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Human embryonic stem cells as a model for nutritional programming: an evaluation.

Our laboratory is evaluating whether an epigenetic mechanism involving alterations in DNA methylation can alter the trajectory of embryonic/fetal development in response to maternal nutrients. A similar mechanism may operate in embryo culture environments commonly used in human assisted conception. Since developmental studies on early human embryos in utero are obviously not possible, we have begun to investigate the utility of human embryonic stem cells (hESC) to uncover potential programming mechanisms. This review highlights some of the advantages and problems associated with such a model and suggests that these issues are also broadly applicable to utility of hESC for more general toxicology and drug screening applications.

Adult↗

The Collaborative Evaluation Fellows Project. Background and overview of the model.

The Collaborative Evaluation Fellows Project (CEFP) of the American Cancer Society builds organizational capacity for evaluation by partnering with schools of public health to conduct local evaluation studies. This model was envisioned in response to the American Cancer Society's growing demand for program evaluation and the challenges of institutionalizing evaluation nationwide and at all levels of the organization. The CEFP also formalizes partnerships between the American Cancer Society and universities, and provides practical opportunities for public health graduate students and faculty. Working with an American Cancer Society evaluation facilitator and an advisory group, faculty and graduate students use a 15-step process to conduct evaluation studies at the local level. Students also can use these data for their master's these. The 15-step process is based on the utilization-focused evaluation approach and is designed to foster the use of evaluation findings by program stakeholders. The CEFP model has been implemented in American Cancer Society offices nationwide and has been replicated with another nonprofit health organization.

Cooperative Behavior↗

Former-resident self-assessment: a tool for residency program curriculum evaluation in obstetrics and gynecology.

OBJECTIVE: To determine recent residents' confidence in managing problems in obstetrics and gynecology. STUDY DESIGN: All former residents from 1998 to 2002 were invited to participate. They were asked to complete a 32-item survey to assess confidence in obstetric and gynecologic care using Likert-scale responses. The study was approved by the local institutional review board. The t test was used for statistical analysis; p<0.05 was considered significant. RESULTS: Twenty-eight individuals graduated from the program during the study period; 61% responded to the survey. Respondents reported the lowest confidence in the business aspects of medicine, gynecologic ultrasound, laparoscopically assisted hysterectomy, pessary placement and cancer staging. They reported the highest confidence in routine obstetrics, laparoscopic sterilization, contraception, abnormal Pap smears, abdominal surgery and diagnostic laparoscopy, along with other categories. CONCLUSION: Residents are confident about management of most problems in obstetrics and gynecology. Periodic review of graduates' perceptions of training may be useful in modifying the curriculum.

Clinical Competence↗

[Long-term outcomes of psychosomatic rehabilitation].

According to the latest state of research psychosomatic rehabilitation can be considered as effective and efficient. Several program-evaluation studies document process and outcomes of over 4000 psychosomatic patients in rehabilitation clinics so far. The majority of patients in all studies show positive therapy outcomes, which also can be demonstrated in follow-up investigations. Those positive results cover disease and disorder related aspects as well as cost relevant facets. This paper presents one of those program-evaluation studies which reports the outcomes of a one year and a five year follow-up respectively. It focuses on the outcomes of those subjects which participated in both inquiries. In addition to single criteria the construction of a multiple outcome criterion is discussed.

Adult↗

Tuberculosis screening. Evaluation of a food handlers' program.

An evaluation of a tuberculosis screening program for food handlers revealed an unexpectedly low cost ($45) per identifiable candidate for preventive treatment (324 of 6,090 individuals screened). Four new active cases of tuberculosis were identified, and a risk/benefit analysis projected a potential reduction of 19.4 new active cases over the subsequent ten-year period.

Adolescent↗

An expanded surgical suture and needle evaluation and selection program by a healthcare resource management group purchasing organization.

