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PubMed2006

Building on existing models from human medical education to develop a communication curriculum in veterinary medicine.

Communication is a core clinical skill of veterinary medicine and one that needs to be taught and learned to the same degree as other clinical skills. To provide this education and essential expertise, veterinary schools in many countries, especially including North America, the United Kingdom, and Australia, have begun to develop programs and communication curricula. Human medical education, however, has 30 years' experience in developing communication curricula, and is thus an excellent resource upon which veterinary educators can build and shape their own communication programs. This article describes a skills-based communication course that has been successfully implemented for veterinary medical education at Ontario Veterinary College (OVC) and was based on the University of Calgary Faculty of Medicine's well-established program. The Calgary-Cambridge Guides and supporting textbooks provide the scaffolding for teaching, learning, and evaluation in both programs. Resources such as space and materials to support the OVC program were also patterned after Calgary's program. Communication skills, and the methods for teaching and learning them, are equally applicable for the needs of both human medicine and veterinary medicine. The research evidence from human medicine is also very applicable for veterinary medicine and provides it the leverage it needs to move forward. With this extensive base available, veterinary medicine is in a position to move communication skills training forward rapidly.

Animals↗
PubMed1991

Accessory apartment conversion programs.

In recent years, state housing finance agencies have joined with state units on aging to develop programs to help the frail, elderly homeowner. Under an accessory apartment conversion program, a low-income homeowner will borrow money at a reduced interest rate to underwrite conversion of excess space into a rental apartment. The tenant will provide additional income as well as, ideally, certain kinds of personal assistance and a friendly presence. To date, few elderly clients have used this option. The initial rationale for the program is explained as are plausible reasons for the fact that it has not met expectations.

Aged↗
PubMed1992

The ESRC/UFC-ISC 1991 census of population initiative: delivering the data of the decade.

"This article describes the programme of data purchase, dissemination, training and development support which the Economic and Social Research Council (ESRC) in collaboration with the Information Systems Committee of the Universities Funding Council (UFC-ISC) has put in place to...[inform users about] new products derived from the Census [of the United Kingdom]. As a preliminary some background to the census itself and to the Census Initiative are provided." Topics covered include census outputs, new features of the census, linked datasets, linked software, and Census Initiative datasets, training and development programs, and organization.

Censuses↗
PubMed1984

Setting program standards for New York State's periodic medical review.

This article describes the methodology used to develop program standards for a new periodic medical review/independent professional review (PMR/IPR) in New York State nursing homes. The new program consists of two stages: a first, cursory stage for the purpose of identifying patients to be subjected to a more thorough process review in the second stage. Program standards consist of (1) norms for the percentage of patients failing Stage 1 before a second stage is undertaken in a nursing home and (2) norms for the percentage of patients failing the second stage before the home is subject to corrective action. The actual standards that were developed are also presented.

New York↗
PubMed2006

Training and development of anesthesia in Nepal - 1985 to 2005.

PURPOSE: To describe the self-sustaining anesthesia training and development program in Nepal from 1985 through 2005, and the Canadian contributions. METHODS: We examined the training program and outcome of the diploma in anesthesia (DA) and MD anesthesiology programs in Nepal over a 20-year period. Issues related to recruitment, funding, specialist training opportunities and professional development were examined and summarized. RESULTS: In 1985 there were seven Nepalese physician anesthesiologists in Nepal. With Canadian support of faculty members and the Canadian Anesthesiologists' Society International Education Fund, a one-year DA training program began in 1985, and a three-year MD anesthesia program began in 1996. As of 2005, 43 anesthesiologists were trained in the DA program, and 19 Nepalese completed MD anesthesia training. Thirteen (30%) of DA graduates have since left the country, compared to only two (10.5%) physicians from the MD anesthesia training program. Annual anesthesia symposia began in 1986, and the Society of Anesthesiologists of Nepal was formed in 1987. Nepalese anesthesiologists have been attending and presenting papers at international scientific meetings since 1991. CONCLUSION: The devotion of Nepalese anesthesiologists in teaching and training, strong guidance from Canadian medical faculties, and local government support have contributed to the successful development of Nepalese anesthesia training programs. Establishment of the training programs has assisted recruitment of trained anesthesiologists to different regional hospitals. Finally, the formation of a national society, with an organized annual symposium has improved professional self-esteem, and raised the profile of anesthesiology in Nepal.

Anesthesiology↗
PubMedDate not supplied

Surveys explore critical governance relationship.

