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PubMed1995

Research issues related to optimal oral health outcomes.

Patient outcomes form one part of the classic triad used to define quality of care: structure, process, and outcome. Outcomes research in dentistry should focus on global questions such as: What difference does dental care make to a patient? Do patients derive perceptible benefits from their dental care? What dental treatments work the best? Like programs or other courses of action, treatment outcomes are considered on three levels: the policy level, which asks, "Are we doing the right things for our target population, given our resources?" program evaluation, in which specific program objectives are set in terms of achievement or maintenance of certain rates and measures; and the individual patient level, in which specific physiologic, psychological, and sociological measures are used to determine individual treatment outcomes. Each level of evaluation can use treatment outcomes or oral health status measures as evaluation criteria. Clinicians routinely face the challenge of providing "appropriate" care to older veterans--a concept that considers the accuracy of risk assessment and diagnosis as well as treatment outcomes (such as the relative effectiveness and cost-effectiveness of alternative treatment strategies, together with the short- and longer-term physiologic and psychological results). Outcomes research is even more challenging when considering its application in older populations whose physical, social, and psychological health are increasingly interrelated and variable with age. Thus, outcomes research, and particularly research on the appropriateness of care, must consider the values and preferences (utility) of those outcomes for older veterans and their families. Optimal oral health outcomes can be achieved through invigorated oral health services research to better understand patients' preferences related to dental treatment decisions, to define oral health outcomes incorporating these preferences, and to assess the effectiveness of the current dental delivery system and its various components, including the appropriate mix of dental providers and allied health personnel, emerging technologies, and innovative prevention and health promotion strategies. An administrative structure and incentives should be established to support dental health services and outcomes research within the Department of Veterans Affairs (VA). A dental service network with an oversight board could be established to evaluate issues related to treatment outcomes. Alternatively, a Geriatric Research Education and Clinical Center devoted to the improvement of the quality of VA dental care and the oral health care delivery system could be established.

Aged↗
PubMed1977

The American Oil Chemists' Society's Smalley mycotoxin check sample program : an evaluation.

For many years the American Oil Chemists' Society has offered through its Smalley Committee a number of oilseed and oilseed product check sample programs for interested analysts throughout the World. The goals of these programs are the standardization and upgrading of analytical proficiency, as well as providing recognition for excellence. A Smalley Subcommittee was formed to establish a check sample program for Mycotoxin contaminated commodities. This program was initiated in the (1974-1975) season with a deoiled aflatoxin contaminated peanut meal series and a deoiled aflatoxin contaminated cottonseed meal series. Each series consisted of an initial practice sample and five check meal samples provided at one month intervals. Laboratories participating in this program represent a cross section of industry, regulatory agencies, and referee chemists in North America and Europe. Methods of analysis for these series are restricted to those of A.O.A.C. and A.O.C.S. paraphrases. These are the C.B. or B.F. Methods for peanut products and the Pons procedure for cottonseed products. Operational and statistical evaluations of these two series seasons are presented.

Computers↗
PubMedDate not supplied

[Pre-test and post-test evaluation of HIV/AIDS educational program for adolescent].

The increasing incidence of AIDS among young people involves the need for effective HIV/AIDS prevention programs. The evaluation of such a program, using pretest, information and posttest, was performed in a high-school of Iaşi City, on a sample of 169 pupils. They answered a semi-structured questionnaire, concerning false and real HIV ways of transmission, attitudes and pre-conceptions about HIV infected people and preventive knowledge. The findings of this study showed that the cognitive level increases with age (higher at 17-19 years old pupils) and the receptivity is higher at 15-16 years old pupils.

Acquired Immunodeficiency Syndrome↗
PubMed1977

Faculty evaluation by residents in a family medicine residency program.

