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PubMed1995

Implementation of a program model to develop specialty staff resource nurses in genetics.

A CNS program to develop staff resource nurses in the specialty area of genetics was implemented. The purpose of the program was to provide staff nurses with necessary knowledge and skills to improve identification of and services for clients with genetic conditions. Twenty-eight staff nurses completed the program, which consisted of a 2-day workshop, a 3-month preceptorship, and regularly scheduled continuing education meetings. Pre- and postworkshop test scores indicated a significant gain in nurses' knowledge of genetic concepts and resources. Resource nurses' interventions with genetic clients increased 3 and 6 months after the workshop. Staff nurse-to-CNS referral of genetic clients continued to increase 3 and 6 months after the workshop. The described program can be used as a model by CNSs in other settings and specialty areas.

Education, Nursing, Continuing↗
PubMed1991

Autonomous departments of emergency medicine in contemporary academic medical centers.

There are currently 20 autonomous departments of emergency medicine in United States medical schools. EDs seeking autonomous status should institute a faculty development program to channel faculty energy into worthwhile research projects; establish protected time for clinical faculty to increase research productivity; develop expertise to compete for extramural funding; initiate an intramural research program so that faculty can learn the basics of grantsmanship; teach health care issues in ambulatory medicine; become involved in interdisciplinary teaching programs and curriculum development; maintain the present faculty commitment to 24-hour attending coverage; and develop university-based programs that originate from the ED. Program directors should establish liaisons with the medical school dean to acquaint him with the advantages of an autonomous department of emergency medicine; attempt to assess other relationships within the medical school to determine support for emergency medicine and to uncover and address opposition to autonomous departmental status; attempt to serve on medical school committees to meet other faculty, solve problems with them and develop trusting relationships; and develop broad-based support for autonomous departmental status both within and outside of the university. By devising and following a deliberate approach to attaining departmental status, emergency medicine will be assured of continued growth in the important decade ahead.

Academic Medical Centers↗
PubMed1975

A client-developed methadone maintenance program.

A realistic methadone maintenance program is a continuum of four related areas: intake, rehabilitation with on-going evaluation, detoxification, and postdetoxification followup, each jointly administered by client volunteers and professional staff. In the early stages of client treatment, pharmacists have more frequent contact with program participants than do other staff professionals. At the Minneapolis Pilot City Health Center, 31 of 69 participants in the methadone maintenance program were interviewed by their pharmacist to determine client understanding of program objectives, interpretation of program effectiveness, and suggestions for program improvement. Client understanding of the objectives or program elements ranged from 30 to 97 %. Client evaluation of the effectiveness of program elements ranged from 0 to 65%. The client-developed program included intake procedures to establish for each client the program objectives, rules, evaluation, guidelines, client goals, dismissal guidelines, and a review of supportive services. Rehabilitation would be continuous with consistent on-going evaluation to measure goal attainment, a decline in disruptive behavior, and freedom from illicit drug use. Detoxification should be undertaken after the client's behavior has stabilized and he has developed a marketable skill. Monitoring of the client to assure a drug-free state would be an important element of the postdetoxification follow-up.

Allied Health Personnel↗
PubMed2003

Analysis of federal support for postgraduate general dentistry.

We compared the funding granted by the federal government between 1985 and 1997 to stimulate the growth of AEGD and GPR programs across HRSA regions, states, and populations. Information regarding the number, size, and location of programs available during the time period of 1985 to 1997 was collected. During this period, although the number of programs remained constant, the composition of the programs changed, with AEGD programs increasing by 113 percent and GPR programs decreasing by 13 percent. HRSA Regions 2, 3, and 5 combined offered over 50 percent of all programs. The number of residency positions rose by 28 percent in civilian programs and dropped by 11 percent in Veterans and Military (VA/M) positions. Overall growth in AEGD positions increased 208 percent, while the civilian GPR positions remained constant and the number of VA/M GPR positions dropped by 30 percent. A higher percentage increase in programs occurred in cities of greater than 500,000 population than in less densely populated areas. HRSA spent dollar 41,254,501 in the thirteen-year time frame, and funding by region varied by over a hundredfold. Programs in the least dense population groups were often the least funded. There was great variability in the amount of HRSA money received by state, with fifteen states receiving no funding during the thirteen years. Without HRSA dollars, it is apparent that the postgraduate general dental training program would not have gained the vitality it currently offers. However, attention must be paid to developing programs among states with a lack of infrastructure in dental education and training.

Costs and Cost Analysis↗
PubMed2002

Differential effects of the early and late intrauterine environment on corticotrophic cell development.

