Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Integrated Programs”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 361 records · Page 20Linked to original sources
PubMed2002

Diabetes disease management in a community-based setting.

PURPOSE: The medical cost of diabetes in the United States in 1997 was at least $98 billion. This study illustrates the behavioral change and medical-care utilization impact that occurs in a community-based setting of a diabetes disease-management program that is applied to program participants in a health insurance plan's health maintenance organization and preferred provider organization. DESIGN: A historical control comparison of diabetes-management participants. METHODOLOGY: One hundred twenty-seven identified diabetes patients are followed from baseline through 1 year. Differences in behavior are compared at program intake and at a 6-month reassessment. Differences in medical-service utilization are compared in the baseline year and the year subsequent to program enrollment. Poisson multivariate-regression models are estimated for counts of inpatient, emergency department, physician evaluation and management, and facility visits, while also controlling for potential confounders. PRINCIPAL FINDINGS: Behaviors improved between program intake and the 6-month reassessment. From patient reports, the number of participants having a hemoglobin A1c test increased by 44.9 percent (p < .001), and there was a 53.2-percent decrease in symptoms of hyperglycemia (p = .002). From medical claims after program enrollment, a drop occurred during the program year in every dimension of medical-service utilization. Regression results show that in-patient admissions decreased by 391 (p < .001) per 1,000 for each group, while controlling for age, length of membership, and the number of comorbid claims for congestive heart failure. In the analysis of costs that were pre- and post-enrollment, which included disease-management program costs, a 4.34:1 return on investment was calculated. CONCLUSION: The diabetes program provides patients with comprehensive information and counseling relative to practicing self-management of diabetes through a number of integrated program components. This study strongly suggests that the implementation of such a program is associated with positive behavioral change and, thus, with substantial reduction in medical-service utilization. In addition, the intervention resulted in a net decrease in direct medical costs.

Aged↗
PubMed2004

Integration of microbial ecology and statistics: a test to compare gene libraries.

Libraries of 16S rRNA genes provide insight into the membership of microbial communities. Statistical methods help to determine whether differences in library composition are artifacts of sampling or are due to underlying differences in the communities from which they are derived. To contribute to a growing statistical framework for comparing 16S rRNA libraries, we present a computer program, integral -LIBSHUFF, which calculates the integral form of the Cramér-von Mises statistic. This implementation builds upon the LIBSHUFF program, which uses an approximation of the statistic and makes a number of modifications that improve precision and accuracy. Once integral -LIBSHUFF calculates the P values, when pairwise comparisons are tested at the 0.05 level, the probability of falsely identifying a significant P value is 0.098 for a study with two libraries, 0.265 for three libraries, and 0.460 for four libraries. The potential negative effects of making the multiple pairwise comparisons necessitate correcting for the increased likelihood that differences between treatments are due to chance and do not reflect biological differences. Using integral -LIBSHUFF, we found that previously published 16S rRNA gene libraries constructed from Scottish and Wisconsin soils contained different bacterial lineages. We also analyzed the published libraries constructed for the zebrafish gut microflora and found statistically significant changes in the community during development of the host. These analyses illustrate the power of integral -LIBSHUFF to detect differences between communities, providing the basis for ecological inference about the association of soil productivity or host gene expression and microbial community composition.

Aeromonas↗
PubMedDate not supplied

A data-based agenda for doctoral nursing education reform.

BACKGROUND: Continuing concerns over the diverse degree names and the quality and quantity of doctoral nursing programs make it essential that nursing leadership take consensus-driven action on the basis of today's educational realities. PURPOSE: To explore the state of US doctoral nursing education to determine what leadership initiatives are needed in program definition, scope, and resources. METHOD: The researchers used a mailed survey (63.4% response rate) and Web site review (all remaining progress) to gather data on all US doctoral nursing education programs (n = 87). The survey included 12 items pertaining to each degree program and 11 institutional environmental questions. DISCUSSION: The doctor of philosophy was the most common degree title (n = 71). Degree title was not consistently associated with requirements (eg, dissertation and practica requirements) or stated degree purposes. Reports of program resources, as defined by faculty rank and research experience, indicated fiscal and educational threats to program integrity in many schools. CONCLUSIONS: Although individual schools should continue efforts to increase educational quality, consensus and action by all doctoral programs is needed. Five recommendations for immediate action are proposed.

