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PubMed2001

Evaluation of Baby Advocate, a childhood immunization reminder system.

Childhood immunizations, based on CDC recommendations, are recognized as a cost effective and health promoting practice. However, ensuring full immunization requires a long-term commitment on the part of parents and providers. This article describes a program at Advocate Health care to increase the percentage of children fully immunized at two years to 90%. Termed Baby Advocate, the program uses a mailed reminder system that includes vaccine and growth and development information along with gifts and incentives. Volume, satisfaction and immunization status data are presented.

Chicago↗
PubMed1983

Peer training of safety-related skills to institutional staff: benefits for trainers and trainees.

A peer training program, in which experienced staff trained new staff, was evaluated as a method for teaching and maintaining safety-related caregiver skills in an institutional setting for the developmentally disabled. Three sets of safety-type skills were assessed in simulated emergency situations: responding to facility fires, managing aggressive attacks by residents, and assisting residents during convulsive seizures. Using a multiple-baseline research design, results indicated that the peer training program was an effective method of training the three types of emergency skills to new direct care staff. The program also appeared effective in improving the skills of the peer trainers. Perhaps most importantly, results indicated that if experienced staff functioned as peer trainers for particular emergency skills, then their proficiency in those skills maintained over time whereas their proficiency declined in emergency skills for which they did not act as peer trainers. Social validity information collected from available staff 23 months after the program was completed supported the utility of the training in terms of staff responses during actual emergencies. Also, acceptability measures indicated that staff liked participating in the program. However, some inconsistencies between staff verbal reports and performance-based measures of acceptability were noted. Results are discussed regarding the overall effectiveness of the peer training program, the importance of maintenance strategies for safety-related skills, and the need for multidimensional analyses of staff acceptability in staff training/management research.

Accident Prevention↗
PubMed2005

Promoting a biopsychosocial orientation in family practice: effect of two teaching programs on the knowledge and attitudes of practising primary care physicians.

The bio-psychosocial (BPS) approach to patient care has gained acceptance in medical education. However, reported teaching programs rarely describe the efficacy of alternative approaches to continuing medical education aimed at promoting a BPS approach. The objective was to describe and evaluate the effect of two teaching programs on learners' BPS knowledge, management intentions, patient-centered attitudes, professional self-esteem, burnout, work related strain and mental workload. The learners were Israeli general practitioners. The first ("didactic") program consisted of problem-based reading assignments, lectures and discussions. The second ("interactive") program consisted of reading assignments, lectures and discussions, in addition to role-playing exercises, Balint groups and one-to-one counseling by a facilitator. One month before and six months after the teaching interventions, we used structured questionnaires to test for knowledge, management intentions (responses to questions, such as "what would you tell a patient with ...") and attitudes. Both programs led to measurable improvement in knowledge, intentions, patient-centered attitudes and self-esteem. The interactive teaching approach improved significantly more the learners' professional self-esteem and intentions than the didactic approach. Self-reported burnout significantly increased after the program. It is concluded that teaching intervention enhanced a BPS orientation and led to changes in knowledge, intentions, self-esteem and attitudes. An interactive method of instruction was more effective in achieving some of these objectives than a didactic one. The observed increase in burnout was unexpected and requires further study and confirmation.

Burnout, Professional↗
PubMedDate not supplied

Translation, cross-cultural adaptation, and validation of the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Dougados Functional Index (DFI) in a Spanish speaking population with spondyloarthropathies.

