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PubMed1999

[The effect of selected prophylactic-educational programs on oral hygiene, periodontium and caries in school children during a 4-year observation].

The aim of the work was the continuation of the evaluation of the efficacy of three prophylactic-educational programs in the field of oral cavity hygiene, status of periodontium and dental caries, and their influence on the forming of pro-health awareness and correct hygiene habits among school children. The work under discussion is the second stage of observations of the above-mentioned programs as well as the complete evaluation of 4-years examinations. The clinical and questionnaire studies were carried out in two elementary schools in Szczecin. Two hundred and twenty-three pupils were randomly allocated to three test groups: I (45 children), II (71 children), III (60 children) and control group K (47 children). In both schools mentioned above the examinations started when children were 7-8 years old and all of them were receiving planned stomatological treatment and contact fluoridation. All programs of the second stage of studies were the same as those of the first stage [49], only with the modified frequency of meetings with children. Program I, carried out in group I, was based on individual, motivating instructions of oral cavity hygiene (total 10 meetings during second stage of research). Programs II and III (group II and III accordingly) were expanded by educational activity among children and their parents. Additionally program III was enriched by professional mechanical tooth-cleaning, the use of fissure sealants, intensive dental care and proximal surface cleaning with dental floss (Tab. 1). The above-mentioned programs were carried out in co-operation with school dentists, teachers, fifth year dentistry students and students from Medical College--Oral Hygienist Faculty. After 4-years-long studies the evaluation of the three above-mentioned programs in oral cavity hygiene was achieved by using OHI-S and PI(QH). The status of periodontium was evaluated by GI and the intensity of dental caries by DMFT and DMFS. The increase of caries during the second stage of examinations was additionally evaluated and analysed thoroughly. The questionnaire studies made it possible to estimate the changes in the pro-health awareness among examined children. Reduction of OHI-S after 4 years was about 23% to 26% (Fig. 1). The status of gums shows the state of oral cavity hygiene in a better way. In control group the state remained unchanged, but in groups I, II and III it improved considerably (reduction of GI about 46% to 79%--Fig. 2). The reduction of caries in examined groups obtained after 4 years of studies was about 25% to 77% (Fig. 3) however during the second stage of research if figured out from 17% up to 72% (Fig. 4). Extreme increase of DS observed in the second stage of studies was 2.0 in control group K, a little less--1.51 in group I and 0.38 in group III (Fig. 5). The DS in group III reached the value -0.27 which proved that program III was the most efficient. The results of questionnaire studies showed a distinct improvement of health awareness among examined children. However the value of GI indicated some discrepancy between children's health knowledge and pro-health behaviour. Also it was noticed that the level of parents' education and their socioeconomic status had influence on building up good hygiene habits and on the state of caries among the examined children. The studies proved that the implementation of the above-mentioned prophylactic-educational programs or similar ones in elementary school conditions is possible with the use of hygienist under the dentist's supervision.

Child↗
PubMedDate not supplied

Economic considerations for aortic surgery: retroperitoneal approach--is it worth it?

