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PubMed1981

Allied health perspectives in the 1980s.

A number of changes taking place in our society are affecting the health care delivery system and influencing allied health education and practice. This article summarizes changes in population characteristics, technology, disease patterns, health care needs, and the programs designed to meet those needs as they influence health personnel development in general and allied health in particular. A current definition of allied health is presented, along with an analysis of allied health personnel in the health care work force and of educational programs preparing allied health personnel. Implications of trends in allied health in the United States are projected and current eras in allied health education are discussed. Finally, the recommendations of the National Commission on Allied Health Education are summarized along the the programmatic response of the American Society of Allied Health Professions.

Allied Health Personnel↗
PubMed1979

A colorimetric assay of lysogenic induction designed for screening potential carcinogenic and carcinostatic agents.

Simple, rapid colorimetric tests for lysogenic induction (the derepression of a latent bacterial virus) are described. A quantitative test and a more rapid semiquantitative test are based on the assay of the beta-galactosidase synthesized from lacZ gene fused to an operon under lambda repressor control. These biochemical "inductests" are suitable for screening programs designed to detect agents that damage DNA and that are of potential interest in carcinogenesis and cancer chemotherapy.

Bacteriophage lambda↗
PubMed1988

A typology of Medicaid managed care.

This article presents a typology for use in classifying and interpreting the findings of the growing empirical literature on managed care initiatives in the Medicaid program. Six key program attributes are identified for use in examining similarities and differences among these programs. Several alternative arrangements for each attribute are described from among the more than 60 different programs attempted. The typology is illustrated with five specific program designs, and selected empirical results from them are used to demonstrate how the typology can be employed.

Delivery of Health Care↗
PubMed1991

Resident, faculty, and residency program development. An integrated approach through annual retreats.

Retreats during residency training have evolved as an escape from the daily routine. Recognizing that the retreat format could also be used as a foundation for program design and personal development, we have designed annual retreats for each of the 3 years of pediatric residency training. The sessions vary in length and agenda, but serve as the basis for an ongoing effort fostering growth and maturation of the department and its component participants. The effectiveness of the program (and the morale of the residents) is greatly influenced by this program.

Chicago↗
PubMed1987

Health advocacy for young, low-income, inner-city women.

The Urban Women's Health Advocacy Training Project was a university-based demonstration program designed to collect data on the health status of urban women and to test nursing interventions for training community health advocates. Thirty Hispanic and black trainees between 17 and 21 years of age were selected to participate in an eight-week, 20-h/w program emphasizing women's health education, health advocacy skills, and career awareness. This project has many implications for nursing practice with young, inner-city women. Enhancing the self-care and advocacy skills of these women maximizes their potential for use of available health services and their ability to influence the expansion of the services required to meet their own and their families' health care needs. Problems in funding and conducting such demonstration projects are discussed.

Adolescent↗
PubMed1975

Utilization of emergency dental services by rural, nonreservation Indians.

The Shasta-Trinity-Siskiyou Indian dental clinic, which serves rural, nonreservation Indians in California, implemented a health education program designed to convert patients from an emergency to a routine care basis. A study was conducted, therefore, of the utilization patterns of 109 emergency patients treated at a clinic from September, 1971, through November, 1972, in order to provide information to improve this educational program. The results of the study showed that 58.7 percent of the emergency patients returned for routine care. Analyses of those patients who returned and those who did not return for care were made with regard to age, sex, time since last dental visit, and type of emergency treatment received. There were significant differences between the two groups of emergency patients with regard to age and type of treatment received. Those most likely to return for routine care were the patients 15 years or younger, and those who had received operative care. The emergency patients in the 16-25 age group, and those who received periodontal care were the least likely to return. No significant differences were found with regard to sex, or time since last dental visit. The emergency patients and patients whose initial visit to the clinic was for routine care were compared. A significant difference was found with regard to age. The patients 15 years or younger had the lowest percentage of initial visits for emergency care, and the 16-25 year age group had the highest. No significant differences were found with regard to sex, or time since last dental visit. This study may well be the first to examine the utilization of dental services by rural, non reservation Indians. The findings presented can serve as a basis for future investigation to improve the provision of dental services to this patient population.

