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PubMed1988

[Computer diagnosis of gastric dysplasia and program design].

Two step processes were taken in computer diagnosis of gastric dysplasia. 1. 5 measurement values of dysplastic glandular tube obtained by using image analysis system were taken as the basis for judging the degree of dysplasia. Three glandular tubes of dysplasia were measured in each case. 2. Computer pathology diagnostic program using BASIC language ran in IBM computer. 5 parameters were input into computer for three stage-diagnosis. The first stage: 5 parameters were counted basing on three models to obtain three values which reflected the objective feature of the same glandular tube from different aspects. The second stage: diagnosis of a dysplastic glandular tube was obtained depending on the three values judged synthetically. Variate 'N' was introduced for controlling the first and second stage diagnosis of the three glandular tubes. The third stage diagnosis started as soon as N = 3. The third stage: diagnostic values of three glandular tubes were balanced and analysed depending on diagnostic criteria to reach the final diagnosis.

Diagnosis, Computer-Assisted↗
PubMed2025

Building a Digital Health Research Platform to Enable Recruitment, Enrollment, Data Collection, and Follow-Up for a Highly Diverse Longitudinal US Cohort of 1 Million People in the All of Us Research Program: Design and Implementation Study.

BACKGROUND: Longitudinal cohort studies have traditionally relied on clinic-based recruitment models, which limit cohort diversity and the generalizability of research outcomes. Digital research platforms can be used to increase participant access, improve study engagement, streamline data collection, and increase data quality; however, the efficacy and sustainability of digitally enabled studies rely heavily on the design, implementation, and management of the digital platform being used. OBJECTIVE: We sought to design and build a secure, privacy-preserving, validated, participant-centric digital health research platform (DHRP) to recruit and enroll participants, collect multimodal data, and engage participants from diverse backgrounds in the National Institutes of Health's (NIH) All of Us Research Program (AOU). AOU is an ongoing national, multiyear study aimed to build a research cohort of 1 million participants that reflects the diversity of the United States, including minority, health-disparate, and other populations underrepresented in biomedical research (UBR). METHODS: We collaborated with community members, health care provider organizations (HPOs), and NIH leadership to design, build, and validate a secure, feature-rich digital platform to facilitate multisite, hybrid, and remote study participation and multimodal data collection in AOU. Participants were recruited by in-person, print, and online digital campaigns. Participants securely accessed the DHRP via web and mobile apps, either independently or with research staff support. The participant-facing tool facilitated electronic informed consent (eConsent), multisource data collection (eg, surveys, genomic results, wearables, and electronic health records [EHRs]), and ongoing participant engagement. We also built tools for research staff to conduct remote participant support, study workflow management, participant tracking, data analytics, data harmonization, and data management. RESULTS: We built a secure, participant-centric DHRP with engaging functionality used to recruit, engage, and collect data from 705,719 diverse participants throughout the United States. As of April 2024, 87% (n=613,976) of the participants enrolled via the platform were from UBR groups, including racial and ethnic minorities (n=282,429, 46%), rural dwelling individuals (n=49,118, 8%), those over the age of 65 years (n=190,333, 31%), and individuals with low socioeconomic status (n=122,795, 20%). CONCLUSIONS: We built a participant-centric digital platform with tools to enable engagement with individuals from different racial, ethnic, and socioeconomic backgrounds and other UBR groups. This DHRP demonstrated successful use among diverse participants. These findings could be used as best practices for the effective use of digital platforms to build and sustain cohorts of various study designs and increase engagement with diverse populations in health research.

Humans↗
PubMed2005

Diffusion of an effective skin cancer prevention program: design, theoretical foundations, and first-year implementation.