Curriculum↗
PubMed1996

Improving patient care delivery with integrated case management.

Providers and payers in an integrated delivery system can increase the coordination and cost-effectiveness of the services they provide by developing a strong case management program. Integrated case management can provide the common thread for developing and meeting joint goals, such as reduced lengths of stay, cost-per-case reductions, decreased admission/readmission rates, and increased patient satisfaction. Providers and payers should design and integrate their case management services to allow for greater sharing of resources and integration of patient care goals and incentives.

Case Management↗
PubMed1999

[Is vocational integration in the competitive labor market a realistic goal for the chronically mentally ill?].

A wide range of sheltered jobs has been created in the second or special labour market with the aim of enabling the chronically mentally ill to participate in working life. However, having a job in the special labour market often precludes the chance of obtain-ing employment in the competitive labour market. To date, vocational integration programs enable only a small number of persons with psychiatric disabilities to attain reintegration into competitive employment. The predictors of successful vocational integration are subsequently discussed. A substantial increase in both sheltered and competitive jobs on the common labour market could be achieved for mentally ill and disabled people by adapting the "supported employment" model, as widely practised in the USA, to European labour market standards and appropriately funding its implementation. The utilisation of this model could serve to reduce the necessity of further expansion in the special labour market.

Employment↗
PubMed2002

Comparison of anthracycline-induced death of human leukemia cells: programmed cell death versus necrosis.

We investigated the mode of cell death induced by the anthracyclines, aclarubicin, doxorubicin and daunorubicin in the human leukemia cell lines, HL60 and Jurkat. The cells were incubated with drug concentrations up to 500 nM for periods between 3 and 24 hours, followed by morphological and biochemical analyses. All three substances induced DNA fragmentation, evident as DNA laddering and appearance of cells with hypodiploid DNA content, externalization of phosphatidyl serine, activation of caspases and degradation of the apoptosis-specific endonuclease inhibitor DFF45. However, concentrations and times necessary for these effects to occur were different, aclarubicin being the quickest acting drug with a lag phase of 3 h, followed by daunorubicin with 6 h and doxorubicin with 24 h. More importantly, aclarubicin induced these effects while the cell membrane was intact, whereas doxorubicin and daunorubicin led to immediate loss of membrane integrity. Programmed cell death is characterised by preservation of membrane integrity in order to allow removal of apoptotic bodies, whereas cell rupture is an early event in necrosis. We therefore suggest that, in our experimental settings, doxorubicin- and daunorubicin-induced cell death occurs by necrosis, while aclarubicin induces programmed cell death.

Aclarubicin↗
PubMed1998

Effectiveness of in-patient rehabilitation for sub-chronic and chronic low back pain by an integrative group treatment program (Swiss Multicentre Study).

In this multicentre intervention study, we compared an integrated group treatment program which combines psychological and education methods into a more active training approach, with the traditional individual approach of physiotherapy and physical procedures for sub-chronic and chronic low back pain. Our 411 patients had a 4-week inpatient treatment: 243 patients in an experimental program and 168 in a traditional program. Outcomes of 283 patients were assessed 3 months and 1 year after entry. The dropout rate was 31.1%. Both conditions demonstrated favourable initial effects on functional and psychological parameters, but the integrated approach showed better long-term results for work rehabilitation than the traditional approach. The most successful patients (n = 58) were younger and had a higher educational level in comparison to the unsuccessful subgroup (n = 71). The main conclusion is that an integrated approach promoting self control and behaviour change through educational measures achieves better long-term results than the traditional individual physiotherapy approach.

Adult↗
PubMed1998

A graduate school curriculum in clinical hypnosis.

