SEARCH · Search PubMed

Results for “Program Sustainability”

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.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,675 records · Page 93Linked to original sources

PubMedDate not supplied

Public reaction to Victoria's "2 Fruit 'n' 5 Veg Every Day" campaign and reported consumption of fruit and vegetables.

BACKGROUND: The Victorian "2 Fruit 'n' 5 Veg Every Day" campaign was aimed at increasing awareness of the need to eat more fruit and vegetables and encouraging increased consumption of these foods in the Australian state of Victoria. The demand-side component of the campaign, which had television advertising as a centerpiece, ran from 1992 to 1995. METHODS: Annual postcampaign telephone surveys of approximately 500 Victorians ages 20 and over were conducted with the aim of examining public awareness of the campaign, beliefs about desirable eating habits for fruit and vegetables, and reported consumption of these foods. RESULTS: Over the years, patterns in the level of public awareness, reported consumption, and beliefs about appropriate levels of consumption have tended to parallel changes in the level of mass media investment. During the campaign's most intense period of promotional activity, significant increases in all of these variables occurred. CONCLUSIONS: The results suggest that significant achievements can be made with relatively small-budget mass media promotion of dietary recommendations, especially when part of a more comprehensive program. However, campaigns may need to be adequately resourced for several years if sustained change is to be achieved.

Adult↗

PubMed1995

Programmed ventricular stimulation in survivors of acute myocardial infarction: long-term follow-up.

The prognostic significance of ventricular tachyarrhythmias induced by programmed ventricular stimulation was evaluated in 492 consecutive survivors of acute myocardial infarction (AMI). Holter monitoring, signal-averaged electrocardiogram (ECG) and measurement of left ventricular ejection fraction (EF) were also performed. The protocol used up to 3 extrastimuli. Sustained monomorphic ventricular tachycardia (VT) < 270 beats/min, > 270 beats/min (ventricular flutter) (VFI), and ventricular fibrillation (VF) were induced in 99, 66 and 52 patients, respectively. Long term follow-up (mean 3.7 +/- 2.2 years) showed that most episodes of VT occurred during the first months following AMI (n = 14), but some patients (n = 6) could develop VT as late as 4 years after AMI. Sudden death (SD) (n = 22) always occurred during the first year following AMI. Multivariate analysis demonstrated that EF < 30% and induction of a VT < 270 beats/min were the only predictors for total cardiac death (P < 0.001). EF < 30%, induction of a VT < 270 beats/min and also of VFI (P < 0.05) were predictors for VT and SD: the risk was 4% in patients without inducible VT, 12% in those with inducible VF1, and 21% in those with inducible VT < 270 beats/min. In conclusion, induction of a sustained monomorphic VT < 270 beats/min or > 270 beats/min is a predictor of arrhythmic events during the first year as well as 4 years after myocardial infarction. However the risk of arrhythmic sudden death decreases after the first year, while the risk of VT persists. Because of the low positive predictive value of programmed stimulation (respectively 21% and 12% for the induction of a sustained VT and VFI), we recommended the indication of programmed stimulation in only the patients with one abnormal non-invasive investigation.

Actuarial Analysis↗

PubMed1985

Efficacy of combination therapy with mexiletine and a type IA agent for inducible ventricular tachyarrhythmias secondary to coronary artery disease.

The efficacy of combination therapy using a type IA agent (quinidine or procainamide) and a type IB agent (mexiletine) in suppressing inducible sustained ventricular tachyarrhythmias was studied in 23 patients undergoing serial drug testing with programmed stimulation. All patients had coronary artery disease (CAD) with previous myocardial infarction and abnormal left ventricular function (mean ejection fraction 35%). Fifty-five percent of the patients presented with syncope or cardiac arrest. In 19 patients therapy had failed during empiric trials of 1 to 3 antiarrhythmic agents. All 23 patients had inducible sustained ventricular tachyarrhythmias (18 had uniform morphology sustained ventricular tachycardia (VT) and 5 had ventricular fibrillation [VF]) during control electrophysiologic study, and therapy had failed with a type IA agent and mexiletine alone. The combination therapy of mexiletine and the type IA agent prevented induction of any ventricular tachyarrhythmias in 8 of 23 patients. In 15 patients, the combination significantly prolonged the tachycardia cycle length and reduced the symptoms associated with the induced arrhythmia. Patients more likely to respond to the combination had shorter cycle lengths and polymorphic configuration of the control-induced arrhythmia. The increased efficacy of the combination therapy could not be attributed to higher plasma drug levels for the combination, as there was no significant difference in plasma levels for each drug when given alone or in combination. Thus, the increased efficacy most likely reflects a synergistic electropharmacologic effect of the 2 agents.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2005

