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At least 163 records · Page 9Linked to original sources
PubMed2005

Why have academic medical centers survived?

Over the past decade, many observers predicted the demise of the academic medical center (AMC) due to competition from community hospitals and physicians, fragile finances, inefficiency, and organizational complexity. In 2004, we interviewed 23 AMC and community hospital administrators to determine why those predictions have proven unfounded, learn the leaders' current concerns and priorities, and to identify desirable changes. Chief concerns were reimbursement uncertainty, federal research policy, ineffective internal decision-making, and clinical quality (mentioned in more than 75% of interviews). Priorities included ensuring sufficient investment capital, revising undergraduate and graduate curricula, strengthening ties with physicians and community hospitals, attracting faculty, and meeting regulatory requirements. We advocate that the AMC: (1) modify the research model to allow greater collaboration with institutions and researchers; (2) enhance free and open export of new and proven clinical techniques and knowledge; (3) devote greater attention to meeting patients' increasing needs for counsel and guidance, not just intervention, given the plethora of complex new technologies and their promotion in the popular media; and (4) simplify their organizations. To accomplish this, it is desirable for future leaders to gain experience outside the AMC, and for faculty and institutions to be less inwardly focused and more attentive to preserving the public's trust.

Academic Medical Centers↗
PubMedDate not supplied

CAM therapies and nursing competency.

Americans are embracing complementary and alternative medical (CAM) therapies in ever-increasing numbers, with more than $30 billion spent on CAM each year. This consumer-driven trend challenges staff development leaders to learn more about CAM and the implications for staff competency. This article reviews CAM integration from the Federal to state level, and describes guidelines to facilitate development of policies related to CAM, nursing competency, and promotion of patient advocacy in use of CAM therapies.

Clinical Competence↗
PubMed2005

Informed consent in pediatric clinical trials.

PURPOSE OF REVIEW: Clinical research in children is increasing. Concerns have been raised about both the inclusion and the exclusion of children in such research. Corresponding to these concerns, issues in informed consent for pediatric trials have become more pressing. This review discusses informed consent in pediatric trials and characterizes the latest literature. RECENT FINDINGS: Research into the consent process has shown that central concepts in pediatric research such as randomization and the distinctions between phases of clinical trials are not uniformly understood by parents or older pediatric patients. Newer approaches that are being developed to help remedy these deficits include the use of staged informed consent, the incorporation of interactive computer technologies to convey complex ideas, and variations in approaches to assent of the child based on multifactorial assessments of competence. Other variables in the consent process that are being studied for their impact on the process include individual life experiences and cultural background. Gaps in federal regulation and oversight of "informed consent" are emerging as new cases test established assumptions. SUMMARY: Lessons learned from recent studies regarding oversight of the consent process in pediatric clinical trials, the complex nature of assent, the impact of cultural variables, and more effective means of communicating what is involved in a clinical trial will shape future studies in consent and help to improve the process.

Adolescent↗
PubMed2000

Promises unfulfilled: implementation of expanded coverage for the elderly poor.

OBJECTIVE: To examine implementation of the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs, enacted in 1988. The article summarizes the origin of the QMB and SLMB programs, describes what we have learned about QMB and SLMB enrollment in state Medicaid programs and, despite some encouraging news on the federal front, identifies policy issues that remain in assuring access to health care for the low-income elderly. SOURCE: Based in part on research that assessed state variations in Medicaid QMB and SLMB enrollment of low-income Medicare beneficiaries and identified best practices among states in administration of the QMB and SLMB programs. STUDY DESIGN: Telephone interviews were conducted with officials in ten states to elicit qualitative information about how state Medicaid programs have implemented federal protections for low-income Medicare beneficiaries. PRINCIPAL FINDINGS: The QMB and SLMB programs fail to reach a sizable proportion of potentially eligible individuals in most states. Fragmentation of Medicare and Medicaid benefits, complex Medicaid eligibility and income verification processes, and rigid federal and state administrative and data systems, impede efforts to achieve promised protection for low-income elderly persons. CONCLUSIONS: For low-income Medicare beneficiaries, obtaining financial protection against their high out-of-pocket health care costs remains an important issue. The complexities associated with aligning Medicare and Medicaid to deliver health benefits to low-income older persons makes improved coordination across federal and state agencies uncertain.

Aged↗
PubMed1983

Can medical students acquire patient centered attitudes at medical schools?

Progress in psychosomatic medicine will largely depend on the kind of attitudinal learning that takes place at medical schools. What can be achieved by a patient-centered training programme emphasizing attitudinal learning? In a research programme 350 students were introduced to principles of patient-centered medicine in so-called peer groups on history taking ('Anamnesegruppen'). By the end of group work, students exhibited more realistic and less defensive expectations towards the patients and felt more confident about their peers' support. The interviewing skills had improved. The training scheme appeals to approximately 20% of the students. It has been adopted by various other places in the Federal Republic of Germany and Switzerland. Basic institutional aids became apparent: access to patients, supervision, regional meetings. It is assumed that students learn how to link role performance with personal self-awareness, how to trust and be accepted, how to face the faculty. Four overlapping stages basic to the learning process (exposing, reflecting, acting, progressing) are discussed. It is concluded that in medical schools patient-oriented attitudinal learning is possible. Peer learning seems to be decisive. Interdisciplinary research into peer learning is recommended.

