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At least 1,261 records · Page 70Linked to original sources
PubMed1989

Comparative effects of driver improvement programs on crashes and violations.

Recent reviewers of well-controlled driver improvement program evaluations have suggested that some programs result in measurable reductions in violations but not crashes. A comprehensive review of 65 studies evaluating driver improvement activities was conducted to determine the generality of these findings and to explore possible explanations of the lack of correspondence between violation and crash effects. Nineteen studies evaluating 59 driver improvement activities were found to be methodologically adequate. The major findings of the review are: (1) that driver improvement activities generally do result in reductions in violations; (2) there is an unpredictable and sometimes undesirable effect on crashes even in the presence of desirable violation effects; and (3) the lack of correspondence between violation and crash effects is not explained by lack of statistical power or by the types of violations affected. Further examination of driver improvement interventions revealed no strong evidence for different effects related to characteristics such as direct vs. indirect participant contact and group vs. individual contact.

Accident Prevention↗
PubMed2001

Phase I/II trial evaluating combined radiotherapy and in situ gene therapy with or without hormonal therapy in the treatment of prostate cancer--a preliminary report.

PURPOSE: To report the preliminary results of a Phase I/II study combining radiotherapy and in situ gene therapy (adenovirus/herpes simplex virus thymidine kinase gene/valacyclovir) with or without hormonal therapy in the treatment of prostate cancer. METHODS AND MATERIALS: Arm A: low-risk patients (T1-T2a, Gleason score <7, pretreatment PSA <10) were treated with combined radio-gene therapy. A mean dose of 76 Gy was delivered to the prostate with intensity-modulated radiotherapy. Arm B: high-risk patients (T2b-T3, Gleason score >or=7, pretreatment PSA >or=10) were treated with combined radio-gene therapy and hormonal therapy. Hormonal therapy was comprised of a 4-month leuprolide injection and 2-week use of flutamide. Arm C: Stage D1 (positive pelvic lymph node) patients received the same regimen as Arm B, with the additional 45 Gy to the pelvic lymphatics. Treatment-related toxicity was assessed using Cancer Therapy Evaluation Program common toxicity score and Radiation Therapy Oncology Group (RTOG) toxicity score. RESULTS: Thirty patients (13 in Arm A, 14 in Arm B, and 3 in Arm C) completed the trial. Median follow-up was 5.5 months. Eleven patients (37%) developed flu-like symptoms (Cancer Therapy Evaluation Program Grade 1) of fatigue and chills/rigors after gene therapy injection but recovered within 24 h. Four patients (13%) and 2 patients (7%) developed Grade 1 and 2 fever, respectively. There was no patient with weight loss. One patient in Arm B developed Grade 3 elevation in liver enzyme, whereas 11 and 2 patients developed Grade 1 and 2 abnormal liver function tests. There was no Grade 2 or above hematologic toxicity. Three patients had transient rise in creatinine. There was no RTOG Grade 3 or above lower gastrointestinal toxicity. Toxicity levels were as follows: 4 patients (13%), Grade 2; 6 patients (20%), Grade 1; and 20 patients (67%), no toxicity. There was 1 patient with RTOG Grade 3 genitourinary toxicity, 12 patients (40%) with Grade 2, 8 patients (27%) with Grade 1, and 9 patients (30%) with no toxicity. No patient dropped out from the trial or had to withhold treatment because of severe toxicity. CONCLUSIONS: This is the first trial of its kind in the field of prostate cancer that aims to expand the therapeutic index of radiotherapy by combining in situ gene therapy. Initial experience has demonstrated the safety of this approach. There is no added toxicity to each therapy used alone. Long-term follow-up and larger cohort studies are warranted to evaluate long-term toxicity and efficacy.

Adenoviridae↗
PubMed1994

The use of a shared donor oocyte program to evaluate the effect of uterine senescence.

