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PubMed1991

Clinical medical librarian: the last unicorn?

In the information age of the 1990s, the clinical medical librarian (CML) concept, like many other personalized library services, is often criticized as being too labor-intensive and expensive; others praise its advantages. To determine the attitudes of medical school library directors and clinical department heads toward implementation and feasibility of a CML program, forty randomly selected medical schools were surveyed. A double-blind procedure was used to sample department heads in internal medicine, pediatrics, and surgery, as well as health sciences library directors identified by the Association of Academic Health Sciences Library Directors (AAHSLD) annual statistics. The survey instrument was designed to measure responses to the following attitudinal variables: acceptance and nonacceptance of a CML program; importance to patient care, education, and research; influence on information-seeking patterns of health care professionals; ethical issues; CML extension services; and costs. Seventy-nine usable questionnaires out of a total of 120 (66%) were obtained from clinical medical personnel, and 30 usable questionnaires out of a total of 40 (75%) were obtained from medical school library directors. Survey results indicated significant differences between clinical medical personnel and library personnel regarding attitudes toward CML influence on information-seeking patterns, ethics, alternative CML services, and costs. Survey results also indicated a continuing strong support for CML programs in the medical school setting; however, differences of opinion existed toward defining the role of the CML and determining responsibility for funding.

Attitude of Health Personnel↗
PubMed1980

Data processing in pathology laboratories: the extension of the Phoenix system into haematology.

A computer data-processing system in the chemical pathology laboratories of the Royal Postgraduate Medical School at Hammersmith Hospital was described recently. This has now been extended to include the haematology laboratory. In the main, the original 'Phoenix' programs were adaptable to the new subject, but two major new programs were required, one to deal with automated blood counting by the Coulter S and one to accept film examination results on-line. The programs and procedures have been thoroughly tested and in routine use since 1977. The results have fully justified their introduction.

Computers↗
PubMed2004

Ethical guidelines for the evaluation of living organ donors.

Transplantation is an effective, life-prolonging treatment for organ failure. Demand has steadily increased over the past decade, creating a shortage in the supply of organs. In addition, the number of deceased organ donors has reached a plateau. Living-donor transplantation is increasingly an option, influenced by favourable clinical outcomes and increased waiting times at most transplant centres across North America. Living-donor kidney transplants have exceeded deceased-donor transplant rates at some centres. Organ donations from living donors have challenged transplant programs to develop a framework for determining donor acceptability. After a multidisciplinary consensus-building process of discussion and debate, the Multi-Organ Transplant Program of the University Health Network in Toronto has developed ethical guidelines for these procedures. These proposed guidelines address ethical concerns related to selection criteria and procedures, voluntariness, informed consent and disclosure of risks and benefits to both donor and recipient.

Ethics, Clinical↗
PubMed1981

Comprehensive hearing aid program within an ear, nose, and throat office.

Hearing aid dispensing within an otolaryngological/audiological clinic is a well accepted fact, and offers total hearing care in a professional setting. The effectiveness of such a program as to wearing habits and acceptance of services rendered, to my knowledge, has not been studied. This paper discussed data obtained from a questionnaire sent out to 1100 hearing aid patients. The questionnaire was designed to study satisfaction with clinic services and costs, acceptance and adjustment, communication abilities and wearing habits. Statistical analysis was performed by the Department of Biometry at LSU Shreveport. The information received is valuable in determining when hearing aids are most helpful and least helpful and brings out some factors which should influence one in determining who should and should not be fitted with amplification.

Adolescent↗
PubMedDate not supplied

Automated interviewing for hepatitis B risk assessment and vaccination referral.

INTRODUCTION: This study describes a convenient, anonymous, and private method to assess risk for hepatitis B and recommend vaccination for those determined to be at risk. METHODS: We used an automated telephone interview and computerized risk assessment to inform callers of their hepatitis B risk status and direct those at risk for testing, counseling, and vaccination. The project's efficacy was compared to previously reported projects, and the expense was compared to estimates assuming universal vaccination. RESULTS: This pilot project found that 63% of completed interviews indicated risk. Of those at risk, 47% reported for testing, and 89% of those tested required vaccination. Of those requiring vaccine, 75% (32% of at-risk callers) completed the three-dose series. Of those tested, 9% previously had natural infections and 2% were carriers. CONCLUSIONS: Until adolescents are universally vaccinated, computerized hepatitis B risk assessment can facilitate prevention and decrease vaccination program costs. Privacy and anonymity may increase participation of groups difficult to reach before the onset of risky behaviors that results in treatment for STDs and drug abuse.