Accountability in graduate medical education is dependent on the willingness of the residents and faculty to make their expectations and commitments explicit and to be held reponsible for fulfilling their commitments. In an effort to encourage accountability, residents in the University of Oklahoma Family Practice Residency Program evaluated the effectiveness of faculty members as learning facilitators. Several dimensions of the learning facilitator role were examined at a resident retreat and the results of the initial evaluations were discussed individually with each faculty member. A subsequent evaluation was conducted one year later, and a comparison of the results of the two evaluations suggests that such efforts can serve to stimulate modification of selected behaviors and thereby improve the quality of teaching in family practice residencies.

Evaluation Studies as Topic↗
PubMed2005

Making it better: building evaluation capacity in community mental health.

This paper describes a province-wide initiative aimed at building the capacity of community mental health programs to participate in program evaluation and development by transferring knowledge, promoting discussion and developing resources. Active involvement of stakeholders and evaluation of the current capacity of the field informed the ongoing development of the initiative. Recovery served as a guiding framework for formulating and understanding community mental health outcomes. Despite the interest of the field in evaluation activities, programs were constrained by limited resources and accountability structures. Sustainability of the project would be enhanced by direct work with programs to facilitate application of Continuous Improvement.

Canada↗
PubMed2001

Energy for living with cancer: preliminary findings of a cancer rehabilitation group intervention study.

PURPOSE/OBJECTIVES: To evaluate the acceptability and efficacy of a rehabilitation group intervention for people with cancer experiencing cancer-related fatigue (CRF) and examine the effects of the program on CRF distress. quality of life (QOL), and depression. DESIGN: Prospective, pre-/post-test intervention. SETTING: An outpatient area of a 551 -bed tertiary-care community hospital in the southeastern United States. SAMPLE: 20 participants have completed the program in four different groups. The preliminary mean age was 63.6 (range = 38-86). These participants had six different types of cancers, and 15 patients were receiving some form of cancer therapy during their participation in the program. METHODS: After providing informed consent participants completed the Cancer-Related Fatigue Distress Scale, the Center for Epidemiological Studies-Depression, the Functional Living Index-Cancer, and a demographic Information form. The intervention consists of eight weekly, 90-minute sessions with educational and sharing components. At the eighth session, participants were asked to complete the three instruments plus a program evaluation. MAIN RESEARCH VARIABLES: CRF distress, depression, QOL. FINDINGS: Preliminary results indicate that the program provided information, support, and management strategies for CRF. The mean for the program evaluations overall was 9.8 (0-10 scale, range = 9-10). Statistically significant differences were found for pre- and post-test fatigue distress and QOL scores. CONCLUSIONS: Preliminary findings indicate that this intervention is appropriate and beneficial for patients with cancer experiencing fatigue, even for those patients who are very debilitated. IMPLICATIONS FOR NURSING PRACTICE: The program can be used as a rehabilitation program to help people with cancer to manage the sequelae of their illness and treatments.

Adaptation, Psychological↗
PubMed1986

[Detectability of glaucomatous visual field defects with the Octopus automatic perimeter. A comparison between program G-1 and programs 31 and 32 and their combinations].

Twenty-three patients between 31 and 76 years of age suffering from either hypertension or glaucoma underwent automatic perimetry with Octopus programs 31 or 32, followed by program G-1. This was done to compare the information content of the latter, new program with that of the former two, long-used in different combinations. Only one eye of any one patient was considered in this study. Using an evaluation program, the G-1 program calculates the so-called "field indices" which help to interpret the results. These field indices are the mean differential light sensitivity threshold (mDLS), the mean defect (MD), the loss variance (LV), and the corrected loss variance (corrected for short-term fluctuations (CLV)). In order to compare programs 31, 32, and their combination 31 + 32, with the field indices of program G-1, the mean DLS was taken from the Delta evaluation program, while the mean defect, the loss variance, and the corrected loss variance were calculated on the basis of programs 31, 32, and the combination of them. The mDLS and mean defect determined with program G-1 were significantly different from those found with programs 31, 32, and the combination of them. On the one hand, this was due to the difference in test patterns, that of G-1 being more centrally weighted; on the other hand, this is indicative of the precision and discrimination capability of Octopus measurements. Calculation of loss variance and corrected loss variance reveals no significant difference between the examination methods as regards these field indices, that is, between G-1 and 31, 32, or 31 + 32.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2001

Telehealth success: evaluation framework development.

