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PubMedDate not supplied

Screening to control infectious diseases: evaluation of control programs for gonorrhea and syphilis.

Gonorrhea and syphilis serve as models for the definition of criteria for the evaluation of screening programs for detection of disease. Mass screening and selective screening are distinguished from individual screening (case finding). Important characteristics of screening tests are sensitivity, specificity, efficiency, precision, accuracy, and acceptability. Program evaluation includes process evaluation and outcome evaluation. Major criteria to consider in the evaluation of mass screening programs are prevalence and incidence of disease, predictive value of tests used, yield, available screening tests, acceptance, follow-up services, costs and benefits, and control over the spread of infection. All forms of screening programs should be evaluated by available methods so that they will operate with maximal efficiency and so that nonproductive programs can be discarded.

Communicable Disease Control↗
PubMed2001

Advances in management of neurosurgical trauma in different continents.

Neurotrauma is a major public health problem. The incidence varies from 67 to 317 per 100,000 and mortality rates are in the range of near 1% for minor injury, 18% for mild injury, and 48% for severe head injury. It is the main cause of death and disability in people under 40 years old. Several problems appear when outcome measurements, rehabilitation programs and treatment options are considered. In order to solve these problems a worldwide campaign is outlined. It focuses on epidemiology, prevention, education, treatment, rehabilitation, social re-insertion, and outcome measurements. The goals of such a program are to take into account realities in both developed and developing countries, to develop worldwide acceptable programs and guidelines, and to test those guidelines and programs and diminish mortality and morbidity, improving quality of life. We describe the concept of Centers of Excellence and an educational program, Advanced Brain Life Support. Such a program is a moral obligation because mortality and morbidity tend to decrease in Centers of Excellence.

Brain Injuries↗
PubMed2002

SoftCopy Display Quality Assurance Program at Texas Children's Hospital.

With growing dependence on picture archiving and communication systems for viewing images, a quality assurance program to monitor the condition of workstation displays has become increasingly important. At present there is no universally accepted program for PACS, but there are groups such as DICOM Working Group 11 of the ACR-NEMA and AAPM Task Group 18 that are working on image quality guidelines for interpretation from soft-copy displays. Texas Children's Hospital (TCH) is developing our own quality assurance program. Data is being collected to determine the appropriate frequency of calibration, the useful life of the displays, appropriate manufacturers, and model-dependent limits on maximum and minimum luminance (black level), symptoms of degradation, and monitor cleanliness. Our system includes a variety of monitors manufactured by Sun, AFP, Siemens, Image Systems, Barco, and Orwin. We are presently collecting data on individual monitor luminance functions but have not yet initiated service calls based on deviation from the DICOM Part 14 Grayscale Display Function (GSDF). The GSDF was intended to produce a grayscale in which driving levels produce changes in luminance that are perceptually equivalent throughout the entire luminance range for a specific test target. Our data is based on measurements of luminance from a digital Society of Motion Picture and Television Engineers (SMPTE) test pattern, which is a standard used by many other institutions. TCH's biomedical engineer measures luminance data each month from the display of the SMPTE pattern and record the results in a spreadsheet. The engineer also makes subjective evaluations of sharpness, geometric distortion, and artifacts. When a monitor's luminance falls outside of arbitrary 10% limits of maximum or minimum luminance, then a service call is placed to the vendor. The luminance check by the biomedical engineer is used to verify both routine and unscheduled calibrations. In addition to the monthly monitor checks, the vendor calibrates the monitor every three months. The vendor checks the following: width and height of display, focus and position of image, SMPTE test pattern, and a graph of the GSDF Index produced by an automatic calibration software by the video driver card. Monitors are also cleaned occasionally for dust, fingerprints, ink, and pencil marks, which accumulate with routine use. This paper reports data collected to date on luminance drift, as well as conclusions on appropriate frequency of test and calibration, and our experience with monitor useful life.

Computer Terminals↗
PubMed1980

An evaluation of behavioral techniques reinforced with an anorectic drug in a double-blind weight loss study.

Sixty obese outpatients participated in a double-blind comparison of diethylpropion hydrochloride and placebo in conjunction with a behavior modification program for weight reduction. Assessments of efficacy and program acceptance included total weight loss, percent of initial (baseline) weight loss, percent excess weight lost, effectiveness of overall program, and helpfulness of medication. Diethylpropion was significantly better than placebo in all five assessments. An added behavioral technique, a substantial refundable deposit of money, reduced the attrition rate of all study entrants from 50% to 10%; thus patient compliance was greatly enhanced.

