Substance abuse treatment engagement, completion and short-term outcomes in the Western Cape province, South Africa: Findings from the Service Quality Measures Initiative.

PubMed

Myers, Bronwyn; Williams, Petal Petersen; Govender, Rajen; Manderscheid, Ron; Koch, J Randy

2018-04-01

Optimizing the effectiveness of substance use disorder (SUD) treatment is critical in low-and middle-income countries (LMICs) with limited opportunities for SUD treatment. This is the first study to identify targets for interventions to improve the quality of SUD treatment in a LMIC. We explored correlates of three indicators of treatment quality (treatment engagement, completion and abstinence at treatment exit) using data from a SUD performance measurement system implemented in the Western Cape Province of South Africa. The sample included data from 1094 adult treatment episodes representing 53% of the treatment episodes in 2016. Using multivariate logistic regression analyses, we modeled socio-demographic, substance use and program correlates of treatment engagement, completion, and abstinence at treatment exit. Overall, 59% of patients completed treatment (48% of patients from outpatient services). Treatment completion was associated with greater likelihood of abstinence at treatment exit. Patients were more likely to complete treatment if they engaged in treatment, were older, and had more severe drug problems (characterized by daily drug use and heroin problems) and attended programs of shorter duration. Residential treatment was associated with greater likelihood of treatment engagement, completion, and abstinence at treatment exit. Improving rates of outpatient treatment completion will enhance the effectiveness of South Africa's SUD treatment system. Interventions that promote engagement in treatment, particularly among younger patients; reduce program length through referral to step-down continuing care; and ensure better matching of drug problem to treatment level and type could improve rates of treatment completion. Copyright © 2018 Elsevier B.V. All rights reserved.

Establishing High-Quality Prostate Brachytherapy Using a Phantom Simulator Training Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thaker, Nikhil G.; Kudchadker, Rajat J.; Swanson, David A.

2014-11-01

Purpose: To design and implement a unique training program that uses a phantom-based simulator to teach the process of prostate brachytherapy (PB) quality assurance and improve the quality of education. Methods and Materials: Trainees in our simulator program were practicing radiation oncologists, radiation oncology residents, and fellows of the American Brachytherapy Society. The program emphasized 6 core areas of quality assurance: patient selection, simulation, treatment planning, implant technique, treatment evaluation, and outcome assessment. Using the Iodine 125 ({sup 125}I) preoperative treatment planning technique, trainees implanted their ultrasound phantoms with dummy seeds (ie, seeds with no activity). Pre- and postimplant dosimetric parametersmore » were compared and correlated using regression analysis. Results: Thirty-one trainees successfully completed the simulator program during the period under study. The mean phantom prostate size, number of seeds used, and total activity were generally consistent between trainees. All trainees met the V100 >95% objective both before and after implantation. Regardless of the initial volume of the prostate phantom, trainees' ability to cover the target volume with at least 100% of the dose (V100) was not compromised (R=0.99 pre- and postimplant). However, the V150 had lower concordance (R=0.37) and may better reflect heterogeneity control of the implant process. Conclusions: Analysis of implants from this phantom-based simulator shows a high degree of consistency between trainees and uniformly high-quality implants with respect to parameters used in clinical practice. This training program provides a valuable educational opportunity that improves the quality of PB training and likely accelerates the learning curve inherent in PB. Prostate phantom implantation can be a valuable first step in the acquisition of the required skills to safely perform PB.« less

Performance Contracting and Quality Improvement in Outpatient Treatment: Effects on Waiting Time and Length of Stay

PubMed Central

Stewart, Maureen T.; Horgan, Constance M.; Garnick, Deborah W.; Ritter, Grant; McLellan, A. Thomas

2012-01-01

We evaluate effects of a performance contract (PC) implemented in Delaware in 2001 and participation in quality improvement (QI) programs on waiting time for treatment and length of stay (LOS) using client treatment episode level data from Delaware (n = 12,368) and Maryland (n = 147,151) for 1998 – 2006. Results of difference-in-difference analyses indicate waiting time declined 13 days following the PC, after controlling for client characteristics and historical trends. Participation in the PC and a formal QI program was associated with a decrease of 20 days. LOS increased 22 days under the PC and 24 days under the PC and QI programs, after controlling for client characteristics. The PC and QI program were associated with improvements in LOS and waiting time, although we cannot determine which aspects of the programs (incentives, training, monitoring) resulted in these changes. PMID:22445031

Impact of Arsenic Treatment Techniques on Distribution Water Quality

EPA Science Inventory

This presentation will summarize the results of the distribution water quality studies (arsenic, lead, and copper) of the demonstration program. The impact of the treatment systems by type of system (adsorptive media, coagulation/filtration, ion exchange, etc) will be shown by co...

An Amazing Medical Discovery! A Comprehensive Neighborhood Quality of Life Enrichment Program. An Intensive Prevention Program To Address the Social Causes of Individual and Community Pathology in an Inner-City Neighborhood. Revised.

ERIC Educational Resources Information Center

Miami-Dade Community Coll., FL. Medical Center Campus.

In 1991, Miami-Dade Community College (MDCC) developed a proposal for the Comprehensive Neighborhood Quality of Life Enrichment Program, a program to be based on the principles of holism, prevention, and community synergy, focusing on the treatment of individuals with many, complex, and "all-at-once" needs. The program will operate in a poor…

Land Application of Wastes: An Educational Program. Treatment Systems, Effluent Qualities, and Costs - Module 4, Objectives, Script, and Booklet.

ERIC Educational Resources Information Center

Clarkson, W. W.; And Others

This module describes the following conventional treatment systems and evaluates their use as pretreatment steps for land application: preliminary, primary, secondary, disinfection, and advanced waste treatment. Effluent qualities are summarized, a brief discussion of application systems is given, and cost comparisons are discussed in some detail.…

The impact of an empowering Internet-based Breast Cancer Patient Pathway program on breast cancer patients' clinical outcomes: a randomised controlled trial.

PubMed

Ryhänen, Anne M; Rankinen, Sirkku; Siekkinen, Mervi; Saarinen, Maiju; Korvenranta, Heikki; Leino-Kilpi, Helena

2013-04-01

To evaluate the effect of the Breast Cancer Patient Pathway program on breast cancer patient's empowerment process. The results of earlier studies indicate that the use of tailored Internet-based patient education programs increased patient's knowledge level; however, other outcome measures differed. This randomised control trial studied the effect of the Internet-based patient educational program on breast cancer patients' empowerment. In this study, we measured the quality of life, anxiety and managing with treatment-related side effects as the outcomes of breast cancer patients' empowering process. Breast cancer patients who were Internet users in one Finnish university hospital during 2008-2010 were randomised to the control group (n=43) and the intervention group (n=47). Baseline data were collected first in the hospital and the following data seven times during the treatment process, the last time one year after breast cancer diagnosis. There were no statistically significant differences in the quality of life, anxiety or side effects of treatment between the groups. The amount of treatment-related side effects was connected to both physical and psychological well-being. In this study, the Breast Cancer Patient Pathway program did not decrease anxiety level or treatment-related side effects among breast cancer patients or improve subscales of quality of life when compared with controls. There is a need to relieve the side effects caused by patients' care with the help of patient education. Internet-based patient education programs need more focus when developing new patient education methods. © 2013 Blackwell Publishing Ltd.

Session IV: Current Insights into Wilderness and Adventure Therapy. Family Crisis and the Enrollment of Children in Wilderness Treatment

ERIC Educational Resources Information Center

Harper, Nevin J.

2009-01-01

Wilderness camps and programs have long been identified as viable residential treatment options for troubled adolescents (Durkin, 1988). Wilderness treatment programs in the United States, regardless of reputation and service quality, have recently received increased scrutiny from government, mainly by being depicted as in pedagogical alignment…

COMPUTER PROGRAM FOR CALCULATING THE COST OF DRINKING WATER TREATMENT SYSTEMS

EPA Science Inventory

This FORTRAN computer program calculates the construction and operation/maintenance costs for 45 centralized unit treatment processes for water supply. The calculated costs are based on various design parameters and raw water quality. These cost data are applicable to small size ...

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mundy, D; Tryggestad, E; Beltran, C

Purpose: To develop daily and monthly quality assurance (QA) programs in support of a new spot-scanning proton treatment facility using a combination of commercial and custom equipment and software. Emphasis was placed on efficiency and evaluation of key quality parameters. Methods: The daily QA program was developed to test output, spot size and position, proton beam energy, and image guidance using the Sun Nuclear Corporation rf-DQA™3 device and Atlas QA software. The program utilizes standard Atlas linear accelerator tests repurposed for proton measurements and a custom jig for indexing the device to the treatment couch. The monthly QA program wasmore » designed to test mechanical performance, image quality, radiation quality, isocenter coincidence, and safety features. Many of these tests are similar to linear accelerator QA counterparts, but many require customized test design and equipment. Coincidence of imaging, laser marker, mechanical, and radiation isocenters, for instance, is verified using a custom film-based device devised and manufactured at our facility. Proton spot size and position as a function of energy are verified using a custom spot pattern incident on film and analysis software developed in-house. More details concerning the equipment and software developed for monthly QA are included in the supporting document. Thresholds for daily and monthly tests were established via perturbation analysis, early experience, and/or proton system specifications and associated acceptance test results. Results: The periodic QA program described here has been in effect for approximately 9 months and has proven efficient and sensitive to sub-clinical variations in treatment delivery characteristics. Conclusion: Tools and professional guidelines for periodic proton system QA are not as well developed as their photon and electron counterparts. The program described here efficiently evaluates key quality parameters and, while specific to the needs of our facility, could be readily adapted to other proton centers.« less

[Development and short-term effects of a standardized patient education program for in-patient cardiologic rehabilitation].

PubMed

Seekatz, B; Haug, G; Mosler, G; Schwaab, B; Altstidl, R; Worringen, U; Faller, H; Meng, K

2013-10-01

Patient education is an essential part in the treatment of coronary heart disease in medical rehabilitation. In the German-speaking area, no standardized and evaluated patient education program for coronary heart disease is available so far. In this paper, we demonstrate the development of a quality assured patient education program based on a health-education program of the German statutory pension insurance scheme. In a multi-level approach, an existing program was modified concerning treatment evidence, practical guidelines, theories of health and illness behavior and quality criteria for patient education as well as clinical experience and thereafter manualized. In a formative evaluation, feasibility and patient acceptance of this modified program were assessed using evaluation questionnaires of patients and trainers. Afterwards, effects of the patient education program as compared to a traditional education program were assessed on a short-term (at discharge), medium-term (6-month follow-up) and long-term (12-month follow-up) basis in a multicenter quasi-experimental control group study of patients with coronary heart disease (n=434). Results of the formative evaluation demonstrate an overall good acceptance and a good feasibility of the manualized program. Short-term results show a significant small treatment effect in the primary outcome variable patients' knowledge (p=0.001, η2 =0.028). Furthermore, small effects were also observed among some secondary outcomes, such as attitude towards medication, planning of physical activity, psychological quality of life and satisfaction with the education program. A standardized education program for patients with coronary heart disease has been developed in a systematic process based on established quality standards. Depending on the outstanding medium and long-term effects, the program may be recommended for general use in medical rehabilitation. The manual provides the prerequisites allowing for a successful transfer into clinical practice. © Georg Thieme Verlag KG Stuttgart · New York.

An In-Depth Survey of the Screening and Assessment Practices of Highly Regarded Adolescent Substance Abuse Treatment Programs

ERIC Educational Resources Information Center

Gans, Jeremy; Falco, Mathea; Schackman, Bruce R.; Winters, Ken C.

2010-01-01

Aims: To examine the quality of screening and assessment practices at some of the most highly regarded adolescent substance use treatment programs in the United States. Methods: Between March and September 2005, telephone surveys were administered to directors of highly regarded programs. Several different publications and databases were then used…

Poster - Thur Eve - 54: A software solution for ongoing DVH quality assurance in radiation therapy.

PubMed

Annis, S-L; Zeng, G; Wu, X; Macpherson, M

2012-07-01

A program has been developed in MATLAB for use in quality assurance of treatment planning of radiation therapy. It analyzes patient DVH files and compiles dose volume data for review, trending, comparison and analysis. Patient DVH files are exported from the Eclipse treatment planning system and saved according to treatment sites and date. Currently analysis is available for 4 treatment sites; Prostate, Prostate Bed, Lung, and Upper GI, with two functions for data report and analysis: patient-specific and organ-specific. The patient-specific function loads one patient DVH file and reports the user-specified dose volume data of organs and targets. These data can be compiled to an external file for a third party analysis. The organ-specific function extracts a requested dose volume of an organ from the DVH files of a patient group and reports the statistics over this population. A graphical user interface is utilized to select clinical sites, function and structures, and input user's requests. We have implemented this program in planning quality assurance at our center. The program has tracked the dosimetric improvement in GU sites after VMAT was implemented clinically. It has generated dose volume statistics for different groups of patients associated with technique or time range. This program allows reporting and statistical analysis of DVH files. It is an efficient tool for the planning quality control in radiation therapy. © 2012 American Association of Physicists in Medicine.

Water Quality: Water Education for Teachers. A 4-H School Enrichment Program.

ERIC Educational Resources Information Center

Powell, G. Morgan; Kling, Emily B.

This looseleaf notebook is a teacher resource package that is designed for enrichment program use. It contains five units dealing with water quality: (1) The Water Cycle; (2) Our Water Supply; (3) Waste/Water Treatment; (4) Water Conservation; (5) Water Pollution. The units provide background information, experiments, stories, poems, plays, and…

Qualities of the Participant Experience in an Object-Based Museum Outreach Program to Retirement Communities

ERIC Educational Resources Information Center

Smiraglia, Christina

2015-01-01

Reminiscence programs that stimulate participants' memories through discussion are popular as both enrichment activity and clinical treatment for older adults. Museums in multiple countries are starting to offer reminiscence opportunities on-site and through outreach. This study is an investigation of the qualities of the participant experience in…

Air quality impacts of transit improvement, preferential lane, and carpool/vanpool programs. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

DiRenzo, J.F.; Rubin, R.B.

1978-03-01

The report was prepared in accordance with Section 108(f) of the Clean Air Act, as amended, August 1977. It is intended to assist urban areas in developing State Implementation Plans and integrating their transportation system management and air quality planning programs as required by FHWA, UMTA, and EPA. The report analyzes the air quality, travel, energy consumption, economic, and cost impacts of three types of transportation programs: priority treatment for high occupancy vehicles on freeways and arterials; areawide carpool and vanpool programs; and transit fare reductions and service improvements. Important factors (e.g., meteorological conditions, traffic volumes and speeds, and changesmore » in modal choice) likely to influence air quality and emissions for the above programs are also analyzed.« less

Exercise and Education Program After Breast Cancer: Benefits on Quality of Life and Symptoms at 3, 6, 12, and 24 Months' Follow-up.

PubMed

Leclerc, Anne-France; Slomian, Justine; Jerusalem, Guy; Coucke, Philippe; Bury, Thierry; Deflandre, Dorian; Devos, Martine; Bruyère, Olivier; Foidart-Dessalle, Marguerite; Kaux, Jean-François; Crielaard, Jean-Michel; Maquet, Didier

2018-05-19

Various clinical trials have demonstrated the benefits of physical training offered during and/or after breast cancer treatments. However, given the variety of adverse events that may be encountered, physical training could be combined with psychologic, relational, and social guidance. This kind of multidisciplinary program, as well as its long-term effects, have been little studied so far. Therefore, the objective of our study was to determine the benefits at 3, 6, 12, and 24 months of a 3-month exercise and education program among women after breast cancer treatment. Two hundred nine outpatients treated for primary breast carcinoma were divided into a control group (n = 106) and an experimental group (n = 103) which underwent a 3-month rehabilitation program including physical training and psychoeducational sessions. The assessments, performed before the program and at 3, 6, 12, and 24 months after inclusion, included validated questionnaires on quality of life and symptoms. The analyses revealed an improvement in quality of life and symptoms after the exercise and education program within the experimental group and a maintenance of these improvements during the 2 years of follow-up. These improvements were significantly better than those in the control group, clearly demonstrating that the program has benefits. This trial identified the benefits of a well-detailed 3-month exercise and education program over 24 months' follow-up among women after breast cancer treatment. Copyright © 2018 Elsevier Inc. All rights reserved.

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

PubMed Central

Shaw, Brian I.; Asadhi, Elijah; Owuor, Kevin; Okoth, Peter; Abdi, Mohammed; Cohen, Craig R.; Onono, Maricianah

2016-01-01

Integrated community case management (iCCM) programs that train lay community health workers (CHWs) in the diagnosis and treatment of diarrhea, malaria, and pneumonia have been increasingly adopted throughout sub-Saharan Africa to provide services in areas where accessibility to formal public sector health services is low. One important aspect of successful iCCM programs is the acceptability and utilization of services provided by CHWs. To understand community perceptions of the quality of care in an iCCM intervention in western Kenya, we used the Primary Care Assessment Survey to compare caregiver attitudes about the diagnosis and treatment of childhood pneumonia as provided by CHWs and facility-based health workers (FBHWs). Overall, caregivers rated CHWs more highly than FBHWs across a set of 10 domains that capture multiple dimensions of the care process. Caregivers perceived CHWs to provide higher quality care in terms of accessibility and patient relationship and equal quality care on clinical aspects. These results argue for the continued implementation and scale-up of iCCM programs as an acceptable intervention for increasing access to treatment of childhood pneumonia. PMID:26976883

Exploring the Relationship Between Treatment Satisfaction, Perceived Improvements in Functioning and Well-Being and Gambling Harm Reduction Among Clients of Pathological Gambling Treatment Programs

PubMed Central

Bernhard, Bo; Abarbanel, Brett L. L.; St. John, Sarah; Kalina, Ashlee

2014-01-01

The objective of this study was to evaluate the relationship between treatment service quality, perceived improvement in social, functional, and material well-being and reduction in gambling behaviors among clients of Nevada state-funded pathological gambling treatment programs. Utilizing survey data from 361 clients from 2009 to 2010, analyses revealed that client satisfaction with treatment services is positively associated with perceived improvements in social, functional, and material well-being, abstinence from gambling, reduction in gambling thoughts and reduction in problems associated with gambling, even after controlling for various respondent characteristics. These findings can be useful to treatment program staff in managing program development and allocating resources. PMID:23756725

Quality assurance of radiotherapy in cancer treatment: toward improvement of patient safety and quality of care.

PubMed

Ishikura, Satoshi

2008-11-01

The process of radiotherapy (RT) is complex and involves understanding of the principles of medical physics, radiobiology, radiation safety, dosimetry, radiation treatment planning, simulation and interaction of radiation with other treatment modalities. Each step in the integrated process of RT needs quality control and quality assurance (QA) to prevent errors and to give high confidence that patients will receive the prescribed treatment correctly. Recent advances in RT, including intensity-modulated and image-guided RT, focus on the need for a systematic RTQA program that balances patient safety and quality with available resources. It is necessary to develop more formal error mitigation and process analysis methods, such as failure mode and effect analysis, to focus available QA resources optimally on process components. External audit programs are also effective. The International Atomic Energy Agency has operated both an on-site and off-site postal dosimetry audit to improve practice and to assure the dose from RT equipment. Several countries have adopted a similar approach for national clinical auditing. In addition, clinical trial QA has a significant role in enhancing the quality of care. The Advanced Technology Consortium has pioneered the development of an infrastructure and QA method for advanced technology clinical trials, including credentialing and individual case review. These activities have an impact not only on the treatment received by patients enrolled in clinical trials, but also on the quality of treatment administered to all patients treated in each institution, and have been adopted globally; by the USA, Europe and Japan also.

[The total-quality-management-analysis of the continuation and discontinuation of alcohol family treatment: a grassroots approach].

PubMed

Nishikawa, K; Tatsuki, S

2001-06-01

A family support/treatment program was provided to thirty-three cases where a drinking family member (identified patient) had shown alcohol related problems but not yet admitted the problem. After a period of between thirteen and twenty-one months of family treatment, fourteen (42.4%) identified patients started their own treatment. The only statistically significant factor that was related to the patients' treatment program participation was the continuation of family members' involvement in a family treatment program. Among the thirty-three cases, a little less than one half (48.5%) continued the family program. In order to increase the patients' participation, it is crucial to encourage family members to continue their family support/treatment program. In order to identify factors that contribute treatment continuation as well as dropouts, workshops were held with those who dropped out and those who continued the family treatment program. The Total-Quality-Management (TQM) affinity and arrow diagram techniques were employed to classify the participants' statements and to find cause-effect relationships among the identified factors, respectively. Five family treatment discontinuation factors were identified: 1) a lack of information about family support program, 2) resistance against a "family change" orientation in family treatment program, 3) family member burnout, 4) a misfit between family needs for immediate problem solutions and what family program offers, and 5) a temporal improvement of patients' drinking problems. While widely varied factors were found to contribute discontinuation, only a very few factors were identified to facilitate the treatment continuation. It was concluded that treatment discontinuation, rather than continuation, was the norm among the families of problem drinkers. Based on the above findings, three kaizen plans were proposed. First, in order to make sure that family members obtain necessary information about the family support/treatment program, a pamphlet would be created and handed out to those who come to family treatment. Second, family support efforts would be emphasized more. Treatment staff is expected to become more cautious with regard to the family behavior change facilitation, especially at the early stage. Third, treatment staff is expected to become more aggressive about contacting family group members when they do not show up to a meeting.

Despite Resources From The ACA, Most States Do Little To Help Addiction Treatment Programs Implement Health Care Reform.

PubMed

Andrews, Christina; Abraham, Amanda; Grogan, Colleen M; Pollack, Harold A; Bersamira, Clifford; Humphreys, Keith; Friedmann, Peter

2015-05-01

The Affordable Care Act (ACA) dramatically expands health insurance for addiction treatment and provides unprecedented opportunities for service growth and delivery model reform. Yet most addiction treatment programs lack the staffing and technological capabilities to respond successfully to ACA-driven system change. In light of these challenges, we conducted a national survey to examine how Single State Agencies for addiction treatment--the state governmental organizations charged with overseeing addiction treatment programs--are helping programs respond to new requirements under the ACA. We found that most Single State Agencies provide little assistance to addiction treatment programs. Most agencies are helping programs develop collaborations with other health service programs. However, fewer than half reported providing help in modernizing systems to support insurance participation, and only one in three provided assistance with enrollment outreach. In the absence of technical assistance, it is unlikely that addiction treatment programs will fully realize the ACA's promise to improve access to and quality of addiction treatment. Project HOPE—The People-to-People Health Foundation, Inc.

Web-based treatment program using intensive therapeutic contact for patients with eating disorders: before-after study.

PubMed

ter Huurne, Elke D; Postel, Marloes G; de Haan, Hein A; Drossaert, Constance H C; DeJong, Cor A J

2013-02-04

Although eating disorders are common in the Netherlands, only a few patients are treated by mental health care professionals. To reach and treat more patients with eating disorders, Tactus Addiction Treatment developed a web-based treatment program with asynchronous and intensive personalized communication between the patient and the therapist. This pilot study evaluated the web-based treatment program using intensive therapeutic contact in a population of 165 patients with an eating disorder. In a pre-post design with 6-week and 6-month follow-ups, eating disorder psychopathology, body dissatisfaction, Body Mass Index, physical and mental health, and quality of life were measured. The participant's satisfaction with the web-based treatment program was also studied. Attrition data were collected, and participants were classified as noncompleters if they did not complete all 10 assignments of the web-based treatment program. Differences in baseline characteristics between completers and noncompleters were studied, as well as reasons for noncompletion. Furthermore, differences in treatment effectiveness, treatment adherence, and baseline characteristics between participants of the three major eating disorder diagnostic groups EDNOS (n=115), BN purging (n=24), and BN nonpurging (n=24) were measured. Of the 165 participants who started the web-based treatment program, 89 participants (54%) completed all of the program assignments (completers) and 76 participants (46%) ended the program prematurely (noncompleters). Severe body dissatisfaction and physical and mental health problems seemed to have a negative impact on the completion of the web-based treatment program. Among the participants who completed the treatment program, significant improvements were found in eating disorder psychopathology (F=54.6, df = 68, P<.001, d=1.14). Body dissatisfaction, quality of life, and physical and mental health also significantly improved, and almost all of these positive effects were sustained up to 6 months after the participants had completed the web-based treatment program. Body Mass Index improved only within the group of participants suffering from obesity. The improvement in eating disorder psychopathology occurred in all three eating disorder diagnostic groups, and the percentage of completers did not differ significantly between these groups. Participants' satisfaction with the treatment program, as well as with their therapist, was high, and participants indicated that they would recommend the program to other patients with eating disorders. The results of this study suggest that the web-based treatment program has the potential to improve eating disorder psychopathology in patients with different types of eating disorders.

Helping concerned family members of individuals with substance use and concurrent disorders: An evaluation of a family member-oriented treatment program.

PubMed

Denomme, William James; Benhanoh, Orry

2017-08-01

There is a growing body of research demonstrating that families of individuals with substance use and concurrent disorders (SUCD) experience a wide range of biopsychosocial problems that significantly impedes their quality of life and health. However, there has been a relative lack of treatment programs primarily focused on improving the well-being and quality of life of these family members. The current study assessed the efficacy of such a program at reducing stress, increasing perceived social support from family and friends, and increasing general, dyadic, and self-rated family functioning within these concerned family members. A sample of 125 family members of individuals with SUCDs was recruited, of which 97 participated in the treatment program and 28 were used as the comparison group. Results indicated that the treatment program significantly reduced stress, increased perceived social support from family and friends, and increased general, dyadic and self-rated family functioning. A perceived personal benefits questionnaire demonstrated that participants had a better understanding of SUCDs, better coping capabilities in regard to emotional difficulties, adopted stronger coping methods, participated in more leisure activities, and improved their relationship with the individual with a SUCD. The results of the current study further demonstrate the need to implement more of these family-member oriented psycho-educational treatment programs. Copyright © 2017 Elsevier Inc. All rights reserved.

Positive outcomes following gait therapy intervention for hip osteoarthritis: A longitudinal study.

PubMed

Solomonow-Avnon, Deborah; Herman, Amir; Levin, Daniel; Rozen, Nimrod; Peled, Eli; Wolf, Alon

2017-10-01

Footwear-generated biomechanical manipulation of lower-limb joints was shown to beneficially impact gait and quality of life in knee osteoarthritis patients, but has not been tested in hip osteoarthritis patients. We examined a customized gait treatment program using a biomechanical device shown in previous investigations to be capable of manipulating hip biomechanics via foot center of pressure (COP) modulation. The objective of this study was to assess the treatment program for hip osteoarthritis patients, enrolled in a 1-year prospective investigation, by means of objective gait and spatiotemporal parameters, and subjective quality of life measures. Gait analysis and completion of questionnaires were performed at the start of the treatment (baseline), and after 3, 6, and 12 months. Outcome parameters were evaluated over time using linear mixed effects models, and association between improvement in quality of life measures and change in objective outcomes was tested using mixed effect linear regression models. Quality of life measures improved compared to baseline, accompanied by increased gait speed and cadence. Sagittal-plane hip joint kinetics, kinematics, and spatiotemporal parameters changed throughout the study compared to baseline, in a manner suggesting improvement of gait. The most substantial improvement occurred within 3 months after treatment initiation, after which improvement approximately plateaued, but was sustained at 12 months. Speed and cadence, as well as several sagittal-plane gait parameters, were significant predictors of improvement in quality of life. Evidence suggests that a biomechanical gait therapy program improves subjective and objective outcomes measures and is a valid treatment option for hip osteoarthritis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2222-2232, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Segmenting patients and physicians using preferences from discrete choice experiments.

PubMed

Deal, Ken

2014-01-01

People often form groups or segments that have similar interests and needs and seek similar benefits from health providers. Health organizations need to understand whether the same health treatments, prevention programs, services, and products should be applied to everyone in the relevant population or whether different treatments need to be provided to each of several segments that are relatively homogeneous internally but heterogeneous among segments. Our objective was to explain the purposes, benefits, and methods of segmentation for health organizations, and to illustrate the process of segmenting health populations based on preference coefficients from a discrete choice conjoint experiment (DCE) using an example study of prevention of cyberbullying among university students. We followed a two-level procedure for investigating segmentation incorporating several methods for forming segments in Level 1 using DCE preference coefficients and testing their quality, reproducibility, and usability by health decision makers. Covariates (demographic, behavioral, lifestyle, and health state variables) were included in Level 2 to further evaluate quality and to support the scoring of large databases and developing typing tools for assigning those in the relevant population, but not in the sample, to the segments. Several segmentation solution candidates were found during the Level 1 analysis, and the relationship of the preference coefficients to the segments was investigated using predictive methods. Those segmentations were tested for their quality and reproducibility and three were found to be very close in quality. While one seemed better than others in the Level 1 analysis, another was very similar in quality and proved ultimately better in predicting segment membership using covariates in Level 2. The two segments in the final solution were profiled for attributes that would support the development and acceptance of cyberbullying prevention programs among university students. Those segments were very different-where one wanted substantial penalties against cyberbullies and were willing to devote time to a prevention program, while the other felt no need to be involved in prevention and wanted only minor penalties. Segmentation recognizes key differences in why patients and physicians prefer different health programs and treatments. A viable segmentation solution may lead to adapting prevention programs and treatments for each targeted segment and/or to educating and communicating to better inform those in each segment of the program/treatment benefits. Segment members' revealed preferences showing behavioral changes provide the ultimate basis for evaluating the segmentation benefits to the health organization.

Do Pilates-based exercises following total knee arthroplasty improve postural control and quality of life?

PubMed

Karaman, Aysenur; Yuksel, Inci; Kinikli, Gizem Irem; Caglar, Omur

2017-04-01

The aim of this prospective, randomized, controlled study was to investigate the effects of the addition of Pilates-based exercises to standard exercise programs performed after total knee arthroplasty on quality of life and balance. Forty-six volunteers were divided into two groups. The control group (n = 17) was assigned a standard exercise program after discharge; the study group (n = 17) was assigned Pilates-based exercises along with the standard exercise program. We carried out clinical evaluations of all patients on the day of discharge and after the completion of the 6-week exercise program. We also recorded sociodemographic data, Berg Balance test scores, and Short Form-36 (SF-36) health-related quality of life measurements. When we compared the differences between pre- and post-treatment balance scores of the groups, we found a significant change in favor of the Pilates-based exercise group (13.64 ± 1.45; p < 0.01). The changes in the pre- and post-treatment SF-36 scores of the Pilates-based exercises group were found to be significant in terms of physical function (p = 0.001), physical role restriction (p = 0.01), and physical component score (p = 0.001). Pilates-based exercises performed along with standard exercise programs were more effective for improving balance and quality of life than standard exercise programs alone.

The impact of parity on major depression treatment quality in the Federal Employees' Health Benefits Program after parity implementation.

PubMed

Busch, Alisa B; Huskamp, Haiden A; Normand, Sharon-Lise T; Young, Alexander S; Goldman, Howard; Frank, Richard G

2006-06-01

Since the 1990s, parity laws have been implemented to reduce inequities in mental health coverage compared with that for general medical conditions. It is unclear if parity under managed care is associated with improvements in mental health treatment quality. Major depressive disorder (MDD) is a prevalent but often undetected and undertreated and thus could potentially benefit from parity implementation. The objective of this study was to examine the association between parity implementation and changes in MDD treatment quality in the Federal Employees' Health Benefits (FEHB) Program. We conducted retrospective analyses of insurance claims data. Logistic regression models estimated quality changes for MDD-diagnosed enrollees from pre- to postparity. Subjects included MDD-diagnosed FEHB insured enrollees, aged 18-64, across multiple states and 6 FEHB plans before (1999-2000) and after (2001-2002) parity implementation. Measures included receipt of any antidepressant or psychotherapy within a given calendar year of diagnosis; receipt of appropriate psychotherapy frequency/intensity and duration; and pharmacotherapy duration during acute-phase treatment episodes. Postparity, several plans improved significantly in the likelihood of receiving antidepressant medication. In the acute-phase episodes, the greatest improvement was seen in the likelihood of follow up >or=4 months. Few or no other changes were observed in the acute-phase treatment intensity or duration quality measures. Parity under managed care was associated with modest improvements. The observed improvements were consistent with secular trends in MDD treatment. Whereas mental health parity is an important policy goal, these results highlight its limitations: improving the financing of care may not be sufficient to improve quality.

Evaluation plan for state gas heating system retrofit pilot programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Berry, L.; Vineyard, T.

This report presents a detailed plan for the evaluation of state gas heating system retrofit pilot programs. The major goals of the evaluation procedures are to document the fuel savings and cost effectiveness of (1) the programs implemented by the states and (2) the four retrofit types installed. The major tasks involved in the evaluation include identification of program-eligible households, screening for data quality, assignment of eligible households to treatment or control groups, assembling cost data, collecting pre- and postretrofit consumption data, obtainin pre- and postretrofit weather data, checking for data quality, and analyzing the data. Data analysis relies onmore » the calculation of weather-adjusted normalized annual consumption (NAC) figures for pre- and postretrofit years for treatment and control groups. The differences between the treatment and control groups' NACs for the pre- and postretrofit years are the measure of the program's impact. Cost effectiveness analysis will combine the NAC results with cost data and with a variety of assumptions concerning future fuel prices, retrofit lifetimes, and discount rates to produce benefit/cost indicators.« less

The Prevalence and Correlates of Workplace Depression in the National Comorbidity Survey Replication

PubMed Central

Kessler, Ronald C.; Merikangas, Kathleen R.; Wang, Philip S.

2009-01-01

Objective To review evidence on the workplace prevalence and correlates of major depressive episodes, with a particular focus on the National Comorbidity Survey Replication, the most recent national survey to focus on these issues. Method Nationally representative survey of Diagnostic and Statistical Manual, 4th Revision Mental Disorders. Results A total of 6.4% of employed National Comorbidity Survey Replication respondents had 12-month major depressive disorder. An additional 1.1% had major depressive episodes due to bipolar disorder or mania– hypomania. Only about half of depressed workers received treatment. Fewer than half of treated workers received care consistent with published treatment guidelines. Conclusions Depression disease management programs can have a positive return-on-investment from the employer perspective, but only when they are based on best practices. Given the generally low depression treatment quality documented here, treatment quality guarantees are needed before expanding workplace depression screening, outreach, and treatment programs. PMID:18404010

Effects of a 16-week hydrotherapy program on three-dimensional scapular motion and pain of women with fibromyalgia: A single-arm study.

PubMed

Avila, Mariana Arias; Camargo, Paula Rezende; Ribeiro, Ivana Leão; Alburquerque-Sendín, Francisco; Zamunér, Antonio Roberto; Salvini, Tania Fatima

2017-11-01

Although hydrotherapy is widely used to treat women with fibromyalgia, no studies have investigated the effects of this intervention on scapular kinematics in this population. This study verified the effectiveness of a hydrotherapy program on scapular kinematics, pain and quality of life in women with fibromyalgia. Twenty women completed the study and performed three evaluations before treatment (to establish a baseline), and two other evaluations (after 8 and 16weeks of hydrotherapy) at the end of treatment. Three-dimensional kinematics of the scapula was evaluated during arm elevation in two different planes with the Flock of Birds® system. Patients also answered quality of life and Fibromyalgia Impact Questionnaires and had pain assessed with a digital algometer. Treatment consisted of 2 weekly hydrotherapy sessions, lasting 45min each, for 16weeks. Data were analyzed with a two-way ANOVA (for kinematics results) and one-way ANOVA (for the other variables). Effect size was assessed with Cohen's d coefficient for all quantitative variables. Although an important improvement was achieved in terms of pain and quality of life (P<0.05, effect sizes varied from -1.93 to 1.61 depending on the variable), scapular kinematics did not change after treatment (P>0.05, effect sizes from -0.40 to 0.46 for all kinematic variables). The proposed program of hydrotherapy was effective to improve quality of life, pain intensity and fibromyalgia impact in women with fibromyalgia. However, scapular kinematics did not change after the period of treatment. Although symptoms improved after the treatment, the lack of changes in scapular kinematics may indicate these women have an adaptive movement pattern due to their chronic painful condition. Copyright © 2017 Elsevier Ltd. All rights reserved.

Determinants of hospital-based substance abuse treatment programs.

PubMed

Bell, R

1994-01-01

Experts agree that treatment is the best solution to substance abuse problems. As the societywide problem of drug and alcohol dependence increases, so does the need for treatment programs. Research has shown that many hospitals have entered into the substance abuse treatment program business because a need for quality programs exists and because an alcohol and a substance abuse treatment product line has the potential for increasing sagging revenues. This article addresses the question of what types of hospitals are likely to engage in providing inpatient and/or outpatient treatment programs. The results indicate that organizational size (measured by the number of beds) is the best predictor of treatment service provision for both inpatient and outpatient settings, with larger hospitals being more likely to provide substance abuse programs. A need for additional chemical dependency treatment programs does not appear to be the primary motivating factor for hospitals developing this service. Rather, it seems hospitals provide these programs for other reasons--as part of providing a full array of services, as an average toward achieving organizational goals, as a means of sustaining a competitive advantage, or as a strategy for maintaining the same level of service as the competition.

VA residential substance use disorder treatment program providers' perceptions of facilitators and barriers to performance on pre-admission processes.

PubMed

Ellerbe, Laura S; Manfredi, Luisa; Gupta, Shalini; Phelps, Tyler E; Bowe, Thomas R; Rubinsky, Anna D; Burden, Jennifer L; Harris, Alex H S

2017-04-04

In the U.S. Department of Veterans Affairs (VA), residential treatment programs are an important part of the continuum of care for patients with a substance use disorder (SUD). However, a limited number of program-specific measures to identify quality gaps in SUD residential programs exist. This study aimed to: (1) Develop metrics for two pre-admission processes: Wait Time and Engagement While Waiting, and (2) Interview program management and staff about program structures and processes that may contribute to performance on these metrics. The first aim sought to supplement the VA's existing facility-level performance metrics with SUD program-level metrics in order to identify high-value targets for quality improvement. The second aim recognized that not all key processes are reflected in the administrative data, and even when they are, new insight may be gained from viewing these data in the context of day-to-day clinical practice. VA administrative data from fiscal year 2012 were used to calculate pre-admission metrics for 97 programs (63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs); 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track). Interviews were then conducted with management and front-line staff to learn what factors may have contributed to high or low performance, relative to the national average for their program type. We hypothesized that speaking directly to residential program staff may reveal innovative practices, areas for improvement, and factors that may explain system-wide variability in performance. Average wait time for admission was 16 days (SUD RRTPs: 17 days; MH RRTPs with a SUD track: 11 days), with 60% of Veterans waiting longer than 7 days. For these Veterans, engagement while waiting occurred in an average of 54% of the waiting weeks (range 3-100% across programs). Fifty-nine interviews representing 44 programs revealed factors perceived to potentially impact performance in these domains. Efficient screening processes, effective patient flow, and available beds were perceived to facilitate shorter wait times, while lack of beds, poor staffing levels, and lengths of stay of existing patients were thought to lengthen wait times. Accessible outpatient services, strong patient outreach, and strong encouragement of pre-admission outpatient treatment emerged as facilitators of engagement while waiting; poor staffing levels, socioeconomic barriers, and low patient motivation were viewed as barriers. Metrics for pre-admission processes can be helpful for monitoring residential SUD treatment programs. Interviewing program management and staff about drivers of performance metrics can play a complementary role by identifying innovative and other strong practices, as well as high-value targets for quality improvement. Key facilitators of high-performing facilities may offer programs with lower performance useful strategies to improve specific pre-admission processes.

Chinese expert consensus on programming deep brain stimulation for patients with Parkinson's disease.

PubMed

Chen, Shengdi; Gao, Guodong; Feng, Tao; Zhang, Jianguo

2018-01-01

Deep Brain Stimulation (DBS) therapy for the treatment of Parkinson's Disease (PD) is now a well-established option for some patients. Postoperative standardized programming processes can improve the level of postoperative management and programming, relieve symptoms and improve quality of life. In order to improve the quality of the programming, the experts on DBS and PD in neurology and neurosurgery in China reviewed the relevant literatures and combined their own experiences and developed this expert consensus on the programming of deep brain stimulation in patients with PD in China. This Chinese expert consensus on postoperative programming can standardize and improve postoperative management and programming of DBS for PD.

Program closure and change among VA substance abuse treatment programs.

PubMed

Floyd, A S

1999-10-01

The population of Veterans Affairs (VA) substance abuse treatment programs in 1990 and 1994 was examined to determine which factors-program legitimacy or cost-accounted for program closure and change. Legitimacy is a concept in institutional theory that organizations tend to take on a form appropriate to the environment. The study had two competing hypotheses. The first was that if external pressures push programs to produce high-quality and efficient treatment, then those that are initially closer to the legitimate form should be less likely to close later, and among surviving programs they should be less likely to experience change. The second hypothesis was that cost is the primary factor in program closure and change. The study used data from administrative surveys of all VA programs (273 in 1990 and 389 in 1994). Program legitimacy variables measured whether programs offered the prevalent type of treatment, such as 12-step groups or behavioral treatment, and had the prevalent type of staff. Program costs did not explain closure or change. For inpatient programs, the risk of closure increased in facilities with more than one substance abuse treatment program. The risk of closure increased for outpatient programs offering the prevalent type of treatment, contrary to what was predicted by the legitimacy hypothesis. Inpatient programs that offered the prevalent treatment were less likely to change the type of treatment offered. Patterns of change differed over time for inpatient and outpatient programs. Legitimacy factors, rather than cost, seem to play a role in program closure and change, although the picture is clearer for inpatient programs than for outpatient programs.

Electronic laboratory quality assurance program: A method of enhancing the prosthodontic curriculum and addressing accreditation standards.

PubMed

Moghadam, Marjan; Jahangiri, Leila

2015-08-01

An electronic quality assurance (eQA) program was developed to replace a paper-based system and to address standards introduced by the Commission on Dental Accreditation (CODA) and to improve educational outcomes. This eQA program provides feedback to predoctoral dental students on prosthodontic laboratory steps at New York University College of Dentistry. The purpose of this study was to compare the eQA program of performing laboratory quality assurance with the former paper-based format. Fourth-year predoctoral dental students (n=334) who experienced both the paper-based and the electronic version of the quality assurance program were surveyed about their experiences. Additionally, data extracted from the eQA program were analyzed to identify areas of weakness in the curriculum. The study findings revealed that 73.8% of the students preferred the eQA program to the paper-based version. The average number of treatments that did not pass quality assurance standards was 119.5 per month. This indicated a 6.34% laboratory failure rate. Further analysis of these data revealed that 62.1% of the errors were related to fixed prosthodontic treatment, 27.9% to partial removable dental prostheses, and 10% to complete removable dental prostheses in the first 18 months of program implementation. The eQA program was favored by dental students who have experienced both electronic and paper-based versions of the system. Error type analysis can yield the ability to create customized faculty standardization sessions and refine the didactic and clinical teaching of the predoctoral students. This program was also able to link patient care activity with the student's laboratory activities, thus addressing the latest requirements of the CODA regarding the competence of graduates in evaluating laboratory work related to their patient care. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Cancer survivors' perceived need for supportive care and their attitude towards self-management and eHealth.

PubMed

Jansen, Femke; van Uden-Kraan, Cornelia F; van Zwieten, Valesca; Witte, Birgit I; Verdonck-de Leeuw, Irma M

2015-06-01

The aim of this study was to explore the perceived need for supportive care including healthy lifestyle programs among cancer survivors, their attitude towards self-management and eHealth, and its association with several sociodemographic and clinical variables and quality of life. A questionnaire on the perceived need for supportive care and attitude towards self-management and eHealth was completed by 212 cancer survivors from an online panel. Highest needs were reported regarding physical care (66 %), followed by healthy lifestyle programs (54 %), social care (43 %), psychological care (38 %), and life question-related programs (24 %). In general, cancer survivors had a positive attitude towards self-management and eHealth. Supportive care needs were associated with male gender, lower age, treatment with chemotherapy or (chemo)radiation (versus surgery alone), hematological cancer (versus skin cancer, breast cancer, and other types of cancer), and lower quality of life. A positive attitude towards self-management was associated with lower age. A more positive attitude towards eHealth was associated with lower age, higher education, higher income, currently being under treatment (versus treatment in the last year), treatment with chemotherapy or (chemo)radiation (versus surgery alone), prostate and testicular cancer (versus hematological, skin, gynecological, and breast cancer and other types of cancer), and lower quality of life. The perceived need for supportive care including healthy lifestyle programs was high, and in general, cancer survivors had a positive attitude towards self-management and eHealth. Need and attitude were associated with sociodemographic and clinical variables and quality of life. Therefore, a tailored approach seems to be warranted to improve and innovate supportive care targeting cancer survivors.

A semi-automated tool for treatment plan-quality evaluation and clinical trial quality assurance

NASA Astrophysics Data System (ADS)

Wang, Jiazhou; Chen, Wenzhou; Studenski, Matthew; Cui, Yunfeng; Lee, Andrew J.; Xiao, Ying

2013-07-01

The goal of this work is to develop a plan-quality evaluation program for clinical routine and multi-institutional clinical trials so that the overall evaluation efficiency is improved. In multi-institutional clinical trials evaluating the plan quality is a time-consuming and labor-intensive process. In this note, we present a semi-automated plan-quality evaluation program which combines MIMVista, Java/MATLAB, and extensible markup language (XML). More specifically, MIMVista is used for data visualization; Java and its powerful function library are implemented for calculating dosimetry parameters; and to improve the clarity of the index definitions, XML is applied. The accuracy and the efficiency of the program were evaluated by comparing the results of the program with the manually recorded results in two RTOG trials. A slight difference of about 0.2% in volume or 0.6 Gy in dose between the semi-automated program and manual recording was observed. According to the criteria of indices, there are minimal differences between the two methods. The evaluation time is reduced from 10-20 min to 2 min by applying the semi-automated plan-quality evaluation program.

Rural Child Sexual Abuse Prevention and Treatment.

ERIC Educational Resources Information Center

Ray, JoAnn; Murty, Susan A.

1990-01-01

Reviews literature on rural child sexual abuse and treatment. Surveys providers in rural Washington treatment programs. Responses describe agency characteristics, services, delivery problems, and suggested solutions. Reports providers' perceptions of service quality and interagency cooperation. Cites as problems heavy caseloads, lack of staff, and…

Leadership, Burnout, and Job Satisfaction in Outpatient Drug-Free Treatment Programs

PubMed Central

Broome, Kirk M.; Knight, Danica K.; Edwards, Jennifer R.; Flynn, Patrick M.

2009-01-01

Counselors are a critical component of substance abuse treatment programming, but their working experiences are not yet well understood. As treatment-improvement efforts focus increasingly on these individuals, their perceptions of program leadership, emotional burnout, and job satisfaction and related attitudes take on greater significance. This study explores counselor views and the impact of organizational context using data from a nationwide set of 94 outpatient drug-free (ODF) treatment programs in a hierarchical linear model (HLM) analysis. Results show counselors hold generally positive opinions of program director leadership and job satisfaction, and have low levels of burnout, but they also have important variations in their ratings. Higher counselor caseloads were related to poorer ratings, and leadership behaviors predicted both satisfaction and burnout. These findings add further evidence that treatment providers should also address the workplace environment for staff as part of quality-improvement efforts. PMID:19339143

Leadership, burnout, and job satisfaction in outpatient drug-free treatment programs.

PubMed

Broome, Kirk M; Knight, Danica K; Edwards, Jennifer R; Flynn, Patrick M

2009-09-01

Counselors are a critical component of substance abuse treatment programming, but their working experiences are not yet well understood. As treatment improvement efforts focus increasingly on these individuals, their perceptions of program leadership, emotional burnout, and job satisfaction and related attitudes take on greater significance. This study explores counselor views and the impact of organizational context using data from a nationwide set of 94 outpatient drug-free treatment programs in a hierarchical linear model analysis. Results show counselors hold generally positive opinions of program director leadership and job satisfaction and have low levels of burnout, but they also have important variations in their ratings. Higher counselor caseloads were related to poorer ratings, and leadership behaviors predicted both satisfaction and burnout. These findings add further evidence that treatment providers should also address the workplace environment for staff as part of quality improvement efforts.

40 CFR 122.62 - Modification or revocation and reissuance of permits (applicable to State programs, see § 123.25).

Code of Federal Regulations, 2011 CFR

2011-07-01

... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS EPA ADMINISTERED PERMIT PROGRAMS: THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Transfer, Modification, Revocation and Reissuance, and... limitation guideline, EPA approved or promulgated water quality standards, or the Secondary Treatment...

Quality of Care Provided by a Comprehensive Dementia Care Comanagement Program.

PubMed

Jennings, Lee A; Tan, Zaldy; Wenger, Neil S; Cook, Erin A; Han, Weijuan; McCreath, Heather E; Serrano, Katherine S; Roth, Carol P; Reuben, David B

2016-08-01

Multiple studies have shown that quality of care for dementia in primary care is poor, with physician adherence to dementia quality indicators (QIs) ranging from 18% to 42%. In response, the University of California at Los Angeles (UCLA) Health System created the UCLA Alzheimer's and Dementia Care (ADC) Program, a quality improvement program that uses a comanagement model with nurse practitioner dementia care managers (DCM) working with primary care physicians and community-based organizations to provide comprehensive dementia care. The objective was to measure the quality of dementia care that nurse practitioner DCMs provide using the Assessing Care of Vulnerable Elders (ACOVE-3) and Physician Consortium for Performance Improvement QIs. Participants included 797 community-dwelling adults with dementia referred to the UCLA ADC program over a 2-year period. UCLA is an urban academic medical center with primarily fee-for-service reimbursement. The percentage of recommended care received for 17 dementia QIs was measured. The primary outcome was aggregate quality of care for the UCLA ADC cohort, calculated as the total number of recommended care processes received divided by the total number of eligible quality indicators. Secondary outcomes included aggregate quality of care in three domains of dementia care: assessment and screening (7 QIs), treatment (6 QIs), and counseling (4 QIs). QIs were abstracted from DCM notes over a 3-month period from date of initial assessment. Individuals were eligible for 9,895 QIs, of which 92% were passed. Overall pass rates of DCMs were similar (90-96%). All counseling and assessment QIs had pass rates greater than 80%, with most exceeding 90%. Wider variation in adherence was found among QIs addressing treatments for dementia, which patient-specific criteria triggered, ranging from 27% for discontinuation of medications associated with mental status changes to 86% for discussion about acetylcholinesterase inhibitors. Comprehensive dementia care comanagement with a nurse practitioner can result in high quality of care for dementia, especially for assessment, screening, and counseling. The effect on treatment QIs is more variable but higher than previous reports of physician-provided dementia care. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

MO-E-9A-01: Risk Based Quality Management: TG100 In Action

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huq, M; Palta, J; Dunscombe, P

2014-06-15

One of the goals of quality management in radiation therapy is to gain high confidence that patients will receive the prescribed treatment correctly. To accomplish these goals professional societies such as the American Association of Physicists in Medicine (AAPM) has published many quality assurance (QA), quality control (QC), and quality management (QM) guidance documents. In general, the recommendations provided in these documents have emphasized on performing device-specific QA at the expense of process flow and protection of the patient against catastrophic errors. Analyses of radiation therapy incidents find that they are most often caused by flaws in the overall therapymore » process, from initial consult through final treatment, than by isolated hardware or computer failures detectable by traditional physics QA. This challenge is shared by many intrinsically hazardous industries. Risk assessment tools and analysis techniques have been developed to define, identify, and eliminate known and/or potential failures, problems, or errors, from a system, process and/or service before they reach the customer. These include, but are not limited to, process mapping, failure modes and effects analysis (FMEA), fault tree analysis (FTA), and establishment of a quality management program that best avoids the faults and risks that have been identified in the overall process. These tools can be easily adapted to radiation therapy practices because of their simplicity and effectiveness to provide efficient ways to enhance the safety and quality of treatment processes. Task group 100 (TG100) of AAPM has developed a risk-based quality management program that uses these tools. This session will be devoted to a discussion of these tools and how these tools can be used in a given radiotherapy clinic to develop a risk based QM program. Learning Objectives: Learn how to design a process map for a radiotherapy process. Learn how to perform a FMEA analysis for a given process. Learn what Fault tree analysis is all about. Learn how to design a quality management program based upon the information obtained from process mapping, FMEA and FTA.« less

Protocols for collection of streamflow, water-quality, streambed-sediment, periphyton, macroinvertebrate, fish, and habitat data to describe stream quality for the Hydrobiological Monitoring Program, Equus Beds Aquifer Storage and Recovery Program, city of Wichita, Kansas

USGS Publications Warehouse

Stone, Mandy L.; Rasmussen, Teresa J.; Bennett, Trudy J.; Poulton, Barry C.; Ziegler, Andrew C.

2012-01-01

The city of Wichita, Kansas uses the Equus Beds aquifer, one of two sources, for municipal water supply. To meet future water needs, plans for artificial recharge of the aquifer have been implemented in several phases. Phase I of the Equus Beds Aquifer Storage and Recovery (ASR) Program began with injection of water from the Little Arkansas River into the aquifer for storage and subsequent recovery in 2006. Construction of a river intake structure and surface-water treatment plant began as implementation of Phase II of the Equus Beds ASR Program in 2010. An important aspect of the ASR Program is the monitoring of water quality and the effects of recharge activities on stream conditions. Physical, chemical, and biological data provide the basis for an integrated assessment of stream quality. This report describes protocols for collecting streamflow, water-quality, streambed-sediment, periphyton, macroinvertebrate, fish, and habitat data as part of the city of Wichita's hydrobiological monitoring program (HBMP). Following consistent and reliable methods for data collection and processing is imperative for the long-term success of the monitoring program.

Psychological correlates of obese patients seeking surgical or residential behavioral weight loss treatment.

PubMed

Stout, Anna L; Applegate, Katherine L; Friedman, Kelli E; Grant, John P; Musante, Gerard J

2007-01-01

The purpose of this study was to gain a better understanding of the psychological factors related to obese individuals self-selecting for either a residential cognitive-behavioral-based program or surgical treatment program for weight loss. Two patient samples with a body mass index of > or =35 kg/m(2) were administered a battery of psychological questionnaires, including the Beck Depression Inventory, Binge Eating Scale, and Impact of Weight on Quality of Life-Lite, at the evaluation for entry into either a surgical weight loss treatment program (n = 76) or cognitive-behavioral-based weight loss treatment program (n = 101). No significant difference was found in the mean body mass index of the 2 samples. No significant difference was found in the self-reported level of depressive symptoms of the 2 samples, with both samples obtaining a mean depressive symptom score in the mild range. Surgical treatment seekers, however, reported significantly greater emotional eating and attributed greater impairment in their quality of life to their weight. Individuals seeking a surgical approach to weight loss might perceive their weight as having a greater negative impact on their life than those selecting a residential behavioral lifestyle change approach, even when their weight and depressive symptoms are equivalent. Therefore, an individual's own cognitive appraisal of the negative consequences of their weight might correlate with their treatment choice.

Implementation of Interdisciplinary Cancer Rehabilitation

ERIC Educational Resources Information Center

Cromes, G. Fred, Jr.

1978-01-01

Describes an interdisciplinary cancer-rehabilitation program composed of rehabilitation teams that evaluate patients and suggest or provide treatment with the goal of improved quality of life. Issues, problems, and suggested solutions are discussed with implications for other programs. (Author)

Advanced control technology and airworthiness flying qualities requirements

NASA Technical Reports Server (NTRS)

Snyder, C. T.

1976-01-01

Flying quality requirements are specified in terms of the complete pilot-airframe-systems loop, the task, and the environment. Results from a study of flying qualities are reported. A review of the treatment of failure cases in various flying quality requirements is presented along with a description of the methods used and relevant lessons learned from recent Autoland certification programs.

Mental health team leadership and consumers satisfaction and quality of life.

PubMed

Corrigan, P W; Lickey, S E; Campion, J; Rashid, F

2000-06-01

The purpose of this study was to determine the association between leadership styles of leaders of mental health treatment teams and consumers' ratings of satisfaction with the program and their quality of life. A multifactor model has distinguished three factors relevant to leadership of mental health teams: transformational leadership, in which a leader's primary goal is to lead the team to evolving better programs; transactional leadership, in which the leader strives to maintain effective programs through feedback and reinforcement; and laissez-faire leadership, an ineffective, hands-off leadership style. Research has shown transformational leadership to be positively associated with measures of the team's functioning, but the effects of leadership style on consumers is not well known. A total of 143 leaders and 473 subordinates from 31 clinical teams rated the leadership style of the team leader. In addition, 184 consumers served by these teams rated their satisfaction with the treatment program and their quality of life. Consumers' satisfaction and quality of life were inversely associated with laissez-faire approaches to leadership and positively associated with both transformational and transactional leadership. Moreover, leaders' and subordinates' ratings of team leadership accounted for independent variance in satisfaction ratings-up to 40 percent of the total variance. Leadership seems to be an important variable for understanding a team's impact on its consumers.

Quality Measures for the Care of Patients with Insomnia

PubMed Central

Edinger, Jack D.; Buysse, Daniel J.; Deriy, Ludmila; Germain, Anne; Lewin, Daniel S.; Ong, Jason C.; Morgenthaler, Timothy I.

2015-01-01

The American Academy of Sleep Medicine (AASM) commissioned five Workgroups to develop quality measures to optimize management and care for patients with common sleep disorders including insomnia. Following the AASM process for quality measure development, this document describes measurement methods for two desirable outcomes of therapy, improving sleep quality or satisfaction, and improving daytime function, and for four processes important to achieving these goals. To achieve the outcome of improving sleep quality or satisfaction, pre- and post-treatment assessment of sleep quality or satisfaction and providing an evidence-based treatment are recommended. To realize the outcome of improving daytime functioning, pre- and post-treatment assessment of daytime functioning, provision of an evidence-based treatment, and assessment of treatment-related side effects are recommended. All insomnia measures described in this report were developed by the Insomnia Quality Measures Workgroup and approved by the AASM Quality Measures Task Force and the AASM Board of Directors. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with insomnia. Citation: Edinger JD, Buysse DJ, Deriy L, Germain A, Lewin DS, Ong JC, Morgenthaler TI. Quality measures for the care of patients with insomnia. J Clin Sleep Med 2015;11(3):311–334. PMID:25700881

Quality of friendships and motivation to change in adolescents with Anorexia Nervosa.

PubMed

Malmendier-Muehlschlegel, Anja; Rosewall, Juliet K; Smith, Jared G; Hugo, Pippa; Lask, Bryan

2016-08-01

This study explored the relationship between quality of friendships, motivation to change and peer support among young people receiving inpatient treatment for Anorexia Nervosa (AN). Thirty participants were recruited from three inpatient wards. Questionnaires assessed motivational stage, friendship functions and characteristics of friendships specific to AN. Three friendship functions - Help, Intimacy and Self-Validation - were significantly and positively correlated with greater motivational stage. Describing friends on the ward as supportive of adherence to the treatment program was positively associated with greater motivational stage and higher quality friendships. The association between motivation, friendship quality and peer support in treatment identifies close and supportive friendships among young people with AN as a potential target to improve outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Efficacy of Mobile Health Care Application and Wearable Device in Improvement of Physical Performance in Colorectal Cancer Patients Undergoing Chemotherapy.

PubMed

Cheong, In Yae; An, So Yeon; Cha, Won Chul; Rha, Mi Yong; Kim, Seung Tae; Chang, Dong Kyung; Hwang, Ji Hye

2018-06-01

The use of a mobile health care application, the delivery of health care or health care-related services through the use of portable devices, to manage functional loss, treatment-related toxicities, and impaired quality of life in cancer patients during chemotherapy through supervised self-management has been increasing. The aim of the present study was to evaluate the efficacy and feasibility of comprehensive mobile health care using a tailored rehabilitation program for colorectal cancer patients undergoing active chemotherapy. A total of 102 colorectal cancer patients undergoing chemotherapy underwent 12 weeks of smartphone aftercare through provision of a mobile application and wearable device that included a rehabilitation exercise program and information on their disease and treatment. The grip strength test, 30-second chair stand test, 2-minute walk test, amount of physical activity (International Physical Activity Questionnaire short-form), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30), and nutritional status (Patient-generated Subjective Global Assessment) were assessed and measured at baseline, at mid-intervention (6 weeks), and at completion of the intervention (12 weeks). The rehabilitation exercise intensity was adjusted by the test results at every assessment and through real-time communication between the patients and clinicians. Of the 102 patients, 75 completed all 12 weeks of the smartphone aftercare rehabilitation program. The lower extremity strength (P < .001) and cardiorespiratory endurance (P < .001) was significantly improved. Fatigue (P < .007) and nausea/vomiting (P < .040) symptoms were significantly relieved after the program. A tailored rehabilitation exercise program provided through a comprehensive mobile health care application was effective in improving patients' physical capacity and treatment-related symptoms even during active chemotherapy. Copyright © 2018 Elsevier Inc. All rights reserved.

Comparison of Effectiveness of the Metacognition Treatment and the Mindfulness-Based Stress Reduction Treatment on Global and Specific Life Quality of Women with Breast Cancer

PubMed Central

Rahmani, Soheila; Talepasand, Siavash; Ghanbary-Motlagh, ALi

2014-01-01

Background This study is conducted to compare the metacognition treatment and the mindfulness-based stress reduction treatment on life quality of women with breast cancer. Methods In a quasi-experimental design, with pre-test, post-test and control group, 36 patients with diagnosis of breast cancer, among patients who referred to the Division of Oncology and Radiotherapy of Imam Hossein hospital in Tehran, were selected in accessible way and were assigned randomly to three experimental groups, the first group receiving meta-cognition treatment (n=12), the second one receiving mindfulness-based stress reduction program (n=12), and the other was the control group. Participants completed global life quality in cancer patient's questionnaire and specific quality of life in breast cancer patient's questionnaire in three stages: baseline, after intervention and two-month follow-up. Data were analyzed using the multivariate repeated measurement model. Results Findings showed both treatments were effective in improving global and specific quality of life in patients with breast cancer. The mindfulness -based stress reduction treatment excelled in functions and roles, fatigue, pain, future perspective and treatment side effects symptoms at the end of the treatment and follow-up in comparison to the metacognition treatment. Conclusion Results of this research showed the mindfulness-based stress reduction treatment can be effective in improving global and specific life quality of women with breast cancer and is a selective method for improving quality of life in patients. PMID:25628839

Can disease management reduce health care costs by improving quality?

PubMed

Fireman, Bruce; Bartlett, Joan; Selby, Joe

2004-01-01

Disease management (DM) promises to achieve cost savings by improving the quality of care for chronic diseases. During the past decade the Permanente Medical Group in Northern California has implemented extensive DM programs. Examining quality indicators, utilization, and costs for 1996-2002 for adults with four conditions, we find evidence of substantial quality improvement but not cost savings. The causal pathway--from improved care to reduced morbidity to cost savings--has not produced sufficient savings to offset the rising costs of improved care. We conclude that the rationale for DM programs, like the rationale for any medical treatments, should rest on their effectiveness and value.

The effectiveness of patient navigation programs for adult cancer patients undergoing treatment: a systematic review.

PubMed

Tho, Poh Chi; Ang, Emily

2016-02-01

Advancements in technology and medical treatment have made cancer care treatment more complex. With the current trend of sub-specialization in health care, cancer patients commonly receive care from multiple specialists and have wider treatment options. In view of this, there is a need to coordinate care and integrate information to enhance care and quality of outcomes for patients. Since the successful implementation of programs for increasing the survival rate of breast cancer patients at Harlem Hospital Center, New York, USA, patient navigation programs have been widely introduced in healthcare settings. Some literature has identified nurses as a primary candidate in assuming the role of a navigator. However, there is a need to further explore the effectiveness of patient navigation programs for their effectiveness in improving quality of life, and patient satisfaction and outcomes during the commencement of cancer treatment. The objective of this review was to synthesize the best available evidence on the effectiveness of patient navigation programs in adult cancer patients undergoing treatments such as radiotherapy and/or chemotherapy. This review considered studies that included adults aged 18 years and over, diagnosed with any type of cancer and undergoing treatment in an acute care hospital setting, including inpatient and outpatient/ambulatory care.This review considered studies that evaluated nurse-led patient navigation programs versus no patient navigation program or non-structured care coordination.A patient navigation program includes patient education, psychosocial support, and care coordination.This review considered randomized controlled trials and quasi-experimental studies.The review focused on the effects of patient navigator program clinical/patient outcomes. The review included studies on patient wellbeing and clinical outcomes, but excluded studies that had examined the impact of these programs on efficiency-related outcomes, such as length of hospital stay and resource use. A three-step search strategy was utilized to find both published and unpublished studies in the databases: CINAHL, MEDLINE, Academic Search Complete, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, Google Scholar (SCIRUS), MEDNAR (first 200 hits) and ProQuest Dissertations and Theses published between 1990 to 2013. Only studies published in English were included in this review. Two reviewers independently evaluated the methodological quality of studies that met the inclusion criteria for the review, using a standardized critical appraisal instrument from the Joanna Briggs Institute. Data was extracted from the included papers using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Quantitative data was pooled in a statistical meta-analysis using Review Manager 5.3. Effect sizes expressed as weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis. Heterogeneity was assessed statistically using the standard Chi-square test. Where statistical pooling was not possible, the findings are presented in narrative form. After the process of study selection, four studies (two randomized controlled trials and two quasi-experimental studies) with a total of 667 participants were included in the review. The results demonstrated no statistically significant difference in the quality of life of patients with cancer who had undergone patient navigation programs (pooled weighted difference = 0.41 [95% CI = -2.89 to 3.71], P=0.81). However, the two included studies that assessed patient satisfaction as an outcome measure both showed statistically significant improvements (p-values = 0.03 and 0.001, respectively). In the study that assessed patient distress level, there was no statistically significant difference found between the: nurse-led navigation and non-navigation groups (P = 0.675). Nurse-led patient navigation programs were not effective in addressing outcomes such as quality of life and distress levels, the systematic review did not find any significant difference between the two groups. However, there was a statistically significance difference in increasing patient satisfaction.There is limited evidence that patient navigation programs improve the outcomes of quality of life and reduce distress (for adult patients with cancer undergoing treatment). However, there is good evidence that patient navigation programs improve patients' satisfaction. Therefore it is recommended that patient navigation programs are used for adult cancer patients in the acute care setting to improve patients' satisfaction.There may be a need to explore a more rigorous evaluation of nurse-led navigation programs to determine their effectiveness. Researchers should consider multi-site studies and larger sample sizes for better generalization.

Establishing an endovascular carotid stent program.

PubMed

Raabe, Rod; Chong, Brian

2004-12-01

FDA approval of carotid stent and distal protection devices has transformed carotid artery stenting (CAS) from an investigational procedure to a practical application. Recent approval by the Center for Medicare Services (CMS) has ensured that CAS will be a part of everyday practice throughout the country. To establish a competitive endovascular carotid stent program, one needs to develop an effective strategy. The key to success is substance and service. A high-quality clinical program with excellent communication between the patient and referring physician is essential. You must first get access to the patient by establishing a clinical practice. As a radiologist, you have the advantage of gaining access by identifying appropriate patients through noninvasive vascular labs, CTA, and MRA. An algorithm-driven evaluation and treatment protocol with good pre- and postoperative care, along with a quality assurance program, will ensure that your carotid stent program has substance and delivers optimal service. With good planning, you will have a firm clinical foundation for treatment of carotid artery stenosis in your community. Putting all of the ingredients together will ensure a successful carotid endovascular program.

Influence of a preventive program on the oral health-related quality of life (OHRQoL) of European pregnant women: a cohort study.

PubMed

Martínez-Beneyto, Yolanda; Montero-Martin, Javier; Garcia-Navas, Francisco; Vicente-Hernandez, Ascension; Ortiz-Ruiz, Antonio Jose; Camacho-Alonso, Fabio

2018-04-06

The aim of this study was to compare the impact of oral health on quality of life of a group of pregnant women enrolled in a program of oral health with respect to a control group of non-pregnant women. A cross-sectional study involving a sociodental indicator OHIP-14 and a dental examination was completed to assess pregnant women's knowledge of oral health, hygienic habits, periodontal and caries index. Data were collected from 113 pregnant women and 113 non-pregnant women. Sociodemographic data for both groups were homogeneous. Pregnant women have better values of general and oral health, even though they have not perceived need for dental treatment, compared with control group. A worse periodontal health was observed for the control group. Our results showed that quality of life in pregnant women has been influenced with a statistical significance (p < 0.05) by the variables age, unemployment, level of education, immigration, frequency of brushing, type of dental practice, self-reported general and oral health and perceived treatment needs. The oral quality of life of pregnant women seems to be positively influenced by the incorporation of preventive oral programs during pregnancy.

Predictive and Treatment Validity of Life Satisfaction and the Quality of Life Inventory

ERIC Educational Resources Information Center

Frisch, Michael B.; Clark, Michelle P.; Rouse, Steven V.; Rudd, M. David; Paweleck, Jennifer K.; Greenstone, Andrew; Kopplin, David A.

2005-01-01

The clinical and positive psychology usefulness of quality of life, well-being, and life satisfaction assessments depends on their ability to predict important outcomes and to detect intervention-related change. These issues were explored in the context of a program of instrument validation for the Quality of Life Inventory (QOLI) involving 3,927…

Effects of the Family Schizophrenia Psychoeducation Program for Individuals with Recent Onset Schizophrenia in Viet Nam

PubMed Central

Ngoc, T. N.; Weiss, B.; Trung, L. T.

2016-01-01

Objective Although psychoeducation has been found effective for improving the life functioning of patients with schizophrenia in high income countries, there have been relatively few studies of schizophrenia psychoeducation adapted for low and middle-income countries (LMIC), particularly in Southeast Asia. The present study assessed effects of the Family Schizophrenia Psychoeducation Program (FSPP) among Vietnamese patients and their families on the patients’ (1) quality of life and (2) medication non-compliance, and the family and patients’ (3) stigma towards schizophrenia, and (4) consumer satisfaction. Method This intervention study involved 59 patients, and their families, from the Da Nang Psychiatric Hospital, randomly assigned to treatment (n=30) or control (n=29) conditions. Control subjects received services as usual (antipsychotic medication); treatment group subjects received the FSPP as well. Blind-rater assessments were conducted at T1 immediately after project enrollment (prior to participating in the FSPP) and at T2 six months later. Results There were significant treatment effects on: (1) quality of life, (2) stigma, (3) medication compliance, and (4) consumer satisfaction, with all effects favoring the treatment group. Effect sizes were moderate to large. Conclusions This psychoeducation program appears to reduce stigma, improve quality of life and medication compliance, and increase consumer satisfaction of Vietnamese patients with schizophrenia and their families, beyond the effects of antipsychotic medication. It involves relatively little cost, and it may be useful for it or equivalent programs to be implemented in other hospitals in Viet Nam, and potentially other low-income Asian countries to improve the lives of patients with schizophrenia. PMID:27520922

Effects of the family schizophrenia psychoeducation program for individuals with recent onset schizophrenia in Viet Nam.

PubMed

Ngoc, T N; Weiss, B; Trung, L T

2016-08-01

Although psychoeducation has been found effective for improving the life functioning of patients with schizophrenia in high income countries, there have been relatively few studies of schizophrenia psychoeducation adapted for low and middle-income countries (LMIC), particularly in Southeast Asia. The present study assessed effects of the Family Schizophrenia Psychoeducation Program (FSPP) among Vietnamese patients and their families on the patients' (1) quality of life and (2) medication non-compliance, and the family and patients' (3) stigma towards schizophrenia, and (4) consumer satisfaction. This intervention study involved 59 patients, and their families, from the Da Nang Psychiatric Hospital, randomly assigned to treatment (n=30) or control (n=29) conditions. Control subjects received services as usual (antipsychotic medication); treatment group subjects received the FSPP as well. Blind-rater assessments were conducted at T1 immediately after project enrollment (prior to participating in the FSPP) and at T2 six months later. There were significant treatment effects on: (1) quality of life, (2) stigma, (3) medication compliance, and (4) consumer satisfaction, with all effects favoring the treatment group. Effect sizes were moderate to large. This psychoeducation program appears to reduce stigma, improve quality of life and medication compliance, and increase consumer satisfaction of Vietnamese patients with schizophrenia and their families, beyond the effects of antipsychotic medication. It involves relatively little cost, and it may be useful for it or equivalent programs to be implemented in other hospitals in Viet Nam, and potentially other low-income Asian countries to improve the lives of patients with schizophrenia. Copyright © 2016 Elsevier B.V. All rights reserved.

Services Received and Parental Perception of Quality of Life for Children with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Cholewicki, Judith Marie

2015-01-01

With the rapid increase in the rate of children diagnosed with Autism Spectrum Disorder (ASD), there has been a surge in treatment interventions and outcome measures. Treatment interventions consist of evidence-based practices and programs that lack scientific validation. Parents' selection of a treatment or multiple treatments is often based on…

Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial

PubMed Central

Wang, Philip S.; Simon, Gregory E.; Avorn, Jerry; Azocar, Francisca; Ludman, Evette J.; McCulloch, Joyce; Petukhova, Maria Z.; Kessler, Ronald C.

2010-01-01

Context Although guideline-concordant depression treatment is clearly effective, treatment often falls short of evidence-based recommendations. Organized depression care programs significantly improve treatment quality, but employer-purchasers have been slow to demand these programs based on lack of evidence for cost-effectiveness from their perspective. Objective To evaluate the effects of a depression outreach-treatment program on workplace outcomes of concern to employers. Design Randomized controlled trial with allocation concealment and blinded assessment of depression severity and work performance at 6 and 12 months. Setting and Participants Two-stage screening of employees covered by a managed behavioral health plan identified 604 with clinically significant depression (excluding those with lifetime bipolar disorder, substance disorder, recent mental health specialty care, or suicidality). Intervention A telephonic outreach and care management program encouraged workers to enter outpatient treatment (psychotherapy and/or antidepressant medication), monitored treatment quality-continuity, and attempted to improve treatment by giving recommendations to providers. Participants reluctant to enter treatment were offered a structured telephone cognitive-behavioral psychotherapy. Main Outcome Measures Depression severity (Quick Inventory of Depressive Symptomatology, QIDS-SR) and work performance (WHO Health and Productivity Questionnaire, HPQ, a validated self-report instrument assessing job retention, time missed from work, work performance, and critical workplace incidents). Results Combining data across 6-month and 12-month assessments, the intervention group had significantly lower QIDS-SR scores (1.4 relative-odds of recovery), significantly higher job retention (1.7 relative-odds), and significantly more hours worked among the employed (equivalent to an annualized effect of approximately 2.5 weeks of work) than usual care subjects. Conclusions A systematic program to identify depression and promote effective treatment significantly improves not only clinical outcomes but also workplace outcomes. The financial value of the latter to employers in terms of recovered hiring-training and salary costs suggests that many employers would experience a positive return on investment from outreach and enhanced treatment of depressed workers. PMID:17895456

Health-Related Quality of Life, Depression, Anxiety, and Self-Image in Acute Lymphocytic Leukemia Survivors.

PubMed

Baytan, Birol; Aşut, Çiğdem; Çırpan Kantarcıoğlu, Arzu; Sezgin Evim, Melike; Güneş, Adalet Meral

2016-12-01

With increasing survival rates in childhood acute lymphocytic leukemia (ALL), the long-term side effects of treatment have become important. Our aim was to investigate health-related quality of life, depression, anxiety, and self-image among ALL survivors. Fifty patients diagnosed with ALL and their siblings were enrolled. The Kovacs Children's Depression Inventory, State-Trait Anxiety Inventory, Offer Self-Image Questionnaire, and Pediatric Quality of Life InventoryTM were used for collecting data. ANOVA tests were used to determine if there were any significant differences between groups. ALL survivors had higher depression, more anxiety symptoms, lower quality of life, and more negative self-image when compared to their siblings. Continuous diagnostic and interventional mental health services might be necessary for possible emotional side effects of treatment during and after the treatment. Rehabilitation and follow-up programs should be implemented for children during and after treatment for ALL.

WE-A-BRE-01: Debate: To Measure or Not to Measure

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moran, J; Miften, M; Mihailidis, D

2014-06-15

Recent studies have highlighted some of the limitations of patient-specific pre-treatment IMRT QA measurements with respect to assessing plan deliverability. Pre-treatment QA measurements are frequently performed with detectors in phantoms that do not involve any patient heterogeneities or with an EPID without a phantom. Other techniques have been developed where measurement results are used to recalculate the patient-specific dose volume histograms. Measurements continue to play a fundamental role in understanding the initial and continued performance of treatment planning and delivery systems. Less attention has been focused on the role of computational techniques in a QA program such as calculation withmore » independent dose calculation algorithms or recalculation of the delivery with machine log files or EPID measurements. This session will explore the role of pre-treatment measurements compared to other methods such as computational and transit dosimetry techniques. Efficiency and practicality of the two approaches will also be presented and debated. The speakers will present a history of IMRT quality assurance and debate each other regarding which types of techniques are needed today and for future quality assurance. Examples will be shared of situations where overall quality needed to be assessed with calculation techniques in addition to measurements. Elements where measurements continue to be crucial such as for a thorough end-to-end test involving measurement will be discussed. Operational details that can reduce the gamma tool effectiveness and accuracy for patient-specific pre-treatment IMRT/VMAT QA will be described. Finally, a vision for the future of IMRT and VMAT plan QA will be discussed from a safety perspective. Learning Objectives: Understand the advantages and limitations of measurement and calculation approaches for pre-treatment measurements for IMRT and VMAT planning Learn about the elements of a balanced quality assurance program involving modulated techniques Learn how to use tools and techniques such as an end-to-end test to enhance your IMRT and VMAT QA program.« less

Reciprocal effects among changes in weight, body image, and other psychological factors during behavioral obesity treatment: a mediation analysis.

