Postpartum tubal ligation by nurse--midwives in Thailand: a field trial.
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The purpose of the present work was to assess the adequacy and effectiveness of a public dental program for old-age pensioners. The dental care program offered free consultation and treatment at reduced prices to all pensioners (3072) in a municipality near Oslo in 1979. To study treatment need and access to dental care, a random sample of 430 pensioners was drawn from the total population of old-age pensioners; 371 persons were clinically examined. Of the 3072 old-age pensioners 23.7% responded positively and indicated that they were interested in the program, whereas 19.8% accepted, and 14.6% had the treatment carried out. The program adequacy was low and became lower when more restricted criteria for access to dental services were used. The program effectiveness was 18% or 16%, depending on which criteria were used for access. Acceptance of the program was highest among people who were aware of it, had natural teeth, had a dental problem, did not have their own dentist, had limited education, or were among the young pensioners.
A program for the calculation of sedimentation coefficients of molecules centrifuged in sucrose in vertical rotors has been developed. The program has been tested with both protein and RNA of known sedimentation coefficients. The program can accept any shape of gradient in the range 0-70% sucrose and any temperature in the range of 0-60% C. The program can be used with any vertical rotor for which the dimensions are known.
Microsatellites are repeated small sequence motifs that are highly polymorphic and abundant in the genomes of eukaryotes. Often they are the molecular markers of choice. To aid the development of microsatellite markers we have developed a module that integrates a program for the detection of microsatellites (TROLL), with the sequence assembly and analysis software, the Staden Package. The module has easily adjustable parameters for microsatellite lengths and base pair quality control. Starting with large datasets of unassembled sequence data in the form of chromatograms and/or text data, it enables the creation of a compact database consisting of the processed and assembled microsatellite containing sequences. For the final phase of primer design, we developed a program that accepts the multi-sequence 'experiment file' format as input and produces a list of primer pairs for amplification of microsatellite markers. The program can take into account the quality values of consensus bases, improving success rate of primer pairs in PCR. The software is freely available and simple to install in both Windows and Unix-based operating systems. Here we demonstrate the software by developing primer pairs for 427 new candidate markers for peanut.
Southcentral Foundation's Traditions of the Heart program is an innovative cardiovascular disease prevention program for women designed to build on the strengths of the Alaska Native culture as a way to support and encourage positive lifestyle behaviors that focus on healthy eating, active living, stress management, and tobacco cessation. After conducting assessments of existing intervention programs and formative data collection, we adapted two existing programs, Native Nutrition Circles and A New Leaf... Choices for Healthy Living, to develop the Traditions of the Heart program. We implemented and evaluated a pilot intervention study to determine the program's acceptance among Alaska Native women. We used the evaluation results to further refine our study protocol. This article describes the adaptation of these programs to the cultural needs and strengths of Alaska Native women and the results of the formative evaluation used to improve the program design. The complete pilot study outcomes will be published separately.
NanoVision is a molecular graphics program for the Apple Macintosh. The program follows accepted Macintosh design criteria, making it easy to learn by anyone familiar with the Macintosh. Molecules containing up to 32,000 atoms may be displayed. The program includes a range of molecular display options, including skeletal, ball-and-stick, and CPK. Images may be displayed using up to 240 colors. Color depth cuing is provided, as is Z-clipping. NanoVision images may be easily transferred (cut and paste) to drawing programs.
SCAB chemotherapy streptozocin (streptozotocin) lomustine (CCNU), doxorubicin hydrochloride (Adriamycin), and bleomycin sulfate was given in monthly courses to 20 patients with Stages IIIB, IVA, and IVB previously untreated Hodgkin's disease. Complete remissions were obtained in 15 (75%) of these patients, and partial remissions in two others. Toxicity of this program was acceptable. Although this study was not a direct comparison with MOPP, SCAB would appear to be at least as effective as MOPP and offers a reasonable alternative program for the patient with advanced stage, previously untreated Hodgkin's disease.
PURPOSE: To describe the impact of a selective transportation subsidy on food costs in isolated communities in Northern Canada, and the government's proposal to refine the "food mail" program to promote better nutrition. METHOD: The cost of various components of a Northern Food Basket has been monitored since 1990. An assessment of the probable impact and acceptability of program refinements was made through surveys of merchants and health and social service providers and focus group sessions. Decisions expected following consultations with stakeholders in March and April 1996 are also described. RESULTS: Costs of nutritious perishable food have been reduced in the Northwest Territories, and consumption of these foods in the Baffin region doubled within three years. Program refinements were proposed, with the objective of increasing intakes of calcium, folacin, and vitamin A, reducing dependency on convenience perishable foods, and reducing the cost of a healthy diet.
