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PubMedDate not supplied

A study of federally funded faculty development in family medicine from 1978-1981.

From 1978 to 1982 the federal government invested $13.6 million in family medicine faculty development projects. To synthesize and disseminate the collective experience of these projects, we surveyed directors of the 30 projects funded and begun in 1978. The study's purpose was twofold. First, we wanted to capture the lessons these experienced project directors learned. To accomplish this we asked directors to describe and then evaluate specific approaches they used for eight aspects of their projects: project staff, needs assessment, participant recruitment, project participants, goals and objectives, instructional formats, instructional strategies, and project evaluation methods. We also sought information on additional effects of the projects, present status of faculty participants, and future directions for faculty development in family medicine. The results revealed useful suggestions for designing and conducting faculty development and a consensus on the priority areas for future faculty development efforts: research skills, clinical teaching, academic vitality, and curriculum development.

Faculty, Medical↗
PubMed2005

What can a pilot congestive heart failure disease management program tell us about likely return on investment?: A case study from a program offered to federal employees.

In 1999, the Blue Cross and Blue Shield Federal Employee Program (FEP) implemented a pilot disease management program to manage congestive heart failure (CHF) among members. The purpose of this project was to estimate the financial return on investment in the pilot CHF program, prior to a full program rollout. A cohort of 457 participants from the state of Maryland was matched to a cohort of 803 nonparticipants from a neighboring state where the CHF program was not offered. Each cohort was followed for 12 months before the program began and 12 months afterward. The outcome measures of primary interest were the differences over time in medical care expenditures paid by FEP and by all payers. Independent variables included indicators of program participation, type of heart disease, comorbidity measures, and demographics. From the perspective of the funding organization (FEP), the estimated return on investment for the pilot CHF disease management program was a savings of $1.08 in medical expenditure for every dollar spent on the program. Adding savings to other payers as well, the return on investment was a savings of $1.15 in medical expenditures per dollar spent on the program. The amount of savings depended upon CHF risk levels. The value of a pilot initiative and evaluation is that lessons for larger-scale efforts can be learned prior to full-scale rollout.

Adult↗
PubMed2006

Can science be a business? Lessons from biotech.

In 1976, Genentech, the first biotechnology company, was founded by a young venture capitalist and a university professor to exploit recombinant DNA technology. Thirty years and more than 300 billion dollars in investments later, only a handful of biotech firms have matched Genentech's success or even shown a profit. No avalanche of new drugs has hit the market, and the long-awaited breakthrough in R&D productivity has yet to materialize. This disappointing performance raises a question: Can organizations motivated by the need to make profits and please shareholders successfully conduct basic scientific research as a core activity? The question has largely been ignored, despite intense debate over whether business's invasion of basic science-long the domain of universities and nonprofit research institutions- is limiting access to discoveries, thereby slowing advances in science. Biotech has not lived up to its promise, says the author, because its anatomy, which has worked well in other high-tech sectors, can't handle the fundamental challenges facing drug R&D: profound, persistent uncertainty and high risks rooted in the limited knowledge of human biology; the need for the diverse disciplines involved in drug discovery to work together in an integrated fashion; and barriers to learning, including tacit knowledge and murky intellectual property rights, which can slow the pace of scientific advance. A more suitable anatomy would include increased vertical integration; a smaller number of closer, longer collaborations; an emphasis by universities on sharing rather than patenting scientific discoveries; more cross-disciplinary academic research; and more federal and private funding for translational research, which bridges basic and applied science. With such modifications, science can be a business.

Biotechnology↗
PubMed2006

Needs assessment for health care management education in Russia.

INTRODUCTION: For more than 70 years, health care management in the Soviet Union reflected a centralized directive style familiar to the Soviet political system. Market-oriented reform in post-Soviet Russia is pushing practicing physicians and physician-executives to acquire new information and skills regarding health care management. To assist with health care management in Russia, we analyzed health care providers' educational needs, as they perceive them. METHODS: A total of 4, 367 questionnaires were sent to practicing physicians and physician-executives in 3 regions of the Russian Federation. The questionnaires included 14 items designed to determine respondents' current levels of satisfaction and preferences for health care management education in Russia. RESULTS: There were 847 questionnaires returned, for a total response rate of 19.4%. Physicians were dissatisfied with the current status of health care management education, but they were interested in learning the skills of health care management. The health care legal system and computer systems and data analysis were the most popular courses requested; health care management and marketing were the least popular. Learning interests of executives differed from those of practicing physicians, and regions differed in their combined interests for courses. Medical school and continuing education departments were seen as the best choices for delivering health care management education. DISCUSSION: As health care policy shifts in new directions, physicians in leadership positions expect Russian medical schools and continuing education departments to provide courses that enable improvements in health care.

Adult↗
PubMedDate not supplied

Take word processing one step further.

As financial constraints are placed on departments of nursing, cost-saving solutions must be found. Even as budgets shrink, state and federal agencies create standards that often are more easily tracked with flowsheets and forms. In the past, typesetters were contacted for form production. Today, in-house desk-top publishing can help to reduce costs. The tools may already be available in the word processor currently used. With a little time spent learning advanced features of word processors, attractive desk-top forms, newsletters, brochures, and patient information sheets can be produced. In this article, some of the features available to produce desk-top documents are discussed, as are other desk-top publishing programs.

