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PubMed2001

Establishing an endovascular abdominal aortic program--decisions, decisions, decisions: The London Health Sciences Centre experience.

The endovascular repair of abdominal or thoracic aortic aneurysms is an alternative approach to conventional repair in the compromised patient. Although the long-term efficacy of these procedures has yet to be proved, there is growing interest among vascular surgeons and interventional radiologists throughout North America and Europe in the more frequent use of this technique. Starting an endovascular program necessitates extensive cooperation of the interdisciplinary vascular team. Decisions regarding patient selection, equipment, supplies, staff education, and the location of the procedure must be based on sound principles. This article demonstrates how a program can be planned, implemented, and evaluated by the use of a "decision tree." The experience of the London Health Sciences Centre will be used as a benchmark in the discussion of relative merits of branch points in program development. The article gives persons contemplating a program a structured process in decision making to avoid potential pitfalls.

Angioplasty↗
PubMed2004

An incentive compensation system that rewards individual and corporate productivity.

INTRODUCTION: An economically mature health care market has led to increased cost competition. Subsequently, a perceived need for productivity-based physician compensation has developed. While some institutions have rewarded individual productivity based on specific facets of academic responsibility, such as teaching, research, and patient care, we chose to develop an incentive compensation system that rewards both individual and group productivity. PROGRAM DEVELOPMENT: We developed a physician incentive compensation system that rewards individual and group productivity by capturing multiple aspects of work activity. Faculty members are given compensation value points for clinical productivity, scholarship activities, teaching activities, service activities, and achievement of the department's goals. The system was implemented in a graduated fashion in the Department of Family Medicine at Indiana University beginning July 1, 2000. PROGRAM EVALUATION: In April 2003, all faculty physicians (n=18) participated in a survey about the compensation system. The majority of faculty view the system as a necessity for the department (72.2%); 35.2% were satisfied with the system overall; 35.3% were neutral; and 27.4% were dissatisfied or not sure of their overall satisfaction. CONCLUSIONS: A comprehensive physician incentive compensation system incorporating department goals can be designed and implemented in an academic setting.

Academic Medical Centers↗
PubMed2003

Challenges and opportunities in establishing and maintaining newborn screening systems.

Newborn screening began in the early 1960s and during the four decades it has existed, has become a recognized vital public health prevention program. It has evolved conceptually from a laboratory test for a single disorder, phenylketonuria, to a comprehensive 6-part public health system of education, screening, follow-up, diagnosis, management, and evaluation. Newborn screening in different countries has been successful because of the efforts of a single individual or group of individuals interested in improving the health of children. Newborn screening has been shown to successfully detect serious disorders before symptoms appear and to significantly reduce the morbidity and mortality that might result if left undetected and untreated, yet there have been (and continue to be) obstacles to implementing newborn screening programs. The obstacles are the same for developed or developing programs and include: (1) adequate financing, (2) technology implementation, (3) program logistics, (4) cultural sensitivity, (5) education, and (6) political support. All newborn screening programs must exist within the limitations of their local environment in this regard. Each program confronts these barriers in its own way and various examples of overcoming barriers are discussed including linkages to immunization programs, regional planning, program advocacy, and legislation.

Global Health↗
PubMed1991

Characteristics of older adult learners: a guide for dietetics practitioners.

Characteristics of older adult learners are described and related to program development, implementation, and evaluation. The framework for designing learning experiences consists of four steps: assessment of the needs of the learner; development of learning objectives and determination of content; selection and implementation of appropriate learning activities; and evaluation of the results of learning. Four major assumptions about older adult learners are discussed based on a model designed specifically for adult learners. Active involvement through self-administered questionnaires, interviews, or focus groups helps ensure that nutrition education programs are responsive to the older adult's needs. Age-related changes (ie, in senses of sight and hearing, reaction time, and memory) and psychologic and social changes (ie, loneliness, depression, illness, financial difficulties, or loss of a loved one) may occur in many older learners and need to be considered when selecting appropriate learning activities. A single approach to nutrition education is unlikely to meet the needs and preferences of all older adults. To maximize their effect as educators, dietetics practitioners need to adjust their teaching styles and program development strategies to better fit the characteristics of older adult learners.

Aged↗
PubMed1977

[Education: a theme in gerontology (author's transl)].

