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PubMed2003

The status of bedside ultrasonography training in emergency medicine residency programs.

UNLABELLED: Bedside ultrasonography (BU) is rapidly being incorporated into emergency medicine (EM) training programs and clinical practice. In the past decade, several organizations in EM have issued position statements on the use of this technology. Program training content is currently driven by the recently published "Model of the Clinical Practice of Emergency Medicine," which includes BU as a necessary skill. OBJECTIVE: The authors sought to determine the current status of BU training in EM residency programs. METHODS: A survey was mailed in early 2001 to all 122 Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency programs. The survey instrument asked whether BU was currently being taught, how much didactic and hands-on training time was incorporated into the curriculum, and what specialty representation was present in the faculty instructors. In addition, questions concerning the type of tests performed, the number considered necessary for competency, the role of BU in clinical decision making, and the type of quality assurance program were included in the survey. RESULTS: A total of 96 out of 122 surveys were completed (response rate of 79%). Ninety-one EM programs (95% of respondents) reported they teach BU, either clinically and/or didactically, as part of their formal residency curriculum. Eighty-one (89%) respondents reported their residency program or primary hospital emergency department (ED) had a dedicated ultrasound machine. BU was performed most commonly for the following: the FAST scan (focused abdominal sonography for trauma, 79/87%); cardiac examination (for tamponade, pulseless electrical activity, etc., 65/71%); transabdominal (for intrauterine pregnancy, ectopic pregnancy, etc., 58/64%); and transvaginal (for intrauterine pregnancy, ectopic pregnancy, etc., 45/49%). One to ten hours of lecture on BU was provided in 43%, and one to ten hours of hands-on clinical instruction was provided in 48% of the EM programs. Emergency physicians were identified as the faculty most commonly involved in teaching BU to EM residents (86/95%). Sixty-one (69%) programs reported that EM faculty and/or residents made clinical decisions and patient dispositions based on the ED BU interpretation alone. Fourteen (19%) programs reported that no formal quality assurance program was in place. CONCLUSIONS: The majority of ACGME-accredited EM residency programs currently incorporate BU training as part of their curriculum. The majority of BU instruction is done by EM faculty. The most commonly performed BU study is the FAST scan. The didactic component and clinical time devoted to BU instruction are variable between programs. Further standardization of training requirements between programs may promote increasing standardization of BU in future EM practice.

Curriculum↗
PubMed1998

A comparative study of a new, fully automated procedure and the standard mononuclear cell program using the Cobe Spectra for peripheral blood stem cell collection.

Recently, a completely automated procedure, the AutoPBSC program for the COBE Spectra cell separator, has been developed for peripheral blood stem cell harvest (PBSCH). We compared the performance of the AutoPBSC program with the standard mononuclear cell (MNC) program in the same patients and in a donor. Peripheral blood stem cells (PBSC) were collected from 3 patients or a donor alternately using the MNC program and the AutoPBSC program in a course of PBSC mobilization. Equal blood volume was processed from each patient (200 ml/kg) and a donor (150 ml/kg). We used a harvest volume of 3 ml and a chase volume of 7 ml in all AutoPBSC procedures. The procedure duration was almost equivalent for both programs. The volume of products was significantly lower in the AutoPBSC program (71 +/- 13 ml) than in the MNC program (183 +/- 30 ml). MNC yields were fewer, and total nucleated cell (TNC) and MNC collection efficiency was less for the AutoPBSC program compared to the MNC program. The CD34+ cell collection efficiency was less for the AutoPBSC program (26.5 +/- 13.7%, compared with 77.7 +/- 60.6%; p > 0.05). The contamination of platelets and red cells was significantly less in the AutoPBSC program than in the MNC program. In conclusion, we consider that the collection efficiency in the new program should be improved by modification of parameters because there exist great advantages to automated procedures.

Adult↗
PubMed2006

Factors contributing to intervention fidelity in a multi-site chronic disease self-management program.

