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PubMed2005

Renal and iliac artery stenting by interventional cardiologists and vascular surgeons: the Foundation to Advance Medical Education (FAME) initiative.

The American College of Cardiology, in concert with the Society for Coronary Angiography and Interventions and the Society for Vascular Surgery, planned and implemented an initiative to teach stenting of renal and iliac arteries to their peers in practice. Supported by the Foundation to advance medical Education (FAME), the initiative involved 25 preceptees and 6 preceptors and included a didactic portion (a remote learning exercise), an animal practicum, a procedural simulation, and a preceptor/preceptee training segment, all of which was followed by evaluations by the participants. Assessments of the success of the initiative differed between preceptees, who were positive about the experience, and preceptors, who were more critical of the endeavor (with surgeons more critical than cardiologists). Technical problems, such as obtaining temporary licensure to practice medicine in another state, interfered with the hands-on experiences of several preceptees. Programs such as the FAME initiative will grow in importance as new technologies continue to be introduced into medical practice and the need to train physicians in practice in their use expands.

Animals↗
PubMed2026

Foundation model reveals the shared organization of transcription and topologically associating domains.

The three-dimensional organization of chromatin into topologically associating domains (TADs) may impact gene regulation by bringing distant genes into contact. However, studies of TADs' function and their influence on transcription have been constrained by ambiguities in TAD boundary definitions and challenges in directly measuring their regulatory effects. We overcome these limitations by developing species-level consensus TAD maps for human and mouse by using a bag-of-genes approach that exposes an emergent regulatory structure. To quantify TAD-mediated relationships, we use a foundation model trained on 33 million transcriptomes to define a contextual similarity metric that captures higher-order relationships missed by co-expression. We find that TADs are regions of elevated co-regulation, with our framework yielding testable hypotheses about chromatin organization across cellular states. This TAD-linked enhancement is strongest during early development and declines with aging, while cancer cells show distinct TAD usage that shifts with chemotherapy. Together, these findings suggest that chromatin organization acts through probabilistic rather than deterministic mechanisms.

Humans↗
PubMed2005

Federal, state, and foundation initiatives around evidence-based practices for child and adolescent mental health.

This article is a survey of many of the initiatives developed by federal and state agencies and foundations focusing on evidence-based mental health practices for children and adolescents. The article intends to show the tremendous interest in the development, dissemination, and implementation of evidence-based practice in child and adolescent mental health that is held by a wide variety of agencies and organizations. Several "next steps" for the field are suggested that might be developed in a subsequent series of initiatives. These steps include a better understanding of dissemination and implementation processes, increased clarity around definitions and terms, increased efforts to build infrastructure and support policy change, and the potential for an aggregation of data already gathered on the implementation of evidence-based practices.

Adolescent↗
PubMed2006

Lions Clubs International Foundation Core Four Photoscreening: results from 17 programs and 400,000 preschool children.

INTRODUCTION: Photoscreening programs for preschool vision screening have been promoted by Lions Clubs International Foundation (LCIF) via their 17 Core Four grant project awards since 1999. Results from 15 Core Four grant programs in the United States and one in Taiwan are presented here. METHODS: Photoscreening was modeled after the Tennessee program and instituted statewide in each area. Programs were given latitude with respect to screening instrument and referral criteria, but a partnering academic institution and medical director were expected. Preschool children were screened by volunteers; referred children were examined by community optometrists and ophthalmologists who returned results to each program's coordinating center. Outcome data included number of children screened, referral rate, follow-up rate, and positive predictive value, which was generally determined using AAPOS-defined vision screening criteria. RESULTS: All but one program used the MTI photoscreener (it chose not to participate); photoscreening referral criteria were standard for 13 programs. Through December 2004, more than 400,000 preschool children had been screened. The referral rate for programs using the MTI photoscreener averaged 5.2% (range, 3.7-12.6%). The predictive value of a positive photoscreen was 80%. Overall, 54% of referred children received follow-up examinations. Follow-up rate was the largest variable: 4 programs, screening nearly 250,000 children, had follow-up rates 70% or greater; 10 programs had follow-up data from fewer than 40% of referred children. CONCLUSIONS: Volunteer-led photoscreening programs can be instituted in other locations, including overseas, with high levels of effectiveness. Limitations include the possibility of poor success and variable attention to follow-up.

Amblyopia↗
PubMed2005

ACCF/ASNC appropriateness criteria for single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI): a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group and the American Society of Nuclear Cardiology endorsed by the American Heart Association.