This article describes the design and theoretical foundations of the Pool Cool Diffusion Trial and reports 1st-year findings. Aims of the study are to evaluate the effects of 2 strategies for diffusion of the Pool Cool sun safety program on implementation, maintenance, and sustainability; improvements in environmental supports for sun safety in swimming pools; and sun protection habits and sunburn among participating children. There was a high rate of program participation (86.6%; n=375 swimming pools) in the 1st year and somewhat lower study participation (75.8%). Analysis of pool manager surveys revealed a time effect for overall sun safety programs and for sun safety policies, environmental strategies, and programs for pool users. There were few differences in implementation between treatment groups in year one.

Child↗
PubMedDate not supplied

Participation in programs designed to improve employment outcomes for persons with psychiatric disabilities: evidence from the New York WORKS demonstration project.

The New York WORKS demonstration project was designed to improve employment outcomes for persons with psychiatric disabilities receiving Supplemental Security Income (SSI) disability payments. This article shows how the individual characteristics of participants were related to outcomes at each stage of the multistage recruitment process used in the project and how those characteristics contributed to enrollment. The findings are important to program administrators who are interested in ensuring that SSI recipients receive equal access to employment-related services and who want to improve recruitment strategies for future demonstration projects. The New York WORKS recruitment process used administrative records from the Social Security Administration (SSA) to identify the population of over 68,000 SSI recipients with a diagnosis of a psychiatric disability in Erie County and New York City. Staff involved in the project documented the results of each stage of the recruitment process. The New York WORKS project included four stages: (1) the provision of information (sending a letter and information packet); (2) demonstrated awareness of the project (response to a letter containing an overview of the project); (3) expression of interest (indication of interest in the project, using a postmarked form returned to New York WORKS project staff); and (4) participation (actual enrollment in the program). The project staff members were also able to identify data from administrative records that described the characteristics of the population, including age, sex, type of psychiatric diagnosis, the number of months that the person collected benefits before the recruitment process, employment experience before the recruitment process, and annual earnings in the year before the recruitment process. The data on outcomes at each stage of the recruitment process and the characteristics of SSI recipients were analyzed using an empirical method recently suggested by Heckman and Smith. The analysis identified the relationship between the characteristics of SSI recipients and the outcomes at each stage of the recruitment process and demonstrated how those characteristics contributed to the overall likelihood of enrollment. Demographic characteristics, information about diagnosis, and characteristics related to work history had different effects on outcomes at different stages of the recruitment process. For example, younger SSI recipients were less likely to reply to the information letter but more likely to express an interest in the project and more likely to enroll, given that interest. This result suggests that there may be an information barrier for the younger group of SSI recipients during the early recruitment stages. There were also interesting differences by psychiatric diagnosis and by recent employment experience at each stage of the process. Most notably, persons with anxiety disorders were less likely to express an interest in the project and less likely to enroll in the project if they expressed an interest. This finding suggests that project administrators may need to examine more effective methods to accommodate persons with an anxiety disorder at the enrollment stage of the recruitment process. Persons with relatively low earnings in the year before the project were more likely to respond, to express interest in the project, and to enroll than were those with no earnings and those with relatively high earnings. This finding suggests that the recruitment strategy used by the New York WORKS project is more effective at enrolling a subset of the population that has some demonstrated work capacity and that, of those with a demonstrated work capacity, New York WORKS is enrolling those who are likely to have the most to gain from the project. This finding has implications for the development of sample designs for other demonstration projects, in particular the SSA-proposed mental health treatment study. A number of strategies may lead to improvements in future evaluations of participation in SSA projects and programs. For example, the New York WORKS data did not contain information for all SSI recipients on race, education, or literacy. These factors have been shown to be important in the Job Training Partnership Act literature and are likely to play a role in participation. The inclusion of these data in future evaluations may provide important information on participation in SSA projects. Another useful strategy for future evaluations includes the identification of random samples of those who choose not to enroll at different stages in the process and the collection of information on the reason for the decision. These additional data may help project administrators to gain a clearer description of the reasons for differences in outcome that occur at each stage of the process, assess the overall performance of the recruitment process, and improve the recruitment processes used in future projects.