BACKGROUND AND OBJECTIVES: Disease self-management programs have been a popular approach to reducing morbidity and mortality from chronic disease. Replicating an evidence-based disease management program successfully requires practitioners to ensure fidelity to the original program design. METHODS: The Florida Health Literacy Study (FHLS) was conducted to investigate the implementation impact of the Pfizer, Inc. Diabetes Mellitus and Hypertension Disease Self-Management Program based on health literacy principles in 14 community health centers in Florida. The intervention components discussed include health educator recruitment and training, patient recruitment, class sessions, utilization of program materials, translation of program manuals, patient retention and follow-up, and technical assistance. RESULTS: This report describes challenges associated with achieving a balance between adaptation for cultural relevance and fidelity when implementing the health education program across clinic sites. This balance was necessary to achieve effectiveness of the disease self-management program. The FHLS program was implemented with a high degree of fidelity to the original design and used original program materials. Adaptations identified as advantageous to program participation are discussed, such as implementing alternate methods for recruiting patients and developing staff incentives for participation. CONCLUSION: Effective program implementation depends on the talent, skill and willing participation of clinic staff. Program adaptations that conserve staff time and resources and recognize their contribution can increase program effectiveness without jeopardizing its fidelity.

Journal Article↗
PubMed2005

Comparing the efficacy of two Internet-based, computer-tailored smoking cessation programs: a randomized trial.

BACKGROUND: Online computer-tailored smoking cessation programs have not yet been compared directly. OBJECTIVE: To compare the efficacy of two Internet-based, computer-tailored smoking cessation programs. METHODS: Randomized controlled trial conducted in 2003-2004. Visitors to a smoking cessation website were randomly assigned to either an original online, interactive smoking cessation program or to a modified program. Both programs consisted of tailored, personalized counseling letters based on participants' characteristics, followed by monthly email reminders. The original program was based on psychological and addiction theory, and on preliminary research conducted in the same population. The modified program was shorter and contained more information on nicotine replacement therapy and nicotine dependence, and less information on health risks and coping strategies. In both programs, 1 month and 2 months after entering the study, participants were invited by email to answer the same tailoring questionnaire again in order to receive a second counseling letter. Participants in both programs obtained, on average, 1.2 feedback counseling letters over 2.5 months, and 84% received only 1 feedback letter. The outcome was self-reported smoking abstinence (no puff of tobacco in the previous 7 days), assessed 2.5 months after entry in the program. We report results from intention-to-treat (ITT) analyses, where all non-respondents at follow-up were counted as smokers. RESULTS: The baseline questionnaire was answered by a total of 11969 current (74%) and former (26%) smokers, and the follow-up survey by 4237 people (35%). In an ITT analysis, abstinence rates in baseline current smokers were respectively 10.9% and 8.9% (odds ratio [OR]=1.24, 95% confidence interval [CI]1.08-1.43, P=.003) in the original and modified programs, and 25.2% and 15.7% (OR=1.81, CI 1.51-2.16, P<.001) in baseline former smokers. While we found statistically significant differences in quit rates in smokers in the contemplation stage favoring the original program (OR=1.54, CI 1.18-2.02, P=.002), no between-group differences in quit rates were observed in smokers in the precontemplation (OR=1.07, CI 0.36-3.14, P=.91) and preparation (OR=1.15, CI 0.97-1.37, P=.10) stages of change. CONCLUSIONS: In smokers in the contemplation stage of change and in former smokers, the original program produced higher smoking abstinence rates than the modified program.

Adult↗
PubMedDate not supplied

A return on investment evaluation of the Citibank, N.A., health management program.

OBJECTIVES: Citibank, N.A., initiated a comprehensive health, demand, and disease management program in 1994, using program services offered by Healthtrac, Inc., of Menlo Park, California. Program components included an initial screening of employees, computerized triage of subjects into higher and lower risk intervention programs, extensive follow-up with the higher risk subjects, and general health education and awareness building. The objective of this study was to estimate the financial impact of this program on medical expenditures. METHODS: A quasiexperimental design was applied comparing medical expenditures before vs. after the intervention for program participants and nonparticipants. The 22,838 subjects (11,194 program participants and 11,644 nonparticipants) were followed for an average of 38 months before and after administration of a Healthtrac health risk appraisal (HRA) instrument that triggered the start of the program. To adjust for selection bias to the extent possible with these data, multiple regression models were used to estimate the savings in medical expenditures associated with program participation. The resulting dollar savings were compared to program costs to estimate the economic return on the company's investment in the program. RESULTS: The return on investment (ROI) was estimated to be between $4.56 and $4.73 saved per dollar spent on the program, depending on the discount rate applied. These results are similar to published evaluations of Healthtrac programs implemented with other populations. CONCLUSIONS: Despite limitations inherent in any retrospective observational study, the strong, positive ROI shown here suggests that a well-designed health management program (HMP), which focuses interventions on high risk populations, can result in monetary savings to an organization.

