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PubMed2003

International Academy of Astronautics 5th cosmic study--preparing for a 21st century program of integrated, Lunar and Martian exploration and development (executive summary).

This report is an initial review of plans for a extensive program to survey and develop the Moon and to explore the planet Mars during the 21st century. It presents current typical plans for separate, associated and fully integrated programs of Lunar and Martian research, exploration and development, and concludes that detailed integrated plans must be prepared and be subject to formal criticism. Before responsible politicians approve a new thrust into space they will demand attractive, defensible, and detailed proposals that explain the WHEN, HOW and WHY of each stage of an expanded program of 21st century space research, development and exploration. In particular, the claims of daring, innovative, but untried systems must be compared with the known performance of existing technologies. The time has come to supersede the present haphazard approach to strategic space studies with a formal international structure to plan for future advanced space missions under the aegis of the world's national space agencies, and supported by governments and the corporate sector.

Cost-Benefit Analysis↗
PubMed2005

Medicaid home care services and survival in New York City.

PURPOSE: New York City's Medicaid Home Care Services Program provides an integrated program of housekeeping and personal assistance care along with regular nursing assessments. We sought to determine if this program of supportive care offers a survival benefit to older adults. DESIGN AND METHODS: Administrative data from New York City's Medicaid Home Care Services Program were merged with epidemiologic and diagnostic data collected in a community study of older adults living in northern Manhattan. Of 866 older adults with Medicaid coverage living in the community, 288 (33.3%) received Medicaid home care services in the period from 1994 to 1996. Mortality was tracked through the end of 1999. RESULTS: In proportional hazards models that adjusted for differences in sociodemographic, medical, and functional status, use of Medicaid home care service was associated with a significantly reduced risk of death in people with disability in activities of daily living. IMPLICATIONS: Because the program has distinctive features (greater number of weekly hours than other programs, integration with nursing assessments), it is a special case of community-based long-term care. Still, results from this observational cohort suggest that mortality risk in the most vulnerable elderly population can be reduced through a program of supportive care.

Activities of Daily Living↗
PubMedDate not supplied

[Community in medical education programs of integral general medicine].

This paper includes the chief considerations about the community work in the Integral General Medicine Program Called Plan A36. General considerations are made abour the four years of trainign program in which the medical student in exposed to be in close contac with the most common medical and health problems in his country, and during this period of time, he becomes capable to develop all the techniques to act as a primary contac physicain.

Community Medicine↗
PubMed1992

The Integrated Trauma Program: a model for cooperative trauma triage.

The Integrated Trauma Program (ITP) is the cooperative trauma triage service of the University of Toronto trauma and burn hospitals and the Ontario Ministry of Health. It provides physicians in referring hospitals direct access to a trauma team leader (TTL) in one of several trauma centers through a single phone number. Three adult trauma centers, one pediatric trauma center, and one burn center, all affiliated with the University of Toronto, participate in this program. This article describes the system during the first two years of operation. From July 1989 to June 1991, 1530 requests for patient transfers from a total of 97 hospitals were processed. Of these transfer requests, 77% were accepted by the TTL to a trauma service as multiple trauma cases, 16% were accepted directly to a surgical service without involving the trauma team, 4% were refused by the TTL as inappropriate referrals, and 3% of requests were cancelled by the referring physician. The transfer requests are distributed to a specific trauma center by request of the referring physician (10%), according to a rotation (70%), or as selected by the ITP (20%) when the scheduled hospital is not readily available. Closure of all adult trauma centers occurred on 43 occasions. During these closures, 48 patients bypassed the Toronto trauma centers and were transferred to other cities. The ITP office also keeps an ongoing data base of patients transferred. The mechanism of injury in the majority of cases is vehicular crashes. The mean Injury Severity Score is 24 for adults and 17 for children.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Evaluation of the Tzu Chi Institute for Complementary and Alternative Medicine's Integrative Care Program.

OBJECTIVE: There are an increasing number of clinics providing integrative health care using new and innovative delivery models. The purpose of this study was to quantitatively and qualitatively evaluate the Integrative Care Program offered at the Tzu Chi Institute for Complementary and Alternative Medicine, Vancouver, British Columbia, Canada. DESIGN: At enrollment, data are collected on demographics, health history, current health concerns and diagnoses, quality of life/health status (SF-36) and patient satisfaction. The measures are repeated 6 months into the program. Descriptive analysis was used to summarize the data. Focus groups were also included as part of the study design. RESULTS: Patients seeking integrative care are a highly complex population living with numerous comorbid chronic conditions. Although their baseline scores on the SF-36 are lower than Canadian population norms across all subscales, significant improvement occurred from baseline to 6 months. Qualitative data support that patients were pleased with the clinical care they received and aligned with the philosophical underpinnings of the program. DISCUSSION: This is one of the first studies to evaluate integrative health care. Studies like this are needed to develop appropriate methods to assess models of integrative health care delivery.