Adolescent↗
PubMed1979

Proposition 13: experience in one community mental health center.

The impact of Proposition 13 on one community mental health center in California is described. Although the center has had no layoffs as a result of its passage, the measure has had a serious effect on staff morale, which was already at a low point because of pre-existing budgetary constrictions that led to staff reductions despite increased demands for services. It has also generated several changes in treatment programs designed to reduce overhead costs and make more efficient use of staff time. The author emphasizes that because of the supplemental funds made available by the state from its surplus during fiscal year 1978-79, the full impact of Proposition 13 on local service programs is still to be felt.

California↗
PubMed2006

Development of an obesity prevention and management program for children and adolescents in a rural setting.

This study applied theory-based health behavior change constructs to childhood obesity prevention. Constructs such as goal setting, self-efficacy, and readiness for change were used within a rural community-based program designed to be developmentally appropriate for 6th graders. The project included 2 studies across 12 months. The 1st assessed the scope of the obesity problem within a 3-county area with key stakeholders in health and education. The 2nd implemented a pilot community intervention program within a rural middle school. Participants in the intervention included 65 middle-school students and the families of 25 of these students. Qualitative and quantitative analyses were conducted to assess the effectiveness of the intervention. Changes from pre- to postintervention on relevant measures were statistically significant for families but not for students. Issues related to family versus individual behavior change are discussed, along with implications for managing behaviorally based activity and nutrition interventions within a rural community.

Adolescent↗
PubMed1999

Dental office planning.

BACKGROUND: A properly planned dental office can contribute directly to the success of your practice. Critical steps in creating a successful dental office environment are developing a design program, determining the size and cost of your facility, selecting a location and assembling the appropriate professionals to help with planning and construction. PRACTICE IMPLICATIONS: Planning a dental office is a multifaceted and complex task. For optimal results, you need to completely understand the design and construction process, as no other business activity will demand a greater investment of your time and money.

Costs and Cost Analysis↗
PubMed1979

New issues, new options: a management perspective on population and family planning.

As population problems increasingly are seen in the context of socioeconomic development and as programs to reduce fertility become more diversified and multisectoral, issues facing program managers are changing. In addressing today's challenges in the areas of population policy and development planning, family planning program design, and problem-solving mechanisms, a variety of options can be considered. No blanket prescriptions can be made, but familiarity with some of the alternative and an understanding of their political and administrative implications may be helpful to managers, not only of population programs but in related development field as well.

Family Planning Services↗
PubMed1984

Outpatient use of ceftriaxone: a cost-benefit analysis.

Patients who participated in an outpatient intravenous therapy program designed to limit hospitalization for those who could be maintained on ceftriaxone at home were interviewed regarding costs and benefits. Of the 79 patients interviewed concerning 83 therapeutic episodes, 43.4 percent were able to perform their usual activities as soon as they began the program, 28.9 percent were restricted for part of the time, and 27.7 percent never resumed their usual activities. The 83 therapeutic episodes represent a total of 2,409 outpatient days (mean 29.7; standard deviation [SD] 17.7), 1,406 of which represent unrestricted activities. Costs and benefits of the program were calculated separately for four employment groups: not employed; usually employed, but not while on intravenous therapy; employed while on intravenous therapy, with time off for follow-up visits; and employed while on intravenous therapy, no time off for follow-up required. The mean total benefit, weighted across all four groups, was $6,588.14 (SD = $3,802.90) per patient. Mean weighted costs totalled $1,768.02 (SD = $1,129.36). The overall weighted benefit/cost ratio was approximately 5:1. Although private insurers reimbursed 63 percent of the patients for all hospitalization costs, only 39 percent were fully covered for the follow-up physician visits required during outpatient therapy.