The transition in religious-sponsored health care from a ministry of direct service to one of governance has generated serious and penetrating questions, analyses, and retrenchment. Emphasis on and demand for value-laden leadership development programs are growing at the same time that sponsoring groups are becoming more actively involved in the governance and oversight of their corporate ministries. Two recent Catholic Health Association (CHA) studies focused on the critical governance relationship between the sponsoring group and its incorporated ministries. The first study asked religious institutes and dioceses that were sponsors of CHA member health care freestanding facilities and systems to describe their current governance structure. The second study represented an initial attempt to identify qualitative components of effective governance or sponsorship and asked 19 major superiors and system chief executive officers (CEOs) to characterize an ideal relationship between sponsor and ministry. The studies' findings included the following: In freestanding facilities, lay-religious governing boards have all but replaced the all-sponsor and all-lay advisory boards of the past. Trustee orientation, development, and evaluation were not equally stressed in the three groups surveyed, with trustee evaluation programs lagging behind in all three. Major superiors and CEOs had remarkably similar expectations relating to accountability for mission, relationships between sponsor and corporation, communication, and leadership development. Both major superiors and CEOs looked for greater collaboration in defining roles, translating mission into "business plan", and developing formation programs for leadership. Major superiors' emphasized simplicity of life-style, whereas the CEOs stressed stable commitment to corporate ministry.

Catholicism↗
PubMed2002

Accreditation as an alternative to specialty recognition.

The Commission on Dental Accreditation does not currently accredit postdoctoral training in general anesthesia. This is related to the traditional linkage of accreditation of postdoctoral training programs to ADA specialty recognition. The aforementioned ADA Guidelines are important because they provide the foundation for the continued use of sedation and general anesthesia within dentistry. The one mechanism that would "ensure safety and effective use," maintain "a strong educational foundation," provide "access to adequate training ... develop programs at the postgraduate level" and support expansion of both basic and clinical research is CDA accreditation of postdoctoral programs. Prior to 1991, hen general anesthesia training was acquired by dentists primarily through accredited medical programs, there was little need for anything more than guidelines to protect the public. With the development of non-accredited dental anesthesiology programs in accredited dental schools (primarily in the late 1980's) and the loss of access to general anesthesia training in accredited medical anesthesiology residency programs in the summer of 1991, primary responsibility for all general anesthesia training of dentists shifted to organized dentistry. However, the ADA House declined to recognize dental anesthesiology as a dental specialty on three separate occasions even though the ADA Council on Dental Education felt all requirements were met and favorably recommended specialty recognition in all three instances. Specialty recognition would have provided the needed accreditation mechanism to validate dentistry's continued use of deep sedation and general anesthesia by those practitioners not classified as oral and maxillofacial surgeons. As an alternative to the specialty recognition process and in view of the need to accredit postdoctoral general anesthesia training for dentists, the American Society of Dentist Anesthesiologists has recently requested the CDA offer accreditation for these dental programs. To address this issue and those of other non-ADA-recognized disciplines, the CDA is currently in the initial stages of developing requirements for accrediting non-ADA recognized postdoctoral training programs. This material will be circulated to communities of interest for their input. Details of the process will be forthcoming from ADA sources in the near future.

Accreditation↗
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↗
PubMed1997

The PRECEDE-PROCEED model: application to planning a child pedestrian injury prevention program.

OBJECTIVES: The objectives were first, to modify the PRECEDE-PROCEED model and to use it is as a basis for planning a three year intervention trial that aims to reduce injury to child pedestrians. A second objective was to assess the suitability of this process for planning such a relatively complex program. SETTING: The project was carried out in 47 primary schools in three local government areas, in the Perth metropolitan area. METHODS: The program was developed, based on extensive needs assessment incorporating formative evaluations. Epidemiological, psychosocial, environmental, educational, and demographic information was gathered, organised, and prioritised. The PRECEDE-PROCEED model was used to identify the relevant behavioural and environmental risk factors associated with child pedestrian injuries in the target areas. Modifiable causes of those behavioural and environmental factors were delineated. A description of how the model facilitated the development of program objectives and subobjectives which were linked to strategy objectives, and strategies is provided. RESULTS: The process used to plan the child pedestrian injury prevention program ensured that a critical assessment was undertaken of all the relevant epidemiological, behavioural, and environmental information. The gathering, organising, and prioritising of the information was facilitated by the process. CONCLUSIONS: The use of a model such as PRECEDE-PROCEED can enhance the development of a child injury prevention program. In particular, the process can facilitate the identification of appropriate objectives which in turn facilitates the development of suitable interventions and evaluation methods.

Accident Prevention↗
PubMed2000

Wartime research on malaria chemotherapy.