Adult↗
PubMed1981

The role of neuroleptics in an integrated treatment program for chronic schizophrenics.

An integrated treatment programme for patients with psychoses and hospitalization syndromes is presented. Most of the patients are schizophrenics with many years of hospital care. Neuroleptics are used in conventional doses and since 1971 flupenthixol decanoate is the drug of choice. The residual states are analyzed as well from a medical as from a social psychological point of view. Psychotherapy and social training inside and outside the hospital were means to reach treatment progress. Behaviour therapy was successful on the most deteriorated patients and in young patients a more psychodynamic approach was used including family therapy. Forty-two patients were activated to a life in flats. In 21 patients living near the hospital an economic analysis was made. The economic benefits of the treatment are large. The results show that patients suffering from chronic mental diseases must be treated with a composed programme including medical, social, and psychological parts.

Adult↗
PubMed2003

Developing an integrative therapies program in a tertiary care cardiovascular hospital.

This article describes one hospital's approach to developing an inpatient integrative therapies program and the foundation for a broader integrative healthcare vision. Since the program's inception, additional evidence has accumulated in the literature supporting the impact of integrative therapies strategies on patients' quality of life during inpatient stays. These findings and our own evaluation processes have encouraged continued program growth. Several elements were critical to the program's success. Review of the literature and investigation of other programs served as preparation before the actual program started. It was necessary to have administrative, nursing, and physician champions who were able to envision the program and see the value of this approach for patients. We appreciated the need for evidence-based outcomes research and demonstrable patient outcomes. Finally, a program manager was hired who was able to understand the culture of the hospital and the organizational change process. Each of these basic steps, which called for interdisciplinary collaboration, allowed us to accomplish the goal of using integrative therapies as adjuncts to conventional medical care and thereby supported an integrative approach. Consistently linking the integrative vision to patient needs and requirements helped us to identify many new avenues to expand upon this work. The process of program development described may be useful to other inpatient cardiovascular programs inclusive of critical care settings. Adaptations of our experience to other populations in critical care and across other hospital settings may be possible.

Cardiac Care Facilities↗
PubMed2007

The impact of food supplementation on infant weight gain in rural Bangladesh; an assessment of the Bangladesh Integrated Nutritional Program (BINP).

OBJECTIVES: To examine the efficiency of the Bangladesh Integrated Nutritional Program (BINP) in identifying which infants should be supplemented, whether full supplementation was given for the stipulated period of time, and whether the correct exit criteria from the supplementation programme were used. To test whether targeted food supplementation of infants between 6-12 months of age resulted in enhanced weight gain. SETTING: Mallickbari Union, Bhaluka, a rural area located about 100 km north of Dhaka, Bangladesh. PARTICIPANTS: Five hundred and twenty-six infants followed for 6 to 12 months. RESULTS: Of the 526 infants studied, 368 should have received supplementation based on BINP criteria but only 111 infants (30%) did so, while a further 13% were incorrectly given supplementation. So in total over half (52.8%) of the sample was incorrectly identified for supplementation. In addition, less than a quarter of the infants received the full 90 days of supplementation and close to half of the infants exited the programme without the requisite weight gain. Infants were assigned to one of four groups: correctly supplemented, correctly non-supplemented, incorrectly supplemented or incorrectly non-supplemented. This classification provided natural controls; the correctly supplemented infants versus the incorrectly non-supplemented infants, and the correctly non-supplemented infants versus the incorrectly supplemented infants. There were no significant differences in weight gain between the correctly supplemented group and the incorrectly non-supplemented group or between the correctly non-supplemented and the incorrectly supplemented groups, nor was there any evidence of growth faltering in the incorrectly non-supplemented group. CONCLUSIONS: This study found serious programmatic deficiencies - inability to identify growth faltering in infants, failure to supplement for the full time period and incorrect exit procedures. There was no evidence that food supplementation had any impact on improving infant weight gain.

Bangladesh↗
PubMed1991

A practicum in clinical nutrition as the internship component of an integrated masters/internship program.

In September 1990, Chedoke McMaster Hospitals (CMH) admitted two students to the Practicum in Clinical Nutrition. This program was developed at CMH in affiliation with the graduate programs in nutrition offered at McMaster University and the University of Guelph. This is the first program in Canada to integrate a graduate nutrition degree at the Master's level with a clinical nutrition training program. The purpose of this paper is to describe the need, goals, educational philosophy, developmental process and anticipated benefits of this practicum.

Curriculum↗
PubMed2002

Effect of an integrated nutrition program on child morbidity due to respiratory infection and diarrhea in northern Viet Nam.