OBJECTIVES: The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Dougados Functional Index (DFI) are the most commonly used instruments to measure disease activity and functioning in ankylosing spondylitis (AS). The aim of this study was to translate, adapt and validate these instruments into the Spanish language. METHODS: The BASDAI, BASFI, and DFI questionnaires were translated into Spanish by three independent bilingual physicians who were familiar with the medical aspects of AS and by one professional translator. Two rheumatologists familiar with instrument validation, and who were aware of the purpose of the study, examined semantic, idiomatic and conceptual issues and produced by consensus unified versions of each instrument. English back-translations from the Spanish were done by a professional translator unaware of the original version. Both English versions were compared, and where needed, modifications to the Spanish versions were made. The Spanish versions were administered to 61 ambulatory patients with AS and to 80 patients with undifferentiated spondyloarthropathy for validation purposes. Reliability and responsiveness were measured in 28 patients participating in a physiotherapy program. RESULTS: Reliability showed an acceptable 24-hour test-retest intraclass correlation coefficient (ICC)--BASFI ICC: 0.68, 95% CI: 0.29-0.85; BASDAI ICC: 0.74, 95% CI: 0.52-0.88 and DFI ICC: 0.87, 95% CI: 0.73-0.94. The construct validity of the instruments was evaluated, and BASDAI was correlated with disease activity measured by the total enthesis count (rs: 0.34); general well being in the last week (rs: 0.7); spinal pain (rs: 0.53) and duration of morning stiffness (rs: 0.64). BASFI correlated with Schöber's test (rs: -0.4); occipital-wall distance (rs: 0.38) and thoracic expansion (rs: -0.3). DFI correlated with Schöber's test (rs: -0.36); occipital-wall distance (rs: 0.29) and chest expansion (rs: -0.3). The correlation among DFI and BASFI was rs: 0.83. All instruments showed clinical responsiveness in the physiotherapy program (baseline and end of program; mean +/- SD): BASDAI: 6.25 +/- 1.97 and 3.07 +/- 2.04 (p = 0.0001); BASFI: 5.68 +/- 2.29 and 2.88 +/- 1.77 (p = 0.0001); DFI: 16 +/- 7.6 and 8.0 +/- 5.5 (p = 0.001) with effect sizes and standardized effect sizes > 1. CONCLUSIONS: The Mexican Spanish versions of the BASDAI, BASFI, and DFI showed adequate reliability, validity and responsiveness to clinical change. These instruments can be used in the clinical evaluation of Spanish-speaking patients with AS.

Activities of Daily Living↗
PubMed1990

Five-year results of the peer assessment program of the College of Physicians and Surgeons of Ontario.

The office practices of 918 physicians selected through stratified random sampling from the College of Physicians and Surgeons of Ontario (CPSO) registry were assessed by peers and the Peer Assessment Committee of the CPSO from 1981 to 1985. The sample comprised 662 general practitioners (GPs) and family physicians (FPs) and 256 specialists in 11 fields. Of the physicians 749 (82%) had neither deficient records nor an unsatisfactory level of patient care. Of the GPs and FPs 97 (15%) had serious deficiencies in one or both areas, as compared with 4 (2%) of the specialists (p2 less than 0.00001). The proportions of certificants of the Royal College of Physicians and Surgeons of Canada and of the College of Family Physicians of Canada (CFPC) with serious deficiencies were low (2% and 3% respectively). Three statistically significant predictors of physician performance were found among the GPs and FPs: age, CFPC membership status and type of practice. Of the 56 physicians who were reassessed 6 to 12 months later 29 (52%) had made the improvements recommended by the committee. Our findings demonstrate the need, feasibility and acceptance of a peer assessment program of office practices in Ontario.

Age Factors↗
PubMed2002

Cost-effectiveness of screening the average-risk population for colorectal cancer.

This article reviews several of the recent models addressing the cost-effectiveness of colorectal cancer screening in the average-risk individual (Table 1). How can clinicians and policy makers use this information for decision making regarding colorectal cancer screening? The cost-effectiveness ratios reported by themselves do not identify cost-effective practices. They must be placed in a decision context that is expressed in one of two forms. In the first form, an explicit threshold or maximum amount that a policy maker is willing to spend is stated (e.g., $40,000 per LY gained, as has been quoted as an acceptable amount for a prevention program). In the second form of decision context, a list of medical practices and their associated cost-effectiveness ratios, also known as a league table (Table 2) is used as a basis for comparison with the practice under evaluation (e.g., colorectal cancer screening). The practice with the lowest cost-effectiveness ratio is the most cost-effective practice on the list. Practices with lower cost-effectiveness ratios are considered cost-effective compared with those with higher ratios. Table 2 lists incremental cost-effectiveness ratios for common medical practices. The models discussed in this article suggested that colorectal cancer screening using annual FOBT, flexible sigmoidoscopy at 3 or 5 years, the combination of FOBT and flexible sigmoidoscopy, barium enema, colonoscopy, and even virtual colonoscopy had incremental cost-effectiveness ratios ranging from $6300 to $92,900 per LY saved with most of the cost-effectiveness ratio ranging from $10,000 to $40,000 per LY saved. These ratios are similar to the cost of another widely accepted practice, breast cancer screening with annual mammography in women age 50 and older ($22,000 per LY gained). Colorectal cancer screening with any of the modalities discussed is considered less cost-effective than screening for hemochromatosis, which has an incremental cost-effectiveness ratio of $3665 per LY saved. Based on these ratios, however, screening for colorectal cancer is considered cost-effective compared with cervical cancer screening in women age 20 and older with pap smear every 3 years, which has an incremental cost-effectiveness ratio of $250,000 per LY gained. The clinician can use these incremental cost-effectiveness ratios to evaluate the risks and benefits of alternative practices for the individual, and the policy maker with a limited health care budget can use these ratios to set priorities for funding based on the costs and the expected gains in life expectancy for colorectal cancer screening and for alternative health care programs.

