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PubMed2005

[Implementation of the multi-site Integrated Psychological Treatment (IPT) program for people with schizophrenia. Elaboration of renewed version].

Brenner's Integrated Psychological Treatment (IPT) program (Brenner et al., 1992 ; Pomini et al., 1998), a cognitive-behavioural approach, was implemented in nine of Quebec's clinical settings that treat people with schizophrenia. A study allowed an evaluation of the IPT program in each location, with emphasis on the level of satisfaction of both participants and professionals, the program's strong points, and areas where improvements were needed. The results have shown that the implementation of the program has been successful in all nine clinical settings. Professionals and participants appreciated the IPT program not only for its hierarchic structure that considers the rehabilitation needs of people affected by schizophrenia, but also for its customised application framework, which allows a regular follow-up of a similar group of patients over the course of a one year period. As a result of this study, the modifications proposed and additions have enabled the creation of a Quebec version of the IPT program, which better achieves its objectives, particularly those relating to the maintenance and generalisation of social learning in the context of a participant's real-life situation.

Delivery of Health Care, Integrated↗
PubMed1986

A multidisciplinary patient education workshop to integrate staff training with program development.

A four session multidisciplinary workshop was held to teach Veterans Administration (VA) Medical Center staff basic patient education design principles. During the sessions, staff, working in teams, designed patient education programs on a wide variety of health care topics. Guidance to teams was provided at each step of program development so that at the end of the workshop, programs were ready for implementation. Medical Center standards for patient education and documentation were integrated into program designs.

California↗
PubMed2001

Impact of an integrated adolescent reproductive health program in Brazil.

An impact evaluation of an integrated school- and health-clinic-based adolescent reproductive health initiative was undertaken by the State Secretariats of Health and Education in Bahia, Brazil during 1997-99. The project was initiated in response to continued high pregnancy rates among adolescents and growing numbers of new HIV infections among young adults. It sought to promote responsible sexual and health-seeking behaviors among public secondary-school students, including the use of public health clinics. The study design included a matched control group used to measure project impact. The findings indicate that the project was successful in increasing the flow of sexual and reproductive health information to secondary-school students and that it had an impact on adolescents' intentions to use public health clinics in the future. No effects on sexual or contraceptive-use behaviors or on use of public clinics were observed, however. Client exit-interview data from a subset of project clinics indicate that adolescents who use clinic-based services are overwhelmingly female and considerably older on average and much more likely ever to have been pregnant than are adolescents in the target population for the project.

Adolescent↗
PubMed2002

Enhancing Continuity of Care: Residency Training in an Integrated Inpatient--Partial Hospital Program.

This paper describes a teaching/service model that integrates inpatient, partial hospital, and intensive outpatient treatment. In this model, individual multidisciplinary treatment teams retain responsibility for a patient's care for any or all of three levels of intensity of services accessed during an episode of illness. This teaching/service model allows residents to follow patients for an average of 2.5 weeks across an entire acute episode of care compared with the 7.3 days of the average inpatient stay at the inpatient facility. The opportunity to continue treatment in step-down settings over longer periods of time allows residents and medical students to develop a fuller understanding of their patients. The authors believe that this continuum-care service model more efficiently trains residents in multiple aspects of psychiatric practice and provides patients with better care than the traditional inpatient-care service model.

Journal Article↗
PubMedDate not supplied

Integrating ophthalmological and optometric services in a VA hospital program.

Basic eye care has been available at the Veterans Administration Medical Center (VAMC), Northport, NY, for the past 20 years. The demand for these services increased as the mission of this medical center was broadened to include major medical and surgery services. Increased migration of veterans to Long Island and their subsequent aging further increased the demand for eye-vision care. Originally, primary eye-vision care was provided independently by optometry and ophthalmology services. There was unnecessary duplication of equipment and inappropriate utilization of providers. Consequently, the services provided were quite limited in scope and sophistication. Both patients and providers became disenchanted with this practice mode. In December 1983, the administration of the Northport VAMC approved the establishment of a coordinated eye-vision care program that integrates ophthalmological and optometric services in a matrix structure. Since the program became operational in April 1984, patient satisfaction has increased, the working relationships between optometrists and ophthalmologists have improved, the ophthalmology residency program has been upgraded, and the combined staff productivity has increased.

Consumer Behavior↗
PubMed2003

Ghrelin secretion in severely obese subjects before and after a 3-week integrated body mass reduction program.