Giving youth the social and emotional skills to succeed.

WINGS for Kids is a nonprofit organization based in Charleston, South Carolina, that aims to supply the social and emotional learning (SEL) component into existing programs for school-aged children and thereby assist them to recognize and manage emotions, care about others, make good decisions, behave ethically and responsibly, build satisfying relationships, and avoid negative behaviors. The author, who is the founder and CEO of WINGS, traces the ethos of the organization to her own life experiences as well as her observations of low-income children and families more generally. She describes the strategies and practices that characterize the WINGS approach to SEL. The chapter focuses on the progress made by one boy, who arrived at WINGS at the age of seven, got into disputes from the very first day, and was eventually ejected from the WINGS program but later earned his way back with a commitment to change. He sustained his involvement for a number of years and became an exemplar of what the author states they are trying to accomplish.

Achievement↗

PubMed1993

Therapeutic monitoring and pharmacist intervention in a Hansen's disease clinic.

OBJECTIVE: To describe the role of the clinical pharmacist in a Hansen's disease (HD, leprosy) clinic and to describe the development, validation, and operation of a dapsone compliance monitoring program. RATIONALE: HD remains a major, worldwide healthcare problem. Dapsone is the drug of choice for treatment of HD; however, high rates of noncompliance with this agent have been reported by many treatment centers. The assessment of compliance in HD patients is important to help distinguish between treatment failure secondary to noncompliance or to the development of resistance. SETTING: In the US, the Chicago Regional Hansen's Disease Center at the University of Illinois at Chicago is one of ten centers that provide comprehensive care to patients diagnosed with this condition. This article reviews the clinical pharmacy services and dapsone compliance program in the clinic encompassing the years 1983-93. RESULTS: The clinical pharmacist provides a variety of clinical services in the clinic as well as coordinating the clinical research program. A pharmacist-generated dapsone compliance program led to improvement in compliance rates and clinical outcome. This improvement in compliance has been sustained over an extended period of time. CONCLUSIONS: The clinical pharmacy services performed in the HD clinic provide a model for pharmacy involvement in other chronic disease states. The dapsone compliance program has been successful in improving patient care and obtaining reimbursement for clinical pharmacy services.

Academic Medical Centers↗

PubMed1989

Programmed ventricular stimulation in patients with left ventricular dysfunction and ventricular tachycardia: effects of acute hemodynamic improvement due to nitroprusside.

To assess the electrophysiologic effects of acute hemodynamic improvement in patients with left ventricular systolic dysfunction, 12 patients with a left ventricular ejection fraction less than 0.40 and a history of sustained monomorphic ventricular tachycardia were studied. All patients had underlying coronary artery disease. Patients underwent programmed cardiac stimulation in random order during a baseline period and with nitroprusside infusion. Mean pulmonary capillary wedge pressure decreased from 20 +/- 8 mm Hg at baseline study to 8 +/- 3 mm Hg during nitroprusside infusion (p less than 0.0001). Pulmonary artery, right atrial and systemic arterial pressures also decreased with nitroprusside (p less than 0.01). Cardiac output did not change. Left ventricular dimensions, determined by two-dimensional echocardiography, decreased significantly during nitroprusside infusion. The right ventricular effective refractory period, measured during ventricular drive trains at cycle lengths of 400 and 600 ms, were similar during baseline and nitroprusside periods (271 +/- 30 versus 274 +/- 31 ms at 600 ms, and 249 +/- 25 versus 246 +/- 18 ms at 400 ms). In 2 patients no ventricular arrhythmias were induced during either study period; in the other 10, ventricular tachyarrhythmias were induced during both periods. The mean number of extrastimuli required to induce a ventricular tachyarrhythmia was similar during the baseline period (1.8 +/- 0.6) and during nitroprusside infusion (1.9 +/- 0.7). As well, the mean cycle length of ventricular tachycardia induced was similar during the baseline period (347 +/- 61 ms) and during nitroprusside infusion (342 +/- 70 ms).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1997