A computer program which accepts clinically relevant information can be used to predict breast cancer growth, response to chemotherapy, and disease-free survival. The computer output is patient individualized because the program is highly iterative and simulates up to 2500 patients with exactly the same clinical presentation. Computer predictions have been compared to a broad spectrum of breast cancer data, and a high degree of correlation has been established. There are numerous significant clinical implications which can be derived from the computer model. Among these are the following. (a) Breast cancer tumors do not grow continuously but may have up to five growth plateaus each lasting from a small fraction of a year up to approximately 8 yr. (b) Adjuvant chemotherapy, such as 6-mo treatment with cyclophosphamide-methotrexate-5-fluorouracil, does not eradicate tumors but just reduces the number of viable cells by a factor of 10 to 100 and sets the eventual growth back by several years. This may partially explain why the age-adjusted death rate from breast cancer has not changed in the past 50 yr. (c) The computer model challenges the underlying principles in support of short-term intensive adjuvant chemotherapy, namely Gompertzian kinetics and genetically acquired tumor resistance to drugs. (d) The computer model questions the evidence opposing long-term maintenance chemotherapy protocols and suggests that maintenance protocols should be reexamined.
Recent efforts to involve patients more actively in therapeutic decisions have suggested the relevance of computer-based interventions at clinic visits. This paper presents a longitudinal, experimental study evaluating a computer-based contraceptive decision aid in Chicago and Madison family planning clinic visits. Patient interviews at three time points evaluated patient acceptance by and program impact on 949 young women. Both Chicago and Madison patients reported high acceptance. The program resulted in improved short-term knowledge and confidence in oral contraceptive (OC) efficacy for Chicago and Madison patients. In addition, compared to their control group, Madison experimental group patients had higher OC knowledge 1 year after the initial visit and a trend for fewer pregnancies (P < 0.074). Compared to their control group, a higher percent of the Chicago experimental group patients adopted OC's after stating their intention to do so at the initial visit. Exposure to the computer program had no observable impact on the number of months on the oral contraceptive for Chicago or Madison patients. Overall findings suggest the usefulness of informatics tools as a supplement to patient-provider interactions.
Accreditation or certification is a recognition given to an operation or product that has been evaluated against a standard; be it regulatory or voluntary. The purpose of accreditation is to provide the consumer with a level of confidence in the quality of operation (process) and the product of an organization. Environmental Protection Agency/OCM has proposed the development of an accreditation program under National Environmental Laboratory Accreditation Program for Good Laboratory Practice (GLP) laboratories as a supplement to the current program. This proposal was the result of the Inspector General Office reports that identified weaknesses in the current operation. Several accreditation programs can be evaluated and common components identified when proposing a structure for accrediting a GLP system. An understanding of these components is useful in building that structure. Internationally accepted accreditation programs provide a template for building a U.S. GLP accreditation program. This presentation will discuss the traditional structure of accreditation as presented in the Organization of Economic Cooperative Development/GLP program, ISO-9000 Accreditation and ISO/IEC Guide 25 Standard, and the Canadian Association for Environmental Analytical Laboratories, which has a biological component. Most accreditation programs are managed by a recognized third party, either privately or with government oversight. Common components often include a formal review of required credentials to evaluate organizational structure, a site visit to evaluate the facility, and a performance evaluation to assess technical competence. Laboratory performance is measured against written standards and scored. A formal report is then sent to the laboratory indicating accreditation status. Usually, there is a scheduled reevaluation built into the program. Fee structures vary considerably and will need to be examined closely when building a GLP program.
A comprehensive program was founded in 1982 to provide adolescents with prenatal and family planning care. The program's impact through its first five years of operation on medical aspects of pregnancy course and fetal outcome will be the subject of a separate report. This study examines subsequent maternal and infant health of the patients attending the program compared to a control group. Four hundred ninety-eight adolescents and their newborns attending the program's mother-baby family planning clinic from 1982 to 1989 (subject group) were compared to ninety-one adolescents and their newborns receiving postpartum family planning and pediatrics clinics from 1980 through 1989 (control group). Seventy-five percent of the subject group regularly attended mother-baby clinic, compared to 18% of the control group attending family planning and pediatric clinics (P less than or equal to .0001). The subject group experienced less maternal and infant morbidity, greater school attendance, graduation, employment, and contraceptive use than the control group (P less than or equal to .0001). Many parameters improved with each program year indicating continued wide acceptance of our program by area adolescents.
