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PubMedDate not supplied

[Colonoscopic screening in first-degree relatives of patients with sporadic colorectal cancer].

UNLABELLED: Colonoscopic screening has been recommended in asymptomatic first-degree relatives of patients with colorectal cancer. In fact this population is believed to have an increased risk in developing colorectal neoplasia. The purpose of this study is to report the impact of colonoscopy in a series of completely asymptomatic first-degree relatives of patients operated on for colorectal cancer at our institution. A total of 480 individuals was requested to participate in a screening program based on faecal occult blood testing (FOBT) and colonoscopy in those with positive FOBT. Colonoscopy was also suggested to persons with negative FOBT. After the first 195 examined relatives, FOBT was abandoned because of continuously increasing acceptance of colonoscopy. RESULTS: Two hundred fifty four subjects (52.4%) accepted to participate at the screening program. After the first 195 examined relatives, FOBT was abandoned because of continuously increasing acceptance of colonoscopy. A total of 142 colonoscopies was performed. Colonoscopy was completed in 112 relatives (78.9%). Thirty-three subjects (23.2%) had a positive colonoscopy: one had invasive adenocarcinoma, one had large villous adenoma and 31 had 54 polyps. Twenty-three lesions (40.3%) were located proximal to the splenic flexure. Of the 54 polyps, 45 (83.3%) were less than 1 cm in size. These findings confirm the utility of colonoscopic screening in asymptomatic first-degree relatives of patients with colorectal cancer. However, its feasibility with the current endoscopic facilities remains an unsolved question.

Adenocarcinoma↗
PubMed1989

Promoting family planning for better health: policy and programme implications.

Renewed emphasis is being given to the role of family planning health care programs. This review of the lessons learned during the past decade provides guidance to policy makers and program managers on ways to improve maternal, infant, and child health through family planning and related health and development activities. It covers policies and laws, accessibility to services, acceptability and quality of services, provision for the special needs of high-risk groups, the use of communications programs, the importance of improving the status of women and the quality of life, and the resources needed to implement such a program globally. Practical steps for integrating family planning fully into maternal and child health care are described.

Birth Intervals↗
PubMed2004

The resident 80-hour work week: how has it affected surgical specialties?

OBJECTIVES: To identify strategies employed by surgical departments to address recently implemented resident duty hour regulations, and to assess resident and faculty acceptance of these changes. METHODS: Attendees to the 2003 Residency Program Coordinator/Administrator Workshop for sub-specialties (Denver, CO) were surveyed. RESULTS: The study population included 46 respondents spanning 9 surgical sub-specialties. Forty-eight percent of programs instituted at least 1 administrative change specifically to comply with duty hour regulations. The most commonly employed strategies were the hiring of nurse practitioners or physician assistants (30%) and the use of Internet-based software to track resident duty hours (30%). Other changes included giving call responsibilities to residents on research rotations (19%), institution of home-call (13%), and assignment of a night-float resident (11%). Perceptions of program coordinators indicated that junior residents and junior faculty accepted changes better than did senior residents and senior faculty (P=.025). CONCLUSION: The resident 80-hour work week is a major health care policy change that has required academic sub-specialty departments to make significant alterations in their administrative structure. Further study is necessary to determine how these changes affect both quality of training and patient care in the short and long term.

Accreditation↗
PubMedDate not supplied

Teaching and evaluation of basic surgical techniques: the University of British Columbia experience.

Surgical technical education has traditionally followed an apprenticeship format. The need for innovative undergraduate programs using dry and wet labs prior to clinical exposure continues to be an area of debate. Specific programs have been described to improve surgical skills; however, an accepted platform for training and evaluation of surgical skills programs has not been recognized. Therefore, introduction of specific programs to teach undergraduate medical students surgical skills is essential. This article describes the Basic Surgical Technique (BST) program taught at the University of British Columbia and reports the effectiveness of this program in improving the practical skills of undergraduate medical students. The program includes BST I for third-year students performed in a dry lab setting, and BST II for medical student interns (MSI) performed at the animal laboratories using female domestic swine as subjects. A total of 87 students participated in the study. The program is designed using Piaget's and Vygotsky's pedagogical philosophy of "learning by doing." A semiquantitative method is used to measure and analyze the outcome of this project. Data were validated using student self-evaluation tests and by quantitative evaluation by surgical staff from the surgical wards. Results of this prospective project indicated that the BST program significantly (p < .05) improved the surgical performance of undergraduate students, and that the time lapse between BST I and II has had a negative impact in retention of acquired surgical skills. This study concludes that the BST program taught at the University of British Columbia significantly improves the surgical skills of medical students and improves their self-confidence during their internship.

