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At least 649 records · Page 36Linked to original sources
PubMed1993

Changing perspectives on hospital governance.

In the light of fundamental changes in the delivery of health and social services in Canada, hospital governance must be concerned with protection and enhancement of the organization on behalf of the owner (i.e., taxpayer) as well as accountability to the community it was established to serve. Based on a review of current literature, the authors suggest that the roles and responsibilities of a hospital board entail seven major activities: establish the mission, philosophy and future directions of the institution; choose and evaluate the chief executive officer; establish the ethical principles for the organization; ensure high quality care and services; attract resources to the institution and ensure their effective use; integrate the organization with its environment; and undertake its own self-evaluation, education and development. To play these roles effectively, hospital boards will need to develop more direct links with their communities and learn to share decision making with them.

Canada↗
PubMedDate not supplied

Evaluating food stamp nutrition education: a view from the field of program evaluation.

The purpose of this paper is to review current approaches and issues in the field of program evaluation that apply to the effort of improving the evaluation of Food Stamp Nutrition Education (FSNE). As nutrition educators respond to increasing demands for accountability and measuring results, there are challenges to consider, as well as opportunities to capture. This paper includes a focus on the internal and external functions of evaluation, with attention given to evaluation's internal use and value in improving practice. A list of 10 building blocks is offered as essential for planning useful and credible evaluation of FSNE.

Community Health Services↗
PubMed2000

Consultation skills of medical students before and after changes in curriculum.

The University of Manchester Medical School has adopted problem-based learning as its main educational method, with a change of emphasis from a biomedical to a biopsychosocial approach. The training of junior medical students in clinical interviewing is intended to reinforce and develop their interpersonal skills. We measured the impact of this new curriculum by assessing two intakes of students covering the period before and after its introduction; a third intake was later added to examine the effect of further curriculum adjustments. 86 students, randomly selected, were videorecorded conducting diagnostic interviews with standardized patients 10 weeks after they had started to learn clinical interviewing. Two instruments were developed--a 23-item communication skills scale and a 13-item information-gathering scale and both showed acceptable inter-rater and test-retest reliability. Communication skills did not differ between years. The total score for information-gathering fell by 13% (95% confidence interval -20 to -6%, P < 0.001) in the first year after introduction of the new educational approach but returned to baseline the following year after further modification of the course. Although the new approach yielded no measurable improvement in the process of communication, assessment 10 weeks after the start of interview training may be too early to permit definitive conclusions. We conclude that it is possible to change to a more patient-centred emphasis in teaching medical interviewing. Some initial loss of information content was rectified by adjustment of the course. Our unfavourable early experience highlights the need to evaluate educational change.

Clinical Competence↗
PubMed2000

Minimum standards for electromyography in Canada: a statement of the Canadian Society of Clinical Neurophysiologists.

BACKGROUND: Electromyography (EMG) is a widely used diagnostic technique for disorders of the nervous system. The Canadian Society of Clinical Neurophysiologists (CSCN) promotes the education, evaluation and standards of EMG in Canada. A statement of practice standards was needed to clarify the position of the CSCN on several issues relevant to the practice of EMG. METHODS AND RESULTS: A subcommittee of the CSCN reviewed current patterns of practice and established guidelines for review by the CSCN. The guidelines developed by the subcommittee were reviewed by the CSCN and adopted as recommendations for EMG practice. The subcommittee was charged with formulation of a document for publication. CONCLUSIONS: This document deals with minimum standards for electromyographer education, laboratory operation, equipment and a variety of special circumstances relevant to the practice of EMG. The standards can be adopted by EMG laboratories to guide quality assurance.

Canada↗
PubMed2004

Practicing school psychologists' perceived role in prevention of school violence.

School psychologists have been called upon to take a leadership role in school-violence prevention, but little is known about their involvement in this issue, especially in states where school shootings have occurred. The current study surveyed 258 Michigan school psychologists about their role in prevention of school violence. Analysis suggested respondents felt prepared to address violence prevention but do not have a leadership role and are not sought for advice about prevention. The number of annual special education evaluations was significantly associated with frequency of being sought for advice on violence prevention but was not related to perceptions of leadership or preparedness. Modest relationships were noted between feeling prepared, knowledge of risk factors, and self-perceptions of a leadership role. Suggestions for research are included.

Adolescent↗
PubMed1994

Evaluation of an educational program for asthmatic children ages 4-8 and their parents.