PubMed

Palmeira, António L; Markland, David A; Silva, Marlene N; Branco, Teresa L; Martins, Sandra C; Minderico, Cláudia S; Vieira, Paulo N; Barata, José T; Serpa, Sidónio O; Sardinha, Luis B; Teixeira, Pedro J

2009-02-09

Changes in body image and subjective well-being variables (e.g. self-esteem) are often reported as outcomes of obesity treatment. However, they may, in turn, also influence behavioral adherence and success in weight loss. The present study examined associations among obesity treatment-related variables, i.e., change in weight, quality of life, body image, and subjective well-being, exploring their role as both mediators and outcomes, during a behavioral obesity treatment. Participants (BMI = 31.1 +/- 4.1 kg/m2; age = 38.4 +/- 6.7 y) were 144 women who attended a 12-month obesity treatment program and a comparison group (n = 49), who received a general health education program. The intervention included regular group meetings promoting lasting behavior changes in physical activity and dietary intake. Body image, quality of life, subjective well-being, and body weight were measured at baseline and treatment's end. Mediation was tested by multiple regression and a resampling approach to measure indirect effects. Treatment group assignment was the independent variable while changes in weight and in psychosocial variables were analyzed alternatively as mediators and as dependent variables. At 12 months, the intervention group had greater weight loss (-5.6 +/- 6.8% vs. -1.2 +/- 4.6%, p < .001) and larger decreases in body size dissatisfaction (effect size of 1.08 vs. .41, p < .001) than the comparison group. Significant improvements were observed in both groups for all other psychosocial variables (effect sizes ranging from .31-.75, p < .05). Mediation analysis showed that changes in body image and body weight were concurrently mediators and outcomes of treatment, suggesting reciprocal influences. Weight loss partially mediated the effect of treatment on quality of life and on self-esteem but the reciprocal effect was not observed. Changes in weight and body image may reciprocally affect each other during the course of behavioral obesity treatment. No evidence of reciprocal relationships was found for the other models under analysis; however, weight changes partially explained the effects of treatment on quality of life and self-esteem. Weight and psychosocial changes co-occur during treatment and will probably influence each other dynamically, in ways not yet adequately understood. Results from this study support the inclusion of intervention contents aimed at improving body image in weight management programs.

An Adaptation of Family-Based Behavioral Pediatric Obesity Treatment for a Primary Care Setting: Group Health Family Wellness Program Pilot

PubMed Central

Riggs, Karin R; Lozano, Paula; Mohelnitzky, Amy; Rudnick, Sarah; Richards, Julie

2014-01-01

Objective: To assess the feasibility and acceptability of family-based group pediatric obesity treatment in a primary care setting, to obtain an estimate of its effectiveness, and to describe participating parents’ experiences of social support for healthy lifestyle changes. Methods: We adapted an evidence-based intervention to a group format and completed six 12- to 16-week groups over 3 years. We assessed program attendance and completion, changes in child and parent body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and changes in child quality of life in a single-arm before-and-after trial. Qualitative interviews explored social support for implementing healthy lifestyle changes. Results: Thirty-eight parent-child pairs enrolled (28% of the 134 pairs invited). Of those, 24 (63%) completed the program and another 6 (16%) attended at least 4 sessions but did not complete the program. Children who completed the program achieved a mean change in BMI Z-scores (Z-BMI) of −0.1 (0.1) (p < 0.001) and significant improvement in parent-reported child quality of life (mean change = 8.5; p = 0.002). Mean BMI of parents changed by −0.9 (p = 0.003). Parents reported receiving a wide range of social support for healthy lifestyle changes and placed importance on the absence or presence of support. Conclusions: A pilot group program for family-based treatment of pediatric obesity is feasible and acceptable in a primary care setting. Change in child and parent BMI outcomes and child quality of life among completers were promising despite the pilot’s low intensity. Parent experiences with lack of social support suggest possible ways to improve retention and adherence. PMID:24937148

Nordic walking for cardiovascular prevention in patients with ischaemic heart disease or metabolic syndrome.

PubMed

Vehí, Cristina; Falces, Carles; Sarlat, Miquel Àngel; Gonzalo, Ana; Andrea, Rut; Sitges, Marta

2016-12-16

The incidence of atherosclerotic diseases has increased in Europe due in part to the population's sedentary lifestyle. Physical activity is useful for cardiovascular prevention. Nordic walking (NW) mobilizes a great number of muscular groups and is very popular in northern Europe. There is no data available on its impact in the healthcare system of the Mediterranean area. We propose the implementation of a NW program to promote physical activity and control cardiovascular risk factors (CVRF), as well as to improve quality of life and the adherence to medical treatment in patients with a chronic ischemic heart disease or metabolic syndrome. We selected patients with uncontrolled CVRFs. These patients performed 2 weekly sessions of NW over the course of one year. Baseline data extracted from the patients' medical history, quality of life questionnaires and on adherence to treatment was compared with the results obtained at the end of the program. A reduction in the rate of CVRFs from 4.78 to 3 was observed, with an evident trend towards the improvement of the patients' quality of life and a better adherence to the treatment. The implementation of a NW program is feasible in the public healthcare system and can aid in the management of CVRFs. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Effects of occupational therapy on quality of life of patients with metastatic prostate cancer

PubMed Central

Huri, Meral; Huri, Emre; Kayihan, Hulya; Altuntas, Onur

2015-01-01

Objectives: To evaluate the efficiency of occupational therapy relative to a home program in improving quality of life (QoL) among men who were treated for metastatic prostate cancer (MPC). Methods: Fifty-five men were assigned randomly to either the 12-week cognitive behavioral therapy based occupational therapy (OT-CBSM) intervention (treatment group) or a home program (control group) between March 2012 and August 2014 in the Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey. The Canadian Occupational Performance Measure (COPM) was used to measure the occupational performance and identify difficulties in daily living activities. The QoL and symptom status were measured by The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 and its Prostate Cancer Module. A 12-week OT-CBSM intervention including client-centered training of daily living activities, recreational group activities, and cognitive behavioral stress management intervention were applied. Results: The COPM performance and satisfaction scores, which indicate occupational participation and QoL increased statistically in the treatment group in relation to men who were included in the home-program (p≤0.05). Conclusion: A 12-week OT-CBSM intervention was effective in improving QoL in men treated for MPC, and these changes were associated significantly with occupational performance. PMID:26219446

Treatment Options for Adults with Snoring

MedlinePlus

... Programs Professional Development Home AcademyU Home Study Course Maintenance of Certification Conferences & Events Practice Management Home Resources Quality Clinical Data Registry Research Reimbursement ...

40 CFR 130.11 - Program management.

Code of Federal Regulations, 2011 CFR

2011-07-01

... quality standards (WQS), development of alternative approaches to control pollution, implementation and... primarily to manage the wastewater treatment works construction grants program pursuant to the provisions of 40 CFR part 35, subpart J. A State may also use part of the 205(g) funds to administer approved...

The Performance of Adsorptive Media Full Scale Arsenic Removal Systems - USEPA Arsenic Demonstration Program

EPA Science Inventory

The presentation provides information and data on the performance of several full scale, arsenic removal adsorptive media treatment systems operated under the USEPA arsenic removal demonstration program. The summary includes information on the water quality of the source waters,...

Organizational attributes of practices successful at a disease management program.

PubMed

Cloutier, Michelle M; Wakefield, Dorothy B; Tsimikas, John; Hall, Charles B; Tennen, Howard; Brazil, Kevin

2009-02-01

To assess the contribution of organizational factors to implementation of 3 asthma quality measures: enrollment in a disease management program, development of a written treatment plan, and prescription of severity-appropriate anti-inflammatory therapy. A total of 138 pediatric clinicians and 247 office staff in 13 urban clinics and 23 nonurban private practices completed questionnaires about their practice's organizational characteristics (eg, leadership, communication, perceived effectiveness, job satisfaction). 94% of the clinicians and 92% of the office staff completed questionnaires. When adjusted for confounders, greater practice activity and perceived effectiveness in meeting family needs were associated with higher rates of enrollment in the Easy Breathing program, whereas higher scores for 3 organizational characteristics--communication timeliness, decision authority, and job satisfaction--were associated with both higher enrollment and a greater number of written treatment plans. None of the organizational characteristics was associated with greater use of anti-inflammatory therapy. Three organizational characteristics predicted 2 quality asthma measures: use of a disease management program and creation of a written asthma treatment plan. If these organizational characteristics were amenable to change, then our findings could help focus interventions in areas of effective and acceptable organizational change.

[E-health within the Dutch mental health services: what is the current situation?].

PubMed

Smeets, Odile; Martin Abello, Katherina; Zijlstra-Vlasveld, Moniek; Boon, Brigitte

2014-01-01

The 'e-mental health' currently available, which also covers m-health and i-health, varies from psycho-education and self-tests to self-help, treatment and contact with fellow sufferers. Many programs are based on cognitive behavioural therapy, but other types of therapy are also used. Research shows that online programs for depression, alcohol problems and anxiety can reduce these symptoms and can be cost effective. This applies to both self-help and treatment programs. Many e-programs in the Netherlands have been developed for the Dutch Association of Mental Health and Addiction Care (GGZ) and for treatment of addiction problems. One problem with e-mental-health is that provision is fragmented, and there is no national overview, while insight into quality is important for patients and professionals. The quality hallmark 'Onlinehulpstempel.nl' ('Online help hallmark') provides this insight. The use of e-mental-health within Dutch healthcare services is still in its infancy. New financing methods are stimulating general practitioners to use it. The consolidation of online and face-to-face care ('blended e-health') provides an opportunity for patients and GGZ support personnel within general practice to start to use e-health.

Quality assurance in head and neck surgical oncology: EORTC 24954 trial on larynx preservation.

PubMed

Leemans, C R; Tijink, B M; Langendijk, J A; Andry, G; Hamoir, M; Lefebvre, J L

2013-09-01

The Head and Neck Cancer Group (HNCG) of the EORTC conducted a quality assurance program in the EORTC 24954 trial on larynx preservation. In this multicentre study, patients with resectable advanced squamous cell carcinoma of the larynx or hypopharynx were randomly assigned for treatment with sequential or alternating chemoradiation. The need for a quality assurance program is the evaluation and prevention of differences in treatments between centres in this multidisciplinary study. The surgical subcommittee of the HNCG prepared a questionnaire, and clinical records of all patients were verified during audits of independent teams. Data relating institutional practices were collected during a face to face interview with members of the local team. 271 clinical records from the nine main contributing centres were reviewed. The main difference between centres was the time interval between first consultation and treatment initiation, with a mean of 45 days. On the pathology report the nodal involvement was described by level in 36% of the cases according to the American Academy of Otolaryngology-Head and Neck Surgery classification. Extranodal spread was not always described in neck dissection specimens. The EORTC 24954 trial on larynx preservation was the first prospective trial with a quality assurance program in head and neck surgical oncology. The analysis shows similarities in practices, but also points out some important differences between centres. Operation reports were fairly complete, but uniformity in pathology reports should be improved. Copyright © 2013 Elsevier Ltd. All rights reserved.

Using concept mapping to design an indicator framework for addiction treatment centres.

PubMed

Nabitz, Udo; van Den Brink, Wim; Jansen, Paul

2005-06-01

The objective of this study is to determine an indicator framework for addiction treatment centres based on the demands of stakeholders and in alignment with the European Foundation for Quality Management (EFQM) Excellence Model. The setting is the Jellinek Centre based in Amsterdam, the Netherlands, which serves as a prototype for an addiction treatment centre. Concept mapping was used in the construction of the indicator framework. During the 1-day workshop, 16 stakeholders generated, prioritized and sorted 73 items concerning quality and performance. Multidimensional scaling and cluster analysis was applied in constructing a framework consisting of two dimensions and eight clusters. The horizontal axis of the indicator framework is named 'Organization' and has two poles, namely, 'Processes' and 'Results'. The vertical axis is named ' Task' and the poles are named 'Efficient treatment' and 'Prevention programs'. The eight clusters in the two-dimensional framework are arranged in the following, prioritized sequence: 'Efficient treatment network', 'Effective service', ' Target group', 'Quality of life', 'Efficient service', 'Knowledge transfer', 'Reducing addiction related problems', and 'Prevention programs'. The most important items in the framework are: 'patients are satisfied with their treatment', 'early interventions', and 'efficient treatment chain'. The indicator framework aligns with three clusters of the results criteria of the EFQM Excellence Model. It is based on the stakeholders' perspectives and is believed to be specific for addiction treatment centres. The study demonstrates that concept mapping is a suitable strategy for generating indicator frameworks.

Effects of a multidisciplinar cognitive rehabilitation program for patients with mild Alzheimer's disease

PubMed Central

Viola, Luciane F.; Nunes, Paula V.; Yassuda, Monica S.; Aprahamian, Ivan; Santos, Franklin S.; Santos, Glenda D.; Brum, Paula S.; Borges, Sheila M.; Oliveira, Alexandra M.; Chaves, Gisele F. S.; Ciasca, Eliane C.; Ferreira, Rita C. R.; de Paula, Vanessa J. R.; Takeda, Oswaldo H.; Mirandez, Roberta M.; Watari, Ricky; Falcão, Deusivania V. S.; Cachioni, Meire; Forlenza, Orestes V.

2011-01-01

OBJECTIVE: To evaluate the effects of a multidisciplinary rehabilitation program on cognition, quality of life, and neuropsychiatric symptoms in patients with mild Alzheimer's disease. METHOD: The present study was a single-blind, controlled study that was conducted at a university-based day-hospital memory facility. The study included 25 Alzheimer's patients and their caregivers and involved a 12-week stimulation and psychoeducational program. The comparison group consisted of 16 Alzheimer's patients in waiting lists for future intervention. INTERVENTION: Group sessions were provided by a multiprofessional team and included memory training, computer-assisted cognitive stimulation, expressive activities (painting, verbal expression, writing), physiotherapy, and physical training. Treatment was administered twice a week during 6.5-h gatherings. MEASUREMENTS: The assessment battery comprised the following tests: Mini-Mental State Examination, Short Cognitive Test, Quality of Life in Alzheimer's disease, Neuropsychiatric Inventory, and Geriatric Depression Scale. Test scores were evaluated at baseline and the end of the study by raters who were blinded to the group assignments. RESULTS: Measurements of global cognitive function and performance on attention tasks indicated that patients in the experimental group remained stable, whereas controls displayed mild but significant worsening. The intervention was associated with reduced depression symptoms for patients and caregivers and decreased neuropsychiatric symptoms in Alzheimer's subjects. The treatment was also beneficial for the patients' quality of life. CONCLUSION: This multimodal rehabilitation program was associated with cognitive stability and significant improvements in the quality of life for Alzheimer's patients. We also observed a significant decrease in depressive symptoms and caregiver burden. These results support the notion that structured nonpharmacological interventions can yield adjunct and clinically relevant benefits in dementia treatment. PMID:21915490

Yoga and compassion meditation program improve quality of life and self-compassion in family caregivers of Alzheimer's disease patients: A randomized controlled trial.

PubMed

Danucalov, Marcelo Ad; Kozasa, Elisa H; Afonso, Rui F; Galduroz, José Cf; Leite, José R

2017-01-01

To investigate the effects of the practice of yoga in combination with compassion meditation on the quality of life, attention, vitality and self-compassion of family caregivers of patients with Alzheimer's disease. A total of 46 volunteers were randomly allocated to two groups, the yoga and compassion meditation program group (n = 25), and the control group (CG) that received no treatment (n = 21). The program lasted 8 weeks, and comprised three yoga and meditation practices per week, with each session lasting 1 h and 15 min. Quality of life, attention, vitality, and self-compassion scores were measured pre- and postintervention. The yoga and compassion meditation program group showed statistically significant improvements (P < 0.05) on quality of life, attention, vitality and self-compassion scores as compared with the control group, which showed no statistical significant differences at the postintervention time-point. The findings of the present study suggest that an 8-week yoga and compassion meditation program can improve the quality of life, vitality, attention, and self-compassion of family caregivers of Alzheimer's disease patients. Geriatr Gerontol Int 2017; 17: 85-91. © 2015 Japan Geriatrics Society.

The Use of Breathing Exercises in the Treatment of Chronic, Nonspecific Low Back Pain.

PubMed

Anderson, Barton E; Bliven, Kellie C Huxel

2017-09-01

Clinical Scenario: Research has shown a link between poor core stability and chronic, nonspecific low back pain, with data to suggest that alterations in core muscle activation patterns, breathing patterns, lung function, and diaphragm mechanics may occur. Traditional treatment approaches for chronic, nonspecific low back pain focus on exercise and manual therapy interventions, however it is not clear whether breathing exercises are effective in treating back pain. Focused Clinical Question: In adults with chronic, nonspecific low back pain, are breathing exercises effective in reducing pain, improving respiratory function, and/or health related quality of life? Summary of Key Findings: Following a literature search, 3 studies were identified for inclusion in the review. All reviewed studies were critically appraised at level 2 evidence and reported improvements in either low back pain or quality of life following breathing program intervention. Clinical Bottom Line: Exercise programs were shown to be effective in improving lung function, reducing back pain, and improving quality of life. Breathing program frequencies ranged from daily to 2-3 times per week, with durations ranging from 4 to 8 weeks. Based on these results, athletic trainers and physical therapists caring for patients with chronic, nonspecific low back pain should consider the inclusion of breathing exercises for the treatment of back pain when such treatments align with the clinician's own judgment and clinical expertise and the patient's preferences and values. Strength of Recommendation: Grade B evidence exists to support the use of breathing exercises in the treatment of chronic, nonspecific low back pain.

Transdiagnostic computerised cognitive behavioural therapy for depression and anxiety: A systematic review and meta-analysis.

PubMed

Newby, Jill M; Twomey, Conal; Yuan Li, Susan Shi; Andrews, Gavin

2016-07-15

An increasing number of computerised transdiagnostic cognitive behavioural therapy programs (TD-cCBT) have been developed in the past decade, but there are no meta-analyses to explore the efficacy of these programs, nor moderators of the effects. The current meta-analysis focused on studies evaluating TD-cCBT interventions to examine their effects on anxiety, depression and quality of life (QOL). Results from 17 RCTs showed computerised TD-cCBT outperformed control conditions on all outcome measures at post-treatment, with large effect sizes for depression (g's=.84), and medium effect sizes for anxiety (g=.78) and QOL (g=.48). RCT quality was generally good, although heterogeneity was moderate to high. Further analyses revealed that studies comparing TD-cCBT to waitlist controls had the largest differences (g=.93) compared to active (g=.59) and usual care control groups (g=.37) on anxiety outcomes, but there was no influence of control group subtype on depression outcomes. Treatment length, symptom target (mixed versus anxiety only), treatment design (standardised versus tailored), and therapist experience (students versus qualified therapists) did not influence the results. Preliminary evidence from 4 comparisons with disorder-specific treatments suggests transdiagnostic treatments are as effective for reducing anxiety, and there may be small but superior outcomes for TD-cCBT programs for reducing depression (g=.21) and improving QOL (g=.21) compared to disorder-specific cCBT. These findings show that TD-cCBT programs are efficacious, and have comparable effects to disorder-specific cCBT programs. Copyright © 2016 Elsevier B.V. All rights reserved.

Optimal-rearing density for head-starting green turtles (Chelonia mydas Linnaeus, 1758).

PubMed

Kanghae, Hirun; Thongprajukaew, Karun; Jatupornpitukchat, Sasiporn; Kittiwattanawong, Kongkiat

2016-09-01

While ex situ conservation programs of juvenile green turtles (Chelonia mydas Linnaeus, 1758), before release to natural habitats, have been conducted in several countries, the optimal-stocking density for husbandry has not yet been reported. The optimization of stocking density was the main purpose of this study. The 15-day-old post-hatching turtles (29.30 ± 0.05 g body weight) were reared in round fiberglass tanks at various stocking densities including 20 turtles/m 3 (20TM), 40 turtles/m 3 (40TM), 60 turtles/m 3 (60TM), and 80 turtles/m 3 (80TM), over an 8-week trial. Water quality, survival, growth performance, feed utilization, aggressive behavior, fecal digestive enzymes, and hematological parameters were compared between the treatments, and were used as indicators of a successful captive rearing program. The water quality across the four treatments was in the standard range, but a high-stocking density reduced the quality significantly. No mortality was observed in any treatment group. Superior growth and feed utilization were only observed with the 40TM treatment, relative to the others (P < 0.05). The turtles in this group had no aggressive behavior, as indicated by observing hind limb biting. This treatment manipulated the level of proteolytic activity of pepsin and trypsin in response to density stressor, but not amylase, lipase, and chymotrypsin. The 40TM treatment also maintained the hematological characteristics, indicating no negative effects on health status. Overall, the findings indicate that the captivity program of post-hatching turtles at 40 turtles/m 3 is the preferred option in their head-started propagation, as well as in public displays in zoos or aquaria. Zoo Biol. 35:454-461, 2016. © Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

"Talkin' about a revolution": How electronic health records can facilitate the scale-up of HIV care and treatment and catalyze primary care in resource-constrained settings.

PubMed

Braitstein, Paula; Einterz, Robert M; Sidle, John E; Kimaiyo, Sylvester; Tierney, William

2009-11-01

Health care for patients with HIV infection in developing countries has increased substantially in response to major international funding. Scaling up treatment programs requires timely data on the type, quantity, and quality of care being provided. Increasingly, such programs are turning to electronic health records (EHRs) to provide these data. We describe how a medical school in the United States and another in Kenya collaborated to develop and implement an EHR in a large HIV/AIDS care program in western Kenya. These data were used to manage patients, providers, and the program itself as it grew to encompass 18 sites serving more than 90,000 patients. Lessons learned have been applicable beyond HIV/AIDS to include primary care, chronic disease management, and community-based health screening and disease prevention programs. EHRs will be key to providing the highest possible quality of care for the funds developing countries can commit to health care. Public, private, and academic partnerships can facilitate the development and implementation of EHRs in resource-constrained settings.

Impact of Iyengar yoga on quality of life in young women with rheumatoid arthritis

PubMed Central

Evans, Subhadra; Moieni, Mona; Lung, Kirsten; Tsao, Jennie; Sternlieb, Beth; Taylor, Mihaela; Zeltzer, Lonnie

2012-01-01

Objective Rheumatoid arthritis (RA) is a chronic, disabling disease that can greatly compromise health related quality of life (HRQOL). The aim of this study was to assess the impact of a 6-week twice/week Iyengar yoga (IY) program on HRQOL of young adults with RA compared to a usual-care waitlist control group. Method The program was designed to improve the primary outcome of HRQOL including pain, as well as disability and psychological functioning in patients. Assessments were collected pre, post, and at 2-months following treatment. Weekly ratings of anxiety, depression, pain and sleep were also recorded. A total of 26 participants completed the intervention (yoga = 11; usual care waitlist = 15). All participants were female (mean age =28 years). Results Overall attrition was low at 15%. On average, women in the yoga group attended 96% of the yoga classes. No adverse events were reported. Relative to the usual-care waitlist, women assigned to the yoga program showed significantly greater improvement on standardized measures of HRQOL, pain disability, general health, mood, fatigue, acceptance of chronic pain and self-efficacy regarding pain at post treatment. Almost half of the yoga group reported clinically meaningful symptom improvement. Analysis of the uncontrolled effects and maintenance of treatment effects showed improvements in HRQOL general health, pain disability and weekly ratings of pain, anxiety and depression that maintained at follow-up. Conclusion The findings suggest a brief IY intervention is a feasible and safe adjunctive treatment for young people with RA, leading to health related quality of life (HRQOL), pain disability, fatigue, and mood benefits. Moreover, improvements in quality of life, pain disability and mood persisted at the 2-month follow-up. PMID:23370082

The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial.

PubMed

Jeon, Yun-Hee; Simpson, Judy M; Chenoweth, Lynn; Cunich, Michelle; Kendig, Hal

2013-10-25

A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care--CLiAC) was developed to improve managers' leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster-level analysis. The overall costs and benefits of the program will also be assessed. The outcomes of the trial have the potential to inform actions to enhance leadership and management capabilities of the aged care workforce, address pressing issues about workforce shortages, and increase the quality of aged care services. Australian New Zealand Clinical Trials Registry (ACTRN12611001070921).

Quality of clinical supervision and counselor emotional exhaustion: the potential mediating roles of organizational and occupational commitment.

PubMed

Knudsen, Hannah K; Roman, Paul M; Abraham, Amanda J

2013-01-01

Counselor emotional exhaustion has negative implications for treatment organizations as well as the health of counselors. Quality clinical supervision is protective against emotional exhaustion, but research on the mediating mechanisms between supervision and exhaustion is limited. Drawing upon data from 934 counselors affiliated with treatment programs in the National Institute on Drug Abuse's Clinical Trials Network (CTN), this study examined commitment to the treatment organization and commitment to the counseling occupation as potential mediators of the relationship between quality clinical supervision and emotional exhaustion. The final ordinary least squares (OLS) regression model, which accounted for the nesting of counselors within treatment organizations, indicated that these two types of commitment were plausible mediators of the association between clinical supervision and exhaustion. Higher quality clinical supervision was strongly correlated with commitment to the treatment organization as well as commitment to the occupation of SUD counseling. These findings suggest that quality clinical supervision has the potential to yield important benefits for counselor well-being by strengthening ties to both their employing organization as well the larger treatment field, but longitudinal research is needed to establish these causal relationships. Copyright © 2013 Elsevier Inc. All rights reserved.

Quality of clinical supervision and counselor emotional exhaustion: The potential mediating roles of organizational and occupational commitment

PubMed Central

Knudsen, Hannah K.; Roman, Paul M.; Abraham, Amanda J.

2013-01-01

Counselor emotional exhaustion has negative implications for treatment organizations as well as the health of counselors. Quality clinical supervision is protective against emotional exhaustion, but research on the mediating mechanisms between supervision and exhaustion is limited. Drawing upon data from 934 counselors affiliated with treatment programs in the National Institute on Drug Abuse’s Clinical Trials Network (CTN), this study examined commitment to the treatment organization and commitment to the counseling occupation as potential mediators of the relationship between quality clinical supervision and emotional exhaustion. The final ordinary least squares (OLS) regression model, which accounted for the nesting of counselors within treatment organizations, indicated that these two types of commitment were plausible mediators of the association between clinical supervision and exhaustion. Higher quality clinical supervision was strongly correlated with commitment to the treatment organization as well as commitment to the occupation of SUD counseling. These findings suggest that quality clinical supervision has the potential to yield important benefits for counselor well-being by strengthening ties to both their employing organization as well the larger treatment field, but longitudinal research is needed to establish these causal relationships. PMID:23312873

Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis.

PubMed

Montroy, Joshua; Breau, Rodney H; Cnossen, Sonya; Witiuk, Kelsey; Binette, Andrew; Ferrier, Taylor; Lavallée, Luke T; Fergusson, Dean A; Schramm, David

2016-01-01

The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72-0.91), deep (pRR 0.82; 95% CI0.64-1.05) and organ space (pRR 1.15; 95% CI 0.96-1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39-0.77; deep pRR 0.61, 95% CI 0.50-0.75, and organ space pRR 0.60, 95% CI 0.50-0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities.

Change in Adverse Events After Enrollment in the National Surgical Quality Improvement Program: A Systematic Review and Meta-Analysis

PubMed Central

Montroy, Joshua; Breau, Rodney H.; Cnossen, Sonya; Witiuk, Kelsey; Binette, Andrew; Ferrier, Taylor; Lavallée, Luke T.; Fergusson, Dean A.; Schramm, David

2016-01-01

Background The American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) is the first nationally validated, risk-adjusted, outcomes-based program to measure and compare the quality of surgical care across North America. Participation in this program may provide an opportunity to reduce the incidence of adverse events related to surgery. Study Design A systematic review of the literature was performed. MedLine, EMBASE and PubMed were searched for studies relevant to NSQIP. Patient characteristics, intervention, and primary outcome measures were abstracted. The intervention was participation in NSQIP and monitoring of Individual Site Summary Reports with or without implementation of a quality improvement program. The outcomes of interest were change in peri-operative adverse events and mortality represented by pooled risk ratios (pRR) and 95% confidence intervals (CI). Results Eleven articles reporting on 35 health care institutions were included. Nine (82%) of the eleven studies implemented a quality improvement program. Minimal improvements in superficial (pRR 0.81; 95% CI 0.72–0.91), deep (pRR 0.82; 95% CI0.64–1.05) and organ space (pRR 1.15; 95% CI 0.96–1.37) infections were observed at centers that did not institute a quality improvement program. However, centers that reported formal interventions for the prevention and treatment of infections observed substantial improvements (superficial pRR 0.55, 95% CI 0.39–0.77; deep pRR 0.61, 95% CI 0.50–0.75, and organ space pRR 0.60, 95% CI 0.50–0.71). Studies evaluating other adverse events noted decreased incidence following NSQIP participation and implementation of a formal quality improvement program. Conclusions These data suggest that NSQIP is effective in reducing surgical morbidity. Improvement in surgical quality appears to be more marked at centers that implemented a formal quality improvement program directed at the reduction of specific morbidities. PMID:26812596

77 FR 66470 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-05

... provided by grantees under the SCDTDP and monitor and drive improvement on quality measures; (2) collect... review by the Office of Management and Budget (OMB), in compliance with the Paperwork Reduction Act of... Act of 1995: Proposed Project: Sickle Cell Disease Treatment Demonstration Program-- Quality...

Effects of care coordination on hospitalization, quality of care, and health care expenditures among Medicare beneficiaries: 15 randomized trials.

PubMed

Peikes, Deborah; Chen, Arnold; Schore, Jennifer; Brown, Randall

2009-02-11

Medicare expenditures of patients with chronic illnesses might be reduced through improvements in care, patient adherence, and communication. To determine whether care coordination programs reduced hospitalizations and Medicare expenditures and improved quality of care for chronically ill Medicare beneficiaries. Eligible fee-for-service Medicare patients (primarily with congestive heart failure, coronary artery disease, and diabetes) who volunteered to participate between April 2002 and June 2005 in 15 care coordination programs (each received a negotiated monthly fee per patient from Medicare) were randomly assigned to treatment or control (usual care) status. Hospitalizations, costs, and some quality-of-care outcomes were measured with claims data for 18 309 patients (n = 178 to 2657 per program) from patients' enrollment through June 2006. A patient survey 7 to 12 months after enrollment provided additional quality-of-care measures. Nurses provided patient education and monitoring (mostly via telephone) to improve adherence and ability to communicate with physicians. Patients were contacted twice per month on average; frequency varied widely. Hospitalizations, monthly Medicare expenditures, patient-reported and care process indicators. Thirteen of the 15 programs showed no significant (P<.05) differences in hospitalizations; however, Mercy had 0.168 fewer hospitalizations per person per year (90% confidence interval [CI], -0.283 to -0.054; 17% less than the control group mean, P=.02) and Charlestown had 0.118 more hospitalizations per person per year (90% CI, 0.025-0.210; 19% more than the control group mean, P=.04). None of the 15 programs generated net savings. Treatment group members in 3 programs (Health Quality Partners [HQP], Georgetown, Mercy) had monthly Medicare expenditures less than the control group by 9% to 14% (-$84; 90% CI, -$171 to $4; P=.12; -$358; 90% CI, -$934 to $218; P=.31; and -$112; 90% CI, -$231 to $8; P=.12; respectively). Savings offset fees for HQP and Georgetown but not for Mercy; Georgetown was too small to be sustainable. These programs had favorable effects on none of the adherence measures and only a few of many quality of care indicators examined. Viable care coordination programs without a strong transitional care component are unlikely to yield net Medicare savings. Programs with substantial in-person contact that target moderate to severe patients can be cost-neutral and improve some aspects of care. clinicaltrials.gov Identifier: NCT00627029.

Group exercise to improve quality of life among substance use disorder patients.

PubMed

Muller, Ashley E; Clausen, Thomas

2015-03-01

Quality of life (QoL) is a well-established outcome within clinical practice. Despite the adverse effects of substance use disorders on a wide range of patients' functionality and the multidimensional composition of QoL, the treatment field does not yet systematically assess QoL among patients. Exercise has established positive effects on the QoL of healthy and numerous clinical populations. The potential to integrate exercise within treatment, in order to improve QoL has not been satisfactorily explored. To measure changes in QoL after group exercise among residential substance use disorder patients and to explore the feasibility of the program within a treatment setting. We enrolled 35 patients in four long-term residential substance use disorder treatment facilities in Oslo, into a 10-week group exercise program. We analyzed the 24 participants who exercised as completers, while the 11 participants who did not were analyzed as non-completers. We measured QoL, mental distress, somatic health burden and addiction severity at the beginning and end of the program. The program was feasible for participants and the completion rate was 69%. Completers' physical health domain and psychological health domain of QoL improved significantly. The program engaged the most physically and mentally vulnerable participants, and flexibility and motivational factors were important elements. This study provided promising evidence that low doses of group exercise can yield appreciable benefits, even to patients with more severe health problems. © 2014 the Nordic Societies of Public Health.

Simultaneous delivery time and aperture shape optimization for the volumetric-modulated arc therapy (VMAT) treatment planning problem

NASA Astrophysics Data System (ADS)

Mahnam, Mehdi; Gendreau, Michel; Lahrichi, Nadia; Rousseau, Louis-Martin

2017-07-01

In this paper, we propose a novel heuristic algorithm for the volumetric-modulated arc therapy treatment planning problem, optimizing the trade-off between delivery time and treatment quality. We present a new mixed integer programming model in which the multi-leaf collimator leaf positions, gantry speed, and dose rate are determined simultaneously. Our heuristic is based on column generation; the aperture configuration is modeled in the columns and the dose distribution and time restriction in the rows. To reduce the number of voxels and increase the efficiency of the master model, we aggregate similar voxels using a clustering technique. The efficiency of the algorithm and the treatment quality are evaluated on a benchmark clinical prostate cancer case. The computational results show that a high-quality treatment is achievable using a four-thread CPU. Finally, we analyze the effects of the various parameters and two leaf-motion strategies.

Why the Quality Oncology Practice Initiative Matters: It's Not Just About Cost.

PubMed

Chiang, Anne C

2016-01-01

The nature and cost of cancer care is evolving, affecting more patients and often involving expensive treatment options. The upward cost trends also coincide with a national landscape of increasing regulatory mandates that may demand improved outcomes and value, but that often require significant up-front investment in infrastructure to achieve safety and quality. Oncology practices participating in the American Society of Clinical Oncology (ASCO) Institute for Quality's Quality Oncology Practice Initiative (QOPI) and the QOPI Certification Program (QCP) continue to grow in number and reflect changing demographics of the provision of cancer care. QOPI and QCP benchmarking can be used to achieve quality improvement and to build collaborative quality communities. These programs may be useful tools for oncology practices to comply with new legislation such as the Medicare Access and CHIP Reauthorization Act (MACRA).

Optimizing basin-scale coupled water quantity and water quality man-agement with stochastic dynamic programming

NASA Astrophysics Data System (ADS)

Davidsen, Claus; Liu, Suxia; Mo, Xingguo; Engelund Holm, Peter; Trapp, Stefan; Rosbjerg, Dan; Bauer-Gottwein, Peter

2015-04-01

Few studies address water quality in hydro-economic models, which often focus primarily on optimal allocation of water quantities. Water quality and water quantity are closely coupled, and optimal management with focus solely on either quantity or quality may cause large costs in terms of the oth-er component. In this study, we couple water quality and water quantity in a joint hydro-economic catchment-scale optimization problem. Stochastic dynamic programming (SDP) is used to minimize the basin-wide total costs arising from water allocation, water curtailment and water treatment. The simple water quality module can handle conservative pollutants, first order depletion and non-linear reactions. For demonstration purposes, we model pollutant releases as biochemical oxygen demand (BOD) and use the Streeter-Phelps equation for oxygen deficit to compute the resulting min-imum dissolved oxygen concentrations. Inelastic water demands, fixed water allocation curtailment costs and fixed wastewater treatment costs (before and after use) are estimated for the water users (agriculture, industry and domestic). If the BOD concentration exceeds a given user pollution thresh-old, the user will need to pay for pre-treatment of the water before use. Similarly, treatment of the return flow can reduce the BOD load to the river. A traditional SDP approach is used to solve one-step-ahead sub-problems for all combinations of discrete reservoir storage, Markov Chain inflow clas-ses and monthly time steps. Pollution concentration nodes are introduced for each user group and untreated return flow from the users contribute to increased BOD concentrations in the river. The pollutant concentrations in each node depend on multiple decision variables (allocation and wastewater treatment) rendering the objective function non-linear. Therefore, the pollution concen-tration decisions are outsourced to a genetic algorithm, which calls a linear program to determine the remainder of the decision variables. This hybrid formulation keeps the optimization problem computationally feasible and represents a flexible and customizable method. The method has been applied to the Ziya River basin, an economic hotspot located on the North China Plain in Northern China. The basin is subject to severe water scarcity, and the rivers are heavily polluted with wastewater and nutrients from diffuse sources. The coupled hydro-economic optimiza-tion model can be used to assess costs of meeting additional constraints such as minimum water qual-ity or to economically prioritize investments in waste water treatment facilities based on economic criteria.

Supervised exercise therapy: it does work, but how to set up a program?

PubMed

Hageman, David; van den Houten, Marijn M; Spruijt, Steffie; Gommans, Lindy N; Scheltinga, Marc R; Teijink, Joep A

2017-04-01

Intermittent claudication (IC) is a manifestation of peripheral arterial disease. IC has a high prevalence in the older population, is closely associated with other expressions of atherosclerotic disease and often co-exists in multimorbid patients. Treatment of IC should address reduction of cardiovascular risk and improvement of functional capacity and health-related quality of life (QoL). As recommended by contemporary international guidelines, the first-line treatment includes supervised exercise therapy (SET). In several randomized controlled trials and systematic reviews, SET is compared with usual care, placebo, walking advice and endovascular revascularization. The evidence supporting the efficacy of SET programs to alleviate claudication symptoms is robust. SET improves walking distance and health-related QoL and appears to be the most cost-effective treatment for IC. Nevertheless, only few of all newly diagnosed IC patients worldwide receive this safe, efficient and structured treatment. Worldwide implementation of structured SET programs is seriously impeded by outdated arguments favoring an invasive intervention, absence of a network of specialized physical therapists providing standardized SET and lack of awareness and/or knowledge of the importance of SET by referring physicians. Besides, misguiding financial incentives and lack of reimbursement hamper actual use of SET programs. In the Netherlands, a national integrated care network (ClaudicatioNet) was launched in 2011 to combat treatment shortcomings and stimulate cohesion and collaboration between stakeholders. This care intervention has resulted in optimized quality of care for all patients with IC.

The Therapeutic Relationship in the Brief Treatment of Depression: Contributions to Clinical Improvement and Enhanced Adaptive Capacities

ERIC Educational Resources Information Center

Zuroff, David C.; Blatt, Sidney J.

2006-01-01

Using data from the National Institute of Mental Health Treatment for Depression Collaborative Research Program, the authors examined the impact on treatment outcome of the patient's perception of the quality of the therapeutic relationship and contribution to the therapeutic alliance. Shared variance with early clinical improvement was removed…

Improvements in undergraduate oncology education introduced at Polish medical universities between 2004 and 2010 under Poland's "National Program for Combating Neoplastic Diseases".

PubMed

Matkowski, Rafał; Szelachowska, Jolanta; Szewczyk, Krzysztof; Staszek-Szewczyk, Urszula; Kornafel, Jan

2014-09-01

Cancer patient treatment in Poland remains unsatisfactory when compared to that in other countries. In 2005, this alarming situation prompted the Polish government to launch the "National Program for Combating Neoplastic Diseases" (NPCND). One part of this project was to improve the quality of oncology instruction at the undergraduate level over the years 2006 and 2007 (subsequently extended until 2010 thanks to promising results and the relatively small financial outlay). The program's main aims were to improve existing oncology therapy and to ameliorate the quality of undergraduate oncology education. To evaluate the changes in the quality of undergraduate education as a result of the NPCND program, medical universities were asked to fill out a questionnaire. Responses indicate that the program had a major positive impact on the quality of cancer education mainly as a result of the introduction of a uniform program of training and an increase in the number of classes devoted to oncology. The main unresolved problem is that university hospitals seldom have integrated units catering in-house for surgery, radiotherapy, chemotherapy, etc., and most such "hands-on" teaching still has to be done externally.

Patient navigation and the quality of breast cancer care: an analysis of the breast cancer care quality indicators.

PubMed

Weber, Joseph J; Mascarenhas, Debra C; Bellin, Lisa S; Raab, Rachel E; Wong, Jan H

2012-10-01

Patient navigation programs are initiated to help guide patients through barriers in a complex cancer care system. We sought to analyze the impact of our patient navigator program on the adherence to specific Breast Cancer Care Quality Indicators (BCCQI). A retrospective cohort of patients with stage I-III breast cancer seen the calendar year prior to the initiation of the patient navigation program were compared with patients treated in the ensuing two calendar years. Quality indicators deemed appropriate for analysis were those associated with overcoming barriers to treatment and those associated with providing health education and improving patient decision-making. A total of 134 consecutive patients between January 1, 2006 and December 31, 2006 and 234 consecutive patients between January 1, 2008 and December 31, 2009 were evaluated for compliance with the BCCQI. There was no significant difference in the mean age or race/ethnic distribution of the study population. In all ten BCCQI evaluated, there was improvement in the percentage of patients in compliance from pre and post implementation of a patient navigator program (range 2.5-27.0 %). Overall, compliance with BCCQI improved from 74.1 to 95.5 % (p < 0.0001). Indicators associated with informed decision-making and patient preference achieved statistical significance, while only completion axillary node dissection in sentinel node-positive biopsies in the process of treatment achieved statistical significance. The implementation of a patient navigator program improved breast cancer care as measured by BCCQI. The impact on disease-free and overall survival remains to be determined.

Programmatic assessment of a university-based implant training program using patient-reported outcomes.

PubMed

Al-Sabbagh, Mohanad; Jenkins, Diane W; de Leeuw, Reny; Nihill, Patricia; Robinson, Fonda G; Thomas, Mark V

2014-11-01

The University of Kentucky College of Dentistry (UKCD) established an implant training program that provides training in the use of a single implant system, evidence-based diagnostic and treatment protocols (standardized work practices), and a total quality management system (Implant Quality Assurance Program). The aim of this study was to assess the programmatic effectiveness of the UKCD implant training program by reporting the success and survival of implants placed, using patient-reported outcomes and comparing them to previously established benchmarks. A total of 415 patients (963 implants) were interviewed, approximately 50 percent of all qualified patients. The implant survival rate was 97 percent, and 88 percent of the implants were considered successful (as determined by patient-centric criteria). These outcomes were consistent with the program's previously established benchmarks of 90 percent. These results suggest that work standardization (in the form of specific treatment protocols) and the use of a formal, incremental learning system can result in positive patient outcomes. Clinical outcomes should be monitored in academic dental settings as part of clinical process improvement, and these outcomes can provide a means of assessing the effectiveness of the training program.

Quality of Life and Functional Status across the Life Course

DTIC Science & Technology

2007-05-01

Recovery Practices in Breast Cancer (RESTORE). This is a randomized exercise intervention trial with a lymphedema prevention program. Project 1 is...treatment and beyond. 15. SUBJECT TERMS breast cancer, quality of life, lymphedema, exercise 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF...experience amenorrhea , resulting in infertility, menopausal symptoms, and changes in their life quality. The purposes of this study are: 1) to

The Establishment of a Quality Circles Program and Its Effect on Employee Attitudes, Morale, and Performance at an Army Medical Treatment Facility.

DTIC Science & Technology

1984-08-01

more times. Dr. Kaoru Ishikawa , a professor at the University of Tokyo and a board member of JUSE, used the efforts of Dr. Juran as the background for...his later work with quality circles. Dr. Ishikawa and the JUSE are generally credited with formalizing the modern Japanese quality circle technique in

Spanish language proficiency among providers and Latino clients' engagement in substance abuse treatment.

PubMed

Guerrero, Erick G; Khachikian, Tenie; Kim, Tina; Kong, Yinfei; Vega, William A

2013-12-01

Quality of care, such as provision of services in Spanish, is a common factor believed to improve treatment engagement among Spanish-speaking Latinos in health care. However, there is little evidence that Spanish language proficiency among providers increases treatment access and retention in publicly funded substance abuse treatment. We analyzed client and program data collected in 2010-2011 from publicly funded treatment programs in Los Angeles County, California. An analytic sample of 1903 Latino clients nested within 40 treatment programs located in minority communities was analyzed using multilevel negative binomial regressions on days to initiate and spent in treatment. As hypothesized, Spanish language proficiency was negatively associated with client wait time and positively associated with retention in treatment, after controlling for individual and program characteristics. The path analysis models showed that Spanish language proficiency played a mediating role between professional accreditation and client wait time and retention. These preliminary findings provide an evidentiary base for the role of providers' Spanish language proficiency and Latino engagement in treatment for a population at high risk of treatment dropout. Implications related to health care reform legislation, which seeks to enhance linguistically competent care, are discussed. © 2013.

A rapid communication from the AAPM Task Group 201: recommendations for the QA of external beam radiotherapy data transfer. AAPM TG 201: quality assurance of external beam radiotherapy data transfer.

PubMed

Siochi, R Alfredo; Balter, Peter; Bloch, Charles D; Santanam, Lakshmi; Blodgett, Kurt; Curran, Bruce H; Engelsman, Martijn; Feng, Wenzheng; Mechalakos, Jim; Pavord, Dan; Simon, Tom; Sutlieff, Steven; Zhu, X Ronald

2010-12-04

The transfer of radiation therapy data among the various subsystems required for external beam treatments is subject to error. Hence, the establishment and management of a data transfer quality assurance program is strongly recommended. It should cover the QA of data transfers of patient specific treatments, imaging data, manually handled data and historical treatment records. QA of the database state (logical consistency and information integrity) is also addressed to ensure that accurate data are transferred.

Three-year follow-up results of a residential community reintegration program for patients with chronic acquired brain injury.

PubMed

Geurtsen, Gert J; van Heugten, Caroline M; Martina, Juan D; Rietveld, Antonius C; Meijer, Ron; Geurts, Alexander C

2012-05-01

To evaluate outcomes of a residential community reintegration program 3 years after treatment on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. A follow-up assessment 3 years after treatment was compared with the 1-year follow-up assessment in a prospective cohort study. A tertiary rehabilitation center for acquired brain injury. Of the 67 patients assessed at the 1-year follow-up, 63 subjects (94%; 42 men; mean age at admission to treatment 24.7y; mean time postonset 5.1y) were available at the 3-year follow-up and taken into account in the analyses. A structured residential treatment program directed at improving independence in domestic life, work, leisure time, and social interactions. Community Integration Questionnaire, Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies-Depression scale, and the World Health Organization Quality of Life Scale Abbreviated (5 scales). There were no significant differences for any of the outcome measures between the 1-year and 3-year follow-up assessment. These results indicate that the established significant and clinically relevant improvements after a residential community reintegration program remain stable in the long term. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A Comparison of Assertive Community Treatment Fidelity Measures and Patient-Centered Medical Home Standards

PubMed Central

Vanderlip, Erik R.; Cerimele, Joseph M.; Monroe-DeVita, Maria

2014-01-01

Objective This study compared program measures of assertive community treatment (ACT) with standards of accreditation for the patient-centered medical home (PCMH) to determine whether there were similarities in the infrastructure of the two methods of service delivery and whether high-fidelity ACT teams would qualify for medical home accreditation. Methods The authors compared National Committee for Quality Assurance PCMH standards with two ACT fidelity measures (the Dartmouth Assertive Community Treatment Scale and the Tool for Measurement of Assertive Community Treatment [TMACT]) and with national ACT program standards. Results PCMH standards pertaining to enhanced access and continuity, management of care, and self-care support demonstrated strong overlap across ACT measures. Standards for identification and management of populations, care coordination and follow-up, and quality improvement demonstrated less overlap. The TMACT and the program standards had sufficient overlap to score in the range of a level 1 PCMH, but no ACT measure sufficiently detailed methods of population-based screening and tracking of referrals to satisfy “must-pass” elements of the standards. Conclusions ACT measures and medical home standards had significant overlap in innate infrastructure. ACT teams following the program standards or undergoing TMACT fidelity review could have the necessary infrastructure to serve as medical homes if they were properly equipped to supervise general medical care and administer activities to improve management of chronic diseases. PMID:23820753

The Costs of Small Drinking Water Systems Removing Arsenic from Groundwater

EPA Science Inventory

Between 2003 and 2011, EPA conducted an Arsenic Demonstration Program whereby the Agency purchased, installed and evaluated the performance and cost of 50 small water treatment systems scattered across the USA. A major goal of the program was to collect high-quality cost data (c...

[Evaluation of the quality of care of transient tachypnea in newborns affiliated with the Medical Insurance Siglo XXI program].

PubMed

Pérez-Cuevas, Ricardo; Jasso Gutiérrez, Luis; Doubova, Svetlana; Flores Hernández, Sergio; Mantilla Trollé, Clara; González Guerra, Eduardo; Muñoz Hernández, Onofre

Evaluation of the quality of care of the newborn with complications is an indispensable element for the improvement of strategies directed to reduce newborn mortality rates. The aim of this work was to evaluate the quality of technical and interpersonal care in the management of transient tachypnea of the newborn (TTN) of patients affiliated with the program "Medical Insurance Siglo XXI". A cross-sectional study was conducted in 61 hospitals affiliated with the Health Ministry with at least two cases of TTN during the first semester of 2011. Variables such as mother's health, pregnancy, birth and birth complication characteristics were analyzed. Also, newborn interventions and health conditions upon discharge were included. To measure the quality of care according to prevention, diagnosis and treatment, quality indicators were defined and validated. We analyzed 256 case files with a diagnosis of TTN; 8.9% of the mothers presented risk factors (asthma, diabetes) and 53.5% had complications during pregnancy. There were 60% of cases with TTN born by cesarean delivery; one third of these children had low birth weight and 14% were transferred to another hospital. As for the quality indicators in the area of prevention, more than 90% of risk factors (smoking, asthma, cesarean delivery) were identified. Diagnostic indicators showed that 86-98% of respiratory distress symptoms were sought. Indicators of treatment achieved satisfactory figures for monitoring and support measures. Prevention, diagnosis and treatment indicators made it possible to consider that most TTN cases received appropriate treatment. It is advisable to develop effective strategies to prevent TTN, such as increasing efforts to reduce the increasing rates of cesarean deliveries. Copyright © 2014 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

Association between costs and quality of acute myocardial infarction care hospitals under the Korea National Health Insurance program.

PubMed

Kang, Hee-Chung; Hong, Jae-Seok

2017-08-01

If cost reductions produce a cost-quality trade-off, healthcare policy makers need to be more circumspect about the use of cost-effective initiatives. Additional empirical evidence about the relationship between cost and quality is needed to design a value-based payment system. We examined the association between cost and quality performances for acute myocardial infarction (AMI) care at the hospital level.In 2008, this cross-sectional study examined 69 hospitals with 6599 patients hospitalized under the Korea National Health Insurance (KNHI) program. We separately estimated hospital-specific effects on cost and quality using the fixed effect models adjusting for average patient risk. The analysis examined the association between the estimated hospital effects against the treatment cost and quality. All hospitals were distributed over the 4 cost × quality quadrants rather than concentrated in only the trade-off quadrants (i.e., above-average cost and above-average quality, below-average cost and below-average quality). We found no significant trade-off between cost and quality among hospitals providing AMI care in Korea.Our results further contribute to formulating a rationale for value-based hospital-level incentive programs by supporting the necessity of different approaches depending on the quality location of a hospital in these 4 quadrants.

The Impulsive Lifestyle Counseling Program for Antisocial Behavior in Outpatient Substance Abuse Treatment.

PubMed

Thylstrup, Birgitte; Hesse, Morten

2016-06-01

Antisocial behavior is associated with low quality of life for the patient and with adverse effects on society and those close to the antisocial patient. However, most patients with antisocial behavior are not seen in treatment settings that focus on their personality but rather in criminal justice settings, substance-abuse treatment, and social welfare settings. This article describes the adaptation and implementation of a highly structured manualized treatment, Impulsive Lifestyle Counseling (ILC), based on the Lifestyle Issues program, a 10-week psychoeducation program studied in prison settings. ILC consists of four sessions over 4 weeks and a booster session 8 weeks later. The goal of treatment is described to patients as "to help people identify their impulsive thoughts and lifestyle leading to problems with drug use, other people, and the police." Two clinical examples and reflections on our experiences with the training and implementation of the ILC program are presented. © The Author(s) 2011.

A supply chain model to improve the beef quality distribution using investment analysis: A case study

NASA Astrophysics Data System (ADS)

Lupita, Alessandra; Rangkuti, Sabrina Heriza; Sutopo, Wahyudi; Hisjam, Muh.

2017-11-01

There are significant differences related to the quality and price of the beef commodity in traditional market and modern market in Indonesia. Those are caused by very different treatments of the commodity. The different treatments are in the slaughter lines, the transportation from the abattoir to the outlet, the display system, and the control system. If the problem is not solved by the Government, the gap will result a great loss of the consumer regarding to the quality and sustainability of traditional traders business because of the declining interest in purchasing beef in the traditional markets. This article aims to improve the quality of beef in traditional markets. This study proposed A Supply Chain Model that involves the schemes of investment and government incentive for improving the distribution system. The supply chain model is can be formulated using the Mix Integer Linear Programming (MILP) and solved using the IBM®ILOG®CPLEX software. The results show that the proposed model can be used to determine the priority of programs for improving the quality and sustainability business of traditional beef merchants. By using the models, The Government can make a decision to consider incentives for improving the condition.

Implications of measures of quality of life for policy development.

PubMed

Mosteller, F

1987-01-01

Quality of life measurements can lead to legislative programs for health, new policies for the health care system, and possibly new attitudes in the courts. Clinical decisions, public health evaluations, and advice for legislatures and courts require diverse measures. We illustrate potential use of such measures with reimbursement problems, programs like Head Start, mainstreaming the handicapped, day care and prenatal care, terminal care for the elderly, monitoring programs, and chronic disabilities. The many treatment policies discussed at the Portugal Conference show the need for quality of life measures in clinical trials. The courts, although considering quality of life, do not seem to consider quality of life measures. If scientists and medical experts wish to establish or change the positions of the courts, consensus conferences appear more effective than regulation or new legislation. To contribute more than they now do to policy, workers measuring quality of life need to develop a variety of measures and methods. They, then, must apply them to medical and health problems, build up a substantial literature, and set priorities for the research needs of the field.

7 CFR 632.15 - Eligible uses and treatment of reclaimed lands.

Code of Federal Regulations, 2010 CFR

2010-01-01

... water that may be offered for contract under one ownership is 320 acres for the life of the program. (d... feasible to achieve: (1) Protection of life, property, and elimination of public health and safety hazards... water quality, visual quality, recreation resources, fish and wildlife habitat, and erosion and sediment...

7 CFR 632.15 - Eligible uses and treatment of reclaimed lands.

Code of Federal Regulations, 2011 CFR

2011-01-01

... water that may be offered for contract under one ownership is 320 acres for the life of the program. (d... feasible to achieve: (1) Protection of life, property, and elimination of public health and safety hazards... water quality, visual quality, recreation resources, fish and wildlife habitat, and erosion and sediment...

7 CFR 632.15 - Eligible uses and treatment of reclaimed lands.

Code of Federal Regulations, 2012 CFR

2012-01-01

... water that may be offered for contract under one ownership is 320 acres for the life of the program. (d... feasible to achieve: (1) Protection of life, property, and elimination of public health and safety hazards... water quality, visual quality, recreation resources, fish and wildlife habitat, and erosion and sediment...

Math Problems for Water Quality Control Personnel, Instructor's Manual. Second Edition.

ERIC Educational Resources Information Center

Delvecchio, Fred; Brutsch, Gloria

This document is the instructor's manual for a course in mathematics for water quality control personnel. It is designed so a program may be designed for a specific facility. The problem structures are arranged alphabetically by treatment process. Charts, graphs and/or drawings representing familiar data forms contain the necessary information to…

Health-Related Quality of Life, Depression, Anxiety, and Self-Image in Acute Lymphocytic Leukemia Survivors

PubMed Central

Baytan, Birol; Aşut, Çiğdem; Çırpan Kantarcıoğlu, Arzu; Sezgin Evim, Melike; Güneş, Adalet Meral

2016-01-01

Objective: With increasing survival rates in childhood acute lymphocytic leukemia (ALL), the long-term side effects of treatment have become important. Our aim was to investigate health-related quality of life, depression, anxiety, and self-image among ALL survivors. Materials and Methods: Fifty patients diagnosed with ALL and their siblings were enrolled. The Kovacs Children’s Depression Inventory, State-Trait Anxiety Inventory, Offer Self-Image Questionnaire, and Pediatric Quality of Life InventoryTM were used for collecting data. ANOVA tests were used to determine if there were any significant differences between groups. Results: ALL survivors had higher depression, more anxiety symptoms, lower quality of life, and more negative self-image when compared to their siblings. Conclusion: Continuous diagnostic and interventional mental health services might be necessary for possible emotional side effects of treatment during and after the treatment. Rehabilitation and follow-up programs should be implemented for children during and after treatment for ALL. PMID:27094799

Managing water and salinity with desalination, conveyance, conservation, waste-water treatment and reuse to counteract climate variability in Gaza

NASA Astrophysics Data System (ADS)

Rosenberg, D. E.; Aljuaidi, A. E.; Kaluarachchi, J. J.

2009-12-01

We include demands for water of different salinity concentrations as input parameters and decision variables in a regional hydro-economic optimization model. This specification includes separate demand functions for saline water. We then use stochastic non-linear programming to jointly identify the benefit maximizing set of infrastructure expansions, operational allocations, and use of different water quality types under climate variability. We present a detailed application for the Gaza Strip. The application considers building desalination and waste-water treatment plants and conveyance pipelines, initiating water conservation and leak reduction programs, plus allocating and transferring water of different qualities among agricultural, industrial, and urban sectors and among districts. Results show how to integrate a mix of supply enhancement, conservation, water quality improvement, and water quality management actions into a portfolio that can economically and efficiently respond to changes and uncertainties in surface and groundwater availability due to climate variability. We also show how to put drawn-down and saline Gaza aquifer water to more sustainable and economical use.

Treatment of comorbid pain and PTSD in returning veterans: a collaborative approach utilizing behavioral activation.

PubMed

Plagge, Jane M; Lu, Mary W; Lovejoy, Travis I; Karl, Andrea I; Dobscha, Steven K

2013-08-01

We explore preliminary clinical effectiveness and feasibility of an intervention utilizing collaborative care components and behavioral activation (BA) to treat comorbid chronic pain and posttraumatic stress disorder (PTSD). Descriptive, including pre- and posttreatment assessment results. Portland Veterans Affairs Medical Center. Fifty-eight Iraq and Afghanistan veterans with chronic pain and PTSD symptoms. Veterans participated in a biopsychosocial evaluation and up to eight BA sessions using a collaborative approach involving primary care, mental health, and other clinicians. A physiatrist assisted the psychologist in providing recommendations to primary care providers. Participants were administered pre- and posttreatment measures of PTSD, pain severity, pain interference, mental health, quality of life, satisfaction, and global ratings of change with the purpose of assessing progress and improving quality. Of the 58 participants, 30 completed treatment. Common recommendations included physical therapy and exercise programs, pain medication or pain medication adjustments, and additional diagnostic workups, such as imaging. Participants who completed the program showed significant improvements on measures of PTSD, pain severity, and pain interference. Improvements were also evident on measures of mental health and quality of life. Overall, participants were satisfied with the program, and on average reported feeling "somewhat better." These findings suggest that a collaborative approach that includes BA is feasible and a potentially effective treatment for comorbid chronic pain and PTSD. Wiley Periodicals, Inc.

Effects of occupational therapy on quality of life of patients with metastatic prostate cancer. A randomized controlled study.

PubMed

Huri, Meral; Huri, Emre; Kayihan, Hulya; Altuntas, Onur

2015-08-01

To evaluate the efficiency of occupational therapy relative to a home program in improving quality of life (QoL) among men who were treated for metastatic prostate cancer (MPC). Fifty-five men were assigned randomly to either the 12-week cognitive behavioral therapy based occupational therapy (OT-CBSM) intervention (treatment group) or a home program (control group) between March 2012 and August 2014 in the Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey. The Canadian Occupational Performance Measure (COPM) was used to measure the occupational performance and identify difficulties in daily living activities. The QoL and symptom status were measured by The European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 and its Prostate Cancer Module. A 12-week OT-CBSM intervention including client-centered training of daily living activities, recreational group activities, and cognitive behavioral stress management intervention were applied. The COPM performance and satisfaction scores, which indicate occupational participation and QoL increased statistically in the treatment group in relation to men who were included in the home-program (p less than or equal to 0.05). A 12-week OT-CBSM intervention was effective in improving QoL in men treated for MPC, and these changes were associated significantly with occupational performance.

Activated Sludge. Selected Instructional Activities and References. Instructional Resources Monograph Series.

ERIC Educational Resources Information Center

Shepard, Clinton L.; Walasek, James B.

This monograph contains a variety of selected materials related to wastewater treatment and water quality education and instruction. Part I presents a brief discussion of the activated sludge process in wastewater treatment operations. Part II, Instructional Units, contains selected portions of existing programs which may be utilized in…

Patient-reported outcomes, body composition, and nutrition status in patients with head and neck cancer: Results from an exploratory randomized controlled exercise trial.

PubMed

Capozzi, Lauren C; McNeely, Margaret L; Lau, Harold Y; Reimer, Raylene A; Giese-Davis, Janine; Fung, Tak S; Culos-Reed, S Nicole

2016-04-15

Patients with head and neck cancer experience loss of weight and muscle mass, decreased functioning, malnutrition, depression, and declines in quality of life during and after treatment. The purpose of this exploratory randomized study was to determine the optimal timing for the initiation of a lifestyle and progressive resistance exercise training intervention (during or after radiation therapy), as determined by intervention adherence and by comparing between-group outcomes across 24 weeks. Sixty patients with head and neck cancer were randomized to engage in a 12-week lifestyle intervention and progressive resistance-training program either during radiation treatment or immediately after completion. The primary outcome of body composition--specifically, lean body mass, body mass index, and body fat--as well as secondary outcomes of fitness, quality of life, depression, and nutrition status were evaluated. The progressive resistance-training intervention carried out during treatment did not significantly influence the primary outcome of body composition, despite a significant increase in weekly physical activity reported by the intervention group. A small-to-medium intervention effect was noted for some secondary outcomes, including fitness, quality of life, and nutrition status. Regardless of whether patients received the immediate or delayed progressive resistance-training intervention, the analysis revealed a main effect of time on body composition, fitness, quality of life, depression, and nutritional scores. Although the intervention during treatment did not reduce the loss of lean body mass, delaying the exercise program until after treatment completion was associated with improved intervention adherence, a finding with important clinical implications. © 2016 American Cancer Society.

Making Work Pay: Changes in Effective Tax Rates and Guarantees in U.S. Transfer Programs, 1983-2002

ERIC Educational Resources Information Center

Ziliak, James P.

2007-01-01

In the 1990s, many states liberalized statutory rules regarding the tax treatment of earned and unearned income for welfare program eligibility and benefit levels. I use quality control data from the AFDC/TANF program over 1983-2002 to document changes in the corresponding effective tax rates and benefit guarantees. After welfare reform I find…

Predicting changes in drug use and treatment entry for local programs: a case study.

PubMed

Flaherty, E W; Olsen, K; Bencivengo, M

1980-01-01

Recent sharp decline in treatment admissions by opiate abusers stimulated the conduct of a study designed to provide timely data to treatment system administrators for the next cycle of program and budgetary planning. The process of designing the study involved definition of required study characteristics, review of four categories of drug abuse research, and generation of seven locally relevant hypotheses. Interviews were conducted with 335 heroin adicts: 196 new admissions to treatment and 139 "street" addicts not currently in treatment. Major findings were a marked reduction in the quality, availability, and price of heroin; very negative perceptions of methadone maintenance, especially by female respondents; decline in heroin popularity and increase in reported use of alcohol, amphetamines, and barbiturates; and differing perceptions of treatment by sex of respondent. Response patterns suggest that users who are not entering treatment are less "strung-out than those entering treatment because of decline in availability and quality of heroin and consequent increased mixing of drugs. The emphasis in the report is on the conduct of a study which can be timely, feasible, and useful to local planners. The study weaknesses and recommended remedies are discussed, as well as the characteristics which made the findings immediately useful to administrators and planners.

Changing populations in the public sector: responding to the needs of Texas youth.

PubMed

Johnson, B S; Richardson, P; Brunett, N M

1995-08-01

Treatment of sexually abused and abusing youth requires careful program planning and implementation. Led by its Quality Improvement Council and with considerable staff involvement, Waco Center for Youth in Waco, Texas developed a dual-track approach to treatment of this underserved, often misunderstood, adolescent client population. The sexual abuse survivors' program focuses on the issues of trust, safety, self-esteem, assertiveness, and education. The sex offender program is built on the concepts of self-responsibility; diminishing cognitive distortions; identification of stressors, and their relationship to the offending cycle; and relapse prevention. The staff of Waco Center for Youth are engaged in ongoing analysis of behavioral indicators for successful treatment of sexually abused and abusing adolescents.

Collaborative care for patients with bipolar disorder: a randomised controlled trial

PubMed Central

2011-01-01

Background Bipolar disorder is a severe mental illness with serious consequences for daily living of patients and their caregivers. Care as usual primarily consists of pharmacotherapy and supportive treatment. However, a substantial number of patients show a suboptimal response to treatment and still suffer from frequent episodes, persistent interepisodic symptoms and poor social functioning. Both psychiatric and somatic comorbid disorders are frequent, especially personality disorders, substance abuse, cardiovascular diseases and diabetes. Multidisciplinary collaboration of professionals is needed to combine all expertise in order to achieve high-quality integrated treatment. 'Collaborative Care' is a treatment method that could meet these needs. Several studies have shown promising effects of these integrated treatment programs for patients with bipolar disorder. In this article we describe a research protocol concerning a study on the effects of Collaborative Care for patients with bipolar disorder in the Netherlands. Methods/design The study concerns a two-armed cluster randomised clinical trial to evaluate the effectiveness of Collaborative Care (CC) in comparison with Care as usual (CAU) in outpatient clinics for bipolar disorder or mood disorders in general. Collaborative Care includes individually tailored interventions, aimed at personal goals set by the patient. The patient, his caregiver, the nurse and the psychiatrist all are part of the Collaborative Care team. Elements of the program are: contracting and shared decision making; psycho education; problem solving treatment; systematic relapse prevention; monitoring of outcomes and pharmacotherapy. Nurses coordinate the program. Nurses and psychiatrists in the intervention group will be trained in the intervention. The effects will be measured at baseline, 6 months and 12 months. Primary outcomes are psychosocial functioning, psychiatric symptoms, and quality of life. Caregiver outcomes are burden and satisfaction with care. Discussion Several ways to enhance the quality of this study are described, as well as some limitations caused by the complexities of naturalistic treatment settings where not all influencing factors on an intervention and the outcomes can be controlled. Trial Registration The Netherlands Trial Registry, NTR2600. PMID:21849078

Collaborative care for patients with bipolar disorder: a randomised controlled trial.

PubMed

van der Voort, Trijntje Y G; van Meijel, Berno; Goossens, Peter J J; Renes, Janwillem; Beekman, Aartjan T F; Kupka, Ralph W

2011-08-17

Bipolar disorder is a severe mental illness with serious consequences for daily living of patients and their caregivers. Care as usual primarily consists of pharmacotherapy and supportive treatment. However, a substantial number of patients show a suboptimal response to treatment and still suffer from frequent episodes, persistent interepisodic symptoms and poor social functioning. Both psychiatric and somatic comorbid disorders are frequent, especially personality disorders, substance abuse, cardiovascular diseases and diabetes. Multidisciplinary collaboration of professionals is needed to combine all expertise in order to achieve high-quality integrated treatment. 'Collaborative Care' is a treatment method that could meet these needs. Several studies have shown promising effects of these integrated treatment programs for patients with bipolar disorder. In this article we describe a research protocol concerning a study on the effects of Collaborative Care for patients with bipolar disorder in the Netherlands. The study concerns a two-armed cluster randomised clinical trial to evaluate the effectiveness of Collaborative Care (CC) in comparison with Care as usual (CAU) in outpatient clinics for bipolar disorder or mood disorders in general. Collaborative Care includes individually tailored interventions, aimed at personal goals set by the patient. The patient, his caregiver, the nurse and the psychiatrist all are part of the Collaborative Care team. Elements of the program are: contracting and shared decision making; psycho education; problem solving treatment; systematic relapse prevention; monitoring of outcomes and pharmacotherapy. Nurses coordinate the program. Nurses and psychiatrists in the intervention group will be trained in the intervention. The effects will be measured at baseline, 6 months and 12 months. Primary outcomes are psychosocial functioning, psychiatric symptoms, and quality of life. Caregiver outcomes are burden and satisfaction with care. Several ways to enhance the quality of this study are described, as well as some limitations caused by the complexities of naturalistic treatment settings where not all influencing factors on an intervention and the outcomes can be controlled. The Netherlands Trial Registry, NTR2600.

Effectiveness of a Self Help Cognitive Behavioural Treatment Program for Problem Gamblers: A Randomised Controlled Trial.

PubMed

Oei, T P S; Raylu, N; Lai, W W

2018-06-01

The study aimed to strengthen the scarce literature on self-help treatments for Problem Gambling (PG) by comparing the effectiveness of a Self-Help Cognitive Behavioral Treatment (SHCBT) program (n = 23) with a 6-week Waitlist condition (n = 32) in problem gamblers. Participants were community volunteers with gambling problems and were randomly allocated to the Waitlist and treatment conditions. Results showed significant improvements at post-treatment in gambling behaviors including frequency of gambling, average amount gambled per day and PG symptoms as well as a number of gambling correlates including psychological states (e.g., depression, anxiety and stress), gambling cognitions, gambling urges, gambling related self-efficacy, satisfaction with life, and quality of life among those who completed the SHCBT program, when compared with the waitlist condition. The effect size (partial η 2 ) ranged from .25 to .57 for all assessed outcomes that showed significant improvement from pre- to post-treatment. It was concluded that a self-help CBT program can be beneficial for treating community problem gamblers.

Are All Program Elements Created Equal? Relations Between Specific Social and Emotional Learning Components and Teacher-Student Classroom Interaction Quality.

PubMed

Abry, Tashia; Rimm-Kaufman, Sara E; Curby, Timothy W

2017-02-01

School-based social and emotional learning (SEL) programs are presented to educators with little understanding of the program components that have the greatest leverage for improving targeted outcomes. Conducted in the context of a randomized controlled trial, the present study used variation in treatment teachers' (N = 143) implementation of four core components of the Responsive Classroom approach to examine relations between each component and the quality of teachers' emotional, organizational, and instructional interactions in third, fourth, and fifth grade classrooms (controlling for pre-intervention interaction quality and other covariates). We also examined the extent to which these relations varied as a function of teachers' baseline levels of interaction quality. Indices of teachers' implementation of Morning Meeting, Rule Creation, Interactive Modeling, and Academic Choice were derived from a combination of teacher-reported surveys and classroom observations. Ratings of teacher-student classroom interactions were aggregated across five observations conducted throughout the school year. Structural path models indicated that teachers' use of Morning Meeting and Academic Choice related to higher levels of emotionally supportive interactions; Academic Choice also related to higher levels of instructional interactions. In addition, teachers' baseline interaction quality moderated several associations such that the strongest relations between RC component use and interaction quality emerged for teachers with the lowest baseline interaction quality. Results highlight the value of examining individual program components toward the identification of program active ingredients that can inform intervention optimization and teacher professional development.

Yes, You Can Have a Health Service in a Community College.

ERIC Educational Resources Information Center

Busky, Henry F.

The health services program at Prince George's Community College is oriented toward preventative and educational services as well as referral and the treatment of minor illnesses and injuries. This compilation of statements of intent, forms, and brief descriptive essays covers various aspects of the program. The qualities of a college health…

Addressing Cultural Variables in Parent Training Programs with Latino Families

ERIC Educational Resources Information Center

Barker, Chikira H.; Cook, Katrina L.; Borrego, Joaquin, Jr.

2010-01-01

There has recently been increased attention given to understanding how cultural variables may have an impact on the efficacy of treatments with Latino families seeking psychological services. Within parent training programs, understanding the extent to which culture can affect parenting practices is vital to providing quality care. The focus of…

Design of the Quality of Life in Motion (QLIM) study: a randomized controlled trial to evaluate the effectiveness and cost-effectiveness of a combined physical exercise and psychosocial training program to improve physical fitness in children with cancer.

PubMed

Braam, Katja I; van Dijk, Elisabeth M; Veening, Margreet A; Bierings, Marc B; Merks, Johannes H M; Grootenhuis, Martha A; Chinapaw, Mai J M; Sinnema, Gerben; Takken, Tim; Huisman, Jaap; Kaspers, Gertjan J L; van Dulmen-den Broeder, Eline

2010-11-11

Childhood cancer and its treatment have considerable impact on a child's physical and mental wellbeing. Especially long-term administration of chemotherapy and/or radiotherapy impairs physical fitness both during and after therapy, when children often present with muscle weakness and/or low cardiorespiratory fitness. Physical exercise can improve these two elements of physical fitness, but the positive effects of physical exercise might be further increased when a child's wellbeing is simultaneously enhanced by psychosocial training. Feeling better may increase the willingness and motivation to engage in sports activities. Therefore, this multi-centre study evaluates the short and long-term changes in physical fitness of a child with a childhood malignancy, using a combined physical exercise and psychosocial intervention program, implemented during or shortly after treatment. Also examined is whether positive effects on physical fitness reduce inactivity-related adverse health problems, improve quality of life, and are cost-effective. This multi-centre randomized controlled trial compares a combined physical and psychosocial intervention program for children with cancer, with care as usual (controls). Children with cancer (aged 8-18 years) treated with chemotherapy and/or radiotherapy, and who are no longer than 1 year post-treatment, are eligible for participation. A total of 100 children are being recruited from the paediatric oncology/haematology departments of three Dutch university medical centres. Patients are stratified according to pubertal stage (girls: age ≤10 or >10 years; boys: ≤11 or >11 years), type of malignancy (haematological or solid tumour), and moment of inclusion into the study (during or after treatment), and are randomly assigned to the intervention or control group. Childhood cancer patients undergoing long-term cancer therapy may benefit from a combined physical exercise and psychosocial intervention program since it may maintain or enhance their physical fitness and increase their quality of life. However, the feasibility, patient need, and effectiveness of such a program should be established before the program can be implemented as part of standard care. NTR1531 (The Netherlands National Trial Register).

Union-related correlates of employee referrals to an occupational alcoholism project in a health maintenance organization.

PubMed

Putnam, S L; Stout, R L

1982-03-01

A number of union-related factors, including the degree of unionization and the skill level of the work force, the quality of union-management relations, the extent of union involvement in program development, as well as the provision of supervisory training, have been found to be important in explaining occupational alcoholism program outcome. This study attempted to determine the relationship of such factors to an unusual measure of program outcome, employee referrals to the treatment component of an occupational alcoholism project housed in the counseling department of a health maintenance organization. Multiple-regression techniques were used, with data collected for unionized companies that adopted formal, written employee assistance program (EAP) policies and those that did not. The adoption of an EAP policy seems more important than any other factor in predicting referrals to treatment, In unionized companies without policies, the union-related factors bear no relationship to referrals, while in unionized companies with policies, these variables, particularly the quality of union-management relations, are strong predictors. Supervisory training has only a modest positive effect on referrals. The adoption of an employee assistance policy itself was found to be crucial to program outcome, measured by increased chances of referrals.

Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome.

PubMed

Merritt, Russell J; Cohran, Valeria; Raphael, Bram P; Sentongo, Timothy; Volpert, Diana; Warner, Brad W; Goday, Praveen S

2017-11-01

Intestinal failure is a rare, debilitating condition that presents both acute and chronic medical management challenges. The condition is incompatible with life in the absence of the safe application of specialized and individualized medical therapy that includes surgery, medical equipment, nutritional products, and standard nursing care. Intestinal rehabilitation programs are best suited to provide such complex care with the goal of achieving enteral autonomy and oral feeding with or without intestinal transplantation. These programs almost all include pediatric surgeons, pediatric gastroenterologists, specialized nurses, and dietitians; many also include a variety of other medical and allied medical specialists. Intestinal rehabilitation programs provide integrated interdisciplinary care, more discussion of patient management by involved specialists, continuity of care through various treatment interventions, close follow-up of outpatients, improved patient and family education, earlier treatment of complications, and learning from the accumulated patient databases. Quality assurance and research collaboration among centers are also goals of many of these programs. The combined and coordinated talents and skills of multiple types of health care practitioners have the potential to ameliorate the impact of intestinal failure and improve health outcomes and quality of life.