OBJECTIVE: To determine if there is reduced uterine receptivity after age 40 by the comparison of pregnancy rates (PRs) of donor oocyte recipients > or = 40 years to those under age 40. SETTING: In vitro fertilization-ET facility of a university-based practice, Cooper Institute for In Vitro Fertilization. PATIENTS: All patients registering for the shared donor oocyte program from November 1990 to September 1992. Most recipients were in ovarian failure. INTERVENTIONS: Donors were treated with luteal phase leuprolide acetate (LA) and gonadotropins; recipients were treated with oral E2 in graduated doses and 50 mg IM daily P. Endometrial thickness was considered in the decision to continue with transfer or to freeze all embryos. MAIN OUTCOME MEASURES: Pregnancy rates per transfer in recipients and live birth rates according to age > or = 40 or < 40. RESULTS: The clinical PR per transfer was 29.2% for the younger women and 25.4% for the older recipients. The live birth rate was 29.2% for the younger women and 22.4% for the older recipients. CONCLUSIONS: These data support the conclusion that, if there is a decline in uterine receptivity for embryo implantation with advancing age, it is at least remediable with hormonal adjustments.

Adult↗
PubMed1993

Combining census, dual-system, and evaluation study data to estimate population shares.

"The 1990 [U.S.] census and Post-Enumeration Survey produced census and dual system estimates (DSE) of population by domain, together with an estimated sampling covariance matrix of the DSE. Estimates of the bias of the DSE were derived from various PES evaluation programs. Of the three sources, the unadjusted census is the least variable but is believed to be the most biased, the DSE is less biased but more variable, and the bias estimates may be regarded as unbiased but are the most variable. This article addresses methods for combining the census, the DSE, and bias estimates obtained from the evaluation programs to produce accurate estimates of population shares, as measured by weighted squared- or absolute-error loss functions applied to estimated population shares of domains."

Americas↗
PubMed1991

Overview and update of the Superfund Innovative Technology Evaluation (SITE) Demonstration Program.

The Superfund Innovative Technology Evaluation (SITE) Program is now in its sixth year of demonstrating technologies applicable to Superfund sites. The SITE Program, conducted by the U.S. Environmental Protection Agency's Risk Reduction Engineering Laboratory, is intended to accelerate the use of new and innovative treatment processes as well as evaluate innovative measurement and monitoring techniques. Within the SITE Program, the Demonstration Program and the Emerging Technologies Program are responsible for innovative/alternative waste treatment technology development. Separate and parallel activities are progressing for development and evaluation of measuring and monitoring technologies as well as technology transfer operations.

Environmental Pollution↗
PubMed1994

In vitro anti-Mycobacterium avium activities of quinolones: predicted active structures and mechanistic considerations.

The relationship between the structures of quinolones and their anti-Mycobacterium avium activities has been previously derived by using the Multiple Computer-Automated Structure Evaluation program. A number of substructural constraints required to overcome the resistance of most of the strains have been identified. Nineteen new quinolones which qualify under these substructural requirements were identified by the program and subsequently tested. The results show that the substructural attributes identified by the program produced a successful a priori prediction of the anti-M. avium activities of the new quinolones. All 19 quinolones were found to be active, and 4 of them are as active or better than ciprofloxacin. With these new quinolones, the updated multiple computer-automated structure evaluation program structure-activity relationship analysis has helped to uncover additional information about the nature of the substituents at the C5 and C7 positions needed for optimal inhibitory activity. A possible explanation of drug resistance based on the observation of suicide inactivation of bacterial cytochrome P-450 by the cyclopropylamine moiety has also been proposed and is discussed in this report. Furthermore, we confirm the view that the amount of the uncharged form present in a neutral pH solution plays a crucial role in the drug's penetration ability.

4-Quinolones↗
PubMed1993

Discounting in the economic evaluation of health care interventions.

Do economic theories that underlie discounting have specific implications for program evaluation in health? In this study, both the contemporary practice and the theoretical foundations of discounting are reviewed. The social discount rate controversy is considered, and the two major concepts (i.e., opportunity cost and time preference) involved in the formulation of a social discount rate are outlined. Also described are the arguments for discounting proposed by thinkers in non-economic disciplines. Finally, the implications of choosing a discount rate for evaluation of individual health care programs are considered. It is argued that the conventional practice of discounting all health care programs at a rate of 5% may not consistently reflect societal or individual preference. Specific recommendations arising from this paper are: 1) given the considerable disagreement at the theoretical level as to the appropriate social discount rate, analysts should be specific about what theoretical approach underlies their choice of rate, especially when the analytic result is sensitive to the discount rate; 2) the discount rate chosen should be appropriate for the perspective of the analysis (social vs. individual vs. institutional, etc.); 3) when appropriate, measures should be taken to avoid double discounting, because some health related outcome measures already incorporate individuals' time preference; and 4) it is suggested that the political process may serve as the appropriate means of reflecting social values in the choice of a discount rate. In addition, the authors argue that a consensus conference approach, with political participation, offers a flexible, pragmatic, and explicit way of synthesizing the empirical, normative, and ethical considerations that underlie choice of a discount rate.

