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PubMed2004

Sustainability indicators as a communicative tool: building bridges in Pennsylvania.

Sustainability is a laudable goal, but difficult to define and to implement because of the complexity of interlinked human and natural systems, and the uncertainty inherent in such complex systems. Resilience shows promise as a relevant and measurable attribute of sustainability, which itself defies measurement. Identification and assessment of conditions that are desirable, as well as those that are undesirable, are necessary in order to determine both the degree of progress toward sustainability and the removal of impediments to such progress. Communications incident to the identification and selection of indicators of resilience and sustainability are of potentially greater value than the indicators themselves and so should be given explicit consideration in the design of the indicators development process. Moving towards sustainability requires an iterative, continuing (open-ended), collaborative process. Academic institutions can assist in this process through activities that connect across political, social and discipline boundaries. Boundary organizations are those that have achieved a level of trust among the relevant constituents to management of sustainability and can help convert academic findings that are objectively neutral into options and alternatives that may be politically and economically feasible. The Sustainable Pennsylvania Program is developing demonstration projects with both state and local governmental agencies with the objective of building both capacity and will for moving towards sustainability.

Communication↗
PubMed1997

Effects and sustainability of a cervical screening program in remote Aboriginal Australia.

We assessed the effects of an organised cervical screening program, using a population-based cervical cytology register, for Aboriginal women in the Fitzroy Valley, a remote part of the Kimberley region of Western Australia. Comparison of age-specific screening rates in the area during 1987-88, 1990-92 and 1993-94 showed that establishing the program in late 1989 was accompanied by dramatic increases in cervical screening rates, ranging from two- to over fourfold, with the largest increases in women aged 50 years and over. Following the departure of the coordinator in early 1993, screening rates decreased to between 76 per cent and 29 per cent of their 1990-92 levels, with the largest decreases occurring in the 40-49 and 60-69 years age groups. Rates were still above 1987-88 levels for most age groups. Of 545 women screened during 1991-92, 65 per cent had undergone a second Pap smear within the follow-up period of two to four years. Among women recommended for a repeat smear in two years, the probability of having a second smear was negatively associated with age (log-rank statistic = 35.58, 4 df, P < 0.0001). Follow-up of smears recommended for repeat in 12 months or earlier was less adequate in 1993-94 (46 per cent) than in 1991-92 (75 per cent). The program was successful in recruiting a large proportion of eligible women within a relatively short time, but coverage, especially of older women, was not sustained after a decline in the functioning of the recall system owing to staffing and organisational changes.

Adolescent↗
PubMed1995

Lessons learned in institutionalization of quality assurance programs: an international perspective.

A sustainable quality assurance (QA) program depends on development of a QA structure, ongoing standard setting, routine monitoring, quality improvement activities and the development of a culture of quality. A review of QA implementation in five countries identifies some practical guidelines for successful institutionalization of QA. These experiences underscore the importance of organizational assessment and provide insight about the advantages and disadvantages of an initial QA assessment. Developing a methodology that is both standardized and flexible is stressed, as well as a training strategy that integrates classroom learning, coaching and application. Gradual development of QA structure, based closely on existing systems, is recommended. Issues relating to gaining and sustaining political support, dealing with personnel changes, using appropriate incentives and dissemination are also discussed. Finally, the definition and dimensions of quality are put forth as the foundation for a culture of quality, which develops as individuals and groups commit themselves to their quality ideal.

Developing Countries↗
PubMed2005

Can a handwashing intervention make a difference? Results from a randomized controlled trial in Jerusalem preschools.

BACKGROUND: Preschools are often focal points for the spread of illness among young children. The objective of this preschool intervention trial was to determine whether a hygiene program can promote handwashing and thereby reduce illness absenteeism. METHODS: This cluster randomized trial included 40 Jerusalem preschools with 1029 children for 6 baseline days and 66 study days, yielding 73,779 child days. The main outcomes were rates of handwashing and illness absenteeism. The intervention included an educational program and environmental changes. A simultaneous subtrial was run to test a home component. RESULTS: This multi-site intervention program produced sustained behavioral and environmental changes over a 6-month period. An approximately threefold increase in handwashing with soap was observed among preschool children exposed to the intervention. Neither the preschool nor the home intervention program reduced illness absenteeism or overall absenteeism. CONCLUSIONS: This trial illuminates the potential of the preschool as a promising venue for health promotion activities leading to sustained behavioral change, yet suggests the need for enhanced approaches for reducing illness absenteeism.

Absenteeism↗
PubMed2002

Changing end-of-life planning: the Oregon experience.

