Mediators of telephone-based continuing care for alcohol and cocaine dependence.

A previous randomized trial with 224 alcohol and/or cocaine addicts who had completed an initial phase of treatment indicated that 12 weeks of telephone-based continuing care yielded higher abstinence rates over 24 months than did group counseling continuing care. The current study examined mediators of this treatment effect. Results suggested that self-help involvement during treatment and self-efficacy and commitment to abstinence 3 months after treatment mediated subsequent abstinence outcomes. These analyses controlled for substance use prior to the assessment of mediators. Conversely, there was no evidence that self-help beliefs or social support mediated the treatment effect. These results are consistent with a model in which treatment effects are first accounted for by changes in behavior, followed by changes in self-efficacy and in commitment to abstinence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Credit analysis of nonprofit continuing care retirement communities

The continuing care retirement community (CCRC) industry's growth has gained the attention of the financial community. As the industry's financial and regulatory environments change, credit analysts are developing analytical tools to evaluate these changes. The following article discusses some of these tools, provides a sample credit profile of a CCRC, and reviews recent accounting changes that will affect CCRC credit analysis.     

Randomized trial of continuing care enhancements for cocaine-dependent patients following initial engagement.

Objective: The effects of cognitive–behavioral relapse prevention (RP), contingency management (CM), and their combination (CM + RP) were evaluated in a randomized trial with 100 cocaine-dependent patients (58% female, 89% African American) who were engaged in treatment for at least 2 weeks and had an average of 44 days of abstinence at baseline. Method: The participants were from intensive outpatient programs, which provide 10 hr per week of group counseling. The CM protocol provided gift certificates (maximum value $1,150; mean received = $740) for cocaine-free urines over 12 weeks on an escalating reinforcement schedule, and weekly individual RP sessions were offered for up to 20 weeks. Average number of RP sessions attended was 3 in RP and 13 in CM + RP. Results: Generalizing estimation equation analyses over 18 months postrandomization showed significant effects for CM (but not RP) on urine toxicology and self-reported cocaine use (p = .05), with no significant CM × RP interactions. Secondary analyses indicated CM + RP produced better cocaine urine toxicology outcomes at 6 months than treatment as usual, odds ratio [OR] = 3.96 (1.33, 11.80), p p p p p = .06, and 9 months, OR = 2.93 (0.94, 9.10), p = .06. Differences between the conditions were not significant after 9 months. Conclusions: These results suggest CM can improve outcomes in cocaine-dependent patients in intensive outpatient programs who have achieved initial engagement, particularly when it is combined with RP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementation of evidence-based substance use disorder continuing care interventions.

Continuing care following initial substance use disorder treatment often is associated with improved treatment outcomes and evidence-based interventions (EBIs) have been developed in this area. However, rates of patient participation in continuing care treatment and mutual help groups (MHGs) are low and a large gap exists between the existing EBIs and actual clinical care. This paper uses the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009) to review the literature on continuing care treatment and monitoring, and mutual help-group promotion. Although existing research provides implications for implementing EBIs in continuing care, few direct implementation trials have been conducted. This literature indicates that EBIs in continuing care have been successfully modified for different settings, that they can be delivered using different modalities (e.g., individual, group, and telephone-based care), and that low cost options are available. Additionally, much is known about the differential effectiveness of continuing care with different populations that may guide treatment programs and providers in selecting the most effective interventions for their clients. One significant barrier to successful implementation of EBIs for continuing care is the lack of information about incentives for providing continuing care across what in the CFIR terminology is a program's outer setting (i.e., external economic, political, and social setting), and its inner setting (i.e., internal political, structural, and cultural contexts). Implications for implementation of EBIs in substance use disorder continuing care are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Critical appraisal of continuing medical education in the rheumatic diseases for primary care physicians

OBJECTIVE: To critically appraise evidence of the effectiveness of continuing medical education (CME) in rheumatic diseases for primary care physicians. METHODS: Three physicians independently applied preset criteria to evaluated CME interventions published between January 1966 and August 1993. RESULT: Eight of 166 articles identified were critically appraised, 7 of which had positive results. Marked heterogeneity in educational interventions, evaluative methods, and outcomes was noted. CONCLUSION: Despite generally positive results, weak methodology precludes drawing firm conclusions about the effectiveness of CME in rheumatic diseases.     

