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Worksite health promotion: rationale for military implementation.

Health promotion programs are being offered in many segments of U.S. society. Corporations find offering health promotion programs at the worksite effective and cost-efficient. The U.S. military, following a 1986 Department of Defense directive, has also developed health promotion programs. At present, not all components of military health promotion programs are being offered at the worksite. Improved employee health and lower health care costs are objectives sought by both the military and major corporations. Therefore, full worksite implementation of all health promotion program components will assist the military services in reaching their health goals.

Adolescent↗

[Evaluation of the efficiency of primary care centers. Application of data analysis].

BACKGROUND: One of the major difficulties in evaluating the efficiency of Primary Medical Centres is that of integrating quantitative and qualitative data. METHODS: This study applies the Involved Data Analysis (DEA) for the purpose of evaluating the efficiency of Primary Medial Centres located in the Province of Zaragoza (Spain). DEA is a lineal programming technique that provides information on the relative efficiency of each unit, as compared to all other units. Output such as doctors and nursing services as well as variables relating to the quality of service, and input (personnel and pharmaceutical expenses) referring to 1994, were obtained from Area Management. RESULTS: Without taking qualitative variables into account, only 13 Primary Medical Centres reached maximum efficiency level 1. with a range of 0.53 to 1. Taking quality variables into account, 24 units reached optimum efficiency, with a range of 0.61 to 1. CONCLUSIONS: DEA is a useful tool for both qualitative and quantitative overall evaluation of input and output and identifies units that are inefficient as compared to others. Despite the difficulties involved, the method appears to be beneficial for management as a complementary aid to currently used techniques.

Data Interpretation, Statistical↗

Developing an in-house physician advisor program.

The rapid rise in health care costs during the 1980s has led to a growing demand for utilization management companies, supported by teams of physician advisors. The increasing involvement of physician advisors in day-to-day case review has also led to a growing necessity for their being hired on an in-house basis. This article attempts to show a basic process for developing a functional and efficient in-house physician advisor program.

Consultants↗

Comparing machine-independent versus machine-specific parallelization of a software platform for biological sequence comparison.

A platform program that performs biological sequence comparison provides a case study to compare the relative advantages of a machine-independent approach to parallel computation versus a machine-specific approach. The program consists of two routines: (i) PSCANLIB, which compares a single biological sequence against a database of sequences, and (ii) PCOMPLIB, which compares a database of sequences against another database of sequences, or against itself. The program was first parallelized to run on the Intel Hypercube parallel computer using native Hypercube commands to coordinate the parallel computation. The parallelization logic of the program was then translated into a machine-independent parallel programming language, Linda. These two approaches to parallelization are contrasted in terms of: (i) the expressive power of the logic that coordinates the parallel computation, (ii) the portability of the machine-independent version to other parallel machines and (iii) the relative efficiency of the two versions of the program. In the benchmark tests reported, the benefits of the machine-independent approach were achieved with only a modest sacrifice in efficiency.

Algorithms↗

Rhodium-catalyzed formylation of organomercurials: application to efficient polyol synthesis.

The rhodium-catalyzed formylation of organomercurials-a new transformation of organomercurials-is reported. The addition of 0.50 equiv of 1,4-diazabicyclo[2.2.2]octane (DABCO) was found to promote the reaction, and it is postulated that the DABCO acts as a ligand for mercury. Several examples are presented to document the scope of the reaction. This reaction was developed in the context of a larger program focused on the development of efficient strategies for the synthesis of polyol-derived natural products, and an efficient (8 steps) synthesis of Tolypothrix pentaether that employs this methodology is reported.

Alcohols↗

Considering primary care in Japan.

