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PubMedDate not supplied

Transferring hospital sponsorship of a family practice residency: financial implications.

Family practice residency programs close each year, many in which there is a perception by the sponsoring institution that the program was too costly. Upon the imminent closure of a program's sponsoring hospital, we analyzed and projected the residency's budget and revenues to convince another community hospital to accept transfer of the sponsorship of the program. Revenues directly attributable to the residency (family practice center, grants, Medicare graduate medical education reimbursement) were identified. In addition, we identified that portion of new inpatient revenues necessary to offset the balance of the residency budget. We found that the program could account for reimbursement of 51.8% of its budget through patient care services, requiring 5.2% to be subsidized through state grants and 43.1% through federal graduate medical education reimbursement. Consistent with studies by several authors, family practice residency programs continue to require financial subsidy to balance their budgets. The nation's need for family physicians can only be ensured if state and federal priorities for needed primary health manpower are translated into continued and enhanced financial support.

California↗
PubMed1996

Factors limiting renal transplantation program in Poland.

The shortage of donor organs has been the main obstacle to the expansion of transplantation programs. Recent public opinion survey documented acceptance of the cadaveric kidney procurement in our country but some reluctance to brain death and presumed consent concepts. Recently, the survey was carried out within the medical community to find out whether the level of knowledge and the attitude toward donation has an influence on the slow development of the transplantation program. A questionnaire was addressed to: 1010 general practitioners, neurosurgeons and anesthesiologists; 926 ICU and neurosurgical nurses and 1760 students of 12 medical schools of the country. Vast majority of doctors, nurses and last year medical students accept retrieval and transplantation of kidneys and the heart, but not of the liver. Acceptance of this procedure among junior medical students and university students was lower (78% vs 98%). Most of the respondents would agree to donate their kidneys and other organs, but 20% would protest against harvesting of the organs from their relatives. 100% of the physicians and 80% of medical students and nurses accept the brain death concept(which is accepted only by 60% of non medical university students) but only 44% of the doctors are prepared to switch off the respirator after diagnosis of brain death if harvesting is not taking place. Only half of the physicians would notify the transplantation unit about the possibility of organ retrieval. The reasons mentioned for such decision included fear of negative judgment of the local community and problems with deceased relatives. 60% of physicians talking to the family about retrieval would ask for the relatives' consent despite the fact, that the transplantation law in Poland is based on the presumed consent of each individual. The results of the knowledge survey among medical students documented inadequate medical education concerning problems of transplantation. Educational campaign is needed to promote and extend the cadaveric organ transplantation in our country.

Attitude of Health Personnel↗
PubMed1992

Mobile mammographic screening of self-referred women: results of 22,540 screenings.

In this mass screening mammography program, self-referred women are accepted for screening only if part of a sponsoring organization. Screening is performed with mobile equipment, often at the work site. Of the first 22,540 screenings, 61% (n = 13,784) were of women aged 35-49 years. Eighty-nine percent (n = 20,025) of the screenings were normal. Of 51 women in whom cancer was found, 38 (75%) were recommended for biopsy on the basis of their initial two-view mammogram. The prevalence of breast cancer generally increased with advancing age but was similar between women aged 35-39 years and those aged 40-49 years. Of the 28 women with complete histologic studies, 43% (n = 12) had pure intraductal cancer and another 43% had negative findings at axillary node dissection. Program costs dictated a $65 fee. Within the design of this program it has been possible to screen large numbers of self-referred women and detect early carcinomas. Program design, however, may make screening more expensive than in a fixed screening site accepting only physician-referred women.

Adult↗
PubMed1999

HIV immunization: acceptability and anticipated effects on sexual behavior among adolescents.

Adolescents rated hypothetical human immunodeficiency virus vaccines described as 90% and 50% efficacious and discussed how immunization might influence behavior of their peers. The low-efficacy vaccine was largely unacceptable and most believed immunization with the high-efficacy vaccine would cause increased risk behaviors. Immunization programs will need to address vaccine acceptability issues and behavioral responses to immunization.

AIDS Vaccines↗
PubMedDate not supplied

Computer-based clinical decision aids. A review of methods and assessment of systems.