Adult↗
PubMedDate not supplied

Administration of aerosol pentamidine: a program design.

Aerosol pentamidine (AP) is an FDA-approved prophylaxis against pneumocystis carinii pneumonia (PCP) in HIV-infected individuals who have a CD4+ lymphocyte count less than 200/mm3, constitutional symptoms, or a previous history of the pneumonia. The University of Washington Medical Center, a 450-bed tertiary care center, established a successful aerosol pentamidine treatment program, providing treatment in its special procedure nit. The authors present an overview of AP and discuss the role of interdisciplinary teamwork, staff training, patient teaching, and the provision of safety measures for patients and healthcare providers.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Stress management: a program designed to facilitate coping.

Continual exposure to work-related stressors compounds nurses' workloads, increases their stress levels, and places increased demands on their abilities to adapt. Nurses need to learn and routinely use coping measures to prevent exhaustion and burnout. This article describes the assessment, plan, implementation, and evaluation of an in-house stress management continuing education program to aid staff members in halting the cyclic process of stress.

Adaptation, Psychological↗
PubMed2006

V.I.K. (Very Important Kids): a school-based program designed to reduce teasing and unhealthy weight-control behaviors.

The purpose of this study was to evaluate the feasibility and effectiveness of V.I.K. (Very Important Kids), a school-based, multi-component intervention designed to prevent teasing and unhealthy weight-control behaviors among fourth through sixth grade students. The effectiveness of the V.I.K. intervention was evaluated using a pre-post quasi-experimental design with one school assigned to each condition: intervention and assessment-only control. Data were collected at baseline and at 8-month post-test among 63 students at the intervention school and 57 students at the control school. The V.I.K. intervention included an after-school program, a theater program, school environment components and a family component. Process data suggest that the V.I.K. program can feasibly be implemented within a school setting and can effectively engage students, school staff and parents. Analysis of impact data revealed that the percentage of students reporting being teased decreased significantly in the intervention school relative to the control school, after controlling for baseline levels of teasing, body mass index z score and demographic factors (odds ratio = 0.22; 95% confidence interval = 0.06, 0.88; P = 0.03). These findings provide promising evidence that multi-component, school-based interventions may effectively reduce teasing in elementary schools. Future research of interventions aimed at preventing teasing using a larger sample of schools is warranted.

Aggression↗
PubMed1985

A program designed to facilitate the repetitive acquisition, display, and disk storage of sensory evoked responses.

We present an algorithm that permits automated acquisition, display, and disk storage of single or dual channel sensory evoked potential waveforms using a Pathfinder II evoked response monitor. Once initiated, data acquisition and storage continue at user-specified intervals without additional user input. A cascade screen display provides trend monitoring. The file for data storage is established and searched using standard Pathfinder commands. The algorithm is written in MECOL, the Pathfinder specific programming language. This programming code imposed a number of limitations that had to be overcome to create a versatile and user friendly algorithm. During clinical use in our operating rooms, the program has been found effective and easy to use by both veteran and novice Pathfinder operators. The "hands-off" trend monitoring permitted by this algorithm has reduced the labor-intensive aspect of sensory evoked potential monitoring.

Evoked Potentials, Somatosensory↗
PubMed1983

Reliability and validity of industrial audiometry: implications for hearing conservation program design.