Computer software for rendering and display of three-dimensional data is becoming readily available for all types of computers. Such programs typically accept data from any source, compute a three-dimensional volume of data, and display it with a variety of rendering options. Although not specifically designed for medical image processing, these programs can provide very detailed and finely rendered images that are useful for surgical planning. We use one such program to display data from standard computed tomography scans, which gives us a photorealistic three-dimensional view of patient anatomy. This view can be modified to render tissues transparent, translucent, or opaque, and thus allows the surgeon to selectively enhance bony architecture, tumors, or other details. Images can be rotated, sliced, and displayed in the surgical position. Image animation can be added to facilitate the display of complex anatomic relationships. Our experience with this technology suggests that such programs can provide the basis for personal surgical workstations for medical image analysis and surgical planning. Further development of such generic imaging systems should allow this useful technology to become widely available for surgical planning and education. We discuss our experience with a typical generic imaging workstation.
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AIMS: To develop a computerised method for analysing the results of histopathology external quality assessment (EQA) schemes which can provide confidential personal reports to individual participating pathologists. METHODS: A program was developed using the OMNIS database system, running on Apple Macintosh or IBM compatible computers. RESULTS: The program produces a general report of participants' responses to each case, and a choice of two types of personal report. One of these provides a list of the participant's diagnoses with a list of the most popular (Consensus) diagnoses for comparison. The other provides automatically calculated scores for the pathologist's performance along with simple statistical evaluation. The scores can be calculated by comparison with the consensus of the group or with correct diagnoses if they are known. A histogram indicating the distribution of performance within the group can be produced. The program can accept uncertainty in the form of differential diagnosis lists from participants. Potentially dangerous diagnostic errors can be identified and handled separately. Participants are identified only by code numbers and confidentiality can easily be enforced. The program is currently being used in the national renal pathology EQA scheme and in the local general histopathology scheme in the East Midlands. CONCLUSIONS: This program offers solutions to problems which have bedevilled the organisers of histopathology EQA schemes. It offers confidential advice to pathologists and will help to identify areas where an individual might benefit from continuing career grade medical education. It raises the possibility of the development of nationally agreed standards of performance in the reporting of pathological specimens, and it may be applicable to other specialties where textual reports are produced.
An automated method for the optimal placement of polar hydrogens in a protein structure is described. This method treats the polar, side chain hydrogens of lysine, serine, threonine, and tyrosine and the amino terminus of a protein. The program, called NETWORK, divides the potential hydrogen-bonding pairs of a protein into groups of interacting donors and acceptors. A search is conducted on each of the local groups to find an arrangement which forms the most hydrogen bonds. If two or more arrangements have the same number of hydrogen bonds, the arrangement with the shortest set of hydrogen bonds is selected. The polar hydrogens of the histidyl side chain are specifically treated, and the ionization state of this residue is allowed to change, if this change results in additional hydrogen bonds for the local group. The program will accept Protein Data Bank as well as Biosym-format coordinate files. Input and output routines can be easily modified to accept other coordinate file formats. The predictions from this method are compared to known hydrogen positions for bovine pancreatic trypsin inhibitor, insulin, RNase-A, and trypsin for which the neutron diffraction structures have been determined. The usefulness of this program is further demonstrated by a comparison of molecular dynamics simulations for the enzyme cytochrome P-450cam with and without using NETWORK.
BACKGROUND: Psoriasis vulgaris is a chronic inflammatory skin disease with a substantial impairment of quality of life. Interdisciplinary outpatient educational programs are an innovative supplementary therapy form for the management of this disorder. SUBJECTS AND METHODS: The Task Force on Dermatological Prevention developed a concept for outpatient instruction of psoriasis patients. Five 2-hour classes by dermatologists, psychotherapists/psychologists and dieticians focus on central topics relevant for the patients and the management of the disease. RESULTS: The results presented are based on own experiences with this educational program. The interdisciplinary program is accepted very well and seen as helpful by the concerned. A structure analysis of the effects in a greater number of cases is a current goal. In some areas, health insurance companies are paying for the classes. CONCLUSION: The educational program for the management of psoriasis vulgaris according to the rules of the Task Force on Dermatological Prevention is a supplement of the treatment of patients with this chronic skin disease. Broader implementation in Germany is desirable.
An in-training examination for family practice residents has been developed and used in a regional network residency program over the past three years. The most striking result has been the strong preference expressed by residents for question-specific feedback in order to facilitate learning after taking the examination. A well-designed in-training examination has the potential to meet both individual resident and program goals as an additional measure of resident performance and growth, as well as of the effectiveness of teaching in the various curricular areas. In-training examinations for residents are in use by 12 other specialties in medicine, and have been well-accepted by program directors and residents. A nationally-sponsored in-training examination for family practice residents is needed which includes maximal teaching capability through comprehensive and specific feedback.