The purpose of this report is to describe an expanded suture and needle clinical evaluation program jointly designed by hospital representatives of Consorta, Inc. (Rolling Meadows, Illinois), a leading healthcare resource management and group purchasing organization, and United States Surgical/Davis & Geck Sutures (Division of United States Surgical, Norwalk, Connecticut). In this expanded evaluation program, 42 Consorta shareholder hospitals enrolled 1913 surgeons to participate in Phase II of this non-experimental observational study of the clinical performance of surgical needles and sutures. Performance characteristics of the sutures and needles produced by USS/DG that were evaluated in 25,545 surgical procedures included packaging/ease of opening, needle strength and sharpness, tissue drag, knot security, tensile strength, clinically acceptable determinations, and clinically unacceptable determinations. In these 30-day studies, the surgeons found that the needles and sutures were clinically acceptable in 98.1% of the evaluations. The general, cardiothoracic, and orthopedic surgeons who performed 61.2% of the product evaluations reported that the suture and needle products were clinically acceptable in 98.2% of the evaluations. Nearly half (49.2%) of the evaluations involved the POLYSORB* braided synthetic sutures that received a clinically acceptable rating in 98.2% of the evaluation. The silk suture (SOFSILK*), followed by the monofilament nylon suture (MONOSOF*), were the next most frequently used sutures. The SOFSILK* was found to be clinically acceptable in 99.2% of the evaluations, while MONOSOF* was noted to be clinically acceptable in 98.7% of the evaluations. Surgical needles made by USS/DG Sutures also had a high rating of clinical acceptability (97.9%).

Evaluation Studies as Topic↗

[A PC program for evaluating electrophysiologic signals of mammalian eyes].

BACKGROUND: Electrophysiological measurements in the mammalian eye in vivo or in vitro, i.e. in the arterially perfused cat eye, require storage and analysis of a large amount of data: light-evoked signals, including the electroretinogram (ERG) and the optic nerve response (ONR) are stimulus-related and have to be measured in a triggered mode, whereas the DC-standing potential and flow rate of perfusion medium should be measured continuously. METHOD AND RESULT: In order to facilitate the analysis of these various signals, we developed a computer program, that allows an on-line data analysis and a trend indication for pharmacologically induced changes in signal size as well as efficient storage. The flexible system is based on a "labview" program, the application and efficiency of which are discussed.

Animals↗

[A method of computer-assisted evaluation of programmed single stimulation for determination of sinoatrial conduction time].

The determination of the sino-atrial conduction time by means of premature individual atrial stimulation is an important partial function in the intracardial sino-atrial functional test and a reasonable parameter in selected diagnostic questions for the clarification of syncopic conditions under suspicion of a sick-sinus syndrome. In order to alleviate the clinical use and to reduce the considerable expenditure of time in the calculation of the results for the determination of the sino-atrial conduction time by about 60% a computerized evaluation method was elaborated. This methodology resulted in an exoneration from the manual graphic-calculatory expenditure and in comparison to the traditional calculation method it did not show any statistically significant differences.

Computers↗

Improving chest pain evaluation within a multihospital network by the use of emergency department observation units.

BACKGROUND: Since 1993 the 13 VHA Southern New England (VHA-SNE) hospitals have been engaged in a regionally sponsored initiative to analyze and improve selected clinical processes. Nine of these hospitals have chosen to participate in an initiative in which observation units were postulated to offer a tool for improving the care of patients with chest pain-the VHA initiative to Implement Chest Pain Treatment in Observation Units. THE FIVE PHASES: In phase 1 of the initiative, the VHA-SNE's Clinical Benchmarking Work Group reviewed the medical literature, which confirmed longstanding systemic and pervasive problems in the evaluation of chest pain patients. The work group's preferred practice was the outpatient "rule out myocardial infarction [MI] evaluation" program during monitored observation; serial testing can accurately diagnose low- and moderate-probability patients with MI. In Phase 2 the study group surveyed the emergency departments in the nine hospitals, discovering significant variation in admission rates and practice patterns. During phase 3 the work group identified a health care organization demonstrating best-practice performance--one of the few hospitals in the nation with an operational outpatient "rule out MI evaluation" program. A team site-visited that organization and recorded information about its structure and processes. VHA-SNE then published a monograph that identified its current performance, described the best-practice approach, offered strategies to implement the model program, and analyzed the financial implications and return on investment. In phase 4 a pilot hospital implemented the model program, which in phase 5 is being extended to the other hospitals represented in the work group. Information regarding protocols, lessons learned, and barriers to implementation was freely provided.