BACKGROUND: Evaluation of a number of asthma education programs for children 8-13 has shown improved self-management behaviors and decreased use of healthcare services. However, nearly 80% of children with asthma develop symptoms by age 5. MATERIALS & METHODS: We evaluated a program (Huff and Puff: The Children's Asthma Program) that addresses the developmental learning needs of children ages 4-8. This multicenter study employed a pre- and post-test design to evaluate the impact of the Program on cognitive, behavioral, and affective learning and medical care utilization. We report here data on 128 of the 130 children who completed the program and on the 125 households on which we have nonduplicated data. RESULTS: Statistically significant changes were observed in all categories of learning in those who completed the Program. Medical care utilization (including hospitalizations, days of hospitalization, emergency room visits and sick visits to the physician for "out-of-control" asthma) demonstrated statistically significant decreases. CONCLUSION: The Program was shown to be an effective educational intervention for children 4-8 years of age and their parents in this cohort (nonrandomized, noncontrolled study of volunteers). Future research should also explore ways to utilize and adapt the program for specific populations such as inner-city children and parents and non-English speaking groups.

Asthma↗
PubMed1977

The evaluation of continuing medical education: a literature review.

The literature of continuing medical education (CME) program evaluation was reviewed and analyzed. The "State-of-the-art" of CME evaluation is depicted in a series of tables which indicate evaluation methods and results. Evaluation designs providing strong assurances of valid results were not often found. The weakness of most published evaluations limit possible conclusions about the effectiveness of CME.

Education, Medical, Continuing↗
PubMed2006

Pediatric multiple sclerosis.

BACKGROUND: It is becoming ever more recognized that multiple sclerosis (MS) occurs in children and adolescents. Although early-onset MS is a variant in the spectrum of MS phenotypes, the diagnosis and management of MS in children poses a unique set of challenges for the clinician. Moreover, it is increasingly clear that these patients require specialized care, which includes a closely monitored medication program, physical therapy, cognitive and educational evaluation and intervention, and psychosocial support both for the patient and family. REVIEW SUMMARY: The goal of this article is to familiarize the clinician with the clinical and MRI features of pediatric multiple sclerosis and to summarize what is currently known about the clinical disease course. This article highlights important entities in the differential diagnosis of pediatric MS and discusses management strategies based on current literature. CONCLUSION: Children and adolescents with MS comprise a small but important subset of MS patients who require a multidisciplinary care approach. Additional multicenter studies are required to explore the effects of disease and treatments on physical, psychosocial, educational, and developmental parameters.

Adolescent↗
PubMedDate not supplied

A survey of 'teamwork' in mental health: is it achievable in practice?

As part of an ENB educational evaluation of teamworking in mental health, a report-and-respond survey was used as one of five data collection methods. This instrument disseminated earlier findings back to the participants and invited further comments. This article discusses the usefulness of this type of survey as a data collection tool and presents the findings of the survey which was administered to service professionals, educationalist, students, users and carers involved in mental health throughout England. The findings show that when groups of professionals are working within increasingly tight financial constraints and increased workloads, multiprofessional teamworking can be scarce in reality. These tensions present issues for nurse education and training at both pre- and post-registration levels in relation to the teaching of, for and about effective teamwork.

Data Collection↗
PubMedDate not supplied

[Development and use of a questionnaire for evaluating teacher continuing education on the sex abuse topic].

The authors constructed a questionnaire to evaluate a ten-day-training curriculum for educators concerning the topic of sexual abuse of children. This questionnaire measures learning outcomes as well as behavioral change at work. It consists of three parts: a knowledge test, an attitude questionnaire and a self-report questionnaire. The contents correspond to the training goals. As part of the evaluation study the questionnaire was completed by a sample of 129 educators. The inspection of item-difficulty and reliability yielded positive results-further amelioration can be achieved by minor changes. First analyses confirm the hypothesis that the self-report questionnaire is also a valid instrument for training evaluation. The questionnaire was highly accepted by the trainees, and the costs of evaluation were relatively low. Thus the questionnaire can be recommended as an evaluation instrument for trainings with similar goals and trainees.

Adolescent↗
PubMed1992

Help! Is anyone listening? An assessment of learning needs of practicing physicians.