Under the auspices of the American College of Cardiology Foundation (ACCF) and the American Society of Nuclear Cardiology (ASNC), an appropriateness review was conducted for radionuclide cardiovascular imaging (RNI), specifically gated single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI). The review assessed the risks and benefits of the imaging test for several indications or clinical scenarios and scored them based on a scale of 1 to 9, where the upper range (7 to 9) implies that the test is generally acceptable and is a reasonable approach, and the lower range (1 to 3) implies that the test is generally not acceptable and is not a reasonable approach. The mid range (4 to 6) implies that the test may be generally acceptable and may be a reasonable approach for the indication. The indications for this review were primarily drawn from existing clinical practice guidelines and modified based on discussion by the ACCF Appropriateness Criteria Working Group and the Technical Panel members who rated the indications. The method for this review was based on the RAND/UCLA approach for evaluating appropriateness, which blends scientific evidence and practice experience. A modified Delphi technique was used to obtain first- and second-round ratings of 52 clinical indications. The ratings were done by a Technical Panel with diverse membership, including nuclear cardiologists, referring physicians (including an echocardiographer), health services researchers, and a payer (chief medical officer). These results are expected to have a significant impact on physician decision making and performance, reimbursement policy, and future research directions. Periodic assessment and updating of criteria will be undertaken as needed.

Coronary Circulation↗
PubMed2005

Multivariate analysis of the influence of donor and recipient cytomegalovirus sero-pairing on outcomes in simultaneous kidney-pancreas transplantation: the South-Eastern Organ Procurement Foundation Experience.

The purpose of this study was to determine if donor (D) and recipient (R) CMV sero-pairing at the time of simultaneous kidney-pancreas transplantation (SKPT) subsequently influenced outcomes in a large cohort of patients with long-term follow-up. Between January 1, 1997 and December 31, 1999 complete data were available on 723 primary SKPTs performed at South-Eastern Organ Procurement Foundation member institutions. For purposes of this study, four groups were defined: D+/R-, n = 203 (28%); D+/R+, n = 206 (28%); D-/R+, n = 156 (22%); and D-/R-, n = 158 (22%). Patient and graft survival rates for the study groups were computed by Kaplan-Meier estimates and tests of equality of survival curves were performed utilizing both the log-rank and Wilcoxon test statistics. A multivariate analysis was performed using a Cox proportional hazards model and logistic regression. A total of 56% of Ds were CMV+ and 50% of Rs were CMV-. D serostatus was not, but R serostatus was, a significant independent risk factor for patient and kidney, but not pancreas, graft survival rates in the uncensored analysis. When examining the CMV D/R groups in both univariate and multivariate fashion, CMV sero-pairing was not an independent risk factor for death, graft loss, or rejection. However, when considering CMV sero-pairing as a binary variable (D-/R- versus all other D/R groups), 6-year patient, kidney, and pancreas graft survival rates were significantly higher in the D-/R- group (P < .05). In conclusion, CMV seronegativity is present in half of diabetic patients at the time of SKPT, and protective CMV seronegative matching confers a long-term survival advantage.

Cohort Studies↗
PubMed2005

AORN Foundation shares results of scholarship recipient survey.

SINCE 1992, the AORN Foundation has been awarding scholarships to provide AORN members with funding to attain their education goals. THE SCHOLARSHIP PROGRAM addresses the daunting challenges facing perioperative nurses, including the perioperative nursing shortage, the aging perioperative workforce, lack of tuition funding from hospitals, and the need for perioperative nurses with a bachelor's or higher degree. IN THE SPRING OF 2004, the AORN Scholarship Committee surveyed scholarship recipients to assess the program's effectiveness in meeting these challenges. THIS ARTICLE provides information about the scholarship program, summarizes the survey results, and discusses the effectiveness of the scholarship program.

Career Mobility↗
PubMed2004

Profile of successful AORN Foundation Scholarship applicant.

Each year, the AORN Scholarship Committee selects recipients of AORN Foundation scholarships to support educational advancement. Competition for scholarships increases as more AORN members return to school. Successful applicants are attentive to detail in following application guidelines, clearly articulate their appeal for a scholarship, include documentation of academic records and the school or program accreditation status, and convey their passion for caring through service to the community and to others.

Accreditation↗
PubMed1999

Pushing the frontiers of science--the WHO/Rockefeller Foundation Initiative on implantation.

One approach to fertility regulation for which there is still a large unmet need is a once-a-month method that can be taken at the end of the luteal phase as a menses-inducer. Such a method would have a number of logistical and economic advantages for many women over other currently available methods. However, to be acceptable, menses-inducers of this type must not produce disturbances in subsequent menstrual cycles that would lead to unpredictable menstrual patterns or advance or delay subsequent ovulations. A number of structural and functional factors associated with the cyclical development and demise of the endometrium and corpus luteum in fertile and infertile women have been identified and the opportunity is now presented for interfering with implantation by disrupting the function of these factors at the local level in these tissues without systemic involvement or prolonged activity. The Rockefeller Foundation and WHO are supporting six centers and investigators around the world, as an international collaborative research initiative, to investigate the molecular biology of these factors and the effect on fertility of their manipulation. It is intended that promising leads identified and selected in this way will be developed into new products with industry.