Chest Pain↗

MedDietScore: a computer program that evaluates the adherence to the Mediterranean dietary pattern and its relation to cardiovascular disease risk.

Mediterranean dietary traditions have long been associated with lower mortality rates and better health status. The Mediterranean dietary pattern has become customary to be represented in the form of a pyramid, the base of which refers to foods which are suggested to be consumed most frequently and the top of the pyramid to those foods consumed rarely. Recently, an index (diet score) that estimates the adherence level to Mediterranean diet was developed and associated with cardiovascular disease risk and biomarkers. In this work we present a computer program that can easily calculate this diet score, as well as its association with cardiovascular disease risk. The application of this software to the general public might be a useful tool for the reduction of the disease burden related with nutritional habits at population level.

Biomarkers↗

How does studying schizotypal personality disorder inform us about the prodrome of schizophrenia?

An increasing emphasis in the schizophrenia literature has been on the prodromal phase of the illness. The study of schizophrenia spectrum illness, including schizotypal personality disorder, has added important insight into the etiology, neuropathology, and treatment of schizophrenia, which can facilitate early identification, intervention, and perhaps prevention of the illness. The heterogeneity of the schizophrenia spectrum makes its definition elusive at best. The primary aim of the Cognitive Assessment and Risk Evaluation Program at the authors' institution is to combine the current knowledge of clinical and demographic risk factors for schizophrenia with the rapidly emerging data on vulnerability markers, or endophenotypes, that are associated with schizophrenia. The use of brain-based vulnerability markers may help to identify neurobiologically and clinically meaningful subgroups within this heterogeneous population of individuals in the early stages of schizophrenia. Another important aim of the Cognitive Assessment and Risk Evaluation program is to thoroughly assess those individuals who have not converted to psychosis to understand potential protective factors, reduce the rate of false positives, and decrease disability. The current review details a strategy for researching the schizophrenia prodrome by using information gained from research in schizotypal personality disorder.

Brain↗

The program effect of batterer programs in three cities.

Recent meta-analyses and experimental designs of batterer program evaluations suggest little or no program effect. This finding may be compromised by a variety of analytical issues. Instrumental variable analysis addresses some of these issues, especially the relationship of program dropout to batterer reassault. This method of analysis was, therefore, used to test for program effect in a multi-site evaluation. The sites were three well-established batterer programs using a gender-based, cognitive-behavioral approach (n = 640). Completing a batterer program reduced the likelihood of reassault by 44% to 64%, depending on the specification used. Completing a 3-month program appeared to be as effective as completing a 5 1/2- or 9-month program. This moderate effect is an accomplishment considering the problems associated with the program participants and the inconsistency in the criminal justice system at the research sites. The findings remain tentative because of weak instrumental variables for reassault, but do confirm the need for more complex analyses of program effect.

Colorado↗

Computerized data bases: an integrated approach to monitoring quality of patient care.

Common information is shared by rehabilitation program evaluation, utilization review, and quality assurance. These administrative functions sometimes operate in isolation, not taking advantage of information sharing. This approach fails to recognize the potential for increased efficiency of integrating pertinent information to produce timely and useful reports. We report on a system design which addresses this concern by encouraging information sharing, reducing data duplication and creating a data base to produce needed statistical and management reports. Our discussion highlights the key elements of program evaluation, utilization review, and quality assurance. These elements are described as an integrated approach to meet the Commission on Accreditation of Rehabilitation Facilities and revised Joint Commission on Accreditation of Hospitals standards.

Database Management Systems↗

A toxicology program for evaluating the safety of a chemical warfare decontaminant.

An ideal topical decontaminant for chemical warfare agents should be highly efficacious, easy to use, and have low toxicity. For toxicity assessment, a stepwise approach linking type of toxicity study to stage of decontaminant development is both efficient and economical. In the initial exploratory phase, range-finding acute toxicity studies using a few animals will suffice to screen out highly toxic decontaminants . More definitive acute toxicity studies and a short term mutagenic test are sufficient during the live agent efficacy testing phase. When an efficacious decontaminant is found and is ready to be formulated into a product, a more extensive toxicologic program including a 2-week dermal toxicity study, a skin sensitization study, and an inhalation study (for aerosol or powder formulations) should be implemented before clinical trials.