Adult↗
PubMed1992

Mental health services for Asian Americans and Pacific Islanders.

Inquiries over the past three decades have shown that ethnic minorities drop out of treatment early and tend to have poorer outcomes in psychotherapy. Despite the widespread acceptance that culturally responsive therapy and programs will produce better treatment outcomes for ethnic minorities, few studies have empirically tested this proposition. This paper reviews two types of interventions, ethnic match and parallel programs, to make the mental health system more responsive to the needs of Asian Americans and Pacific Islanders.

Asian↗
PubMed2004

Cost-effectiveness of interventions to reduce the thrombolytic delay for acute myocardial infarction.

OBJECTIVES: The objective of the study was to estimate the costs and health benefits of a public awareness campaign aimed at shortening the delay for thrombolytic therapy in patients with acute myocardial infarction (AMI) and to estimate the incremental costs and benefits of an additional telemedicine program. METHODS AND RESULTS: By using trial data on the impact of a Swedish campaign, a model was developed to simulate the current distribution of thrombolytic delay in Denmark and the delay after a campaign. The reduction in delay was translated into reduced fatality assuming reductions from the campaign and additional effects of a telemedicine program. The costs of the campaign were based on trial data and Danish unit costs while telemedicine costs were taken from a Danish demonstration program. The analyses indicate that the awareness campaign will translate into five fewer fatal AMIs (sixty-two life years gained) and a cost per life year of DKK283,300, with both costs and benefits discounted at 5 percent. When combining the public campaign with prehospital telemedicine diagnostics, the incremental cost per life year gained was DKK854.700. CONCLUSIONS: Programs aimed at reducing delay of thrombolysis in patients with AMI are likely to have a limited impact on AMI fatality. Information campaigns may have acceptable cost-effectiveness ratios, while telemedicine programs lead to threefold greater ratios. Whether such programs can be considered cost-effective will depend on how life year gains are valued by society.

Cost-Benefit Analysis↗
PubMed2003

Preventing disability through community-based health coaching.

The California Public Employees Retirement System (CalPERS) Health Matters program is a randomized controlled trial of a community-based health coaching program operating in Sacramento, California, since January 2001. It is modeled after the Health Enhancement Program and Senior Wellness Program of Seattle, Washington. Like the Health Enhancement Program, this program incorporates a menu of disability-prevention strategies, with health coaching, patient education on the self-management of chronic illness, and fitness forming the program's core. Unlike the Health Enhancement Program, the Health Matters program focuses as much attention on linking participants to existing community, health plan, and self-directed programming as it does encouraging them to participate in programming developed especially for the project. All participants and controls continue to receive their usual medical care from their managed care providers. Eligibility criteria for the program include having one or more qualifying chronic health conditions, being aged 65 and older, being a member of a participating health plan, and being accepted into CalPERS' Long Term Care Insurance Program. Baseline exclusions include being cognitively impaired or qualifying for long-term care insurance benefits due to deficiencies in two or more activities of daily living. The project has been successful in its enrollment strategy. It has also been successful in recruiting participants into project-sponsored, community-based, and self-directed disability-prevention programming. This is particularly true for programming related to diet, exercise, and various aspects of disease management.

Aged↗
PubMed2006

The caCORE Software Development Kit: streamlining construction of interoperable biomedical information services.

BACKGROUND: Robust, programmatically accessible biomedical information services that syntactically and semantically interoperate with other resources are challenging to construct. Such systems require the adoption of common information models, data representations and terminology standards as well as documented application programming interfaces (APIs). The National Cancer Institute (NCI) developed the cancer common ontologic representation environment (caCORE) to provide the infrastructure necessary to achieve interoperability across the systems it develops or sponsors. The caCORE Software Development Kit (SDK) was designed to provide developers both within and outside the NCI with the tools needed to construct such interoperable software systems. RESULTS: The caCORE SDK requires a Unified Modeling Language (UML) tool to begin the development workflow with the construction of a domain information model in the form of a UML Class Diagram. Models are annotated with concepts and definitions from a description logic terminology source using the Semantic Connector component. The annotated model is registered in the Cancer Data Standards Repository (caDSR) using the UML Loader component. System software is automatically generated using the Codegen component, which produces middleware that runs on an application server. The caCORE SDK was initially tested and validated using a seven-class UML model, and has been used to generate the caCORE production system, which includes models with dozens of classes. The deployed system supports access through object-oriented APIs with consistent syntax for retrieval of any type of data object across all classes in the original UML model. The caCORE SDK is currently being used by several development teams, including by participants in the cancer biomedical informatics grid (caBIG) program, to create compatible data services. caBIG compatibility standards are based upon caCORE resources, and thus the caCORE SDK has emerged as a key enabling technology for caBIG. CONCLUSION: The caCORE SDK substantially lowers the barrier to implementing systems that are syntactically and semantically interoperable by providing workflow and automation tools that standardize and expedite modeling, development, and deployment. It has gained acceptance among developers in the caBIG program, and is expected to provide a common mechanism for creating data service nodes on the data grid that is under development.

