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PubMedDate not supplied

The APA/HRSA Faculty Development Scholars Program: introduction to the supplement.

BACKGROUND: The purpose of this project was to improve pediatric primary care medical education by providing faculty development for full-time and community-based faculty who teach general pediatrics to medical students and/or residents in ambulatory pediatric community-based settings. Funding for the program came through an interagency agreement with the Health Resources and Services Administration (HRSA) and the Agency for Healthcare Research and Quality (AHRQ). METHODS: A train-the-trainer model was used to train 112 scholars who could teach skills to general pediatric faculty across the nation. The three scholar groups focused on community-based ambulatory teaching; educational scholarship; and executive leadership. RESULTS: Scholars felt well prepared to deliver faculty development programs in their home institutions and regions. They presented 599 workshops to 7989 participants during the course of the contract. More than 50% of scholars assumed positions of leadership, and most reported increased support for medical education in their local and regional environments. CONCLUSIONS: This national pediatric faculty development program pioneered in the development of a new training model and should guide training of new scholars and advanced and continuing training for those who complete a basic program.

Ambulatory Care↗
PubMed1988

Integrated Academic Information Management Systems (IAIMS). Part II. Planning and implementing integrated information services. Integration and outreach: Integrated Academic Information Management Systems (IAIMS) at Maryland.

The University of Maryland Campus for the Professions is now realizing the first benefits of integrated academic information management systems (IAIMS). With the support of the National Library of Medicine, the information Resources Management Division has joined with the Health Sciences Library to plan and to implement change. Within the information utility concept, networked data communications and end-user computing function as the means to integration. Plans call for new 370-based software to extend system capabilities. Mechanisms for outreach ensure that the potential of integration is realized. These mechanisms include technology assisted learning centers, informatics program development, special programs (geriatrics, hypertension pilot), and new applications (conferencing system, voice mail, videodisc development, interinstitutional resource sharing).

Academic Medical Centers↗
PubMed1995

Temporally distinct patterns of p53-dependent and p53-independent apoptosis during mouse lens development.

Programmed cell death, or apoptosis, is a critical event in the development of multicellular organisms, and its perturbation is implicated in many diseases including cancer. The tumor suppressor protein p53 is known to mediate apoptosis induced by the DNA tumor virus oncoproteins, adenovirus E1A (AdE1A) and SV40 T antigen (SV40 Tag). We have recently demonstrated that the E6 and E7 oncoproteins of human papillomavirus type 16 (HPV-16) modulate apoptosis when expressed in the lens of transgenic mice. In this study we have identified the pathways that mediate E7 induction and E6 inhibition of apoptosis during different stages in the development of the lens. E7 transgenic mice made p53-null were only partially rescued in their apoptotic phenotype, indicating that both p53-dependent and -independent pathways mediate E7-induced apoptosis in the lens. The E6 transgene and p53-null genotype acted additively to reduce levels of apoptosis induced by E7 in neonatal lenses, indicating that E6 modulates apoptosis at least in part through p53-independent mechanisms. The partial reduction in E7-induced apoptosis by the p53-null genotype correlated with an increased incidence of lens tumors in adult E7 transgenic mice. Analyses of embryonic lenses at E13.5, E15.5, and E17.5 revealed a temporally distinct activation of p53-dependent and -independent apoptosis in the E7 lens. During the early stages of lens development, apoptosis was highly p53-dependent, whereas at later stages, apoptosis occurred through both p53-independent and -dependent pathways. This later time correlates temporally with the time of normal fiber cell denucleation, which can be inhibited by E6 through a p53-independent mechanism. These data suggest a similarity between the mechanism regulating E7-induced, p53-independent apoptosis and the apoptotic-like developmental process of fiber cell denucleation, and the mechanisms through which E6 suppresses both processes.

Animals↗
PubMed1996

Developing effective strategies for malaria prevention programs for pregnant African women.

