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PubMed1993

Difficulties in developing a respite program.

St. Paul's Hospital Palliative Care Unit is a 15-bed integrated AIDS and non-AIDS unit that has been open since 1989. A respite program has also been operating since 1989. Overall admissions to the unit have comprised approximately one-third AIDS patients and two-thirds non-AIDS patients. However, the respite patients have consisted of about two-thirds AIDS patients and one-third non-AIDS patients. The 53 patients in the first three years of the respite program have generated 96 respite admissions and 37 non-respite admissions. In the course of developing this program a number of questions and issues have arisen relating to goals and objectives of the respite program, perceptions of the patient and caregivers, and the effectiveness of the program. A review of the utilization patterns of this program and a discussion of selected case histories will be instructional for those who are considering developing their own respite programs.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The ongoing development of a problem-based surgery clerkship: year three.

The third-year clerkship at one college of medicine was modified to reflect an emphasis on adult learning principles and life-long learning habits. Problem-based learning was selected as the educational method, and the development of a cognitive knowledge base, clinical problem-solving skills, and appropriate clinical skills was stressed. At a yearly faculty education retreat, strengths and weaknesses of the clerkship were discussed. As a result of this meeting, several changes were made in the clerkship, including additional stress on students' usage of the medical library and computerized databases, a tutor development program, the addition of expert resource sessions, and more emphasis on students' development of clinical skills through a preceptor program. A comprehensive evaluation program designed to support the educational goals of the clerkship is in place. The major challenge of the program remains the proper synchronization of curricular, clinical, and student self-study activities essential for an ideal learning experience.

Clinical Clerkship↗
PubMed1999

Mentoring program for minority faculty at the University of Pennsylvania School of Medicine.

Research indicates that having a faculty mentor and being part of an active network of peers are critical ingredients of successful academic medicine careers. Minority physicians, however, often do not have mentors, and the problem is greatest for minority groups underrepresented in medicine. The University of Pennsylvania School of Medicine in 1994-1996 undertook to learn the extent of mentoring programs in its departments and divisions and to compare the experiences of underrepresented-minority faculty and others. The results were used to establish a system for mentoring and networking support for minority faculty members. Examining the reports of division and department heads on their formal mentoring programs, it was clear that these leaders considered a mentor essential for career development, but many reported having no systematic plan for mentors for junior faculty. In looking at the reported experiences of minority and non-minority assistant professors (matched for promotion track, department, appointment date, and, where possible, gender), it was found that approximately half of either group did not have mentors. As a result of this information, the school established a faculty development program to meet the faculty members' demonstrated needs: annual career development meetings with new minority faculty; assistance in identifying and assigning mentors; assistance in developing research skills; and monitoring of the retention of minority faculty. As experience with the program produces additional insights into the needs of minority faculty--and particularly of junior faculty--the program will be adjusted and expanded to meet these identified needs.

Adult↗
PubMed1989

Clinical career ladders: the Washington Hospital Center.

The clinical career ladder program developed for pharmacists at The Washington Hospital Center, an 852-bed not-for-profit teaching institution, is described. Many new pharmacists hired during a period of rapid departmental expansion from 1979 to 1984 lacked the knowledge and skills needed to practice effectively in an increasingly complex clinical environment. The existence of a single class of staff pharmacists led to inequities in salaries. A continuing-education program was instituted, but some mechanism of motivating the pharmacists and correcting problems in recruitment, retention, and productivity was needed. In 1984 the department implemented a clinical career ladder with four levels: staff pharmacist, clinical pharmacist, senior clinical pharmacist, and clinical services manager. Duties and responsibilities range from drug distribution, technical supervision, and provision of basic drug information at the staff pharmacist level to supervision of pharmacy services in specified patient-care areas, administrative supervision, and program planning and development at the clinical services manager level. Equity adjustments were made when the program was implemented. Employees who meet the minimum requirements and have received above-standard performance evaluations are considered for promotion. To be promoted to clinical services manager, an employee must apply formally. The program has reduced turnover, particularly among the most highly skilled and productive employees, and has attracted new employees. A career ladder eased problems in employee retention and recruitment, eliminated wage inequities, and became an important motivational force for the professional staff.

Career Mobility↗
PubMed1996

Trauma bereavement program: review of development and implementation.

The Allegheny General Hospital Trauma Bereavement Program demonstrates the importance of specialized follow-up care for surviving family members and loved ones during the year after a death. Sudden, traumatic death leaves the survivors in shocked disbelief and intense emotional pain. Appropriate support and intervention can make a significant contribution to a family's eventual recovery by assisting in the normal grieving process and thus avoiding prolonged, pathologic grieving. The Allegheny General Hospital Trauma Bereavement Program assists a family as it begins to establish hope, order, and the promise of recovery.

Adult↗
PubMed2003

Addressing the new competencies for residents' surgical training.

