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PubMed1991

Findings from an evaluation of PlanAlyzer's double cross-over trials of computer-based, self-paced, case-based programs in anemia and chest pain diagnosis.

We report on three years of research trials of the PlanAlyzer I Project--a carefully controlled research study using a microcomputer-based, self-paced, case-based, event-driven system for medical education. PlanAlyzer presents cases, elicits and critiques a second year student's approach to the diagnosis of anemias and chest pain. PlanAlyzer uses text, hypertext, images and critiquing theory. Students were randomized, one half becoming the experimental group who received the interactive PlanAlyzer cases in anemia, the other half becoming the controls who received the exact same content material in a text format. Later in each year there was a crossover, the controls becoming the experimentals for a similar intervention with the cardiology PlanAlyzer cases. Results at the end of the first two years of trials show that the programs have achieved some significant efficiency and economy gains. 96 faculty hours of classroom time were saved by using PlanAlyzer in their place, with no loss in student achievement. In terms of student proficiency and efficiency, combining the anemia and cardiology trials, the 328 students in the two years of full scale trials were able to accomplish the project's instructional objectives. The experimentals accomplished this in 43% less time than the controls. On the average, for both the anemia and chest pain programs, this amounted to students spending 7.5 hours longer on the 30 text cases than on the same 30 computer cases to achieve the same level of mastery. There have been no significant proficiency differences (as measured by current post-tests) between the experimental and control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia↗
PubMed1996

Administrative and technical support of ambulatory infusional cancer chemotherapy (ICC).

The term "infusion" is generally equated with the parental administration of drugs in a continuous mode of delivery over some unspecified length of time. However, in terms of applicability to this paper, ICC will imply a minimum of a 24-hour delivery schedule and may include four to 7-day schedules up to protracted infusions covering many weeks. Infusional Cancer Chemotherapy programs may employ a single drug used with or without concomitant radiation therapy or admixtures of two and three drugs. Sequential alternating infusions of drug admixtures are a common mode of treatment which allow maximization of dose with minimal side effects and toxicities. The ICC model is based on the tenet that the quality of the program is directly related to the safety, efficiency, and continuity of the care provided. The supporting structures of an ICC program are rooted in four administrative and technical requisites. Strategies for program support include: 1) a team to carry out the treatment approach and to provide instructional and physical care support; 2) pre-established guidelines, protocols, policies, and procedures by which to administer the program; 3) achievement of a safe and reliable means of venous access which promotes the outpatient status; 4) a source for an accurate and reliable ambulatory infusion device and delivery system. A referral base may encompass a wide geographical area, and the patient population may be varied as to ethnicity, intellectual capacity, age, level of activity, family support and life style, thus it is important to develop a program to support the majority of patients as opposed to the carefully selected few.

Ambulatory Care↗
PubMed1987

Optimization of beam weights under dose-volume restrictions.

A basic problem in treatment planning is the selection of weights for a set of beams which will yield the largest tumor dose under constraints limiting the doses received in specified fractions of different normal tissue structures. This report describes a method for formulating and solving this optimization problem as a combinatorial linear program. An illustration is provided by a problem in planning treatment of a thoracic tumor, in which no more than 1/2 or 2/3 of the lung is permitted to receive greater than 20 Gy and no part of the spinal cord allowed to receive greater than 45 Gy. The optimization technique was applied to this example to determine how the maximum tumor dose is affected by changes in the normal tissue constraints and the addition of a tumor dose homogeneity restriction. The linear programming technique yielded a rigorous and efficient determination of the beam weights for the thoracic plan considered. An exhaustive specification of all the underlying linear programs allows problems of moderate dimensions to be solved, while developments in mathematical programming and computer processing suggest approaches to problems of greater complexity.

Humans↗
PubMed2003

Cost-efficient vision screening for astigmatism in native american preschool children.

PURPOSE: To design and test a cost-efficient, community-based vision screening program for a population of Native American preschool children in which there is a high prevalence of astigmatism. METHODS: Based on analysis of vision screening and eye examination data from a preschool population with a 33% prevalence of astigmatism, comparative costs to conduct a 1000-child screening program with a target sensitivity of 90% were estimated for photoscreening, noncycloplegic autorefraction, autokeratometry, and Lea symbols distance visual acuity testing. Results of the cost analysis and examination of sensitivity and specificity data from the preschool population led to development of a hybrid screening program of autokeratometry and visual acuity screening with referral thresholds of 2.25 D of corneal astigmatism or inability to read a 20/63 Lea symbols line on two separate attempts. The screening program was prospectively implemented in a community-based screening of a similar cohort of 167 children, and its efficiency was evaluated by comparison to results of cycloplegic refraction. RESULTS: The community-based screening showed 96.8% sensitivity and 79.2% specificity for detecting the presence of refractive astigmatism of 1.50 D or more. CONCLUSIONS: Referring children who have at least 2.25 D of corneal astigmatism or acuity worse than 20/63 on two attempts, provides the high sensitivity and specificity associated with automated keratometry while maintaining an acuity component that can detect other causes of reduced acuity in the absence of astigmatism.

