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PubMed2006

Governance and management structures for community partnerships: experiences from the Robert Wood Johnson Foundation's Community Partnerships for Older Adults Program.

PURPOSE: This article describes early efforts of four community partnerships in Boston, El Paso, Houston, and Milwaukee to address governance and management structures in ways that promote the sustainability of innovative community-based long-term care system improvements. The four communities are grantees of the Community Partnerships for Older Adults Program, a national initiative of the Robert Wood Johnson Foundation that fosters local partnerships to improve long-term care and supportive-services systems in order to meet the current and future needs of older adults. DESIGN AND METHODS: We examined community partnership approaches to governance and management, as well as evidence of the partnerships' influence in their communities, by using the conceptual framework of the community health partnerships typology developed by Shannon M. Mitchell and Stephen Shortell. RESULTS: Addressing governance and management issues was critical to the early evolution of community partnerships for older adults. Early partnership experiences, particularly with regard to local funders and media, provide evidence of emerging centrality (importance and influence in the community), which forecasts sustainability. Observation over a longer period is needed in order to see whether early successes will be sustained, particularly once original grant funding ends. IMPLICATIONS: Community partnerships for older adults can become influential positive forces but must invest in adequate governance and management structures early on.

Aged↗
PubMed2003

Comparison of the genomes of human and mouse lays the foundation of genome zoology.

The extensive similarities between the genomes of human and model organisms are the foundation of much of modern biology, with model organism experimentation permitting valuable insights into biological function and the aetiology of human disease. In contrast, differences among genomes have received less attention. Yet these can be expected to govern the physiological and morphological distinctions apparent among species, especially if such differences are the result of evolutionary adaptation. A recent comparison of the draft sequences of mouse and human genomes has shed light on the selective forces that have predominated in their recent evolutionary histories. In particular, mouse-specific clusters of homologues associated with roles in reproduction, immunity and host defence appear to be under diversifying positive selective pressure, as indicated by high ratios of non-synonymous to synonymous substitution rates. These clusters are also frequently punctuated by homologous pseudogenes. They thus have experienced numerous gene death, as well as gene birth, events. These regions appear, therefore, to have borne the brunt of adaptive evolution that underlies physiological and behavioural innovation in mice. We predict that the availability of numerous animal genomes will give rise to a new field of genome zoology in which differences in animal physiology and ethology are illuminated by the study of genomic sequence variations.

Animals↗
PubMed1990

Informed inquiry into practice variations: the Maine Medical Assessment Foundation.

This paper reports on the development of a successful physician organized and driven medical assessment program, the Maine Medical Assessment Foundation. Responding to the issues and challenges presented by practice pattern variation in the state of Maine, eight physician specialty study groups have been developed in the state over the past ten years. Working in a confidential, educational, non-regulatory format, study groups have had remarkable success in providing feedback of epidemiologic data on area variations to practitioners. This process has succeeded in modifying practice patterns, resulting in marked improvements in quality of care and decreases in apparently excessive utilization of health care resources. Simultaneously, physicians have become supporters of the process of small area analysis and they have joined in community based outcomes research projects. This successful program can be a model for other areas.

Education, Medical, Continuing↗
PubMed2002

Report of the fifteenth international symposium of the foundation for promotion of cancer research: new horizons in the diagnosis and treatment of hematological malignancies based on molecular genetic features.

The Fifteenth International Symposium of the Foundation for Promotion of Cancer Research entitled 'New Horizons in the Diagnosis and Treatment of Hematological Malignancies Based on Molecular Genetic Features' was held in Tokyo on January 15-17, 2002. Twenty-nine invited speakers, including 12 from abroad and 17 from Japan, presented the updated results of their research. After an overview of the classification of hematological malignancies, new findings on some disease entities based on novel immunophenotypic and molecular genetic features were presented. The results of gene expression profiling and BCL6 and C-MYC gene rearrangement in diffuse large B-cell lymphoma were presented and oncogenic mechanism of acute myeloid leukemia was discussed. In the treatment of non-Hodgkin's lymphoma and acute leukemia, the present consensus and future directions were discussed based on the results of multicenter trials in the USA and Japan. As a molecular targeting therapy, the remarkable effect of a BCR-ABL tyrosine kinase inhibitor, STI571, in chronic myeloid leukemia and gastrointestinal stromal tumor was presented. Thereafter, promising results of active immunotherapy, chimeric anti-CD20 monoclonal antibody, anti-CD20 radioimmunoconjugate and anti-CD22 immunotoxin for B-cell lymphoma were presented. Finally, recent advances in allogeneic hematopoietic stem cell transplantation were discussed, focusing on reduced-intensity preparative regimens. The recent advances in basic and clinical research on hematological malignancies would lead to further improvement in the prognosis and quality of life of patients suffering from leukemia or lymphoma.

