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Residency programs are very new to the optometric profession. In order for optometry to continue its growth, Residency programs must attain its appropriate role in the development of the profession. A committee has been established to support the concept of specialized residency programs in many aspects of optometric care. Initial goals and objections of the committee as well as future endeavors are discussed.
Quality, quality assurance, and quality management are becoming more and more dominating topics in German public health. Quality is named as the most important goal of medical care in the public health related political discussions of physicians, hospitals, health insurances, and politicians but is affected by differences in political, economical, medical, and particular interests. To avoid a single-sided discussion about questions of quality (only with the goal of increasing efficiency and reducing costs), the society of physicians of Germany and the society of panel physicians published a common stock of 10 theses about medical quality assurance and quality improvement in the spring of 1996: (1) Medical quality assurance and quality improvement serve the patient. (2) Medical quality assurance and quality improvement do not primarily serve the improvement of economic efficiency. (3) Quality assurance programs have to be problem oriented and coordinated; quality in the ambulant and hospital setting cannot be different. (4) The appropriateness of quality assurance programs has to be evaluated firmly. (5) Transparency, communication, and cooperation are prerequisites of a successful quality assurance and quality improvement. (6) Comprehensive internal quality assurance is the foundation of continuous quality improvement. (7) External quality assurance should initiate the development of procedures for internal quality assurance. (8) Quality assurance has a chance for realization only if it is carried by the conviction and the effort of every participant to perform at relatively high quality, to subject his own doing to continuous checks and improvement, and to compare with others. (9) Quality has it's price. (10) Quality assurance and continuous quality improvement are the cornerstones of a quality policy in public health. The current situation and future developments of quality assurance in ambulant health care are discussed in this paper.
When chemical dependency is suspected in an emergency medicine resident physician, prompt and appropriate action must be taken to ensure the best possible outcome for all involved. Although residency program accreditation requires that program directors be able to appropriately deal with a chemically dependent resident, few programs have a formal policy in place, and little if any information exists for the formulation of such a policy. Presented here is a discussion of the disease of chemical dependency and how it affects emergency medicine residents, along with practical recommendations for appropriate management.
Many adults with severe disabilities spend considerable amounts of time in segregated day programs. We evaluated the degree to which these programs support purposeful and age-appropriate activity. Observations in 100 congregate community and institutional program sites indicated that approximately half of consumer time was spent in purposeful activity, 75% of which was age-appropriate. In 20% of the sites, though, most activity was age-inappropriate. These results, which were similar across community and institutional settings, are discussed in terms of respective program administrators evaluating their supports through comparisons with activity involvement in other programs and the need for changes in programs providing primarily age-inappropriate activities.
The Sandy Lake school-based diabetes prevention program is a culturally appropriate intervention for Ojibway-Cree students in the 3rd, 4th, and 5th grades. This paper reports the results of the program in changing dietary intake behaviors and related psychosocial factors. Physical activity results are not included. The study was a pretest/post-test, single-sample design conducted during the 1998-1999 school year. A total of 122 students completed all 4 measurements (anthropometry, 24-h dietary recall, and 2 questionnaires), at baseline and follow-up. There were significant increases (P < 0.0001) in dietary intention, dietary preference, knowledge, and dietary self-efficacy, and in the curriculum knowledge scale between baseline and follow-up. Intervention exposure was significantly associated with being in the highest category for knowledge about foods that were low in dietary fat [Medium Exposure odds ratio (OR): 3.4; P < 0.05; High Exposure OR: 6.4; P < 0.05], being in the highest category for dietary self-efficacy (Medium Exposure OR: 3.7; P < 0.05; High Exposure OR: 3.9; P < 0.1), being in the highest category for knowledge about curriculum concepts (Medium Exposure OR: 3.4; P < 0.05; High Exposure OR: 9.4: P < 0.01), and for having met the age + 5 g dietary fiber intake/d (Medium Exposure OR: 2.9; P < 0.1; High Exposure OR: 11.0; P < 0.01). Exposure to the intervention was not associated with dietary intent or the percentage of energy from dietary fat. This program was associated with improved knowledge and the psychosocial factors related to healthy eating and dietary fiber intake of students in a remote First Nations community.
BACKGROUND: Screening is different from investigation, and these differences have important implications in the assessment of screening programs. METHODS: I review the differences between screening and investigation and the implications of these differences derived from a consideration of the four ethical principles of beneficence, nonmaleficence, autonomy, and distributive justice. RESULTS: Because most of the harms of screening fall on the healthy and because screening is initiated by physicians, nonmaleficence takes ethical precedence over beneficence. Issues related to cost and consent are also approached differently in screening compared with investigation, and both take on greater ethical importance. I contend further that these ethical implications require that screening programs be backed up by better evidence than is the usual case for investigative medicine. I suggest an outline for the appropriate assessment of screening programs and for the ethical responsibilities of those involved in screening. CONCLUSIONS: Many current medical screening practices are not concordant with our ethical principles and should be reassessed.
