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PubMedDate not supplied

A worksite intervention to enhance social cognitive theory constructs to promote exercise adherence.

UNLABELLED: The results suggest social cognitive theory variables associated with the adoption of exercise are changeable in a brief worksite intervention. Self-regulation techniques and outcome-expectancy value improved, but self-efficacy did not improve for the treatment group. One possible explanation is, the intervention did not adequately address the ability to overcome barriers to exercise faced by participants in the intervention. Another explanation may be the effect of experiencing the barriers to exercise faced by subjects during the first 4 weeks of a self-regulated exercise program. Before engaging in exercise, the participants had a perceived level of confidence to overcome barriers to exercise. Once faced with real barriers to exercise, the subjects may have reevaluated their ability to overcome these barriers. It is interesting that the comparison group reported small decreases in all social cognitive theory variables measured in this study. The comparison group received a program of assessment, instruction, and access to facilities that is common to many worksite-based fitness promotion programs. Clearly, this approach did not have a favorable impact on psychosocial variables associated with exercise adherence. These results may be explained by a reevaluation of beliefs and perceived capabilities to exercise, once faced with the real experiences and barriers related to the adoption of an exercise program. The small decreases in social cognitive theory variables in the comparison group may explain high dropout rates in many fitness center programs and warrant further study. IMPLICATIONS: Health promotion specialists at the worksite need intervention programs that are safe, effective, and efficient for their employees. This intervention was based in the classroom, and no exercise was performed during class. This is appealing to employees who do not have access to shower facilities at the worksite. Moreover, in many interventions, subjects exercise during class and have limited time to learn specific skills to help them adopt and maintain exercise outside the structure of the intervention. Having established favorable changes in social cognitive theory constructs attributable to the intervention, a follow-up study should be conducted to determine the extent to which these changes predict adherence to regular exercise. These studies would establish the causal linkages between social cognitive theory constructs and regular exercise. LIMITATIONS: There were specific limitations, and the results should be interpreted cautiously. The sample size was relatively small, although similar to other exercise intervention research reviewed by Dishman. Another limitation of the sample was no random assignment to treatment or comparison group. The results apply only to the subjects who volunteered for this study. The measure of outcome-expectancy value is the most vulnerable of those used to measure outcome expectations and outcome expectancies. It is possible that the results of the study would be substantially altered if a better measure were available. The data were collected through self-administered questionnaires. It was assumed the subjects would provide accurate information, but reliance on self-reported data introduces potential sources of error.

Adult↗
PubMedDate not supplied

Using quality and efficiency evaluations of physicians.

Most physicians have long felt that there must be a better way to address the need for improving the cost effectiveness of medical care other than the process-heavy, invasive tactics of traditional UR. The QE strategy of replacing case-by-case pretreatment authorizations and certifications with a more thorough retrospective analysis of medical practice patterns appears to have the potential to dramatically improve managed care results while minimizing many of the more irritating aspects of traditional UR. The QE managed care strategy has much to offer the manager of a medical group practice who has come to realize the importance of demonstrating superior quality and efficiency as a way out of the "price discounting" game.

Efficiency↗
PubMed1981

Trends in cost containment: where do we cut?

The current emphasis on cost containment and its impact on pharmacy practice is reviewed. Methods by which existing standards of practice can be maintained are presented. Strategies for increasing the pharmacist's role in patient care within this climate are discussed. Examples of cost-effective approaches to pharmacy management and practice are outlined. Specific approaches include fiscal management of inventory, efficient use of personnel, and developing programs that reduce health-care cost.

Cost Control↗
PubMed1986

IV additive program saves Montreal hospital $300,000.

The implementation of an adjunct to the unit dose IV system, the Prefilled IV Syringe and Volume Control Set, as an additive antibiotics program, has shown the practicality and efficiency of a centralized drug dispensing service, administered and monitored by qualified clinical pharmacists. Since the introduction of this system at Sir Mortimer B. Davis-Jewish General Hospital, the hospital's pharmacy has been able to achieve optimal cost savings in the amount of $332,500 annually.

