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PubMed1997

Telemedicine in support of peacekeeping operations overseas: an audit.

BACKGROUND AND OBJECTIVE: Since 1993, the Department of Defense has augmented the medical support for Army units on peacekeeping operations in Macedonia through the medium of telemedicine. This project, known as Operation Primetime 1, was the first satellite-based telemedicine system deployed in support of remote primary-care physician in the U.S. military. Its declared aims are: (1) to improve the standard of care; (2) to reduce evacuations; (3) to support junior physicians in the field; and (4) to improve the military effectiveness of the deployed units. This paper audits the success in attaining those goals for the period January 1994 to April 1995. METHODS: A log was collated from the referring units and questionnaires completed by both referring and consulting physicians. The referring physicians were interviewed on their return from Macedonia, and a more detailed study was undertaken of cases in which a change in outcome was noted. Follow-up interview of consultants was not possible. RESULTS: A total of 53 consults were undertaken on 47 patients. The use of telemedicine affected the decision to evacuate 13 times (13/47), with a net reduction of 9 evacuations. Management of individual cases was changed in 30 of the 47 cases in which telemedicine was used. Physician confidence and military effectiveness were also improved. The level of utilization of the system was largely dependent on a training and sustainment program. Units and General Medical Officers who were trained in the clinical use of telemedicine and the technical sustainment of the equipment used the system; those who were not, did not. Most patients (45/47) were treated satisfactorily with a single consult. Telemedicine under these circumstances seems to be cost effective. The deployed sites chose the referral centers that provided the best service. CONCLUSIONS: Telemedicine is a valuable tool capable of augmenting medical support to deployed military units. A successful deployed telemedicine project requires an integrated support package that includes adequate provision for training and equipment sustainment at both ends of the link. Experience with telemedicine in Operation Primetime indicates the potential for substantial cost savings as well as cost-effective medical care. Further application of telemedicine should be encouraged. Successful deployment of telemedicine projects may hinge on an integrated support package.

Europe↗
PubMed1989

A nontraditional supportive services program: VNA independence plus.

The Visiting Nurse Association (VNA) of Texas received a grant from the Robert Wood Johnson Foundation to develop a financially self-sustaining program of nontraditional, homebased supportive services for the elderly in March 1987. The new, fee-for-service program, VNA Independence Plus, used market research to develop a service package that would meet the needs of area elderly. Services offered include housekeeping, transportation, yard care, and handyman services.

Aged↗
PubMed2000

Failure of a brief educational program to improve interpretation of pulmonary artery occlusion pressure tracings.

OBJECTIVE: To determine whether a brief educational program can reduce variability of interpretation of pulmonary artery occlusion pressure (PAOP) tracings. DESIGN: Prospective, observational study. PARTICIPANTS: Twenty-three intensive care nurses and 18 physicians. INTERVENTIONS: Participants interpreted PAOP tracings before and 1 week after receiving a single, brief educational session and/or written materials ("in-service") designed to reduce interobserver variability of PAOP interpretation. Differences between two reference values before and after in-service (mean population and Chief of Critical Care's readings) were compared for both groups. RESULTS: There were no significant differences in the variabilities in PAOP interpretations before and after in-service in either group. CONCLUSIONS: We conclude that this specific educational program was ineffective in reducing variability of interpretation of PAOP tracings. These data suggest that more comprehensive educational tools and/or sustained programs may be required to improve performance of critical care personnel in PAOP interpretation.

Cardiology↗
PubMed2006

Programming CD8+ T cells for effective immunotherapy.

The differentiation state of CD8+ T cells has emerged as a crucial determinant of their ability to respond to tumor and infection. Signals from T-cell receptors, co-stimulatory molecules and cytokine receptors direct the differentiation process. These signals 'program' sustained and heritable gene expression patterns that govern progressive differentiation and lineage commitment. The epigenetic mechanisms by which T cells are programmed are just beginning to be elucidated. Understanding the mechanisms that control CD8+ T-cell differentiation is important in the development of novel immunotherapy strategies.