Adolescent↗
PubMedDate not supplied

Changes in health risks among the participants in the United Auto Workers--General Motors LifeSteps Health Promotion Program.

PURPOSE: To examine health risk changes among participants of a multicomponent worksite health promotion program. DESIGN: A study using health risk changes among health risk appraisal (HRA) participants linked to program participation records. Baseline risk and participation in multiple programs were examined in relation to risk change in multivariate models. SETTING: Worksite health promotion programming sponsored by the United Auto Workers (UAW) and General Motors (GM). SUBJECTS: Active employees (12,984) who voluntarily participated in an HRA in each of two program years. INTERVENTION: The nationwide program was a mailed HRA and a 1-800 nurse line. A pilot program (implemented in two cities) added screening, wellness programs, a materials resource, and, for high risk participants, health coaching and vouchers for medical office visits. MEASURES: Using 13 selected health risk factors from the HRA, changes in overall health risks were measured as program outcomes in three ways: one-directional, net, and risk status change. RESULTS: A greater decrease in the number of health risks was observed with increased program participation. The decrease was significantly related to the number of baseline risk factors and eligibility for high risk programs. Associated with program participation, the number of people at low risk status increased from 70.1% to 71.3% at year 2 among nationwide participants and from 52.4% to 58.9% among pilot participants. CONCLUSIONS: Participation was associated with a significant impact on health risk. Baseline risk of participants and eligibility for high risk programs were necessary factors to control when measuring program effects on health risk changes.

Health Promotion↗
PubMedDate not supplied

Pulmonary rehabilitation programs in Canada: national survey.

OBJECTIVE: To characterize pulmonary rehabilitation (PR) programs in terms of their type, size, duration, patient population, content and staffing. DESIGN: Surveys were sent to members of the Rehabilitation Committee of the Canadian Thoracic Society, as well as any program identified by members of the Canadian Physiotherapy Cardio-Respiratory Society, by provincial lung associations or by the respondents. PARTICIPANTS: Of 51 surveys sent, responses were received from 44 facilities (86% response rate). In-patient or out-patient pulmonary rehabilitation programs were offered by 36 facilities. RESULTS: Most programs (97%) admitted out-patients, and 22% had an in-patient capability. Out-patient programs enrolled 13 patients (median 11; range five to 48) at a given time for a duration of 8.3 weeks (range two to 26). In-patient programs enrolled nine patients at a given time (range two to 26) for 4.6 weeks (range one to eight). Programs included patients with chronic obstructive pulmonary disorder (100%), restrictive disease (93%), asthma (82%), adults with cystic fibrosis (46%), patients pre- or postlung transplantation (45%) and patients receiving mechanical ventilatory support (18%). Breathing retraining, education and upper extremity training were incorporated in more than 90% of all programs. Only one-third of programs offered smoking cessation as part of the rehabilitation. Education sessions on medications and inhaler usage were included in most programs, but sexuality was addressed in only half the programs. CONCLUSIONS: This first comprehensive national survey of PR programs in Canada shows that there are similarities in the format, content and staffing of PR programs. Programs are only able to service a small percentage of patients with chronic respiratory conditions.

Adult↗
PubMed2001

[Analysis on the availability of programs and services for elderly people in Puerto Rico].

This research was conducted with the purpose of analyzing the programs and services available to the aged population in the municipalities of Puerto Rico during 1999 and 2000. The analysis was performed using an evaluation instrument which collected data of the programs and services directed exclusively to the aged population, such as: senior centers, foster homes, institutions, independent living, employed and/or volunteer people, geriatric services, adult education (literacy), recreation, discounts, corporations and/or associations that benefit the aged population, aging offices, support groups, social services, home meal services, and financial aid. Data was also collected from programs and services that benefit diverse aged populations in areas such as: health, housing, employment and social welfare. The sources for the collection of data were directories available to government and private agencies, telephone directories, telephone interviews, and personal visits. The municipalities were divided into two zones, the Northern zone, constituted by 40 municipalities and the Southern zone, constituted by 38 municipalities, for a total of 78 evaluated municipalities. In the Northern region, which accounted to approximately 295,938 aged persons, 18 types of programs or services were found to serve the aged population directly and 50 types were aged-related programs or services. In the Southern region, which accounted for approximately 169,798 aged persons, 13 types of programs or services served the aged exclusively and 43 were aged-related services. The following were among the principal programs or services available: senior centers, foster homes and/or institutions, employment programs, home care services and hospices, independent living, and agricultural extension services. Among the least available programs or services were private home meal services, literacy and retraining, arts and travel services, corporations or associations for the benefit of the aged, geriatric evaluation programs, home repair services, home-assistance programs, support and respite programs, adequate or specialized transportation services, diverse housing models, different types of senior centers, and programs for psychological or psychiatric assistance. In conclusion, the availability of the programs and services in this study and the evaluation of the services needed for a community of aged persons indicate the need for increasing and developing services considered essential in accordance to the population demands.

