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PubMed1989

The road to reorganization. A system keeps its regional network all in the family.

One prominent strategy health-care institutions are pursuing today is the formation of regional networks providing comprehensive continuums of care. Regional activities can be organized according to several distinct geographical parameters: city, county, state, or multistate regions. Although the different types of regionalization may be beneficial, they will generate different types of activities and benefits. Another consideration is that regional structures can range from very loose affiliations to complete ownership. In 1987 the Sisters of Providence health system, Seattle, initiated efforts to create a functionally integrated regional healthcare system in the Portland, OR, market, which had a good framework in place for developing a vertically and horizontally linked comprehensive continuum of care. The Oregon Management Committee, composed of local administrators, was established to identify issues and develop common objectives. The group developed a regional strategic plan and identified eight key areas to begin regionally coordinated activities. It began creating working relationships among institutional counterparts and program integration in several outpatient service areas where duplication was evident. Another effort involved greater coordination of marketing activities.

Catholicism↗
PubMed2006

The new training paradigms and the unfilled match positions of 2004: will history repeat itself?

OBJECTIVE: The new millennium has seen an increase in vascular residency vacancies. The American Board of Vascular Surgery recently proposed new training paradigms, but their impact on recruitment remains unknown. We surveyed vascular fellows regarding factors and timing of career decisions to determine an optimal strategy for recruitment. METHODS: Surveys were sent electronically to vascular residents for completion. Data were analyzed using SPSS software. Additional data were obtained from the National Resident Matching Program. RESULTS: Of the 90 fellows that responded, 84% committed to vascular surgery during residency. Of these, 18% decided during postgraduate year 1, 54% by year 2, 84% by year three, and 95% by year 4. Sixteen percent of all trainees decided in medical school. Seventy-three percent of residents performed a minimum of 20 to 50 cases before reaching a decision. Among the group deciding between years 2 to 4 of residency, there was a significant difference in the number of vascular rotations before career commitment (P = .0001). In the 2004 Match, 21% of vascular residency positions were unfilled, up from 12% in 2003, 9% in 2002, and 4% in 2001. CONCLUSIONS: Leaders in the field of vascular surgery have proposed focused training through the new paradigms. The incline in unmatched vascular residency positions over the past 4 years highlights the importance of a strategic plan to optimize recruitment. Few current trainees decided early in training about career choice, and volume appears critical to the decision process. Utilizing the current matching system (an 18-month process) and without any proactive change in recruitment, an integrated program after medical school would be reasonable for only 16% of applicants, or the 3+3 option for 54% of residents. For the new paradigms to be successful and to prevent more unfilled positions, increased medical student integration into vascular rotations and early active exposure to endovascular and open procedures during general surgical training will be necessary across the country.

Adult↗
PubMed1990

Integrating children with severe disabilities for intensified outdoor education: focus on feasibility.

The feasibility of an intensified (i.e., all-day-for-2-weeks) integrated camping experience for children with and without severe disabilities was evaluated as was the impact of integrated programming on camp staff members' attitudes. Procedures employed for promoting social interactions included positive reinforcement and cooperative learning strategies. Task-analytic procedures were used to teach campers with severe disabilities a domestic skill and a life-long leisure activity. By the end of the 2 weeks, children with severe disabilities demonstrated substantially improved skills in targeted activities. Furthermore, campers without disabilities substantially increased their prosocial interaction bids, and ratings reflective of friendship increased significantly. Also, staff members' perceptions of operating an integrated camp versus a segregated one and their perceptions of the presence of participants with disabilities as facilitative of camp operations improved significantly.

Adolescent↗
PubMed2003

[Malaria research for developing countries: the PAL+ program].