Involved in global competition and with a rapidly aging population, Japan is experiencing major reform in its medical care system and medical education system. Although compulsory national health insurance and accessibility to medical care are supported by the overwhelming majority of the Japanese people, rapidly increasing medical costs have been an important problem. The Japanese government is in the midst of changing the health insurance system from fee-for-service to capitation, and it moved in the 1980s to reduce the number of new physicians as a way to control expenditures. With the lessening of government regulation in the 1990s, each medical school has begun to revise its curriculum to cope with the increasing amount of medical information available and to promote efficient learning. Because postgraduate clinical training programs with defined, comprehensive curricula are rare, and because virtually all clinical training is in inpatient settings, Japanese physicians' clinical competence tends to be insufficient for providing first-class community-based primary care. Japan must try to develop effective education systems in order to deliver better and more efficient medical care, especially primary care.

Career Choice↗

Maternal tetanus immunization in Aceh Province, Sumatra: the cost-effectiveness of alternative strategies.

This paper compares the cost per completed maternal tetanus immunization and an estimate of the cost per death averted in the routine EPI program with similar results from an experimental mass campaign in Aceh Province, Indonesia. The cost-effectiveness of the mass campaign in achieving complete immunization is similar to the routine program. However, the mass campaign is probably less cost-effective in averting neonatal tetanus deaths, due to its broader targetting. Factors affecting efficiency, coverage, and financing of tetanus immunization programs are assessed. While expansion of the routine EPI program is the preferred goal, mass campaigns are judged to be a reasonable part of the multi-year strategy for tetanus control in the province. Recent experiments with an accelerated routine program may provide further alternatives.

Adolescent↗

Assessing the quality of health promotion and patient education programs.

Quality assessment for health promotion and patient education programs helps ensure that these services are efficient and effective, and represent professional standards of practice. It also helps ensure that they are beneficial, accessible, and acceptable to members. Three program characteristics should be considered in defining the objectives of an assessment--the degree of existing knowledge regarding the effectiveness of the program, the degree of risk posed by the program, and the cost of the program. A menu of objective is presented, including assessment of the structure of the program; comparison of the program with state-of-the-art models; assessment of program implementation and coverage; measurement of member/patient response; evaluation of program outcome; and evaluation of cost-effectiveness, opportunity costs, and broad benefits to the organization. Major methods for assessment and evaluation are discussed briefly in relationship to the objectives they address--review of professional staff performance; comparison with models, standards, and other criteria; documentation and management information systems; focus groups and other small-scale qualitative methods; participation in plan monitoring and quality assurance activities; and controlled evaluation studies.

Cost-Benefit Analysis↗

Building the green way.

Just five or six years ago, the term "green building" evoked visions of barefoot, tie-dyed, granola-munching denizens. There's been a large shift in perception. Of course, green buildings are still known for conserving natural resources by, for example, minimizing on-site grading, using alternative materials, and recycling construction waste. But people now see the financial advantages as well. Well-designed green buildings yield lower utility costs, greater employee productivity, less absenteeism, and stronger attraction and retention of workers than standard buildings do. Green materials, mechanical systems, and furnishings have become more widely available and considerably less expensive than they used to be-often cheaper than their standard counterparts. So building green is no longer a pricey experiment; just about any company can do it on a standard budget by following the ten rules outlined by the author. Reliable building-rating systems like the U.S. Green Building Council's rigorous Leadership in Energy and Environmental Design (LEED) program have done much to underscore the benefits of green construction. LEED evaluates buildings and awards points in several areas, such as water efficiency and indoor environmental quality. Other rating programs include the UK's BREEAM (Building Research Establishment's Environmental Assessment Method) and Australia's Green Star. Green construction is not simply getting more respect; it is rapidly becoming a necessity as corporations push it fully into the mainstream over the next five to ten years. In fact, the author says, the owners of standard buildings face massive obsolescence. To avoid this problem, they should carry out green renovations. Corporations no longer have an excuse for eschewing environmental and economic sustainability. They have at their disposal tools proven to lower overhead costs, improve productivity, and strengthen the bottom line.

Conservation of Energy Resources↗

Octopus programs SAPRO and F. Two new principles for the analysis of the visual field.

