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PubMed2001

Establishing the validity of test score inferences: performance of 4th-year U.S. medical students on the ECFMG Clinical Skills Assessment.

BACKGROUND: Although the relations among prematriculation, matriculation, and residency assessments have been studied, measures pertaining to clinical skills have rarely been incorporated in any analyses. PURPOSE: The purpose of this article was to investigate the relations between scores obtained on the Educational Commission for Foreign Medical Graduates Clinical Skills Assessment (CSA) prototype and aptitude-ability measures designed to select medical students, to assess medical students while in medical school, and to evaluate physicians in postgraduate training programs. The sample included 122 4th-year medical students. METHODS: Relations among scores were summarized with correlation coefficients. Analysis of variance was used to compare CSA scores by departmental grades. RESULTS: Significant correlations (p < .01) were found between scores from assessments commonly used in medical school (i.e., United States Medical Licensing Exam [USMLE] Steps 1 and 2) and CSA component scores. There were weak associations between CSA measures and both Medical College Admissions Test scores and residency program evaluations. CONCLUSIONS: The relations between CSA scores and various other medically oriented ability measures provide additional evidence that inferences based on CSA scores are appropriate and valid.

Adult↗
PubMed1993

Use of therapeutic milieu in a community setting.

1. Many of the same components that contribute to the success of milieu therapy in inpatient facilities also promote treatment success for clients living in the community. 2. Treatment goals at the Rosati Center, a transitional residential program for chronically mentally ill homeless persons in St. Louis, generally include supporting residents as they secure their own permanent housing; helping residents apply for entitlements so that they can support themselves upon discharge; connecting residents with outpatient psychiatric treatment; and assisting residents to structure their time and activities as a means to improving coping skills. 3. Program evaluations of the transitional living program at the Rosati Center revealed that implementation of therapeutic milieu concepts (in combination with case management concepts) can be successful. The facility served 228 persons during a 5 1/2-year period. Nearly half of those persons were discharged having fully met the objectives of the transitional program.

Adult↗
PubMedDate not supplied

Validation of the brief multidimensional students' life satisfaction scale among college students.

OBJECTIVE: To investigate the psychometric properties of the BMSLSS among 522 college students. METHODS: Internal consistency reliability explored scale reliability, factor analysis explored construct validity, known-groups validity was assessed by use of items from the National College Youth Risk Behavior Survey and Harvard National Survey of Alcohol Use, and criterion-related validity was explored through analyses with the CDC's Health-Related Quality of Life Scale. RESULTS: Acceptable internal consistency reliability, construct, known-groups, and criterion-related validity were established. CONCLUSIONS: These findings offer preliminary support for the BMSLSS; it could serve as part of comprehensive evaluations of subjective QOL for program evaluation and/or policy purposes among college students.

Adolescent↗
PubMed1998

Federal Employees Health Benefits Program improving carrier performance; conforming changes--OPM. Final rule.

The Office of Personnel Management (OPM) is issuing a final regulation that implements OPM's initiative to ensure high quality customer service to its enrollees in the Federal Employees Health Benefits (FEHB) Program by establishing a performance evaluation program that will hold community-rated carriers accountable for their performance. The regulation would enable OPM to better manage carriers' performance in key contract areas, including customer service measures, information and reporting requirements, and significant events that might affect service to enrollees.

Government Agencies↗
PubMed2002

Evaluation of indications for and outcomes of elective surgery.

BACKGROUND: Wide small-area variations in the rates of elective surgical procedures and lack of systematic outcome measurement have raised questions about the appropriateness of such surgery. Our objective was to determine the feasibility of routine evaluation of indications for and outcomes of elective surgery. METHODS: Participants consisted of 138 surgeons and 5313 patients who underwent 1 or more of 6 specific surgical procedures (for a total of 6274 operations). Surgical indications were evaluated according to published guidelines. Patients' self-reported health-related quality of life (HRQOL) before and at appropriate intervals after surgery was measured with standard, validated generic and disease-specific instruments. Patient-specific results were routinely sent to the surgeons, from whom feedback was requested. RESULTS: Surgeons provided information on the indications for surgery for 44% to 95% of the 6 procedures, and the indications matched the guidelines in 73% to 99% of cases. Completed HRQOL questionnaires were returned by 58% of the patients. Postoperative HRQOL scores were markedly improved in most patients, but in 2% to 26% of the various procedures, there was either no change or a deterioration in HRQOL. In most of the procedure groups a small proportion of patients had relatively minor symptoms and disability preoperatively, but in the cataract surgery group this proportion was large. Opinion among the participating surgeons was divided as to the potential value of this method of evaluation. The cost of the outcome evaluation program was about $12/patient. INTERPRETATION: Evaluation of indications for and outcomes of elective surgery could be implemented systematically at reasonable cost and could be included in an accountability framework for health services. Most surgeons were not enthusiastic about this kind of evaluation.

