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PubMed2005

Person Focused Training: a model for delivering positive behavioural supports to people with challenging behaviours.

BACKGROUND: Person Focused Training is introduced as a model of service delivery for people with severe challenging behaviours. It is defined as training and supporting staff to conduct functional assessments and to design and implement positive behavioural support for specific individuals with challenging behaviours. METHOD: Longitudinal outcome data are presented from 138 behaviour support plans developed by staff over a seven year period were analysed to determine reductions in frequency of challenging behaviours. Degree of behaviour change was determined across topography of behaviour, gender, age, level of disability, location of residence and role of course participant. RESULTS: Results indicate that the implementation by staff of behaviour support plans are associated with significant improvement in 77% of cases at an average follow-up of 22 months after implementation of support plans. Only location of residence was identified as related to reduction in challenging behaviours with large residential centres being associated with lower rates of behavioural improvement. CONCLUSIONS: It is argued that Person Focused training may represent an alternative to existing models of supporting individuals with challenging behaviours. The implications of front-line staff designing and implementing behaviour support plans for the organisation of services and the role of the clinical psychologist are considered.

Adult↗
PubMed1997

Regulatory issues for evaluation of therapies to prevent or arrest disease progression.

The Federal Food Drug and Cosmetic Act gives authority to the US Food and Drug Administration (FDA) to regulate foods, human and veterinary drugs, biological products, and cosmetics which are to be introduced into interstate commerce. The approval of pharmaceutical products for the treatment and/or prevention of periodontal diseases requires presentation of evidence that supports the safety and efficacy of the particular drug therapy in question. Sponsors need to carefully consider each step in the overall development plan beginning with an Investigational New Drug Application and concluding with submission of a New Drug Application for pre-market approval. This paper focuses specifically on the design, conduct, and analysis of clinical trials of drugs for the prevention or treatment of periodontal diseases. It is based upon a guidance document under development at the time of this presentation by FDA's Center for Drug Evaluation and Research that will include separate chemistry, toxicology, and biopharmaceutics sections. Unlike more formal FDA guidelines, a guidance document can be more easily and regularly updated to reflect changes in the state of the art of periodontal diagnosis and treatment.

Clinical Trials as Topic↗
PubMed1996

Status and strategic plans for fluoridation: Centers for Disease Control and Prevention perspective.

This paper summarizes the current status of water fluoridation in the United States and discusses the strategic plan developed by the Division of Oral Health (DOH), Centers for Disease Control and Prevention (CDC) to meet the Healthy People 2000 fluoridation objective. This objective proposes to: "Increase to a least 75 percent the proportion of people served by community water systems providing optimal levels of fluoride (baseline: 62% in 1989)." The CDC strategic plan defines the nature of the problem with attainment of this objective, sets CDC priorities, and establishes six major components for future action: (1) assessment, evaluation and surveillance; (2) consultation; (3) state and regional efforts; (4) professional education and involvement; (5) public education; and (6) quality assurance. Actions in each of the components of the plan to help in the attainment of priorities are detailed. Finally, the broader picture of the federal role in a national fluoride plan is discussed.

Cariostatic Agents↗
PubMedDate not supplied

Outcomes: are they a good thing?

One of the current buzzwords for health care these days is outcomes. Everyone, including payers, is attempting to evaluate the quality of care provided by the outcomes achieved. Outcomes can help the caregiver and the client determine if the appropriate care is being provided; identify if changes need to be made in the care plan; develop a mechanism to discuss effects of care that are understood by all health providers; demonstrate to the client the health care they have received, in a fashion that makes sense to them; and document nursing interventions that are most effective. Outcomes can be the basis for quality improvement and can assist in discharge planning. They also help in evaluating the organization's overall performance. As Martha Stewart would say, "It's a good thing."

Continuity of Patient Care↗
PubMedDate not supplied

[Relations between population, development, and poverty, according to Mexican university professors].

"With data from a survey applied to random samples of university professors in seven Mexican cities during the late eighties, this article examines professors' opinions on the relations between population, development, and poverty. After reviewing tendencies and arguments on population and development found in [the] literature, it provides three simple typologies of population consciousness, poverty determinants, and best economic development plans for the country. It then studies their relations, and concludes by outlining the type of reasoning in each of the main orientations detected by the analysis." (SUMMARY IN ENG)

Americas↗
PubMed1997

Considerations for toxicology studies of respiratory drug products.

The standard approaches for the preclinical development of chronically administered drugs also apply to most respiratory drugs. Modifications from the standard preclinical development plan, however, may be necessary if the drug is administered intranasally or by inhalation. Administration by these routes may result in airway toxicity and the intended patient population is often particularly susceptible. Current and former representatives of the Division of Pulmonary Drug Products (CDER, U.S. FDA) present this article to describe general principles of preclinical development for respiratory drug indications. The article addresses drugs intended for administration by the intranasal or inhalation routes. The article describes the types of studies recommended, considers the initial human dose, and discusses dose-escalation strategies in clinical trials. Other areas of special concern with intranasal or inhalation administration include immunotoxicity, reproductive toxicity, types of dosing apparatus, excipients and extractables, and formulation changes. The approaches described in this article are intended as general information and should be adapted to the scientific considerations and circumstances of a particular drug under development.

