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Results for “Program Acceptability”

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PubMed1991

PHARMFIT--a nonlinear fitting program for pharmacology.

A new program is presented for nonlinear fitting of data from pharmacological and chronobiological investigations. It contains functions for calculating data from ligand-binding studies and competition experiments, for the analysis of dose-response curves, for pharmacokinetic calculations, and for cosine analysis of harmonic and overlapping rhythms. In addition, it is possible to implement general equations by the user. The program allows data exchange with most spreadsheet, database, and graphics presentation programs, and accepts data from two widely used ambulatory 24-h blood-pressure monitoring systems. The fitting procedure uses the Marquardt-Levenberg algorithm. It calculates the weighted or the unweighted fit together with a great variety of statistics for estimation of goodness of fit. A graphics module permits graphical presentation of the fitted curve. Moreover, fitting of data to different models can be compared for the most likely fit and model discrimination statistics for improvement of further experiments are provided. To demonstrate the chronobiological application of the fitting program PHARMFIT, the analysis of telemetric heart rate data from rats is presented.

Binding Sites↗

PubMed1987

Decision analysis: a progress report.

Since its introduction into medicine 15 years ago, decision analysis has been applied to difficult clinical problems. Several important advances have made the process more practical and acceptable: computer programs that eliminate the need for burdensome calculations, improved techniques for designing analytic models, the ability to carry out sensitivity analyses over several dimensions simultaneously, and the elaboration of clinically relevant measures of utility. Using these techniques, analysts have addressed many important clinical issues including screening for and prevention of disease, tradeoffs among tests and treatments, and the interpretation of clinical data under conditions of uncertainty. Problems with the approach remain and applications have not been extensive, but decision analysis is evolving as a powerful clinical tool and gradually is gaining acceptance in medical practice.

Bayes Theorem↗

PubMed1979

Cooperative education of respiratory therapy students.

Cooperative education (coop), applied to respiratory care students at Northeastern University in Boston, Massachusetts since 1974, is designed to enhance self-realization and direction by integrating classroom study with experience in educational, vocational, and cultural learning situations outside the classroom. Achievement of this goal requires a curriculum that allows paid work periods at intervals in the program and acceptance by the institution of responsibility for finding work positions for the students. For students coop education gives reality to learning, increases educational motivation, provides financial aid, and provides useful employment contacts. For the employer it provides a source of labor, facilitates recruitment and retention, and permits better utilization of personnel. For the University it permits more effective use of the physical plant, encourages greater community support, and provides benefits to the faculty. The cooperative education plan offers advantages for respiratory therapy training on both the Association and Baccalaureate level. Successful implementation of the program requires the institution to assume responsibility for integrating the experiential phase into the education process.

Allied Health Personnel↗

PubMed2002

Scoring methods in MALDI peptide mass fingerprinting: ChemScore, and the ChemApplex program.

No universally accepted score is currently available to determine when a matrix-assisted laser desorption ionization (MALDI) peptide mass fingerprint (PMF) experiment has been successfully carried out. We describe a software program (ChemApplex) based on a calculated parameter (Combined Protein Score) that takes into account (1) peak intensity, (2) the mass accuracy of the match, and (3) ChemScore, a theoretical intensity factor that estimates the probability of observing a particular peptide based on a combination of chemical considerations, in particular the amino acid composition of the peptide and the amino acid sequence of the amino acids that span the cleavage site. When these three factors are taken into account both at the level of individual peptides and at the protein level, protein components in mixtures whose peptides contribute less than 1% of the total intensity can often be correctly identified, as is demonstrated for mixtures of standard proteins. Moreover, it is possible to make robust database identifications that are nearly independent of the number of masses submitted and the mass error threshold used for matching. Protein scoring based on Combined Protein Score is orthogonal to many of the commonly used probability-based scoring schemes, and makes it possible to archive a more complete set of parameters that more thoroughly characterize the validity of the database match, which increases the confidence in the identifications.

Amino Acid Sequence↗

PubMed2004

Controversies in prostate cancer screening.