The control of malaria in pregnant African women, one of several child survival strategies applied through antenatal care, has been particularly challenging. Prevention and control recommendations for typical areas of high Plasmodium falciparum transmission have promoted the use of antimalarial chemoprophylaxis to prevent placental infection. Persistently low program coverage coupled with diminishing intervention effectiveness have forced a re-evaluation of the relative importance of malaria in pregnancy. The Mangochi Malaria Research Project (MMRP), a prospective evaluation of malaria prevention in pregnant women in rural Malawi conducted during 1987-1990, contributed to establishing new criteria for policy and program development for malaria prevention in pregnancy. The principle findings of the MMRP include: 1) populations at risk of the adverse consequences of malaria in pregnancy include women with low parity, women infected with human immunodeficiency virus, pregnancy during the high malaria transmission season, and the use of a malaria drug that is suboptimally efficacious; 2) the estimated maximum benefits of an antimalarial intervention that clears placental and umbilical cord parasitemia are a 5-12% reduction of low birth weight (LBW), an approximately 35% reduction in the risk of LBW for risks that are actually preventable once a woman has become pregnant (e.g., risks such as infectious disease or poor nutrition during gestation), and a 3-5% reduction in the rate of infant mortality; 3) the intervention must be capable of rendering the woman malaria parasite free, including clearance of parasites from the placental vascular space and umbilical cord blood; 4) other diseases adversely affect pregnancy outcome and, while the control of malaria in pregnancy may not warrant independent programming, if coupled with prevention programs to provide a range of antenatal services, the incremental costs of malaria control may prove to be highly cost-effective; and 5) the choice of a regimen must balance intervention efficacy with safety, availability, affordability, and simplicity of delivery, and several antimalarials may meet these criteria. The Malawi Ministry of Health has modified its malaria prevention in pregnancy recommendations and now faces the challenge of effective programming to improve child survival.

Africa↗
PubMed1990

Rewarding medical teaching excellence in a major Canadian teaching hospital.

A major Canadian teaching hospital has developed a program to recognize and reward excellence in medical education. The program includes a system to collect and evaluate feedback from trainees and administrators--with an annual celebration event where awards are presented. Three categories of hospital-wide awards are presented: educational administration, program development, and extraordinary contribution. There are departmental awards for best undergraduate and postgraduate physicians, allied health professional, and house staff/fellow. This program functioned well to evaluate teachers across departments and for all levels of trainees in the hospital and will expand to become part of the ongoing evaluation of teachers in the institution.

Awards and Prizes↗
PubMed2005

Challenges in the transition to model-based development.

Practitioners of the art and science of pharmacometrics are well aware of the considerable effort required to successfully complete modeling and simulation activities for drug development programs. This is particularly true because of the current, ad hoc implementation wherein modeling and simulation activities are piggybacked onto traditional development programs. This effort, coupled with the failure to explicitly design development programs around modeling and simulation, will continue to be an important obstacle to the successful transition to model-based drug development. Challenges with timely data availability, high data discard rates, delays in completing modeling and simulation activities, and resistance of development teams to the use of modeling and simulation in decision making are all symptoms of an immature process capability for performing modeling and simulation. A process that will fulfill the promise of model-based development will require the development and deployment of three critical elements. The first is the infrastructure--the data definitions and assembly processes that will allow efficient pooling of data across trials and development programs. The second is the process itself--developing guidelines for deciding when and where modeling and simulation should be applied and the criteria for assessing performance and impact. The third element concerns the organization and culture--the establishment of truly integrated, multidisciplinary, and multiorganizational development teams trained in the use of modeling and simulation in decision-making. Creating these capabilities, infrastructure, and incentivizations are critical to realizing the full value of modeling and simulation in drug development.

Animals↗
PubMed1999

The role of apoptosis in normal and abnormal embryonic development.

Programmed cell death or apoptosis is a widespread biological phenomenon. Apoptosis is characterized by typical cell features such as membrane blebbing, chromatin condensation, and DNA fragmentation. It involves a number of membrane receptors (e.g., Fas, TNFR) and a cascade of signal transduction steps resulting in the activation of a number of cysteine proteases known as caspases. Disordered apoptosis may lead to carcinogenesis and participates in the pathogenesis of Alzheimer disease, Parkinson disease, or AIDS. Programmed cell death plays an important role in the processes of gamete maturation as well as in embryo development, contributing to the appropriate formation of various organs and structures. Apoptosis is one of the mechanisms of action of various cytotoxic agents and teratogens. Teratogen-induced excessive death of embryonic cells is undoubtedly one of the most important events preceding the occurrence of structural abnormalities, regardless of their nature. Therefore understanding the mechanisms involved in physiological as well as in disturbed or dysregulated apoptosis may lead to the development of new methods of preventive treatment of various developmental abnormalities. The present review summarizes data on the mechanisms of programmed cell death and concentrates on apoptosis involved in normal or disturbed gametogenesis and in normal and abnormal embryonic development.

Apoptosis↗
PubMed1999

Therapeutic massage: an education program for rural and remote workers in the palliative care field.