Astigmatism↗
PubMed1998

Efficient simulation of ESEEM spectra using gamma

Using the Gamma class library for C++ it is possible to write very efficient time-domain simulation programs for echo-detected pulse EPR experiments, such as three-pulse ESEEM and HYSCORE. By grouping sections of time-invariant propagators, the initial density operator and the detection operator can be re-defined, and the simulation transforms to that of a free induction decay which can be evaluated very efficiently using elements from Gamma. Compared to a straightforward implementation, reductions in computing time of up to a factor of 673 have been found. Copyright 1998 Academic Press.

Journal Article↗
PubMed2005

[Preparation of silymarin proliposomes and its pharmacokinetics in rats].

AIM: To study the preparation of silymarin proliposomes. To study its physicochemic properties, its pharmacokinetical characteristics and bioavailability in rats after oral administration. METHODS: Silymarin proliposomes were prepared by film-deposition on carriers. When the proliposomes were contacted with water to form liposome suspensions, the tests of physicochemical properties including encapsulation efficiency, particle size and stability of the formed liposome suspensions were determined by HPLC, laser-particle-sizer and etc. The concentrations of non-conjugated and overall silymarin in plasma of rats and their pharmacokinetic behaviors after oral administration were studied by RP-HPLC. The pharmacokinetic parameters were computed by software program 3P97. RESULTS: The encapsulation efficiency of silymarin liposomes could be more than 90%, with an average particle size of about 238.8 nm and a very good stability. The high bioavailability of silymarin proliposomes could be gotten by oral administration. CONCLUSION: Compared with silymarin, silymarin proliposome is a stable and easily industrialized preparation and did enchance the gastrointestinal absorption of silymarin.

Administration, Oral↗
PubMedDate not supplied

Effective health care corporate compliance.

The pace and intensity of oversight and investigation of health care organizations has greatly increased at all levels. Well run organizations with ethical management committed to following all laws and regulations are still at risk for compliance violations and punitive penalties. Under the Federal Sentencing Guidelines, organizations with an "effective" corporate compliance program may receive reduced penalties. The seven components of an effective program as defined in the guidelines are: (1) Standards and procedures; (2) oversight responsibilities; (3) employee training; (4) monitoring and auditing; (5) reporting systems; (6) enforcement and discipline; and (7) response and prevention. Lack of a compliance program needlessly exposes the organization to an avoidable risk of damage from non-compliance--whether intentional or not. Moreover, an effective program can contribute to the efficient operation of the organization and be a key piece of its corporate culture.

Fraud↗
PubMed2002

Measuring efficiency of physician practices using data envelopment analysis.

PURPOSE: Medical-group practices are becoming increasingly common-place, with more than a third of licensed physicians in the United States currently working in this mode. While previous studies have focused on physician practices, little attention has been focused specifically on the contribution of internal organizational factors to overall physician practice efficiency. This paper develops a model to help determine best practices of efficient physician offices while allowing for choices between inputs. Measuring how efficient practices provide services yields useful information to help improve performance of less efficient practices. DESIGN: Data for this study were obtained from the 1999 Medical Group Management Association (MGMA) Cost Report. In this study, 115 primary care physician practices are analyzed. Outputs are defined as gross charges; inputs include square footage and medical, technical, and administrative support personnel. METHODOLOGY: Data envelopment analysis (DEA) is used in this study to develop a model of practice outputs and inputs to help identify the most efficient medical groups. DEA is a linear programming technique that converts multiple input and output measures to a single comprehensive measure of efficiency. These practices are used as a reference set for comparisons with less efficient ones. CONCLUSION: The overall results indicate that size of physician practice does not increase efficiency. There does not appear to be extensive substitution among inputs. Compared to other practices, efficient practices seem to manage each input well.

Benchmarking↗
PubMed1989

Medicaid program; eligibility and coverage requirements--HCFA. Proposed rule.