Aged↗
PubMed2003

Medicare program; Medicare prescription drug discount card. Interim final rule with comment period.

Section 101, subpart 4 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, codified in section 1860D-31 of the Social Security Act, provides for a voluntary prescription drug discount card program for Medicare beneficiaries entitled to benefits, or enrolled, under Part A or enrolled under Part B, excluding beneficiaries entitled to medical assistance for outpatient prescription drugs under Medicaid, including section 1115 waiver demonstrations. Eligible beneficiaries may access negotiated prices on prescription drugs by enrolling in drug discount card programs offered by Medicare-endorsed sponsors. Eligible beneficiaries may enroll in the Medicare drug discount card program beginning no later than 6 months after the date of enactment of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and ending December 31, 2005. After December 31, 2005, beneficiaries enrolled in the program may continue to use their drug discount card during a short transition period beginning January 1, 2006 and ending upon the effective date of a beneficiary's outpatient drug coverage under Medicare Part D, but no later than the last day of the initial open enrollment period under Part D. Beneficiaries with incomes no more than 135 percent of the poverty line applicable to their family size who do not have outpatient prescription drug coverage under certain programs--Medicaid, certain health insurance coverage or group health insurance (such as retiree coverage), TRICARE, and Federal employees Health Benefits Program (FEHBP)--also are eligible for transitional assistance, or payment of $600 in 2004 and up to $600 in 2005 of the cost of covered discount card drugs obtained under the program. In most cases, any transitional assistance remaining available to a beneficiary on December 31, 2004 may be rolled over to 2005 and applied toward the cost of covered discount card drugs obtained under the program during 2005. Similarly, in most cases, any transitional assistance remaining available to a beneficiary on December 31, 2005 may be applied toward the cost of covered discount card drugs obtained under the program during the transition period. The Centers for Medicare & Medicaid Services will solicit applications from entities seeking to offer beneficiaries negotiated prices on covered discount card drugs. Those meeting the requirements described in the authorizing statute and this rule, including administration of transitional assistance, will be permitted to offer a Medicare-endorsed drug discount card program to eligible beneficiaries. Endorsed sponsors may charge beneficiaries enrolling in their endorsed programs an annual enrollment fee for 2004 and 2005 of no more than $30; CMS will pay this fee on behalf of enrollees entitled to transitional assistance. To ensure that eligible Medicare beneficiaries take full advantage of the Medicare drug discount card program and make informed choices, CMS will educate beneficiaries about the existence and features of the program and the availability of transitional assistance for certain low-income beneficiaries; and publicize information that will allow Medicare beneficiaries to compare the various Medicare-endorsed drug discount card programs.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1988

Professional-development and continuing-education programs for pharmacists in large hospitals.

Pharmacy directors at large hospitals nationwide were surveyed to determine the status of professional-development and continuing-education programs for staff pharmacists at their institutions. An 18-item questionnaire was developed and mailed in July 1987 to pharmacy directors of 445 large (bed capacity of greater than or equal to 450) hospitals. The questionnaire was designed to elicit information about who holds responsibility for the professional-development programs, the programs' frequency and format, how attendance is documented, and the types of individuals who present the programs. A total of 327 (73.5%) of the questionnaires were returned, with 256 (78.3%) of the respondents indicating that their department had some form of developmental-training program. Only 45 (17.6%) of these respondents indicated that their department employed an individual whose job title was specific for education or training functions. Hour-long lectures and videotaped programs were the most popular formats; programs were most frequently presented by pharmaceutical sales representatives or clinical or staff pharmacists. Of 251 respondents, only 90 (35.8%) indicated that an educational needs assessment of pharmacists had been conducted in the 18 months before the survey. Of 252 respondents, 138 (54.8%) indicated that their departments had no annual budget for these programs. Although program attendance was documented by 248 (97.3%) of the 256 departments, 111 (43.3%) did not require any type of certification for some programs. Evaluations were required by only 127 (49.6%) of the 256 pharmacy departments offering these programs. Inhouse programs offer opportunities for professional development, but resource allocation, program organization, and incentives for participation such as standards of performance could be improved in many of the programs explored by this survey.