Adult↗
PubMedDate not supplied

Toward implementation of a regional quality assurance program in cytopathology: the Hong Kong experience.

OBJECTIVE: To develop a local quality assurance program in cytopathology based on circulation of patient specimens on glass slides, with limited resources. STUDY DESIGN: A working group was set up for design and running of the program. Participation is on a laboratory basis. The scope and frequency of testing are defined. Well-documented cases (including gynecologic, nongynecologic and fine needle aspiration cytology) with commonly encountered diagnoses are collected. Consensus concerning the diagnosis, interpretive menu and scoring system is sought before the actual slide circulations using express mail. After returning their answers to the program organizer, the participating laboratories receive immediate feedback on their scores, with reference answers, explanatory notes, "whole-mount" images of glass slides and cumulative responses of peer laboratories for on-site checking. At the end of each year, an electronic file containing representative photomicrographs of all cases examined is provided to individual laboratories for their permanent records and training purposes. RESULTS: The program was launched in mid-2003. There were 24 and 27 participating laboratories from Hong Kong (and Macau) in 2003 and 2004, respectively. To date, >150 well-documented cytology cases are available in the slide pool and ready for circulation. As the revenue is mainly to cover the expenses of express mail, the program can be carried out at a relatively low cost. CONCLUSION: In order to have any cytology quality assurance program accepted by local laboratories, it has to be fair and practical. Strict confidentiality needs to be observed throughout the process. This program emphasizes both performance assessment and educational value. Adequate representation from experienced local cytology workers, detailed documentation support from authorities and assistance from dedicated staff are essential to the success of any external proficiency testing scheme. Regular review and evaluation are also necessary for continuous improvement. The Hong Kong experience can serve as an example of running a glass slide-based cytology quality assurance program in a small region with limited resources.

Clinical Laboratory Techniques↗
PubMed1989

Evaluation of a phenytoin dosage regimen design and adjustment computer program.

A computer program for phenytoin (PHT) dosing was developed containing seven different menus: two for drug-naive patients, one using an empirical equation, the other using means for Vmax and Km; two for patients in whom either one or two dose rates and steady-state concentrations are available; two for patients with hypoalbuminemia, and uremia, respectively; and one menu that optimizes Vmax and Km from available steady-state concentrations. The program accepts or converts PHT and sodium PHT, and makes blood level correction for the concomitant administration of 25 different drugs. The evaluation of the program was done by retrospective analysis using data from three study pools: group I involved 47 patients from the University Hospital, group II relied upon 29 patient data supplied from a collaborative Veterans Administration study, and group III involved 26 patients from the Children's Hospital. Predictions were made and compared with found data to be within a range of +/- 15, 20, or 25%. For study group III, many individual blood samples were less than 8 micrograms ml-1; hence, saturation kinetics may not have been involved. It is suspected that saturation kinetics in infants may begin at higher levels. Compliance seems to still be a major problem in PHT monitoring and dosage regimen adjustment. Accepting the data as they are, using one or two dose rates with the corresponding blood concentrations resulted overall in 73-86% achieving blood levels within +/- 25% of the predicted value.

Adolescent↗
PubMed1986

Problems in notification and screening of workers at high risk of disease.

Current and former workers who have been occupationally exposed to hazardous substances have unique medical and social needs. Few programs recognize and accommodate the needs of these workers. Consequently, screening and medical surveillance assume a pivotal role in a system that inadequately deals with the needs of workers identified and notified of occupational disease risks. In some cases, screening programs, ineffective in altering survival patterns, are established because they represent surrogates for other kinds of support programs that do not exist. Where screening techniques are effective and available, there still are problems in getting them funded and established in acceptable programs. This paper details these problems and argues for increased research to enhance the efficacy of screening, not only in preventing disease, but also in improving the quality of life for workers at risk.

Humans↗
PubMed1983

The impact of a medical-school-based summer program on the acceptance of minority undergraduate students into health professional schools.

