Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Integrated Programs”

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 1,459 records · Page 81Linked to original sources
PubMed1995

Innovations in patient care: changing clinical practice and improving quality.

BACKGROUND: In the traditional hospital organization, administrators supply the resources while physicians determine their use. Given this dichotomy, a partnership between clinicians and hospital management is essential for efforts to enhance the quality of care while controlling costs. To foster this partnership, in 1986 the University of Rochester's Strong Memorial Hospital developed its Innovations in Patient Care (IPC) program, which several other medical centers have duplicated. CURRENT STATUS AND LOGISTICS: Hospital operating revenues of approximately $175,000 per year are provided to both fund proposals and support core IPC staff. Clinical staff submit proposals to study innovations to promote higher quality care and/or the efficient and appropriate use of diagnostic and therapeutic services. Many of the 77 projects funded to date have led to important changes in clinical practice. CASE STUDIES: One study, whose principal investigator was assistant director of emergency medicine, showed that structured, condition-specific (for example, asthma, pharyngitis, lacerations, and isolated closed-head injury) quicksheets improved documentation of clinical findings, resource use, and clinical practice. A study organized by the leadership of surgical nursing revealed that a nursing case management model led to reductions in patient length of stay and increases in nurse satisfaction. Another study, designed by a fellow in neonatalogy, developed and tested guidelines for the use of head ultrasounds in screening very-low-birthweight infants for intraventricular hemorrhage. CONCLUSIONS: IPC programs, which integrate well with initiatives in total quality management, can be effectively used to change clinical practice and improve the quality and efficiency of patient care.

Case Management↗
PubMed2000

General surgery and fellowship training: opinions of surgical intern applicants and fellowship directors.

BACKGROUND: Given the pressures that exist today to modify surgical training programs, this study was undertaken to ascertain the opinions of surgical intern applicants and fellowship program directors with regard to the length of surgical training. METHODS: Surveys were sent to fourth-year medical students who were applying for categorical surgical training during a 2-year period at a single university medical center and to fellowship program directors in 6 surgical subspecialties. RESULTS: Ninety-three percent of the applicants planned to pursue fellowship training. Sixty-eight percent of the applicants did not feel that 5 years of general surgery are necessary before beginning a fellowship. Seventy-one percent of the applicants indicated that they would be willing to "short track" into a subspecialty to reduce training time. Virtually all fellowship directors in pediatric surgery (94%), transplantation surgery (94%), and oncologic surgery (100%) felt that 5 years of general surgery training are necessary before entering a fellowship. Significantly fewer fellowship directors in vascular surgery (53%), cardiothoracic surgery (30%), and plastic surgery (17%) felt that 5 years of general surgery are essential before beginning a fellowship (P < or = .001). CONCLUSIONS: For some general surgery subspecialties, a shortened, integrated training program may be desirable from the point of view of both trainees and fellowship directors. Vascular, cardiothoracic, and plastic surgery appear to be those subspecialties that are most amenable to such programs.

Data Collection↗
PubMedDate not supplied

[Community participation patterns in health programs].

The study of some Latin American experiences of participation of the community in health programs allows us to consider the following as minimum requirements to establish interrelationships between local health organisms and the community: a) To have a local health system. b) To have a participating health them. c) To show respect for the community. d) To have contact with community organizations. e) To have contact with private and government organizations at a local level. The models for participation of the community in health are manifold and the experiences have been countless. For teaching purpose and based on Latin American experiences, some considerations are made regarding: 1) Community health volunteers. 2) Local health councils. 3) Local councils for community development. 4) Health brigades. Finally, it is concluded that the active participation of the community organized in health activities is the best guarantee of success in implementing integral health programs.

Child Care↗
PubMed1997

Update from the Commission on Cancer.

A model for an integrated, comprehensive program for high-quality, cost-effective patient care can be found in cancer programs approved by the Commission on Cancer. A key component in assessing the effectiveness of the model is the cancer registry. Changes in the health care delivery system are behind increased demands for and use of cancer registry data. To support this shift and expanded activity, the Commission on Cancer has instituted a series of initiatives. These steps address refinements of the standards for approval, collaborative relationships, performance measurement information, new educational opportunities, and an organized communications campaign.

Cancer Care Facilities↗
PubMed1991

SELEXION. Systematic evolution of ligands by exponential enrichment with integrated optimization by non-linear analysis.