Cooperative Behavior↗
PubMed2000

A conversation with the leaders of the Gates Foundation's Global Health Program: Gordon Perkin and William Foege.

Over the past 3 years, the Bill & Melinda Gates Foundation has committed more than $1.7 billion to help prevent and eradicate diseases that afflict people living in the world's poorest nations. The gifts have revitalized a number of major global health initiatives that in recent years had lost momentum and helped to refocus the world's attention on the health crises facing many developing nations.

Communicable Disease Control↗
PubMedDate not supplied

The MacArthur Foundation Depression Education Program for Primary Care Physicians: background and rationale.

In order to improve the assessment and management of depression in general medical care, the John D. and Catherine T. MacArthur Foundation supported the development, evaluation, and dissemination of an eight-hour depression education program (DEP) for primary care physicians. This publication includes a paper describing the background and educational rationale for the program structure, the complete participant's workbook, and a facilitator's guide for teaching the program. Given in two separate four-hour workshops by a psychiatrist and a primary care physician, DEP is delivered to small groups of learners (about 12) using an interactive adult learning model and multiple teaching techniques including targeted yet flexible objectives, two lectures, videotape demonstration and discussion, role-play exercises, a focused monograph on depression, an interview checklist, structured assessment and outcomes tools, clinical case studies, and audiotape review of actual patient interviews. DEP has been shown in a prospective randomized trial to improve physicians' interview-ing skills as well as simulated-patient satisfaction scores. Over 150 PCPs in four states have taken DEP in more than 30 separate programs given by 24 trained facilitators. Participants, despite a wide diversity of background knowledge and skills, have uniformly reported remarkably positive learner satisfaction with all dimensions of the Program.

Depression↗
PubMed2003

National Kidney Foundation Council on Renal Nutrition survey: past-present clinical practices and future strategic planning.

Early nutritional intervention is thought to play a major role in the preservation of renal function and the overall wellbeing in the renal patient. In preparation for renal replacement therapy (RRT), a consultation with the renal nutritionist to establish a diet consistent with the existing diagnosis may increase the likelihood of reducing cardiovascular risk factors, preventing malnutrition and anemia, and slowing the progression of renal disease, all of which can contribute to positive patient outcomes. In a 1999 United States Renal Data System survey of 3,468 new dialysis patients, 46% indicated that they had not consulted with a dietitian before the initiation of dialysis. To help with establishing education programs, determine staffing guidelines, and planning future endeavors, the National Kidney Foundation Council on Renal Nutrition conducted a survey of their 1,748 members. The survey was designed to assess the current demographic profile and clinical practice elements of practicing renal dietitians. Surveys were distributed as a section of the 1999-2000 winter issue of the CRN Quarterly Newsletter, with 353 of the members responding. Information collected pertained to patient care settings, number of facilities covered, patient age, patient treatment modalities, dietitian contact hours required to effectively educate pre-end-stage renal disease patients on a low-protein diet and to ensure optimal nutrition status for the chronic kidney disease patients. The dietitians of this cohort had practiced dietetics for 14.5 +/- 8.6 years and renal nutrition for 9.15 +/- 6.9 years. The survey data showed a discrepancy between what the clinical practices were in 1999 and what the current recommendations are, based on the Kidney Disease Outcomes Quality Initiatives (K/DOQI) Clinical Practice Guidelines.

Adolescent↗
PubMed1998

Physician partnering in Maine: an update from the Maine Medical Assessment Foundation.

BACKGROUND: The Maine Medical Assessment Foundation (MMAF) has involved the participation of hundreds of physicians in study groups to analyze data on small-area variation and assess physician decision-making patterns. In 1991 the MMAF model was replicated across a tri-state area (Maine, New Hampshire, and Vermont) in an effort called the Outcomes Dissemination Project. THE OUTCOMES DISSEMINATION PROJECT: Five specialty study groups, each meeting three times a year, examined local and national utilization data and guidelines and research findings, participated in outcomes studies and patient education, and disseminated their findings through society presentations and other feedback efforts. Physician surveys indicated that all but one of the study groups were successful in making their existence and activities known to the broader medical community. PARTNERING WITH PURCHASERS AND MEDICAID: In the "Partnership Projects," the MMAF and relevant study groups, collaborating with a Maine business coalition, analyzed variations in utilization across employers, types of health plans (for example, health maintenance organization, preferred provider organization, fee-for-service), and small areas. Through this process, coalition members learned about small-area analysis and the implications of variations in utilization for cost and quality. The first year of the collaborative projects focused on several issues, including the development and dissemination of a practice guideline for the care of patients with chest pain; the dissemination of a practice guideline for the treatment of patients with acute low back pain; and a project designed to address cesarean section rates. SUMMARY: Innovative partnerships have been crafted to allow the tenets of the MMAF's working relationships with the medical community to remain intact, ensuring the ongoing interest and cooperation of hundreds of Maine physicians.