Infectious disease and poor diet are the two proximal causes of malnutrition in children. During the 1990s, integrated nutrition programs implemented by Save the Children (SC) in Viet Nam reduced severe child malnutrition, but it has not been clear if this impact was due primarily to improved diet or reduced disease. The aim of this study was to determine whether a community-based, integrated nutrition program in Viet Nam reduced child morbidity due to diarrhea or acute respiratory infections. Children 5 to 25 months old were randomly selected from randomly assigned intervention and comparison communes. Caregivers of children from the intervention and comparison groups (n = 119 per group) were interviewed about their child's morbidity at program baseline and at study months 2, 4, 6, and 12. Multiple logistic regression and general estimating equations (GEE) were used to evaluate the effect of the intervention on the occurrence of any diarrhea and respiratory illness in the preceding two weeks. Respiratory illness, mainly upper respiratory illness, was more common than diarrheal disease at baseline (54% vs. 6%, respectively). During follow-up, children in the intervention communes had approximately half the respiratory illness experienced by those in comparison communes (AOR = 0.5; p = .001). Diarrheal disease was also lower in the intervention group, although differences were not statistically significant. We conclude that SC's integrated nutrition program was associated with reduced upper respiratory illness, perhaps due to improved hygiene practices and/or improved micronutrient intakes.

Adult↗
PubMed1995

Visions realized and dreams dashed: Helen Penhale and the first basic integrated baccalaureate program in nursing in the west, at the University of Alberta 1952-1956.

The first basic degree program in nursing in Canada was established at the University of British Columbia in 1919. This program and those that followed elsewhere were of the non-integrated form, wherein a diploma program offered by a hospital was supplemented by university courses in the arts, humanities, and sciences. In 1942 an innovative basic baccalaureate program in nursing was established at the University of Toronto; courses in nursing, given by the university, were offered in conjunction with university courses in other subjects. Only two other attempts were made to set up integrated programs in Canada prior to release of the Report of the Royal Commission on Health Services of 1964; McMaster University established a program in 1946, and, in an attempt that was ultimately unsuccessful, a program was established at the University of Alberta in 1952. The purpose of this study was to examine the conditions surrounding the initiation and termination of a basic degree program in the 1950s at the University of Alberta, in order to understand the key issues in the movement to establish basic university degree programs for nurses, and the gender discrimination relative to nurses and nursing students that has prevailed in health and education. Although the conflict at the University of Alberta was a very difficult one for the nurses involved, and although the Director who had the temerity to establish the program relinquished her position when the program was summarily terminated, this episode in Canadian nursing history provides insight into the climate in which baccalaureate nursing education existed and into some of the issues relative to its development.

Alberta↗
PubMed2006

Reflection on academic protected time: an opportunity to integrate educational programs.

OBJECTIVES: We sought to identify the structure of academic protected time curriculum and to determine interest in a knowledge-sharing, web-based initiative. METHODS: We undertook a survey of the 16 obstetrics and gynaecology program directors in Canada. RESULTS: The response rate was 88%. Seventy-one percent of the responding program directors are responsible for developing protected time curriculum. Seventy-eight percent use a template based on a two-year rotation of topics, 64% use lectures as the main educational format, and 50% have incorporated professional competencies into academic time. The largest barrier to curriculum development is time constraints. Seventy-eight percent of program directors are interested in a network for sharing ideas. CONCLUSIONS: In most programs, the curriculum for academic protected time is developed by program directors, who are dependent upon lectures and limited by time constraints. Programs therefore have difficulty integrating professional competencies into the academic curriculum. This educational environment could prove fertile ground for establishing a collaborative curriculum initiative.

Alberta↗
PubMed1999

A method of teaching clinical research in a community hospital residency program.

BACKGROUND: To provide clinical research experience in community hospital programs, we integrated research training with the daily work of surgical residency. METHODS: Teaching conferences and daily care of patients served as a source of projects. Emphasizing team work, high-yield projects are assigned to principal resident investigators, who lead a project team. Regular meetings with the faculty provides guidance and supervision, working to meet an abstract deadline. RESULTS: Over a 3-year period, 10 of 16 trainees participated in at least one project. Thirteen projects were presented at national meetings and 13 articles (including 6 from presentations) were published. Three projects were abandoned for lack of progress, and 5 manuscripts have been rejected. CONCLUSION: The integrated program trains multiple residents/projects with low requirements in space and funding, but high demands of organization and faculty time.

Curriculum↗
PubMed1998

New approaches to smoking prevention in the north.