PURPOSE: Prostate cancer is the most common cancer in men and the second most common cause of cancer death in men, and yet controversy continues to surround the practice of prostate cancer screening. Despite recent studies that have cast doubt over the true efficacy of breast cancer screening programs, the National Cancer Institute continues to support breast cancer screening and it has withheld endorsement of widespread prostate cancer screening. Criticisms of prostate cancer screening include the financial burden of screening, the morbidity of prostate biopsy, the low positive predictive value of screening, the over treatment of an indolent disease and the lack of evidence demonstrating a mortality benefit due to screening. MATERIALS AND METHODS: We formulated a comprehensive discussion addressing the criticisms of prostate cancer screening. RESULTS: In an effort to highlight the importance of prostate cancer screening we noted how concerns regarding cost, morbidity and low positive predictive value are common to widely accepted screening programs for other common malignancies. We also draw attention to the danger of abandoning prostate cancer screening, a practice that is called into question by watchful waiting series and Markov modeling of prostate cancer treatment. Finally, we observed how the implementation of prostate cancer screening in the United States has led to the phenomenon of stage migration and paralleled the decrease in the prostate cancer mortality rate. CONCLUSIONS: The prostate specific antigen era has brought great promise for improving the prognosis of prostate cancer. We must continue to seek support for widespread prostate cancer screening.

Humans↗

PubMed1992

Intraoperative and external radiotherapy in resected gastric cancer: updated report of a phase II trial.

From September 1984 to August 1991, 48 evaluable patients with resected gastric cancer and apparent disease confined to locoregional area were treated with intraoperative electron beam boost to the celiac axis and peripancreatic nodal areas (15 Gy) and external irradiation (40 to 46 Gy in 4 to 5 weeks) including the gastric bed and upper abdominal nodal draining regions. At the time of evaluation for IORT, the disease was primary in 38 cases, recurrent but resectable in four (anastomosis), and unresectable in four (nodal). Post operative complications were reversible. Acute tolerance to the complete treatment program was acceptable. Late complications included life-threatening events: Six episodes of gastro intestinal bleeding (three of them had an arteriographic documentation of arterioenteric fistula) and nine with severe enteritis (five required reoperation). Other long-term treatment related complications were six cases of vertebral collapse. The median follow-up time for the entire group is 22 months. Locoregional recurrence/persistence of disease has been identified in five patients (three with residual and/or recurrent postsurgical tumor). Systemic tumor progression has been detected in 15 patients (11 in intra-abdominal sites). Overall actuarial survival for patients with positive or negative serosal involvement was 33% versus 56%. It is concluded that the treatment program described is able to induce a high locoregional tumor control rate (100%) when used strictly in an adjuvant setting and might control long term, a small portion of patients not amenable for curative surgery (2 out of 8 patients with confirmed residual post-surgical disease). Gastrointestinal bleeding and enteritis are findings that indicate treatment intensity at the upper limits of tissue tolerance. Assessment of long term tolerance of pancreatic parenchyma and large blood vessels (tissues included in the IRORT field) are pending for longer follow-up and the appropriate selective studies.

Humans↗

PubMed1979

Use and acceptance of the "paper pill". A novel approach to oral contraception.

A randomized, crossover study comparing the acceptance of and attitudes towards two dosage forms of the same oral contraceptive product - a paper presentation and the conventional tablet, was carried out in a network of rural and suburban research centers in the State of Durango, México. The results failed to show any significant advantage (in terms of acceptability or continuation) of the paper formulation. Although two-thirds of the participants indicated a preference for the conventional tablet, there was a high degree of acceptance of the paper formulation among new oral contraceptive acceptors.

Adolescent↗

PubMed2000

Process measures in an antenatal smoking cessation trial: another part of the picture.

Data on provider and patient compliance can be crucial in understanding the degree of a health education program's effectiveness, as well as in identifying areas where the program requires modification. However, such data are rarely systematically reported in randomized trials. This report assesses the degree to which doctors and midwives complied with intervention protocols in a hospital antenatal smoking cessation trial, and also examines the program's acceptability to patients. Provider compliance was assessed principally via consultation audiotapes and provider-completed checklists. The audiotape analysis identified substantial compliance problems. For example, in relation to six specific smoking-related pregnancy risks, the proportions of Experimental Women informed about each individual risk ranged from 26 to 38% and the proportions receiving counselling items ranged from 52 to 79%. Doctors only informed a minority of Experimental Women of the increased risk of Sudden Infant Death Syndrome (28%) and of the presence of toxic chemicals in tobacco (21%). Comparison of compliance data from audiotapes and provider checklists revealed there was no significant agreement in three of four cases tested. Experimental Patients completed questionnaires to assess recall of smoking advice and to rate 12 program features. Of specific Experimental Program elements, the videotape (85%) received the highest level of positive patient ratings and the lottery (42%) the lowest. The process evaluation indicated that the Experimental Program needed some modification to increase its suitability for routine application. The findings also support the value of including an objective measure of provider compliance.

