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PubMed1989

Hospital violence reduction among high-risk patients.

We describe the success of one general hospital in reducing violent behavior among a group of repetitively disruptive patients. Following a pilot phase during which violent incidents at the medical center were characterized by location, type, and person responsible, a group of patients at high risk for repeated violence was identified (N = 48). Data were gathered for 1 year before and after the institution of a program designed to reduce violence, primarily in ambulatory care areas, among this group. Outcome assessment included comparison of the number of violent incidents and the number of visits to the medical center during the 12 months before and after the program was started. The number of incidents declined by 91.6%, and visits to the medical center for any reason decreased by 42.2%. The ratio of violent incidents to visits after the program was begun was less than one sixth the rate before the program. Components of the program are described, including staff resistance and management strategies.

Adult↗
PubMed1992

Helmets! All the pros wear them.

OBJECTIVE: To assess the outcome of a multidisciplinary community campaign to increase helmet use and determine the success of a school education and helmet distribution program. DESIGN: Survey research. SETTING: Large metropolitan area and two elementary schools. PARTICIPANTS: Five hundred representative families in a metropolitan area and students enrolled in two elementary schools. INTERVENTIONS: A 1-year-long regional media campaign and a helmet distribution program in one elementary school after 4 weeks of safety instruction. RESULTS: Evaluation of the community component 1 year after initiation of the campaign revealed a 23% awareness of the promotion. Factors associated with wearing a helmet in the community included higher income levels, higher level of education, and male sex. The school component survey revealed that 73% of the children in school A reported helmet use vs 23% in school B. This multifaceted approach to affect helmet use demonstrated variable success in our community. CONCLUSION: This campaign effort achieved its greatest success in promoting community awareness of the importance of helmet use. However, further studies need to be performed to determine the success of the school education and helmet distribution program.

Bicycling↗
PubMed1996

Immunization status as determined by patients' hand-held cards vs medical records.

OBJECTIVE: To determine whether patients' hand-held immunization cards provide accurate assessments of immunization status when compared with their corresponding medical records. SETTING: Urban hospital emergency department immunization program. DESIGN: Comparison of 2 criterion standards. PATIENTS: Children aged 4 months to 6 years who presented consecutively with their immunization cards and received routine care in the hospital's pediatric clinic. SELECTION: Of 673 eligible patients seen in the immunization program from November 1992 to October 1993, 140 were randomly selected for comparison of immunization card and medical record immunization dates; in addition, all 123 eligible patients seen between August and October 1994 were selected. Of the total of 263 children, medical records for 257 (98%) were available for review. The dates of diphtheria-tetanus-pertussis, polio, measles-mumps-rubella, and Haemophilus influenzae type b immunization from immunization cards and medical records were recorded, as were patient age, sex, and ethnicity. Immunization card-medical record immunization date pairs were compared. Each immunization card and medical record was categorized as up to date, due for immunization, or delayed 2 months or more for any immunization at the time of the visit. RESULTS: In 218 (85%) of 257 cases, the immunization card and medical record immunization dates were identical (McNemar test, P = .63). The immunization card and medical record agreed that patients were due for immunization in 91 cases and agreed that patients were not due for immunization in 138 cases (kappa = 0.77; 95% confidence interval, 0.70-0.85). The immunization card and medical record agreed that patients were delayed for 1 or more immunizations in 51 cases and agreed that patients were not delayed in 187 cases (kappa = 0.79; 95% confidence interval, 0.71-0.88). CONCLUSION: The hand-held immunization card is a suitable alternative to the medical record when the need for immunization is assessed or when rates of immunization delay in populations are determined.

Emergency Service, Hospital↗
PubMed1998

Center-specific graft and patient survival rates: 1997 United Network for Organ Sharing (UNOS) report.