The developing embryo and fetus respond to a range of intrauterine stressors, but the effect of chronic intrauterine stress on the programmed development of pituitary corticotrophs has not been investigated. We have used a pregnant sheep model in which the embryonic environment at conception has been surgically perturbed by uterine carunclectomy. This procedure results in the development of fetuses that either are placentally restricted and chronically hypoxemic or that demonstrate compensatory placental growth and maintain normoxemia throughout late gestation. We found that uterine carunclectomy resulted in the emergence of a population of non-corticotrophin-releasing hormone (non-CRH) target cells that secreted high amounts of adrenocorticotrophic hormone (ACTH) in the fetal pituitary. This change in corticotroph development was independent of late-gestation hypoxemia. However, chronic hypoxemia during late gestation (in either carunclectomized or non-carunclectomized uterine environments) resulted in a reduction in the proportion of ACTH stored in CRH-target. Thus, the early and late intrauterine environments differentially program the development of specific corticotrophic cell types in the fetal pituitary. These patterns of altered corticotroph development are important given the central roles of the hypothalamo-pituitary-adrenal axis in the fetal adaptive response to intrauterine stress and in the early programming of adult disease.

Adrenocorticotropic Hormone↗
PubMed1998

Telemedicine. Secrets to success.

In designing telemedicine programs, developers must carefully assess needs, select the right technology and figure out how to pay for their programs.

Arizona↗
PubMed2001

Sample Core Competencies in Child and Adolescent Psychiatry Training: A Starting Point.

In an effort to improve the preparedness of residents to address health care needs, the Accreditation Council for Graduate Medical Education mandated that all Residency Review Committees (RRCs) incorporate the general competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice into their requirements. In response, the Psychiatry RRC mandated that child and adolescent psychiatry programs develop one competency for each of the six areas, effective January 1, 2001. To assist in this effort, the Work Group on Training and Education of the American Academy of Child and Adolescent Psychiatry has developed sample core competencies for each area. These samples are meant to serve as potential models for consideration by training programs as they develop criteria tailored to their program's unique resources and needs.

Journal Article↗
PubMedDate not supplied

Coordinating Canada's research response to global health challenges: the Global Health Research Initiative.

The Global Health Research Initiative (GHRI) involving the Canadian International Development Agency, the Canadian Institutes of Health Research, Health Canada and the International Development Research Centre seeks to coordinate Canada's research response to global health challenges. In light of numerous calls to action both nationally and internationally, an orientation to applied health policy and systems research, and to public health research and its application is required to redress global inequalities in wealth and health and to tackle well-documented constraints to achieving the United Nations Millennium Development Goals. Over the last four years, the GHRI has funded close to 70 research program development and pilot projects. However, longer-term investment is needed. The proposed dollars 100 million Teasdale-Corti Global Health Research Partnership Program is such a response, and is intended to support teams of researchers and research users to develop, test and implement innovative approaches to strengthening institutional capacity, especially in low- and middle-income countries; to generating knowledge and its effective application to improve the health of populations, especially those most vulnerable; and to strengthen health systems in those countries. While Canada stands poised to act, concerted leadership and resources are still required to support "research that matters" for health and development in low- and middle-income countries.

Canada↗
PubMed2006

Adaptive roles of programmed cell death during nervous system development.

The programmed cell death (PCD) of developing cells is considered an essential adaptive process that evolved to serve diverse roles. We review the putative adaptive functions of PCD in the animal kingdom with a major focus on PCD in the developing nervous system. Considerable evidence is consistent with the role of PCD in events ranging from neurulation and synaptogenesis to the elimination of adult-generated CNS cells. The remarkable recent progress in our understanding of the genetic regulation of PCD has made it possible to perturb (inhibit) PCD and determine the possible repercussions for nervous system development and function. Although still in their infancy, these studies have so far revealed few striking behavioral or functional phenotypes.

Adaptation, Physiological↗
PubMed2005

Learning from communities: overcoming difficulties in dissemination of prevention and promotion efforts.

The model of prevention science advocated by the Institute of Medicine (P. J. Mrazek & R. J. Haggerty, 1994) has not lead to widespread adoption of prevention and promotion programs for four reasons. The model of dissemination of programs to communities fails to consider community and organizational capacity to implement programs, ignores the need for congruence in values between programs and host sites, displays a pro-innovation bias that undervalues indigenous practices, and assumes a simplistic model of how community organizations adopt innovations. To address these faults, researchers should locate, study, and help disseminate successful indigenous programs that fit community capacity and values. In addition, they should build on theoretical models of how locally developed programs work to make existing programs and polices more effective.