Female↗

PubMed1990

Filariasis eradication on Kinmen Proper, Kinmen (Quemoy) Islands, Republic of China.

A control program for bancroftian filariasis was conducted on Kinmen Proper from 1970 to 1982. The combined method of mass chemotherapy with diethylcarbamazine (DEC) for microfilarial carriers and larvicide with sumithion for mosquitoes was used on the island for 3 years (1974-76). The microfilarial rate and microfilarial density decreased from 8.4% and 14.6/20 microns in 1970-73 to 0.7% and 5.3/20 microns in 1976. The infection rate, infective rate, and larval density of Culex quinquefasciatus, the only mosquito vector of the parasite, decreased from 10.3%, 6.4%, and 6.4 in 1970-73 to 0.3%, 0.2%, and 1.3, in 1976, respectively. For final elimination of the infection, DEC medicated salt (0.33%, w/w) was then administered to the whole population for 6 months (March-September 1977). All accepted the program and no adverse side-effects were noted. Six annual follow-up surveys (1977-82) revealed only 3 out of 3853 previous carriers to be positive. These carriers were cured with a course of 5 g DEC. All family members of the 3 carriers and of the 12 neighbouring families were also given DEC medicated salt for 4 months in order to clear the only remaining source of filarial transmission. In conclusion, administration of DEC medicated salt is simple, rapid, safe, inexpensive, efficient, and practical for filariasis control or eradication.

Adolescent↗

PubMed1994

Testing strategies to increase use of chloroquine chemoprophylaxis during pregnancy in Malaŵi.

The widespread problem of low and non-compliance to antimalarial chemoprophylaxis during pregnancy demands that attention be focused on alternative approaches to programming, product acceptability and demand for preventive services. This study describes the testing of three interventions to determine their effect on use of chloroquine (currently the most widely used drug for chemoprophylaxis) during pregnancy. The strategies evolved from community-based formative research undertaken to learn about the local concept of malaria and issues surrounding malaria prevention and treatment during pregnancy. The resulting interventions were tested in four clinics, and included a change in the health education message given during antenatal sessions, distribution of a sugar-coated chloroquine tablet, and an intervention combining the two strategies. The results showed a 45% increase in chloroquine use when the health education message was changed, and a 64% increase when the product was changed. High use levels were maintained with the combined intervention; an additive effect was seen. The study shows that improving the product was the most important factor in increasing the use of the program, and that changing the health education message can also make an impact on use.

Chemistry, Pharmaceutical↗

PubMed2002

"Trial" prescriptions to reduce drug wastage: results from Canadian programs and a community demonstration project.

OBJECTIVE: To determine the acceptability of a program to avoid drug wastage through "trial" prescriptions. STUDY DESIGN: Cross-sectional survey, followed by a 9-month demonstration project. METHODS: Consultants to trial prescription programs operated by 2 public- and 3 private-sector drug plans in Canada were surveyed. All of the trial prescription programs were voluntary. The demonstration project involved 215 English-speaking adults who filled a "new" prescription for an angiotensin-converting enzyme inhibitor, beta-blocker, or calcium channel blocker (CCB) in 1 of 16 Peterborough, Ontario pharmacies. Patients received a 7-day supply of medication and a reminder card on which the dispensing pharmacist recorded the mutually agreed date and time the patient would be contacted to assess the results of the "trial." Patients who tolerated the medication received the balance of their original prescription. RESULTS: Most patients (86%) who were offered trials in the demonstration project accepted them, and most (82%) who accepted them found them helpful. The proportion of patients who received the balance varied by program, ranging from 47.1% to 86.6%. The dollar value of the wastage avoided through trial prescriptions varied by drug class. This was driven largely by differences in the unit cost of the medications, but also to a lesser extent by larger prescriptions for CCBs. CONCLUSIONS: Trial prescriptions were acceptable to patients and, if focused on specific medications, could reduce the direct cost of drug wastage. More work is needed to define the conditions under which trial prescription programs are feasible for pharmacists and drug plans.

