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Results for “Program Acceptability”

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PubMed1983

Teenagers' assessment of reproductive health-care services.

Adolescent clients of a Teen Health Clinic were surveyed to determine those aspects of the service that were considered crucial to patient acceptance and program continuance. A simple one-page questionnaire enabled the clients to express their feelings about personnel, services, environment, and educational materials used in the clinic. Eighty-five percent of the clients expressed positive reactions to the clinic, while only 25.5% offered negative statements. Most respondents indicated clinic staff as the feature they liked most about the service and mentioned routine clinical activities as the part they liked least. Of the topics on which teenage clients wanted more information, 68% indicated that they wanted factual data rather than information about feelings, emotions, or relationships.

Adolescent↗

PubMed1993

A case study in progress: practice guidelines and the affirmative defense in Maine.

To encourage physicians to practice less defensively, the Maine Medical Liability Demonstration project adopted the controversial "affirmative defense" to combat runaway malpractice liability by granting immunity to physicians who follow practice guidelines. Despite challenges from trial lawyers, physicians are beginning to accept the program.

Defensive Medicine↗

PubMed2001

Health technology assessment of three screening methods in Switzerland.

OBJECTIVE: To describe the level of health technology assessments for three screening methods in Switzerland. METHODS: Analysis of documents and expert opinions on mammography screening, ultrasound examinations during normal pregnancy, and screening for prostate-specific antigen (PSA) with a focus on services provided, recommendations, formal regulations, national papers, projects, and formal assessments. RESULTS: Preventive services are explicitly recommended by the Swiss federal law on health insurance. Two routine ultrasound examinations during normal pregnancy as well as PSA analysis for men over 40 years of age on medical indication are covered by basic health insurance. Mammography screening every 2 years has been covered since 1997 for women over 50 years. A systematic screening program for mammography exists in the western part of Switzerland, and a nationwide program is planned. However, a national program may not come into being until a quality assurance program for evaluation is established, and a nationwide fee for reimbursement-to include all costs of such a program-is accepted by providers and insurers. CONCLUSION: According to the Swiss health insurance law, the effectiveness of mammography screening and ultrasound examinations during normal pregnancy have to be proven. Systematic evaluation of these screening methods is in preparation. PSA is not part of current evaluation. It can be concluded that health technology assessment in Switzerland is now required by law for several medical services. However, limited financial and personnel resources as well as the lack of disease registers may hamper progress in the near future.

Adult↗

PubMed2000

Immunological tolerance--the liver effect.

The developing immune system in the embryo is programmed to accept all its own tissues as self-products and not react against them. It has been the aim of transplantation research for the past 40 years to try and manipulate the developed immune system temporarily to a similar status to that in the embryo at the time of an organ graft, so that the organ graft is accepted but immunity generally is not interfered with. Such a state is known as immunological tolerance and can be produced in the laboratory by a number of special techniques, none of which is appropriate for clinical use in organ grafting. In pigs and rats, an allografted liver can sometimes survive permanently without any immunosuppressive treatment in immunologically mature animals.

Animals↗

PubMed1991

The optimism of policy choices in child welfare.

That the desire for sure answers to problems in child welfare has led to acceptance of programs on the basis of faith rather than realism is illustrated by examination of some current programs. The need for rational choices in policy, program, and practice that respond to the basic human requirements of vulnerable families is highlighted.

Adolescent↗

PubMed2001

Outcome of the use of pediatric donor livers in adult recipients.

The prolonged waiting time caused by the lack of donor livers leads to an increasing number of terminally ill patients waiting for lifesaving liver transplantation. To rescue these patients, transplant programs are accepting donor organs from the expanded donor pool, using donors of increasingly older age, as well as from the pediatric age group, often despite significant mismatch in liver size. We investigated the outcome of 102 consecutive liver transplantations using pediatric donor livers in adult recipients. One-year graft survival using donors aged 12 years or younger (group 1, n = 14) and donors aged 12 to 18 years (group 2, n = 88) was compared. In addition, risk factors for graft loss and vascular complications were analyzed. The 1-year graft survival rate in adult transplant recipients in group 1 was 64.3% compared with 87.5% in those in group 2 (P =.015). The main cause of graft loss was arterial complications, occurring in 5 of 16 transplant recipients (31.3%). Major risk factors for graft loss and vascular complications were related to the size of the donor: age, height and weight, body surface area of donor and recipient, and warm ischemic time. We conclude that the outcome of small pediatric donor livers in adult recipients is poor, mainly because of the increased incidence of arterial complications. When a pediatric donor is used in an adult recipient, ischemic time should be kept to a minimum and anticoagulative therapy should be administered in the immediate postoperative period to avoid arterial complications. However, because small pediatric donors are the only source of lifesaving organs for the infant recipient, the use of small pediatric donor livers in adults should be avoided.

