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PubMed2003

Barriers to preventive interventions for coronary heart disease.

Many barriers exist to the delivery of preventive services by cardiologists and other physicians. Appropriate training and the development of supportive infrastructures can effectively overcome these barriers. In addition, institutional priorities must change to encourage such efforts. Cardiologists must continue to recognize the importance of risk-factor modification, and training programs in cardiology should teach appropriate counseling techniques, the use of risk-factor-lowering pharmacologic agents, and the manner in which cardiologists should interface with dietitians and other ancillary personnel [77]. In addition, it is important to recognize and teach, both didactically and by example, that counseling patients and carrying out long-term preventive interventions can be as gratifying and interesting as performing dramatic procedures that, although valuable and rewarding, take place at a very late point in the patient's clinical course, a point that might have been averted by greater attention to risk-factor modification. Increasingly, the public and governmental agencies are becoming involved in encouraging such an approach [66], and health care provider groups [78] and organizations [67] are also facilitating the development of a more comprehensive approach to the delivery of preventive intervention [79].

Coronary Disease↗

PubMed1979

Inclusion of a program of instruction in care of the disabled in a dental school curriculum.

Lack of practitioner training is considered a major reason for dental neglect of disabled persons. The feasibility of instruction in the care of the disabled for dental and dental hygiene students at the undergraduate level was demonstrated in a prototype program encompassing a continuum of didactic courses, clinical experiences in extramural and intramural settings, inservice training and continuing education, interdisciplinary activities, and evaluative research. Successful implementation of such a program required developing and using appropriate support systems, such as instructional materials, social services, public relations, and monitoring of care delivery. A format combining specific courses with inclusion of disability subject matter in existing courses appeared to be advantageous in intergrating the program into the dental curriculum. Evaluation data indicated the value of undergraduate training in improving access to dental care for the disabled patient.

Attitude↗

PubMed2004

Surface dust contamination and perceived indoor environment in office buildings.

UNLABELLED: The purpose of the study was to evaluate the impact of cleaning on indoor environment quality. Surface dust contamination and occupants' perception of the work environment factors and symptoms were the parameters studied. Six multi-floor office buildings were selected. Dust contamination on surfaces was sampled with gelatine foils and quantified using a BM-Dustdetector. Occupants' perceptions of the environment were assessed with modified MM-40 questionnaires. The results indicated that each building had its own surface dust contamination profile. Weekly cleaning maintained the surface dust contamination at the highest acceptable level for indoor environments. The occupants and their activities have a major effect on the level of dust particle contamination on desks. The correlation between the perceived surface dust contamination and the level of satisfaction with cleaning was as expected. Furthermore, surface dust contamination appeared not to be associated with work-related symptoms. PRACTICAL IMPLICATIONS: The results provide information about current program for contractors and clients, e.g. appropriate cleaning intervals of different surfaces, and the influence of disorder on result. After the evaluation of surface dust contamination levels, it will be possible for cleaning companies to focus on the most important surfaces to clean in order to enhance the quality of the indoor environment in office buildings. This should lead to future development work, which will require cooperation between contractors, clients, and research scientists. In office environments where high cleanliness is required, objective measurements (with instruments) are needed in addition to subjective measurements (the perceptions of occupants). It is essential to evaluate the efficiency of cleaning programs regularly with effective and appropriate quality-monitoring methods.

Analysis of Variance↗

PubMedDate not supplied

Knowledge and management of diarrhea among underserved minority parents/caregivers.

OBJECTIVE: Dehydration resulting from diarrhea continues to be a cause of morbidity, mortality, and increased health care costs in the United States. This study assesses parental knowledge of the causes and signs of diarrhea and dehydration. It also examines parental-care practices during an episode of diarrhea. METHODS: A survey was given to 219 parents/caregivers of children less than 5 years of age who presented to a pediatric continuity clinic. A bilingual interviewer was used to administer the surveys to participants for assessing knowledge of causes, signs, and treatment of diarrhea; signs of dehydration; and care practices during an episode of diarrhea. RESULTS: A wide variation in the level of awareness of signs, causes, and treatment of diarrhea was detected. General knowledge of diarrhea was related positively to accessibility of health information, level of education, ethnicity, and experience with dehydration. General knowledge of diarrhea, adjusted for level of education, was higher in African Americans than in Hispanics. CONCLUSIONS: In children, dehydration from diarrhea may be prevented by increasing parents'/caregivers' general knowledge of diarrhea and dehydration and the appropriate usage of oral rehydration solutions. Intervention programs designed to increase parents'/caregivers' knowledge must be culturally sensitive and appropriate for diverse educational backgrounds and must assist in improving access to health-related information.