Certification↗
PubMedDate not supplied

Family planning program effects on the fertility of low-income U.S. women.

Under rigorous statistical controls, it has been shown that the larger the proportion of lower SES women enrolled in organized family planning programs, the lower their fertility. Program effects independent of other social, economic and cultural factors were shown for lower SES whites and blacks, and for most age groups. The potential of a fully implemented program to reduce fertility differentials between upper and lower SES groups was assessed, using 1969-1970 fertility rates and the estimates of 1969 program impact. Although we believe that the program's impact has increased in magnitude over time, even these estimates from an early point in U.S. program development provide impressive documentation that the program reduces fertility in the subpopulation served by the program, and, by implication, that there is a genuine need for organized family planning services, even in an industrialized nation like the United States. If there were no need, there could be no program effect. The family planning program was one of the major new health and social programs introduced in the mid-1960s. This study shows that, far from failing, the program was succeeding very well in attaining its objectives. The program works because it gives women of lower socioeconomic status access to modern and effective methods of contraception that they would not otherwise have. As a result, the rates of unwanted and mistimed pregnancy of patients are lower than those of comparable women who lack access to organized clinic programs.

Adolescent↗
PubMedDate not supplied

[AIDS prevention in secondary school: program summary and evaluation].

BACKGROUND: In the past decade a number of school AIDS prevention programs addressed to adolescents have been published in Spain. This paper aims to compile, describe and assess these programs. METHODS: AIDS prevention programs addressed to secondary school students which were published in Spain from 1990 to 1997 were included in the study. The collection of the programs was made by contacting aids prevention heads of national and regional governments. Each program was described in a standardized form and assessed according to the following quality criteria: preventive skills training, teachers or peer delivered, active pedagogical methodology, and at least administered along four sessions. RESULTS: 19 programs were included. Seventy-four percent (n = 14) are specific AIDS prevention programs and 26% (n = 5) sexual health programs. Among the AIDS programs, 57% include skills training, 93% are delivered by teachers, 100% propose active learning methodology and 64% are recommended to be developed in four or even more sessions. Only one of the sexual health programs includes skills training, all of them are delivered by teachers and use active learning methodology and 60% (n = 3) are recommended to be applied in four or even more sessions. CONCLUSIONS: Nearly all regional governments have developed or adapted secondary school preventive materials. Most of them are AIDS-specific programs. They use active learning methodology and suitable providers, but an important percentage of the programs lack a higher number of sessions and skills training. Programs should include peer-delivered activities.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Enrichment and recruitment programs at dental schools: impact on enrollment of underrepresented minority students.

Dental schools have created summer enrichment and recruitment programs to increase enrollment of underrepresented and disadvantaged students. Enrichment programs strengthen students' academic skills in the areas of basic medical sciences, communications, test taking, and other learning strategies. The purpose of this study was to identify program characteristics of summer enrichment and recruitment programs and to determine which characteristics predicted participant enrollment in dental school. Twenty-three schools received a survey, and seventeen responded for a response rate of 74 percent. The majority of program participants were underrepresented minority (URM) students (program median=99 percent). The leading program goals were to increase minority enrollment (47 percent) and URM competitiveness (35 percent). The median program length was seven weeks and forty hours per week. Programs offered the following components: basic sciences (thirty-two median hours). DAT review/preparation (thirty median hours), introduction to dentistry (sixteen median hours), preclinical laboratory activities (sixteen median hours), and learning strategies (nine median hours). The length of program time in existence was a significant predictor of participant enrollment into dental school (R square=.320; p=.035). The overall median percentage for dental school enrollment in the study was 52.3 percent. The directors of six programs who place more than 60 percent of their students in dental school were interviewed. They reported that mentorship, institutional support, program structure, and admission policies were key factors contributing to success. It is concluded that recruitment and enrichment programs are a viable option to increase URM dental school enrollment.

Career Choice↗
PubMed2006

The status of ultrasonography training and use in general surgery residency programs.