Attitude of Health Personnel↗
PubMed2005

Learning from the U.S. National Assessment of Climate Change Impacts.

The U.S. National Assessment of the Potential Consequences of Climate Variability and Change was a federally coordinated nationwide effort that involved thousands of experts and stakeholders. To draw lessons from this effort, the 10 authors of this paper, half of whom were not involved in the Assessment, developed and administered an extensive survey, prepared a series of working papers, and conducted an invitational workshop in Washington, DC, on April 29, 2004. Considering all these sources, the authors conclude that the Assessment was largely successful in implementing its basic design of distributed stakeholder involvement and in achieving its basic objectives. Future assessments could be significantly improved if greater attention were devoted to developing a collective understanding of objectives, preparing guidance materials and providing training for assessment participants, developing a budgeting mechanism which would allow greater freedom in allocating resources across various assessment activities, and creating an environment in which assessments were part of an ongoing process.

Climate↗
PubMed2006

Strategies to enhance price and quality competition in health care: lessons learned from tracking local markets.

Drawing on observations from tracking changes in local health care markets over the past ten years, this article critiques two Federal Trade Commission and Department of Justice recommendations to enhance price and quality competition. First, we take issue with the notion that consumers, acting independently, will drive greater competition in health care markets. Rather we suggest an important role remains for trusted agents who can analyze inherently complex price and quality information and negotiate on consumers' behalf. With aggregated information identifying providers who deliver cost-effective care, consumers would be better positioned to respond to financial incentives about where to seek care and thereby drive more meaningful competition among providers to reduce costs and improve quality. Second, we take issue with the FTC/DOJ recommendation to provide more direct subsidies to prevent distortions in competition. In the current political environment, it is not practical to provide direct subsidies for all of the unfunded care that exists in health care markets today; instead, some interference with competition may be necessary to protect cross subsidies. Barriers can be reduced, though, by revising pricing policies that have resulted in marked disparities in the relative profitability of different services.

Catchment Area, Health↗
PubMed2001

Preemptive biopreparedness: can we learn anything from history?

The treat of bioterrorism is in the public eye again, and major public health agencies are urging preparedness efforts and special federal funding. In a sense, we have seen this all before. The Centers for Disease Control and Prevention grew substantially during the Cold War era in large part because Alexander Langmuir, Chief Epidemiologist of the CDC, used an earlier generation's anxieties to revitalize the CDC, create an Epidemic Intelligence Service, and promote epidemiologic "surveillance" as part of the nation's defense. Retrospective investigation suggests that, while Langmuir contributed to efforts promoted by the Department of Defense and the Federal Civil Defense Administration, the United States did not have real cause to fear Communist biological warfare aggression. Given clear historical parallels, it is appropriate to ask, What was gained and what was lost by Langmuir's central role in that first instance of American biopreparedness? Among the conclusions drawn is that biopreparedness efforts fed the Cold War climate, narrowed the scope of public health activities, and failed to achieve sustained benefits for public health programs across the country.

Biological Warfare↗
PubMed1992

The growth of gerontology & geriatrics in the United States.

Since the confirmation of the Older American's Act (OAA) in 1965, the growth of gerontology and geriatrics, has literally come of age in the United States. Although individual aging courses were offered in higher education prior to passage of the OAA, few gerontology programs had been established. On campuses where gerontology courses were available, they represented electives connected with a pre-existing discipline, such as social work or family studies. However, 1965 was a watershed year for gerontology instruction since it heralded the provision of federal funding support, beginning with that of the Administration on Aging (AoA), to help develop, pilot, and oversee gerontological programs in American institutions of higher learning. Initially, instruction was at an undergraduate level, but later gerontology degree programs were established at the master's level, with the first gerontology degree program originating at North Texas State University, in 1967. This program was followed a year later (1968) by a program at the University of South Florida. While funding from AoA began in 1966, funding from other federal agencies (e.g., the Bureau of Health Professions (BHP); the National Institute on Aging (NIA); the National Institute of Mental Health (NIMH), Mental Disorders of Aging Branch; and the Veteran's Administration (VA))--the five agencies that became the basis for a 1984 and 1987 Report on Education and Training in Geriatrics and Gerontology,--did not begin until the mid 1970s. The mid 1970s reflected the growing awareness of the demographic shift in America and around the world, particularly in developed nations.(ABSTRACT TRUNCATED AT 250 WORDS)

California↗
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↗
PubMed2003

Public policy and evidence-based practice.