Animals↗
PubMed2006

Sustainability of public health programs: the example of tobacco treatment services in Massachusetts.

Sustaining important public or grant-funded services after initial funding is terminated is a major public health challenge. We investigated whether tobacco treatment services previously funded within a statewide tobacco control initiative could be sustained after state funding was terminated abruptly. We found that 2 key strategies-redefining the scope of services being offered and creative use of resources-were factors that determined whether some community agencies were able to sustain services at a much higher level than others after funding was discontinued. Understanding these strategies and developing them at a time when program funding is not being threatened is likely to increase program sustainability.

Community Health Centers↗
PubMed2004

Randomized controlled trial of a teacher-led asthma education program.

Our objective was to determine whether an asthma education program in schools would have 1) a direct impact on student knowledge and attitudes to asthma and quality of life of the students with asthma, 2) an indirect impact on teacher knowledge and attitudes to asthma and on school policies about asthma, and 3) a sustainable program after the resources to implement the research were withdrawn. Seventeen intervention and 15 control schools participated in a controlled trial. Baseline knowledge and attitudes were measured in year 8 students (ages 13-14 years) and their teachers together with quality of life in the students with asthma. A three-lesson package about asthma was delivered by teachers as part of the Personal Development/Health/Physical Education (PD/H/PE) curriculum. Follow-up questionnaires were administered to students and staff. Efforts to change school policies were documented. Five years after the intervention, PD/H/PE teachers were contacted to determine whether the program was still operating. Main outcome measures included asthma knowledge, attitudes, and quality of life. Questionnaires were returned by 4,161/4,475 of the year 8 students at baseline and by 3,443 at follow-up. In intervention schools, compared with control schools, students showed improved asthma knowledge (P < 0.0001), improvement in tolerance to asthma (P = 0.02), internal control (P = 0.03), and less tendency to believe in the role of chance in asthma control (P = 0.04). Students from intervention but not control schools showed significant improvements in overall quality of life (P = 0.003 vs. P = 0.82, respectively). Teachers from intervention schools showed significant increases in knowledge compared to control schools (P < 0.0001). Intervention schools were more likely to seek further health education about asthma (P < 0.01). Five years after the 35 schools involved in the development of the materials or the trial had been offered the Living With Asthma package, 25 (71%) were still teaching the program to most or all of their students. Fifty-nine of the 61 (97%) high schools in the Hunter Region now have the program. Management and distribution of the Living With Asthma program have been taken over by the Asthma Foundation of New South Wales. The package has been updated and is being offered to all high schools throughout New South Wales as part of the National Asthma-Friendly Schools Project. In conclusion, a teacher-led asthma education program in secondary school had direct and indirect beneficial outcomes and was sustained at a high level for 5 years in most schools in the Hunter Region, despite minimal ongoing maintenance and support from health workers.

Adolescent↗
PubMed2002

Sustainable business makes dollars and sense.

The last decade has marked a radical change in the business of sustainability, say environmental activists and industrialists alike. On the wane are "greenwashing" campaigns in which corporations promote dubious environmental accomplishments to draw attention away from environmentally damaging practices. On the rise are corporate investments in sustainability programs, new types of environmental markets, and public demand for green products and investments. Once an afterthought, an annoyance, or a nonentity, sustainability is now often a focal point for businesses. No longer thought of as a business cost, environmentally benign practices are now viewed as a competitive advantage as companies seek to win both stockholders and customers.

Commerce↗
PubMed2005

The SUCOZOMA program: results and challenges.