Large state-by-state variations exist in location of dying and level of aggressive treatment during the final phase of life. This paper describes Oregon's incremental gains toward improving advance planning for end-of-life care in a state with the lowest rate of in-hospital deaths. Action strategies have required data gathering and reporting, and coalition building with a focus on systems change. Also, public education through the news media has proved to be a vital component of Oregon's process of change. The impact of media coverage is complemented by continuing education for health professionals. Special efforts are still needed to improve access to the Physician's Orders for Life-Sustaining Treatment program (POLST) for some rural, minority, and pediatric populations and for persons living at home with a diagnosis other than cancer. However, with enough time, a sustained effort, and a broad coalition of partners, profound change is possible.

Advance Directives↗
PubMedDate not supplied

Deploying the chronic care model to implement and sustain diabetes self-management training programs.

PURPOSE: The purpose of this project was to evaluate the utility of using the 6 elements of the chronic care model (CCM; health system, community, decision support, self-management support, clinical information systems, and delivery system design) to implement and financially sustain an effective diabetes self-management training (DSMT) program. METHODS: The University of Pittsburgh Medical Center (UPMC) uses all elements of the CCM. Partnerships were formed between UPMC and western Pennsylvanian community hospitals and practices; the American Diabetes Association DSMT recognition program provided decision support. A clinical data repository and reorganization of primary care practices aided in supporting DSMT. The following process and patient outcomes were measured: number of recognized programs, reimbursement, patient hemoglobin A1C levels, and the proportion of patients who received DSMT in primary care practices versus hospital-based programs. RESULTS: Using elements of the CCM, the researchers were able to gain administrative support; expand the number of recognized programs from 3 to 21; cover costs through increased reimbursement; reduce hemoglobin A1C levels (P < .0001), and increase the proportion of patients receiving DSMT through delivery in primary care (26.4% suburban; 19.8% urban) versus hospital-based practices (8.3%; P < .0001). CONCLUSIONS: The CCM serves as an effective model for implementing and sustaining DSMT programs.

Chronic Disease↗
PubMed2004

Using linking systems to build capacity and enhance dissemination in heart health promotion: a Canadian multiple-case study.

The purpose of this paper is to examine the utility of linking systems between public health resource and user organizations for health promotion dissemination and capacity building, and to identify factors related to the success of linking systems. The design is a parallel-case study using key informant interviews and content analysis of project reports (synthesized qualitative and quantitative data) of three provincial dissemination projects of the Canadian Heart Health Initiative-Dissemination Phase. Each provincial project used linking activities with public health user groups including meetings, skill building, resources, collaboration, networking and research feedback to facilitate capacity building for and implementation of heart health promotion activities. This paper presents empirical examples of linking system designs, activities, and qualitative and quantitative changes in the public health user groups' health promotion capacity, program delivery and sustainability. The findings indicate enhanced health promotion skills, partnerships, resources, infrastructure, and increased programming and sustainability in the targeted public health organizations of all three provincial projects. Identified barriers to the success of linking systems included lack of appropriately skilled personnel, funds, buy-in and leadership. We conclude that linking systems can be flexibly used to build capacity and disseminate health promotion innovations, and suggest conditions for success.

Canada↗
PubMed2006

Cost-effectiveness of WISEWOMAN, a program aimed at reducing heart disease risk among low-income women.

OBJECTIVE: To quantify the cost-effectiveness of the WISEWOMAN program. WISEWOMAN is a Centers for Disease Control and Prevention (CDC)-funded lifestyle intervention program that provides low-income uninsured women aged 40-64 with chronic disease risk factor screenings, lifestyle interventions, and referral services in an effort to prevent coronary heart disease (CHD) and improve health. METHODS: We used data for 3015 WISEWOMAN participants who completed baseline and 1-year follow-up screenings. We quantified the average per capita cost of providing WISEWOMAN over the last 6 months of the reporting period. We assessed 1-year reductions in select CHD risk factors. We calculated the cost-effectiveness ratio by dividing the average per capita cost by average predicted life-years gained. RESULTS: The cost of providing WISEWOMAN services to each additional participant averaged 270 US dollars per participant. Participants significantly improved their systolic (1.3%) and diastolic (1.7%) blood pressure, total (2%) and high-density lipoprotein (HDL) (0.7%) cholesterol, and 10-year risk of CHD (8.7%). There were also significant reductions in percent of women who smoked (11.7%) or had high blood pressure (15.8%) or high cholesterol (13.1%). The bestcase cost-effectiveness ratio was 470 US dollars per percentage point reduction in CHD risk, or 4400 US dollars per discounted life-year gained; however, sensitivity analysis revealed substantial uncertainty around this estimate. CONCLUSIONS: Although more research is needed to confirm the assumptions used in the model, results of our analysis suggest that the WISEWOMAN program is a cost-effective approach for reducing CVD risk among low-income, uninsured women aged 40-64, especially if improvements in risk factors are sustainable when program participation concludes.

Cardiovascular Diseases↗
PubMed1990

Prognostic significance of sustained monomorphic ventricular tachycardia induced by programmed ventricular stimulation using up to triple extrastimuli in survivors of acute myocardial infarction.