Biomedical Research↗
PubMed1994

Foundations of the new nosology.

DSM-III and its revisions have provided little in the way of explicit historical or philosophical foundations. The logical empiricism embedded in its operational criteria and its external approach to validation are inadequate to account for the presumption of nosological regularities or the specific categories endorsed by the taxonomy. The nosologic operation that Jaspers referred to as the "synthesis of disease entities" is explored in connection with the central distinction in DSM-IV between mood disorders and schizophrenic disorders. This synthetic operation is analyzed in terms of the paradigmatic shift from the mania-melancholia matrix of pre-modern psychiatry to the manic-depression/dementia praecox model defined by the work of Kraepelin. In the context of this analysis the self-evidence of these regularities is questioned.

Bipolar Disorder↗
PubMed1981

Ludwik Fleck's "On the question of the foundations of medical knowledge".

According to Fleck, a fact is not something objectively given but rather a social event. Scientific facts are no exception, as can be seen through the annals of medicine. Fleck argues that if the physical sciences initially appear to be immune to such social conditioning, this misconception can be corrected by recognizing the similarities between the natural sciences and medicine both historically and epistemologically. Fleck's ideas are not new, having been presented by him in 1935, but it was only recently that they have begun to strike a responsive chord. Kuhn was aware of Fleck's work when he began to promulgate his own ideas in the 1960s. But there are important differences as well as similarities which can only be appreciated once Fleck's own work has had a proper hearing. To this end the University of Chicago Press has published a translation-edition of the full monograph in 1979. In "On the question of the foundations of medical knowledge', Fleck's own précis to this major work, he correctly foretold the dawning of the sociology of cognition.

History, 20th Century↗
PubMed1977

The American Physical Therapy Association's code of ethics: its historical foundations.

This paper surveys selected historical foundations of the present American Physical Therapy Association's CODE OF ETHICS, showing the extent to which the present code draws upon oaths, ideas in ethics textbooks, and other sources. The article presenta a basis for understanding the significance of these historical influences and provides one means by which physical therapists can more fully appreciate the relevance of the code today.

Codes of Ethics↗
PubMed2001

The foundation and evolution of the Middlesex Hospital's lying-in service, 1745-86.

The Middlesex Hospital was founded in 1745, and opened the first British in-patient lying-in service in 1747. Men-Midwives were instrumental in founding and supporting the service. The hospital's lying-in service featured prominently in its fundraising literature, and the level of demand from benefactors suggests it was popular. From 1764 the hospital also provided domiciliary services, initially to cope with excess demand and later to compete with domiciliary charities. In 1786 it closed the in-patient services, and from this date provided only domiciliary lying-in services. From 1757, in common with the London lying-in hospitals, the Middlesex Hospital faced competition from a domiciliary charity: The Lying-In Charity for Delivering Poor Married Women in Their Own Homes. Later in the century it also faced competition from dispensaries. This paper describes the foundation and evolution of the Middlesex Hospital's lying-in service, including quantitative information about admissions and about the hospitals income and expenditure during the eighteenth century. It compares the characteristics of domiciliary and in-patient services, to analyse why in-patient services were supported by men-midwives and by benefactors.

England↗
PubMed1981

Cadaver donor renal transplantation by centers of the Southeastern Organ Procurement Foundation.

This report summarizes the results after two years of a continuing prospective study of cadaver donor renal transplantation being conducted by the Southeastern Organ Procurement Foundation (SEOPF). Data are presented on 942 first grafts. Blood transfusions were found to be a major (if not the major) determinant of allograft survival. HLA-A and -B matching was of significant value and the effect of compatibility became more significant as time passed. ALS provided for better long-term survival of more compatible grafts, but it was not a "safer" immunosuppressant. Autogenous nephrectomy appeared to aid in the survival of more incompatible allografts, but not more compatible allografts. Kidneys obtained and implanted locally and kidneys obtained at one center and implanted at another had the same incidence of acute tubular necrosis (ATN) as well as the same patient and graft survival. Preservation time did not relate to ATN, patient survival, or graft survival (within the limits of the study); however, ATN did adversely affect graft survival. The final systolic pressure of the perfusion pump was the only perfusion characteristic which predicted ATN. Race, sex, pregnancy, and duration of dialysis did not correlate with graft survival if the effects of transfusions and compatibility were controlled.