BACKGROUND: Planned reductions in reimbursement for all forms of vascular surgery dictate a need for the development of more cost efficient, yet quality oriented, treatment programs. We are faced with an increasingly older patient population with multiple comorbidities. In this environment it will become extremely difficult to accomplish aortic surgery in a way which will be profitable for our hospitals. More than 100,000 aortic surgeries are performed annually in the United States. Previous reports suggest that earlier hospital discharges and reduced postoperative complications occur when a retroperitoneal approach is used for aortic surgery. Other publications refute this concept. In an effort to determine the most cost efficient method for aortic surgery in our institution, while maintaining high standards of care and outcome, we compared the retroperitoneal approach to the conventional transperitoneal aortic operation. PATIENTS AND METHODS: Between December 1995 and April 1998, 120 patients underwent aortic surgery by either the transperitoneal (n = 60) or retroperitoneal approach (n = 60). All patients were enrolled prospectively in a vascular registry and retrospectively reviewed. Patients were randomly assigned to one of three vascular surgeons. A clinical pathway for elective aortic surgery was developed and applied to both groups. Patients were evaluated with respect to demographics, comorbidities, preoperative risk stratification, conduct of the operative procedure, length of stay, complications, cost, clinical outcomes and patient satisfaction. The indications for aortic surgery were similar in both groups--64% for aneurysm disease and 36% for occlusive disease. Both symptomatic and asymptomatic aneurysms were included and size ranged from 4.4 cm to 14 cm. All aortic reconstructions were done in the standard manner using knitted Dacron velour prostheses in either the aortic tube, bi-iliac or bi-femoral configuration. Statistical analysis of means and medians was accomplished using the Wilcoxin Rank-sum test and percentages were compared using Fisher's Exact test. P values less than 0.05 indicate statistical significance. RESULTS: There were no statistically significant differences in patient demographics. The incidence of atherosclerotic coronary artery disease, obstructive pulmonary disease, diabetes, hyperlipidemia, tobacco abuse, distal lower extremity occlusive disease and the results of chemical myocardial stress evaluations were similar in both groups. Comorbidities of preexisting renal insufficiency/failure and morbid obesity were increased in the retroperitoneal group. Five patients in the retroperitoneal group represented redo aortic surgery and there were no redo procedures in the transperitoneal group. Length of operative procedures and blood replacement requirements for both groups were similar. The transperitoneal group required 2-3 liters more intraoperative intravenous (i.v.) crystalloid than the retroperitoneal group (p < 0.0001). Statistically significant reductions in ICU days, postoperative ileus and total lengths of stay were observed in the retroperitoneal group (p < 0.0001). This resulted in substantial reductions in hospital costs for the retroperitoneal group (p < 0.01). Postoperative complications were similar for both groups except for statistically significant increases in pulmonary edema (p < 0.01) and pneumonia (p < 0.001) in the transperitoneal group. Cardiac arrhythmias, primarily atrial dysrhythmias, were more frequent in the transperitoneal group but this failed to reach statistical significance (p < 0.16). Combined thirty day mortality was 0.9%. Time of recovery to full activity and patient satisfaction substantially favored the retroperitoneal group. CONCLUSION: Our clinical pathway and algorithm for aortic surgery was easily followed by those patients in the retroperitoneal approach group and resulted in decreases in ICU time, postoperative ileus, volume of intraoperative crystalloid and total length of stay. The patients in the transperitoneal group often failed to progress appropriately on the pathway. Reduced hospital costs associated with aortic surgery using the retroperitoneal approach has increased the profitability for this surgery in our institution by an average of $4000 per case and has increased the value (quality/cost) of this surgery to our patients and our institution. This was accomplished in an academic environment with surgical residency training where cost containment has historically been difficult.

Aorta↗
PubMed1996

Costs in Perspective: Understanding Cost-Effectiveness Analysis.

This paper covers five questions: (1) What is cost-effectiveness analysis;quest; (2) How can cost-effectiveness analysis help policymakers allocate scarce resources;quest; (3) What are misconceptions about the cost effectiveness of health care interventions;quest; (4) What is an attractive cost-effectiveness ratio;quest; (5) What is the relevance of cost effectiveness to clinicians? The cost side of the equation includes more than simply the cost of the intervention, but rather the cost of all of the downstream clinical events that occur with either therapeutic alternative. Cost-effectiveness analyses are used to help decisionmakers rank programs competing for scarce resources in order to achieve the following objective: to maximize the net health benefits derived from a fixed budget for a target population. A simple example is shown. Measured cost-effectiveness ratios for selected cardiovascular interventions are displayed. The systematic use of information on effectiveness and cost effectiveness should help those involved in setting policies to have a more rational basis for funding of new programs and discontinuation of funding for old programs. In Canadian health care it is important that we use this information to make room for innovations that are effective and efficient, and to remove funding from programs that are either known to be ineffective and costly or inefficient use of resources. More energy should be put toward generating the information necessary to make these kinds of decisions.

Journal Article↗
PubMed1993

Dissemination and use of a school-based nutrition education program for secondary school students.

Program dissemination and implementation represent critical components of effective school-based health promotion interventions. This study examined the dissemination and implementation of a nutrition teaching program, Nutrition For Life, in New York State secondary schools. Some 1,312 health, home economics, and physical education teachers in junior and senior high schools provided information through random sample mail surveys. Logistic regression procedures examined teacher and school characteristics associated with receipt and use of the program. Overall, 50% of junior high school and 33% of senior high school teachers received the program and three-quarters of these teachers used it. At both levels, home economics teachers were more likely to receive and use the program than health teachers. Peer-led teacher training workshops organized through an existing community-based network provide an effective and efficient mechanism for disseminating nutrition teaching programs.