British Columbia↗
PubMed1997

[MMR, diphtheria-tetanus and polio vaccination of students in Aargau].

In order to update our information concerning immunization coverage in Switzerland we analysed data from the public school immunization program of the canton of Aargau between 1988-90. We compared these results with those of two districts from the school year 1993-94. 97% of all the matriculating or graduating school children could be reached. As expected, the immunization rates of 98% for poliomyelitis and 96% for diphtheria/tetanus were high. Following initiation of the nationwide MMR (Measles/Mumps/Rubella) Immunization Program in 1987, coverage of preschool children with the MMR-vaccination could be improved from 44% in the late 1980's to 70-80% in the early 1990's. As a result of offering the vaccine free of charge to all matriculating and graduating children, the MMR-immunization rate could be increased to 90-94%, and the measles immunization rate even further to 97% indicating the importance of the school immunization program. This high level of acceptance in Aargau shows that an increase in the immunization rate even in infant and preschool children can be realised, if the pediatricians and the general practitioners improve their efforts. In regions with similar epidemiological conditions MMR-reimmunization in school children is to be recommended.

Child↗
PubMed2003

[Overactive bladder--which diagnosis investigations are necessary before initiating primary treatment?].

The symptom complex of frequency and urgency with or without urge incontinence is termed overactive bladder (OAB) according to the new definition by the International Continence Society. The background for this change in definition is the great economic and social importance of the disease, the rising costs in medicine, and the tendency to develop the simplest possible therapeutic strategies. Therapy consists of the administration of an anticholinergic/spasmolytic drug for at least 3 months. Although a great percentage of patients with OAB can be clinically identified, the required exclusion of "local pathologic and metabolic factors" calls for a minimal diagnostic program to come to fairly exact findings. This includes a detailed case history with standardized and evaluated questionnaires, a bladder diary, detailed clinical examination, urine analysis consisting of microscopic and microbiologic examination, uroflowmetry including measurement of residual urine, and examination of the kidneys and the upper urinary tract (determination of creatine and sonography). Minimally invasive tests to improve validity regarding obstruction and detrusor overactivity are being developed. These tests are intended to make an invasive pressure-flow study unnecessary. However, using the above-described minimal diagnostic program, one has to take into account that patients suffering from complaints without underlying idiopathic detrusor overactivity and with urgency/urge incontinence due to bladder outlet obstruction are referred for primary therapy with anticholinergic/antispastic drugs. In cases of neurologic signs, pathologic urinary findings, reduced urinary flow rate with residual urine, and problems of the upper urinary tract, further diagnostic studies are necessary. In any case, such patients need not undergo primary therapy on the basis of a clinical diagnosis. An ex iuvantibus therapy with anticholinergic drugs--even if limited to 3 months--is not acceptable if the diagnostic minimal program is not used.

Bacteriuria↗
PubMedDate not supplied

Public attitude toward pesticides. A random survey of pesticide use in Allegheny County, Pa.

Pesticide use was examined by means of a random survey in Allegheny County, Pa., in October and November 1973. The objectives included gaining insight into the need for a new community pesticide program and estimating its public acceptance. The 110 survey sites were grouped as single-family dwellings, commercial and recreational lawns, institutions, farms, rights-of-way, and wasteland. In the single-family dwellings, most householders (85 percent) used a pesticide in the previous 12 months, usually an aerosol insecticide (76 percent) or herbicide (55 percent). Their pesticide selections were most often based on advertisements of availabel products. A high percentage lacked either the interest or the knowledge of the information on the pesticide's label. No observation in this or any other study supports the need for a new special program in pesticides or indicates that a substantial segment of the public would use its services. The main users of "hard" pesticides were the golf courses, rights-of-way, and one farm-nursery. The rights-of-way used chemicals only for vegetation control. Utilities and railroads contracted with pesticide companies for this work. Municipal users applied pesticides recommended by dealers. The golf courses and a farm-nursery used a broad range of fungicides, insecticides, and herbicides, which they selected because of information received from the Pennsylvania Extension Service and professional organizations.

Aerosols↗
PubMed2001

A collaborative model to guide program development and change: involving the users.