In July 2001 the Accreditation Council for Graduate Medical Education (ACGME) charged U.S. residency training programs to implement a curriculum and evaluation plan covering six competencies. The authors describe the curriculum and evaluation strategy of the first surgical training program developed to meet the competencies, and list each competency and the teaching method and measurement instruments used. Implementation began July 1, 2001, and the program was fully operational on July 1, 2002. Meeting the curriculum challenges required modification of the existing curriculum and the addition of new instructional units. Nine additional evaluation instruments were needed. The largest investment was in planning and implementation, a one-time development cost. Staff workload increased by 252 hours; this is expected to be a continuing annual requirement. Faculty workload increased by two hours per resident and each resident's workload increased by 112 hours per year (2.3 hours per week). The transition was smoother than expected. Faculty and residents' buy-in was crucial. Faculty and residents were alerted to upcoming changes at the beginning of the year in a grand rounds presentation on the ACGME competencies and the approach to meeting requirements. Updates were presented periodically. The authors recommend that residency programs engaged in similar efforts make effective use of instruments developed elsewhere and collaborate with other programs rather than develop everything locally. The program's benefits include time savings and the availability of validity data and norms to inform decision making on residents' and program progress.

Clinical Competence↗
PubMed2000

Work-site cancer screening: a Latino case study.

PURPOSE/OBJECTIVES: To develop a work-site cancer education and detection program targeted for Latino women and evaluate the effectiveness of the program in a firm with a majority of employees from Latino backgrounds. DESIGN: Program implementation and evaluation. SETTING: A Latino-owned industrial firm in Detroit, MI. SAMPLE: 560 of 857 female employees. Among the 202 women who were eligible for mammography, 142 participated in the screening. METHODS: Education and mammography were offered to women employees of Mexican Industries in Michigan. Education programs and mammograms were conducted at the work site. The programs were offered in English and Spanish. MAIN OUTCOME MEASURES: Participation in education and mammography and evaluation of program components. FINDINGS: Pre- and post-tests of knowledge indicated increases in the understanding of breast cancer. Evaluation of the educational program indicated high ratings of the presentations and materials. CONCLUSIONS: Work-site cancer education and detection programs are cost effective in firms where the majority of employees are from one ethnic/racial group and where the programs take into consideration the cultural background of the employees. IMPLICATIONS FOR NURSING PRACTICE: Cancer education and detection programs should consider the possibility of work-site interventions as well as the ethnic/racial background of employees during program development.

Adult↗
PubMed2006

The role of telemedicine and information technology in the redevelopment of medical systems: The case of Kosova.

The medical system of Kosova was largely destroyed in 1999 by the departing Serbian forces, leaving behind Albanian physicians systematically excluded from advanced medical services for a decade and medical facilities severely damaged in the course of departure in a region with an infrastructure fragmented over the years. The medical system of Kosova can be analyzed for the effectiveness of the many efforts following the disruption of medical care in the 1990s. In this paper, the application of telemedicine and information is recounted. The medical system of Kosova was offered the concept of the International Virtual E-Hospital and this model was used to support, supplement, and guide a massive program development that involved essentially every physician and medical personnel in the region. Currently, the Telemedicine Center of Kosova (TCK) is providing information resources for medical education programs within the Kosova's medical system as well as regional and international consultations and collaboration. Furthermore, it is developing the human resources that will lead and implement telemedicine programs in this region and making serious strides in the redevelopment of medical systems using information technology.

Developing Countries↗
PubMed2006

Wiring the HIV/AIDS system: building interorganizational infrastructure to link people, sites, and networks.

This paper presents a case example of the new "geometry of care" (Rier and Indyk, this volume), by examining selected examples from five facets of a program developed by the lead author and in operation since 1989. This program is designed to understand, build, revise, and maintain the organizational infrastructure with which to link diverse players and sites, and combine these into a web for producing, assessing, and exchanging the information needed to combat HIV/AIDS. Each example demonstrates how opportunities were exploited for developing and linking resources within and between systems of care and prevention. The program began as an iterative and systems approach to improve access of high-risk, hard-to-reach inner city New York populations to HIV/AIDS services, treatment, and research. The approach is also currently being further elaborated and applied in Argentina and India (see Boylan et al., this volume), and is adaptable to other local and global public health challenges (see Indyk & Rier, this volume).

Acquired Immunodeficiency Syndrome↗
PubMed2006

Teaching organization theory for healthcare management: three applied learning methods.

Organization theory (OT) provides a way of seeing, describing, analyzing, understanding, and improving organizations based on patterns of organizational design and behavior (Daft 2004). It gives managers models, principles, and methods with which to diagnose and fix organization structure, design, and process problems. Health care organizations (HCOs) face serious problems such as fatal medical errors, harmful treatment delays, misuse of scarce nurses, costly inefficiency, and service failures. Some of health care managers' most critical work involves designing and structuring their organizations so their missions, visions, and goals can be achieved-and in some cases so their organizations can survive. Thus, it is imperative that graduate healthcare management programs develop effective approaches for teaching OT to students who will manage HCOs. Guided by principles of education, three applied teaching/learning activities/assignments were created to teach OT in a graduate healthcare management program. These educationalmethods develop students' competency with OT applied to HCOs. The teaching techniques in this article may be useful to faculty teaching graduate courses in organization theory and related subjects such as leadership, quality, and operation management.