Ghrelin, the endogenous ligand of GH-secretagogue receptors, has been implicated in the regulation of feeding behavior and energy balance. Aim of the study was to investigate ghrelin levels in fasting conditions and after a standard meal test in obese subjects before and after a 3-week integrated body weight reduction (BWR) program (consisting of energy-restricted diet, exercise training, psychological counselling and nutritional education). Weight, height, fat mass, fat free mass (by impedentiometry), circulating ghrelin, insulin and leptin levels were evaluated in 10 obese subjects (3 male, 7 female; mean age: 35 +/- 9.3 yr; body mass index BMI: 45.2 +/- 10.6 kg/m2) before and after weight reduction. At baseline, obese subjects showed significantly lower ghrelin levels than controls, which were negatively correlated with BMI, weight, insulin and leptin levels. Fasting ghrelin levels were not modified by standard meal test in obese subjects (from 110.8 +/- 69.7 to 91.8 +/- 70.2 pmol/l p=ns), while a significant reduction was observed in controls (from 352.4 +/- 176.7 to 199.0 +/- 105.2 pmol/l; p<0.01). After a 3-week integrated BWR program obese subjects significantly reduced weight, BMI and leptin levels, while no significant changes were found both in fasting ghrelin and in ghrelin response after the meal. In conclusion, 5% weight loss obtained after a short-term period of integrated BWR program is not sufficient to normalize fasting ghrelin levels nor to restore the normal ghrelin suppression after a meal in severely obese subjects.

Adult↗
PubMedDate not supplied

A model for integrating hepatitis C services into an HIV/AIDS program.

Service provision to persons with or at risk for hepatitis C (HCV) has become an important goal for local health departments across the nation. The shared routes of HIV and HCV, the high coinfection rate of HIV/HCV, and the lack of federal or state funding to support HCV programs are reasons for integrating hepatitis C screening and treatment services into existing HIV/AIDS programs. Such an integration of health services conserves resources. This article reviews the development and progress of a county public health department program's integration of HIV/AIDS and HCV services and provides recommendations for other HIV/AIDS programs that might be considering integration of HIV/AIDS and HCV services.

AIDS-Related Opportunistic Infections↗
PubMed1995

Integrating postgraduate pharmacy training programs into colleges of pharmacy.

An important issue facing colleges of pharmacy is the integration of postgraduate clinical training programs into the mainstream of pharmacy education. Colleges of pharmacy have a major role to play in postgraduate clinical training programs to the benefit of the college, resident, and institution. Students must be provided with information about residencies during their first year, and this information must be continually reinforced throughout their academic career. Residency and fellowship programs contribute significantly to the education of pharmacy students. Colleges must take an active role, working in partnership with institutions to enhance postgraduate pharmacy training programs.

Career Choice↗
PubMed1976

The University of Michigan integrated premedical-medical program.

The University of Michigan Medical School and the College of Literature Science and the Arts are now conducting a six-year program for recent high school graduates which integrates a liberal education and the work necessary for the M. D. degree. There is a single admission point in the spring for seniors in high school. Personal characteristics are heavily emphasized in the admissions process. A number of innovative course sequences have been developed for the program. A variety of evaluation studies are being conducted and will be available as they are completed.

Curriculum↗
PubMed2001

The TestSmart-HPV Program--development of an integrated approach for testing high production volume chemicals.

The TestSmart program was developed in response to the High Production Volume Chemical Challenge, a voluntary initiative under which chemical producers provide basic toxicity data on chemicals produced in greater than one million pounds annually. Specifically, under the Challenge, chemical producers will generate data as needed to complete the Screening Information Data Set (SIDS), as defined by the Organization for Economic Cooperation and Development (OECD). The TestSmart program is a collaborative effort of the Johns Hopkins Center for Alternatives to Animal Testing, the Environmental Defense Fund, Carnegie-Mellon University, and the University of Pittsburgh. The goal of the TestSmart program is to provide a humane and efficient approach to collecting SIDS data. The program has two objectives, one immediate and the other more long term. The immediate objective has been to make recommendations to reduce the number of animals used in collecting SIDS data under the Challenge. This was accomplished, through a group process, by examining the current status of alternative methods for SIDS endpoints and by providing an assessment of the "state of readiness" of current and potential future alternatives. The long-term objective is to provide a model for other programs to follow the TestSmart concept of a more efficient and humane approach to obtain toxicological data of interest to regulators and the public.

Animal Testing Alternatives↗
PubMed2002

Uniting security forces against risk.