Animals↗

Methods for quality adjustment of life years.

Several valuation techniques are in use for quality adjusting life years in cost utility analysis. The paper gives an overview of the variability in results. A close inspection of a number of instruments with respect to their theme, instructions, decision framing and the phrasing of questions make many of the observed differences in results understandable. When judging the validity of the different techniques, three points should be kept in mind. One is that statements about validity should be made with respect to concrete versions rather than broad categories like 'the rating scale', 'time trade-off' etc. Another point is that a valuation technique that is valid in clinical decision analysis may not be valid in health program evaluation, and vice versa. The third point is that quality weights for life years are empirically more meaningful, in the sense that they are more amenable to empirical testing, if they are interpreted simply as preference weights rather than measures of amounts of well life in the utilitarian tradition. Time trade-off with a moderate time horizon is recommended in clinical decision analysis, while a combination of time trade-off and a variant of person trade-off is recommended in health program evaluation.

Attitude to Health↗

Dialogue boxes: a tool for collaborative process evaluation.

Process evaluation is now a core component of health promotion program evaluations. Over the past decade, considerable attention and resources were devoted to developing sensitive and collaborative process evaluation methodologies. These efforts share the broad commitments that process evaluation should (a) support program goals and objectives, (b) lead to program improvement, and (c) whenever possible, develop evaluation capacity among participants. This article describes dialogue boxes, a process evaluation tool that has proven extremely useful in diverse health promotion program and planning efforts. The tool itself is described, along with eight lessons learned about the power of this seemingly simple evaluation method, comments about the challenges of this type of process evaluation, and tips for using dialogue boxes in health promotion planning and programs.

Communication↗

Measuring self-reported sunburn: challenges and recommendations.

Sunburn is a major preventable risk associated with the development of malignant melanoma and basal cell carcinoma. Thus, it is considered a key epidemiological concept to assess in prevention research and a core component of routine behavioural surveillance and program evaluation efforts. This review examined 38 English- language survey instruments and research reports published between 1990 and 1999 that used self-report data or parent-proxy reports of sunburn outcome. A qualitative review of the instruments and reports identified several methodological issues: the conceptual and operation definitions of sunburn; the recall period, and the use of self-reports and parent-proxy reports. As there was little consistency in definitional issues or recall periods across the studies, it is difficult to meaningfully compare their findings. Key issues that program evaluators and researchers should consider in determining the strengths and limitations of various definitions, measures and approaches are examined. Recommendations for measurement of sunburn and for further research are included.

Adolescent↗

An evaluation model for psychoeducational interventions using interactive multimedia.

A review of published evaluations of psychoeducational interventions using interactive digital multimedia shows that evaluations typically address only some of the areas that collectively would constitute a comprehensive evaluation. There appears to be a need for an accepted standard for these evaluations, based on a general evaluation model that encompasses all relevant aspects of development, efficacy and use of multimedia interventions. A comprehensive model is proposed which includes special features of multimedia interventions that lead to unique evaluation requirements. The model integrates relevant aspects of program evaluation and clinical trials models in order to provide a unique model that includes all the evaluation domains relevant to digital multimedia interventions. These include evaluation of intervention theory, intervention design strategies, the formative process, intervention efficacy (process and outcome) and contextual issues such as evaluability assessment, reporting and stakeholder issues. The application of individual components of the model is illustrated with reference to problems in the evaluation literature on a particular type of digital multimedia intervention, electroencephalographic biofeedback for Attention-Deficit/Hyperactivity Disorder. The model should be useful for researchers planning evaluations of digital multimedia interventions, especially in the psychoeducational domain. This paper provides a theoretical and evidential background for the evaluation model, and includes a checklist and flowchart for the planning and conduct of the evaluation.

Attention Deficit Disorder with Hyperactivity↗