Aged↗

PubMed1996

Screening for prostate cancer is neither appropriate nor cost-effective.

Seen from a societal perspective, the health gains that might result from prostate screening are too uncertain to justify the substantial associated costs and adverse health effects. Clinicians who rely on observational screening studies to justify current screening practices should be aware of the potential biases that render conclusions suspect. Medical history documents numerous cases of medical interventions that appeared reasonable at the time, but ultimately proved worthless and even harmful. Before embarking on an ambitious screening program for prostate cancer, clinicians should demand that five basic criteria are satisfied: (1) that prostate cancer is a significant health burden, (2) that screening can identify localized disease, (3) that tests used in screening programs have acceptable performance among the population being tested, (4) that the potential for cure is greater among patients with screen-detected disease, and (5) that screen-detected patients have improved health outcomes compared with those who are not screened. Randomized trials provide the best methodology for determining the efficacy of screening and treatment. Clinicians are often too quick to credit medical intervention for successful outcomes and blame tumor biology for disease progression. Furthermore, when faced with a decision of administering or withholding therapy, physicians generally wish to err on the side of having done everything possible. Data modeling can provide critical insights concerning these issues using currently available information. Three recently published models suggest that the overall benefit to a population of men screened for prostate cancer can be measured in days of additional time of life gained, not months or years. Furthermore, models suggest that a substantial number of men need to undergo treatment in order to avert a single cancer death. The costs of implementing a screening program are enormous and deflect resources away from alternative uses, such as increased basic science funding to identify a cure for this disease. Therefore, based on the evidence presented, I believe that without more substantial data supporting the efficacy of screening programs, screening for prostate cancer is neither appropriate nor cost-effective.

Cost-Benefit Analysis↗

PubMed1994

Admission requirements, acceptance rates, and financial assistance in clinical psychology programs. Diversity across the practice-research continuum.

129 directors (80% response) of APA-accredited clinical psychology programs provided information pertaining to admission requirements, acceptance rates, financial assistance, and theoretical orientations. Summary data are presented and comparisons are made among 4 types of clinical programs: PsyD programs, practice-oriented PhD programs, equal-emphasis PhD programs, and research-oriented PhD programs. Clinical doctoral programs held similar expectations for undergraduate preparation in psychology, but robust differences emerged on preferred Graduate Record Examination scores, acceptance rates, and financial assistance. In the most extreme comparison (PsyD vs. research-oriented PhD programs), students were 4 times more likely to gain acceptance but 6 times less likely to receive full financial assistance in PsyD programs. Implications of these results for potential graduate students and for the future of applied psychology programs are briefly discussed.

Curriculum↗

PubMed2004

Service learning at dementia care programs: an orientation and training program.

The present paper describes a project that addresses the unique challenge service-learners face at dementia care programs. The project was conducted in conjunction with two courses on aging that offer students a service-learning (S-L) option at a university adult day service (ADS) program that accepts service-learners from these courses. The intervention consisted of two elements: (a) an orientation and follow- up sessions in which students learned about the causes of dementia, the behavioral characteristics exhibited by persons with dementia, and the best methods of interacting effectively with cognitively impaired persons; and (b) a structured scrapbook project for service-learners to exercise their new knowledge and skills. The authors designed the project to increase students' comfort in the dementia care setting and to facilitate students' knowledge of the elderly. The following sections describe the project and its procedures, benefits, and challenges. Recommendations for continuing the project and for adapting the project to other dementia sites are provided.

Aged↗

PubMed2002

Feasibility of computerized scheduled gradual reduction for adolescent smoking cessation.