Adolescent↗

PubMed1976

A review of small canned computer programs for survey research and demographic analysis.

A variety of small canned computer programs for survey research and demographic analysis appropriate for use in developing countries are reviewed in this article. The programs discussed are SPSS (Statistical Package for the Social Sciences); CENTS, CO-CENTS, CENTS-AID, CENTS-AIE II; MINI-TAB EDIT, FREQUENCIES, TABLES, REGRESSION, CLIENT RECORD, DATES, MULT, LIFE, and PREGNANCY HISTORY; FIVFIV and SINSIN; DCL (Demographic Computer Library); MINI-TAB Population Projection, Functional Population Projection, and Family Planning Target Projection. A description and evaluation for each program of uses, instruction manuals, computer requirements, and procedures for obtaining manuals and programs are provided. Such information is intended to facilitate and encourage the use of the computer by data processors in developing countries.

Computers↗

PubMed1998

Effect of volume reduction on lung transplant timing and selection for chronic obstructive pulmonary disease.

BACKGROUND: End-stage chronic obstructive pulmonary disease has traditionally been treated with lung transplantation. For 2 years, our lung transplantation program has placed patients with appropriate criteria for lung transplantation and volume reduction into a prospective management algorithm. These patients are offered the lung volume reduction option as a "bridge" to "extend" the eventual time to transplantation. We examine the results of this pilot program. METHODS: From October 11, 1993, to April 17, 1997, 31 patients were evaluated for lung transplantation who also had physiologic criteria for volume reduction (forced expiratory volume in 1 second < or = 25%; residual volume > 200%; significant ventilation/perfusion heterogeneity). All patients completed 6 weeks of pulmonary rehabilitation and then had baseline pulmonary function and 6-minute walk tests. These patients were then offered volume reduction as a "bridge" and were simultaneously listed for transplantation. Postoperatively, these 31 patients were then divided into two groups: Those with satisfactory results at 4 to 6 months after volume reduction and those with unsatisfactory results. Volume reduction was performed through a video thoracic approach in 87% of the patients and bilateral median sternotomy in the remaining 13%. The condition of the patients was monitored after the operation with repeated pulmonary function tests and 6-minute walk tests at 3-month intervals. RESULTS: Twenty-four of 31 patients (77.4%) had primary success (at 4 to 6 months) results after lung volume reduction and 7 patients (22.6%) had primary failure, including 1 patient who died in the perioperative period (3.2%). Four patients (16.7%) from the primary success cohort had significant deterioration in their pulmonary function during intermediate-term follow-up and were then reconsidered for lung transplantation. Two of them have subsequently undergone transplantation with good postoperative pulmonary function results. Interestingly, three patients had alpha 1-antitrypsin deficiency; two had a poor outcome of lung volume reduction and primary failure. CONCLUSIONS: Lung volume reduction in these patients is safe. Seventy-seven percent of otherwise suitable candidates for lung transplantation achieved initial good results from volume reduction and were deactivated from the list (placed on status 7). Most patients entering our prospective management algorithm have either significantly delayed or completely avoided lung transplantation after volume reduction. Lung volume reduction has substantially affected the practice, timing, and selection of patients for lung transplantation. Our waiting list now has a reduced percentage of patients with a diagnosis of chronic obstructive pulmonary disease compared with 3 years ago. Our experience suggests that lung volume reduction may be limited as a "bridge" in alpha 1-antitrypsin deficiency.

Algorithms↗

PubMedDate not supplied

HQEF update: master's degree program guidelines for a concentration in healthcare quality management.

The Healthcare Quality Educational Foundation (HQEF), in its quest to identify formal educational opportunities for healthcare quality leaders, determined that academia lacked a standardized curriculum for healthcare quality management. Because a majority of the members of the National Association for Healthcare Quality (NAHQ) expressed a need for master's degree programs, the foundation appointed a committee composed of academicians and quality management professionals to define a curriculum appropriate for a master's degree program with a concentration in healthcare quality management. This article identifies the HQEF's goals and outlines the activities undertaken by the committee to define guidelines for colleges and universities interested in developing master's degree programs.

Curriculum↗

PubMed2005

The role of the forensic pathologist in quality assurance and safety of patient care.