Adolescent↗
PubMed1991

Evaluation of a Computerized Clinical Information System (Micromedex).

This paper summarizes data collected as part of a project designed to identify and assess the technical and organizational problems associated with the implementation and evaluation of a Computerized Clinical Information System (CCIS), Micromedex, in three U.S. Department of Veterans Affairs Medical Centers (VAMCs). The study began in 1987 as a national effort to implement decision support technologies in the Veterans Administration Decentralized Hospital Computer Program (DHCP). The specific objectives of this project were to (1) examine one particular decision support technology, (2) identify the technical and organizational barriers to the implementation of a CCIS in the VA host environment, (3) assess the possible benefits of this system to VA clinicians in terms of therapeutic decision making, and (4) develop new methods for identifying the clinical utility of a computer program designed to provide clinicians with a new information tool. The project was conducted intermittently over a three-year period at three VA medical centers chosen as implementation and evaluation test sites for Micromedex. Findings from the Kansas City Medical Center in Missouri are presented to illustrate some of the technical problems associated with the implementation of a commercial database program in the DHCP host environment, the organizational factors influencing clinical use of the system, and the methods used to evaluate its use. Data from 4581 provider encounters with the CCIS are summarized. Usage statistics are presented to illustrate the methodological possibilities for assessing the "benefits and burdens" of a computerized information system by using an automated collection of user demographics and program audit trails that allow evaluators to monitor user interactions with different segments of the database.

Computer Systems↗
PubMed1986

Selecting subpopulations for intervention.

The effectiveness of a program designed to eliminate exposure to a risk factor may be enhanced by selecting specific subpopulations for the intervention effort. A second factor is called an intervention effect modifier of the first factor if the effect of the intervention. If an intervention effect modifier exists, a program's effectiveness may be enhanced by choosing a subpopulation for intervention on the basis of the distribution of that factor. We discuss the conditions in which intervention effect modification can occur when there is a third factor which influences risk. Additivity of incidence rates, the criterion when only two factors are involved, is neither necessary nor sufficient to rule out intervention effect modification in this situation. We also discuss the cost effectiveness of intervention strategies when the cost per successful intervention varies.

Costs and Cost Analysis↗
PubMed2005

A randomized controlled study of a computerized limited education program among young adults with asthma.

The aim of the study was to assess the effectiveness of a computerized limited asthma education program, designed to suit young people. The study was conducted with 97 young adults (18-25 years) with asthma, 48 were randomized to the intervention group and 49 to the control group, and they were followed for 12 months. The intervention group completed an interactive computer program of 30-min duration providing information about asthma, mechanisms, trigger factors, allergies and medication use, which was followed by a 30-min discussion with a specialized asthma nurse. The control group followed the routine schedule for asthma outpatients. The outcomes of the study were number of hospital admissions, emergency visits, asthma symptoms, knowledge about asthma, lung function and quality of life. No effect was found regarding admission to hospital, emergency visits, prevalence of respiratory symptoms, knowledge of asthma or quality of life. However, forced exhaled volume in 1s (FEV(1)) increased significantly, mainly among the atopic subjects. In conclusion, an intervention with a limited asthma education program did not show an effect on asthma symptoms, asthma knowledge or quality of life parameters.

Adolescent↗
PubMed1998

Creatine kinase activity in human spermatozoa and seminal plasma lacks predictive value for male fertility in in vitro fertilization.

