Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Program Sustainability”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 991 records · Page 55Linked to original sources
PubMed1999

Community-based dental programs: University of Medicine and Dentistry of New Jersey-New Jersey Dental School.

The dental school plans to incorporate CODE into the curriculum so that more students have community-based dental educational experiences. Future plans also include increasing standardization of reports, clinical and administrative procedures, resources, and processes across the sites in order to lower managerial overhead. This process will be aided by further enhancement of computerized information systems and electronic links. The major lesson learned is that new extramural programs can be created and sustained by pooling school resources with those from the private and public sectors. Funding sources and opportunities available to one party alone are insufficient. While one-time funding was used to build and furnish the NJDS extramural sites, the clinics were established only after business plans demonstrated the availability of funds to sustain their operations. The Statewide Network of Community Oral Health Care and CODE models are still evolving, but they are replicable not only in dental education but in other types of health services. The details of the partnerships and funding streams will vary from site to site, but through outreach and careful negotiation with potential partners and detailed contracts, the community service and educational missions of a health professions school can have a successful outcome.

Community Dentistry↗
PubMed2001

[Sibutramine--antidepressive agent tested against obesity].

Eight European centers recruited 605 obese patients (BMI 30-45 kg/m2) for a six month period of weight loss with sibutramine (10 mg/d) combined with an individualized 600 kcal/d deficit. 467 (77%) patients with > 5% weight loss were then randomized to sibutramine (10 mg/day) and placebo groups over a further 18 months. Initially weight loss progressed to a total of -11.3 +/- 5.5 kg. After randomization the placebo group regained weight to -4.7 +/- 7.2 kg from baseline at 2 years; the sibutramine group only showed slight weight regain to -10.2 kg +/- 9.3 kg (mean group difference 5.5 kg, 95% C.I. 2.9, 8.1, p < 0.001). VLDL fell and HDL increased more than expected by weight loss. Twenty (3%) patients were withdrawn because of increases in blood pressure. This individualized management program achieves metabolically significant and sustained weight loss in 77% of obese patients.

Antidepressive Agents, Second-Generation↗
PubMed2002

[Professional formation and its accreditation in medicine. A paradigm to sustain public confidence].

Sustaining quality control of learning programs for health professions has become a central issue in university systems, under the pressure of an unexpected merging of new medical schools in Chile, during the last decade, and the massive arrival of other Latin American physicians. Accreditation of institutions and programs represents valid safeguards used in most countries where professional training processes take place. Due guarantee of its quality is required to assure proper health care to people. The authors provide specific arguments to support systematic evaluation and accreditation processes, as those introduced in our country to fulfill the requirements of a high level medical practice.

Accreditation↗
PubMed2002

Environmental water in a regulated river system: the Murrumbidgee River planning approach to the determination of environmental needs.

The major platform of the Council of Australian Governments (COAG) water reform program is the equitable and sustainable sharing of surface and groundwater resources between the environment and consumptive water users. In the regulated section of the Murrumbidgee River below Burrinjuck Dam, approximately 2,800 GL of the available surface water (4,300 GL) is diverted or extracted for irrigation uses in the Murrumbidgee Irrigation Area and Districts, and in the Coleambally Irrigation Area. Environmental flow rules have been developed for the Murrumbidgee which provide for an allocation of water to the environment but on the basis of no more than a 10% impact on farm-gate income of irrigation farmers. This provision limits the volume of water that can be used for environmental purposes, so the most effective use must be made of it. To identify and quantify the benefits to the environment of this limited additional volume of water and to determine the most effective use of the water, an "environmental spreadsheet matrix" has been developed. This paper outlines the development and use of the matrix in the planned implementation of flow regimes appropriate to the protection and enhancement of riparian and aquatic ecosystems and ecological processes.

Australia↗
PubMed2002

The American Hospital Quest for Quality Prize.

Improving the quality and safety of health care requires dedicated leadership and the involvement of everyone who affects care within an organization, from trustees and administrators to physicians, nurses and frontline staff. To honor organizations that have made exceptional improvements in quality and patient safety, the American Hospital Association, along with McKesson Corp. and McKesson Foundation, established The American Hospital Quest for Quality Prize: honoring leadership and innovation in patient care quality, safety and commitment. The award recognizes hospitals and health systems that have created measurable and sustainable quality and patient safety programs. Among other things, the organization must have a blame-free work environment and systems in place to help identify actual and potential adverse events and solutions to improve them. As the winner of the inaugural Quest for Quality Prize, Missouri Baptist Medical Center, Town and Country, Mo., received $75,000 to further its safety and quality efforts. Two finalists--Children's Hospitals and Clinics, Minneapolis/St. Paul, Minn., and Fairview Hospital, Great Barrington, Mass.--each received a $12,500 award. A Citation of Merit was presented to Brigham and Women's Hospital, Boston.