Recently, novel technologies for isolation of nucleic acid molecules with specific biological activities have been reported. In each case, the enrichment process involves repeated rounds of selection from complex mixtures of nucleic acid sequences, followed by polymerase chain reaction (PCR) amplification of ligand sequences that function in the desired manner. Particular variations in experimental conditions can dramatically alter the outcome of these processes. In this study, we use mathematical analysis and computer simulation to predict which variations have the greatest impact and to develop strategies and guidelines for enhanced effectiveness. First, we perform reconstruction tests to demonstrate that a mathematical description based on equilibrium binding is sufficient to explain the high levels of enrichment attained in the laboratory after just a few rounds. Then, we show the expected enrichment for an extensive range of conditions; and, finally, we determine the optimum protein and nucleic acid concentrations to use for maximum enrichment, while also ensuring a high likelihood of recovering even the rare molecule that binds well. The strategies and guidelines for enhanced effectiveness are generally applicable to processes for systematic enrichment of DNA, RNA or peptide ligands and have been implemented in an interactive simulation program for integrated non-linear optimization of enrichment using any target of interest.

Biological Evolution↗
PubMedDate not supplied

Case management: key to access, quality, and financial success.

Several strategic, organizational, and operational variables drive successful case management programs. Organizational goals and accountability for support by administrative and medical staff leaders set the stage for a comprehensive program. The integration of utilization review, discharge planning, and other functions into the role of the case manager improves productivity and continuity. Choosing a model for assigning patients, a variable unique to the institution, should be carefully considered. Regardless of the power of strategic goals or the creative selection of a model, daily practices that promote daily review and communication will reveal all of the opportunities for improved performance. Complications are avoided one patient at a time and patients deserve vigilance. Length of stay is shortened 1 day at a time and we can no longer afford to miss these opportunities. In the period of high census, an unnecessary day for one patient at the end of his/her stay may mean another patient being diverted to another hospital away from his/her physician and past medical records. Creating constructive physician partnerships and cooperative relationships with postacute care providers can bring a case management program to higher level of performance. While many organizations have employees called "case managers," fewer have a comprehensive approach that has the potential to drive so many important indicators of performance.

Case Management↗
PubMed1989

Birth weight outcomes in a teenage pregnancy case management project.

While many comprehensive health care programs for pregnant adolescents are designed to improve the birth weights of the babies born, few provide statistical evidence that they were able to do so. In this study, information was gathered prospectively on 411 mothers in a Teenage Pregnancy and Parenting Program (TAPP) that coordinated medical, educational, and social services through individual case management and agency-level coordination, information on the mothers, their pregnancy, and services received. The low birth weight rate for TAPP participants was significantly lower than the rate for San Francisco teens prior to the establishment of the program (8.1% versus 12.0% p less than 0.05). The mean weights of babies born to teens in TAPP were significantly higher than those in San Francisco after controlling for differences in the race, infant gender, parity, and age (p less than 0.0001). Participation in the TAPP program prior to delivery was more strongly associated with better birth weight outcomes than was race, age, parity, or gender. Participation in the TAPP program was associated with significantly better birth weights independent of receiving a minimal number of prenatal medical visits adequate for the gestational age of the baby at birth. Our results provide evidence of better health outcomes for the babies of teens who had case management that included continuous individual counseling and coordination of health, education, psychosocial, and nutrition services.

Adolescent↗
PubMed2004

The effectiveness of home-study driver education compared to classroom instruction: the impact on student knowledge and attitudes.

PROBLEM: Home-study driver education programs exist in several states, but none have been scientifically evaluated to determine if such courses are as effective as classroom courses for teaching driver education. METHOD: Over 1,300 students were randomly assigned to classroom instruction, or CD ROM, workbook, or Internet/workbook home-study courses and compared on proctored exit examination knowledge and attitude scores, and written knowledge test outcomes. RESULTS: Few differences were found on exit examination knowledge and attitude scores, but they tended to favor the CD and Internet/workbook home-study courses over the classroom or workbook courses. Differences favoring the classroom on written knowledge test outcomes likely reflect a bias in classroom courses toward teaching test-specific material. DISCUSSION: The findings present no compelling evidence that home-study courses are less effective than classroom courses for teaching driver education. IMPACT ON INDUSTRY: The findings could result in more widespread use of home-study courses. Also, the use of low-cost home-study courses as the first course of a two-stage driver education and training system could make integrating such programs with graduated driver licensing more feasible and acceptable to the public.