Adolescent↗
PubMed2002

Urging health system research: identifying gaps and fortifying tuberculosis control in Pakistan.

AIM: To assess the significance of health system research in reducing the burden of tuberculosis and improving the performance of National Tuberculosis Control Program in Pakistan. METHOD: Qualitative and quantitative content analysis of research papers on tuberculosis and influence of the research knowledge on the efficiency of the National Tuberculosis Control Program. RESULTS: We analyzed 268 research papers on tuberculosis in Pakistan published in the 1960-2002 period, from both national and international perspectives. The majority of the studies covered epidemiology of tuberculosis (n=76) in Pakistan, whereas the rest of the papers addressed issues like pediatric tuberculosis (n=53), tuberculosis among Pakistani immigrants (n=35), tuberculosis-HIV synergism (n=24), care seeking (n=19), adherence with tuberculosis treatment (n=14), tuberculosis among women (n=12), tuberculosis prevention (n=12), directly observed treatment short-course (DOTS) strategy modification (n=5), tuberculosis drug resistance (n=7), operational research (n=5), tuberculosis case management (n=4), and research on Mycobacterium (n=2). Qualitative analysis revealed that research and spending on tuberculosis policy and nationwide tuberculosis interventions are not sufficient. Available research knowledge has not yet been translated into the tuberculosis policy and interventions. Furthermore, the lack of insight of the health system on community dynamics and tuberculosis intervention has led to failure in achieving the desired targets in tuberculosis control. CONCLUSION: Health system in Pakistan needs to improve tuberculosis control interventions by conducting extensive research on the various potential weaknesses in the field. For an effective tuberculosis eradication program in a highly endemic country such as Pakistan, health system research should be an integral part of the National Tuberculosis Control Program.

Child↗
PubMed2000

Where are the economic guidelines coming from?

Economic guidelines recommend methods that should be employed in conducting economic evaluations of healthcare programs. The nature of the efficiency or equity goal underpinning economic guidelines is unclear. What is also unclear is how the methods recommended in the guidelines are linked to the underlying efficiency or equity goal being targeted. If it is unclear what efficiency/equity objectives are being pursued, then it is unlikely that even full implementation of economic guidelines will improve resource allocation.

Cost Control↗
PubMedDate not supplied

Linking outcomes management and practice improvement. The link between outcomes management and JCAHO functions.

Staff participating in the CABG outcomes management program continue to examine the effectiveness and efficiency of care processes and to redesign care to improve patient and organizational outcomes. In fact, this quality enhancement program is neverending as we strive continually to improve the care of CABG patients. The success, measured through improved process and outcome variables, has promoted the implementation of similar programs for other patient populations. Using foresight in the development of outcomes management programs to ensure inclusiveness of regulatory body or agency criteria encourages comprehensive programs that yield positive outcomes for both patients and organizations.

Coronary Artery Bypass↗
PubMedDate not supplied

Snow skiing injuries in physically disabled skiers.

This study, through retrospective review, examines the injury rate of selected disable skiing populations in general and as compared to able-bodied skiers in areas where comparison was possible. Data on disabled skiers gathered from instructional programs at multiple sites indicate that the disabled skier had a very low rate of injury occurrence. Where comparison could be make, it was found that there was no significant difference in overall injury rates between able-bodied and physically disabled skiers. Disabled skiers appear to sustain less severe injuries, and they do not show the trend in increasing injury rates that able-bodied skiers in this study show. In addition, the uphill transport of skiers with a disability who use sit- or mono-skis was examined in one large program and found to be efficient and exceedingly safe, with no injuries reported. A major limitation of this study is the inconsistency in methods of data collection and reporting. There is a need for further prospective studies in the general able-bodied and disabled skiing populations with direct comparisons of rate, location and severity of injury, type of disability, and experience level of the skier. We hope that this study will stimulate more ski areas to allow disabled skiers on their slopes, even it limited to participation in supervised, instructional programs.

Athletic Injuries↗
PubMed2005

Use of quality index in the evaluation of organ procurement and transplant programs in a University Hospital.