During the last three decades a great deal of research has been devoted to the development of integrated clinical decision support systems. This report aims to give a basic understanding of what is required for such a system. By means of a large literature study a survey is given of the major components of computer-based clinical aid systems. The main approaches and several aspects of evaluation of such programs are described. The computer has several inherent capabilities which are suitable for medical problem solving and can help in the formalization of medical knowledge. The components of such systems include the computer database, the reasoning engine and the user interface. The different approaches on which the reasoning engine is built are based on manipulation of information and advocate the use of knowledge to construct a solution to a problem. The information in the mode vary from data-intensive to knowledge-intensive. Assessment of decision support systems is a very important phase in the development of such systems. Evaluation should be made on the accuracy of the program, the nature of the system, the use of the data and the acceptance by the target users. Whatever the model is, its effectiveness will depend on the data with which the program has to work. Acceptance by physicians depends among other things on ease of use of the user interface. Profound changes in the delivery of health care will be induced through the rapid growth of on-line computer communication together with the development of integrated clinical decision support systems and electronic medical records. Notwithstanding the rapid growth of computer technology, computer-aided decision making is in its infancy and real support in daily practice is not yet achieved.

Algorithms↗
PubMed1991

Vascular rehabilitation: benefits of a structured exercise/risk modification program.

A vascular rehabilitation program was designed to increase exercise tolerance and reduce the risk of cardiovascular disease in patients with lower extremity arterial occlusive disease. Sixty-eight patients (32 men, 36 women); ages 55 to 85 years (mean, 68 years) with claudication 30 (44%), or recovering from lower extremity revascularization 36 (53%), or endovascular procedures 2 (3%) entered the vascular rehabilitation program. Each underwent a physical examination, risk factor assessment, noninvasive arterial studies, and cardiac evaluation. A history was taken from each patient also. Six patients (9%) were excluded on recognition of silent myocardial ischemia. Sixty-two patients (91%) were accepted for exercise training in a program designed to offer 24 (1-hour) monitored exercise sessions, 12 (1-hour) personalized education lectures, and development of a home maintenance exercise program. No deaths or major morbidity occurred. Seventeen patients (27%) did not finish the program, eight (13%) because of development of significant cardiac, extremity, or cerebrovascular disease and nine for nonmedical reasons. Of the 45 patients (73%) who completed the program, 38 (88%) had documented increases in walking distances of greater than 100% (122% to 450%). All 45 patients designed home exercise programs, and 88% of the smokers quit. Long-term follow-up was available on 100% of the patients. Thirty-eight patients (84%) have been followed for 2 years or more. Thirty-eight (84%) maintained or improved walking distances recorded on exit from the program. Thirty of the 36 patients (83%) who stopped smoking remained nonsmokers. Significant reductions in cholesterol were seen at 1 year, and significant reductions in triglycerides were seen at 12 weeks and 1 year.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

Quadruplet pregnancy in IVF.

The frequency of multiple pregnancy following IVF with the presently accepted methods is ten times higher than in natural cycles, and is identical to that following induction of ovulation with HMG. In spite of the fact that multifetal pregnancy exposes both fetus and mother to certain dangers, most couples joining IVF programs expose themselves to, and generally accept the risk of, multiple pregnancy, since this is their last resort for having a baby of their own. We report such a case of quadruplet pregnancy after the IVF procedure and review the literature.

Abortion, Induced↗
PubMed2004

Use of a computerized evaluation system in a psychiatry clerkship.

OBJECTIVE: Paper-based evaluations of medical students on clerkships are inefficient and time consuming to compile and analyze. To improve the evaluation process, the authors developed a web-based program. METHODS: A secure web-based system was designed to collect evaluations of students and their feedback about the clerkship. Acceptance, compliance, and impact of the web-based system on the clerkship were assessed. RESULTS: The web-based program was universally accepted by medical students who have been 100% compliant with prompt completion of their evaluations of the rotation. Most of the preceptors have utilized the program, resulting in a more timely receipt of their evaluations of students. The web-based program computes numerical scores, compiles comments, and formats reports. The clerkship director has unlimited access to all of the data, which allows for efficient and timely communication with preceptors, medical students, and the dean's office. CONCLUSIONS: During the clerkship, the web-based program for evaluation and feedback has improved the efficiency of the evaluation process and the timely communication with students and preceptors.