ABO Blood-Group System↗
PubMed2000

"No fear" curricular change: monitoring curricular change in the W. K. Kellogg Foundation's National Initiative on Community Partnerships and Health Professions Education.

PURPOSE: To assess the effect of the W. K. Kellogg Foundation's five-year (9/91 to 9/96) primary care curricular change initiative involving seven sites and 27 schools with respect to courses offered, graduates' specialty choices, and valued school features (e.g., reputation, research, productivity, school climate) and to track how well the schools possessed or developed the processes associated with enduring curricular change. METHOD: Information was collected via pre- and post-surveys of faculty and students, site visits, annual reports, and medical students' specialty match results. RESULTS: In general, the schools either possessed or developed the institutional, curricular design, and curriculum features associated with successful curricular change. Further, the initiative had a positive or neutral impact on most of the valued features: 199 courses were revised or developed, including 138 offered in the community, involving 141 interdisciplinary faculty. Comparing 1991-1997 data, the average percentage increases in students' selecting primary care from the involved schools were greater than the national percentages. In 1997, a larger percentage of project school graduates selected primary care than the national average. CONCLUSION: Medical schools can make major curricular changes and achieve intended outcomes (e.g., new and/ or revised courses, multidisciplinary instruction, instruction in the community, and changes in specialty choice), and this can occur without negatively impacting other valued school aspects.

Curriculum↗
PubMed2006

Teaching foundational physical examination skills: study results comparing lay teaching associates and physician instructors.

BACKGROUND: The purpose of this pilot study was to determine differences in the physical exam skills of first-year medical students learning physical exam exclusively from standardized physical examination teaching associates (SPETAs) or physician faculty. METHOD: In all, 144 first-year medical students were randomized to receive SPETA or physician-led physical examination instruction. Students participated in an OSCE assessment immediately following the end of the curriculum block. RESULTS: SPETA-trained students performed equivalently to physician faculty trained students across all stations with a mean of 82.9% versus 81.2% (p = .226). Students taught by SPETAs performed significantly better on the abdominal OSCE with a mean score of 88.8%, while physician faculty taught students had a mean score of 85.4% (p = .03). CONCLUSION: Findings from this study suggest that SPETAs can effectively teach foundational physical examination skills to medical students at a similar and sometimes better performance level as physician faculty.

Education, Medical, Undergraduate↗
PubMed1984

Obesity, alcohol consumption and blood pressure in Australian men and women. The National Heart Foundation of Australia Risk Factor Prevalence Study.

The associations of obesity and alcohol consumption with blood pressure and the prevalence of hypertension were studied in 5550 male and female subjects aged 25 to 64 years, surveyed in the National Heart Foundation of Australia 1980 Risk Factor Prevalence Study. Body mass index was significantly and independently associated with blood pressure levels in both sexes. A maximum of 30% of hypertension in the study population could be attributed to overweight. The association between body mass index and hypertension was greater in men under 45 years in whom a maximum of 60% of hypertension could be attributed to overweight. In both men and women receiving antihypertensive treatment, body mass index was positively associated with blood pressure. Overweight hypertensives were less likely to achieve normal blood pressure on treatment. Alcohol consumption was significantly and independently associated with blood pressure levels in males. A similar trend in females failed to reach statistical significance because of the lesser consumption of alcohol by females. A maximum of 11% of hypertension in males and 1% in females could be attributed to alcohol consumption. These estimates were reduced when age and body mass were taken into account.

Adult↗
PubMed1997

Molecular temporal bone pathology: I. Historical foundation.

The application of molecular biology techniques to temporal bone research is resulting in rapid changes in our understanding of the fundamental mechanisms of auditory, facial nerve, and vestibular function. The use of the polymerase chain reaction, cDNA libraries, and in situ hybridization histochemistry, the determination of genetic defects, and the manipulation of transgenic animals are the molecular biology tools that are available to approach these research problems. Knowledge of the molecular pathology that results in the otologic and neuro-otologic dysfunction many of our patients experience is currently in its infancy. A review of the historical foundation of temporal bone pathology and the evolution of the application of cell and molecular biology methods to archival celloidin-embedded human temporal bone material is presented.