The purpose of this project was to modify a smoking cessation program that uses computerized scheduled gradual reduction for use with adolescent smokers and to test the feasibility of this cessation approach in group support and minimal contact modalities. Utilizing a lesson plan approach with high school marketing students in five high schools and student survey feedback, the LifeSign program was modified to be an acceptable smoking cessation program for adolescent smokers. In the first study, 17 adolescent smokers used the modified program with seven associated weekly group support sessions. At the end of treatment, 29% had quit smoking, and over half of those who continued to smoke reduced their smoking rate by 50%. In the second study, the LifeSign for Teens program was evaluated with 18 adolescent smokers in a minimal contact format. At the end of treatment, 17% had quit smoking, and mean smoking rate reductions of 43% were found among those who continued smoking. At 1-year follow-up, all subjects who had quit at posttreatment reported continuous abstinence. The results of these two small trials suggest that a computerized scheduled gradual reduction approach may be an accepted and potentially efficacious approach for smoking cessation among adolescent smokers.

Adolescent↗

PubMed1980

A breast self-examination program for high school students.

Breast self-examination (BSE) is an important adjunct to the detection of breast cancer at an early stage. High school students were instructed in the importance and methods of BSE. By use of questionnaires, the program was evaluated for interest, acceptability, and compliance. It was found that high school students were not adverse to learning about BSE, found the program acceptable, and maintained some compliance at one year.

Adolescent↗

PubMed2003

Quality of care for children in commercial and Medicaid managed care.

CONTEXT: Many states have turned to commercial health plans to serve Medicaid beneficiaries and to achieve cost-containment goals. Assumptions that the quality of care provided to Medicaid beneficiaries through these programs is acceptable have not been tested. OBJECTIVE: To compare the quality of care provided to children and adolescents in commercial and Medicaid managed care in the United States. DESIGN, SETTING, AND POPULATION: Using 1999 data collected through the Health Plan Employer Data and Information Set, we examined reported quality-of-care indicators for children and adolescents. Results from 423 commercial and 169 Medicaid plans were compared. Matched pairs analyses were performed using data from each of the 81 companies serving both populations to control for corporate differences. Correlation coefficients and regression procedures were used to examine observed variations in health plan performance. MAIN OUTCOME MEASURES: Quality indicators including prenatal care, childhood immunizations, well-child visits, adolescent immunizations, and myringotomy and tonsillectomy rates. RESULTS: Using standard indicators of clinical performance, children and adolescents enrolled in Medicaid received worse care compared with their commercial counterparts. For most of the 81 health plans serving both populations, Medicaid enrollees had statistically significantly (P<.001) lower rates than commercial plans for clinical quality indicators (eg, childhood immunization rates of 69% vs 54%); for clinical access indicators (eg, well-child visits in the first 15 months of life, 53% vs 31%); and for common procedures (eg, myringotomies for children aged 0-4 years, 35 vs 2 per 1000 members). Conversely, some plans demonstrated equal and high-quality care for both populations. Regression models failed to identify consistent plan characteristics that explained the observed differences in quality of care. CONCLUSIONS: Most commercial health plans do not deliver high-quality care on a number of performance indicators for children enrolled in Medicaid. Policy makers and the public need plan-specific quality information to inform purchasing decisions.

Adolescent↗

PubMed2005

Machine safety evaluation in small metal working facilities: an evaluation of inter-rater reliability in the quantification of machine-related hazards.

BACKGROUND: Each year there are an estimated 4.2-6.7 amputations per 10,000 workers in the metal fabrication trades in the United States. The Minnesota Machine Guarding Study evaluates the effectiveness of a peer-based technical and educational intervention designed to reduce exposure to amputation hazards among workers in small machining/metal working shops. The study reported here involved the development and evaluation of methods for measuring machine safety, which will be used in the intervention study. METHODS: Using OSHA regulations, ANSI standards, and industry best practices, we developed 23 machine-safety scorecards. The safety scores were dependent on the presence or absence of guards, other safety devices and implements, and the presence or absence of acceptable administrative programs. Inter-rater reliability was assessed for the evaluation of eight types of commonly used metal fabrication machines. RESULTS: Of the 23 most common types of machines, there were a sufficient number of machines to evaluate inter-rater reliability for eight types. Three raters in four shops assessed fifty-nine machines. Overall, the kappa statistic ranged from 0.57 to 0.84, indicating good to very good concordance between raters. In general, machines did not fare well with regard to compliance with current standards. DISCUSSION: The ability to assess machine-related hazards is important in industries where it is difficult to identify and count injuries in a timely fashion. Machinists and safety professionals may use this scoring system as a means of reproducible assessment of machine safety.

Accidents, Occupational↗