CONTEXT: Multiple comprehensive, risk-adjusted studies evaluating short-term surgical mortality have been reported previously. This report analyzes short-term and long-term outcomes, both nationally and at each individual transplant program, for all solid organ transplantations performed in the United States. OBJECTIVES: To report graft and patient survival rates for all solid organ transplantations, both nationally and at each specific transplant program in the United States, and to compare the expected survival rate with the actual survival rate of each individual program. DESIGN AND SETTING: Multivariate regression analysis of donor and recipient factors affecting graft and patient survival of all kidney, liver, pancreas, heart, lung, and heart-lung transplants reported to the United Network for Organ Sharing from 742 separate transplant programs. PATIENTS: A cohort of 97587 solid organ transplantations performed on 92966 recipients in the United States from January 1988 through April 1994. MAIN OUTCOME MEASURES: Short-term and conditional 3-year national and individual transplant program graft and patient survival rates overall and from 2 separate eras (era 1, January 1988-April 1992; era 2, May 1992-April 1994); comparison of actual center-specific performance with risk-adjusted expected performance and identification of centers with better-than-expected or worse-than-expected survival rates. RESULTS: One-year graft follow-up exceeded 98% and conditional 3-year follow-up exceeded 91% for all organs. Graft and patient survival improved significantly in era 2 compared with era 1 for all cadaver organs except heart, which remained the same. One-year cadaveric graft survival ranged from 81.5% for heart to 61.9% for heart-lung and 3-year conditional graft survival ranged from 91.3% for pancreas to 74.7% for lung. The percentage of programs whose actual 1-year graft survival was not different from or was better than their risk-adjusted expected survival ranged from 98.3% for heart-lung to 75.7% for liver. Most kidney, liver, and heart programs whose actual survival was significantly less than expected performed small numbers (less than the national average) of transplantations per year. CONCLUSIONS: Graft and patient survival for solid organ transplantations showed improvement over time. Conditional 3-year graft and patient survival rates were approximately 90% for all organs except for lung and heart-lung. The conditional 3-year survival rates were better than 1-year survival rates, indicating the major risk after transplantation occurs in the first year. The majority of transplant programs achieved actual survival rates not significantly different from their expected survival rates. Center effects were most significant within the first year after transplantation and had much less influence on long-term survival outcomes.

Actuarial Analysis↗
PubMed1986

Ethical dilemmas in workplace health promotion.

In less than a decade, workplace health promotion programs designed to promote employee health and help reduce the high cost of health insurance premiums paid by business and industry have proliferated. Notwithstanding the latent benefits and cost savings that corporate management expects to gain from the investment in such programs, it is argued that workplace health promotion is not without potential misuse and that its goals and methods ought not to be above ethical scrutiny. Drawing on earlier work, we discuss how workplace health promotion may pose ethical problems related to social justice, protection of privacy, and social control. The attendant moral dilemmas for the professional whose responsibility it is to develop and implement such programs are also presented.

Ethics↗
PubMed2006

Application of theory-based health behavior change techniques to the prevention of obesity in children.

Few studies that apply behavior change constructs such as goal setting, self-efficacy, and readiness for change to childhood obesity interventions exist. The purpose of this study was to adapt these constructs for use within a community-based obesity prevention program designed for fifth and sixth graders and their families. Games, worksheets, and a helpful acronym made the constructs developmentally appropriate and comprehensible to 11- and 12-year-olds. The age-adapted techniques have the potential to enhance obesity programs in a population for whom the obesity issue is critical.

Abbreviations as Topic↗
PubMed2000

Validating a practical approach to determine weight control in obese children and adolescents.

OBJECTIVE: To study the usefulness of a mathematical index for assessing changes in body composition of obese children and adolescents who undergo a weight control program. DESIGN: A short-term longitudinal (mean of 19 months) cohort study. SUBJECTS: Sixty-seven obese children and adolescents (38 M, 29 F, age 6-16 (mean 11)y) who took part in a clinic-based weight control program. MEASUREMENTS: Percentage body fat was assessed at the start of the program by underwater weighing (UWW) and by bioelectrical impedance (BIA). Response to the program was assessed by a mathematical index (MI), based on observed and expected changes in height and weight, and by changes in percentage fat as measured by BIA. RESULTS: Adiposity, as assessed by BIA at the start of the program, was highly correlated to that obtained by UWW (r = 0.96 for fat-free mass). Changes in the MI over the program were correlated fairly well (r = -0.81, SEE = 3.57 kg) with changes in percentage fat as assessed by BIA. CONCLUSION: Using change in BIA as criterion, the MI is valid for assessing changes in percentage body fat of obese children and adolescents over time. This index is of use to clinicians who lack body composition equipment and need a quick method to analyze the effectiveness of a weight control program in obese children and adolescents.

Adipose Tissue↗
PubMed1976

The modification of multiple articulation errors based on distinctive feature theory.

The effectiveness of articulation remediation procedures based on distinctive feature theory was evaluated through the administration of an articulation program designed for this purpose. Two preschool children with multiple phoneme errors which could be described by a distinctive feature analysis were the subjects. Both children substituted stop phonemes for most continuant phonemes. Each child was individually administered the distinctive feature program which is described in full. Data are presented which indicate the adequacy of the treatment program, the acquisition of correct articulation of the two directly treated target phonemes, and the concurrent improvement of five other nontreated error phonemes. Such across-phoneme generalization was predicted by distinctive feature theory. Certain modifications in the treatment program are suggested and theoretical/empirical questions regarding articulation remediation from a distinctive features viewpoint are discussed.