BACKGROUND: Effective use of ultrasonography (US) by surgeons was demonstrated a decade ago. Major surgical organizations now require its incorporation into surgical training and practice. But little information about the teaching of US to surgical residents exists. This study assesses the current status of US training in general surgery residency programs. STUDY DESIGN: A survey was mailed to the directors of 255 Accreditation Council for Graduate Medical Education-accredited general surgery residency programs. It questioned whether and how US was taught, who performed the examinations, and the types of US performed. Data were analyzed using chi-square tests comparing university versus community programs and training and practice in trauma US versus training in other US modalities. RESULTS: The response rate was 51% (130 of 255). Ninety-six percent of the programs responding taught US, with no differences between university- and community-based training programs in presence of training. Focused Assessment for the Sonography of Trauma (FAST) instruction was done by 79% (hands-on) and 68% (didactic) of programs that responded. Abdominal, laparoscopic, breast, endocrine, and vascular US were each taught less frequently (22% to 55%). Program directors at university programs reported that their attending surgeons performed FAST and abdominal US more often than their community counterparts (71% and 31% versus 47% and 14%). Program directors reported that university trainees performed laparoscopic, endocrine, and vascular US more often than community surgery residents (47%, 17%, 35% versus 29%, 3%, 19%). Program directors reported that surgery attendings or residents performed trauma and laparoscopic US more often than their radiology counterparts, and radiology attendings or residents performed more abdominal, breast, endocrine, and vascular US. CONCLUSIONS: The majority of general surgery residency programs whose directors responded to this survey are teaching US, but most of the training is in FAST. There is no difference in the reported presence of overall US training between university and community programs. But university programs report that their surgeons or residents performed more US in all areas (other than breast) than their community counterparts reported.

General Surgery↗
PubMed2005

A multidimensional cancer rehabilitation program for cancer survivors: effectiveness on health-related quality of life.

OBJECTIVE: A multidimensional rehabilitation program for cancer survivors was developed to overcome cancer-related problems and to improve quality of life. The two purposes of the study were to describe the effectiveness of the program and to obtain information about patient preferences for multi or mono dimensional rehabilitation programs. METHODS SUBJECTS: cancer survivors with different diagnoses, and cancer-related physical and psychosocial problems. INTERVENTION: a 15-week rehabilitation program including individual exercise, sports, psycho-education, and information. Group-wise randomization was implemented by assigning one half of the patients to the complete program while the other half were allowed to choose which program components they considered relevant. MEASURES: Health-Related Quality of Life [RAND-36 and Rotterdam Symptom Check List (RSCL)], exercise capacity (symptom limited bicycle ergometry), muscle force (hand-held dynamometry), and patient preferences. Measurements were performed before (T0) and after the rehabilitation program (T1), and at a 3-month follow-up (T2). RESULTS: After the rehabilitation program, cancer survivors (n=63) displayed statistically significant improvements on health-related quality of life with effect sizes (ES) varying from 0.38 to 0.99 (RAND-36) and from -0.34 to -0.57 (RSCL), most persistent at 3-month follow-up. Furthermore, statistically significant improvements in exercise capacity and muscle force of upper and lower extremities were displayed after rehabilitation. If offered a choice, 80% of the patients prior to start and 58% of the patients after completion of the program indicated that they preferred the entire multidimensional program. CONCLUSION: A multidimensional rehabilitation program has statistically and clinically relevant beneficial effects on health-related quality of life, exercise capacity, and muscle force in cancer patients with different diagnoses. Furthermore, if offered the choice, the majority of cancer survivors seem to prefer multidimensional programs to programs with only one component.

Adult↗
PubMed2003

The residents' viewpoint of the matching process, factors influencing their program selection, and satisfaction with the results.

PURPOSE: The purpose of this study was to determine the factors considered by oral and maxillofacial surgery residents in selecting residency programs, to estimate the level of their satisfaction with the selection and matching processes, and to analyze the relationship between these factors and overall satisfaction with their match. MATERIALS AND METHODS: A questionnaire was sent to 675 residents listed as members of the American Association of Oral and Maxillofacial Surgeons, and 208 responded to the survey. Of these residents, 56.7% were in an MD integrated program, 30.3% were in a 4-year certificate program, 10.6% were in an MD optional program, and 2.4% were in a combined PhD program. RESULTS: There were no differences between the program types and the number of resident applications or the number of interviews. Residents in the MD integrated programs had significantly higher board scores than both the MD optional residents and the 4-year certificate residents. The most important factors that residents considered when making their match list were as follows: good relationships between residents, good relationships between residents and attendings, training in orthognathic surgery, training in implant surgery, and training in dentoalveolar surgery. When residents were asked whether they were satisfied with the program in which they were currently enrolled, MD integrated residents were significantly more satisfied than were those residents in the MD optional and 4-year certificate program. Additional predictors of residence satisfaction were satisfied with the results of the match process, accuracy of the program in representing itself during the interview process, and less importance placed on orthognathic surgery training. Although generally satisfied, 25% would want to go to a different program if they could go through the match again. CONCLUSIONS: The majority of residents seem to be satisfied with the program in which they matched. Among the important factors determining satisfaction are the degree of honesty during the interview process, good relations among residents and between residents and attending doctors, the scope of clinical training, and the didactic/academic content of the program.