The prognostic significance of sustained monomorphic ventricular tachycardia (VT) induced by programmed ventricular stimulation using up to 3 extrastimuli was evaluated in 133 consecutive survivors of acute myocardial infarction (AMI) at a mean interval of 1.8 +/- 1.1 months after onset. This was compared with hemodynamic and angiographic abnormalities shown by cardiac catheterization and ventricular ectopic activity detected by Holter monitoring. Sustained monomorphic VT was induced in 25 (19%) patients, sustained polymorphic VT in 11 (8%) patients, nonsustained monomorphic VT (greater than or equal to 10 beats) in 12 patients (9%) and nonsustained polymorphic VT in 9 patients (7%). Multivariate logistic regression analysis of clinical, angiographic, hemodynamic and electrocardiographic variables showed that the presence of a left ventricular aneurysm (p = 0.005) and Lown grade 4B ventricular ectopic activity (p less than 0.001) were independent predictors of inducibility of sustained monomorphic VT. During a mean follow-up of 21 +/- 13 months, there were 8 (6%) sudden cardiac deaths and 3 (2.3%) spontaneous occurrences of life-threatening sustained VT. The 2-year probability of freedom from sudden cardiac death or sustained ventricular tachyarrhythmias was 53 +/- 13% for patients with inducible sustained monomorphic VT, 70 +/- 10% for those with a left ventricular ejection fraction less than 40% and 58 +/- 13% for those with Lown grade 4B ventricular ectopic activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

After adoption: sustaining the innovation. A case study of disseminating the hospital elder life program.

OBJECTIVES: To examine key factors that influence sustainability in the diffusion of the Hospital Elder Life Program (HELP) as an example of an evidence-based, multifaceted, innovative program to improve care for hospitalized older adults. DESIGN: Longitudinal, qualitative study between November 2000 and November 2003 based on 102 in-depth interviews every 6 months during HELP implementation. SETTING: Thirteen hospitals implementing HELP. PARTICIPANTS: Forty-two hospital staff members (physician, nursing, volunteer, and administrative staff) implementing HELP, conducted 102 interviews. MEASUREMENTS: Staff experiences sustaining the program, including challenges and strategies that they viewed as successful in addressing these challenges. RESULTS: Of the 13 hospitals studied, 10 were sustaining HELP at the end of the study period; three terminated the program (after 24 months, 12 months, and 6 months). Critical factors were identified as influencing whether the program was sustained: the presence of clinical leadership, the ability and willingness to adapt the original HELP protocols to local hospital circumstances and constraints, and the ability to obtain longer-term resources and funding for HELP. CONCLUSION: Recognizing the need for sustained clinical leadership and funding as well as the inevitable modifications required to sustain innovative programs can promote more-realistic goals and expectations for health services researchers, clinicians, and policy makers in their laudable efforts to translate research into practice.

Aged↗
PubMed2006

Evaluation of efficacy expectations for novel and non-chemical helminth control strategies in ruminants.

The interest in novel methods of controlling helminth infections in ruminants is driven primarily by the development of parasite resistance to currently available anthelmintics. While the purpose of anthelmintics is to achieve high efficacy, i.e. >90% reduction of adult and/or larval parasites in the target host animal, the purpose of novel parasite control methods is rather to assist in maintaining parasite infections below the economic threshold. The ability to maintain parasite levels below the economic threshold is related not only to the efficacy of the control method, but also to the epidemiology of the parasites, climatic conditions, the livestock management program, and integration in a sustainable parasite control program. Because of this fundamental difference, novel parasite control methods need to be evaluated using efficacy criteria different from that adopted for anthelmintics. Although the efficacy of novel parasite control methods may be demonstrated in classic dose-confirmation studies, the impact on livestock production parameters can only be evaluated when tested on-farm. In this paper, the rationale for evaluating novel methods differently from anthelmintics is reviewed, potential performance expectations are presented, and four novel parasite control methods (vaccines, nematophagous fungi, condensed tannins, and immunonutrition) are assessed based on the potential performance criteria.

Animal Husbandry↗
PubMed2001

A multi-project systems approach to developing community trust and building capacity.

Community characteristics are being recognized as important determinants for effective community-based programs. Community capacity to collaboratively identify issues, establish collective goals, and mobilize resources is built on experience with such interactions and trust among collaborators. Conceptual approaches and methods to develop community capacity rarely have been a focus of research programs, at least in part due to categorical funding, which often limits the scope and duration of interventions, thereby limiting capacity development. This approach uses multiple categorical funding sources to create sustained community programs involving multiple systems to increase capacity. Quasi-experimental evidence of increases in community capacity within two Alabama communities is presented.

Adult↗
PubMed2000

Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points.

