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Smokescreen for the 1990s is a brief program designed specifically for general practitioners to help patients to stop smoking and is based on the latest research in smoking cessation. This article looks at the major principles on which the revised program is based and outlines the key steps taken to assist smokers according to their readiness to quit.
This article presents an overview of and an insight into the world of medical screening. Specific examples of screening programs designed for a variety of employee populations with a potential for exposure to some very common and some very exotic work place hazards are provided. The benefits to be derived from such programs and some of their limitations are outlined.
Two powerful forces in Canada's health care system today are the rapidly growing seniors population and the trend toward community care. Recently, five hospitals in southwestern Ontario initiated a program designed to avert the admission of seniors to hospital and provide them with supports at home to maintain their health. Simultaneous research was conducted to assess the impact and effectiveness of the program.
Solutions to straightforward resource management problems need not always involve the use of complex, specialised and expensive software solutions. Commercially available 'off the shelf' packages have increased in flexibility and ease of use, and are usually an order of magnitude cheaper than their custom designed counterparts. In response to a request for a low cost database suitable to be used on a stand-alone microcomputer system, the widely available integrated software package Smart was used. The program specification required quantification and analysis of the workload in a medium sized operating theatre suite (at 6,000 cases/year) to be undertaken. In addition to providing Database, Spreadsheet and Wordprocessor modules, each with rapid and easy exchange of data from one module to another, Smart incorporates its own programming language. This may be used to build up complex series of instructions for data manipulation, to generate menus and create a naive user front end to the finished program. Although an adequate knowledge of database construction and basic programming are necessary, professional programming skills are not required. NOTIS, the Newham Operating Theatre Information System, is a menu driven program designed to be used by clerical staff, and accepting patient data derived from within the operating theatre. At the end of each month a set of predetermined reports are produced. These reports are designed to provide information on the workload, case type and medical personnel involvement applicable to theatre managers, anaesthetists and surgical staff.
The paper describes a program, designed for a desk-top computer, which can be used to derive the rate equations of enzyme catalysed reactions with up to ten enzyme-containing intermediates included in the mechanism. The program allows the rate equation to be presented in simplified forms of practical use and in a variety of formats.
The National Cholesterol Education Program has underscored the need for health professionals to work together to promote dietary changes and reduce blood cholesterol levels across the population. This article reports the results of an evaluation of several low-intensity intervention programs designed for the general public that could be offered on a larger scale, either through traditional outlets for short courses or on an outpatient basis after physician referral. The interventions were designed as classes, required approximately 8 hr of contact time with the participants, cost approximately $20 per participant, and were taught by nutritionists and dietitians recruited from the community and trained for this program. Results indicated that similar net reductions in total cholesterol of about 4% were achieved at 1-yr follow-up either from a course which focused on changing eating patterns or from one which focused on weight loss and weight-loss management. These results support the hypothesis that cholesterol reduction is possible with inexpensive and simple methods in healthy, low-risk populations.
OBJECTIVE: The primary aim of the present article was to identify palliative care patient populations who are willing to participate in and able to complete a group exercise/physical training program designed specifically for the individual patient. METHOD: We conducted a prospective phase II intervention study examining the willingness and ability of palliative care cancer patients to participate in a group exercise physical training program. Patients who were diagnosed with incurable cancer and had a life expectancy of less than 1 year at two outpatient clinics were invited to participate in an exercise program in the hospitals. The groups met twice a week over a 6-week period. RESULTS: One hundred one consecutive patients were asked for inclusion. Sixty-three patients agreed to participate. Sixteen (25%) of the 63 patients dropped out after consent was given, but before the program started due to medical problems, social reasons, or death. Thus, 47 patients started the exercise program. Thirteen patients withdrew during the program due to sudden death, medical problems, or social reasons. The most frequent reasons for withdrawal were increased pain or other symptoms. Thirty-four patients completed the exercise program. SIGNIFICANCE OF RESULTS: A high proportion of incurable cancer patients were willing to participate (63%) in a structured exercise program. The attrition rate was high, but despite being severely ill, 54% of the patients completed the exercise period. This shows that a physical exercise program tailored to the individual patient is feasible in this population.