Adolescent↗
PubMed1987

The making of an adolescent clinic.

This paper addresses the nationwide need for comprehensive health care services directed toward adolescents, outlining a multidisciplinary team program designed to provide such services. The national problem of teenage pregnancy is discussed, and the multidisciplinary team's success with family planning counseling is described. The authors strongly encourage the development of more school- or community-based clinics based on a comprehensive health care team model.

Adolescent↗
PubMed2000

A graded work site intervention program to improve sun protection and skin cancer awareness in outdoor workers in Israel.

OBJECTIVES: A graded worksite intervention program to improve sun protection and skin cancer awareness of outdoor workers was implemented and evaluated longitudinally over a period of 20 months. METHODS: Outdoor male workers (144/213 recruits) from geographically separated units of the Israel National Water Company were allocated to complete (n = 37), partial (n = 72) or minimal (n = 35) intervention groups. Subsequent to the assignment and training of local safety officers, an educational and medical screening package was provided to the corresponding groups either once, or repeatedly a year later. Personal sun protective gear was provided upon repeated intervention. Outcome measures were evaluated through self-response questionnaires administered prior to the first intervention pulse, and 8 months after the first and second interventions. RESULTS: A 15-61% improvement in sun-protection habits was noted in the entire study population 8 months after initialization, compared to no sunscreen use, 20% sun-exposed skin area and highest mean occupational exposure dose of 1.68 MED/day at pre-test. An even greater use of sunscreen was evident 1 year later in the complete and partial intervention groups, + 80% and + 52%, respectively. The baseline rate of self-examination of the skin in the same two groups (49%) increased significantly at post-test (+ 71% and + 53%, respectively). CONCLUSIONS: This integrated intervention program led to significantly improved sun protection and skin cancer awareness. Repeated intervention combined with the supply of sun-protective gear contributed to an even greater impact.

Adult↗
PubMed1997

Competency-based learning in traumatology.

BACKGROUND: A multidisciplinary, competency-based trauma teaching program was introduced for final year medical students (n = 67) at Royal Prince Alfred Hospital (RPAH) in 1994 to complement the surgical clerkship. METHODS: The method involved small groups rotating through a series of teaching stations each structured to address a predetermined competency. Four 3-hour sessions were held on the subject areas of resuscitation, plastic, orthopedic, and neurotrauma. Performance in the trauma section of a summative Objective Structured Clinical Examination (OSCE), 6 months after the teaching, was compared with that of a control group (n = 127) from other campuses where trauma was taught by a series of discipline-based lectures. Three trauma OSCE stations were designed to test psychomotor skills while five addressed aspects of the cognitive domain. Checklists were used to ensure standardization of scoring in a range of questions asked for skills tested at each station. RESULTS: The marks of the RPAH students (mean 78% +/- SD 9%) were significantly higher (P < 0.0005) than the controls (mean 70% +/- SD 9%) in the 8 trauma questions. There was no significant difference (P = 0.8) in marks obtained by the study group (mean 61% +/- SD 8%) and controls (mean 63% +/- SD 7%) in 22 questions sampling a wide spectrum of nontrauma subject areas. The study group performed significantly better in one of the three skills stations and three of the five problem-solving stations when compared with the control group. CONCLUSION: The innovation has the potential to fulfill a need for an integrated trauma program in the undergraduate core curriculum.

Australia↗
PubMed1999

[Reproductive characteristics of women from 15 to 49 years of age: comparative studies and planning for actions].

INTRODUCTION: The availability of socioeconomic, demographic and reproductive health data about women at national, regional and municipal levels allows comparisons between regions and may offer background information for planning actions of the Program of Integrated Assistance for Women's Health. METHODS: A population-based cross-sectional study was carried out in Southern Brazil. Three thousand and two women aged 15 to 49 years living in an urban area in Pelotas, were selected for inclusion in the study. A structured questionnaire was used to collect the socioeconomic, demographic and reproductive characteristics. The analysis included comparison of means and proportions. In the sterilization analysis the data were controlled for age. RESULTS: Nearly 56% of the women were married/in union and 35% were single. A third of them were housewives and 50% were wage workers. The mean of schooling was 8.5 years. Almost, half of the adolescents (15 to 19 years old) have an active sexual life, and of those 33% had already been pregnant. A high percentage of unwanted pregnancy was reported, mainly among younger women. Near the end of their reproductive life (women aged 45 to 49 years) the mean of children per woman was 2.4. The most prevalent methods were pill and sterilization. Among married women or those living in consensual union, 15% had been sterilized. The sterilization rate increased with age and attained nearly 25% of women aged over 35 years; 29.6% of sterilized women had had a stillborn child and 18.3% a pre-term baby; 20% of husbands/partners did not accept the use of any contraceptive method. CONCLUSIONS: The study results confirm the need for additional attention to and development of special programs for adolescents, improvements in the access to services, increase in the use of the contraceptive options already available and research and programatic actions related to the theme "men/reproductive health.