Benefits of a Pharmacology Antimalarial Reference Standard and Proficiency Testing Program Provided by the Worldwide Antimalarial Resistance Network (WWARN)

PubMed Central

Lourens, Chris; Lindegardh, Niklas; Barnes, Karen I.; Guerin, Philippe J.; Sibley, Carol H.; White, Nicholas J.

2014-01-01

Comprehensive assessment of antimalarial drug resistance should include measurements of antimalarial blood or plasma concentrations in clinical trials and in individual assessments of treatment failure so that true resistance can be differentiated from inadequate drug exposure. Pharmacometric modeling is necessary to assess pharmacokinetic-pharmacodynamic relationships in different populations to optimize dosing. To accomplish both effectively and to allow comparison of data from different laboratories, it is essential that drug concentration measurement is accurate. Proficiency testing (PT) of laboratory procedures is necessary for verification of assay results. Within the Worldwide Antimalarial Resistance Network (WWARN), the goal of the quality assurance/quality control (QA/QC) program is to facilitate and sustain high-quality antimalarial assays. The QA/QC program consists of an international PT program for pharmacology laboratories and a reference material (RM) program for the provision of antimalarial drug standards, metabolites, and internal standards for laboratory use. The RM program currently distributes accurately weighed quantities of antimalarial drug standards, metabolites, and internal standards to 44 pharmacology, in vitro, and drug quality testing laboratories. The pharmacology PT program has sent samples to eight laboratories in four rounds of testing. WWARN technical experts have provided advice for correcting identified problems to improve performance of subsequent analysis and ultimately improved the quality of data. Many participants have demonstrated substantial improvements over subsequent rounds of PT. The WWARN QA/QC program has improved the quality and value of antimalarial drug measurement in laboratories globally. It is a model that has potential to be applied to strengthening laboratories more widely and improving the therapeutics of other infectious diseases. PMID:24777099

Multileaf collimator characteristics and reliability requirements for IMRT Elekta system.

PubMed

Liu, Chihray; Simon, Thomas A; Fox, Christopher; Li, Jonathan; Palta, Jatinder R

2008-01-01

Understanding the characteristics of a multileaf collimator (MLC) system, modeling MLC in a treatment planning system, and maintaining the mechanical accuracy of the linear accelerator gantry head system are important factors in the safe implementation of an intensity-modulated radiotherapy program. We review the characteristics of an Elekta MLC system, discuss the necessary MLC modeling parameters for a treatment planning system, and provide a novel method to establish an MLC leaf position quality assurance program. To perform quality assurance on 40 pairs of individual MLC leaves is a time-consuming and difficult task. In this report, an effective routine MLC quality assurance method based on the field edge of a backup jaw as referenced in conjunction with a diode array as a radiation detector system is discussed. The sensitivity of this test for determining the relative leaf positions was observed to be better than 0.1 mm. The Elekta MLC leaf position accuracy measured with this system has been better than 0.3 mm.

Managing la malilla: Exploring drug treatment experiences among injection drug users in Tijuana, Mexico, and their implications for drug law reform

PubMed Central

Syvertsen, Jennifer; Pollini, Robin A.; Lozada, Remedios; Vera, Alicia; Rangel, Gudelia; Strathdee, Steffanie A.

2012-01-01

Background In August 2009, Mexico reformed its drug laws and decriminalized small quantities of drugs for personal use; offenders caught three times will be mandated to enter drug treatment. However, little is known about the quality or effectiveness of drug treatment programs in Mexico. We examined injection drug users’ (IDUs) experiences in drug treatment in Tijuana, Mexico, with the goal of informing program planning and policy. Methods We examined qualitative and quantitative data from Proyecto El Cuete, a multi-phased research study on HIV risk among IDUs in Tijuana. Phase I consisted of 20 in-depth interviews and Phase II employed respondent-driven sampling to recruit 222 IDUs for a quantitative survey. We also reviewed national drug policy documents, surveillance data, and media reports to situate drug users’ experiences within the broader sociopolitical context. Results Participants in the qualitative study were 50% male with a mean age of 32; most injected heroin (85.0%) and methamphetamine (60.0%). The quantitative sample was 91.4% male with a mean age of 35; 98.2% injected heroin and 83.7% injected heroin and methamphetamine together. The majority of participants reported receiving treatment: residential treatment was most common, followed by methadone; other types of services were infrequently reported. Participants’ perceptions of program acceptability and effectiveness were mixed. Mistreatment emerged as a theme in the qualitative interviews and was reported by 21.6% of Phase II participants, primarily physical (72.0%) and verbal (52.0%) abuse. Conclusions Our results point to the need for political, economic, and social investment in the drug treatment system before offenders are sentenced to treatment under the revised national drug law. Resources are needed to strengthen program quality and ensure accountability. The public health impact of the new legislation that attempts to bring drug treatment to the forefront of national drug policy should be systematically evaluated. PMID:20800464

Quality assurance of HDR prostate plans: program implementation at a community hospital.

PubMed

Rush, Jennifer B; Thomas, Michael D

2005-01-01

Adenocarcinoma of the prostate is currently the most commonly diagnosed cancer in men in the United States, and the second leading cause of cancer mortality. The utilization of radiation therapy is regarded as the definitive local therapy of choice for intermediate- and high-risk disease, in which there is increased risk for extracapsular extension, seminal vesicle invasion, or regional node involvement. High-dose-rate (HDR) brachytherapy is a logical treatment modality to deliver the boost dose to an external beam radiation therapy (EBRT) treatment to increase local control rates. From a treatment perspective, the utilization of a complicated treatment delivery system, the compressed time frame in which the procedure is performed, and the small number of large dose fractions make the implementation of a comprehensive quality assurance (QA) program imperative. One aspect of this program is the QA of the HDR treatment plan. Review of regulatory and medical physics professional publications shows that substantial general guidance is available. We provide some insight to the implementation of an HDR prostate plan program at a community hospital. One aspect addressed is the utilization of the low-dose-rate (LDR) planning system and the use of existing ultrasound image sets to familiarize the radiation therapy team with respect to acceptable HDR implant geometries. Additionally, the use of the LDR treatment planning system provided a means to prospectively determine the relationship between the treated isodose volume and the product of activity and time for the department's planning protocol prior to the first HDR implant. For the first 12 HDR prostate implants, the root-mean-square (RMS) deviation was 3.05% between the predicted product of activity and time vs. the actual plan values. Retrospective re-evaluation of the actual implant data reduced the RMS deviation to 2.36%.

Developing and Implementing a Quality Assurance Strategy for Electroconvulsive Therapy.

PubMed

Hollingsworth, Jessa; Baliko, Beverly; McKinney, Selina; Rosenquist, Peter

2018-04-17

The literature provides scant guidance in effective quality assurance strategies concerning the use of electroconvulsive therapy (ECT) for the treatment of psychiatric conditions. Numerous guidelines are published that provide guidance in the delivery of care; however, little has been done to determine how a program or facility might ensure compliance to best practice for safety, tolerability, and efficacy in performing ECT. The objective of this project was to create a quality assurance strategy specific to ECT. Determining standards for quality care and clarifying facility policy were key outcomes in establishing an effective quality assurance strategy. An audit tool was developed utilizing quality criteria derived from a systematic review of ECT practice guidelines, peer review, and facility policy. All ECT procedures occurring over a 2-month period of May to June 2017 were retrospectively audited and compared against target compliance rates set for the facility's ECT program. Facility policy was adapted to reflect quality standards, and audit findings were used to inform possible practice change initiatives, were used to create benchmarks for continuous quality monitoring, and were integrated into regular hospital quality meetings. Clarification on standards of care and the use of clinical auditing in ECT was an effective starting point in the development of a quality assurance strategy. Audit findings were successfully integrated into the hospital's overall quality program, and recognition of practice compliance informed areas for future quality development and policy revision in this small community-based hospital in the southeastern United States. This project sets the foundation for a quality assurance strategy that can be used to help monitor procedural safety and guide future improvement efforts in delivering ECT. Although it is just the first step in creating meaningful quality improvement, setting clear standards and identifying areas of greatest clinical need were crucial beginning for this hospital's growing program.

Group Singing as a Therapy during Diabetes Training--A Randomized Controlled Pilot Study.

PubMed

Groener, J B; Neus, I; Kopf, S; Hartmann, M; Schanz, J; Kliemank, E; Wetekam, B; Kihm, L; Fleming, T; Herzog, W; Nawroth, P P

2015-11-01

Comprehensive diabetes treatment has been shown to reduce quality of life in diabetic patients. However, there is evidence to suggest that group singing can have positive effects on quality of life in various clinical settings. In this randomized controlled pilot study, the effect of singing as a therapy to reduce stress and improve quality of life was investigated in insulin-dependent diabetic patients, undergoing a lifestyle intervention program. Patients from the singing group felt less discontented following treatment. This effect, however, was lost after 3 months. No effect on serum cortisol and plasma adrenocorticotropic hormone (ACTH) levels could be seen when comparing the singing group with the control group, although reduced levels of ACTH and cortisol 3 days after treatment could be found and were still present after 3 months within the group of patients who undertook singing as a therapy. Singing led to an increase in bodyweight, which interestingly had no effect on glucose control or methylglyoxal levels. Therefore, singing during a lifestyle intervention program for insulin-dependent diabetic patients had a short lasting and weak effect on patients' mood without affecting glucose control, but no significant effect on stress related hormones. © Georg Thieme Verlag KG Stuttgart · New York.

Perceived Autonomy Support in the NIMH RAISE Early Treatment Program.

PubMed

Browne, Julia; Penn, David L; Bauer, Daniel J; Meyer-Kalos, Piper; Mueser, Kim T; Robinson, Delbert G; Addington, Jean; Schooler, Nina R; Glynn, Shirley M; Gingerich, Susan; Marcy, Patricia; Kane, John M

2017-09-01

This study examined perceived support for autonomy-the extent to which individuals feel empowered and supported to make informed choices-among participants in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP). The aims of this study were to evaluate whether NAVIGATE, the active treatment studied in RAISE ETP, was associated with greater improvements in perceived autonomy support over the two-year intervention, compared with community care, and to examine associations between perceived autonomy support and quality of life and symptoms over time and across treatment groups. This study examined perceived autonomy support among the 404 individuals with first-episode psychosis who participated in the RAISE ETP trial (NAVIGATE, N=223; community care, N=181). Three-level conditional linear growth modeling was used given the nested data structure. The results indicated that perceived autonomy support increased significantly over time for those in NAVIGATE but not in community care. Once treatment began, higher perceived autonomy support was related to higher quality of life at six, 12, and 18 months in NAVIGATE and at 12, 18, and 24 months in community care. Higher perceived autonomy support was related to improved scores on total symptoms and on excited symptoms regardless of treatment group and time. Overall, perceived autonomy support increased in NAVIGATE but not for those in community care and was related to improved quality of life and symptoms across both treatment groups. Future research should examine the impact of perceived autonomy support on a wider array of outcomes, including engagement, medication adherence, and functioning.

A Real-Time Safety and Quality Reporting System: Assessment of Clinical Data and Staff Participation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rahn, Douglas A.; Kim, Gwe-Ya; Mundt, Arno J.

Purpose: To report on the use of an incident learning system in a radiation oncology clinic, along with a review of staff participation. Methods and Materials: On September 24, 2010, our department initiated an online real-time voluntary reporting system for safety issues, called the Radiation Oncology Quality Reporting System (ROQRS). We reviewed these reports from the program's inception through January 18, 2013 (2 years, 3 months, 25 days) to assess error reports (defined as both near-misses and incidents of inaccurate treatment). Results: During the study interval, there were 60,168 fractions of external beam radiation therapy and 955 brachytherapy procedures. There were 298 entriesmore » in the ROQRS system, among which 108 errors were reported. There were 31 patients with near-misses reported and 27 patients with incidents of inaccurate treatment reported. These incidents of inaccurate treatment occurred in 68 total treatment fractions (0.11% of treatments delivered during the study interval). None of these incidents of inaccurate treatment resulted in deviation from the prescription by 5% or more. A solution to the errors was documented in ROQRS in 65% of the cases. Errors occurred as repeated errors in 22% of the cases. A disproportionate number of the incidents of inaccurate treatment were due to improper patient setup at the linear accelerator (P<.001). Physician participation in ROQRS was nonexistent initially, but improved after an education program. Conclusions: Incident learning systems are a useful and practical means of improving safety and quality in patient care.« less

Enhancing access and retention in substance abuse treatment: the role of Medicaid payment acceptance and cultural competence.

PubMed

Guerrero, Erick G

2013-10-01

Health insurance coverage and quality of care are common factors believed to improve access for and retention of racial and ethnic minority groups in health care. However, there is little evidence that acceptance of public insurance and provision of culturally responsive care decrease wait time and retention of minority populations in community-based substance abuse treatment. We analyzed client and program data collected in 2010-2011 from publicly funded treatment programs in Los Angeles County, CA. An analytical sample of 13,328 primarily African American and Latino clients nested within 104 treatment programs located in minority communities was analyzed using multilevel negative binomial regressions on count measures of days to initiate and days spent in treatment. Programs that accepted public insurance (p<.001) and in which staff reported personal involvement (p<.01) and linkages and resources with minority communities (p<.001) were negatively associated with client wait time. Similarly, programs with culturally responsive policies and assessment and treatment practices (p<.05) were positively associated with retention in treatment, after controlling for individual and program characteristics. These preliminary findings provide an evidentiary base for the role of community-based financial and cultural practices in improving accessibility and treatment adherence in a population at high risk of treatment dropout. Implications related to health care reform legislation, which seeks to expand public insurance and enhance culturally competent care, are discussed. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The Mediating Role of Exercise on Relationships Between Fatigue, Sleep Quality, and Quality of Life for Adolescents With Cancer.

PubMed

Wu, Wei-Wen; Jou, Shiann-Tarng; Liang, Shu-Yuan; Tsai, Shao-Yu

2018-02-27

Fatigue and poor sleep are two of the most common and most distressing symptoms for adolescents with cancer. These 2 symptoms concurrently heighten distress, further decreasing quality of life (QoL). The aims of this study were to describe the degree of exercise involvement, fatigue, sleep quality, and QoL among adolescents with cancer and to determine whether exercise mediates the relationships between (a) fatigue and QoL and (b) sleep quality and QoL. A cross-sectional study of 100 participants was conducted. Multiple regression was performed to examine the mediation relationship. Participants in the off-treatment group had a significantly higher degree of exercise involvement, as well as less fatigue, greater sleep quality, and less QoL distress. Exercise partially mediated the adverse effect of fatigue on QoL for adolescents undergoing cancer treatment, accounting for 49.80% of the total variation; exercise partially mediated the adverse effect of poor sleep on QoL for adolescents both in treatment and in survivorship, accounting for 42.06% and 28.71% of the total variations, respectively. Exercise partially mediated the relationship between fatigue and QoL for adolescents in cancer treatment and partially mediated the relationship between sleep quality and QoL both for those in cancer treatment and for those in survivorship. Developing tailored exercise programs based on both treatment status and the degree of fatigue and sleep quality is important. In-service education that enhances nurses' awareness of the importance of exercise in improving adolescents' QoL is recommended.

How seed orchard culture affects seed quality: experience with the southern pines

Treesearch

James P. Barnett

1996-01-01

Tree improvement programs have influenced significantly the quality of southern pine seeds produced when compared to collections from native stands. Seed orchard management practices such as fertilization can increase seed size and reduce seed dormancy. These result in the need for less complex pregermination treatments. Repeated cone collections from the same clones...

EVALUATION OF A PROTOCOL FOR DRINKING WATER TREATMENT DATA REQUIRED BY THE FOOD QUALITY PROTECTION ACT

EPA Science Inventory

Under the Food Quality Protection Act (FQPA), the USEPA Office of Pesticide Programs (OPP) considers drinking water as a route for pesticide exposure in its human health risk assessments, and may require data on the fate of a pesticide in drinking water be supplied to OPP by the ...

National Pollutant Discharge Elimination System (NPDES) Permit Application Requirement for Storm Water Discharges

DTIC Science & Technology

1991-05-01

schedule for construction, upgrading or operation of wastewater treatment facilities or any other environmental programs, which may effect storm water quality of...if the storm water quality may be similar. c. Two sets of samples are required to be collected: (1) A grab during the first 30 minutes of the rainfall

The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial

PubMed Central

2013-01-01

Background A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care − CLiAC) was developed to improve managers’ leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program. Methods Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster-level analysis. The overall costs and benefits of the program will also be assessed. Discussion The outcomes of the trial have the potential to inform actions to enhance leadership and management capabilities of the aged care workforce, address pressing issues about workforce shortages, and increase the quality of aged care services. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12611001070921) PMID:24160714

Linking data to decision-making: applying qualitative data analysis methods and software to identify mechanisms for using outcomes data.

PubMed

Patel, Vaishali N; Riley, Anne W

2007-10-01

A multiple case study was conducted to examine how staff in child out-of-home care programs used data from an Outcomes Management System (OMS) and other sources to inform decision-making. Data collection consisted of thirty-seven semi-structured interviews with clinicians, managers, and directors from two treatment foster care programs and two residential treatment centers, and individuals involved with developing the OMS; and observations of clinical and quality management meetings. Case study and grounded theory methodology guided analyses. The application of qualitative data analysis software is described. Results show that although staff rarely used data from the OMS, they did rely on other sources of systematically collected information to inform clinical, quality management, and program decisions. Analyses of how staff used these data suggest that improving the utility of OMS will involve encouraging staff to participate in data-based decision-making, and designing and implementing OMS in a manner that reflects how decision-making processes operate.

78 FR 11858 - Applications for New Awards; Arts in Education Model Development and Dissemination Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-20

... the treatment for project participants and, where feasible, for a comparison group of non... in the project (control group). The effect of the project is the average difference in outcomes between the treatment and control groups. Integrating means (i) encouraging the use of high-quality arts...

A Study of Clinical Supervision Techniques and Training in Substance Abuse Treatment

ERIC Educational Resources Information Center

West, Paul L.; Hamm, Terri

2012-01-01

Data from 57 clinical supervisors in licensed substance abuse treatment programs indicate that 28% had completed formal graduate course work in clinical supervision and 33% were professionally licensed or certified. Findings raise concerns about the scope and quality of clinical supervision available to substance abuse counselors. (Contains 3…

Waste Water Plant Operators Manual.

ERIC Educational Resources Information Center

Washington State Coordinating Council for Occupational Education, Olympia.

This manual for sewage treatment plant operators was prepared by a committee of operators, educators, and engineers for use as a reference text and handbook and to serve as a training manual for short course and certification programs. Sewage treatment plant operators have a responsibility in water quality control; they are the principal actors in…

Vestibular rehabilitation in a patient with whiplash-associated disorders.

PubMed

Tuo, Kwo-Shieng; Cheng, Yuan-Yang; Kao, Chung-Lan

2006-12-01

Whiplash-associated disorders are characterized by multiple physical complaints after a flexion-extension trauma to the neck. They are difficult to treat, and they often result in great impact on the patient's quality of life. In this paper, the comprehensive treatment of a patient with whiplash-associated disorders is presented. The purpose is to highlight the importance of accurate diagnosis and appropriate treatment plans to improve patients' quality of life. This 23-year-old woman experienced a traffic accident which caused severely painful neck disability, numbness over bilateral upper limbs, dizziness, double vision and loss of balance. Among these symptoms, dizziness was the problem that bothered the patient most. She received a comprehensive rehabilitation program including physical modalities, trigger point injections for relief of pain, as well as a vestibular rehabilitation program, which included exercises challenging and improving her balance function, head-eye coordination exercise, visual-ocular control exercise and sensory substitution-promoting exercises. She resumed her previous full-time work after 3 weeks of treatment. This successfully treated case illustrates the importance of correct diagnosis and appropriate treatment for patients who suffer from whiplash-associated disorders.

Acceptance and relationship context: a model of substance use disorder treatment outcome.

PubMed

Gifford, Elizabeth V; Ritsher, Jennifer B; McKellar, John D; Moos, Rudolf H

2006-08-01

This study presented and tested a model of behavior change in long-term substance use disorder recovery, the acceptance and relationship context (ARC) model. The model specifies that acceptance-based behavior and constructive social relationships lead to recovery, and that treatment programs with supportive, involved relationships facilitate the development of these factors. This study used a prospective longitudinal naturalistic design and controlled for baseline levels of study variables. The model was tested on a sample of 2549 patients in 15 residential substance use disorder treatment programs. Acceptance-based responding (ABR), social relationship quality (SRQ), treatment program alliance (TPA) and substance use-related impairment were assessed using interviews and self-report questionnaires. TPA predicted ABR and SRQ and, in turn, ABR predicted better 2-year and 5-year treatment outcomes. The baseline-controlled model accounted for 41% of the variance in outcome at 2-year follow-up and 28% of the variance in outcome at 5-year follow-up. CONCLUSIONS Patients from treatment programs with an affiliative relationship network are more likely to respond adaptively to internal states associated previously with substance use, develop constructive social relationships and achieve long-term treatment benefits.

ORGANIZATIONAL ATTRIBUTES OF PRACTICES SUCCESSFUL AT A DISEASE MANAGEMENT PROGRAM

PubMed Central

Cloutier, Michelle M.; Wakefield, Dorothy B.; Tsimikas, John; Hall, Charles B.; Tennen, Howard; Brazil, Kevin

2009-01-01

Objective To assess the contribution of organizational factors to implementation of three asthma quality measures: enrollment in a disease management program, development of a written treatment plan and prescribing severity-appropriate anti-inflammatory therapy. Study design 138 pediatric clinicians and 247 office staff in 13 urban clinics and 23 non-urban, private practices completed questionnaires about their practice’s organizational characteristics (e.g. leadership, communication, perceived effectiveness, job satisfaction). Results 94% of clinicians and 92% of office staff completed questionnaires. When adjusted for confounders, greater practice activity and perceived effectiveness in meeting family needs was associated with higher rates of Easy Breathing enrollment, whereas higher scores for three organizational characteristics--communication timeliness, decision authority and job satisfaction--were associated both with higher numbers of enrolled children and a greater number of written treatment plans. None of the organizational characteristics were associated with greater use of anti-inflammatory therapy. Conclusions Three organizational characteristics predicted two quality asthma measures - use of a disease management program and creation of a written asthma treatment plan. If these organizational characteristics are amenable to change, our results could help focus interventions in areas of effective and acceptable organizational change. PMID:18835488

Quality measurers of therapeutic communities for substance dependence: an international collaborative study survey in Latin America.

PubMed

Gómez-Restrepo, Carlos; Maldonado, Patricia; Rodríguez, Nelcy; Ruiz-Gaviria, Rafael; Escalante, Miguel Ángel; Gómez, Raúl Ángel; de Araujo, Marcelo Ribeiro; de Oliveira, Ana Carolina Schmidt; Rivera, Joel Salvador Chávez; García, Jorge Alberto Godínez; Ferrand, Marina Piazza; Blitchtein-Winicki, Dora

2017-12-20

In Latin America, substance related disorders are highly prevalent and one of the treatment strategies is the Therapeutic Communities (TCs), however, in Latin America there is scarce data about this treatment strategies, their quality, drop-out rates and patient satisfaction. Based on a previous study in 5 Latin American countries, the TCs who had a score equal or higher than 9 according to the De Leon criteria which are some fundamental items that the TCs should meet, were selected to carry out a descriptive and retrospective study of qualitative and quantitative characteristics of the TCs. Data from 58 TCs in 5 countries were included, with a sample of 1414 patients interviewed, of which most were single men, with no hospitalization history in a therapeutic community. Marijuana was the most commonly substance used in the 30 days prior to hospitalization, with 78% of interviewees referring alcohol consumption in the last 6 months and an average onset of psychoactive substances at 16 years of age. A 79% of the patients interviewed perceived some improvement during their stay in the TCs. The less fulfilled Quality Indicators by the TCs were "Requesting a professional qualification to former addicts that belonged to the program" and "Work as part of the therapeutic program". Among the reasons for discharge found in the database, 44% were due to therapeutic discharge with fulfillment of the treatment plan and 44% withdraws. The user satisfaction with TCs, in terms of infrastructure and quality are quite high, as the fulfillment of essential quality items, however, the follow up information to evaluate effectiveness of the treatment is poor or in some cases unknown.

SU-E-T-216: TPS QC Supporting Program by a Third-Party Evaluation Agency in Japan.

PubMed

Fukata, K; Minemura, T; Kurokawa, C; Miyagishi, T; Itami, J

2012-06-01

To equalize the quality of radiation therapy in Japan by supporting quality control of radiation treatment planning system. Center for Cancer Control and Information Service in National Cancer Center supports the QA-QC of the cancer core hospitals in Japan as a third-party evaluation agency. Recently, a program for assessing the quality of treatment planning system (TPS) began as a part of our QA-QC supporting activities. In this program, a questionnaire about TPS was sent to 45 prefectural cancer core hospitals in Japan. The object of this questionnaire is to assess the proper commissioning, implement and applications of TPSs. The contents of the questionnaire are as follows; 1) calculate MUs which deliver 1000 cGy to the point of SSD = 100 cm, 10 cm depth with field sizes ranging from 5×5 to 30 × 30 cm 2 , and obtain doses at several depths for the calculated MUs, 2) calculate MUs which deliver 1000 cGy to the point of SSD = 100 cm, 10 cm depth for wedge fields whose angles are from 15 to 60 degrees, and obtain doses at several depths with the MUs, 3) calculate MU which deliver 1000 cGy to the point of STD = 100 cm, 10 cm depth with 10×10 cm 2 field size and obtain doses at several depths with the MU. In this program, 179 beam data from 44 facilities were collected. Data were compared in terms of dose per MU, output factor, wedge factor and TMR. It was found that 90% of the data agreed within 2%. The quality of the treatment planning system was investigated through the questionnaire including the information of essential beam data. We compared 179 beam data in TPSs sent from 44 facilities and 90% of the data showed good agreement. © 2012 American Association of Physicists in Medicine.

Evaluation of a four- versus six-week length of stay in the Navy's alcohol treatment program.

PubMed

Trent, L K

1998-05-01

Attempts to balance escalating health care costs with resource downsizing have prompted alcohol treatment directors in the U.S. Navy to consider reducing the standard length of stay in treatment. The objectives of this study were to (1) determine whether a 4-week inpatient treatment program is as effective as a 6-week program, and (2) explore the potential for matching patients to a 4- or 6-week program according to the severity of their condition at intake. A total of 2,823 active-duty alcohol-dependent inpatients (2,685 men, 138 women) at 12 Navy treatment facilities participated in the evaluation. All facilities conducted a 6-week program until data had been collected for 1,380 participants; they then switched to a 4-week program (n = 1,443). Background information and clinical profile were obtained when patients entered treatment; 1-year outcome data (e.g., alcohol use, behavior problems, job performance, quality of life) were obtained from participants, work supervisors and aftercare advisors. Hierarchical multiple regression analyses were used to assess the effect of length of stay on outcome and to examine patient-program interactions. The single best predictor of success at 1 year was months of aftercare attendance. Program membership failed to explain any of the observed differences in the criterion measures, once the effects of other predictors had been taken into account. Severity of condition and patient-program interactions were likewise nonsignificant. It was concluded that a reduction in length of stay from 6 weeks to 4 weeks in the Navy's inpatient alcohol treatment program would not have an adverse effect on outcome.

SU-G-201-01: An Automated Treatment Plan Quality Assurance Program for High-Dose Rate (HDR) Brachytherapy with a VaginalCylinder Applicator

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhou, Y; Tan, J; Jiang, S

Purpose: Plan specific quality assurance (QA) is an important step in high dose rate (HDR) brachytherapy to ensure the integrity of a treatment plan. The conventional approach is to assemble a set of plan screen-captures in a document and have an independent plan-checker to verify it. Not only is this approach cumbersome and time-consuming, using a document also limits the items that can be verified, hindering plan quality and patient safety. We have initiated efforts to develop a web-based HDR brachytherapy QA system called AutoBrachy QA, for comprehensive and efficient QA. This abstract reports a new plugin in this systemmore » for the QA of a cylinder HDR brachytherapy treatment. Methods: A cylinder plan QA module was developed using Python. It was plugged into our AutoBrachy QA system. This module extracted information from CT images and treatment plan. Image processing techniques were employed to obtain geometric parameters, e.g. cylinder diameter. A comprehensive set of eight geometrical and eight dosimetric features of the plan were validated against user specified planning parameter, such as prescription value, treatment depth and length, etc. A PDF document was generated, consisting of a summary QA sheet with all the QA results, as well as images showing plan details. Results: The cylinder QA program has been implemented in our clinic. To date, it has been used in 11 patient cases and was able to successfully perform QA tests in all of them. The QA program reduced the average plan QA time from 7 min using conventional manual approach to 0.5 min. Conclusion: Being a new module in our AutoBrachy QA system, an automated treatment plan QA module for cylinder HDR brachytherapy has been successfully developed and clinically implemented. This module improved clinical workflow and plan integrity compared to the conventional manual approach.« less

Exercise program for children and adolescents with leukemia and lymphoma during treatment: A comprehensive review.

PubMed

Zucchetti, Giulia; Rossi, Francesca; Chamorro Vina, Carolina; Bertorello, Nicoletta; Fagioli, Franca

2018-05-01

An exercise program (EP) during cancer treatment seems to be a valid strategy against physiological and quality-of-life impairments, but scientific evidence of benefits among pediatric patients is still limited. This review summarizes the literature focused on randomized controlled trials of EP offered to patients during leukemia and lymphoma treatment. Studies published up to June 2017 were selected from multiple databases and assessed by three independent reviewers for methodological validity. The review identified eight studies, but several types of bias have to be avoided to provide evidence-based recommendations accessible to patients, families, and professionals. © 2018 Wiley Periodicals, Inc.

A prospective study to evaluate a residential community reintegration program for patients with chronic acquired brain injury.

PubMed

Geurtsen, Gert J; van Heugten, Caroline M; Martina, Juan D; Rietveld, Antonius C; Meijer, Ron; Geurts, Alexander C

2011-05-01

To examine the effects of a residential community reintegration program on independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. A prospective cohort study with a 3-month waiting list control period and 1-year follow up. A tertiary rehabilitation center for acquired brain injury. Patients (N=70) with acquired brain injury (46 men; mean age, 25.1y; mean time post-onset, 5.2y; at follow up n=67). A structured residential treatment program was offered directed at improving independence in domestic life, work, leisure time, and social interactions. Community Integration Questionnaire (CIQ), Employability Rating Scale, living situation, school, work situation, work hours, Center for Epidemiological Studies Depression Scale, EuroQOL quality of life scale (2 scales), World Health Organization Quality of Life Scale Abbreviated (WHOQOL-BREF; 5 scales), and the Global Assessment of Functioning (GAF) scale. There was an overall significant time effect for all outcome measures (multiple analysis of variance T(2)=26.16; F(36,557) 134.9; P=.000). There was no spontaneous recovery during the waiting-list period. The effect sizes for the CIQ, Employability Rating Scale, work hours, and GAF were large (partial η(2)=0.25, 0.35, 0.22, and 0.72, respectively). The effect sizes were moderate for 7 of the 8 emotional well-being and quality of life (sub)scales (partial η(2)=0.11-0.20). The WHOQOL-BREF environment subscale showed a small effect size (partial η(2)=0.05). Living independently rose from 25.4% before treatment to 72.4% after treatment and was still 65.7% at follow up. This study shows that a residential community reintegration program leads to significant and relevant improvements of independent living, societal participation, emotional well-being, and quality of life in patients with chronic acquired brain injury and psychosocial problems hampering societal participation. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia

PubMed Central

Morris, Mary B; Chapula, Bushimbwa Tambatamba; Chi, Benjamin H; Mwango, Albert; Chi, Harmony F; Mwanza, Joyce; Manda, Handson; Bolton, Carolyn; Pankratz, Debra S; Stringer, Jeffrey SA; Reid, Stewart E

2009-01-01

The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth of literature describing task shifting in sub-Saharan Africa, where services for antiretroviral therapy (ART) have scaled up rapidly in the face of generalized human resource crises. As part of ART services expansion in Lusaka, Zambia, we implemented a comprehensive task-shifting program among existing health providers and community-based workers. Training begins with didactic sessions targeting specialized skill sets. This is followed by an intensive period of practical mentorship, where providers are paired with trainers before working independently. We provide on-going quality assessment using key indicators of clinical care quality at each site. Program performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. From 2005 to 2007, we trained 516 health providers in adult HIV treatment; 270 in pediatric HIV treatment; 341 in adherence counseling; 91 in a specialty nurse "triage" course, and 93 in an intensive clinical mentorship program. On-going quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. Our task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful, long-term solutions to the human resource crisis are also urgently needed to expand the number of providers and to slow staff migration out of the region. PMID:19134202

Identifying and reducing disparities in successful addiction treatment completion: testing the role of Medicaid payment acceptance.

PubMed

Guerrero, Erick G; Garner, Bryan R; Cook, Benjamin; Kong, Yinfei; Vega, William A; Gelberg, Lillian

2017-05-25

Medicaid has become the largest payer of substance use disorder treatment and may enhance access to quality care and reduce disparities. We tested whether treatment programs' acceptance of Medicaid payments was associated with reduced disparities between Mexican Americans and non-Latino Whites. We analyzed client and program data from 122 publicly funded treatment programs in 2010 and 112 programs in 2013. These data were merged with information regarding 15,412 adult clients from both periods, of whom we selected only Mexican Americans (n = 7130, 46.3%) and non-Latino Whites (n = 8282, 53.7%). We used multilevel logistic regression and variance decomposition to examine associations and underlying factors associated with Mexican American and White differences in treatment completion. Variables of interest included client demographics; drug use severity and mental health issues; and program license, accreditation, and acceptance of Medicaid payments. Mexican Americans had lower odds of treatment completion (OR = 0.677; 95% CI = 0.534, 0.859) compared to non-Latino Whites. This disparity was explained in part by primary drug used, greater drug use severity, history of mental health disorders, and program acceptance of Medicaid payments. The interaction between Mexican Americans and acceptance of Medicaid was statistically significant (OR = 1.284; 95% CI = 1.008, 1.637). Findings highlighted key program and client drivers of this disparity and the promising role of program acceptance of Medicaid payment to eliminate disparities in treatment completion among Mexican Americans. Implications for health policy during the Trump Administration are discussed.

Promoting Afterschool Quality and Positive Youth Development: Cluster Randomized Trial of the Pax Good Behavior Game.

PubMed

Smith, Emilie Phillips; Osgood, D Wayne; Oh, Yoonkyung; Caldwell, Linda C

2018-02-01

This randomized trial tested a strategy originally developed for school settings, the Pax Good Behavior Game (PAX GBG), in the new context of afterschool programs. We examined this approach in afterschool since 70% of all juvenile crime occurs between the hours of 3-6 pm, making afterschool an important setting for prevention and promotion. Dual-career and working families need monitoring and supervision for their children in quality settings that are safe and appropriately structured. While substantial work has identified important features of afterschool programs, increasing attention is being given to how to foster quality. PAX GBG, with its focus on shared norms, cooperative teams, contingent activity rewards, and liberal praise, could potentially enhance not only appropriate structure and supportive relationships, but also youth self-regulation, co-regulation, and socio-emotional development. This study examined the PAX GBG among 76 afterschool programs, serving 811 youth ages 5-12, who were diverse in race-ethnicity, socio-economic status, and geographic locale. Demographically matched pairs of afterschool programs were randomized to PAX GBG or treatment-as-usual. Independent observers conducted ratings of implementation fidelity and program quality across time; along with surveys of children's problem and prosocial behavior. Interaction effects were found using hierarchical linear models such that experimental programs evidencing higher implementation fidelity demonstrated better program quality than controls, (i.e., less harshness, increased appropriate structure, support, and engagement), as well as reduced child-reported hyperactivity and intent-to-treat effects on prosocial behavior. This study demonstrates that best practices fostered by PAX GBG and implemented with fidelity in afterschool result in higher quality contexts for positive youth development.

Quality of life and its correlates among a group of infertile Iranian women.

PubMed

Aliyeh, Ghasemzad; Laya, Farzadi

2007-07-01

Despite a high epidemiological burden, data concerning the impact of infertility on quality of life are controversial in western countries and little information is available for eastern countries. The aim of this study was to investigate women's health-related quality of life and its correlates in a group of infertile Iranian women. In this cross-sectional study, women who visited the Majidi Infertility Center in Tabriz either for treatment or for basic examinations were studied. Structured and measurement-specific questionnaires for health-related quality of life and some psychological aspects of infertility were adapted from previous studies. The data were entered into a computer and statistically analyzed. Twelve percent of the women seeking infertility treatment had poor and nearly half had good quality of life. No correlation was found between quality of life and age, length of married life, type of infertility, or length of time seeking treatment. There was a strong inverse correlation between irrational parenthood cognitions and quality of life. Economic pressure and psychological pressure from the community and family were inversely correlated with quality of life. Considering the roles of irrational parenthood cognitions as well as community and family pressure on quality of life among infertile women, it appears vital to plan psychological consultations and educational programs both for infertile couples and their close relatives.

Quality of care in American Indian child and adolescent behavioral health: A pilot study of patient and family perspectives

PubMed Central

Podlogar, Matthew C.; Novins, Douglas K.

2015-01-01

Research regarding the quality of behavioral health care for American Indian (AI) children and adolescents is extremely limited, and no study has considered the qualitative perspectives of the AI children receiving such services or that of their families. This pilot study investigated AI patient and family perspectives of what quality of care means to them. Data were drawn from interviews of parents (n = 15), and the youth (if they were age 11 or older; n = 11) of 16 children and adolescents who received treatment at three behavioral health programs serving AI communities. Interview transcripts were coded and analyzed for key themes that related to treatment structure, process, and outcomes. According to these participants, the principal indicator of treatment quality was “being able to trust the clinician.” The most valued treatment outcomes for improvement were the youth’s “self-efficacy and self-worth,” “functioning in school,” and “relationship with the family.” Future research is needed on how to best integrate these domains into specific and objective indicators for standardized quality of care assessments of AI child and adolescent behavioral health services. PMID:25961647

Quality controls for gamma cameras and PET cameras: development of a free open-source ImageJ program

NASA Astrophysics Data System (ADS)

Carlier, Thomas; Ferrer, Ludovic; Berruchon, Jean B.; Cuissard, Regis; Martineau, Adeline; Loonis, Pierre; Couturier, Olivier

2005-04-01

Acquisition data and treatments for quality controls of gamma cameras and Positron Emission Tomography (PET) cameras are commonly performed with dedicated program packages, which are running only on manufactured computers and differ from each other, depending on camera company and program versions. The aim of this work was to develop a free open-source program (written in JAVA language) to analyze data for quality control of gamma cameras and PET cameras. The program is based on the free application software ImageJ and can be easily loaded on any computer operating system (OS) and thus on any type of computer in every nuclear medicine department. Based on standard parameters of quality control, this program includes 1) for gamma camera: a rotation center control (extracted from the American Association of Physics in Medicine, AAPM, norms) and two uniformity controls (extracted from the Institute of Physics and Engineering in Medicine, IPEM, and National Electronic Manufacturers Association, NEMA, norms). 2) For PET systems, three quality controls recently defined by the French Medical Physicist Society (SFPM), i.e. spatial resolution and uniformity in a reconstructed slice and scatter fraction, are included. The determination of spatial resolution (thanks to the Point Spread Function, PSF, acquisition) allows to compute the Modulation Transfer Function (MTF) in both modalities of cameras. All the control functions are included in a tool box which is a free ImageJ plugin and could be soon downloaded from Internet. Besides, this program offers the possibility to save on HTML format the uniformity quality control results and a warning can be set to automatically inform users in case of abnormal results. The architecture of the program allows users to easily add any other specific quality control program. Finally, this toolkit is an easy and robust tool to perform quality control on gamma cameras and PET cameras based on standard computation parameters, is free, run on any type of computer and will soon be downloadable from the net (http://rsb.info.nih.gov/ij/plugins or http://nucleartoolkit.free.fr).

Contribution of Wastewater Treatment Plant Effluents to Nutrient Dynamics in Aquatic Systems: A Review

NASA Astrophysics Data System (ADS)

Carey, Richard O.; Migliaccio, Kati W.

2009-08-01

Excessive nutrient loading (considering nitrogen and phosphorus) is a major ongoing threat to water quality and here we review the impact of nutrient discharges from wastewater treatment plants (WWTPs) to United States (U.S.) freshwater systems. While urban and agricultural land uses are significant nonpoint nutrient contributors, effluent from point sources such as WWTPs can overwhelm receiving waters, effectively dominating hydrological characteristics and regulating instream nutrient processes. Population growth, increased wastewater volumes, and sustainability of critical water resources have all been key factors influencing the extent of wastewater treatment. Reducing nutrient concentrations in wastewater is an important aspect of water quality management because excessive nutrient concentrations often prevent water bodies from meeting designated uses. WWTPs employ numerous physical, chemical, and biological methods to improve effluent water quality but nutrient removal requires advanced treatment and infrastructure that may be economically prohibitive. Therefore, effluent nutrient concentrations vary depending on the particular processes used to treat influent wastewater. Increasingly stringent regulations regarding nutrient concentrations in discharged effluent, along with greater freshwater demand in populous areas, have led to the development of extensive water recycling programs within many U.S. regions. Reuse programs provide an opportunity to reduce or eliminate direct nutrient discharges to receiving waters while allowing for the beneficial use of reclaimed water. However, nutrients in reclaimed water can still be a concern for reuse applications, such as agricultural and landscape irrigation.

SUPERFUND TREATABILITY CLEARINGHOUSE: SOIL STABILIZATION PILOT STUDY, UNITED CHROME NPL SITE PILOT STUDY AND HEALTH AND SAFETY PROGRAM, UNITED CHROME NPL SITE PILOT STUDY

EPA Science Inventory

This document is a project plan for a pilot study at the United Chrome NPL site, Corvallis, Oregon and includes the health and safety and quality assurance/quality control plans. The plan reports results of a bench-scale study of the treatment process as iieasured by the ...

Development and Exchange of Instructional Resources in Water Quality Control Programs, IV: Selecting Instructional Media and Instructional Systems.

ERIC Educational Resources Information Center

Durham, W. Harry; And Others

This document is one of a series of reports which reviews instructional materials and equipment for water and wastewater treatment plant personnel. A system is presented to assist in standardizing the production of lesson plans and instructional materials in the water quality control field. A procedure for selecting appropriate instructional media…

Equal Opportunity Climate and Total Quality Management: A Preliminary Study.

DTIC Science & Technology

1994-09-01

The purpose of the present study is to show the relationship between military Equal Opportunity (EO) and Total Quality Management (TQM). Three...military units were identified that had a recognized TQM program and had completed the Military Equal Opportunity Climate Survey (MEOCS). These three units...commitment, satisfaction, positive EO behaviors (minorities asked to make suggestions, socializing ), fair treatment, and supervision. Discussion

[Therapeutic benefit of a registered psychoeducation program on treatment adherence, objective and subjective quality of life: French pilot study for schizophrenia].

PubMed

Sauvanaud, F; Kebir, O; Vlasie, M; Doste, V; Amado, I; Krebs, M-O

2017-05-01

In schizophrenic disorders, supportive psychosocial therapies have been used as adjuncts to pharmacotherapy to help alleviate residual symptoms and to improve social functioning and quality of life. Among these therapies, psychoeducational therapies showed a significant efficacy on improving drug adherence and on reducing relapses. However, according to the French Health Agency, fewer than 10% of psychiatric structures in France offer registered psychoeducation programs. Caregiver apprehension of patients' depressive reactions to the awareness of the disease could underlie the underuse of psychoeducation therapies. Indeed, the psychoeducation programs' impact on objective and subjective quality of life is discussed among the literature. In this context, we conducted a retrospective, monocentric, open-labelled and non-controlled pilot study to measure the impact of a registered psychoeducation program on objective and subjective quality of life of patients suffering from schizophrenia. Secondary objectives included measures of the effects on drug observance and awareness of the disease. We included stabilized patients over the age of eighteen suffering from schizophrenia. Referent psychiatrics were asked to inform the patient of the diagnosis and to prescribe psychoeducation therapy. From 2011 to 2014, we offered three ambulatory programs, each program including fifteen two-hour group sessions. The groups were opened for three to six patients and managed by two caregivers. Themes discussed during the sessions included: schizophrenic disease, treatments, relationships to family, diet, social issues, toxics, relaxation. Objective and subjective quality of life were evaluated one month before and one month after the program using respectively the global assessment functioning (GAF) and the subjective quality of life (SQoL) scales. The Medical Adherence Rating Scale (MARS) and the French IQ8 scale evaluated respectively drug adherence and awareness of the disease. All patients gave their written consent for the study. Based on medical records and scales, we compared data before and after the program using the Wilcoxon test, adapted for small samples. Fourteen patients, with a mean age of 37.6 years, were included. All patients had a chronic antipsychotic treatment and four benefitted from a bitherapy with a mood stabilizer. The mean length of disease was 15.3 years, with a mean number of 3.4 hospitalizations before inclusion. The participation rate was nearly twelve sessions out of fifteen. Mean GAF score before the program was 48/100. After the program, mean GAF score was significantly increased to 54/100 (P=0.008). As to SQoL score, we found a significant difference of the sub item psychological well-being from 3.2/5 before the program to 3.8/5 after the program (P=0.03). Global SQoL score and other sub items (self-esteem, resilience, and physical well-being) showed a slight but not significant improvement. The sub items family relationships and sentimental life were diminished, non-significantly. Concerning the drug adherence, the mean MARS score was significantly increased from 6.1 to 6.4/8 (P=0.03). Comparison of the insight IQ8 scale showed a slight but non-significant increase. When asked to note the program, patients were globally very satisfied, with a mean rate of 8.6/10. Of fourteen patients, one needed to be hospitalized three years after program. This retrospective study on a small sample of patients suffering from schizophrenic disorder pointed out a significant improvement on drug adherence, objective quality of life and psychological well-being, after an eight-month registered program of psychoeducational therapy. These results are in line with a recent report from the Cochrane group who reported a significant raise of GAF associated with psychoeducational therapies. The literature data for subjective quality of life are more contradictory. Despite the small sample and evaluation means that need to be corrected in further studies, we reproduced the results described in the literature regarding the improvement on drug adherence. However, the stability of these effects should be checked in the medium and long term. Adjunctive psychoeducation therapy has a positive impact on reducing relapses in schizophrenia. In this study, we showed a significant benefit on drug adherence, objective quality of life and psychological well-being on a small sample of patients and provide arguments for the development of psychoeducation programs which are currently underrepresented in France. Our results encourage conducting a further prospective multicenter controlled study on a larger sample to clarify the benefit of psychoeducational therapy on objective and subjective quality of life in schizophrenia. Copyright © 2016 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

A failure modes and effects analysis study for gynecologic high-dose-rate brachytherapy.

PubMed

Mayadev, Jyoti; Dieterich, Sonja; Harse, Rick; Lentz, Susan; Mathai, Mathew; Boddu, Sunita; Kern, Marianne; Courquin, Jean; Stern, Robin L

2015-01-01

To improve the quality of our gynecologic brachytherapy practice and reduce reportable events, we performed a process analysis after the failure modes and effects analysis (FMEA). The FMEA included a multidisciplinary team specifically targeting the tandem and ring brachytherapy procedure. The treatment process was divided into six subprocesses and failure modes (FMs). A scoring guideline was developed based on published FMEA studies and assigned through team consensus. FMs were ranked according to overall and severity scores. FM ranking >5% of the highest risk priority number (RPN) score was selected for in-depth analysis. The efficiency of each existing quality assurance to detect each FM was analyzed. We identified 170 FMs, and 99 were scored. RPN scores ranged from 1 to 192. Of the 13 highest-ranking FMs with RPN scores >80, half had severity scores of 8 or 9, with no mode having severity of 10. Of these FM, the originating process steps were simulation (5), treatment planning (5), treatment delivery (2), and insertion (1). Our high-ranking FM focused on communication and the potential for applicator movement. Evaluation of the efficiency and the comprehensiveness of our quality assurance program showed coverage of all but three of the top 49 FMs ranked by RPN. This is the first reported FMEA process for a comprehensive gynecologic brachytherapy procedure overview. We were able to identify FMs that could potentially and severely impact the patient's treatment. We continue to adjust our quality assurance program based on the results of our FMEA analysis. Published by Elsevier Inc.

Health Changes in Low Income Men Transitioning from a State Funded Prostate Cancer Program to Comprehensive Insurance.

PubMed

Nabhani, Jamal A; Kuang, Ruby; Liu, Hui; Kwan, Lorna; Litwin, Mark S

2018-07-01

We evaluated the effect of transitioning from a prostate cancer specific treatment program to comprehensive insurance under the ACA (Patient Protection and Affordable Care Act) on the physical, mental and prostate cancer related health of poor, previously uninsured men. We assessed general and prostate cancer specific health related quality of life using the RAND SF-12v2™ (12-Item Short Form Survey, version 2) and the UCLA PCI (Prostate Cancer Index) at 3 time points in 24 men who transitioned to comprehensive insurance as the insured group relative to 39 who remained in the prostate cancer program as the control group. We used mixed effects models controlling for treatment and patient factors to measure health differences between the groups during the transition period. Demographics, prostate cancer treatment patterns, and mental, physical and general health were similar before transition in the control and insured groups. After transition men who gained insurance coverage reported significantly worse physical health than men who remained in the prostate cancer program (p = 0.0038). After adjustment in the mixed effects model physical health remained worse in men who gained insurance (p = 0.0036). Mental health and prostate cancer related quality of life did not differ with time between the groups. Compared to controls who remained in the state funded prostate cancer treatment program for poor, uninsured men, newly insured men reported worse physical health after transitioning to ACA coverage. Providers and policy makers may draw important lessons from understanding the mechanisms of this paradoxical worsening in physical health after gaining insurance. These results inform the development of disease specific models of care in the broader health insurance context. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Are exercise programs effective for improving health-related quality of life among cancer survivors? A systematic review and meta-analysis.

PubMed

Mishra, Shiraz I; Scherer, Roberta W; Snyder, Claire; Geigle, Paula; Gotay, Carolyn

2014-11-01

To evaluate the effectiveness of exercise interventions on overall health-related quality of life (HRQOL) and its domains among cancer survivors who have completed primary treatment. 11 electronic databases were searched from inception (dates varied) to October 2011. The authors also identified eligible trials through a search of additional sources. 40 trials with 3,694 participants met the inclusion criteria. At 12 weeks, cancer survivors exposed to exercise interventions had greater positive improvement in overall HRQOL (standardized mean difference [SMD] 0.48; 95% confidence interval [CI] [0.16, 0.81]), emotional well-being (SMD 0.33; 95% CI [0.05, 0.61]), and social functioning (SMD 0.45; 95% CI [0.02, 0.87]); and had a significant reduction in anxiety (SMD -0.26; 95% CI [-0.44, -0.07]) and fatigue (SMD -0.82; 95% CI [-1.5, -0.14]). Exercise programs have a beneficial effect on HRQOL and most of its domains and can be integrated into the management plans for cancer survivors who have completed treatment. Future research is needed to help understand specific attributes of exercise programs that are beneficial for improving HRQOL within and across cancer types. Evidence presented in this review supports the inclusion of exercise programs in clinical guidelines for the management of cancer survivors who have completed treatment, such as the Oncology Nursing Society's Putting Evidence Into Practice resource.

Impact of Dual Disorders, Trauma, and Social Support on Quality of Life Among Women in Treatment for Substance Dependence.

PubMed

Brown, Suzanne; Jun, Min Kyoung; Min, Meeyoung Oh; Tracy, Elizabeth M

2013-01-01

Women with dual disorders report lower levels of social support than women with substance dependence alone, and lower levels of social support have been associated with lower quality of life among individuals with substance use disorders. However, little is known about the impact of trauma symptoms and violence exposure on quality of life for women with dual disorders. The purpose of this study was to examine the impact of dual disorders, trauma, and social support related to recovery on various domains of quality of life among women in substance abuse treatment. This study utilized multiple standardized measures and hierarchical ordinary least squares regression to examine quality of life, trauma, and social support in women with dual disorders. Four domains of quality of life were measured (Physical, Psychological, Social, and Environmental Domains). Participants ( N =369) were recruited from three inner city women only addiction treatment programs. IRB approval was obtained prior to sample recruitment. Presence of a dual disorder was significantly associated with lower quality of life in the Physical and Psychological domains. However, this difference was no longer significant when trauma symptoms were added to the model. Trauma symptoms and Support for Recovery significantly predicted quality of life across all four domains and Friends Support for Abstinence across three domains. Findings suggest that the presence of a dual disorder in women may indicate a history of trauma. They also support the importance of both friend's support for abstinence and recovery support as predictors of quality of life in women with dual disorders. Interventions that focus on social support and quality of life in treatment with women with substance use disorders may potentially enhance treatment outcomes.

The quality of sputum smear microscopy in public-private mix directly observed treatment laboratories in West Amhara region, Ethiopia.

PubMed

Manalebh, Almaw; Demissie, Meaza; Mekonnen, Daniel; Abera, Bayeh

2015-01-01

Ethiopia adopted Public-Private Mix Directly Observed Treatment Short Course Chemotherapy (PPM-DOTS) strategy for tuberculosis (TB) control program. Quality of sputum smear microscopy has paramount importance for tuberculosis control program in resource-poor countries like Ethiopia. A cross-sectional study was conducted to assess the quality of sputum smear microscopy in 37 Public-Private Mix laboratories in West Amhara, Ethiopia. The three external quality assessment methods (onsite evaluation, panel testing and blind rechecking) were employed. Onsite assessment revealed that 67.6% of PPM-DOTS laboratories were below the standard physical space (5 X 6) m2. The average monthly workload per laboratory technician was 19.5 (SD±2.9) slides with 12.8% positivity rate. The quality of Acid Fast Bacilli (AFB) staining reagents was sub-standard. The overall agreement for blind rechecking of 1,123 AFB slides was 99.4% (Kappa = 0.97). Reading of 370 AFB panel slides showed 3.5% false reading (Kappa = 0.92). Moreover, the consistency of reading scanty bacilli slides was lower (93%) compared to 1+, 2+ and 3+ bacilli. Based on blind rechecking and panel testing results, PPM-DOTS site laboratories showed good agreement with the reference laboratory. Physical space and qualities of AFB reagents would be areas of intervention to sustain the quality of sputum smear microscopy. Therefore, regular external quality assessment and provision of basic laboratory supplies for TB diagnosis would be the way forward to improve the quality of sputum smear microscopy services in PPM-DOTS laboratories.

The Quality of Sputum Smear Microscopy in Public-Private Mix Directly Observed Treatment Laboratories in West Amhara Region, Ethiopia

PubMed Central

Manalebh, Almaw; Demissie, Meaza; Mekonnen, Daniel; Abera, Bayeh

2015-01-01

Ethiopia adopted Public-Private Mix Directly Observed Treatment Short Course Chemotherapy (PPM-DOTS) strategy for tuberculosis (TB) control program. Quality of sputum smear microscopy has paramount importance for tuberculosis control program in resource-poor countries like Ethiopia. A cross-sectional study was conducted to assess the quality of sputum smear microscopy in 37 Public-Private Mix laboratories in West Amhara, Ethiopia. The three external quality assessment methods (onsite evaluation, panel testing and blind rechecking) were employed. Onsite assessment revealed that 67.6% of PPM-DOTS laboratories were below the standard physical space (5 X 6) m2. The average monthly workload per laboratory technician was 19.5 (SD±2.9) slides with 12.8% positivity rate. The quality of Acid Fast Bacilli (AFB) staining reagents was sub-standard. The overall agreement for blind rechecking of 1,123 AFB slides was 99.4% (Kappa = 0.97). Reading of 370 AFB panel slides showed 3.5% false reading (Kappa = 0.92). Moreover, the consistency of reading scanty bacilli slides was lower (93%) compared to 1+, 2+ and 3+ bacilli. Based on blind rechecking and panel testing results, PPM-DOTS site laboratories showed good agreement with the reference laboratory. Physical space and qualities of AFB reagents would be areas of intervention to sustain the quality of sputum smear microscopy. Therefore, regular external quality assessment and provision of basic laboratory supplies for TB diagnosis would be the way forward to improve the quality of sputum smear microscopy services in PPM-DOTS laboratories. PMID:25849516

Predictors of outcome at 1 year in adolescents with DSM-5 restrictive eating disorders: report of the national eating disorders quality improvement collaborative.

PubMed

Forman, Sara F; McKenzie, Nicole; Hehn, Rebecca; Monge, Maria C; Kapphahn, Cynthia J; Mammel, Kathleen A; Callahan, S Todd; Sigel, Eric J; Bravender, Terrill; Romano, Mary; Rome, Ellen S; Robinson, Kelly A; Fisher, Martin; Malizio, Joan B; Rosen, David S; Hergenroeder, Albert C; Buckelew, Sara M; Jay, M Susan; Lindenbaum, Jeffrey; Rickert, Vaughn I; Garber, Andrea; Golden, Neville H; Woods, Elizabeth R

2014-12-01

The National Eating Disorders Quality Improvement Collaborative evaluated data of patients with restrictive eating disorders to analyze demographics of diagnostic categories and predictors of weight restoration at 1 year. Fourteen Adolescent Medicine eating disorder programs participated in a retrospective review of 700 adolescents aged 9-21 years with three visits, with DSM-5 categories of restrictive eating disorders including anorexia nervosa (AN), atypical AN, and avoidant/restrictive food intake disorder (ARFID). Data including demographics, weight and height at intake and follow-up, treatment before intake, and treatment during the year of follow-up were analyzed. At intake, 53.6% met criteria for AN, 33.9% for atypical AN, and 12.4% for ARFID. Adolescents with ARFID were more likely to be male, younger, and had a longer duration of illness before presentation. All sites had a positive change in mean percentage median body mass index (%MBMI) for their population at 1-year follow-up. Controlling for age, gender, duration of illness, diagnosis, and prior higher level of care, only %MBMI at intake was a significant predictor of weight recovery. In the model, there was a 12.7% change in %MBMI (interquartile range, 6.5-19.3). Type of treatment was not predictive, and there were no significant differences between programs in terms of weight restoration. The National Eating Disorders Quality Improvement Collaborative provides a description of the patient population presenting to a national cross-section of 14 Adolescent Medicine eating disorder programs and categorized by DSM-5. Treatment modalities need to be further evaluated to assess for more global aspects of recovery. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Self-reported Improvement in Side Effects and Quality of Life With Integrative Medicine in Breast Cancer Patients.

PubMed

Hack, Carolin C; Hackl, Janina; Hüttner, Nina B M; Langemann, Hanna; Schwitulla, Judith; Dietzel-Drentwett, Svenja; Fasching, Peter A; Beckmann, Matthias W; Theuser, Anna-Katharin

2018-05-01

Although the demand from patients for integrative medicine is increasing, complementary medicine services are still quite heterogeneous and have not been incorporated into clinical routine. The aim of this study was to systematically evaluate improvements in side effects and quality of life associated with a hospital-based integrative medicine program in the modern breast cancer patient care setting. In a cross-sectional study, integrative health counseling and treatment were evaluated in women with breast cancer. Over a 15-month period, data for 75 patients from an integrative medicine consultancy service with standardized operating procedures were collected at the University Breast Center for Franconia. At baseline, the patients answered a questionnaire on their medical history, symptoms, and the treatment goals they were hoping to achieve with integrative medicine. In the follow-up, patient-reported outcomes related to side effects of conventional cancer treatment and patients' quality of life were analyzed. Among 60 patients with the therapy goal of reducing the side effects of conventional treatment, 46 (76.7%) were successful. Among 57 patients hoping to improve disease-related quality of life, 46 (82%) reported success. Whereas patients with metastatic disease achieved a reduction in the side effects of conventional therapy, quality-of-life improvements were predominantly achieved by patients with a good treatment prognosis. Breast cancer patients benefit from the counseling and treatment provided with integrative medicine in all phases of tumor disease. Integrative treatment services should be included as part of patient care in clinical routine work to offer patients the maximum quality of care and safety with complementary therapies.

Innovative and Alternative Technologies. Instructor Guide. Working for Clean Water: An Information Program for Advisory Groups.

ERIC Educational Resources Information Center

Cole, Charles A.

Innovative and alternative methods of wastewater treatment can improve the efficiency and lower the cost of waste treatment procedures. Described in this instructor's guide is a one-hour learning session for citizens interested in improving water quality planning and decision making. Among the topics covered are the need for alternative wastewater…

Design of a randomized controlled trial of Internet-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors.

PubMed

Atema, Vera; van Leeuwen, Marieke; Oldenburg, Hester S A; Retèl, Valesca; van Beurden, Marc; Hunter, Myra S; Aaronson, Neil K

2016-11-25

Menopausal symptoms are common and may be particularly severe in younger women who undergo treatment-induced menopause. Medications to reduce menopausal symptoms are either contra-indicated or have bothersome side effects. Previous studies have demonstrated that face-to-face cognitive behavioral therapy (CBT) is effective in alleviating menopausal symptoms in women with breast cancer. However, compliance with face-to-face CBT programs can be problematic. A promising approach is to use the Internet to make this form of CBT more accessible and feasible for patients. This study is evaluating the efficacy and cost-effectiveness of an Internet-based CBT program, with or without therapist guidance, in alleviating or reducing the severity of menopausal symptoms. In a multicenter, randomized controlled trial we are evaluating the efficacy of two Internet-based CBT programs in alleviating or reducing the impact of menopausal symptoms, and particularly hot flushes and night sweats, in breast cancer survivors who have experienced a treatment-induced menopause. Secondary outcomes include sexual functioning, sleep quality, hot flush frequency, psychological distress, health-related quality of life and cost-effectiveness. We will recruit 248 women who will be randomized to either a therapist guided or a self-management version of the 6-week Internet-based CBT program, or to a usual care, waiting list control group. Self-administered questionnaires are completed at baseline (T0), and at 10 weeks (T1) and 24 weeks (T2) post-randomization. Internet-based CBT is a potentially useful treatment for reducing menopausal symptoms in breast cancer survivors. This study will provide evidence on the efficacy and cost-effectiveness of such an Internet-based CBT program, with or without therapist support. If demonstrated to be efficacious and cost-effective, the availability of such structured supportive intervention programs will be a welcome addition to standard medical treatment offered to cancer patients with treatment-induced menopause. The study is retrospectively registered at ClinicalTrials.gov on January 26th 2016 ( NCT02672189 ).

Integrated programs for women with substance use issues and their children: a qualitative meta-synthesis of processes and outcomes.

PubMed

Sword, Wendy; Jack, Susan; Niccols, Alison; Milligan, Karen; Henderson, Joanna; Thabane, Lehana

2009-11-20

There is a need for services that effectively and comprehensively address the complex needs of women with substance use issues and their children. A growing body of literature supports the relevance of integrated treatment programs that offer a wide range of services in centralized settings. Quantitative studies suggest that these programs are associated with positive outcomes. A qualitative meta-synthesis was conducted to provide insight into the processes that contribute to recovery in integrated programs and women's perceptions of benefits for themselves and their children. A comprehensive search of published and unpublished literature to August 2009 was carried out for narrative reports of women's experiences and perceptions of integrated treatment programs. Eligibility for inclusion in the meta-synthesis was determined using defined criteria. Quality assessment was then conducted. Qualitative data and interpretations were extracted from studies of adequate quality, and were synthesized using a systematic and iterative process to create themes and overarching concepts. A total of 15 documents were included in the meta-synthesis. Women experienced a number of psychosocial processes during treatment that played a role in their recovery and contributed to favourable outcomes. These included: development of a sense of self; development of personal agency; giving and receiving of social support; engagement with program staff; self-disclosure of challenges, feelings, and past experiences; recognizing patterns of destructive behaviour; and goal setting. A final process, the motivating presence of children, sustained women in their recovery journeys. Perceived outcomes included benefits for maternal and child well-being, and enhanced parenting capacity. A number of distinct but interconnected processes emerged as being important to women's addiction recovery. Women experienced individual growth and transformative learning that led to a higher quality of life and improved interactions with their children. The findings support the need for programs to adopt practices that focus on improving maternal health and social functioning in an environment characterized by empowerment, safety, and connections. Women's relationships with their children require particular attention as positive parenting practices and family relationships can alter predispositions toward substance use later in life, thereby impacting favourably on the cycle of addiction and dysfunctional parenting.

Associations Between Quality of Life and Functioning in an Assertive Community Treatment Population.

PubMed

Clausen, Hanne; Landheim, Anne; Odden, Sigrun; Heiervang, Kristin Sverdvik; Stuen, Hanne Kilen; Killaspy, Helen; Šaltytė Benth, Jurate; Ruud, Torleif

2015-11-01

Level of functioning is positively associated with subjective quality of life for people with severe mental illness, but a detailed relationship between functioning and satisfaction with various life domains is largely unknown, and this gap prompted this study. Demographic and clinical data were obtained from 149 patients engaged with 12 assertive community treatment teams in Norway. Multivariate regression analyses were used to explore associations between subjective quality of life and patient characteristics. Analyses confirmed positive associations between quality of life and age, functioning, and weekly contact with family and friends and a negative association with anxiety and depressive symptoms. Positive associations between several areas of practical and social functioning and satisfaction with related life domains also were found. Although a causal direction of the associations between functioning and life satisfaction has not been determined in this study, the positive findings might indicate that programs aiming to improve functioning could affect patients' quality of life.

Training substance abuse treatment staff to care for co-occurring disorders.

PubMed

Hunter, Sarah B; Watkins, Katherine E; Wenzel, Suzanne; Gilmore, Jim; Sheehe, John; Griffin, Belle

2005-04-01

Although co-occurring disorders have been associated with poorer substance abuse treatment outcomes and higher costs of care, few individuals with co-occurring disorders receive appropriate mental health care. This article describes the design and implementation of an intervention to improve the quality of mental health care provided in outpatient substance abuse treatment programs without requiring new treatment staff. The intervention focuses on individuals with affective and anxiety disorders and consists of three components: training and supervising staff, educating and activating clients, and linking with community resources. We evaluated three treatment programs (one intervention and two comparison) for the first component by having program staff complete both self-administered questionnaires and semistructured interviews. Staff knowledge and attitudes about co-occurring disorders, job satisfaction, and morale all indicated an improvement at the intervention relative to the comparison sites. The evaluation is still under way; results for implementation of the other two components and for outcomes will be reported later.

[Evaluating the effectiveness of a disease management program diabetes in the German Statutory Health Insurance: first results and methodological considerations].

PubMed

Drabik, Anna; Graf, Christian; Büscher, Guido; Stock, Stephanie

2012-01-01

Disease management programs (DMPs) were implemented in the German Statutory Health Insurance (SHI) in a nationwide rollout in 2002. The explicit goal of the programs is to improve coordination and quality of care for the chronically ill (Sect. 137f, SGB V). To reach this goal extensive quality assurance measures in the programs are mandatory, enrolment and coordination of care rests with the primary care or DMP physician, treatment is based on evidence-based care guidelines, and patients are offered diabetes education classes to support self-management. The present study evaluates the DMP diabetes mellitus type II, a nationwide program offered by the BARMER, a German health insurance company. To minimize selection bias we formed a control group of administrative data using a propensity score matching approach. In comparison to the control group DMP participants have a significantly lower mortality rate, and their average drug and hospital costs are reduced. Enrolled patients also had a lower mean number of hospital stays and shorter hospital stays. These results indicate that the programs meet the initial goal of improving the quality of care for the chronically ill. Copyright © 2011. Published by Elsevier GmbH.

Assessment of water quality in canals of eastern Broward County, Florida, 1969-74

USGS Publications Warehouse

Waller, Bradley G.; Miller, Wesley L.

1982-01-01

An intensive water-quality monitoring program was started in 1969 to determine the effects of man-induced contaminants on the water quality in the primary canal system of eastern Broward County, Florida. This report covers the first 6 years of the program and provides a data base that can be used to compare future changes in water-quality conditions. Most data indicate that beyond the small seasonal fluctuation in constituent level, the greatest adverse effect on the quality of water is caused by discharge of sewage and treated sewage effluent to the canals. The areas affected by sewage have greater concentrations of macronutrients, trace metals, and pesticides than unaffected areas. Major-ion concentrations were affected only by season and local lithology. Over the 6-year study a gradual decrease in macronutrient concentration and an increase in dissolved oxygen have occurred. This improvement in water quality is attributed to a decrease of sewage discharge into canals and better treatment of sewage effluents. (USGS)

The effects of professional development related to classroom assessment on student achievement in science

NASA Astrophysics Data System (ADS)

Mazzie, Dawn Danielle

This study investigated the relationship between students' standardized test scores in science and (a) increases in teacher assessment literacy and (b) teacher participation in a Teacher Quality Research (TQR) project on classroom assessment. The samples for these studies were teachers from underperforming schools who volunteered to take part in a professional development program in classroom assessment. School groups were randomly assigned to the treatment group. For Study 1, teachers in the treatment received professional development in classroom assessment from a trained assessment coach. Teachers in the control received no professional development. For Study 2, teachers in Treatment 1 received professional development in classroom assessment from a trained assessment coach and teachers in Treatment 2 received professional development in classroom assessment from a facilitator with one day of training. Teachers in both groups completed a measure of assessment literacy, the Teacher Quality Research Test of Assessment Literacy Skills (TQR_TALS), prior to the beginning and then again at the conclusion of the four month professional development program. A hierarchical linear model (HLM) analysis was conducted to determine the relationship between students' standardized test scores in science and (a) increases in teacher assessment literacy and (b) teacher TQR status. Based upon these analyses, the professional development program increased teachers' assessment literacy skills; however, the professional development had no significant impact on students' achievement.

Impacts of a Discussion-Based Academic Language Program on Classroom Interactions in 4th through 7th Grades

ERIC Educational Resources Information Center

LaRusso, Maria; Jones, Stephanie M.; Kim, Ha Yeon; Kim, James; Donovan, Suzanne; Snow, Catherine

2016-01-01

This paper presents an exploratory analysis of treatment-control differences in the quality of classroom interactions in 4th through 7th grade urban classrooms. Word Generation (WG) is a research-based academic language program for middle school students designed to teach novel vocabulary and literacy through language arts, math, science, and…

Group cognitive behavioral therapy to improve the quality of care to opioid-treated patients with chronic noncancer pain: a practice improvement project.

PubMed

Whitten, Stacey K; Stanik-Hutt, Julie

2013-07-01

To enhance outcomes of patients with chronic noncancer pain (CNCP) treated with opioids in a primary care setting by implementing an evidence-based quality improvement project. The project consisted of the implementation of a 6-week cognitive behavioral therapy (CBT) program. Twenty-two patients with CNCP completed the program. Impact of the project was evaluated by comparing pre- and postintervention participant self-reports of mood on the Beck Depression Inventory and functional status on the Brief Pain Inventory and Short Form-36. Patient perception of treatment benefit was also measured using the Patient Global Impression of Change. Qualitative provider perceptions of the program were also collected. Paired t-test statistics were used to analyze the data. Mood (including negative attitude, performance difficulty, and physical complaints), and patient impression of treatment benefit improved significantly after CBT was added. Primary care providers reported that the CBT supported their overall management of these complex patients. The addition of a CBT program improved selected outcomes in this self-selected sample of patients with CNCP treated with opioids. ©2012 The Author(s) ©2012 American Association of Nurse Practitioners.

Differences in Multidisciplinary and Interdisciplinary Treatment Programs for Fibromyalgia: A Mapping Review

PubMed Central

Molinari, Enrico

2017-01-01

Fibromyalgia is a multifaceted chronic pain syndrome and the integration of different health disciplines is strongly recommended for its care. The interventions based on this principle are very heterogeneous and the difference across their structures has not been extensively studied, leading to incorrect conclusions when their outcomes are pooled. The objective of this mapping review was to summarize the characteristics of these programs, with particular focus on the integration of their components. We performed a search of the literature about treatments for fibromyalgia involving multiple disciplines on PubMed and Scopus. Starting from 560 articles, we included 22 noncontrolled studies, 10 controlled studies, and 17 RCTs evaluating the effects of 38 multidisciplinary or interdisciplinary interventions. The average quality of the studies was low. Their outcomes were usually pain intensity, quality of life, and psychological variables. We created a map of the programs based on the degree of integration of the included disciplines, which ranged from a juxtaposition of few components to a complex harmonization of different perspectives obtained through teamwork strategies. The rehabilitation programs were then thoroughly described with regard to the duration, setting, therapeutic components, and professionals included. The implications for future quantitative reviews are discussed. PMID:28620267

Cognitive Rehabilitation for Executive Dysfunction in Parkinson's Disease: Application and Current Directions

PubMed Central

Calleo, Jessica; Burrows, Cristina; Levin, Harvey; Marsh, Laura; Lai, Eugene; York, Michele K.

2012-01-01

Cognitive dysfunction in Parkinson's disease contributes to disability, caregiver strain, and diminished quality of life. Cognitive rehabilitation, a behavioral approach to improve cognitive skills, has potential as a treatment option to improve and maintain cognitive skills and increase quality of life for those with Parkinson's disease-related cognitive dysfunction. Four cognitive rehabilitation programs in individuals with PD are identified from the literature. Characteristics of the programs and outcomes are reviewed and critiqued. Current studies on cognitive rehabilitation in PD demonstrate feasibility and acceptability of a cognitive rehabilitation program for patients with PD, but are limited by their small sample size and data regarding generalization of effects over the long term. Because PD involves progressive heterogeneous physical, neurological, and affective difficulties, future cognitive rehabilitation programs should aim for flexibility and individualization, according to each patient's strengths and deficits. PMID:22135762

Managed care and the quality of substance abuse treatment.

PubMed

Shepard, Donald S; Daley, Marilyn; Ritter, Grant A; Hodgkin, Dominic; Beinecke, Richard H

2002-12-01

In the US, the spiraling costs of substance abuse and mental health treatment caused many state Medicaid agencies to adopt managed behavioral health care (MBHC) plans during the 1990s. Although research suggests that these plans have successfully reduced public sector spending, their impact on the quality of substance abuse treatment has not been established. The Massachusetts Medicaid program started a risk-sharing contract with MHMA, a private, for-profit specialty managed behavioral health care (MBHC) carve-out vendor on July 1, 1992. This paper evaluates the carve-out s impact on spending per inpatient episode and three proxy measures of quality: (i) access to inpatient treatment (ii) 30-day re-admissions and (iii) continuity of care. Medicaid claims for inpatient treatment were collapsed into episodes. Clients were tracked across the five-year period and an interrupted time series design was used to compare the three quality outcomes and spending in the year prior to (FY1992) and the four years during MHMA (FY1993-FY1996). Logistic and linear regression models were used to control for race, disability status, age, gender and primary diagnosis. Despite a 99% reduction in the use of hospital-based settings, access to 24-hour services overall increased by 38%, largely due to an expansion in the use of freestanding detoxification and acute residential services. Continuity improved by 73%. Nevertheless, rates of 7-day (58%) and 30-day (24%) readmission increased significantly, even after controlling for increases in disability status. Per episode spending decreased by 76% ($2,773), characterized by a dramatic spending reduction in FY1993 that was maintained but not augmented in subsequent years. The carve-out had mixed effects on the quality of substance abuse treatment. While one of the three measures (readmission rates) deteriorated, two improved (access and continuity). Rapid re-admissions were strongly associated with shorter lengths of stay, suggesting that strengthening discharge planning may preserve the benefits of MBHC while avoiding its risks. Since reductions in Medicaid spending were impressive but finite, MBHC may not be the permanent solution to inflation in behavioral health care. MBHC firms should implement quality-monitoring programs to ensure that aggressive utilization management strategies do not compromise quality of care. The impact of managed behavioral health care should ideally be evaluated in randomized controlled studies. In addition, research is needed to establish that the quality measures employed in this evaluation - improved access, enhanced continuity and fewer rapid re-admissions actually correspond to reductions in drug or alcohol use and other favorable outcomes obtained through client self-report or urinalysis.

A randomized trial of an acid-peptic disease management program in a managed care environment.