OBJECTIVE: The purpose of our retrospective database analysis was to describe and evaluate the outcomes of a weight loss intervention in a community medical wellness center. RESEARCH METHODS AND PROCEDURES: Four hundred eighteen overweight and obese adults entered the program between 2001 and 2004. Forty-seven percent completed the 6-month program designed using standards and recommendations established by the NIH, the American Dietetic Association, and the American Academy of Sports Medicine. Data analysis was limited to 198 participants (142 women, 56 men) completing the program. RESULTS: Individuals completing the 6-month program averaged a weight loss of 7.3% in men and 4.7% in women. Fasting lipids and blood glucose improved in both genders regardless of age. Outcomes including BMI and lipids improved in women regardless of menopausal status or hormone replacement therapy. There was a significant correlation between percentage weight loss and number of weekly counseling sessions attended and number of visits to the wellness center for exercise. DISCUSSION: Participants who complete a structured community-based weight management program can achieve significant weight loss and improvement in cardiovascular risk factors regardless of age, gender, or menopausal status. Our analysis suggests that national treatment guidelines/recommendations for weight management can be effectively implemented in a community medical wellness center. The relatively high drop-out rate associated with this program suggests the need to identify strategies and techniques to enhance adherence and completion of programs.
PURPOSE: Our objective in this study was to compare the quality of care provided under the Minnesota Senior Health Options (MSHO), a special program designed to serve dually eligible older persons, to care provided to controls who received fee-for-service Medicare and Medicaid managed care. DESIGN AND METHODS: Two control groups were used; one was drawn from nonenrollees living in the same area (Control-In) and another from comparable individuals living in another urban area where the program was not available (Control-Out). Cohorts living in the community and in nursing homes were included. Quality measures for both groups included mortality rates, preventable hospital admissions, and preventable emergency room (ER) visits. For the community group, nursing home admission rates were also tracked. For nursing home residents, quality measures included quality indicators derived from the Minimum Data Set. RESULTS: There were no differences in mortality rates for either cohort. MSHO had fewer short-stay nursing home admissions but no difference for stays 90 days or longer. MSHO community and nursing home residents had fewer preventable hospital and ER visits compared to Control-In. There were no major differences in nursing home quality indicator rates. IMPLICATIONS: The cost of changing the model of care for dual eligibles from a mixture of fee-for-service and managed care to a merged managed-care approach cannot be readily justified by the improvements in quality observed.
OBJECTIVES: We propose and test a method for constructing episodes of care from data within administrative databases and electronic health records. SUBJECTS: We created a measure for severity of episodes of illness for 565 randomly chosen developmentally delayed children who were enrolled in the Medicaid program. DESIGN: Regression analysis was conducted to test the percentage of variance explained by our proposed mathematical model in cost of care. DATA COLLECTION: Data included both hospitalizations and clinic visits obtained from Medicaid programs from one southeastern state. METHODS: For each patient, the likelihood that two diagnoses are part of the same episode is proportional to the similarity of the two diagnoses and to the short time interval between them. When this likelihood exceeds a preset cutoff, then the two diagnoses are part of the same episode. The cutoff is estimated by selecting number of days before two very similar diagnoses are considered to be part of separate episodes. The similarity between two diagnoses is assumed to be proportional to co-occurrence of the two diagnoses within a fixed period (usually 30 days). The severity of an episode was calculated using a Muliplicative Multiattribute Utility model, where severity of each diagnosis is aggregated to estimate the overall severity of the episode. Severity of each diagnosis was assumed to be proportional to average cost of a diagnosis-if patients do not die before care is delivered. The article includes an algorithm that can classify a patient's diagnosis into episodes of care and measure severity of the episodes from date of diagnoses, code for the diagnoses, and charges for the visit. To facilitate integration with existing database, the article includes a Standard Query Language computer program. To evaluate the method of constructing episodes of care, we regressed cost of care on the patient's number of episodes of care within the year, average severity of the episodes within the year, and the interaction between number and average severity of the episodes. RESULTS: The number of episodes (alpha = .001), the average severity of the episodes (alpha = .001), and the product of the two (alpha = .001) had statistically significant relationships to the average cost of the case. The 3 variables together explained 53% of variation in yearly cost of care. CONCLUSIONS: These data suggest that our proposed mathematical approach is reasonable and produces severity scores that are predictive of objective criteria such as cost of care.