Implementing telehealth applications represents a substantial investment of resources, which is one reason why success is of great interest. Many research and evaluation studies have investigated measures of successful telehealth systems. However, the term "telehealth" represents a wide range of variables including clinical application, characteristics of the information being transmitted, temporal relationships of data transfer and the organizational context. These sources of variability pose many challenges for evaluation as well as for building a cumulative history of research. A conceptual framework is required that assists in categorizing results and drawing conclusions based on an accumulation of findings. One measure of "success" in health care is quality patient care and this reflects a primary reason for ICT investments. For this reason, Donabedian's work in evaluating quality provides the basis for the proposed framework. DeLone and McLean's definitions of IS success assist in conceptualizing Donabedian's structure-outcome-process variables in a telehealth context. Multiple evaluation approaches have been used to address different types of questions. Prior to the technologies being introduced to clinical care, there are usually many studies to demonstrate their effectiveness. Health Technology Assessment examines a broader context than the technology alone, including costs and comparing alternatives that would exist in the absence of telehealth. It considers performance measures; outcomes; summary measures, operational considerations, and other issues. Program Evaluation examines use of the technology to provide a service or deliver a program. Evaluation questions often address whether the program goals have been met and if it is operating as expected. Perhaps of greater concern than the evaluation approach taken is generalizability of findings. Recent studies have given inadequate attention to defining what is done (i.e. comparison of telehealth to most appropriate alternative), identifying the beneficiaries of telehealth (i.e. ensuring randomly selected participants take part) and what is measured (i.e. including benefits, drawbacks and side effects of telehealth). Evaluation efforts and frameworks have identified "success" factors such as technical acceptability of the system, cost/benefit/effectiveness, organizational support, satisfaction, recruitment and retention, client outcomes such as quality of life, acceptance by consumers and providers. Less is known about the relationship among these variables and whether the findings around one variable are generalizable to other settings or applications. For example, organizational support may be essential for successful provider-patient interactions via videoconference, which result in higher quality of life. A conceptual framework would assist in accumulating this type of evidence and supporting more advanced research efforts.

Computer Communication Networks↗
PubMed1997

Utility of the Inventory of Suicide Orientation-30 (ISO-30) for adolescent psychiatric inpatients: linking clinical decision making with outcome evaluation.

This report describes a study that integrates program evaluation with clinical practice. The subjects were 139 adolescent psychiatric inpatients who were tested with the Inventory of Suicide Orientation-30 (ISO-30) at admission and retested six days after admission. Aggregate analyses showed statistically significant changes in the direction of decreased suicidality on all ISO-30 indices. Further analyses compared the data with normative data from the ISO-30 manual, and also evaluated the relationships between ISO-30 scores and length of stay. Implications of the results and also methods of integrating outcome with clinical practice are discussed.

Adolescent↗
PubMedDate not supplied

Program planning and evaluation: principles and procedures for nurse managers.

This article provides an overview of essential principles and procedures of program planning and evaluation. The relevance of these concepts to the task of health and nursing care is discussed in terms of three primary evaluation domains: (1) estimating need and designing evaluable programs; (2) determining the extent of program implementation; and (3) assessing program-related outcomes. The article has relevance for nurse managers concerned with programmatic decision making and accountability.

Decision Making↗
PubMed1983

Analytic procedures for evaluating health care. Statistical control charts.

The concern for quality of health care motivates evaluation programs designed to monitor the health care system, patient outcome, and provider expertise. An array of audit methods and instruments for evaluating professional and institutional performance has been developed. Although evaluation is viewed by many as the basis for accountability and improvement of health care, few are aware that most existing evaluation programs are really data-collecting systems. Very little if any, analysis of the data is done with the objective of optimizing the system. The "sampling with intervention" procedures often used to monitor the health care delivery system are primarily directed toward the individual patient while the system and provider continue to operate in the established mode. This article outlines analytic procedures for interpreting evaluation data generated by quality control and audit systems. Five common univariate statistical quality control charts are described.