A summer program for minority-group undergraduate students who are oriented toward careers in health was established at the Tulane School of Medicine in 1968. Students were admitted independent of their performance in undergraduate science courses. Beginning in 1972, follow-up statistics were maintained on all participants; utilizing these statistics, the authors evaluated the impact of summer program intervention on the acceptance rate into health professional schools of 303 participants between 1972 and 1979. The results show that 209 (70 percent) of the participants were accepted by a health professional school, compared with 37 percent of 212 applicants to the 1976 summer program who were not selected for summer program participation. These results strongly suggest that summer program intervention plays a positive role in the student's attempt to gain admittance to a health professional school.

Education, Premedical↗
PubMed2006

Implementation of an aggressive random drug-testing policy in a rural school district: Student attitudes regarding program fairness and effectiveness.

School districts are increasingly initiating random drug-testing (RDT) programs in an effort to curb substance-use rates among students, yet little is known about student attitudes toward RDT and potential obstacles to program acceptance and effectiveness. The authors surveyed 1011 9th through 11th grade students in 2 rural high schools in North Florida regarding the pending implementation of one of the most aggressive RDT programs in the nation. A significant majority of students predicted that RDT would be effective, yet students were more clearly divided in their perceptions of the fairness and the accuracy of testing. Student perceptions of whether there is a drug problem at their school proved to be a robust predictor of perceptions of policy fairness. Student substance-use rates were more limited predictors of policy effectiveness and fairness. These results may prove useful to school administrators, health professionals, and policy makers seeking to build acceptance for RDT in their schools.

Adolescent↗
PubMedDate not supplied

Point-of-care testing: managing people and technology. A win-win approach to successful point-of-care test management.

The objective of this article is to provide a step-by-step approach to evaluating the need for a point-of-care testing program. It also describes a process for writing a proposal for the implementation of the program, getting the program accepted by all stake-holder groups, and managing it after it has been established. More importantly, the actions described will help assure that the program design: 1. fits the information needs of the patient care area where it will be implemented 2. meshes with the resources available in the organization 3. takes advantage of the state-of-the-art in laboratory technology.

Feasibility Studies↗
PubMed1993

Potential use of mass media to reach urban intravenous drug users with AIDS prevention messages.

To access the potential of using the mass media to reach urban intravenous drug users (IVDUs) with AIDS prevention messages, we: 1) questioned 353 participants in a Baltimore IVDU cohort study on their media use and sources of AIDS information, 2) analyzed data on Baltimore AIDS public service announcement (PSA) airings during a 3-month period, and 3) discussed with media executives their willingness to air a variety of potential AIDS messages. Forty-seven percent of all respondents reported that they learned the most about AIDS from television. Participants watched television a median of 28 hours/week; 52% of IVDUs listened to ratio > or = 12 hours/week. Eight hundred eleven AIDS television PSAs were aired; 37% of PSAs were placed on news programs; 53% of respondents watched news programs. Acceptability of hypothetical prevention messages (e.g., on sexual abstinence, condom use, or safer drug use practices) varied with media reach (national vs local) and type (television vs radio). We conclude that media could reach IVDUs with AIDS prevention messages. Television could be used to direct IVDUs to local prevention programs and provide safe/safer sex messages. Explicit and detailed AIDS prevention messages would be acceptable to some local radio stations.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Evaluating the clinical skills of foreign medical school graduates participating in an internship preparation program.

In the fall of 1986, the Ministry of Health of the province of Ontario, Canada, implemented a special 36-week internship preparation program for graduates of foreign medical schools. The program accepts 24 candidates per year and is offered at the five Ontario medical schools. At the time of this study, two cohorts of participants had completed the program. As part of the evaluation process, each participant was administered a battery of the same Objective Structured Clinical Examination-type test stations, prior to and on completion of the pre-internship experience. Repeating the same examination permitted investigation of the predictive and construct validities of the clinical skills tests, as well as the stability of the validity and high reliability estimates that emerged from the testing of the first cohort. The results provide convincing evidence of the testing approach's predictive and construct validity and reliability.

Clinical Competence↗
PubMed1996

A program on the rise: the combined (M.D./Ph.D.) Degree Program at the University of Connecticut School of Medicine.