Colonoscopy↗
PubMed1993

Community-based home-care program for the management of pre-eclampsia: an alternative.

OBJECTIVE: To evaluate the safety, acceptability and cost of a community-based home-care program for the management of mild pre-eclampsia. DESIGN: A descriptive study of outcomes between Apr. 1, 1985, and Dec. 31, 1989. SETTING: St. Boniface General Hospital, Winnipeg. PATIENTS: Urban Winnipeg residents between 27 and 40 weeks' gestation with mild pre-eclampsia who demonstrated acceptance and compliance with home-care management; 321 patients of 1330 were enrolled in the program. INTERVENTIONS: Bed rest at home with daily biochemical and biophysical follow-up protocol and weekly clinic visits; patient education; hospital admission for labour, induction, worsening pre-eclampsia or noncompliance with rest at home. OUTCOME MEASURES: Patterns of referral to the program; clinical, biochemical and biophysical profiles; incidence of severe complications; reduction in total hospital stay and cost analysis. RESULTS: As many women were referred from physicians' offices as were referred from the hospital's antepartum unit, the average gestational age at referral being 36 weeks. Most (205 [64%]) of the women were nulliparous. The average length of stay in the program was 11.5 days. The program's availability resulted in a reduction of 2 days (from 5.7 days to 3.7 days) on average in the length of hospital stay when analysed for all 1330 women with pre-eclampsia. Of the 321 patients in the program 137 (43%) were admitted to hospital for worsening pre-eclampsia; severe pre-eclampsia developed 4 days after admission in 9. No patient suffered eclampsia, disseminated intravascular coagulopathy, abruption or fetal loss related to pre-eclampsia while in the program. The estimated cost saving in the management of pre-eclampsia was over $700,000 over the study period. CONCLUSION: The community-based home-care program is a safe, feasible and less costly alternative to hospital admission in the management of mild pre-eclampsia.

Cost Savings↗
PubMedDate not supplied

Utilizing grassroots workers in family planning programs in India: prospects and problems.

In order to rapidly expand the network of delivery systems and speed up the process of acceptance of family planning messages and methods, a shift took place in the Indian family planning program from the bureaucratic "clinical" approach to the people oriented "extension" approach. As a result, there is an increasing emphasis on moving the family planning efforts closer to the grassroots level. A key methodological issue centers on the proper selection, cultural acceptability, and the effectiveness of the grassroots workers who are to be trained and through whom family planning motivational messages and methods are to be introduced. The Indian government, from time to time, has trained and utilized different groups of grassroots workers in its family planning promotional efforts. Anthropological field studies were conducted in two different regions in India to examine the potential and actual roles of two groups of grassroots workers--opinion leaders and traditional birth attendants--in the delivery of family planning services in the rural areas. These studies revealed that while the traditional birth attendants can be trained and utilized to a limited extent in promoting family planning efforts, especially to the eligible female clients, the role of the opinion leaders in such efforts is at best questionable. Based on these field studies, cultural and technical (including bureaucratic) problems in training and utilizing opinion leaders and traditional birth attendants are explored in detail. Modifications in the training program strategies are suggested to improve and expand the family planning delivery system in rural India.

Advertising↗
PubMed2005

Candid candidate comments: the relationship between residency program selection factors and match list placements from ranked applicants.

OBJECTIVE: The purpose of this study was to explore the relationship between residency program selection factors and placements we received on candidates' match lists. STUDY DESIGN: An annual (2001-2004) telephone survey of applicants (n = 140) ranked for acceptance to the department's residency program addressed 16 program selection factors important in choosing our site. Candidates' comments about these program selection factors were recorded. Logistic regression was conducted with program selection factors as independent variables and program receipt of candidates' top quartile match list rankings as the dependent variable. RESULTS: The overall response rate was 68% (n = 95). Applicants' positive ratings on 3 program selection factors were related to our receipt of top quartile match list rankings: 1) our capacity to meet personal career goals (odds ratio [OR] 4.59); 2) positive faculty-resident relationships (OR 1.97); and 3) suitable location (OR 1.96). CONCLUSION: The single most important factor contributing to receipt of candidates' top quartile match list placements was positive perceptions of our program's abilities to meet their personal career goal needs.