The time has come to add to the body of EBP implementation knowledge at multiple levels, including knowledge about policy, program priorities, clinician practice, consumer adherence, and family member support. Implementation at the policy level, however, is primary and paramount. The national initiative supporting EBP implementation is one of the most important innovations on the mental health horizon. It will serve as the testing ground for what can be learned about bridging the gap between science and service. This important initiative will not go far if it is not supported by mental health policies--at state and federal levels--that create the organizational and financial incentives to implement EBPs. In addition, it will be a time-limited activity if it also does not yield lessons about how to adapt to new evidence and on-going systemic changes. Organizations must be flexible and able to learn and adapt. The promise of decades of research must be realized in practice. There is an opportunity to combine quality improvement with accountability through performance measurement and the implementation of effective new services and treatments. The Surgeon General simultaneously identified this research's promise and documented its shortcomings. His report outlines courses of action for policymakers that should guide clinicians away from service disparities and toward the implementation of EBP.

Age Factors↗
PubMed2004

[Ethics in the process of teaching-learning in obstetrical nursing].

This objective of this study was to observe ethics and solidarity in the teaching-care process in women during prenatal care and childbirth. A centralized case study was carried out using critical-reflexive pedagogy. Thirty-nine nursing students and six teachers who taught theoretical-practice classes were interviewed at the Federal University of Ceará. The results showed that students and teachers are aware of the need for ethics competency and its applicability in care and that there is a need for new learning strategies to enable the student to develop interactive and human actions and solidarity. Updated care methodologies are needed that involve women as process participants and enable respect to their dignity.

Education, Nursing↗
PubMed2000

[Learning leadership: nurses opinion about their academic education].

The purpose of the present study was to identify nurses opinion about aspects of their academic undergraduate education directed to form leaders of the nursing team. Therefore, authors interviewed 17 nurses from a public federal hospital who experience the condition of being staff leaders. The collected material was analyzed through the technique of content analysis. Results evidenced a dissatisfaction concerning their academic training on leadership. The approached aspects showed the importance of a reflection about the need of teaching-learning strategies that allow students to develop leadership skills.

Attitude of Health Personnel↗
PubMed2005

Identifying best practices states in motorcycle rider education and licensing.

PROBLEM: After decreasing to a historic low in 1997, motorcycle crash-related fatalities are increasing. Although causes remain unclear, motorcycle rider education and licensing play key roles in reducing motorcycle crashes and injuries. Yet, little is known about what constitutes effective rider training and licensing. This study develops a model of best practices in motorcycle rider education and licensing and combines primary and secondary data to identify states that most closely adhere to this model. Evidence on the validity of the model is also examined. METHOD: States were rated along three areas of best practices: (a) program administration; (b) rider education; and (c) licensing based on 2001 data collected for a National Highway Traffic Safety Administration (NHTSA)-sponsored study. RESULTS: Results indicate wide variation in states' adherence to best practices; several states meet most, others very few. When the areas of best practices are considered separately, a state tends to behave similarly on all three. Initial evidence supports the validity of the model, with high best practices states having the lowest rates of motorcycle fatalities. IMPACT ON TRAFFIC SAFETY: As motorcycle-related crashes increase and state and federal support for rider education programs diminishes, it is critical that states identify deficiencies in their program and learn from successful states about efficient, cost-effective strategies for increasing best practices in motorcycle rider education and licensing.

Accidents, Traffic↗
PubMed1997

Integrating children's health services: evaluation of a national demonstration project.

OBJECTIVES: Increasingly, the public and private sectors are turning to "service integration" efforts to reduce, if not eliminate, barriers to needed care created by categorical programs. In 1991, the Robert Wood Johnson Foundation established a new national demonstration project, called the Child Health Initiative, intended to test the feasibility of developing mechanisms at the community level to coordinate the delivery of health services and to pay for those services through a flexible pool of previously categorical funds. This article presents the findings of an independent evaluation of the Child Health Initiative. METHOD: The evaluation utilized a combination of qualitative methods to assess and describe the experiences of the communities as they developed and implemented integrated health services. It used a repeated measures design involving two site visits and interim telephone interviews, as well as review of documents. RESULTS: Overall, the demonstration project achieved mixed success. Both care coordination and the production of community health report cards were found to be achievable within the relatively short life of the foundation grant. However, many sites experienced significant delays in the production of report cards and implementing care coordination plans because the sites largely did not benefit from the successful models already in existence. Little clear progress was made in implementing the decategorization component of the project. Sites experienced difficulties due to lack of previous experience with this new undertaking, the inability to secure active cooperation from local, state, and federal agencies, the relatively short duration of the project, and other factors. CONCLUSIONS: A number of lessons were learned from this project that may be useful in future decategorization experiments, including (1) a clear understanding of the concept and its applications among all parties is essential, (2) high-level political commitments to the effort are needed between all levels of government, (3) adequate technical assistance should be provided to surmount technical considerations in establishing a workable approach to decategorization, and (4) decategorization and service integration efforts should focus on both the health and social sectors.

Child↗
PubMed2004

Keynote address: medical informatics and emergency medicine.

A personal look at some of the developments in practical clinical informatics over the past two decades, with discussion of several successful projects, including the National Center for Emergency Medicine Informatics, the Azyxxi system, Federal Project ER One, the Institutes for Innovation in Medicine, the Medical MediaLab, Project Sentinel, and others. Lessons learned, and hints and suggestions for future developers and informaticists.

Emergency Medicine↗