In this research we report an analysis of comments from managers and executives in healthcare organizations to provide insights into the strategic management needs of healthcare organizations. The comments were obtained as part of a survey that asked upper-level managers and executives to identify strategic management skill and knowledge needs in healthcare organizations. After completing the survey, the respondents were given the opportunity to comment on any topics of concern to them. A total of 67 comments, many of them extensive and insightful, were obtained. In this paper, we review the literature dealing with educational and developmental needs of healthcare managers. Much of this literature is academic in nature and permits an interesting comparison to the perspective of management and executive practitioners. Emerging from the literature was a concern for environmental turbulence and a recognition that healthcare managers are at risk of falling behind in terms of skill development under such conditions. Respondent comments suggested a recognition of the potential problems. The comments are classified into four major categories: needs and skills in turbulent conditions; program and educational needs; issue clarification; and additional comments. Moreover, the first two categories appeared to break out into a set of six additional themes, which we suggest will be important to those designing programs for executive development in healthcare during turbulent times. While the source of this research is healthcare settings in Canada and the USA, the findings should be applicable to international healthcare organizations that use strategic management concepts and practices.
Microprocessors have a major impact on cardiac pacemaker technology. The development of adaptive systems capable of responding to physiologic variables will ultimately improve the care of the individual patient. However, in order to minimize power drain, it will be necessary to incorporate certain functions into the hardware outside the microprocessor. In addition, specifically designed program languages may indeed become necessary.
This study assessed whether immigrant adolescents receive health education and services in schools at levels comparable to native-born peers. Surveys from 2,635 8th and 10th graders allowed comparisons between students living in the United States "always" (n = 2,080), "more than six years" (n = 299), and "six years or less" (n = 191). Immigrant students were equally likely to receive health education, more likely to use peer counseling or support groups (p < .001), and less likely to use health services (p < .05). They communicated more often with staff (p < .05), were more concerned about mental health issues (p < .01), and were likely to have these topics addressed in school (p < .05). They were more positive about health education (p < .05), learned something new (p < .01), and communicated with parents when offered (p < .001). Schools provide a critical gateway and opportunity for reaching immigrant students and families with programs designed to meet their unique health and mental health needs. Questions remain, however, about health education and services being provided to non-mainstreamed, Limited English Proficient students who recently immigrated. Implications for program and service delivery and future research are discussed.
For the past three decades, much attention has been focused on developing diversity programs designed to improve the academic success of underrepresented minorities, primarily in mathematics, science, and engineering. However, ethnic minorities remain underrepresented in science majors and careers. Over the last 10 years, the Biology Scholars Program (BSP), a diversity program at the University of California (UC), Berkeley, has worked to increase the participation and success of students majoring in the biological sciences. A quantitative comparison of students in and out of the program indicates that students in BSP graduate with a degree in biology at significantly higher rates than students not in BSP regardless of race/ethnicity. Furthermore, students who are in BSP have statistically lower high school grade point averages (GPAs) and Scholastic Achievement Test (SAT) scores than students not in BSP. African-American and Hispanic students who join BSP graduate with significantly higher UC Berkeley biology GPAs than non-BSP African-American and Hispanic students, respectively. Majority (Asian and White) students in BSP graduate with statistically similar UC GPAs despite having lower SAT scores than non-BSP majority students. Although BSP students are more successful in completing a biology degree than non-program members, the results raise a series of questions about why the program works and for whom.