Career Choice↗
PubMed2002

Longitudinal analysis of student performance in a dental hygiene distance education program.

The purpose of the study was to determine if learners who receive face-to-face instruction in an educational program performed statistically better on established benchmark assessments (GPA, course averages, and NBDHE) than learners at a distance from the didactic course instructor. A comparative, quasi-experimental, ex-post facto study was conducted. The treatment variable was program type: face-to-face vs. distance. The performance of five consecutive classes was analyzed, from 1997 to 2001. These five classes consisted of 221 learners, 105 of them at the host site and 115 using distance learning. The experimental groups were divided based upon location--host or cooperating college (distance) site learners. Study results identified no significant difference between host and distance learner performance for the entire educational program. The use of interactive television (ITV) for delivery of an educational program using distance education technology provided acceptable results in learner didactic performance. Learners at both the host and cooperating college (distance) sites performed equally well. The results were used to document program outcomes.

Analysis of Variance↗
PubMed1982

Preventive dental programs for school-age children in 8 countries: pilot survey, 1979.

This paper reports the results of a pilot project, sponsored by the FDI Working Group on Oral Health Promotion, which was designed to describe preventive dental programs for school-age children in 10 countries. A mail questionnaire was developed to obtain information about program philosophy, target population, preventive program components, promotion and educational methods, barriers to program development, program priorities and evaluation methods. In this pilot phase, a total of 27 questionnaires were returned from 8 countries (Argentina, Federal Republic of Germany, France, Japan, Singapore, Sweden, Thailand, United Kingdom). Respondents generally recognized the need to include three major program elements in order to build comprehensive programs, primary preventive measures, early detection and treatment services, and instructional activities for children and adults. Financial problems were cited most frequently as barriers to program development, followed by manpower, public acceptance, policy decisions, policy-maker attitudes, legal constraints and transportation. The domain of educational problems associated with initiating and maintaining children's preventive dental programs is broad and diverse. Educational problems, roles and methods seemed to be pervasive, cutting across all program components. Although the greatest educational emphasis appeared to be on oral hygiene, the need was also recognized to include educational components for each dental program element or service, such as fluoride rinsing. Educational needs related not only to children, but to policy-makers, dental and other health professionals and program and school personnel. The FDI Working Group has expanded the survey and collected data from a much larger number of countries during 1979-1981. Results of the larger survey will be presented at the Annual World Dental Congress of the FDI in Vienna, 1982.

Asia↗
PubMed2002

Control of small ruminant brucellosis by use of Brucella melitensis Rev.1 vaccine: laboratory aspects and field observations.

Brucellosis vaccines are essential elements in control programs. Since first developed in the mid-1950s, the Brucella melitensis vaccine strain Rev.1 has been used worldwide and its significant value in protecting sheep and goats in endemic areas recognized. This review provides historical background on the development of the vaccine, its use and field complications arising in Israel following changes in the strain's pathogenicity. The urgent need for resolving cases of vaccine strain excretion in the milk, horizontal transfer and a unique case of human infection has led to identification of an atypical B. melitensis biovar 1 strain that resembles strain Rev.1 in susceptibility to penicillin and dyes. An omp2 based PCR method has been developed that traced the lineage of Israeli B. melitensis biovar 1 strains. This locus serves as an epidemiological tag for the Rev.1 vaccine strain. Despite the rapid development of new approaches in the field of vaccination, it is anticipated that in the near future the Rev.1 vaccine would remain the only accepted vaccine in national control programs.

Animals↗
PubMed2004

Implementation of HaemScreen, a workplace-based genetic screening program for hemochromatosis.

