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PubMed1986

Using the day treatment appropriateness scale with rural, alcoholic clients.

Inadequate selection of patients is one factor in the underutilization of day-treatment programs. The Day Treatment Appropriateness Scale (DTAS; Lefkovitz, P. M., Int. J. Part. Hosp. 1:45-47, 1982) is one of only two reported instruments designed to assist in patient selection; it has been shown to predict validly successful completion of a day-treatment program for chronic, psychiatric patients. This report addresses the use of the DTAS in an alcohol day-treatment program located in a rural, midwestern, community mental-health center. The DTAS was not found to predict accurately successful program completion among alcoholic clients in day treatment. Possible explanations of the findings and additional predictive variables are reported.

Alcoholism↗
PubMed1994

A new model for a smoking cessation program: adding compliance efforts and provider education to the mix.

MetroHealth, through the coordination of the Pharmacy Department, wanted to establish a smoking cessation program that would provide appropriate and cost-effective therapy. Requirement of patient participation in behavioral modification programs in conjunction with nicotine replacement therapy and continuous provider education allowed the program to attain its goals. The authors describe the nuts and bolts of establishing such a program.

Behavior Therapy↗
PubMed2003

Position of the American Dietetic Association: child and adolescent food and nutrition programs.

It is the position of the American Dietetic Association that all children and adolescents, regardless of age; gender; socioeconomic status; racial, ethnic, or linguistic diversity; or health status should have access to food and nutrition programs that ensure the availability of a safe and adequate food supply that promotes optimal physical, cognitive, and social growth and development. Appropriate food and nutrition programs include food assistance and meal programs, nutrition education initiatives, nutrition screening and assessment followed by appropriate nutrition intervention, and anticipatory guidance to promote optimal nutrition status. Malnutrition has been linked to delayed physical, psychosocial, and cognitive development and is now recognized as a major contributor to the growing problem of overweight and obesity in the child and adolescent population. Food and nutrition programs create a safety net that ensures that children and adolescents at risk for poor nutritional intakes have access to a safe, adequate, and nutritious food supply and nutrition screening, assessment evaluation, and intervention. It is important that continued funding be provided for these programs, which have been consistently shown to have a positive impact on child and adolescent well-being. Food and nutrition programs will continue to serve not only as a means to combat hunger and food insecurity but also as a vehicle for nutrition education and promotion of physical activity designed to combat overweight and prevent chronic disease. It is the role of the credentialed dietetics professional to support permanent, adequate funding to food and nutrition programs, universal health-care reimbursement for nutrition services, and the use of research and surveillance programs to justify, evaluate, and improve these programs. In addition, the dietetics professional is responsible for serving as a nutrition resource to all groups and individuals working with children and adolescents, acting as an advocate for the establishment of child-care, school, and community settings conducive to the development of good nutrition habits. J Am Diet Assoc. 2003;103:887-893.

Adolescent↗
PubMedDate not supplied

Arthritis in motion: an exercise program for chronic arthritis patients.

Appropriate exercise is often a key factor in successful management of chronic arthritis. Leigh Memorial Hospital has met the needs of arthritis patients through a program called "Arthritis in Motion," where patients receive instruction and support in learning about coping with their disease through exercise.

Arthritis↗
PubMed1984

Evaluation of a presurgical group program given at two different times.

This study was designed to test the outcomes of a preoperative teaching program for cholecystectomy patients and to determine the appropriate time to offer the program. The hypotheses were: (a) Patients in a preadmission program will recover better than those in a program given the eve of surgery, and (b) patients in the control group will have a poorer recovery than those in the two experimental groups. The outcomes measured were state-anxiety, ventilatory function, well-being, pain, functional ability, analgesics, and length of hospitalization. There were no significant differences between the three groups except in state-anxiety the eve of surgery which was higher in the control than in the two experimental groups. State-anxiety the eve of surgery and trait-anxiety were the most important variables affecting outcomes. There was a positive and significant linear relationship between pre- and postoperative state-anxiety.