The automatic Octopus perimeter has a large software development potential. An important property of the Octopus programs developed to date is their ability to distinguish between pathological and normal behaviour. At the moment, program development is concentrating upon programs in which criteria of normality are used as feed-back parameters during the examination itself, and thus guide the visual field analysis. This property permits the algorithm to undertake a precise spatial analysis of disturbed visual field areas, without wasting time on a detailed analysis of normal areas. The efficiency of a visual field examination program is thereby substantially increased (SAPRO* program). Using the F-program series, individual (as opposed to fixed) stimuli configurations can be realised, which may represent a better fit to a particular problem. The principles of two other programs, SARGON and DELTA, have been described before (Fankhauser and Jenni 1981).

Computers↗

From clinical guidelines to quality assurance: the experience of Assistance Publique-Hôpitaux de Paris.

OBJECTIVES: The objectives of this study are: to present the history of the development of clinical guidelines in France. to present the implementation of a program of clinical guidelines in Assistance Publique-Hôpitaux de Paris (AP-HP), the regional public hospital system of the Paris metropolitan area, and to discuss the lessons learned from this program, which provide a basis for a better policy of guidelines at a national level. CONTENT: The objective of the AP-HP program is to promote the appropriate use of clinical guidelines and to evaluate their impact on quality of care and/or costs. Experiments such as controlled trials are used to test the effectiveness of some implementation strategies, to verify that guidelines do improve the process of care and to improve physician compliance with clinical guidelines. Guidelines are developed in a context of budget constraint, and the general aim of the program is to promote the more efficient use of available health resources. RESULTS: In a context of health care inflation, the desire of public authorities is to use guidelines as a tool for cost control strategy, either for ambulatory care or for hospitals. AP-HP experience shows that it is very difficult to develop a national program of clinical guidelines and to implement it in every hospital, as was done in France (but not clearly evaluated) in ambulatory care (under the name 'references médicales'). Guidelines need to be locally adapted, and the best implementation strategies depend on local resources, for example the existence of a pertinent information system. The role of financial incentives is present in French policies, and the role of the drug industry needs to be evaluated.

France↗

[Effects of a structured drug education program on knowledge and medication compliance for hemodialysis patients].

PURPOSE: The purpose of this study was to analysis the effects of a structured drug education program on knowledge and medication compliance for hemodialysis patients. METHOD: Hemodialysis patients were recruited from a kidney center, at a university hospital located in G city, Korea. Thirty subjects in the control group received no intervention and 30 subjects in the experimental group received a structured drug education program. RESULT: There were significant increases in medication knowledge and medication compliance in the experimental group compared to the control group. CONCLUSION: According to the above results, this education program for hemodialysis patients increased knowledge and medication compliance. These findings suggest that a structured drug education program can be used as an efficient nursing intervention for hemodialysis patients.

Adult↗

Application of advanced Monte Carlo Methods in numerical dosimetry.

Many tasks in different sectors of dosimetry are very complex and highly sensitive to changes in the radiation field. Often, only the simulation of radiation transport is capable of describing the radiation field completely. Down to sub-cellular dimensions the energy deposition by cascades of secondary electrons is the main pathway for damage induction in matter. A large number of interactions take place until such electrons are slowed down to thermal energies. Also for some problems of photon transport a large number of photon histories need to be processed. Thus the efficient non-analogue Monte Carlo program, AMOS, has been developed for photon and electron transport. Various applications and benchmarks are presented showing its ability. For radiotherapy purposes the radiation field of a brachytherapy source is calculated according to the American Association of Physicists in Medicine Task Group Report 43 (AAPM/TG43). As additional examples, results for the detector efficiency of a high-purity germanium (HPGe) detector and a dose estimation for an X-ray shielding for radiation protection are shown.

Algorithms↗

[Prevention of cisplatin nephrotoxicity in cancer: adjusting the dosage with a computerized chrono-pump].

