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PubMedDate not supplied

Effect of training and a structured office practice on physician-delivered nutrition counseling: the Worcester-Area Trial for Counseling in Hyperlipidemia (WATCH).

We examined the effectiveness of a training program for physician-delivered nutrition counseling, alone and in combination with a structured office practice environment for nutrition management, on physicians' counseling practices. Forty-five primary care internists and 1,278 of their patients in the top quarter of the cholesterol distribution at a central Massachusetts health maintenance organization (the Fallon Clinic) were enrolled into a randomized controlled trial. Physicians were randomized by site into three conditions: (1) usual care, (2) physician nutrition counseling training, and (3) physician nutrition counseling training plus a structured office practice environment for nutrition management (prompts and the provision of lipid results and counseling algorithms). A randomly selected 325 patients were given a 10-item patient exit interview (PEI) assessing whether the physician provided advice; assessed past changes, barriers, and resources; negotiated specific plans and goals; provided patient materials; referred the patient to a dietitian; and developed plans for follow-up. Condition 3 physicians demonstrated significantly greater implementation of the nutrition counseling sequence than did physicians in either of the other two conditions (P < .0001). Referrals to nutrition services were markedly reduced in condition 2, despite PEI scores no different than those in condition 1. Higher PEI scores for patients seen by physicians in condition 3 were stable for as long as two years beyond training. Primary care internists, when provided with both training in counseling techniques and a supportive office environment, will carry out patient counseling appropriately. Training alone, however, is not sufficient and may be counterproductive. Medical Subject Headings (MeSH): hypercholesterolemia, diet therapy, coronary disease, health behavior, primary health care, medical education, managed care programs.

Adult↗

PubMed1995

NASA science utilization plans for the Space Station.

The Mir-1 and International Space Station Alpha capabilities present the science community with unique long duration platforms to conduct a wide range of scientific research in the microgravity and life sciences as well as in the observational sciences, NASA is developing plans to use the capabilities of Mir and Space Station as they emerge during the development of the orbital program. In both cases the planned science utilization programs take advantage of the volume, crew, power, microgravity and logistics resupply unique to each phase. The paper will present these utilization plans in the context of an evolving scientific program.

Animals↗

PubMedDate not supplied

Issues emerging from the London Learning Disability Plan.

This article gives an overview of the draft of the London Learning Disability Plan developed by the Department of Health, Social Services Inspectorate and the National Health Service Executive. The London Plan is founded on a social model of disability in which there is not only a strong focus on health and social care, but also an integration with housing, education, employment, leisure and other relevant organizations. It advocates integrated commissioning and delivery of specialist learning disability services that will require both health services and nurses to change existing structures and interventions. New forms of workforce development will emerge and clarification will be required about the future role of learning disability nurses within London. Information specific to the Plan is gathered from the Department of Health's learning disabilities Web site. The Plan is laid out in four booklets, one of which (Booklet 2: 'Services to Improve People's Lives') was not available at the time of writing. The article thus contains information and proposals that may be altered by subsequent publication.

Adult↗

PubMed2006

Use of information systems in Air Force medical treatment facilities in strategic planning and decision-making.

An exploratory study used Ansoff's strategic planning model as a framework to assess perceived effectiveness of information systems in supporting strategic business plan development at Air Force medical treatment facilities (MTFs). Results showed information systems were most effective in supporting historical trend analysis, strategic business plans appeared to be a balance of operational and strategic plans, and facilities perceived a greater need for new clinical, vice administrative, information systems to support strategic planning processes. Administrators believed information systems should not be developed at the local level and perceived information systems have the greatest impact on improving clinical quality outcomes, followed by ability to deliver cost effective care and finally, ability to increase market share.

Decision Making↗

PubMed1981

Nurse-intern programs: how they're working.

Results of the study support conclusions drawn from the literature: The nurse-intern program stands as an efficient, effective method of orienting new graduate nurses in their first work experience. Internships provide a highly realistic vehicle for smoothing the transition from student to staff nurse and also promote recruitment and retention of qualified personnel. Participation in an intern program helps the graduate assume increasingly responsible roles as he or she gains self-confidence, competence, and comfort in the clinical setting and becomes more able to give quality patient care. Strong similarities among programs as noted in both the study and the literature suggest that despite differences in titles and settings for these programs, many commonalities do exist. A common feature seems to be the placement of a limited number of participants in one or two areas for a lengthy period under the guidance of a specified individual. This overall structure, in conjunction with a well-developed plan of program objectives and experiences, appears to constitute the formula for success. Agencies considering development of a nurse-intern program would do well to first consider their ultimate goal in establishing such a program. Realistic assessment of the agency's capabilities and resources in relation to this desired end will help set the tone for subsequent program planning and minimize future frustration. For a program of this type, support from all levels of administration is essential, since the hoped-for return on investment may be some time in coming.