Canada↗
PubMed1989

Taking to the skies.

The role of Helicopter EMS must be to improve patient care and/or to ensure the most rapid transport of critically ill or injured patients. It has been suggested by Rhee et al, that the aeromedical service can be justified when the speed of the helicopter transport, the skills of the medical crew, and/or the ability of the helicopter to overcome environmental obstacles is likely to contribute to improved patient outcome. If one adds the essentials of well-trained, professional personnel and equipment, the "helicopter" becomes an important part of the overall medical care system and an essential component in improving patient outcome. While reviewing the role of the HEMS, it cannot be sufficiently emphasized that such a service in no way replaces an established ground ambulance system. A proficient, well-trained and well-equipped ground EMS program remains the backbone of an efficient pre-hospital and interhospital system. HEMS cannot be viewed as an isolated component of any EMS system. Instead, it must serve to complement the existing resources of the community. These is sufficient literature to suggest that the use of air medical services in transporting patients to tertiary care facilities or trauma centers has led to an improvement in overall survival rates. At the same time, an apparent paradox in mortality rate has occurred at the receiving hospital. While more patients are saved by speedy transport to a hospital, the mortality rate in that hospital may actually increase. Some patients who may have died from their injuries at the scene, or in transit, now die upon admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Aircraft↗
PubMedDate not supplied

A more total approach to productivity improvement.

Increasing reimbursement pressures now compel hospitals to be more cost effective. But traditional methods for productivity may not be adequate to meet the new demands of a turbulent environment. Typical productivity programs reflect two approaches. First, more efficient production controls result in more output of work per man-hour. Second, a more rational management system seeks efficiency through better goal-setting, coordination, and problem solving. This article focuses on a third approach: hospital adaptation, through which the hospital's total productivity capacity is utilized. Strategic planning, marketing, reorganization, and other strategies represent a new context. They are the latest frontier for using hospital resources in socially effective and economically efficient ways. There is also greater involvement of the hospitals' medical staff in controlling costs and utilization. The combination of these approaches can be a powerful means for realizing productivity improvement.

Culture↗
PubMedDate not supplied

[Methodological assessment of nutritional problems as part of a health care initiative for hospitalized children].

A health care initiative has been set up in a French regional hospital to improve the management of children admitted to the pediatric unit. It involves screening these children, aged between 6 months and 5 years, for nutritional problems. Health care professionals are first trained. They then measure and weigh the children according to a predetermined protocol and calculate an indicator (weight/height ratio) using the EPI-INFO computer program. The medical team is notified if a child is found to be over- or underweight and decisions are taken as to whether further investigations will be carried out. The family are interviewed and the child's eating habits are observed. Nutritional advice is given and the child's doctor is informed. This initiative has been planned and analyzed according to recognized good practice in community programs. All the health care professionals involved in the scheme participated during the year of the study. In total, 1,004 children were admitted to the hospital and 964 were included in the study (97. 8%). Of these, 142 children (14.7%) were included after their discharge from the hospital. Sixty-nine children were identified as being over- or underweight, with 25 (2.6%) underweight and 44 (4.6%) overweight. Sixty-five of these children were identified before their discharge from hospital. The notification rate was only 64.5% and the treatment rate was similar. Efficacy was not assessed. This initiative requires the active participation and awareness of the entire health care team. Improvement should be possible with better computer programs, regular data collection and improved efficiency, which is often not the case when dealing with obesity problems.

Child Nutritional Physiological Phenomena↗
PubMed2000

Ensuring that forensic psychiatry thrives as a medical specialty in the 21st century.

The author contends that forensic psychiatry will thrive as a legitimate medical specialty in the 21st century only if it helps to fulfill the crucial requirement of medical systems in the new health care era. The article presents six basic requirements of future medical systems: effective, efficient, and responsible organizations; quality educational programs of the appropriate type and size; linkage to health care networks; primary care capacity and services; restructured systems for research; and effective leadership. Specific opportunities for forensic psychiatry to help meet these requirements are outlined. The author presents major implications of these opportunities for forensic academicians and practitioners as well as for the American Academy of Psychiatry and the Law.