This paper, drawing upon data from a Rural Health, Support, Education and Training (RHSET) funded project, focuses on the evaluation of a massage education program developed specifically for rural and remote palliative care workers. An 8 week pilot massage education course was run for palliative care workers in the Albury-Wodonga area and, from this course, an instructional video education package on massage has been developed. The program was evaluated by using a questionnaire, journals and focus group interviews. Feedback from participants was incorporated into both the pilot course and final education package, which was consistent with the action research framework. The major findings of the project were that skill development in the therapeutic use of massage was attained and that job satisfaction was indeed achieved by palliative care workers.

Attitude of Health Personnel↗
PubMed2002

Microteaching and standardized students support faculty development for clinical teaching.

OBJECTIVE: If faculty development programs are to have impact, we believe they should be made up of several self-reinforcing workshops that provide opportunities for behavior review, practice, reflection, and reinforcement within a context of interdisciplinary perspectives. A program was developed that supports these four activities and includes clinical faculty from medicine, dentistry, nursing, and pharmacy. DESCRIPTION: At the University of Illinois at Chicago we have focused our efforts to improve clinical teaching through a program of two parallel courses. One course focuses on the "one-minute teacher" approach to clinical teaching. We call this course "Teaching-on-the-Fly," reflecting what many of our faculty attendees have suggested they do. The second course is "Feedback Strategies." The two courses are identical in format, which is a series of three three-to-four-hour small-group workshops of not more than eight participants. The first two workshops in each series are titled "Teaching-on-the-Fly I and II" and "Feedback Strategies I and II," respectively. Workshop I is separated from Workshop II by two weeks. During this hiatus faculty are urged to practice the skills learned and to reflect on what worked and what did not work in Workshop I. Six months following both series' Workshop II, "Advanced Teaching-on-the-Fly" and "Advanced Feedback Strategies" workshops are held. Each workshop begins with videotaping of two separate teaching encounters in which each participant interacts with standardized students. Standardized student and clinical faculty interactions are meant to mimic typical teaching and feedback situations. Teaching encounters are limited to five minutes, maximizing the similarity to the stress and frenetic quality of many of today's clinical settings. In Workshop II and in the advanced workshops the standardized students offer one positive comment to the faculty immediately following their encounter. Students are taught how to give this feedback. Immediately after videotaping, faculty adjourn to a small-group discussion. Workshops consist of reflective discussions during the review of each participant's videotape, brief lectures, and responsive comments and instruction by the workshop leaders. Participants are asked to reflect on each workshop and to bring examples of problems and opportunities gained to succeeding workshops in the series. DISCUSSION: Several theories support these clinical teaching workshops. (1) Outcomes research in continuing medical education suggests the need for ongoing reinforcement, which we do structurally through the three-session model. (2) We use a classical microteaching approach to develop insight and self-awareness. Each videotaped encounter is reviewed, stopped at key points, and discussed by the entire group. These discussions commonly open up after the workshop leaders ask questions such as, "What were you thinking there?" or "What were you trying to do?" or "What would you ask next?" (3) We emphasize the importance of knowing-in-action and the related reflection that guides action in practice. (4) The quality of the workshops is enhanced using standardized students, whom we carefully train and use repeatedly. At least two students have worked with us from their first years through their final clinical years. We are currently examining the program's impact through videotape review.

Education, Medical, Continuing↗
PubMed2006

Support and intervention groups for adolescents with cancer in two Ontario communities.

Adolescents who are treated for cancer must learn to negotiate challenging developmental tasks in the context of their treatment and adverse effects. Adverse affects of disease and treatment may prevent some of these adolescents from achieving full psychosocial development. Two programs developed independently to address the psychosocial and unique contextual needs of adolescents and young adults from different geographic regions in Ontario, Central urban and Northeastern rural, are described. The program in the urban area consists of eight 2-h sessions that combined structured creative activities and informal discussions of issues generated by adolescents; it includes a pre- post- intervention evaluation with standardized questionnaires. The Northeastern rural program consists of a monthly support open group that encourages sharing personal experiences and an annual expressive art retreat; both components include informal evaluation. Formal evaluation of these programs is in progress. Informal feedback from participants and parents suggest positive effects. These distinct and unique programs continue to evolve, as they address the unique psychosocial needs of adolescents and young adults in urban and rural areas.

Adolescent↗
PubMed1996

Faculty development for community practitioners.