Platinum and its derivates are particularly efficient in treatment of ovarian and testis carcinomas. Nevertheless, the high nephrotoxicity of these drugs limits their use. It is known that nephrotoxicity appears when platinum plasmatic concentrations are higher than 1.5 mg/l. Moreover, the wide variability between patients and between cures, emphasizes the difficulties of utilization. Using a computerized pump and a program for individual dosage regimen, an efficient prevention of plasmatic overdosages have been realised and nephrotoxicity accidents have been avoided.

Aged↗

On the solution of mixed-integer nonlinear programming models for computer aided molecular design.

This paper addresses the efficient solution of computer aided molecular design (CAMD) problems, which have been posed as mixed-integer nonlinear programming models. The models of interest are those in which the number of linear constraints far exceeds the number of nonlinear constraints, and with most variables participating in the nonconvex terms. As a result global optimization methods are needed. A branch-and-bound algorithm (BB) is proposed that is specifically tailored to solving such problems. In a conventional BB algorithm, branching is performed on all the search variables that appear in the nonlinear terms. This translates to a large number of node traversals. To overcome this problem, we have proposed a new strategy for branching on a set of linear branchingfunctions, which depend linearly on the search variables. This leads to a significant reduction in the dimensionality of the search space. The construction of linear underestimators for a class of functions is also presented. The CAMD problem that is considered is the design of optimal solvents to be used as cleaning agents in lithographic printing.

Journal Article↗

Outcomes of poorly functioning patients with personality disorders in a day treatment program.

OBJECTIVE: Rates of completion, complications, and outcome were examined in a sample of poorly functioning patients who participated in a group-oriented day treatment program for patients with personality disorders. METHODS: The study was a naturalistic prospective study of 183 patients admitted to a day treatment program in Oslo, Norway. The program consists of a combination of group analytically oriented groups and cognitive-behavioral groups. The Global Severity Index (GSI) of the Symptom Check List, the circumplex version of the Inventory of Interpersonal Problems (IIP-C), and the Global Assessment of Functioning (GAF) were administered at admission and discharge. RESULTS: A total of 138 [corrected] patients (77 percent) completed the day treatment program. Few patients experienced treatment complications. Effect sizes for GAF, GSI, and IIP-C scores for treatment completers were in the medium-to-high range, indicating a fair level of improvement. Patients' rating of benefit was positive. CONCLUSIONS: The results are promising as a first step toward development of a cost-efficient comprehensive long-term treatment program for patients with severe personality disorders.

Adult↗

[At what time is a reduction of medical under- or overtreatment sensible? Treatment of acute depression as an example].

OBJECTIVE: 1) To portray the mathematical relationship between the size of an underuse or overuse problem caused by non-compliance of health professionals and the cost-effectiveness of a quality improvement program; 2) to demonstrate the applicability of the models to a real-world problem (underuse and overuse in the treatment of major depression) and to stress the importance of the costs of a quality improvement program using this example. METHODS: Mathematical formulation of the relationship between the costs of a quality improvement program and the degree of underuse and overuse. RESULTS: The example of reducing underuse in the treatment of major depression shows that an intervention with a favorable cost-effectiveness ratio may be economically unattractive if a quality improvement program incurs high costs secondary to a small quality deficit. The application example also shows that reducing treatment overuse is inefficient if overuse is small and hence the costs of a quality improvement program are higher than the costs of overuse. CONCLUSIONS: The explicit consideration of the size of an underuse or overuse problem in the cost-effectiveness ratio of a quality improvement program may contribute to a more efficient use of health care resources.

Amitriptyline↗

A compression mechanism for sequence databases to improve the efficiency of conventional tools.

This paper describes a method to compress molecular biology databases that are characterized by an increasing proportion of data derived from genome projects. The performance of our tool has been tested on various data files of the EMBL nucleotide sequence database. The best compression ratios were achieved on EST (Expressed Sequence Tags) data, typically derived from large-scale sequence projects. The compression of sequence database updates was tested in combination with the common Unix compression program 'compress'. Our tool improved the efficiency of 'compress' on average by 16%.

Base Sequence↗