Cost of Illness↗
PubMed1992

A microcomputer program for evaluating sampling error: an application to stereological methods for electron microscopy.

In situations where there is a need to minimize sampling error or sample size, the coefficient of variation (CV) may be used to evaluate sampling error as a function of the number of observations or subjects in a sample. For example, CV is useful for estimating the minimum number of electron micrographs (Nmin) required to obtain a representative field sample for stereological analysis. To facilitate the determination of Nmin, we have written a program (COEFficient) for DOS microcomputers which calculates CVs. COEF assists the user in reducing error to that which solely reflects biological variability, thereby minimizing the time and cost of subsequent analyses.

Microcomputers↗
PubMed2003

Evaluating disease management program effectiveness: an introduction to time-series analysis.

Currently, the most widely used method in the disease management (DM) industry for evaluating program effectiveness is referred to as the "total population approach." This model is a pretest-posttest design, with the most basic limitation being that without a control group, there may be sources of bias and/or competing extraneous confounding factors that offer a plausible rationale explaining the change from baseline. Furthermore, with the current inclination of DM programs to use financial indicators rather than program-specific utilization indicators as the principal measure of program success, additional biases are introduced that may cloud evaluation results. This paper presents a non-technical introduction to time-series analysis (using disease-specific utilization measures) as an alternative, and more appropriate, approach to evaluating DM program effectiveness than the current total population approach.

Disease Management↗
PubMed1992

[Criteria for the evaluation of programs for rehabilitation of apprehended drivers].

The preparation of criteria for the judgment of programs provided for rehabilitation (re-education) of delinquent drivers is in regard of the development of these measures--likewise in European foreign countries--necessary to secure their suitableness, their effectiveness, their controlled optimization, their credibility and their quality. Only programs (courses) can be suitable, which apply for the psychological knowledge about measures for behavior modification so that it relates perfectly to the target group. These measures have to be investigated for their effectiveness--especially if they result in legal consequences. Therefore the fundamental demand of Wittmann (1985) has to be repeated: Evaluation is a necessary, unquestioned task of all social institutions, which long for a rational manifestation and justification of their activity. Finally, behavior modification of delinquent drivers require a continuous safe-guarding of their quality within the scope of the acknowledged norms in Europe.

Alcohol Drinking↗
PubMed2004

An integrated comprehensive occupational surveillance system for health care workers.

BACKGROUND: Workers in the health care industry may be exposed to a variety of work-related stressors including infectious, chemical, and physical agents; ergonomic hazards; psychological hazards; and workplace violence. Many of these hazards lack surveillance systems to evaluate exposures and health outcomes. The development and implementation of a comprehensive surveillance system within the Duke University Health System (DUHS) that tracks occupational exposures and stressors as well as injuries and illnesses among a defined population of health care workers (HCWs) is presented. METHODS: Human resources job and work location data were used to define the DUHS population at risk. Outcomes and exposure data from existing occupational health and safety programs, health promotion programs, and employee health insurance claims, were linked with human resources data and de-identified to create the Duke Health and Safety Surveillance System (DHSSS). RESULTS: The surveillance system is described and four examples are presented demonstrating how the system has successfully been used to study consequences of work-related stress, hearing conservation program evaluation, risk factors for back pain and inflammation, and exposures to blood and body fluids (BBF). CONCLUSIONS: Utilization of existing data, often collected for other purposes, can be successfully integrated and used for occupational health surveillance monitoring of HCWs. Use of the DHSSS for etiologic studies, benchmarking, and intervention program evaluation are discussed.

Health Personnel↗
PubMed2001

Approaches to risk-adjusting outcome measures applied to criminal justice involvement after community service.