Nursing↗
PubMed1997

Educating rural allied health professionals: an interdisciplinary effort.

This article describes the process and outcome of an innovative, interdisciplinary educational effort which was initiated in rural Maine. Within the context of a comprehensive, statewide interdisciplinary rural health care training project that was federally funded through the Interdisciplinary Training for Health Care for Rural Areas (ITHCRA) grant program, a primary strategy for recruiting and training rural allied health practitioners was the development and implementation of a year long interdisciplinary graduate course sequence. The results of the evaluation suggested that interdisciplinary education is not only useful in learning the roles and functions of allied health professions, but is valuable tool in promoting the development of skills necessary for competent and relevant rural allied health practice.

Allied Health Personnel↗
PubMed2003

The Federal Nursing Services Award. Enlisted women with breast cancer: balancing demands and expectations.

Diagnosis with breast cancer is not an automatic cause for discharge from the military. Therefore, it is important to know how this disease impacts enlisted women in the military. This study describes how enlisted women manage diagnosis and treatment within the context of their military careers. Grounded theory guided the study methodology. Audiotaped semistructured interviews were conducted three times over 9 months to learn how treatment impacted work demands. Data saturation was attained after 46 interviews were conducted. Participants had to balance demands and expectations among the Military Career and Military Medical Subsystems and their Social Support Subsystem. Support from the chain of command was critical in women's ability to balance demands and expectations of career, family, and illness. Military nurses are in a unique position to create strategies that will assist enlisted women in coping with breast cancer.

Activities of Daily Living↗
PubMed2002

Protecting the health of United States military forces in Afghanistan: applying lessons learned since the Gulf War.

Four weeks after the terrorist attacks on the World Trade Center and the Pentagon, US combat troops began bombing missions over Afghanistan in Operation Enduring Freedom. Additional Reserve and National Guard personnel were called to active duty to support the war effort and to ensure security throughout the United States. All of these troops will require health care and assistance during and after this war on terrorism. They will benefit from recent federal legislation that has increased access to health care and from the changes implemented by the Departments of Defense and Veterans Affairs since the Gulf War. An innovative Defense Department "Force Health Protection" strategy places greater emphasis on helping service members and families stay healthy and fit and on preventing injury and illness. The two agencies also have developed new post-deployment clinical practice guidelines, established deployment research centers, and made further improvements in preventive medicine, health surveillance, and risk communication and are thus better prepared for this newest generation of war veterans.

Afghanistan↗
PubMed1994

A competency-based training program in early intervention.

This paper describes a federally funded training program developed to prepare entry-level occupational therapists to deliver early intervention services. The program had two phases. Phase I was designed to provide occupational therapy supervisors with advanced skills for supervising and teaching the students about the provision of early intervention services. These skills were specific supervisory strategies and learning techniques designed to facilitate optimal communication between the student, the supervisor, and the academic faculty members, as well as to facilitate consistency of information between workshops and practices in the clinic. Phase II involved a 12-week clinical fieldwork experience for the students in an early intervention program combined with didactic programs at the university. Both supervisors and students provided feed-back on the program. Supervisors reported that the training strengthened their supervisory skills and techniques. Students reported that the training helped them to clarify the role of occupational therapy in early intervention and that they had developed skills critical to providing family-centered early intervention. These skills included both providing direct treatment to children and working in partnership with families and caregivers.

Adolescent↗
PubMed1999

[What expectations do medical students in the new federal state have of a psychosomatic medicine practicum?].

Including psychotherapy and psychosomatics in the medical curriculum of universities in East Germany (in accordance with current German regulations for doctor's licence to practise) offered an important opportunity to increase psychosocial competence while at the same time the legal aspects, which had differed before the German reunification, were also adjusted and equalised. Whereas the corresponding theory is presented in lectures, in a psychosomatic seminar the students should perceive and learn to handle the emotional exchange in the relation between doctor and patients. A questionnaire dealing with patient expectations at Halle university was analysed with respect to more cognitive and more affective expectations towards the seminar with particular reference to the gender of the interrogated subject and to individual wishes regarding subsequent specialist training. By means of a two-point survey we also explored the extent to which the psychosomatic seminar came up to the expectations of the students. This investigation came to the conclusion that conditions for communicating affective contents within a psychosomatic seminar are better than usually assumed.

Data Collection↗
PubMed1989

Oregon's Patrick case and Supreme Court decision.

Does the Patrick decision affect properly done peer review used to consider quality patient care? The answer is most definitely no! If guidelines are followed that abide by the HCQIA and hospital peers review bylaws, then one can be fairly certain that physician reviewers are, indeed, immune to most liability challenges (one should remember, however, that compliance with HCQIA only provides immunity from federal and state law private claims, and not actions by the U.S. Department of Justice as a State Attorney General, i.e. criminal antitrust claims). We must be aware of and revise where necessary to conform to HCQIA our own hospital medical staff bylaws and policies as well as state procedural and reporting policies. We have learned that anticompetitive acts in the business of medicine are dealt with under the law no differently than anticompetitive acts in any other business. We must be aware of antitrust laws and remember as an extension of Patrick that medical groups dealing with alternative health delivery systems and joint ventures must consider any anticompetitive aspects of proposed contracts. Failure to do so could put us in jail.