During this past half century, there has been remarkable increase in the role of forensic pathologists and medical examiners in the determination of cause and manner of deaths in health care facilities and investigations of quality of patient care. Autopsy data are an essential part of this quality assurance (QA) program in patient care, especially in trauma centers' QA programs. Forensic pathologists participate in evaluating appropriateness of patient care where death occurs during or following therapeutic and diagnostic procedures. Continuous quality improvement programs now extend into data sharing in child and elder abuse, monitoring of defective medical devices and consumer products which contributed to deaths. In recent years, forensic pathologists are increasingly requested directly by family members to conduct private autopsies to provide independent opinions as to quality of patient care. Thus forensic pathologists are contributing expertise to an ever widening circle of influence in prevention of unnecessary deaths with quality assurance programs and peer review processes.

California↗

PubMed1988

The prevalence at birth of congenital malformations in communities near the Hanford site.

The authors examined the prevalence of congenital malformations among births in Benton and Franklin counties, in southeastern Washington State, from 1968 through 1980. The Hanford Site is in this area and serves as a major employer. In addition, various agriculturally and chemically related activities are in the area. Hospital and vital records were used to identify 454 malformation cases among 23,319 births; this yielded a malformation rate of 19.6 per 1,000 births, a rate similar to those reported in other studies. The rates of specific malformations ascertained during the first year of life were compared with combined rates from the states of Washington, Oregon, and Idaho from the Birth Defects Monitoring Program. Among defects that would be expected to be comparably ascertained, a statistically significant elevated rate of neural tube defects was observed (1.72 per 1,000 births vs. 0.99 per 1,000). Rates of cleft lip were significantly lower in Benton and Franklin counties than in the Birth Defects Monitoring Program (0.59 per 1,000 vs. 1.17 per 1,000). For congenital heart defects, pyloric stenosis, and Down syndrome, which are often not diagnosed in the newborn period, Birth Defects Monitoring Program data did not offer appropriate comparisons. The rates of these defects did not appear to be elevated in relation to rates found in other relevant populations. When rates of neural tube defects were compared with those in populations other than the Birth Defects Monitoring Program, the Benton and Franklin county rates were still considered to be elevated. The increased bicounty rate cannot be explained by employment of the parents at Hanford or by the impact of plant emissions on the local population.

Congenital Abnormalities↗

PubMed2002

Two perspectives on the indicators of quality in psychiatry residencies: program directors' and residents'.

PURPOSE: To determine whether psychiatry program directors and residents agree on the characteristics most important in determining the quality of a residency program. METHOD: The authors carried out factor analyses of the results of two national surveys that asked participants to rate the importance of 41 items in determining the quality of residency programs: a 1997 survey completed by 180 psychiatry residents and a 1998 survey completed by 234 psychiatry program directors and rotation heads. RESULTS: Residents' factors determining program quality were the interpersonal culture in the program, the curriculum, academic resources and opportunities, clinical resources and opportunities, and outcomes. Program directors' factors were program administration, curriculum and clinical resources, the quality of the institution, the supportiveness of the program, and individual preferences. CONCLUSIONS: Program directors and residents focus on different indicators of the quality of residency programs, differences that can be conceptualized as those between the "producer" and the "consumer" of the program. Four domains appear to underlie the results of the resident and faculty factor analyses: the context, content, culture, and consequences of the program. Multidimensional evaluations by multiple stakeholders may be the most appropriate way to evaluate the quality of residency programs. These results also strongly suggest that the interpersonal culture of a program should be assessed as part of its evaluation process.

Attitude of Health Personnel↗

PubMed2006

Development of an obesity prevention and management program for children and adolescents in a rural setting.

This study applied theory-based health behavior change constructs to childhood obesity prevention. Constructs such as goal setting, self-efficacy, and readiness for change were used within a rural community-based program designed to be developmentally appropriate for 6th graders. The project included 2 studies across 12 months. The 1st assessed the scope of the obesity problem within a 3-county area with key stakeholders in health and education. The 2nd implemented a pilot community intervention program within a rural middle school. Participants in the intervention included 65 middle-school students and the families of 25 of these students. Qualitative and quantitative analyses were conducted to assess the effectiveness of the intervention. Changes from pre- to postintervention on relevant measures were statistically significant for families but not for students. Issues related to family versus individual behavior change are discussed, along with implications for managing behaviorally based activity and nutrition interventions within a rural community.