The ethic of fairness in program evaluation requires that measures of behavioral health agency performance be sensitive to differences in those agencies' caseload composition. The authors describe two traditional approaches to the statistical risk adjustment of outcome measures (stratification weighting and pre-post measurement) that are designed to account for differences in caseload composition and introduce a method that incorporates the strengths of both approaches. Procedures for deriving each of these measures are described in detail and demonstrated in the evaluation of a statewide system of community-based behavioral health care programs. This evaluation examines the degree to which service recipients get into trouble with the law after treatment. Three measures are recommended for inclusion in outcome-oriented "report cards," and the interpretation of each measure is discussed. Finally, the authors suggest formats for graphic and tabular presentation of the risk-adjusted evaluation for sharing findings with diverse stakeholder groups.

Adult↗
PubMed2002

Client-service matching in substance abuse treatment for women with children.

This article addresses the relation between services matched to client-identified needs and substance abuse treatment outcomes for women with children. The study uses data collected for a program evaluation of an enhanced substance abuse services program for mothers involved with the child welfare system. In-person surveys were conducted with 183 women who were currently attending, or had recently completed substance abuse treatment. Bivariate tests and multivariate logistic regression models were conducted to assess the association between matched client-identified service needs and two treatment outcomes: substance use and satisfaction with treatment. Matched counseling services (domestic violence services, family counseling) were associated with reports of reduced substance use; matched ancillary services (housing, job training, legal services) were associated with clients' satisfaction with treatment. However, the total number of services clients received had a stronger relationship to treatment outcomes than did services matched to client-identified needs.

Case Management↗
PubMed1994

Clinical indicators as a stimulus to QA in hospitals an early report.

To increase medical staff involvement in hospital quality assurance activities and to increase the clinical component of a hospital accreditation process, the Australian Council on Health Standards (ACHS) through its Care Evaluation Program (CEP) has combined with the Medical Colleges, which are the professional associations for surgeons, internists, etc. Objective measures of care (clinical indicators) have been developed, and the first set (Hospital Wide Medical Indicators--HWMIs) was introduced into the Accreditation process from January 1993. Both quantitative and qualitative information is being received back by the Care Evaluation Program. The latter information reveals that the indicators have stimulated an increase in QA in hospitals.

Accreditation↗
PubMedDate not supplied

Operating room registered nurses internship program. A recruitment and retention strategy.

The acute nursing shortage, particularly in perioperative nursing, was a driving force for the creation of a registered nurse (RN) internship program. The program was developed according to the Association of periOperative Nurses (AORN) Standards and Recommended Practices and national practice. Program evaluations led to positive changes in the program. This article describes the process that was followed and the unique features of the program.

Education, Nursing, Continuing↗
PubMed1990

The Preventive Cardiology Academic Award program: a focus on physician education.

The National Heart, Lung, and Blood Institute (NHLBI) has funded the Preventive Cardiology Academic Award (PCAA) for more than a decade. The background for focusing on physicians in training and prevention is reviewed, as well as the status of the 49 medical schools that have received the award. This report presents a synthesis of the objectives for the award, curricular approaches, and teaching strategies employed by awardees and also the framework for program evaluation. The degree of institutionalization of the programs and the diffusion nationally as well as trends in the program over the past decade are examined.

Awards and Prizes↗
PubMed1997

The decline of youth suicidal behavior in an urban, multicultural public school system following the introduction of a suicide prevention and intervention program.

A 5-year longitudinal study of suicidal behavior of students attending Dade County Public Schools (DCPS) in Miami, Florida, between the 1989-1990 and 1993-1994 school years, is described. As the fourth largest public school system in the United States, DCPS is representative of an urban, multicultural community. The prevalence of suicidal behavior among DCPS students necessitated the development of a districtwide Suicide Prevention and School Crisis Management Program (SPSCMP), including the creation of the "Youth in Crisis Hotline." A review of eight national school districts' suicide prevention and intervention programs indicates similarities with the DCPS model. Statistical data compiled by the DCPS program are organized into annual, monthly, grade level, and school level classifications, and are analyzed to determine the degree and direction of self-destructive behavior among youth in a culturally and linguistically diverse school population following the introduction of a suicide prevention and intervention program. Evaluative data regarding the effectiveness of the program as well as implications for suicide prevention and intervention are discussed.

Adolescent↗