OBJECTIVE: To examine the predictive value of creatine kinase in human spermatozoa and seminal plasma from patients treated in an IVF program. DESIGN: Prospective, blind clinical study. SETTING: Male infertility clinic. PATIENT(S): Seventy-three patients and 32 fathers (age, <45 years). INTERVENTION(S): Determination of creatine kinase activity in seminal plasma, washed spermatozoa, and swim-up purified spermatozoa from patients treated in an IVF program. MAIN OUTCOME MEASURE(S): Creatine kinase activity in seminal plasma, washed spermatozoa, and swim-up purified spermatozoa. RESULT(S): Creatine kinase activity in washed spermatozoa correlated significantly with normal sperm morphology. No significant correlations were found between creatine kinase activity or creatine kinase isoenzyme ratio in seminal plasma, washed spermatozoa, or swim-up purified spermatozoa and success in the IVF program. The percentage of spermatozoa with normal morphology was significantly lower in patients whose sperm did not fertilize than in patients whose sperm did fertilize oocytes and in the control group of proven fathers. CONCLUSION(S): Total creatine kinase activity and creatine kinase isoenzyme distribution are not sperm function markers for prediction of male fertility in IVF treatment.

Adult↗
PubMed1998

Organizational guidelines for dual disorders programs.

Dual disorders--combined severe mental disorders and substance use disorders--were barely recognized two decades ago. As a result of the high prevalence and serious consequences of these disorders, they have received considerable attention over the last two decades. Knowledge has accumulated about dual disorders and their treatment, and treatment providers may now consider numerous options for clinical interventions and program designs. In this article, we offer guidelines concerning these options. We review the current knowledge about dual disorders and the results of recent research on the assessment and treatment of these disorders. We present treatment principles, recommendations on the components and organization of dual disorders programs, and suggestions for dealing with clinical issues that remain controversial. We conclude with comments on the demands of the managed care environment and the heightened importance of continued research in this area.

Counseling↗
PubMed2000

Glutamic acid decarboxylase and IA-2 autoantibodies in type 1 diabetes: comparing sample substrates for autoantibody determinations.

Large-scale programs designed to assess risk for type 1 diabetes through serologic assessment of autoantibodies to recombinant beta-cell autoantigens are hampered by several limitations, including the methods for sample collection and assay performance, as well as the volume required for autoantibody determinations. The present study was designed to develop a low sample-volume, primary screening method for autoantibody detection of high specificity and sensitivity, and to determine the feasibility of dried blood spots collected on filter paper in serving as vehicles for such determinations. Autoantibodies to glutamic acid decarboxylase (GAD) and ICA512bdc (IA-2), both individually and in combination, were determined in persons with type 1 diabetes, healthy controls, or individuals with other autoimmune disorders. Autoantibody results for serum, plasma, and dried blood spots were compared. GAD, IA-2, and combined GAD/IA-2 autoantibodies were concordant in their measurement from minimal volumes of serum, plasma, and whole blood extracted from dried filter paper. The autoantibody levels from the dried blood spots were, however, lower than corresponding serum samples, and, as currently designed, failed to detect low-titer autoantibodies. Despite this limitation, screening for diabetes risk can be performed using small volumes of whole blood, serum, or plasma collected onto filter paper. These methodological improvements should simplify matters, reduce costs, and increase the efficacy of screening programs for type 1 diabetes. Further development of better substrates/methods for blood-specimen collection seems necessary to exploit the full potential of this and other autoantibody measurement strategies for screening large populations.

Journal Article↗
PubMed1978

Evaluation of goal attainment in geriatric settings.

Determination of the impact of programs designed to enhance the functional independence of geriatric residents requires prior specification of goals in terms that clearly indicate the desired outcomes. The Geriatric Resident Goals Scale (GRGS) is a listing of specific goals developed to provide a systematic means of assessing resident status and program effectiveness. For male residents in a VA Nursing Home Care Unit, the obtained internal consistency reliability coefficient was .97 (N = 198), and the reliability coefficient reflecting a combination of test-retest and interrater consistency was .95 (N = 22). For a group of 178 residents, the GRGS was predictive of level of independence ratings (r = .82) and mental status (r = .71). The data showed the GRGS to be a highly reliable and valid means of assessing the functioning of geriatric residents, lending support to an assessment process based on a listing of specific goals. The GRGS can be viewed as a general procedure that is adaptable to a range of geriatic settings and programs.

Activities of Daily Living↗