Extramural programs may be evaluated in terms of effectiveness in achieving their particular goals. The components of structure, process, and outcome are examined as related sets of program elements. Goals influence appropriate structure in organization, facilities, and manpower. Structure in turn influences process or activities which result in outcome. Outcome is considered in terms of goals. Each set of elements is examined by institutional faculty and administration, extramural faculty, and students. Where all agree that desired outcome variables are relevant to the goal(s) and are achieved, the program is "effective." Where outcome and goal are not compatible, process and then structure must be examined for appropriateness of each. When there is disagreement between groups about any element, a problem area in the program is specifically identified. The procedure for cyclic assessment may be used by a school or program for self-study or for periodic internal monitoring of problem areas. Use of this method has shown some characteristics common to different types of extramural programs.
Current child sexual abuse prevention programs assume that, by targeting potential victims, they can reduce the prevalence of child sexual abuse. This article presents findings, however, that suggest this assumption is flawed. First, recent studies indicate that the prevalence of abuse has not decreased over the history of prevention programs. Second, because of the pervasiveness of the threat of child sexual abuse, it is doubtful that prevention programs can adequately prepare children for the diversity of approaches by potential offenders. It is suggested instead that potential offenders are more appropriate targets of prevention programs. Because a large portion of abuse appears to be related to socialized relational patterns gone awry, it is suggested that a more efficacious method of prevention is a school-based program that promotes healthy relationship patterns. The article compares the existing victim-based paradigm with the proposed potential healthy relationships paradigms along four domains: underlying assumptions, orientation, method, and goals.
It is impossible to talk about nutrition and the elderly without reviewing related factors such as program funding levels, income and purchasing power, education, medical implications, and resulting social costs.Although we have witnessed a tremendous increase in federal appropriations for Title VII programs, many senior citizens have not and will not benefit from nutrition programs. As the ratio of elderly citizens to total population increases, we may expect: (1) an increase in program budgets with a concomitant decrease in the proportion of senior citizens served; and (2) a regressed government attitude toward income-related support programs, causing decreased purchasing power, ineffective nutrition programs, and little relative improvement in the health of our elderly population.
BACKGROUND: A patient-specific measure of defibrillation efficacy that requires a minimum number of ventricular fibrillation (VF) episodes would be valuable for programming implantable cardioverter-defibrillators (ICDs). The upper limit of vulnerability (ULV) is the weakest shock strength at or above which VF is not induced when a stimulus is delivered during the vulnerable phase of the cardiac cycle. It correlates with the defibrillation threshold (DFT) and can be determined with a single episode of VF. The objective of this study was to test the hypothesis that ICDs programmed on the basis of the ULV convert spontaneous ICD-detected VF reliably. METHODS AND RESULTS: We studied 100 consecutive patients at ICD implantation and during follow-up of 20 +/- 7 months. At implantation, the ULV and DFT were determined, and the ICD system was tested at a shock strength equal to the ULV + 3 J. During follow-up, the strength of the first shock was programmed to the ULV + 5 J for arrhythmias detected in the VF zone (cycle length < 292 +/- 17 ms). We reviewed stored detection intervals and electrograms from spontaneous episodes of ICD-detected VF to determine the success rate for appropriate first shocks. The programmed first-shock strength was 17.5 +/- 5.2 J. During follow-up, there were 120 appropriate first shocks in 37 patients. The arrhythmia was rapid monomorphic ventricular tachycardia (VT) in 70% of episodes (31 patients), VF in 11% (13 patients), polymorphic VT in 1%, and unclassified in 17% (15 patients). The first shock was successful in 119 of 120 episodes (99%; 95% CI, 93% to 100%). One unclassified episode required two shocks. No patient had syncope associated with an ICD shock or arrhythmic death. CONCLUSIONS: ICD shocks can be programmed on the basis of the ULV, a measurement made in regular rhythm, without a direct measure of defibrillation efficacy.
To ensure high standards of nursing care, staff development educators need to develop a quality assurance (QA) plan specifically designed to monitor the outcome of educational activities. This article focuses on the design of a QA plan and its use in assessing nursing education programs for their quality, appropriateness, and clinical application.