The paper presents a review of the history of educational gerontology ("andragogy" or "gerontagogy") which has a special role within the field of gerontology. Whereas gerontological sciences such as biology, medicine, psychology, and sociology in (frequently interdisciplinary) approaches study the process of aging, educational gerontology makes use of the findings of these research areas, intending to influence the process of aging. There is a need for education in old age - provided this is not restricted to the acquisition of knowledge and skills or the extension of academic training into old age. It is stressed that an offer of "education for the aged" or even of "help for the life in age" very ofter is rejected by old people as they are induced to feel incompetent when invited to school and training courses of that kind. Future "gerontagogy" will have to notice and to respect resistance of that kind and will have to endeavour to increase the motivation to learn in old age in adequate ways. A first goal of educational gerontology should be to develop programs going beyond those developed for children and realized in traditional institutions of pedagogy. Referring to results of differential gerontology programs for "educating" and "stimulating" aged persons will have to be rather variable to fit individual goals and motivations of the old. The differential approach necessary to meet individual and rather specific demands will require a more thorough "training of trainers" than is realized today in the Federal Republic of Germany.

Age Factors↗
PubMed2004

The Ontario Cardiac Rehabilitation Pilot Project: Recommendations for health planning and policy.

BACKGROUND: Expansion of cardiac rehabilitation (CR) could save both lives and costs by reducing illness and use of health care services. In February 2001, the Ontario Ministry of Health and Long-Term Care (the Ministry) announced a pilot project (the Pilot) to implement and evaluate a comprehensive, multifactoral model of CR service delivery at 17 centres across Ontario. OBJECTIVES: To design, coordinate and evaluate a coordinated model of CR service delivery, and to collect and evaluate an extensive set of clinical and administrative data. METHODS AND RESULTS: The Pilot was a large, province-wide observational investigation of a health service delivery model for CR and secondary prevention care. The present paper is the third in a three-part, policy-related series. In the present paper, the results of the evaluation of the service delivery model and the final health policy recommendations that were made to the Ministry in September 2002 are presented. CONCLUSIONS: Within approximately one year, 4922 patients were enrolled in the Pilot at participating sites throughout Ontario; 88% of sites implemented all elements of the comprehensive services model, either on-site or through internal/external partnerships, and 94% of sites implemented the multidisciplinary Pilot staffing model. Based on this rapid and near-total implementation of the Pilot model, it was concluded that the Pilot model of care was generalizable. Furthermore, regional coordination was achieved through operationalization of the coordinating centres' roles in quality management, regional planning and program development, education and outreach.

Cardiac Rehabilitation↗
PubMedDate not supplied

A train-the-trainer model for integrating evidence-based medicine training into podiatric medical education.

This article presents the development, implementation, and evaluation of a national evidence-based medicine faculty-development program for podiatric medical educators. Ten faculty members representing six accredited colleges of podiatric medicine, one podiatric medical residency program, and a Veterans Affairs podiatry service participated in a 2-day workshop, which included facilitated discussions, minilectures, hands-on exercises, implementation planning, and support after the workshop. Participants' evidence-based medicine skills were measured by retrospective self-reported ratings before and after the workshop. Participants also reported their implementation of "commitments to change" on follow-up surveys at 3 and 12 months. Participants' evidence-based medicine practice and teaching skills improved after the intervention. They listed a total of 84 commitments to change, most of which related to the program objectives. By 12 months after the workshop, participants as a group had fully implemented 24 commitments (32%), partially implemented 36 (48%), and failed to implement 15 (20%) of a total of 75 commitments with follow-up data. The most common barriers to change at 12 months were insufficient resources, systems problems, and short patient visit times. A train-the-trainer faculty-development program can improve self-reported evidence-based medicine skills and behaviors and affect curriculum reform at podiatric medical educational institutions.

Curriculum↗
PubMed2006

Establishment of the major compatibility complex-dependent development of CD4+ and CD8+ T cells by the Cbl family proteins.

Casitas B cell lymphoma (Cbl) proteins are negative regulators for T cell antigen receptor (TCR) signaling. Their role in thymocyte development remains unclear. Here we show that simultaneous inactivation of c-Cbl and Cbl-b in thymocytes enhanced thymic negative selection and altered the ratio of CD4(+) and CD8(+) T cells. Strikingly, the mutant thymocytes developed into CD4(+)- and CD8(+)-lineage T cells independent of the major histocompatibility complex (MHC), indicating that the CD4(+)- and CD8(+)-lineage development programs are constitutively active in the absence of c-Cbl and Cbl-b. The mutant double-positive (DP) thymocytes exhibited spontaneous hyperactivation of nuclear factor-kappa B (NF-kappaB). Additionally, they failed to downregulate the pre-TCR and pre-TCR signaling. Thus, our data indicate that Cbl proteins play a critical role in establishing the MHC-dependent CD4(+) and CD8(+) T cell development programs. They likely do so by suppressing MHC-independent NF-kappaB activation, possibly through downmodulating pre-TCR signaling in DP thymocytes.

