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Study Objective: To investigate the suitability of the nursing home as a site for teaching physical diagnosis to second-year medical students., Design: Prospective comparison of teaching sessions in the nursing home to concurrent control sessions in acute care wards., Setting: Nursing Home Care Unit (NHCU) and acute care hospital wards of a Veterans Affairs Medical Center., Patients: Sessions with 38 NHCU patients and 68 hospital patients., Measurements and Main Results: Patient interviews and student questionnaires were used to obtain responses on a 1-10 scale (1 = poor, 10 = excellent). Patient responses were very favorable in both settings for overall quality of experience (mean score NHCU vs control: 8.8 vs 8.6) and willingness to participate again (8.4 vs 8.2). Student ratings showed no significant differences for patient attitude (7.4 vs 8.4) or quality of exam (7.2 vs 7.7) while quality of history (6.0 vs 7.6) and overall quality of session (7.6 vs 8.6) were rated higher (P less than 0.05) for the control sessions. Students rated both environments highly (8.6 vs 8.4) but reported that fewer NHCU sessions were interrupted (15% vs 25%) or disrupted by noise (6% vs 30%, P less than 0.005)., Conclusions: Advantages of the nursing home include readily available patients who view participation favorably, instructive physical findings, and a suitable environment. However, students rate the quality of the histories obtained there lower. This problem could be addressed by more careful patient selection and greater emphasis by course instructors on other goals of the history in addition to exploring the chief complaint.

In February 1988, the Pharmaceutical Manufacturers Association of Canada (PMAC) published a Code of Marketing Practices which recommends that PMAC members provide essential product information to drug information centres a minimum of two weeks prior to the marketing of new prescription drugs. A one-year study was undertaken by our Drug Information (DI) Centre to assess the compliance of PMAC companies with this guideline. Product information was mailed to our DI Centre two weeks or more prior to marketing for only 3/28 (10.7%) new prescription drugs and for none of 27 (0%) new prescription drug dosage forms or strengths. No product information was received for 10/28 (35.7%) new prescription drugs and 21/27 (77.8%) new prescription drug dosage forms or strengths. In several situations, new drugs appeared in journal advertisements or were being detailed to physicians prior to receipt of new product information. Manufacturers are encouraged to review their procedures for disseminating new product information to ensure that DI centres are notified of new product introductions at least two weeks in advance of detailing or marketing.

This article describes a system of Scheduled Days Off (SDO) that was implemented on a trial basis for one year by the Physiotherapy Section of Foothills Provincial General Hospital in Calgary, Alberta. Development of the SDO system was an attempt by the Physiotherapy Section to improve the quality of working life without a negative impact on productivity or quality of care. Each full-time physiotherapist extended work hours by 15 minutes per day and received an SDO following 30 working days. A productivity analysis of weighted units per paid hour and patient attendances per paid hour demonstrated an increase in productivity following implementation of the system. Work time used for personal appointments, sick time and staff satisfaction were evaluated and showed positive changes during the trial period.

We estimate a generalized linear model to examine adult and teenage cigarette demand. Out analysis focuses on the extent to which excise taxes and regulations restricting smoking in public places affect cigarette consumption. The adult results indicate that the price elasticity of demand is unstable over time, ranging from 0.06 in 1970 to -0.23 in 1985. These estimates are lower than most found in previous studies. The teenage price elasticity does not differ statistically from the estimates for adults. Additionally, regulations restricting smoking in public places have a significant effect on both adult and teenage cigarette demand.

Partial-hospitalization services for children and adolescents continue to be an underutilized component of the mental health delivery system. With little treatment-effectiveness research available, there is limited incentive for shifts in reimbursement policies or for traditional referral sources to alter referral patterns. This paper provides an overview of published effectiveness research, a discussion of methodological difficulties, and an example of ongoing research for critique. Clearly, research in child and adolescent partial hospitalization must begin to address the lack of available effectiveness data. Partial-hospitalization advocates must compare both various program models and treatment of specific populations. In addition, studies comparing outcome of partial-hospitalization programs with outcome from other treatment modes are essential. The entire continuum of care must be subjected to rigorous and scientific study. The next decade will no doubt bring a large number of treatment-effectiveness studies, now lacking, for comprehensive analysis of options and outcomes.

