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PubMed1997

Costs of family planning programmes in fourteen developing countries by method of service delivery.

The cost effectiveness of several modes of family planning service delivery based on the cost per couple-year of protection (CYP), including commodity costs, is assessed for 1991-92 using programme and project data from fourteen developing countries (five in Africa, four in Asia, three in Latin America and two in the Middle East). More than 100 million CYP were provided through these family planning services during the 12 months studied. Sterilisation services provided both the highest volume (over 60% of total) and the lowest cost per CYP ($1.85). Social marketing programmes (CSM), delivering almost 9 million CYPs, had the next lowest cost per CYP on average ($2.14). Clinic-based services excluding sterilisation had an average cost of $6.10. The highest costs were for community-based distribution projects (0.7 million CYPs), which averaged $9.93, and clinic-based services with a community-based distribution component (almost 6 million CYPs), at a cost of $14.00 per CYP. Based on a weighted average, costs were lowest in the Middle East ($3.37 per CYP for all modes of delivery combined) and highest in Africa ($11.20).

Cost-Benefit Analysis↗
PubMed1989

Family planning programmes in ten developing countries: cost effectiveness by mode of service delivery.

The cost effectiveness of various modes of family planning service delivery based on the cost per couple-year of protection (CYP) is assessed using 1984 data for 63 projects in ten countries (three each in Africa and Asia, and four in Latin America). More than 4.8 million CYPs were provided through these projects during the year studied. Programmes with the highest volume of services delivered corresponded to lowest average costs: social marketing (2.8 million CYPs) and sterilization projects (960,000 CYPs) cost about $2 per CYP, on average; highest costs were for full service clinics and community-based distribution projects ($13-14 per CYP). Costs of clinics combined with community-based distribution services fell approximately midway between these two extremes.

Africa↗
PubMed1990

[Development of a city planning hygiene analysis and its application in the framework of an environmental-epidemiological study].

A "town-planning hygienic analysis" is presented which has been developed within an environmental epidemiological study. This analysis contains 7 marks (maximum sound pressure level Lmax, equivalent pressure level Leq, housing conditions/sanitary, size of flat, brightness/day-light ratio, environment, building order) whose quality is scored into 3 categories (very good/good, sufficient, insufficient). The evaluation is performed by relating the frequency of the proportional quality as well as the score for the general quality, which is constructed by the mean of the proportional qualities. First results are discussed with a comparative study on 297 flats.

City Planning↗
PubMed1990

Case two. Development of a strategic plan and the planning process at a medical center.

In 1983, the medical center had no strategic planning process and no individual or department with an identified responsibility for planning to meet the needs of the organization and its service community. There were limited resources to apply to this endeavor and a prevailing attitude among current leadership that any planning done should be focused solely on facilities development. While the process pursued in this case is similar to that in Case One, unlike Case One, conditions within the organization are less than ideal for the implementation of any process, formal or informal, for the formulation of strategy. Read alone, the case is instructive. Considered in combination with Case One, it provides grist for a good discussion of the differences between organizations which have the capacity to be strategically managed and those which have learning to do.

Chief Executive Officers, Hospital↗
PubMed2002

The effectiveness of personal education plans in continuing professional development: an evaluation.

The aim of this study was to evaluate the use of personal education plans (PEPs) as a method of continuing professional development (CPD), by means of a questionnaire, analysis of completed PEP reports, and in-depth interviews. The setting was the Yorkshire Deanery, and the participants were general practitioners (GPs) who had completed a PEP. The main outcome measures were reported identification of learning needs, educational methods used, and support received. GPs' views were received on their experiences of undertaking PEPs, personal and professional development, and changes in patient care that resulted from their PEPs. Personal impression was the most frequently used method of deciding on learning needs. A variety of educational methods were used, the most frequent being personal reading, practical sessions, and taught courses. The majority of respondents felt that they were well supported by their GP tutors, and that the PEP had helped them to enhance their personal knowledge and skills, as well as to improve service to patients. There were gains in terms of increased confidence and self-awareness. Most were keen to use PEPs in future, and hoped to involve other members of the practice. Our results suggest that PEPs are an effective method of CPD in that they frequently lead to reported changes in patient care, and personal and professional development of the learner.

Adult↗
PubMed2005

Vocational analysis of health care professions as a basis for innovative curricular planning. An analysis and prognosis of the development of the professional competencies of midwives--cornerstones of innovative curricula in tertiary education.

This article describes current and future tendencies in the development of curriculum planning for health care professions in Germany, using the example of midwifery education. In particular, it discusses 'output-based control' of curriculum planning giving consideration to issues related to German education, health policies and professional educational theories with a view to the general international development. The results of this analysis constitute the starting point for the conceptual planning of a dissertation at the medical faculty of the Berlin Charité with the goal of developing a competency model for the curriculum planning of midwifery education, thus creating a modern curriculum as a basis for a fundamental reform of German midwifery education.

Competency-Based Education↗
PubMed2006

Comparison of conventional to intensity modulated radiation therapy for abdominal neuroblastoma.