Collaborative office rounds: continuing education in the psychosocial/developmental aspects of child health.

OBJECTIVES: In recent years there has been increasing emphasis on the mental health aspects of primary health care for children and adolescents. The Health Resources and Services Administration's Maternal and Child Health Bureau has contributed to efforts aimed at strengthening primary care not only in early identification and beginning intervention with mental disorders, but also in prevention of emotional and behavioral problems and in promotion of positive psychosocial development. The Collaborative Office Rounds (COR) Program is a noteworthy part of these efforts. METHODS: The COR program supports small discussion groups that meet at regular intervals over sustained periods of time to address the mental health aspects of pediatric care. The groups are jointly led by pediatricians and child psychiatrists. Although they vary in a number of ways, all are concerned with the day-to-day psychosocial issues that confront primary care providers serving children, adolescents, and their families. RESULTS: COR groups have addressed a wide range of areas including numerous problems and disorders, health supervision issues, family and community topics, personal challenges and practical complexities, and clinical management issues. Evaluation information indicates a positive response on the part of participants and moderators. This is reflected in group stability, high attendance rates, universal readiness to recommend the COR experience, and a variety of collateral accomplishments. CONCLUSIONS: Experience to date points to the COR group as a useful tool for addressing psychosocial issues in primary care. Its potential may be more fully realized by applying this approach more widely, even as further assessment is pursued.

Adolescent↗

PubMed1991

Risk management: the clinician's defense against liability.

As Stock and LeFroy conclude, a RM program lends structure and direction to management. Consistent delivery of high-quality service requires that hundreds of individuals perform numerous roles with a value-added service orientation. Jan Carlzon, the Director of Scandinavian Airlines and the person responsible for its remarkable turnaround, has the proper perspective: "We don't seek to be one thousand percent better at any one thing. We seek to be one percent better at one thousand things." Risk management is one factor in the development of a service-oriented health care culture that leads to sustained profitability through a stable patient base. The development of a RM program for a private dental office will lay the groundwork for a higher goal; a demonstrable, verifiable quality of care throughout the practice.

Canada↗

PubMed2006

Humanitarian ventures or 'fistula tourism?': the ethical perils of pelvic surgery in the developing world.

The vesico-vaginal fistula from prolonged obstructed labor has become a rarity in the industrialized West but still continues to afflict millions of women in impoverished Third World countries. As awareness of this problem has grown more widespread, increasing numbers of American and European surgeons are volunteering to go on short-term medical mission trips to perform fistula repair operations in African and Asian countries. Although motivated by genuine humanitarian concerns, such projects may serve to promote 'fistula tourism' rather than significant improvements in the medical infrastructure of the countries where these problems exist. This article raises practical and ethical questions that ought to be asked about 'fistula trips' of this kind, and suggests strategies to help insure that unintended harm does not result from such projects. The importance of accurate data collection, thoughtful study design, critical ethical oversight, logistical and financial support systems, and the importance of nurturing local capacity are stressed. The most critical elements in the development of successful programs for treating obstetric vesico-vaginal fistulas are a commitment to developing holistic approaches that meet the multifaceted needs of the fistula victim and identifying and supporting a 'fistula champion' who can provide passionate advocacy for these women at the local level to sustain the momentum necessary to make long-term success a reality for such programs.

Altruism↗

PubMed1994

Effects of incremental doses of procainamide in patients with sustained uniform ventricular tachycardia.