Animals↗
PubMed1976

Critique of an earlier study of the Sacramento Medical Care Foundation's Certified Hospital Admission Program (CHAP).

The Certified Hospital Admission Program (CHAP), which was originated by the Medical Care Foundation of Sacramento, California, is regarded as a prototype of admission certification programs and the concurrent monitoring of inpatient care. These peer review functions have now been made key elements of provider utilization review requirements and of Professional Standards Review Organizations' program operations for Medicare and Medicaid. The present article questions, on methodological and interpretive grounds, earlier published findings and conclusions about CHAP's effectiveness. Significant deficiencies in evaluating its impact may mean that the success of CHAP has not yet been demonstrated and, hence, that an adequate basis for formulating certain national peer review policies may not exist.

Adult↗
PubMed1992

An overview of the development and refinement of the Resource-Based Relative Value Scale. The foundation for reform of U.S. physician payment.

Responding to distortions in payment rates between services, policymakers in the United States have sought a systematic and rational foundation for determining physician fees. One such approach to paying physicians, the Resource-Based Relative Value Scale (RBRVS), determines fees by measuring the relative resource costs required to produce them. On January 1, 1992, the Medicare program implemented a new payment system for physician services based on the RBRVS. This article provides a brief history of the RBRVS and a summary of the methods and data used to derive it. This overview represents the culmination of 6 years of research by the Harvard RBRVS study team and provides a road map to the study's concepts and definitions. The overview also provides a context for the articles in this issue that describe five major studies undertaken since 1988. The study's overall results are presented in the last article of the series.

Data Collection↗
PubMed1998

The new entrepreneurial foundation for the nurse executive.

Nurse executive are well positioned to be the entrepreneurial spirit needed to help their organization adapt to a rapidly changing health care industry. The article suggests a foundation to help nurse executives expand their entrepreneurial role. Areas for consideration and development include awareness, environment, education, characteristics and principles.

Entrepreneurship↗
PubMed1982

HLA standardization and proficiency testing in the Southeastern organ Procurement Foundation.

Five years of experience with cell exchanges between laboratories comprising the Southeastern Organ Procurement Foundation (SEOPF) were analyzed in order to evaluate progress in HLA typing proficiency. The results of the analysis of 15 cell exchanges involving a total of 60 cells indicate that the average detection rate was 95% or greater for HLA-A1, 2, 3, 9, 10, 11, 28, and 29; B7, 8, 12, 13, 14, 15, 17, 27, and 40. HLA-A locus antigens were detected more often (85.8%) than B locus antigens (80.9%). False negative results were more frequent than false positive antigen assignments. Errors in antigen assignments tended to be nonrandomly distributed for certain antigens belonging to cross-reacting groups but usually were randomly distributed for well defined antigens. During the period of the study, SEOPF laboratories demonstrated improved proficiency in the identification of most HLA-A, B, and C provisional (w) specificities. The results demonstrate the benefits of interlaboratory proficiency testing and indicate that cell exchanges can be carried out successfully on a regional basis.

Cell Survival↗
PubMed1987

Identification of donor factors predisposing to high discard rates of cadaver kidneys and increased graft loss within one year posttransplantation--SEOPF 1977-1982. South-Eastern Organ Procurement Foundation.

From 1977 to 1982, the South-Eastern Organ Procurement Foundation (SEOPF) conducted a prospective study to determine the fate of all cadaver kidneys retrieved by member institutions. During the study period, 6152 kidneys were retrieved, 1264 being discarded. Donor factors predisposing to wastage included AB and A blood groups, donor age greater than 30, hospitalization greater than 3 days, serum creatinine greater than 2.0 mg%, average systolic blood pressure less than 80, last-hour urine output less than 100 ml, proteinuria, heart not beating at time of nephrectomy, and kidneys not removed en bloc. Donor factors affecting graft survival rate at one year include age, length of hospitalization, last-hour urine output, and changing serum creatinine. The data suggest that certain donor kidneys are less likely than others to be transplanted depending on donor characteristics and retrieval practices. Furthermore, some of these factors have a negative impact on long-term success when kidneys are transplanted.

Adolescent↗