD) was 11.14(+/- 4.85), and three months after AAT it was 7.29(+/- 7.11) (p < 0.05). In the control group, the average baseline score was 5.45(+/- 3.27) and three months later it was 5.63(+/- 3.59). The evaluation of salivary CgA, as a mental stress index, showed a decreasing tendency in the AAT group. Our findings demonstrate the usefulness of using several methods for evaluation of the changes in patients given AAT.

Aged↗

Native American medicine in the treatment of chronic illness: developing an integrated program and evaluating its effectiveness.

Traditional Native American healing practices are increasingly sought after by Native Americans as well as non-Natives. A series of meetings between traditional Native American healers and the author resulted in dialogues on the Native American worldview and biomedicine. Recommendations arose for how Native American treatment should proceed in the modern world and how to effectively introduce interested non-Natives to Native American healing practices. An approach for bridging cultures to facilitate the interaction of non-Natives with traditional healers was developed. A total of 116 patients were treated by the author in conjunction with traditional Native American healers. More than 80% of patients showed significant, persistent benefits from a time-intensive treatment program. A comparison group consisting of patients from the author's emergency room practice had significantly lower rates of improvement. An intensive program inspired by Native American practices lasting 7 to 10 days can achieve both health benefits and improved cost-effectiveness in the treatment of chronic physical illness. The treatment philosophy underlying this approach is best described as a dynamic energy system. Within this theoretical framework, physical illness, which is viewed as simultaneously spiritual, mental, and physical, can be treated by counseling and ceremony. Due to the interaction and hierarchical nature of these levels, intervention at any one level affects the others.

Chronic Disease↗

House fire injury prevention update. Part II. A review of the effectiveness of preventive interventions.

OBJECTIVE: To evaluate and summarize the house fire injury prevention literature. METHODS: MEDLINE (1983 to March 1997) was searched by keyword: fire, burn, etiology, cause, prevention, epidemiology, and smoke detector/alarm. ERIC (1966 to March 1997) and PSYCLIT (1974 to June 1997) were searched by keyword: as above, and safety, skills, education, and training. Other sources included references of retrieved publications, review articles, and books; Injury Prevention hand search; government documents; and internet sources. Sources relevant to residential fire injury prevention were selected, evaluated, and summarized. RESULTS: Forty three publications were selected for review, including seven randomized controlled trials, nine quasiexperiments, two natural experiments, 21 prospective cohort studies, two cross sectional surveys, one case report, and one program evaluation. These studies examined the following types of interventions: school (9), preschool (1), and community based educational programs (5); fire response training programs for children (7), blind adolescents (2), and mentally retarded adults (5) and children (1); office based counseling (4); home inspection programs (3); smoke detector giveaway campaigns (5); and smoke detector legislation (1). CONCLUSIONS: This review of house fire prevention interventions underscores the importance of program evaluation. There is a need for more rigorous evaluation of educational programs, particularly those targeted at schools. An evidence based, coordinated approach to house fire injury prevention is critical, given current financial constraints and the potential for program overload for communities and schools.

Adolescent↗

Pediatric resuscitation: development of a mock code program and evaluation tool.

Effective and efficient resuscitation skills are especially significant for pediatric care providers because of the increased neurologic morbidity and mortality associated with pediatric arrests. A mock code system was initiated to assess and enhance the competency of the medical and nursing staff who respond to pediatric arrests in all areas of an acute care general hospital. Two mock codes are conducted each month using a data collection tool. All of the critical skills involved in a pediatric resuscitation are listed in the tool and each skill is evaluated as met or not met. The tool identifies areas for further education and quantifies improvement in skills over a period of time. In addition, the Pediatric CPR Committee uses the data from the mock codes to initiate systems and equipment improvements.

Cardiopulmonary Resuscitation↗

The use of the donor oocyte program to evaluate embryo implantation.