American Hospital Association↗
PubMed2002

[Social and economic impact of violence in the Americas].

Violence is a social and a public health problem that has grown in the Americas in recent decades that has negative effects on social, health, and the economy of countries, communities, families, and individuals. More than 115,000 people are murdered every year, the majority of them are men; other 55,000 commit suicide. In 20 to 60% of households some form of domestic violence against girls, boys, women, and the elderly occurs; juvenile gangs, involved in violent and criminal activities, increases at alarming rate. Other forms of violence are wars and internal or international conflicts, political violence, abductions, lynching, multinational violence by organized crime units involved in narcotic trafficking, sexual trade or smuggling of weapons. The public health approach is based on a methodology of work, as follows: 1. Characterization of the problem in its basic variables of person, place, time, circumstances, and related situations; 2. Identification of causes, associations, or risk factors; 3. Proposal of interventions and their evaluation; 4. Extension of the evaluated interventions. Violence is an intentional act of multicausal origin. Various factors are interconnected showing the relations among them. Those which have been primarily studied or that have shown greater evidence are discussed. A historical look is proposed, that integrates the repression and control, the prevention and the recovery of the social fabric. Violence demands an expenditure of money that represents a significant proportion of the GDP that was estimated in $168 billion dollars for Latin America. Violence can be prevented. Primary prevention projects are driven to avoid the occurrence of a violent act, but if it has already occurred it is necessary to avoid its repetition, through secondary prevention projects. Tertiary prevention is applied in order to avoid major damages; it aims at improving the quality of life of those already traumatized. The programs should be comprehensive and sustained in the medium and long terms. Finally, comments have been made on PAHO and WHO policies, in particular the recently launched World Report on Violence and Health, a working tool for violence prevention.

Americas↗
PubMed2005

Impact of restaurant hygiene grade cards on foodborne-disease hospitalizations in Los Angeles County.

Although health departments routinely inspect restaurants to assess compliance with established hygienic standards, few data are available on the effectiveness of these efforts in preventing foodborne disease. The study reported here assessed the impact on foodborne-disease hospitalizations in Los Angeles County of a restaurant hygiene grading system that utilized publicly posted grade cards. The grading systm was introduced in January 1998. Hospital discharge data on foodborne-disease hospitalizations were analyzed for Los Angeles County and, as a control, for the rest of California during the period 1993-2000. Ordinary least-squares regression analysis was done to measure the effect of the grading progam on these hospitalizations. After baseline temporal and geographic trends were adjusted for, the restaurant hygiene grading program was associated with a 13.1 percent decrease (p < .01) in the number of foodborne-disease hospitalizations in Los Angeles County in the year following implementation the program (1998). This decrease was sustained over the next two years (1999-2000). The results suggest that restaurant hygiene grading with public posting of results is an effective intervention for reducing the burden of foodborne disease.

Bacterial Infections↗
PubMed2006

Building an academic-community partnered network for clinical services research: the Community Health Improvement Collaborative (CHIC).

OBJECTIVE: Community-based participatory research is recommended for research on health disparities and to improve uptake of clinical research findings. We describe the development of a multicenter consortium designed to support a community agency-academic partner infrastructure to support community-based, health-services research on multiple sources of health and healthcare disparities in local communities. DESIGN: We describe the development of the Los Angeles Community Health Improvement Collaborative (CHIC). RESULTS: The CHIC partners examined the research capacity and health priorities of its partners and developed a research agenda focused on four tracer conditions (depression, violence, diabetes, and obesity) and four areas for development of research capacity: public participation in all phases of research; understanding community and organizational context for clinical services interventions; practical clinical services trial methods; and advancing health information technology for clinical services research. The partners pooled resources to develop these areas for the tracer conditions. CONCLUSIONS: The challenges of a participatory approach to community-based clinical services research go beyond the significant methodologic and operational issues for specific projects and include building a sustainable capacity for research, community programs, and partnership across diverse communities and stakeholder organizations even when funding sources are not fully aligned with these goals.

Community Participation↗
PubMedDate not supplied

PROMETHEUS payment: better for patients, better for physicians.

Although pay for performance is a positive development in the history of quality improvement in this country, it is generally accepted that most pay-for-performance programs do not offer a sustainable business model. PROMETHEUS Payment is a new approach to provider payment that is predicated on paying for the resources to be brought to bear to treat a patient for a condition in accordance with good clinical practice guidelines. It is explicitly designed to reduce the administrative burden on physicians in favor of improved care coordination and collaboration among providers without requiring them to financially integrate or take insurance risk.