Adult↗
PubMed1988

Preclinical toxicology of pirmenol hydrochloride.

Pirmenol hydrochloride (CI-845), a new orally effective antiarrhythmic agent, has undergone a comprehensive preclinical safety evaluation program. Repeated dose studies to evaluate chronic toxicity in rodents revealed few drug-related findings. A dose-related body weight gain suppression occurred in mice receiving up to 160 mg/kg for thirteen weeks. Rats also exhibited decreased body weight in a fifty-two-week study. Depressed fasting glucose levels were seen in rats at 50 mg/kg after thirteen weeks, but this effect was less prominent following fifty-two weeks of dosing. No other drug-related signs of toxicity were seen in rodents. Four-week repeated-dose intravenous studies in rats were uneventful. Occasional emesis and salivation, together with dryness of the oral mucosa, occurred in dogs given 10 mg/kg intravenously for four weeks. Drug-related increased heart rates, increased QRS duration, and reduced ST interval were seen thirty minutes postdose in dogs receiving 5 mg/kg or more intravenously. When dogs received pirmenol orally for fifty-two weeks, electrocardiographic and heart rate changes were variable and less pronounced than seen in the intravenous study. Clinical signs consisted of exaggerated pharmacologic responses similar to those found after intravenous dosing. Reproduction studies in rats and rabbits showed that pirmenol is not teratogenic. Reduced food intake and a 50% decrease in body weight gain were seen in rats at the top dose level of 150 mg/kg. Significantly reduced mean fetal weight and increased postimplantation loss indicated that 150 mg/kg was embryotoxic to rats. A top dose of 50 mg/kg in rabbits did not produce any signs of maternal or fetotoxicity, aside from a moderate suppression of maternal weight gain.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1980

Changing oral hygiene attitudes and habits.

Up to the time of establishment (1962) of the Dental Health Education and Research Foundation, the philosophy and practice of preventive dentistry was almost unknown in Australia. Australians' dental health was generally as bad as any country in the world. Children were given little dental health instruction in schools. The majority of parents were seemingly uninformed about the need for the preservation and care of their own or their children's teeth. Dental Health Educators were trained to instruct school children in such subjects as diet, oral hygiene and plaque control. A Good Teeth Puppet Theatre was established and a special preventive dentistry orientated script written. A Mobile Dental Health Education Unit (caravan), equipped with a room darkened and lit by ultraviolet light, audiovisual instruction area and a mini laboratory, was built and set up in secondary schools. Pupils are encouraged to have their plaque disclosed using a yellow dye which becomes fluorescent when viewed under ultraviolet light; descriptive films are demonstrated and personal dental health instruction given. More than two and a half million children have participated in these programs. Evaluation studies of the school programs revealed that after six months children were able to recall more than 70% of the dental health message. Results of a recent WHO survey of the oral health status of 13-14-year-olds in Canterbury (New Zealand), Sydney (Australia), Trondelag (Norway), Yamanashi (Japan) and Hannover (West Germany) showed that the Sydney children had the lowest caries rate. The Sydney survey was carried out in the same are where the above Dental Health Education and Research Foundation community dental health programs operate.

Attitude↗
PubMedDate not supplied

[Teacher's opinions regarding graduation programs at the University of São Paulo Medical School--PAC-II].

The authors show the results of the "Curricular Evaluation Program" of University of São Paulo Medical School pertaining to the year of 1996. This program (PAC-II) is based on teachers' opinions regarding the subjects taught (1st to 4th grades) and hospital intern courses. The opinions collected concerning such programs were definitely favorable. Most of the teachers considered the programs to be either good or very good. It was also identified that the hospital intern courses were a little more valued than the other courses taught in the first four grades.

Curriculum↗
PubMed2000

Target drug programs and medication use evaluation.

