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221 electrocardiograms (ECGs) recorded from adult subjects with cardiac symptomatology were interpreted by clinicians and the Mount Sinai (MS) and Veterans' Administration (VA) computer programs. After the clinicians had eliminated their interobserver variability, their interpretations and those of the computer programs were compared with the corresponding clinico-pathological data that had been derived independently of the ECG. A measure of overall diagnostic accuracy was used which showed that the performance of the 2 computer programs was similar and somewhat worse than that of the clinicians. The clinicians and the computer programs were not as good at diagnosing the ECGs of women as at diagnosing those of men. As the VA program's interpretations may be altered by including information about the patient's provisional diagnosis, 6 different sets of these prior probabilities were used to analyse 141 of the original 221 ECGs. Different fixed sets of prior probabilities made only a small difference to overall diagnostic accuracy but a marked difference to the VA program's ability to differentiate Normal from Abnormal. Optimizing the prior probabilities for the individual subjects increased the VA program's overall diagnostic accuracy up to that of the clinicians. Both computer programs correctly diagnosed sinus rhythm as the dominant rhythm in 165 out of 177 subjects. The MS program diagnosed the dominant rhythm as Atrial Fibrillation in 35 out of 41 subjects and the VA program in 27 (X(2) = 3.24; not significant). ECG interpretation; Mount Sinai program; Veterans' Administration program; independent clinico-pathological data; sex differences in the ECG; prior probabilities.
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There is a sparsity of studies specifying the relative effectiveness of different types of treatment programs in treating a similar target population of drug and alcohol abusers in the same locale. In this paper, two drug and alcohol rehabilitation programs are described and their relative effectiveness compared in treating similar target populations. The first treatment program evaluated is a medically oriented hospitalization program and the second is a short-term therapeutic community program, called "Feedback" because it is structured on the basis of a collection of feedback and behavior modification principles and techniques. Both programs were implemented by basically the same staff and both treated similar target populations of multiple drug abusers and alcohol abusers during comparable time periods. The results indicated that the feedback program was significantly more effective in rehabilitating multiple drug abusers (nonheroin abusers) than the hospitalization program with regard to three criteria (return to work for 60 days, perform effectively according to the supervisor, and control drug or alcohol problems). But both programs were equally effective in rehabilitating alcohol abusers (problem drinkers and alcoholics).
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Four basic types of evaluation, each appropriate in a distinctive situation, are the clinical review and the clinical trial, which are concerned with the care of the individual patient, and the program review and program trial, which deal with programs or services directed at groups or populations. Evaluative reviews are primarily motivated by concern with the welfare of the specific population served, and they appraise specific activities in specific settings as a basis for decisions concerning these activities. Clinical and program trials aim to generate knowledge of more general applicability, especially concerning causal relationships between care and outcomes. The types of evaluation differ in the questions they pose and in the methods used to answer them. Failure to draw a distinction between program reviews and program trials is a frequent cause of wasteful or unhelpful evaluative studies.
A community program for the control of cardiovascular risk factors, the CHAD program, was instituted in a family practice in western Jerusalem in 1971. The effectiveness of the program was evaluated by comparing the findings of community surveys conducted in 1970 and 1975 and by comparing the changes with those observed in an adjacent control neighborhood. This paper reports the findings among men aged 35 years and above. In the community exposed to the program there was a decrease in mean systolic and disatolic pressures, in the prevalence of hypercholesterolemia, and in the prevalence of cigarette smoking. The changes in blood pressures and smoking habits were significantly greater than those observed in the control population. In the control population (only) there was a small increase in mean body weight and a decrease in reported physical activity. The findings suggest that it is possible for a program that operates and through primary health care to have an appreciable influence upon cardiovascular risk factors in the community.
When the nature of motor response is varied, holding the number of alternative responses constant, differences in choice reaction time can be attributed to differences in response programming time. The present experiments suggest that although changes in response duration are not necessary to produce small differences in programming time, such response duration changes may be a sufficient condition for the programming time to change and necessary condition for very large changes in programming time. Implications of this conclusion for theories of response programming are discussed.
With the increased complexity of blood component therapy, it is important to be able to modify physician behavior with reliable educational programs. A standardized educational program on the use of red blood cells and whole blood was tested in 22 hospitals in a regional blood program using medical audit and computer monitoring to evaluate effectiveness. Most hospitals were eager to take advantage of the education program but were unwilling to use the audit-education cycle. At the same time, computer monitoring of indivisual hospital ordering and transfusion practices demonstrated an increased utilization of red blood cells in 64 per cent of hospitals with an overall improvement of 8 per cent. The improved use of red blood cells was appreciated within the month of the program and then sustained for six to twelve months at the new level.