Education, Nursing, Baccalaureate↗

PubMed2004

Where grasps are made reveals how grasps are planned: generation and recall of motor plans.

The end-state comfort effect (Rosenbaum et al. 1990, 1992, 1993, 1996) predicts that people will grasp an object for transport in a way that allows joints to be in mid-range at the end of the transport. When participants in the present study took hold of a vertical cylinder to move it to a new position, grasp heights on the cylinder were inversely related to the height of the target position, as predicted by the end-state comfort effect. This demonstrates that where people grasp objects can give insight into the planning of movement. In the computational model of motor planning developed by Rosenbaum et al. (1995, 2001) it is assumed that goal postures are planned by a two-stage process of recall and generation. The distinction between recall and generation had not so far been tested. In the present study, the pattern of grasp heights in successive transports was consistent with the view that participants generated a plan the first time they moved the cylinder between two points, and that they subsequently recalled what they had done before, making small adjustments to that recalled plan. This outcome provides evidence for distinct effects of recall and generation on movement planning.

Adolescent↗

PubMed2002

Barriers to Alzheimer disease drug discovery and drug development in the pharmaceutical industry.

The drug development process in the pharmaceutical industry has evolved from separate programs, specific for each country, into one coordinated, global development scheme. As a result, such a development program must meet regulatory requirements for all countries in which approval for the new drug will be sought. Barriers to Alzheimer disease (AD) drug discovery and development in the pharmaceutical industry can be categorized as (1) regulatory, (2) logistical, and (3) drug development issues. Some of the regulatory barriers could be overcome by international harmonization of guidelines for the development of antidementia drugs. The logistical issues can be reduced through international collaboration in the conduct of clinical studies, and the developmental issues can be addressed by using an expedited drug development plan that not only can reduce the time but also the resources required to develop the drug.

Alzheimer Disease↗

PubMed2002

Assessing the skills for family planning nurse prescribing: development of a psychometrically sound training needs analysis instrument.

RATIONALE AND AIMS: Family planning nurses have been identified for early development for prescribing authority in the United Kingdom (UK). Currently, no psychometrically founded training needs analysis instrument exists that can reliably assess the nature and extent of the specific educational provision required for this role. This paper is concerned with the development of an instrument capable of defining the development needs for family planning nurse prescribing. METHODS: A national survey was conducted with 388 family planning nurses, using a modified training needs analysis instrument. Respondents were required to assess the importance of 40 tasks, firstly for the role of the family planning nurse (FPN), and again for the role of the family planning nurse prescriber (FPNP). The data from each set of ratings were separately factor analysed using orthogonal Varimax rotations and Cronbach's alpha was computed for each factor. RESULTS: Six factors emerged from the family planning nurse ratings ('professional development', 'managing patient consultations', 'critical appraisal', 'clinical information giving and professional accountability', 'collaborative working and current National Health Service (NHS) issues' and 'dispensing of drugs') and nine factors emerged from the FPNP ratings ('research and practice development', 'prescribing and professional accountability', 'management/leadership', 'clinical decision making and risk assessment', 'advanced health assessment', 'critical appraisal', 'referral processes', 'core nursing skills' and 'dispensing of drugs'. This suggests that the role of the FPNP is more extended and, moreover, that the two roles are configured very differently but in a way that makes logical and coherent sense within existing research and government policy. This indicates that the instrument is valid. Moreover, all but two of the factors had a Cronbach's alpha score of >0.7 and so can be considered reliable. CONCLUSIONS: The results indicate that the modified instrument is valid and reliable and therefore can be used with confidence to assess the training needs of FPNPs. In addition, the factors have outlined a cogent definition of the role of the FPNP, which can be used both to inform educational programmes and to assess their efficacy.

Clinical Competence↗

PubMed1981

Functional fiefdom, poverty model or individualism? Development of intergovernmental relations in health planning.

The United States national government has the power under the National Health Planning and Development Act of 1974 to establish and exercise legal control over a system of Health System Agencies, State Health Planning and Development Agencies, and State Health Coordinating Councils. Although the national government appears to have the legal powers necessary to direct and control the health planning process, a federal system has difficulties in the implementation of planning which has centralized goals or direction. The states and regions have the potential power to weaken the strength of the national government. Three trends in the developing relationship between the national, state, and regional units in health planning are discussed. The first, the functional fiefdom, consists of self-perpetuating, narrow purpose agencies which are not responsible to local or state-wide elected officials. These are professional bureaucracies which create and reinforce cozy relationships with supportive interest groups. The second trend, the poverty model, includes the lack of control by local elected officials, a large role to nongovernmental actors, and a direct relationship between Washington and the regional planning agencies. The last trend appears to be an individualistic one with every unit fending for itself. A case study of Massachusetts along with supplemental materials from other states is presented to illustrate the trends.