The literature suggests a growing interest in hypnosis training. With this growing interest, there has been an increase in training opportunities for the interested clinician. However, much of that training is in the form of a single course or workshop, or a series of single workshops. Many programs only offer hypnosis courses when the appropriate faculty is interested in offering such a course. Other programs offer a minimal exposure to hypnosis, less than a minimal degree of training as suggested by ASCH. This paper describes a formal, integrated curriculum in clinical hypnosis that is offered through a psychology graduate school. An integrated program offers students and practicing professionals the opportunity to learn hypnosis in an environment that offers ongoing supervision and support of their long term development.

Curriculum↗
PubMed2003

Preparing to respond: Joint Trauma Training Center and USAF Nursing Warskills Simulation Laboratory.

Injuries related to the events of September 11, 2001, and continuing military actions associated with Operation Enduring Freedom underscore the accurate focus of the Joint Trauma Training Center and the Warskills Simulation Laboratory. These two programs ensure that nurses are prepared to respond to diverse medical situations worldwide. Outcome measures from both initiatives attest to the effectiveness of an integrated program that facilitates critical thinking skills and clinical judgment to increase the nurses' ability to provide trauma care to severely injured military personnel.

Clinical Competence↗
PubMed1978

Regionalization of poison centers--a rational role model.

The Rocky Mountain Poison Center is a model system for regionalization. Minimal cost is achieved by concentrating expensive equipment and information materials in the main center. Access to information is rapid because each subregional center has a POISINDEX and thus the capacity to provide standardized initial therapy as soon as contact is made. Full integration of professional activities from training to education is accomplished within the framework of Emergency Medical Services. Public education is uniform throughout the region so that medical interaction is consistent and the public receives maximum reinforcement. Funding is found through many sources and includes a cost-sharing program in which 18 Colorado hospitals participate. Institutions with similar regionalized programs, integrated with Emergency Medical Services and drug consultation, will provide cost effective programs well-tailored to the unique characteristics of each region.

Drug Information Services↗
PubMed1986

Integrated pharmacy nurse program of medication administration and intravenous therapy.

This is a descriptive report of a pharmacy nurse program involving medication administration and intravenous (IV) therapy programs that have been in continuous operation for over 15 years. Information is presented on organizational and personnel considerations for initiating and maintaining such a program. The benefits and obstacles encountered with this program are addressed. The primary reasons for an integrated pharmacy nurse program of medication administration and IV therapy are to better ensure quality of patient services in the medication distribution process from the inception of the physician's order until a patient receives a medication and to assign administrative responsibility for the entire medication process. The presence of a controlled environment with properly trained personnel is more likely to result in decreased medication errors. In this era of unprecedented medical malpractice judgements and high costs for extended lengths of stay associated with medication and IV therapy misadventures, low error rates are especially important.

Georgia↗
PubMedDate not supplied

Concept of the developmental education program model.

The need to assist minority students to succeed in baccalaureate nursing programs has been well documented in the literature. Described in this article is a model framework to assist schools of nursing in developing comprehensive integrated programs for student development and retention.

Education, Nursing, Baccalaureate↗
PubMed2001

Ovine scrapie. New tools for control of an old disease.

Ovine scrapie was described nearly 300 years ago and is endemic in many parts of the world. The recent emergence of a related bovine disease in the United Kingdom and Europe, with probable transmission to humans, has lent urgency to scrapie surveillance and control programs. The biology, genetics, diagnosis, and proposed routes of transmission can be understood in the context of the presumed causative agent, the prion protein. An integrated program of management and husbandry to reduce introduction and spread of the disease within a flock, diagnosis of preclinically infected sheep in both live animal and postmortem settings, and identification of breeding stock of low risk of scrapie are reviewed as the basis for scrapie eradication programs.

Animals↗
PubMed2005

Emergency medicine management of the geriatric patient: an educational program for medical students.