Adolescent↗

PubMed2004

CURATA: A patient health management program for the treatment of osteoarthritis in Québec: an integrated approach to improving the appropriate utilization of anti-inflammatory/analgesic medications.

OBJECTIVES: To identify gaps in current osteoarthritis (OA) care in Quebec, Canada, and to implement and evaluate interventions to promote appropriate use of evidence-based medicine. STUDY DESIGN: Pretest and posttest; analysis of the Quebec health insurance database. METHODS: CURATA is a patient health management program utilizing an evidence-based approach for OA treatment. Evaluation of the current level of care revealed major gaps in physicians' knowledge of (1) risk factors for gastrointestinal (GI) toxicity associated with nonsteroidal anti-inflammatory drugs (NSAIDs); (2) NSAID-induced toxicity associated with long-term administration and contraindications for NSAID use in patients with hypertension, cardiovascular disease, or renal insufficiency; (3) choice of cytoprotection; and (4) use of nonpharmacologic treatments for OA. The CURATA intervention consisted of educational workshops, with and without presentation of a decision tree regarding appropriate use of pharmacologic and nonpharmacologic OA treatments. Participating physicians were asked to complete an 8-item questionnaire before and after the workshop, as well as 3 and 6 months later, to test their immediate and remote knowledge of treatment choices. The prescribing patterns of GPs also were evaluated through analysis of the Quebec health insurance database. RESULTS: The participating physicians were better immediate and remote risk assessors of GI bleeding and made more appropriate treatment choices (15.2% improvement relative to mean preworkshop score). CONCLUSION: These evidence-based interventions were successful not only in improving the physicians' knowledge regarding the diagnosis and management of OA, but also--more importantly--in changing their behavior to make more appropriate therapy choices for their patients.

Analgesics↗

PubMed2001

Feasibility of a nurse-run asthma education program for urban African-Americans: a pilot study.

The objective of the study was to assess the feasibility of implementing and evaluating a culturally appropriate in-patient asthma education program specifically targeted for African-Americans. A consecutive sample of 28 African-American patients ages 18-50 who were hospitalized for asthma were randomized to an intervention group, which received three one-on-one sessions on chronic asthma management, or a control group, which received the usual care. Data on symptom frequency, self-management behaviors, quality of life, depression, and health care resource use were collected at baseline and at 3 and 6 months. Although the time required to recruit our sample took longer than anticipated, 28 subjects agreed to be in the study (70% acceptance rate) and complete the baseline interview. We observed no statistically significant differences from baseline or changing trends in frequency of asthma symptoms, self-management behaviors, and health care resource use between the intervention and control groups at 3 and 6 months. However patients in the intervention group demonstrated a greater average increase in asthma-related quality of life and a greater average decrease in depression than the control group. Feasibility issues included shortened length of stay, which necessitated conducting all three self-management sessions together; multiple interruptions during the sessions, and retention issues at 3- and 6-month follow-ups. The lessons learned from this pilot study are invaluable in that they will enable us to make changes in our existing protocol to ensure the success of a larger clinical trial.

Adolescent↗

PubMed1986

Assuring the quality of a clinical pharmacokinetics service.

A quality assurance program for a clinical pharmacokinetics service that meets current Joint Commission on Accreditation of Hospitals (JCAH) requirements for quality assurance is described. The clinical pharmacokinetics service is provided by pharmacists who have been certified through a staff development program. The clinical pharmacokinetics quality assurance program is part of the department's overall quality assurance program. Information from records maintained by pharmacists who are involved in the pharmacokinetics service is reviewed monthly and compared with 14 criteria that were approved by the pharmacy and therapeutics committee. Results of the monthly audits are summarized in a trend report; these results are communicated to the pharmacists involved, and any necessary corrective actions are taken. The program has led to more appropriate selection of target peak and trough serum drug concentrations, improved documentation of patient data, and better monitoring of each patient's renal function. Physician use of the service has increased as the quality of the service has improved. The quality assurance program has provided mechanisms for monitoring the quality of patient-care services and satisfying current JCAH requirements.

Hospital Bed Capacity, 100 to 299↗

PubMed1995

Health promotion communications system: a model for a dispersed population.