Despite extensive national and international intervention, little progress has been made in controlling, malaria and other communicable diseases afflicting many developing countries in the world. In response to the need to pursue and enhance investigation, the French Ministry of Research launched the PAL+ program in 1999 with the purpose of promoting concerted "research on malaria and other communicable diseases afflicting developing countries". The program is focused on developing methods of prevention and treatment for countries in Sub-Saharan Africa, Southeast Asia, and Latin America. Advancement of these scientific goals is further by a determined efforts (i) to provide means for national coordination and scientific organization of malaria research in France and (ii) to revive the spirit and mechanisms that characterized previous operations of cooperation between France and countries in the southern hemisphere. This new vision of cooperation is based on two organizational approaches. The first involves integrated programs in which training and transfer of knowledge are essential. The second involves joint projects in which networks maintained by a continuous exchange in operational seminars contribute to establishing a permanent dialogue between the North and South. Priority research areas have been encouraged to respond to specific public health issues with emphasis on establishing a balance between work in the field and development of knowledge. The priority areas include (i) responding to the increasing incidence of drug resistance by identifying of new antimalarial drugs and defining new therapeutic strategies; (ii) understanding the implications of the pathophysiology and physiopathology mechanisms underlying severe malaria manifestations for development of a malaria vaccine; (iii) finding new opportunities for prevention of malaria based on more effective vector control; (iv) using social anthropology to factor population behaviour and habits into the design of effective malaria control measures. The PAL+ program was founded on a commitment to provide participating countries with the means necessary to improve their research capability and to coordinate and structure scientific research by creating enduring partnerships between investigators in France and southern hemisphere countries. For this purpose the PAL+ workshop program involving regular encounters between northern and southern hemisphere researchers has been set up to encourage discussion, interaction, and multidisciplinary projects. The exceptionally instructive impact of these workshops has proven to be an essential element in the overall PAL+ program that has greatly stimulated malaria research. This program has been successful in creating a new spirit of intervention and has provided a rarely equalled vehicle for collaboration. By bringing the whole research community together over the major research programs now under way in the North/South networks, the PAL+ program represents a new and decisive step in achieving the long-sought goal of meaningful scientific cooperation between northern and southern hemisphere countries in the domain of public health.

Antimalarials↗
PubMedDate not supplied

2.5 years follow-up of weight and Body Mass Index values in the Weight Control for Life! program: a descriptive analysis.

This descriptive study monitored weight, Body Mass Index, and percent excess weight changes in 60 clients, (44 women, 16 men) at about 1 year and 2.5 years following participation in the Weight Control for Life! program. The program integrates the habit reversal treatment model with contingency management and operant reinforcement principles; nutrition education; physical activity; stress management; cognitive-restructuring; relapse prevention; social support; intensive, on-going maintenance; self-monitoring; and the use of a medically supervised very-low-calorie diet or low-calorie-diet. Clients' pretreatment and posttreatment weights averaged 104.28 kg (229.42 lb) and 79.89 kg (175.76 lb), respectively, representing a 68% reduction in excess body weight at the end of the weight loss phase of the program. Mean weight loss at about 1 year and 2.5 years post weight loss was 19.28 kg (42.42 lb) and 13.09 kg (28.80 lb), indicating subjects maintained 75% and 52% of their weight losses at these two time periods. Men lost more weight and maintained better losses than women. Overall, there was a 41% reduction in excess body weight at the end of 2.5 years.

Adolescent↗
PubMed2005

Viruses - seeking and destroying the tumor program.

DNA viruses have enormous utility in cancer research, both as tools for tumor target discovery as well as agents for lytic cancer therapies. This is because there is a profound functional overlap between the DNA viral and tumor cell programs. DNA viruses encode proteins that elicit growth deregulation in infected cells similar to that engendered by mutations in tumor cells. Evolution has refined viral proteins to target the critical cellular hubs that regulate growth. Thus, viral proteins are discriminating biochemical probes that can be used to identify and characterize novel tumor targets. Moreover, the overlap between the DNA viral and tumor programs can also be exploited for the development of lytic cancer therapies. Discovering whether tumor cells selectively complement the replication of viral mutants can reveal novel oncolytic viral therapies, as well as unexpected tumor properties. For example, altered RNA export was recently uncovered as a novel tumor cell property that underlies ONYX-015 replication, a promising oncolytic adenoviral therapy. A perspective is provided on how adenovirus could be systematically exploited to map the requisite role, or indeed the redundancy, of cellular pathways that act in an integrated program to elicit pathological replication. This knowledge has important applications for the rational design of the next generation of oncolytic viruses, as well as the discovery of efficacious combination cancer therapies.