We used a theoretical framework of adult learning, physician learning and change, and educational evaluation to assess physician--learner needs. The study emphasized the physician's perspective and the context of expressed needs. The respondents acknowledged ineffective learning patterns and lack of ongoing self-assessment, and identified changing and specific, emerging, learning needs. New roles are suggested for CME providers. We believe our findings support the usefulness of an integrated theoretical perspective to guide needs assessment that will be cognizant of the complexity of ongoing professional learning.

Education, Medical, Continuing↗
PubMed2006

Evaluation of an educational intervention to encourage advance directive discussions between medicine residents and patients.

INTRODUCTION: Most medical schools are remiss in preparing physicians in end-of-life communication skills. As a result, many residents are uncomfortable with approaching the patient, have not developed the skills required to discuss the patients' wishes, and avoid end-of-life conversations. OBJECTIVE: To evaluate an educational intervention focused on teaching residents skills to discuss advance directives. METHODS: Medicine Residents attended a morning report consisting of both didactic training and participation in a role-play exercise. Charts of inpatients were audited ten days prior to and five days subsequent to the intervention to ascertain if there was a documented do-not-resuscitate (DNR) discussion. RESULTS: Seventy-nine records of patients assigned to eight physicians who attended the intervention and who were responsible for patients before and after the intervention were reviewed. Of the patients assigned to these residents before the intervention, 32% had a documented DNR discussion. Thirty-four (34%) of the physicians had discussions after the intervention, demonstrating only minimal improvement. CONCLUSIONS: A single intervention may be inadequate to affect physician practices related to DNR discussions. Physicians may need more interactive, experiential learning opportunities and related supervision over the course of their training in order to improve these communication skills. A chart review that only records if a DNR discussion was documented in the medical record may not be the best tool to evaluate the success of this educational intervention. Improvement in attitudes and knowledge were not able to be measured.

Adult↗
PubMed1985

Parental evaluations of a sex education course for young adolescents.

Parental evaluations of their children's participation in a school-based sex education program for young adolescents were conducted by interview using a structured questionnaire. Parents were asked questions concerning: course objectives, course content, instructional materials, expectations, perceived effectiveness, and important outcomes of the instruction. The sex education course was six weeks in length, meeting for 50 minutes daily. The program was comprehensive and did not avoid areas typically thought of as controversial. The results indicated parental support for the sex education program and the evaluation provided useful information for program revision. An examination of the findings suggest a paradox in that parents want their children to be informed about sexuality and to be able to make decisions that would avoid problems, but they are uneasy about dealing directly with sexual behavior.

Adolescent↗
PubMed1989

The content of prenatal care.

Prenatal care consists of patient education, evaluation of the pregnant woman for physical or historic factors requiring special care, careful assessment of gestational age, and determination of the success with which the mother and fetus(es) are tolerating the pregnancy. These elements of care during pregnancy are reviewed in turn. Additional, less tangible components of care may help explain the salutary effects of prenatal care on pregnancy outcome. The obstetric health care provider's expression of caring for the woman and her pregnancy adds to her existing social support and is a vital aspect of prenatal care.

Cost-Benefit Analysis↗
PubMed1995

Perinatal regionalization versus hospital competition: the Hartford example.

OBJECTIVES: The increasingly competitive health care environment may undermine effective traditional regional organizations. It is urgent to document the benefits of perinatal regionalization for the emerging health care system. We present a case study that illustrates many of the challenges to and benefits of perinatal regionalization in the 1990s. BACKGROUND: The controversy in Hartford was sparked by a proposed merger of two major pediatric services into a full-service children's hospital. Community hospitals reacted with plans to upgrade their obstetrics/neonatal facilities toward level II (intermediate) or II+ (intensive) neonatal intensive care units (NICUs). The fear that unrestricted competition would drive up overall health care costs prompted the hospital association and Chamber of Commerce to retain consultants to evaluate the number and location of regional NICU beds. METHODS: The consultant team interviewed stake-holders in area hospitals, health maintenance organizations, insurance companies, businesses, state agencies, and community groups, and analyzed quantitative data on newborn discharges. RESULTS: The existing system worked remarkably well for clinical care, training, referrals, and provider and patient satisfaction. There was a high level of inter-hospital collaboration and regional leadership in obstetrics and pediatrics, but strong and growing competition between their hospitals. Hospital administrators enumerated the competitive threats that obligated them to compete and the financial disincentives to support the regional structures. Business leaders and insurance executives emphasized the need to control costs. Analysis of discharge data showed marginal adequacy of NICU beds but maldistribution between NICUs, particularly between level III and level II units. The consultants recommended no new beds based on population projections, declining lengths of stay nationally, and substantial gains available from aggressive back-transport of convalescing infants. The consultants emphasized the need for all stakeholders to support the regional infrastructure (referral, transport, education, evaluation, quality assurance) and to modify competition when it impaired effective regionalization. CONCLUSIONS: Regionalization permits better care at lower cost, yet competition may disrupt this effective system. Active cooperation by stakeholders is vital. Substantial new research is required to define optimal regional organization.