There is debate as to whether community genetic screening for the mutation(s) causing hereditary hemochromatosis (HH) should be implemented, due to issues including disease penetrance, health economic outcomes, and concerns about community acceptance. Hemochromatosis is a common preventable iron overload disease, due in over 90% of cases to C282Y homozygosity in the HFE gene. We are, therefore, piloting C282Y screening to assess understanding of genetic information and screening acceptability in the workplace setting. In this program, HaemScreen, education was by oral or video presentation in a group setting. C282Y status was assessed by polymerase chain reaction (PCR) and melt-curve analysis on DNA obtained by cheek-brush sampling. Of eligible participants, 5.8% (1.5-15.8%) attended information and screening sessions, of whom 97.7% (5571 individuals) chose to be tested. Twenty-two C282Y (1 : 253) homozygotes were identified and offered clinical follow-up. There were 638 heterozygotes (1 : 8.7). The determinants for participation have been analyzed in terms of the principles outlined in the Health Belief Model. Widespread screening for HH is readily accepted in a workplace setting, and a one-to-many education program is effective. The level of participation varies greatly and the advertizing and session logistics should be adapted to the specific features of each workplace.

Adolescent↗
PubMed2001

Prevention research and its actual application to health services.

The effectiveness of alcohol abuse programs, whether to treat or to prevent, is of major importance to health services research. Demonstrating effectiveness has been appropriate to establish a sound scientific basis for these programs and to increase public acceptance. Analysis of the costs of prevention efforts in terms of their demonstrated effectiveness in reducing health services demand also is essential. In the end, health services policy deliberations are optimally based on what effect is delivered for the cost of the service, not simply on a determination of which service is the most effective. However, in a time of scarce resources prevention should be studied with the same rigor as treatment in order to determine the best return on investment.

Alcoholism↗
PubMed1990

Potato growth and yield using nutrient film technique (NFT).

Potato plants, cvs Denali and Norland, were grown in polyvinyl chloride (PVC) trays using a continuous flowing nutrient film technique (NFT) to study tuber yield for NASA's Controlled Ecological Life Support Systems (CELSS) program. Nutrient solution pH was controlled automatically using 0.39M (2.5% (v/v) nitric acid (HNO3), while water and nutrients were replenished manually each day and twice each week, respectively. Plants were spaced either one or two per tray, allotting 0.2 or 0.4 m2 per plant. All plants were harvested after 112 days. Denali plants yielded 2850 and 2800 g tuber fresh weight from the one- and two-plant trays, respectively, while Norland plants yielded 1800 and 2400 g tuber fresh weight from the one- and two-plant trays. Many tubers of both cultivars showed injury to the periderm tissue, possibly caused by salt accumulation from the nutrient solution on the surface. Total system water usage throughout the study for all the plants equaled 709 liters (L), or approximately 2 L m-2 d-1. Total system acid usage throughout the study (for nutrient solution pH control) equaled 6.60 L, or 18.4 ml m-2 d-1 (7.2 mmol m-2 d-1). The results demonstrate that continuous flowing nutrient film technique can be used for tuber production with acceptable yields for the CELSS program.

Culture Media↗
PubMed1999

[Target controlled infusion (TCI): applications of the "TCI visual" program in anesthesia and sedation with propofol].

BACKGROUND: Systems for Target Controlled Infusion accepting not only patient' data, like Diprifusor, but also a pharmacokinetic model have not been available in Italy in the last years. Therefore a program which controls a Pilot Anesthesia Vial pump and accepts any pharmacokinetic model was developed and applied to propofol infusion for anaesthesia and sedation. METHODS: Two versions of the Visual TCI program have been developed. The first, at intervals, supplies the anaesthetist with the values for the pump; the second directly interacts with the pump. The program also supplies the anaesthetist with the current amount of drug in each compartment and with the estimated awakening time. DESIGN: preliminary prospective study. SETTING: operatory theatre and Intensive Care Unit in a University Hospital. PATIENTS: 6 patients undergoing total intravenous anaesthesia with propofol and fentanyl for abdominal surgery; 6 patients undergoing sedation with propofol in an Intensive Care Unit (the first 4-hour period was taken into account). INTERVENTIONS: propofol infusion was regulated by the Visual TCI program. The first version was employed in three patients of each group and the second one in the others. Hypo- and hypertensive episodes (systolic pressure less than 80 mmHg or higher than basal value plus 25%) were recorded during anaesthesia and sedation. Propofol concentration was measured in plasma three times at defined intervals and per cent differences between measured and computer-calculated values (Predictive error, PE) were calculated. RESULTS: No hypo- or hypertensive episodes were recorded. PE was 27.4 +/- 17.9%. CONCLUSIONS: The program was easily employed, caused no inconvenience, and its use was associated with a remarkable cardiovascular stability. PE distribution was acceptable on the ground of the criteria reported in the literature. The program can be applied to drugs other than propofol, with both two and three compartment pharmacokinetic models and the anaesthetist can choose the most suitable model for the patient.

Adult↗