Improving the efficiency of disease management programs by assessing patients' readiness to change.
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Behavior Therapy↗
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Results for “Program Acceptability”
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Immunisation policy: from compliance to concordance?
Immunisation has proved a highly effective public health policy. However, it has come under public suspicion at times, with large falls in pertussis immunizations in the 1980s and smaller falls in measles, mumps and rubella (MMR) vaccine uptake recently. Immunisation scares have also occurred in other countries. This discussion paper explores the concepts of herd immunity, altruism, and informed consent. Historical, quantitative, and qualitative research on the sociology of immunisation is reviewed. Recent research has shown that the concerns of parents include a loss of trust in health professionals and increasing worries about side effects. The sociologist Streefland is the leader of the World Health Organisation Sociology and Immunisation Project. His concept of the five perspectives on immunisation is explained. Concordance is then described as a dialogue based on mutual respect between different perspectives. Finally, some suggestions are made for immunisation policy in the UK. Immunisation policy should move from the current situation, which largely assumes the passive compliance of the population, to a policy where people are actively involved and their views respected.
Health Knowledge, Attitudes, Practice↗
Symbols, rationality, and justice: rationing health care.
Proposals to ration health care in the United States meet a number of objections, symbolic and literal. Nonetheless, an acceptance of the idea of rationing is a necessary first step toward universal health insurance. It must be understood that universal health care requires an acceptance of rationing, and that such an acceptance must precede enactment of a program, if it is to be economically sound and politically feasible. Commentators have argued that reform of the health care system should come before any effort to ration. On the contrary, rationing and reform cannot be separated. The former is the key to the latter, just as rationing is the key to universal health insurance.
Health Care Rationing↗
Multicentre evaluation of the Boehringer Mannheim/Hitachi 747 analysis system.
Analytical performance and practicability of the new Boehringer Mannheim/Hitachi 747 analysis system were assessed in a multicentre evaluation involving four laboratories. The analytical performance was evaluated according to a protocol similar to the ECCLS guidelines and comprised 13 analytes including enzymes, substrates and electrolytes. About 65,000 results were obtained within three months. The evaluation was planned and supported by a program system called "Computer Aided Evaluation". Acceptance criteria have been established for judging the results. The median of the within-run coefficients of variation (CVs) in control sera of all methods was below 1%, being far below the acceptance limit of 2%. The median of CVs of between-days imprecision was below 2% (acceptance criterion 3%). The high degree of precision prompted us to set up a biometrical model suitable for the differentiation between deviant points, outliers and measurements that can still be explained by the system performance. No relevant drift effects were observed during eight hours. The methods were linear over a wide range, avoiding rerun analysis in most cases. No sample-related carry-over was found. Reagent-dependent carry-over outside the acceptance limits was measured from uric acid to phosphorus to a slight extent, and from triacylglycerols to lipase, as well as from total protein to bilirubin to a perceptible degree. It can be avoided by separating these reagent combinations in the channel arrangement. Taking a systematic deviation of more than 10% as unacceptable, four of the 13 analytes suffered from interference by haemoglobin, one by bilirubin and one by turbidity. The Boehringer Mannheim/Hitachi 747 analysis system is capable of determining serum indices which in combination with the interferogram allow an assessment of the interference. With the exception of chloride the recovery of the assigned values for all control sera showed values between 95 and 105%. Out of 40 method comparison studies for enzymes and substrates, 31 yielded regression equations with less than 5% proportional errors and less than 5% constant errors. Deviations exceeding these acceptance criteria can be explained by differences in the reagent formulation, in the method employed or in calibration. The agreement of the ISE method comparisons was within a +/- 5% deviation over a wide analytical range. Practicability of the Boehringer Mannheim/Hitachi 747 analysis system was assessed with the help of a questionnaire, in which properties of the instrument were quantified, thus permitting a relatively objective rating. The 190 questions were placed in 14 groups, each dealing with an attribute of the instrument.(ABSTRACT TRUNCATED AT 400 WORDS)
Autoanalysis↗
[Preventive vaccination is used too little. Number of FSME cases is even slightly increased].
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Adult↗
[Determination of estradiol-17 beta concentration in the saliva of fertile women during the menstrual cycle by an ELISA-type immunoenzymatic, competitive method].
In accordance with the lipophilic properties that are presented by steroidal molecules and the easy of their diffusion and ultrafiltration across serum to saliva, a competitive immunoenzymatic method based on the solid phase system (ELISA) is here in described, it aims to evaluate 17B oestradiol during menstrual cycle using saliva as the biological fluid. In order to apply this competitive system, the requirements are: as antigen 17B oestradiol immobilized on a solid phase, anti 17B oestradiol sheep serum, (1er. Ab) rabbit-globulin anti sheep serum (2o. Ab). The latter when it's conjugated to an enzyme will reveal and will evaluate the presence of 17B oestradiol-antibody reaction. This ELISA method offers acceptable results within a quality control program, indicating with respect to sensibility, a minimum detection level of 2.5 pg/ml. The specificity, which depends on the antibody used and its interaction with the structurally related steroids was not significative with oestrone (1.32%) and oestradiol, (2.46%). The recovery of 17B E2 was adequate (90-95%). In the standard curve the interassay coefficient of variation ranged between 3.0-4.8%; in the saliva samples, the intra assay and inter assay coefficient of variation were 7.2-9.4 and 4.8-12.1% respectively. With respect to the biological fluid used, we can say that saliva is one of the most accessible fluids in the human body and it can be obtained daily without problem. One additional advantage is that 17B E2 values showed excellent correlation with the menstrual cycle phases. So, because the safety, low cost and simplicity we think this ELISA method appears to be very convenient in order to measure oestradiol in normal and pathological conditions.