The research program Sustainable Coastal Zone Management (SUCOZOMA), which was started in 1996 by the Swedish Foundation of Strategic Environmental Research, was motivated by the recognition of increasingly severe global, regional and national coastal problems. The program approached the complex issues of coastal eutrophication, fishing practices, and overexploited coastal resources, with a concerted effort involving multidisciplinarity, stakeholder cooperation, and a focus on the problems perceived as most serious by the public and decision-makers. As the program was concluded in 2004 it had resulted in the completion or near-completion of 22 doctoral dissertations and approximately one hundred publications. More than 40 scientists were involved in the program. Göteborg University was the host university, but important research teams have also been located at Stockholm University, the Beijer Institute, and the Kristineberg Marine Research Station of the Royal Swedish Academy of Sciences, and within the National Board of Fisheries. During the program, networks of stakeholders were established and SUCOZOMA had contributed to numerous political and administrative processes relevant for integrated coastal zone management (ICZM). SUCOZOMA program results can be grouped into different categories. Many of the projects in the two phases of the program produced results which can be defined as technical or practical and available for direct implementation in, e.g. mussel cultivation, restoration and safeguarding of spawning areas, seal-safe fishing gear or sustainable fishing of underexploited species. Other results can be characterized as policy oriented, and the impact of these can only be fairly evaluated as new policies are put into effect. SUCOZOMA resulted in important new knowledge regarding coastal science and management, but also concerning the organization required to conduct an end-user oriented multidisciplinary program effectively.

Animals↗
PubMed2000

Beyond a code of ethics for bioengineers: the role of ethics in an integrated compliance program.

Developing a code of ethics for biomedical engineering professionals is a very important first step in clarifying their professional obligations and in helping to establish and maintain their professional autonomy. However, it is only that--a first step. Unless ways can be found to bring the principles contained in this code to bear on the everyday decision making of these professionals, this code will have little practical influence. One effective way to bring a code of ethics to bear on decision making is to integrate it into organizational compliance programs. Such programs often have company-specific codes of ethics attached to them, and these company-specific codes can either include the principles contained in the professional code of ethics or reference the code by title. After defining what I take to be the challenge of compliance, I consider four (4) roles that codes of ethics and ethics generally can play in helping to create and sustain programs at the organizational level that integrate ethics and compliance and thereby aim to make a practical difference in the everyday decision making of bioengineering professionals. These four roles include: framing the program, grounding the standards, achieving critical distance, and creating and sustaining an ethical organizational culture.

Biomedical Engineering↗
PubMed2026

Trends in demographic and health survey publications based on a bibliometric analysis.

BACKGROUND: The Demographic and Health Surveys (DHS) Program, launched in 1984, provides high-quality population health data that underpins a vast body of global health research. However, the scale and growth patterns of DHS-based publications remain underexplored, particularly as donor funding uncertainties threaten program sustainability. OBJECTIVE: We examine temporal trends in DHS-based research output from 1984 to 2025, quantifying growth patterns and publication delays to inform understanding of the program's global research expansion. METHODS: A systematic bibliometric review was conducted following PRISMA guidelines across PubMed, Scopus, Web of Science, Dimensions, Wiley, and CINAHL. Eligible peer-reviewed articles using DHS data between 1984 and 2025 were identified. Annual publication counts were analyzed, segmented regression identified growth inflection points, and timeliness was assessed by calculating lag between survey completion and publication. RESULTS: Over 10,000 DHS-based publications were identified. Annual output rose from isolated studies in the 1980s to several hundred annually by the 2010s. Segmentation analysis revealed two rapid growth phases: a 56-publications/year increase from 2004-2012, and a 71-publications/year increase from 2012 to 2024. Despite this growth, median lag from survey completion to publication remained approximately 5 years, with only a modest recent improvement (Kendall's &#x3c4;&#x2009;=&#x2009; -0.623, p&#x2009;<&#x2009;0.001). CONCLUSION: DHS data have fueled exponential growth in global health research over four decades, confirming their vital role in evidence generation. However, persistent publication delays highlight the need to shorten the pathway from data collection to dissemination through strengthened research capacity in low- and middle-income countries. Sustained funding is essential to maintain this critical evidence source.

