Diagnosis and Treatment of the Elderly Alcoholic

Treatment interventions will be much more effective when delivered through facilities serving the aged, such as senior citizen programs, outpatient, geriatric, medical or psychiatric programs, nursing homes, or home-care programs. It is unlikely that significant numbers of elderly will be willing to go to alcoholism programs to deal with their problem drinking.     

International programs for the detection of breast cancer

The benefit of early breast cancer detection is the foundation for programs around the globe to reduce morbidity and mortality related to breast cancer. These programs range from educational programs targeted to women and health professionals to organized or opportunistic screening programs that target specific age groups of women. Modern mammography programs tend to follow the protocols from the randomized clinical trials, but there is variation in key program elements such as the age groups invited to screening, the screening interval, performance indicators, and the uptake rate. Until recently, the emphasis on early breast cancer detection was limited to mammography, but the steady rise in incidence and mortality in low and medium resource countries, where mammography may be unaffordable, has led to a renewal in emphasizing the incremental value of downsizing palpable tumors through physical exams. There is consensus that programs should be designed based on disease burden and available resources, but that even in low resource countries there are opportunities to reduce breast deaths through earlier diagnosis and effective treatment. Screening programs are most effective when they are organized, and program planners should consider WHO criteria and local input data as a basis for tailoring screening programs to the needs of their population.     

Assessment of the performance of electrocardiographic computer programs with the use of a reference data base

To allow an exchange of measurements and criteria between different electrocardiographic (ECG) computer programs, an international cooperative project has been initiated aimed at standardization of computer-derived ECG measurements. To this end an ECG reference library of 250 ECGs with selected abnormalities was established and a comprehensive reviewing scheme was devised for the visual determination of the onsets and offsets of P, QRS, and T waves. This task was performed by a group of cardiologists on highly amplified, selected complexes from the library of ECGs. With use of a modified Delphi approach, individual outlying point estimates were eliminated in four successive rounds. In this way final referee estimates were obtained that proved to be highly reproducible and precise. This reference data base was used to study measurement results obtained with nine vectorcardiographic and 10 standard 12-lead ECG analysis programs. The medians of program determinations of P, QRS, and T wave onsets and offsets were close to the final referee estimates. However, an important variability could be demonstrated between measurements from individual programs and mean differences from the referee estimates amounted to 10 msec for QRS for certain programs. In addition, the variances of all programs with respect to the referee point estimates were variable. Some programs proved to be more accurate and stable when the data from high- vs low-noise recordings were analyzed. Average Q wave durations calculated from ECGs for which programs agreed on the presence of a Q or QS wave differed by more than 8 msec in several program-to-program comparisons. Such differences may have important consequences with respect to diagnostic performance. Various factors that might explain these differences have been determined. The present study demonstrates that to allow an exchange of results and diagnostic criteria between different ECG computer programs, definitions, minimum wave requirements, and measurement procedures urgently need to be standardized.     

Evaluation of seven school-based prevention programs: a final report on the Napa project

Described is a series of evaluation studies of seven school-based prevention programs, including four generic in-service teacher-training programs, two alternatives programs, and a drug education course. The programs were delivered to elementary or junior high students, and were evaluated individually and in several combinations or sequences, using rigorous research procedures and a comprehensive set of process and outcome measures. Only the drug education course showed any pattern of significant effects, and these were short-term and obtained only for girls. The findings call into question the efficacy of generic prevention programs, at least as such programs are commonly implemented.     