销售商激励合同的比较分析研究

在制造商雇用销售商来销售产品的市场背景下,文章着重分析了制造商采取三种不同的销售激励合同时,销售商努力行为的变化情况.三种激励合同中,一种是线性合同--固定提成合同,另外两种是分段线性合同--提成递增或递减合同和保底封顶合同.通过模型的分析发现,不同的激励合同形式下,销售商的努力行为会受到合同中参数的影响,制造商可以根据不同市场运作目标--比如为了推广新产品、为了扩大产品市场份额等进行合同形式的选择.     

A randomized trial of extended telephone-based continuing care for alcohol dependence: Within-treatment substance use outcomes.

Objective: The study tested whether adding up to 18 months of telephone continuing care, either as monitoring and feedback (TM) or longer contacts that included counseling (TMC), to intensive outpatient programs (IOPs) improved outcomes for alcohol-dependent patients. Method: Participants (N = 252) who completed 3 weeks of IOP were randomized to up to 36 sessions of TM (M = 11.5 sessions), TMC (M = 9.1 sessions), or IOP only (treatment as usual [TAU]). Quarterly assessment of alcohol use (79.9% assessed at 18 months) was corroborated with available collateral reports (N = 63 at 12 months). Participants with cocaine dependence (N = 199) also provided urine samples. Results: Main effects favored TMC over TAU on any alcohol use (odds ratio [OR] = 1.88, CI [1.13, 3.14]) and any heavy alcohol use (OR = 1.74, CI [1.03, 2.94]). TMC produced fewer days of alcohol use during Months 10–18 and heavy alcohol use during Months 13–18 than TAU (ds = 0.46–0.65). TMC also produced fewer days of any alcohol use and heavy alcohol use than TM during Months 4–6 (ds = 0.39 and 0.43). TM produced lower percent days alcohol use than TAU during Months 10–12 and 13–15 (ds = 0.41 and 0.39). There were no treatment effects on rates of cocaine-positive urines. Conclusions: Adding telephone continuing care to IOP improved alcohol use outcomes relative to IOP alone. Conversely, shorter calls that provided monitoring and feedback but no counseling generally did not improve outcomes over IOP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contracts: A primer for psychologists.

Most psychologists in private practice will at some point consider contracting with a managed care organization (MCO) as a part of joining that MCO's provider panel. Such contracts are structured to advantage the HMO, and there are a number of specific contractual features that psychologists have often found problematic. This article offers a review of issues and contractual features that psychologists may wish to consider when contracting with MCOs and offers recommendations for alternative contractual arrangements that may be helpful for psychologists to negotiate when possible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing on-line for continuing education credit

BACKGROUND: The Internet was evaluated as a source of continuing education credit for RNs. METHOD: Using the search engines Alta Vista, Excite, Magellan, and Infoseek, 600 World Wide Web sites were reviewed for on-line programs that would lead to the receipt of a continuing education (CE) certificate of completion for a varying number of CE hours. RESULTS: Five sites provided CE programs online and one site used e-mail to deliver the program to personal computers. All sites offered certificates and were approved to offer continuing nursing education credit through a state board of nursing or through the agency sponsoring the Internet site. The CE hours were also approved by the American Nurses Credentialing Center's Commission on Accreditation. CONCLUSION: The findings indicate the Internet is a source of CE units (hours) for nurses that may be used to satisfy requirements of state boards of nursing. The sites are easily accessible and eliminate travel and great expenses. The Internet is a rich source of current health-related information not approved for CE units but pertinent to health care professionals.     