Clinical Clerkship↗
PubMed1993

Helping patients receive medical benefits. Collaboration between hospitals and legal services assists providers and low-income Kansans.

In Kansas, legal services lawyers have teamed up with Catholic healthcare administrators to help uninsured and underinsured hospital patients receive healthcare benefits from programs for which they may be eligible. The project--Hospital Patient Assistance Program--provides comprehensive assistance in establishing a patient's eligibility for medical benefits. Hospital participation in the program is simple. When business office or admissions staff discover that a self-pay patient has been registered with the program, they refer the patient to Kansas Legal Services; Inc. (KLS). KLS staff members try to determine if the patient is eligible for benefits from any of a number of programs, including Medicaid, Medicare, and Crime Victims Assistance. If KLS finds no programs for which the patient is eligible, it does not accept the case and notifies the hospital. Hospitals participating in the program have found that many accounts they previously wrote off as not collectible can be paid. Since the program began in 1990, participating hospitals have realized almost $8 million in payments from various benefit sources.

Catholicism↗
PubMedDate not supplied

Admissions procedures of educational programs for the specialist in blood bank technology.

A national survey of specialists in blood bank technology educational programs was performed to describe current admissions procedures. Programs generally were AABB approved for and accepted either two or four students annually from 10 to 14 complete applications which result from 25 to 50 inquiries. The program selection criteria usually included an evaluation of overall GPA, science GPA, prior blood bank experience, three professional references, and a non-standardized interview with the medical director, educational coordinator, and other faculty or staff. Admissions procedures were characterized by an admissions committee of four members differentially weighting the various selection criteria that often were not quantified through the use of a point value system. Programs reported that their admissions procedures were not quantified through the use of a point value system. Programs reported to their admissions procedures were objective enough and resulted in students of adequate quality, even though their procedures could be improved, possibly with more specific AABB guidelines.

Blood Banks↗
PubMed1999

Off the beaten track: MSN education for a changing health care environment.

Given the dynamic nature of the health care environment, what should be the focus of graduate education in nursing? New advanced practice roles for nurses are emerging, but few university-based educational programs exist to respond to the need. In developing a Master's program, Baylor University School of Nursing accepted the challenge to deviate from tradition by preparing a nurse who has the advanced knowledge and skills necessary to proactively address the present and future needs of health care in multiple settings and roles. This article discusses this unique and creative program in patient care management. Outcome evaluation reveals that students are attaining the terminal objectives, meeting the outcome criteria, and readily securing employment.

Case Management↗
PubMed1977

One third of a million days of care at home, 1959 to 1975.

Although articles on studies of organized home care programs are numerous, reports of long-term effectiveness of these programs are scanty. While government spokesmen appear to advocate more widespread use of alternatives to hospitalization, there has been serious criticism of the efficiency and accomplishments of home care services. A medically oriented home care program in Saskatoon (population, less than 150 000) has grown steadily over a 16-year period and is now serving a daily average of 200 individuals. All patients have required "hospital-like care" at home and most have not ordinarily been sufficiently mobile during their time in the program to attend hospital outpatient services. Many have required "concentrated care" through daily visits of professional health personnel. The program is designed for the physically ill and disabled and is administered by the major teaching hospital in the city, although it provides services to the whole community. Over one third of the patients referred in recent years had been at home. Almost one half of the patients have undergone satisfactory rehabilitation at home. The program has also proven to be an acceptable alternative to long-term institutional care for the permanently seriously disabled, a large number of whom are elderly. The program has been able to operate at considerably less cost to the public than inpatient (hospital or institutional) services would have entailed.

Consumer Behavior↗
PubMed2005

Developing and evaluating a smoking cessation program combined with an Internet-assisted instruction program for adolescents with smoking.