INTRODUCTION: Although intravenously administered procainamide has been used extensively during electropharmacologic testing for more than 10 years, there is little information available on the effects of incremental dosing of procainamide in patients with inducible, monomorphic ventricular tachycardia (VT). METHODS AND RESULTS: Twenty-nine patients with coronary artery disease had sustained monomorphic VT reproducibly induced in the baseline, drug-free state. Programmed stimulation was repeated 5 minutes after loading infusion (50 mg/min) of 7.5 and 15 mg/kg (all patients) and 22.5 mg/kg of procainamide (15 patients), while maintaining continuous infusion of 0.055, 0.11, and 0.165 mg/kg per minute after each increment in dose, respectively. Corresponding procainamide plasma concentrations were 5.6 +/- 2, 10.5 +/- 3, and 14.5 +/- 3 mg/L before, and 4.7 +/- 2, 9.6 +/- 3, and 14.6 +/- 4 mg/L after electrophysiologic study at each increment in dose of procainamide, respectively. Each incremental dose of procainamide resulted in significant prolongation of tachycardia cycle length and QRS duration during sinus rhythm and right ventricular pacing. Five (17%), 7 (24%), and 1 (7%) patients, respectively, had no inducible sustained VT following the incremental dosing of procainamide. Three of five patients who had no inducible VT at 7.5 mg/kg had VT induced again at a higher dose of procainamide. Four of 24 patients whose VT remained inducible at 7.5 mg/kg of procainamide had no VT induced at 15 mg/kg of procainamide. Twelve (41%), 15 (52%), and 6 (40%) patients, respectively, no longer had VT with baseline morphology induced following the incremental dosing of procainamide. VT with new morphology compared to baseline was induced in more than 40% of patients at one or more of the three different procainamide dosing regimens. The mean cycle length of VTs with new morphology was significantly shorter than the cycle length of tachycardias with baseline morphology at each particular dose of procainamide. CONCLUSION: Similar serum procainamide concentrations before and after programmed stimulation can be achieved at the described dosing regimen. Although 7.5 and 15 mg/kg of procainamide are both effective in suppressing induction of all VT in 20% to 25% of patients, non-inducibility at a particular dose of procainamide does not predict noninducibility at a respectively higher or lower dose. New morphologies of VT that are frequently faster than VTs with baseline morphology at a particular dose of procainamide can be induced in approximately half of the patients, and the clinical significance of these arrhythmias remains to be determined.

Adult↗

PubMed1990

Nicotine gum: does providing it free in a smoking cessation program alter success rates?

Successful strategies to enhance smoking cessation are important in family medicine. Many facets of smoking-cessation programs have been evaluated to determine their effectiveness in contributing to success. One factor that has not been investigated is the effect of cost to the smoker of nicotine gum. A retrospective analysis of the 1-year sustained (lapse-free abstinence) success rates of 375 participants in a smoking-cessation program, led by family physicians, revealed that participants who were provided nicotine gum by their employer had a significantly higher 1-year success rate (38% vs 27%) than those who purchased the gum individually.

Adolescent↗

PubMed1999

Tedisamil in a chronic canine model of atrial flutter.

Tedisamil inhibits several cardiac potassium channels including Ito, Ikr, and the adenosine triphosphate (ATP)-sensitive potassium channel (I(KATP)), which may be important in the initiation and maintenance of atrial arrhythmias. We herein report the efficacy of tedisamil in terminating and protecting against the reinduction of atrial flutter (AFL) in a conscious canine model. Sustained AFL (> 15 min) was induced in eight of 10 mongrel dogs by programmed atrial stimulation (PAS) 2-41 days after producing a surgical barrier to conduction in the right atrium. At the time of surgery, an epicardial electrode was attached to the right atrial appendage for pacing and recording. Normal saline, 1 ml/kg, was infused after 15 min of AFL as placebo. Tedisamil (1.0 mg/kg) was given intravenously after 30 min of sustained AFL while recording surface ECGs and atrial electrograms. Conversion to sinus rhythm was achieved in 10 of 10 trials (eight dogs) in a mean time of 20.5 s (SD, +/- 11.8 s). Tedisamil had a negative chronotropic effect lasting > or =2 h and was protective against the reinduction of AFL. In five dogs, PAS was able to induce AFL in only two of seven trials 2 h after drug infusion. The corrected QT interval (QTc) was lengthened for the first 15 min after tedisamil administration (mean, +/- 39.3 ms; p < 0.05), but thereafter returned to baseline. The QRS interval was not altered by tedisamil. Saline alone, given after 15 min of sustained AFL, converted AFL in one of 11 trials (eight dogs) but did not alter the RR interval, QTc, or QRS interval compared with values measured during AFL. No significant adverse effects of tedisamil were observed. The results indicate that tedisamil is effective in interrupting and/or preventing reinduction of canine AFL, possibly by prolonging atrial refractoriness through inhibition of one or more potassium ion repolarizing currents in atrial muscle. Further studies are required to address the exact mechanism by which tedisamil exerts its antiarrhythmic effect.