Adaptor Proteins, Signal Transducing↗
PubMed2001

Evaluation of a weekend respite program for persons with Alzheimer disease.

The documented under-use of respite programs in the face of unmet family caregiver needs is puzzling. The purpose of this study was to explore family caregivers' experience with a pilot respite program of weekend care for persons with Alzheimer disease (AD) or a related dementia. The goal-free evaluation approach captured the responses of 18 family caregivers to a pilot program developed by a community nursing organization. A content analysis of the caregiver interviews identified 3 categories: caregiver self-care, relief for the caregiver, and safety and comfort of the family member. The results suggest a link between the family caregiver achieving respite and the safety and comfort of the family member. The caregivers' perspective regarding the costs and benefits of respite influences the frequency with which they use the program. Research implications are discussed.

Adult↗
PubMedDate not supplied

Baseline characteristics of major depressive disorder patients in clinical trials in Europe and United States: is there a transatlantic difference?

There is a widely spread belief that different patients are being recruited into antidepressant clinical trials conducted in Europe and the USA which is probably generated by the fact that recruitment strategies vary between the two continents. In order to get an insight into the patients' characteristics in clinical studies on both continents, we compared the baseline characteristics of depressed patients in a database of a cancelled development program of an antidepressant (2220 patients, Intention-to-Treat group). For the evaluation of continental differences, we compared the elements of demographics, previous psychiatric history, DSM-III-R criteria, HAM-D and MADRS total scores and separate items and/or factors and CGI severity scores at baseline. USA patients had statistically significantly higher baseline values on height, weight and BMI. European patients showed statistically significantly higher baseline severity scores on HAM-D, MADRS and CGI. Furthermore, European patients had statistically significantly higher baseline scores on HAM-D factors I ('anxiety/somatization'), VI ('sleep disturbance'), and HAM-D Angst anxiety/agitation factor, whereas USA patients had a statistically significantly higher baseline value on the Bech depression factor and the HAM-D Angst retarded depression factor. European patients appear to have a more severe depressive episode with more anxiety and melancholic features. Some of the statistically significant differences found may be the result of a large sample size and are probably without any clinical relevance when the absolute size of the difference is taken into account. Our opinion is that the differences found in our sample between European and USA populations are much smaller than is generally expected and not of a magnitude that would question the reliability of the results obtained in our global world-wide, antidepressant drug development program. If our findings were reproducible in other antidepressant databases it would indicate that data gathered in Europe and the USA within a global antidepressant drug development can be pooled.

Adolescent↗
PubMed1996

Clinical development of a cyclosporine microemulsion in transplantation.

Current clinical difficulties in the use of cyclosporine in transplantation are in part due to its narrow therapeutic window between effective immunosuppression and adverse events and in part due to suboptimal absorption associated with wide pharmacokinetic variability. Under the assumption that the latter aspects are largely formulation-related, a clinical development program was undertaken to compare the conventional formulation (Sandimmun) with a new microemulsion preconcentrate (Neoral). After oral administration, Neoral immediately forms a microemulsion in aqueous gastrointestinal fluids yielding a homogeneous dispersion from which cyclosporine is more readily absorbed. Single-dose crossover studies in healthy subjects were initially performed to document improved bioavailability and dose linearity, lower intrasubject pharmacokinetic variability, and reduced food effect with Neoral. In a subsequent phase of the development program, questions that could only be assessed in transplant patients at steady state were addressed in small, open-label studies under a trough concentration-guided strategy. This approach was necessary to maintain effective immunosuppression while determining appropriate and safe guidelines for converting between formulations, assessing the trough: area under the curve correlation and exploring for potential differences in metabolism. Multicenter, double-blind, randomized investigations were then performed to compare the formulations in stable and de novo transplant populations. In this context, the conversion approach, the safety/tolerability profile, and the attendant pharmacokinetic advantages of the microemulsion formulation were confirmed in larger populations under clinical conditions. It is anticipated that the more precise pharmacokinetic control possible with Neoral will provide a firmer base from which to elucidate the relationship between cyclosporine exposure and graft survival to optimize cyclosporine-based immunosuppressive regimens.

Biological Availability↗
PubMedDate not supplied

Developing a blood conservation program in cardiac surgery.

The beneficial effects of blood transfusions have been described and widely accepted. Multiple factors, including shortages, costs, infectious risks, immunologic risks, and the risk/benefit ratio to the patient, have made the medical community reassess the guidelines for transfusion. Cardiac surgery presents a unique subset of patients, because intervention at multiple stages in the care of these patients is possible to decrease the need for transfusion. An algorithm for a cardiac surgery program was developed and a reassessment performed. Once it was seen that no detrimental effect on patient care occurred, the program was expanded, was enhanced, and subsequently has been offered to the rest of the health care system. This program has resulted in a decrease in cost while maintaining patient outcomes. The success of the program is believed to be a result of the multidisciplinary approach taken, with a commitment from all members of the blood reduction team being the key component of this success.