Malaria was a major problem for the opposing forces in World War II. During the first year of operations in the South West Pacific the casualties caused by this disease greatly exceeded the numbers of battle casualties. In response to this situation comprehensive research and development programs to discover new antimalarial drugs were undertaken in the United States and Britain. In both countries compounds synthesised by co-operating chemical laboratories were screened against bird malaria and those with high activity and low toxicity were tested in man. The wartime program in America was funded by the Office of Scientific Research and Development and co-ordinated through a specially designated body under the Committee on Medical Research of the National Research Council. It was an enormous undertaking involving a massive co-operative effort between pharmacologists, chemists, and clinical research scientists from American universities, the US Public Health Service, and the laboratories of commercial pharmaceutical companies. The British program, on a much smaller scale, was based on a co-operative arrangement between the research laboratories of Imperial Chemical Industries at Manchester, the Liverpool School of Tropical Medicine and the British Medical Research Council. The wartime programs in both countries identified a number of promising leads but lacked the resources to permit their rapid clinical evaluation against field strains of human malaria. This deficiency was overcome by experiments conducted by the Land Headquarters Medical Research Unit of the Australian Army in Cairns, Queensland with the use of army volunteers. Large scale clinical trials of the most promising compounds which emerged from the American and British programs were carried out in Australia. This co-operative endeavour among allied scientists resulted in a range of new drugs which have had an enduring influence on malaria chemotherapy.

Antimalarials↗
PubMed2005

Community-based participatory research in the California Health Interview Survey.

INTRODUCTION: The California Health Interview Survey, the largest state health survey in the United States, uses community-based participatory research principles to develop each cycle. Other large-scale health surveys rarely include participatory research approaches. Every 2 years, the California Health Interview Survey generates state and local population-based data on health insurance coverage, access to health care, chronic disease prevalence and management, health behaviors and disease prevention, and other health issues in California. The survey is used for policy and program development, advocacy, and research. METHODS: The development of the California Health Interview Survey involves more than 145 people from more than 60 state and local policymaking bodies, public health agencies, advocacy groups, research organizations, and health care organizations. They participate as volunteers in an advisory board, on technical advisory committees, and in work groups that interact with California Health Interview Survey research staff in an accountable advisory process that shapes survey topics, measures, and sample design and determines languages selected for translation. Survey results and data are provided to the communities involved in the survey. RESULTS: California Health Interview Survey data have been widely used by local, state, and national public health leaders, policymakers, advocates, and researchers to improve access to health insurance and health care services and to develop and target prevention programs for obesity and chronic illnesses. CONCLUSION: The California Health Interview Survey participatory research model has been an effective approach to planning and implementing a health survey and should be considered by developers of other large health surveys.

California↗
PubMed2004

The implementation of a fitness program for children with disabilities: a clinical case report.

PURPOSE: The purpose of this report is to describe a community-based fitness program developed and implemented for children with disabilities. Several outcomes are reported for one of the participants, J, an 11-year-old girl with hypotonia and mild mental retardation, to illustrate the strengths and limitations of this program and to help guide clinicians and researchers in developing and critically assessing the effectiveness of similar programs. SUMMARY OF KEY POINTS: The fitness program, called "Off the Couch," (OTC) was provided in six-week sessions for one hour per week. Outcomes examined included the energy expenditure index (EEI), rating of perceived exertion (RPE), maximum running velocity, and the overall daily activity level of the child and the number of exercise sessions that the child participated in over a two-week time period. J demonstrated a reduction in EEI and a slight improvement in maximum running velocity. Activity level remained at a relatively high level. The program is discussed with respect to feasibility in a clinical setting, suggestions for similar programs and areas for related research. J's outcomes are discussed in terms of their functional relevance.

Journal Article↗
PubMed2005

Involving the pharmaceutical and biotech communities in medication development for substance abuse.

Pharmacotherapy as adjunctive treatment is an integral part of the strategy for treating substance abuse. Although there are several approved drugs for the treatment of opioid, alcohol, and nicotine dependence, the pharmaceutical industry, for a variety of reasons, has been reluctant to enter this area to develop medications for substance abuse indications. Therefore, in 1990, a Medication Development Program was established by NIDA to carry out and assist in stimulating development of new pharmacotherapies. It is vital for NIDA to provide clear leadership and establish a collaborative working relationship with the pharmaceutical industry, providing scientific, development, and financial assistance, depending on the size, resources, and expertise of the company. An important NIDA role in this effort is setting standards, such as establishing Target Product Profiles (TPPs), predictive decision trees for selection of clinical candidates, and animal models to evaluate safety and potential effectiveness prior to human studies. NIDA can further establish standards for clinical studies, including Proof of Concept (PoC), Phase 2 (or Learning) trials to establish initial proof of safety and effectiveness, and Phase 3 (or Confirming) trials to validate Phase 2 findings. NIDA and other government agencies need to work to improve industry incentives to participate in medication development for substance abuse. Specific incentives, such as market exclusivity and patent extension, as provided in BioShield and pediatric drug legislation, should be strongly considered. NIDA can further assist industry to navigate the regulatory and, if needed, controlled substance scheduling processes, by establishing a true Federal partnership between NIDA, FDA, and DEA.