Adenosine Triphosphate↗

PubMed1990

Worldwide control of disease through immunization. Progress and prospects.

In summary, tremendous advances have been made over the past 15 years toward the development of effective national immunization programs throughout the world. Immunization levels among children in the developing world have risen dramatically, and in some instances, now equal or exceed levels in industrialized nations. There is no room for complacency, however, because millions of children remain incompletely immunized and many die each year from measles, pertussis, and neonatal tetanus. Immunization activities need to be intensified, accelerated, and sustained within the context of the primary health care system. Expansion of immunization programs to include additional vaccines and other simple health interventions will yield further benefits in the years ahead.

BCG Vaccine↗

PubMed1995

What have we learned about treating child physical abuse? A literature review of the last decade.

A literature review of articles on treatment of physically abused children and treatment of physically abused parents was undertaken. Only articles that had more than five subjects in the sample, at least 15% of the children in the sample having been physically abused and either pretest, posttest; comparison group; or randomization between different treatments used in the design were selected. Twelve papers meeting these criteria for abusive parents and 13 for treatment of abused children were found. Treatment duration ranged from 4 weeks to 12 months for parents and 4 weeks to 24 months for children. A wide range of treatments were used, the most popular for children being therapeutic daycare, with emphasis on improving developmental skills. While most programs showed some improvement with treatment, many had no, or very short, follow-up to see if improvement was sustained. More emphasis needs to be placed on rigorous evaluation and longer-term follow-up of children in physical abuse treatment programs.

Child↗

PubMed1995

Relation between heart rate variability and spontaneous and induced ventricular arrhythmias in patients with coronary artery disease.

OBJECTIVES: The aim of this study was to determine the relation between autonomic control of heart rate and the spontaneous occurrence and inducibility of ventricular arrhythmias in patients with coronary artery disease. BACKGROUND: Low heart rate variability increases the risk of arrhythmic events. It is not known whether impaired autonomic heart rate control reflects alterations in functional factors that contribute to the initiation of spontaneous arrhythmias or whether it is the consequence of an anatomic substrate for reentrant tachyarrhythmias. METHODS: Fifty-four patients with coronary artery disease with a history of sustained ventricular tachycardia (n = 25) or cardiac arrest (n = 29) were studied by 24-h ambulatory electrocardiographic recording and by programmed electrical stimulation. Heart rate variability was compared among the patients with and without spontaneous ventricular arrhythmias and with and without inducibility of sustained ventricular tachyarrhythmias. RESULTS: Eight patients had a total of 21 episodes of sustained ventricular tachycardia on Holter recordings. Standard deviation of RR intervals and low frequency and very low frequency components of heart rate variability were significantly blunted in patients with sustained ventricular tachycardias compared with those without repetitive ventricular ectopic activity (p < 0.05, p < 0.01 and p < 0.05, respectively). However, no significant alterations were observed in heart rate variability before the onset of 21 episodes of sustained ventricular tachycardia. Heart rate variability did not differ between the patients with or without nonsustained episodes of ventricular tachycardia. In patients with frequent ventricular ectopic activity, low frequency and very low frequency power components were significantly blunted compared with those with infrequent ventricular ectopic activity (p < 0.01 and p < 0.001, respectively). Heart rate variability did not differ significantly between the patients with and without inducible sustained ventricular tachyarrhythmias. CONCLUSIONS: Impaired very low and low frequency oscillation of heart rate reflects susceptibility to the spontaneous occurrence of ventricular arrhythmias but may not reflect the instantaneous triggers for life-threatening arrhythmias or a specific marker of the arrhythmic substrate for ventricular tachyarrhythmias.