Hearing conservation in industry relies heavily on monitoring audiometry to detect early noise-induced hearing loss in workers who are exposed to potentially damaging noise, with or without hearing protectors. The "real-world" reliability and validity of these measurements, as well as otoscopic observations in industry, have not been extensively investigated. In addition, there is considerable controversy over the selection of a definition of "significant threshold shift" in industrial audiometry. These and related issues were considered in a series of three studies utilizing data from an active hearing conservation program. Test-retest variability in industry is much higher than has been reported for clinical settings; this variability is reduced by pure-tone averaging. Workers referred for otologic evaluation were found to have hearing levels which were, on the average, about 5 dB better than indicated by plant audiometry, even without excluding 4% of referred workers who had unilateral deafness and showed "shadow curves" on the plant audiograms. Otoscopic data obtained by the plant audiometrists were uncorrelated with the results of otoscopy by consultant otologists. Techniques borrowed from decision theory and signal detection theory were used to evaluate possible criteria for significant threshold shift. Criteria based on pure-tone averaging were superior to those based on a certain amount of threshold shift for any frequency tested. It is proposed that a significant threshold shift be defined as a 10 dB or greater change for the worse for either the 0.5, 1, 2 kHz pure-tone average or the 3, 4, 6 kHz pure-tone average, in either ear, and that such shifts be validated by prompt retesting. Even with this criterion, a substantial number of shifts (most shifts, in some situations) will be either spurious or attributable to disorders other than noise-induced hearing loss, such as presbycusis. Otologic referral in cases of large or repeated shifts may prevent unjustified administrative actions, to the advantage of both workers and management. A practical consequence of the use of monitoring audiometry may be a de facto lowering of the permissible exposure level to 85 dBA TWA.

Adult↗
PubMedDate not supplied

Level three evaluation of an education program designed to implement patient care redesign.

Patient care redesign is a process of reorienting healthcare institutions to a more patient-centered process. Inova Health System, a large Northern Virginia system, recently instituted such a redesign. The System's department of education was charged with designing a curriculum to introduce the new concept to all staff. This article analyzes the results of a survey that evaluated self-reported behaviors and attitudes of staff following attendance at the mandatory classes and discusses methodological aspects of the evaluation. The approach to evaluation discussed in this article provides a practical model for staff development educators when confronted with the task of evaluating results of educational programs.

Attitude of Health Personnel↗
PubMed1997

Lessons for program design from the PMM projects.

The Prevention of Maternal Mortality (PMM) Network designed and tested projects for reducing maternal deaths. The focus was on improving the availability, quality and utilization of emergency obstetric care (EmOC) for women with serious complications. Teams' projects included interventions in health facilities (to improve skills and services and reduce delays in treatment) and in communities (to address lack of transport, funds and information concerning obstetric complications). The teams' results, reported in this volume, offer several lessons for program planners. Despite difficult conditions in the project countries, the teams demonstrated that it is almost always possible to make improvements in the delivery of EmOC. Their work shows that EmOC can be improved not only by concentrating on hospitals and physicians, but also by focusing on peripheral facilities and other qualified staff. The teams' findings regarding utilization of EmOC suggest that more people utilize services when they know them to be functioning well. Community efforts, including education and mobilization, have a role to play in improving utilization once services are in place. Improving EmOC need not be costly, because in many areas the necessary facilities exist and staff are already in place.

Africa, Western↗
PubMed1993

Work-site physical fitness programs. Comparing the impact of different program designs on cardiovascular risks.

The relative impact of three different approaches to physical fitness at the work site on cardiovascular risk reduction is examined, based on before/after health screening of employees, and employees' reports of participation in physical exercise activities. The three approaches tested were: 1) a staffed physical fitness facility, 2) one-to-one counseling with at-risk employees, and 3) a combination of one-to-one counseling with employees plus organization of the work site to encourage peer support and mutual exercise activity at work. A fourth site is used as a control site. The program that was centered around a physical fitness facility had little measurable impact on cardiovascular risks, and showed results similar to those at the control site. Both of the other programs were more effective, with the combination of counseling and plant organization providing the best health outcomes in terms of frequency of exercise, adequacy of blood pressure control (among hypertensives), weight loss (among the overweight), and smoking cessation. These results indicate that systematic, ongoing outreach to enlist employees in various types of exercise programs is more effective than the presence of fitness facilities without such outreach. Moreover, significant increases in frequency of exercise can be sustained without a substantial investment in facilities.

Cardiovascular Diseases↗