Enzyme-Linked Immunosorbent Assay↗
The importance of engaging policy-makers at the outset to guide research on and introduction of vaccines: the use of policy-maker surveys.
Face-to-face surveys of policy-makers and other influential leaders are a useful tool to identify, at an early stage, (a) major issues regarding the introduction of a new vaccine, (b) persons and groups in a country who play a major decision-making or influential role in the introduction of vaccines, (c) potential obstacles to the introduction of vaccines, and (d) data-needs of policy-makers to overcome these obstacles. By surveying the opinions and beliefs of those who will make or influence decisions on whether to introduce a new vaccine, these studies can help ensure that research activities respond to the needs of policy-makers in countries endemic for the target diseases. These surveys can also inform vaccine-introduction strategies by identifying financially and politically feasible means of distributing, targeting, and financing the vaccines. This paper describes the methodology used in conducting such surveys and discusses methodological issues. It also presents lessons learnt from two policy-maker surveys carried out in several Asian countries in regard to new-generation vaccines against cholera, typhoid fever, and shigellosis; and future vaccines against dengue fever/dengue haemorrhagic fever.
Asia↗
Abamectin as a pesticide for agricultural use.
The avermectins are a family of macrocyclic lactones, produced by the soil organism Streptomyces avermitilis, which were discovered in the mid-1970's as a direct result of a screening effort for natural products with anthelmintic properties. Avermectin B1 (abamectin), the major component of the fermentation, also showed potent activity against arthropods in preliminary laboratory evaluations and was subsequently selected for development to control phytophagous mites and insect pests on a variety of agricultural and horticultural crops worldwide. Major applications for which abamectin is currently registered include uses on ornamental plants, citrus, cotton, pears and vegetable crops at rates in the range of 5 to 27 grams abamectin per hectare as a foliar spray. Abamectin has shown low toxicity to non-target beneficial arthropods which has accelerated its acceptance into Integrated Pest Management (IPM) programs. Extensive studies have been conducted to support the safety of agricultural uses of abamectin to man and the environment. Abamectin is highly unstable to light and has been shown to photodegrade rapidly on plant and soil surfaces and in water following agricultural applications. Abamectin was also found to be degraded readily by soil microorganisms. Abamectin residues in or on crops are very low, typically less than 0.025 ppm, resulting in minimal exposure to man from harvesting or consumption of treated crops. In addition, abamectin does not persist or accumulate in the environment. Its instability as well as its low water solubility and tight binding to soil, limit abamectin's bioavailability in non-target organisms and, furthermore, prevent it from leaching into groundwater or entering the aquatic environment.
Agriculture↗
A preventive dentistry component in the curriculum of Israeli dental students.
A preventive dentistry program conducted by 34 and 27 senior dental students as an integral part of children's clinic was evaluated. At the initial meeting of the three-session program, dental knowledge and oral hygiene levels were all 265 participating children. Follow-up who had participated in the prevent program the previous year and were now continuing their treatments, demonstrated significantly improved dental knowledge oral hygiene as compared to new patients. All of the children demonstrated significantly improved dental knowledge and oral hygiene at the final session of the program. The effectiveness on the participating children, this program was also successful in being accepted by students and faculty as a regular component of the clinical curriculum. The model presented here will be modified and improved on for future continued implementation.
Curriculum↗
Compliance with five health promotion recommendations in a university-based family practice.
Although numerous recommendations are available to guide the primary care physician's provision of preventive health services, a minority of Americans receive recommended care. This study assessed the extent to which patients in a large, university-based family medicine program were receiving five well-accepted health promotion services. These services included fecal occult blood testing, Papanicolaou smears, mammography, serum cholesterol measurements, and tetanus immunization. Demographic factors associated with receipt of these services were assessed. A minority of active patients received the five health promotion services in the recommended interval: fecal occult blood testing 13%, Papanicolaou smear 41%, mammography 16%, cholesterol measurements 20%, and tetanus immunization 19%. The patient's physician practice group, type of medical insurance, physician visit frequency, and increasing age were associated with compliance with the five studied health promotion services.
Academic Medical Centers↗
Management of obesity in black females in a community model clinic: A preliminary study.