Humans↗
PubMedDate not supplied

Technical assistance offered to community health programs through a resource model.

A multidisciplinary unit in the Department of Community Medicine, Mount Sinai School of Medicine, consists of a core group of specialists who plan, develop, and evaluate community health care programs. The primary tools used by the staff of the Services Coordination Unit, epidemiology and behavioral and management sciences, result in improved organization and coordination of health services and community resources. The small unit of specialists functions as a resource group, helping community groups address the complex problems of planning, organization, delivery, and financing of health services. By offering technical assistance rather than day-to-day health care services, the unit has established an education and training program in New York's East Harlem, which surrounds the medical school. Over the last 10 years, that approach has enhanced the administrative and financial viability of existing health programs in East Harlem. Since the unit's establishment, it has collaborated with a broad variety of community groups. More than 20 programs have resulted. The income generated by the unit completely covers the expenses and has done so since 1976; "seed money" was used for startup and the first 3 years of operation. The unit is paid for long-term services and for most consultations.

Community Health Services↗
PubMed1981

Content analysis: an approach to evaluating nutritional care.

A research panel utilized content analysis techniques for quantifying the content of nutritional care plans developed by senior level dietetic students. The content was organized into six subject matter categories relevant to sociocultural and physical factors: cultural, economic, physical, psychological, religious, and social. The average score of six coders was used in determining the content. Content analysis proved to be an effective method of evaluating the content of nutritional care plans and could be further utilized in dietetic education to help dietetic students apply the theories learned in the classroom to actual patient care.

Diet↗
PubMedDate not supplied

Using the resource utilisation system to analyse cross boundary flow of patients.

The need for information in respect of the treatment patterns of cross boundary flow patients is of increasing importance to hospital managers. Until recently, detailed information as to services being utilised by such patients and the costs involved, have not been available. Using RUS to build specific patient clinical/costing profiles now provides the information that management requires to: determine services and resources being utilised; identify the patient's Board of origin; assist in long-term service planning; develop new service budgets and determine the impact upon existing budget allocations; anticipate the impact on new services.

Catchment Area, Health↗
PubMed2006

The development of national competency standards for the midwife in Australia.

OBJECTIVE: to develop and validate national competency standards for midwives in Australia. This study was part of a commissioned national research project to articulate the scope of practice of Australian midwives and to develop national competency standards to assist midwives to deliver safe and competent midwifery care. DESIGN: a multi-method, staged approach was used to collect data through a literature review, workshop consultations, interviews, surveys and written submissions in order to develop national competency standards for Australian midwives. Subsequently, direct observation of practice in a range of settings ensured validation of the competencies. SETTING: maternity-care settings in each state and territory in Australia. PARTICIPANTS: midwives, other health professionals and consumers of midwifery care. FINDINGS: The national competency standards for the midwife were developed through research and consultation before being validated in practice. KEY CONCLUSIONS: the national competency standards are currently being implemented into education, regulation and practice in Australia. These will be minimum competency standards required of all midwives who seek authority to practise as a midwife in Australia. It is expected that all midwives will demonstrate that they are able to meet the competency standards relevant to the position they hold. IMPLICATIONS FOR PRACTICE: the competency standards establish a national standard for midwives and reinforce responsibility and accountability in the provision of quality midwifery care through safe and effective practice. In addition, individual midwives may use the competency standards as the basis of their ongoing professional development plans.

Australia↗
PubMedDate not supplied

Immune modulator studies in primates: the utility of flow cytometry and immunohistochemistry in the identification and characterization of immunotoxicity.

Exposure to natural environmental products, biopharmaceuticals, or investigational adjuvants has the potential to negatively impact the immune system, resulting in either up- or downregulation of immune function (immunomodulation). Many current protocols for primate toxicologic testing call for the evaluation of changes in immune cell number (peripheral blood or tissue), alterations in the weights of immune system organs (lymph nodes, spleen, thymus), and/or increases in the overall incidence of infections or neoplasms; these data are relied upon to suggest altered immune function. However, these are informative only when clear differences in frequency and/or severity of effects can be distinguished across control and dosed groups. In the absence of such distinct morphologic or clinical pathologic changes, the identification of potential immunomodulatory effects can present a much greater challenge. Additional evaluations may be needed to detect altered immune system integrity; these are based on in vivo assessments in primates of cellular or humoral responsiveness. Immunomodulatory effects can be characterized by in vitro or in vivo immune function tests: these tests require prestudy planning to integrate assessments into ongoing toxicology programs. These methods also involve specialized training and equipment, particularly if the intent is to evaluate parameters in a GLP laboratory setting. In primate toxicology, the added costs required to perform a complete functional analysis of the immune system can be substantial, but may be warranted depending on the clinical development plans. Two analytical methods that are easily incorporated into the standard toxicology profile in primates are flow cytometry and immunohistochemistry. Flow cytometry (FC) is used to assess changes in the relative distribution of immune cell marker expression, and where marker expression is known to fluctuate with the state of cell activation, can also provide information on functional attributes of immune cells. Immunohistochemistry (IHC) provides a means to evaluate similar characteristics of immune cells within tissue sections. Used together, FC and IHC can aid in the identification of changes in immune system that may not be apparent by traditional testing procedures (such as H&E staining), thus aiding in the characterization of immune system alterations. This presentation focused on the utility of flow cytometry and immunohistochemistry in a standard primate toxicology evaluation, with representative examples showing the benefits of these technologies in the diagnosis of potential immunomodulatory effects.