Community Mental Health Services↗
PubMed1990

MolStruc: a force field calculation program allowing interactive modifications of the force field parameters.

To analyze the influence of parameters and functions on the energy and geometry obtained through different force field calculations, we have developed program MolStruc. This software allows the user to choose between two sets of functions and parameters, MM2 and AMBER. The MM2 option of the program was developed to compute the coulombic energy in a dipole or monopole approximation. To establish comparisons between the energy values, the coulombic contribution is computed in the same way in the Amber and MM2 options of the program. The force field parameters can be handled interactively (through addition or modification). The program was used to study molecules of a representative sample displaying most of the problems encountered in molecular mechanics (MM).

Algorithms↗
PubMed1994

The management of acute respiratory infections in Honduras: a field test of the Focused Ethnographic Study (FES).

The World Health Organization has recently developed an ethnographic research manual, The Focused Ethnographic Study (FES) for ARI, whose purpose is to facilitate Acute Respiratory Infection (ARI) program development by providing information about the context in which families perceive and respond to ARI, and by identifying factors that facilitate or impede prompt care-seeking for children with pneumonia. The methodology is focused around answering a set of pre-defined "Programme Managers' Questions" which represent the main concerns and needs of ARI programs. The FES is designed to address both the need for in-depth information about the household and community-level factors which affect the management of ARI, and the need for timely, program relevant, and focused information. A field test of this manual was conducted in Honduras, and a number of recommendations to the local ARI program were developed concerning improving communication about ARI with mothers of young children. The Honduran field-test of the FES shows how systematic ethnographic research can be conducted and translated into concrete recommendations for bridging the social and communication gap which so often exists between health workers and the communities they serve.

Acute Disease↗
PubMed1967

Health, population, and economic development. International health programs have an important role in promoting economic development and population control.

Health as a basic human value is particularly important to people in the developing world. Rates of economic development lower than had been hoped for and ever more steeply rising population growth have precipitated a reaction against public health programs. Among economists, agriculturalists, and even health professionals the philosophy arose that one should "hold back" on using modern weapons against disease because they are "too effective." To satisfy the recognized popular demand, simple and relatively ineffective measures of curative medicine could be substituted. It was said that the emphasis should be, instead, on agriculture, community development, education, and industrialization and that family planning should be pushed as a separate program. Documentation presented here sharply challenges such a point of view. No segment of the total development process can be effective without the other sectors.

Demography↗
PubMed1987

Developmental intervention for low birth weight infants: improved early development outcome.

This prospective longitudinal study was designed to evaluate the effects of a multidisciplinary infant development program (IDP) on the mental and physical development of low birth weight infants (less than 1,800 g). Infants in the neonatal intensive care were randomly assigned to the IDP or to traditional care (control group). IDP infants received developmental interventions in the hospital and at home through the first 2 years of life. Counseling and parenting education were provided to their parents during this same period. The control group received all the postnatal care and referrals customarily given in traditional care. Both IDP and control infants were enrolled in an independent follow-up program, which used the Bayley Scales of Infant Development in a blind evaluation design. The IDP group had a significantly lower incidence of developmental delay (P less than .05) and scored significantly higher than the control group (P less than .05) on mean mental and physical indices at 12 and 24 months of adjusted age.

Counseling↗
PubMed1994

Antiulcer prescribing program in a state correctional system.

OBJECTIVE: To describe a formulary antiulcer agent prescribing program developed as the result of a drug use evaluation (DUE). Program implementation, methods, cost impact, and results of a follow-up DUE are provided. BACKGROUND: The institution is a 51,000-bed correctional system consisting of 40 separate units each containing an ambulatory care clinic. Medication orders are transmitted via mainframe computer system to one of four pharmacies, which collectively dispense an average of 4000 medication orders (30 days' supply) per day. METHODS: Results from the antiulcer agent (cimetidine, ranitidine, sucralfate) DUE revealed that the agents studied were prescribed in dosages and durations exceeding criteria developed by the Pharmacy and Therapeutics Committee. A program designed to reduce dosages to maintenance therapy after eight weeks at treatment dosage was developed by the Pharmacy and Therapeutics Committee with staff physician input. Antiulcer agent use and expenditures were followed and a follow-up DUE was completed seven months after program implementation. Antacid use and frequency of upper gastrointestinal studies that were ordered were followed. RESULTS: The follow-up DUE showed the mean daily dosage for prescribed histamine2-receptor antagonists decreased (cimetidine from 694 to 454 mg, ranitidine from 280 to 183 mg) and the mean duration of therapy decreased from 14 to 10 months. The percentage of patients with potentially significant drug interactions decreased from 14.2 to 6.5 percent. The mean number of antiulcer agents dosage units dispensed per month decreased by 24,461 units, resulting in a projected annual savings of $327,273. There were no identifiable clinically important changes in the use of antacid products or prescribing of upper gastrointestinal studies. CONCLUSIONS: A cost-savings program sponsored by the pharmacy and therapeutics committee decreased costs, corrected prescribing to more closely meet preset criteria, and produced no discernable unfavorable effect on patient care.