Developing the academic skills of the individuals who will serve as educators and role models in the community is critical to pediatric resident education in community settings. The main focus of any faculty development program must be on teaching, although for a subset of individuals, the development of research skills should also be a consideration. The three key elements that must be considered for an effective faculty development program include: (1) creating a culture of mutual respect between full-time and community faculty; (2) basing the program on sound principles of education theory, especially adult learning theory, using appropriately trained faculty; and (3) establishing ongoing institutional financial and philosophical support. Effectively addressing these elements should create a faculty development program that will help the community practitioner become an effective role model and practitioner- preceptor-educator.

Community Medicine↗
PubMed2003

Commercialization of a novel fermentation concept.

Fermentation is the core of biotechnology where current methodologies span across technologies based on the use of either solid or liquid substrates. Traditionally, solid substrate fermentation technologies have been the widely practiced in the Far East to manufacture fermented foods such as soya sauce, sake etc. The Western World briefly used solid substrate fermentation for the manufacture of antibiotics and enzymes but rapidly replaced this technology with submerged fermentation which proved to be a superior technology in terms of automation, containment and large volume fermentation. Biocon India developed its enzyme technology based on solid substrate fermentation as a low-cost, low-energy option for the production of specialty enzymes. However, the limitations of applying solid substrate fermentation to more sophisticated biotechnology products as well as large volume fermentations were recognized by Biocon India as early as 1990 and the company embarked on a 8 year research and development program to develop a novel bioreactor capable of conducting solid substrate fermentation with comparable levels of automation and containment as those practiced by submerged fermentation. In addition, the novel technology enabled fed-batch fermentation, in situ extraction and other enabling features that will be discussed in this article. The novel bioreactor was christened the "PlaFractor" (pronounced play-fractor). The next level of research on this novel technology is now focused on addressing large volume fermentation. This article traces the evolution of Biocon India's original solid substrate fermentation to the PlaFractor technology and provides details of the scale-up and commercialization processes that were involved therein. What is also apparent in the article is Biocon India's commercially focused research programs and the perceived need to be globally competitive through low costs of innovation that address, at all times, processes and technologies that exhibit high degrees of conformance to the international standards of regulatory and good manufacturing practice.

Bioreactors↗
PubMedDate not supplied

APA/HRSA National Faculty Development Scholars Program: community-based teaching track.

OBJECTIVES: Goals and objectives of the APA/HRSA National Faculty Development Scholars Program are described in a companion article in this supplement. Program objectives of the Community-Based Teaching Track were to 1) identify individuals with faculty development skills to serve as regional leaders, conducting local and regional workshops; 2) create a national network of leaders, thereby promoting sustainability; and 3) increase educational contributions of office-based preceptors. Participant objectives were to 1) meet expectations of the program; 2) possess knowledge, skills, and attitudes needed to recruit and retain community-based preceptors; 3) possess knowledge and skills needed to conduct faculty development workshops for practitioners; and 4) form local and national collegial networks. METHODS: Academicians and practitioners were selected to form 2 cohorts, starting in 1999 (N = 20) and 2000 (N = 22), respectively. Workshops were developed on the basis of projected needs and iterative needs assessments of the participants. Each participant was required to conduct workshops between meetings, first locally and then regionally or nationally. OUTCOMES: Forty-two participants conducted 307 workshops attended by 3815 individuals. Participants reported specific knowledge and skills gained from the program and increases in multiple areas of competence. Networks were formed, leading to collaborative regional and national presentations and formation of an APA Faculty Development Special Interest Group. Participants reported increased recruitment of training sites and preceptors, with enhanced relationships. CONCLUSION: Program and participant objectives of the Community-Based Teaching Track were met, including implementation of multiple new workshops, development of skills, and creation of a support network to enhance the sustainability of that success.

Ambulatory Care↗
PubMed1996

Cleveland clinic rotodynamic pump.

BACKGROUND: It is now accepted that 70% to 80% of patients with end-stage heart failure would benefit from a permanent implanted left ventricular assist device. Previously there was little consideration of the use of nonpulsatile pumps for this function. METHODS: An extensive 5-year engineering research and development program to develop a permanent implanted nonpulsatile blood pump has been undertaken. RESULTS: We have developed a continuous-flow blood pump of small size (207 g) and low power requirement (6.5 watts) producing 5 L/min flow with low hemolysis. CONCLUSIONS: This pump has the potential to be the basis of an innovative ventricular assist system.

Animals↗
PubMedDate not supplied

A new software for initiating and optimising insulin treatment of out-patients.