1. Corporations with geographically dispersed populations need to provide flexible health promotion programs tailored to meet specific employee interests and needs. 2. Bell Atlantic developed a dispersed model approach based on the transtheoretical model of behavior change. The key to this model is to identify at which stage the individual is operating and provide appropriate information and behavior change programs. 3. Components of the program include: health risk appraisal; exercise/activity tracking system; on line nurse health information service; network of fitness facilities; employee assistance programs; health library available by fax; health film library; network of health promotion volunteers; and targeted health and marketing messaged via corporate media.

Health Promotion↗

PubMedDate not supplied

State health department and university evaluation of North Carolina's Maternal Outreach Worker Program.

INTRODUCTION: The Maternal Outreach Worker (MOW) Program is a social support intervention using lay helpers to provide support, health education, and outreach to Medicaid eligible women at risk for poor pregnancy and parenting outcomes. State Health Department and University collaborators designed a two-pronged evaluation comprised of programwide and interview study components to assess the impact of the program on pregnancy outcomes, health behaviors, and infant health status. METHODS: Programwide evaluation data are based on 1992-1995 N.C. birth files for the original 24 participating counties and include 1,726 MOW participant births and 12,988 comparison births whose records were linked to birth files and met the study criteria. For the interview study 373 MOW participants and 332 comparison women were personally interviewed three times: during pregnancy, one month postpartum, and one year after delivery. RESULTS: Risk factors associated with poor pregnancy and parenting outcomes were greater among MOW participants than comparisons in both the programwide and intensive study components. Caucasian MOW participants had slightly higher rates of adequate prenatal care. African Americans were found to have less adequate prenatal care. Fewer than expected LBW and VLBW births were observed for African-American MOW participants. MOW Program participation did not affect the utilization of health and social services for infants. African Americans, regardless of whether they received MOW services, fared better than Caucasians in terms of having their pregnancy needs fulfilled. CONCLUSIONS: Findings show the need to further explore appropriate measures of maternity support program outcomes and indicate inconsistent program benefit among subpopulations.

Adolescent↗

PubMed1988

AIDS funding: competing needs and the politics of priorities.

Despite the Department of Health and Human Service's 1983 claim that AIDS is the nation's "number one health priority," funding for AIDS research, prevention, and treatment remains inadequate. Worse, it is often marshaled from or juxtaposed against other necessary health allocations. Consequent AIDS-related resource crises include diverting funds for research on other diseases to AIDS investigations, propping up AIDS prevention efforts at the expense of traditional sexually transmitted disease control programs, and pitting the health needs of AIDS patients against the needs of those seeking other urgent health services, e.g., prenatal care. While this forced competition typically is blamed on fiscal constraints, examination of federal spending priorities suggests that it results principally from Reagan Administration policies. This Administration has consistently boosted military spending at the expense of social and health services, and has deliberately undermined efforts to obtain sufficient and new allocations for AIDS. In order to avert political divisions spurred by competition for currently scarce resources, AIDS and other health activists together must argue that excessive military allocations must be shifted to health research and services, and that a national health program must be implemented, if AIDS programs are to be funded appropriately without jeopardizing other necessary health initiatives.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Functional decline in frail community-dwelling stroke patients.

Patients who suffer a stroke event are at high risk of functional decline after the post-acute rehabilitation period. The aim of the present study was the evaluation of factors associated with functional decline in a large sample of older patients with stroke living in the community. The study population consisted of all patients admitted to home care programs after a post-acute rehabilitation program--with at least 1 year of follow-up--in twenty-two Italian Home Health Agencies from 2000 to 2002 (n=1338). For the present study we selected 355 (26%) patients with diagnosis of stroke. After 1 year of in-home care program, 149 out of 355 stroke survivors (42%) had presented a worsening in the activities of daily living (ADL) scale score. In the final adjusted model, patients with cognitive impairment (OR 2.59, 95% CI, 1.45-4.64), pressure ulcer (OR 2.74, 95% CI, 1.45-5.18), urinary incontinence (OR 1.64, 95% CI, 1.01-3.29), or hearing impairment (OR 1.83, 95% CI, 1.02-3.29) were more likely to significantly decline in physical functioning after a period of 1 year in-home care program. Our study documents that functional decline of stroke patients was largely dependent on specific subjects' clinical characteristics. Three of four concomitant disabling conditions associated in our sample with functional decline--pressure ulcer, urinary incontinence, hearing--can be prevented and eventually treated or modified. Appropriate post-acute rehabilitation programs and adequate home care interventions focused on the prevention and treatment of these conditions might be correlated to better outcomes in older post-stroke patients.

Activities of Daily Living↗