These proposed regulations would amend the requirements for coverage of certain groups of individuals under Medicaid and the requirements for determining Medicaid eligibility. The amendments would implement or conform the regulations to various statutes, including the Tax Equity and Fiscal Responsibility Act of 1982, the Omnibus Budget Reconciliation Act of 1987, and the Medicare Catastrophic Coverage Act of 1988. The amendments also would make some administrative changes to achieve more efficient operation of the Medicaid program.

Aid to Families with Dependent Children↗
PubMed1984

Minimal interventions for weight control: a cost-effective alternative.

Two studies were conducted to evaluate simpler, less intensive interventions for weight control which presumably would be more cost-effective and efficient than a "full-length" behavioral treatment program. In Study 1, participants in a minimal intervention (MI1) program who attended no regularly scheduled meetings and initially only received three simple verbal instructions about how to lose weight, lost an average of 11.1 lb. by 7-month follow-up. Subjects in three variations of a shortened, less intensive, 6-week behavioral weight loss program lost 7.8, 6.5 and 6.3 lb. but did not significantly differ from MI1 subjects in the amount of weight lost. In Study 2, MI2 subjects lost 5.5 lb. compared to subjects in two variations of a full-length program who lost 8.1 and 11.1 lb. by 6-month follow-up. Again, none of the groups significantly differed from each other in the amount lost. It was concluded that a minimal intervention program seems to produce weight loss and to be a cost-effective and efficient method for some subjects. The difference between the two minimal intervention programs may be related to the payment of a monetary deposit; a model for future research was presented to investigate simpler, less intensive interventions in combination with more complex ones in a "stepped-care" fashion.

Adolescent↗
PubMed1989

Modulations of the in vitro translational efficiencies of Yellow Fever virus mRNAs: interactions between coding and noncoding regions.

As an approach to define the structural features within the 5' noncoding region of Yellow Fever virus (YFV) that modulate mRNA translational efficiency, we have studied how minor changes in this region affect the translational capacity in vitro of the corresponding mRNAs. A cDNA sequence coding for part of the YFV structural proteins was inserted into the vector pGEM3 containing the bacteriophage T7 promoter. This vector was engineered by site-directed mutagenesis to permit in vitro synthesis of transcripts containing only 5 vector nucleotides at their 5' end. The sequence of the YFV 5' untranslated region was further modified in order to alter the secondary structure of resulting T7 transcripts. The efficiency of these messengers in programming cell-free translation systems varied from 1- to 15-fold, correlating inversely with the potential of the 5' untranslated sequences to form stable secondary structures. A chimaeric messenger containing the YFV 5' noncoding (5' NC) region linked to a heterologous mRNA derived from Germiston virus, was tested for its in vitro translatability. We found a translational efficiency about 2-fold higher than that obtained with homologous transcripts, suggesting that YFV 5' NC region can function as a potential enhancer for gene expression. Data obtained with a series of plasmids constructed by linking the native YFV 5'NC region to various coding regions of the YFV genome indicated that interactions between the untranslated sequence and protein coding regions influence mRNAs translational efficiency.

Base Sequence↗
PubMed1987

A computerized diet analysis system for the research nutritionist.

A computerized diet analysis system can assist in the many dietary computations performed daily by the research nutritionist. When selecting a computerized diet analysis system, the research nutritionist must consider present and future needs and select a system that is accurate, efficient, and cost-effective. The purpose of this article is to review the computer needs of the research nutritionist, identify areas to be considered when selecting a diet analysis system, and describe a system that functions easily in research or clinical settings. The diet analysis system described here is interactive and easy to use and provides flexible programming to accommodate changing research or clinical needs. The nutrient data base is accurate, verified, and periodically updated by the company that provides the system. Data entry is easy, and new foods or recipes can readily be added to the nutrient data base. The system's programs and special features provide efficient, accurate methods for creating and analyzing complex research diets, analyzing nutrient intake, and reporting nutrient data.

Computer Systems↗
PubMed1988

Evaluation of a prescreening blood donor program for prevention of perinatal transfusion-acquired cytomegalovirus (CMV) infection.