Organizations have different structures and cultures within which to conduct their business activities. Ranging from autocratic and rigid styles to more laissez-faire models, this report describes the program development and change model used by the Missouri Kidney Program (MoKP). Two examples illustrate how involvement of renal community professional staff and MoKP program staff in instituting and modifying program elements help to build in acceptance from the very beginning, avoiding start-up difficulties and miscues on implementation. Examples cited are the inception of the Nutritional Supplement Program and ongoing modification of the Centralized Drug Program's formulary. The Missouri Kidney Program uses a participatory approach to involve the users of service in program design and modification and historically has used this sort of approach with relative success over time.

Humans↗
PubMed2006

[Motor skills testing in patients with chronic renal failure].

BACKGROUND: During chronic renal failure, number of complex metabolic and endocrinal changes in organism can develop, which in consequence lead to an inception of associate complications and in principle change the activity of all organ systems. Functional capacity of the chronically dialysed patients is limited, muscle strength is decreased, joint mobility is limited and the muscular imbalance is frequently found. According to the recent literature, an acceptable choice of exercise activity could contribute to prevention of disturbances and improve the patient's status. An essential part of each exercise program for these patients is an acceptable motor tests battery (1, 2, 3, 4, 5, 6 and 7). The aim of our study was to choose an acceptable motor tests battery, which should target such components of motor performance, whose certain rate is necessary for self-sufficiency keeping and perform activities of daily living. METHODS AND RESULTS: We observed mixed group of 23 patients. For evaluation of the functional condition we used the "Senior Fitness Test Manual" (8), which measures these physical attributes: muscle strength, physical endurance, flexibility, agility and balance. The input results we compared with population standard specification used in the test battery. Results of the tests showed that the group of patients in comparison with the population standard specification have reached subnormal and risk performances, especially in tests requiring for its implementation muscular strength of lower extremities and physical efficiency. Normal and above normal performances we observed in patients that were physically active before and during regular dialysis treatment. CONCLUSIONS: After the evaluation of result, we consider the selected battery of motor tests as an acceptable choice for motor skills testing in renal dialysed patients all age categories.

Adult↗
PubMed1995

Fostering multiculturalism: the English Conversation Pairs Program.

Exposure to and personal interactions with people of diverse cultures foster an acceptance of multiculturalism. To this end, the English Conversation Pairs Program provides weekly conversation sessions between students who are native speakers of English (NSE) and students who speak English as a second language (ESL). Attitudes of twenty-two NSE students are surveyed before and after participation in the Conversation Pairs Program. This paper discusses (a) NSE students' perceptions of the program, (b) perceived changes in cultural sensitivity of NSE students, (c) activities which enhance and/or hamper program effectiveness, and (d) variables which influence program effectiveness.

Acculturation↗
PubMed1992

Implementation of capillary blood glucose monitoring in a teaching hospital and determination of program requirements to maintain quality testing.

PURPOSE: To study the implementation of bedside capillary glucose monitoring using a hospital-wide quality control (QC) program. METHODS: A prospective study of QC performance in 7 outpatient and 39 inpatient treatment units was performed in a large teaching hospital over a 2-year period. Approximately 800 nurses were trained to perform bedside capillary glucose monitoring (Accu-Chek II, Boehringer-Mannheim, Indianapolis, IN). An eight-point QC program was instituted including proficiency testing, instrument maintenance, performance of daily controls, storage of reagent strips and supplies, instrument calibration, and documentation procedures. RESULTS: Comparison of laboratory and bedside test results (split-sample proficiency testing) revealed Y = 1.004X + 7.26, r = 0.95, with a mean percent difference of -4.2% (p < 0.001). Less than 7% of results fell outside +/- 20% of the laboratory results. QC scores (0 = worst to 4 = best), based on adherence to the QC program, improved from 0 on the first inspection to 3.7 +/- 0.17 by the 11th inspection. The most common QC deficiencies were failure to perform split-sample testing (41.4%) and failure to perform instrument maintenance (30.2%). Significant differences were noted in the QC performance of different types of medical services. During the 2-year study period, the total number of glucose assays performed in the clinical laboratories decreased by 22.2% concurrent with initiation of bedside testing. The number of instruments in the hospital increased from 10 to 46. CONCLUSIONS: Bedside capillary glucose assays can be widely implemented in large hospitals with an acceptable degree of accuracy. QC programs with frequent inspections are necessary to identify units that function inadequately, and a formal disciplinary policy is required to ensure compliance with the program.

Blood Glucose↗
PubMed2001

Maximizing the success rate of minimal model insulin sensitivity measurement in humans: the importance of basal glucose levels.