Adolescent↗

PubMed2004

A new work placement model for unemployed methadone maintenance patients.

Traditionally, methadone-maintained patients have made only limited progress in vocational rehabilitation programs, largely because they encounter multiple individual-level barriers to their employment. The Customized Employment Supports (CES) model is designed to help patients overcome these employment barriers and attain paid work as soon as possible. To facilitate this transition, the model assigns CES counselors small caseloads so that, using intensive interventions, they can engage patients in a working alliance and enhance patients' self-efficacy. Methods used to help patients increase their self-efficacy are derived from social psychological literature and include role modeling, persuasion, and minimizing emotional arousal. Because the transition to competitive work is a major change, many patients initially take smaller steps such as entering training programs and accepting informal employment. The CES model is being evaluated in a randomized clinical trial.

Employment↗

PubMed1994

Flexible algorithm for direct multiple alignment of protein structures and sequences.

The recently described equivalence between the alignment of two proteins and a conformation of a lattice chain on a two-dimensional square lattice is extended to multiple alignments. The search for the optimal multiple alignment between several proteins, which is equivalent to finding the energy minimum in the conformational space of a multi-dimensional lattice chain, is studied by the Monte Carlo approach. This method, while not deterministic, and for two-dimensional problems slower than dynamic programming, can accept arbitrary scoring functions, including non-local ones, and its speed decreases slowly with increasing number of dimensions. For the local scoring functions, the MC algorithm can also reproduce known exact solutions for the direct multiple alignments. As illustrated by examples, both for structure- and sequence-based alignments, direct multi-dimensional alignments are able to capture weak similarities between divergent families much better than ones built from pairwise alignments by a hierarchical approach.

Algorithms↗

PubMed1993

Intraoperative and external preoperative radiotherapy in invasive bladder cancer: effect of neoadjuvant chemotherapy in tumor downstaging.

Absence of residual cancer (pT0) in the cystectomy specimen was evaluated in patients with invasive bladder cancer treated with intraoperative (IORT) (15 Gy) and preoperative external beam radiotherapy (EBR) (46 Gy/5 weeks) with or without neoadjuvant chemotherapy. The overall pT0 rate was 68% (67% and 70% in patients with or without neoadjuvant chemotherapy, respectively). The tolerance to the program was acceptable in both groups. It is concluded that intense, combined modality treatment is feasible in bladder cancer patients, and the addition of neoadjuvant chemotherapy does not increase the morbidity. Preliminary results on disease-free survival are encouraging.

Aged↗

PubMedDate not supplied

Role of therapy or monitoring in preventing progression to gastric cancer.

It is generally accepted that intestinal-type gastric adenocarcinoma arises through a multistep process originating with chronic gastritis, progressing through stages of atrophy, intestinal metaplasia, and dysplasia and finally invasive carcinoma. This sequential process, known as the "Correa cascade" is in many instances initiated by Helicobacter pylori infection and perpetuated by a number of environmental and host factors. Given that the development of carcinoma can be the end point of this sequential process, there is great interest in determining which if any of these steps may be reversible. Clinical studies have shown that the eradication of H. pylori can lead to resolution of chronic gastritis, and a few studies have suggested some improvement in gastric atrophy. Intestinal metaplasia, however, does not appear to be as reversible. Nevertheless, results of several intriguing studies of high-risk populations support the notion that eradication of H. pylori may decrease or delay progression to gastric carcinoma despite the inability to reverse all mucosal damage. The applicability of these findings to low-risk countries such as the United States and the United Kingdom remain uncertain. Currently, in the United States, there is no widely accepted screening program for H. pylori infection in asymptomatic individuals, and consensus regarding surveillance for gastric intestinal metaplasia or dysplasia is lacking. The purpose of this report is to evaluate the available data regarding the epidemiology of H. pylori and associated carcinoma, discuss relevant human and animal data that address eradication strategies in the prevention of gastric carcinoma, and finally discuss current recommendations regarding screening programs aimed at high-risk populations.