PubMed

Ofman, Joshua J; Segal, Richard; Russell, Wayne L; Cook, Deborah J; Sandhu, Meenu; Maue, Susan K; Lowenstein, Edward H; Pourfarzib, Ray; Blanchette, Erv; Ellrodt, Gray; Weingarten, Scott R

2003-06-01

To study the effectiveness of a disease management program for patients with acid-related disorders. A cluster-randomized clinical trial of 406 patients comparing a disease management program with "usual practice." Enrolled patients included those presenting with new dyspepsia and chronic users of antisecretory drugs in 8 geographically separate physician offices associated with the Orlando Health Care Group. There were 35 providers in the intervention group and 48 in the control group. The disease management program included evidence-based practice guidelines implemented by using physician champions, academic detailing, and multidisciplinary teams. Processes of care, patient symptoms, quality of life, costs, and work days lost were measured 6 months after patient enrollment. Compared with usual practice, disease management was associated with improvements in Helicobacter pylori testing (61% vs 9%; P = .001), use of recommended H pylori treatment regimens (96% vs 10%; P = .001), and discontinuation rates of proton pump therapy after treatment (70% vs 36%; P = .04). There were few differences in patient quality of life or symptoms between the 2 study groups. Disease management resulted in fewer days of antisecretory therapy (71.7 vs 88.1 days; P = .02) but no difference in total costs. This disease management program for patients with acid-related disorders led to improved processes of care. The effectiveness of such a program in other settings requires further study.

Therapeutic Inertia and Treatment Intensification.

PubMed

Josiah Willock, Robina; Miller, Joseph B; Mohyi, Michelle; Abuzaanona, Ahmed; Muminovic, Meri; Levy, Phillip D

2018-01-29

This review aims to emphasize how therapeutic inertia, the failure of clinicians to intensify treatment when blood pressure rises or remains above therapeutic goals, contributes to suboptimal blood pressure control in hypertensive populations. Studies reveal that the therapeutic inertia is quite common and contributes to suboptimal blood pressure control. Quality improvement programs and standardized approaches to support antihypertensive treatment intensification are ways to combat therapeutic inertia. Furthermore, programs that utilize non-physician medical professionals such as pharmacists and nurses demonstrate promise in mitigating the effects of this important problem. Therapeutic inertia impedes antihypertensive management and requires a broad effort to reduce its effects. There is an ongoing need for renewed focus and research in this area to improve hypertension control.

Changes in quality of life (WHOQOL-BREF) and addiction severity index (ASI) among participants in opioid substitution treatment (OST) in low and middle income countries: an international systematic review.

PubMed

Feelemyer, Jonathan P; Jarlais, Don C Des; Arasteh, Kamyar; Phillips, Benjamin W; Hagan, Holly

2014-01-01

Opioid substitution treatment (OST) can increase quality of life (WHOQOL-BREF) and reduce addiction severity index (ASI) scores among participants over time. OST program participants have noted that improvement in quality of life is one of the most important variables to their reduction in drug use. However, there is little systematic understanding of WHOQOL-BREF and ASI domain changes among OST participants in low and middle-income countries (LMIC). Utilizing PRISMA guidelines we conducted a systematic literature search to identify OST program studies documenting changes in WHOQOL-BREF or ASI domains for participants in buprenorphine or methadone programs in LMIC. Standardized mean differences for baseline and follow-up domain scores were compared along with relationships between domain scores, OST dosage, and length of follow-up. There were 13 OST program studies with 1801 participants from five countries eligible for inclusion in the review. Overall, statistically significant changes were noted in all four WHOQOL-BREF domain and four of the seven ASI domain scores (drug, psychological, legal, and family) documented in studies. Dosage of pharmacologic medication and length of follow-up did not affect changes in domain scores. WHOQOL-BREF and ASI domain scoring is a useful tool in measuring overall quality of life and levels of addiction among OST participants. Coupled with measurements of blood-borne infection, drug use, relapse, and overdose, WHOQOL-BREF and ASI represent equally important tools for evaluating the effects of OST over time and should be further developed as integrated tools in the evaluation of participants in LMIC. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Reducing Nutrients to San Francisco Bay through Additional Wastewater Sidestream Treatment Project

EPA Pesticide Factsheets

Information about the SFBWQP Reducing Nutrients to San Francisco Bay Project, part of an EPA competitive grant program to improve SF Bay water quality focused on restoring impaired waters and enhancing aquatic resources.

Total chemical management in photographic processing

USGS Publications Warehouse

Luden, Charles; Schultz, Ronald

1985-01-01

The mission of the U. S. Geological Survey's Earth Resources Observation Systems (EROS) Data Center is to produce high-quality photographs of the earth taken from aircraft and Landsat satellite. In order to meet the criteria of producing research-quality photographs, while at the same time meeting strict environmental restrictions, a total photographic chemical management system was installed. This involved a three-part operation consisting of the design of a modern chemical analysis laboratory, the implementation of a chemical regeneration system, and the installation of a waste treatment system, including in-plant pretreatment and outside secondary waste treatment. Over the last ten years the result of this program has yielded high-quality photographs while saving approximately 30,000 per year and meeting all Environmental Protection Agency (EPA) restrictions.

Quality of life-related outcomes from a patient-tailored integrative medicine program: experience of Russian-speaking patients with cancer in Israel.

PubMed

Sharabi, Ilanit Shalom; Levin, Anna; Schiff, Elad; Samuels, Noah; Agour, Olga; Tapiro, Yehudith; Lev, Efraim; Keinan-Boker, Lital; Ben-Arye, Eran

2016-10-01

Complementary/integrative medicine (CIM) is increasingly being integrated with standard supportive cancer care. The effects of CIM on quality of life (QOL) during chemotherapy need to be examined in varied socio-cultural settings. We purpose to explore the impact of CIM on QOL-related outcomes among Russian-speaking (RS) patients with cancer. RS patients undergoing chemotherapy receiving standard supportive care were eligible. Patients in the treatment arm were seen by an integrative physician (IP) and treated within a patient-tailored CIM program. Symptoms and QOL were assessed at baseline, at 6, and at 12 weeks with the Edmonton Symptom Assessment Scale (ESAS), the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Of 70 patients referred to the treatment arm, 50 (71.4 %) underwent IP assessment and CIM treatments. Of 51 referred to the control arm, 38 (76 %) agreed to participate. At 6 weeks, CIM-treated patients reported improved ESAS scores for fatigue (P = 0.01), depression (P = 0.048), appetite (P = 0.008), sleep (P < 0.0001), and general wellbeing (P = 0.004). No improvement was observed among controls. Between-group analysis found CIM-treated patients had improved sleep scores on ESAS (P = 0.019) and EORTC (P = 0.007) at 6 weeks. Social functioning improved between 6 and 12 weeks (EORTC, P = 0.02), and global health status/QOL scale from baseline to 12 weeks (EORTC, P = 0.007). A patient-tailored CIM treatment program may improve QOL-related outcomes among RS patients undergoing chemotherapy. Integrating CIM in conventional supportive care needs to address cross-cultural aspects of care. The study protocol was registered at ClinicalTrials.gov ( https://clinicaltrials.gov/ct2/show/NCT01860365 ).

[Quality assurance using routine data. Is outcome quality now measurable?].

PubMed

Kostuj, T; Smektala, R

2010-12-01

Health service quality in Germany can be shown by the data from the external quality assurance program (BQS) but as these records are limited to the period of in-hospital stay no information about outcome after discharge from hospital can be obtained. Secondary routine administrative data contain information about long-term outcome, such as mortality, subsequent revision and the need for care following surgical treatment due to a hip fracture.Experiences in the use of secondary data dealing with treatment of hip fractures from the BQS are available in our department. In addition we analyzed routine administrative data from the health insurance companies Knappschaft Bahn-See and AOK in a cooperative study with the WidO (scientific institute of the AOK). These routine data clearly show a bias because of poor quality in coding as well as broad interpretation possibilities of some of the ICD-10 codes used.Consequently quality assurance using routine data is less valid than register-based conclusions. Nevertheless medical expertise is necessary to avoid misinterpretation of routine administrative data.

[Integration of nutritional care into cancer treatment: need for improvement].

PubMed

Joly, Caroline; Jacqueline-Ravel, Nathalie; Pugliesi-Rinaldi, Angela; Bigler-Perrotin, Lucienne; Chikhi, Marinette; Dietrich, Pierre-Yves; Dulguerov, Pavel; Miralbell, Raymond; Picard-Kossovsky, Michel; Seium, Yodit; Thériault, Michel; Pichard, Claude

2011-11-16

Progresses in cancer treatment transformed cancer into a chronic disease associated with growing nutritional problems. Poor nutritional status of cancer patients worsens morbidity, mortality, overall cost of care and decreases patients' quality of life, oncologic treatments tolerance and efficacy. These adverse effects lead to treatment modifications or interruptions, reducing the chances to control or cure cancer. Implementation of an interdisciplinary and longitudinal integration of nutritional care and nutritional information into cancer treatment (The OncoNut Program) could prevent or treat poor nutritional status and its adversely side effects.

Use of Veterans Health Administration Mental Health and Substance Use Disorder Treatment After Exiting Prison: The Health Care for Reentry Veterans Program.

PubMed

Finlay, Andrea K; Stimmel, Matthew; Blue-Howells, Jessica; Rosenthal, Joel; McGuire, Jim; Binswanger, Ingrid; Smelson, David; Harris, Alex H S; Frayne, Susan M; Bowe, Tom; Timko, Christine

2017-03-01

The Veterans Health Administration (VA) Health Care for Reentry Veterans (HCRV) program links veterans exiting prison with treatment. Among veterans served by HCRV, national VA clinical data were used to describe contact with VA health care, and mental health and substance use disorder diagnoses and treatment use. Of veterans seen for an HCRV outreach visit, 56 % had contact with VA health care. Prevalence of mental health disorders was 57 %; of whom 77 % entered mental health treatment within a month of diagnosis. Prevalence of substance use disorders was 49 %; of whom 37 % entered substance use disorder treatment within a month of diagnosis. For veterans exiting prison, increasing access to VA health care, especially for rural veterans, and for substance use disorder treatment, are important quality improvement targets.

Changes in dialysis treatment modalities during institution of flat rate reimbursement and quality assurance programs.

PubMed

Kleophas, Werner; Karaboyas, Angelo; Li, Yun; Bommer, Juergen; Reichel, Helmut; Walter, Andreas; Icks, Andrea; Rump, Lars C; Pisoni, Ronald L; Robinson, Bruce M; Port, Friedrich K

2013-09-01

Dialysis procedure rates in Germany were changed in 2002 from per-session to weekly flat rate payments, and quality assurance was introduced in 2009 with defined treatment targets for spKt/V, dialysis frequency, treatment time, and hemoglobin. In order to understand trends in treatment parameters before and after the introduction of these changes, we analyzed data from 407 to 618 prevalent patients each year (hemodialysis over 90 days) in 14-21 centers in cross-sections of the Dialysis Outcomes and Practice Patterns Study (phases 1-4, 1998-2011). Descriptive statistics were used to report differences over time in the four quality assurance parameters along with erythropoietin-stimulating agent (ESA) and intravenous iron doses. Time trends were analyzed using linear mixed models adjusted for patient demographics and comorbidities. The proportion of patients with short treatment times (less than 4 h) and low spKt/V (below 1.2) improved throughout the study and was lowest after implementation of quality assurance. Hemoglobin levels have increased since 1998 and remained consistent since 2005, with only 8-10% of patients below 10 g/dl. About 90% of patients were prescribed ESAs, with the dose declining since peaking in 2006. Intravenous iron use was highest in 2011. Hence, trends to improve quality metrics for hemodialysis have been established in Germany even after introduction of flat rate reimbursement. Thus, analysis of facility practice patterns is needed to maintain quality of care in a cost-containment environment.

[Minimal provider volume in total knee replacement : an analysis of the external quality assurance program of North Rhine-Westphalia (QS-NRW)].

PubMed

Kostuj, T; Schulze-Raestrup, U; Noack, M; Buckup, K; Smektala, R

2011-05-01

A minimal provider volume for total knee replacement (TKR) was introduced in 2006. Does this lead to an improvenment in quality or not? The records of treatment in the compulsory external quality assurance program of the Land of North Rhine-Westphalia (QS-NRW) were evaluated. A total of 125,324 comparable records from the QS-NRW program were available to determine the appearance of general and surgical complications. In a logistical regression model the risk factors age, gender, ASA classification, comorbidity and duration were taken into account. A significant reduction could only be shown for pneumonia, thrombotic events and lung embolisms as well as vascular injury. In 2006 and 2007 malpositioning of implants was significantly higher and from 2005 to 2008 the number of fractures rose compared to 2004. Deep infections and reoperations did not change significantly during the whole study period. This evaluation could not show an improvement in quality due to the minimal provider volume. Thus the minimal provider volume should not be taken into account as a main criterion to improve quality. Further outcome studies and creating an arthroplasty register in Germany are more useful.

[Effectiveness of virtual immersion programmes in patients with Parkinson's disease. A systematic review].

PubMed

Morales-Gomez, S; Elizagaray-Garcia, I; Yepes-Rojas, O; de la Puente-Ranea, L; Gil-Martinez, A

2018-02-01

Parkinson disease (PD) is the second most common neurodegenerative disease. Virtual reality (VR) is being used in rehabilitation of neurological patients. To analyze the VR systems' therapeutically effectiveness through PD diagnosed subjects with variables of motor, quality of life and cognition. Electronics database were used to look for articles: Medline, EMBASE, PEDro, CINAHL and Cochrane. The inclusion criteria were: randomized control trial (RCT) performed in PD with at least one VR variable included in the therapeutically treatment and diagnosed PD subjects. Four RCT were chosen showing all good methodology quality. Concordance between evaluators was moderate-high. VR was the main treatment in all of them. VR was more effective in balance improvement in PD subjects than conventional physiotherapy in two RCT. VR was not more effective in balance improvement in PD subjects than conventional physiotherapy in two RCT. Contradictory evidences where showed between the effectiveness of the VR programs versus conventional programs in the effectiveness of balance treatment with PD subjects. Non-motor variables improvement was not greater in subjects with VR treatments versus the ones with conventional physiotherapy in the four RCT. The treatments with VR cannot be assumed as more effectives than conventional physiotherapy through PD subjects in motor and psychosocial variables.

Review and evaluation of online tobacco dependence treatment training programs for health care practitioners.

PubMed

Selby, Peter; Goncharenko, Karina; Barker, Megan; Fahim, Myra; Timothy, Valerie; Dragonetti, Rosa; Kemper, Katherine; Herie, Marilyn; Hays, J Taylor

2015-04-17

Training health care professionals is associated with increased capacity to deliver evidence-based smoking cessation interventions and increased quit rates among their patients. Online training programs hold promise to provide training but questions remain regarding the quality and usability of available programs. The aim was to assess the quality of English-language online courses in tobacco dependence treatment using a validated instrument. An environmental scan was conducted using the Google search engine to identify available online tobacco dependence treatment courses. The identified courses were then evaluated using the Peer Review Rubric for Online Learning, which was selected based on its ability to evaluate instructional design. It also has clear and concise criteria descriptions to ensure uniformity of evaluations by trained experts. A total of 39 courses were identified, of which 24 unique courses were assessed based on their accessibility and functionality during the period of evaluation. Overall, the course ratings indicated that 17 of 24 courses evaluated failed to meet minimal quality standards and none of the courses evaluated could be ranked as superior. However, many excelled in providing effective navigation, course rationale, and content. Many were weak in the use of instructional design elements, such as teaching effectiveness, learning strategies, instructor's role, and assessment and evaluation. Evaluation results and suggestions for improvement were shared with course administrators. Based on the courses evaluated in this review, course developers are encouraged to employ best practices in instructional design, such as cohesiveness of material, linearity of design, practice exercises, problem solving, and ongoing evaluation to improve existing courses and in the design of new online learning opportunities.

NADA Ear Acupuncture: An Adjunctive Therapy to Improve and Maintain Positive Outcomes in Substance Abuse Treatment

PubMed Central

Carter, Kenneth; Olshan-Perlmutter, Michelle; Marx, Jonathan; Martini, Janet F.; Cairns, Simon B.

2017-01-01

The National Acupuncture Detoxification Association protocol (NADA) is an adjunctive therapy using 1 to 5 invariant ear acupuncture/acupressure points. This is a randomized prospective study to determine if NADA plus traditional treatment enhance outcomes: quality of life, depression, anxiety and abstinence from substance abuse. There were 100 patients enrolled in the Keystone Substance Abuse Services-Winthrop University Department of Sociology and Anthropology NADA study. All patients completed Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES) prior to starting the program and at program completion. Patients self-reported alcohol, tobacco, and drug use prior to starting the program at program completion and at 3 and 6 month follow- up. Patient characteristics are predictive of completion versus non-completion when race, criminal history and initial drug test is considered. Those identified as nonwhite, (p < 0.05) and patients with positive initial drug test, (p < 0.01) were more likely to complete treatment in the NADA group. Also, among patients with criminal history a higher percentage failed to complete the program in the control group (p < 0.05). Participation in NADA positively associated with Q-LES score (p < 0.05), feeling better about oneself and improved energy (p < 0.05), likelihood of employment upon discharge (p < 0.05), and decreased alcohol use at 3 month follow up (p < 0.05) and 6-month follow-up (p < 0.01). NADA group reported less tobacco use at 6 months (p < 0.05). PMID:28621706

Program structure and counselor-client contact in outpatient substance abuse treatment.

PubMed

Knight, Danica K; Broome, Kirk M; Simpson, D Dwayne; Flynn, Patrick M

2008-04-01

To examine organizational structural attributes associated with counselor-client contact. Data were collected in 2004 and 2005 for a federally funded project, which simultaneously examines organizational structure, functioning, and resources among outpatient substance abuse treatment programs. The study uses a naturalistic design to investigate organizational structure measures-ownership, accreditation, and supplemental services-as predictors of time in counseling and case management, and caseload size, controlling for geographic differences. Directors at 116 outpatient drug-free treatment programs located in four regions across the U.S. (Great Lakes, Gulf Coast, Northwest, and Southeast) voluntarily completed a survey about program structure. Clients received more counseling hours in programs that were "intensive," publicly owned, accredited, and had a lower proportion of recently hired counselors. More case management hours were offered in "intensive," private-for-profit or publicly owned (versus private-nonprofit) programs, serving a lower proportion of dual-diagnosis clients, and providing more on-site supplemental services. Smaller caseloads were found in programs that were accredited and had a smaller average client census and a lower proportion of criminal justice referred clients. Organizational attributes are related to counselor-client contact and may have implications for staff turnover and service quality.

Do less effective teachers choose professional development does it matter?

PubMed

Barrett, Nathan; Butler, J S; Toma, Eugenia F

2012-10-01

In an ongoing effort to improve teacher quality, most states require continuing education or professional development for their in-service teachers. Studies evaluating the effectiveness of various professional development programs have assumed a normal distribution of quality of teachers participating in the programs. Because participation in many professional development programs is either targeted or voluntary, this article suggests past evaluations of the effectiveness of professional development may be subject to selection bias and policy recommendations may be premature. This article presents an empirical framework for evaluating professional development programs where treatment is potentially nonrandom, and explicitly accounts for the teacher's prior effectiveness in the classroom as a factor that may influence participation in professional development. This article controls for the influence of selection bias on professional development outcomes by generating a matched sample based on propensity scores and then estimating the program's effect. In applying this framework to the professional development program examined in this article, less effective teachers are found to be more likely to participate in the program, and correcting for this selection leads to different conclusions regarding the program's effectiveness than when ignoring teacher selection patterns.

The San Antonio CATs Initiative.

PubMed

Rugh, John D; Hendricson, William D; Hatch, John P; Glass, Birgit J

2010-01-01

There is evidence from medicine that schools and practitioners are slow to adopt new and proven effective treatments while marketing efforts lead practitioners to too quickly adopt unproven modalities. To address these problems, the dental school at the University of Texas Health Sciences Center at San Antonio, has developed a program designed to teach students, faculty, and practitioners the skills of accessing the literature as an intrinsic part of treatment. The Critically Appraised Topics (CATs) program is described and evidence is presented showing that participants can be taught to prepare high-quality summaries of the literature pertinent to clinical problems.

Keeping Up-To-Date: The San Antonio CATs Initiative

PubMed Central

Rugh, John D.; Hendricson, William D.; Hatch, John P.; Glass, Birgit J.

2010-01-01

There is evidence from medicine that schools and practitioners are slow to adopt new and proven effective treatments while marketing efforts lead practitioners to too quickly adopt unproven modalities. To address these problems, the dental school at the University of Texas Health Sciences Center at San Antonio, has developed a program designed to teach students, faculty, and practitioners the skills of accessing the literature as an intrinsic part of treatment. The Critically Appraised Topics (CATs) program is described and evidence is presented showing that participants can be taught to prepare high-quality summaries of the literature pertinent to clinical problems. PMID:20836411

Use of a SmartPhone/Tablet-Based Bidirectional Telemedicine Disease Management Program Facilitates Early Detection and Treatment of COPD Exacerbation Symptoms.

PubMed

Smith, Heidi S; Criner, Andrew J; Fehrle, Dolores; Grabianowski, Carla L; Jacobs, Michael R; Criner, Gerard J

2016-05-01

Early treatment of worsening chronic obstructive pulmonary disease (COPD) symptoms speeds recovery, improves quality of life, and reduces the need for hospitalization. Patients may fail to recognize worsening symptoms leading to delays in treatment. A telemedicine application could facilitate detection and treatment of worsening symptoms. To work, such an application requires consistent use by patients and quick responses from healthcare providers. We conducted a quality assurance assessment of our system to see if we were meeting these goals. Thirty patients were provided a smartphone application for daily COPD symptom reporting. Reports between November 2012 and September 2013 were reviewed. Symptoms reports and interventions were time-stamped by the application. Adherence reporting was calculated as the number of reports made divided by the number of days enrolled in the program for each patient. Time to intervention was calculated as the time a report was submitted to the time a treatment recommendation was sent to the patient. There were 4,434 symptom reports made over 5,178 patient-days of observation for an average reporting compliance of 85.6%. Median reporting compliance was 90.7% (interquartile range, 83.8-98%). Four hundred seventy-five symptom reports resulted in an alert. The average response time for all alerts was 6.64 h, with a median response time of 5.75 h. From this quality assessment we were able to conclude that patient adherence to the reporting system exceeded 90% for over half of the participants. Furthermore, over 50% of worsening COPD symptom reports were responded to in less than 6 h with patient-specific treatment recommendations.

Use of a SmartPhone/Tablet-Based Bidirectional Telemedicine Disease Management Program Facilitates Early Detection and Treatment of COPD Exacerbation Symptoms

PubMed Central

Smith, Heidi S.; Criner, Andrew J.; Fehrle, Dolores; Grabianowski, Carla L.; Criner, Gerard J.

2016-01-01

Abstract Introduction: Early treatment of worsening chronic obstructive pulmonary disease (COPD) symptoms speeds recovery, improves quality of life, and reduces the need for hospitalization. Patients may fail to recognize worsening symptoms leading to delays in treatment. A telemedicine application could facilitate detection and treatment of worsening symptoms. To work, such an application requires consistent use by patients and quick responses from healthcare providers. We conducted a quality assurance assessment of our system to see if we were meeting these goals. Materials and Methods: Thirty patients were provided a smartphone application for daily COPD symptom reporting. Reports between November 2012 and September 2013 were reviewed. Symptoms reports and interventions were time-stamped by the application. Adherence reporting was calculated as the number of reports made divided by the number of days enrolled in the program for each patient. Time to intervention was calculated as the time a report was submitted to the time a treatment recommendation was sent to the patient. Results: There were 4,434 symptom reports made over 5,178 patient-days of observation for an average reporting compliance of 85.6%. Median reporting compliance was 90.7% (interquartile range, 83.8–98%). Four hundred seventy-five symptom reports resulted in an alert. The average response time for all alerts was 6.64 h, with a median response time of 5.75 h. Conclusions: From this quality assessment we were able to conclude that patient adherence to the reporting system exceeded 90% for over half of the participants. Furthermore, over 50% of worsening COPD symptom reports were responded to in less than 6 h with patient-specific treatment recommendations. PMID:26451903

[Does transcutaneous electrical nerve stimulation or therapeutic ultrasound increase the effectiveness of exercise for knee osteoarthritis: a randomized controlled study].

PubMed

Eyigör, Sibel; Karapolat, Hale; Ibisoğlu, Uğur; Durmaz, Berrin

2008-01-01

The aim of this study was to determine if transcutaneous electrical nerve stimulation (TENS) or therapeutic ultrasound (US) increase the effectiveness of exercise on pain, function, muscle strength and quality of life for knee osteoarthritis (OA). Forty-five patients with primary knee OA diagnosis according to American College Rheumatology criteria were sequentially divided into 3 random groups. The patients in group 1 received TENS (with superficial heat and exercise), group 2 received US (with superficial heat and exercise), and group 3 acted as controls (superficial heat and exercise). Outcome measures were included as visual analog scale (VAS), a 20-meter walking test, Lequesne index, WOMAC scores, isokinetic muscle testing, and the Short Form 36 (SF 36). All treatment groups, physical modalities were carried out for a total fifteen sessions. All of the patients were subjected to six weeks of exercise program. All of the treatment groups had significant improvement on activity VAS, 20 meter walking test, Lequesne index, WOMAC scores, and most of the sub-scores of SF36 when compared with their initial status (p<0.05). All of the treatment groups, a significant muscle strength gain in most of the angular velocity in knee extensor PT values after the treatment (p<0.05). However there was no statistically significant difference after the treatment between the all treatment groups (p>0.05). All of the treatment groups were effective on pain, function, muscle strength and quality of life in patients with knee OA. Statistically significant differences could not be found between the treatment groups. The exercise program, as it is cheaper, more easily performed and efficient, may be preferable for the treatment of knee OA. It is difficult to say, TENS or US could increase the effectiveness of isokinetic exercise for pain, function, muscle strength and quality of life of knee OA in this study.

Teachers' Perceptions of School Organizational Climate as Predictors of Dosage and Quality of Implementation of a Social-Emotional and Character Development Program.

PubMed

Malloy, Margaret; Acock, Alan; DuBois, David L; Vuchinich, Samuel; Silverthorn, Naida; Ji, Peter; Flay, Brian R

2015-11-01

Organizational climate has been proposed as a factor that might influence a school's readiness to successfully implement school-wide prevention programs. The aim of this study was to evaluate the influence of teachers' perceptions of three dimensions of school organizational climate on the dosage and quality of teacher implementation of Positive Action, a social-emotional and character development (SECD) program. The dimensions measured were teachers' perceptions of (a) the school's openness to innovation, (b) the extent to which schools utilize participatory decision-making practices, and (c) the existence of supportive relationships among teachers (teacher-teacher affiliation). Data from 46 teachers in seven schools enrolled in the treatment arm of a longitudinal, cluster-randomized, controlled trial were analyzed. Teacher perceptions of a school's tendency to be innovative was associated with a greater number of lessons taught and self-reported quality of delivery, and teacher-teacher affiliation was associated with a higher use of supplementary activities. The findings suggest that perceptions of a school's organizational climate impact teachers' implementation of SECD programs and have implications for school administrators and technical assistance providers as they work to implement and sustain prevention programs in schools.

Implementation of a laboratory quality assurance program: the Louisville experience.

PubMed

Metz, Michael J; Abdel-Azim, Tamer; Miller, Cynthia J; Lin, Wei-Shao; ZandiNejad, Amirali; Oliveira, Gustavo M; Morton, Dean

2014-02-01

Remakes, or the refabrication of dental prostheses, can occur as a result of inherent inaccuracies in both clinical and laboratory procedures. Because dental schools manage large numbers of predoctoral dental students with limited familiarity and expertise as related to clinical prosthodontic techniques, it is likely these schools will experience an elevated incidence of laboratory remakes and their ramifications. The University of Louisville School of Dentistry, not unlike other dental schools, has experienced remakes associated with both fixed and removable prosthodontic procedures. Limitations in faculty standardization and variable enforcement of established preclinical protocols have been identified as variables associated with the high percentage of remakes documented. The purpose of this study was to introduce the implementation of a new multidepartmental quality assurance program designed to increase consistency and quality in both information provided to commercial dental laboratories and the prostheses returned. The program has shown to be advantageous in terms of cost-effectiveness and treatment outcomes. A statistically significant decrease in remake percentages has been recorded from inception of this program in December 2010 until December 2012. Furthermore, this program has resulted in more consistent communication between the dental school and commercial dental laboratories, among faculty members, and between faculty and students.

Brief hypnotherapeutic-behavioral intervention for functional abdominal pain and irritable bowel syndrome in childhood: a randomized controlled trial.

PubMed

Gulewitsch, Marco Daniel; Müller, Judith; Hautzinger, Martin; Schlarb, Angelika Anita

2013-08-01

Functional abdominal pain and irritable bowel syndrome are two prevalent disorders in childhood which are associated with recurrent or chronic abdominal pain, disabilities in daily functioning, and reduced quality of life. This study aimed to evaluate a brief hypnotherapeutic-behavioral intervention program in a prospective randomized controlled design. Thirty-eight children, 6 to 12 years of age, and their parents were randomly assigned to a standardized hypnotherapeutic-behavioral treatment (n = 20) or to a waiting list condition (n = 18). Both groups were reassessed 3 months after beginning. Primary outcome variables were child-completed pain measures and pain-related disability. Secondary outcome variables were parent-completed measures of their children's pain and pain-related disability. Health-related quality of life from both perspectives also served as a secondary outcome. In the treatment group, 11 of 20 children (55.0%) showed clinical remission (>80% improvement), whereas only one child (5.6%) in the waiting list condition was classified as responder. Children in the treatment group reported a significantly greater reduction of pain scores and pain-related disability than children of the waiting list condition. Parental ratings also showed a greater reduction of children's abdominal pain and pain-related disability. Health-related quality of life did not increase significantly. Hypnotherapeutic and behavioral interventions are effective in treating children with long-standing AP. Treatment success of this brief program should be further evaluated against active interventions with a longer follow-up.

Understanding the Mechanisms Through Which an Influential Early Childhood Program Boosted Adult Outcomes

PubMed Central

Heckman, James; Pinto, Rodrigo

2013-01-01

A growing literature establishes that high quality early childhood interventions targeted toward disadvantaged children have substantial impacts on later life outcomes. Little is known about the mechanisms producing these impacts. This paper uses longitudinal data on cognitive and personality traits from an experimental evaluation of the influential Perry Preschool program to analyze the channels through which the program boosted both male and female participant outcomes. Experimentally induced changes in personality traits explain a sizable portion of adult treatment effects. PMID:24634518

The Interservice Physician Assistant Program: Education quantity and quality.

PubMed

Harrison, Randolph Scott; Adamson, Katherine Justen; Kroger, Shan Michael

2015-12-01

The Interservice Physician Assistant Program (IPAP) was formed in 1996 by the assimilation of three service programs (Army, Air Force, and Navy). Applicants are selected from each service and upon successful completion of the program become commissioned officers within their respective medical corps. Clinical training takes place within military treatment facilities across the United States. Located in San Antonio, Texas, the program graduates about 169 PAs a year. Graduates are deployed to attend to service personnel, refugees, civilians, and victims of epidemics. The IPAP is unique in that it is the largest PA program in the world and its applicant pool is restricted to military personnel.

Tracking the quality of care for sick children using lot quality assurance sampling: targeting improvements of health services in Jigawa, Nigeria.

PubMed

Oladele, Edward Adekola; Ormond, Louise; Adeyemi, Olusegun; Patrick, David; Okoh, Festus; Oresanya, Olusola Bukola; Valadez, Joseph J

2012-01-01

In Nigeria, 30% of child deaths are due to malaria. The National Malaria Control Program of Nigeria (NMCP) during 2009 initiated a program to improve the quality of paediatric malaria services delivered in health facilities (HF). This study reports a rapid approach used to assess the existing quality of services in Jigawa state at decentralised levels of the health system. NMCP selected Lot Quality Assurance Sampling (LQAS) to identify the variation in HF service quality among Senatorial Districts (SD). LQAS was selected because it was affordable and could be used by local health workers (HW) in a population-based survey. NMCP applied a 2-stage LQAS using a structured Rapid Health Facility Assessment (R-HFA) tool to identify high and low performing SD for specified indicators. LQAS identified variations in HF performance (n = 21) and enabled resources to be targeted to address priorities. All SD exhibited deficient essential services, supplies and equipment. Only 9.7% of HF had Artemisinin-based Combination Therapies and other first-line treatments for childhood illnesses. No SD and few HF exhibited adequate HW performance for the assessment, treatment or counselling of sick children. Using the IMCI algorithm, 17.5% of HW assessed the child's vaccination status, 46.8% assessed nutritional status, and 65.1% assessed children for dehydration. Only 5.1% of HW treatments were appropriate for the assessment. Exit interviews revealed that 5.1% of caregivers knew their children's illness, and only 19.9% could accurately describe how to administer the prescribed drug. This R-HFA, using LQAS principles, is a rapid, simple tool for assessing malaria services and can be used at scale. It identified technical deficiencies that could be corrected by improved continuing medical education, targeted supervision, and recurrent R-HFA assessments of the quality of services.

Tracking the Quality of Care for Sick Children Using Lot Quality Assurance Sampling: Targeting Improvements of Health Services in Jigawa, Nigeria

PubMed Central

Oladele, Edward Adekola; Ormond, Louise; Adeyemi, Olusegun; Patrick, David; Okoh, Festus; Oresanya, Olusola Bukola; Valadez, Joseph J.

2012-01-01

Background In Nigeria, 30% of child deaths are due to malaria. The National Malaria Control Program of Nigeria (NMCP) during 2009 initiated a program to improve the quality of paediatric malaria services delivered in health facilities (HF). This study reports a rapid approach used to assess the existing quality of services in Jigawa state at decentralised levels of the health system. Methods NMCP selected Lot Quality Assurance Sampling (LQAS) to identify the variation in HF service quality among Senatorial Districts (SD). LQAS was selected because it was affordable and could be used by local health workers (HW) in a population-based survey. NMCP applied a 2-stage LQAS using a structured Rapid Health Facility Assessment (R-HFA) tool to identify high and low performing SD for specified indicators. Findings LQAS identified variations in HF performance (n = 21) and enabled resources to be targeted to address priorities. All SD exhibited deficient essential services, supplies and equipment. Only 9.7% of HF had Artemisinin-based Combination Therapies and other first-line treatments for childhood illnesses. No SD and few HF exhibited adequate HW performance for the assessment, treatment or counselling of sick children. Using the IMCI algorithm, 17.5% of HW assessed the child’s vaccination status, 46.8% assessed nutritional status, and 65.1% assessed children for dehydration. Only 5.1% of HW treatments were appropriate for the assessment. Exit interviews revealed that 5.1% of caregivers knew their children’s illness, and only 19.9% could accurately describe how to administer the prescribed drug. Conclusion This R-HFA, using LQAS principles, is a rapid, simple tool for assessing malaria services and can be used at scale. It identified technical deficiencies that could be corrected by improved continuing medical education, targeted supervision, and recurrent R-HFA assessments of the quality of services. PMID:23028519

Evaluating the Sustained Health Impact of Household Chlorination of Drinking Water in Rural Haiti

PubMed Central

Harshfield, Eric; Lantagne, Daniele; Turbes, Anna; Null, Clair

2012-01-01

The Jolivert Safe Water for Families program has sold sodium hypochlorite solution (chlorine) and conducted household visits in rural Haiti since 2002. To assess the impact of the program on diarrheal disease, in 2010 we conducted a survey and water quality testing in 201 program participants and 425 control households selected at random. Fifty-six percent of participants (versus 10% of controls) had free chlorine residuals between 0.2 and 2.0 mg/L, indicating correct water treatment. Using intention-to-treat analysis, we found that significantly fewer children < 5 in participant households had an episode of diarrhea in the previous 48 hours (32% versus 52%; P < 0.001) with 59% reduced odds (odds ratio = 0.41, 95% confidence interval = 0.21–0.79). Treatment-on-treated estimates of the odds of diarrhea indicated larger program effects for participants who met more stringent verifications of participation. Diarrheal disease reduction in this long-term program was comparable with that seen in short-term randomized, controlled interventions, suggesting that household chlorination can be an effective long-term water treatment strategy. PMID:22987657

Evaluating the sustained health impact of household chlorination of drinking water in rural Haiti.

PubMed

Harshfield, Eric; Lantagne, Daniele; Turbes, Anna; Null, Clair

2012-11-01

The Jolivert Safe Water for Families program has sold sodium hypochlorite solution (chlorine) and conducted household visits in rural Haiti since 2002. To assess the impact of the program on diarrheal disease, in 2010 we conducted a survey and water quality testing in 201 program participants and 425 control households selected at random. Fifty-six percent of participants (versus 10% of controls) had free chlorine residuals between 0.2 and 2.0 mg/L, indicating correct water treatment. Using intention-to-treat analysis, we found that significantly fewer children < 5 in participant households had an episode of diarrhea in the previous 48 hours (32% versus 52%; P < 0.001) with 59% reduced odds (odds ratio = 0.41, 95% confidence interval = 0.21-0.79). Treatment-on-treated estimates of the odds of diarrhea indicated larger program effects for participants who met more stringent verifications of participation. Diarrheal disease reduction in this long-term program was comparable with that seen in short-term randomized, controlled interventions, suggesting that household chlorination can be an effective long-term water treatment strategy.

Cardiac rehabilitation programs and health-related quality of life. State of the art.

PubMed

Cano de la Cuerda, Roberto; Alguacil Diego, Isabel María; Alonso Martín, Joaquín Jesús; Molero Sánchez, Alberto; Miangolarra Page, Juan Carlos

2012-01-01

Cardiovascular disease is the main health problem in developed countries. Prevention is presented as the most effective and efficient primary care intervention, whereas cardiac rehabilitation programs are considered the most effective of secondary prevention interventions; however, these are underused. This literature review examines the effectiveness and the levels of evidence of cardiac rehabilitation programs, their components, their development and role in developed countries, applications in different fields of research and treatment, including their psychological aspects, and their application in heart failure as a paradigm of disease care under this type of intervention. It is completed by a review of the impact of such programs on measures of health-related quality of life, describing the instruments involved in studies in recent scientific literature. Copyright © 2011 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Individualized Infliximab Treatment Guided by Patient-managed eHealth in Children and Adolescents with Inflammatory Bowel Disease.

PubMed

Carlsen, Katrine; Houen, Gunnar; Jakobsen, Christian; Kallemose, Thomas; Paerregaard, Anders; Riis, Lene B; Munkholm, Pia; Wewer, Vibeke

2017-09-01

To individualize timing of infliximab (IFX) treatment in children and adolescents with inflammatory bowel disease (IBD) using a patient-managed eHealth program. Patients with IBD, 10 to 17 years old, treated with IFX were prospectively included. Starting 4 weeks after their last infusion, patients reported a weekly symptom score and provided a stool sample for fecal calprotectin analysis. Based on symptom scores and fecal calprotectin results, the eHealth program calculated a total inflammation burden score that determined the timing of the next IFX infusion (4-12 wk after the previous infusion). Quality of Life was scored by IMPACT III. A control group was included to compare trough levels of IFX antibodies and concentrations and treatment intervals. Patients and their parents evaluated the eHealth program. There were 29 patients with IBD in the eHealth group and 21 patients with IBD in the control group. During the control period, 94 infusions were provided in the eHealth group (mean interval 9.5 wk; SD 2.3) versus 105 infusions in the control group (mean interval 6.9 wk; SD 1.4). Treatment intervals were longer in the eHealth group (P < 0.001). Quality of Life did not change during the study. Appearance of IFX antibodies did not differ between the 2 groups. Eighty percent of patients reported increased disease control and 63% (86% of parents) reported an improved knowledge of the disease. Self-managed, eHealth-individualized timing of IFX treatments, with treatment intervals of 4 to 12 weeks, was accompanied by no significant development of IFX antibodies. Patients reported better control and improved knowledge of their IBD.

EPA versus Colorado: national unity versus state flexibility

DOE Office of Scientific and Technical Information (OSTI.GOV)

Foster, T.

When the Environmental Protection Agency (EPA) reviewed Colorado's National Pollutant Discharge Elimination System (NPDES) permit program under the federal Clean Water Act, it found a conflict between federal and state perspectives on how much flexibility from national norms is allowable for state peculiarities. Colorado's hydrology and geography seemed to justify a water quality program providing for various opportunities to review water quality decisions before requiring advanced waste treatment (AWT), and to avoid AWT when justified. Conflict arose because few streams in Colorado provide mixing zones or dilution that Eastern streams enjoy. The author reviews the legal developments as EPA arguedmore » for national uniformity and Colorado for flexibility. States might be tempted to return permitting programs to EPA if they cannot retain enough flexibility in the law to protect their interests.« less

Home-based asthma education of young low-income children and their families.

PubMed

Brown, Josephine V; Bakeman, Roger; Celano, Marianne P; Demi, Alice S; Kobrynski, Lisa; Wilson, Sandra R

2002-12-01

To conduct a controlled trial of a home-based education program for low-income caregivers of young children with asthma. Participants were randomized to treatment-eight weekly asthma education sessions adapted from the Wee Wheezers program (n = 49)-or usual care (n = 46). Baseline and 3- and 12-month follow-up data were gathered from caregivers and from children's medical records. Treatment was associated with less bother from asthma symptoms, more symptom-free days, and better caregiver quality of life at follow-up for children 1-3, but not those 4-6, years of age. Treatment and control groups did not differ in caregiver asthma management behavior or children's acute care utilization. This home-based asthma education program was most effective with younger children; perhaps their caregivers were more motivated to learn about asthma management. Targeting psychosocial factors associated with asthma morbidity might also enhance the efficacy of asthma education for these families.

The impact of a multidisciplinary self-care management program on quality of life, self-care, adherence to anti-hypertensive therapy, glycemic control, and renal function in diabetic kidney disease: A Cross-over Study Protocol.

PubMed

Helou, Nancy; Talhouedec, Dominique; Shaha, Maya; Zanchi, Anne

2016-07-19

Diabetic kidney disease, a global health issue, remains associated with high morbidity and mortality. Previous research has shown that multidisciplinary management of chronic disease can improve patient outcomes. The effect of multidisciplinary self-care management on quality of life and renal function of patients with diabetic kidney disease has not yet been well established. The aim of this study is to evaluate the impact of a multidisciplinary self-care management program on quality of life, self-care behavior, adherence to anti-hypertensive treatment, glycemic control, and renal function of adults with diabetic kidney disease. A uniform balanced cross-over design is used, with the objective to recruit 40 adult participants with diabetic kidney disease, from public and private out-patient settings in French speaking Switzerland. Participants are randomized in equal number into four study arms. Each participant receives usual care alternating with the multidisciplinary self- care management program. Each treatment period lasts three months and is repeated twice at different time intervals over 12 months depending on the cross-over arm. The multidisciplinary self-care management program is led by an advanced practice nurse and adds nursing and dietary consultations and follow-ups, to the habitual management provided by the general practitioner, the nephrologist and the diabetologist. Data is collected every three months for 12 months. Quality of life is measured using the Audit of Diabetes-Dependent Quality of Life scale, patient self-care behavior is assessed using the Revised Summary of Diabetes Self-Care Activities, and adherence to anti-hypertensive therapy is evaluated using the Medication Events Monitoring System. Blood glucose control is measured by the glycated hemoglobin levels and renal function by serum creatinine, estimated glomerular filtration rate and urinary albumin/creatinine ratio. Data will be analyzed using STATA version 14. The cross-over design will elucidate the responses of individual participant to each treatment, and will allow us to better evaluate the use of such a design in clinical settings and behavioral studies. This study also explores the impact of a theory-based nursing practice and its implementation into a multidisciplinary context. ClinicalTrials.gov identifier: NCT01967901 , registered on the 18th of October 2013.

Impact of Family Planning and Business Trainings on Private-Sector Health Care Providers in Nigeria.

PubMed

Ugaz, Jorge; Leegwater, Anthony; Chatterji, Minki; Johnson, Doug; Baruwa, Sikiru; Toriola, Modupe; Kinnan, Cynthia

2017-06-01

Private health care providers are an important source of modern contraceptives in Sub-Saharan Africa, yet they face many challenges that might be addressed through targeted training. This study measures the impact of a package of trainings and supportive supervision activities targeted to private health care providers in Lagos State, Nigeria, on outcomes including range of contraceptive methods offered, providers' knowledge and quality of counseling, recordkeeping practices, access to credit and revenue. A total of 965 health care facilities were randomly assigned to treatment and control groups. Facilities in the treatment group-but not those in the control group-were offered a training package that included a contraceptive technology update and interventions to improve counseling and clinical skills and business practices. Multivariate regression analysis of data collected through facility and mystery client surveys was used to estimate effects. The training program had a positive effect on the range of contraceptive methods offered, with facilities in the treatment group providing more methods than facilities in the control group. The training program also had a positive impact on the quality of counseling services, especially on the range of contraceptive methods discussed by providers, their interpersonal skills and overall knowledge. Facilities in the treatment group were more likely than facilities in the control group to have good recordkeeping practices and to have obtained loans. No effect was found on revenue generation. Targeted training programs can be effective tools to improve the provision of family planning services through private providers.

Feasibility of the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program for symptom improvement among breast cancer survivors.

PubMed

Lengacher, Cecile A; Reich, Richard R; Ramesar, Sophia; Alinat, Carissa B; Moscoso, Manolete; Cousin, Lakeshia; Marino, Victoria R; Elias, Maya N; Paterson, Carly L; Pleasant, Michelle L; Rodriguez, Carmen S; Wang, Hsiao-Lan; Kip, Kevin E; Meng, Hongdao; Park, Jong Y

2018-02-01

The purpose of this pilot study was to test the feasibility of delivering the mobile mindfulness-based stress reduction for breast cancer (mMBSR(BC)) program using an iPad and to evaluate its impact on symptom improvement. A single group, pre-posttest design was implemented among female stages 0-III breast cancer survivors (BCS) who completed treatment. Data were collected at baseline and week 6 on measures of psychological and physical symptoms and quality of life. The mMBSR(BC) program is a standardized, stress-reducing intervention that combines sitting and walking meditation, body scan, and yoga and is designed to deliver weekly 2-hour sessions for 6 weeks using an iPad. The mean age of the 15 enrolled BCS was 57 years; one participant was non-Hispanic black, and 14 were non-Hispanic white. Of the 13 who completed the study, there were significant improvements from baseline to 6 weeks post-mMBSR(BC) in psychological and physical symptoms of depression, state anxiety, stress, fear of recurrence, sleep quality, fatigue, and quality of life (P's < .05). Effect sizes for improvements of multiple symptoms ranged from medium to large. These results provide preliminary support that the mMBSR(BC) program may be feasible and acceptable, showing a clinical impact on decreasing psychological and physical symptoms. This mobile-based program offers a delivery of a standardized MBSR(BC) intervention to BCS that is convenient for their own schedule while decreasing symptom burden in the survivorship phase after treatment for breast cancer. Copyright © 2017 John Wiley & Sons, Ltd.

MO-A-16A-01: QA Procedures and Metrics: In Search of QA Usability

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sathiaseelan, V; Thomadsen, B

Radiation therapy has undergone considerable changes in the past two decades with a surge of new technology and treatment delivery methods. The complexity of radiation therapy treatments has increased and there has been increased awareness and publicity about the associated risks. In response, there has been proliferation of guidelines for medical physicists to adopt to ensure that treatments are delivered safely. Task Group recommendations are copious, and clinical physicists' hours are longer, stretched to various degrees between site planning and management, IT support, physics QA, and treatment planning responsibilities.Radiation oncology has many quality control practices in place to ensure themore » delivery of high-quality, safe treatments. Incident reporting systems have been developed to collect statistics about near miss events at many radiation oncology centers. However, tools are lacking to assess the impact of these various control measures. A recent effort to address this shortcoming is the work of Ford et al (2012) who recently published a methodology enumerating quality control quantification for measuring the effectiveness of safety barriers. Over 4000 near-miss incidents reported from 2 academic radiation oncology clinics were analyzed using quality control quantification, and a profile of the most effective quality control measures (metrics) was identified.There is a critical need to identify a QA metric to help the busy clinical physicists to focus their limited time and resources most effectively in order to minimize or eliminate errors in the radiation treatment delivery processes. In this symposium the usefulness of workflows and QA metrics to assure safe and high quality patient care will be explored.Two presentations will be given:Quality Metrics and Risk Management with High Risk Radiation Oncology ProceduresStrategies and metrics for quality management in the TG-100 Era Learning Objectives: Provide an overview and the need for QA usability metrics: Different cultures/practices affecting the effectiveness of methods and metrics. Show examples of quality assurance workflows, Statistical process control, that monitor the treatment planning and delivery process to identify errors. To learn to identify and prioritize risks and QA procedures in radiation oncology. Try to answer the question: Can a quality assurance program aided by quality assurance metrics help minimize errors and ensure safe treatment delivery. Should such metrics be institution specific.« less

Adaptation of intensive mental health intensive case management to rural communities in the Veterans Health Administration.

PubMed

Mohamed, Somaia

2013-03-01

There has been increasing concern in recent years about the availability of mental health services for people with serious mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment. The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small specialized case management teams in rural areas.

Cost-effectiveness of rapid HCV testing and simultaneous rapid HCV and HIV testing in substance abuse treatment programs

PubMed Central

Schackman, Bruce R.; Leff, Jared A.; Barter, Devra M.; DiLorenzo, Madeline A.; Feaster, Daniel J.; Metsch, Lisa R.; Freedberg, Kenneth A.; Linas, Benjamin P.

2014-01-01

Aims To evaluate the cost-effectiveness of rapid hepatitis C virus (HCV) and simultaneous HCV/HIV antibody testing in substance abuse treatment programs. Design We used a decision analytic model to compare the cost-effectiveness of no HCV testing referral or offer, off-site HCV testing referral, on-site rapid HCV testing offer, and on-site rapid HCV and HIV testing offer. Base case inputs included 11% undetected chronic HCV, 0.4% undetected HIV, 35% HCV co-infection among HIV-infected, 53% linked to HCV care after testing antibody positive, and 67% linked to HIV care. Disease outcomes were estimated from established computer simulation models of HCV (HEP-CE) and HIV (CEPAC). Setting and Participants Data on test acceptance and costs were from a national randomized trial of HIV testing strategies conducted at 12 substance abuse treatment programs in the USA. Measurements Lifetime costs (2011 US dollars) and quality-adjusted life years (QALYs) discounted at 3% annually; incremental cost-effectiveness ratios (ICERs) Findings On-site rapid HCV testing had an ICER of $18,300/QALY compared with no testing, and was more efficient than (dominated) off-site HCV testing referral. On-site rapid HCV and HIV testing had an ICER of $64,500/QALY compared with on-site rapid HCV testing alone. In one and two-way sensitivity analyses, the ICER of on-site rapid HCV and HIV testing remained <$100,000/QALY, except when undetected HIV prevalence was <0.1% or when we assumed frequent HIV testing elsewhere. The ICER remained <$100,000/QALY in approximately 90% of probabilistic sensitivity analyses. Conclusions On-site rapid hepatitis C virus and HIV testing in substance abuse treatment programs is cost-effective at a <$100,000/ quality-adjusted life years threshold. PMID:25291977

Use of wetlands for water quality improvement under the USEPA Region V Clean Lakes Program

NASA Astrophysics Data System (ADS)

Landers, Judith C.; Knuth, Barbara A.

1991-03-01

The United States Environmental Protection Agency (USEPA) Region V Clean Lakes Program employs artificial and modified natural wetlands in an effort to improve the water quality of selected lakes. We examined use of wetlands at seven lake sites and evaluated the physical and institutional means by which wetland projects are implemented and managed, relative to USEPA program goals and expert recommendations on the use of wetlands for water quality improvement. Management practices recommended by wetlands experts addressed water level and retention, sheet flow, nutrient removal, chemical treatment, ecological and effectiveness monitoring, and resource enhancement. Institutional characteristics recommended included local monitoring, regulation, and enforcement and shared responsibilities among jurisdictions. Institutional and ecological objectives of the National Clean Lakes Program were met to some degree at every site. Social objectives were achieved to a lesser extent. Wetland protection mechanisms and appropriate institutional decentralization were present at all sites. Optimal management techniques were employed to varying degrees at each site, but most projects lack adequate monitoring to determine adverse ecological impacts and effectiveness of pollutant removal and do not extensively address needs for recreation and wildlife habitat. There is evidence that the wetland projects are contributing to improved lake water quality; however, more emphasis needs to be placed on wetland protection and long-term project evaluation.

Predictors of improvement in subjective sleep quality reported by older adults following group-based cognitive behavior therapy for sleep maintenance and early morning awakening insomnia.

PubMed

Lovato, Nicole; Lack, Leon; Wright, Helen; Kennaway, David J

2013-09-01

Cognitive behavior therapy is an effective nonpharmacologic treatment for insomnia. However, individualized administration is costly and often results in substantial variability in treatment response across individual patients, particularly so for older adults. Group-based administration has demonstrated impressive potential for a brief and inexpensive answer to the effective treatment of insomnia in the older population. It is important to identify potential predictors of response to such a treatment format to guide clinicians when selecting the most suitable treatment for their patients. The aim of our study was to identify factors that predict subjective sleep quality of older adults following group-based administration of cognitive behavior therapy for insomnia (CBT-I). Eighty-six adults (41 men; mean age, 64.10 y; standard deviation [SD], 6.80) with sleep maintenance or early morning awakening insomnia were selected from a community-based sample to participate in a 4-week group-based treatment program of CBT-I. Participants were required to complete 7-day sleep diaries and a comprehensive battery of questionnaires related to sleep quality and daytime functioning. Hierarchical multiple regression analyses were used to identify factors predicting subjective sleep quality immediately following treatment and at 3-month follow-up. Sleep diaries reported average nightly sleep efficiency (SE), which was used as the outcome measure of sleep quality. Participants with the greatest SE following treatment while controlling for pretreatment SE were relatively younger and had more confidence in their ability to sleep at pretreatment. These characteristics may be useful to guide clinicians when considering the use of a group-based CBT-I for sleep maintenance or early morning awakening insomnia in older adults. Copyright © 2013 Elsevier B.V. All rights reserved.

A critical review of accounting and economic methods for estimating the costs of addiction treatment.

PubMed

Cartwright, William S

2008-04-01

Researchers have been at the forefront of applying new costing methods to drug abuse treatment programs and innovations. The motivation for such work has been to improve costing accuracy. Recent work has seen applications initiated in establishing charts of account and cost accounting for service delivery. As a result, researchers now have available five methods to apply to the costing of drug abuse treatment programs. In all areas of costing, there is room for more research on costing concepts and measurement applications. Additional work would be useful in establishing studies with activity-based costing for both research and managerial purposes. Studies of economies of scope are particularly relevant because of the integration of social services and criminal justice in drug abuse treatment. In the long run, managerial initiatives to improve the administration and quality of drug abuse treatment will benefit directly from research with new information on costing techniques.

Horticultural therapy: a pilot study on modulating cortisol levels and indices of substance craving, posttraumatic stress disorder, depression, and quality of life in veterans.

PubMed

Detweiler, Mark B; Self, Jennifer A; Lane, Sandra; Spencer, Luise; Lutgens, Brian; Kim, Dong-Yun; Halling, Mary H; Rudder, Tammie C; Lehmann, Lauren P

2015-01-01

Horticultural therapy (HT) is a subgroup of occupational therapy (OT). Both HT and OT have been successful as adjunctive treatment modalities in substance abuse treatment. Studies have indicated that gardening promotes neuroendocrine and affective restoration from stress. The study intended to assess the effect of HT versus nonhorticultural OT on cortisol levels, depression, symptoms of posttraumatic stress disorder (PTSD), alcohol cravings, and quality of life. The research team designed a randomized pilot study. The study was open for participation from July 2012-October 2012. It took place during multiple occurrences of a 28-d treatment programs for substance use disorder at a Veterans Affairs medical center. Participants • Participants were 49 veterans, averaging 46.4 y old (SD = 11.9); the dropout rate was 37%. Participants were randomly assigned to the HT or the OT group. They attended supervised HT and OT groups 5 h/d for 3 wk. Outcome Measures • Pre- and posttreatment, participants completed the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF), the Alcohol Craving Questionnaire (ACQ-NOW), the Posttraumatic Stress Disorder Checklist Civilian Version (PCLC), and the Center for Epidemiologic Studies Depression Scale (CES-D). Salivary cortisol samples were taken at wk 1, 2, and 3. A repeated measures analysis of variance (ANOVA) (F2,20 = 0.878) revealed that the HT performed was associated with a 12% reduction in salivary cortisol levels from wk 1 to wk 3, but the difference was not statistically significant (P = .43). Separate 1-way analyses of covariance (ANCOVAs) revealed no statistically significant differences in the self-administered tests, although both the Q-LES-Q-SF and CES-D showed a trend toward improving quality of life and depressive symptoms in the HT group compared with the OT group. Additional analysis of the nonbiologic tests suggests that most participants in the HT and OT had some benefit from the programmed activities. The trends suggest that HT may modulate stress in veterans, as evidenced by decreased cortisol levels and depressive symptoms, and may improve quality of life more than the programs in which the OT group participated. Further investigation with larger samples, including a nontreatment control group, is needed to determine whether the observed trends are treatment effects or due to abstinence.

Evaluation of a functional medicine approach to treating fatigue, stress, and digestive issues in women.

PubMed

Cutshall, Susanne M; Bergstrom, Larry R; Kalish, Daniel J

2016-05-01

Fatigue, stress, and digestive disorders are common among adults, especially women. We conducted a 28-week pilot study to assess the efficacy of a functional medicine approach to improving stress, energy, fatigue, digestive issues, and quality of life in middle-aged women. Findings showed significant improvements in many stress, fatigue, and quality-of-life measures. The treatment program increased mean salivary dehydroepiandrosterone levels and the cortisol-dehydroepiandrosterone ratio. Stool sample analyses suggested that these treatments reduced Helicobacter pylori infections. This study suggests that functional medicine may be an effective approach to managing stress and gastrointestinal symptoms. Copyright © 2016 Elsevier Ltd. All rights reserved.

Innovating for quality and value: Utilizing national quality improvement programs to identify opportunities for responsible surgical innovation.

PubMed

Woo, Russell K; Skarsgard, Erik D

2015-06-01

Innovation in surgical techniques, technology, and care processes are essential for improving the care and outcomes of surgical patients, including children. The time and cost associated with surgical innovation can be significant, and unless it leads to improvements in outcome at equivalent or lower costs, it adds little or no value from the perspective of the patients, and decreases the overall resources available to our already financially constrained healthcare system. The emergence of a safety and quality mandate in surgery, and the development of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) allow needs-based surgical care innovation which leads to value-based improvement in care. In addition to general and procedure-specific clinical outcomes, surgeons should consider the measurement of quality from the patients' perspective. To this end, the integration of validated Patient Reported Outcome Measures (PROMs) into actionable, benchmarked institutional outcomes reporting has the potential to facilitate quality improvement in process, treatment and technology that optimizes value for our patients and health system. Copyright © 2015 Elsevier Inc. All rights reserved.

Quality assurance in military medical research and medical radiation accident management.

PubMed

Hotz, Mark E; Meineke, Viktor

2012-08-01

The provision of quality radiation-related medical diagnostic and therapeutic treatments cannot occur without the presence of robust quality assurance and standardization programs. Medical laboratory services are essential in patient treatment and must be able to meet the needs of all patients and the clinical personnel responsible for the medical care of these patients. Clinical personnel involved in patient care must embody the quality assurance process in daily work to ensure program sustainability. In conformance with the German Federal Government's concept for modern departmental research, the international standard ISO 9001, one of the relevant standards of the International Organization for Standardization (ISO), is applied in quality assurance in military medical research. By its holistic approach, this internationally accepted standard provides an excellent basis for establishing a modern quality management system in line with international standards. Furthermore, this standard can serve as a sound basis for the further development of an already established quality management system when additional standards shall apply, as for instance in reference laboratories or medical laboratories. Besides quality assurance, a military medical facility must manage additional risk events in the context of early recognition/detection of health risks of military personnel on deployment in order to be able to take appropriate preventive and protective measures; for instance, with medical radiation accident management. The international standard ISO 31000:2009 can serve as a guideline for establishing risk management. Clear organizational structures and defined work processes are required when individual laboratory units seek accreditation according to specific laboratory standards. Furthermore, international efforts to develop health laboratory standards must be reinforced that support sustainable quality assurance, as in the exchange and comparison of test results within the scope of external quality assurance, but also in the exchange of special diagnosis data among international research networks. In summary, the acknowledged standard for a quality management system to ensure quality assurance is the very generic standard ISO 9001.Health Phys. 103(2):221-225; 2012.

Imaging and Data Acquisition in Clinical Trials for Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

FitzGerald, Thomas J., E-mail: Thomas.Fitzgerald@umassmed.edu; Bishop-Jodoin, Maryann; Followill, David S.

2016-02-01

Cancer treatment evolves through oncology clinical trials. Cancer trials are multimodal and complex. Assuring high-quality data are available to answer not only study objectives but also questions not anticipated at study initiation is the role of quality assurance. The National Cancer Institute reorganized its cancer clinical trials program in 2014. The National Clinical Trials Network (NCTN) was formed and within it was established a Diagnostic Imaging and Radiation Therapy Quality Assurance Organization. This organization is Imaging and Radiation Oncology Core, the Imaging and Radiation Oncology Core Group, consisting of 6 quality assurance centers that provide imaging and radiation therapy qualitymore » assurance for the NCTN. Sophisticated imaging is used for cancer diagnosis, treatment, and management as well as for image-driven technologies to plan and execute radiation treatment. Integration of imaging and radiation oncology data acquisition, review, management, and archive strategies are essential for trial compliance and future research. Lessons learned from previous trials are and provide evidence to support diagnostic imaging and radiation therapy data acquisition in NCTN trials.« less

Effectiveness of a family-oriented rehabilitation program on the quality of life of parents of chronically ill children.

PubMed

West, C A; Besier, T; Borth-Bruhns, T; Goldbeck, L

2009-01-01

Parents of chronically ill children face numerous burdens in daily life, which can impair their quality of life (QoL) significantly. Therefore in family-oriented rehabilitation, not only the children themselves, but also their parents receive interventions. These aim at stabilizing parents both mentally and physically to enable them to support their children in the best possible way. This study investigates the effects of an inpatient family-oriented rehabilitation program on the QoL of parents of chronically ill children. A consecutive sample of 231 mothers and 155 fathers of children suffering from cancer, cardiac diseases or cystic fibrosis participated in the study. In a prospective longitudinal study, parental QoL was repeatedly assessed using the Ulm Quality of Life Inventory for Parents (ULQIE) at three different time points: admission to the rehabilitation clinic, discharge after four weeks of inpatient treatment, and at a six-month follow-up. Parental QoL increased markedly during rehabilitation treatment (mothers eta (2)=.326, fathers eta (2)=.249). Moreover, six months after the intervention, parental quality of life was still markedly improved compared to baseline assessment (mothers eta (2)=.259, fathers eta (2)=.069). The child's diagnosis had no effect on the level and course of parental QoL. Taking part in family-oriented rehabilitation can improve the QoL of parents of children suffering from cancer, cardiac diseases or cystic fibrosis. Such programs could be expected to affect the way chronically ill children cope with their condition and this should be examined in future studies.

Effect of a Complementary/Integrative Medicine Treatment Program on Taxane-Induced Peripheral Neuropathy: A Brief Report.

PubMed

Ben-Arye, Eran; River, Yaron; Keshet, Yael; Lavie, Ofer; Israeli, Pesi; Samuels, Noah

2018-06-01

Peripheral neuropathy is a common complication of cancer treatment impairing quality of life and function. This study explored the impact of a complementary and integrative medicine (CIM) program on taxane-induced peripheral neuropathy (TIPN). Taxane-treated female patients with breast and gynecological cancer reporting TIPN-related symptoms were referred to an integrative physician, followed by patient-tailored CIM treatments (acupuncture with/without other modalities). Assessment of study outcomes at 6 to 12 weeks was conducted using the Measure Yourself Concerns and Wellbeing, which documented free-text narratives about patients' experience during the CIM treatment process. Content was analyzed using ATLAS.Ti software. Of the 125 patients treated with taxanes, 69 had been referred for CIM treatment of TIPN-associated symptoms. Multidisciplinary narrative analysis identified 2 groups of CIM-treated patients: those with an apparently moderate improvement in symptoms (n = 35) and those with either only an apparent mild or no improvement at all. For 10 patients, assessment of their response to treatment was unclear. The 2 identified groups had similar demographic, cancer-related, and quality of life-related parameters at baseline. Content analysis of patients with an apparent moderate improvement suggested a short-term (24-48 hours) effect with acupuncture treatment, either alone or combined with manual, mind-body, and anthroposophic music therapies. Symptoms showing improvement included paresthesia and numbness. Acupuncture and other CIM therapies may result in a short-term and transitory reduction in TIPN-related symptoms.

Experiences of burnout among drug counselors in a large opioid treatment program: A qualitative investigation.

PubMed

Beitel, Mark; Oberleitner, Lindsay; Muthulingam, Dharushana; Oberleitner, David; Madden, Lynn M; Marcus, Ruthanne; Eller, Anthony; Bono, Madeline H; Barry, Declan T

2018-03-09

Little is known about possible experiences of burnout among drug counselors in opioid treatment programs that are scaling up capacity to address the current opioid treatment gap. Participants in this quality improvement study were 31 drug counselors employed by large opioid treatment programs whose treatment capacities were expanding. Experiences of burnout and approaches for managing and/or preventing burnout were examined using individual semi-structured interviews, which were audiotaped, transcribed, and systematically coded by a multidisciplinary team using grounded theory. Rates of reported burnout (in response to an open-ended question) were lower than expected, with approximately 26% of participants reporting burnout. Counselor descriptions of burnout included cognitive, affective, behavioral, and physiological symptoms; and job-related demands were identified as a frequent cause. Participants described both self-initiated (e.g., engaging in pleasurable activities, exercising, taking breaks during workday) and system-supported strategies for managing or preventing burnout (e.g., availing of supervision and paid time off). Counselors provided recommendations for system-level changes to attenuate counselor risk of burnout (e.g., increased staff-wide encounters, improved communication, accessible paid time off, and increased clinical supervision). Findings suggest that drug counselor burnout is not inevitable, even in opioid treatment program settings whose treatment capacities are expanding. Organizations might benefit from routinely assessing counselor feedback about burnout and implementing feasible recommendations to attenuate burnout and promote work engagement.

Quality control of antibiotics before the implementation of an STD program in Northern Myanmar.

PubMed

Prazuck, Thierry; Falconi, Isabelle; Morineau, Guy; Bricard-Pacaud, Véronique; Lecomte, Antoine; Ballereau, Francoise

2002-11-01

The ready availability of poor-quality drugs in developing countries leads to treatment failure and, consequently, excess mortality and morbidity. Moreover, the widespread availability of substandard drugs plays a key role in increasing the resistance to antimicrobial drugs.GOAL As a prerequisite to the establishment of a sexually transmitted disease (STD) control program, this study aimed to evaluate the quality of antibiotics recommended for treatment of STDs that were locally available in the capital of a province of Northern Myanmar. In addition to the hospital pharmacy, we selected at random 5 of the 41 drug sellers and 5 of the 40 general practitioners who sell antibiotics in the city of Myitkyina. Twenty-one marketing products corresponding to nine different antibiotics used for STD treatment were purchased (benzathine benzylpenicillin, benzylpenicillin, ceftriaxone, chlortetracycline, ciprofloxacin, clotrimazole, co-trimoxazole, doxycycline, and erythromycin). Drugs were sent to France, where they were analyzed according to the WHO guidelines. Drugs were considered to be standard if their dosage remained in the 10% range of the expected value. Among the 21 different specialty products, only three displayed the official "registered" label. Three drugs were expired and the expiration date was not available for six others. One product did not contain the active drug declared (chlortetracycline; Lombisin, Unicorn, China) and did not show any in vitro activity against bacteria. Seven of 21 products (33%) did not contain the stated dosage (1, more than stated dosage; 6, less than stated dosage). The highest deficit observed was 48% in two products (co-trimoxazole, Yong Fong, Myanmar; benzylpenicillin, China [city and manufacturer unknown]). The dosage was not available for five drugs. As a result, only 8 of 21 products (38%) did not contain the stated dosage of active drug. These findings suggest that public health policies based on national treatment guidelines should rigorously include the monitoring of quality control of available antimicrobial products. In the absence of such measures, specific treatment strategies are likely to fail and to generate drug resistance.

Women's entrepreneurship and intimate partner violence: A cluster randomized trial of microenterprise assistance and partner participation in post-conflict Uganda (SSM-D-14-01580R1).

PubMed

Green, Eric P; Blattman, Christopher; Jamison, Julian; Annan, Jeannie

2015-05-01

Intimate partner violence is widespread and represents an obstacle to human freedom and a significant public health concern. Poverty alleviation programs and efforts to economically "empower" women have become popular policy options, but theory and empirical evidence are mixed on the relationship between women's empowerment and the experience of violence. We study the effects of a successful poverty alleviation program on women's empowerment and intimate partner relations and violence from 2009 to 2011. In the first experiment, a cluster-randomized superiority trial, 15 marginalized people (86% women) were identified in each of 120 villages (n = 1800) in Gulu and Kitgum districts in Uganda. Half of villages were randomly assigned via public lottery to immediate treatment: five days of business training, $150, and supervision and advising. We examine intent-to-treat estimates of program impact and heterogeneity in treatment effects by initial quality of partner relations. 16 months after the initial grants, the program doubled business ownership and incomes (p < 0.01); we show that the effect on monthly income, however, is moderated by initial quality of intimate partner relations. We also find small increases in marital control (p < 0.05), self-reported autonomy (p < 0.10), and quality of partner relations (p < 0.01), but essentially no change in intimate partner violence. In a second experiment, we study the impact of a low-cost attempt to include household partners (often husbands) in the process. Participants from the 60 waitlist villages (n = 904) were randomly assigned to participate in the program as individuals or with a household partner. We observe small, non-significant decreases in abuse and marital control and large increases in the quality of relationships (p < 0.05), but no effects on women's attitudes toward gender norms and a non-significant reduction in autonomy. Involving men and changing framing to promote more inclusive programming can improve relationships, but may not change gender attitudes or increase business success. Increasing women's earnings has no effect on intimate partner violence. Copyright © 2015. Published by Elsevier Ltd.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Angers, Crystal Plume; Bottema, Ryan; Buckley, Les

Purpose: Treatment unit uptime statistics are typically used to monitor radiation equipment performance. The Ottawa Hospital Cancer Centre has introduced the use of Quality Control (QC) test success as a quality indicator for equipment performance and overall health of the equipment QC program. Methods: Implemented in 2012, QATrack+ is used to record and monitor over 1100 routine machine QC tests each month for 20 treatment and imaging units ( http://qatrackplus.com/ ). Using an SQL (structured query language) script, automated queries of the QATrack+ database are used to generate program metrics such as the number of QC tests executed and themore » percentage of tests passing, at tolerance or at action. These metrics are compared against machine uptime statistics already reported within the program. Results: Program metrics for 2015 show good correlation between pass rate of QC tests and uptime for a given machine. For the nine conventional linacs, the QC test success rate was consistently greater than 97%. The corresponding uptimes for these units are better than 98%. Machines that consistently show higher failure or tolerance rates in the QC tests have lower uptimes. This points to either poor machine performance requiring corrective action or to problems with the QC program. Conclusions: QATrack+ significantly improves the organization of QC data but can also aid in overall equipment management. Complimenting machine uptime statistics with QC test metrics provides a more complete picture of overall machine performance and can be used to identify areas of improvement in the machine service and QC programs.« less

The National Shipbuilding Research Program. Survey of Air and Water Quality Pollution Prevention and Control Technology Used in Shipyards and Similar Industries

DTIC Science & Technology

1998-01-09

vehicle washing 3. TSP and citric acid for bilge cleaning 1. no capture and filtration of weld fumes 8 1. black beauty abrasives 2...treatment 1. not treated N/A 12 N/A 1. treated on-site. with gravity oil water separator, acid cracking of the emulsion layer and parallel...less energy-intensive treatment technologies such as constructed wetlands for sewage treatment and anoxic limestone drains for acid mine drainage

40 CFR 133.100 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Purpose. 133.100 Section 133.100 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS SECONDARY TREATMENT REGULATION § 133.100 Purpose. This part provides information on the level of effluent quality attainable...

40 CFR 133.100 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 23 2013-07-01 2013-07-01 false Purpose. 133.100 Section 133.100 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS SECONDARY TREATMENT REGULATION § 133.100 Purpose. This part provides information on the level of effluent quality attainable...

40 CFR 133.100 - Purpose.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Purpose. 133.100 Section 133.100 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS SECONDARY TREATMENT REGULATION § 133.100 Purpose. This part provides information on the level of effluent quality attainable...

40 CFR 133.100 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Purpose. 133.100 Section 133.100 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS SECONDARY TREATMENT REGULATION § 133.100 Purpose. This part provides information on the level of effluent quality attainable...

Challenges faced by cervical cancer prevention programs in developing countries: a situational analysis of program organization in Argentina.

PubMed

Arrossi, Silvina; Paolino, Melisa; Sankaranarayanan, Rengaswamy

2010-10-01

to carry out a situational analysis of cervical cancer prevention activities in Argentina, specifically regarding (a) the organizational framework of cervical cancer prevention activities; (b) Pap-smear coverage; (c) cytology laboratory organization; and (d) follow-up/treatment of women with abnormal lesions. a situational analysis of provincial cervical cancer programs using data from an ad-hoc questionnaire sent to the leaders of cervical cancer prevention programs in Argentina's 24 provinces. In addition, the provinces' program guidelines, statistical reports, laws, and program regulations were reviewed and certain key leaders were personally interviewed. data were obtained for 19 of Argentina's 24 provinces. Four of the 19 provinces had no formal program framework. Conventional cytology was the most commonly used screening test. Screening was mainly opportunistic. The recommended interval between normal tests was 3 years in most provinces. The eligible age for screening ranged from 10-70 years of age; however, annual or biannual screening was the usual practice after becoming sexually active. None of the provincial programs had data available regarding Pap-smear coverage. Most of the cytology laboratories did not have a quality control policy. The number of smears read varied greatly by laboratory (650-24 000 per year). A log of events related to screening and treatment did not exist in most provinces. screening in Argentina is mainly opportunistic, characterized by an estimated low coverage, coexisting with over-screening of women with access to health services, and an absence of quality control procedures. Policies for cervical cancer screening in the provinces vary and, most often, deviate from the national recommendation of one Pap smear every 3 years for women 35-64 years of age. Ensuring compliance with national program guidelines is an essential step toward significantly reducing the burden of cervical cancer.

[Modern problems of maintenance of hygienic safety of drinking water consumption at the regional level].

PubMed

Tulakin, A V; Tsyplakova, G V; Ampleeva, G P; Kozyreva, O N; Pivneva, O S; Trukhina, G M

Problems of hygienic reliability of the drinking water use in regions of the Russian Federation are observed in the article. The optimization of the water use was shown must be based on the bearing in mind of regional peculiarities of the shaping of water quality of groundwater and surface sources of the water use, taking into account of the effectiveness of regional water protection programs, programs for water treatment, coordination of the activity of economic entities and oversight bodies in the management of water quality on the basis of socio-hygienic monitoring. Regional problems requiring hygienic justification and accounting, include such issues as complex hydrological, hydrogeological, climatic and geographical conditions, pronouncement of the severity of anthropogenic pollution of sources of water supply, natural conditions of the shaping of water quality, efficiency of the water treatment. There is need in the improvement of the problems of the water quality monitoring, including with the use of computer technology, which allows to realize regional hygienic monitoring and spatial-temporal analysis of the water quality, to model the water quality management, to predict conditions of the water use by population in regions taking into account peculiarities of the current health situation. In the article there is shown the practicability of the so-called complex concept of multiple barriers suggesting the combined use of chemical oxidation and physical methods of the preparation of drinking water. It is required the further development of legislation for the protection of water bodies from pollution with the bigging up the status of sanitary protection zones; timely revision of the regulatory framework, establishing sanitary-epidemiological requirements to potable water and drinking water supply. The problem of the provision of the population with safe drinking water requires complex solution within the framework of the implementation of target programs adopted at the Federal and regional levels.

Effectiveness of Oncologist-Referred Exercise and Healthy Eating Programming as a Part of Supportive Adjuvant Care for Early Breast Cancer.

PubMed

Kirkham, Amy A; Van Patten, Cheri L; Gelmon, Karen A; McKenzie, Donald C; Bonsignore, Alis; Bland, Kelcey A; Campbell, Kristin L

2018-01-01

Randomized trials have established efficacy of supervised exercise training during chemotherapy for breast cancer for numerous health outcomes. The purpose of this study was to assess reach, effectiveness, maintenance, and implementation of an evidence-based exercise and healthy eating program offered within an adjuvant care setting. Women receiving adjuvant chemotherapy for breast cancer were given a prescription by their oncologist to participate in the Nutrition and Exercise during Adjuvant Treatment (NExT) program. The NExT program consisted of supervised, moderate-intensity, aerobic and resistance exercise three times a week during adjuvant therapy, followed by a step-down in supervised sessions per week for 20 additional weeks, plus one group-based healthy eating session. Usual moderate-to-vigorous physical activity (MVPA) and health-related quality of life (HRQoL) were assessed by questionnaire at baseline, program completion, and one year later, along with measures of satisfaction and safety. Program reach encompassed referral of 53% of eligible patients, 78% uptake ( n  = 73 enrolled), and 78% retention for the 45.0 ± 8.3-week program. During the program, MVPA increased (116 ± 14 to 154 ± 14 minutes per week, p  = .014) and HRQoL did not change. One year later, MVPA (171 ± 24 minutes per week, p  = .014) and HRQoL (44 ± 1 to 49 ± 1, p  < .001) were significantly higher than baseline. Exercise adherence was 60% ± 26% to three sessions per week during treatment. No major adverse events occurred and injury prevalence did not change relative to baseline. Participants were highly satisfied. This oncologist-referred exercise and healthy eating supportive-care program for breast cancer patients receiving chemotherapy was safe, successful in reaching oncologists and patients, and effective for improving MVPA and maintaining HRQoL. Despite evidence that exercise is both safe and efficacious at improving physical fitness, quality of life, and treatment side effects for individuals with cancer, lifestyle programming is not offered as standard of cancer care. This study describes an oncologist-referred, evidence-based exercise and healthy eating program offered in collaboration with a university as supportive care to women with breast cancer receiving chemotherapy. The program was well received by oncologists and patients, safe, and relatively inexpensive to operate. Importantly, there was a significant positive impact on physical activity levels and health-related quality of life lasting for 2 years after initiation of therapy. © AlphaMed Press 2017.