Child, Preschool↗
PubMed2006

Use of clinical guidelines for whiplash by insurers.

OBJECTIVE: To describe the opinions of, use of, and compliance with guidelines for whiplash associated disorders (whiplash) by insurance staff after an implementation program. DESIGN: Observational design using questionnaires. SETTING: Insurance offices in New South Wales, Australia. STUDY PARTICIPANTS: 138 insurance staff (60% response rate) working in compulsory third party (CTP) claims for the 8 CTP insurers in NSW. INTERVENTION: Responses were collected after an implementation program that included education workshops provided by an insurance regulator and by insurance staff trained by the regulator. RESULTS: After implementation, 73% were aware of the CTP guidelines for whiplash, 85% had access to them, and compliance with the recommendations was 71%. Awareness of, and compliance with the guidelines was not related to attending the regulator workshop (P = 1.0). Insurance staff found the guidelines to be helpful, with the mean ratings for relevance to work and in managing claims being 7.8/10 and 6.9/10, respectively. CONCLUSION: Awareness of, and compliance with guidelines for whiplash among insurance staff was high after the implementation program, but was not related to attending the regulator workshop. Compliance may be improved by addressing the barriers nominated by the participants. Developing a specific guideline for the insurer market was considered useful.

Clinical Protocols↗
PubMed2001

Middle school primary prevention program for eating disorders: a controlled study with a twelve-month follow-up.

The aim of this pilot study was to evaluate the efficacy of a new school-based eating disorder prevention program designed to reduce dietary restraint and the level of preoccupation with regard to shape and weight. One hundred and six (61 females and 45 males) 11 to 12-year-old students were evaluated, 55 of whom participated in the program (experimental group). An additional 51 students formed the control group. The program met for six sessions, two hours per session. After six months, the experimental group received two booster sessions of two hours in two consecutive weeks. Outcome measures included the Eating Disorder Examination Questionnaire (EDE-Q), the children's version of the Eating Attitudes Test (EAT), the Rosenberg Self-Esteem Scale (RSES), and a Knowledge Questionnaire (KQ) devised by the authors of the program. The questionnaires were administered in both the experimental and control groups, one week before the intervention, one week afterwards, and at six-month and 12-month follow-ups. Unlike a previous school-based eating disorder prevention program, in the experimental group both an increase in knowledge and a decrease in some attitudes were maintained at 12-month follow-up (Eating Concerns EDE-Q scores). Although more intensive interventions seem necessary to modify shape and weight concern and self-esteem, these findings suggest that the intervention had been useful since it led to both an increase in knowledge and a decrease in some dysfunctional eating attitudes.

Journal Article↗
PubMed1993

Behavioral management of chronic pain and excess disability: long-term follow-up of an outpatient program.

OBJECTIVE: To assess the overall efficiency of an outpatient behavioral rehabilitation program for excess disability and chronic pain and to describe the program staff, treatment components and outcomes in sufficient detail to facilitate comparison with similar programs. DESIGN: Eight-year follow-up study of patients referred and treated. SETTING: Outpatient primary care and multispecialty group medical practice. PATIENTS: 354 of 421 unselected patients referred for the behavioral management of excess disability, who completed the treatment program and participated in follow-up. INTERVENTIONS: 15-20 sessions of physical and occupational therapy, 5-10 sessions of biofeedback, and one or two family sessions all based upon behavioral techniques described by Fordyce and by Roberts. MAIN OUTCOME MEASURES: Questionnaires, including analog scales, administered before treatment and at 1, 6, 12, and 24 months posttreatment. RESULTS: Patients (n = 67) who dropped out did not differ systematically from those who participated (n = 354). The treatment program resulted in a marked and enduring reduction of pain, and a statistically and clinically significant improvement in patients' ability to function at work and in the home. Patients overwhelmingly endorsed the program. CONCLUSIONS: A brief, inexpensive, outpatient behavioral rehabilitation program for chronic pain and excess disability can achieve a clinically significant and lasting reduction of pain and improvement in function at work and at home.

Adolescent↗
PubMed1991

Results after 1 year of non-operative occlusal caries treatment of erupting permanent first molars.

The aim of this study was to evaluate a treatment program designed to control occlusal caries on the basis of intensive patient education and professional toothcleaning. The sample consisted of 56 6-8-yr-old children with their permanent right first molars in different stages of eruption. Data from the program were compared with previous data recorded in a similar sample of children. After 1 yr the majority of children in the study group had their permanent right first molars in full occlusion. A significant decrease of surfaces with easily detectable plaque and an increase of surfaces without plaque was observed. The proportion of arrested lesions increased and active enamel lesions decreased. Fissure sealing was only needed in two teeth in contrast to more than 2/3 of molars in a comparable sample of children. The program proved to be an efficient alternative to fissure sealing in preventing occlusal caries in erupting teeth.