Abortion, Induced↗
PubMed1997

Anthelmintic treatment strategies: current status and future.

Despite the array of anthelmintics and endectocides and delivery systems available for use in the prevention and control of nematode parasites of ruminants, the number of highly effective control programs that have been developed and even the number of such programs that have been successfully implemented in commercial animal production, there have been no recent innovations or discoveries in regard to strategies, new anthelmintics, or systems for controlling nematode parasites through anthelmintic use. In the traditional sense of chemotherapy-chemoprophylaxis, we have probably achieved the maximum effect of what is possible from excellent anthelmintics developed by the pharmaceutical industry over the last 35 years, i.e. from thiabendazole through levamisole and morantel tartrate, to more advanced benzimidazoles and to the avermectins and milbemycins. At the core of all anthelmintic treatment-related problems is the lingering conception among a large body of animal producers that anthelmintic treatment is the only effort needed to control parasitism and its effects on host animals. This concept has given rise to the long-standing difficulty of drug resistance in sheep nematodes and the not remote possibility of its development in nematodes of cattle. Along with this are serious concerns over environmental toxicity, tissue residues and enormous financial investment to develop new and novel anthelmintic compounds. Progress is being made in current and intensive searches for development and testing of control approaches alternative to anthelmintics, e.g. helminth vaccines, biological control agents such as fungi, selection of resistant sires, alternative chemicals and nematode growth regulators. A timetable for when alternative controls can be developed fully and put into practical use cannot be predicted. It is universally acknowledged among parasitologists that existing anthelmintics must be preserved and utilized judiciously to ensure continued effectiveness. A major example is to be found in strategic or integrated control programs in Australia developed over the last 10 years to combat widespread drug resistance in sheep. Major imperatives for future programs and systems of controlling nematode parasites of ruminants are improved means of getting producers to adopt proven and sustainable methods.

Animal Husbandry↗
PubMedDate not supplied

Why women still die from cervical cancer.

Cervicovaginal cytology, known as Pap smear, is the most effective screening test in medical oncology. Introduced by Dr. George Papanicolaou in 1940, the Pap smear is now being recognized as a major contributor to the remarkable decrease in cervical cancer morbidity and mortality among women throughout the world. However, there are still significant numbers of women who lose their lives to cervical cancer every day. To overcome this major problem, first, we must search for the reasons for these lost lives and then take appropriate measures to resolve the existing issues. There is now substantial evidence that emphasizes the importance of an effective screening program. This program must integrate education and accessibility to health care for all women regardless of age, race, ethnic background and socioeconomic status. The public, the media, the government and health care providers must also become acutely aware of the inherent difficulties involved in providing a high-quality Pap smear. Compounded by medicolegal pressures and reimbursement issues, the Pap smear has become one of the more difficult tests to perform. Current reimbursement mechanisms are not appropriate for the cost of providing the service and cannot guarantee the resources necessary for a high-quality Pap smear. Congress should consider mandating direct billing to the patient for the service, so that cervicovaginal cytology could be reimbursed on a level commensurate with the requirements of providing quality service. A concerted effort should also be made to enhance the level of public knowledge about the issues surrounding Pap smear. This could be achieved by fostering the idea of designating a "Cervical Cancer Awareness Month," and by encouraging the spirit of community networking.

Age Factors↗
PubMedDate not supplied

Cultural construction of health and institutional measures of change in rural Bangladesh: cases of BRAC's village organization and ICDDR,B's MCH-FP programmes.