Autonomic Nervous System↗

PubMed2004

Residential treatment for smokeless tobacco use: a case series.

We developed and implemented a novel 8-day residential treatment program for smokeless tobacco (ST) use. A multidisciplinary team delivered behavioral treatment, nicotine patches were adjusted to achieve 100% replacement of baseline peak serum nicotine concentrations, and bupropion sustained-release was prescribed. Mean participant age (+/- SD) was 47.4 +/- 18.2 years. Mean nicotine patch dose at program end was 43.2 mg/day +/- 13.9 (range 14 to 66 mg/d). Median percent replacement by serum nicotine concentrations was 86.6% (IQR: 75-113.8%). At 1 year, the biochemically-confirmed (urine anabasine <2.0 ng/mL) self-reported 7-day point prevalence tobacco abstinence rate was 58% (14/24). A residential treatment program for ST users may be effective. More research is needed to replicate our findings and determine if comparable abstinence rates can be achieved with outpatient ST treatment programs using similar behavioral and pharmacotherapies.

Administration, Cutaneous↗

PubMed2006

Governance and management structures for community partnerships: experiences from the Robert Wood Johnson Foundation's Community Partnerships for Older Adults Program.

PURPOSE: This article describes early efforts of four community partnerships in Boston, El Paso, Houston, and Milwaukee to address governance and management structures in ways that promote the sustainability of innovative community-based long-term care system improvements. The four communities are grantees of the Community Partnerships for Older Adults Program, a national initiative of the Robert Wood Johnson Foundation that fosters local partnerships to improve long-term care and supportive-services systems in order to meet the current and future needs of older adults. DESIGN AND METHODS: We examined community partnership approaches to governance and management, as well as evidence of the partnerships' influence in their communities, by using the conceptual framework of the community health partnerships typology developed by Shannon M. Mitchell and Stephen Shortell. RESULTS: Addressing governance and management issues was critical to the early evolution of community partnerships for older adults. Early partnership experiences, particularly with regard to local funders and media, provide evidence of emerging centrality (importance and influence in the community), which forecasts sustainability. Observation over a longer period is needed in order to see whether early successes will be sustained, particularly once original grant funding ends. IMPLICATIONS: Community partnerships for older adults can become influential positive forces but must invest in adequate governance and management structures early on.

Aged↗

PubMed1982

Recent advances in antiarrhythmic drug research: studies in chronic canine myocardial infarction-ventricular tachyarrhythmia models.

Several chronic canine myocardial infarction-ventricular tachyarrhythmia models are now available for the evaluation of new antiarrhythmic drugs. The available models fulfill many, but not all of the requirements for an ideal chronic arrhythmia model. Sustained arrhythmias can be initiated in these animals using routine methods of programmed pacing. Presumably, the mechanism for these arrhythmias is localized re-entry, similar to that in patients with previous myocardial infarction and chronic coronary artery disease. However, these models are not suitable for determining whether a new drug will abolish spontaneously-occurring ventricular extrasystoles. In addition, these models are of unproven value in the study of acute spontaneously-occurring sudden death, although recently initiated, provocative work may shed further light on this subject. Most importantly, the available models do seem well-suited to the evaluation of new drugs intended for use of chronic coronary artery disease patients at risk for sustained re-entrant ventricular tachycardia or fibrillation. Notably, the results of preliminary electropharmacologic studies in these canine models parallel closely those findings reported in human patients with sustained life-threatening ventricular tachyarrhythmias. Therefore, increased use of these chronic models for new antiarrhythmic drug testing appears promising.

Animals↗