During a three-month period, March-May 1978, 23 black females were accepted as patients in the obesity program at the model office of the Department of Community Health and Family Practice, College of Medicine, Howard University.An aggregate of 55 visits made by these patients was recorded for the same period.The mean age of the patients was 38.3 years (SD:13.67), and half of the patients were below 40. Nearly 70 percent had a history of obesity in either one or both parents. More than one half had had high blood pressure and 70 percent of the patients had attempted dieting previously. Common snacks taken by the patients were carbohydrate-rich foods.Based on previous medical and dietary history and behavior patterns related to food intake, the patients were prescribed low-calorie or modified high-protein diets. Each patient at the clinic had a program devised individually for her. A team consisting of a physician, nutritionist, and health educator looked for patterns of behavior causing patients to overeat.The mean initial weight of all patients was 218 lb at registration and the weight after seven weeks of follow-up was 213.8 lb.
Adolescent↗
The Billings method of family planning: an assessment.
The Billings/ovulation method is a periodic abstinence method of regulating births based on the client's interpretation of changing patterns in secretions of cervical mucus monitored by external self-examination. It was developed in Australia and is now widely promoted overseas. This paper outlines the method's recent history and goes on to discuss its physiological basis, its use-effectiveness as measured in a number of major trials, and some evidence concerning its general acceptability and applicability in family planning programs.
Body Temperature Regulation↗
Increasing radiographer productivity by an incentive point system.
Because of a very low technologist productivity in their Radiology Department, the authors describe a Productive Point System they developed and implemented to solve this personnel problem. After establishing the average time required to perform all exams, point credits (one point for every ten minutes utilized) were assigned to each exam performed, thereby determining an index of production. A Productive Index of 80% was considered realistic and was the equivalent of 192 points for a 40-hour work week. From 1975 to 1978 personal productivity increased from 79% to 113%. This resulted in an average yearly fiscal savings of over $20,000.00 for this three-year period. There was also a significant improvement in exam efficiency and quality, job attitude, personnel morale, and public relations. This program was highly successful because technologist acceptance and cooperation was complete, and this occurred mainly because the system supports the normal occupational goals and expectations of technologists.
Efficiency↗
Cost-effective wound care: new priorities driven by outcomes.
International demands for optimizing the quality and cost effectiveness of health care requires the rethinking of traditional wound care paradigms. This essay defines cost effectiveness as the comparative measure of costs to achieve a given clinical outcome. Among some of the issues that need to be addressed are having more studies that compare the cost effectiveness of wound care modalities, defining what an acceptable outcome for a prescribed treatment program is, deciding who should define the significant outcome, and measuring the values of each therapy.
Cost-Benefit Analysis↗
High-resolution chromatography of proteins in short columns and adsorptive membranes.
Short chromatographic columns prepared from stacks of microporous adsorptive membranes are promising for preparative-scale fractionation of even rather closely related proteins, but careful selection of operating conditions is needed for success. It has been shown that existing devices exhibit very low internal diffusional resistance, and that resolution is almost totally independent of percolation velocity. Total column length is short, however, and the number of plates exhibited under isocratic low-loading conditions is small, on the order of 100. Simulations using a large survey of protein thermodynamic data show that one can frequently obtain excellent protein separations in these short columns by using the sensitivity of protein adsorption equilibria to eluting solvent composition. In fact, some proteins can be separated in a single stage utilizing this 'on-off' behavior and properly selected solvent gradients. Solely on-off, or differential elution, behavior cannot often be depended upon under the mild conditions need for preparative operations. Carefully programmed gradient elution can frequently produce acceptable purification by maximizing both differential elution and differential migration, resulting in protein separations in columns of less than fifty plates. Means for doing this are described for some simple situations, and criteria are provided for selecting modulator gradient schedules.
Animals↗
Integrating the Lactational Amenorrhea Method into a family planning program in Ecuador.
This paper reports the results of a 12-month implementation study documenting the process of integrating the Lactational Amenorrhea Method (LAM) into a multiple-method family planning service-delivery organization, the Céntro Médico de Orientación y Planificación Familiar (CEMOPLAF), in Ecuador. LAM was introduced as a family planning option in four CEMOPLAF clinics. LAM was accepted by 133 breastfeeding women during the program's first five months, representing about one-third of postpartum clients. Seventy-three percent of LAM acceptors were new to any family planning method. Follow-up interviews with a systematic sample of 67 LAM users revealed that the method was generally used correctly. Three pregnancies were reported, none by women who were following LAM as recommended. Service providers' knowledge of LAM resulted in earlier IUD insertions among breastfeeding women. Relationships with other maternal and child health organizations and programs were also established.
Adult↗
Immunizations: physicians must act now to ensure all our children are immunized.
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Child↗
A performance-based development system.
Team efforts by nurse educators and nurse administrators resulted in modification of the orientation process to better accommodate part-time nurses. Use of the Performance Base Development System (PBDS) was initiated and scheduling flexibility was introduced as a "Med-Plus" program. Over 30 nurses have had acceptable assessments and became valuable members of the staff. Not all problems involving part-time nurses have been solved, but those related to documentation of performance ability have been addressed effectively.
Employee Performance Appraisal↗