Minimal model analysis of glucose and insulin concentrations in the intravenous glucose tolerance test (IVGTT) has been widely used to obtain a measure of insulin sensitivity in humans. Issues of model validity and IVGTT protocol have been explored extensively. Less attention has been paid, however, to the computer programming protocol for estimating the model parameters (programming implementation). Minimal model analysis of data from an IVGTT protocol involving a high glucose dose (0.5 g/kg) and a reduced sample schedule, employed in healthy pre- or post-menopausal women, healthy men or men with coronary heart disease or chronic heart failure (20 in each group), was undertaken according to 12 different programming implementations using a commercially available model-equation-solving program. The ability of the program to arrive at an acceptable solution to the model equations gave a success rate of between 39% and 96%, depending on the implementation. Variation in basal glucose assignment significantly affected the magnitude of estimates of insulin sensitivity. The maximum modelling success rate was achieved by introduction of an imputed glucose measurement at 360 min from the glucose injection, taking the basal glucose level as the fasting glucose concentration, and overweighting the initial glucose measurement after a delay for mixing. Use of this implementation to analyse data from a study comparing insulin sensitivities obtained using the minimal model and a euglycaemic clamp reference gave a correlation of 0.80 (P<0.001) between the two methods. Straightforward variations in programming implementation, involving appropriate assignment of the basal glucose concentration and use of an imputed glucose measurement signifying re-establishment of basal glucose levels following the IVGTT, can considerably improve modelling success rate.

Analysis of Variance↗
PubMed2001

Education about genetic testing for breast cancer susceptibility: patient preferences for a computer program or genetic counselor.

The purpose of this study was to describe and compare patient preferences for a genetic counselor or an interactive computer program for various components of genetic education and counseling for breast cancer susceptibility. As part of a randomized intervention study on genetics education and counseling for breast cancer risk, 29 women at moderate risk were educated by both a genetic counselor and an interactive computer program. After both educational interventions, participants completed Likert-style and open-ended questionnaires about what they liked most and least about each intervention, and whether they preferred the counselor or computer for a variety of tasks. Participants were largely satisfied with both the computer program and the genetic counselor. A majority preferred the genetic counselor for addressing their concerns, discussing options and alternatives, being sensitive to emotional concerns, helping to make a decision, being a good listener, assuring understanding, helping to make a good choice, helping to understand genes and breast cancer, telling them what they needed to know, being respectful, setting a relaxed tone, and putting them at ease. However, a majority of the women either preferred the computer program or were neutral about allowing patients to learn at their own pace, helping to avoid embarrassment, making good use of time, explaining genes and breast cancer, and treating the patient as an adult. Qualitative analysis of open-ended questions affirmed that patients valued the personal interactions with the counselors, and liked having their specific questions answered. They liked that the computer was self-paced, informative and private, and could be used without causing embarrassment. We concluded that a computer literate, mostly white group of women at moderate risk for inherited susceptibility to breast cancer preferred interacting with a genetic counselor for personal, individualized components of the genetic counseling process, but accepted or preferred a computer program for being self-paced, private, and informative. By incorporating such a computer program into the genetic education process, it is possible that genetic counselors would be able to spend more time performing the personal, individualized components of genetic counseling.

Adult↗
PubMed2006

Feasibility of a web-based continuing medical education program in dermatology: the DermoFAD experience in Italy.

BACKGROUND: Web-based systems are increasingly being considered for medical education. A draft legislation on distance-learning programs was licensed in Italy by the National Commission for Continuous Education in November 2003. A series of pilot studies were developed, among these the DermoFAD project, based on five simulated clinical cases of acne and a systematic appraisal of the evidence for their clinical management. From July 1 to August 27, 2004, a total of 500 medical doctors participated in a free of charge evaluation program of the project. OBSERVATIONS: Users were distributed all over Italy. Two hundred and eighty-one (56.2%) were primary care physicians, 83 (16.6%) dermatologists, and 136 (27.2%) other medical specialists. A wide range of connecting times was observed. The pass rate of each individual case, at first attempt, ranged from 44 to 77%. When asked to assess the overall distance-learning experience, 98% of the doctors considered it to be enjoyable. A total of 2,152 continuing medical education (CME) credits were awarded. Over 50% of the users stated they would still use the system if they had to pay for it. CONCLUSIONS: Our experience shows that distance learning is feasible and is well accepted by physicians. The DermoFAD program was an efficient means of delivering CME to the Italian medical community at large.