Assessing the Accessibility of Content for Geriatric Fellowship Programs

The information available on program websites concerning geriatric fellowships in internal medicine and family medicine is a crucial factor in generating applicants' interest in individual programs. Our study aimed to quantify the accessibility and quality of information available on accredited geriatric (family medicine and internal medicine) fellowship program websites and further analyze the implications of the results obtained. A list of geriatric (family medicine and internal medicine) fellowship programs was analyzed through quantified measures after being verified for accreditation. Certain criteria were evaluated for each of these programs, such as website accessibility and whether critical information was available on online program websites. These criteria were centered on academic, administrative, and application-based factors. Hundred and fifty eight Family Medicine and Internal Medicine geriatric fellowship programs were identified in total, of which only 150 were accredited by the Accreditation Council for Graduate Medical Education and considered for analysis. Of these, 20 (13.33%) programs had website links that were nonfunctional and only 145 programs had websites at all. On programs' websites, information regarding aspects such as contact information—including phone number or email for the program—were lacking. Other information regarding past and current fellows, research, and curriculum were also generally lacking. Geriatric Fellowship websites in Family Medicine and Internal Medicine can gain better traction from those interested in applying for their programs by updating information more often and providing more and better information concerning critical aspects of the programs themselves online.     

Contrasting the models. Reflections on the pattern of geriatric evaluation unit care

In order to understand geriatric assessment programs better, it is necessary to understand some of the general subgroups of such programs. This article compares various aspects of geriatric evaluation units.     

Community-based hepatitis B screening programs in the United States in 2008

Summary.  The Centers for Disease Control and Prevention (CDC) recommends hepatitis B surface antigen (HBsAg) testing to identify hepatitis B virus (HBV) infection for foreign-born persons from areas with HBsAg prevalence of ≥2%. Currently, most HBsAg screening in the United States is performed by independent community organizations. For these HBsAg screening programs, we collected information about the location, number of people screened, other services beyond screening provided, the population/ethnicity groups targeted for screening, and the prevalence of HBsAg among those screened. We identified programs offering screening by contacting programs known to us, from interviews with identified programs, and from structured Internet searches, and collected information using a simple e-mail survey with follow-up phone calls. We identified 55 possible community HBsAg screening programs, of which we successfully contacted 31 programs. In the past year, contacted programs screened an estimated 21 817 patients with an 8.1% average HBsAg prevalence. The majority of programs screened persons born in Asia and their children, and a small number of programs screened persons from Africa or Eastern Europe; very few programs screened U.S.-born persons at risk of HBV infection due to behavioural factors. We identified few or no programs in the American Southeast, the Midwest, and the Southwest outside of California and the Houston area. The HBsAg screening programs that we contacted were effective in identifying and screening patients at risk of HBV as evidenced by the high prevalence observed among those screened. However, their efforts alone are likely insufficient to meet the need for screening recommended by CDC.     

Progress and challenges in graduate education in gerontology: the U.S. Experience

The history and current status of graduate programs in gerontology in the United States are reviewed. Masters degree programs began in 1967, and currently exist at 57 universities in the United States. Challenges for these programs include maintaining enrollment and identifying employment for program graduates, given competition from graduates from other disciplines that have advantages such as state licensure. Doctoral programs in aging began in 1989, with nine current programs. Results to date suggest that graduates with doctorates in gerontology can succeed in academic, policy, research, and business settings. Challenges for these programs include competition from traditional disciplinary doctoral programs. The U.S. experience suggests that successful development of graduate programs in gerontology must be attentive to providing stable academic structures for these programs, and careful consideration of how gerontology graduates will compete with graduates from traditional disciplines and professions.     

Use of specific inhalation challenge in the evaluation of workers at risk for occupational asthma: a survey of pulmonary, allergy, and occupational medicine residency training programs in the United States and Canada

STUDY OBJECTIVES: To document the current practice of occupational asthma (OA) diagnosis and use of specific inhalation challenge (SIC). DESIGN, SETTING, AND PARTICIPANTS: A survey evaluating the current practice of SIC was mailed to 259 residency training programs in adult pulmonary diseases, allergy and immunology, and occupational medicine accredited in the United States and Canada during the year 2000. RESULTS: Forty-six percent (123 of 259 programs) participated. Ninety-two programs reported that patients with OA were seen during the previous year, 15 programs reported that SIC had been performed, and 10 programs reported that patients had been referred to other sites for SIC. A total of 259 patients underwent SIC. No unexpected adverse reactions were reported. Forty-one programs reported that they had been willing to undertake SIC but were unable to do so. The most common barriers cited were lack of availability of SIC within the evaluating institution, inability to locate a site for referral, concerns about reimbursement, and lack of an appropriate diagnostic reagent for use in SIC. Seventy-four programs indicated that SIC was useful, and 34 programs included training in the use of SIC was part of the residency curriculum. CONCLUSION: Although SIC is considered the "gold standard" for objective documentation of OA, the test is performed in only a few institutions in the United States and Canada. Many institutions indicate that SIC is not available, even when desired for patient management. Only a minority of participating residency training programs include SIC as a formal part of the training curriculum.     