The study aims to examine the perceptions, causes, and treatment of diseases among the people of a few selected villages in Matlab and their relation to traditional culture and interventions made by BRAC and ICDDR,B in the form of rural development and MCH-FP programs. Four sets of villages were chosen purposively--two DSS and the other two non-DSS. In one of the DSS villages the MCH-FP program is underway, while the other does not have such programs. Likewise, one of the non-DSS villages has the rural development program of BRAC, while the other does not have any. From each village 10 respondents were selected purposively to gather information. The perception of disease is mostly defined in terms of the functions of the body. On very few occasions it is defined in terms of the action rendered by germs or the pathological condition of the body organs. The difference between the meaning and the actual diseases is often blurred. While identifying the causes, often the reference is made to invisible spirits, locally known as alga batash. The modes of treatment combine both modern and traditional elements. However, the health teaching educates them about the perception, causes, and treatment of certain diseases. In society, the elderly people, religious preachers, and traditional healers play important roles to influence the mind of the people. Sometimes gender relations and other structural features also bear on the minds of the illiterate poor. The difference between the intervention and non-intervention villages is expressed in the fact that the people of the intervention villages are constantly exposed to the agents making changes, while in the non-intervention villages it is intermittent. Traditional culture still plays an important role in the construction of disease perception and the choice of treatment, while modern approaches are combined with it. The intervention procedures widen modern approaches but could not eliminate the traditional notions altogether.

Asia↗
PubMed1993

The joint JMA-JICA project in Nepal.

Nepal is among the 20 countries with the lowest human development index, according to the criteria of the United Nations Development Program (UNDP), and has a very high under-five mortality rate, according to the United Nations Children's Fund (UNICEF). In December 1992, the Japan Medical Association (JMA) and the Japan International Cooperation Agency (JICA) began jointly carrying out a maternal and child health (MCH) project. Its beneficiaries are the population of Kavre District, the District Public Health Office in Kavre, the Central Region Health Directorate, and the Ministry of Health of Nepal. The MCH project stems from a request to Japan made by His Majesty's Government of Nepal to implement and evaluate a new health system policy in a model area, the Kavre District. The project's main goal is to improve the general health and to reduce the maternal, infant, and under-five child mortality rates by providing basic primary health care services and means of disease prevention. It will improve the government's medical care delivery system, better educate the population and promote community action in questions related to health and hygiene. This is the first cooperative project organized by JICA that involves the participation of a non-governmental organization, in this case, the JMA. The JMA will construct the primary Health Care (PHC) Center, equip it with a dormitory and safe water supply system, and provide sufficient drugs for 2 years. The Japan International Cooperation Agency will dispatch MCH experts and provide medical equipment and supplies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Peer review of the quality of care. Reliability and sources of variability for outcome and process assessments.

CONTEXT: Peer assessments have traditionally been used to judge the quality of care, but a major drawback has been poor interrater reliability. OBJECTIVES: To compare the interrater reliability for outcome and process assessments in a population of frail older adults and to identify systematic sources of variability that contribute to poor reliability. SETTING: Eight sites participating in a managed care program that integrates acute and long-term care for frail older adults. PATIENTS: A total of 313 frail older adults. DESIGN: Retrospective review of the medical record with 180 charts randomly assigned to 2 geriatricians, 2 geriatric nurse practitioners, or 1 geriatrician and 1 geriatric nurse practitioner and 133 charts randomly assigned to either a geriatrician or a geriatric nurse practitioner. MAIN OUTCOME MEASURES: Interrater reliabilities for structured implicit judgments about process and outcomes for overall care and care for each of 8 tracer conditions (eg, arthritis). RESULTS: Outcome measures had higher interrater reliability than process measures. Five outcome measures achieved fair to good reliability (more than 0.40), while none of the process measures achieved reliabilities more than 0.40. Three factors contributed to poorer reliabilities for process measures: (1) an inability of reviewers to differentiate among cases with respect to the quality of management, (2) systematic bias from individual reviewers, and (3) systematic bias related to the professional training of the reviewer (ie, physician or nurse practitioner). CONCLUSIONS: Peer assessments can play an important role in characterizing the quality of care for complex patients with multiple interrelated chronic conditions, but reliability can be poor. Strategies to achieve adequate reliability for these assessments should be applied. These strategies include emphasizing outcomes measurement, providing more structured assessments to identify true differences in patient management, adjusting systematic bias resulting from the individual reviewer and their professional background, and averaging scores from multiple reviewers. Future research on the reliability of peer assessments should focus on improving the ability of process measures to differentiate among cases with respect to the quality of management and on identifying additional sources of systematic bias for both process and outcome measures. Explicit recognition of factors influencing reliability will strengthen efforts to develop sound measures for quality assurance.

Aged↗