Morbidity and mortality rates of noncommunicable diseases (NCD) are very high in Siberia. The prevalence of NCD risk factors is also very high, smoking being one of the most widespread risk factors. Prevention and cessation of smoking may improve the health of the population. Within the framework of the WHO MONICA (Monitoring Cardiovascular Diseases) project, we have conducted three population surveys in Novosibirsk within a 10-year period (1984-1995) to show trends of cardiovascular diseases and their risk factors. We also conducted similar surveys in some Siberian regions. Economic crisis and social stress greatly affect the health of the population, and new methods and approaches to disease prevention are needed. As participants in the WHO CINDI program (Countrywide Integrated Program for Disease Prevention), we started our work to reduce and control the main NCD risk factors. Smoking being widespread in Siberia, we started an anti-smoking campaign in Novosibirsk as participants in the international "QUIT & WIN" campaign in 1994. In 1995 we arranged a similar contest at the local level in the city; and now in May 1996 we are again taking part in the QUIT & WIN campaign.

Adult↗
PubMedDate not supplied

The nature and effectiveness of program models for adolescents at risk of entering the formal child protection system.

This article compares rationales and outcome research for five areas of programming for adolescents: adolescent competence and skill development programs, family- and parent-focused programs, social integration programs, multiple component programs, and neighborhood transformation programs. The article examines program evidence for maltreated teens as well as teens coping with a variety of other challenges. The study uses a framework based on common developmental challenges and risk factors for adolescents to select and review programs.

Adolescent↗
PubMed2004

Comparison of a sprayable pheromone formulation and two hand-applied pheromone dispensers foruse in the integrated control of oriental fruit moth (Lepidoptera: Tortricidae).

The efficacy of integrated programs using a sprayable pheromone formulation or one of two hand-applied pheromone dispensers, and a conventional oriental fruit moth, Grapholita molesta (Busck) (Lepidoptera: Tortricidae) control program, was compared using 4-5-ha blocks of peach orchard at three Niagara Peninsula farms during 2000-2002. In the integrated programs, chlorpyrifos and mating disruption with 3M Sprayable Pheromone, Isomate OFM Rosso, or Rak 5 hand-applied dispensers were used to control first-generation larvae, and mating disruption alone was used to control second- and third-generation larvae. In the conventional program, chlorpyrifos was used to control first-generation larvae, and pyrethroid insecticides were used to control larvae of the later generations. All programs were effective at maintaining fruit infestation by G. molesta below the industry tolerance level of 1%. An integrated program using sprayable pheromone required the use of more supplementary insecticide applications to control second- and third-generation larvae than a program using hand-applied dispensers. The elimination of insecticide sprays from integrated program blocks did not result in an increase in damage by plant bugs, Lygus spp. (Hemiptera: Miridae) or by the plum curculio, Conotrachelus nenuphar (Herbst) (Coleoptera: Curculionidae).

Animals↗
PubMed2006

Quality improvement of oral medication administration in patients with enteral feeding tubes.

BACKGROUND: The correct administration of oral drugs to patients on enteral tube feeding presents a special challenge. As patients are usually unable to swallow oral drugs and many drugs should not be crushed, ways have to be found to administer them through the feeding tube. Measures to improve the quality of oral drug administration in patients with enteral feeding tubes may consist of introducing guidelines, training nurses, or giving patient-tailored advice by the pharmacy. An integrated program comprising all these measures is likely to result in the greatest improvements. METHODS: A study was undertaken in two Dutch hospitals to investigate the effect of such an integrated program. RESULTS: The integrated program in hospital I resulted in a decrease in the number of tube obstructions (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.047 to 1.05). There was a significant decrease in the number of administration errors per nurse in hospital II (OR 0.003, 95% CI 0.0005 to 0.02). CONCLUSIONS: This multidisciplinary program comprising several interventions to promote the correct administration of drugs through an enteral feeding tube results in substantial improvements. As errors concerning administration of drugs to patients with enteral feeding tubes may lead to adverse drug events and loss of effect, these improvements are likely to contribute to a decrease in patient morbidity.

Data Interpretation, Statistical↗
PubMed1999

Integrating Application Programs for Bioinformatics Using a Web Browser.

We have constructed a general framework for integrating application programs with control through a local Web browser. This method is based on a simple inter-process message function from an external process to application programs. Commands to a target program are prepared in a script file, which is parsed by a message dispatcher program. When it is used as a helper application to a Web browser, these messages will be sent from the browser by clicking a hyper-link in a Web document. Our framework also supports pluggable extension-modules for application programs by means of dynamic linking. A prototype system is implemented on our molecular structure-viewer program, MOSBY. It successfully featured a function to load an extension-module required for the docking study of molecular fragments from a Web page. Our simple framework facilitates the concise configuration of Web softwares without complicated knowledge on network computation and security issues. It is also applicable for a wide range of network computations processing private data using a Web browser.

Journal Article↗