AIM: To evaluate organ procurement efficiency at Hospital Clinic of Barcelona (HCP), a University Hospital, in 2000 and 2003 compared with other Catalan, other Spanish, and American (US) results. METHODS: Efficacy rate of the donor procurement was calculated per million population per year (pmp/y). Efficacy rate in kidney, liver, and heart transplantation was calculated also in pmp/y. We evaluated 1-year graft survival. RESULTS: During this period, the average rate number of donors was 49.1 pmp/y in HCP, 38 in Catalonia, 33.4 in Spain, and 21.7 in the United States. The average rate of kidney transplantation was 74 pmp/y in HCP, 55 in Catalonia, 47 in Spain, and 24.6 in the United States. The average rate of liver transplantation was 44.5, 26.6, 23.2, and 18 pmp/y, respectively. The average rate of heart transplantation was 13.3, 8.5, 7.8, and 6.4 pmp/y, respectively. One-year graft survival in HCP was 90.6% for kidney, 89.5% for liver, and 88.2% for heart transplants. DISCUSSION: The results show that organ procurement and transplantation programs in HCP are efficient. The organizational model is based on a hospital transplant coordinator and efficient, well-trained transplant teams.

Graft Survival↗
PubMed1989

Medicaid program; eligibility determinations based on disability--HCFA. Final rule.

This final rule specifies HCFA's policy concerning the relationship between State Medicaid eligibility determinations based on disability and disability determinations made by the Social Security Administration (SSA) under the Supplemental Security Income (SSI) program. The rule clarifies the controlling nature of SSA determinations of disability, specifies when the State Medicaid agency must make independent disability determinations, clarifies the terminology used to describe the composition of the review team and the information considered under Medicaid in making disability determinations, and extends the Medicaid time limit for making eligibility determinations based on disability from 60 days to 90 days to ensure maximum uniformity in the disability determination process used by SSA and the State Medicaid agencies. These changes will enhance the effective and efficient administration of the Medicaid program.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Using administrative data to reward agency performance: the case of the federal adoption incentive program.

This article explores the history of the federal Adoption Incentive Program, the first federal child welfare outcome-based incentive program to rely solely on administrative data, and discusses it within the context of other prior and ongoing federal child welfare incentive programs. Various data-related issues are also examined, including the use of data to project program utilization and costs, set baselines for the number of adoptions, and award funds. Challenges in the legislatively required use of AFCARS data for determining the amount of incentive funds awarded and the impact of the program on AFCARS reporting are also discussed. The article concludes with a look at the impact of the Adoption Incentive Program on adoption and predictions for the future.

Adoption↗
PubMedDate not supplied

Case management for the subacute patient in a skilled nursing facility.

The goal of case management has always been to manage care, cost, and outcomes. The Balanced Budget Act of 1997 and the subsequent implementation of managed care and the prospective payment system have introduced many challenges to the postacute care delivery system. The implementation of sound clinical, fiscal, and operational strategies is critical to the continued delivery of quality services and the maximization of revenue. The implementation of case management principles provides an opportunity to balance care with cost. This article focuses on the development and implementation of a case management program at a skilled nursing facility that specifically addresses the needs of a subacute population. The program's purpose is to promote efficiency, efficacy, and effectiveness of services for short-term subacute patients who will eventually return to the community. The long-term goal of the program is to classify all patients into case management categories and assign them to RN case managers or social workers, based on acuity and need.

Case Management↗
PubMed1989

Case management in a community-based AIDS agency.

The case management program at APLA hastens the receipt of medical, psychological, and social services to persons diagnosed with AIDS and ARC. The design accommodates the unique problems encountered by this client population that are created largely by the stigma and fear associated with HIV infection in the United States. As a community-based AIDS agency, APLA expediently uses the services of professional and paraprofessional volunteers to extend the capacity of case management staff. The complexity of care associated with HIV infection has demanded the development of a sophisticated information management system to improve the communications and the efficiency of the case management program.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Structure generation by reduction: a new strategy for computer-assisted structure elucidation.