Adjuvants, Immunologic↗
PubMed1985

Channelling, a new immunization strategy.

In 1981, with PAHO/WHO technical assistance, the Ministry of Health, Colombia, designed what is known as the channelling strategy, aimed at improving immunization coverage. This name was given because the strategy is designed to establish communication channels through direct action aimed at promoting health. Health workers and community leaders or guides conduct household visits to identify unvaccinated children or those with incomplete vaccination schedules and "channel" them to health centers or health posts. The channelling strategy developed in Colombia was briefly mentioned in the case study on the Colombian Vaccination Crusade of 1984. It is now being employed for ORT and other PHC components in the Colombian Child Survival and Development Plan, 1985-1987. In the meantime, other countries have adopted the channelling strategy, which is described in this article.

Americas↗
PubMed2000

Dosimetric comparison of pre-planned and or-planned prostate seed brachytherapy.

PURPOSE: To compare the dosimetry of the traditional two step procedure (volume study + treatment planning several weeks later) with that of an OR-based single procedure in which these two steps follow one another immediately. Computer generated treatment plans were used in both procedures. METHODS AND MATERIALS: Several dosimetric parameters relating to target coverage were obtained from dose volume histograms of CT-based evaluation plans developed either 1 or 3 days following seed implantation. A total of 113 patients with early stage (T1C, T2A) prostate cancer were used for this retrospective study. RESULTS: The fraction of target (prostate) covered by the prescription dose (144 Gy), 90% of the prescription dose (115 Gy), and the dose encompassing 90% of the target in the evaluation plan were all statistically significantly improved for OR-based plans compared to pre-planned cases. CONCLUSION: In our hands, there is a small but significant improvement in dose coverage of the prostate when the ultrasound volume study and treatment planning are combined into a single procedure.

Brachytherapy↗
PubMed1993

A community wide promotion of asthma self management: process evaluation.

AIMS: During the months February through July 1991, a community wide promotion of asthma self-management was undertaken as a pilot study for the national launch of an asthma action plan developed by the Asthma Foundation of New Zealand in conjunction with the Royal New Zealand College of General Practitioners. METHODS: A multidisciplinary team of hospital and community-based health workers was established, with the aim of educating and resourcing general practitioners, practice nurses and retail pharmacists to enable them to effectively promote and distribute the asthma action plan. 332 general practitioners and 148 retail pharmacists were surveyed through postal and telephone questionnaires at the completion of the promotion, to assess its impact on health professionals and to obtain feedback for the national promotion of the asthma action plan. RESULTS: 108 (73%) of pharmacists who responded and were involved with the promotion found their participation to be worthwhile, although some had difficulty allocating sufficient time to give detailed advice to patients. Of the 240 general practitioners who responded, 77% indicated that they had used the asthma action plan with their patients. They were positive about the use of the workshop format that had provided education and resources for the plan, and of those that had used the plan, 94% indicated that they would continue to promote the plan, or one similar. CONCLUSIONS: The promotion of the asthma action plan in Canterbury had a major impact on health professionals. The community-wide promotion might have had a greater impact on people with asthma had television advertising been used. The pilot project provided useful feedback for the Asthma Foundation in their preparation for the national launch.

Asthma↗
PubMed1975

Food for all.

Ensuring food for all requires an interdisciplinary approach, an evaluation of all sectors of the economy and the formulation of objectives which include proper nutrition in overall development plans. It is my contention that the introduction of nutrition priorities at this level, complemented with the traditional immediate and short-term measures of food aid, nutrition programmes, health campaigns and nutrition education will do much to alleviate the world's food problems. Priorities must be defined, planning structures strengthened, and politicians convinced that objectives can be reached. Otherwise, meagre resources will continue to give low priority to agriculture and social reform and we will have accomplished little toward our objective of food for all.

Agriculture↗
PubMed2006

Marketing the gastrointestinal practice: strategic considerations.

The health care marketplace is changing rapidly with increasing competition, changing reimbursement, and greater shifting of cost to patients making them more price sensitive. To be financially viable, the successful gastrointestinal practice must be more market responsive in its approach to planning, develop a unique advantage that will be of value to referral sources, and understand how customers evaluate alternative competing practices. This article focuses on these elements of practice success.

Gastroenterology↗
PubMed1977

Management by objectives for the dental office.

Management by objectives is a better way to run a dental practice. The required planning will take additional time in the initial stages but can save a great deal of time in the long run. The major requirement is the establishment of specific measurable objectives over a defined period of time. Encouraging your staff to participate whenever possible will result in better objectives, more commitment, and greater motivation. By stating where you want to go and developing plans to reach this destination, you will be able to work smarter and not harder.

Dental Assistants↗