Adult↗
PubMed1997

Computer-aided preoperative planning of tissue expansion.

The aim of this paper is to introduce a computer program developed to provide objective, quantitative data useful to ensure proper expander selection when having to use a rectangular tissue expander. The program is developed to calculate the volume of a rectangular tissue expander to obtain the exact amount of yield needed to allow for reconstruction of a determined defect. The only data to be supplied are the length and the width of the defect to be reconstructed. In our opinion, although its use is not aimed at replacing clinical judgment based on experience and careful observation, this program may be considered a simple and useful adjunct for the inexperienced surgeon (or the occasional operator) planning to use a rectangular tissue expander.

Decision Support Techniques↗
PubMed2001

The National Commission on Nurse Anesthesia Education 10 years later--Part 2: Years following the commission (1994 to present).

In 1989, the National Commission on Nurse Anesthesia Education was implemented to reverse a severe shortage of CRNAs. The Commission, charged with scrutinizing all aspects of nurse anesthesia educational programs, developed 8 goals with corresponding strategies that were used by the Commission Implementation Task Force to actualize its charge. These goals and strategies contributed to an increase of annual graduates from nurse anesthesia programs and the development of 10 new programs. These activities were documented in Part 1 of this article, which appeared in the October 2001 AANA Journal. Following completion of the 3-year project, the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) and the AANA Education Committee began carrying out the final recommendations made by the Commission. Part 2 addresses the accomplishments of the Education Committee and COA in implementing the recommendations of the Commission, discusses current status of educational programs and CRNA manpower, and identifies roles for both educators and practitioners in protecting the future of the profession.

Education, Nursing↗
PubMed2006

Developing research capacity building for Aboriginal & Torres Strait Islander health workers in health service settings.

INTRODUCTION: Aboriginal and Torres Strait Islander health workers (hereafter called health workers) can play a major role in facilitating culturally appropriate health care delivery and program development through the acquisition of improved skills in the planning, monitoring and evaluation of these programs (RCB). However, many Aboriginal and Torres Strait Islander people and communities remain concerned about research and related activities. Health workers are well placed to assist communities to not only embrace research, but to be active players and promoters of relevant, appropriate and acceptable research. One means of achieving the twin goals of RCB and community acceptance and involvement in research, is through health workers undertaking research of health priority issues and evaluation of activities, such as program delivery, that are of direct relevance to their community's aim of improving or enhancing service delivery. This article outlines the development and content of a community-based RCB framework for health workers. The focus is on the major issues that enhance a proactive service delivery model using culturally appropriate research methods. Development process: The RCB framework described here was developed, over a period of time, through community workshops and consultations aimed at deriving general consensus on the key issues and components of a culturally-appropriate, community-based training process. The framework has subsequently been reviewed by Aboriginal and Torres Strait Islander community representatives from across Australia. The overall aim of the framework is to supplement current (institutionally-based) education and training resources for health workers with community-based research training modules. These modules can be tailored to provide research and evaluation skills relevant to health workers taking a more proactive role in facilitating health and wellbeing programs in their own communities. The use of collaborative consultation and participatory methods are intended to be a two-way education process. Course content: A visual pathway is used that encompasses the impact of health and practice in the community for health workers at a grass-roots level. This enables elements of the RCB process to be divided into a series of connected modules. These are: (i 'assessing' Existing Services; (ii) methods and measures for Identifying Need at various levels; (iii) important issues in Program Development; (iv) how the former contributes to Service Improvement; (v) resultant Outcomes that will impact on community and service provision; and (vi) Evaluation Methods and applying findings to service delivery. CONCLUSIONS: Active participation by the Aboriginal and Torres Strait Islander community is fundamental for effective research practices and outcomes. The aim is to provide health workers and community members with a working knowledge of research ethics and methods so that they can assist, monitor and steer the development of culturally appropriate research activities that will lead to provision of the highest quality services 'back' to the community. This RCB framework will enable health workers to be more proactive, self-reliant and self-sufficient within their community and healthcare settings.

Community Health Planning↗