Bibliometrics↗
PubMed2005

Clinical outcomes associated with changes in a chronic disease treatment program in an Australian Aboriginal community.

In late 1995, a treatment program for renal disease and hypertension was introduced into a remote Aboriginal community. Over the next 3.5 years, mean blood pressure levels were markedly reduced, renal function stabilised, and rates of both renal and non-renal deaths declined significantly. In 1999-2000, responsibility for the program was passed to the community's local Health Board, which subsequently faced deficiencies in clinical information systems and a shortfall in funding. After the handover, the intensity of the program declined, and compliance with medicines fell. Blood pressures in the treatment cohort increased, renal function deteriorated, and rates of deaths from natural causes subsequently rose. From 2002 to mid-2003, the adjusted risks of renal and non-renal deaths in the treatment cohort were three and 9.5 times the respective risks of people during the first 18 months of treatment in the systematic phase of the program. Sustained vigorous activity, both in treatment of people already identified and in community screening for treatment eligibility, is required to maintain good results in any chronic disease program. Adequate resources and well supported staff are essential, and constant evaluation is needed to follow outcomes and modify strategies as necessary.

Adult↗
PubMed1996

Planning, development, and execution of an international training program in laparoscopic surgery.

In the late 1980s, minimally invasive surgery experienced unprecedented growth. Centers appeared worldwide, providing a variety of training opportunities and laboratory experiences. Because standard surgical training varies greatly from country to country, it became apparent that this variety was even more pronounced in the area of minimally invasive and laparoscopic surgery, posing significant credentialling difficulties for professional standards committees wishing to certify surgical staff who submit unevaluable credentials from all over the world. In January 1993, the Center for Minimally Invasive Surgery at New England Medical Center and Tufts University School of Medicine was asked to plan and execute a program of education, training, and credentialling for a multispecialty surgical staff in the Eastern province of Saudi Arabia. A four-stage program was designed and developed to provide credentialling from the technician level through the instructor surgeon level. A multidisciplinary course was developed and a team placed on site for 1 month to execute the program. This program began with an 8-h didactic/video session in basic laparoscopy, covering areas common to the involved subspecialties: surgery, urology, and gynecology. This session was followed by hands-on training sessions in general surgery and urology and credentialling in gynecology. Physicians who successfully completed the examination in basic laparoscopy were later eligible for credentialling at one of three clinical specialty levels: basic clinical laparoscopy, advanced clinical laparoscopy, or instructor in clinical laparoscopy. Education and credentialling in minimally invasive surgery can be accomplished by executing a program of basic science and clinical training for physicians, technicians, and nurses that accommodates a wide range of experience of participants, from novice to master surgeon. Support from the hospital administrators and department chairs was instrumental in the program's success. Among the goals we accomplished was identification of persons in an institution who could serve as future instructors and certifiers for the hospital's self-sustaining program as well as providing a relationship in which international institutions can serve as a resource for further continuing medical education and clinical and laboratory training. This program may well serve as the model template for international credential standards of the future.

Education, Medical, Continuing↗
PubMed2004

Accountability framework for managing stakeholders of health programs.

Understanding the incentives of stakeholders and employing effective management practices with various stakeholder groups is essential for program sustainability. This paper offers a conceptual model that depicts four different types of stakeholder interests that are relevant to health service organizations. The study identified the major stakeholders of telehealth programs, compared the influence of stakeholders by organizational ownership and investigated the practices used to manage these stakeholders. Quantitative and qualitative analyses demonstrated empirical support for the stakeholder model. The paper suggests that the model can be used as a stakeholder management tool in healthcare organizations and offers an assessment of the utility of the stakeholder framework in organizational research

Health Services Administration↗
PubMedDate not supplied

Empowering potential: a theory of wellness motivation.