Humans↗
PubMed1990

Hidden mortality rate associated with extracorporeal membrane oxygenation.

We reviewed the outcome of all infants referred to, and accepted in, our extracorporeal membrane oxygenation (ECMO) program during a 52-month period. One hundred sixty-seven referrals, representing 158 infants and nine mothers who had not yet delivered their infants, were accepted. Eighteen infants (11.3% of all neonates transported) died before leaving the referring hospital, during transport, or shortly after admission to our unit. Contraindications to ECMO excluded 17 (10.1%) of the 167 referrals. Sixty-two infants (37.1%) initially did not meet ECMO criteria. Two died before ECMO could be started. Sixty-eight infants (40.7%) were given ECMO therapy, and 11 died (16.1%). Nine mothers were referred because of fetal conditions that might require ECMO; of these infants, two died during delivery and three had contraindications to the use of ECMO. The four remaining infants were given ECMO therapy; three survived. The overall mortality rate was 27.5% (46/167); 18 (39.1%) of the 46 deaths were associated with transfer. The mortality rate associated with congenital diaphragmatic hernia was 63.6%. We recommend early transport of infants with this type of hernia during the postoperative "honeymoon" or during in utero transport with delivery at an ECMO center. We also recommend that infants with meconium aspiration syndrome be transported to an ECMO center when an oxygenation index of 25 is reached. The mortality rate associated with transport needs to be considered in evaluating ECMO programs. Earlier, expedited transfers may increase the survival rate.

Evaluation Studies as Topic↗
PubMed1999

Residential treatment for dually diagnosed homeless veterans: a comparison of program types.

This study compared two types of residential programs that treat dually diagnosed homeless veterans. Programs specializing in the treatment of substance abuse disorders (SA) and those programs addressing both psychiatric disorders and substance abuse problems within the same setting (DDX) were compared on (1) program characteristics, (2) clients' perceived environment, and (3) outcomes of treatment. The study was based on surveys and discharge reports from residential treatment facilities that were under contract to the Department of Veterans Affairs Health Care for Homeless Veterans program, a national outreach and case management program operating at 71 sites across the nation. Program characteristics surveys were completed by program administrators, perceived environment surveys were completed by veterans in treatment, and discharge reports were completed by VA case managers. DDX programs were characterized by lower expectations for functioning, more acceptance of problem behavior, and more accommodation for choice and privacy, relative to SA programs after adjusting for baseline differences. Dually diagnosed veterans in DDX programs perceived these programs as less controlling than SA programs, but also as having lower involvement and less practical and personal problem orientations. At discharge, a lower percentage of veterans from DDX than SA programs left without staff consultation. A higher percentage of veterans from DDX than SA programs were discharged to community housing rather than to further institutional treatment. Program effects were not different for psychotic and non-psychotic veterans. Although differences were modest, integration of substance abuse and psychiatric treatment may promote a faster return to community living for dually diagnosed homeless veterans. Such integration did not differentially benefit dually diagnosed veterans whose psychiatric problems included a psychotic disorder.

Adult↗
PubMed2003

Increasing dental hygiene student diversity: life-performance questions as alternative admissions criteria.

The goal of this study was to create a race/ethnic-neutral admission process. An increase in student diversity in the Northern Arizona University Dental Hygiene Program (NAU DH) was accomplished through modification of its acceptance process. Sixty students, 22% underrepresented minority (URM), were selected using alternative criteria compared with 6.7% URM that would have been accepted using traditional criteria. For the purpose of this study, URM are defined as African American, Hispanic, Native American, or bicultural, groups that are underrepresented in dental hygiene. Six life-performance questions were added on the written application and were designed to assess the candidates' personal characteristics, including (1) leadership, (2) community service, (3) realistic self-appraisal, (4) personal support system, (5) ability to deal with racism, (6) ability to set goals and self-responsibility. Scores from the response to these questions were used as part of the total selection criteria. Data analysis revealed that white candidates scored higher than URM candidates on grade point average (GPA), science GPA, and total points, yet both groups scored the same on life-performance questions. On the basis of these findings, we conclude that alternative criteria in the acceptance process more fairly assesses candidates' qualifications and increases the diversity of the NAU DH student population. These alternative acceptance criteria may serve as a model for dental hygiene and other allied health programs.