Humans↗
PubMed1990

[Frequency of the onset of supraventricular tachyarrhythmias as a function of underlying heart disease].

The prevalence of inducible ventricular arrhythmias is related to the underlying pathology. This study was undertaken to determine the prevalence of supraventricular tachyarrhythmias (SVT), atrial tachycardia, flutter or fibrillation, sustained for over 30 seconds. Programmed atrial stimulation was used to deliver 1 or 2 extrastimuli during sinus and paced rhythm in 230 subjects without obvious cardiac disease (149 without and 81 with spontaneous SVT) and 432 patients with documented cardiac pathology (407 without and 25 with spontaneous SVT). The incidence of inducible SVT with respect to that of spontaneous SVT and in relation to cardiac pathology was as follows: (table; see text) The prevalence of inducible SVT in patients without spontaneous SVT was related to the type of pathology: (table; see text) These results show that in patients with spontaneous SVT the induction of the arrhythmia was facilitated by the presence of underlying cardiac pathology (sensitivity increasing from 67% to 88%). In patients without spontaneous SVT, the nature of the underlying disease was related to the prevalence of inducible SVT, the risk being major in SA block, right ventricular dysplasia and mitral valve prolapse (60-80%) and moderate in dilated CMP and myocardial infarction (35 to 40%).

Adult↗
PubMed1978

Public beliefs about causes and prevention of heart attacks.

Interviews with a probability sample of 617 adults in the Chicago area indicated widespread lack of information about major probable causes of heart attacks in persons younger than 60 years: 28% named cigarette smoking, 21% named high blood pressure, and 13% named cholesterol or fat in the diet or blood. Half did not name any of these risk factors, and only 1% named all three. Although three fourths believed that heart attacks are preventable, few named specific behaviors that would effectively reduce risk factors other than smoking. Sustained community-wide educational programs about reducing coronary risk factors are clearly needed and can be effective.

Adult↗
PubMed1982

Disuse and aging.

A review of biologic changes commonly attributed to the process of aging demonstrates the close similarity of most of these to changes subsequent to a period of enforced physical inactivity. The coincidence of these changes from the subcellular to the whole-body level of organization, and across a wide range of body systems, prompts the suggestion that at least a portion of the changes that are commonly attributed to aging is in reality caused by disuse and, as such, is subject to correction. There is no drug in current or prospective use that holds as much promise for sustained health as a lifetime program of physical exercise.

Aged↗
PubMed1994

[Assessment of the autonomic nervous system after infarction and its prognostic significance].

Recently there has been increased interest in the analysis of heart rate variability (HRV) and baroreflex sensitivity (BRS) for postinfarction risk stratification. HRV and BRS are decreased in patients following myocardial infarction and both a reduced HRV and a depressed BRS identify a subgroup at higher risk of cardiac mortality and arrhythmic events. In a large trial of post-myocardial infarction patients the relative risk of mortality was 5.3 times higher in the group with depressed HRV (standard deviation of normal RR intervals over 24 hour recordings < 50 ms) than in the group with preserved HRV. These findings were later confirmed by both time domain and power spectral analysis of HRV. The predictive value of depressed HRV was found to be independent of other established risk predictors including other Holter features and left ventricular ejection fraction. By testing reflex vagal activity, in a series of 78 patients recovering from a first myocardial infarction, the risk of death increased more than 15 times in the presence of a markedly depressed BRS (< or = 3 ms/mmHg). In a subsequent study BRS was found to be the most significant predictor of induction of sustained monomorphic ventricular tachycardia at programmed electrical stimulation. BRS seems to be more valuable than HRV in the prediction of arrhythmic events by providing a relative risk four times greater than HRV to accurately predict inducibility to ventricular tachycardia. Additional data have shown that BRS but not HRV did clearly separate postinfarction patients with aborted sudden death from similar patients without ventricular tachycardia or fibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)

Autonomic Nervous System↗
PubMed1993

The influence of the Occupational Safety and Health Administration on infection control practice.

Beginning with the Occupational Safety and Health Administration's (OSHA) activities to enforce the Centers for Disease Control (CDC) and Prevention guidelines on Universal Precautions in 1987, this agency has had a direct and sustained impact on infection control programs. This article details how OSHA works, the OSHA inspection process, the bloodborne pathogens standard, current promulgation activities, other OSHA standards, OSHA reform, and the future of this agency.