Target drug programs and medication use evaluations are activities that are undertaken to improve the correct use of drugs. These programs should focus on inappropriate drug use, drug use problems, optimizing use of drugs, and improving the level of patient care. To monitor the effects of the programs, several types of outcomes have been evaluated, such as economic and financial, clinical quality, quality of life, patient satisfaction, and collaborative practice. The methodology to classify and monitor drug use incorporates the classification system developed by the World Health Organization, which takes into account each drug's anatomic, therapeutic, and chemical classification. In order to avoid focusing only on drugs and drug costs in these programs, and to allow for monitoring the impact of the programs on clinical practice, linking drug data to patient data is stressed. Target drug programs improve the appropriate use of drugs, and by doing so, contribute to safe and rational use of drugs in society.

Drug Prescriptions↗
PubMed2003

A framework for evaluating comprehensive community initiatives.

This article describes a model and design for evaluating a comprehensive community health promotion initiative. The theoretically based model was designed by the authors to evaluate a countywide initiative based on developmental assets, a framework for healthy youth development promoted by the Search Institute in Minneapolis, Minnesota. The model includes the components of a typical logic model and incorporates concepts proposed by diffusion of innovations, social cognitive theory, and Search Institute's conceptual model for community change. The model highlights the priorities of local stakeholders and directs evaluation activities in multiple community sectors over time. The evaluation design is presented according to the Centers for Disease Control and Prevention framework for program evaluation in public health.

Academies and Institutes↗
PubMed2002

Morbidity and management conference: an approach to quality improvement in brain injury rehabilitation.

BACKGROUND: Program Evaluation and Quality Improvement (QI) are an ongoing focus of all brain injury rehabilitation programs, but it is difficult to consistently include the entire rehabilitation team in QI activities and to focus on issues that cross the continuum of care. In addition, recent reports have provided a renewed emphasis on reduction of medical errors and improving the overall quality of care for individuals with chronic conditions. Rehabilitation Medicine has a long history of working as a coordinated multidisciplinary team caring for complex patients with chronic conditions and is in a position to be a leader in QI activities. DESIGN: We have modified the traditional Morbidity and Mortality conference to include a multidisciplinary case discussion to identify system issues with quality of care. SETTING: This is completed in a nonpunitive format that does not assign individual blame. CONCLUSION: This Rehabilitation Morbidity and Management Conference is an important addition to the QI activities of our program.

Brain Injuries↗
PubMed1998

Implementation of the Henry J. Kaiser Family Foundation's Community Health Promotion Grant Program: a process evaluation.

The Community Health Promotion Grants Program, sponsored by the Henry J. Kaiser Family Foundation, represents a major health initiative that established 11 community health promotion projects. Successful implementation was characterized by several critical factors: (1) intervention activities; (2) community activation; (3) success in obtaining external funding; and (4) institutionalization. Analysis of the program was based on data from several sources: program reports, key informant surveys, and a community coalition survey. Results indicate that school-based programs focusing on adolescent health problems were the most successful in reaching the populations they were targeting. The majority of the programs were able to attract external funding, thereby adding to their initial resource base. The programs were less successful in generating health promotion activities and in achieving meaningful institutionalization in their communities.

Adolescent↗
PubMed1991

Patient satisfaction with a psychiatric day treatment program.

Patient perceptions can contribute significantly to partial hospitalization program evaluation. A retrospective study of patients' satisfaction ratings and comments concerning a day treatment program using a discharge questionnaire yielded high degrees of satisfaction. This may reflect a priori selection biases toward patients who formed a working alliance within the program. Comparison with a group of patients admitted to the program who did not complete a discharge questionnaire failed to differentiate the two groups on the basis of demographic or clinical characteristics. Attendance by males admitted to the program who completed a questionnaire was significantly (p less than .01) more frequent than by males who did not complete the questionnaire. Consistency in individual component ratings with overall satisfaction with the program suggests nonspecific benefits, with group psychotherapy evoking polarized perceptions. The latter observation suggests the need for careful matching of patients with specific treatment modalities employed in a day treatment setting. Suggestions are made regarding the administration and construction of a patient satisfaction questionnaire as well as for the application of this measure in enhancing program efficacy.

Day Care, Medical↗
PubMed1981

The GENE-TOX program: genetic activity evaluation.