Two computer programs were developed, program I to optimise insulin treatment using six injections per day, and program II to convert these insulin profiles into less frequent injections of mixtures of regular and NPH insulin. The first software in an HP 41 CV pocket computer uses iterative adjustments during the day and on subsequent days to determine the optimal timing and dosage of insulin. Six self-monitored glucose values at 3 h intervals, insulin doses, and the effects of insulin on plasma glucose are memorised for calculations. The calculated insulin doses were applied by Optipen as five s.c. injections of regular insulin and one bedside injection of NPH insulin. After 5 days the optimised individual insulin profiles with six daily injections were processed by program II. It applies the pharmacokinetics of regular and NPH insulin to make suggestions for a more conventional insulin therapy with one, two, three or four daily injections of regular insulin, NPH insulin, or varying mixtures of both insulins. The procedure was well tolerated in eight insulin-dependent diabetes mellitus out-patients. Insulin therapy with two or three injections, fitted by the second program and selected according to the quality score, produced plasma glucose profiles as satisfactory as those obtained with six injections. The system allows the fine tuning of insulin therapy to out-patients with their individual diets and physical activities.

Adult↗
PubMed2006

A minimally invasive breast biopsy clinic: an innovative way to teach breast fellows how to perform breast ultrasound and ultrasound-guided breast procedures.

BACKGROUND: The ability to perform breast ultrasound and ultrasound-guided breast procedures are increasingly important skills for breast surgeons. Breast fellowship programs must develop programs to ensure adequate ultrasound training for breast fellows. METHODS: A Minimally Invasive Breast Biopsy Clinic was established at the Los Angeles County + University of Southern California Medical Center to provide breast fellows with comprehensive, hands-on, "live-patient" breast ultrasound training. RESULTS: From December 2004 though February 2005, 5 breast fellows received training in the Minimally Invasive Breast Biopsy Clinic. Each fellow received a minimum of 18 weeks of "live-patient" experience. Although the learning curve varied among the fellows, all showed proficiency in performing breast ultrasound and ultrasound-guided core biopsies by the 12th week. A total of 39 patients with fibroadenomas underwent 62 ultrasound-guided procedures, including 30 vacuum-assisted percutaneous excisions, 16 cryoablations, and 16 core biopsies. CONCLUSION: The Minimally Invasive Breast Clinic model provided breast fellows with sufficient "live-patient" experience to enable confident performance of breast ultrasound and ultrasound-guided breast procedures. The selection of patients with fibroadenomas facilitated safe and efficient training without interfering with the management of cancer patients.

Adult↗
PubMed2004

Food safety practices and readiness to implement HACCP programs in assisted-living facilities in Iowa.

OBJECTIVE: To evaluate current food-handling practices and employee food safety knowledge and attitudes and to provide baseline data for implementing the Hazard Analysis and Critical Control Point (HACCP) program in assisted-living foodservices for elderly persons. DESIGN: Food-handling practices were observed at each assisted-living facility using a structured observation form. A validated questionnaire was used to determine demographic information and employees' attitudes and knowledge about food safety. SUBJECTS/SETTING: A convenience sample of 40 assisted-living facilities in Iowa was recruited from a list obtained from the Iowa Department of Elder Affairs. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to summarize data. One-way analysis of variance was used to assess differences in attitudes and food safety knowledge among the managers, cooks, and other foodservice employees. Multiple linear regression determined the relationship between manager and facility demographics and the food safety practice score. RESULTS: Proper food-handling practices were followed in many assisted-living facilities, but areas in need of improvement were identified. Some HACCP prerequisite programs were found to be inadequate, including a lack of written standard operating procedures, documentation of food safety practices, and training. Temperatures and chemical concentrations need to be checked routinely. Foodservice employees had a significant amount of food safety knowledge (14.6+/-3.0 out of 20 possible points), and employees with food safety certification scored higher than those with no certification (15.6+/-2.6 and 13.9+/-3.1, respectively; P </=.001). CONCLUSIONS: Training programs, both basic food safety and the HACCP program, will support improvement of safe food-handling practices and implementation of prerequisite programs and the HACCP program. Developing prerequisite programs, including sanitation standard operating procedures, will aid assisted-living facilities in moving toward HACCP program implementation.

Adult↗
PubMed2003

Ruralising medical curricula: the importance of context in problem design.

The establishment of a new medical school in northern Australia, with its focus on preparing graduates to understand the health care needs of the regional population, has raised an interesting issue in problem design for teaching and assessing in an integrated curriculum. This issue is the extent to which the clinical content of a teaching or assessment problem should consider more subtle contextual issues that help to define the different roles played by rural practitioners, rather than what might be regarded as appropriate for "generic" medical education. This brief paper provides example case studies that highlight the challenge facing curriculum designers developing programs for rural clinical schools.

Australia↗