Facility Regulation and Control↗
PubMed1995

[Atrial electrophysiological study of unexplained ischemic cerebrovascular disorders].

The aim of this study was to search for the presence of atrial vulnerability by programmed atrial stimulation in patients with unexplained ischaemic cerebrovascular strokes and to evaluate the effects of intravenous flecainide acetate on the electrophysiological parameters and on the induction of atrial arrhythmias. Thirty-eight patients (20 men, 18 women) with a mean age of 38.4 +/- 11 years were investigated. Programmed atrial pacing triggered a sustained (> 1 min) atrial arrhythmia with 1 or 2 extrastimuli in 23 of the 38 patients (61%), in these patients, there was a significant shortening of the effective refractory periods (ERP: 193 +/- 23 vs 218 +/- 30 ms; p < 0.02) and of the functional refractory periods (FRP: 228 +/- 25 vs 253 +/- 27 ms; p < 0.01) with lengthening of the A2 auriculogramme (99.7 +/- 22 vs 76.1 +/- 16 ms; p < 0.05). A combined study of the refractory periods and conduction defects provides a means of calculating an index of latent vulnerability which is greatly shortened when an atrial arrhythmia is induced (2 +/- 0.5 cm vs 3 +/- 0.6 cm; p < 0.001). Atrial arrhythmias could not be initiated after intravenous 3 mg/kg of flecainide acetate in 4 subjects (17%) with initially positive atrial stimulation tests. This study confirms the high frequency of atrial vulnerability in patients with unexplained ischaemic cerebrovascular strokes. In their population, the authors observed a low efficacy of flecainide acetate in the prevention of reinduction of atrial arrhythmias. The indication of long-term antiarrhythmic drugs in these patients are questionnable and should be assessed by a prospective long-term multicentre trial.

Adult↗
PubMedDate not supplied

Estimation of breast cancer risk by women aged 40 and over: a population-based study.

OBJECTIVE: Identify factors associated with knowledge of breast cancer and estimation of risk. METHODS: Telephone survey of 412 women aged 40 and over, living in Montreal and selected by random digit dialing. RESULTS: The majority of the respondents had recently been exposed to some information on breast cancer, but only a third quoted the average lifetime probability estimate of about 1 in 10. Older individuals systematically considered themselves at low risk (odds ratio (OR) of perceiving risk as lower than average for women aged 50 or over versus under 50: 2.6, 95% confidence interval: (1.5, 4.6)). In addition, both a first-degree family history of breast cancer (OR: 5.3 (1.7, 17.0)) and a recent mammogram (OR: 3.0 (1.4, 6.2)) were strongly associated with a woman's probability of perceiving herself at high risk. CONCLUSIONS: Information campaigns should emphasize the frequency of breast cancer in different age groups and the strength of the established associations with specific risk factors. Better knowledge of risk could promote sustained participation in breast screening programs.

Adult↗
PubMed1994

Response to sotalol predicts the response to amiodarone during serial drug testing in patients with sustained ventricular tachycardia and coronary artery disease.

UNLABELLED: It was analyzed whether the response to sotalol can predict the response to amiodarone as evaluated by programmed ventricular stimulation in 30 patients with coronary artery disease and documented recurrent sustained ventricular tachycardia (VT). Programmed ventricular stimulation was performed using 1 or 2 extrastimuli during sinus rhythm and 4 drive cycle lengths at 2 right ventricular sites. If no ventricular tachyarrhythmia was induced, a third extrastimulus was introduced during a paced cycle length of 500 ms. During the control study, VT (mean cycle length 305 +/- 63 ms) was induced in all patients, and the right ventricular effective refractory period (during S1-S1 = 500 ms) was 223 +/- 12 ms. After sotalol, sustained and nonsustained VT were inducible in 22 (73%) and 7 (23%) patients, respectively. One patient did not undergo stimulation on sotalol, because of side effects. After amiodarone, sustained and nonsustained VT were inducible in 23 (77%) and 7 (23%) patients, respectively. The mean cycle length of the induced VT was prolonged after both drugs by 17% (p < 0.001). The effective refractory period was prolonged by 15% (p < 0.001) after sotalol and by 13% (p < 0.001 compared with baseline study; p = NS between both drugs) after amiodarone. Thus, concordant results (effective or ineffective drug) between sotalol and amiodarone were found in 26 patients (87%). IN CONCLUSION: (1) The effects of sotalol and amiodarone on the cycle length of induced VT and on right ventricular effective refractory period were similar; and (2) inability to suppress VT by amiodarone can be predicted from the response to sotalol.(ABSTRACT TRUNCATED AT 250 WORDS)

Amiodarone↗