Forecasting↗
PubMedDate not supplied

Measuring contract agency performance with administrative data.

This article uses administrative data to analyze the relative performance of contract agencies-those organizations under contract with a city child welfare agency to provide out-of-home care services to children placed in the custody of the public agency-by examining how long it took children placed in out-of-home care to return home to their families. The objective was to determine whether credible empirical evidence could show a relationship between length of stay and the agency providing care. Agency level reunification rates are widely distributed around the mean, indicating that contract agency performance differs and that "agency effects" leave an independent imprint on a child's out-of-home care experience.

Child↗
PubMed2001

[Safety profile of statins].

HMG-CoA reductase inhibitors (statins) are the treatment of choice for patients with hypercholesterolaemia. Several large-scale clinical trials have examined the efficacy and tolerability of statins, providing a wealth of information on their safety and adverse effect profile. Adverse hepatic effect is reflected as asymptomatic elevations in serum levels of aminotransaminases. Myopathy, occasionally leading to myoglobulinuria secondary to rhabdomyolysis, is a rare and potentially fatal complication. Cerivastatin, the last statin approved for use in humans, was voluntarily withdrawn from the market by Bayer, because fatal rhabdomyolysis was most frequently reported with cerivastatin than for other approved statins. The concomitant use of statins with drugs that inhibit CYP3A4 (cyclosporin, erythromycin, clarithromycin, itraconazole, and ketoconazole), may result in increased plasma concentrations of HMG-CoA reductase inhibitors leading occasionally to myotoxicity. Fibric acid derivatives can produce myotoxicity, and the association of both types of drugs increases the risk of this adverse event. The reason for the greater association of rhabdomyolysis with cerivastatin than with other statins is unknown. The efficiency of post marketing drug surveillance programs in different countries, was the clue for the awareness of this problem.

Anticholesteremic Agents↗
PubMed2002

The role of clinical governance as a strategy for quality improvement in primary care.

This power considers the process of implementing clinical governance in primary care and its impact on quality improvement. It discuss how clinical governance is being implemented both at the level of Primary Care Organisations and general practices, and the challenges to implementing clinical governance. It also suggests a model for promoting the factors that will help clinical governance improve quality of care. The experience of implementing clinical governance is broadly positive to date. However, the government needs to match its commitment to a ten-year programme of change with realistic timetables to secure the cultural and organisational changes needed to improve quality of care.

Efficiency, Organizational↗
PubMed2002

Data-Based Interval Throwing Programs for Collegiate Softball Players.

OBJECTIVE: To construct interval throwing programs followed by a simulated game for collegiate softball players at all positions. The programs are intended to be used as functional progressions within a comprehensive rehabilitation program for an injured athlete or to augment off-season conditioning workouts. DESIGN AND SETTING: We collected data over a single season of National Collegiate Athletic Association softball at the University of Delaware and Goldey Beacom College. We observed 220 half-innings of play and 2785 pitches during data collection. SUBJECTS: The subjects were collegiate-level softball players at all positions of play. MEASUREMENTS: We recorded the number of pitches for pitchers. For catchers, we recorded the number of sprints to back up a play, time in the squat stance, throws back to the pitcher, and the perceived effort and distance of all other throws. We also collected the perceived effort and distance of all throws for infielders and outfielders. RESULTS: Pitchers threw an average of 89.61 pitches per game; catchers were in the squat stance 14.13 minutes per game; infielders threw the ball between 4.28 times per game and 6.30 times per game; and outfielders threw distances of up to 175 feet. CONCLUSIONS: We devised the interval throwing programs from the data collected, field dimensions, the types of injuries found to occur in softball, and a general understanding of tissue healing. We designed programs that allow a safe and efficient progressive return to sport.

Journal Article↗