[Clinical research on post-stroke hemiplegia treated with the optimized rehabilitation program of integrated Chinese and western medicine].

PubMed

Zhang, Xiao-Li; Qi, Rui; Yan, Jun-Tao

2013-12-01

To explore the optimized rehabilitation program in the treatment of post-stroke hemiplegia at the recovery stage. Based on the randomized controlled principle, 60 patients were randomized into an rehabilita tion + massage group (group A) and an rehabilitation + acupuncture group (group B), 30 cases in each one. Bobath sport therapy and functional training were adopted in the two groups. In the group A, the massage therapy was added. The rolling method and palm-rubbing method were used on the affected side, the pressing, kneading and plucking methods were applied to Jianliao (LI 15), Jianzhen (SI 9), Quchi (LI 11), Huantiao (GB 30), Weizhong (BL 40), Chengshan (BL 57), Zusanli (ST 36) and the other acu points; and the nipping method was adopted at the twelve Jing-well points. In the group B, acupuncture was applied to Baihui (BL 20), Jianliao (LI 15), Quchi (LI 11), Shousanli (LI 10), Huantiao (GB 30), Yanglingquan (GB 34), Jiexi (ST 41) and the other acupoints. The treatment was given once a day, 5 treatments a week in the two groups. The efficacy was evaluated in 3 weeks. Fugl-Meyer scale, Barthel index (BI) score, modified Rankin scale and stroke-specific quality of life (SS-QOL) were used to assess the limb motor function, the activity of daily life (ADL), independent activity of life and the quality of life of the patients in the two groups before and after treatment. Based on the total cost and benefit, the health economics evaluation was conducted in the patients of the two groups. The treatments all improved the limb motor function (group A: 26.00 (22) vs 37.00 (33); group B: 30.50 (21) vs 39.50 (36)), the independent activity of life, ADL (group A: 43.50 +/- 22.25 vs 57.50 +/- 22.25; group B: 52.83 +/- 16.59 vs 66.67 +/- 12.82) and the quality of life (group A: 122.23 +/- 30.00 vs 145.50 +/- 28.14; group B: 132.43 +/- 23.87 vs 151.47 +/- 22.37) in the patients of the two groups. The differences in all the indices were significant statistically before and after treatment in the two groups (all P<0.05). Above indices after treatment were not different obviously between the two groups (all P>0.05). In terms of health economics, the expense was decreased by RMB 688.48 while BI was increased by every 5 score in group A in comparison with the group B. Both the rehabilitation and massage therapy and the rehabilitation and acupuncture therapy improve the limb motor function and the quality of life in the patients of post-stroke hemiplegia. The therapeutic efficacies are similar between the two therapeutic programs. The program of rehabilitation and massage is more economical in the aspects of ADL improvement, being advantageous at simple operation and low cost.

Muscle stretching exercises and resistance training in fibromyalgia: which is better? A three-arm randomized controlled trial.

PubMed

Assumpção, Ana; Matsutani, Luciana A; Yuan, Susan L; Santo, Adriana S; Sauer, Juliana; Mango, Pamela; Marques, Amelia P

2017-11-29

Exercise therapy is an effective component of fibromyalgia (FM) treatment. However, it is important to know the effects and specificities of the different types of exercise: muscle stretching and resistance training. To verify and compare the effectiveness of muscle stretching exercise and resistance training for symptoms and quality of life in FM patients. Randomized controlled trial. Physical therapy service, FM outpatient clinic. Forty-four women with FM (79 screened). Patients were randomly allocated into a stretching group (n=14), resistance group (n=16), and control group (n=14). Pain was assessed using the visual analog scale, pain threshold using a Fischer dolorimeter, FM symptoms using the Fibromyalgia Impact Questionnaire (FIQ), and quality of life using the Medical Outcomes Study 36-item Short- Form Health Survey (SF-36). The three intervention groups continued with usual medical treatment. In addition, the stretching and resistance groups performed two different exercise programs twice a week for 12 weeks. After treatment, the stretching group showed the highest SF-36 physical functioning score (p=0.01) and the lowest bodily pain score (p=0.01). The resistance group had the lowest FIQ depression score (p=0.02). The control group had the highest score for FIQ morning tiredness and stiffness, and the lowest score for SF-36 vitality. In clinical analyses, the stretching group had significant improvement in quality of life for all SF-36 domains, and the resistance group had significant improvement in FM symptoms and in quality of life for SF-36 domains of physical functioning, vitality, social function, emotional role, and mental health. Muscle stretching exercise was the most effective modality in improving quality of life, especially with regard to physical functioning and pain, and resistance training was the most effective modality in reducing depression. The trial included a control group and two intervention groups, both of which received exercise programs created specifically for patients with FM. In clinical practice, we suggest including both of these modalities in an exercise therapy program for FM.

Early family-based intervention in the path to alcohol problems: rationale and relationship between treatment process characteristics and child and parenting outcomes.

PubMed

Nye, C L; Zucker, R A; Fitzgerald, H E

1999-03-01

Risk for subsequent development of alcohol problems is not uniform across the population of alcoholic families, but varies with parental comorbidity and family history. Recent studies have also identified disruptive child behavior problems in the preschool years as predictive of alcoholism in adulthood. Given the quality of risk structure in highest risk families, prevention programming is more appropriately family based rather than individual. A family-based intervention program for the prevention of conduct problems among preschool-age sons of alcoholic fathers was implemented to change this potential mediating risk structure. A population-based recruitment strategy enrolled 52 alcoholic families in a 10-month intervention involving parent training and marital problem solving. The study examined the interplay between parent treatment investment and parent and therapist expectations and satisfaction in predicting change in child behavior and authoritative parenting style during the program, and for 6 months afterward among the 29 families whose sustained involvement allowed these effects to be evaluated. Parent expectations at pretreatment influenced their early investment in the program, which in turn predicted child and parenting outcomes. Parent and therapist satisfaction ratings during treatment were associated with one another and with expectations that the program would continue to promote changes in their child. Parent investment was a particularly salient influence on outcome, as higher investment throughout the program was associated with improvement in child behavior and authoritative parenting at termination. Findings indicate that treatment process characteristics mediate the influence of baseline parent functioning on treatment success and that treatment changes themselves predict later child outcomes.

Long-term effect of the self-management comprehensive coping strategy program on quality of life in patients with breast cancer treated with high-dose chemotherapy.

PubMed

Gaston-Johansson, Fannie; Fall-Dickson, Jane M; Nanda, Joy P; Sarenmalm, Elisabeth Kenne; Browall, Maria; Goldstein, Nancy

2013-03-01

This study aims to examine the effectiveness of a self-management multimodal comprehensive coping strategy program (CCSP) on quality of life (QOL) among breast cancer patients 1 year after treatment. Patients (n = 110) with stage II, III, or IV breast cancer scheduled to receive high dose chemotherapy and autologous hematopoietic stem cell transplantation were randomized to either CCSP treatment or control group. The CCSP intervention was taught 2 week before hospital admission with reinforcement at specified times during treatment and 3 months after discharge. The CCSP components included educational information, cognitive restructuring, coping skills enhancement, and relaxation with guided imagery. Instruments administered at baseline included the following: Quality of Life Index-Cancer Version (QOLI-CV), State-Trait Anxiety Inventory, Beck Depression Inventory, and Coping Strategies Questionnaire. At 1-year follow-up, patients (n = 73) completed and returned the follow-up QOLI-CV. Patients were mainly ≥ 40 years of age, married, Caucasian, and diagnosed with advanced breast cancer. A model measuring effectiveness of CCSP on QOL (total and subscale) at 1-year follow-up showed that the CCSP group (n = 38) had significant improvement in overall QOL (p < 0.01), health and functioning (p < 0.05), and socioeconomic (p < 0.05) and psychological/spiritual well-being (p < 0.01) compared with the control group (n = 35). The CCSP patients frequently used the CCSP to manage psychological (51%) and sleep problems (60%). The CCSP improved QOL for patients at 1-year follow-up. Patients overwhelmingly reported that CCSP was beneficial. The CCSP as an effective coping intervention has potential as a self-management program for breast cancer survivors. Copyright © 2012 John Wiley & Sons, Ltd.

Cost-effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: design of a cluster-randomized controlled trial.

PubMed

van Dijk, Susan E M; Pols, Alide D; Adriaanse, Marcel C; Bosmans, Judith E; Elders, Petra J M; van Marwijk, Harm W J; van Tulder, Maurits W

2013-05-07

Co-morbid major depression is a significant problem among patients with type 2 diabetes mellitus and/or coronary heart disease and this negatively impacts quality of life. Subthreshold depression is the most important risk factor for the development of major depression. Given the highly significant association between depression and adverse health outcomes and the limited capacity for depression treatment in primary care, there is an urgent need for interventions that successfully prevent the transition from subthreshold depression into a major depressive disorder. Nurse led stepped-care is a promising way to accomplish this. The aim of this study is to evaluate the cost-effectiveness of a nurse-led indicated stepped-care program to prevent major depression among patients with type 2 diabetes mellitus and/or coronary heart disease in primary care who also have subthreshold depressive symptoms. An economic evaluation will be conducted alongside a cluster-randomized controlled trial in approximately thirty general practices in the Netherlands. Randomization takes place at the level of participating practice nurses. We aim to include 236 participants who will either receive a nurse-led indicated stepped-care program for depressive symptoms or care as usual. The stepped-care program consists of four sequential but flexible treatment steps: 1) watchful waiting, 2) guided self-help treatment, 3) problem solving treatment and 4) referral to the general practitioner. The primary clinical outcome measure is the cumulative incidence of major depressive disorder as measured with the Mini International Neuropsychiatric Interview. Secondary outcomes include severity of depressive symptoms, quality of life, anxiety and physical outcomes. Costs will be measured from a societal perspective and include health care utilization, medication and lost productivity costs. Measurements will be performed at baseline and 3, 6, 9 and 12 months. The intervention being investigated is expected to prevent new cases of depression among people with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression, with subsequent beneficial effects on quality of life, clinical outcomes and health care costs. When proven cost-effective, the program provides a viable treatment option in the Dutch primary care system. Dutch Trial Register NTR3715.

Relations of changes in wastewater-treatment practices to changes in stream-water quality during 1978-88 in the Chicago area, Illinois, and implications for regional and national water-quality assessments

USGS Publications Warehouse

Terrio, P.J.

1994-01-01

A study in the upper Illinois River Basin defined relations between changes in wastewater-treatment practices and changes in stream-water quality on the basis of available information. These relations were examined for five large wastewater-treatment plants in the Chicago area, Illinois. At the three largest treatment plants, two major changes in wastewater-treatment practices were identified--the cessation of chlorination and the implementation of Chicago's Tunnel and Reservoir Plan (TARP). Other changes, such as improved aeration and expansion of the facilities, also were made at some of the treatment plants. At the Calumet Water Reclamation Plant, median densities of fecal coliform bacteria in the effluent increased from 3,100 to 1,200,000 colonies per 100 milliliters after the cessation of chlorination. Median densities at the nearest downstream monitoring site increased from 9,500 to 250,000 colonies per 100 milliliters. Similar changes in bacteria densities were indicated for other treatment plants and stream-monitoring sites, but increases in densities of fecal coliform bacteria were not indicated at distances greater than 7 miles downstream. Substantial changes in effluent and stream-water quality, primarily improvements, were identified after the implemen- of TARP and improvements in aeration. Decreases in some of the largest concentrations of ammonia were particularly notable and were likely results of the cape and treatment of combined sewer overflows by TARP. Improvements in water quality were commonly related to climatic season, with greater changes taking place during warm periods. Substantial decreases in concentrations were identified for many constituents, including oxygen demand, ammonia, bacteria, and cyanide. The water-quality data available for this study were considered to be more accurate and were more comprehensive than data from most other monitoring programs. The results of this study, however, identified some needed enhancements to increase the usefulness of the data for additional purposes and analyses.

Water-quality conditions and an evaluation of ground- and surface-water sampling programs in the Livermore-Amador Valley, California

USGS Publications Warehouse

Sorenson, S.K.; Cascos, P.V.; Glass, R.L.

1984-01-01

A program to monitor the ground- and surface water quality in the Livermore-Amador Valley has been operated since 1976. As of 1982, this monitoring network consisted of approximately 130 wells, about 100 of which were constructed specifically for this program, and 9 surface water stations. Increased demand on the groundwater for municipal and industrial water supply in the past has caused a decline in water levels and a gradual buildup of salts from natural surface-water recharge and land disposal of treated wastewater from waste treatment plants. Results of this study identify the salt buildup to be the major problem with the groundwater quality. Established water quality objectives for dissolved solids are exceeded in 52 of 130 wells. Concentrations of dissolved nitrate are also in excess of basin objectives and health standards. Water quality in both surface and groundwater is highly variable areally. Magnesium to calcium magnesium bicarbonate groundwater are found in the areas where most of the high volume municipal wells are located. Large areas of sodium bicarbonate water occur in the northern part of the valley. Except for two stations on Arroyo Las Positas which has sodium chloride water, surface water is mixed-cation bicarbonate water. (USGS)

Development of the hepatitis C self-management program.

PubMed

Groessl, Erik J; Weingart, Kimberly R; Gifford, Allen L; Asch, Steven M; Ho, Samuel B

2011-05-01

Chronic hepatitis C infection (HCV) is a major health problem that disproportionately affects people with limited resources. Many people with HCV are ineligible or refuse antiviral treatment, but less curative treatment options exist. These options include adhering to follow-up health visits, lifestyle changes, and avoiding hepatotoxins like alcohol. Herein, we describe a recently developed self-management program designed to assist HCV-infected patients with adherence and improve their health-related quality of life (HRQOL). The development of the Hepatitis C Self-Management Program (HCV-SMP) was informed by scientific literature, qualitative interviews with HCV-infected patients, self-management training, and feedback from HCV clinical experts. The Hepatitis C Self-Management Program (HCV-SMP) is a multi-faceted program that employs cognitive-behavioral principles and is designed to provide HCV-infected people with knowledge and skills for improving their HRQOL. The program consists of six 2-h workshop sessions which are held weekly. The sessions consist of a variety of group activities, including disease-specific information dissemination, action planning, and problem-solving. The intervention teaches skills for adhering to challenging treatment recommendations using a validated theoretical model. A randomized trial will test the efficacy of this novel HCV self-management program for improving HRQOL in a difficult to reach population. Published by Elsevier Ireland Ltd.

Improvement in Quality of Life Questionnaire Measures (PCOSQ) in Obese Adolescent Females with PCOS treated with Lifestyle Changes and Oral Contraceptives, with or without Metformin

PubMed Central

Harris-Glocker, Miranda; Davidson, Kristin; Kochman, Lynda; Guzick, David; Hoeger, Kathleen

2013-01-01

We studied the effect of metformin or placebo in a lifestyle modification program (LSM) combined with oral contraceptives (OC) on quality of life parameters measured by the PCOS questionnaire (PCOSQ) in obese adolescent women with validated PCOS. The quality of life indicators were measured at baseline and conclusion for 5 domains on the PCOSQ, with equal improvement in scores in both placebo and Metformin groups, suggesting metformin addition does not add improvement to quality of life measures above those observed with lifestyle modification and oral contraceptive treatment. PMID:19781696

The cost-effectiveness of rapid HIV testing in substance abuse treatment: results of a randomized trial.

PubMed

Schackman, Bruce R; Metsch, Lisa R; Colfax, Grant N; Leff, Jared A; Wong, Angela; Scott, Callie A; Feaster, Daniel J; Gooden, Lauren; Matheson, Tim; Haynes, Louise F; Paltiel, A David; Walensky, Rochelle P

2013-02-01

The President's National HIV/AIDS Strategy calls for coupling HIV screening and prevention services with substance abuse treatment programs. Fewer than half of US community-based substance abuse treatment programs make HIV testing available on-site or through referral. We measured the cost-effectiveness of three HIV testing strategies evaluated in a randomized trial conducted in 12 community-based substance abuse treatment programs in 2009: off-site testing referral, on-site rapid testing with information only, on-site rapid testing with risk-reduction counseling. Data from the trial included patient demographics, prior testing history, test acceptance and receipt of results, undiagnosed HIV prevalence (0.4%) and program costs. The Cost-Effectiveness of Preventing AIDS Complications (CEPAC) computer simulation model was used to project life expectancy, lifetime costs, and quality-adjusted life years (QALYs) for HIV-infected individuals. Incremental cost-effectiveness ratios (2009 US $/QALY) were calculated after adding costs of testing HIV-uninfected individuals; costs and QALYs were discounted at 3% annually. Referral for off-site testing is less efficient (dominated) compared to offering on-site testing with information only. The cost-effectiveness ratio for on-site testing with information is $60,300/QALY in the base case, or $76,300/QALY with 0.1% undiagnosed HIV prevalence. HIV risk-reduction counseling costs $36 per person more without additional benefit. A strategy of on-site rapid HIV testing offer with information only in substance abuse treatment programs increases life expectancy at a cost-effectiveness ratio <$100,000/QALY. Policymakers and substance abuse treatment leaders should seek funding to implement on-site rapid HIV testing in substance abuse treatment programs for those not recently tested. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The Cost-effectiveness of Rapid HIV Testing in Substance Abuse Treatment: Results of a Randomized Trial*

PubMed Central

Schackman, Bruce R.; Metsch, Lisa R.; Colfax, Grant N.; Leff, Jared A.; Wong, Angela; Scott, Callie A.; Feaster, Daniel J.; Gooden, Lauren; Matheson, Tim; Haynes, Louise F.; Paltiel, A. David; Walensky, Rochelle P.

2012-01-01

BACKGROUND The President’s National HIV/AIDS Strategy calls for coupling HIV screening and prevention services with substance abuse treatment programs. Fewer than half of US community-based substance abuse treatment programs make HIV testing available on-site or through referral. METHODS We measured the cost-effectiveness of three HIV testing strategies evaluated in a randomized trial conducted in 12 community-based substance abuse treatment programs in 2009: off-site testing referral, on-site rapid testing with information only, on-site rapid testing with risk reduction counseling. Data from the trial included patient demographics, prior testing history, test acceptance and receipt of results, undiagnosed HIV prevalence (0.4%) and program costs. The Cost Effectiveness of Preventing AIDS Complications (CEPAC) computer simulation model was used to project life expectancy, lifetime costs, and quality-adjusted life years (QALYs) for HIV-infected individuals. Incremental cost-effectiveness ratios (2009 US $/QALY) were calculated after adding costs of testing HIV-uninfected individuals; costs and QALYs were discounted at 3% annually. RESULTS Referral for off-site testing is less efficient (dominated) compared to offering on-site testing with information only. The cost-effectiveness ratio for on-site testing with information is $60,300/QALY in the base case, or $76,300/QALY with 0.1% undiagnosed HIV prevalence. HIV risk-reduction counseling costs $36 per person more without additional benefit. CONCLUSIONS A strategy of on-site rapid HIV testing offer with information only in substance abuse treatment programs increases life expectancy at a cost-effectiveness ratio <$100,000/QALY. Policymakers and substance abuse treatment leaders should seek funding to implement on-site rapid HIV testing in substance abuse treatment programs for those not recently tested. PMID:22971593

Safety climate and workplace violence prevention in state-run residential addiction treatment centers.

PubMed

Lipscomb, Jane A; London, M; Chen, Y M; Flannery, K; Watt, M; Geiger-Brown, J; Johnson, J V; McPhaul, K

2012-01-01

To examine the association between violence prevention safety climate measures and self reported violence toward staff in state-run residential addiction treatment centers. In mid-2006, 409 staff from an Eastern United States state agency that oversees a system of thirteen residential addiction treatment centers (ATCs) completed a self-administered survey as part of a comprehensive risk assessment. The survey was undertaken to identify and measure facility-level risk factors for violence, including staff perceptions of the quality of existing US Occupational Safety and Health Administration (OSHA) program elements, and ultimately to guide violence prevention programming. Key informant interviews and staff focus groups provided researchers with qualitative data with which to understand safety climate and violence prevention efforts within these work settings. The frequency with which staff reported experiencing violent behavior ranged from 37% for "clients raised their voices in a threatening way to you" to 1% for "clients pushed, hit, kicked, or struck you". Findings from the staff survey included the following significant predictors of violence: "client actively resisting program" (OR=2.34, 95% CI=1.35, 4.05), "working with clients for whom the history of violence is unknown" (OR=1.91, 95% CI=1.18, 3.09) and "management commitment to violence prevention" reported as "never/hardly ever" and "seldom or sometimes" (OR=4.30 and OR=2.31 respectively), while controlling for other covariates. We utilized a combination of qualitative and quantitative research methods to begin to describe the risk and potential for violence prevention in this setting. The prevalence of staff physical violence within the agency's treatment facilities was lower than would be predicted. Possible explanations include the voluntary nature of treatment programs; strong policies and consequences for resident behavior and ongoing quality improvement efforts. Quantitative data identified low management commitment to violence prevention as a significant predictor of staff reported violence.

The 12-month effects of structured lifestyle advice and pelvic floor muscle training for pelvic organ prolapse.

PubMed

Due, Ulla; Brostrøm, Søren; Lose, Gunnar

2016-07-01

We evaluated the 12-month effects of adding pelvic floor muscle training to a lifestyle advice program in women with symptomatic pelvic organ prolapse stage II-III and the number of women who had sought further treatment. This study was a 12-month follow up of a randomized controlled trial comparing a structured lifestyle advice program alone (lifestyle group) or in combination with pelvic floor muscle training (training and lifestyle group). Both programs consisted of six separate group sessions within 12 weeks. Data were available from 83 (76%) of the 109 originally included women. At the 12-month follow up, 34/83 (41%) had not sought further treatment, 13/43 (30%) in the lifestyle group and 21/40 (52%) in the training and lifestyle group, and these could be included for analysis. The lifestyle group had significantly improved bladder symptoms compared with baseline on single-item analysis (p = 0.01). The training and lifestyle group had significantly improved pelvic organ prolapse symptoms on single-item analysis (p = 0.02) and of bowel-related quality of life (p = 0.04). No significant between-group differences were found in the symptom and quality of life scores. All together 49 women (59%) had sought further treatment, 70% in the lifestyle group, and 48% in the training and lifestyle group (p = 0.05). Twenty-six in the lifestyle group, and 15 in the training and lifestyle group had sought conservative treatment. Four women in each group had received surgery. More severe anterior prolapse and more bladder symptoms at the 3-month follow up were significantly associated with having sought further treatment in both groups. At 12-month follow up, the effects of adding pelvic floor muscle training to a structured lifestyle advice program were limited. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

A study to establish reasonable action limits for patient-specific quality assurance in intensity-modulated radiation therapy.

PubMed

Both, Stefan; Alecu, Ionut M; Stan, Andrada R; Alecu, Marius; Ciura, Andrei; Hansen, Jeremy M; Alecu, Rodica

2007-03-07

An effective patient quality assurance (QA) program for intensity-modulated radiation therapy (IMRT) requires accurate and realistic plan acceptance criteria--that is, action limits. Based on dose measurements performed with a commercially available two-dimensional (2D) diode array, we analyzed 747 fluence maps resulting from a routine patient QA program for IMRT plans. The fluence maps were calculated by three different commercially available (ADAC, CMS, Eclipse) treatment planning systems (TPSs) and were delivered using 6-MV X-ray beams produced by linear accelerators. To establish reasonably achievable and clinically acceptable limits for the dose deviations, the agreement between the measured and calculated fluence maps was evaluated in terms of percent dose error (PDE) for a few points and percent of passing points (PPP) for the isodose distribution. The analysis was conducted for each TPS used in the study (365 ADAC, 162 CMS,220 Eclipse), for multiple treatment sites (prostate, pelvis, head and neck, spine, rectum, anus, lung, brain), at the normalization point for 3% percentage difference (%Diff) and 3-mm distance to agreement (DTA) criteria. We investigated the treatment-site dependency of PPP and PDE. The results show that, at 3% and 3-mm criteria, a 95% PPP and 3% PDE can be achieved for prostate treatments and a 90% PPP and 5% PDE are attainable for any treatment site.

Quality Measures for Hospice and Palliative Care: Piloting the PEACE Measures

PubMed Central

Rokoske, Franziska S.; Durham, Danielle; Cagle, John G.; Hanson, Laura C.

2014-01-01

Abstract Background: The Carolinas Center for Medical Excellence launched the PEACE project in 2006, under contract with the Centers for Medicare & Medicaid Services (CMS), to identify, develop, and pilot test quality measures for hospice and palliative care programs. Objectives: The project collected pilot data to test the usability and feasibility of potential quality measures and data collection processes for hospice and palliative care programs. Settings/subjects: Twenty-two hospices participating in a national Quality Improvement Collaborative (QIC) submitted data from 367 chart reviews for pain care and 45 chart reviews for nausea care. Fourteen additional hospices completed a one-time data submission of 126 chart reviews on 60 potential patient-level quality measures across eight domains of care and an organizational assessment evaluating structure and processes of care. Design: Usability was assessed by examining the range, variability and size of the populations targeted by each quality measure. Feasibility was assessed during the second pilot study by surveying data abstractors about the abstraction process and examining the rates of missing data. The impact of data collection processes was assessed by comparing results obtained using different processes. Results: Measures shown to be both usable and feasible included: screening for physical symptoms on admission and documentation of treatment preferences. Methods of data collection and measure construction appear to influence observed rates of quality of care. Conclusions: We successfully identified quality measures with potential for use in hospices and palliative care programs. Future research is needed to understand whether these measures are sensitive to quality improvement interventions. PMID:24921162

What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears.

PubMed

Boorman, Richard S; More, Kristie D; Hollinshead, Robert M; Wiley, James P; Mohtadi, Nicholas G; Lo, Ian K Y; Brett, Kelly R

2018-03-01

The purpose of this study was to examine 5-year outcomes in a prospective cohort of patients previously enrolled in a nonoperative rotator cuff tear treatment program. Patients with chronic (>3 months), full-thickness rotator cuff tears (demonstrated on imaging) who were referred to 1 of 2 senior shoulder surgeons were enrolled in the study between October 2008 and September 2010. They participated in a comprehensive, nonoperative, home-based treatment program. After 3 months, the outcome in these patients was defined as "successful" or "failed." Patients in the successful group were essentially asymptomatic and did not require surgery. Patients in the failed group were symptomatic and consented to undergo surgical repair. All patients were followed up at 1 year, 2 years, and 5 or more years. At 5 or more years, all patients were contacted for follow-up; the response rate was 84%. Approximately 75% of patients remained successfully treated with nonoperative treatment at 5 years and reported a mean rotator cuff quality-of-life index score of 83 of 100 (SD, 16). Furthermore, between 2 and 5 years, only 3 patients who had previously been defined as having a successful outcome became more symptomatic and underwent surgical rotator cuff repair. Those in whom nonoperative treatment had failed and who underwent surgical repair had a mean rotator cuff quality-of-life index score of 89 (SD, 11) at 5-year follow-up. The operative and nonoperative groups at 5-year follow-up were not significantly different (P = .11). Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Radiation oncology and medical physicists quality assurance in British Columbia Cancer Agency Provincial Prostate Brachytherapy Program.

PubMed

Keyes, Mira; Morris, William James; Spadinger, Ingrid; Araujo, Cynthia; Cheung, Arthur; Chng, Nick; Crook, Juanita; Halperin, Ross; Lapointe, Vince; Miller, Stacy; Pai, Howard; Pickles, Tom

2013-01-01

To describe in detail British Columbia (BC) Cancer Agency (BCCA) Provincial Prostate Brachytherapy (PB) Quality Assurance (QA) Program. The BCCA PB Program was established in 1997. It operates as one system, unified and supported by electronic and information systems, making it a single PB treatment provider for province of BC and Yukon. To date, >4000 patients have received PB (450 implants in 2011), making it the largest program in Canada. The Program maintains a large provincial prospective electronic database with records on all patients, including disease characteristics, risk stratification, pathology, preplan and postimplant dosimetric data, follow-up of prostate-specific antigen, and toxicity outcomes. QA was an integral part of the program since its inception. A formal QA Program was established in 2002, with key components that include: unified eligibility criteria and planning system, comprehensive database, physics and oncologist training and mentorship programs, peer review process, individual performance outcomes and feedback process, structured continuing education and routine assessment of the program's dosimetry, toxicity and prostate-specific antigen outcomes, administration and program leadership that promotes a strong culture of patient safety. The emphasis on creating a robust, broad-based network of skilled providers has been achieved by the program's requirements for training, education, and the QA process. The formal QA process is considered a key factor for the success of cancer control outcomes achieved at BCCA. Although this QA model may not be wholly transferable to all PB programs, some of its key components may be applicable to other programs to ensure quality in PB and patient safety. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

Enhancing Pediatricians' Behavioral Health Competencies Through Child Psychiatry Consultation and Education.

PubMed

Walter, Heather J; Kackloudis, Gina; Trudell, Emily K; Vernacchio, Louis; Bromberg, Jonas; DeMaso, David R; Focht, Glenn

2018-07-01

The objective of this study was to assess feasibility, utilization, perceived value, and targeted behavioral health (BH) treatment self-efficacy associated with a collaborative child and adolescent psychiatry (CAP) consultation and BH education program for pediatric primary care practitioners (PCPs). Eighty-one PCPs from 41 member practices of a statewide pediatric practice association affiliated with an academic medical center participated in a program comprising on-demand telephonic CAP consultation supported by an extensive BH learning community. Findings after 2 years of implementation suggest that the program was feasible for large-scale implementation, was highly utilized and valued by PCPs, and was attributed by PCPs with enhancing their BH treatment self-efficacy and the quality of their BH care. After participation in the program, nearly all PCPs believed that mild to moderate presentations of common BH problems can be effectively managed in the primary care setting, and PCP consultation utilization was congruent with that belief.

The quest to standardize hemodialysis care.

PubMed

Hegbrant, Jörgen; Gentile, Giorgio; Strippoli, Giovanni F M

2011-01-01

A large global dialysis provider's core activities include providing dialysis care with excellent quality, ensuring a low variability across the clinic network and ensuring strong focus on patient safety. In this article, we summarize the pertinent components of the quality assurance and safety program of the Diaverum Renal Services Group. Concerning medical performance, the key components of a successful quality program are setting treatment targets; implementing evidence-based guidelines and clinical protocols; consistently, regularly, prospectively and accurately collecting data from all clinics in the network; processing collected data to provide feedback to clinics in a timely manner, incorporating information on interclinic and intercountry variations; and revising targets, guidelines and clinical protocols based on sound scientific data. The key activities for ensuring patient safety include a standardized approach to education, i.e. a uniform education program including control of theoretical knowledge and clinical competencies; implementation of clinical policies and procedures in the organization in order to reduce variability and potential defects in clinic practice; and auditing of clinical practice on a regular basis. By applying a standardized and systematic continuous quality improvement approach throughout the entire organization, it has been possible for Diaverum to progressively improve medical performance and ensure patient safety. Copyright © 2011 S. Karger AG, Basel.

Temporal performance assessment of wastewater treatment plants by using multivariate statistical analysis.

PubMed

Ebrahimi, Milad; Gerber, Erin L; Rockaway, Thomas D

2017-05-15

For most water treatment plants, a significant number of performance data variables are attained on a time series basis. Due to the interconnectedness of the variables, it is often difficult to assess over-arching trends and quantify operational performance. The objective of this study was to establish simple and reliable predictive models to correlate target variables with specific measured parameters. This study presents a multivariate analysis of the physicochemical parameters of municipal wastewater. Fifteen quality and quantity parameters were analyzed using data recorded from 2010 to 2016. To determine the overall quality condition of raw and treated wastewater, a Wastewater Quality Index (WWQI) was developed. The index summarizes a large amount of measured quality parameters into a single water quality term by considering pre-established quality limitation standards. To identify treatment process performance, the interdependencies between the variables were determined by using Principal Component Analysis (PCA). The five extracted components from the 15 variables accounted for 75.25% of total dataset information and adequately represented the organic, nutrient, oxygen demanding, and ion activity loadings of influent and effluent streams. The study also utilized the model to predict quality parameters such as Biological Oxygen Demand (BOD), Total Phosphorus (TP), and WWQI. High accuracies ranging from 71% to 97% were achieved for fitting the models with the training dataset and relative prediction percentage errors less than 9% were achieved for the testing dataset. The presented techniques and procedures in this paper provide an assessment framework for the wastewater treatment monitoring programs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Ensuring quality: a key consideration in scaling-up HIV-related point-of-care testing programs

PubMed Central

Fonjungo, Peter N.; Osmanov, Saladin; Kuritsky, Joel; Ndihokubwayo, Jean Bosco; Bachanas, Pam; Peeling, Rosanna W.; Timperi, Ralph; Fine, Glenn; Stevens, Wendy; Habiyambere, Vincent; Nkengasong, John N.

2016-01-01

Objective: The objective of the WHO/US President's Emergency Plan for AIDS Relief consultation was to discuss innovative strategies, offer guidance, and develop a comprehensive policy framework for implementing quality-assured HIV-related point-of-care testing (POCT). Methods: The consultation was attended by representatives from international agencies (WHO, UNICEF, UNITAID, Clinton Health Access Initiative), United States Agency for International Development, Centers for Disease Control and Prevention/President's Emergency Plan for AIDS Relief Cooperative Agreement Partners, and experts from more than 25 countries, including policy makers, clinicians, laboratory experts, and program implementers. Main outcomes: There was strong consensus among all participants that ensuring access to quality of POCT represents one of the key challenges for the success of HIV prevention, treatment, and care programs. The following four strategies were recommended: implement a newly proposed concept of a sustainable quality assurance cycle that includes careful planning; definition of goals and targets; timely implementation; continuous monitoring; improvements and adjustments, where necessary; and a detailed evaluation; the importance of supporting a cadre of workers [e.g. volunteer quality corps (Q-Corps)] with the role to ensure that the quality assurance cycle is followed and sustained; implementation of the new strategy should be seen as a step-wise process, supported by development of appropriate policies and tools; and joint partnership under the leadership of the ministries of health to ensure sustainability of implementing novel approaches. Conclusion: The outcomes of this consultation have been well received by program implementers in the field. The recommendations also laid the groundwork for developing key policy and quality documents for the implementation of HIV-related POCT. PMID:26807969

Patient Navigation in Breast Cancer Treatment and Survivorship: A Systematic Review.

PubMed

Baik, Sharon H; Gallo, Linda C; Wells, Kristen J

2016-07-25

Patient navigation is an intervention approach that improves cancer outcomes by reducing barriers and facilitating timely access to cancer care. Little is known about the benefits of patient navigation during breast cancer treatment and survivorship. This systematic review evaluates the efficacy of patient navigation in improving treatment and survivorship outcomes in women with breast cancer. The review included experimental and quasi-experimental studies of patient navigation programs that target breast cancer treatment and breast cancer survivorship. Articles were systematically obtained through electronic database searches of PubMed/MEDLINE, PsycINFO, Web of Science, CINAHL, and Cochrane Library. The Effective Public Health Practice Project Quality Assessment Tool was used to evaluate the methodologic quality of individual studies. Thirteen studies met the inclusion criteria. Most were of moderate to high quality. Outcomes targeted included timeliness of treatment initiation, adherence to cancer treatment, and adherence to post-treatment surveillance mammography. Heterogeneity of outcome assessments precluded a meta-analysis. Overall, results demonstrated that patient navigation increases surveillance mammography rates, but only minimal evidence was found with regard to its effectiveness in improving breast cancer treatment outcomes. This study is the most comprehensive systematic review of patient navigation research focused on improving breast cancer treatment and survivorship. Minimal research has indicated that patient navigation may be effective for post-treatment surveillance; however, more studies are needed to draw definitive conclusions about the efficacy of patient navigation during and after cancer treatment. © 2016 by American Society of Clinical Oncology.

Patient Navigation in Breast Cancer Treatment and Survivorship: A Systematic Review

PubMed Central

Baik, Sharon H.; Gallo, Linda C.

2016-01-01

Purpose Patient navigation is an intervention approach that improves cancer outcomes by reducing barriers and facilitating timely access to cancer care. Little is known about the benefits of patient navigation during breast cancer treatment and survivorship. This systematic review evaluates the efficacy of patient navigation in improving treatment and survivorship outcomes in women with breast cancer. Methods The review included experimental and quasi-experimental studies of patient navigation programs that target breast cancer treatment and breast cancer survivorship. Articles were systematically obtained through electronic database searches of PubMed/MEDLINE, PsycINFO, Web of Science, CINAHL, and Cochrane Library. The Effective Public Health Practice Project Quality Assessment Tool was used to evaluate the methodologic quality of individual studies. Results Thirteen studies met the inclusion criteria. Most were of moderate to high quality. Outcomes targeted included timeliness of treatment initiation, adherence to cancer treatment, and adherence to post-treatment surveillance mammography. Heterogeneity of outcome assessments precluded a meta-analysis. Overall, results demonstrated that patient navigation increases surveillance mammography rates, but only minimal evidence was found with regard to its effectiveness in improving breast cancer treatment outcomes. Conclusion This study is the most comprehensive systematic review of patient navigation research focused on improving breast cancer treatment and survivorship. Minimal research has indicated that patient navigation may be effective for post-treatment surveillance; however, more studies are needed to draw definitive conclusions about the efficacy of patient navigation during and after cancer treatment. PMID:27458298

Assessing the psychosocial needs and program preferences of adolescents and young adults with cancer.

PubMed

Barakat, Lamia P; Galtieri, Liana R; Szalda, Dava; Schwartz, Lisa A

2016-02-01

Adolescents and young adults (AYA) are a developmentally distinct cancer group, vulnerable to psychosocial late effects and with a range of unmet psychosocial needs. We sought to better understand psychosocial care needs and program preferences to inform development of more easily accessible and effective AYA psychosocial programs. AYA on and off treatment for cancer (n = 111, ages 12-25 years) were approached during an outpatient clinic visit and completed a survey as part of a quality improvement initiative. The survey comprised an open-ended question on challenges related to cancer and treatment and closed-ended questions on access to and preference for various services and programs. Qualitative analyses were used to summarize themes for most significant challenges, and descriptive statistics were used for closed-ended questions. Most common themes for challenges included treatments and associated physical changes, barriers to pursuit of academic/vocational goals, and social isolation. For preferred program focus, AYA ranked highest increasing strength and endurance/reintegration into sports and dealing with physical changes resulting from treatment. AYA's preferred modalities for program delivery were one-on-one/in person and message boards/Facebook. Most of the sample indicated that lack of awareness prevented their accessing available programs. New information was identified that can be used to address access barriers and to offer AYA psychosocial programs in formats that might improve interest and accessibility. Ongoing evaluation of AYA psychosocial programs is recommended to determine acceptability, feasibility, and effectiveness to meet the evolving needs of AYA patients with cancer.

A Review of Multidisciplinary Interventions in Atopic Dermatitis

PubMed Central

Spielman, Sara C.; LeBovidge, Jennifer S.; Timmons, Karol G.; Schneider, Lynda C.

2015-01-01

Multidisciplinary interventions have been developed for patients with atopic dermatitis (AD) and their families, with the aim of improving outcomes such as disease control, adherence, and quality of life. We reviewed the content of different multidisciplinary approaches to intervention for AD and evidence for their impact on key outcome measures. We also provided data from our multidisciplinary outpatient program for pediatric AD. Studies included in the review suggest benefits of multidisciplinary interventions as models of treatment or adjuncts to standard medical care, with a positive impact on outcomes including disease severity and itching/scratching. There were limitations to existing studies, including heterogeneous methods used to assess quality of life outcomes across studies and lack of controlled studies assessing the outcome of clinical care programs. Further research will be useful in assessing the impact of multidisciplinary interventions on important outcomes such as treatment adherence and sleep, identifying the elements of multidisciplinary interventions that are most critical for improved outcomes, and identifying the best candidates for multidisciplinary intervention approaches. PMID:26239470

The Role of Leaders’ Working Alliance in Premarital Education

PubMed Central

Owen, Jesse J.; Rhoades, Galena K.; Stanley, Scott M.; Markman, Howard J.

2011-01-01

Premarital (and general relationship) education programs, as a prevention method, have been shown to have a positive effect on marital quality and can prevent divorce. However, it is unclear whether these positive effects are consistent across leaders who conduct premarital education programs. Examining the variability in relationship outcomes attributed to the leaders of premarital education programs, and the role of general therapeutic factors such as working alliance in explaining relationship outcomes, may help increase the effectiveness of these programs. Accordingly, this study examined 31 leaders who trained 118 couples (236 attendees) in a randomized clinical trial of PREP, a research-based and empirically supported premarital education program being compared to a treatment as usual track. The results demonstrated that couples’ relationship outcomes from pre to post training varied based on the leader who provided the premarital education training. Both training in PREP and aggregated leader working alliance quality (as rated by attendees) explained variability between leaders in change in attendees’ observed negative and positive communication. Leaders’ aggregated working alliance quality also explained change in relationship satisfaction. Additionally, attendees’ ratings of their leaders’ working alliance predicted change in their relationship satisfaction and confidence, and attendees had higher positive communication when they reported better working alliance with their leader. PMID:21355646

Physical ExeRcise Following Esophageal Cancer Treatment (PERFECT) study: design of a randomized controlled trial.

PubMed

van Vulpen, Jonna K; Siersema, Peter D; van Hillegersberg, Richard; Nieuwenhuijzen, Grard A P; Kouwenhoven, Ewout A; Groenendijk, Richard P R; van der Peet, Donald L; Hazebroek, Eric J; Rosman, Camiel; Schippers, Carlo C G; Steenhagen, Elles; Peeters, Petra H M; May, Anne M

2017-08-18

Following esophagectomy, esophageal cancer patients experience a clinically relevant deterioration of health-related quality of life, both on the short- and long-term. With the currently growing number of esophageal cancer survivors, the burden of disease- and treatment-related complaints and symptoms becomes more relevant. This emphasizes the need for interventions aimed at improving quality of life. Beneficial effects of post-operative physical exercise have been reported in several cancer types, but so far comparable evidence in esophageal cancer patients is lacking. The aim of this study is to investigate effects of physical exercise on health-related quality of life in esophageal cancer patients following surgery. The Physical ExeRcise Following Esophageal Cancer Treatment (PERFECT) study is a multicenter randomized controlled trial including 150 esophageal cancer patients after surgery with curative intent. Patients are randomly allocated to an exercise group or usual care group. The exercise group participates in a 12-week combined aerobic and resistance exercise program, supervised by a physiotherapist near the patient's home-address. In addition, participants in the exercise group are requested to be physically active for at least 30 min per day, every day of the week. Participants allocated to the usual care group are asked to maintain their habitual physical activity pattern. The primary outcome is health-related quality of life (EORTC-QLQ-C30). Secondary outcomes include esophageal cancer specific quality of life, fatigue, anxiety and depression, sleep quality, work-related factors, cardiorespiratory fitness (VO 2peak ), muscle strength, physical activity, malnutrition risk, anthropometry, blood markers, recurrence of disease and survival. All questionnaire outcomes, diaries and accelerometers are assessed at baseline, post-intervention (12 weeks post-baseline) and 24 weeks post-baseline. Physical fitness, anthropometry and blood markers are assessed at baseline and post-intervention. In addition, adherence and safety are monitored throughout the exercise program. This randomized controlled trial investigates effects of physical exercise versus usual care in esophageal cancer patients after surgery. As the design of the exercise program closely resembles daily practice, this study can contribute both to evidence on effects of exercise in esophageal cancer patients, and to potential implementation strategies. Trial registration:Netherlands Trial Registry NTR5045 Date of trial registration: January 19th, 2015 Date and version study protocol: February 2017, version 1.

The feasibility and acceptability of virtual environments in the treatment of childhood social anxiety disorder.

PubMed

Sarver, Nina Wong; Beidel, Deborah C; Spitalnick, Josh S

2014-01-01

Two significant challenges for the dissemination of social skills training programs are the need to assure generalizability and provide sufficient practice opportunities. In the case of social anxiety disorder, virtual environments may provide one strategy to address these issues. This study evaluated the utility of an interactive virtual school environment for the treatment of social anxiety disorder in preadolescent children. Eleven children with a primary diagnosis of social anxiety disorder between 8 to 12 years old participated in this initial feasibility trial. All children were treated with Social Effectiveness Therapy for Children, an empirically supported treatment for children with social anxiety disorder. However, the in vivo peer generalization sessions and standard parent-assisted homework assignments were substituted by practice in a virtual environment. Overall, the virtual environment programs were acceptable, feasible, and credible treatment components. Both children and clinicians were satisfied with using the virtual environment technology, and children believed it was a high-quality program overall. In addition, parents were satisfied with the virtual environment augmented treatment and indicated that they would recommend the program to family and friends. Findings indicate that the virtual environments are viewed as acceptable and credible by potential recipients. Furthermore, they are easy to implement by even novice users and appear to be useful adjunctive elements for the treatment of childhood social anxiety disorder.

The feasibility and acceptability of virtual environments in the treatment of childhood social anxiety disorder

PubMed Central

Wong, Nina; Beidel, Deborah C.; Spitalnick, Josh

2013-01-01

Objective Two significant challenges for the dissemination of social skills training programs are the need to assure generalizability and provide sufficient practice opportunities. In the case of social anxiety disorder, virtual environments may provide one strategy to address these issues. This study evaluated the utility of an interactive virtual school environment for the treatment of social anxiety disorder in preadolescent children. Method Eleven children with a primary diagnosis of social anxiety disorder between 8 to 12 years old participated in this initial feasibility trial. All children were treated with Social Effectiveness Therapy for Children, an empirically supported treatment for children with social anxiety disorder. However, the in vivo peer generalization sessions and standard parent-assisted homework assignments were substituted by practice in a virtual environment. Results Overall, the virtual environment programs were acceptable, feasible, and credible treatment components. Both children and clinicians were satisfied with using the virtual environment technology, and children believed it was a high quality program overall. Additionally, parents were satisfied with the virtual environment augmented treatment and indicated that they would recommend the program to family and friends. Conclusion Virtual environments are viewed as acceptable and credible by potential recipients. Furthermore, they are easy to implement by even novice users and appear to be useful adjunctive elements for the treatment of childhood social anxiety disorder. PMID:24144182

The assessment and treatment of performance anxiety in musicians.

PubMed

Clark, D B; Agras, W S

1991-05-01

Performance anxiety in musicians may be severe enough to require intervention but has been the subject of relatively little clinical research. The authors' objectives were to describe the results of a comprehensive clinical and laboratory assessment and to perform a double-blind, placebo-controlled study comparing buspirone, cognitive-behavior therapy, and the combination of these treatments for performance anxiety. Ninety-four subjects were recruited by mass media announcements and were seen in a university-based outpatient psychiatric clinic. Assessments were 1) questionnaires for all 94 subjects, 2) diagnostic interview of 50 subjects, and 3) laboratory performance of 34 subjects. Treatment conditions were 1) 6 weeks of buspirone, 2) 6 weeks of placebo, 3) a five-session, group cognitive-behavior therapy program with buspirone, or 4) the cognitive-behavior therapy program with placebo. Treatment outcome measures included subjective anxiety ratings and heart rate measures during a laboratory performance, a questionnaire measure of performance confidence, and a blind rating of musical performance quality. All subjects fulfilled criteria for DSM-III-R social phobia. Of the 15 full-time professional musicians, ten had tried propranolol and three had stopped performing. Most of the subjects had substantial anxiety and heart rate increases during laboratory speech and musical performances. Cognitive-behavior therapy resulted in statistically significant reductions in subjective anxiety, improved quality of musical performance, and improved performance confidence. Buspirone was not an effective treatment. Cognitive-behavior therapy is a viable treatment approach for performance anxiety in musicians.

Clinical pathways for acute coronary syndromes in China: protocol for a hospital quality improvement initiative.

PubMed

Rong, Ye; Turnbull, Fiona; Patel, Anushka; Du, Xin; Wu, Yangfeng; Gao, Runlin

2010-09-01

Clinical pathways have been shown to be effective in improving quality of care for patients admitted to hospital for acute coronary syndromes (ACS) in high-income countries. However, their utility has not formally been evaluated in low- or middle-income countries. The Clinical Pathways for Acute Coronary Syndromes in China program is a 7-year study with the overall goal of reducing evidence-practice gaps in the management of patients admitted to hospitals in China with suspected ACS. The program comprises 2 phases: a prospective survey of current management of ACS patients to identify the areas that evidence-based patient care can be potentially improved, and a quality care initiative to maximize the use of evidence-based investigations and treatments for ACS patients in China. In this article, we outline the details of the study protocol, including key aspects of the development, implementation, and evaluation of the quality improvement initiative (clinical pathway) for management of patients with suspected ACS.

[Quality of life among people addicted to psychoactive substances participating in the opiate substitution treatment].

PubMed

Kotwas, Artur; Karakiewicz, Beata; Sein Anand, Jacek

2014-01-01

Opiate addiction remains a major threat to public health worldwide. It also had a number of negative consequences for the psychosocial and economic functioning of abusers. One of the most common addiction treatment method is maintenance methadone therapy. An important part of evaluating the effectiveness of the participation of a person addicted to methadone treatment is to assess the quality of life determined by participation in substitution therapy. Quality of life of persons addicted to psychoactive substances determined by socio-demographic situation. The study involved 234 outpatient addicts included in the methadone maintenance treatment programs in Szczecin, Warsaw and Lublin. It was based on a diagnostic survey performed using an original questionnaire and the SF-36 v2. In a research of subjective qual- ity of life, respondents obtained results at the level sufficient, higher values were obtained in the domains of physical than mental health. Respondents from Szczecin and Warszawa scored higher, statistically significant, the assessment than patients from Lublin. 1. Variation of respondents quality of life was conditioned by the place of performance of therapy. 2. Respondents had the greatest disparity in the subjective evaluation of physical and mental health. 3. Age was an important factor affecting the marks obtained by the respondents in the SF-36 v2.

Cost-Utility and Cost-Effectiveness Analyses of Face-to-Face Versus Telephone-Based Nonpharmacologic Multidisciplinary Treatments for Patients With Generalized Osteoarthritis.

PubMed

Cuperus, Nienke; van den Hout, Wilbert B; Hoogeboom, Thomas J; van den Hoogen, Frank H J; Vliet Vlieland, Thea P M; van den Ende, Cornelia H M

2016-04-01

To evaluate, from a societal perspective, the cost utility and cost effectiveness of a nonpharmacologic face-to-face treatment program compared with a telephone-based treatment program for patients with generalized osteoarthritis (GOA). An economic evaluation was carried out alongside a randomized clinical trial involving 147 patients with GOA. Program costs were estimated from time registrations. One-year medical and nonmedical costs were estimated using cost questionnaires. Quality-adjusted life years (QALYs) were estimated using the EuroQol (EQ) classification system, EQ rating scale, and the Short Form 6D (SF-6D). Daily function was measured using the Health Assessment Questionnaire (HAQ) disability index (DI). Cost and QALY/effect differences were analyzed using multilevel regression analysis and cost-effectiveness acceptability curves. Medical costs of the face-to-face treatment and telephone-based treatment were estimated at €387 and €252, respectively. The difference in total societal costs was nonsignificantly in favor of the face-to-face program (difference €708; 95% confidence interval [95% CI] -€5,058, €3,642). QALYs were similar for both groups according to the EQ, but were significantly in favor of the face-to-face group, according to the SF-6D (difference 0.022 [95% CI 0.000, 0.045]). Daily function was similar according to the HAQ DI. Since both societal costs and QALYs/effects were in favor of the face-to-face program, the economic assessment favored this program, regardless of society's willingness to pay. There was a 65-90% chance that the face-to-face program had better cost utility and a 60-70% chance of being cost effective. This economic evaluation from a societal perspective showed that a nonpharmacologic, face-to-face treatment program for patients with GOA was likely to be cost effective, relative to a telephone-based program. © 2016, American College of Rheumatology.

The role of leaders' working alliance in premarital education.

PubMed

Owen, Jesse J; Rhoades, Galena K; Stanley, Scott M; Markman, Howard J

2011-02-01

Premarital (and general relationship) education programs, as a prevention method, have been shown to have a positive effect on marital quality and can prevent divorce. However, it is unclear whether these positive effects are consistent across leaders who conduct premarital education programs. Examining the variability in relationship outcomes attributed to the leaders of premarital education programs, and the role of general therapeutic factors such as working alliance in explaining relationship outcomes, may help increase the effectiveness of these programs. Accordingly, this study examined 31 leaders who trained 118 couples (236 attendees) in a randomized clinical trial of the Prevention and Relationship Enhancement Program (PREP), a research-based and empirically supported premarital education program being compared with a treatment as usual track. The results demonstrated that couples' relationship outcomes from pre- to post-training varied on the basis of the leader who provided the premarital education training. Both training in PREP and aggregated leader working alliance quality (as rated by attendees) explained variability between leaders in change in attendees' observed negative and positive communication. Leaders' aggregated working alliance quality also explained change in relationship satisfaction. In addition, attendees' ratings of their leaders' working alliance predicted change in their relationship satisfaction and confidence, and attendees had higher positive communication when they reported better working alliance with their leader. PsycINFO Database Record (c) 2011 APA, all rights reserved.

Analysis of Gap in Service Quality in Drug Addiction Treatment Centers of Kerman, Iran, Using SERVQUAL Model.

PubMed

Naqavi, Mohammad Reza; Refaiee, Raheleh; Baneshi, Mohammad Reza; Nakhaee, Nouzar

2014-01-01

Treatment of drug addicts is one of the main strategies of drug control in Iran. Client satisfaction strongly influences the success of any treatment program. This study aimed to explore the difference between customer expectations and perceptions in drug addiction treatment centers of Kerman, Iran, using SERVQUAL model. Using a cross-sectional design 260 clients referring to drug addiction treatment centers of Kerman, were enrolled in 2012. From among 84 clinics, 20 centers were selected randomly. Based on the number of clients registered in each center, a random sample proportional to the size was selected and 290 subjects were invited for interviews. A well validated 22-item questionnaire, which measured the 5 dimensions of service quality (reliability, assurance, tangibility, empathy, and responsiveness), was completed by participants. Each item measured 2 aspects of service quality; expectations and perceptions. Mean ± SD (Standard deviation) age of the subjects was 37.7 ± 9.4. Most of them were male (87.7%). Less than half of them had an educational level lower than diploma. The total score of clients` expectations was higher than their perceptions (P < 0.001). Considering the 5 dimensions of the SERVQUAL model, only 1 dimension (i.e., assurance) showed no difference between perceptions and expectations of the participants (P = 0.134). There was a gap between the clients' expectations and what they actually perceived in the clinics. Thus, more attention should be devoted to the clients' views regarding service quality in addiction treatment clinics.

Adapting water treatment design and operations to the impacts of global climate change

NASA Astrophysics Data System (ADS)

Clark, Robert M.; Li, Zhiwei; Buchberger, Steven G.

2011-12-01

It is anticipated that global climate change will adversely impact source water quality in many areas of the United States and will therefore, potentially, impact the design and operation of current and future water treatment systems. The USEPA has initiated an effort called the Water Resources Adaptation Program (WRAP) which is intended to develop tools and techniques that can assess the impact of global climate change on urban drinking water and wastewater infrastructure. A three step approach for assessing climate change impacts on water treatment operation and design is being persude in this effort. The first step is the stochastic characterization of source water quality, the second step is the application of the USEPA Water Treatment Plant model and the third step is the application of cost algorithms to provide a metric that can be used to assess the coat impact of climate change. A model has been validated using data collected from Cincinnati's Richard Miller Water Treatment Plant for the USEPA Information Collection Rule (ICR) database. An analysis of the water treatment processes in response to assumed perturbations in raw water quality identified TOC, pH, and bromide as the three most important parameters affecting performance of the Miller WTP. The Miller Plant was simulated using the EPA WTP model to examine the impact of these parameters on selected regulated water quality parameters. Uncertainty in influent water quality was analyzed to estimate the risk of violating drinking water maximum contaminant levels (MCLs).Water quality changes in the Ohio River were projected for 2050 using Monte Carlo simulation and the WTP model was used to evaluate the effects of water quality changes on design and operation. Results indicate that the existing Miller WTP might not meet Safe Drinking Water Act MCL requirements for certain extreme future conditions. However, it was found that the risk of MCL violations under future conditions could be controlled by enhancing existing WTP design and operation or by process retrofitting and modification.

Haemophilia and exercise.

PubMed

Souza, J C; Simoes, H G; Campbell, C S G; Pontes, F L; Boullosa, D A; Prestes, J

2012-02-01

One of the most important objectives of intervention programs for persons with haemophilia (PWH) is to improve their quality of life. Regular physical activity has been recommended as an adjunct to conventional treatment, with positive results in the prevention of joint problems and bleeding, in addition to the improvement in cardiovascular function, muscle strength, and body composition. The objective of the present review was to present the benefits of aerobic and resistance training programs in PWH, as well to discuss the best exercise dose-response in the different levels of disease severity. We considered randomized controlled trials, study cases and literature reviews from MEDLINE and Highwire databases. After a detailed analysis of the studies involving exercise for PWH, it can be concluded that this intervention elicits some benefits for physical fitness and blood coagulation mechanisms, suggesting the application of physical training as a non pharmacological treatment in association with conventional treatment. Adequate and periodized resistance training considering the disease severity, accompanied by physical education professionals could improve muscle strength, balance and proprioception. In addition, aerobic training could reduce the risks of obesity and several metabolic and cardiovascular diseases. Exercise can improve several outcomes of quality in PWH. © Georg Thieme Verlag KG Stuttgart · New York.

An online intervention for reducing depressive symptoms: secondary benefits for self-esteem, empowerment and quality of life.

PubMed

Crisp, Dimity; Griffiths, Kathleen; Mackinnon, Andrew; Bennett, Kylie; Christensen, Helen

2014-04-30

Internet-based interventions are increasingly recognized as effective for the treatment and prevention of depression; however, there is a paucity of research investigating potential secondary benefits. From a consumer perspective, improvements in indicators of wellbeing such as perceived quality of life may represent the most important outcomes for evaluating the effectiveness of an intervention. This study investigated the 'secondary' benefits for self-esteem, empowerment, quality of life and perceived social support of two 12-week online depression interventions when delivered alone and in combination. Participants comprised 298 adults displaying elevated psychological distress. Participants were randomised to receive: an Internet Support Group (ISG); an automated Internet psycho-educational training program for depression; a combination of these conditions; or a control website. Analyses were performed on an intent-to-treat basis. Following the automated training program immediate improvements were shown in participants׳ self-esteem and empowerment relative to control participants. Improvements in perceived quality of life were reported 6-months following the completion of the intervention when combined with an ISG. These findings provide initial evidence for the effectiveness of this online intervention for improving individual wellbeing beyond the primary aim of the treatment. However, further research is required to investigate the mechanisms underlying improvement in these secondary outcomes. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

AMDTreat 5.0+ with PHREEQC titration module to compute caustic chemical quantity, effluent quality, and sludge volume

USGS Publications Warehouse

Cravotta, Charles A.; Means, Brent P; Arthur, Willam; McKenzie, Robert M; Parkhurst, David L.

2015-01-01

Alkaline chemicals are commonly added to discharges from coal mines to increase pH and decrease concentrations of acidity and dissolved aluminum, iron, manganese, and associated metals. The annual cost of chemical treatment depends on the type and quantities of chemicals added and sludge produced. The AMDTreat computer program, initially developed in 2003, is widely used to compute such costs on the basis of the user-specified flow rate and water quality data for the untreated AMD. Although AMDTreat can use results of empirical titration of net-acidic or net-alkaline effluent with caustic chemicals to accurately estimate costs for treatment, such empirical data are rarely available. A titration simulation module using the geochemical program PHREEQC has been incorporated with AMDTreat 5.0+ to improve the capability of AMDTreat to estimate: (1) the quantity and cost of caustic chemicals to attain a target pH, (2) the chemical composition of the treated effluent, and (3) the volume of sludge produced by the treatment. The simulated titration results for selected caustic chemicals (NaOH, CaO, Ca(OH)2, Na2CO3, or NH3) without aeration or with pre-aeration can be compared with or used in place of empirical titration data to estimate chemical quantities, treated effluent composition, sludge volume (precipitated metals plus unreacted chemical), and associated treatment costs. This paper describes the development, evaluation, and potential utilization of the PHREEQC titration module with the new AMDTreat 5.0+ computer program available at http://www.amd.osmre.gov/.

Pioneering the psychiatric nurse role in foster care.

PubMed

Bertram, Julie E; Narendorf, Sarah Carter; McMillen, J Curtis

2013-12-01

Older youth served in the foster care system have elevated rates of mental health disorders and are high users of mental health services, yet concerns have been raised about the quality of this care. This paper describes the details of a psychiatric nurse's work within a multidisciplinary team to address gaps in care for older youth with psychiatric disorders. We describe the process, outcomes, and lessons learned in developing and piloting a psychiatric nurse intervention for older youth in the foster care system as part of a multidimensional treatment foster care program. Our experiences support further work to develop a role for nursing to improve the quality of mental health treatment in foster care. © 2013.

Pioneering the Psychiatric Nurse Role in Foster Care (*)

PubMed Central

Bertram, Julie E.; Narendorf, Sarah Carter; McMillen, J. Curtis

2013-01-01

Older youth served in the foster care system have elevated rates of mental health disorders and are high users of mental health services, yet concerns have been raised about the quality of this care. This paper describes the details of a psychiatric nurse’s work within a multidisciplinary team to address gaps in care for older youth with psychiatric disorders. We describe the process, outcomes, and lessons learned in developing and piloting a psychiatric nurse intervention for older youth in the foster care system as part of a multidimensional treatment foster care program. Our experiences support further work to develop a role for nursing to improve the quality of mental health treatment in foster care. PMID:24238008

Use of the evidence base in substance abuse treatment programs for American Indians and Alaska Natives: pursuing quality in the crucible of practice and policy.

PubMed

Novins, Douglas K; Aarons, Gregory A; Conti, Sarah G; Dahlke, Dennis; Daw, Raymond; Fickenscher, Alexandra; Fleming, Candace; Love, Craig; Masis, Kathleen; Spicer, Paul

2011-06-16

A variety of forces are now shaping a passionate debate regarding the optimal approaches to improving the quality of substance abuse services for American Indian and Alaska Native communities. While there have been some highly successful efforts to meld the traditions of American Indian and Alaska Native tribes with that of 12-step approaches, some American Indian and Alaska Natives remain profoundly uncomfortable with the dominance of this Euro-American approach to substance abuse treatment in their communities. This longstanding tension has now been complicated by the emergence of a number of evidence-based treatments that, while holding promise for improving treatment for American Indian and Alaska Natives with substance use problems, may conflict with both American Indian and Alaska Native and 12-step healing traditions. We convened a panel of experts from American Indian and Alaska Native communities, substance abuse treatment programs serving these communities, and researchers to discuss and analyze these controversies in preparation for a national study of American Indian and Alaska Native substance abuse services. While the panel identified programs that are using evidence-based treatments, members still voiced concerns about the cultural appropriateness of many evidence-based treatments as well as the lack of guidance on how to adapt them for use with American Indians and Alaska Natives. The panel concluded that the efforts of federal and state policymakers to promote the use of evidence-based treatments are further complicating an already-contentious debate within American Indian and Alaska Native communities on how to provide effective substance abuse services. This external pressure to utilize evidence-based treatments is particularly problematic given American Indian and Alaska Native communities' concerns about protecting their sovereign status. Broadening this conversation beyond its primary focus on the use of evidence-based treatments to other salient issues such as building the necessary research evidence (including incorporating American Indian and Alaska Native cultural values into clinical practice) and developing the human and infrastructural resources to support the use of this evidence may be far more effective for advancing efforts to improve substance abuse services for American Indian and Alaska Native communities.

Providing Effective Speech-Language Pathology Group Treatment in the Comprehensive Inpatient Rehabilitation Setting.

PubMed

Baron, Christine; Holcombe, Molly; van der Stelt, Candace

2018-02-01

Group treatment is an integral part of speech-language pathology (SLP) practice. The majority of SLP literature concerns group treatment provided in outpatient settings. This article describes the goals, procedures, and benefits of providing quality SLP group therapy in the comprehensive inpatient rehabilitation (CIR) setting. Effective CIR groups must be designed with attention to type and severity of communication impairment, as well physical stamina of group members. Group leaders need to target individualized patient goals while creating a challenging, complex, and dynamic group context that supports participation by all group members. Direct patient-to-patient interaction is fostered as much as possible. Peer feedback supports goal acquisition by fellow group members. The rich, complex group context fosters improved insight, initiation, social connectedness, and generalization of communication skills. Group treatment provides a unique type of treatment not easily replicated with individual treatment. SLP group treatment in a CIR is an essential component of an intensive, high-quality program. Continued advocacy for group therapy provision and research into its efficacy and effectiveness are warranted. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[Laparoscopic "fast-track" sigmoidectomy for diverticulitis disease in Germany. Results of a prospective quality assurance program].

PubMed

Tsilimparis, N; Haase, O; Wendling, P; Kipfmüller, K; Schmid, M; Engemann, R; Schwenk, W

2010-09-01

The natural course of sigmoid colon diverticulitis during conservative therapy and the assessment of the perioperative morbidity after sigmoid colon resection are differently evaluated by surgeons and gastroenterologists. The "fast-track" rehabilitation accelerates the reconvalescence and reduces the rate of postoperative general complications after colorectal surgery. The results of the laparoscopic "Fast-track" sigmoidectomy should be examined within a quality assurance program to better evaluate the perioperative risks following surgical management of diverticulitis. A prospective data collection within the voluntary quality assurance program "fast-track" Kolon II was performed. All participating clinics agreed on a multimodal, evidence-based standard perioperative treatment in terms of a "fast-track" rehabilitation for elective operations for sigmoid diverticulitis. Data from 846 patients undergoing laparoscopic "fast-track" sigmoid colon resection in 23 surgical departments in Germany were collected and evaluated. The mean age of the patients was 63 years (range 23 - 91). 203 patients (24 %) had severe co-morbidities (ASA classification III - IV). A conversion to conventional open surgery was necessary in 51 cases (6 %). Complications occurred in 93 patients (11 %). 76 patients suffered a surgical complication (8.9 %) and 32 patients (3.8 %) a general complication. Two patients died postoperatively due to multi-organ failure following anastomotic leaks. The patients took solid food in median on day 1 after surgery (range, 0 - 5) and passed stool on day 2 (range, 0 - 22). Predefined discharge criteria (free of pain on oral medication, normal oral feeding, stool) were met on day 4 (range, 1 - 58) and the patients were discharged on day 7 (range, 3 - 72). The 30-day re-admission rate was 3.9 %. Patients undergoing laparoscopic "fast-track" sigmoidectomy had a low rate of general complications and had a rapid reconvalescence with a short postoperative in-patient treatment as documented in a german quality assurance program. Copyright Georg Thieme Verlag KG Stuttgart . New York.

[Organized breast cancer screening].

PubMed

Rouëssé, Jacques; Sancho-Garnier, Hélèn

2014-02-01

Breast screening programs are increasingly controversial, especially regarding two points: the number of breast cancer deaths they avoid, and the problem of over-diagnosis and over-treatment. The French national breast cancer screening program was extended to cover the whole country in 2004. Ten years later it is time to examine the risk/benefit ratio of this program and to discuss the need for change. Like all forms of cancer management, screening must be regularly updated, taking into account the state of the art, new evidence, and uncertainties. All screening providers should keep themselves informed of the latest findings. In the French program, women aged 50-74 with no major individual or familial risk factors for breast cancer are offered screening mammography and clinical breast examination every two years. Images considered non suspicious of malignancy by a first reader are re-examined by a second reader. The devices and procedures are subjected to quality controls. Participating radiologists (both public and private) are required to read at least 500 mammographies per year. The program's national participation rate was 52.7 % in 2012. When individual screening outside of the national program is taken into account (nearly 15 % of women), coverage appears close to the European recommendation of 65 %. Breast cancer mortality has been falling in France by 0.6 % per year for over 30 years, starting before mass screening was implemented, and by 1.5 % since 2005. This decline can be attributed in part to earlier diagnosis and better treatment, so that the specific impact of screening cannot easily be measured. Over-treatment, defined as the detection and treatment of low-malignancy tumors that would otherwise not have been detected in a person's lifetime, is a major negative effect of screening, but its frequency is not precisely known (reported to range from 1 % to 30 %). In view of these uncertainties, it would be advisable to modify the program in order to increase its efficiency, by targeting populations at a higher risk than the women currently included, and to reduce the number of mammograms done outside the program, as they are not subject to the same quality controls. Risks could be reduced by increasing the sensitivity of mammography and the specificity of the readings. Moreover, it is mandatory to inform women of both the benefits and risks of screening, in compliance with the principle of enabling patients to make a free and informed choice.

7 CFR 634.26 - Contract modifications.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.26... thereof, or to accomplish equitable treatment with respect to other conservation, land-use, or water... water-quality plan. A contract may be modified only if it is determined that such modifications are...

7 CFR 634.26 - Contract modifications.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.26... thereof, or to accomplish equitable treatment with respect to other conservation, land-use, or water... water-quality plan. A contract may be modified only if it is determined that such modifications are...

7 CFR 634.26 - Contract modifications.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.26... thereof, or to accomplish equitable treatment with respect to other conservation, land-use, or water... water-quality plan. A contract may be modified only if it is determined that such modifications are...

7 CFR 634.26 - Contract modifications.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., DEPARTMENT OF AGRICULTURE LONG TERM CONTRACTING RURAL CLEAN WATER PROGRAM Participant RCWP Contracts § 634.26... thereof, or to accomplish equitable treatment with respect to other conservation, land-use, or water... water-quality plan. A contract may be modified only if it is determined that such modifications are...

Development and Evaluation of the Sleep Treatment and Education Program for Students (STEPS)

ERIC Educational Resources Information Center

Brown, Franklin C.; Buboltz, Walter C., Jr.; Soper, Barlow

2006-01-01

University students report significantly worse sleep quality than the general population. Sleep problems are related to increased health concerns, irritability, depression, fatigue, and attention and concentration difficulties, along with poor academic performance. Clinical research indicates that psychoeducational interventions are among the most…

EVALUATING TREATMENT TECHNOLOGIES - QA APPROACHES IN THE USA AND GERMANY

EPA Science Inventory

The US EPA and the German Federal Ministry of Education and Research entered into a Bilateral Agreement in 1990 to gain a better understanding of each country's efforts in developing and demonstrating remedial technologies. Under Phase II of the Agreement, SITe Program quality ma...

Perceptions of staff attributes in substance abuse treatment.

PubMed

Grosenick, J K; Hatmaker, C M

2000-10-01

Qualified professional staff contribute significantly to successful health-care service delivery. Organizations view six categories of staff attributes as valued qualities of competent personnel: knowledge and experience, organizational citizenship, interpersonal skills, service orientation, personal attributes, and leadership skills. This study presents the perceptions regarding these and other staff attributes held by female clients and staff from a substance abuse treatment facility. Results indicated that four attributes were perceived as particularly influential in assisting women to reach treatment goals. These included knowledge and experience, supportiveness, nonthreatening behaviors, and availability. Attention to these variables may prove useful as treatment programs strive to improve client outcomes.

Quality of Life in Women with Stage 1 Stress Urinary Incontinence after Application of Conservative Treatment-A Randomized Trial.

PubMed

Ptak, Magdalena; Brodowska, Agnieszka; Ciećwież, Sylwester; Rotter, Iwona

2017-05-30

Stress urinary incontinence (SUI) influences quality of life in female patients. In this study, we used ICIQ LUTS QoL (The International Consultation Incontinence Questionnaire Lower Urinary Tract Symptoms quality of life) to determine the quality of life (QoL) in various domains in patients with stage 1 SUI. The study included 140 perimenopausal women subjected to urodynamic tests at the Department of Gynaecology, Endocrinology and Gynaecologic Oncology, Pomeranian Medical University, Police (Poland) in 2013-2015. The study subjects were divided into two groups, A and B. Each patient completed two questionnaires, an original survey developed by the authors and the validated ICIQ LUTS QoL. Two exercise programs, each lasting for 3 months and consisting of 4 weekly sessions, were recommended to the study subjects. The program for Group A included exercises for pelvic floor muscles (PFM) with simultaneous tension of the transverse abdominal muscle (TrA), and the program for Group B, PFM exercises without TrA tension. After completing the exercise programs, patients with stage 1 SUI, both from Group A and from Group B, showed a significant improvement in most QoL domains measured with ICIQ LUTS QoL. However, more beneficial effects of the training were observed in the group subjected to PFM exercises with TrA tension.

Corps of Engineers Land Treatment of Wastewater Research Program, An Annotated Bibliography.

DTIC Science & Technology

1983-04-01

engineering) Waste treatment Waste water 4 20. ABST14ACT (Eacabsue an reverse oh It necwwey mad tdertlfy by block number) *This bibliography contains...1982) Distribution of phosphorus in soils irri ated with municipal waste- water effluent: A 5-year study. Journal of Environmental Quality, vol. 11...vol. 44, p. 383-394. The removal of seeded coliphage f2 and indigenous enteroviruses from primary and secondary wastewaters applied by spray

Problems in the evaluation of day hospitals.

PubMed

Guy, W; Gross, G M

1967-06-01

The day hospital has been utilized as a means both to maintain and improve remission status of previously hospitalized patients and, more recently, as an alternative to inpatient treatment. Although uniformly encouraging, the reports of treatment success are ambiguous and complicated by the recency and diversity of the programs. Proposals to reduce confusion in the areas of identification of population, definition of treatment, treatment effects, and assessment procedures are discussed. The concept of therapeutic community with its emphasis on socialization processes makes symptom reduction alone an insufficient criterion of treatment success. More comprehensive measures of the permanency of remission and quality of social adjustment are advocated.

Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA)

PubMed Central

Konrad-Martin, Dawn; Reavis, Kelly M.; McMillan, Garnett; Helt, Wendy J.; Dille, Marilyn

2015-01-01

Prevention and rehabilitation of hearing loss and tinnitus, the two most commonly awarded service-connected disabilities, are high priority initiatives in the Department of Veterans Affairs (VA). At least 4,000 Veterans, most with significant hearing loss, will receive cisplatin this year, with more than half sustaining permanent hearing shift and nearly 40% developing new tinnitus. With improved survivability following cancer treatment, Veterans treated with cisplatin are approached with the dual goals of effective treatment and preserved quality of life. This article describes COMP-VA, a comprehensive ototoxicity monitoring program developed for VA patients receiving cisplatin. The program includes an individualized pretreatment prediction model that identifies the likelihood of hearing shift given cisplatin dose and patient factors. It supports both manual and automated hearing testing with a newly developed portable audiometer capable of performing the recommended procedures on the chemotherapy unit during treatment. It also includes objective methods for identifying outer hair cell changes and predicting audiogram changes using distortion-product otoacoustic emissions. We describe this program of evidence-based ototoxicity monitoring protocols using a case example to give the reader an understanding of how this program would be applied, along with a plan for future work to accomplish the final stages of program development. PMID:24805896

Structure and management of tuberculosis control programs in fragile states--Afghanistan, DR Congo, Haiti, Somalia.

PubMed

Mauch, Verena; Weil, Diana; Munim, Aayid; Boillot, Francois; Coninx, Rudi; Huseynova, Sevil; Powell, Clydette; Seita, Akihiro; Wembanyama, Henriette; van den Hof, Susan

2010-07-01

Health care delivery is particularly problematic in fragile states often connected with increased incidence of communicable diseases, among them tuberculosis. This article draws upon experiences in tuberculosis control in four fragile states from which four lessons learned were derived. A structured inventory to extract common themes specific for TB control in fragile states was conducted among twelve providers of technical assistance who have worked in fragile states. The themes were applied to the TB control programs of Afghanistan, DR Congo, Haiti and Somalia during the years 2000-2006. Case notifications and treatment outcomes have increased in all four countries since 2003 (treatment success rates 81-90%). Access to care and case detection however have remained insufficient (case detection rates 39-62%); There are four lessons learned: 1. TB control programs can function in fragile states. 2. National program leadership and stewardship are essential for quality and sustained TB control. 3. Partnerships with non-governmental providers are vital for continuous service delivery; 4. TB control programs in fragile states require consistent donor support. Despite challenges in management, coordination, security, logistics and funding, TB control programs can function in fragile states, but face considerable problems in access to diagnosis and treatment and therefore case detection. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

A Pilot Feasibility Study of Whole-systems Ayurvedic Medicine and Yoga Therapy for Weight Loss.