Pregnancy rates (PRs) are generally higher in most IVF programs when embryos derived from donor oocytes are transferred compared to the PRs of women undergoing IVF-ET. DeZiegler et al., using the transfer of frozen embryos (either patient or donor derived) in natural cycles, found a higher PR following donor oocyte derived ET and thus concluded that the lower PR in the non-donor cycles was not related to the controlled ovarian hyperstimulation (COH) regimen. Their data thus suggested the improved PR with donor embryos may be related to better quality oocytes used for recipients; however, a more receptive endometrium in the oocyte recipients could also explain the data. The studies presented herein further evaluated the latter hypothesis of improved endometrial environment for recipients by comparing PRs in donors vs recipients in a shared oocyte program. Also the study would determine if endometrial echo patterns (EP) and/or thickness (ET) help predict better PRs as they do in stimulated cycles. Finally studies would be performed to compare PRs in older vs younger oocyte recipients to see if there may be a uterine senescence in humans as in other animals and to see if age has an adverse effect on the endometrium as evidenced by sonographic studies. Study 1 compared the clinical PRs in donors vs recipients in a shared program from 1/1/92 to 12/31/92. PR for donors was 23.6% (17 pregnant in 72 transfers) compared to 34.6% for recipients (26/75). Mean age of the donors was 32 compared to 39.8 for recipients. If recipients > 40 were eliminated the PR for recipients was 44.1% (15/34). Study 2 evaluated PRs according to ET and EP in 58 transfers using donor oocytes (44 patients). There were only 2 clinical pregnancies of 22 transfers (9%/cycle) when ET was < 10 mm at the time of the donor's hCG injection compared to 14 pregnant of 36 transfers (38.7%) when ET was > or = 10 mm (p < 0.01). However, there were no differences in PR when the endometrium compared to myometrium was hypoechogenic, isoechogenic, or hyperechogenic. The respective PRs were 16.7% (1/6), 31% (9/39) and 26.1% (6/23). Study 3 evaluated PRs in donor oocyte recipients according to age (< 40 vs > or = 40 years). After evaluating PRs after the first 58 ETs to recipients of shared oocytes we found a much lower PR in women > or = 40 (2/23, 8.6%/cycle) vs 14/55 (25.4%) in those < 40.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

Quality of institutional and community human service programs in Canada and the United States.

This methodological and substantive study was based on Wolfensberger and Thomas' (1983) Program Analysis of Service Systems' Implementation of Normalization Goals (PASSING), a program evaluation method used by teams of trained raters to assess the quality of human service programs. PASSING is based on Social Role Valorization, an internationally influential theoretical and philosophical approach to structuring human services, particularly services for persons with handicaps or other potentially devaluing conditions. The data for this study were derived from a sample of 213 programs evaluated with PASSING during 1983-88 in Canada (45%), the United States (51%), and the United Kingdom (4%). The programs served mainly mentally retarded persons (40%), subgroups of clients with "mixed" (different) impairments and conditions (38%), or psychiatrically impaired persons (6%). The results showed that PASSING has adequate internal consistency and interrater reliability and yields data suitable for statistical treatment with interval-level, parametric procedures. The average level of quality of services in the sample on the total PASSING scale and its five subscales (Program Relevance, Intensity, Integrativeness, Image Projection, and Felicity) was only modest, however. Community group residences (n = 77) were of significantly better quality than community vocational programs (n = 56), and both were superior to institutional residences (n = 20). Also, Canadian programs (n = 76) were of significantly better quality than U.S. programs (n = 77). An outstanding vocational program that was not part of the study sample was used to illustrate concrete ways in which the quality of many human service programs could be greatly improved, typically at little cost.

Activities of Daily Living↗

[Second opinion in Switzerland. Design of program and evaluation study].

From 1994 till 1996, the sickness funds represented in the Forum schweizerischer Krankenversicherer are carrying-out a Second Opinion Pilot Program. This program is subject to a scientific evaluation. The objectives and the organisation of the program are presented, and material and methods of the study are described.

Cohort Studies↗

Criteria for the safety evaluation of flavoring substances. The Expert Panel of the Flavor and Extract Manufacturers Association.

The current status of the GRAS evaluation program of flavoring substances operated by the Expert Panel of FEMA is discussed. The Panel maintains a rigorous rotating 10-year program of continuous review of scientific data related to the safety evaluation of flavoring substances. The Panel concluded a comprehensive review of the GRAS (GRASa) status of flavors in 1985 and began a second comprehensive review of the same substances and any recently GRAS materials in 1994. This second re-evaluation program of chemical groups of flavor ingredients, recognized as the GRAS reaffirmation (GRASr) program, is scheduled to be completed in 2005. The evaluation criteria used by the Panel during the GRASr program reflects the significant impact of advances in biochemistry, molecular biology and toxicology that have allowed for a more complete understanding of the molecular events associated with toxicity. The interpretation of novel data on the relationship of dose to metabolic fate, formation of protein and DNA adducts, enzyme induction, and the cascade of cellular events leading to toxicity provides a more comprehensive basis upon which to evaluate the safety of the intake of flavor ingredients under conditions of intended use. The interpretation of genotoxicity data is evaluated in the context of other data such as in vivo animal metabolism and lifetime animal feeding studies that are more closely related to actual human experience. Data are not viewed in isolation, but comprise one component that is factored into the Panel's overall safety assessment. The convergence of different methodologies that assess intake of flavoring substances provides a greater degree of confidence in the estimated intake of flavor ingredients. When these intakes are compared to dose levels that in some cases result in related chemical and biological effects and the subsequent toxicity, it is clear that exposure to these substances through flavor use presents no significant human health risk.

Animals↗