Adolescent↗
PubMed1994

Risk factors for dropping out of a parenting education program.

This study compared those who completed a clinic-based parenting program to dropouts in an attempt to identify risk factors for parents not completing the program. The program, aimed at mothers at risk for child maltreatment, was offered at three Seattle, Washington health centers providing comprehensive pediatric care to low-income families. We obtained baseline information from an intake questionnaire, the Nursing Child Assessment Teaching Scale (NCATS), and the Home Observation for Measurement of the Environment (HOME). Of the 172 enrollees, 124 (72%) completed the program. Univariate analyses showed that dropouts were more likely to be located at Clinic Site Three (42% vs. 10%, p < .001), teenaged (44% vs. 23%, p = .010), and African-American (56% vs. 32%, p = .010), and to have HOME scores less than 32 (57% vs. 33%, p = .023). There were no statistically significant differences between those who dropped out and those who didn't in marital status, education, referral rate to Child Protective Services prior to the start of parenting classes, or NCATS scores. Multivariate analyses showed that age less than 20 was significantly associated with dropping out when race and HOME scores were taken into account. There was significant interaction between age less than 20 and Clinic Site Three. These data suggest that program planners need to develop appropriate strategies to retain teenage mothers in parenting programs.

Adult↗
PubMed2004

A new dynamic model of the cortico-basal ganglia loop.

An important issue in the neural control of posture and movement is how motor-related areas of the cerebral cortex modulate the activity of the output nuclei of the basal ganglia. In this chapter, the functional significance of the 'hyperdirect' cortico-subthalamo-pallidal pathway is emphasized, and further a new dynamic model of basal ganglia function is presented. When a voluntary movement is about to be initiated by cortical mechanisms, a corollary signal is conveyed through the 'hyperdirect' pathway to first inhibit large areas of the thalamus and cerebral cortex that are related to both the selected motor program and other competing programs. Next, another corollary signal is sent through the 'direct' cortico-striato-pallidal pathway to disinhibit this second pathway's targets, and ensure activation of only the selected motor program. Finally, a third corollary signal is sent through the 'indirect' cortico-striato-external pallido-subthalamo-internal pallidal pathway to strongly inhibit this third pathway's targets. This sequential information processing ensures that only the selected motor program is initiated, executed and terminated at the appropriate times, whereas other competing programs are canceled.

Animals↗
PubMed1983

Nursing quality assurance: a process, not a tool.

A meaningful quality assurance program comes only with appropriate knowledge, communication, and accountability for all quality assurance functions among nurses at all levels. Describing the implementation of their quality assurance program, these authors tell of their eventual realization that, in fact, they had merely implemented a quality assurance tool that brought the nursing staff little benefit and a lot of grief. Highlighting the identified problems, the factors contributing to the program's failure, and the actions they took to develop and meet appropriate objectives, they detail their later, successful implementation of the concept and the process of quality assurance. Their experience provides readers with food for thought and stimulus for critical evaluations of their own quality assurance programs.

Attitude of Health Personnel↗
PubMed1979

Diabetic patient compliance as a function of patient counseling.

The impact of a specially designed patient education program upon the diabetes-related knowledge and compliance of insulin dependent diabetic patients was investigated. The program consisted of an audiovisual presentation, illustrated handout material, and pharmacist-patient counseling. Based on statistical considerations, 65 eligible patients were assigned systematically to a control group (Group I) and a study group (Group II) and were evaluated for compliance following a standardized protocol. Immediately following the interview, Group II patients were instructed utilizing the patient education program. Scores for initial and final evaluations of knowledge and compliance were compared using appropriate statistical procedures. The program was successful in producing improvements in both knowledge and compliance but a need for individualization of patient education efforts was indicated. Significant improvements in compliance were not observed among patients older than the mean age for study patients and those with diabetes complicated by cardiovascular and hypertensive disease.