PubMed

Rioux, Jennifer; Thomson, Cynthia; Howerter, Amy

2014-01-01

To develop and test the feasibility of a whole-systems lifestyle intervention for obesity treatment based on the practices of Ayurvedic medicine/ Yoga therapy. A pre-post weight loss intervention pilot study using conventional and Ayurvedic diagnosis inclusion criteria, tailored treatment within a standardized treatment algorithm, and standardized data collection instruments for collecting Ayurvedic outcomes. A convenience sample of overweight/obese adult community members from Tucson, Arizona interested in a "holistic weight loss program" and meeting predetermined inclusion/exclusion criteria. A comprehensive diet, activity, and lifestyle modification program based on principles of Ayurvedic medicine/yoga therapy with significant self-monitoring of lifestyle behaviors. The 3-month program was designed to change eating and activity patterns and to improve self-efficacy, quality of life, well-being, vitality, and self-awareness around food choices, stress management, and barriers to weight loss. Changes in body weight, body mass index; body fat percentage, fat/lean mass, waist/hip circumference and ratio, and blood pressure. Diet and exercise self-efficacy scales; perceived stress scale; visual analog scales (VAS) of energy, appetite, stress, quality of life, well-being, and program satisfaction at all time points. Twenty-two adults attended an in-person Ayurvedic screening; 17 initiated the intervention, and 12 completed the 3-month intervention. Twelve completed follow-up at 6 months and 11 completed follow-up at 9 months. Mean weight loss at 3 months was 3.54 kg (SD 4.76); 6 months: 4.63 kg, (SD 6.23) and 9 months: 5.9 kg (SD 8.52). Self-report of program satisfaction was more than 90% at all time points. An Ayurveda-/yoga-based lifestyle modification program is an acceptable and feasible approach to weight management. Data collection, including self-monitoring and conventional and Ayurvedic outcomes, did not unduly burden participants, with attrition similar to that of other weight loss studies.

Scale-up of networked HIV treatment in Nigeria: creation of an integrated electronic medical records system.

PubMed

Chaplin, Beth; Meloni, Seema; Eisen, Geoffrey; Jolayemi, Toyin; Banigbe, Bolanle; Adeola, Juliette; Wen, Craig; Reyes Nieva, Harry; Chang, Charlotte; Okonkwo, Prosper; Kanki, Phyllis

2015-01-01

The implementation of PEPFAR programs in resource-limited settings was accompanied by the need to document patient care on a scale unprecedented in environments where paper-based records were the norm. We describe the development of an electronic medical records system (EMRS) put in place at the beginning of a large HIV/AIDS care and treatment program in Nigeria. Databases were created to record laboratory results, medications prescribed and dispensed, and clinical assessments, using a relational database program. A collection of stand-alone files recorded different elements of patient care, linked together by utilities that aggregated data on national standard indicators and assessed patient care for quality improvement, tracked patients requiring follow-up, generated counts of ART regimens dispensed, and provided 'snapshots' of a patient's response to treatment. A secure server was used to store patient files for backup and transfer. By February 2012, when the program transitioned to local in-country management by APIN, the EMRS was used in 33 hospitals across the country, with 4,947,433 adult, pediatric and PMTCT records that had been created and continued to be available for use in patient care. Ongoing trainings for data managers, along with an iterative process of implementing changes to the databases and forms based on user feedback, were needed. As the program scaled up and the volume of laboratory tests increased, results were produced in a digital format, wherever possible, that could be automatically transferred to the EMRS. Many larger clinics began to link some or all of the databases to local area networks, making them available to a larger group of staff members, or providing the ability to enter information simultaneously where needed. The EMRS improved patient care, enabled efficient reporting to the Government of Nigeria and to U.S. funding agencies, and allowed program managers and staff to conduct quality control audits. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The effect of extremity strength training on fibromyalgia symptoms and disease impact in an existing multidisciplinary treatment program.

PubMed

Kas, Tamara; Colby, Megan; Case, Maureen; Vaughn, Dan

2016-10-01

The purpose of this study was to examine the effect of upper and lower body extremity strengthening exercise in patients with Fibromyalgia (FM) within an existing multidisciplinary treatment program. Patients between the ages of 18-65 with the medical diagnosis of FM. Comparative study design. The control and experimental group received the same multidisciplinary treatment except that the experimental group performed upper and lower extremity strengthening exercises. The Fibromyalgia Impact Questionnaire (FIQ) was administered at evaluation and discharge from the program in order to measure change in quality of life (QOL). Statistically significant changes in FIQ scores were found for both groups. The addition of extremity strengthening in the experimental group produced an average 4 points greater reduction in FIQ score, however, these results are not considered statistically significant. This study appears to validate the success of a multidisciplinary approach in treating patients with FM, with the possibility for further benefit with the addition of extremity strengthening. Copyright © 2016 Elsevier Ltd. All rights reserved.

Iraq and Afghanistan Veterans: National Findings from VA Residential Treatment Programs

PubMed Central

Cook, Joan M.; Dinnen, Stephanie; O’Donnell, Casey; Bernardy, Nancy; Rosenheck, Robert; Desai, Rani

2013-01-01

A quality improvement effort was undertaken in Department of Veterans Affairs’ (VA) residential treatment programs for Posttraumatic Stress Disorder (PTSD) across the United States. Qualitative interviews were conducted with over 250 directors, providers, and staff during site visits of 38 programs. The aims of this report are to describe clinical issues and distinctive challenges in working with veterans from Iraq and Afghanistan and approaches to addressing their needs. Providers indicated that the most commonly reported problems were: acute PTSD symptomotology; other complex mental health symptom presentations; broad readjustment problems; and difficulty with time demands of and readiness for intensive treatment. Additional concerns included working with active duty personnel and mixing different eras in therapy. Programmatic solutions address structure (e.g., blended versus era-specific therapy), content (e.g., physical activity), and adaptations (e.g., inclusion of family; shortened length of stay). Clinical implications for VA managers and policy makers as well as non-VA health care systems and individual health care providers are noted. PMID:23458113

First German Disease Management Program for Breast Cancer

PubMed Central

Rupprecht, Christoph

2005-01-01

The first disease management program contract for breast cancer in Germany was signed in 2002 between the Association of Regional of Physicians in North-Rhine and the statutory health insurance companies in Rhineland. At the heart of this unique breast cancer disease management program is a patient-centered network of health care professionals. The program's main objectives are: (1) to improve the quality of treatment and post-operative care for breast cancer patients, (2) to provide timely information and consultation empowering the patient to participate in decisionmaking, (3) to improve the interface between inpatient and outpatient care, and (4) to increase the number of breast-conserving surgeries. PMID:17288079

First German disease management program for breast cancer.

PubMed

Rupprecht, Christoph

2005-01-01

The first disease management program contract for breast cancer in Germany was signed in 2002 between the Association of Regional of Physicians in North-Rhine and the statutory health insurance companies in Rhineland. At the heart of this unique breast cancer disease management program is a patient-centered network of health care professionals. The program's main objectives are: (1) to improve the quality of treatment and post-operative care for breast cancer patients, (2) to provide timely information and consultation empowering the patient to participate in decisionmaking, (3) to improve the interface between inpatient and outpatient care, and (4) to increase the number of breast-conserving surgeries.

A pilot study examining the effect of mindfulness-based stress reduction on symptoms of chronic mild traumatic brain injury/postconcussive syndrome.

PubMed

Azulay, Joanne; Smart, Colette M; Mott, Tasha; Cicerone, Keith D

2013-01-01

To evaluate the effectiveness of the mindfulness-based stress reduction (MBSR) program tailored to individuals with mild traumatic brain injury (mTBI). A convenience sample recruited from clinical referrals over a 2-year period completed outcome measures pre- and posttreatment intervention. Post-acute brain injury rehabilitation center within a suburban medical facility. Twenty-two individuals with mTBI and a time postinjury more than 7 months. Eleven participants were men and 11 were women, ranging in age from 18 to 62 years. A 10-week group (with weekly 2-hour sessions) modeled after the MBSR program of Kabat-Zinn, but with modifications designed to facilitate implementation in a population of individuals with brain injury. (The treatment involved enhancement of attentional skills, in addition to increased awareness of internal and external experiences associated with the perspective change of acceptance and nonjudgmental attitude regarding those experiences). Perceived Quality of Life Scale, Perceived Self-Efficacy Scale, and the Neurobehavioral Symptom Inventory. Secondary measures included neuropsychological tests, a self-report problem-solving inventory, and a self-report measure of mindfulness. Clinically meaningful improvements were noted on measures of quality of life (Cohen d = 0.43) and perceived self-efficacy (Cohen d = 0.50) with smaller but still significant effects on measures of central executive aspects of working memory and regulation of attention. The MBSR program can be adapted for participants with mTBI. Improved performance on measures associated with improved quality of life and self-efficacy may be related to treatment directed at improving awareness and acceptance, thereby minimizing the catastrophic assessment of symptoms associated with mTBI and chronic disability. Additional research on the comparative effectiveness of the MBSR program for people with mTBI is warranted.

Development of a group therapy to enhance treatment motivation and decision making in severely obese patients with a comorbid mental disorder.

PubMed

Wild, Beate; Herzog, Wolfgang; Wesche, Daniela; Niehoff, Dorothea; Müller, Beat; Hain, Bernhard

2011-05-01

The prevalence rate of mental disorders in severely obese patients appears to be high. In the Department of Psychosomatic Medicine, Heidelberg, we established a short outpatient group intervention for severely obese patients with an affective, anxiety, and/or eating disorder who either are not able to make a clear decision for an intensive weight loss program or who have already decided to undergo bariatric surgery but are advised to attend a support group before surgery. The aim of the group intervention was to reduce depressive symptoms and, in indecisive patients, to enhance the motivation of the patients for engagement in further intensive treatment programs, including bariatric surgery. Descriptive data of the first two intervention groups are provided. The treatment program and topics of the group sessions are explained. Time series analysis methods are used to investigate the development of a single patient during the intervention program. Initially, 16 patients joined the group program; ten of these attended the group therapy to completion. The remaining ten patients showed clinically relevant reduction in depression levels and improvement in mental quality of life. Results of the single-case time series analysis indicate that the temporal relationship between eating behavior and depression changed during treatment. The group program, as outlined, could be a useful intervention for severely obese patients with comorbid depression, anxiety, or eating disorder. A gap in the health care system is thus bridged by this short intervention that can encourage further treatment decisions such as bariatric surgery.

Clinical audit system as a quality improvement tool in the management of breast cancer.

PubMed

Vijayakumar, Chellappa; Maroju, Nanda Kishore; Srinivasan, Krishnamachari; Reddy, K Satyanarayana

2016-11-01

Quality improvement is recognized as a major factor that can transform healthcare management. This study is a clinical audit that aims at analysing treatment time as a quality indicator and explores the role of setting a target treatment time on reducing treatment delays. All newly diagnosed patients with breast cancer between September 2011 and August 2013 were included in the study. Clinical care pathway for breast cancer patients was standardized and the timeliness of care at each step of the pathway was calculated. Data collection was spread over three phases, baseline, audit cycle I, and audit cycle II. Each cycle was preceded by a quality improvement intervention, and followed by analysis. A total of 334 patients with breast cancer were included in the audit. The overall time from first visit to initiation of treatment was 66.3 days during the baseline period. This improved to 40.4 and 28.5 days at the end of Audit cycle I and II, respectively. The idealized target time of 28 days for initiating treatment was achieved in 5, 23.5, and 65.2% of patients in the baseline period, Audit cycle I, and Audit Cycle II, respectively. There was improvement noted across all steps of the clinical care pathway. This study confirms that audit is a powerful tool in quality improvement programs and helps achieve timely care. Gains achieved through an audit process may not be sustainable unless underlying patient factors and resource deficits are addressed. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

[Effects of educational program of manual lymph massage on the arm functioning and the quality of life in breast cancer patients].

PubMed

Lee, Eun Sook; Kim, Sung Hyo; Kim, Sun Mi; Sun, Jeong Ju

2005-12-01

The purpose of this study was to determine the effect of EPMLM (educational program of manual lymph massage) on the arm functioning and QOL (quality of life) in breast cancer patients with lymphedema. Subjects in the experimental group (n=20) participated in EPMLM for 6 weeks from June to July, 2005. The EPMLM consisted of training of lymph massage for 2 weeks and encourage and support of self-care using lymph massage for 4 weeks. The arm functioning assessed at pre-treatment, 2 weeks, and 6 weeks using Arm functioning questionnaire. The QOL assessed at pre-treatment and 6 weeks using SF-36. The outcome data of experimental group was compared with control group (n=20). The collected data was analyzed by using SPSS 10.0 statistical program. The arm functioning of experimental group was increased from 2 weeks after (W=.224, p=.011) and statistically differenced with control group at 2 weeks (Z=-2.241, p=.024) and 6 weeks (Z=-2.453, p=.013). Physical function of QOL domain increased in experimental group (Z=-1.162, p=.050), also statistically differenced with control group (Z=-2.182, p= .030) at 6 weeks. The results suggest that the educational program of manual lymph massage can improve arm functioning and physical function of QOL domain in breast cancer patients with lymphedema.

Development of a Breast Cancer Treatment Program in Port-au-Prince, Haiti: Experiences From the Field

PubMed Central

Libby, Rachel; Patberg, Elizabeth; Gabriel, Dieudina; Al-Quran, Samer; Kasher, Matthew; Heldermon, Coy; Daily, Karen; Auguste, Joseph R.; Suprien, Valery C.; Hurley, Judith

2016-01-01

Purpose The nonprofit Project Medishare launched a breast cancer treatment program in Port-au-Prince in July 2013 to address the demand for breast cancer care in Haiti. We outline the development of the program, highlight specific challenges, and discuss key considerations for others working in global oncology. Methods We reflected on our experiences in the key areas of developing partnerships, building laboratory capacity, conducting medical training, using treatment algorithms, and ensuring access to safe, low-cost chemotherapy drugs. We also critically reviewed our costs and quality measures. Results The program has treated a total of 139 patients with breast cancer with strong adherence to treatment regimens in 85% of patients. In 273 chemotherapy administrations, no serious exposure or adverse safety events were reported by staff. The mortality rate for 94 patients for whom we have complete data was 24% with a median survival time of 53 months. Our outcome data were likely influenced by stage at presentation, with more than half of patients presenting more than 12 months after first noticing a tumor. Future efforts will therefore focus on continuing to improve the level of care, while working with local partners to spread awareness, increase screening, and get more women into care earlier in the course of their disease. Conclusion Our experiences may inform others working to implement protocol-based cancer treatment programs in resource-poor settings and can provide valuable lessons learned for future global oncology efforts. PMID:28717677

Substance-dependence rehab treatment in Thailand: a meta analysis.

PubMed

Verachai, Viroj; Kittipichai, Wirin; Konghom, Suwapat; Lukanapichonchut, Lumsum; Sinlapasacran, Narong; Kimsongneun, Nipa; Rergarun, Prachern; Doungnimit, Amawasee

2009-12-01

To synthesize the substance-dependence researches focusing on rehab treatment phase. Several criteria were used to select studies for meta analysis. Firstly, the research must have focused on the rehab period on the substance-dependence treatment, secondly, only quantitative researches that used statistics to calculate effect sizes were selected, and thirdly, all researches were from Thai libraries and were done during 1997-2006. The instrument used for data collection was comprised of two sets. The first used to collect the general information of studies including the crucial statistics and test statistics. The second was used to assess the quality of studies. Results from synthesizing 32 separate studies found that 323 effect sizes were computed in terms of the correlation coefficient "r". The psychology approach rehab program was higher in effect size than the network approach (p < 0.05). Additionally, Quasi-experimental studies were higher in effect size than correlation studies (p < 0.05). Among the quasi-experimental studies it was found that TCs revealed the highest effect size (r = 0.76). Among the correlation studies, it was found that the motivation program revealed the highest effect size (r = 0.84). The substance-use rehab treatment programs in Thailand which revealed the high effect size should be adjusted to the current program. However, the narcotic studies which focus on the rehab phase should be synthesized every 5-10 years in order to integrate new concept into the development of future the substance-dependence rehab treatment program, especially those at the research unit of the Drug Dependence Treatment Institute/Centers in Thailand.

Cost-Effectiveness and Quality of Care of a Comprehensive ART Program in Malawi

PubMed Central

Orlando, Stefano; Diamond, Samantha; Palombi, Leonardo; Sundaram, Maaya; Shear Zinner, Lauren; Marazzi, Maria Cristina; Mancinelli, Sandro; Liotta, Giuseppe

2016-01-01

Abstract The aim of this study is to assess the cost-effectiveness of a holistic, comprehensive human immunodeficiency virus (HIV) treatment Program in Malawi. Comprehensive cost data for the year 2010 have been collected at 30 facilities from the public network of health centers providing antiretroviral treatment (ART) throughout the country; two of these facilities were operated by the Disease Relief through Excellent and Advanced Means (DREAM) program. The outcomes analysis was carried out over five years comparing two cohorts of patients on treatment: 1) 2387 patients who started ART in the two DREAM centers during 2008, 2) patients who started ART in Malawi in the same year under the Ministry of Health program. Assuming the 2010 cost as constant over the five years the cost-effective analysis was undertaken from a health sector and national perspective; a sensitivity analysis included two hypothesis of ART impact on patients’ income. The total cost per patient per year (PPPY) was $314.5 for the DREAM protocol and $188.8 for the other Malawi ART sites, with 737 disability adjusted life years (DALY) saved among the DREAM program patients compared with the others. The Incremental Cost-Effectiveness Ratio was $1640 per DALY saved; it ranged between $896–1268 for national and health sector perspective respectively. The cost per DALY saved remained under $2154 that is the AFR-E-WHO regional gross domestic product per capita threshold for a program to be considered very cost-effective. HIV/acquired immune deficiency syndrome comprehensive treatment program that joins ART with laboratory monitoring, treatment adherence reinforcing and Malnutrition control can be very cost-effective in the sub-Saharan African setting. PMID:27227921

A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial

PubMed Central

Rojas, Graciela; Guajardo, Viviana; Castro, Ariel; Fritsch, Rosemarie; Moessner, Markus; Bauer, Stephanie

2018-01-01

Background In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. Objective The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. Methods In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. Results Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). Conclusions Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management of depressive patients. Future cost-effectiveness studies are needed. Trial Registration Clinicaltrials.gov NCT02200367; https://clinicaltrials.gov/ct2/show/NCT02200367 (Archived by WebCite at http://www.webcitation.org/6xtZ7OijZ) PMID:29712627

76 FR 39110 - Medicare Program; Section 3113: The Treatment of Certain Complex Diagnostic Laboratory Tests...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

... access to care, quality of care, health outcomes, and expenditures. DATES: Supporting information to... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-5058-N... Tests Demonstration. The Demonstration is mandated by section 3113 of the Affordable Care Act. This...

Crossing the Quality Chasm: Challenges for Counselor Training Programs

ERIC Educational Resources Information Center

McCarty, Dennis; Gardin, John; Edmundson, Eldon

2007-01-01

Treatment for alcohol and drug disorders is changing. The evidence is emerging in federally sponsored reports, initiatives, and strategic plans from the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The reports and…

78 FR 18336 - Public Water System Supervision Program Approval for the State of Michigan

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

... comply with the National Primary Drinking Water Regulations, including the Ground Water Rule, the Stage 2 Disinfectants and Disinfection Byproducts Rule, the Long-Term 2 Enhanced Surface Water Treatment Rule, the Lead... following offices: Michigan Department of Environmental Quality, Office of Drinking Water and Municipal...

40 CFR 125.68 - Special conditions for section 301(h) modified permits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Criteria for Modifying the Secondary Treatment Requirements Under Section 301(h) of the Clean Water Act...: (1) Biomonitoring requirements of § 125.63(b); (2) Water quality requirements of § 125.63(c); (3...

40 CFR 125.68 - Special conditions for section 301(h) modified permits.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Criteria for Modifying the Secondary Treatment Requirements Under Section 301(h) of the Clean Water Act...: (1) Biomonitoring requirements of § 125.63(b); (2) Water quality requirements of § 125.63(c); (3...

Parenting training for women in residential substance abuse treatment. Results of a demonstration project.

PubMed

Camp, J M; Finkelstein, N

1997-01-01

This paper presents findings on the impact of implementing a parenting component in two urban residential treatment programs in Massachusetts for pregnant and parenting chemically-dependent women. The parenting component consisted of multiple services for both women and their infants while they were in residential treatment as well as aftercare services after discharge from treatment. Findings presented focus on: (a) the characteristics of the 170 pregnant and parenting women who participated in the parenting component during its 48 months of implementation; (b) changes in the parenting skills and self-esteem of women who completed parenting training; (c) the quality of mother-child interaction; and (d) the participants' perceptions about the impact of the parenting training. Women in both programs made dramatic improvements in self-esteem and experienced significant gains in parenting knowledge and attitudes. The participants were also overwhelmingly positive about the impact of the parenting training on their lives. Study findings underline the importance of parenting services for pregnant and parenting women in residential substance abuse treatment.

Pelvic Floor Muscle Training: Underutilization in the USA.

PubMed

Lamin, Eliza; Parrillo, Lisa M; Newman, Diane K; Smith, Ariana L

2016-02-01

Pelvic floor disorders are highly prevalent in women of all ages and can greatly impair quality of life. Pelvic floor muscle training (PFMT) is a viable treatment option for several pelvic floor conditions including urinary incontinence and pelvic organ prolapse. PFMT is a program of therapy initiated by an experienced clinician (e.g., women's health or urology nurse practitioner (NP), physical therapist (PT)) that involves exercises for women with stress urinary incontinence (UI) and exercises combined with behavioral or conservative treatments (lifestyle changes, bladder training with urge suppression) for women with urgency or mixed UI. These exercise programs are more comprehensive than simple Kegel exercises. Despite evidence-based research indicating the efficacy and cost-effectiveness for treatment of urinary incontinence, PFMT is not commonly used as a first-line treatment in clinical practice in the USA (Abrams et al., 2012). This article will review PFMT for the treatment of UI and pelvic organ prolapse (POP) and theorize how this conservative therapy can be utilized more effectively in the USA.

Case-based reimbursement for psychiatric hospital care.

PubMed

Sederer, L I; Eisen, S V; Dill, D; Grob, M C; Gougeon, M L; Mirin, S M

1992-11-01

A fixed-prepayment system (case-based reimbursement) for patients initially requiring hospital-level care was evaluated for one year through an arrangement between a private nonprofit psychiatric hospital and a self-insured company desiring to provide psychiatric services to its employees. This clinical and financial experiment offered a means of containing costs while monitoring quality of care. A two-group, case-control study was undertaken of treatment outcomes at discharge, patient satisfaction with hospital care, and service use and costs during the program's first year. Compared with costs for patients in the control group, costs for those in the program were lower per patient and per admission; cumulative costs for patients requiring rehospitalization were also lower. However, costs for outpatient services for patients in the program were not calculated. Treatment outcomes and patients' satisfaction with hospital care were comparable for the two groups.

A Review of Quality Assurance Methods to Assist Professional Record Keeping: Implications for Providers of Interpersonal Violence Treatment

PubMed Central

Bradshaw, Kelsey M.; Donohue, Brad; Wilks, Chelsey

2014-01-01

Errors have been found to frequently occur in the management of case records within mental health service systems. In cases involving interpersonal violence, such errors have been found to negatively impact service implementation and lead to significant trauma and fatalities. In an effort to ensure adherence to specified standards of care, quality assurance programs (QA) have been developed to monitor and enhance service implementation. These programs have generally been successful in facilitating record management. However, these systems are rarely disseminated, and not well integrated. Therefore, within the context of interpersonal violence, we provide an extensive review of evidence supported record keeping practices, and methods to assist in assuring these practices are implemented with adherence. PMID:24976786

Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol.

PubMed

Bennell, Kim L; Egerton, Thorlene; Pua, Yong-Hao; Abbott, J Haxby; Sims, Kevin; Metcalf, Ben; McManus, Fiona; Wrigley, Tim V; Forbes, Andrew; Harris, Anthony; Buchbinder, Rachelle

2010-10-14

Hip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function. The trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS) and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline. The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA.

The Design and Implementation of a Public Relations Program in Support of the Composite Health Care System at Ireland Army Community Hospital, Fort Knox, Kentucky

DTIC Science & Technology

1987-10-01

effectiveness of a particular health care provider or treatment procedure (Doering, 1983; Ben-Sira, 1983; Kotler & Clarke, 1986). Instead, much of a...criteria for quality of care ( Kotler & Clarke, 1986). There is great potential for positively influencing a patient’s percep- tion of care through a...important quality of care indicator for patients (Doering, 1983; Kotler & Clarke, 1986). Personal attention of the patient must remain a primary

Implementation of a 12-week disease management program improved clinical outcomes and quality of life in adults with asthma in a rural district hospital: pre- and post-intervention study.

PubMed

Chamnan, Parinya; Boonlert, Kittipa; Pasi, Wanit; Yodsiri, Songkran; Pong-on, Sirinya; Khansa, Bhoonsab; Yongkulwanitchanan, Pichapat

2010-03-01

Despite the availability of effective medical treatment and disease management guidelines, asthma remains a poorly controlled disease in developing countries. There is little evidence of the effectiveness of disease management guidelines in rural clinical practice. The effect of disease management guidelines on clinical outcomes and quality of life in asthmatic patients in a rural community hospital was examined. Fifty-seven patients aged > or = 16 years with physician-diagnosed asthma from a hospital outpatient clinic in Ubon-ratchathani, Thailand, were recruited. Asthma diagnosis was confirmed by reviewing clinical records. We implemented a 12-week disease management program, including the use of written asthma treatment plan and asthma action plan tailored to individual patients. Using one-group pre- and post-intervention design, we compared the average number of emergency visits and hospitalizations from acute asthmatic attacks before and after the implementation of interventions using the Wilcoxon matched-pairs signed-rank test. We also compared patient's asthma quality of life (AQL) scores, measured using the 7-point scaled Mini Asthma Quality of Life Questionnaire. It was found that among the 57 patients, 38 (67%) were women, and the mean age (SD) of the patients was 47.6 (17.0) years. Sixteen patients (28%) had a family history of asthma. Emergency visits decreased from 0.48 (SD = 0.83) per patient before implementation of interventions to 0.11 (0.37) per patient after implementation of interventions (p = 0.003). Hospitalizations with acute asthma attacks reduced from 0.14 (0.35) per patient to 0.04 (0.27) per patient (p = 0.034). Overall AQL scores increased significantly from 3.7 to 5.4 (p < 0.001), with most improvement observed in symptoms and emotions. It was concluded that implementation of a 12-week asthma disease management program could reduce emergency visits and hospitalizations, and improve patients' quality of life in a rural practice setting.

The effectiveness of mindfulness-based stress reduction (MBSR) for survivors of breast cancer: study protocol for a randomized controlled trial.

PubMed

Huang, Jiayan; Shi, Lu

2016-04-22

After treatment completion, breast cancer (BC) survivors frequently experience residual symptoms of pain, fatigue, high levels of psychological stress, anxiety, depression, fear of recurrence, and metastasis. Post-treatment stress, in particular, can adversely affect health-related quality of life, which, in turn, induces onset or recurrence of chronic diseases. Effective interventions that target these psychological symptoms and their physiological consequences are needed, especially for economically disadvantaged patients. However, in China, few evidence-based intervention strategies have been established among BC survivors. This study will formally adapt, develop, and evaluate an intensive mindfulness-based stress reduction (MBSR) intervention protocol to improve mental health, quality of life, and compliance with medication among Chinese BC survivors. A randomized, waitlist-controlled clinical trial will be conducted. Based on our power calculation, 418 BC survivors will be recruited from 10 low-income communities in Shanghai. All subjects will be randomly assigned either to the MBSR program or to a waitlisted usual care regimen that will offer the MBSR program after the completion of the other trial arm (after 6 months follow-up). Our 8-week MBSR intervention program will provide systematic training to promote stress reduction by self-regulating arousal to stress. Assessments will be made at baseline, 4 weeks (in the middle of the first MBSR intervention), 8 weeks (at the end of the first MBSR intervention), 6 months, and 12 months, and will include measures of psychological symptoms (depression, anxiety, and perceived stress), quality of life, and medication adherence. The expected outcome will be the improvement in psychological symptoms, quality of life, and medication compliance in the MBSR intervention group. This study will help develop an affordable, self-care psychological intervention protocol to help Chinese BC survivors improve their quality of life, and could be helpful in further developing affordable disease management plans for patients of other chronic diseases. ChiCTR-IOR-14005390 (10/27/2014).

Online psycho-education to the treatment of bipolar disorder: protocol of a randomized controlled trial.

PubMed

González-Ortega, Itxaso; Ugarte, Amaia; Ruiz de Azúa, Sonia; Núñez, Nuria; Zubia, Marta; Ponce, Sara; Casla, Patricia; Llano, Josu Xabier; Faria, Ángel; González-Pinto, Ana

2016-12-22

Bipolar disorder patients frequently present recurrent episodes and often experience subsyndromal symptoms, cognitive impairment and difficulties in functioning, with a low quality of life, illness relapses and recurrent hospitalization. Early diagnosis and appropriate intervention may play a role in preventing neuroprogression in this disorder. New technologies represent an opportunity to develop standardized psychological treatments using internet-based tools that overcome some of the limitations of face-to-face treatments, in that they are readily accessible and the timing of therapy can be tailored to user needs and availability. However, although many psychological programs are offered through the web and mobile devices for bipolar disorder, there is a lack of high quality evidence concerning their efficacy and effectiveness due to the great variability in measures and methodology used. This clinical trial is a simple-blind randomized trial within a European project to compare an internet-based intervention with treatment as usual. Bipolar disorder patients are to be included and randomly assigned to one of two groups: 1) the experimental group (tele-care support) and 2) the control group. Participants in both groups will be evaluated at baseline (pre-treatment) and post-treatment. This study describes the design of a clinical trial based on psychoeducation intervention that may have a significant impact on both prognosis and treatment in bipolar disorder. Specifically, bringing different services together (service aggregation), it is hoped that the approach proposed will significantly increase the impact of information and communication technologies on access and adherence to treatment, quality of the service, patient safety, patient and professional satisfaction, and quality of life of patients. NCT02924415 . Retrospectively registered 27 September 2016.

Reforming Cardiovascular Care in the United States towards High-Quality Care at Lower Cost with Examples from Model Programs in the State of Michigan.

PubMed

Alyeshmerni, Daniel; Froehlich, James B; Lewin, Jack; Eagle, Kim A

2014-07-01

Despite its status as a world leader in treatment innovation and medical education, a quality chasm exists in American health care. Care fragmentation and poor coordination contribute to expensive care with highly variable quality in the United States. The rising costs of health care since 1990 have had a huge impact on individuals, families, businesses, the federal and state governments, and the national budget deficit. The passage of the Affordable Care Act represents a large shift in how health care is financed and delivered in the United States. The objective of this review is to describe some of the economic and social forces driving health care reform, provide an overview of the Patient Protection and Affordable Care Act (ACA), and review model cardiovascular quality improvement programs underway in the state of Michigan. As health care reorganization occurs at the federal level, local and regional efforts can serve as models to accelerate improvement toward achieving better population health and better care at lower cost. Model programs in Michigan have achieved this goal in cardiovascular care through the systematic application of evidence-based care, the utilization of regional quality improvement collaboratives, community-based childhood wellness promotion, and medical device-based competitive bidding strategies. These efforts are examples of the direction cardiovascular care delivery will need to move in this era of the Affordable Care Act.

Outcomes of Prolonged Exposure therapy for veterans with posttraumatic stress disorder.

PubMed

Goodson, Jason T; Lefkowitz, Carin M; Helstrom, Amy W; Gawrysiak, Michael J

2013-08-01

Prolonged Exposure (PE) is an evidenced-based psychotherapy for posttraumatic stress disorder (PTSD) that is being disseminated nationally within the U.S. Department of Veterans Affairs (VA) with promising initial results. Empirical evidence, however, regarding the effectiveness of PE for treatment of PTSD in military veterans is limited. Building on previous treatment outcome research, the current study investigated the effectiveness of PE in a diverse veteran sample. One-hundred fifteen veterans were enrolled in PE at an urban VA medical center and its surrounding outpatient clinics. PTSD and depression symptoms as well as quality of life were measured before and after treatment. Several baseline patient characteristics were examined as predictors of treatment response. Eighty-four participants completed treatment. Participants experienced a 42% reduction in PTSD symptoms, a 31% reduction in depression symptoms, and an increase in quality of life following PE. Veterans not prescribed psychotropic medication reported greater PTSD symptom reduction than veterans prescribed such medication. The implications of these results for treatment programs targeting PTSD in veterans are discussed. Copyright © 2013 International Society for Traumatic Stress Studies.

Toward a joint health and disease management program. Toronto hospitals partner to provide system leadership.

PubMed

Macleod, Anne Marie; Gollish, Jeffrey; Kennedy, Deborah; McGlasson, Rhona; Waddell, James

2009-01-01

The Joint Health and Disease Management Program in the Toronto Central Local Health Integration Network (TC LHIN) is envisioned as a comprehensive model of care for patients with hip and knee arthritis. It includes access to assessment services, education, self-management programs and other treatment programs, including specialist care as needed. As the first phase of this program, the hospitals in TC LHIN implemented a Hip and Knee Replacement Program to focus on improving access and quality of care, coordinating services and measuring wait times for patients waiting for hip or knee replacement surgery. The program involves healthcare providers, consumers and constituent hospitals within TC LHIN. The approach used for this program involved a definition of governance structure, broad stakeholder engagement to design program elements and plans for implementation and communication to ensure sustainability. The program and approach were designed to provide a model that is transferrable in its elements or its entirety to other patient populations and programs. Success has been achieved in creating a single wait list, developing technology to support referral management and wait time reporting, contributing to significant reductions in waits for timely assessment and treatment, building human resource capacity and improving patient and referring physician satisfaction with coordination of care.

Evolving Clinical Cancer Radiotherapy: Concerns Regarding Normal Tissue Protection and Quality Assurance

PubMed Central

Choi, Won Hoon

2016-01-01

Radiotherapy, which is one of three major cancer treatment methods in modern medicine, has continued to develop for a long period, more than a century. The development of radiotherapy means allowing the administration of higher doses to tumors to improve tumor control rates while minimizing the radiation doses absorbed by surrounding normal tissues through which radiation passes for administration to tumors, thereby reducing or removing the incidence of side effects. Such development of radiotherapy was accomplished by the development of clinical radiation oncology, the development of computers and machine engineering, the introduction of cutting-edge imaging technology, a deepened understanding of biological studies on the effects of radiation on human bodies, and the development of quality assurance (QA) programs in medical physics. The development of radiotherapy over the last two decades has been quite dazzling. Due to continuous improvements in cancer treatment, the average five-year survival rate of cancer patients has been close to 70%. The increases in cancer patients’ complete cure rates and survival periods are making patients’ quality of life during or after treatment a vitally important issue. Radiotherapy is implemented in approximately 1/3 to 2/3s of all cancer patients; and has improved the quality of life of cancer patients in the present age. Over the last century, as a noninvasive treatment, radiotherapy has unceasingly enhanced complete tumor cure rates and the side effects of radiotherapy have been gradually decreasing, resulting in a tremendous improvement in the quality of life of cancer patients. PMID:26908993

Health-related quality of life in end-stage renal disease patients: the effects of renal rehabilitation.

PubMed

Kouidi, E

2004-05-01

Health-related quality of life (HRQoL) consists of a number of components like functional status, psychological and social functioning, cognition and disease and treatment-related symptoms. End-stage renal disease (ESRD) patients display emotional disturbances, as well as non-adherence to treatment and fluid and food intake, depression, anxiety, social withdrawal and cardiovascular and other co-existing disease morbidity. They have very low functional capacity and physical limitations in their daily activities that affect their mortality and morbidity. Exercise training in ESRD patients is effective in increasing work related activities and important components of their daily life and improving physical functioning. A physical rehabilitation program also leads to a reduction in depression and improvement in family and social interactions. Therefore, renal rehabilitation should be considered as an important therapeutic method for improving physical fitness, social function, well-being and thus health-adjusted quality of life in ESRD patients.

Weight management program for treatment-emergent weight gain in olanzapine-treated patients with schizophrenia or schizoaffective disorder: A 12-week randomized controlled clinical trial.

PubMed

Kwon, Jun Soo; Choi, Jung-Seok; Bahk, Won-Myoung; Yoon Kim, Chang; Hyung Kim, Chan; Chul Shin, Young; Park, Byung-Joo; Geun Oh, Chang

2006-04-01

The main objective was to assess the efficacy of a weight management program designed for outpatients taking olanzapine for schizophrenia or schizoaffective disorder and to compare these patients with a randomized control group. The effects of the weight management program were also assessed with regard to safety and quality of life. Forty-eight patients were enrolled in a 12-week, randomized, multicenter weight management study. Thirty-three patients were randomly allocated to an intervention group in which they received olanzapine within a weight management program. Fifteen patients were allocated to a control group in which they were given olanzapine treatment as usual outpatients. Weight, body mass index (BMI), and measurements of safety and quality of life were evaluated. The study was conducted from January 7, 2003, to September 16, 2003. Thirty-six patients (75%) completed this study. We found significant differences in weight (-3.94 +/- 3.63 kg vs. -1.48 +/- 1.88 kg, p = .006) and BMI (-1.50 +/- 1.34 vs. -0.59 +/- 0.73, p = .007) change from baseline to endpoint between the intervention and control groups, respectively. Significant differences in weight reduction were initially observed at week 8 (p = .040). No significant differences were found with regard to the safety outcomes. When the ratio of low-density lipoproteins to high-density lipoproteins was calculated, change from baseline was greater in the intervention group than the control group (-0.19 vs. -0.04), but the difference was not statistically significant (p = .556). After the completion of the weight management program, there was a trend toward statistical difference in the physical health score changes between the weight management and control groups (1.12 in the intervention group vs. -0.93 in the control group, p = .067). The weight management program was effective in terms of weight reduction in patients with schizophrenia or schizoaffective disorder taking olanzapine and was also found to be safe in terms of psychiatric symptoms, vital signs, and laboratory data. In addition, such a weight management program might improve quality of life in patients with schizophrenia or schizoaffective disorder with respect to their physical well-being.

A nonpharmacological approach to improve sleep quality in older adults.

PubMed

Rawtaer, Iris; Mahendran, Rathi; Chan, Hui Yu; Lei, Feng; Kua, Ee Heok

2018-06-01

Poor sleep quality is highly prevalent among older adults and is associated with poor quality of life, cognitive and physical decline, depression, and increased mortality. Medication options commonly used are not ideal, and alternative treatment strategies are needed. We evaluate a community-based psychosocial intervention program and its effect on sleep quality in older adults. Elderly participants aged 60 and above were included. Those with Geriatric Depression Scale and Geriatric Anxiety Inventory scores above 5 and 10, respectively, were excluded. The community program included tai chi exercise, art therapy, mindfulness awareness practice, and music reminiscence therapy. Pittsburgh Sleep Quality Index, Geriatric Depression Scale, and Geriatric Anxiety Inventory were administered at baseline and at 1 year. A hundred and eighty-nine subjects (44 men, 145 women; mean age = 69 years, SD = 5.7, range = 60-89) participated. The proportion of participants with good sleep quality had increased from 58.2% to 64.6%. Sleep disturbance was significantly reduced (baseline, 1.04; postintervention, 0.76; mean difference 0.28; P < .01); men experienced greater improvement (P < .001). Improvements were independent of changes in depressive and anxiety symptoms. Participation in this community program led to positive effects on sleep disturbances after a year. Psychosocial interventions have potential as a nondrug intervention approach for sleep problems, and further research is needed to understand its mediating mechanisms. © 2017 John Wiley & Sons Australia, Ltd.

Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment.

PubMed

Dimeo, F; Schwartz, S; Wesel, N; Voigt, A; Thiel, E

2008-08-01

Fatigue is a relevant problem of cancer patients during and after treatment. Several studies have shown that exercise can improve quality of life and functional status of cancer patients undergoing chemo- or radiotherapy. However, there is a lack of information about the effects of this intervention on persistent cancer-related fatigue. Therefore, we assessed the effects of an exercise program on cancer-related fatigue after treatment. A consecutive series of 32 cancer patients with mild to severe persistent fatigue [scores on the Brief Fatigue Inventory (BFI) > 25] participated in a 3-week exercise program consisting of endurance (30 min walking on a treadmill) and resistance/coordination exercises for the major muscle groups. Fatigue, mood, and anxiety were assessed with questionnaires and physical performance with a stress test before and after the program. At the end of the program, we observed a significant increase of physical performance (workload at the anaerobic threshold pre 61 +/- 26 W, post 78 +/- 31 W, P < 0.0001) and reduction of global fatigue (Functional Assessment of Cancer Therapy: pre 45.7 +/- 13.4, post 52.6 +/- 12.4, P < 0.0001; BFI: pre 37.9 +/- 18.3, post 31.2 +/-17.1, P < 0.001). However, no significant improvement of cognitive fatigue or reduction of anxiety was observed. A 3-week exercise program leads to a substantial improvement of physical performance and reduction of mental and physical fatigue in cancer patients after treatment. However, this intervention does not affect depression, anxiety, or cognitive fatigue.

Urban household food security, Madagascar.

PubMed

Balachander, J

1997-12-01

This article discusses the success of the Madagascar Food Security and Nutrition project in decreasing malnutrition and monitoring child health. Success has occurred in the following realms: effective collaboration between government and nongovernmental organizations (NGOs), capacity building through investment in training of community workers, increased quality of services provided by community nutrition workers, community involvement, government commitment, and a flexible program design. NGOs were able to respond to community concerns by adding program inputs without losing the focus on core nutrition interventions. Community workers were selected from a group of mothers. Women were trained to monitor the growth of all children under age 5. Children who were severely malnourished were identified and referred to rehabilitation centers for treatment lasting up to 3 weeks. The program offered support and nutrition education for mothers of sick children. One drawback of the treatment program was the inability of mothers to stay for long periods of time during the duration of treatment. The program offers distribution of iodine capsules as part of a long-term salt iodization program that is supported by UNICEF and the World Bank. The program also offers microcredit. Since 1993, 28,000 children under age 5 have been weighed each month. These children came from two provinces and belonged to 300,000 families. The monitored children were 66% of the total number of children aged under 5 years. Malnutrition rates decreased from 46% to 37%.

Reforming the community research program: from Community Clinical Oncology Program to the National Cancer Institute Community Oncology Research Program.

PubMed

Zon, Robin T

2014-01-01

Community research has been an integral and influential component of the National Research Program since the late 1970s. Institutionalization of community research in the Community Clinical Oncology Program (CCOP) has resulted in successful collaborations, meaningful accrual, achievement of quality standards, and translation of research into clinical practice. Although the national clinical trial system is undergoing modernization and improvement, the success of the CCOP and minority-based CCOP in cancer treatment, prevention, and control research is being extended to include cancer care delivery research in the newly created National Cancer Institute (NCI) Community Oncology Research Program. This article briefly presents a historic perspective of community involvement in federally sponsored clinical trials and introduces the continued involvement in the newly created NCI program.

A randomized controlled trial examining Iyengar yoga for young adults with rheumatoid arthritis: a study protocol

PubMed Central

2011-01-01

Background Rheumatoid arthritis is a chronic, disabling disease that can compromise mobility, daily functioning, and health-related quality of life, especially in older adolescents and young adults. In this project, we will compare a standardized Iyengar yoga program for young people with rheumatoid arthritis to a standard care wait-list control condition. Methods/Design Seventy rheumatoid arthritis patients aged 16-35 years will be randomized into either the 6-week Iyengar yoga program (12 - 1.5 hour sessions twice weekly) or the 6-week wait-list control condition. A 20% attrition rate is anticipated. The wait-list group will receive the yoga program following completion of the first arm of the study. We will collect data quantitatively, using questionnaires and markers of disease activity, and qualitatively using semi-structured interviews. Assessments include standardized measures of general and arthritis-specific function, pain, mood, and health-related quality of life, as well as qualitative interviews, blood pressure/resting heart rate measurements, a medical exam and the assessment of pro-inflammatory cytokines. Data will be collected three times: before treatment, post-treatment, and two months following the treatment. Discussion Results from this study will provide critical data on non-pharmacologic methods for enhancing function in rheumatoid arthritis patients. In particular, results will shed light on the feasibility and potential efficacy of a novel intervention for rheumatoid arthritis symptoms, paving the way for a larger clinical trial. Trial Registration ClinicalTrials.gov NCT01096823 PMID:21255431

Interpersonal Responses and Pain Management Within the US Military.

PubMed

McGeary, Cindy A; Blount, Tabatha H; Peterson, Alan L; Gatchel, Robert J; Hale, Willie J; McGeary, Donald D

2016-06-01

Purpose Chronic pain poses a significant problem for the US military. The benefits of self-management treatments for chronic pain are well-documented, but interpersonal responses also influence physical and psychological health and may not be addressed through self-management treatments alone. The current study examines whether perceived interpersonal responses to pain, as measured by the Multidimensional Pain Inventory (MPI), change as a result of participation in an intensive pain management program. It was hypothesized that interpersonal responses to pain would be significantly correlated to psychosocial and physical pain outcomes and that interpersonal responses to pain would change significantly for completers of a functional restoration (FR) program compared to those who were randomized to treatment-as-usual in the military medical system. Methods Forty-four participants were randomly assigned to one of two treatment groups. One treatment group received FR (n = 26) and the other group received treatment-as-usual (n = 18). Significant other responses to chronic pain were measured by the MPI (Pain 23(4):345-356, 1985). Participants also completed measures of impacted quality of life, reported disability, psychological distress, fear avoidance, pain interference, and physical activity. Results Perceived higher punishing responses from a significant other were significantly related to worse physical health-related quality of life (p = .037), work-related fear avoidance (p = .008), pain interference (p = .026), affective distress (p = .039), and pain while lifting (p = .017). Perceived higher solicitous responses from significant others were significantly associated with lower mental health-related quality of life (p = .011), household activity (p = 017), general activity (p = .042), self-reported disability (p = .030), lifting capacity (p = .005), and aerobic capacity (p = .009). Conclusions While findings are preliminary and of limited scope, it appears that the perception of significant others' responses may be impacted by psychosocial and physical pain outcomes and may change after treatment. More work in this area is needed to uncover the benefits one might achieve when a significant other is included within the FR treatment framework.

Effect of health insurance and facility quality improvement on blood pressure in adults with hypertension in Nigeria: a population-based study.

PubMed

Hendriks, Marleen E; Wit, Ferdinand W N M; Akande, Tanimola M; Kramer, Berber; Osagbemi, Gordon K; Tanovic, Zlata; Gustafsson-Wright, Emily; Brewster, Lizzy M; Lange, Joep M A; Schultsz, Constance

2014-04-01

IMPORTANCE Hypertension is a major public health problem in sub-Saharan Africa, but the lack of affordable treatment and the poor quality of health care compromise antihypertensive treatment coverage and outcomes. OBJECTIVE To report the effect of a community-based health insurance (CBHI) program on blood pressure in adults with hypertension in rural Nigeria. DESIGN, SETTING, AND PARTICIPANTS We compared changes in outcomes from baseline (2009) between the CBHI program area and a control area in 2011 through consecutive household surveys. Households were selected from a stratified random sample of geographic areas. Among 3023 community-dwelling adults, all nonpregnant adults (aged ≥18 years) with hypertension at baseline were eligible for this study. INTERVENTION Voluntary CBHI covering primary and secondary health care and quality improvement of health care facilities. MAIN OUTCOMES AND MEASURES The difference in change in blood pressure from baseline between the program and the control areas in 2011, which was estimated using difference-in-differences regression analysis. RESULTS Of 1500 eligible households, 1450 (96.7%) participated, including 564 adults with hypertension at baseline (313 in the program area and 251 in the control area). Longitudinal data were available for 413 adults (73.2%) (237 in the program area and 176 in the control area). Baseline blood pressure in respondents with hypertension who had incomplete data did not differ between areas. Insurance coverage in the hypertensive population increased from 0% to 40.1% in the program area (n = 237) and remained less than 1% in the control area (n = 176) from 2009 to 2011. Systolic blood pressure decreased by 10.41 (95% CI, -13.28 to -7.54) mm Hg in the program area, constituting a 5.24 (-9.46 to -1.02)-mm Hg greater reduction compared with the control area (P = .02), where systolic blood pressure decreased by 5.17 (-8.29 to -2.05) mm Hg. Diastolic blood pressure decreased by 4.27 (95% CI, -5.74 to -2.80) mm Hg in the program area, a 2.16 (-4.27 to -0.05)-mm Hg greater reduction compared with the control area, where diastolic blood pressure decreased by 2.11 (-3.80 to -0.42) mm Hg (P = .04). CONCLUSIONS AND RELEVANCE Increased access to and improved quality of health care through a CBHI program was associated with a significant decrease in blood pressure in a hypertensive population in rural Nigeria. Community-based health insurance programs should be included in strategies to combat cardiovascular disease in sub-Saharan Africa.

Effect of exercise type on smoking cessation: a meta-analysis of randomized controlled trials.

PubMed

Klinsophon, Thaniya; Thaveeratitham, Premtip; Sitthipornvorakul, Ekalak; Janwantanakul, Prawit

2017-09-06

Exercise is one choice of additional treatment for smoking cessation by relieving nicotine withdrawal symptoms and smoking craving. The possible mechanism of the effect of exercise on relieving nicotine withdrawal symptoms and smoking craving is including affect, biological, and cognitive hypotheses. Evidence suggests that different types of exercise have different effects on these mechanisms. Therefore, type of exercise might have effect on smoking cessation. The purpose of this study is to systematically review randomized controlled trials to gain insight into which types of exercise are effective for smoking cessation. Publications were systemically searched up to November 2016 in several databases (PubMed, ScienceDirect, PEDro, Web of Science, Scopus and Cochrane Library), using the following keywords: "physical activity", "exercise", "smoking", "tobacco" and "cigarette". The methodological quality was assessed independently by two authors. Meta-analysis was conducted to examine the effectiveness of the type of exercise on smoking cessation. The quality of the evidence was assessed and rated according to the GRADE approach. 20 articles on 19 studies were judged to meet the selection criteria (seven low-risk of bias RCTs and 12 high-risk of bias RCTs). The findings revealed low quality evidence for the effectiveness of yoga for smoking cessation at the end of the treatment. The evidence found for no effect of aerobic exercise, resisted exercise, and a combined aerobic and resisted exercise program on smoking cessation was of low to moderate quality. Furthermore, very low to low quality evidence was found for no effect of physical activity on smoking cessation. There was no effect of aerobic exercise, resisted exercise, physical activity and combined aerobic and resisted exercise on smoking cessation. There was a positive effect on smoking cessation at the end of treatment in the program where yoga plus cognitive-behavioral therapy (CBT) was used. However, which of the two work is still to be studied.

Challenging stereotypes and changing attitudes: Improving quality of care for people with hepatitis C through Positive Speakers programs.

PubMed

Brener, Loren; Wilson, Hannah; Rose, Grenville; Mackenzie, Althea; de Wit, John

2013-01-01

Positive Speakers programs consist of people who are trained to speak publicly about their illness. The focus of these programs, especially with stigmatised illnesses such as hepatitis C (HCV), is to inform others of the speakers' experiences, thereby humanising the illness and reducing ignorance associated with the disease. This qualitative research aimed to understand the perceived impact of Positive Speakers programs on changing audience members' attitudes towards people with HCV. Interviews were conducted with nine Positive Speakers and 16 of their audience members to assess the way in which these sessions were perceived by both speakers and the audience to challenge stereotypes and stigma associated with HCV and promote positive attitude change amongst the audience. Data were analysed using Intergroup Contact Theory to frame the analysis with a focus on whether the program met the optimal conditions to promote attitude change. Findings suggest that there are a number of vital components to this Positive Speakers program which ensures that the program meets the requirements for successful and equitable intergroup contact. This Positive Speakers program thereby helps to deconstruct stereotypes about people with HCV, while simultaneously increasing positive attitudes among audience members with the ultimate aim of improving quality of health care and treatment for people with HCV.

A comparison of water-based and land-based core stability exercises in patients with lumbar disc herniation: a pilot study.

PubMed

Bayraktar, Deniz; Guclu-Gunduz, Arzu; Lambeck, Johan; Yazici, Gokhan; Aykol, Sukru; Demirci, Harun

2016-01-01

To determine and compare the effects of core stability exercise programs performed in two different environments in lumbar disc herniation (LDH) patients. Thirty-one patients who were diagnosed with LDH and were experiencing pain or functional disability for at least 3 months were randomly divided into two groups as land-based exercises or water specific therapy. Also, 15 age-sex-matched healthy individuals were recruited as healthy controls. Both groups underwent an 8-week (3 times/week) core stabilization exercise program. Primary outcomes were pain, trunk muscle static endurance and perceived disability level. The secondary outcome was health-related quality of life. Level of static endurance of trunk muscles was found to be lower in the patients compared to the controls at baseline (p < 0.05). Both treatment groups showed significant improvements in all outcomes (p < 0.05) after 8-week intervention. When two treatment groups were compared, no differences were found in the amount of change after the intervention (p > 0.05). After the treatment, static endurance of trunk muscles of the LDH patients became similar to controls (p > 0.05). According to these results, core stabilization exercise training performed on land or in water both could be beneficial in LDH patients and there is no difference between the environments. An 8-week core stabilization program performed in water or on land decrease pain level and improve functional status in LDH patients. Both programs seem beneficial to increase health-related quality of life and static endurance of trunk muscles. Core stability exercises could be performed in water as well, no differences were found between methods due to environment.

Use of Joint Commission International Standards to Evaluate and Improve Pediatric Oncology Nursing Care in Guatemala

PubMed Central

Day, Sara W.; McKeon, Leslie M.; Garcia, Jose; Wilimas, Judith A.; Carty, Rita M.; de Alarcon, Pedro; Antillon, Federico; Howard, Scott C.

2017-01-01

Background Inadequate nursing care is a major impediment to development of effective programs for treatment of childhood cancer in low-income countries. When the International Outreach Program at St. Jude Children’s Research Hospital established partner sites in low-income countries, few nurses had pediatric oncology skills or experience. A comprehensive nursing program was developed to promote the provision of quality nursing care, and in this manuscript we describe the program’s impact on 20 selected Joint Commission International (JCI) quality standards at the National Pediatric Oncology Unit in Guatemala. We utilized JCI standards to focus the nursing evaluation and implementation of improvements. These standards were developed to assess public hospitals in low-income countries and are recognized as the gold standard of international quality evaluation. Methods We compared the number of JCI standards met before and after the nursing program was implemented using direct observation of nursing care; review of medical records, policies, procedures, and job descriptions; and interviews with staff. Results In 2006, only 1 of the 20 standards was met fully, 2 partially, and 17 not met. In 2009, 16 were met fully, 1 partially, and 3 not met. Several factors contributed to the improvement. The pre-program quality evaluation provided objective and credible findings and an organizational framework for implementing change. The medical, administrative, and nursing staff worked together to improve nursing standards. Conclusion A systematic approach and involvement of all hospital disciplines led to significant improvement in nursing care that was reflected by fully meeting 16 of 20 standards. PMID:23015363

An evaluation of substance misuse treatment providers used by an employee assistance program.

PubMed

Miller, N A

1992-05-01

Structural measures of access, continuity, and quality of substance misuse treatment services were compared in 30 fee-for-service (FFS) facilities and nine health maintenance organizations (HMOs). Probit models related effects of the provider system (FFS or HMO) and the system's structural characteristics to 243 employees' access to and outcomes from treatment. Access was decreased in Independent Practice Association (IPA)/network HMOs and in all facilities which did not employ an addictionologist or provide coordinated treatment services. When bivariate correlations were examined, both use of copayments and imposing limits to the levels of treatment covered were negatively related to access, while a facility's provision of ongoing professional development was positively associated with access. These correlations did not remain significant in the multivariate probits. Receiving treatment in a staff model HMO and facing limits to the levels of treatment covered were negatively associated with attaining sufficient progress, while receiving treatment in a facility which provided ongoing professional development was positively related to progress: these effects did not remain significant in multivariate analyses. Implications for employee assistance program (EAP) staff in their role as case managers and for EAP staff and employers in their shared role as purchasers of treatment are discussed.

Improved self-management skills predict improvements in quality of life and depression in patients with chronic disorders.

PubMed

Musekamp, Gunda; Bengel, Jürgen; Schuler, Michael; Faller, Hermann

2016-08-01

Self-management programs aim to improve patients' skills to manage their chronic condition in everyday life. Improvement in self-management is assumed to bring about improvements in more distal outcomes, such as quality of life. This study aimed to test the hypothesis that changes in self-reported self-management skills observed after participation in self-management programs predict changes in both quality of life and depressive symptoms three months later. Using latent change modeling, the relationship between changes in latent variables over three time points (start and end of rehabilitation, after three months) was analysed. The sample comprised 580 patients with different chronic conditions treated in inpatient rehabilitation clinics. The influence of additional predictor variables (age, sex, perceived social support) and type of disorder as a moderator variable was also tested. Changes in self-reported self-management skills after rehabilitation predicted changes in both quality of life and depressive symptoms at the end of rehabilitation and the 3 months follow-up. These relationships remained significant after the inclusion of other predictor variables and were similar across disorders. The findings provide support for the hypothesis that improvements in proximal outcomes of self-management programs may foster improvements in distal outcomes. Further studies should investigate treatment mechanisms. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Intensive Versus Distributed Aphasia Therapy: A Nonrandomized, Parallel-Group, Dosage-Controlled Study.

PubMed

Dignam, Jade; Copland, David; McKinnon, Eril; Burfein, Penni; O'Brien, Kate; Farrell, Anna; Rodriguez, Amy D

2015-08-01

Most studies comparing different levels of aphasia treatment intensity have not controlled the dosage of therapy provided. Consequently, the true effect of treatment intensity in aphasia rehabilitation remains unknown. Aphasia Language Impairment and Functioning Therapy is an intensive, comprehensive aphasia program. We investigated the efficacy of a dosage-controlled trial of Aphasia Language Impairment and Functioning Therapy, when delivered in an intensive versus distributed therapy schedule, on communication outcomes in participants with chronic aphasia. Thirty-four adults with chronic, poststroke aphasia were recruited to participate in an intensive (n=16; 16 hours per week; 3 weeks) versus distributed (n=18; 6 hours per week; 8 weeks) therapy program. Treatment included 48 hours of impairment, functional, computer, and group-based aphasia therapy. Distributed therapy resulted in significantly greater improvements on the Boston Naming Test when compared with intensive therapy immediately post therapy (P=0.04) and at 1-month follow-up (P=0.002). We found comparable gains on measures of participants' communicative effectiveness, communication confidence, and communication-related quality of life for the intensive and distributed treatment conditions at post-therapy and 1-month follow-up. Aphasia Language Impairment and Functioning Therapy resulted in superior clinical outcomes on measures of language impairment when delivered in a distributed versus intensive schedule. The therapy progam had a positive effect on participants' functional communication and communication-related quality of life, regardless of treatment intensity. These findings contribute to our understanding of the effect of treatment intensity in aphasia rehabilitation and have important clinical implications for service delivery models. © 2015 American Heart Association, Inc.

Implementation of a "No Fly" safety culture in a multicenter radiation medicine department.

PubMed

Potters, Louis; Kapur, Ajay

2012-01-01

The safe delivery of radiation therapy requires multiple disciplines and interactions to perform flawlessly for each patient. Because treatment is individualized and every aspect of the patient's care is unique, it is difficult to regiment a delivery process that works flawlessly. The purpose of this study is to describe one safety-directed component of our quality program called the "No Fly Policy" (NFP). Our quality assurance program for radiation therapy reviewed the entire process of care prior, during, and after a patient's treatment course. Each component of care was broken down and rebuilt within a matrix of multidisciplinary safety quality checklists (QCL). The QCL process map was subsequently streamlined with revised task due dates and stopping rules. The NFP was introduced to place a holding pattern on treatment initiation pending reconciliation of associated stopping events. The NFP was introduced in a pilot phase using a Six-Sigma process improvement approach. Quantitative analysis on the performance of the new QCLs was performed using crystal reports in the Oncology Information Systems. Root cause analysis was conducted. Notable improvements in QCL performance were observed. The variances among staff in completing tasks reduced by a factor of at least 3, suggesting better process control. Steady improvements over time indicated an increasingly compliant and controlled adoption of the new safety-oriented process map. Stopping events led to rescheduling treatments with average and maximum delays of 2 and 4 days, respectively, with no reported adverse effects. The majority of stopping events were due to incomplete plan approvals stemming from treatment planning delays. Whereas these may have previously solicited last-minute interventions, including intensity modulated radiation therapy quality assurance, the NFP enabled nonpunitive, reasonable schedule adjustments to mitigate compromises in safe delivery. Implementation of the NFP has helped to mitigate risk from expedited care, convert reactive to proactive delays, and created a checklist, process driven, and variance-reducing culture in a large, multicenter department. Copyright © 2012 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Posttreatment attrition and its predictors, attrition bias, and treatment efficacy of the anxiety online programs.

PubMed

Al-Asadi, Ali M; Klein, Britt; Meyer, Denny

2014-10-14

Although relatively new, the field of e-mental health is becoming more popular with more attention given to researching its various aspects. However, there are many areas that still need further research, especially identifying attrition predictors at various phases of assessment and treatment delivery. The present study identified the predictors of posttreatment assessment completers based on 24 pre- and posttreatment demographic and personal variables and 1 treatment variable, their impact on attrition bias, and the efficacy of the 5 fully automated self-help anxiety treatment programs for generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder with or without agoraphobia (PD/A), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). A complex algorithm was used to diagnose participants' mental disorders based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders were offered an online 12-week disorder-specific treatment program. A total of 3199 individuals did not formally drop out of the 12-week treatment cycle, whereas 142 individuals formally dropped out. However, only 347 participants who completed their treatment cycle also completed the posttreatment assessment measures. Based on these measures, predictors of attrition were identified and attrition bias was examined. The efficacy of the 5 treatment programs was assessed based on anxiety-specific severity scores and 5 additional treatment outcome measures. On average, completers of posttreatment assessment measures were more likely to be seeking self-help online programs; have heard about the program from traditional media or from family and friends; were receiving mental health assistance; were more likely to learn best by reading, hearing and doing; had a lower pretreatment Kessler-6 total score; and were older in age. Predicted probabilities resulting from these attrition variables displayed no significant attrition bias using Heckman's method and thus allowing for the use of completer analysis. Six treatment outcome measures (Kessler-6 total score, number of diagnosed disorders, self-confidence in managing mental health issues, quality of life, and the corresponding pre- and posttreatment severity for each program-specific anxiety disorder and for major depressive episode) were used to assess the efficacy of the 5 anxiety treatment programs. Repeated measures MANOVA revealed a significant multivariate time effect for all treatment outcome measures for each treatment program. Follow-up repeated measures ANOVAs revealed significant improvements on all 6 treatment outcome measures for GAD and PTSD, 5 treatment outcome measures were significant for SAD and PD/A, and 4 treatment outcome measures were significant for OCD. Results identified predictors of posttreatment assessment completers and provided further support for the efficacy of self-help online treatment programs for the 5 anxiety disorders. Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG).

Analysis of Gap in Service Quality in Drug Addiction Treatment Centers of Kerman, Iran, Using SERVQUAL Model

PubMed Central

Naqavi, Mohammad Reza; Refaiee, Raheleh; Baneshi, Mohammad Reza; Nakhaee, Nouzar

2014-01-01

Background Treatment of drug addicts is one of the main strategies of drug control in Iran. Client satisfaction strongly influences the success of any treatment program. This study aimed to explore the difference between customer expectations and perceptions in drug addiction treatment centers of Kerman, Iran, using SERVQUAL model. Methods Using a cross-sectional design 260 clients referring to drug addiction treatment centers of Kerman, were enrolled in 2012. From among 84 clinics, 20 centers were selected randomly. Based on the number of clients registered in each center, a random sample proportional to the size was selected and 290 subjects were invited for interviews. A well validated 22-item questionnaire, which measured the 5 dimensions of service quality (reliability, assurance, tangibility, empathy, and responsiveness), was completed by participants. Each item measured 2 aspects of service quality; expectations and perceptions. Findings Mean ± SD (Standard deviation) age of the subjects was 37.7 ± 9.4. Most of them were male (87.7%). Less than half of them had an educational level lower than diploma. The total score of clients` expectations was higher than their perceptions (P < 0.001). Considering the 5 dimensions of the SERVQUAL model, only 1 dimension (i.e., assurance) showed no difference between perceptions and expectations of the participants (P = 0.134). Conclusion There was a gap between the clients’ expectations and what they actually perceived in the clinics. Thus, more attention should be devoted to the clients’ views regarding service quality in addiction treatment clinics. PMID:25984274

Evaluating the electronic tuberculosis register surveillance system in Eden District, Western Cape, South Africa, 2015.

PubMed

Mlotshwa, Mandla; Smit, Sandra; Williams, Seymour; Reddy, Carl; Medina-Marino, Andrew

2017-01-01

Tuberculosis (TB) surveillance data are crucial to the effectiveness of National TB Control Programs. In South Africa, few surveillance system evaluations have been undertaken to provide a rigorous assessment of the platform from which the national and district health systems draws data to inform programs and policies. Evaluate the attributes of Eden District's TB surveillance system, Western Cape Province, South Africa. Data quality, sensitivity and positive predictive value were assessed using secondary data from 40,033 TB cases entered in Eden District's ETR.Net from 2007 to 2013, and 79 purposively selected TB Blue Cards (TBCs), a medical patient file and source document for data entered into ETR.Net. Simplicity, flexibility, acceptability, stability and usefulness of the ETR.Net were assessed qualitatively through interviews with TB nurses, information health officers, sub-district and district coordinators involved in the TB surveillance. TB surveillance system stakeholders report that Eden District's ETR.Net system was simple, acceptable, flexible and stable, and achieves its objective of informing TB control program, policies and activities. Data were less complete in the ETR.Net (66-100%) than in the TBCs (76-100%), and concordant for most variables except pre-treatment smear results, antiretroviral therapy (ART) and treatment outcome. The sensitivity of recorded variables in ETR.Net was 98% for gender, 97% for patient category, 93% for ART, 92% for treatment outcome and 90% for pre-treatment smear grading. Our results reveal that the system provides useful information to guide TB control program activities in Eden District. However, urgent attention is needed to address gaps in clinical recording on the TBC and data capturing into the ETR.Net system. We recommend continuous training and support of TB personnel involved with TB care, management and surveillance on TB data recording into the TBCs and ETR.Net as well as the implementation of a well-structured quality control and assurance system.

The effect of performance-based financing on illness, care-seeking and treatment among children: an impact evaluation in Rwanda.

PubMed

Skiles, Martha Priedeman; Curtis, Siân L; Basinga, Paulin; Angeles, Gustavo; Thirumurthy, Harsha

2015-09-14

Performance-based financing (PBF) strategies are promoted as a supply-side, results-based financing mechanism to improve primary health care. This study estimated the effects of Rwanda's PBF program on less-incentivized child health services and examined the differential program impact by household poverty. Districts were allocated to intervention and comparison for PBF implementation in Rwanda. Using Demographic Health Survey data from 2005 to 2007-08, a community-level panel dataset of 5781 children less than 5 years of age from intervention and comparison districts was created. The impacts of PBF on reported childhood illness, facility care-seeking, and treatment received were estimated using a difference-in-differences model with community fixed effects. An interaction term between poverty and the program was estimated to identify the differential effect of PBF among children from poorer families. There was no measurable difference in estimated probability of reporting illness with diarrhea, fever or acute respiratory infections between the intervention and comparison groups. Seeking care at a facility for these illnesses increased over time, however no differential effect by PBF was seen. The estimated effect of PBF on receipt of treatment for poor children is 45 percentage points higher (p = 0.047) compared to the non-poor children seeking care for diarrhea or fever. PBF, a supply-side incentive program, improved the quality of treatment received by poor children conditional on patients seeking care, but it did not impact the propensity to seek care. These findings provide additional evidence that PBF incentivizes the critical role staff play in assuring quality services, but does little to influence consumer demand for these services. Efforts to improve child health need to address both supply and demand, with additional attention to barriers due to poverty if equity in service use is a concern.

[Efficiency of kinesi- and hydrokinesitherapy in children with bronchial asthma].

PubMed

Surovenko, T N; Iashchuk, A V; Iansons, T Ia; Ezhov, S N

2003-01-01

The authors review efficiency of various programs of kinesi and hydrokinesitherapy of children with atopic bronchial asthma (BA). Efficiency of the treatment was assessed by quality of life using the questionnaire by A. West, D. French "Childhood asthma questionnaire" (adapted for Russia by V. I. Petrov et al). Monitoring of the activity of allergic inflammation of the upper respiratory tracts was performed by examination of the nasal lavage fluid for nitric oxide metabolites, of the lower respiratory tracts--by the metabolites in the condensate of the expired air. It is shown that hydrokinesitherapy raises BA children's quality of life and declines inflammation activity leading to reduction of the number of BA exacerbations and hospitalizations. The above criteria of the treatment efficacy proved sensitive.

Improved Design Process Part of the Ship Producibility Program of the National Shipbuilding Research Program

DTIC Science & Technology

1977-04-01

Exh and Escape Fresh Water Feed Treatment Cargo Oil Tank Cleaning Diesel Generator Piping Piping Material Schedule List of Motors and... tank length frame and stiffener spacing, etc. One yard buys only mill edge plates, and one yard buys only cold flange quality plates. 2-13 C. POST...gage boards, all interconnecting piping and valves, and all mounted on a common foundation, or a pump room assembled on a tank top unit. Use of packages

Naval Outpatient Medical Care and Services: A Comparison of the Perceptions of Satisfaction Held by Sub-Groupings of a Beneficiary Population

DTIC Science & Technology

1985-07-01

include: a Health Care Consumers’ Council that provides a formal communication mechanism between health care managers and the consumers; 5 a Patient... Management Program (HCQA/RMP). The method for identifying the patients’ level of satisfaction is through satisfaction survey questionnaires and the purpose...care they receive in Military Treatment Facilities. This is part of a feedback mechanism of the Quality Assurance/Risk Management Program developed to

Optimisation of near-infrared reflectance model in measuring protein and amylose content of rice flour.

PubMed

Xie, L H; Tang, S Q; Chen, N; Luo, J; Jiao, G A; Shao, G N; Wei, X J; Hu, P S

2014-01-01

Near-infrared reflectance spectroscopy (NIRS) has been used to predict the cooking quality parameters of rice, such as the protein (PC) and amylose content (AC). Using brown and milled flours from 519 rice samples representing a wide range of grain qualities, this study was to compare the calibration models generated by different mathematical, preprocessing treatments, and combinations of different regression algorithm. A modified partial least squares model (MPLS) with the mathematic treatment "2, 8, 8, 2" (2nd order derivative computed based on 8 data points, and 8 and 2 data points in the 1st and 2nd smoothing, respectively) and inverse multiplicative scattering correction preprocessing treatment was identified as the best model for simultaneously measurement of PC and AC in brown flours. MPLS/"2, 8, 8, 2"/detrend preprocessing was identified as the best model for milled flours. The results indicated that NIRS could be useful in estimation of PC and AC of breeding lines in early generations of the breeding programs, and for the purposes of quality control in the food industry. Copyright © 2013 Elsevier Ltd. All rights reserved.

Assessment of Reactive Catch Basin Larvicide Treatments Toward Improved Water Quality Using FourStar(®) Briquets and CocoBear™ Larvicide Oil.

PubMed

Harbison, Justin E; Zazra, Dave; Henry, Marlon; Xamplas, Christopher; Kafensztok, Ruth

2015-09-01

Because it is often logistically impossible to monitor all catch basins within an operational area, local mosquito control programs will preemptively treat catch basins with larvicides each season. However, these larvicides can, ostensibly, be considered water quality pollutants. To experimentally reduce the use of larvicides toward improving water quality, 30 basins within a small 0.7-km(2) residential area were monitored weekly for the presence of larvae and pupae for 14 wk in the summer of 2013. Once a basin was found to reach a threshold of 12 mosquitoes per dip sample, it received a FourStar® Briquet (a 180-day briquet formulation of 6% Bacillus sphaericus and 1% B. thuringiensis israelensis). Each week a FourStar-treated basin surpassed this threshold, it was treated with an application of CocoBear™ oil (10% mineral oil). By the end of trials, all but one basin received a briquet and 13 required at least 4 treatments of CocoBear, suggesting that preemptive treatment is appropriate for the study area.

The Impact of a Cognitive Behavioral Pain Management Program on Sleep in Patients with Chronic Pain: Results of a Pilot Study.

PubMed

Blake, Catherine; Cunningham, Jennifer; Power, Camillus K; Horan, Sheila; Spencer, Orla; Fullen, Brona M

2016-02-01

To determine the impact of a cognitive behavioral pain management program on sleep in patients with chronic pain. Prospective nonrandomized controlled pilot study with evaluations at baseline and 12 weeks. Out-patient multidisciplinary cognitive behavioral pain management program in a university teaching hospital. Patients with chronic pain who fulfilled the criteria for participation in a cognitive behavioral pain management program. Patients assigned to the intervention group (n = 24) completed a 4 week cognitive behavioral pain management program, and were compared with a waiting list control group (n = 22). Assessments for both groups occurred at baseline and two months post cognitive behavioral pain management program. Outcome measures included self-report (Pittsburgh Sleep Quality Index) and objective (actigraphy) sleep measures, pain and quality of life measures. Both groups were comparable at baseline, and all had sleep disturbance. The Pittsburgh Sleep Quality Index correlated with only two of the seven objective sleep measures (fragmentation index r = 0.34, P = 0.02, and sleep efficiency percentage r = -0.31, P = 0.04). There was a large treatment effect for cognitive behavioral pain management program group in mean number of wake bouts (d = 0.76), where a significant group*time interaction was also found (P = 0.016), showing that the CBT-PMP group improved significantly more than controls in this sleep variable. Patients attending a cognitive behavioral pain management program have high prevalence of sleep disturbance, and actigraphy technology was well tolerated by the patients. Preliminary analysis of the impact of a cognitive behavioral pain management program on sleep is promising, and warrants further investigation.

Cancer nutrition and rehabilitation—its time has come!

PubMed Central

Chasen, M.R.; Dippenaar, A.P.

2008-01-01

Cancer is a systemic disease that can affect nearly every organ in the body, resulting in a progressive loss of organ function. That loss of function may be initially slow, having minimal effect, or it may be rapid, resulting in more dramatic changes. The usual medical management of patients with cancer has focused more specifically on the administration of cytotoxic treatments. These treatments can potentially eradicate or minimize the tumour, but they may also have toxic side effects that in turn can also affect the patient. Cancer rehabilitation is a process that assists the individual with a cancer diagnosis to obtain optimal physical, social, psychological, and vocational functioning within the limits created by the disease and its treatment. The McGill Cancer Nutrition and Rehabilitation (cnr) program developed as a result of the ever-increasing demand for a focus on addressing individual cancer patients and their needs, as well as on achieving optimal tumour-related outcomes. Using an interdisciplinary approach, the cnr’s global objective is to empower individuals who are experiencing loss of function, fatigue, malnutrition, psychological distress, and other symptoms as a result of cancer or its treatment to improve their own quality of life. All team members—experts in their respective fields—assess all patients. At a subsequent team discussion and planning meeting, a specific 8-week program is designed for each patient. The hoped-for outcome for the cnr program is primarily to empower patients to “take control” or to enable them to improve their own quality of life. This article reviews the philosophy of the cnr’s approach and the roles played by the various members of the team. PMID:18596892

Database-supported teleconferencing: an additional clinical mentoring tool to assist a multinational company HIV/AIDS treatment program in Africa.

PubMed

Clevenbergh, P; Van der Borght, S F M; van Cranenburgh, K; Janssens, V; Kitenge Lubangi, C; Gahimbaza, L; Lange, J M A; Rinke de Wit, T F; Rijckborst, H

2006-01-01

The lack of human resources for health is presently recognized as a major factor limiting scale-up of antiretroviral treatment (ART) programs in resourcelimited settings. The mobilization of public and private partners, the decentralization of care, and the training of non-HIV specialist nurses and general practitioners could help increase the number of HIV-infected patients receiving ART. In addition to other forms of training, scheduled teleconferences (TCs) have been organized to support a comprehensive HIV treatment program delivered by a private company's health team. To describe the role of the TC as an additional tool in mentoring a company's health care workers (HCWs). For this study, all TC reports were retrospectively reviewed and the questions classified by topic. Participating Heineken physicians evaluated the technical quality and scientific relevance of the TCs through an anonymous survey. From October 2001 to December 2003, 10 HCWs working in 14 operating companies in 5 African countries raised 268 problems during 45 TCs. A total of 79 questions (29%) were asked about antiretroviral (ARV) therapy, 53 (20%) about the diagnosis and treatment of opportunistic infection, 43 (16%) about ARV toxicity, 40 (15%) about care organization and policy, 32 (12%) about laboratory or drug supply, and 21 (8%) about biological parameters. The mean TC attendance rate was 70%. The level of satisfaction among local company physicians was 65% for logistics, 89% for scientific relevance, 84% for applicability of advice, and 85% overall. The most common complaints concerned the poor quality of the telephone connection and language problems for francophone participants. Database-supported teleconferencing could be an additional tool to mentor company HCWs in their routine care of HIV-infected workers and family members. The role and costeffectiveness of telemedicine in improving health outcomes should be further studied.