Child↗
PubMed1993

Computer analysis of qualitative data: a comparison of three packages.

This article describes and compares three computer programs designed to assist in the analysis of narrative text. Ethnograph, GATOR, and Martin were compared in the context of a qualitative study of women and their husbands following mastectomy in order to (a) describe the fit between research purpose and program capabilities and (b) explore the influence, if any, of particular program features on research methods or analysis. The comparison suggests that methodological assistance provided by the programs involves differences in approach sufficient to make prior consideration of the fit between program capabilities and research purposes, methods, and style an important research decision. Descriptions of the programs and their application provide guidelines for comparison of these and other computer programs.

Evaluation Studies as Topic↗
PubMed2001

Evaluation of a new computer intervention to teach people with autism or Asperger syndrome to recognize and predict emotions in others.

This randomized controlled trial looked at the effect of a new computer program designed to teach people with autistic spectrum disorders to better recognize and predict emotional responses in others. Two groups of 11 children (age 12-18) with autism or Asperger syndrome at two special schools participated: one group used the computer program for 10 half-hour sessions over 2 weeks. Within-program data showed a significant reduction in errors made from first to last use. Students were assessed pre- and post-intervention using facial expression photographs, cartoons depicting emotion-laden situations, and non-literal stories. Scores were not related to age or verbal ability. The experimental group made gains relative to the control group on all three measures. Gains correlated significantly with the number of times the computer program was used and results suggest positive effects. Further research could assess whether these gains generalized into real life or improved performance on theory of mind measures.

Adolescent↗
PubMed1999

Immunization outreach in an inner-city housing development: reminder-recall on foot.

OBJECTIVE: To determine rates of immunization coverage among children 3 to 72 months of age in a large public housing development, to develop a community-based outreach program to increase coverage, and to evaluate the effect of the program. DESIGN: A door-to-door canvass of the development by specially trained emergency medical technicians to enroll families, to determine immunization status from written records, and to follow-up to encourage immunizations and well-child care. The program was evaluated, comparing rates of immunization by age with an expectation based on the immunization histories before enrollment. SETTING: A Chicago public housing development, October 1993 through December 1996. OUTCOME VARIABLES: Antigen-specific and series-specific coverage based on written records. RESULTS: Of the caregivers, 92% were able to identify a primary care provider. At the time of enrollment, 37% of 1075 children were up-to-date, but that proportion varied by age with 27% of children 19 to 35 months of age being up-to-date. The program increased rates of immunization compared with the expectation from the preenrollment rates. At their final assessment, 50% of the children were up-to-date. For individual vaccines, there was a positive program effect. For example, before enrollment, 22% of children 15 months of age had received measles, mumps, and rubella vaccine. However, 39% of children who were enrolled in the program before they were 12 months of age had received their first immunizations by 15 months of age. CONCLUSIONS: Children in the housing development had very low rates of immunization before enrollment. An in-person intervention was effective in reaching families and determining immunization status. In the 3-year enrollment and observation period, rates of immunization increased.

Chicago↗
PubMedDate not supplied

Evaluating a continuing education program.

This study evaluated an innovative program designed to assist registered nurses to achieve professional competency in a role that was introduced in the career structure and was new to Western Australian nurses. Quantitative and qualitative methods were used to determine formative and summative aspects of the program. The framework for data processing was Stake's Countenance Model. Data were collected from participants and preceptors over one year. A variety of instruments were used including interviews, questionnaires, document reviews and observations. Findings indicate that the program facilitated development of professional behaviours and that the participants found it worthwhile. The method of evaluation was able to demonstrate that the program outcomes were logically and empirically contingent upon transactions and antecedents and were congruent with the program's intentions.

Career Mobility↗
PubMed1995

DNAdraw: a program for preparing DNA and protein data for publication.

DNAdraw is a Macintosh program designed to prepare DNA and protein data for publication. In additional to providing standard ways of highlighting data, e.g., fonts, styles and shading, DNAdraw has special features for formatting sequence data and for handling aligned sequence data. Output for the program is to a PostScript printer. A simple example is presented to illustrate DNAdraw formatting and highlighting, and an example for aligned data is given. This new version of the program that has been written for other machines is the first to run under a Graphical User Interface (GUI) and incorporates many new features.

Amino Acid Sequence↗