Adenoviridae↗
PubMed2006

Epidemiologic trends and costs of fragmentation.

The data that were reviewed in this article documented that in health systems, which manage behavioral health disorders independently from general medical disorders, the estimated 10% to 30% of patients with behavioral health service needs can expect (1) poor access or barriers to medical or mental health care; (2) when services are available, most provided will not meet minimum standards for expected outcome change; and (3) as a consequence of (1) and (2), medical and behavioral disorders will be more persistent with increased complications, will be associated with greater disability, and will lead to higher total health care and disability costs than will treatment of patients who do not have behavioral health disorders. This article proposes that these health system deficiencies will persist unless behavioral health services become an integral part of medical care (ie, integrated). By doing so, it creates a win-win situation for virtually all parties involved. Complex patients will receive coordinated general medical and behavioral health care that leads to improved outcomes. Clinicians and the hospitals that support integrated programs will be less encumbered by cross-disciplinary roadblocks as they deliver services that augment patient outcomes. Health plans (insurers) will be able to decrease administrative and claims costs because the complex patients who generate more than 80% of service use will have less complicated claims adjudication and better clinical outcomes. As a result, purchaser premiums, whether government programs, employers, or individuals, will decrease and the impact on national budgets will improve. Ongoing research will be important to assure that application of the best clinical and administrative practices are used to achieve these outcomes.

Behavioral Medicine↗
PubMed1998

Development of a hypermedia program designed to assist patients with localized prostate cancer in making treatment decisions.

The Prostate Centre, a hypermedia program integrating CD-ROM and Internet technology, was developed to help patients with localized prostate cancer access detailed and current information about available treatment options. Personal interviews with ten patients confirmed the need for more specific information examining the diagnosis and treatment of prostate cancer, as well as the suitability of computers for conveying this information. Sample screen designs effectively determined patients' visual preferences and were a useful springboard for conversation about a number of other relevant topics. Pilot testing of the resulting prototype elicited a positive response about the program from this sample audience. Patients regarded the program as useful, relevant to their needs, and navigable. Although the small sample size limited the study's generalizability, the method of involving patients in the design process successfully guided the program's development toward a greater fit with the users' needs.

CD-ROM↗
PubMed2000

Population mobility and infectious diseases: the diminishing impact of classical infectious diseases and new approaches for the 21st century.

In an increasingly globalized world, rapid population mobility and migration is reducing the differences in infectious disease epidemiology between regions of the world. The movement and relocation of populations between locations where the prevalence and incidence of infections are markedly different poses current and future challenges to those involved in clinical infectious diseases and public health program management. Historically, international attention has focused on the screening and treatment of acute infections of epidemic potential, but, as immigration significantly changes the demography of many nations, chronic infections will require increased attention. In countries with large mobile populations, the population-based burden of infections with long latency periods or significant noninfectious sequelae will make up an increasing amount of the infectious disease caseload and will require more-modern approaches than the traditional screening of arrivals. The globalization of chronic infectious disease epidemiology will require corresponding development of integrated programs to anticipate and manage these diseases in response to an increasingly mobile patient population.

Communicable Disease Control↗
PubMed2000

[Drug addicts with severe mental disorders can be helped by programs using moderate means. Good results when psychiatric, social and drug abuse services cooperate].

Dependency disorders are more common than expected in psychiatric populations. Untreated, dual diagnosis leads to severe social and psychiatric deterioration. Nine treatment resistant, homeless, drug addicts suffering from chronic psychotic disorders were selected to take part in a case management program, integrating social services with regular psychiatric treatment. All but one were greatly improved in general terms as well as regarding their ability to maintain an ordered life style. The need for institutional care decreased dramatically.

Community Mental Health Services↗
PubMed1996

Specificity of hemoglobin A1c measurement by cation exchange liquid chromatography. Evaluation of a Mono S column method.