Bed Occupancy↗
PubMed1985

Quality assurance and the role of self-evaluation and continuing education.

Optimal practice competency requires planned change. Self-evaluation, goal-setting, planning and implementing change, and continual evaluation are required to keep a practice at its best. In this article, the authors recommend steps toward regular self-assessment and new sources of information and advice.

Clinical Competence↗
PubMed1997

Baseline and post-treatment assessment of the general health status of head and neck cancer patients compared with United States population norms.

BACKGROUND: It is a common perception that the overall health of patients with head and neck cancer (HNC) is likely to be poor compared with the general population. This project was undertaken to investigate the pre- and post-treatment, global health status of HNC patients in comparison with age-matched, U.S. population norms using a self-administered general health status survey. METHODS: Between July 1, 1993, and May 1, 1996, 180 patients underwent pretreatment and 6 month follow-up evaluation with the standard version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The SF-36 scale scores, means, standard deviations, and 95% confidence intervals were calculated for each SF-36 scale as well as for physical-health-component summary scores (PCS) and mental-health-component summary scores (MCS). Comparisons of these scores were made to U.S. population normative data. Pretreatment and 6-month follow-up SF-36 scores were compared. RESULTS: In the 45-54-year age group, all 8 SF-36 scale scores, the PCS, and MCS scores were significantly worse for the HNC patients in comparison with age-matched norms (p < .05). In the 55-64-year age group, the HNC patients were worse in 5 of the 8 SF-36 scale scores and the MCS score in comparison with age-matched norms (p < .05). In the 65-74-year age group, the HNC patients scored significantly worse in the mental health scale. In the comparison of pretreatment and 6-month follow-up scores, the HNC patients had significant decreases in the physical functioning scale (p = .003) and the PCS score (p = .047). The HNC patients showed significant improvement in the mental health scale (p = .049) and improvement in the bodily-pain scale, which approached significance (p = .053) at 6-month follow-up. The HNC patients showed a marked decrease in general health status with increasing stage of HNC. CONCLUSIONS: This work provides objective support for the perception that many HNC patients are initially seen for treatment with baseline health status functioning significantly below their age-matched contemporaries in the general population. An educated evaluation of global health outcomes following treatment in the HNC patient population must begin with an accurate pretreatment assessment of these parameters. Self-reported health-status assessment (HSA) is a useful means of evaluating global health status in this patient population.

Adult↗
PubMedDate not supplied

Lake Superior Rural Cancer Care Project, Part III: provider practice.

PURPOSE: Effective methods that encourage rural primary-care physicians to adopt state-of-the-art cancer-management practices are needed. The purpose of this study was to evaluate educational and systems strategies to improve rural primary-care physicians' cancer practice behaviors. DESCRIPTION OF STUDY: The Lake Superior Rural Cancer Care Project was a group-randomized, controlled trial conducted with 18 rural communities in the North Central United States over 4 years. Although the unit of analysis was the community, the subjects were 104 primary-care physicians and 2089 rural patients with cancer. The intervention was educational and comprised systems strategies that targeted rural primary-care physicians and their healthcare delivery systems. The outcome measures reported here were physician practice behaviors regarding cancer diagnosis, staging, treatment, clinical trial participation, and post-treatment surveillance. RESULTS: The intervention significantly improved 5 of the 37 cancer practice end points. The overall result of the study did not support the majority of the study hypotheses. Because 16 practice end points were found to be at acceptable performance levels, the possibility of a measurable intervention effect was limited. CLINICAL IMPLICATIONS: Earlier, the authors reported the results of the intervention on providers' cancer management knowledge, which showed significant improvement. The present study findings demonstrated that improving provider knowledge does not necessarily improve practice performance. Changing practice behaviors requires much more effort. Furthermore, interventions found to be effective in other diseases, types of providers, or settings may not work on rural providers for cancer management.

Aged↗