Data Collection↗
PubMed2004

[Development and effects of a health promotion program utilizing the mail function of mobile phones].

PURPOSE: The purpose of the study was to develop a health education program, named "i-exerM," utilizing the mail function of the mobile phone and affect its effects setting body weight reduction as the achievement target. METHODS: The i-exerM was developed with 136 adults (28 males and 108 females) living or working in Shizuoka Prefecture, and subscribing to the i-mode of NTT DoCoMo orJ-sky of JPHONE (currently Vodafone), who indicated an interest in participating in a body weight reduction twelve week (between July 15th and October 9th, 2003) program. As-one of the special characteristics of the i-exerM, the subjects were informed once every day via mailing to the mobile phone some new items regarding body weight reduction knowledge and practice. By use of a self-monitoring method, the subjects were asked to register the body weight via internet from time to time. Information for each individual at the start and the end of the i-exerM monitoring session was collected with a questionnaire covering physical conditions, lifestyle and program evaluation, without an meeting with the participants during the program. From this trial result, the enforcement potential of healthy education utilizing the mail function of mobile phones was examined. RESULTS: 1) Those who submitted a questionnaire before the i-exerM start and after the end were 14 adult (50%) males and 69 adult (64%) females. 2) A tendency for reduced body weight was found in 63 (46%) of 136 adults who participated in the i-exerM. Furthermore, average body weights were significantly reduced (P < 0.001) from 73.2 kg to 71.1 kg (males), and from 58.8 kg to 57.6 kg (females). 3) The i-exerM program was evaluated positively, 44 adults (32%) indicating that it was "greatly effective" for "stimulating consideration of body reduction and starting concrete efforts." CONCLUSION: The success of the current i-exerM program suggests its possible application for chronic disease states such as hypertension and hyperlipidemia.

Adult↗
PubMed1993

Twin pregnancies in the second trimester in women in an alpha-fetoprotein screening program: sonographic evaluation and outcome.

OBJECTIVE: We correlated sonographic findings with fetal outcomes in women with unsuspected twin pregnancies who had sonography in the second trimester as part of a screening program for maternal serum alpha-fetoprotein (MSAFP) level and history of neural tube defect. MATERIALS AND METHODS: The study group consisted of 97 women with twin pregnancies who participated in a screening program for MSAFP level and history of neural tube defect. Seventy-three had normal MSAFP levels, 21 had elevated MSAFP levels, and two had low MSAFP levels. One patient had a family history of anencephaly. All 97 patients had sonography during their second trimester of pregnancy. Sonographic findings were reviewed retrospectively for information on gestational age, fetal anomalies, sex of the fetus, location of the placenta, presence and thickness of a dividing membrane, and interpretation of amnionicity and chorionicity. Information on fetal outcome included gestational age at delivery, survival, birth weight, sex, congenital anomalies, obstetric complications, amnionicity, chorionicity, and placental abnormalities. RESULTS: Amnionicity and chorionicity were correctly detected on sonograms in 44 (90%) of 49 diamniotic-dichorionic gestations, 23 (72%) of 32 diamniotic-monochorionic gestations, and two (50%) of four monoamniotic-monochorionic gestations. Fetal anomalies were present at delivery in five neonates and had been correctly detected at sonography in one (hemivertebra); one fetus with duodenal atresia had abnormal sonographic findings in the third trimester. Missed anomalies included absent forearm, cleft lip and palate, and imperforate anus. Sex of the fetuses was correctly predicted on the basis of sonographic findings in 40 of 43 pairs. Nine twin pairs had possible twin-twin transfusion syndrome suspected sonographically on the basis of abnormal fluid volumes, discrepant growth measurements, and abnormal findings on Doppler studies. Outcomes included two confirmed cases of the syndrome (two survivors, two deaths) and three probable cases (six deaths); four pregnancies resulted in eight survivors who were delivered after 34.4 weeks' gestation and had birth weights in the 25th percentile or higher. Survival rates for diamniotic-dichorionic, diamniotic-monochorionic, and monoamniotic-monochorionic gestations were 90%, 91%, and 50%, respectively. Fetuses in women with MSAFP levels greater than 4.5 multiples of the median and with monochorionic placentation had lower survival rates than fetuses in women with normal MSAFP levels and monochorionic placentation (67% vs 96%). Half the fetuses delivered after 20 weeks' gestation had birth-weight discordance of less than 10%. Premature deliveries occurred in 56% of pregnancies. CONCLUSION: The results suggest that (1) sonography is useful in predicting placentation, (2) placentation may be helpful in predicting fetal outcome, (3) increased MSAFP levels correlate with increased perinatal mortality in diamniotic-monochorionic pregnancies, and (4) caution should be taken in diagnosing and determining prognosis for suspected twin-twin transfusion syndrome in the second trimester.