Learning from peer assessment: the role of the external quality assurance multilaboratory thrombophilia test process

The quality control process is a critical feature of pathology best practice. In addition to internal quality control processes applied on a test-to-test or day-to-day basis, the participation of laboratories in external quality assurance programs (QAPs) is critical to achieving ongoing test accuracy. There are several such programs operating in the international arena. With respect to thrombophilia, these include the Australia-based Royal College of Pathologists of Australia QAP, the United Kingdom-based National External Quality Assessment Service, and the International Thrombophilia External Quality Assessment Scheme, based in the Netherlands. Although there are some similarities between the programs, some diversity is also apparent. Each of the programs assess for the common markers of congenital thrombophilia, such as antithrombin, protein C, protein S, and activated protein C resistance. Testing of some acquired markers of thrombophilia, such as lupus anticoagulant, and genetic tests such as factor V Leiden and prothrombin G20210A mutation, are also available. This report focuses on some recent trends from these programs.     

Understanding prevention effectiveness in real-world settings: the National Cross-Site Evaluation of high risk youth programs

The National Cross-Site Evaluation is a large multisite evaluation (MSE) of 48 substance abuse prevention programs, 5,934 youth participating in programs, and 4,539 comparison youth programs. Data included a self-report questionnaire administered at 4 points in time, detailed dosage data on over 217,000 program contacts, and detailed site visit information. In a pooled analysis, the programs did not demonstrate significant positive effects on a composite outcome measure of tobacco, alcohol, and marijuana use in the previous 30 days. However, disaggregated analyses indicated that 1) sites in which comparison groups had strong opportunity to participate in prevention programs suppressed observed effects; 2) youth who had already started using before they entered programs reduced use significantly more than comparison youth who had started using; and 3) both males and females who participated in programs significantly reduced use relative to comparisons, but in very different patterns. Combining these patterns produced an apparent null effect. Finally, programs that incorporated at least 4 out of 5 effective intervention characteristics identified in the study significantly reduced use for both males and females relative to comparison youth. The lessons produced by this study attest to the value of MSE designs as a source of applicable knowledge about prevention interventions.     

Data processing in pathology laboratories: the extension of the Phoenix system into haematology

A computer data-processing system in the chemical pathology laboratories of the Royal Postgraduate Medical School at Hammersmith Hospital was described recently. This has now been extended to include the haematology laboratory. In the main, the original‘Phoenix’programs were adaptable to the new subject, but two major new programs were required, one to deal with automated blood counting by the Coulter S and one to accept film examination results on-line. The programs and procedures have been thoroughly tested and in routine use since 1977. The results have fully justified their introduction.     

Effectiveness of nonpharmacological interventions in delaying the institutionalization of patients with dementia: a meta-analysis