BACKGROUND AND PURPOSE: Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs. SUBJECTS: Forty adults (17 male, 23 female), aged 23 to 58 years (mean=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study. METHODS: Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable. RESULTS Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain. CONCLUSION AND DISCUSSION: A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.

Adult↗
PubMed2004

Physical activity intervention for older adults with intellectual disability: report on a pilot project.

A 12-week pilot project on physical activity was introduced in a day habilitation setting to a group of 12 older adults with intellectual disability and a variety of physical and behavioral conditions. Our purpose was to determine whether (a) this intervention would positively impact physical function in this population, (b) consumers would choose to participate in physical activity sessions, and (c) day habilitation staff could sustain this program beyond the intervention period. Findings indicate that 92% of participants experienced improvement in at least one domain of physical function, physical activity sessions remained a popular activity choice for consumers, and many participants sustained functional gains 1 year after habilitation staff assumed responsibility for sessions.

Adult↗
PubMed2000

Economic model of sustained-release bupropion hydrochloride in health plan and work site smoking-cessation programs.

The development and application of an economic model designed to assess the specific costs and benefits of health plan coverage of smoking-cessation programs involving sustained-release bupropion hydrochloride are described. A cohort of 100,000 employees or health plan members and 60,000 adult dependents was followed from the start of the model to either retirement at age 65 or death at age 85. The model was used to compare outcomes for coverage versus no coverage of sustained-release bupropion hydrochloride as a component of a smoking-cessation benefit under four managed care plan scenarios and four employer scenarios. For the managed care scenarios involving coverage of bupropion sustained-release the overall decrease in health care costs over a 20-year period ranged from $7.9 million to $8.8 million; for every dollar spent covering smoking cessation, $4.10-$4.69 in health care costs was saved. For the employer scenarios, health care costs over 20 years decreased by $8.3 million to $14.0 million, and smoking-related indirect costs decreased an additional $5.1 million to $7.7 million; for every dollar spent covering smoking cessation, $5.04-$6.48 was saved. A model developed to assess the specific costs and benefits of covering sustained release bupropion hydrochloride as a component of a smoking-cessation benefit indicated cost savings for health plans and employers.

Adult↗
PubMedDate not supplied

Compliance education through participational QA programs.

Attaining and sustaining an acceptable level of compliance to regulations, guidelines, or directives presents a challenge to every company. Compliance education programs usually combine in-house tailored programs with extramural courses, both of which are very valuable. It is recommended that two motivational participational Quality Assurance programs be added to your compliance education: (1) Deputy Quality Assurance monitoring program and (2) Quality Assurance group auditing. Both programs provide the researcher active involvement, on an ad hoc basis, in the compliance assessment process, and an increased awareness of the practical application of compliance principles. Through self-discovery and team building, both the researcher and Quality Assurance gain a mutual trust and respect for their respective expertise. Motivation is enhanced through this environment and provides a self-perpetuating impetus for proactive improvements in the compliance process. From a Quality Assurance perspective, effective compliance education combines in-house tailored compliance programs and extramural courses or meetings with these two participational Quality Assurance programs. The combination has the potential for going beyond our basic understanding of compliance and creating a compliance consciousness that can successfully translate into continually improving our compliance programs.

Humans↗
PubMed2026

The Effect of Game-Based Virtual Reality Rehabilitation and Its Impact on Upper Extremity Function After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

BACKGROUND: Arthroscopic rotator cuff repair (ARCR) often results in prolonged recovery and limited shoulder function. Conventional physical therapy rehabilitation programs require sustained patient engagement; however, adherence is frequently low. Game-based virtual reality (VR) offers an interactive and engaging environment that may enhance rehabilitation outcomes. OBJECTIVE: To evaluate the effect of a game-based VR program on the function of the upper limb in patients following ARCR. METHODS: A randomized controlled trial was conducted with patients who underwent ARCR. Participants were randomized into two groups: game-based VR or conventional rehabilitation. Outcomes were evaluated using the Disabilities of the Arm, Shoulder and Hand score, pain severity by the Numerical Pain Rating Scale, range of motion measures, and muscle strength testing. Assessments were performed at baseline and at 6 weeks and 12 weeks post surgery. RESULTS: Results have shown significant within-group improvements in pain, function, range of motion, and isometric muscle strength across all time points (P < 0.05). Between-group analysis revealed greater improvements in pain, function, flexion range, and abduction and external rotation strength in the experimental group at both time points (P < 0.05). Abduction range improved significantly only at 12 weeks (P = 0.02), whereas external rotation range showed no significant difference between groups at either time point (P > 0.05). CONCLUSION: The findings indicate that integrating game-based VR rehabilitation provides additional benefits over conventional therapy in improving pain and upper extremity function following ARCR. These findings support the use of VR as an effective alternative to the conventional rehabilitation for postoperative rehabilitation.

Humans↗