Community Networks↗
PubMed1999

An overview of the National Kidney Foundation-Dialysis Outcomes Quality Initiative Implementation.

Rigorously developed clinical practice guidelines have the potential to improve outcomes and favorably alter practice patterns. Because of widespread community concerns over the quality of dialysis care, the National Kidney Foundation initiated a Dialysis Outcomes Quality Initiative (NKF-DOQI) in March 1995 in an effort to create evidence-based best-practice clinical guidelines. Independent interdisciplinary Work Groups reviewed the available body of scientific literature on four selected topics: hemodialysis adequacy, peritoneal dialysis adequacy, vascular access, and anemia. More than 11,000 publications were identified, of which 1,500 were considered relevant and were subjected to structured review. Draft guidelines, with supporting rationales of their evidentiary basis, were subjected to a three-stage public and organizational review process. The final guidelines were issued in the fall of 1997. Because the potential benefit of guidelines depends on their implementation, planning for the implementation of NKF-DOQI was begun simultaneously with its review process. A 3-year implementation plan, with specific priorities and estimated costs, was developed and set into action by the end of 1997. The main objectives of the rather diverse and multifaceted plan of action are translating the NKF-DOQI Guidelines into clinical practice, building on what has been accomplished, and continued evaluation and review of the Guidelines.

Evidence-Based Medicine↗
PubMed1999

Forum of the End-Stage Renal Disease Networks' role in implementing the National Kidney Foundation-Dialysis Outcomes Quality Initiative Clinical Practice Guidelines.

The development and release of the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Clinical Practice Guidelines marks an important step in the on-going process of improving the renal dialysis patient's outcomes. The Forum of End-Stage Renal Disease (ESRD) Networks' role in this process should be considered within the context of its mission and the ESRD Networks' Congressional mandate. In addition, facilitating the implementation of the NKF-DOQI Guidelines is one component of the Forum's current quality-related agenda. Environmental trends and current research indicate a variety of factors critical to the successful implementation of the NKF-DOQI Guidelines. The Forum's plan encompasses each of the following key elements: defining and evaluating the Guidelines and clinical performance measures (CPMs); prioritizing and locally disseminating NKF-DOQI Guidelines; converting NKF-DOQI Guidelines into CPMs; expanding the information infrastructure; and conducting quality activities and engaging local physicians. Keeping in mind the broader national agenda for quality improvement in the renal community, including continuing medical education programs focused on quality measurement and improvement tools and techniques, developing decision support tools and increasing on-line access to evidence-based reports and literature is important as well. Carrying out the Forum's plan for implementing the NKF-DOQI Guidelines, in collaboration with national nephrology professional and patient organizations, will facilitate Guideline adoption and use across the renal community.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1999

The role of the health care team in the implementation of the National Kidney Foundation-Dialysis Outcomes Quality Initiative: a case study.

The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) provides an opportunity to review multidisciplinary practice in end-stage renal disease settings across the country. The role of the nephrology nurse, nephrology technician, renal dietitian, and nephrology social worker are reviewed through a case presentation referencing NKF-DOQI Guidelines. Each discipline provides an overview of its respective assessments and interventions focused on improving the patient's outcome.

Foundations↗
PubMed1999

The role of providers in implementation of the National Kidney Foundation-Dialysis Outcomes Quality Initiative: Fresenius Medical Care North America perspective.

This is a brief review of the history of utilization of quality indicators by a major dialysis provider and how those indicators have been modified in response to the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI). Fresenius Medical Care North America (FMCNA) has monitored adequacy of dialysis, anemia management, and nutrition therapy for a number of years, using a self-directed continuous quality improvement program. FMCNA supports the NKF-DOQI Guidelines and has used the DOQI as it continues to enhance its patient quality care program. Specific goals and action thresholds of that program are delineated.

Foundations↗
PubMed1984

The Twins Foundation: twins take up the challenge.

Revelations about twins are abundant, but the information often is inaccessible. Therefore, The Twins Foundation, a multifaceted, international, nonprofit agency has been formed. Through development of a Research Library, Museum and Hall of Fame, it will provide archival and research support to the growing number of disciplines involved in twin studies; provide a central respository and clearing house of information about twins for the general public; enlist twin achievers to act as role models for adolescent twins; and collect information about the contributions twins have made to their societies in order to dispel still prevalent negative stereotypes about multiples.

Female↗