A method was developed for evaluating the specificity of the ion exchange chromatographic HbA1c method by Pharmacia which uses a Mono S column. To investigate hemoglobin fractions potentially interfering in HbA1c analysis, the chromatographic resolution was enhanced and a peak integration program was used which enables the quantitation of overlapping and even shoulder-like peaks. Hemoglobin was incubated with glucose in vitro and the chromatograms were analyzed before and after incubation. Five minor peaks were detected, close to hemoglobin A1c, which could not be conclusively identified as hemoglobins previously described. Four of these peaks, the stable ones, were included in the fraction of the chromatogram to be measured as HbA1c by the routine method. In practice, these peaks comprise 20%-35% of the routine HbA1c result in diabetic patients and 30%-45% in non-diabetic subjects. Three of these minor peaks were non-dependent on glucose. The chromatography and the peak integration method described can also be used to study hemoglobin adducts other than glycohemoglobin.

Buffers↗
PubMed1991

Integration of AIDS program activities into national health systems.

In this paper we have defined integration as being the health unit team acceptance of responsibility for all aspects of care at the health service/community interface level. The health unit functions within a system whose elements (hospitals, laboratory, pharmacy, etc.) function in complementarity with those of the FLHS. Vertical approaches are often adopted because of weaknesses in some elements of the NHS, thereby further undermining such an NHS. The development of innovative community-based approaches in some areas and countries has resulted from this type of situation. However, isolated from the NHS, such approaches cannot be expected to be sustainable or to have long-term impact. Integration is the best choice of approach; it offers a chance to influence the course of the AIDS epidemic and the response of health systems in each country. The basic structure of the NHS and the characteristics of a FLHS are analyzed. The challenge to AIDS programs is to define more exactly objectives and activities at the operational, interface levels. Based on this analysis, planning of operations should be delegated to the district. Weakness of some elements and aspects of the NHS which are relevant to AIDS control program implementation can be overcome, not by organizing the program vertically and independently from the NHS, but rather by sharing resources to strengthen the weak elements. Integration may be more difficult in the early stages of implementation, but in the long term it offers sustainable development of AIDS prevention and control activities.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Dialysis treatment of insulin dependent diabetic patients: ten years experience.

From January 1973 to March 1983, 108 IDD patients with a mean age of 46 years were accepted to the dialysis program of the Hôpital de la Pitié. Since January 1973, 67 patients have been treated by hemodialysis. Since August 1978, 38 patients have been treated by CAPD. Three patients have been treated by intermittent peritoneal dialysis. Although diabetic patients remain at a higher risk compared to patients of the same age group, very encouraging results are observed including a 75% survival rate at three years among hemodialyzed patients less than 50 years old. Since 1978, CAPD, when home dialysis was possible, was selected as a first choice treatment. Some severe peritoneal complications still jeopardize the advantages of this method. Diabetics with ESRD, even in the older age group, should not be excluded from treatment. They should be offered within an integrated program all dialysis methods and transplantation.

Acute Kidney Injury↗
PubMed1999

Assessing the Winning Teams program of interactive satellite-based training.

This research assessed an interactive satellite-based training program integrating interactive audiovisual experiences with face-to-face interactions. Key elements were content created by experts, high-quality video segments, satellite-based interaction, off-line interactions among teams of parents and caregivers, workshops, and team building exercises. For pragmatic reasons, it was necessary to develop brief assessment instruments concurrently with training. A large set of survey items were created from draft materials and reduced empirically through piloting to those with the best psychometric properties. To avoid the appearance of traditional testing, knowledge was assessed with Likert items. Surveys measured participant satisfaction, knowledge, attitudes, and the application and articulation of concepts. Participant satisfaction was high. Participants increased positive attitudes and learned appropriate vocabulary. Training was more effective than no training or watching videotapes. The program appears to represent a viable model of training that could successfully be applied to Internet technologies.

Consumer Behavior↗
PubMed1981

Replication of viral DNA sequences integrated within the chromatin of SV40-transformed Chinese hamster lung cells.