Amnion↗
PubMed1976

Comparison of rehospitalized and nonrehospitalized psychiatric patients on community adjustment: self-assessment guide.

The measurement of community adjustment has become an essential component of community mental health program evaluation. The primary objective of community-oriented hospital psychiatric services is to return the patient to the community as quickly as possible, and to enable the patient to maintain himself in the community in a normal manner (Joint Commission on Mental Illness and Health, 1961). Attempts to evaluate hospital mental health programs have necessarily looked at measures of recidivism such as return rate and length of community tenure (Anthony et al., 1972; Rosenblatt and Mayer, 1974). For more immediate measures and qualitative assessment of community tenure, however, evaluators have relied on questionnaires that purport to measure community adaptation and social adjustment. A major reason for the use of community adjustment measures for evaluation in community-oriented hospital programs is the relative lack of predictive ability of any measures of patient adjustment while the patient is still in hospital (Ellsworth et al., 1968; Williams and Walker, 1961). It appears that all measures of success while the patient is still hospitalized, even goal-attainment measures, have little relationship to posthospital adjustment or recidivism (Willer and Miller, 1975). The present study examines the relationship of community adjustment to rehospitalization through comparison of rehospitalized and nonrehospitalized patients on a community adjustment scale.

Affect↗
PubMed1996

Conformational sampling by NMR solution structures calculated with the program DIANA evaluated by comparison with long-time molecular dynamics calculations in explicit water.

The NMR solution structure of bovine pancreatic trypsin inhibitor (BPTI) obtained by distance geometry calculations with the program DIANA is compared with groups of conformers generated by molecular dynamics (MD) simulations in explicit water at ambient temperature and pressure. The MD simulations started from a single conformer and were free or restrained either by the experimental NOE distance restraints or by time-averaged restraints; the groups of conformers were collected either in 10 ps intervals during 200 ps periods of simulation, or in 50 ps intervals during a 1 ns period of simulation. Overall, these comparisons show that the standard protein structure determination protocol with the program DIANA provides a picture of the protein structure that is in agreement with MD simulations using "realistic" potential functions over a nanosecond timescale. For well-constrained molecular regions there is a trend in the free MD simulation of duration 1 ns that the sampling of the conformation space is slightly increased relative to the DIANA calculations. In contrast, for surface-exposed side-chains that are less extensively constrained by the NMR data, the DIANA conformers tend to sample larger regions of conformational space than conformers selected from any of the MD trajectories. Additional insights into the behavior of surface side-chains come from comparison of the MD runs of 200 ps or 1 ns duration. In this time range the sampling of conformation space by the protein surface depends strongly on the length of the simulation, which indicates that significant side-chain transitions occur on the nanosecond timescale and that much longer simulations will be needed to obtain statistically significant data on side-chain dynamics.

Amino Acid Sequence↗