The main objective of this study was to identify the number and type of alcoholism programs in the province of Ontario, Canada, which endorse treatment goals other than complete abstinence. A survey of all alcoholism programs in the province revealed that 36.7% of the programs found nonabstinence goals appropriate for at least some clients. Endorsement of nonabstinence goals was lowest for detoxication centers and residential treatment services, and highest for nonresidential programs and assessment-referral services. Endorsement of nonabstinence goals was higher among programs aimed at young people and those associated with the criminal justice system. Within a treatment program, the use of various kinds of assessment methods and treatment modalities did not appear to be closely associated with the endorsement of abstinence vs nonabstinence treatment goals.
Home intravenous antibiotic therapy (HIVAT) grew out of one hospital's experience with home parenteral nutrition. Because of current accelerated pace of discharge planning, the social worker plays a major role in choosing appropriate candidates for this program and in helping them solve practical and affective problems. Patients report a high degree of satisfaction with this homecare plan. Benefits such as early return to employment are noted. Shortened hospital stays lower treatment costs. The program is adaptable for many patients where medical treatment initiated in the hospital continues at home.
OBJECTIVE: The principal objective of this paper is to identify the economic costs and benefits of pedophile treatment programs incorporating both the tangible and intangible cost of sexual abuse to victims. METHOD: Cost estimates of cognitive behavioral therapy programs in Australian prisons are compared against the tangible and intangible costs to victims of being sexually abused. Estimates are prepared that take into account a number of problematic issues. These include the range of possible recidivism rates for treatment programs; the uncertainty surrounding the number of child sexual molestation offences committed by recidivists; and the methodological problems associated with estimating the intangible costs of sexual abuse on victims. RESULTS: Despite the variation in parameter estimates that impact on the cost-benefit analysis of pedophile treatment programs, it is found that potential range of economic costs from child sexual abuse are substantial and the economic benefits to be derived from appropriate and effective treatment programs are high. CONCLUSIONS: Based on a reasonable set of parameter estimates, in-prison, cognitive therapy treatment programs for pedophiles are likely to be of net benefit to society. Despite this, a critical area of future research must include further methodological developments in estimating the quantitative impact of child sexual abuse in the community.
Achieving satisfactory, long-term functional outcomes after total wrist arthroplasty surgery has proved more complicated than with arthroplasties in joints such as the hip or knee. However, improvements in implant design and surgical technique have resulted in recent successes and evidence that wrist arthroplasty may be an appropriate choice to improve function in select patients. This article reviews factors that therapists must consider in planning, implementing, and progressing individual patients' rehabilitation programs after wrist arthroplasty surgery. Therapists must be knowledgeable about the specifics of each patient's surgery so that the rehabilitation program can be customized appropriately and can contribute to achieving pain-free stable wrist movement that allows patients to perform their desired functional activities.
Since 1980, asthma prevalence, hospitalization, and mortality have been increasing in the United States. Because of concern about asthma-related morbidity among children in Central Harlem, New York City (NYC), the Harlem Children's Zone Asthma Initiative (HCZAI) was established in 2001 to reduce asthma-related morbidity through improved surveillance, health-care use, and health-care service delivery for children aged < or =12 years living in a 60-block radius of Central Harlem known as the Harlem Children's Zone Project. Families of children with asthma or asthma-like signs or physical findings consistent with asthma are invited to participate in the program. This report summarizes preliminary data collected during 2001-2004 on the effectiveness of the program in reducing asthma-related morbidity; data indicate decreased parental/guardian reports of school absences among children enrolled in the program, both for any reason and because of asthma. In addition, emergency department and unscheduled physician office visits for treatment of asthma decreased from 35% to 8% after 18 months of the program, indicating improved asthma management and appropriate use of health-care services by program enrollees. The effectiveness of HCZAI underscores the utility of community-based public health programs in reducing asthma morbidity.
The paper describes a non-intrusive, computer assisted, program evaluation design for matching sub-types of substance abuse patients to appropriate treatment programs in any multi-modal treatment network. The design incorporates the methodological advantages of an experimental paradigm without the administrative and clinical problems of random patient assignment, and untreated control groups. The specific objectives of this design are: (1) The development of a generalizable evaluation process to efficiently match patients with programs. (2) An overall increase in treatment success through improvement of treatment assignment procedures. (3) A general improvement in cost-effectiveness through reductions in patient drop-out, recidivism, and treatment overlap.
The purpose of this study was to describe the effects of motivating factors and characteristics of the nursing profession on students selecting nursing as a career. Students from three types of programs in North Carolina (N = 495) were asked to complete a survey during the first month of their nursing program. Motivating factors influencing the decision to become a nurse were past experience with a loved one or self being ill and/or hospitalized, past health care work experience, and having a family member or friend who was a nurse. Characteristics about the nursing profession influencing career decisions were care and concern for others, job security, and variety of work settings. None of the motivating factors nor characteristics of the nursing profession differed among students from each program type. Data from this survey can be used to developed appropriate recruitment strategies for each program type.