Attitude to Health↗
PubMed2006

Diabetic patient compliance as a function of counseling. 1979.

The impact of a specially designed patient education program upon the diabetes-related knowledge and compliance of insulin dependent diabetic patients was investigated. The program consisted of an audiovisual presentation, illustrated handout material, and pharmacist-patient counseling. Based on statistical considerations, 65 eligible patients were assigned systematically to a control group (Group I) and a study group (Group II) and were evaluated for compliance following a standardized protocol. Immediately following the interview, Group II patients were instructed utilizing the patient education program. Scores for initial and final evaluations of knowledge and compliance were compared using appropriate statistical procedures. The program was successful in producing improvements in both knowledge and compliance but a need for individualization of patient education efforts was indicated. Significant improvements in compliance were not observed among patients older than the mean age for study patients and those with diabetes complicated by cardiovascular and hypertensive disease.

Diabetes Mellitus↗
PubMedDate not supplied

Justifying prenatal screening and genetic amniocentesis programs by cost-effectiveness analyses: a re-evaluation.

A strength of cost-effectiveness analysis is the presentation of all relevant clinical options, variables, and outcomes and the placement of values on the outcomes. Despite success in many fields of health policy, cost-effectiveness analysts have failed to provide a complete evaluation of prenatal screening and genetic amniocentesis programs. Specifically, all published cost-effectiveness analyses of these programs at best only partially acknowledge the potential life of the aborted fetus. These incomplete evaluations not only violate some basic principles of cost-effectiveness analysis, they also produce conclusions that may be misleading. Ultimately, society must answer two basic questions regarding the use of cost-effectiveness to justify prenatal screening programs: Is cost-effectiveness analysis an appropriate tool for the evaluation of these programs? If so, then what are the outcomes of interest? This paper first shows that the current literature does not present a complete evaluation of these programs. The ramifications of this incomplete evaluation are presented from several perspectives. Finally, given the problems associated with the use of cost-effectiveness analysis, the article suggests that cost-effectiveness analysis is not yet an appropriate tool to justify prenatal screening or genetic amniocentesis programs.

Abortion, Eugenic↗
PubMed1998

A holistic approach to the economic evaluation of health programs using institutionalist methodology.

The paper examines possibilities for employing more holistic approaches to the evaluation of health care programs. It is argued that the reductionism of conventional forms of economic evaluation, where value (or benefit) is seen in terms of either health consequences or individuals' utility, can cause a number of aspects of such programs to be overlooked. As such, this imposes fairly strict limits on the capacity of economic evaluation to inform public policy. In contrast, institutionalist economic theory in common with the community development approach to health promotion is an area of research which acknowledges that change to the broader socio-political environment can be a source of value. It is suggested that this idea has, for instance, significance for the evaluation of indigenous health programs where notions of "cultural appropriateness" have strong influence over the effectiveness and acceptability of such programs. It is concluded that no one evaluative approach is appropriate in all situations and that a greater receptiveness to broader sources of social value can help to improve the way evaluations are conducted.

Evaluation Studies as Topic↗
PubMed1968

The effects of graduated stimulus change on the acquisition of a simple discrimination in severely retarded boys.

Methods were compared for teaching severely retarded boys to discriminate the position of a 0.75-in. black square and to press the response key closest to it. Seven boys were given trial-and-error training; one learned the task. The six boys who did not learn were presented with a program of graduated stimulus changes. All but one acquired the performance, and he was under appropriate control during the program. When he reached the criterion stimuli, he reverted to a position-based response learned during trial-and-error training. Six similar subjects were presented with graduated stimulus training alone. All six learned the criterion discrimination with few or no errors. Both groups were tested for retention of the criterion performance 35 days after training was completed. Two boys who had near-perfect criterion discrimination performances showed no signs of retention after 35 days. These boys had a history of trial-and-error training.

Adolescent↗
PubMed1994

A model of ergonomics intervention in industry: case study in Japan.