Effects of a Short-Term Dance Movement Therapy Program on Symptoms and Stress in Patients With Breast Cancer Undergoing Radiotherapy: A Randomized, Controlled, Single-Blind Trial.

PubMed

Ho, Rainbow T H; Fong, Ted C T; Cheung, Irene K M; Yip, Paul S F; Luk, Mai-Yee

2016-05-01

Integrated interventions with combined elements of body movement and psychotherapy on treatment-related symptoms in cancer patients are relatively scarce. The aim of the present study is to investigate the effectiveness of dance movement therapy (DMT) on improving treatment-related symptoms in a randomized controlled trial. A total of 139 Chinese patients with breast cancer awaiting adjuvant radiotherapy were randomized to DMT or control group. The intervention included six 1.5-hour DMT sessions provided twice a week over the course of radiotherapy. Self-report measures on perceived stress, anxiety, depression, fatigue, pain, sleep disturbance, and quality of life were completed before and after the three-week program. DMT showed significant effects on buffering the deterioration in perceived stress, pain severity, and pain interference (Cohen d = 0.34-0.36, P < 0.05). No significant intervention effects were found on anxiety, depression, fatigue, sleep disturbance, and quality of life (Cohen d = 0.01-0.20, P > 0.05). The short-term DMT program can counter the anticipated worsening of stress and pain in women with breast cancer during radiotherapy. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Air Toxics Under the Big Sky: Examining the Effectiveness of Authentic Scientific Research on High School Students' Science Skills and Interest.

PubMed

Ward, Tony J; Delaloye, Naomi; Adams, Earle Raymond; Ware, Desirae; Vanek, Diana; Knuth, Randy; Hester, Carolyn Laurie; Marra, Nancy Noel; Holian, Andrij

2016-01-01

Air Toxics Under the Big Sky is an environmental science outreach/education program that incorporates the Next Generation Science Standards (NGSS) 8 Practices with the goal of promoting knowledge and understanding of authentic scientific research in high school classrooms through air quality research. A quasi-experimental design was used in order to understand: 1) how the program affects student understanding of scientific inquiry and research and 2) how the open inquiry learning opportunities provided by the program increase student interest in science as a career path . Treatment students received instruction related to air pollution (airborne particulate matter), associated health concerns, and training on how to operate air quality testing equipment. They then participated in a yearlong scientific research project in which they developed and tested hypotheses through research of their own design regarding the sources and concentrations of air pollution in their homes and communities. Results from an external evaluation revealed that treatment students developed a deeper understanding of scientific research than did comparison students, as measured by their ability to generate good hypotheses and research designs, and equally expressed an increased interest in pursuing a career in science. These results emphasize the value of and need for authentic science learning opportunities in the modern science classroom.

Air Toxics Under the Big Sky: examining the effectiveness of authentic scientific research on high school students' science skills and interest

NASA Astrophysics Data System (ADS)

Ward, Tony J.; Delaloye, Naomi; Adams, Earle Raymond; Ware, Desirae; Vanek, Diana; Knuth, Randy; Hester, Carolyn Laurie; Marra, Nancy Noel; Holian, Andrij

2016-04-01

Air Toxics Under the Big Sky is an environmental science outreach/education program that incorporates the Next Generation Science Standards (NGSS) 8 Practices with the goal of promoting knowledge and understanding of authentic scientific research in high school classrooms through air quality research. This research explored: (1) how the program affects student understanding of scientific inquiry and research and (2) how the open-inquiry learning opportunities provided by the program increase student interest in science as a career path. Treatment students received instruction related to air pollution (airborne particulate matter), associated health concerns, and training on how to operate air quality testing equipment. They then participated in a yearlong scientific research project in which they developed and tested hypotheses through research of their own design regarding the sources and concentrations of air pollution in their homes and communities. Results from an external evaluation revealed that treatment students developed a deeper understanding of scientific research than did comparison students, as measured by their ability to generate good hypotheses and research designs, and equally expressed an increased interest in pursuing a career in science. These results emphasize the value of and need for authentic science learning opportunities in the modern science classroom.

Air Toxics Under the Big Sky: Examining the Effectiveness of Authentic Scientific Research on High School Students’ Science Skills and Interest

PubMed Central

Delaloye, Naomi; Adams, Earle Raymond; Ware, Desirae; Vanek, Diana; Knuth, Randy; Hester, Carolyn Laurie; Marra, Nancy Noel; Holian, Andrij

2016-01-01

Air Toxics Under the Big Sky is an environmental science outreach/education program that incorporates the Next Generation Science Standards (NGSS) 8 Practices with the goal of promoting knowledge and understanding of authentic scientific research in high school classrooms through air quality research. A quasi-experimental design was used in order to understand: 1) how the program affects student understanding of scientific inquiry and research and 2) how the open inquiry learning opportunities provided by the program increase student interest in science as a career path. Treatment students received instruction related to air pollution (airborne particulate matter), associated health concerns, and training on how to operate air quality testing equipment. They then participated in a yearlong scientific research project in which they developed and tested hypotheses through research of their own design regarding the sources and concentrations of air pollution in their homes and communities. Results from an external evaluation revealed that treatment students developed a deeper understanding of scientific research than did comparison students, as measured by their ability to generate good hypotheses and research designs, and equally expressed an increased interest in pursuing a career in science. These results emphasize the value of and need for authentic science learning opportunities in the modern science classroom. PMID:28286375

Multiple Interactive Pollutants in Water Quality Trading

NASA Astrophysics Data System (ADS)

Sarang, Amin; Lence, Barbara J.; Shamsai, Abolfazl

2008-10-01

Efficient environmental management calls for the consideration of multiple pollutants, for which two main types of transferable discharge permit (TDP) program have been described: separate permits that manage each pollutant individually in separate markets, with each permit based on the quantity of the pollutant or its environmental effects, and weighted-sum permits that aggregate several pollutants as a single commodity to be traded in a single market. In this paper, we perform a mathematical analysis of TDP programs for multiple pollutants that jointly affect the environment (i.e., interactive pollutants) and demonstrate the practicality of this approach for cost-efficient maintenance of river water quality. For interactive pollutants, the relative weighting factors are functions of the water quality impacts, marginal damage function, and marginal treatment costs at optimality. We derive the optimal set of weighting factors required by this approach for important scenarios for multiple interactive pollutants and propose using an analytical elasticity of substitution function to estimate damage functions for these scenarios. We evaluate the applicability of this approach using a hypothetical example that considers two interactive pollutants. We compare the weighted-sum permit approach for interactive pollutants with individual permit systems and TDP programs for multiple additive pollutants. We conclude by discussing practical considerations and implementation issues that result from the application of weighted-sum permit programs.

Comparison of university and private-practice orthodontic treatment outcomes with the American Board of Orthodontics objective grading system.

PubMed

Cook, Devon R; Harris, Edward F; Vaden, James L

2005-06-01

Treatment outcomes and duration of treatment for patients treated in university graduate orthodontic programs and private orthodontic practices were assessed and compared with the ABO objective grading system. The treatment records of 139 randomly selected adolescents who had received comprehensive orthodontic treatment were examined. Seventy-seven subjects had been treated in 3 postgraduate orthodontic clinics, and 62 had been treated in 3 private orthodontic practices. Pretreatment, all subjects had Class II Division 1 malocclusions and ANB angles equal to or greater than 4 degrees . All patients were treated with premolar extractions. Posttreatment dental casts were measured and scored with the ABO objective grading system. No significant differences were found between the groups in the alignment, buccolingual inclination, and overjet components. Patients treated in private practice had significantly lower scores for marginal ridge height and occlusal relationship. Patients treated in the university programs had significantly lower scores for occlusal contact and interproximal contact components. There was no significant difference in the overall score, thus no significant difference in the overall quality of orthodontic treatment outcome between patients treated in university programs and private practices. However, the university group had a significantly larger sample variance for the overall score. There was no significant difference in the duration of the treatment between patients treated in a university setting and in a private practice.

Hospital ownership and performance: evidence from stroke and cardiac treatment in Taiwan.

PubMed

Lien, Hsien-Ming; Chou, Shin-Yi; Liu, Jin-Tan

2008-09-01

This paper compares program expenditure and treatment quality of stroke and cardiac patients between 1997 and 2000 across hospitals of various ownership types in Taiwan. Because Taiwan implemented national health insurance in 1995, the analysis is immune from problems arising from the complex setting of the U.S. health care market, such as segmentation of insurance status or multiple payers. Because patients may select admitted hospitals based on their observed and unobserved characteristics, we employ instrument variable (IV) estimation to account for the endogeneity of ownership status. Results of IV estimation find that patients admitted to non-profit hospitals receive better quality care, either measured by 1- or 12-month mortality rates. In terms of treatment expenditure, our results indicate no difference between non-profits and for-profits index admission expenditures, and at most 10% higher long-term expenditure for patients admitted to non-profits than to for-profits.

Organization of population-based cancer control programs: Europe and the world.

PubMed

Otter, Renée; Qiao, You-Lin; Burton, Robert; Samiei, Massoud; Parkin, Max; Trapido, Edward; Weller, David; Magrath, Ian; Sutcliffe, Simon

2009-01-01

As cancer is to a large extent avoidable and treatable, a cancer control program should be able to reduce mortality and morbidity and improve the quality of life of cancer patients and their families. However, the extent to which the goals of a cancer control program can be achieved will depend on the resource constraints a country faces. Such population-based cancer control plans should prioritize effective interventions and programs that are beneficial to the largest part of the population, and should include activities devoted to prevention, screening and early detection, treatment, palliation and end-of-life care, and rehabilitation. In order to develop a successful cancer control program, leadership and the relevant stakeholders, including patient organizations, need to be identified early on in the process so that all partners can take ownership and responsibility for the program. Various tools have been developed to aid them in the planning and implementation process. However, countries developing a national cancer control program would benefit from a discussion of different models for planning and delivery of population-based cancer control in settings with differing levels of resource commitment, in order to determine how best to proceed given their current level of commitment, political engagement and resources. As the priority assigned to different components of cancer control will differ depending on available resources and the burden and pattern of cancer, it is important to consider the relative roles of prevention, early detection, diagnosis, treatment, rehabilitation and palliative care in a cancer control program, as well as how to align available resources to meet prioritized needs. Experiences from countries with differing levels of resources are presented and serve to illustrate the difficulties in developing and implementing cancer control programs, as well as the innovative strategies that are being used to maximize available resources and enhance the quality of care provided to cancer patients around the world.

Failure mode and effects analysis based risk profile assessment for stereotactic radiosurgery programs at three cancer centers in Brazil.

PubMed

Teixeira, Flavia C; de Almeida, Carlos E; Saiful Huq, M

2016-01-01

The goal of this study was to evaluate the safety and quality management program for stereotactic radiosurgery (SRS) treatment processes at three radiotherapy centers in Brazil by using three industrial engineering tools (1) process mapping, (2) failure modes and effects analysis (FMEA), and (3) fault tree analysis. The recommendations of Task Group 100 of American Association of Physicists in Medicine were followed to apply the three tools described above to create a process tree for SRS procedure for each radiotherapy center and then FMEA was performed. Failure modes were identified for all process steps and values of risk priority number (RPN) were calculated from O, S, and D (RPN = O × S × D) values assigned by a professional team responsible for patient care. The subprocess treatment planning was presented with the highest number of failure modes for all centers. The total number of failure modes were 135, 104, and 131 for centers I, II, and III, respectively. The highest RPN value for each center is as follows: center I (204), center II (372), and center III (370). Failure modes with RPN ≥ 100: center I (22), center II (115), and center III (110). Failure modes characterized by S ≥ 7, represented 68% of the failure modes for center III, 62% for center II, and 45% for center I. Failure modes with RPNs values ≥100 and S ≥ 7, D ≥ 5, and O ≥ 5 were considered as high priority in this study. The results of the present study show that the safety risk profiles for the same stereotactic radiotherapy process are different at three radiotherapy centers in Brazil. Although this is the same treatment process, this present study showed that the risk priority is different and it will lead to implementation of different safety interventions among the centers. Therefore, the current practice of applying universal device-centric QA is not adequate to address all possible failures in clinical processes at different radiotherapy centers. Integrated approaches to device-centric and process specific quality management program specific to each radiotherapy center are the key to a safe quality management program.

[Qualitative evaluation of TAMARPP, the relapse prevention program for substance abusers at the Mental Health and Welfare Center].

PubMed

Taniai, Tomoko; Yottsuji, Naomi; Okuda, Hidemi; Karibe, Haruo; Miura, Kasumi; Hiraga, Masasi; Kondo, Ayumi; Matsumoto, Toshihiko

2014-12-01

The development of an effective treatment system for patients with addiction-related problems like substance abuse or pathological gambling is urgently needed. The purpose of this study was to clarify the therapeutic factors of the Tama Mental Health and Welfare Center Relapse Prevention Program (TAMARPP). The program is provided at the Tama Comprehensive Center for Mental Health and Welfare, which is operated publicly by the Tokyo Metropolitan Government. Seven personnel (3 clinical psychologists, 2 public health nurses, and 2 recovering counselors) searched the consultation records of 31 participants who had continued treatment longer than 1 year, and made a list of qualitative factors that may positively impact participant outcome. The following six factors were extracted: 1) a "no-blame" atmosphere that makes participants feel safe and free; 2) a mutual helping process that enables participants to empathize with one another; 3) an individual-centered approach that focuses on a participant's motivation to recover; 4) a psycho-educational process that establishes treatment goals; 5) a treatment goal that involves some type of social role; and 6) the referral of graduates to another long-term treatment program such as Narcotics Anonymous. Our results suggest the need of personnel to provide treatment as follows: 1) keep the circumstances safe; 2) use a method that matches the participant's motivation; 3) refer graduates to another in-depth treatment program; 4) emphasize the relationship between thinking, emotion, and behavior; and 5) improve the quality of life of the participant. The missions of our center, an official institution that runs such a program, are as follows: 1) to be the first place at which addicts seek aid during the early stage; 2) to cooperate with other facilities in order to provide social resources that support recovery; and 3) to support patients suffering from both addiction and comorbid psychiatric diseases.

Cost-Effectiveness of the Hepatitis C Self-Management Program

ERIC Educational Resources Information Center

Groessl, Erik J.; Sklar, Marisa; Laurent, Diana D.; Lorig, Kate; Ganiats, Theodore G.; Ho, Samuel B.

2017-01-01

Background. Despite the emergence of new hepatitis C virus (HCV) antiviral medications, many people with chronic HCV know little about their disease, are at risk for transmitting HCV to others, and/or are not considered good treatment candidates. Self-management interventions can educate HCV-infected persons, improve their quality of life, and…

New quality assurance program integrating "modern radiotherapy" within the German Hodgkin Study Group.

PubMed

Kriz, J; Baues, C; Engenhart-Cabillic, R; Haverkamp, U; Herfarth, K; Lukas, P; Schmidberger, H; Marnitz-Schulze, S; Fuchs, M; Engert, A; Eich, H T

2017-02-01

Field design changed substantially from extended-field RT (EF-RT) to involved-field RT (IF-RT) and now to involved-node RT (IN-RT) and involved-site RT (IS-RT) as well as treatment techniques in radiotherapy (RT) of Hodgkin's lymphoma (HL). The purpose of this article is to demonstrate the establishment of a quality assurance program (QAP) including modern RT techniques and field designs within the German Hodgkin Study Group (GHSG). In the era of modern conformal RT, this QAP had to be fundamentally adapted and a new evaluation process has been intensively discussed by the radiotherapeutic expert panel of the GHSG. The expert panel developed guidelines and criteria to analyse "modern" field designs and treatment techniques. This work is based on a dataset of 11 patients treated within the sixth study generation (HD16-17). To develop a QAP of "modern RT", the expert panel defined criteria for analysing current RT procedures. The consensus of a modified QAP in ongoing and future trials is presented. With this schedule, the QAP of the GHSG could serve as a model for other study groups.

Sustainability of ARV provision in developing countries: challenging a framework based on program history.

PubMed

Azeredo, Thiago Botelho; Oliveira, Maria Auxiliadora; Santos-Pinto, Cláudia Du Bocage; Miranda, Elaine Silva; Osorio-de-Castro, Claudia Garcia Serpa

2017-08-01

The provision of ARVs is central to HIV/AIDS programs, because of its impact on the course of the disease and on quality of life. Although first-line treatments costs have declined, treatment-associated expenses are steeper each year. Sustainability is therefore an important variable for the success of treatment programs. A conceptual framework on sustainability of ARV provision was developed, followed by data collection instruments. The pilot study was undertaken in Brazil. Bolivia, Peru and Mozambique, were visited. Key informants were identified and interviewed. Investigation of sustainability related to ARV provision involved implementation and routinization events of provision schemes. Evidence of greater sustainability potential was observed in Peru, where provision is implemented and routinized by the National HIV/AIDS program and expenditures met by the government. In Mozambique, provision is dependent on donations and external aid, but the country displays a great effort to incorporate ARV provision and care in routine healthcare activities. Bolivia, in addition to external dependence on financing and management of drug supply, presents problems regarding implementation and routinization. The conceptual framework was useful in recognizing events that influence sustainable ARV provision in these countries.

Blended care; development of a day treatment program for medically unexplained physical symptoms (MUPS) in the Dutch Armed Forces.

PubMed

Zeylemaker, M M P; Linn, F H H; Vermetten, E

2015-01-01

A subgroup of servicemen can be identified that seek a disproportionally amount of health care in comparison to diagnostic and therapeutic perspectives. This group can be identified on the basis of an absence of a structural medical explanation for their symptoms. The symptoms manifest predominantly as fatigue and pain, and are often chronic. Patients with medical unexplained medical symptoms (MUPS) often have multiple and complex problems that would be best treated by a multidisciplinary team of medical specialists and paramedics. The military is characterized by high loyalty towards peers and leadership, leading to neglect for personal care. While consensus on the biological basis for these complaints is lacking, awareness on the need for effective treatments for this patient group is high. Based on reviews, expert recommendations and clinical demand, a specialized treatment program for soldiers with MUPS has recently been developed and implemented in the system of health care in the Netherlands Armed Forces. We developed a functional rehabilitation program with blended care elements of cognitive behavioral therapy (CBT), physical therapy, case management, and psychoeducation, embedded in a day treatment setting. The program received high scores on participant as well as team satisfaction. The program is illustrated by two clinical vignettes. The blended care program for MUPS that focused on allostatic load awareness offered a more holistic and preventive approach that contributed to a reduction of unnecessary medical consumption, and increased job participation. We recommend that the development of guidelines for diagnoses and treatment of these complaints in military settings will improve the quality of patient care, reduce disability, facilitate reintegration, and encourage scientific research.

The Cost-Effectiveness of the Kiva Antibullying Program: Results from a Decision-Analytic Model.

PubMed

Persson, Mattias; Wennberg, Linn; Beckman, Linda; Salmivalli, Christina; Svensson, Mikael

2018-05-04

Bullying causes substantial suffering for children and adolescents. A number of bullying prevention programs have been advocated as effective methods for counteracting school bullying. However, there is a lack of economic evaluations of bullying prevention programs assessing the "value for money." The aim of this study was to assess the cost-effectiveness of the Finnish bullying prevention program KiVa in comparison to "status quo" (treatment as usual) in a Swedish elementary school setting (grades 1 to 9). The cost-effectiveness analysis was carried out using a payer perspective based on a Markov cohort model. The costs of the program were measured in Swedish kronor and Euros, and the benefits were measured using two different metrics: (1) the number of victim-free years and (2) the number of quality adjusted life years (QALYs). Data on costs, probability transitions, and health-related quality of life measures were retrieved from published literature. Deterministic and probabilistic sensitivity analyses were carried out to establish the uncertainty of the cost-effectiveness results. The base-case analysis indicated that KiVa leads to an increased cost of €829 for a gain of 0.47 victim-free years per student. In terms of the cost per gained QALY, the results indicated a base-case estimate of €13,823, which may be seen as cost-effective given that it is lower than the typically accepted threshold value in Swedish health policy of around €50,000. Further research is needed to confirm the conclusions of this study, especially regarding the treatment effects of KiVa in different school contexts.

The Effectiveness of Structured Group Education on Ankylosing Spondylitis Patients.

PubMed

Kasapoglu Aksoy, Meliha; Birtane, Murat; Taştekin, Nurettin; Ekuklu, Galip

2017-04-01

Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease that affects the axial skeleton which can lead to structural and functional impairments. It has a negative impact on the person's daily life activities. Early diagnosis, exercise and patient education are factors playing a major role on prognosis. The purpose of the study was to compare the structured theoretical and exercise educational program with routine clinic educational efforts on the parameters of the disorder over a 3 month follow up. This randomized, educational intervention study was performed on 41 AS patients. A 5 day structured education and exercise program was applied to the first group of patients (Group 1) in subgroups consisting 4-5 patients each. Patients had group exercises throughout the education program. The second group followed routine clinical care. The effectiveness of the treatment was assessed by Bath ankylosing spondylitis functional (BASFI), Bath ankylosing spondylitis disease activity (BASDAI), Bath ankylosing spondylitis global (BAS-G), Bath ankylosing spondylitis metrology indices (BASMI), chest expansion, short form-36 (SF-36), ankylosing spondylitis quality of life scale (ASQoL) and laboratory parameters in all patients. Patients were evaluated on initiation and after 3 months. Significant improvements in BASFI, BASDAI and BAS-G, chest expansion, SF-36 and ASQoL indices were observed in Group 1 No difference could be found in BASMI and chest expansion. A structured educational and exercise intervention had a positive effect on the functional status,disease activity, and general well-being and quality of life. It also, shows that education programs should be within the routine treatment program for AS.

The effects of exercise training in a weight loss lifestyle intervention on asthma control, quality of life and psychosocial symptoms in adult obese asthmatics: protocol of a randomized controlled trial.

PubMed

Freitas, Patricia D; Ferreira, Palmira G; da Silva, Analuci; Trecco, Sonia; Stelmach, Rafael; Cukier, Alberto; Carvalho-Pinto, Regina; Salge, João Marcos; Fernandes, Frederico L A; Mancini, Marcio C; Martins, Milton A; Carvalho, Celso R F

2015-10-21

Asthma and obesity are public health problems with increasing prevalence worldwide. Clinical and epidemiologic studies have demonstrated that obese asthmatics have worse clinical control and health related quality of life (HRQL) despite an optimized medical treatment. Bariatric surgery is successful to weight-loss and improves asthma control; however, the benefits of nonsurgical interventions remain unknown. This is a randomized controlled trial with 2-arms parallel. Fifty-five moderate or severe asthmatics with grade II obesity (BMI ≥ 35 kg/m(2)) under optimized medication will be randomly assigned into either weight-loss program + sham (WL + S group) or weight-loss program + exercise (WL + E group). The weight loss program will be the same for both groups including nutrition and psychological therapies (every 15 days, total of 6 sessions, 60 min each). Exercise program will include aerobic and resistance muscle training while sham treatment will include a breathing and stretching program (both programs twice a week, 3 months, 60 min each session). The primary outcome variable will be asthma clinical control. Secondary outcomes include HRQL, levels of depression and anxiety, lung function, daily life physical activity, body composition, maximal aerobic capacity, strength muscle and sleep disorders. Potential mechanism (changes in lung mechanical and airway/systemic inflammation) will also be examined to explain the benefits in both groups. This study will bring a significant contribution to the literature evaluating the effects of exercise conditioning in a weight loss intervention in obese asthmatics as well as will evaluate possible involved mechanisms. NCT02188940.

Design of the Physical exercise during Adjuvant Chemotherapy Effectiveness Study (PACES): a randomized controlled trial to evaluate effectiveness and cost-effectiveness of physical exercise in improving physical fitness and reducing fatigue.

PubMed

van Waart, Hanna; Stuiver, Martijn M; van Harten, Wim H; Sonke, Gabe S; Aaronson, Neil K

2010-12-07

Cancer chemotherapy is frequently associated with a decline in general physical condition, exercise tolerance, and muscle strength and with an increase in fatigue. While accumulating evidence suggests that physical activity and exercise interventions during chemotherapy treatment may contribute to maintaining cardiorespiratory fitness and strength, the results of studies conducted to date have not been consistent. Additional research is needed to determine the optimal intensity of exercise training programs in general and in particular the relative effectiveness of supervised, outpatient (hospital- or physical therapy practice-based) versus home-based programs. This multicenter, prospective, randomized trial will evaluate the effectiveness of a low to moderate intensity, home-based, self-management physical activity program, and a high intensity, structured, supervised exercise program, in maintaining or enhancing physical fitness (cardiorespiratory fitness and muscle strength), in minimizing fatigue and in enhancing the health-related quality of life (HRQoL). Patients receiving adjuvant chemotherapy for breast or colon cancer (n = 360) are being recruited from twelve hospitals in the Netherlands, and randomly allocated to one of the two treatment groups or to a 'usual care' control group. Performance-based and self-reported outcomes are assessed at baseline, at the end of chemotherapy and at six month follow-up. This large, multicenter, randomized clinical trial will provide additional empirical evidence regarding the effectiveness of physical exercise during adjuvant chemotherapy in enhancing physical fitness, minimizing fatigue, and maintaining or enhancing patients' quality of life. If demonstrated to be effective, exercise intervention programs will be a welcome addition to the standard program of care offered to patients with cancer receiving chemotherapy. This study is registered at the Netherlands Trial Register (NTR 2159).

Applications of Fluorescence Spectroscopy for dissolved organic matter characterization in wastewater treatment plants

NASA Astrophysics Data System (ADS)

Goffin, Angélique; Guérin, Sabrina; Rocher, Vincent; Varrault, Gilles

2016-04-01

Dissolved organic matter (DOM) influences wastewater treatment plants efficiency (WTTP): variations in its quality and quantity can induce a foaming phenomenon and a fouling event inside biofiltration processes. Moreover, in order to manage denitrification step (control and optimization of the nitrate recirculation), it is important to be able to estimate biodegradable organic matter quantity before biological treatment. But the current methods used to characterize organic matter quality, like biological oxygen demand are laborious, time consuming and sometimes not applicable to directly monitor organic matter in situ. In the context of MOCOPEE research program (www.mocopee.com), this study aims to assess the use of optical techniques, such as UV-Visible absorbance and more specifically fluorescence spectroscopy in order to monitor and to optimize process efficiency in WWTP. Fluorescence excitation-emission matrix (EEM) spectroscopy was employed to prospect the possibility of using this technology online and in real time to characterize dissolved organic matter in different effluents of the WWTP Seine Centre (240,000 m3/day) in Paris, France. 35 sewage water influent samples were collected on 10 days at different hours. Data treatment were performed by two methods: peak picking and parallel factor analysis (PARAFAC). An evolution of DOM quality (position of excitation - emission peaks) and quantity (intensity of fluorescence) was observed between the different treatment steps (influent, primary treatment, biological treatment, effluent). Correlations were found between fluorescence indicators and different water quality key parameters in the sewage influents. We developed different multivariate linear regression models in order to predict a variety of water quality parameters by fluorescence intensity at specific excitation-emission wavelengths. For example dissolved biological oxygen demand (r2=0,900; p<0,0001) and ammonium concentration (r2=0,898; p<0,0001) present good correlation with specific fluorescence peaks and indicators. These indicators derived from 3D spectrofluorescence could be used in order to characterize DOM online and thus to optimize process efficiency in WWTP.

What Medical Directors Need to Know about Dialysis Facility Water Management.

PubMed

Kasparek, Ted; Rodriguez, Oscar E

2015-06-05

The medical directors of dialysis facilities have many operational clinic responsibilities, which on first glance, may seem outside the realm of excellence in patient care. However, a smoothly running clinic is integral to positive patient outcomes. Of the conditions for coverage outlined by the Centers for Medicare and Medicaid Services, one most critical to quality dialysis treatment is the provision of safe purified dialysis water, because there are many published instances where clinic failure in this regard has resulted in patient harm. As the clinical leader of the facility, the medical director is obliged to have knowledge of his/her facility's water treatment system to reliably ensure that the purified water used in dialysis will meet the standards for quality set by the Association for the Advancement of Medical Instrumentation and used by the Centers for Medicare and Medicaid Services for conditions for coverage. The methods used to both achieve and maintain these quality standards should be a part of quality assessment and performance improvement program meetings. The steps for water treatment, which include pretreatment, purification, and distribution, are largely the same, regardless of the system used. Each water treatment system component has a specific role in the process and requires individualized maintenance and monitoring. The medical director should provide leadership by being engaged with the process, knowing the facility's source water, and understanding water treatment system operation as well as the clinical significance of system failure. Successful provision of quality water will be achieved by those medical directors who learn, know, and embrace the requirements of dialysis water purification and system maintenance. Copyright © 2015 by the American Society of Nephrology.

Setting the Stage: Current State of Affairs and Major Challenges

PubMed Central

Reynolds, Steven J.; Quinn, Thomas C.

2010-01-01

The global human immunodeficiency virus (HIV) pandemic reached staggering proportions over the past 2 decades, particularly in areas of sub-Saharan Africa and other developing countries. Tremendous increases in donor resources over the past decade have allowed for a rapid scale-up of antiretroviral treatment and greater access to basic care and prevention programs in countries worst affected by HIV infection and AIDS. These programs have had a tremendous impact on the lives of millions of individuals and have also created optimism and hope where previously there was despair. Major challenges remain in combating the current HIV pandemic with regard to access to treatment; efficiency, quality, and sustainability of current programs; and the scale-up of evidence-based, effective prevention strategies. The global health community and political leaders will need to overcome these challenges if a long-term effective response to the HIV pandemic is to be achieved. PMID:20397959

A Multidisciplinary Patient Navigation Program Improves Compliance With Adjuvant Breast Cancer Therapy in a Public Hospital.

PubMed

Castaldi, Maria; Safadjou, Saman; Elrafei, Tarek; McNelis, John

Cancer health disparities affecting low-income and minority patients have been well documented to lead to poor outcomes. This report examines the impact of patient navigation on adherence to prescribed adjuvant breast cancer treatment. A multidisciplinary patient navigation program was initiated at a public safety net hospital to improve compliance with 3 National Quality Forum measures: (1) administration of combination chemotherapy for women with Stage (defined by the American Joint Committee on Cancer [AJCC]) T1c, II, or III hormone receptor-negative breast cancer within 120 days; (2) administration of endocrine therapy for women with AJCC Stage T1c, II, or III hormone receptor-positive breast cancer within 365 days; and (3) radiation therapy for women receiving breast-conserving surgery within one year. Implementation of a multidisciplinary patient navigation program reduced time to treatment and improved compliance with adjuvant therapy for breast cancer in an underserved minority community.

Virtual reality rehabilitation as a treatment approach for older women with mixed urinary incontinence: a feasibility study.

PubMed

Elliott, Valérie; de Bruin, Eling D; Dumoulin, Chantale

2015-03-01

Motivated patients are more likely to adhere to treatment resulting in better outcomes. Virtual reality rehabilitation (VRR) is a treatment approach that includes video gaming to enhance motivation and functional training. The study objectives were (1) to evaluate the feasibility of using a combination of pelvic floor muscles (PFM) exercises and VRR (PFM/VRR) to treat mixed urinary incontinence (MUI) in older women, (2) to evaluate the effectiveness of the PFM/VRR program on MUI symptoms, quality of life (QoL), and (3) gather quantitative information regarding patient satisfaction with this new combined training program. Women 65 years and older with at least 2 weekly episodes of MUI were recruited. Participants were evaluated two times before and one time after a 12-week PFM/VRR training program. Feasibility was defined as the participants' rate of participation in and completion of both the PFM/VRR training program and the home exercise. Effectiveness was evaluated through a bladder diary, pad test, symptom and QoL questionnaire, and participant's satisfaction through a questionnaire. Twenty-four women (70.5 ± 3.6 years) participated. The participants complied with the study demands in terms of attendance at the weekly treatment sessions (91%), adherence to home exercise (92%) and completion of the three evaluations (96%). Post-intervention, the frequency and quantity of urine leakage decreased and patient-reported symptoms and QoL improved significantly. Most participants were very satisfied with treatment (91%). A combined PFM/VRR program is an acceptable, efficient, and satisfying functional treatment for older women with MUI and should be explore through further RCTs. © 2014 Wiley Periodicals, Inc.

SU-F-T-234: Quality Improvements in the Electronic Medical Record of Patients Treated with High Dose-Rate Brachytherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Diener, T; Wilkinson, D

Purpose: To improve workflow efficiency and patient safety by assessing the quality control documentation for HDR brachytherapy within our Electronic Medical Record System (Mosaiq). Methods: A list of parameters based on NRC regulations, our quality management program (QMP), recommendations of the ACR and the American Brachytherapy Society, and HDR treatment planning risks identified in our previous FMEA study was made. Next, the parameter entries were classified according to the type of data input—manual, electronic, or both. Manual entry included the electronic Brachytherapy Treatment Record (BTR) and pre-treatment Mosaiq Assessments list. Oncentra Treatment Reports (OTR) from the Oncentra Treatment Control Systemmore » constituted the electronic data. The OTR includes a Pre-treatment Report for each fraction, and a Treatment Summary Report at the completion of treatment. Each entry was then examined for appropriateness and completeness of data; adjustments and additions as necessary were then made. Results: Ten out of twenty-one recorded treatment parameters were identified to be documented within both the BTR and OTR. Of these ten redundancies, eight were changed from recorded values to a simple checklist in the BTR to avoid recording errors. The other redundancies were kept in both documents due to their value to ensuring patient safety. An edit was made to the current BTR quality assessment; this change revises the definition of a medical event in accordance with ODH Regulation 3701:1-58-101. One addition was made to the current QMP documents regarding HDR. This addition requires a physician to be present through the duration of HDR treatment in accordance with ODH Regulation 3701:1-58-59; Paragraph (F); Section (2); Subsection (a). Conclusion: Careful examination of HDR documentation that originates from different sources can help to improve the accuracy and reliability of the documents. In addition, there may be a small improvement in efficiency due to elimination of unnecessary redundancies.« less

Improvement in quality-of-life questionnaire measures in obese adolescent females with polycystic ovary syndrome treated with lifestyle changes and oral contraceptives, with or without metformin.

PubMed

Harris-Glocker, Miranda; Davidson, Kristin; Kochman, Lynda; Guzick, David; Hoeger, Kathleen

2010-02-01

We studied the effect of metformin or placebo in a lifestyle modification program combined with oral contraceptives (OC) on quality-of-life parameters measured by the polycystic ovary syndrome (PCOS) questionnaire in obese adolescent women with validated PCOS. The quality-of-life indicators were measured at baseline and conclusion for five domains on the PCOS questionnaire, with equal improvement in scores in both placebo and metformin groups, suggesting that the addition of metformin does not add improvement to quality-of-life measures above those observed with lifestyle modification and OC treatment. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Tuberculosis: evidence review for newly arriving immigrants and refugees

PubMed Central

Greenaway, Christina; Sandoe, Amelia; Vissandjee, Bilkis; Kitai, Ian; Gruner, Doug; Wobeser, Wendy; Pottie, Kevin; Ueffing, Erin; Menzies, Dick; Schwartzman, Kevin

2011-01-01

Background: The foreign-born population bears a disproportionate health burden from tuberculosis, with a rate of active tuberculosis 20 times that of the non-Aboriginal Canadian-born population, and could therefore benefit from tuberculosis screening programs. We reviewed evidence to determine the burden of tuberculosis in immigrant populations, to assess the effectiveness of screening and treatment programs for latent tuberculosis infection, and to identify potential interventions to improve effectiveness. Methods: We performed a systematic search for evidence of the burden of tuberculosis in immigrant populations and the benefits and harms, applicability, clinical considerations, and implementation issues of screening and treatment programs for latent tuberculosis infection in the general and immigrant populations. The quality of this evidence was assessed and ranked using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation). Results: Chemoprophylaxis with isoniazid is highly efficacious in decreasing the development of active tuberculosis in people with latent tuberculosis infection who adhere to treatment. Monitoring for hepatotoxicity is required at all ages, but close monitoring is required in those 50 years of age and older. Adherence to screening and treatment for latent tuberculosis infection is poor, but it can be increased if care is delivered in a culturally sensitive manner. Interpretation: Immigrant populations have high rates of active tuberculosis that could be decreased by screening for and treating latent tuberculosis infection. Several patient, provider and infrastructure barriers, poor diagnostic tests, and the long treatment course, however, limit effectiveness of current programs. Novel approaches that educate and engage patients, their communities and primary care practitioners might improve the effectiveness of these programs. PMID:20634392

Effects of Clinical Pilates Exercises on Patients Developing Lymphedema after Breast Cancer Treatment: A Randomized Clinical Trial.

PubMed

Şener, Hülya Özlem; Malkoç, Mehtap; Ergin, Gülbin; Karadibak, Didem; Yavuzşen, Tuğba

2017-01-01

The aim of the present study was to compare the effects of clinical Pilates exercises with those of the standard lymphedema exercises on lymphedema developing after breast cancer treatment. The study comprised 60 female patients with a mean age of 53.2±7.7 years who developed lymphedema after having breast cancer treatment. The patients were randomized into two groups: the clinical Pilates exercise group (n=30), and the control group (n=30). Before, and at the 8th week of treatment, the following parameters were measured: the severity of lymphedema, limb circumferences, body image using the Social Appearance Anxiety Scale, quality of life with the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-BR23), and upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Both groups performed one-hour exercises three days a week for 8 weeks. After treatment, the symptoms recovered significantly in both groups. Reductions in the severity of lymphedema, improvements in the social appearance anxiety scale scores, quality of life scores, and upper extremity functions scores in the clinical Pilates exercise group were greater than those in the control group. Clinical Pilates exercises were determined to be more effective on the symptoms of patients with lymphedema than were standard lymphedema exercises. Clinical Pilates exercises could be considered a safe model and would contribute to treatment programs.

Effects of Clinical Pilates Exercises on Patients Developing Lymphedema after Breast Cancer Treatment: A Randomized Clinical Trial

PubMed Central

Şener, Hülya Özlem; Malkoç, Mehtap; Ergin, Gülbin; Karadibak, Didem; Yavuzşen, Tuğba

2017-01-01

Objective The aim of the present study was to compare the effects of clinical Pilates exercises with those of the standard lymphedema exercises on lymphedema developing after breast cancer treatment. Materials and Methods The study comprised 60 female patients with a mean age of 53.2±7.7 years who developed lymphedema after having breast cancer treatment. The patients were randomized into two groups: the clinical Pilates exercise group (n=30), and the control group (n=30). Before, and at the 8th week of treatment, the following parameters were measured: the severity of lymphedema, limb circumferences, body image using the Social Appearance Anxiety Scale, quality of life with the European Organization for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-BR23), and upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure. Both groups performed one-hour exercises three days a week for 8 weeks. Results After treatment, the symptoms recovered significantly in both groups. Reductions in the severity of lymphedema, improvements in the social appearance anxiety scale scores, quality of life scores, and upper extremity functions scores in the clinical Pilates exercise group were greater than those in the control group. Clinical Pilates exercises were determined to be more effective on the symptoms of patients with lymphedema than were standard lymphedema exercises. Conclusions Clinical Pilates exercises could be considered a safe model and would contribute to treatment programs. PMID:28331763

The impact of length of stay on recovery measures in faith-based addiction treatment.

PubMed

Lashley, Mary

2018-03-30

To determine the impact of length of stay among homeless men in faith-based residential addictions recovery on physical activity, depression, self-esteem, and nicotine dependence. A time series design was utilized to measure changes in the four quality measures at program entry and at 3, 6, and 9 months following admission. The sample consisted of 175 homeless residents enrolled in a faith-based residential recovery program. Paired t tests were used to determine the change in average instrument response from admission to each follow-up period. Analysis of variance (ANOVA) and Tukey posthoc tests were used to assess for differences in length of stay between demographic variables. Statistically significant improvements were noted in self-esteem and depressive symptomatology at 3 and 6 months following admission and in physical activity levels at 3 months following admission. Nicotine dependence scores declined at 3 and 6 months but were not statistically significant. Time spent in this faith-based spiritual recovery program had a significant impact on depression, self-esteem, and physical activity. Recommendations for future study include conducting research to analyze the relationship between distinct program elements and quality indicators and comparing faith-based programs to other similar programs and to publicly funded secular recovery programs. © 2018 Wiley Periodicals, Inc.

Unique Practice, Unique Place: Exploring Two Assertive Community Treatment Teams in Maine.

PubMed

Schroeder, Rebecca A

2018-06-01

Assertive Community Treatment (ACT) is a model of care that provides comprehensive community-based psychiatric care for persons with serious mental illness. This model has been widely documented and has shown to be an evidence-based model of care for reducing hospitalizations for this targeted population. Critical ingredients of the ACT model are the holistic nature of their services, a team based approach to treatment and nurses who assist with illness management, medication monitoring, and provider collaboration. Although the model remains strong there are clear differences between urban and rural teams. This article describes present day practice in two disparate ACT programs in urban and rural Maine. It offers a new perspective on the evolving and innovative program of services that treat those with serious mental illness along with a review of literature pertinent to the ACT model and future recommendations for nursing practice. The success and longevity of these two ACT programs are testament to the quality of care and commitment of staff that work with seriously mentally ill consumers. Integrative care models such as these community-based treatment teams and nursing driven interventions are prime elements of this successful model.

Evaluation of a patient navigation program.

PubMed

Koh, Catherine; Nelson, Joan M; Cook, Paul F

2011-02-01

This study examined the value and effectiveness of a patient navigation program in terms of timeliness of access to cancer care, resolution of barriers, and satisfaction in 55 patients over a six-month period. Although not statistically significant, the time interval between diagnostic biopsy to first consultation with a cancer specialist after program implementation was reduced from an average of 14.6 days to 12.8 days. The time interval between diagnostic biopsy to initiation of cancer treatment also was reduced from 30 days to 26.2 days (not statistically significant). In addition, 71% of patient barriers were resolved by the time treatment was initiated. Overall, patients were highly satisfied with their navigated care experience. Consistent evaluation and monitoring of quality-of-care indicators are critical to further develop the program and to direct resource allocation. Oncology nurses participating in patient navigation programs should be encouraged to evaluate their importance and impact in this developing concept. Nurses should seek roles that allow them to optimize the effective use of their specialized knowledge and skills to the benefit of patients along the cancer care continuum.

Effects of a Yoga Program on Mood States, Quality of Life, and Toxicity in Breast Cancer Patients Receiving Conventional Treatment: A Randomized Controlled Trial

PubMed Central

Rao, Raghavendra Mohan; Raghuram, Nagaratna; Nagendra, Hongasandra Ramarao; Kodaganur, Gopinath S; Bilimagga, Ramesh S; Shashidhara, HP; Diwakar, Ravi B; Patil, Shekhar; Rao, Nalini

2017-01-01

Aims: The aim of this study is to compare the effects of yoga program with supportive therapy counseling on mood states, treatment-related symptoms, toxicity, and quality of life in Stage II and III breast cancer patients on conventional treatment. Methods: Ninety-eight Stage II and III breast cancer patients underwent surgery followed by adjuvant radiotherapy (RT) or chemotherapy (CT) or both at a cancer center were randomly assigned to receive yoga (n = 45) and supportive therapy counseling (n = 53) over a 24-week period. Intervention consisted of 60-min yoga sessions, daily while the control group was imparted supportive therapy during their hospital visits. Assessments included state-trait anxiety inventory, Beck's depression inventory, symptom checklist, common toxicity criteria, and functional living index-cancer. Assessments were done at baseline, after surgery, before, during, and after RT and six cycles of CT. Results: Both groups had similar baseline scores. There were 29 dropouts 12 (yoga) and 17 (controls) following surgery. Sixty-nine participants contributed data to the current analysis (33 in yoga, and 36 in controls). An ANCOVA, adjusting for baseline differences, showed a significant decrease for the yoga intervention as compared to the control group during RT (first result) and CT (second result), in (i) anxiety state by 4.72 and 7.7 points, (ii) depression by 5.74 and 7.25 points, (iii) treatment-related symptoms by 2.34 and 2.97 points, (iv) severity of symptoms by 6.43 and 8.83 points, (v) distress by 7.19 and 13.11 points, and (vi) and improved overall quality of life by 23.9 and 31.2 points as compared to controls. Toxicity was significantly less in the yoga group (P = 0.01) during CT. Conclusion: The results suggest a possible use for yoga as a psychotherapeutic intervention in breast cancer patients undergoing conventional treatment. PMID:28827925

The RESOLVE Trial for people with chronic low back pain: protocol for a randomised clinical trial.

PubMed

Bagg, Matthew K; Hübscher, Markus; Rabey, Martin; Wand, Benedict M; O'Hagan, Edel; Moseley, G Lorimer; Stanton, Tasha R; Maher, Chris G; Goodall, Stephen; Saing, Sopany; O'Connell, Neil E; Luomajoki, Hannu; McAuley, James H

2017-01-01

Low back pain is the leading worldwide cause of disability, and results in significant personal hardship. Most available treatments, when tested in high-quality randomised, controlled trials, achieve only modest improvements in pain, at best. Recently, treatments that target central nervous system function have been developed and tested in small studies. Combining treatments that target central nervous system function with traditional treatments directed towards functioning of the back is a promising approach that has yet to be tested in adequately powered, prospectively registered, clinical trials. The RESOLVE trial will be the first high-quality assessment of two treatment programs that combine central nervous system-directed and traditional interventions in order to improve chronic low back pain. To compare the effectiveness of two treatment programs that combine central nervous system-directed and traditional interventions at reducing pain intensity at 18 weeks post randomisation in a randomised clinical trial of people with chronic low back pain. Two-group, randomised, clinical trial with blinding of participants and assessors. Two hundred and seventy-five participants with chronic low back pain that has persisted longer than 3 months and no specific spinal pathology will be recruited from the community and primary care in Sydney, Australia. Both of the interventions contain treatments that target central nervous system function combined with treatments directed towards functioning of the back. Adherence to the intervention will be monitored using an individual treatment diary and adverse events recorded through passive capture. Participants are informed prior to providing informed consent that some of the treatments are not active. Blinding is maintained by not disclosing any further information. Complete disclosure of the contents of the intervention has been made with the UNSW HREC (HC15357) and an embargoed project registration has been made on the Open Science Framework to meet the Declaration of Helsinki requirement for transparent reporting of trial methods a priori. Participants randomised to Intervention A will receive a 12-session treatment program delivered as 60-minute sessions, scheduled approximately weekly, over a period of 12 to 18 weeks. All treatment sessions are one-on-one. The program includes a home treatment component of 30minutes, five times per week. The intervention comprises discussion of the participant's low back pain experience, graded sensory training, graded motor imagery training and graded, precision-focused and feedback-enriched, functional movement training. Treatment progression is determined by participant proficiency, with mandatory advancement at set time points with respect to a standard protocol. Participants randomised to Intervention B will receive a 12-session treatment program of the same duration and structure as Intervention A. The intervention comprises discussion of the participant's low back pain experience, transcranial direct current stimulation to the motor and pre-frontal cortices, cranial electrical stimulation, and low-intensity laser therapy and pulsed electromagnetic energy to the area of greatest pain. Treatment is delivered according to published recommendations and progressed with respect to a standard protocol. The primary outcome is pain intensity at 18 weeks post randomisation. Secondary outcomes will include disability, depression, pain catastrophising, kinesiophobia, beliefs about back pain, pain self-efficacy, quality of life, healthcare resource use, and treatment credibility. Assessment will occur at baseline and at 18, 26 and 52 weeks after randomisation. Treatment credibility will be assessed at baseline and 2 weeks after randomisation only. A statistician blinded to group status will analyse the data by intention-to-treat using linear mixed models with random intercepts. Linear contrasts will be constructed to compare the adjusted mean change (continuous variables) in outcome from baseline to each time point between intervention A and intervention B. This will provide effect estimates and 95% confidence intervals for any difference between the interventions. Preliminary data suggest that combining treatments that target central nervous system function with traditional interventions is a promising approach to chronic low back pain treatment. In the context of modest effects on pain intensity from most available treatments, this approach may lead to improved clinical outcomes for people with chronic low back pain. The trial will determine which, if either, of two treatment programs that combine central nervous system-directed and traditional interventions is more effective at reducing pain intensity in a chronic low back pain cohort. Central nervous system-directed interventions constitute a completely new treatment paradigm for chronic low back pain management. The results have the potential to be far reaching and change current physiotherapy management of chronic low back pain in Australia and internationally. Copyright © 2016 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

Efficacy of a multimodal physiotherapy treatment program for hip osteoarthritis: a randomised placebo-controlled trial protocol

PubMed Central

2010-01-01

Background Hip osteoarthritis (OA) is a common condition leading to pain, disability and reduced quality of life. There is currently limited evidence to support the use of conservative, non-pharmacological treatments for hip OA. Exercise and manual therapy have both shown promise and are typically used together by physiotherapists to manage painful hip OA. The aim of this randomised controlled trial is to compare the efficacy of a physiotherapy treatment program with placebo treatment in reducing pain and improving physical function. Methods The trial will be conducted at the University of Melbourne Centre for Health, Exercise and Sports Medicine. 128 participants with hip pain greater or equal to 40/100 on visual analogue scale (VAS) and evidence of OA on x-ray will be recruited. Treatment will be provided by eight community physiotherapists in the Melbourne metropolitan region. The active physiotherapy treatment will comprise a semi-structured program of manual therapy and exercise plus education and advice. The placebo treatment will consist of sham ultrasound and the application of non-therapeutic gel. The participants and the study assessor will be blinded to the treatment allocation. Primary outcomes will be pain measured by VAS and physical function recorded on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) immediately after the 12 week intervention. Participants will also be followed up at 36 weeks post baseline. Conclusions The trial design has important strengths of reproducibility and reflecting contemporary physiotherapy practice. The findings from this randomised trial will provide evidence for the efficacy of a physiotherapy program for painful hip OA. Trial Registration Australian New Zealand Clinical Trials Registry reference: ACTRN12610000439044 PMID:20946621

A systematic review of satisfaction and pediatric obesity treatment: new avenues for addressing attrition.

PubMed

Skelton, Joseph A; Irby, Megan Bennett; Geiger, Ann M

2014-01-01

Pediatric obesity treatment programs report high attrition rates, but it is unknown if family experience and satisfaction contributes. This review surveys the literature regarding satisfaction in pediatric obesity and questions used in measurement. A systematic review of the literature was conducted using Medline, PsychINFO, and CINAHL. Studies of satisfaction in pediatric weight management were reviewed, and related studies of obesity were included. Satisfaction survey questions were obtained from the articles or from the authors. Eighteen studies were included; 14 quantitative and 4 qualitative. Only one study linked satisfaction to attrition, and none investigated the association of satisfaction and weight outcomes. Most investigations included satisfaction as a secondary aim or used single-item questions of overall satisfaction; only one assessed satisfaction in noncompleters. Overall, participants expressed high levels of satisfaction with obesity treatment or prevention programs. Surveys focused predominantly on overall satisfaction or specific components of the program. Few in-depth studies of satisfaction with pediatric obesity treatment have been conducted. Increased focus on family satisfaction with obesity treatment may provide an avenue to lower attrition rates and improve outcomes. Enhancing measurement of satisfaction to yield actionable responses could positively influence outcomes, and a framework, via patient-centered care principles, is provided. © 2013 National Association for Healthcare Quality.

Randomized, controlled trial of biofeedback with anal manometry, transanal ultrasound, or pelvic floor retraining with digital guidance alone in the treatment of mild to moderate fecal incontinence.

PubMed

Solomon, Michael J; Pager, Chet K; Rex, Jenny; Roberts, Rachael; Manning, Jane

2003-06-01

A prospective, three-armed, randomized, controlled trial was performed to assess whether pelvic floor exercises with biofeedback using anal manometry or transanal ultrasound are superior to pelvic floor exercises with feedback from digital examination alone in terms of continence, quality of life, physiologic sphincter strength, and compliance. Its secondary objectives were to assess whether there are any differences in these outcomes between biofeedback with transanal ultrasound vs. anal manometry and to correlate the physiologic measures with clinical outcome. One hundred twenty patients with mild to moderate fecal incontinence were randomized into one of three treatment groups: biofeedback with anal manometry, biofeedback with transanal ultrasound, or pelvic floor exercises with feedback from digital examination alone. Commencing one week after an initial 45-minute assessment session, patients attended monthly treatments for a total of five sessions. Each session lasted 30 minutes and involved sphincter exercises with biofeedback that involved instrumentation or digital examination alone, and patients were encouraged to perform identical exercises twice per day between outpatient visits. One hundred two patients (85 percent) completed the four-month treatment program. Across all treatment allocations, patients experienced modest but highly significant improvements in all nine outcome measures during treatment, with 70 percent of all patients perceiving improvement in symptom severity and 69 percent of patients reporting improved quality of life. With the possible exception of isotonic fatigue time, there were no significant differences between the three treatment groups in compliance, physiologic sphincter strength, and clinical or quality-of-life measures. Correlations between physiologic measures and clinical outcomes were much stronger with ultrasound-based measures than with manometry. Although patients in this study who completed pelvic floor exercises with feedback from digital examination achieved no additional benefit from biofeedback and measurement with transanal ultrasound or manometry, it may be that the guidance received through digital examination alone offered patients in the pelvic floor exercise group an effective biofeedback mechanism. Contrary to our hypothesis, the use of transanal ultrasound offered no benefit over manometry, but the use of ultrasound for isotonic fatigue time and isometric fatigue contractions provided potentially important physiologic measures that require further study. This study has confirmed, through a large sample of patients, that pelvic floor retraining programs are an effective treatment for improving physiologic, clinical, and quality-of-life parameters in the short term.

Promoting household water treatment through women's self help groups in Rural India: assessing impact on drinking water quality and equity.

PubMed

Freeman, Matthew C; Trinies, Victoria; Boisson, Sophie; Mak, Gregory; Clasen, Thomas

2012-01-01

Household water treatment, including boiling, chlorination and filtration, has been shown effective in improving drinking water quality and preventing diarrheal disease among vulnerable populations. We used a case-control study design to evaluate the extent to which the commercial promotion of household water filters through microfinance institutions to women's self-help group (SHG) members improved access to safe drinking water. This pilot program achieved a 9.8% adoption rate among women targeted for adoption. Data from surveys and assays of fecal contamination (thermotolerant coliforms, TTC) of drinking water samples (source and household) were analyzed from 281 filter adopters and 247 non-adopters exposed to the program; 251 non-SHG members were also surveyed. While adopters were more likely than non-adopters to have children under 5 years, they were also more educated, less poor, more likely to have access to improved water supplies, and more likely to have previously used a water filter. Adopters had lower levels of fecal contamination of household drinking water than non-adopters, even among those non-adopters who treated their water by boiling or using traditional ceramic filters. Nevertheless, one-third of water samples from adopter households exceeded 100 TTC/100ml (high risk), and more than a quarter of the filters had no stored treated water available when visited by an investigator, raising concerns about correct, consistent use. In addition, the poorest adopters were less likely to see improvements in their water quality. Comparisons of SHG and non-SHG members suggest similar demographic characteristics, indicating SHG members are an appropriate target group for this promotion campaign. However, in order to increase the potential for health gains, future programs will need to increase uptake, particularly among the poorest households who are most susceptible to disease morbidity and mortality, and focus on strategies to improve the correct, consistent and sustained use of these water treatment products.

Cost-Effectiveness of a Collaborative Care Depression and Anxiety Treatment Program in Patients with Acute Cardiac Illness.

PubMed

Celano, Christopher M; Healy, Brian; Suarez, Laura; Levy, Douglas E; Mastromauro, Carol; Januzzi, James L; Huffman, Jeff C

2016-01-01

To use data from a randomized trial to determine the cost-effectiveness of a collaborative care (CC) depression and anxiety treatment program and to assess effects of the CC program on health care utilization. The CC intervention's impact on health-related quality of life, depression-free days (DFDs), and anxiety-free days (AFDs) over the 24-week postdischarge period was calculated and compared with the enhanced usual care (EUC) condition using independent samples t tests and random-effects regression models. Costs for both the CC and EUC conditions were calculated on the basis of staff time, overhead expenses, and treatment materials. Using this information, incremental cost-effectiveness ratios were calculated. A cost-effectiveness acceptability plot was created using nonparametric bootstrapping with 10,000 replications, and the likelihood of the CC intervention's cost-effectiveness was assessed using standard cutoffs. As a secondary analysis, we determined whether the CC intervention led to reductions in postdischarge health care utilization and costs. The CC intervention was more costly than the EUC intervention ($209.86 vs. $34.59; z = -11.71; P < 0.001), but was associated with significantly greater increases in quality-adjusted life-years (t = -2.49; P = 0.01) and DFDs (t = -2.13; P = 0.03), but not AFDs (t = -1.92; P = 0.057). This translated into an incremental cost-effectiveness ratio of $3337.06 per quality-adjusted life-year saved, $13.36 per DFD, and $13.74 per AFD. Compared with the EUC intervention, the CC intervention was also associated with fewer emergency department visits but no differences in overall costs. This CC intervention was associated with clinically relevant improvements, was cost-effective, and was associated with fewer emergency department visits in the 24 weeks after discharge. Copyright © 2016. Published by Elsevier Inc.

An intensive social cognitive program (can do treatment) in people with relapsing remitting multiple sclerosis and low disability: a randomized controlled trial protocol.

PubMed

Jongen, Peter Joseph; Heerings, Marco; Ruimschotel, Rob; Hussaarts, Astrid; Evers, Silvia; Duyverman, Lotte; Valkenburg-Vissers, Joyce; Cornelissen, Job; Bos, Michel; van Droffelaar, Maarten; Lemmens, Wim A; Donders, Rogier; van der Zande, Anneke; Visser, Leo H

2016-05-28

In people with multiple sclerosis (MS) disabilities and limitations may negatively affect self-efficacy. Lowered self-efficacy has been associated with decreases in health-related quality of life, physical activity and cognitive performance. In an explorative observational study we found that a 3-day intensive social cognitive program (Can Do Treatment [CDT]) with the participation of support partners was followed by substantial increases in self-efficacy control and health-related quality of life 6 months after treatment in those people with MS who had relapsing remitting disease and low disability. CDT is a sociologically oriented approach, its goal is to uncover and promote existing capabilities, and the notion "stressor" is the central concept. CDT's components are plenary group sessions, small group sessions, consultations, a theatre evening, and start of the day with a joint activity. The small group sessions form the actual training. Depending on their individual goals the participants join the training groups 'Body', 'Feeling' or 'Life', to work out their aims and to reduce their stressors. The multidisciplinary team includes a psychiatrist, psychiatric nurse, neurologist, specialized MS nurse, physiotherapist, dance therapist, and a person with MS. To evaluate the (cost)effectiveness of CDT in persons with relapsing remitting MS and low disability we perform a single-centre, randomized controlled trial in 140 patients, with or without support partners. The primary outcome is self-efficacy control. The secondary outcomes are self-efficacy function, health-related quality of life, autonomy and participation, anxiety, depression, cost effectiveness and cost utility. The tertiary outcome is care-related strain to support partners. Outcomes are assessed at baseline and at 1, 3 and 6 months after CDT. This randomized controlled trial will adequately evaluate the clinical and cost effectiveness of a 3-day intensive social cognitive program in people with relapsing remitting MS and low disability, with self-efficacy control as primary outcome. Application number: 22444.

Promoting Household Water Treatment through Women's Self Help Groups in Rural India: Assessing Impact on Drinking Water Quality and Equity

PubMed Central

Freeman, Matthew C.; Trinies, Victoria; Boisson, Sophie; Mak, Gregory; Clasen, Thomas

2012-01-01

Household water treatment, including boiling, chlorination and filtration, has been shown effective in improving drinking water quality and preventing diarrheal disease among vulnerable populations. We used a case-control study design to evaluate the extent to which the commercial promotion of household water filters through microfinance institutions to women's self-help group (SHG) members improved access to safe drinking water. This pilot program achieved a 9.8% adoption rate among women targeted for adoption. Data from surveys and assays of fecal contamination (thermotolerant coliforms, TTC) of drinking water samples (source and household) were analyzed from 281 filter adopters and 247 non-adopters exposed to the program; 251 non-SHG members were also surveyed. While adopters were more likely than non-adopters to have children under 5 years, they were also more educated, less poor, more likely to have access to improved water supplies, and more likely to have previously used a water filter. Adopters had lower levels of fecal contamination of household drinking water than non-adopters, even among those non-adopters who treated their water by boiling or using traditional ceramic filters. Nevertheless, one-third of water samples from adopter households exceeded 100 TTC/100ml (high risk), and more than a quarter of the filters had no stored treated water available when visited by an investigator, raising concerns about correct, consistent use. In addition, the poorest adopters were less likely to see improvements in their water quality. Comparisons of SHG and non-SHG members suggest similar demographic characteristics, indicating SHG members are an appropriate target group for this promotion campaign. However, in order to increase the potential for health gains, future programs will need to increase uptake, particularly among the poorest households who are most susceptible to disease morbidity and mortality, and focus on strategies to improve the correct, consistent and sustained use of these water treatment products. PMID:22957043

SU-E-T-616: Plan Quality Assessment of Both Treatment Planning System Dose and Measurement-Based 3D Reconstructed Dose in the Patient

DOE Office of Scientific and Technical Information (OSTI.GOV)

Olch, A

2015-06-15

Purpose: Systematic radiotherapy plan quality assessment promotes quality improvement. Software tools can perform this analysis by applying site-specific structure dose metrics. The next step is to similarly evaluate the quality of the dose delivery. This study defines metrics for acceptable doses to targets and normal organs for a particular treatment site and scores each plan accordingly. The input can be the TPS or the measurement-based 3D patient dose. From this analysis, one can determine whether the delivered dose distribution to the patient receives a score which is comparable to the TPS plan score, otherwise replanning may be indicated. Methods: Elevenmore » neuroblastoma patient plans were exported from Eclipse to the Quality Reports program. A scoring algorithm defined a score for each normal and target structure based on dose-volume parameters. Each plan was scored by this algorithm and the percentage of total possible points was obtained. Each plan also underwent IMRT QA measurements with a Mapcheck2 or ArcCheck. These measurements were input into the 3DVH program to compute the patient 3D dose distribution which was analyzed using the same scoring algorithm as the TPS plan. Results: The mean quality score for the TPS plans was 75.37% (std dev=14.15%) compared to 71.95% (std dev=13.45%) for the 3DVH dose distribution. For 3/11 plans, the 3DVH-based quality score was higher than the TPS score, by between 0.5 to 8.4 percentage points. Eight/11 plans scores decreased based on IMRT QA measurements by 1.2 to 18.6 points. Conclusion: Software was used to determine the degree to which the plan quality score differed between the TPS and measurement-based dose. Although the delivery score was generally in good agreement with the planned dose score, there were some that improved while there was one plan whose delivered dose quality was significantly less than planned. This methodology helps evaluate both planned and delivered dose quality. Sun Nuclear Corporation has provded a license for the software described.« less

The implementation of Prime Vendor Europe and its successful impact on an overseas naval medical treatment facility.

PubMed

Koerner, S D; Anaya, M A

1996-10-01

Prime Vendor Europe (PVE) is the commercial pharmaceutical ordering and delivery program that is revolutionizing overseas health care delivery at military health care treatment facilities located in the European theater. Mirroring civilian programs already available and replacing the Federal Supply System, PVE offers many benefits never before realized at overseas military health care treatment facilities, including: diminished order turnaround times with resultant decreased Operating Target requirements; rapid order confirmation after order placement; lower carrying costs and inventory needs; better dating of pharmaceuticals received; redistribution and increased efficiency of the current manhours needed to operate a pharmacy supply system; order tracking capabilities; and enhancement of the present cooperative and constructive dichotomous relationship between medical logistics and pharmacy regarding pharmaceutical purchasing practices. This paper will explore the fundamentals, past performance, continuous quality improvement of logistical functions, frame-work establishment for PVE, implementation of PVE, and subsequent observed command benefits of PVE realization.

A pilot qualitative study to explore stakeholder opinions regarding prescribing quality indicators

PubMed Central

2012-01-01

Background Information on prescribing quality of diabetes care is required by health care providers, insurance companies, policy makers, and the public. Knowledge regarding the opinions and preferences of all involved parties regarding prescribing quality information is important for effective use of prescribing quality indicators. Methods Between June and December 2009 we conducted semi structured interviews with 16 key-informants representing eight different organizations in the Netherlands involved in healthcare quality measurement and improvement. The interview guide included topics on participants’ opinions and preferences regarding existing types of prescribing quality indicators in relation to their aim of using quality information. Content analysis methods were used to process the resulting transcripts following the framework of predetermined themes. Results Findings from this qualitative study of stakeholder preferences showed that indicators focusing on undertreatment are found important by all participants. Furthermore, health care providers and policy makers valued prescribing safety indicators, insurance companies prioritized indicators focusing on prescribing costs, and patients’ organization representatives valued indicators focusing on interpersonal side of prescribing. Representatives of all stakeholders preferred positive formulation of the indicators to motivate health care providers to participate in health improvement programs. A composite score was found to be most useful by all participants as a starting point of prescribing quality assessment. Lack of information on reasons for deviating from guidelines recommendations appeared to be the most important barrier for using prescribing quality indicators. According to the health care providers, there are many legitimate reasons for not prescribing the recommended treatment and these reasons are not always taken into account by external evaluators. The latter may cause mistrust of health care providers towards external stakeholders and limit the use of PQI in external quality improvement programs. Conclusion Prescribing quality indicators are considered to be an important tool for assessing quality of provided diabetes care by all participants, although the preferences for specific types of indicators may differ by stakeholder depending on their user aim. Introduction of information systems to register the reasons for deviating from the recommended drug treatment may contribute to a more widespread use of PQI for assessment of provided health care quality to diabetic patents. This study identified the potential preferences regarding quality indicators for diabetes care, and this could be used for development of questionnaires to conduct a survey among a larger group of participants. PMID:22769967

Challenges and successes of a multidisciplinary pediatric obesity treatment program.

PubMed

Walsh, Stephanie M; Palmer, Wendy; Welsh, Jean A; Vos, Miriam B

2014-12-01

Despite the well-documented need for multidisciplinary pediatric obesity treatment programs, few programs exist and best practices are not clearly defined. We describe the design and initial quality-related outcomes of the Strong4Life multidisciplinary pediatric obesity treatment program along with some challenges and solutions implemented over the first 2 years. The purpose of this report is to inform others interested in designing similar programs. The Strong4Life Clinic obesity program was designed to provide children with the medical care, as well as the behavior change guidance and support needed to reverse their obesity and/or minimize the related health risks. This low-intensity program is designed to provide approximately 6 hours of care over 12 months from a medical provider, psychologist, registered dietitian nutritionist, exercise physiologist, and nurse. Between August 2011 and February 2014, the Strong4Life clinic served 781 high-risk (mean sex- and age-adjusted body mass index [BMI] percentile 98.8) and racially/ethnically diverse (45% non-Hispanic black and 24% Hispanic) patients. Of the 781 patients seen, 66% returned for at least 1 visit. Nearly all returning Strong4Life patients stabilized or improved their BMI (90% of those who participated <6 months, 97% of those who participated 6 to <12 months, and 92% of those who participated ≥12 months). This report describes a low-intensity multidisciplinary weight management program that is feasible. Initial assessment of the program suggests benefit in most patients who participate >6 months, but longer follow-up and assessment of comorbidities are needed. © 2014 American Society for Parenteral and Enteral Nutrition.

Efficacy of neurodevelopmental treatment combined with the Nintendo® Wii in patients with cerebral palsy

PubMed Central

Acar, Gönül; Altun, Gamze Polen; Yurdalan, SaadetUfuk; Polat, Mine Gülden

2016-01-01

[Purpose] The aim of this study was to investigate the efficiency of Nintendo® Wii games in addition to neurodevelopmental treatment in patients with cerebral palsy. [Subjects and Methods] Thirty hemiparetic cerebral palsy patients (16 females, 14 males; mean age, 6–15 years) were included in the study and divided into two groups: a neurodevelopmental treatment+Nintendo Wii group (group 1, n=15) and a neurodevelopmental treatment group (group 2, n=15). Both groups received treatment in 45-minute sessions 2 days/week for six weeks. Use of the upper extremities, speed, disability and functional independence were evaluated using the Quality of Upper Extremity Skills Test, Jebsen Taylor Hand Function Test, ABILHAND-Kids test, and Pediatric Functional Independence Measure (self-care) before and after treatment. [Results] There were statistically significant improvements in all parameters for group 1 and group 2 (except quality of function) after six weeks of treatment. Intergroup analysis showed that group 1 was superior to group 2 in mean change differences in the Jebsen Taylor Hand Function Test. [Conclusion] Our results showed that neurodevelopmental treatment is effective for improving hand functions in hemiplegic cerebral palsy. To provide a enjoyable, motivational, safe, and effective rehabilitation program, the Nintendo® Wii may be used in addition to neurodevelopmental treatment. PMID:27134357

Efficacy of neurodevelopmental treatment combined with the Nintendo(®) Wii in patients with cerebral palsy.

PubMed

Acar, Gönül; Altun, Gamze Polen; Yurdalan, SaadetUfuk; Polat, Mine Gülden

2016-03-01

[Purpose] The aim of this study was to investigate the efficiency of Nintendo(®) Wii games in addition to neurodevelopmental treatment in patients with cerebral palsy. [Subjects and Methods] Thirty hemiparetic cerebral palsy patients (16 females, 14 males; mean age, 6-15 years) were included in the study and divided into two groups: a neurodevelopmental treatment+Nintendo Wii group (group 1, n=15) and a neurodevelopmental treatment group (group 2, n=15). Both groups received treatment in 45-minute sessions 2 days/week for six weeks. Use of the upper extremities, speed, disability and functional independence were evaluated using the Quality of Upper Extremity Skills Test, Jebsen Taylor Hand Function Test, ABILHAND-Kids test, and Pediatric Functional Independence Measure (self-care) before and after treatment. [Results] There were statistically significant improvements in all parameters for group 1 and group 2 (except quality of function) after six weeks of treatment. Intergroup analysis showed that group 1 was superior to group 2 in mean change differences in the Jebsen Taylor Hand Function Test. [Conclusion] Our results showed that neurodevelopmental treatment is effective for improving hand functions in hemiplegic cerebral palsy. To provide a enjoyable, motivational, safe, and effective rehabilitation program, the Nintendo(®) Wii may be used in addition to neurodevelopmental treatment.

Identifying and ranking implicit leadership strategies to promote evidence-based practice implementation in addiction health services.

PubMed

Guerrero, Erick G; Padwa, Howard; Fenwick, Karissa; Harris, Lesley M; Aarons, Gregory A

2016-05-14

Despite a solid research base supporting evidence-based practices (EBPs) for addiction treatment such as contingency management and medication-assisted treatment, these services are rarely implemented and delivered in community-based addiction treatment programs in the USA. As a result, many clients do not benefit from the most current and efficacious treatments, resulting in reduced quality of care and compromised treatment outcomes. Previous research indicates that addiction program leaders play a key role in supporting EBP adoption and use. The present study expanded on this previous work to identify strategies that addiction treatment program leaders report using to implement new practices. We relied on a staged and iterative mixed-methods approach to achieve the following four goals: (a) collect data using focus groups and semistructured interviews and conduct analyses to identify implicit managerial strategies for implementation, (b) use surveys to quantitatively rank strategy effectiveness, (c) determine how strategies fit with existing theories of organizational management and change, and (d) use a consensus group to corroborate and expand on the results of the previous three stages. Each goal corresponded to a methodological phase, which included data collection and analytic approaches to identify and evaluate leadership interventions that facilitate EBP implementation in community-based addiction treatment programs. Findings show that the top-ranked strategies involved the recruitment and selection of staff members receptive to change, offering support and requesting feedback during the implementation process, and offering in vivo and hands-on training. Most strategies corresponded to emergent implementation leadership approaches that also utilize principles of transformational and transactional leadership styles. Leadership behaviors represented orientations such as being proactive to respond to implementation needs, supportive to assist staff members during the uptake of new practices, knowledgeable to properly guide the implementation process, and perseverant to address ongoing barriers that are likely to stall implementation efforts. These findings emphasize how leadership approaches are leveraged to facilitate the implementation and delivery of EBPs in publicly funded addiction treatment programs. Findings have implications for the content and structure of leadership interventions needed in community-based addiction treatment programs and the development of leadership interventions in these and other service settings.

Use of the evidence base in substance abuse treatment programs for American Indians and Alaska natives: pursuing quality in the crucible of practice and policy

PubMed Central

2011-01-01

Background A variety of forces are now shaping a passionate debate regarding the optimal approaches to improving the quality of substance abuse services for American Indian and Alaska Native communities. While there have been some highly successful efforts to meld the traditions of American Indian and Alaska Native tribes with that of 12-step approaches, some American Indian and Alaska Natives remain profoundly uncomfortable with the dominance of this Euro-American approach to substance abuse treatment in their communities. This longstanding tension has now been complicated by the emergence of a number of evidence-based treatments that, while holding promise for improving treatment for American Indian and Alaska Natives with substance use problems, may conflict with both American Indian and Alaska Native and 12-step healing traditions. Discussion We convened a panel of experts from American Indian and Alaska Native communities, substance abuse treatment programs serving these communities, and researchers to discuss and analyze these controversies in preparation for a national study of American Indian and Alaska Native substance abuse services. While the panel identified programs that are using evidence-based treatments, members still voiced concerns about the cultural appropriateness of many evidence-based treatments as well as the lack of guidance on how to adapt them for use with American Indians and Alaska Natives. The panel concluded that the efforts of federal and state policymakers to promote the use of evidence-based treatments are further complicating an already-contentious debate within American Indian and Alaska Native communities on how to provide effective substance abuse services. This external pressure to utilize evidence-based treatments is particularly problematic given American Indian and Alaska Native communities' concerns about protecting their sovereign status. Summary Broadening this conversation beyond its primary focus on the use of evidence-based treatments to other salient issues such as building the necessary research evidence (including incorporating American Indian and Alaska Native cultural values into clinical practice) and developing the human and infrastructural resources to support the use of this evidence may be far more effective for advancing efforts to improve substance abuse services for American Indian and Alaska Native communities. PMID:21679438

Cost-effectiveness analysis of genotyping for HLA-B*5801 and an enhanced safety program in gout patients starting allopurinol in Singapore.

PubMed

Dong, Di; Tan-Koi, Wei-Chuen; Teng, Gim Gee; Finkelstein, Eric; Sung, Cynthia

2015-11-01

Allopurinol is an efficacious urate-lowering therapy (ULT), but is associated with rare serious adverse drug reactions of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), with higher risk among HLA-B*5801 carriers. We assessed the cost-effectiveness of HLA-B*5801 testing, an enhanced safety program or strategies with both components. The analysis adopted a health systems perspective and considered Singaporean patients with chronic gout, over a lifetime horizon, using allopurinol or probenecid. The model incorporated SJS/TEN and gout treatment outcomes, allele frequencies, drug prices and other medical costs. Based on cost-effectiveness threshold of US$50,000 per quality-adjusted life year, HLA-B*5801-guided ULT selection or enhanced safety program was not cost effective. Avoidance of ULTs was the least preferred strategy as uncontrolled gout leads to lower quality-adjusted life years and higher costs. The analysis underscores the need for biomarkers with higher positive predictive value for SJS/TEN, less expensive genetic tests or safety programs, or more effective gout drugs. .

Data-driven management using quantitative metric and automatic auditing program (QMAP) improves consistency of radiation oncology processes.

PubMed

Yu, Naichang; Xia, Ping; Mastroianni, Anthony; Kolar, Matthew D; Chao, Samuel T; Greskovich, John F; Suh, John H

Process consistency in planning and delivery of radiation therapy is essential to maintain patient safety and treatment quality and efficiency. Ensuring the timely completion of each critical clinical task is one aspect of process consistency. The purpose of this work is to report our experience in implementing a quantitative metric and automatic auditing program (QMAP) with a goal of improving the timely completion of critical clinical tasks. Based on our clinical electronic medical records system, we developed a software program to automatically capture the completion timestamp of each critical clinical task while providing frequent alerts of potential delinquency. These alerts were directed to designated triage teams within a time window that would offer an opportunity to mitigate the potential for late completion. Since July 2011, 18 metrics were introduced in our clinical workflow. We compared the delinquency rates for 4 selected metrics before the implementation of the metric with the delinquency rate of 2016. One-tailed Student t test was used for statistical analysis RESULTS: With an average of 150 daily patients on treatment at our main campus, the late treatment plan completion rate and late weekly physics check were reduced from 18.2% and 8.9% in 2011 to 4.2% and 0.1% in 2016, respectively (P < .01). The late weekly on-treatment physician visit rate was reduced from 7.2% in 2012 to <1.6% in 2016. The yearly late cone beam computed tomography review rate was reduced from 1.6% in 2011 to <0.1% in 2016. QMAP is effective in reducing late completions of critical tasks, which can positively impact treatment quality and patient safety by reducing the potential for errors resulting from distractions, interruptions, and rush in completion of critical tasks. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Isocenter verification for linac‐based stereotactic radiation therapy: review of principles and techniques

PubMed Central

Sabet, Mahsheed; O'Connor, Daryl J.; Greer, Peter B.