Humans↗
PubMedDate not supplied

Medicaid: lessons from a decade.

Drawing on a decade of analysis and examination of the Medicaid program, this paper assesses what we have learned about Medicaid--its role, its successes, and its setbacks. In the absence of universal coverage for health and long-term care, Medicaid is a critical component of our social safety net, taking on the highest-risk, sickest, and often most expensive populations from private insurance and Medicare. Yet the substantial costs to federal and state governments incurred in filling this role, especially in lean economic times, remain its greatest challenge.

Foundations↗
PubMed2001

Back to sleep: good advice for parents but not for hospitals?

BACKGROUND: In October 1998, when we surveyed nurses working in Iowa obstetric units about infant sleeping position in the hospital and recommendations for infant sleeping position at home, we learned that the side position was used frequently in the hospital and also was considered to be an acceptable alternative for sleeping position at home. OBJECTIVE: The purpose of our present study was to determine why nurses continued to use and endorse the side sleeping position rather than the supine position. DESIGN: We surveyed all Iowa hospitals that had an obstetric service as of July 1999 to learn why the side position was used. RESULTS: All 94 hospitals with obstetric services responded to the survey and revealed that 2 major factors were considered when an infant was put to sleep on his/her side. The most frequent response was fear of aspiration (57 responses or 51.4%) and the second was adherence to a federal brochure that lists side sleeping as a reasonable alternative (38 responses or 34.2%). CONCLUSION: We conclude that the reasons reported for use of the side position in Iowa maternity hospitals do not justify its continuing use. We believe that information about the importance of placing an infant on his/her back to sleep and its superiority over placing an infant on his/her side to sleep is sufficient to warrant its availability in every maternity hospital. We speculate that if the infant sleeping position used in the hospital is not different from that taught to parents, there will be less parental confusion and greater adherence to infant positioning shown to reduce sudden infant death syndrome.

Attitude of Health Personnel↗
PubMed2006

An analysis of respondent driven sampling with Injection Drug Users (IDU) in Albania and the Russian Federation.

Injection drug users in Tirana, Albania and St. Petersburg, Russia were recruited into a study assessing HIV-related behaviors and HIV serostatus using Respondent Driven Sampling (RDS), a peer-driven recruitment sampling strategy that results in a probability sample. (Salganik M, Heckathorn DD. Sampling and estimation in hidden populations using respondent-driven sampling. Sociol Method. 2004;34:193-239). This paper presents a comparison of RDS implementation, findings on network and recruitment characteristics, and lessons learned. Initiated with 13 to 15 seeds, approximately 200 IDUs were recruited within 8 weeks. Information resulting from RDS indicates that social network patterns from the two studies differ greatly. Female IDUs in Tirana had smaller network sizes than male IDUs, unlike in St. Petersburg where female IDUs had larger network sizes than male IDUs. Recruitment patterns in each country also differed by demographic categories. Recruitment analyses indicate that IDUs form socially distinct groups by sex in Tirana, whereas there was a greater degree of gender mixing patterns in St. Petersburg. RDS proved to be an effective means of surveying these hard-to-reach populations.

Adolescent↗
PubMed2006

Incorporating problem-based learning exercises into an environmental health curriculum.

Environmental health professionals are often confronted with difficult conflicts involving multiple stakeholders. A problem-based-learning approach was used to engage students in a mock conflict resolution exercise involving the heavily publicized dispute over industrial contamination of an aquifer supplying drinking water to neighborhoods in Woburn, Massachusetts. This dispute provided the basis for the bestselling novel A Civil Action, by Jonathan Harr, as well as a major motion picture bearing the same name. Students were assigned to one of three stakeholder groups: the affected families, an industry consortium, or state and federal regulatory authorities. These stakeholder groups were then directed to participate in alternative-dispute-resolution mock negotiations, with the course instructor serving as a neutral facilitator. The "problem" the students were assigned was to reach a consent agreement that was acceptable to all three stakeholder groups. Two groups of undergraduate students (from different semesters) successfully completed all five phases of this endeavor, with nearly unanimous agreement that the approach was more rapid and potentially less expensive than the civil-litigation process portrayed in the book and movie. The alternative-dispute-resolution approach also provided a less adversarial environment, thereby allowing the industry and community groups to work together to forge a more creative, long-term agreement than that which resulted from the actual civil litigation.

Curriculum↗
PubMed1997

Creative inservices to meet mandatory education requirements.

To meet the mandates of federal and accreditation bodies, home care organizations must be prepared to conduct required education. There is a need to be creative and heighten the interest of the staff while doing more with shrinking education dollars. This article presents one agency's approach to the annual mandatory inservice program that allows the staff to have fun while learning.

Community Health Nursing↗