This paper presents the results of an ergonomics survey in four different Japanese work places. The survey consisted of two parts. In the first part, the physical and psycho-social problems of the female workers were investigated. Questionnaire techniques were used to assess musculoskeletal disorders in various parts of the body and of psycho-social stress at work as well as in the daily life situation. Furthermore, work posture analysis, task analysis, simple clinical tests and flexibility tests were conducted. In the second part, the ergonomics intervention practices in different types of Japanese work places were examined. Three different questionnaires were developed and used to collect information from representatives of employees, management and responsible governmental agents of the Department of Industrial Safety and Health, Ministry of Labor, with regard to ergonomic interventions at work places. Management, employees, and government representatives expressed desire for cooperation and participation for arrangement of the ergonomics intervention program. A model for appropriate ergonomics intervention in industry is developed with regard to physical and psycho-social problems at work. Factors influencing worker participation and the establishment of a dynamic system of ergonomics intervention at work places are discussed. Practical ways for improving the working conditions of female workers are: (i) cooperation between managers, workers, and government officers is regarded as vital for the ergonomics intervention program, (ii) worker participation, (iii) appropriate training course with regard to ergonomics education, and (iv) managerial support.

Adult↗
PubMed1994

Autologous blood pre-deposit and cell salvage in orthopedic surgery.

A successful autologous blood program should enrol all appropriate patients, conserve homologous blood and minimize the exposure to the risks of donor blood. A program of autotransfusion and proper use of blood has been implemented since 1980 with the objectives of including all eligible patients and to transfuse autologous blood only. The following strategies were adopted: critical review of transfusion indications; control of over-transfusion; avoidance of waste; systematic and integrated use of all autotransfusion techniques currently available. Results in 1992 in elective surgery: 98% enrolment, 75% blood conservation. Exposure to homologous blood was completely avoided in 53% of the cases.

Blood Preservation↗
PubMed1982

Changes in the epidemiologic pattern of dental caries in a Danish rural community over a 10-year period.

A number of reports during recent years have suggested that dental caries is decreasing in several populations. In order to substantiate this, recordings of dental caries collected over a 10-year period were analyzed. All children received systematic preventive and restorative care from kindergarten to 9th or 10th grade (age approximately 16 years). Each cohort consisted of 50-60 children, and data on dental caries were available on all children in 1st through 7th grade over a 9-year period. Mean DMFS had decreased with 72% for 1st graders, 65% for 4th graders and 69% for 7th graders. Analyses of the distribution of children according to DMFS showed that in spite of the general decrease in mean DMFS, some children still showed high DMFS-values. The variability according to DMFS was increased during the same period as indicated by the coefficient of variation. Furthermore, children with a given, high DMFS account for a decreasing fraction of all DMF-surfaces in the population as the mean DMFS decreases. It is suggested that the effect on mean DMFS for the entire group of children of a hypothetical, individualized preventive program for high-risk individuals would be limited. In the light of these findings the appropriateness of special preventive programs for "high-risk" individuals is questioned.

Adolescent↗
PubMed1991

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); drug benefits; appropriate level of care provisions--Department of Defense. Final rule.

This final rule amends the DoD Regulation 6010.8-R (32 CFR part 199) by: (1) Establishing the absolute requirement for approval by the Food and Drug Administration (FDA) of all prescription drugs and medicines (drugs grandfathered by the Federal Food, Drug and Cosmetic Act of 1938 may be covered under CHAMPUS as if FDA approved); (2) clarifying that medical care related to the use of Group C drugs (approved and distributed by the National Cancer Institute) and Treatment Investigational New Drugs (INDs) will not automatically be considered as experimental when the patient's medical condition warrants the use of these drugs; and (3) reclarifying a CHAMPUS provision that allows benefits in an acute facility above the appropriate level of care. The above changes are reasonable and necessary for effective and uniform administration of CHAMPUS.

Drugs, Investigational↗