A program titled Contemporary Concerns about Food and Health (CCFH) was developed by the Florida Cooperative Extension Service after research in five counties showed 30%-74% of 2,308 middle-aged citizens to have three or more characteristics that placed them at above-average risk for developing diseases such as cardiovascular disease, adult-onset diabetes, and cirrhosis. CCFH addressed the effects of dietary and other practices that contribute to such lifestyle-related diseases. This article describes the test of the effectiveness of this program in increasing participant knowledge about the causes and preventions of health risk and in motivating them to make healthful risk-reducing changes in their lifestyles. A comparison, four-group, quasi-experimental design was used to study the program in five counties. The four groups included (a) those who participated only in CCFH lessons; (b) lesson participants who had also completed a computerized healthrisk profile; (c) a random sample of persons who completed only the health profile; and (d) a control group randomly selected to match both groups of lesson participants closely in age, sex, race, and county of residence. Results showed that lesson participants knew the answers to a significantly greater number of knowledge items than did the comparison groups, and they reported making more, and more important, changes in their lifestyles for reducing their risks of developing health problems.

From 1985 to 1988, a state-wide program of cancer education was offered to community-based allied health professionals (AHPs) at five different program sites in Pennsylvania. During this three-year period, 512 social workers, clergy, dieticians, physical therapists and others received training to increase their knowledge about cancer and counseling, improve their supportive attitude regarding cancer patients and families, and decrease stress related to their work with this population. Overall, the Program was successful in reaching AHPs working with cancer clients who had little formal training in the cancer field. At the beginning of training, it was observed that AHPs with initially higher levels of education and more years of work experience with cancer patients had higher levels of counseling knowledge. Those who were women, worked in hospitals, or had worked with cancer patients longer exhibited higher levels of cancer knowledge. Participants who were women and who had more education had reported lower levels of job stress. Among those AHPs who completed the training courses, cancer knowledge increased by 14 percent. In addition, knowledge related to counseling cancer patients and their families improved by 11 percentage points. Perceived job stress among the AHPs also declined by 10 percent. Finally, participant supportive attitude concerning cancer clients improved.

In 1986 a new graduate training program (GMTSI) was set up in the NHS for general management trainees. The completion of the two year program by the first intake of graduates in the summer of 1988 indicated that more thought needed to be given to identifying the skills and competence training needs in a program of this type. Accordingly, the NHS Training Authority commissioned Warwick Health Services Research Unit to carry out a study into the skills training needs of graduates entering the general management program. The methods adopted involved firstly group and individual semi-structured interviews with participants and managers to identify a wide range of possible skills and competences, and secondly a postal survey of all 230 trainees and mentors who had experience of the training program to help prioritize these skills. In this manner an extensive amount of information was collected on the preferred principal method of delivery for training in each of the 60 plus skills identified (district placement or management education centre), the optimal timing within the 22 month program for training in each of the skills identified and the relative importance of training for each skill. The present paper presents a selection of the study findings. Furthermore, it outlines the manner in which the project findings are being implemented in one education centre based regional consortium to provide graduate trainees with skills training geared to their immediate and short-term training needs.

The primary objective in medical training remains skill development in the delivery of medical care through the understanding of bedside data collection, natural history of disease, use of diagnostic tools and the influence of therapy--all applied to a specific patient. More recently, also considered important is training on the broader issues of health care delivery and public policy, especially since the environment of medicine is changing rapidly. With limited curricular time these issues must compete with the traditional and important clinical training. To evaluate how these subjects have been included in internal medicine training, the Resident Physicians Section (RPS) of the American Society of Internal Medicine (ASIM) sponsored a survey of United States internal medicine chief residents which was conducted by the Internal Medicine Center to Advance Research and Education (IMCARE). The objectives of the study were to 1) study the extent of training on health care delivery and public policy issues offered to residents by internal medicine residency programs; 2) assess training opportunities now available; and 3) determine areas of study not fulfilling perceived needs. The questionnaire contained 12 questions. Chief residents rated the 1) quality of their program in preparing residents on health care delivery, public policy issues and practice management; 2) level of instruction provided on 12 topics; and 3) degree of priority these same topics should have. Respondents were asked to identify 1) any other relevant areas their residency program covered particularly well; 2) the amount of time which should be devoted to these socioeconomic topics in each year of training; and 3) the most appealing formats for learning about these topics. Despite the rapidly growing influence of socioeconomic issues on medical practice, many chief residents perceive that important topics are not being addressed adequately. This study provides information on areas addressed well and topics that should receive greater attention. Recommendations are made for further studies and strategies to increase the emphasis on socioeconomic topics during medical education.