OBJECTIVE: To compare three different techniques of irradiating abdominal neuroblastoma. PATIENTS AND METHODS: Six children with a median age of 4.1 years underwent radiotherapy (RT) to the primary site as part of treatment for high-risk neuroblastoma. Four had midline disease while two had well-lateralized lesions. Three different RT techniques were compared. Technique A used parallel-opposed AP/PA fields prescribed to the midplane of the patient. For Techniques B and C, intensity modulated radiation therapy (IMRT) plans were developed using inverse treatment planning with a sliding window or dynamic multileaf collimator approach, seven coplanar beams, and a 0.25 x 0.5 cm minimum beam resolution. The clinical target volume (CTV) included the tumor present prior to second look surgery but after induction chemotherapy with a 1.5 cm margin. The planning target volume (PTV) was the CTV with a 0.5 cm margin. The CTV was planned to receive 100% of the prescribed dose. For Technique C, the vertebral bodies adjacent to the tumor were included in the PTV to minimize heterogeneity of dose. Six MV photons were used for all techniques. Bilateral kidneys, liver, spine, spleen, stomach and bilateral iliac crests were contoured. RESULTS: Dose to the PTV and CTV were not significantly different using the three techniques. In comparison to Technique A, Techniques B and C delivered a lower mean dose to the bilateral kidneys in the four children with midline tumors but not the two children with a lateralized tumor where the contralateral kidney received a higher mean dose. Dose to the spine was less homogeneous with Technique B compared to Techniques A and C. The spleen, liver and stomach mean doses were higher using Techniques B and C compared to Technique A. CONCLUSION: Although Technique C was the best method of RT delivery in midline tumors with respect to kidney doses, this was at a cost of a higher mean dose to the liver, stomach, and spleen. This, together with the theoretical increase in secondary malignancies, should be considered when treating a child with IMRT techniques. IMRT was not found to be better than the conventional AP/PA field for lateralized tumors.

Abdominal Neoplasms↗
PubMed1993

State units and convergence models: needs assessment revisited.

Based on a comprehensive survey of state and territorial units on aging, this article reexamines and evaluates the needs assessment process in place in social service agencies. Although most agencies reported multiple sources of planning data, serious limitations in the representativeness of selected data sets were still apparent. We outline a convergence model of needs assessment that utilizes a long-range planning perspective for the development of planning models.

Health Services Needs and Demand↗
PubMed2001

The 'value case' for investment in occupational health.

This paper introduces the problems facing occupational health departments in the current environment created by new legislation and changes in social attitudes. The problems of establishing the true costs and benefits of service provision are discussed. The paper also explains the employment of the 'value principle' in organizations and postulates its use in order to establish the appropriate position of occupational health in corporate thinking. A practical system is suggested, based on a four-step process of strategic planning, issues development, option establishment and plan implementation, which can be used to evaluate and justify investment in services. The problems of future risk are addressed. The paper concludes with the priority of establishing the strategic importance of occupational health services alongside other personnel issues and expresses the possibility of using the same principles outside the business world.

Attitude to Health↗
PubMed1990

Neurosurgical staff development model: from concept to implementation.

Nurses new to the neuroscience specialty often have fears regarding their expertise in this field. This article describes a staff development model successfully implemented in a 560-bed tertiary care center. The historical evolution of the model is discussed and components of the model in relation to professional development are presented. Future plans for development, evaluation and integration of the model into a clinical ladder program are also discussed.

Career Mobility↗
PubMed1996

Self-determination instructional strategies for youth with learning disabilities.

The concept of self-determination is rapidly gaining attention and acceptance within the disability fields. The focus on self-determination is particularly strong in the transition-from-school-to-adulthood movement. The recent Individuals With Disabilities Education Act of 1990 mandated that students with disabilities be involved in the development of their transition plans and that students' preferences and interests be taken into account as transition plans are developed. This article describes four self-determination models and examines several instructional programs and strategies to promote self-determination in students with learning disabilities. Emerging issues in self-determination are examined, and the research and policy implications of these issues are discussed. These issues include (a) redefinition of roles, (b) the importance of taking risks, (c) individual versus group orientation for self-determination, and (d) the importance of early experiences.

Curriculum↗
PubMed2000

Embedded evaluation of preferences sampled from person-centered plans for people with profound multiple disabilities.

We investigated a brief, embedded assessment for evaluating preferences sampled from person-centered plans. After developing person-centered plans for individuals with multiple disabilities, systematic assessments were conducted with preferences sampled from the plans. An assessment of sampled preferences was then embedded within the participants' daily routines. The two assessments identified similar preferences based on participant approach responses. Both assessments also indicated inconsistencies with reported preferences in the person-centered plans. Overall, results suggested the embedded assessment may be an alternative means of evaluating some preferences reported through person-centered planning.

Adult↗
PubMed1989

The role of occupational health clinics in surveillance of occupational disease.

Academic occupational health centers can support state-based occupational disease surveillance by playing a role in case identification and management, physician education, workplace investigation, and surveillance case criteria development. The existing centers can also serve as models for developing new clinics. As plans for developing surveillance continue, the role of these centers should be explicitly defined, and they should be included in helping to develop mechanisms for reporting. In all these ways, the centers can significantly enhance the development of a national surveillance system for occupational disease.

Education, Medical↗