Allied Health Personnel↗
PubMedDate not supplied

Comparison of laboratory performance with blind and mail-distributed proficiency testing samples.

Simulated addict urine samples containing drugs were sent to collaborating hospital administrators and officials of methadone centers, who then forwarded the samples to their supporting laboratories as though they were ordinary specimens from patients. The laboratories, which were already participating in the proficiency testing program of the Center for Disease Control, received the identical test samples in the mail as part of a regular Center for Disease Control proficiency testing program. Most of the laboratories performed acceptably with the mail-distributed samples, but many performed poorly when the identical samples were sent to them as if they were specimens from patients. Because of the limitations of proficiency testing involving mail-distribution samples and the impracticality of extensive testing with blind samples on a national level, the Center for Disease Control proposes to compliment its regular proficiency testing program with a monitored, onsite program of performance evaluation.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

An updated survey on the utilization of hand over mouth (HOM) and restraint in postdoctoral pediatric dental education.

A survey of directors of advanced educational programs in pediatric dentistry, identical to one conducted in 1979, was undertaken to examine the utilization of and indications for various physical restraint techniques. Updated results indicated that there is still a high acceptance of the hand-over-mouth (HOM) technique. Only 11.1% of programs never use the technique. However, the acceptance of airway restriction is significantly lower than in 1979. Program directors currently report increased situations in which other physical restraint techniques, such as the Papoose Board, are recommended. Despite the continued acceptance of physical restraint techniques, a significant number of directors report that they are less certain that these techniques do not induce psychological problems. Although the current survey data indicates that there may be a discrepancy between professional standards as espoused by program directors, and material standards, that discrepancy is greatest for those program directors with tenures in excess of 10 years. These directors were much more likely to believe that HOM was indicated in situations other than for the control of hysterical and tantrum-like behavior and were much less likely to tell the child why HOM was being used. Additionally, such directors were as likely to use airway restriction as were 1979 respondents, although directors with tenures of less than 10 years were significantly less likely to use airway restriction.

Child Behavior Disorders↗
PubMed2003

International developments in newborn screening quality assurance.

The five dimensions of quality are Accessibility, Acceptability, Effectiveness, Efficiency and Safety. A newborn screening program consists of a number of interlinked parts, not usually managed by the same individual, and the quality of the program is dependent on the quality of program planning, specimen collection, laboratory testing and follow up, diagnosis and treatment. Outcome assessment and feedback into program planning complete the loop. Use of the quality parameters can quantify ongoing improvements to our screening programs.

Efficiency, Organizational↗
PubMedDate not supplied

A day treatment program in a therapeutic community setting: six-month outcomes. The Walden House Day Treatment Program.

Although not well represented in the literature, day treatment programs targeting substance abuse problems have increased in both number and acceptability in recent years. This article reports on a day treatment program based on the Therapeutic Community (TC), and on outcomes for a sample of substance abuse clients (n = 66) entering the program. Participants were interviewed early in treatment and 6 months after admission using the Addiction Severity Index (ASI) and other measures. Clients entering day treatment were demographically diverse, with serious substance-abuse problems and psychiatric morbidity. Median retention in day treatment was about 5 weeks, but many clients received a contiguous episode of residential treatment, so that the median for total time in treatment was 18 weeks. Clients located and interviewed at 6-month follow-up (n = 38) showed significant improvement in alcohol and drug use, legal and social problems, and psychiatric symptoms. Findings suggest that day treatment can be used effectively as a precursor to residential treatment and that some clients applying for residential treatment can be treated effectively in day treatment alone.

Adult↗
PubMedDate not supplied

Spotlight on the: preventive maintenance program, Camden-Clark Memorial Hospital.

The preventive maintenance program instituted at Camden-Clark Memorial Hospital (Parkersburg, West Virginia) aids in the efficient and safe use of medical electronic instrumentation in the general- and critical-care areas of the hospital. Depending on the equipment involved, regular, preventive inspections are performed daily, monthly, quarterly, or annually. Both mechanical and electrical inspection procedures are followed to insure that the equipment is operating safely and in an acceptable clinical manner. This preventive maintenance program requires skilled staff members as well as a basic supply of spare parts, test equipment, and stand-by equipment.

Electronics, Medical↗