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Public Law 100-461, Foreign Operations, Export Financing and Related Programs Appropriations Act, 1989, 1 October 1988.

This Act does the following among other things: 1) prohibits using funds appropriated under the Act to lobby for abortion and 2) prohibits making development assistance funds available 1) to pay for abortions as a method of family planning (FP) or to motivate or coerce any person to perform abortions; 2) to pay for involuntary sterilization as a method of FP or to coerce or provide any financial incentive to any person to undergo sterilization; 3) to pay for biomedical research that relates to the methods of, or performance of, abortions or involuntary sterilization as a means of FP; or 4) to any country or organization if the use of such funds by such country or organization would violate any of the abortion or involuntary sterilization provisions. It also reaffirms the commitment of the US Congress to population, development assistance, and the need for informed voluntary FP.

Abortion, Induced↗

Evaluation of developmentally appropriate programs for adolescent tobacco cessation.

Despite introduction of numerous smoking prevention programs in schools, tobacco use has not declined among adolescents. Schools face the dilemma of what to do with students who smoke and are not ready to quit. This study evaluated two programs based on the stages of change model. The educational program, the Tobacco Education Group (TEG), was designed for adolescents not yet thinking about quitting. The cessation program, the Tobacco Awareness Program (TAP), was intended for adolescents who want to quit. Evaluation was completed on 351 students at six public high schools. Compared to a control group of adolescent smokers not assigned to programs, both intervention groups significantly decreased tobacco use. Self-reported use was validated biochemically. Self-efficacy for quitting increased in both programs. Posttest use was predicted by posttest self-efficacy, peer support, and parental support, after controlling for initial use and initial self-efficacy.

Adolescent↗

Outpatient diagnostic program encourages appropriate utilization.

Hospital conducts special program, medical staff members refer patients, Blue Cross/Blue Shield provides coverage for outpatient diagnostic testing to help curb unnecessary inpatient stays and costs/Program's savings, criteria, peer review, procedures noted.

Blue Cross Blue Shield Insurance Plans↗

Is accurate rate response programming necessary?

Exercise capacity and general well-being are improved by appropriately programmed rate responsive pacemakers when compared to fixed rate units. Ten patients had activity sensing DDDR units implanted for combined AV block and sinus node incompetence. Ten patients had Sensolog activity sensing VVIR units implanted for complete heart block. The effects of over and under programming of rate response in both dual and single chamber activity sensor rate adaptive pacemakers has been assessed subjectively by visual analog scales and specific activity questionnaires and objectively by graded treadmill testing and the performance of standardized daily activities. Patients were randomly programmed to absent rate response (VVI in the Sensolog group), hyporesponsive (DDD in the dual chamber group), appropriate response (VVIR, DDDR according to Manufacturer's instructions) and over responsive (VVIR+, DDDR+) in a double-blind crossover design. Thirty percent of patients demanded early crossover from VVI, 30% from DDDR+ and 50% from VVIR+. Perception of Exercise Capability was similar to objective exercise treadmill times which were shorter in VVI than in VVIR or VVIR+ (P less than 0.05) or control subjects (P less than 0.001). There was no difference between any dual chamber mode or control subjects. General well-being was poorest in DDDR+ and VVIR+ modes despite objective improvement in exercise capacity. Symptoms were least in VVIR and DDDR and all but one patient chose appropriate programming as their overall preferred mode. Thus, even inaccurate rate response programming results in similar and improved exercise capacity compared to absent rate response but overprogramming is unacceptable to most patients, confirming that appropriate programming and sensor specificity is critical in rate responsive pacing.

Arrhythmia, Sinus↗

Accessibility to primary health care centers: experience and evaluation of an appointment system program.

Appropriate access to health care is one of the components of Primary Health Care (PHC) and it can be a good quality indicator. We present in this paper the results of 1 year of follow-up of an appointment system applied in 29 PHC centers in the Balearic Islands, Spain; the program was set up by the National Institute of Health. Telephonic appointment proportion increased from the first weeks, stabilizing at about 70%. The number of calls that it is necessary to make in order to get an appointment at peak time is now 1.5 and only 1 throughout the rest of the day. To determine changes in the waiting time and visit time, and the user opinion of the system, an enquiry was made to a sample of patients 1 month before, and 1 month, 6 months and 1 year after the program started. The waiting time is now less than 15 min for most of the people interviewed, in contrast with the previous situation when the waiting time was more than 30 min. The visit time is longer now and more than two thirds of the people think that care is better or much better than prior to the start of the program. These results have been verified in the waiting room (11.2 min mean waiting time and 7.2 min mean visit time). We conclude that we have achieved the goals of the appointment system program in all the centers covered by our department.

Appointments and Schedules↗

Appropriateness in programs for continuous quality improvement in clinical laboratories.

BACKGROUND: External reviews and the accreditation of medical laboratories involve more than the mere assessment of conformance with standards for organisational processes. The new approaches to quality improvement suggest that, rather than using inspection to correct unusual errors, there should be more emphasis on improving the processes of health care to ensure that desired outcomes are produced. Appropriateness plays a key role in programs for quality improvement. METHODS: Appropriateness in laboratory medicine can be assessed, and improved, through the governance of the entire testing process. This begins with test selection, proceeds through valuable pre-, intra- and post-analytical procedures, and concludes by assuring the correct interpretation and utilization of laboratory information. RESULTS: The International Standard, specifically developed for medical laboratories (ISO 15189) recognizes the value of appropriate interpretation and advisory services, although it does not specify requirements for assessing appropriateness, requesting tests and interpreting results. The effectiveness of clinical laboratories can be assessed by using surrogate markers, which indicate physicians' satisfaction, and clinical audits. Effectiveness is also enhanced by stressing the importance of the technical and professional competence of evaluators. CONCLUSIONS: Inappropriate laboratory utilization unjustifiably increases health care costs, can harm patients and perpetuates the vision of laboratory testing as a commodity. Improvement in laboratory appropriateness can be achieved by seeking a better relationship with physicians and by stressing the role of laboratory specialists in providing clinical advice for the selection of laboratory tests, and the interpretation and utilization of their results, thus leading to more satisfactory clinical outcomes.

Clinical Laboratory Techniques↗

Development of a strategy for decreasing multi-drug resistant bacteria with implementation of a program emphasizing appropriate antibiotic utilization and strict infection control measures in western South Dakota.

In this follow-up of an article written in the South Dakota Journal of Medicine, February 2001, Antimicrobial Resistance: Steps to Reduce the Problem with Emphasis on Antibiotic Utilization--The Rapid City Experience, subsequent local analysis based on evolving literature, local measures undertaken, and results of these measures will be presented. With national numbers of Methicillin resistant Staphylococcus aureus (MRSA) and Vancomycin resistant enterococcus (VRE) rising, steps taken in the Rapid City Region have shown reduction in these two pathogens. The two key components of these programs have been appropriate antibiotic utilization and strict adherence to aggressive infection control measures.

Anti-Bacterial Agents↗