Government↗

PubMed2006

Linking linear programming and spatial simulation models to predict landscape effects of forest management alternatives.

Forest management planners require analytical tools to assess the effects of alternative strategies on the sometimes disparate benefits from forests such as timber production and wildlife habitat. We assessed the spatial patterns of alternative management strategies by linking two models that were developed for different purposes. We used a linear programming model (Spectrum) to optimize timber harvest schedules, then a simulation model (HARVEST) to project those schedules in a spatially explicit way and produce maps from which the spatial pattern of habitat could be calculated. We demonstrated the power of this approach by evaluating alternative plans developed for a national forest plan revision in Wisconsin, USA. The amount of forest interior habitat was inversely related to the amount of timber cut, and increased under the alternatives compared to the current plan. The amount of edge habitat was positively related to the amount of timber cut, and increased under all alternatives. The amount of mature northern hardwood interior and edge habitat increased for all alternatives, but mature pine habitat area varied. Mature age classes of all forest types increased, and young classes decreased under all alternatives. The average size of patches (defined by age class) generally decreased. These results are consistent with the design goals of each of the alternatives, but reveal that the spatial differences among the alternatives are modest. These complementary models are valuable for quantifying and comparing the spatial effects of alternative management strategies.

Computer Simulation↗

PubMed1988

Health care in the Yemen Arab Republic.

The Yemen Arab Republic has health-care problems similar to other developing countries yet lacks the abundant oil reserves of its Arabian peninsula neighbors to address these problems. An ambitious 5 year health plan developed in 1977 has been impeded by a lack of material and human resources. The infant mortality rate remains one of the highest in the world, schistosomiasis drains the energy of the people, and tuberculosis and malaria remain endemic. Progress is, however, being made in health-care educational programs within Sanaa University and the Health Manpower Institutes to develop the resources of the Yemeni people to meet the health-care needs of their country.

Adult↗

PubMed2001

Healthy city projects in developing countries: the first evaluation.

The 'healthy city' concept has only recently been adopted in developing countries. From 1995 to 1999, the World Health Organization (WHO), Geneva, supported healthy city projects (HCPs) in Cox's Bazar (Bangladesh), Dar es Salaam (Tanzania), Fayoum (Egypt), Managua (Nicaragua) and Quetta (Pakistan). The authors evaluated four of these projects, representing the first major evaluation of HCPs in developing countries. Methods used were stakeholder analysis, workshops, document analysis and interviews with 102 managers/implementers and 103 intended beneficiaries. Municipal health plan development (one of the main components of the healthy city strategy) in these cities was limited, which is a similar finding to evaluations of HCPs in Europe. The main activities selected by the projects were awareness raising and environmental improvements, particularly solid waste disposal. Two of the cities effectively used the 'settings' approach of the healthy city concept, whereby places such as markets and schools are targeted. The evaluation found that stakeholder involvement varied in relation to: (i) the level of knowledge of the project; (ii) the project office location; (iii) the project management structure; and (iv) type of activities (ranging from low stakeholder involvement in capital-intensive infrastructure projects, to high in some settings-type activities). There was evidence to suggest that understanding of environment-health links was increased across stakeholders. There was limited political commitment to the healthy city projects, perhaps due to the fact that most of the municipalities had not requested the projects. Consequently, the projects had little influence on written/expressed municipal policies. Some of the projects mobilized considerable resources, and most projects achieved effective intersectoral collaboration. WHO support enabled the project coordinators to network at national and international levels, and the capacity of these individuals (although not necessarily their institutions) was increased by the project. The average annual running cost of the projects was approximately 132,000 US dollars per city, which is close to the costs of the only other HCP for which a cost analysis has been undertaken, Bangkok (115,000 US dollars per year) Recommendations for these and other HCPs are provided.

Community Health Planning↗

PubMed1980

Reading between the lines: societal norms in Sierra Leonean readers.

A content analysis of primary school readers in Sierra Leone revealed that the particular modern and traditional normative aspirations expressed in the National Development Plan for 1974/5-1978/9 were also generally reflected in the children's readers. Compared to the 1964 readers, the 1st indigenous readers developed circa 1977 contained markedly greater emphasis on traditional norms, though modernity norms continued to dominate, and substantially less emphasis on Efficacy (a central aspect of modernity) and on Nonparochial Affiliation. This closely corresponded with the intent of the National Plan to continue on a modernizing course employing the traditional norms of Manual Labor and Social Cohesion in a grassroots effort to develop the agricultural sector, with nationalism in a less important role. Apart from lesser emphasis on Efficacy and underemphasis on the Value of Education, both discordant with national goals, the 1977 readers seem to provide children and teachers with a fairly accurate image of the national ethos. This may help to account for the generally positive relationship that has been found between schooling and economic development.