To determine when during S phase integrated viral DNA sequences in several tsA SV40-transformed Chinese hamster cell clones replicate, we pulse-labeled cultures with BrdUrd and subsequently collected mitotic cells during sequential time intervals. Restriction endonuclease mapping indicated that each of the three SV40-transformed Chinese hamster lung cell clones contained a single viral DNA sequence at a different, but in each case unique, chromosomal site. DNA was extracted from each population of mitotic cells and then was resolved into dense, BrdUrd-containing and light, unsubstituted DNA fractions by cesium chloride gradient centrifugation. In each pair of samples obtained, we measured viral DNA sequences by solution hybridization using single-stranded SV40 32P-labeled DNA probes. Our results support the conclusions that specific genes within a mammalian DNA are programmed to replicate at particular times during S phase, and that the SV40 A gene product, large T antigen, programs integrated viral DNA sequences to replicate very early in S phase. The fractions of viral DNA replicated early in S phase appeared to correlate with each clone's content of functional large T antigen at permissive and nonpermissive culture temperatures.

Animals↗
PubMed1986

Baccalaureate nursing education at extension sites: a survey.

The use of extension sites in baccalaureate nursing education has increased significantly since 1978. This survey found that the majority of extension sites were developed for RNs although large numbers of generic students are also served. The use of extension sites ranges from delivering selected courses away from the lead campus to delivering an entire program. Extension sites may be located on other university campuses or may be found in a store front setting or other community agency. Administrative control of extension sites emanates from the lead campus. Faculty participation in faculty activities, such as school of nursing or university committees, is expected. The degree to which this is accomplished, however, may vary. In order to maintain program integrity, the curriculum must remain the same regardless of where it is implemented. One of the primary ways of doing this is to use the same syllabi, texts and, in many cases, the same exams. Faculty may be stationary at established extended sites or may travel from the lead campus to teach, carrying with them educational materials. Extension sites are a phenomenon of the here and now. They provide a way of delivering baccalaureate nursing education to students who might otherwise be denied this level of education. Extension sites may be operationally cumbersome, challenging, and costly, but they are meeting a need. With the advent of more sophisticated telecommunications and the continued demand for baccalaureate level education, the possibility exists for even greater variation and potential for this type of program.

Curriculum↗
PubMed1995

Infiltrating the curriculum: an integrative approach to history for medical students.

I believe that the purpose of history in a medical school can be related to two simple goals: first, to make students a bit skeptical about everything else they are to be taught in the other lectures--skepticism fosters humility and life-long learning; second, to make them aware that medical history is a research discipline as compelling as any of the basic and clinical sciences they are traditionally taught. In the fall of 1988, I was given an opportunity to build a "course" in history for medical students--a course with no fixed time slot, no fixed syllabus, and no fixed content. I wanted to teach history of anatomy during anatomy sessions, history of pathology during pathology, history of obstetrics during obstetrics, and so on. I hoped to end each session with a disciplinary controversy that extended into present practice. The ultimate manifestation of infiltration would be to have one question on every exam that the students would write during their medical school experience. This is the story of how my medical history teaching moved from nothing to a program integrated throughout four years of medical studies, complete with goals and objectives and two questions of every exam. The content, advantages, and problems of the approach in the Queen's University experience will be presented.

Canada↗
PubMed1987

[Program of continuous ambulatory peritoneal dialysis and renal transplantation in insulin-dependent diabetics in the terminal stage of renal insufficiency].

A program of continuous ambulatory peritoneal dialysis (CAPD)-renal transplantation was set up on less than 55 years old insulin dependent diabetics with end stage renal failure. Ten patients were included (age range: 9-45 years, mean: 35.6). All these patients had many complications: retinopathy, arteritis, ischemic heart disease, hypertension, neuropathy, cutaneous infection. One patient refused CAPD and was hemodialyzed for 8 months before grafting. Nine patients were treated for 3 to 45 months (mean: 14.8). During CAPD therapy, better control of hypertension and blood glucose levels were achieved. Five patients received a cadaver renal transplant 3 to 27 months (mean: 13.3) after starting CAPD. All these transplants are functioning 12 to 62 months after grafting (mean: 26.4). No post-operative complications can be directly related to CAPD. No vascular complications occurred during post-transplant follow-up. So, an integrated program CAPD-renal transplantation could be of value for young insulin-dependent diabetics.

Adult↗