Contemporary healthcare policies are designed to shape the conditions that can help delay the institutionalization of patients with dementia. This can be done by developing support programs that minimize healthcare risks for the patients with dementia and their informal caregivers. Many support programs have been developed, and some of them are effective, but there has been no systematic review with a meta-analysis of all types of nonpharmacological support programs with odds of institutionalization or time to institutionalization as an outcome measure. A systematic review with a meta-analysis was therefore conducted to estimate the overall effectiveness of nonpharmacological support programs for caregivers and patients with dementia that are intended to delay institutionalization. Thirteen support programs with a total of 9,043 patients were included in the meta-analyses. The estimated overall effectiveness suggests that these programs significantly decrease the odds of institutionalization (odds ratio (OR)=0.66, 95% confidence interval (CI)=0.43–0.99, P =.05) and significantly increase the time to institutionalization (standardized mean difference (SMD)=1.44, 95% CI=0.07–2.81, P =.04). A meta-analysis of the best-quality studies still showed a positive significant result for the odds of institutionalization (OR=0.60, 95% CI=0.43–0.85, P =.004), although the time to institutionalization was no longer significant (SMD=1.55, 95% CI=–0.35– 3.45, P =.11). The analysis of the intervention characteristics showed that actively involving caregivers in making choices about treatments distinguishes effective from ineffective support programs. Further investigation should be directed toward calculating the potential efficiency of these support programs by applying net-benefit or cost-effectiveness analysis.     

Comparisons of perceptions of the environments of adolescent drug treatment residential and outpatient programs by staff versus clients and by sex of staff and clients

The Moos Community Oriented Program Environment Scale (COPES) was administered to 482 adolescent clients and 291 drug counselors in 30 outpatient and 27 residential drug treatment programs. Both clients and staff of residential programs were found to rate their programs more positively than did clients and staff of outpatient programs in the following specific ways: "encourage and provide more support"; "provide more practical help", such as training; "more concern with clients' personal problems"; and "encourage clients to argue, express anger, and display aggressive behavior". The only COPES factor on which the outpatient programs were perceived as superior to residential programs was "spontaneity" ("The program encourages clients to act openly and to express their feelings openly"). Across both types of programs, staff perceived the programs significantly more positively than did clients. The male staff ratings were the most positive of the ratings of the four subgroups. Female clients rated the program environments more positively than did male clients, but female staff did not rate the program environments more positively relative to male staff. Since the female staff ratings tend to be somewhat more similar to the ratings of the clients, both male and female, than did the male staff ratings, it might seem reasonable to hypothesize that the female staff ratings are more valid than the male staff ratings.     

Report of the Task Force on Residency Training Information (2005-2006), American Board of Emergency Medicine

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the ninth annual report on the status of US emergency medicine residency programs.     

An integrated exploration into the social and environmental determinants of health: the Saskatchewan Population Health and Evaluation Research Unit (SPHERU)

The Saskatchewan Population Health and Evaluation Research Unit (SPHERU) is a new interdisciplinary research institute established by the Universities of Saskatchewan and Regina. SPHERU developed four of its research programs using a hierarchic model of health determining conditions and contexts. In descending order these programs include: Economic and Environmental Globalization, Governance and Health Community/Environment as a Health Determinant Multiple Roles, Gender and Health Determinants of Healthy Childhood Development A fifth program researching the determinants of health of indigenous peoples spans all four levels. Two research projects, one on power, control and health, and another on community capacity building approaches to human service programs, assist SPHERU in developing the theoretical linkages between its programs. This article describes SPHERU's research model and the Unit's approach to research and summarizes each of its current research programs and projects.     

Participation of older adults in health programs and research: a critical review of the literature.

This collection of five papers evaluates the participation of older adults in clinical trials, health promotion/disease prevention initiatives, and health programs designed to maintain or improve the functioning of chronically ill older adults. Understanding the willingness or unwillingness of older adults to participate in these programs is critical to the development and implementation of health programs and policies for this population. In this introductory paper we briefly review illustrative literature to provide both an overview of the participation of older adults in health programs as well as background information relevant to the symposium papers.     

Report of the Task Force on Residency Training Information (2004-2005), American Board of Emergency Medicine

The American Board of Emergency Medicine gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the eighth annual report on the status of US emergency medicine residency programs.     

Report of the Task Force on Residency Training Information (2007-2008), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the eleventh annual report on the status of US emergency medicine residency programs.     

Report of the Task Force on Residency Training Information (2010-2011), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents in those programs. We present the 2011 annual report on the status of US emergency medicine training programs.