The purpose of this study was to evaluate the efficacy of a prescreened CMV seronegative blood donor group in preventing transfusion-acquired CMV infection in premature infants in the perinatal period. Group 0 donors with known CMV seronegative status were recruited to supply blood to the neonatal intensive care nurseries. One hundred and twenty-seven low birth weight infants born of CMV seronegative mothers remained seronegative when blood for transfusion was screened for CMV antibody. Twenty two infants shared six units of CMV seropositive blood due to technical errors or poor sensitivity of the test kit in the initial phase of the study. Fifteen of these patients were in the study group. One infant died of immaturity at four weeks of age and two of the remaining 14 showed asymptomatic CMV infection. Another infant who received granulocyte concentrates from CMV seropositive donors had symptomatic CMV infection. Throughout the 24 month study period, blood supply to the ICN was adequate and timely. The donor seroconversion rate was 0.7% per annum. Only one infant was exposed to the risk of CMV infection due to donor seroconversion. We conclude that the prescreening donor program is a sensible and efficient approach for providing CMV seronegative blood in neonatal transfusion therapy.

Antibodies, Viral↗
PubMed2000

Immunization (EPI) in Ethiopia: acceptance, coverage, and sustainability.

Ethiopia has been engaged in expanding immunization services against the six childhood diseases since 1980. According to plans set at the beginning of the program, the country should have achieved universal child immunization by now. However, the child immunization coverage has never reached the level that is desired to curtail disease transmission and to reduce the morbidity burden associated with the target diseases. This study used the potential of social science research methods in understanding social, cultural, political and economic factors that influence the efficiency and effectiveness of immunization programs in the Ethiopian context. A better understanding of these factors is believed to improve the quality and sustainability of immunization programs. This research focused on relevant issues at micro- and macro-levels. The study basically utilized qualitative research methods involving multiple data collection tools and information sources. Factors related to acceptors, immunization service providers and organization of health services that influence the successful implementation and sustainability of the immunization program in the Ethiopian context are identified and discussed. Strengthening efforts to improve technical capacity of service providers, increasing social mobilization activities, instituting quality assurance schemes and improving management of resources (human, finance and material) are among the major recommendations.

Child↗
PubMedDate not supplied

The use of key informant networks in assessment of community health.

Program planning requires the acquisition of current, reliable information to accurately define the need for the program and to aid in developing its basic structure. In a time of financial restraint, a cost- and time-efficient method for collecting information for program development is important. This paper presents a strategy, borrowed from anthropology, that develops a network of key individuals in the community as a source of information and as a potential resource in program development. The effectiveness of this approach as a method for data collection is illustrated through application to a health and medical needs assessment of a geriatric population. A community diagnosis of this population was obtained.

Anthropology↗
PubMed2002

Cost analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality and dialysis access.

BACKGROUND: Care of patients with end-stage renal disease (ESRD) is important and resource intense. To enable ESRD programs to develop strategies for more cost-efficient care, an accurate estimate of the cost of caring for patients with ESRD is needed. METHODS: The objective of our study is to develop an updated and accurate itemized description of costs and resources required to treat patients with ESRD on dialysis therapy and contrast differences in resources required for various dialysis modalities. One hundred sixty-six patients who had been on dialysis therapy for longer than 6 months and agreed to enrollment were followed up prospectively for 1 year. Detailed information on baseline patient characteristics, including comorbidity, was collected. Costs considered included those related to outpatient dialysis care, inpatient care, outpatient nondialysis care, and physician claims. We also estimated separately the cost of maintaining the dialysis access. RESULTS: Overall annual cost of care for in-center, satellite, and home/self-care hemodialysis and peritoneal dialysis were US $51,252 (95% confidence interval [CI], 47,680 to 54,824), $42,057 (95% CI, 39,523 to 44,592), $29,961 (95% CI, 21,252 to 38,670), and $26,959 (95% CI, 23,500 to 30,416), respectively (P < 0.001). After adjustment for the effect of other important predictors of cost, such as comorbidity, these differences persisted. Among patients treated with hemodialysis, the cost of vascular access-related care was lower by more than fivefold for patients who began the study period with a functioning native arteriovenous fistula compared with those treated with a permanent catheter or synthetic graft (P < 0.001). CONCLUSION: To maximize the efficiency with which care is provided to patients with ESRD, dialysis programs should encourage the use of home/self-care hemodialysis and peritoneal dialysis.

Adult↗
PubMed1998

Security and electronic signature standards--HCFA. Proposed rule.

This rule proposes standards for the security of individual health information and electronic signature use by health plans, health care clearinghouses, and health care providers would use the security standards to develop and maintain the security of all electronic individual health information. The electronic signature standard is applicable only with respect to use with the specific transactions defined in the Health Insurance Portability and Accountability Act of 1996, and when it has been determined that an electronic signature must be used. The use of these standards would improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general. This rule would implement some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996.

Centers for Medicare and Medicaid Services, U.S.↗