Data were collected from 29 individuals who were attempting to initiate and sustain programs of cardiac risk factor modification. Data were analyzed through the technique of constant comparative analysis. Empowering potential, the basic social process identified from the data, explained individual motivation to initiate and sustain cardiovascular health behavior. Empowering potential was a continuous process of individual growth and development which facilitated the emergence of new and positive health patterns. Within the process of empowering potential, individuals use a variety of strategies which guide the initiation and maintenance of health-related change. The process of empowering potential consists of three stages: appraising readiness, changing, and integrating change. Two categories occurred throughout the process of empowering potential: imaging and social support systems. These findings provide a better understanding of how motivated action is initiated and reinitiated over time.

Adult↗
PubMed2003

Prevention of cervical cancer.

Cervical screening in Australia is a successful public health initiative. Since the introduction of the National Cervical Screening Program in 1991, there has been a significant fall in incidence of and mortality from cervical cancer. Laboratory quality procedures are critical to ensuring optimal outcomes. Laboratory accreditation procedures are being reviewed in line with recent government recommendations. For a sustainable program, cost-containment issues need to be considered; screening interval, management of screen-detected abnormalities, and new technologies are the critical drivers of cost.

Accreditation↗
PubMed2005

Mobilizing communities: an overview of the Community Coalition Partnership Programs for the Prevention of Teen Pregnancy.

The Community Coalition Partnership Programs for the Prevention of Teen Pregnancy (CCPP) was a seven-year (1995-2002) demonstration program funded by the Centers for Disease Control and Prevention (CDC) Division of Reproductive Health conducted in 13 U.S cities. The purpose of the CCPP was to demonstrate whether community partners could mobilize and organize community resources in support of comprehensive, effective, and sustainable programs for the prevention of initial and subsequent pregnancies. This article provides a descriptive overview of the program origins, intentions, and efforts over its planning and implementation phases, including specific program requirements, needs and assets assessments, intervention focus, CDC support for evaluation efforts, implementation challenges, and ideas for translation and dissemination. CDC hopes that the experiences gained from this effort lead to a greater understanding of how to mobilize community coalitions as an intervention to prevent teen pregnancy and address other public health needs.

Adolescent↗
PubMed2004

The Eat Well SA project: an evaluation-based case study in building capacity for promoting healthy eating.

The term 'capacity building' is used in the health promotion literature to mean investing in communities, organizations and structures to enhance access to knowledge, skills and resources needed to conduct effective health programs. The Eat Well SA project aimed to increase consumption of healthy food by children, young people and their families in South Australia. The project evaluation demonstrated that awareness about healthy eating among stakeholders across a range of sectors, coalitions and partnerships to promote healthy eating and sustainable programs had been developed. The project achievements were analysed further using a capacity-building framework. This analysis showed that partnership development was a key strategy for success, leading to increased problem-solving capacity among key stakeholders and workers from education, child care, health, transport and food industry sectors. It was also a strategy that required concerted effort and review. New and ongoing programs were initiated and institutionalized within other sectors, notably the child care, vocational education and transport sectors. A model for planning and evaluating nutrition health promotion work is described.

Adolescent↗
PubMed2006

Gastrointestinal nematode control programs with an emphasis on cattle.

Control strategies for nematode parasites rely on knowledge of the relationships between the parasites and their hosts. Specifically, these programs are based on identifying crucial points of interaction in the environment provided by the host, including genetics and the immune response, and critical periods in the physical environment in which the eggs and larval stages must develop. When these targets are identified and the interactions understood, cost-effective sustainable programs can be developed using currently available antiparasitic compounds. Resistance to the major classes of anthelmintic compounds requires consideration of new approaches, such as immunity or genetics of the host. Additionally, the efficacy of these compounds can be expanded with combined or concomitant use. Increased study of the use of novel approaches, including fungi, elements such as copper, and plant products, has also occurred. This article explores each of these areas to allow readers to appreciate how various approaches may be developed and incorporated into an effective parasite control program.

Animals↗