In a three-stage project, a computer program was devised to assist in the nursing process. As Stage I, a definition of nursing was developed upon which a systems model of the nursing process was constructed. In Stage II, the computer program was written to collect patient data and formulate nursing diagnoses related to functions of the skin, mucous membranes, nails, and hair. The program was designed to serve as a model for the development of a more comprehensive program that would include other functional areas, suggest patient objectives and nurse interventions, and help to evaluate nursing care. In Stage III, initial trials were conducted to obtain feedback from nurses. Nurses found the program took too long but agreed that with modification it could help them give better care.
This article describes a successful developmental program specifically designed for academically "high risk" students entering a two-year community college career program in allied health. The program consisted of providing an intensive three-week instructional program to students before they entered the allied health career program, and subsequently providing an ongoing support system of tutoring, counseling and career development activities. Participants attained higher levels of academic performance and retention than nonparticipants.
In the Hypertension Detection and Follow-up Program, the largest standardized hypertension detection, follow-up, and treatment program to date in the United States, participation rates have been high at all stages. More than 75% of those with suspected hypertension at screening attended follow-up rescreening, and more than 80% of the 5,314 hypertensive patients assigned to program treatment remained active at the end of one year. Differences in participation rates were generally small. To accomplish this, intensive efforts were required to maximize attendance, and the program was shaped to reduce known barriers to initial attendance and long-term adherence. Against the background of a high overall program response rate for all sex-race groups, factors that might be associated with variations in response were examined: age, socioeconomic characteristics, health status, and appointment schedule.
Adjustment measures for students who took part in two work programs for EMR graduates of special schools were compared. Fifty students took part in a work program (direct placement in the work) and 50 students, a work-study program. The students, their parents, and their employers were interviewed regarding vocational satisfaction and adjustment. The work-study program graduates were significantly more stable, satisfied, and adjusted than were the work-program graduates (p is less than .001), but their professional opportunities (reflected by the number of different jobs held) were limited.
OBJECTIVE: Programmed oocyte retrieval was performed in order to make the in vitro fertilization (IVF) program cheaper and work of the IVF team easier. METHOD: In a group of 77 patients included in the IVF program, the menstrual cycle was modified with estrogen-progesterone contraceptive pills. For this reason, it was possible to start the stimulation protocol in all patients on the same day. The stimulation protocol was a combination of clomiphene (100 mg) for 5 days and HMG (150 IU) every other day. Cycles were monitored by ultrasound only. RESULT: The implantation rate per embryo transfer was 22.4%. The number of embryos per embryo transfer was low (2.6 +/- 1.4) and eliminated the need for cryopreservation. Fertilization rate (82%) and embryo transfer rate (87%) were high. The take home baby rate was 14.3%. CONCLUSION: Seventy percent of all punctures were performed in 3 days in the middle of the week. In our conditions, programmed oocyte retrieval is associated with significant economic benefits.
The MUMPS computer language is widely and increasingly used for medical applications. It is useful for medical students and others in the medical environment to have an understanding of such languages that can help them perform their jobs well. The author is therefore making available an interactive teaching program to instruct such people in the MUMPS computer language. Use of the teaching program is reported for 19 novice MUMPS programmers and compared with results for two experienced programmers. Free-text comments by the novices emphasize areas in which they had difficulty. There is a considerable variation in the mean time taken by the novices to answer the questions, and in the number of questions repeated because of erroneous answers. Most novices found the teaching program very helpful. A copy of the Standard MUMPS teaching program and the QUEST driver on which it is based has been sent to 24 institutions, including six in Europe and one in Japan, for further use.
In November 1974, in response to a mandate in the revised National Cancer Act of 1974, a plan was introduced for the formation of a Diet, Nutrition, and Cancer Program. Dr. Frank J. Rauscher, Director of the National Cancer Institute, selected a group of scientists who defined the goals of the program and recommended the appointment of a program director and of an advisory committee. These recommendations were accepted, and an Advisory Committee, reflecting a cross-section of scientific expertise, has been selected. To recommend a well-balanced program, it will be necessary for the Advisory Committee to assess the current state of the art of nutrition in cancer etiology and therapy and to be apprised of current opportunities, needs, and resources. Toward this end, a literature survey project has been initiated and two specialized workshops have been held.
This paper outlines an approach to studying productivity in clinical research programs that incorporates environmental, organizational, provider, and patient specific factors in the model of production process. We describe how this approach has been applied to the National Cancer Institute's (NCI) Community Clinical Oncology Programs (CCOPs). Next, a practical evaluative model of the productive process in CCOPs is outlined and its use in evaluation and monitoring performance in CCOPs is discussed. Each level of the model is described and a number of factors potentially affecting each level are explored. Finally, we discuss the strengths and weaknesses of this approach and show how management can use it to study and improve the productivity of clinical research programs.