The need for continuing education in ethics as reported by rural and urban mental health care providers.

Continuing professional education (CPE) sponsors planning events for mental health care licensees can assure better attendance if they can successfully address the needs of their target audience. Offering topics of interest is particularly crucial when CPE events need to draw large numbers of attendees to be financially viable. A survey of nearly 400 health licensees regarding CPE needs, especially as related to ethics, revealed that the greatest interest in such CPE was reported by master's-level mental health care providers. Topic areas with the greatest draw were the management of clients who present with special issues (e.g., substance abuse, medical illness, or cultural diversity) and competent management of colleague misconduct and impairment, rather than more traditional ethics issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Brighton resuscitation ambulances: a continuing experiment in prehospital care by ambulance staff

Two ambulances from the existing fleet in Brighton and one in Hove are equipped with portable defibrillator-oscilloscope units. Selected attendants have been trained not only to defibrillate patients but also to perform endotracheal intubation and administer intravenous atropine and lignocaine for carefully defined indications. In the two years up to December 1975 the ambulances responded to 2253 calls which were considered possible emergencies. Retrospective analysis showed that half of these had been for patients with myocardial infarction, coronary insufficiency, or angina. The ambulances took a median time of five minutes to reach a patient. Attempts at resuscitation were made in 207 patients with circulatory arrest, of whom 160 had ventricular fibrillation. Coordinated rhythm was restored at least transiently in 66 patients, and 27 of them survived to leave hospital. Sixteen of the survivors had been in ventricular fibrillation before the arrival of the ambulance. The delay before admission to hospital was reduced: over 50% of patients carried in the ambulances were admitted within two hours of the onset of major symptoms. No extra ambulance staff have been employed for the scheme. The increased load on hospital services has been limited by encouraging a rational admission policy and also by early discharge.     

Optimal Bid Model for Price-Time Biparameter Construction Contracts

Construction clients are increasingly calling for bids that require competing contractors to submit both the bid price and contract time. In such situations contractors are faced with the problem of deciding which combination of bid price and contract time to submit. An important consideration is the cost of time to the client. This varies from contract to contract and is usually expressed in terms of a unit time value such as liquidated damages rate or, for highway contracts, a daily road user cost. The unit time value is normally set out in the contract appendix and often used by the client as a basis for determining the contractor's total combined bid. This kind of procurement method is commonly referred to as the A + B method. To illustrate the mechanism of price-time biparameter procurement, a total combined bid Iso-map is developed in this study. The contractor's price-time performance curve is then incorporated into the map to determine the contractor's optimal bid parameters: tender price and contract time. Also, based on this mechanism, a mathematical optimization bid model is developed for calculating the optimal bid parameters.     

The impact on hospital emergency care of the introduction of continuing care into the health centers of Logro?o

Eleven species of Caribbean marine algae (red, green, and brown) were investigated for their cholesterol content. All of them were found to contain this sterol. Consistent with previously reported results, all five red algae contained large quantities of cholesterol. However, the two brown algae and three of the four green algae in our study also contained significant quantities of cholesterol.     

Why Contracts: Evidence

Contracts are a ubiquitous part of the architecture, engineering, and construction industry. Despite this, they are poorly understood by practitioners and academics. This paper empirically tests a conceptual model of the contract that seeks to improve our understanding of contracts. This model argues that the contract should be viewed as a managerial tool that provides the structure within which we accomplish the project tasks. The choice of the appropriate contract facilitates a process that allows the parties to achieve superior performance. The model views the contract as a multidimensional instrument that addresses three critical questions: (1) what is the structure of the organizational relationship between firms; (2) what is the disposition of risk and reward for involvement in the project; and (3) how will conflicts between firms be resolved? This paper empirically examines the first two dimensions. In order to address these distinct but intertwined questions, theories from Transaction Cost Economics and Agency Theory are brought to bear. The results of the study suggest that the conceptual model explains some of the variation in project performance, and therefore holds promise as a strategic management tool.