A problem common to computer programs for structure elucidation is the efficient and prospective use of the input information to constrain the structure generation process. The input may consist of potentially overlapping substructure requirements and alternative substructure interpretations of spectral data. Other useful information may be structural features that must not be present in the output structures. All of these may interact in a complex manner that is impossible to determine by use of a bond-by-bond structure assembly algorithm. A new method is described called structure reduction. In contrast to structure assembly, this method begins with a set of all bonds and removes inconsistent bonds as structure generation progresses. This results in a more efficient use of the input information and the ability to use potentially overlapping required substructures. Several examples illustrate the application of our computer program COCOA, which uses this method to solve real-world structure elucidation problems.

Chemical Phenomena↗
PubMed2005

Incremental cost-effectiveness ratios (ICERs): the silence of the lambda.

Despite the central role of the threshold incremental cost-effectiveness ratio (ICER), or lambda (lambda), in the methods and application of cost-effective analysis (CEA), little attention has been given to the determining the value of lambda. In this paper we consider 'what explains the silence of the lambda'? The concept of the threshold ICER is critically appraised. We show that there is 'silence of the lambda' with respect to justification of the value of ICER thresholds, their use in decision-making and their relationship to the opportunity cost of marginal resources. Moreover, the 'sound of silence' extends to both 'automatic cut-off' and more sophisticated approaches to the use of lambda in determining recommendations about health care programs. We argue that the threshold value provides no useful information for determining the efficiency of using available resources to support new health care programs. On the contrary, the threshold approach has lead to decisions that resulted in increased expenditures on health care programs and concerns about the sustainability of public funding for health care programs without any evidence of increases in total health gains. To improve efficiency in resource allocation, decision-makers need information about the opportunity costs of programs.

Cost-Benefit Analysis↗
PubMed1975

Mobilization of duplicates in a Regional Medical Library Program.

An overabundance of duplicate journals without an efficient and economical method of distribution caused one library's staff to reassess traditional methods of dispersal. A simplified form for listing duplicates was devised. In conjunction with the Regional Medical Library Program and the extension program, lists of duplicates were distributed to hospital and clinical libraries. These libraries selected materials to strengthen their ability to fill information needs at the local level and to conserve RMLP support for esoteric and expensive materials. In a two-year period, 86,000 individual pieces were distributed. Some lessening of interlibrary loan requests from heavy users was documented. In an evaluation survey users expressed satisfaction with the program. The successful use of the duplicate program will lead to a further experiment--the library will attempt to fill interlibrary loan requests for common journals with hard copy rather than photocopy in a cost and time reduction effort.

Book Collecting↗
PubMed2006

AGO1 homeostasis entails coexpression of MIR168 and AGO1 and preferential stabilization of miR168 by AGO1.

Arabidopsis ARGONAUTE1 (AGO1) encodes the RNA slicer enzyme of the microRNA (miRNA) pathway and is regulated by miR168-programmed, AGO1-catalyzed mRNA cleavage. Here, we describe two additional regulatory processes required for AGO1 homeostasis: transcriptional coregulation of MIR168 and AGO1 genes, and posttranscriptional stabilization of miR168 by AGO1. Disrupting any of these regulatory processes by using mutations or transgenes disturbs a proper functioning of the miRNA pathway. In contrast, minor perturbation leads to fine-tuned posttranscriptional adjustment of miR168 and AGO1 levels, thereby maintaining a proper balance of other miRNAs, which, together with AGO1, control the mRNA levels of miRNA targets. We suggest that miR168 stabilization occurs at the level of silencing-complex assembly and that modulating the efficiency of assembling miRNA-programmed silencing complexes will also be important in other contexts.

Arabidopsis↗
PubMed1987

Resident performance evaluation.

The authors have developed a resident evaluation system that minimizes inefficiencies and achieves the aims of evaluation. Individual resident performance is evaluated on each monthly rotation by those who have had significant contact with him as determined by the resident. Residents are rated as "below," "adequate," or "above" for these performance categories: (1) overall performance, (2) basic knowledge, (3) organizational skills, (4) communication skills, (5) interpersonal relationships, and (6) other areas and comments. The results are shared with the resident in a feedback session and recommendations made. These evaluations are summarized and discussed with the resident by the program director at the end of each year. This system has proved to be an efficient use of attending radiologist's and program director's time. The format has been accepted readily by all participants. The system has been helpful in identifying problem areas in resident performance and in curriculum and has resulted in prompt corrective action.

Employee Performance Appraisal↗