Threats to your facility's physical and information security become more complex all the time. To create a truly effective security program, consider developing an integrated security program that encompasses both traditional and information technology protection. The result? A strong, streamlined program that enables--not inhibits--healthcare delivery.

Computer Security↗
PubMed2005

Changes in body composition, physical performance and cardiovascular risk factors after a 3-week integrated body weight reduction program and after 1-y follow-up in severely obese men and women.

OBJECTIVE: To investigate the short- and medium-term (ie, at 1-y follow-up) effects of a hospital-based body weight reduction (BWR) program lasting 3 weeks in severely obese individuals. DESIGN: Longitudinal, clinical intervention study entailing energy-restricted diet, tailored aerobic-strength exercise, psychological counselling and nutritional education during a 3-week period followed by 49 weeks of indirect supervision at home. SUBJECTS: In all, 45 women and 19 men aged 30.2 +/- 7.2 y (mean +/- s.d.) with severe obesity (BMI: 41.3 +/- 4.3 kg/m(2)), classified as weight losers (final < initial weight) and regainers (final> or =initial weight). INTERVENTIONS: Body composition, physical performance and cardiovascular risk factors before and after the BWR program and at follow-up. RESULTS: The large majority of the experimental subjects obtained a clinical success after the 1-y period, and the rate was higher in females (n = 37/45, ie, 82.2%) than in males (n = 11/19, ie, 57.9%). At follow-up, weight losers had higher percent fat-free mass, muscle strength, HDL-cholesterol and self-reported physical activity level and lower total cholesterol and glucose levels than weight regainers (P < 0.05-0.01). Males displayed significantly larger fat-free mass losses than females at post-BWR and at follow-up. CONCLUSIONS A 3-week hospital-based integrated BWR program resulted in a high rate of clinical success in severely obese individuals at 1-y follow-up (particularly in females), that was associated with increased levels of self-reported physical activity and improved muscle strength and lipid profile. Further research is needed to establish the long-term effects (ie, at 2-5 y) associated to this treatment.

Adult↗
PubMed2002

Mental health care and nutrition. Integrating specialist services into primary care.

PROBLEM BEING ADDRESSED: Primary care reform is an important component of health services restructuring. One of the goals of primary care reform is to integrate specialized services into primary care settings. To date, few programs have successfully achieved this. OBJECTIVE OF PROGRAM: To integrate specialized mental health services into the offices of family physicians through the Hamilton Health Services Organization (HSO) Mental Health and Nutrition Program. MAIN COMPONENTS OF PROGRAM: Since 1994, the Hamilton HSO Mental Health and Nutrition Program has integrated mental health counselors, psychiatrists, and dietitians into the offices of 87 family physicians. Activities of specialists are coordinated by a central administrative body. CONCLUSION: Lessons learned from this program can indicate how to succeed in integrating specialist services into primary care offices.

Delivery of Health Care, Integrated↗
PubMed2003

Changes of autonomic cardiac profile after a 3-week integrated body weight reduction program in severely obese patients.

The autonomic control of the heart is abnormal in obese subjects due to a prevalence of sympathetic over parasympathetic limb of the autonomic balance. We evaluated the effects of a short-term (3 weeks) integrated body weight reduction program (consisting of energy restricted diet and high-intensity exercise training) on heart rate variability (HRV) in severely obese, normotensive patients. The HRV was evaluated both in the time and frequency domain over a 18-hour Holter recording period obtained before and at the end of the third week. Three-week body weight reduction program reduced BMI (from 41.4 +/- 4.6 to 39.5 +/- 4.3 kg/m2, -4.6%, p<0.0001) and heart rate (from 77.8 +/- 8.6 to 73.6 +/- 8.7 b/min, p=0.0003). Significant changes in the autonomic profile were observed both in the time and frequency domain (SD of RR interval, SDRR: +16.1%; mean squared successive difference: (MSSD) +16.7%; percentage of RR intervals differing more than 50 msec from the preceding one, pNN50: +31.8%; low frequency oscillation, LF: +17.1%; high frequency oscillation, HF: +/- 18.2%). In conclusion, this study demonstrates that a short-term, integrated body weight reduction program is able to favorably modify the autonomic profile in a population of normotensive, severely obese subjects. The reduction of heart rate and the increase in parasympathetic activity may consistently contribute to a reduction of the risk of cardiovascular morbidity and of sudden cardiac death, still high in this patients' group.

Adult↗