Adenocarcinoma↗

PubMed1994

The acceptance and growth of MSN/MBA programs.

The value of graduate programs that enable nurses to earn masters degrees in nursing (MSN) and business administration (MBA) through coordinated courses of study has been debated repeatedly. This article describes the subsequent development of the dual degree option (MSN/MBA) within US nursing graduate programs, explores the opportunities and problems reported by programs offering this form of education, and considers the future development of these types of programs. The article is based on a survey of 167 schools of nursing offering graduate programs. The authors describe the challenges to these programs' continued expansion and the role that healthcare reform may have in shaping the education market.

Curriculum↗

PubMed2002

"It takes a village": understanding concurrent sexual partnerships in Seattle, Washington.

BACKGROUND: Sexually transmitted infections (STIs) are efficiently spread via concurrent partnerships. GOAL: This study identifies patterns of concurrency in Seattle STI clinics and community samples to enhance partner notification and counseling. STUDY DESIGN: Semistructured interviews with heterosexuals (108 with gonorrhea, chlamydial infection, or nongonococcal urethritis and 120 from high STI prevalence and randomly selected neighborhoods) were tape-recorded, transcribed, and analyzed for content. RESULTS: Six main forms of concurrency were identified: experimental, separational, transitional, reciprocal, reactive, and compensatory. Experimental concurrency, overlapping short-term partnerships, was most common. Men practiced concurrency to avoid becoming partnerless during partnership disintegration; more women, especially STI patients, reported reactive concurrency, recruiting new partners rather than leaving partners with other partners. Concurrency clustered by age and when occurring during separation and transitioning between partners was socially acceptable. CONCLUSIONS: Prevalence of concurrent partnerships in all groups studied suggests linkages to individuals' life stage and some social acceptability. STI programs should develop prevention messages to reflect different forms of concurrency.

Adult↗

PubMed2004

Electroconvulsive therapy practice in Thailand.

OBJECTIVES: To obtain an overview of electroconvulsive therapy (ECT) practice in Thailand. METHODS: Questionnaires were sent to all institutions providing psychiatric care; data were collected from September 1, 2001, to August 31, 2002. RESULTS: Fifty-three responses were received from 67 institutions (79.1%). ECT is available in 26 hospitals. Approximately 6,914 patients received 51,565 ECT treatments, of which, 6,469 patients (93.56%) received 48,240 treatments (93.55%) in the psychiatric hospitals. The ECT utilization rate was 11.15 patients treated per 100,000. Twelve institutions used MECTA (Spectrum or SR1) or Thymatron DGx. Bilateral ECT was used exclusively in all institutions. In 2 medical schools, all patients received double ECT throughout their treatment courses. Unmodified ECT was always used in nine psychiatric hospitals and five general hospitals, and occasionally used in 2 university hospitals comprising 94.2% of all ECT usage. Patients with schizophrenia most frequently received ECT (74%), followed by mania (8%) and major depression (7%). The nurse alone administered ECT in four psychiatric hospitals. Although the death rate was estimated at 0.08%, there was no ECT-related death during the survey period. Continuation ECT was performed in 11 and maintenance ECT in 6 institutions. Five institutions had acceptable training programs for psychiatry residents but none had training syllabus, 2 institutions had teaching schedule for medical students. CONCLUSIONS: ECT use in Thailand is high. Nearly all ECTs (93.6%) were performed in the psychiatric hospital and 94.2% of all treatments were unmodified ECT. Lacking of proper training in ECT is evident.

Adolescent↗

PubMed1997

A successful, preventive-oriented village health worker program in Hebron, the West Bank, 1985-1996.

Village health rooms (VHRs) were established in villages with no on-site health facilities in the Hebron District of the West Bank, beginning in 1985. By 1991, the program served a total population of 40,000 in 49 VHRs and by the end of 1996 covered 69 villages in Hebron and 20 in other districts that were previously served by visiting vaccination teams and nearby clinics. The VHRs provide close contact with the population of mothers for well child and pregnancy care, health education and provide visiting doctor/nurse teams for backup services and supervision. Data on coverage, utilization, costs, and outcome measures are presented. The program is accepted and grows despite adverse social and political conditions.

Community Health Services↗

PubMed2004

Blood pressure and renal function after kidney donation from hypertensive living donors.