Animals↗
PubMed1980

Social indicators: for individual well-being or social control?

This article is concerned with the way that social statistics reflect particular views of the world, and focuses on the specific case of the Organization for Economic Cooperation and Development's program to develop a set of social indicators. Some illustrations of previous attempts to collect social indicators are given, but the bulk of the article discusses the series of contradictions which regulate the generation and use of statistics by governments, the principal one being between measures which play the ideological role of displaying economic and social "progress" and measures which are of direct use in social planning. This is discussed both for social indicators in general and for social concerns linked to the measurement of health. The article ends with an attempt to evaluate the future of the OECD program within the development of modern capitalism.

Government↗
PubMed1986

Pancreatitis: an important cause of abdominal symptoms in patients on peritoneal dialysis.

In an eight-month period, four patients in our peritoneal dialysis program developed acute pancreatitis, an incidence significantly higher than that in our hemodialysis program. Diagnosis was difficult since the symptoms of pancreatitis were similar to those of peritoneal dialysis-associated peritonitis. Further difficulties in diagnosis were due to unreliability of serum amylase levels and "routine" ultrasound examinations in suggesting the presence of pancreatitis. Computerized tomography performed in three patients showed enlarged, edematous pancreata with large extrapancreatic fluid collections in all cases. Two patients died, one directly due to complications of pancreatitis. One patient was changed to hemodialysis and showed clinical and radiologic resolution of his pancreatitis. One patient remains on peritoneal dialysis but has now had four attacks of acute pancreatitis. No patient had classic risk factors for development of pancreatitis. Review of patient histories showed no common historical factors except for renal failure itself, peritoneal dialysis, peritonitis, catheter surgery, and hypoproteinemia. It is possible that metabolic abnormalities related to absorption of glucose and buffer from dialysate or absorption of a toxic substance present in dialysate, bags, or tubing can cause pancreatitis in patients on peritoneal dialysis. We feel that a diagnosis of pancreatitis should be considered when peritoneal dialysis patients present with abdominal pain, particularly if peritoneal fluid cultures are negative or if patients with positive cultures do not have prompt resolution of symptoms with appropriate antibiotic therapy.

Abdomen↗
PubMed2000

Theory and practice: applying the ecological model to formative research for a WIC training program in New York State.

This article discusses the application of the ecological model to formative research in a practical setting of a training program developed for the Child Growth Monitoring Project of the New York State WIC program. The ecological model was selected to guide the formative research because it offered a concrete framework to account for the reciprocal interaction of behavior and environment. This model describes five levels of influence on behavior: individual, interpersonal, organizational, community and policy. Because we knew from the start that the intervention would focus on training, we focused our efforts on collecting data at those ecological levels that we considered potentially amenable to change through a training program--individual (WIC providers and clients), interpersonal (provider-client interaction) and organizational (physical layout of WIC sites and sequence of activities). However, our experiences both with the training program and the post-training evaluation, using ecological theory, indicated the fallacy of failing to apply the ecological model consistently throughout the formative research. Therefore, for maximum effect when using the ecological model, it is recommended that the whole model be applied at all stages of formative research: development, implementation and evaluation. A matrix is presented for monitoring complete application of the model.

Child↗
PubMed1996

Physician involvement and assessment in the development of hospital oncology programs.

Hospitals and other healthcare facilities are focusing resources on the care of the cancer patient. Physicians should become involved in all aspects of the development of oncology programs. Physicians need to be involved from the initial program development, through the strategic planning to the formulation of the business plan. Strong physician leadership is needed to coordinate care provided by physicians and ancillary staff. Educational programs for patients, their families, and physicians need to be developed by the medical director, physicians, and ancillary staff. Continuing evaluation and assessment of the entire cancer program is essential to monitor the achievement of goals and objectives set forth in the strategic plan.

Oncology Service, Hospital↗
PubMed2001

A conceptual model for leadership development.

Collaboration among schools of public health and national, state, and local health agencies has resulted in creation of comprehensive public health workforce education and training initiatives that offer integrated, sequential, and accessible professional development programs, including a nation-wide network of public health leadership institutes. A conceptual model for leadership development is presented. It contains seven elements considered critical for design of leadership programs in public health: capacity/competence needs; program target; area served; program content; training level; learning approach; and implementation methods. This model can be used to design leadership as well as public health workforce education and training programs.

Cooperative Behavior↗

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