Analysis of Variance↗
PubMed1999

Forceps and vacuum delivery: expectations of residency and fellowship training program directors.

The objective of this study is to compare current forceps training practices in North American obstetrical residency training programs with that in maternal-fetal medicine fellowship programs. We sent a survey to all obstetrics and gynecology residency training programs and to all maternal-fetal medicine fellowship programs in North America. After sending out 354 questionnaires, 219 were returned for a response rate of 62%. The response rate for fellowship programs (52 of 59; 88%) was significantly greater than that of residency training programs (167 of 295; 56.6%) (p < 0.05). All fellowship training programs were using the 1988 ACOG forceps classification system, as were 98% of the residency training programs. Eighty-five percent of fellowship directors and 80% of residency directors felt the same system should be used for vacuum deliveries. All residency and fellowship directors expected proficiency with both instruments for outlet deliveries. For low deliveries requiring < or =45 degrees of rotation, at least 92% expected proficiency with both instruments. For low-forceps deliveries with >45 degrees of rotation, 82% of fellowship directors and 80% of residency directors expected proficiency. For low-vacuum deliveries with >45 degrees of rotation, 80% of fellowship directors and 76% of residency directors expected proficiency. Significantly more fellowship directors expected midforceps proficiency (47%) than did residency program directors (38%) (p < 0.05). Midvacuum proficiency was expected by 73% of fellowship directors and 69% of residency directors. The ACOG 1988 forceps classification system has now achieved wide acceptance and is taught by both residency and fellowship program directors. Most program directors favor using the same classification system for vacuum extraction deliveries. In general, the expectations of the residency program directors mirror those of maternal-fetal medicine fellowship directors. While outlet and low operations with < or =45 degrees of rotation are taught and proficiency is expected, most programs no longer expect proficiency in midforceps delivery, but do expect proficiency in midvacuum delivery. Proficiency in low operations with rotations < or =45 degrees is still expected.

Adult↗
PubMed1993

Syringe and needle exchange programs: Part I.

Syringe and needle exchange (SANE) programs appear to be a pragmatic approach to reducing the rising incidence of human immunodeficiency virus (HIV) infection among intravenous drug users (IVDUs). One purported indication of the effectiveness of SANE programs is lower prevalence rates of cases of AIDS or of HIV seropositivity in cities with SANE programs than in cities without such programs. In each positive comparison cited, however, the lower levels of HIV seropositivity were already present before the establishment of SANE programs. A second indicator of SANE effectiveness is a reduction in prevalence of hepatitis B in SANE program participants. Multiple factors working in concert, not simply the SANE programs, however, account for such progress; such factors include reductions in sharing of uncleaned injection equipment; legal exchange or sale of syringes at pharmacies; regular rinsing of used "works" with bleach; and epidemiologic fluctuations in the prevalence or a saturation level of the hepatitis B virus in IVDUs. A third indicator of the value of SANE programs is that they enable some otherwise unreachable IVDUs to make contact with a social or health facility. SANE programs do not facilitate the induction of new IVDUs or increase the frequency of injection by older addicts. From 60% to 90% of SANE attenders will return borrowed used injection equipment. Most participants reported that they reduced the frequency of lending or borrowing unclean injection equipment. Counterbalancing the above, SANE programs attract only a minority of all IVDUs in most cities, and they fail to attract the youngest subset of IVDUs. The attrition rate is high; only a small percentage of attenders remain with the program for more than a few months. Although many of the initial concerns about SANE programs have not been realized and there have been important public health gains to those who continue to attend them, SANE programs deserve more careful, unbiased, longitudinal research before they are established on a wide scale in the United States.

Age Factors↗