This article describes the experience of fourth-year medical students participating in a geriatric education program integrated into a 4-week emergency medicine student clerkship. Between July 2002 and April 2003, all students in this required clerkship participated in a geriatric educational program consisting of a small group discussion of medical and psychosocial issues of older adult emergency department (ED) patients. Students used learned skills to evaluate older adult ED patients for medical and psychosocial issues and later followed up with these patients by telephoning them at their homes or visiting them in the hospital. Students tracked their evaluations of the medical problems, functional abilities, and social supports of patients in the ED. Students also noted when their assessments resulted in the acquisition of new skills or knowledge and when their evaluation of geriatric syndromes resulted in a change of the patient care plan. Seventy-seven students evaluated 217 patients in the ED, of whom 167 (77%) received a follow-up visit or phone call. Students documented learning new skills while caring for 80 (48%) of the older adult patients. Qualitative survey responses from students indicated that students had increased understanding of the importance of assessing functional status and social supports and providing interdisciplinary care. Integrating geriatric education modules into existing emergency medicine clerkships is an effective method to expand the geriatric curriculum in medical schools and to emphasize the importance of geriatric assessment and syndromes in emergency care.

Adult↗
PubMed2002

The effect of an integrated stress management program on the psychologic and physiologic stress reactions of peptic ulcer in Korea.

The purpose of this study was to identify the effects of an integrated stress management program on symptoms of stress and ulcer healing in a sample of Koreans at a major medical center in Seoul. The study employed an experimental design with two treatment groups. One treatment group (n = 23) participated in an integrated stress management program (ISMP) that consisted of seven 1-hour sessions over a 4-week period. A second treatment group (n = 24) was only given a tape on progressive muscle relaxation (PMR). The ISMP treatment group reported significantly lower stress symptom scores than the PMR only group (t = 3.66, p < .001). The ISMP group also demonstrated greater improvement in ulcer healing than the PMR group (t = 1.95, p < .05). The integrated stress management program was more effective in decreasing self-reported stress symptoms and resulted in more significant ulcer healing than the progressive muscle relaxation treatment.

Adaptation, Psychological↗
PubMed1992

Computer quantitation of saturation impairment time as an index of oxygenation during sleep.

The measurement of oxygenation during sleep has become a standard procedure in the assessment of hypoxemia in patients with various disorders. However, an accepted method for quantitating this hypoxemia is not available. This study describes the development of computerized data acquisition and analysis programs to quantitate nocturnal hypoxemia in patients with sleep and breathing disorders. The acquisition program samples the voltage output from pulse oximeters used to measure oxyhemoglobin saturation (SpO2) and stores this on an IBM PC or compatible computer. The analysis program integrates the SpO2 over time below the patient's pretest baseline as well as the integral below 90, 80, 70, 60 and 50% saturation. We refer to each integral as Saturation Impairment Time or SIT. In order to compare these integrals between patients or between the same patient but different studies, the integral is divided by the total sleep study time. We refer to each of these integrals, corrected for sleep study time, as the SIT index. Evaluation of the SIT index in 10 consecutive patients referred for various sleep disorders revealed acquisition program detection and deletion of 48 of 57 (86%) oximeter probe artifacts (mean duration of 3 seconds for undetected artifacts). There were no significant artifacts in the analysis program calculation of the SIT index in these same patients. In conclusion, computer programs were developed to measure and quantitate oxygen saturation measured by oximeters. Preliminary results reveal an accuracy of measurement which should prove acceptable in further clinical evaluations.

Diagnosis, Computer-Assisted↗
PubMed1998

Care management the right balance of care and management?

In 1990, nursing leadership at St. Peter's Medical Center, realizing a need to be creative in order to meet the cost and quality demands of the ever-changing health care system, developed a case management system model called Care Management. The qualifications for the role and the orientation of the Care Managers is describes changes in the program. Innovative programs integrated into the model include patient pathways, workers' compensation care management, and ambulatory care management. Outcomes described include length stay and cost reductions. Future direction of the program in the continuum of care is reviewed.

Academic Medical Centers↗
PubMedDate not supplied

Program accreditation and correctional treatment.

In the correctional field, treatment program accreditation requires the support of correctional administrators and program providers for successful introduction. How accreditation criteria are developed and a support structure for the process in corrections is achieved is in itself an interesting story. Her Majesty's Prison Service has, in 3.5 years, accelerated the effectiveness of correctional treatment programming, established a platform for program integrity, obtained acceptance by the institutional leadership, and increased pride and morale among prison officers. In this article we describe the development, structure, content, and benefits of correctional treatment program accreditation as it has occurred in England and Wales.

Accreditation↗