Dermatology↗
PubMed1984

Temporal effects of prompting on acceptance and follow-up in a community-based hypertension screening program.

This study evaluated the effects of prompts and reinforcement on two aspects of hypertension control: a) attendance at a community-based blood pressure screening program and b) follow-up visits to a physician's office by persons identified through screening as at-risk clients. Baseline data showed a decreasing trend in attendance at the screening sessions and a 51% "no show" rate for physician follow-ups. Screening session attendance increased following intervention; however, attendance rates across weeks appeared to vary mainly as a function of the prompting schedule (monthly newsletter announcements ) rather than the availability of reinforcement. Finally, the intervention not only increased the percentage of at-risk clients who saw a physician, but also decreased the latency between the time of initial screening and the follow-up appointment.

Adolescent↗
PubMed2004

[Compliance with infection control guidelines].

Compliance is the degree to which advice is adhered to. It can be assumed that compliance rates are considerably less than 100% for nearly all infection control guidelines. Factors that may influence compliance rates can be found on different levels of the health care system. Health care workers may adhere to guidelines because they believe that a measure is effective, they receive positive or negative feedback, or because they follow role models. The institution is responsible for providing the structural conditions that allow easy adherence. Incentives for the institution are regulations that have been made mandatory by law or financial considerations. Finally, guidelines must be accepted by society to be widely adhered to. Compliance can be measured by direct or indirect surveillance. If it is found to be under the expected value, it should be improved using interventional programs. Long-lasting effects on compliance rates can be achieved by using a multifactorial approach that considers all levels of the health care system. The goal of the program should be clearly defined and accepted by all parties. Especially the institution should highly value the goal. Strategies that may be used to improve compliance include educational programs for health care workers, provision of better structures by the institution, e. g., administrative sanction or rewarding, or education of patients to influence the expectations of society. As long as there are no striking new interventions to protect the patients, the improvement of compliance with existing guidelines remains the most important measure to reduce rates of nosocomial infection.

Germany↗
PubMed2006

K-Train--a computer-based, interactive training program with an incorporated certification system for practicing kinetic perimetry: evaluation of acceptance and success rate.

PURPOSE: To evaluate, in an experimental study, an interactive, computer-based teaching procedure for kinetic perimetry that incorporates an evaluation system for scoring examination technique. METHODS AND SUBJECTS: K-Train was developed and based on the original user interface of the new semi-automated kinetic perimetry (SKP) feature of the OCTOPUS 101 perimeter (HAAG-STREIT, Koeniz, Switzerland). The trainer creates a 3D individual "hill of vision" for a specific pathology and the trainee can individually select target characteristics and independently define origin, end and direction of each kinetic stimulus with the help of vectors. Quality of the perimetric examination can be quantitatively assessed by the ratio of intersection area and union area of the trainee's result and the related trainer-defined original isopter. This ratio and other parameters are used to define a score of "perimetric quality". The general acceptance of K-Train was assessed in 30 participants in two perimetric courses. The success rate was examined by comparing the scores before and after a perimetric training session. RESULTS: The K-Train course was graded by the participants with an average score of 1.35 (range 1-3) in a scoring system ranging from 1=excellent to 6=unsatisfactory. The average perimetric quality score increased from 48 before to 59 (max. 100) after the training (27 trainees) indicating that K-Train was able to achieve and also verify a considerable success rate. CONCLUSION: The acceptance of K-Train, a computer-based, interactive tool that allows for certification, education and quality control of kinetic perimetry, is high. K-Train is capable of improving a trainee's individual performance in kinetic perimetry and of verifying this by an appropriate scoring system.

Adult↗
PubMed2002

Some recovery processes in mutual-help groups for persons with mental illness; I: qualitative analysis of program materials and testimonies.

Outcome research is beginning to suggest that mutual-help programs lead to significant improvements in the quality of life and related factors of members who have serious mental illness. This paper is the first in a series that examines recovery processes that may account for these positive outcomes. In Study 1, a content analysis was completed on one dimension of the written program for GROW, a mutual-help program with more than 40 years of experience. Thirteen reliable recovery processes emerged from this analysis; most prominent among these was to "be reasonable" and to "decentralize from self by participating in community." In Study 2, the recovery processes that emerged from this analysis of one aspect of GROW's written program were applied to 22 written testimonies made by Growers. Results of this analysis again showed being reasonable and decentralizing from self by participating in community were essential processes in this mutual-help program. Analysis of the personal testimonies also showed accepting one's personal value as an important element in the GROW program.

Community Mental Health Services↗