To apply behavior analysis to normal adults in non institutional settings, we may have to encourage their participation in the design and implementation of behavioral technology. This study evaluates a technology by which the members of a student housing cooperative manage their own staff with a minimum of supervision by one of the program designers. This staff management system consisted of prompts, self-reports, spot checks, and contingent rent reductions. Six resident staff members performed substantially more of their assigned tasks when this system was used. In addition, the management system was acceptable to the members, was affordable, and maintained high levels of staff performance during a 5-year follow-up. Participation by the members in the design and implementation of this system appears to have been useful in helping the behavior analysts to develop an unusually durable management system.
CONTEXT: The Wellness Challenge program introduces the philosophy of the healing power of God and stresses the importance of developing a sense of spirituality in conjunction with the promotion of good health. OBJECTIVE: To employ scientific rigor to the outcome measures of the Seventh-Day Adventist Wellness Challenge program. DESIGN: A 2-tailed, paired sample t test. SETTING: East Pasco Medical Center in Zephyrhills, Fla. PARTICIPANTS: 165 participants. INTERVENTION: Presurvey, 21-day outpatient wellness intervention; postsurvey, 6 weeks after completion of the program. MAIN OUTCOME MEASURES: Changes in behaviors related to cigarette smoking, alcohol use, eating patterns, exercise, water consumption, rest, relaxation, and time spent outdoors, as well as demographic data. RESULTS: Statistically significant differences were found between the pre- and postprogram clinical and laboratory test results for the participants' blood pressure, weight, glucose levels, and cholesterol at .05 alpha. Furthermore, self-health improvements measured by a pre- and postsurvey response confirmed statistically significant improvement in participants' willingness to improve their lifestyle behaviors for a potentially greater quality of life. CONCLUSION: The Wellness Challenge program offers ways to reduce risk factors related to chronic disease while improving the quality of life within an adult population by allowing people to slowly incorporate newly acquired tools into their everyday life.
Obesity is a risk factor for a variety of chronic diseases. Although weight loss may reduce these risks, weight loss programs designed for black women have yielded mixed results. Studies suggest that religion/spirituality is a prominent component of black culture. Given this, the inclusion of religion/spirituality as an active component of a weight loss program may enhance the benefits of the program. The role of religion/spirituality, however, has not been specifically tested as a mechanism that enhances the weight loss process. This paper presents the results of "Faith on the Move," a randomized pilot study of a faith-based weight loss program for black women. The goals of the study were to estimate the effects of a 12-week culturally tailored, faith-based weight loss intervention on weight loss, dietary fat consumption and physical activity. The culturally tailored, faith-based weight loss intervention was compared to a culturally tailored weight loss intervention with no active faith component. Fifty-nine overweight/obese black women were randomized to one of the two interventions. Although the results were not statistically significant, the effect size suggests that the addition of the faith component improved results. These promising preliminary results will need to be tested in an adequately powered trial.
OBJECTIVE: The purpose of this study was to compare the quality of diabetes care provided to American Indians/Alaska Natives (AI/AN) by urban and rural Indian health programs. DESIGN: Medical record review data collected by the Indian Health Service as part of the Diabetes Care and Outcomes Audit in 2002. SETTING: Seventeen urban Indian health clinics and 225 rural Indian health programs. PATIENTS: All urban AI/AN patients (n = 710) and random sample records of rural AI/AN patients (n=1420). MAIN OUTCOMES MEASURES: Adherence to guidelines for process measures and intermediate outcomes of diabetes care. RESULTS: Compared to the rural sample, urban patients were more likely to have received diabetes education during the prior year (P < or = .05). Annual dental examinations were less common among urban patients than rural patients (19% vs 41%, P < or = .001). Completion of laboratory testing and immunizations were similar in both groups. Adjusted mean levels for intermediate outcomes of diabetes care and the percentage achieving recommended levels varied slightly but were not statistically or clinically significant. CONCLUSIONS: Few differences in the quality of diabetes care were found between urban and rural Indian health sites. Differences in the receipt of dental examinations may reflect differences in resources and staffing between urban and rural settings. This study serves as a baseline for the assessment of ongoing interventions aimed at improving the quality of care.