BACKGROUND: Rising numbers of patients reaching end-stage kidney disease intensify the demand for expansion of the living-kidney-donor pool. On the basis of low risk in white donors with essential hypertension, our transplant center undertook a structured program of accepting hypertensive donors if kidney function and urine protein were normal. This study reports outcomes of hypertensive donors 1 year after kidney donation. METHODS: We studied detailed measurements of blood pressure (oscillometric, hypertensive therapy nurse [RN], and ambulatory blood pressure monitoring [ABPM]), clinical, and renal characteristics (iothalamate glomerular filtration rate [GFR], urine protein, and microalbumin) in 148 living kidney donors before and 6 to 12 months after nephrectomy. Twenty-four were hypertensive (awake ABPM>135/85 mm Hg and clinic/RN BP>140/90 mm Hg) before donation. RESULTS: After 282 days, normotensive donors had no change in awake ABPM pressure (pre 121 +/- 1/75 +/- 2 vs. post 120 +/- 1/ 5 +/- 1 mm Hg), whereas BP in hypertensive donors fell with both nonpharmacologic and drug therapy (pre 142 +/- 3/85 +/- 2 to post 132 +/- 2/80 +/- 1 mm Hg, P<.01). Hypertensive donors were older (53.4 vs. 41.4 years, P<.001) and had lower GFR after kidney donation (61 +/- 2 vs. 68 +/- 1 mL/min/1.73m, P<.01). After correction for age, no independent BP effect was evident for predicting GFR either before or after nephrectomy. Urine protein and microalbumin did not change in either group after donor nephrectomy. CONCLUSIONS: Our results indicate that white subjects with moderate, essential hypertension and normal kidney function have no adverse effects regarding blood pressure, GFR, or urinary protein excretion during the first year after living kidney donation. Although further studies are essential to confirm long-term safety, these data suggest that selected hypertensive patients may be accepted for living kidney donation.

Adult↗

PubMed2004

Screening for colorectal cancer.

Screening for a disease is an important concept in modern day preventive medicine. The aim is early disease detection and treatment of both asymptomatic individuals and those at risk of the disease, with the goal of better survival. The WHO published a set of essential criteria for screening in 1968 and colorectal cancer has been identified as a candidate disease. Three methods of screening are evaluated here: fecal occult blood test, flexible sigmoidoscopy and colonoscopy. Newer techniques are still being studied and preliminary results are encouraging. The incidence of colorectal cancer in Asia has been increasing in association with changes in lifestyle and therefore, designing efficient, acceptable screening programs for these populations is an important issue in the prevention of this common malignant disease.

Asia↗

PubMed1997

Predictions of carbamazepine concentrations using a Bayesian program (PKS System, Abbott): a retrospective evaluation in an outpatient population.

This work evaluates the performance of a Bayesian program (PKS System, Abbott) for predicting carbamazepine concentrations in an outpatient population. The retrospective study involved 20 epileptic patients (12 adults and 8 children) receiving carbamazepine monotherapy orally. The program was used to predict measured serum levels after feedback of 0, 1 or 2 steady-state concentrations. A significant negative prediction bias was observed when no feedback concentration was used for estimation. However, the prediction bias (mean prediction error; m.e.) decreased as soon as one feedback concentration was used for estimation. Precision (mean absolute prediction error; m.a.e.) was significantly improved with one feedback concentration and was even better with two concentrations. Likewise, r.m.s.e. (root mean squared error; composite of bias and precision) regularly decreased when the number of feedback concentrations used was increased. Eleven percent of the estimates were unacceptable clinically (prediction error > 2 mg L-1) when 1 feedback concentration was used; less than 3% were unacceptable when two concentrations were used. Thus the performance of the Bayesian dosing program is acceptable when two feedback concentrations are known, and seems able to help the clinician adjust carbamazepine dosage in an outpatient population.

Administration, Oral↗

PubMed1978

General purpose digital display system for computed tomography images.

The authors describe a microprocessor-based digital image display system utilizing a solid-state image memory with a high quality television-type monitor for display of computed tomography images. It is an alternative to a commercially available display system, and offers the potential for research in digital image display. It is now under clinical evaluation. Image input to the stand-alone display system is via 9-track magnetic tape common to almost all CT machines, and it may be programmed to accept digital tapes from any type of CT machine and display them in a common format.

Data Display↗