Africa↗

PubMedDate not supplied

Planning for burn disasters: lessons learned from one hundred years of history.

The terrorist attacks of September 11th have prompted interest in developing plans to manage thousands of burn casualties. There is little actual experience in the United States in managing disasters of this magnitude. As an alternative, lessons may be learned from the historical experiences of previous civilian burn or fire disasters occurring in this country. A review of relevant medical, fire service, and popular literature pertaining to civilian burn or fire disasters occurring in the United States between the years 1900 and 2000 was performed. In the 20th century, 73 major U.S. fire or burn disasters have occurred. With each disaster prompting a strengthening of fire regulations or building codes, the number of fatalities per incident has steadily decreased. Detailed examination of several landmark fires demonstrated that casualty counts were great but that most victims had fatal injuries and died on the scene or within 24 hours. A second large cohort comprised the walking wounded, who required minimal outpatient treatment. Patients requiring inpatient burn care comprise a small percentage of the total casualty figure but consume enormous resources during hospitalization. Burn mass casualty incidents are uncommon. The number of casualties per incident decreased over time. In most fire disasters, the majority of victims either rapidly die or have minimal injuries and can be treated and released. As a result, most disasters produce fewer than 25 to 50 patients requiring inpatient burn care. This would be a rational point to begin burn center preparations for mass casualty incidents. A robust outpatient capability to manage the walking wounded is also desirable.

Burns↗

PubMed1996

An inter district quality partnership: the experience of a large rural health service.

Despite the proliferation of healthcare literature on the subject of quality programs, there is very little on the subject which considers it in a rural context. This paper is a case study outlining the efforts of six facilities within a large rural health service of South West NSW to establish a partnership in the planning, development and management of quality issues.

Aged↗

PubMed2002

Experience, knowledge and attitudes of mental health staff regarding clients with a borderline personality disorder.

A survey of mental health staff experience, knowledge and attitudes regarding the management of clients with a diagnosis of borderline personality disorder (BPD) aimed to obtain baseline data to provide direction for developing planned education and determining staff willingness to participate in such training. A 23-item questionnaire was developed and posted to mental health staff in a public Area Mental Health Service in New South Wales (n = 516). A total of 229 staff completed the questionnaire. Most staff (85%) reported having contact with clients who have a diagnosis of BPD at least once a month or more frequently, with 32% of respondents reporting daily contact. Eighty per cent of respondents found dealing with clients who have a BPD to be moderate to very difficult; 84% of staff felt that dealing with this client group was more difficult than dealing with other client groups. Most staff (82%) believed that, as mental health professionals, they had a role in the assessment, management and referral of clients with BPD, as well as in educating and providing information. Staff readily identified resources which would be helpful to them when working with such clients. It was encouraging to see that the majority of staff (95%) indicated their willingness to gain further education and training in the management of these clients. Although many staff believed they were knowledgeable about and confident in managing these clients, most staff also indicated difficulties posed by these clients and perceived a need for further education and training in this area.

Adult↗

PubMed2005

The recruitment phoenix: strategies for attracting medical students into obstetrics and gynecology.

In less than a decade, the popularity of obstetrics and gynecology as a career choice has declined significantly. The American College of Obstetricians and Gynecologists (ACOG) and the Association of Professors of Gynecology and Obstetrics (APGO) are working to develop a multifaceted approach aimed at reversing this trend. We report on the findings and action plan developed by the ACOG Medical Student Recruitment Task Force as well as the current activities of APGO related to recruitment. Strategies include improving the quality of the medical student clerkship, frankly addressing gender and lifestyle issues that dissuade students from choosing obstetrics and gynecology as a career, and engaging students early in their medical school careers through student interest groups and mentoring programs.

Career Choice↗

PubMedDate not supplied

How siblings resolve their conflicts: the importance of first offers, planning, and limited opposition.

Sixty-four sibling dyads (4-12 years old; 61% males; 83% European-American) were asked to resolve an ongoing conflict. Older siblings provided leadership by suggesting, modifying, justifying, and requesting assent to plans for conflict resolution. Younger siblings countered and disagreed, but also contributed to planning and agreed to their siblings' plans. Compromises were associated with first offers that met both children's goals, future-oriented planning, and limited opposition. Win-loss outcomes followed offers favoring only one child and arguments over older siblings' plans. Conflicts were unresolved when negotiations included frequent accusations and opposition, but little planning. Thus mutually beneficial conflict resolution required that children shift focus from debating past wrongs to developing plans to meet their unrealized goals in future interaction.

Age Factors↗