The GENE-TOX program, a two-phase evaluation from the existing literature of selected bioassays for detecting mutagenicity and presumptive carcinogenicity, is described. Sponsored and directed by the Office of Testing and Evaluation within the U.S. Environmental Protection Agency's (EPA) Office of Pesticides and Toxic Substances, this program will aid EPA in establishing standard genetic testing and evaluation procedures for the regulation of toxic substances and determining the direction of research and development in the area of genetic toxicology.

Animals↗
PubMed1992

Evaluation of patient counseling microcomputer software programs.

Five patient counseling drug information programs are evaluated using specific criteria definitions. This article compares the features and ratings of each program. The scope of drug coverage is found to be good to excellent. Most of the programs fared poorly in the timeliness of the database. Updates to the programs range from quarterly to undefined schedule. The ease of readability of all the programs is excellent. The inclusion of key components of information is determined to be good to excellent. The overall patient performance ratings are excellent for each of the programs. The programs are all competitively priced. All of the programs evaluated are easy to use. The only distinguishing feature among the programs is the format of the printed output.

Computer-Assisted Instruction↗
PubMed2005

Performance evaluation for diversity programs.

This policy paper addresses the problem of underrepresentation of minorities in the health care professions. Projections are that by 2050 minorities will represent 49% of the U.S. population. Several notable reports suggest that the health care of underrepresented minorities is improved when providers of similar ethnic and racial backgrounds provide the care. However, minority representation in the health care professions has not kept pace with the increase of minorities in the population. A variety of groups (federal, state, private, and health professional educational institutions) have provided billions of dollars toward increasing the number of underrepresented minority health care providers. However, the effectiveness of these programs is not readily evident. Therefore, we recommend comprehensive evaluations of programs funded to increase diversity in the health professions and the development of a Minority Health Care Professionals Center to assume accountability for monitoring programs that receive funding to increase the number of underrepresented minority health care providers.

Career Choice↗
PubMed1998

When the patient cannot come to the doctor: a medical housecalls program.

OBJECTIVES: To describe a medical housecalls program and to assess its ability to meet the medical needs of homebound patients. PROGRAM STRUCTURE: The housecalls program is part of a larger ambulatory practice situated in a senior center staffed by geriatricians and nurse practitioners. The practice serves as the major teaching site of outpatient geriatrics for a medical residency program. Scheduled visits are made every 3 to 4 months, and unscheduled visits are made weekday days for acute problems. PARTICIPANTS: Patients are eligible for the housecalls program if they live within a 15- minute drive of the center and are unable to leave their home. PROGRAM EVALUATION: The majority of the 71 patients in the housecalls program between 1993 and 1995 were female (81%), aged 85 years or older (52%), and dependent in one or more activities of daily living: 65% were dependent in bathing and 42% in dressing. A substantial minority (16%) had severe cognitive impairment. Patients received a mean of 5.0 visits per patient-year. The majority of patients (59%) were treated at home for an acute illness or symptom ranging from upper respiratory tract infections to pneumonia and congestive heart failure. Approximately one-quarter of the patients or their proxies elected to avoid hospitalization; several of these patients had complex illnesses managed in their homes. CONCLUSIONS: A wide range of medical problems can be addressed in patients' homes. Because our patients could not leave their homes easily, or at all, it is probable they would not have received routine medical care and would have used the emergency room for evaluation of acute problems if the housecalls program were not available. Despite their potential value in the care of frail older patients, housecalls will likely not become a widespread practice until barriers to their performance cited by physicians are addressed.

Aged↗
PubMedDate not supplied

Evaluation of an extended degree program in public health for working professionals.

The faculty of the School of Public Health, University of California at Berkeley, developed an extended degree program in health services administration for persons who could not attend the university full time. Course formats were redesigned so the courses could be taught off campus in Sacramento and in the San Francisco Bay Area. The extended degree program was designed to be the equivalent of the in-residence program in all respects: the minimum number of units required for the degree was the same and regular faculty taught in both programs. The course of study for the two programs was similar; a major difference, however, was that many more electives were available to on-campus students. Two cohorts of extended degree students were admitted (34 and 37), and 61 completed the program. This article evaluates the success of that program. Evaluation began in 1980, 4 years after the first cohort, and 2 years after the second cohort were graduated--sufficient time for the graduates and faculty to reflect on their experiences. By the measures used--entering grade point average, graduating grade point average, and scores on a common comprehensive examination--the two groups were comparable. Faculty and students alike evaluated the program favorably. All but one graduate stated that they would recommend this program to others if it were available.

Adult↗