The Combined M.D./Ph.D. Degree Program (CDP) of the University of Connecticut School of Medicine is an intensive seven-year program that allows exceptional students simultaneously to develop both clinical and research skills. Each year the program accepts up to four highly qualified students from an applicant pool that has been increasing in both size and talent. Currently, there are 25 students in the program. Each student receives a waiver of tuition and fees for both graduate and medical school as well as a fellowship stipend of $14,700 per year for all seven years. In the initial two years the combined-degree students are enrolled in medical school and participate in laboratory research. During the next three years students focus exclusively on graduate course work and the doctoral dissertation. Following the thesis defense, they enter the final two years of medical school and are graduated with the dual degree. As of May 1995 the CDP has graduated 15 students, each of whom is currently pursuing a career in academic medicine.

Animals↗
PubMed1998

Scintillation camera quality control, Part I: Establishing the quality control program.

This is the first article in a four-part series on scintillation camera quality control. This series of articles will include both theory and practical knowledge on setting up a quality control program, acceptance testing and quality control for planar, SPECT and special imaging procedures. On completion of this article the reader should be able to: (a) discuss the purpose of a quality control program; (b) know how to establish the performance criteria for a scintillation camera; (c) know how to design a quality control program; (d) be able to set up the schedule for the quality control program; (e) understand the economics of quality control; and (f) justify the expenditure of the institution's resources on quality control.

Costs and Cost Analysis↗
PubMedDate not supplied

[A contribution safety on using low molecular weight heparin in patients with renal failure].

OBJECTIVES: 1. To promote safe and appropriate use of low molecular weight heparins in patients with renal failure. 2. To analyze results from a pharmaceutical intervention program. MATERIAL AND METHODS: Data from a prospective, 16-month study are presented. The entire adult population of a general hospital with 41,792 stays/year is included. An intensive monitoring program for low molecular weight heparin prescriptions in patients with renal failure is implemented. This program identifies patients using a computerized unit dose system, and is aided by a software able to calculate creatinine clearance using the Cockroft-Gault formula from an interphase between laboratory, pharmacy and admissions data, and by an algorithm to establish a recommended pharmaceutical intervention according to renal failure severity and low molecular weight heparin indication, either with prophylactic or therapeutic purposes. RESULTS: In all, 221 patients were identified, corresponding to 2.9% of admitted patients and 25.5% of patients with renal failure. Answers were assessable for 128 patients (61%). Extent of program acceptance according to physician-accepted pharmaceutical interventions was proportional to renal failure severity and therapy intensiveness. An acceptance of 70% was obtained for treatments with clearance < 30 mL/min, of 41.8% for treatments with 30-60 mL/min, of 31.5% for prophylaxis, and of 21.4% for low-risk patients. CONCLUSIONS: 1. Program repercussions improve prescription safety. 2. Scarce literature and a belief in low molecular weight heparin safety account for responses regarding pharmaceutical intervention. 3. Integrated computerized systems are essential for the implementation of intensive pharmaceutical care programs.

Adult↗
PubMed1976

A method of developing and evaluating a clinical performance program for physical therapy interns.

A method used by interns and supervisors in developing and evaluating a clinical performance program during a 6-week internship in the Division of Physical Therapy at the University of Michigan Medical Center is presented. This method required a statement of educational resources available, establishment of criteria for judging acceptable performance, statement by the intern of his educational objectives, negotiation of a written contract, and maintenance of a log. The 32 participants thought that this was a rational and acceptable program and stated that they would, if given a choice, elect to follow the same procedure again.

Clinical Competence↗
PubMed1984

[Clinical aspects of ovarian endodermal sinus tumor].

To study the clinical characteristics of ovarian endodermal sinus tumor, 22 patients with this disease who were managed at the Kurume University Hospital from 1970 to 1983 are analysed retrospectively. Before 1977 the patients received mainly radiation therapy as a postoperative treatment, and only two of 13 patients during this period survived. After 1978, multi-drug combination chemotherapy brought a remarkable improvement in the prognosis showing six survival cases out of 8 patients, and four of them are still alive with no evidence of the disease. Although the therapeutic efficacy of the combination of vincristine, actinomycin D and cyclophosphamide, or cis-diamminedichloroplatinum, vinblastine and bleomycin was evident as previously reported, half of the cases achieved a drug-resistance against these regimens during the first line therapy and this required a change in the program. Further, two drop out cases caused by the severe side effects of these aggressive treatment were noted. The best treatment for malignant germ cell tumors is not yet known, and a more effective and acceptable program is demanded to attain the goal of chemotherapy.

Adolescent↗