2011-01-01

There have been several manual, semi‐automatic and fully‐automatic methods proposed for verification of the position of mechanical isocenter as part of comprehensive quality assurance programs required for linear accelerator‐based stereotactic radiosurgery/radiotherapy (SRS/SRT) treatments. In this paper, a systematic review has been carried out to discuss the present methods for isocenter verification and compare their characteristics, to help physicists in making a decision on selection of their quality assurance routine. PACS numbers: 87.53.Ly, 87.56.Fc, 87.56.‐v PMID:22089022

Quality Measures for the Care of Patients with Narcolepsy

PubMed Central

Krahn, Lois E.; Hershner, Shelley; Loeding, Lauren D.; Maski, Kiran P.; Rifkin, Daniel I.; Selim, Bernardo; Watson, Nathaniel F.

2015-01-01

The American Academy of Sleep Medicine (AASM) commissioned a Workgroup to develop quality measures for the care of patients with narcolepsy. Following a comprehensive literature search, 306 publications were found addressing quality care or measures. Strength of association was graded between proposed process measures and desired outcomes. Following the AASM process for quality measure development, we identified three outcomes (including one outcome measure) and seven process measures. The first desired outcome was to reduce excessive daytime sleepiness by employing two process measures: quantifying sleepiness and initiating treatment. The second outcome was to improve the accuracy of diagnosis by employing the two process measures: completing both a comprehensive sleep history and an objective sleep assessment. The third outcome was to reduce adverse events through three steps: ensuring treatment follow-up, documenting medical comorbidities, and documenting safety measures counseling. All narcolepsy measures described in this report were developed by the Narcolepsy Quality Measures Work-group and approved by the AASM Quality Measures Task Force and the AASM Board of Directors. The AASM recommends the use of these measures as part of quality improvement programs that will enhance the ability to improve care for patients with narcolepsy. Citation: Krahn LE, Hershner S, Loeding LD, Maski KP, Rifkin DI, Selim B, Watson NF. Quality measures for the care of patients with narcolepsy. J Clin Sleep Med 2015;11(3):335–355. PMID:25700880

Application of an Environmental Decision Support System to a Water Quality Trading Program Affected by Surface Water Diversions

NASA Astrophysics Data System (ADS)

Obropta, Christopher C.; Niazi, Mehran; Kardos, Josef S.

2008-12-01

Environmental decision support systems (EDSSs) are an emerging tool used to integrate the evaluation of highly complex and interrelated physicochemical, biological, hydrological, social, and economic aspects of environmental problems. An EDSS approach is developed to address hot-spot concerns for a water quality trading program intended to implement the total maximum daily load (TMDL) for phosphorus in the Non-Tidal Passaic River Basin of New Jersey. Twenty-two wastewater treatment plants (WWTPs) spread throughout the watershed are considered the major sources of phosphorus loading to the river system. Periodic surface water diversions to a major reservoir from the confluence of two key tributaries alter the natural hydrology of the watershed and must be considered in the development of a trading framework that ensures protection of water quality. An EDSS is applied that enables the selection of a water quality trading framework that protects the watershed from phosphorus-induced hot spots. The EDSS employs Simon’s (1960) three stages of the decision-making process: intelligence, design, and choice. The identification of two potential hot spots and three diversion scenarios enables the delineation of three management areas for buying and selling of phosphorus credits among WWTPs. The result shows that the most conservative option entails consideration of two possible diversion scenarios, and trading between management areas is restricted accordingly. The method described here is believed to be the first application of an EDSS to a water quality trading program that explicitly accounts for surface water diversions.

Quality assurance past and present in Canada

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bush, R.S.

Quality assurance in any clinical field must involve the three components of clinical care: (a) diagnosis and evaluation of patients; (b) medical decision making and treatment; and (c) outcome analysis. Nationally, there have been five annual reviews of outcome from all cancer centers following radiation therapy for cancer at various sites. These reviews are voluntary and organized through the Canadian Association of Radiologists. The objective is to determine if there are any major differences in outcome across the country, and if so, can such differences be related to the population treated or technique used. So far no major differences havemore » been noted. There is a National Tumour Reference Center funded by the National Cancer Institute of Canada (NCIC) to provide assistancein establishing diagnostic criteria in pathology. Ontario has been active through the staging and reporting, together with an evaluative program for this staging system. All other quality assurance programs take place at the level of local centers.« less

Cognitive behavior therapy for comorbid migraine and/or tension-type headache and major depressive disorder: An exploratory randomized controlled trial.

PubMed

Martin, Paul R; Aiello, Rachele; Gilson, Kathryn; Meadows, Graham; Milgrom, Jeannette; Reece, John

2015-10-01

Numerous studies have demonstrated comorbidity between migraine and tension-type headache on the one hand, and depression on the other. Presence of depression is a negative prognostic indicator for behavioral treatment of headaches. Despite the recognised comorbidity, there is a limited research literature evaluating interventions designed for comorbid headaches and depression. Sixty six participants (49 female, 17 male) suffering from migraine and/or tension-type headache and major depressive disorder were randomly allocated to a Routine Primary Care control group or a Cognitive Behavior Therapy group that also received routine primary care. The treatment program involved 12 weekly 50-min sessions administered by clinical psychologists. Participants in the treatment group improved significantly more than participants in the control group from pre-to post-treatment on measures of headaches, depression, anxiety, and quality of life. Improvements achieved with treatment were maintained at four month follow-up. Comorbid anxiety disorders were not a predictor of response to treatment, and the only significant predictor was gender (men improved more than women). The new integrated treatment program appears promising and worthy of further investigation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effect of a new social support program by voluntary organization in pediatric oncology department in a developing country.

PubMed

Nair, Manjusha; Parukkutty, Kusumakumary; Kommadath, Sheethal

2014-04-01

Comprehensive childhood cancer treatment in the modern era means not only strenuous treatment regimens and meticulous nursing care, it also implies attention to social, psychological, and financial aspects of disease and treatment. In a developing country like ours, though it is possible to provide good medical and nursing care in government set-up, there is always shortage of workforce and financial support, leading to nonadherence to treatment regimens by patients and parents, resulting in suboptimal treatment outcomes. Overcrowding of pediatric cancer patients along with general patients for lab tests and other hospital services, poor drug compliance, treatment abandonment, and lost to follow-up, lack of funding to meet nonmedical expenses and inadequate facility for providing psychological support were some of the major reasons we could identify as lacunae in our pediatric oncology division (POD). We introduced a new social support program with the help of additional staff supported by a nongovernmental agency, and new quality improvement services were introduced. The impact was demonstrable as reduction in waiting time in the hospital, allayed anxiety of painful procedures, better drug compliance, less treatment abandonment, and improved follow-up. This can be emulated in similar other resource-limited centers.

Effect of computerized cognitive behavioral therapy on acquisition of coping skills among cocaine-dependent individuals enrolled in methadone maintenance.

PubMed

Kiluk, Brian D; DeVito, Elise E; Buck, Matthew B; Hunkele, Karen; Nich, Charla; Carroll, Kathleen M

2017-11-01

The acquisition of coping skills has long been considered one of the putative mechanisms of cognitive behavioral therapy (CBT) for substance use disorders, yet consistent statistical support is lacking. This study sought to replicate and extend prior findings regarding the quality of coping skills as a mediator of abstinence outcomes from a computerized CBT program for substance users. Participants were methadone-maintained, cocaine dependent individuals enrolled in a clinical trial evaluating the efficacy of computer-based training for CBT ('CBT4CBT') as an add-on to treatment as usual (TAU+CBT4CBT) compared to TAU only. A subsample (N=71) completed a role play assessment to measure coping skills, the Drug Risk Response Test (DRRT), which was administered before, during (week 4), and after the 8-week treatment period. Participants' verbal responses to various high-risk situations for cocaine use were recorded and independent evaluators rated the quality of the coping responses. Results of repeated measures analyses revealed a main effect of time for the quality of overall responses [F(1, 141.26)=4.29, p<0.01], indicating improvement in the quality of coping skills across groups, yet no differential effect of treatment. Despite the significant association between coping responses and abstinence outcomes, analyses did not support the quality of coping skills as a mediator of treatment effects. However, among the high-risk situations wherein individuals provided lower quality responses at baseline, those assigned to TAU+CBT4CBT showed greater improvement compared to those assigned to TAU only [F(1, 697.65)=6.47, p=0.01]. This study failed to replicate the quality of coping skills as a mediator of CBT4CBT's effect on reducing drug use previously shown in a mixed outpatient substance use sample. However, in this methadone maintained sample, those with poorer quality skills in response to certain high-risk situations at baseline appeared to improve their coping strategies following CBT4CBT compared to standard methadone treatment alone. Copyright © 2017 Elsevier Inc. All rights reserved.

Analysis of Quality Indicators for Colorectal Cancer Surgery in Units Accredited by the Spanish Association of Coloproctology.

PubMed

de la Portilla, Fernando; Builes, Sergio; García-Novoa, Alejandra; Espín, Eloy; Kreisler, Esther; Enríquez-Navascues, José María; Biondo, Sebastiano; Codina, Antonio

2018-04-01

Currently, there is growing interest in analyzing the results from surgical units and the implementation of quality standards in order to identify good healthcare practices. Due to this fact, the Spanish Association of Coloproctology (AECP) has developed a unit accreditation program that contemplates basic standards. The aim of this article is to evaluate and analyze the specific quality indicators for the surgical treatment of colorectal cancer, established by the program. Data were collected from colorectal units during the accreditation process. We analyzed prospectively collected data from elective colorectal surgeries at 18 Spanish coloproctology units during the period 2013-2017. Three main and four secondary quality indicators were considered. Colon and rectal surgeries were analyzed independently; furthermore, results were compared according to surgical approach. A total of 3090 patients were included in the analysis. The global anastomotic leak rate was 7.8% (6.6% colon vs 10.6% rectum), while the surgical site infection rate was 12.6% (11.4% colon vs 14.8% rectum). Overall 30-day mortality was 2.3%, and anastomotic leak-related mortality was 10.2%. There were higher surgical site infection and mortality rates in the patients operated by open approach, however there was no difference in the anastomotic leak rate when compared with minimally invasive approaches. The evaluation of these results has determined optimal quality indices for the units accredited in the treatment of colorectal cancer. Furthermore, it allows us to establish realistic references in our country, thereby providing a better understanding and comparison of outcomes. Copyright © 2018 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Feasibility of antiretroviral treatment monitoring in the era of decentralized HIV care: a systematic review.

PubMed

Pham, Minh D; Romero, Lorena; Parnell, Bruce; Anderson, David A; Crowe, Suzanne M; Luchters, Stanley

2017-01-19

Regular monitoring of HIV patients who are receiving antiretroviral therapy (ART) is required to ensure patient benefits and the long-term effectiveness and sustainability of ART programs. Prompted by WHO recommendations for expansion and decentralization of HIV treatment and care in low and middle income countries, we conducted a systematic review to assess the feasibility of treatment monitoring in these settings. A comprehensive search strategy was developed using a combination of MeSH and free text terms relevant to HIV treatment and care, health service delivery, health service accessibility, decentralization and other relevant terms. Five electronic databases and two conference websites were searched to identify relevant studies conducted in LMICs, published in English between Jan 2006 and Dec 2015. Outcomes of interest included the proportion of patients who received treatment monitoring and health system factors related to monitoring of patients on ART under decentralized HIV service delivery models. From 5363 records retrieved, twenty studies were included in the review; all but one was conducted in sub-Saharan African countries. The majority of studies (15/20) had relatively short follow-up duration (≤24 months), and only two studies were specifically designed to assess treatment monitoring practices. The most frequently studied follow-up period was 12 months and a wide range of treatment monitoring coverage was observed. The reported proportions of patients on ART who received CD4 monitoring ranged from very low (6%; N = 2145) to very high (95%; N = 488). The median uptake of viral load monitoring was 86% with studies in program settings reporting coverage as low as 14%. Overall, the longer the follow-up period, the lower the proportion of patients who received regular monitoring tests; and programs in rural areas reported low coverage of laboratory monitoring. Moreover, uptake in the context of research had significantly better where monitoring was done by dedicated research staff. In the absence of point of care (POC) testing, the limited capacity for blood sample transportation between clinic and laboratory and poor quality of nursing staff were identified as a major barrier for treatment monitoring practice. There is a paucity of data on the uptake of treatment monitoring, particularly with longer-term follow-up. Wide variation in access to both virological and immunological regular monitoring was observed, with some clinics in well-resourced settings supported by external donors achieving high coverage. The feasibility of treatment monitoring, particularly in decentralized settings of HIV treatment and care may thus be of concern and requires further study. Significant investment in POC diagnostic technologies and, improving the quality of and training for nursing staff is required to ensure effective scale up of ART programs towards the targets of 90-90-90 by the year 2020.

Mind-body medicine and lifestyle modification in supportive cancer care: A cohort study on a day care clinic program for cancer patients.

PubMed

Jeitler, Michael; Jaspers, Jessica; von Scheidt, Christel; Koch, Barbara; Michalsen, Andreas; Steckhan, Nico; Kessler, Christian S

2017-12-01

We developed an integrative day care clinic program for cancer patients focusing on mind-body techniques and health-promoting lifestyle modification (7-hour once-per-week group sessions over 12 weeks). A cohort study design with a waiting group was implemented. Outcome parameters were assessed at the beginning, at the end of the active program, and at a 6-month follow-up. Patients waiting >4 and <12 weeks before treatment start were allocated to the waiting group and additionally assessed at the start of their day care program. Outcome measures included quality of life (FACT-G, FACT-B/C, WHO-5), fatigue (FACIT-F), depression/anxiety (HADS), and mood states (ASTS). A per protocol analysis using mixed linear models was performed. One hundred patients were screened on-site for eligibility. Eighty-six cancer survivors (83% female; mean age 53.7 ± 9.7 years; 49% breast cancer) were included into the study. Sixty-two patients were allocated to the intervention group and 24 patients, to the waiting group (mean waiting time 5 ± 1 weeks). Sixty-six data sets were included in the final analysis. Significant improvements were observed in favor of the intervention group after 12 weeks compared with the waiting group at the end of the waiting period for quality of life, anxiety/depression, and fatigue. Results from the 6-month follow-up for the whole study population showed lasting improvement of quality of life. The program can be considered as an effective means to improve quality of life, fatigue, and mental health of cancer patients. Moreover, it appears to have a sustainable effect, which has to be proved in randomized trials. Copyright © 2017 John Wiley & Sons, Ltd.

Feasibility of Group Schema Therapy for Outpatients with Severe Borderline Personality Disorder in Germany: A Pilot Study with Three Year Follow-Up

PubMed Central

Fassbinder, Eva; Schuetze, Maren; Kranich, Annika; Sipos, Valerija; Hohagen, Fritz; Shaw, Ida; Farrell, Joan; Arntz, Arnoud; Schweiger, Ulrich

2016-01-01

Borderline Personality Disorder (BPD) is a severe, challenging to treat mental disorder. Schema therapy (ST) as an individual therapy has been proven to be an effective psychological treatment for BPD. A group format of ST (GST) has been developed and evaluated in a randomized controlled trial in the United States and piloted in The Netherlands. These results suggest that GST speeds up and amplifies treatment effects of ST and might reduce delivery costs. However, feasibility in the German health care system and with BPD patients with high BPD severity and comorbidity, and frequent hospitalization, has not been tested to date. We investigated GST in 10 severely impaired, highly comorbid female patients with BPD, that needed frequent hospital admission. Patients received an outpatient ST-treatment program with weekly group and individual sessions for 1 year. Outcome measures including BPD severity, general psychopathology, psychosocial functioning, quality of life, happiness, schemas, and modes, and days of hospitalization were assessed at the start of treatment and 6, 12, and 36 months later with semi-structured interviews and self-report measures. We observed significant decreases in severity of BPD symptoms, general symptom severity, dysfunctional BPD-specific modes and schemas, and days of hospitalization. Functional modes, quality of live and happiness improved. The results of this feasibility study are promising and encourage further implementation of ST outpatient treatment programs even for patients with severe BPD and high hospitalization risk. However, small sample size and the missing of a control group do not allow the generalizability of these findings. PMID:27933020

A rationale and model for addressing tobacco dependence in substance abuse treatment.

PubMed

Richter, Kimber P; Arnsten, Julia H

2006-08-14

Most persons in drug treatment smoke cigarettes. Until drug treatment facilities systematically treat their patients' tobacco use, millions will flow through the drug treatment system, overcome their primary drug of abuse, but die prematurely from tobacco-related illnesses. This paper reviews the literature on the health benefits of quitting smoking for drug treatment patients, whether smoking causes relapse to other drug or alcohol abuse, the treatment of tobacco dependence, and good and bad times for quitting smoking among drug treatment patients. It also presents a conceptual model and recommendations for treating tobacco in substance abuse treatment, and provides references to internet and paper-copy tools and information for treating tobacco dependence. At present, research on tobacco treatment in drug treatment is in its infancy. Although few drug treatment programs currently offer formal services, many more will likely begin to treat nicotine dependence as external forces and patient demand for these services increases. In the absence of clear guidelines and attention to quality of care, drug treatment programs may adopt smoking cessation services based on cost, convenience, or selection criteria other than efficacy. Because research in this field is relatively new, substance abuse treatment professionals should adhere to the standards of care for the general population, but be prepared to update their practices with emerging interventions that have proven to be effective for patients in drug treatment.

Effects of feeding distillers dried grains with solubles, high-protein distillers dried grains, and corn germ to growing-finishing pigs on pig performance, carcass quality, and the palatability of pork.

PubMed

Widmer, M R; McGinnis, L M; Wulf, D M; Stein, H H

2008-08-01

An experiment was conducted to investigate pig performance, carcass quality, and palatability of pork from pigs fed distillers dried grains with solubles (DDGS), high-protein distillers dried grains (HPDDG), and corn germ. Eighty-four pigs (initial BW, 22 +/- 1.7 kg) were allotted to 7 dietary treatments with 6 replicates per treatment and 2 pigs per pen. Diets were fed for 114 d in a 3-phase program. The control treatment was based on corn and soybean meal. Two treatments were formulated using 10 or 20% DDGS in each phase. Two additional treatments contained HP-DDG in amounts sufficient to substitute for either 50 or 100% of the soybean meal used in the control treatment. An additional 2 treatments contained 5 or 10% corn germ, which was calculated to provide the same amount of fat as 10 or 20% DDGS. Results showed that for the entire experiment, pig performance was not affected by DDGS or HP-DDG, but final BW increased (linear, P < 0.05) as corn germ was included in the diets. Carcass composition and muscle quality were not affected by DDGS, but LM area and LM depth decreased (linear, P < 0.05) as HP-DDG was added to the diets. Lean meat percentage increased and drip loss decreased as corn germ was included in the diets (quadratic, P < 0.05). There was no effect of DDGS on fat quality except that belly firmness decreased (linear, P < 0.05) as dietary DDGS concentration increased. Including HP-DDG or corn germ in the diets did not affect fat quality, except that the iodine value increased (linear, P < 0.05) in pigs fed HP-DDG diets and decreased (linear, P < 0.05) in pigs fed corn germ diets. Cooking loss, shear force, and bacon distortion score were not affected by the inclusion of DDGS, HP-DDG, or corn germ in the diets, and the overall palatability of the bacon and pork chops was not affected by dietary treatment. In conclusion, feeding 20% DDGS or high levels of HP-DDG to growing-finishing pigs did not negatively affect overall pig performance, carcass composition, muscle quality, or palatability but may decrease fat quality. Feeding up to 10% corn germ did not negatively affect pig performance, carcass composition, carcass quality, or pork palatability but increased final BW of the pigs and reduced the iodine value of belly fat.

Evaluation of programs for adolescents with greater psychosocial needs: community-based Project P.A.T.H.S. in Hong Kong.

PubMed

Shek, Daniel T L; Law, Moon Y M

2017-02-01

This study examined the perceptions of the Tier 2 Program of the Project P.A.T.H.S. (Positive Adolescent Training through Holistic Social programmes) among Chinese secondary school students displaying greater psychosocial needs. Results showed that participants held positive views of program qualities, implementer qualities, as well as the perceived effectiveness of the program. Significant grade differences in terms of various indicators of satisfaction related to program qualities, implementer qualities, and program effectiveness were found. Correlation analyses showed that there were significant inter-relationships amongst program qualities, implementer qualities and program effectiveness. In line with the predictions, both program qualities and implementer qualities were significant predictors of perceived program effectiveness. The present study provides support for the perceived effectiveness of the Tier 2 Program of the Project P.A.T.H.S. in the community-based project context.

Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises.

PubMed

Kraaijenga, Sophie A C; van der Molen, Lisette; Jacobi, Irene; Hamming-Vrieze, Olga; Hilgers, Frans J M; van den Brekel, Michiel W M

2015-11-01

Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in HNC survivors, long-term (i.e., beyond 5 years) prospectively collected data on objective and subjective treatment-induced functional outcomes (and their impact on QoL) still are scarce. The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients. The study was conducted as a randomized controlled trial on preventive swallowing rehabilitation (2006-2008) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants. Multidimensional assessment of functional sequels was performed with videofluoroscopy, mouth opening measurements, Functional Oral Intake Scale, acoustic voice parameters, and (study specific, SWAL-QoL, and VHI) questionnaires. Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment. At a mean follow-up of 6.1 years most initial tumor-, and treatment-related problems remained similarly low to those observed after 2 years follow-up, except increased xerostomia (68%) and increased (mild) pain (32%). Acoustic voice analysis showed less voicedness, increased fundamental frequency, and more vocal effort for the tumors located below the hyoid bone (n = 12), without recovery to baseline values. Patients' subjective vocal function (VHI score) was good. Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort, originating from preventive and continued post-treatment rehabilitation programs.

The effects of a multiple family therapy on adolescents with eating disorders: an outcome study.

PubMed

Gelin, Zoé; Fuso, Silvana; Hendrick, Stephan; Cook-Darzens, Solange; Simon, Yves

2015-03-01

Multiple Family Therapy (MFT) has gained increasing popularity in the treatment of eating disorders and many programs have been developed over the past decade. Still, there is little evidence in the literature on the effectiveness on MFT for treating eating disorders. The present study examines the effects of a particular model of Multiple Family Therapy on eating disorder symptoms, quality of life, and percentage of Expected Body Weight (%EBW) in adolescents with eating disorders (ED). Eighty-two adolescents with ED, aged between 11 and 19 years, were assessed before and after treatment using the Eating Disorders Inventory 2 (EDI-2), the Outcome Questionnaire 45 (OQ-45) and %EBW. Results showed a significant increase in %EBW between the beginning and end of treatment, with a large effect size. 52.4% of patients achieved an EBW above 85%. Symptoms relative to all EDI dimensions (except for bulimia) significantly decreased during treatment. The three dimensions related to quality of life assessment also improved over the course of MFT. At the end of treatment, 70.7% of patients had a total OQ-45 score below clinical significance. This study suggests that Multiple Family Therapy may benefit adolescents with eating disorders, with improvement on several outcome measures (%EBW, ED symptoms, and quality of life). However, the lack of a comparison group entails caution when drawing conclusions. © 2014 Family Process Institute.

Are patent medicine vendors effective agents in malaria control? Using lot quality assurance sampling to assess quality of practice in Jigawa, Nigeria.

PubMed

Berendes, Sima; Adeyemi, Olusegun; Oladele, Edward Adekola; Oresanya, Olusola Bukola; Okoh, Festus; Valadez, Joseph J

2012-01-01

Patent medicine vendors (PMV) provide antimalarial treatment and care throughout Sub-Saharan Africa, and can play an important role in the fight against malaria. Their close-to-client infrastructure could enable lifesaving artemisinin-based combination therapy (ACT) to reach patients in time. However, systematic assessments of drug sellers' performance quality are crucial if their role is to be managed within the health system. Lot quality assurance sampling (LQAS) could be an efficient method to monitor and evaluate PMV practice, but has so far never been used for this purpose. In support of the Nigeria Malaria Booster Program we assessed PMV practices in three Senatorial Districts (SDs) of Jigawa, Nigeria. A two-stage LQAS assessed whether at least 80% of PMV stores in SDs used national treatment guidelines. Acceptable sampling errors were set in consultation with government officials (alpha and beta <0.10). The hypergeometric formula determined sample sizes and cut-off values for SDs. A structured assessment tool identified high and low performing SDs for quality of care indicators. Drug vendors performed poorly in all SDs of Jigawa for all indicators. For example, all SDs failed for stocking and selling first-line antimalarials. PMV sold no longer recommended antimalarials, such as Chloroquine, Sulfadoxine-Pyrimethamine and oral Artesunate monotherapy. Most PMV were ignorant of and lacked training about new treatment guidelines that had endorsed ACTs as first-line treatment for uncomplicated malaria. There is urgent need to regularly monitor and improve the availability and quality of malaria treatment provided by medicine sellers in Nigeria; the irrational use of antimalarials in the ACT era revealed in this study bears a high risk of economic loss, death and development of drug resistance. LQAS has been shown to be a suitable method for monitoring malaria-related indicators among PMV, and should be applied in Nigeria and elsewhere to improve service delivery.

Are Patent Medicine Vendors Effective Agents in Malaria Control? Using Lot Quality Assurance Sampling to Assess Quality of Practice in Jigawa, Nigeria

PubMed Central

Berendes, Sima; Adeyemi, Olusegun; Oladele, Edward Adekola; Oresanya, Olusola Bukola; Okoh, Festus; Valadez, Joseph J.

2012-01-01

Background Patent medicine vendors (PMV) provide antimalarial treatment and care throughout Sub-Saharan Africa, and can play an important role in the fight against malaria. Their close-to-client infrastructure could enable lifesaving artemisinin-based combination therapy (ACT) to reach patients in time. However, systematic assessments of drug sellers’ performance quality are crucial if their role is to be managed within the health system. Lot quality assurance sampling (LQAS) could be an efficient method to monitor and evaluate PMV practice, but has so far never been used for this purpose. Methods In support of the Nigeria Malaria Booster Program we assessed PMV practices in three Senatorial Districts (SDs) of Jigawa, Nigeria. A two-stage LQAS assessed whether at least 80% of PMV stores in SDs used national treatment guidelines. Acceptable sampling errors were set in consultation with government officials (alpha and beta <0.10). The hypergeometric formula determined sample sizes and cut-off values for SDs. A structured assessment tool identified high and low performing SDs for quality of care indicators. Findings Drug vendors performed poorly in all SDs of Jigawa for all indicators. For example, all SDs failed for stocking and selling first-line antimalarials. PMV sold no longer recommended antimalarials, such as Chloroquine, Sulfadoxine-Pyrimethamine and oral Artesunate monotherapy. Most PMV were ignorant of and lacked training about new treatment guidelines that had endorsed ACTs as first-line treatment for uncomplicated malaria. Conclusion There is urgent need to regularly monitor and improve the availability and quality of malaria treatment provided by medicine sellers in Nigeria; the irrational use of antimalarials in the ACT era revealed in this study bears a high risk of economic loss, death and development of drug resistance. LQAS has been shown to be a suitable method for monitoring malaria-related indicators among PMV, and should be applied in Nigeria and elsewhere to improve service delivery. PMID:22984555

23 CFR 637.207 - Quality assurance program.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Quality assurance program. 637.207 Section 637.207... CONSTRUCTION INSPECTION AND APPROVAL Quality Assurance Procedures for Construction § 637.207 Quality assurance program. (a) Each STD's quality assurance program shall provide for an acceptance program and an...

Empowered diabetes management: life coaching and pharmacist counseling for employed adults with diabetes.

PubMed

Nishita, Christy; Cardazone, Gina; Uehara, Denise Lea; Tom, Tammy

2013-10-01

The Hawai'i Demonstration to Maintain Independence and Employment was a randomized controlled trial examining the effect of a participant-driven, multicomponent intervention on 190 employed adults with diabetes, 36% of whom were Asian and 35% of whom were Native Hawaiian or Pacific Islander. A no treatment concurrent control group was used, and the treatment group was provided an intervention that paired each participant with a life coach and a pharmacist counselor with whom they worked to achieve collaboratively chosen goals. Treatment fidelity data suggest that the intervention was largely implemented as planned. Life coaches and pharmacists performed key program functions with high to moderate adherence. The quality of their adherence to the intervention model ranged from basic to above basic and below basic to above basic for life coaches and pharmacists, respectively. Results of repeated-measures analysis of covariance analyses indicate that the intervention had a significant positive effect on participants' diabetes self-efficacy, quality of life, and body mass index but not on hemoglobin A1c levels. Further analyses examining just the treatment group indicate a dosage effect, with body mass index and quality of life outcomes optimized among participants who engaged in a greater number of sessions with life coaches and pharmacists. Implications of the study findings for practice are discussed.

Potassium ferrate treatment of RFETS` contaminated groundwater

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1995-01-01

The potassium ferrate treatment study of Rocky Flats Environmental Technology Site (RFETS) groundwater was performed under the Sitewide Treatability Studies Program (STSP). This study was undertaken to determine the effectiveness of potassium ferrate in a water treatment system to remove the contaminants of concern (COCS) from groundwater at the RFETS. Potassium ferrate is a simple salt where the iron is in the plus six valence state. It is the iron at the plus six valence state (Fe {sup +6}) that makes it an unique water treatment chemical, especially in waters where the pH is greater than seven. In basic solutionsmore » where the solubility of the oxides/hydroxides of many of the COCs is low, solids are formed as the pH is raised. By using ferrate these solids are agglomerated so they can be effectively removed by sedimentation in conventional water treatment equipment. The objective of this study was to determine the quality of water after treatment with potassium ferrate and to determine if the Colorado Water Quality Control Commission (CWQCC) discharge limits for the COCs listed in Table 1.0-1 could be met. Radionuclides in the groundwater were of special concern.« less

A Comprehensive Quality Assurance Program for Personnel and Procedures in Radiation Oncology: Value of Voluntary Error Reporting and Checklists

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kalapurakal, John A., E-mail: j-kalapurakal@northwestern.edu; Zafirovski, Aleksandar; Smith, Jeffery

Purpose: This report describes the value of a voluntary error reporting system and the impact of a series of quality assurance (QA) measures including checklists and timeouts on reported error rates in patients receiving radiation therapy. Methods and Materials: A voluntary error reporting system was instituted with the goal of recording errors, analyzing their clinical impact, and guiding the implementation of targeted QA measures. In response to errors committed in relation to treatment of the wrong patient, wrong treatment site, and wrong dose, a novel initiative involving the use of checklists and timeouts for all staff was implemented. The impactmore » of these and other QA initiatives was analyzed. Results: From 2001 to 2011, a total of 256 errors in 139 patients after 284,810 external radiation treatments (0.09% per treatment) were recorded in our voluntary error database. The incidence of errors related to patient/tumor site, treatment planning/data transfer, and patient setup/treatment delivery was 9%, 40.2%, and 50.8%, respectively. The compliance rate for the checklists and timeouts initiative was 97% (P<.001). These and other QA measures resulted in a significant reduction in many categories of errors. The introduction of checklists and timeouts has been successful in eliminating errors related to wrong patient, wrong site, and wrong dose. Conclusions: A comprehensive QA program that regularly monitors staff compliance together with a robust voluntary error reporting system can reduce or eliminate errors that could result in serious patient injury. We recommend the adoption of these relatively simple QA initiatives including the use of checklists and timeouts for all staff to improve the safety of patients undergoing radiation therapy in the modern era.« less

7 CFR 1901.202 - Nondiscrimination in FmHA or its successor agency under Public Law 103-354 programs.

Code of Federal Regulations, 2012 CFR

2012-01-01

... person or cause any person to be subjected to discrimination on the ground of race, color, or national... unequal treatment in priority, quality, quantity, methods, or charges for service, use, occupancy or... criteria or methods of administration that have the effect of subjecting a person to discrimination with...

7 CFR 1901.202 - Nondiscrimination in FmHA or its successor agency under Public Law 103-354 programs.

Code of Federal Regulations, 2013 CFR

2013-01-01

... person or cause any person to be subjected to discrimination on the ground of race, color, or national... unequal treatment in priority, quality, quantity, methods, or charges for service, use, occupancy or... criteria or methods of administration that have the effect of subjecting a person to discrimination with...

7 CFR 1901.202 - Nondiscrimination in FmHA or its successor agency under Public Law 103-354 programs.

Code of Federal Regulations, 2010 CFR

2010-01-01

... person or cause any person to be subjected to discrimination on the ground of race, color, or national... unequal treatment in priority, quality, quantity, methods, or charges for service, use, occupancy or... criteria or methods of administration that have the effect of subjecting a person to discrimination with...

7 CFR 1901.202 - Nondiscrimination in FmHA or its successor agency under Public Law 103-354 programs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... person or cause any person to be subjected to discrimination on the ground of race, color, or national... unequal treatment in priority, quality, quantity, methods, or charges for service, use, occupancy or... criteria or methods of administration that have the effect of subjecting a person to discrimination with...

7 CFR 1901.202 - Nondiscrimination in FmHA or its successor agency under Public Law 103-354 programs.

Code of Federal Regulations, 2011 CFR

2011-01-01

... person or cause any person to be subjected to discrimination on the ground of race, color, or national... unequal treatment in priority, quality, quantity, methods, or charges for service, use, occupancy or... criteria or methods of administration that have the effect of subjecting a person to discrimination with...

INVESTIGATING THE SOURCES OF THE MUTAGENIC ACTIVITY FOUND IN A RIVER USING THE SALMONELLA ASSAY AND DIFFERENT WATER EXTRACTION PROCEDURES

EPA Science Inventory

Abstract
As a consequence of the routine surface water quality-monitoring program of Sao Paulo State (Brazil), which includes the Salmonella microsome mutagenicity assay as one of its parameters, we detected a river used as a drinking water source after treatment, that repeate...

NCORP’s First Year Reviewed | Division of Cancer Prevention

Cancer.gov

By the numbers, the first year of NCI’s Community Oncology Research Program (NCORP) has made progress in clinical trials for prevention, control, health-related quality of life, comparative effectiveness and screening; accrual to NCI National Clinical Trials Network treatment and imaging trials; and in new areas of emphasis in cancer care delivery research and cancer

Development and Exchange of Instructional Resources in Water Quality Control Programs, II: Instructional Materials Available.

ERIC Educational Resources Information Center

Austin, John H.

This document is one in a series of reports which reviews instructional materials and equipment for water and wastewater treatment plant personnel. Approximately 900 items are listed in this document along with guidelines for the production of instructional materials. Information is provided regarding the source, type of material, intended…

A singular value decomposition linear programming (SVDLP) optimization technique for circular cone based robotic radiotherapy.

PubMed

Liang, Bin; Li, Yongbao; Wei, Ran; Guo, Bin; Xu, Xuang; Liu, Bo; Li, Jiafeng; Wu, Qiuwen; Zhou, Fugen

2018-01-05

With robot-controlled linac positioning, robotic radiotherapy systems such as CyberKnife significantly increase freedom of radiation beam placement, but also impose more challenges on treatment plan optimization. The resampling mechanism in the vendor-supplied treatment planning system (MultiPlan) cannot fully explore the increased beam direction search space. Besides, a sparse treatment plan (using fewer beams) is desired to improve treatment efficiency. This study proposes a singular value decomposition linear programming (SVDLP) optimization technique for circular collimator based robotic radiotherapy. The SVDLP approach initializes the input beams by simulating the process of covering the entire target volume with equivalent beam tapers. The requirements on dosimetry distribution are modeled as hard and soft constraints, and the sparsity of the treatment plan is achieved by compressive sensing. The proposed linear programming (LP) model optimizes beam weights by minimizing the deviation of soft constraints subject to hard constraints, with a constraint on the l 1 norm of the beam weight. A singular value decomposition (SVD) based acceleration technique was developed for the LP model. Based on the degeneracy of the influence matrix, the model is first compressed into lower dimension for optimization, and then back-projected to reconstruct the beam weight. After beam weight optimization, the number of beams is reduced by removing the beams with low weight, and optimizing the weights of the remaining beams using the same model. This beam reduction technique is further validated by a mixed integer programming (MIP) model. The SVDLP approach was tested on a lung case. The results demonstrate that the SVD acceleration technique speeds up the optimization by a factor of 4.8. Furthermore, the beam reduction achieves a similar plan quality to the globally optimal plan obtained by the MIP model, but is one to two orders of magnitude faster. Furthermore, the SVDLP approach is tested and compared with MultiPlan on three clinical cases of varying complexities. In general, the plans generated by the SVDLP achieve steeper dose gradient, better conformity and less damage to normal tissues. In conclusion, the SVDLP approach effectively improves the quality of treatment plan due to the use of the complete beam search space. This challenging optimization problem with the complete beam search space is effectively handled by the proposed SVD acceleration.

A singular value decomposition linear programming (SVDLP) optimization technique for circular cone based robotic radiotherapy

NASA Astrophysics Data System (ADS)

Liang, Bin; Li, Yongbao; Wei, Ran; Guo, Bin; Xu, Xuang; Liu, Bo; Li, Jiafeng; Wu, Qiuwen; Zhou, Fugen

2018-01-01

With robot-controlled linac positioning, robotic radiotherapy systems such as CyberKnife significantly increase freedom of radiation beam placement, but also impose more challenges on treatment plan optimization. The resampling mechanism in the vendor-supplied treatment planning system (MultiPlan) cannot fully explore the increased beam direction search space. Besides, a sparse treatment plan (using fewer beams) is desired to improve treatment efficiency. This study proposes a singular value decomposition linear programming (SVDLP) optimization technique for circular collimator based robotic radiotherapy. The SVDLP approach initializes the input beams by simulating the process of covering the entire target volume with equivalent beam tapers. The requirements on dosimetry distribution are modeled as hard and soft constraints, and the sparsity of the treatment plan is achieved by compressive sensing. The proposed linear programming (LP) model optimizes beam weights by minimizing the deviation of soft constraints subject to hard constraints, with a constraint on the l 1 norm of the beam weight. A singular value decomposition (SVD) based acceleration technique was developed for the LP model. Based on the degeneracy of the influence matrix, the model is first compressed into lower dimension for optimization, and then back-projected to reconstruct the beam weight. After beam weight optimization, the number of beams is reduced by removing the beams with low weight, and optimizing the weights of the remaining beams using the same model. This beam reduction technique is further validated by a mixed integer programming (MIP) model. The SVDLP approach was tested on a lung case. The results demonstrate that the SVD acceleration technique speeds up the optimization by a factor of 4.8. Furthermore, the beam reduction achieves a similar plan quality to the globally optimal plan obtained by the MIP model, but is one to two orders of magnitude faster. Furthermore, the SVDLP approach is tested and compared with MultiPlan on three clinical cases of varying complexities. In general, the plans generated by the SVDLP achieve steeper dose gradient, better conformity and less damage to normal tissues. In conclusion, the SVDLP approach effectively improves the quality of treatment plan due to the use of the complete beam search space. This challenging optimization problem with the complete beam search space is effectively handled by the proposed SVD acceleration.

Evaluating a measure of social health derived from two mental health recovery measures: the California Quality of Life (CA-QOL) and Mental Health Statistics Improvement Program Consumer Survey (MHSIP).

PubMed

Carlson, Jordan A; Sarkin, Andrew J; Levack, Ashley E; Sklar, Marisa; Tally, Steven R; Gilmer, Todd P; Groessl, Erik J

2011-08-01

Social health is important to measure when assessing outcomes in community mental health. Our objective was to validate social health scales using items from two broader commonly used measures that assess mental health outcomes. Participants were 609 adults receiving psychological treatment services. Items were identified from the California Quality of Life (CA-QOL) and Mental Health Statistics Improvement Program (MHSIP) outcome measures by their conceptual correspondence with social health and compared to the Social Functioning Questionnaire (SFQ) using correlational analyses. Pearson correlations for the identified CA-QOL and MSHIP items with the SFQ ranged from .42 to .62, and the identified scale scores produced Pearson correlation coefficients of .56, .70, and, .70 with the SFQ. Concurrent validity with social health was supported for the identified scales. The current inclusion of these assessment tools allows community mental health programs to include social health in their assessments.

Evaluation of the Effectiveness of a Multimodal Complementary Medicine Program for Improving the Quality of Life of Cancer Patients during Adjuvant Radiotherapy and/or Chemotherapy or Outpatient Aftercare.

PubMed

Domnick, Martin; Domnick, Manju; Wiebelitz, Karl-Rüdiger; Beer, André-Michael

2017-01-01

Evidence for complementary therapies as important strategies to relieve cancer treatment-associated symptoms is increasing. Mostly, these complementary therapies start at the end of adjuvant treatments, resulting in a long delay until the well-being of patients is addressed. Further, long distances between the rehabilitation center and the patients' residence hinder patients' compliance. The multimodal outpatient LOTUS Care Cure Project (LCCP) was tested in a randomized controlled trial including patients of various cancer entities and stages while on adjuvant chemotherapy and/or radiotherapy or outpatient aftercare. The intervention group received the LCCP additionally to the conventional treatment (LCCP group, n = 50). The control group (CG) was split into 2 groups, with (CG1, n = 33) and without (CG2, n = 17) weekly talks. The primary endpoint was quality of life (QoL) after 3 months. In the LCCP group, QoL significantly improved after 3 months compared to CG2 (p = 0.022) but not compared to CG1. Other parameters showing a significant improvement were cognitive (p < 0.05, vs. CG1 and CG2) and social function (p < 0.05, vs. CG2). This pilot study describes a multimodal outpatient complementary therapy program conducted in parallel with conventional therapies and its potential to significantly improve QoL and reduce treatment-associated side effects. To substantiate these data, multicenter trials are needed. © 2017 S. Karger AG, Basel.

A study to establish reasonable action limits for patient‐specific quality assurance in intensity‐modulated radiation therapy

PubMed Central

Alecu, Ionut M.; Stan, Andrada R.; Alecu, Marius; Ciura, Andrei; Hansen, Jeremy M.; Alecu, Rodica

2007-01-01

An effective patient quality assurance (QA) program for intensity‐modulated radiation therapy (IMRT) requires accurate and realistic plan acceptance criteria—that is, action limits. Based on dose measurements performed with a commercially available two‐dimensional (2D) diode array, we analyzed 747 fluence maps resulting from a routine patient QA program for IMRT plans. The fluence maps were calculated by three different commercially available (ADAC, CMS, Eclipse) treatment planning systems (TPSs) and were delivered using 6‐MV X‐ray beams produced by linear accelerators. To establish reasonably achievable and clinically acceptable limits for the dose deviations, the agreement between the measured and calculated fluence maps was evaluated in terms of percent dose error (PDE) for a few points and percent of passing points (PPP) for the isodose distribution. The analysis was conducted for each TPS used in the study (365 ADAC, 162 CMS, 220 Eclipse), for multiple treatment sites (prostate, pelvis, head and neck, spine, rectum, anus, lung, brain), at the normalization point for 3% percentage difference (%Diff) and 3‐mm distance to agreement (DTA) criteria. We investigated the treatment‐site dependency of PPP and PDE. The results show that, at 3% and 3‐mm criteria, a 95% PPP and 3% PDE can be achieved for prostate treatments and a 90% PPP and 5% PDE are attainable for any treatment site. PACS Numbers: 87.53Dq, 87.53Tf, 87.53Xd, 87.56Fc PMID:17592459

Clinical Impact and Cost-Effectiveness of an Education Program for PD Patients: A Randomized Controlled Trial

PubMed Central

Ory-Magne, Fabienne; Arcari, Céline; Mohara, Christine; Pourcel, Laure; Derumeaux, Hélène; Bérard, Emilie; Bourrel, Robert; Molinier, Laurent; Brefel-Courbon, Christine

2016-01-01

Background Parkinson’s disease (PD) is characterized by its impact on quality of life, constituting a substantial economic burden on society. Education programs implicating patients more in the management of their illness and complementing medical treatment may be a beneficial adjunct in PD. This study assessed the impact of an education program on quality of life and its cost-effectiveness in PD patients. Methods This single-center, prospective, randomized study assessed an education program consisting of individual and group sessions over a 12-month period. A total of 120 PD patients were assigned to either the Treated by Behavioral Intervention group (TTBI) or the no TTBI group. The primary outcome criterion was quality of life assessed using PDQ39. The Unified Parkinson’s Disease Rating Scale (UPDRS) and psychological status were collected. An economic evaluation was performed, including calculations of incremental cost-effectiveness ratios (ICERs). Results After 12 months of follow-up, changes recorded in the PDQ39 between the groups were not significantly different but better changes were observed in each dimension in the TTBI group compared to the no TTBI group. UPDRS I, II and total score were significantly improved in TTBI group compared to the no TTBI group. Mean annual costs did not differ significantly between the two groups. Conclusion This study suggested that the education program positively impacts the perceived health of PD patients without increasing medical costs. PMID:27685455

Pioneering quality assessment in European cancer centers: a data analysis of the organization for European cancer institutes accreditation and designation program.

PubMed

Saghatchian, Mahasti; Thonon, Frédérique; Boomsma, Femke; Hummel, Henk; Koot, Bert; Harrison, Chris; Rajan, Abinaya; de Valeriola, Dominique; Otter, Renée; Laranja Pontes, José; Lombardo, Claudio; McGrath, Eoin; Ringborg, Ulrik; Tursz, Thomas; van Harten, Wim

2014-09-01

In order to improve the quality of care in Cancer Centers (CC) and designate Comprehensive Cancer Centers (CCCs), the Organization for European Cancer Institutes (OECI) launched an Accreditation and Designation (A&D) program. The program facilitates the collection of defined data and the assessment of cancer center quality. This study analyzes the results of the first 10 European centers that entered the program. The assessment included 927 items divided across qualitative and quantitative questionnaires. Data collected during self-assessment and peer-review from the 10 first participating centers were combined in a database for comparative analysis using simple statistics. Quantitative and qualitative results were validated by auditors during the peer review visits. Volumes of various functions and activities dedicated to care, research, and education varied widely among centers. There were no significant differences in resources for radiology, radiotherapy, pathologic diagnostic, and surgery. Differences were observed in the use of clinical pathways but not for the practices of holding multidisciplinary team meetings and conforming to guidelines. Regarding human resources, main differences were in the composition and number of supportive care and research staff. All 10 centers applied as CCCs; five obtained the label, and five were designated as CCs. The OECI A&D program allows comparisons between centers with regard to management, research, care, education, and designation as CCs or CCCs. Through the peer review system, recommendations for improvements are given. Assessing the added value of the program, as well as research and patient treatment outcomes, is the next step. Copyright © 2014 by American Society of Clinical Oncology.

Multicenter Collaborative Quality Assurance Program for the Province of Ontario, Canada: First-Year Results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Létourneau, Daniel, E-mail: daniel.letourneau@rmp.uh.on.ca; Department of Radiation Oncology, University of Toronto, Toronto, Ontario; McNiven, Andrea

2013-05-01

Purpose: The objective of this work was to develop a collaborative quality assurance (CQA) program to assess the performance of intensity modulated radiation therapy (IMRT) planning and delivery across the province of Ontario, Canada. Methods and Materials: The CQA program was designed to be a comprehensive end-to-end test that can be completed on multiple planning and delivery platforms. The first year of the program included a head-and-neck (H and N) planning exercise and on-site visit to acquire dosimetric measurements to assess planning and delivery performance. A single dosimeter was used at each institution, and the planned to measured dose agreementmore » was evaluated for both the H and N plan and a standard plan (linear-accelerator specific) that was created to enable a direct comparison between centers with similar infrastructure. Results: CQA program feasibility was demonstrated through participation of all 13 radiation therapy centers in the province. Planning and delivery was completed on a variety of infrastructure (treatment planning systems and linear accelerators). The planning exercise was completed using both static gantry and rotational IMRT, and planned-to-delivered dose agreement (pass rates) for 3%/3-mm gamma evaluation were greater than 90% (92.6%-99.6%). Conclusions: All centers had acceptable results, but variation in planned to delivered dose agreement for the same planning and delivery platform was noted. The upper end of the range will provide an achievable target for other centers through continued quality improvement, aided by feedback provided by the program through the use of standard plans and simple test fields.« less

Modification of infant hypothyroidism and phenylketonuria screening program using electronic tools.

PubMed

Taheri, Behjat; Haddadpoor, Asefeh; Mirkhalafzadeh, Mahmood; Mazroei, Fariba; Aghdak, Pezhman; Nasri, Mehran; Bahrami, Gholamreza

2017-01-01

Congenital hypothyroidism and phenylketonuria (PKU) are the most common cause for preventable mental retardation in infants worldwide. Timely diagnosis and treatment of these disorders can have lasting effects on the mental development of newborns. However, there are several problems at different stages of screening programs that along with imposing heavy costs can reduce the precision of the screening, increasing the chance of undiagnosed cases which in turn can have damaging consequences for the society. Therefore, given these problems and the importance of information systems in facilitating the management and improving the quality of health care the aim of this study was to improve the screening process of hypothyroidism and PKU in infants with the help of electronic resources. The current study is a qualitative, action research designed to improve the quality of screening, services, performance, implementation effectiveness, and management of hypothyroidism and PKU screening program in Isfahan province. To this end, web-based software was designed. Programming was carried out using Delphi.net software and used SQL Server 2008 for database management. Given the weaknesses, problems, and limitations of hypothyroidism and PKU screening program, and the importance of these diseases in a national scale, this study resulted in design of hypothyroidism and PKU screening software for infants in Isfahan province. The inputs and outputs of the software were designed in three levels including Health Care Centers in charge of the screening program, provincial reference lab, and health and treatment network of Isfahan province. Immediate registration of sample data at the time and location of sampling, providing the provincial reference Laboratory and Health Centers of different eparchies with the ability to instantly observe, monitor, and follow-up on the samples at any moment, online verification of samples by reference lab, creating a daily schedule for reference lab, and receiving of the results from analysis equipment; and entering the results into the database without the need for user input are among the features of this software. The implementation of hypothyroidism screening software led to an increase in the quality and efficiency of the screening program; minimized the risk of human error in the process and solved many of the previous limitations of the screening program which were the main goals for implementation of this software. The implementation of this software also resulted in improvement in precision and quality of services provided for these two diseases and better accuracy and precision for data inputs by providing the possibility of entering the sample data at the place and time of sampling which then resulted in the possibility of management based on precise data and also helped develop a comprehensive database and improved the satisfaction of service recipients.

Intensive weekend group treatment for panic disorder and its impact on co-occurring PTSD: A pilot study.

PubMed

Teng, Ellen J; Barrera, Terri L; Hiatt, Emily L; Chaison, Angelic D; Dunn, Nancy Jo; Petersen, Nancy J; Stanley, Melinda A

2015-06-01

This pilot study examines the feasibility, acceptability, and potential effectiveness of delivering an intensive weekend group treatment for panic disorder (PD) to Veterans returning from deployments to Iraq and Afghanistan with co-occurring posttraumatic stress disorder (PTSD). The treatment program lasted 6h each day and was delivered by two experienced therapists. Patients received core components of panic treatment, including psychoeducation, cognitive restructuring, and interoceptive exposure. The interoceptive exposure exercises directly targeted anxiety sensitivity, a psychological construct also implicated in the maintenance of PTSD. Eighty-nine percent of patients who expressed interest in the treatment attended a baseline evaluation, and 63% of those who were study eligible initiated treatment. Treatment retention was high, with all 10 patients who initiated treatment completing the program. Veterans reported finding the treatment and delivery format highly acceptable and reported high levels of satisfaction. Panic symptoms improved significantly following the treatment and were maintained at a 7-month follow-up, with 71.4% of the sample reporting being panic free. Co-occurring PTSD symptoms also improved along with symptoms of anxiety and depression. Preliminary findings suggest that brief and intensive group treatments for PD/PTSD are a promising method of delivering cognitive behavioral therapy that may rapidly improve symptoms. This innovative treatment delivery format also may be a cost-effective way of increasing treatment engagement through increased access to quality care. Published by Elsevier Ltd.

Interpersonal styles, peer relationships, and outcomes in residential substance use treatment.

PubMed

Harrison, Anna J; Timko, Christine; Blonigen, Daniel M

2017-10-01

Interpersonal relationships play a key role in recovery from substance use disorders (SUDs). We examined the associations between problematic interpersonal styles, peer relationships, and treatment outcomes in a sample of U.S. military veterans in residential SUD treatment. Participants were 189 veterans enrolled in a residential SUD treatment program at a Department of Veterans Affairs medical center. Participants were interviewed at the time of treatment entry (baseline), one month into treatment, and 12months following discharge from treatment. More problematic interpersonal styles at treatment entry, measured by the Inventory of Interpersonal Problems-Circumplex (IIP-C), predicted more SUD symptoms 12months post-discharge (r=0.29, P<0.01). Results of a principal components analysis of the IIP-C subscales revealed three main factors of interpersonal styles: Passive, Cruel/Aloof, and Controlling. With the exception of the Passive factor, the relationship between these interpersonal styles and SUD symptoms 12months after discharge was mediated by relationship quality with peers one month in treatment: i.e., more problematic interpersonal styles at baseline predicted poorer relationship quality with peers at 1month, which in turn predicted more SUD symptoms at 12months. Results demonstrate the importance of assessing interpersonal styles among patients in residential SUD treatment, as well as potentially augmenting existing evidence-based psychosocial treatments with a focus on interpersonal styles. Copyright © 2017 Elsevier Inc. All rights reserved.

Military sexual assault, gender, and PTSD treatment outcomes of U.S. Veterans.

PubMed

Tiet, Quyen Q; Leyva, Yani E; Blau, Kathy; Turchik, Jessica A; Rosen, Craig S

2015-04-01

This study examined whether gender and military sexual assault (MSA) were associated with psychiatric severity differences at initiation of treatment for posttraumatic stress disorder (PTSD) and whether MSA and gender predicted psychiatric treatment outcomes. Male (n = 726) and female (n = 111) patients were recruited from 7 U.S. Department of Veterans Affairs (VA) PTSD specialty intensive treatment programs and completed an intake survey; 69% (n = 574) of the participants completed a 4-month postdischarge follow-up survey. Measures included current PTSD and depressive symptoms, aggressive/violent behaviors, alcohol and drug use severity, and quality of life. Multilevel multivariate regression analyses were conducted to examine the main and interaction effects of gender and MSA on psychiatric treatment outcomes at 4-month follow-up, including demographics, baseline severity, hostile fire, and treatment length of stay. Baseline PTSD severity did not differ by gender or MSA status, but women had more severe depressive symptoms (d = 0.40) and less aggressive/violent symptoms (d = -0.46) than men. Gender, MSA status, and the interaction between gender and MSA did not predict treatment outcomes as hypothesized. Male and female veterans with and without MSA responded equally well to treatment in VA PTSD intensive treatment programs. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Benefits and costs of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease - a multi-centre randomised controlled equivalence trial.

PubMed

Holland, Anne E; Mahal, Ajay; Hill, Catherine J; Lee, Annemarie L; Burge, Angela T; Moore, Rosemary; Nicolson, Caroline; O'Halloran, Paul; Cox, Narelle S; Lahham, Aroub; Ndongo, Rebecca; Bell, Emily; McDonald, Christine F

2013-09-08

Pulmonary rehabilitation is widely advocated for people with chronic obstructive pulmonary disease (COPD) to improve exercise capacity, symptoms and quality of life, however only a minority of individuals with COPD are able to participate. Travel and transport are frequently cited as barriers to uptake of centre-based programs. Other models of pulmonary rehabilitation, including home-based programs, have been proposed in order to improve access to this important treatment. Previous studies of home-based pulmonary rehabilitation in COPD have demonstrated improvement in exercise capacity and quality of life, but not all elements of the program were conducted in the home environment. It is uncertain whether a pulmonary rehabilitation program delivered in its entirety at home is cost effective and equally capable of producing benefits in exercise capacity, symptoms and quality of life as a hospital-based program. The aim of this study is to compare the costs and benefits of home-based and hospital-based pulmonary rehabilitation for people with COPD. This randomised, controlled, equivalence trial conducted at two centres will recruit 166 individuals with spirometrically confirmed COPD. Participants will be randomly allocated to hospital-based or home-based pulmonary rehabilitation. Hospital programs will follow the traditional outpatient model consisting of twice weekly supervised exercise training and education for eight weeks. Home-based programs will involve one home visit followed by seven weekly telephone calls, using a motivational interviewing approach to enhance exercise participation and facilitate self management. The primary outcome is change in 6-minute walk distance immediately following intervention. Measurements of exercise capacity, physical activity, symptoms and quality of life will be taken at baseline, immediately following the intervention and at 12 months, by a blinded assessor. Completion rates will be compared between programs. Direct healthcare costs and indirect (patient-related) costs will be measured to compare the cost-effectiveness of each program. This trial will identify whether home-based pulmonary rehabilitation can deliver equivalent benefits to centre-based pulmonary rehabilitation in a cost effective manner. The results of this study will contribute new knowledge regarding alternative models of pulmonary rehabilitation and will inform pulmonary rehabilitation guidelines for COPD.

A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial.

PubMed

Rojas, Graciela; Guajardo, Viviana; Martínez, Pablo; Castro, Ariel; Fritsch, Rosemarie; Moessner, Markus; Bauer, Stephanie

2018-04-30

In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management of depressive patients. Future cost-effectiveness studies are needed. Clinicaltrials.gov NCT02200367; https://clinicaltrials.gov/ct2/show/NCT02200367 (Archived by WebCite at http://www.webcitation.org/6xtZ7OijZ). ©Graciela Rojas, Viviana Guajardo, Pablo Martínez, Ariel Castro, Rosemarie Fritsch, Markus Moessner, Stephanie Bauer. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.04.2018.

The Hospital at Home program: no place like home.

PubMed

Lippert, M; Semmens, S; Tacey, L; Rent, T; Defoe, K; Bucsis, M; Shykula, T; Crysdale, J; Lewis, V; Strother, D; Lafay-Cousin, L

2017-02-01

The treatment of children with cancer is associated with significant burden for the entire family. Frequent clinic visits and extended hospital stays can negatively affect quality of life for children and their families. Here, we describe the development of a Hospital at Home program (H@H) that delivers therapy to pediatric hematology, oncology, and blood and marrow transplant (bmt) patients in their homes. The services provided include short infusions of chemotherapy, supportive-care interventions, antibiotics, post-chemotherapy hydration, and teaching. From 2013 to 2015, the H@H program served 136 patients, making 1701 home visits, for patients mainly between the ages of 1 and 4 years. Referrals came from oncology in 82% of cases, from hematology in 11%, and from bmt in 7%. Since inception of the program, no adverse events have been reported. Family surveys suggested less disruption in daily routines and appreciation of specialized care by hematology and oncology nurses. Staff surveys highlighted a perceived benefit of H@H in contributing to early discharge of patients by supporting out-of-hospital monitoring and teaching. The development of a H@H program dedicated to the pediatric hematology, oncology, or bmt patient appears feasible. Our pilot program offers a potential contribution to improvement in patient quality of life and in cost-benefit for parents and the health care system.

SU-C-BRD-05: Implementation of Incident Learning in the Safety and Quality Management of Radiotherapy: The Primary Experience in a New Established Program with Advanced Techniques

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, R; Wang, J

2014-06-15

Purpose: To explore the implementation and effectiveness of incident learning for the safety and quality of radiotherapy in a new established radiotherapy program with advanced technology. Methods: Reference to the consensus recommendations by American Association of Physicist in Medicine, an incident learning system was specifically designed for reporting, investigating, and learning of individual radiotherapy incidents in a new established radiotherapy program, with 4D CBCT, Ultrasound guided radiotherapy, VMAT, gated treatment delivered on two new installed linacs. The incidents occurring in external beam radiotherapy from February, 2012 to January, 2014 were reported. Results: A total of 33 reports were analyzed, includingmore » 28 near misses and 5 incidents. Among them, 5 originated in imaging for planning, 25 in planning, 1 in plan transfer, 1 in commissioning and 1 in treatment delivery. Among them, three near misses originated in the safety barrier of the radiotherapy process. In terms of error type, 1 incident was classified as wrong patient, 7 near misses/incidents as wrong site, 6 as wrong laterality, 5 as wrong dose, 7 as wrong prescription, and 7 as suboptimal plan quality. 5 incidents were all classified as grade 1/2 of dosimetric severity, 1 as grade 0, and the other 4 as grade 1 of medical severity. For the causes/contributory factors, negligence, policy not followed, inadequate training, failure to develop an effective plan, and communication contributed to 19, 15, 12, 5 and 3 near misses/incidents, respectively. The average incident rate per 100 patients treated was 0.4; this rate fell to 0.28% in the second year from 0.56% in the first year. The rate of near miss fell to 1.24% from 2.22%. Conclusion: Effective incident learning can reduce the occurrence of near miss/incidents, enhance the culture of safety. Incident learning is an effective proactive method for improving the quality and safety of radiotherapy.« less

An economic evaluation: Simulation of the cost-effectiveness and cost-utility of universal prevention strategies against osteoporosis-related fractures

PubMed Central

Nshimyumukiza, Léon; Durand, Audrey; Gagnon, Mathieu; Douville, Xavier; Morin, Suzanne; Lindsay, Carmen; Duplantie, Julie; Gagné, Christian; Jean, Sonia; Giguère, Yves; Dodin, Sylvie; Rousseau, François; Reinharz, Daniel

2013-01-01

A patient-level Markov decision model was used to simulate a virtual cohort of 500,000 women 40 years old and over, in relation to osteoporosis-related hip, clinical vertebral, and wrist bone fractures events. Sixteen different screening options of three main scenario groups were compared: (1) the status quo (no specific national prevention program); (2) a universal primary prevention program; and (3) a universal screening and treatment program based on the 10-year absolute risk of fracture. The outcomes measured were total directs costs from the perspective of the public health care system, number of fractures, and quality-adjusted life-years (QALYs). Results show that an option consisting of a program promoting physical activity and treatment if a fracture occurs is the most cost-effective (CE) (cost/fracture averted) alternative and also the only cost saving one, especially for women 40 to 64 years old. In women who are 65 years and over, bone mineral density (BMD)-based screening and treatment based on the 10-year absolute fracture risk calculated using a Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tool is the best next alternative. In terms of cost-utility (CU), results were similar. For women less than 65 years old, a program promoting physical activity emerged as cost-saving but BMD-based screening with pharmacological treatment also emerged as an interesting alternative. In conclusion, a program promoting physical activity is the most CE and CU option for women 40 to 64 years old. BMD screening and pharmacological treatment might be considered a reasonable alternative for women 65 years old and over because at a healthcare capacity of $50,000 Canadian dollars ($CAD) for each additional fracture averted or for one QALY gained its probabilities of cost-effectiveness compared to the program promoting physical activity are 63% and 75%, respectively, which could be considered socially acceptable. Consideration of the indirect costs could change these findings. PMID:22991210

TU-AB-BRD-04: Development of Quality Management Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thomadsen, B.

2015-06-15

Current quality assurance and quality management guidelines provided by various professional organizations are prescriptive in nature, focusing principally on performance characteristics of planning and delivery devices. However, published analyses of events in radiation therapy show that most events are often caused by flaws in clinical processes rather than by device failures. This suggests the need for the development of a quality management program that is based on integrated approaches to process and equipment quality assurance. Industrial engineers have developed various risk assessment tools that are used to identify and eliminate potential failures from a system or a process before amore » failure impacts a customer. These tools include, but are not limited to, process mapping, failure modes and effects analysis, fault tree analysis. Task Group 100 of the American Association of Physicists in Medicine has developed these tools and used them to formulate an example risk-based quality management program for intensity-modulated radiotherapy. This is a prospective risk assessment approach that analyzes potential error pathways inherent in a clinical process and then ranks them according to relative risk, typically before implementation, followed by the design of a new process or modification of the existing process. Appropriate controls are then put in place to ensure that failures are less likely to occur and, if they do, they will more likely be detected before they propagate through the process, compromising treatment outcome and causing harm to the patient. Such a prospective approach forms the basis of the work of Task Group 100 that has recently been approved by the AAPM. This session will be devoted to a discussion of these tools and practical examples of how these tools can be used in a given radiotherapy clinic to develop a risk based quality management program. Learning Objectives: Learn how to design a process map for a radiotherapy process Learn how to perform failure modes and effects analysis analysis for a given process Learn what fault trees are all about Learn how to design a quality management program based upon the information obtained from process mapping, failure modes and effects analysis and fault tree analysis. Dunscombe: Director, TreatSafely, LLC and Center for the Assessment of Radiological Sciences; Consultant to IAEA and Varian Thomadsen: President, Center for the Assessment of Radiological Sciences Palta: Vice President of the Center for the Assessment of Radiological Sciences.« less

10 CFR 63.144 - Quality assurance program change.

Code of Federal Regulations, 2013 CFR

2013-01-01

... assurance program information that duplicates language in quality assurance regulatory guides and quality... 10 Energy 2 2013-01-01 2013-01-01 false Quality assurance program change. 63.144 Section 63.144... REPOSITORY AT YUCCA MOUNTAIN, NEVADA Quality Assurance § 63.144 Quality assurance program change. Changes to...

10 CFR 63.144 - Quality assurance program change.

Code of Federal Regulations, 2014 CFR

2014-01-01

... assurance program information that duplicates language in quality assurance regulatory guides and quality... 10 Energy 2 2014-01-01 2014-01-01 false Quality assurance program change. 63.144 Section 63.144... REPOSITORY AT YUCCA MOUNTAIN, NEVADA Quality Assurance § 63.144 Quality assurance program change. Changes to...

10 CFR 63.144 - Quality assurance program change.

Code of Federal Regulations, 2012 CFR

2012-01-01

... assurance program information that duplicates language in quality assurance regulatory guides and quality... 10 Energy 2 2012-01-01 2012-01-01 false Quality assurance program change. 63.144 Section 63.144... REPOSITORY AT YUCCA MOUNTAIN, NEVADA Quality Assurance § 63.144 Quality assurance program change. Changes to...

German diabetes management programs improve quality of care and curb costs.

PubMed

Stock, Stephanie; Drabik, Anna; Büscher, Guido; Graf, Christian; Ullrich, Walter; Gerber, Andreas; Lauterbach, Karl W; Lüngen, Markus

2010-12-01

This paper reports the results of a large-scale analysis of a nationwide disease management program in Germany for patients with diabetes mellitus. The German program differs markedly from "classic" disease management in the United States. Although it combines important hallmarks of vendor-based disease management and the Chronic Care Model, the German program is based in primary care practices and carried out by physicians, and it draws on their personal relationships with patients to promote adherence to treatment goals and self-management. After four years of follow-up, overall mortality for patients and drug and hospital costs were all significantly lower for patients who participated in the program compared to other insured patients with similar health profiles who were not in the program. These results suggest that the German disease management program is a successful strategy for improving chronic illness care.

Quality of life after cancer-How the extent of impairment is influenced by patient characteristics.

PubMed

Peters, Elisabeth; Mendoza Schulz, Laura; Reuss-Borst, Monika

2016-10-10

Although this effect is well known, tailored treatment methods have not yet been broadly adopted. The aim of this study was to identify those patient characteristics that most influence the impairment of quality of life and thus to identify those patients who need and can benefit most from specific intervention treatment. 1879 cancer patients were given the EORTC QLQ C-30 questionnaire at the beginning and end of their inpatient rehabilitation. Patients' scores were compared to those of 2081 healthy adults (Schwarz and Hinz, Eur J Cancer 37:1345-1351, 2001). Furthermore, differences in quality of life corresponding to sex, age, tumor site, TNM stage, interval between diagnosis and rehabilitation, and therapy method were examined. Compared to the healthy population, the study group showed a decreased quality of life in all analyzed domains. This difference diminished with increasing age. Women reported a lower quality of life then men in general. Patients with prostate cancer showed the least impairment in several domains. Patients having undergone chemotherapy as well as radiotherapy were impaired the most. Surprisingly, TNM stage and interval between diagnosis and rehabilitation did not significantly influence quality of life. Global quality of life and all functional domains significantly improved after a 3-week rehabilitation program. Despite an individualized and increasingly better tolerable therapy, the quality of life of cancer patients is still considerably impaired. However, systematic screening of psychosocial aspects of cancer, e.g. quality of life, could enable improved intervention.

Air quality impacts of transit improvement, preferential lane, and carpool programs: an annotated bibliography of demonstration and analytical experience. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

DiRenzo, J.F.; Rubin, R.B.

1978-03-01

In accordance with the Clean Air Act Amendments of 1977, the Environmental Protection Agency is evaluating the use and cost-effectiveness of alternative short-range transit fare and service improvement strategies, carpool and vanpool strategies, and strategies involving the preferential treatment of high occupancy vehicles to improve air quality in urban areas. The evaluation of individual strategies and combinations of the above strategies includes their emission and air quality impacts and their related energy, noise, and economic impacts. A comprehensive literature review was also conducted, as part of this evaluation, to identify both observed and projected travel, emission, air quality, energy, noise,more » and economic impacts of the short-range low-cost strategies of interest.« less

Short- and Long-Term Changes in Health-Related Quality of Life with Weight Loss: Results from a Randomized Controlled Trial.

PubMed

Pearl, Rebecca L; Wadden, Thomas A; Tronieri, Jena Shaw; Berkowitz, Robert I; Chao, Ariana M; Alamuddin, Naji; Leonard, Sharon M; Carvajal, Raymond; Bakizada, Zayna M; Pinkasavage, Emilie; Gruber, Kathryn A; Walsh, Olivia A; Alfaris, Nasreen

2018-06-01

The objective of this study was to determine the effects of weight loss and weight loss maintenance (WLM) on weight-specific health-related quality of life in a 66-week trial. Adults with obesity (N = 137, 86.1% female, 68.6% black, mean age = 46.1 years) who had lost ≥ 5% of initial weight in a 14-week intensive lifestyle intervention/low-calorie diet (LCD) program were randomly assigned to lorcaserin or placebo for an additional 52-week WLM program. The Impact of Weight on Quality of Life-Lite (IWQOL-Lite) scale (including five subscales), Patient Health Questionnaire-9 (depression), and Perceived Stress Scale were administered at the start of the 14-week LCD program, randomization, and week 52 of the randomized controlled trial (i.e., 66 weeks total). Significant improvements in all outcomes, except weight-related public distress, were found following the 14-week LCD program (P values < 0.05). Improvements were largely maintained during the 52-week randomized controlled trial, despite weight regain of 2.0 to 2.5 kg across treatment groups. Participants who lost ≥ 10% of initial weight achieved greater improvements in physical function, self-esteem, sexual life, and the IWQOL-Lite total score than those who lost < 5% and did not differ from those who lost 5% to 9.9%. Improvements in weight-specific health-related quality of life were achieved with moderate weight loss and were sustained during WLM. © 2018 The Obesity Society.

Improved quality monitoring of multi-center acupuncture clinical trials in China

PubMed Central

2009-01-01

Background In 2007, the Chinese Science Division of the State Administration of Traditional Chinese Medicine(TCM) convened a special conference to discuss quality control for TCM clinical research. Control and assurance standards were established to guarantee the quality of clinical research. This paper provides practical guidelines for implementing strict and reproducible quality control for acupuncture randomized controlled trials (RCTs). Methods A standard quality control program (QCP) was established to monitor the quality of acupuncture trials. Case report forms were designed; qualified investigators, study personnel and data management personnel were trained. Monitors, who were directly appointed by the project leader, completed the quality control programs. They guaranteed data accuracy and prevented or detected protocol violations. Clinical centers and clinicians were audited, the randomization system of the centers was inspected, and the treatment processes were audited as well. In addition, the case report forms were reviewed for completeness and internal consistency, the eligibility and validity of the patients in the study was verified, and data was monitored for compliance and accuracy. Results and discussion The monitors complete their reports and submit it to quality assurance and the sponsors. Recommendations and suggestions are made for improving performance. By holding regular meetings to discuss improvements in monitoring standards, the monitors can improve quality and efficiency. Conclusions Supplementing and improving the existed guidelines for quality monitoring will ensure that large multi-centre acupuncture clinical trials will be considered as valid and scientifically stringent as pharmaceutical clinical trials. It will also develop academic excellence and further promote the international recognition of acupuncture. PMID:20035630

DOE Office of Scientific and Technical Information (OSTI.GOV)

Malkoske, Kyle; Nielsen, Michelle; Brown, Erika

The Canadian Partnership for Quality Radiotherapy (CPQR) and the Canadian Organization of Medical Physicist’s (COMP) Quality Assurance and Radiation Safety Advisory Committee (QARSAC) have worked together in the development of a suite of Technical Quality Control (TQC) Guidelines for radiation treatment equipment and technologies, that outline specific performance objectives and criteria that equipment should meet in order to assure an acceptable level of radiation treatment quality. Early community engagement and uptake survey data showed 70% of Canadian centers are part of this process and that the data in the guideline documents reflect, and are influencing the way Canadian radiation treatmentmore » centres run their technical quality control programs. As the TQC development framework matured as a cross-country initiative, guidance documents have been developed in many clinical technologies. Recently, there have been new TQC documents initiated for Gamma Knife and Cyberknife technologies where the entire communities within Canada are involved in the review process. At the same time, QARSAC reviewed the suite as a whole for the first time and it was found that some tests and tolerances overlapped across multiple documents as single tests could pertain to multiple quality control areas. The work to streamline the entire suite has allowed for improved usability of the suite while keeping the integrity of single quality control areas. The suite will be published by the JACMP, in the coming year.« less

Outpatient treatment of deep venous thrombosis in diverse inner-city patients.

PubMed

Dunn, A S; Schechter, C; Gotlin, A; Vomvolakis, D; Jacobs, E; Sacks, H S; Coller, B

2001-04-15

We sought to describe the development and outcomes of a hospital-based program designed to provide safe and effective outpatient treatment to a diverse group of patients with acute deep venous thrombosis. Patients enrolled in the program were usually discharged on the day of or the day after presentation. Low- molecular-weight heparin was administered for a minimum of 5 days and warfarin was given for a minimum of 3 months. The hospital provided low-molecular-weight heparin free of charge to patients. Patients received daily home nursing visits to monitor the prothrombin time, assess compliance, and detect complications. The inpatient and outpatient records of the first 89 consecutive patients enrolled in the program were reviewed. Patients were observed for a 3-month period after enrollment. The median length of stay was 1 day. Low-molecular-weight heparin was administered for a mean (+/- standard deviation [SD]) of 4.7 +/- 2.4 days at home. Recurrent thromboembolism was noted in 1 patient (1%), major bleeding in 2 patients (2%), and minor bleeding in 2 patients (2%). No patients died or developed thrombocytopenia. Assuming that patients would have been hospitalized for the duration of treatment with low-molecular-weight heparin, the program eliminated a mean of 4.7 days of hospitalization, with an estimated reduction of $1,645 in total health care costs per patient. This hospital-based program to provide outpatient treatment of deep venous thrombosis to a diverse group of inner-city patients achieved a low incidence of adverse events and substantial health care cost savings. Specific strategies, including providing low-molecular-weight heparin free of charge and daily home nursing visits, can be utilized to facilitate access to outpatient treatment and ensure high-quality care.

Insights about health-related quality of life in cancer patients indicate demands for better pharmaceutical care.

PubMed

Ibrahim, Nagwa A; Björnsdottir, Ingunn; Al Alwan, Ashraf S; Honore, Per Hartvig

2014-08-01

To highlight the health-related quality of life scale scores for Saudi patients with different types of cancer, to get understanding and foundation for improvements. To suggest suitable plans for quality of life improvement based on study outcome. The role of oncology pharmacy will be stressed. A cross-sectional descriptive study was conducted at a tertiary regional hospital using the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. Attendees were patients diagnosed with any type of cancer and eligible for active anticancer treatment and/or palliative care. Quality of life was evaluated for 87 participants. Most of patients were aged between 51 and 60 years; and 50% had active treatment with chemotherapy. Patients seemed to perform well with respect to average scores in both the symptoms and the functional health status scales. The mean score for the global quality of life scale was 47.2 ± 27.1, while the range of mean scores for the five function subscales was 59.0 ± 27.1 to 81.6 ± 13.8, indicating average level of general wellbeing with above average to high level of functional health status, while >50% of the patients met the operational criterion having less severe symptoms. Outpatients generally had somewhat higher scores as compared to hospitalized patients. The general quality of life seemed satisfactory, but there is still need to improve care. Based on results from other studies, oncology pharmacists' roles are essential to improve quality of life through treatment counseling, follow-up on drug support therapy, stress on patient's education through specific programs, review and update the local guidelines, and conduct more research. © Prince Sultan Military Medical City, Saudi Arabia 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.