Aged↗
PubMed1986

KINPAK--a program for standardized pharmacokinetic analysis.

Concept and routines of a new program package (KINPAK) for standardized evaluation of kinetic parameters are described. The package is mainly designed for the investigation of bioavailability or bioequivalence of pharmaceutical products. The data analysis is not based on compartmental or other specific model assumptions. Instead, the experimental data are fitted by new descriptive smoothing functions which are well adapted to the general form of concentration-time curves, but sufficiently flexible to give a good fit for nearly all experimental data sequences. The results are checked and, when necessary, corrected by a set of biologically based plausibility tests, which were heuristically derived from about 33,000 experimental concentrations. During the program development 2264 data sequences based on 40 different drugs were used as references; 95% could be evaluated successfully. The relevant biological parameters are calculated from the geometric properties of the fitted curves. Therefore, they will yield valid results even for curves which cannot be evaluated by compartmental models (e.g., multiple peak curves). The results are listed by KINPAK in various tables ready for presentation to regulatory agencies. Thus, errors of transcription are eliminated. The program, developed primarily for the investigation of bioavailability and bioequivalence in industrial drug research, should be of great interest for research laboratories, universities, and hospitals who are in need of a standardized evaluation system for comparative studies.

Biological Availability↗
PubMed2006

Brains Rule!: a model program for developing professional stewardship among neuroscientists.

Brains Rule! Neuroscience Expositions, funded through a National Institute on Drug Abuse Science Education Drug Abuse Partnership Award, has developed a successful model for informal neuroscience education. Each Exposition is a "reverse science fair" in which neuroscientists present short neuroscience teaching modules to students. This study focuses on results of assessments conducted with neuroscientist presenters during Expositions at two sites, Atlanta, Georgia and Corpus Christi, Texas. The effects of participating in the Expositions on presenters' perceptions of their own presentation and communication skills were evaluated, as was the potential for increased active participation by neuroscientists in future outreach programs. In four of the five Expositions studied, pre- versus post-event surveys demonstrated significant changes in presenters' perceptions of their own abilities to explain neuroscience concepts to children. Over the course of an Exposition, presenters learned to fit their approaches to conveying neuroscience concepts to fifth through eighth graders and learned to link information they presented about the brain and nervous system to children's past experiences to improve comprehension. The present data suggest that Brains Rule! Neuroscience Expositions are effective in improving communication and teaching skills among neuroscience professionals and contribute to professional stewardship by increasing motivation to participate in future informal education programs.

Brain↗
PubMed1987

Dental education: trends and assumptions for the 21st century.

Dental educational institutions, as components of university systems, must develop strategic plans for program development, resource allocation, evaluation, and continued financial support. This dynamic process will be accomplished in a competitive academic arena where program excellence and program relevance are key issues in the game of survival. This article focuses on issues and trends that form the basis for planning assumptions and initiatives into the next decade and into the 21st century. This is our challenge, this is our mission if we are to be catalysts for change in the future.

Curriculum↗
PubMed1985

Into the looking glass: self-assessment for allied health faculty development.

Frequently allied health faculty are unprepared to assume the role of professional academician. Instituting a professional development program can assist faculty in enhancing their effectiveness in that role. As the first step, a faculty group in the School of Health Related Professions, State University of New York at Buffalo, designed a questionnaire to obtain information on faculty members' judgments about their own skills in various activities--teaching, research, writing, service, and administration--and the importance of these activities. The goal of this survey was to identify those activities for which there was the greatest need for faculty development. Research and writing were identified as areas having the greatest overall potential for professional development. The survey also provided groundwork for implementing an on-going professional development program that could be systematically evaluated.

Allied Health Personnel↗
PubMed1985

Chronic mentally ill women: emergence and legitimation of program issues.

Program development for chronic mentally ill women is emerging in a climate where more general concerns relating to women's health and mental health are increasingly being examined. Although in the past the special needs of chronic mentally ill women have received scant attention in the professional literature, there is evidence today of a growing commitment to serving this population. The author traces the emergence and legitimation of three specific issues--homelessness, skills training, and family planning--that reflect the complexity of program development for this population. As specific issues in service delivery to chronic mentally ill women come to the fore and move toward relevant solutions, we may anticipate a sharpening of planning concepts. Both male and female chronic mental patients stand to benefit from these developments.

Activities of Daily Living↗