To evaluate the impact of Maine's Medicaid waiver for the mentally retarded, baseline and 1-year followup data were obtained for 191 waiver clients and a comparison population of 115 persons excluded from the program because of enrollment limits. Program effectiveness was evaluated through measures of changes in clients' personal and community living skills. Medicaid and other data were used to establish individual and aggregate costs. It was found that the waiver program is a cost-effective alternative to intermediate care placements but that client screening is necessary to limit the enrollment of clients not at risk of institutional placement.

This paper attempts to apply a traditional risk and value analysis to the Search for Extraterrestrial Intelligence--SETI. In view of the difficulties of assessing the probability of success, a comparison is made between SETI and a previous search for extraterrestrial life, the biological component of Project Viking. Our application of simple Utility Theory, given some reasonable assumptions, suggests that SETI is at least as worthwhile as the biological experiment on Viking.

In many countries the realization of the vaccination programmes is prevented by the lack of motivation of the population. We report herewith the positive results of a programme of social mobilisation observed in the Agadir province following the organization of National Vaccination Days in Morocco.

The situation of parenteral nutrition practised in our hospital over one year was analyzed from the standpoint of Pharmacy Services, with a random sample of 26 patients with 322 days on parenteral nutrition. The most important results showed that the degree of compliance of the application sheets was 85.3%. The protocolized nutrient units were used in 80.1% of total days on parenteral nutrition, with an average of 0.97 +/- 0.60 modifications per day 855.0% electrolytes and 39.9% insulin). During the follow-up of parenteral nutrition, analytical determinations were performed every 2.3 +/- 1.8 and 4.2 +/- 2.6 days in blood and urine respectively. 30 biochemical alterations were observed, in particular hyperglycaemia (26.7%), hypoglycaemia (10%), hyperpotassemia (13.3%) and hyponatraemia (13.3%). In 70% of cases, corrective action was taken within 24 hours. The average number of multidisciplinary communications was 4.5 per patient. The initiative was taken by the pharmacist in 75.8% of cases, and the most frequent reason for communication was analysis of biochemical situation of patient and proposal for modification in daily intake.

This survey examined the characteristics of families who used a sick child day-care center and the variables that determined their use in comparison with families who did not use such a facility. Families who used sick child day-care had more favorable attitudes toward the facility and a greater need for these services.

Despite the enormous body of literature concerning Performance Appraisal, when all is said and done, more seems to have been said than done--at least done effectively. This article analyses the conceptual and methodological basis of performance appraisal, to disclose the complexity of this common management evaluation instrument. There is a concentration on methodology. This has been a purposeful approach since organisations have been, and are most concerned with the search for a sound methodology, akin to a search for the Holy Grail. Several common measurement tools are examined and it is finally concluded that there is no one best way to measure performance. A scheme that is methodologically sound and conceptually pure does not exist.

An analysis was made of the effectiveness of therapeutic measures undertaken in the fit-for-work male population of Minsk. Significant differences were revealed in the changes of the levels and mean magnitudes of risk factors depending on the attitude towards realization of medical recommendations. The therapeutic measures were recorded to produce the most pronounced effect in respect to the incidence of arterial hypertension, excess body weight, tobacco smoking, and to the number of persons engaged in sports. The beneficial effect of preventive measures primarily tells on a relatively scanty group of persons at high risk as a result of which the significance of differences was disclosed in respect to the incidences and was not disclosed in respect to the mean values of arterial pressure and tobacco smoking.

A study to evaluate the impact of a medical self-care program on older adults was conducted. The test group (n = 161) participated in an 11-session educational intervention with training in clinical skills, lifestyle, and the use of health services. The comparison group (n = 164) received no intervention. The test group was assessed pre-intervention, post-intervention, and six months post-intervention and the comparison group was assessed at corresponding intervals. The results indicated that medical self-care instruction produces substantial improvements in health-related knowledge, health skills performance, and health actions. This study produced no evidence, however, that medical self-care instruction has any effect on health status, the utilization of medical care, or other aspects of life quality.

In 1987 and 1988, the authors presented four continuing nursing education workshops on AIDS to Iowa nurses. The article discusses these workshops in terms of their background, content, presenters, participants, strategies of presentation, changes which took place as a result of participants' feedback, and evaluations. In addition, it discusses how these workshops affected the presenters personally.