OBJECTIVE: The purpose of this study was to develop a smoking cessation program combined with an Internet-assisted instruction (IAI) program to help youth smokers quit smoking, and to evaluate the effectiveness of the program in changing youth's attitudes toward smoking, smoking behavior, and self-efficacy for smoking cessation. METHODS: To achieve this goal, a comparative study of 77 senior high students divided into two groups was conducted. One group, designated as the experimental group, accepted a 6-week smoking cessation program plus an IAI program and the other group did not receive any intervention as the comparison group. All participants completed questionnaires before and after the program. RESULTS: The results showed that the strategy of combining the smoking cessation program and an IAI program was highly effective in terms of effects upon the youth's attitude towards smoking, smoking behavior, and self-efficacy. There was a highly positive correlation between the participants' attitude toward smoking and self-efficacy. In contrast, cigarette consumption was in a strongly negative correlation with self-efficacy. CONCLUSION: Most of all participants in the experimental group recognized the effectiveness of the program, and thought the smoking cessation program with an IAI program was helpful and welcomed by youth. This study can serve as reference for future design and implementation of IAI programs for youth smoking cessation.

Adolescent↗
PubMedDate not supplied

The curriculum revolution: transforming barriers to education for registered nurses.

While designing an RN/BSN program, a small group of faculty accepted the challenge of the National League for Nursing (NLN) to initiate flexible, innovative learning experiences. Heeding the pleas of nursing leaders to engage in a curriculum revolution while incorporating the caution to maintain a balance within the curriculum, the group developed a nursing program that meets the current standards for NLN accreditation.

Curriculum↗
PubMed1976

Graduates and splitees from therapeutic community drug treatment programs: a comparison.

As greater numbers of drug abusers seek treatment and drug rehabilitation program resources become more and more scarce, selection processes should become based on scientific research rather than on the intuition of a few influential personnel. Many therapeutic community drug treatment programs have a preferential policy for accepting voluntary over court-ordered commitments. Our findings indicate that such a policy discriminates against those individuals who are most likely to succeed in completing their treatment. Our data also indicate that the success of male drug addicts in completing therapeutic community drug treatment programs is associated with sociological variables. The success of women, on the other hand, is more associated with psychologically oriented concerns.

Adult↗
PubMed1997

The universality of a self-help program of American origin: narcotics anonymous in Israel.

A phenomenological field study of Narcotics Anonymous (NA) in Israel focused on the way a self-help program, based on American Christian ideology was adopted in Israel. Acculturation problems were anticipated, due to cultural, demographic and religious differences. Participant observations and open-ended interviews supplied the raw data. Emphasis was placed on the factors and processes definable as typically American: voluntarism and pragmatism, personal sharing as a basis for relationships, spiritual rather than religious faith, the idea of a "personal God" guiding individuals, faith in God without religious tradition and formal ritualism. The results showed that, for the substance-dependents, the issue is generally irrelevant, and they accepted most "American" components of the program unquestioningly. However, two discrete features of Christian ideology required conscious incorporation by NA's Israeli members: (1) the concept of a "Loving God" who is non-punitive, which for many members was opposed to their traditions and upbringing, and (2) kneeling to pray, a recommendation which many members initially found problematic. The conclusion denotes a factor facilitating the transfer of therapeutic programs from one culture to another--that of personal suffering as a universal domain. It transcends all cultural boundaries and generates willingness to accept foreign concepts which reveal suffering and propose a pragmatic way to end it.

Alcoholics Anonymous↗
PubMed1997

Computer program for the equations describing the steady state of enzyme reactions.

MOTIVATION: The derivation of steady-state equations is frequently carried out in enzyme kinetic studies. Done manually, this becomes tedious and prone to human error. The computer programs now available which are able to accept reaction mechanisms of some complexity are focused only on the strict steady-state approach. RESULTS: Here we present a computer program called REFERASS, with a short computation time and a user-friendly format for the input and output files, able to derive the strict steady-state equations and/or those corresponding to the usual assumption that one ore more of the reversible steps are in rapid equilibrium. This program handles enzyme-catalysed reactions with mechanisms involving up to 255 enzyme species connected by up to 255 reaction steps, subject to limits imposed by the memory and disk space available.

Algorithms↗