Models, Theoretical↗
PubMedDate not supplied

Developing a community program on cancer pain and fatigue.

PURPOSE: The overall purpose of this project was to establish a community-based educational model on pain and fatigue management for individuals with cancer. The specific aims were: 1) to develop an appropriate educational program; 2) to pilot test this program in a community setting that supported a self-care approach; and 3) to evaluate the program process and outcomes. DESCRIPTION OF PROGRAM: The I Feel Better program was implemented through a two-session educational workshop taught by masters-prepared oncology nurses and was held at four Southern California sites of The Wellness Community. The focus of the sessions was to provide participants with general information about each symptom, assessment and management of those symptoms, and strategies for effectively communicating with their healthcare providers. Sessions of 2.5-hour duration were held on Saturday mornings and required preregistration. RESULTS: The participants were primarily female and White, with an average age of 58 years. Participants reported considerable pain and fatigue. They also lacked accurate information about pain management. Program evaluation revealed that the content and format were well received by the participants. They rated the program as extremely useful and reported positive outcomes after the first session. CLINICAL IMPLICATIONS: This pilot educational intervention program has strong implications for multidisciplinary educational approaches for patients with cancer. Limitations resulted from the setting selected and the possibility that participants were already active in their fight against cancer. Generalization to other community settings may not be as successful. Programs could be cosponsored by several collaborating institutions to share resources. Referral to community programs by physicians, nurses, and social workers can occur as needed when identified during patient interventions. The voluntary participation of health professionals in community education programs could provide a valuable service for patients and a rewarding experience for educators.

Adult↗
PubMed2005

Production and formulation of adenovirus vectors.

Adenovirus vectors have attracted considerable interest over the past decade, with ongoing clinical development programs for applications ranging from replacement therapy for protein deficiencies to cancer therapeutics to prophylactic vaccines. Consequently, considerable product, process, analytical, and formulation development has been undertaken to support these programs. For example, "gutless" vectors have been developed in order to improve gene transfer capacity and durability of expression; new cell lines have been developed to minimize recombination events; production conditions have been optimized to improve volumetric productivities; analytical techniques and scaleable purification processes have advanced towards the goal of purified adenovirus becoming a "well-characterized biological"; and liquid formulations have been developed which maintain virus infectivity at 2-8 degrees C for over 18 months. These and other advances in the production of adenovirus vectors are discussed in detail in this review. In addition, the needs for the next decade are highlighted.

Adenoviridae↗
PubMed1998

Cost effective, hospital based occupational health services. Successful program.

1. Development of hospital based occupational health service programs focused on meeting business needs is a response to declining inpatient utilization rates, increasing numbers of physicians, and expanding payer control. 2. Nurse practice models using nurse practitioners have demonstrated high quality, cost effective care. 3. Responsiveness to meeting both employee client and employer needs is the key to successful program development.

Cost-Benefit Analysis↗
PubMed2000

The importance of local data in unintended pregnancy prevention programming.

OBJECTIVE: Lack of local data on pregnancy intendedness poses a serious problem for those responsible for regional program development and evaluation. This article demonstrates how the Boulder County Health Department addressed this problem by conducting its own assessment. The information gathered served as the basis for collaborative population-based programming and policy development aimed at decreasing unintended pregnancy in the county. METHODS: A random-digit-dial telephone survey of 300 men and 300 women was conducted to estimate the prevalence of unintended pregnancy and establish groups at highest risk. Qualitative data regarding the psychosocial and contextual factors associated with unintended pregnancy were gathered in six focus groups conducted with 46 males and females aged 18-28 who had experienced an unintended pregnancy. RESULTS: The prevention strategies identified by the focus group participants lead to the development of locally relevant interventions among specific high-risk populations identified in the telephone survey. Programmatic and policy initiatives included raising awareness among key service providers and the community at large, creative means of bringing information and resources to those at risk, strengthening the delivery of clinical services, and promoting school involvement in unintended pregnancy prevention. CONCLUSION: Maternal and child health authorities should encourage the collection and use of pregnancy intendedness data at the local level.

Adolescent↗
PubMed1994

[Work in community health is about to change].

Changes in Ontario's political, social and economic environments have necessitated an unprecedented transformation in the health care system. The change in focus from the individual to the community now includes core units such as families, groups and communities. Visiting nurses, public health nurses and community health nurses have worked in Community Health Centres (CHCs) since 1970. However, the role of nurses working in these centres has not been clearly defined in the literature. Nor is there is a general consensus on their title. Nurse practitioners, primary care nurses or community health nurses are all used. As well, there is no existing educational program in Ontario that trains this type of nurse. This article discusses and gives examples of nurses working in community health, whose primary clinical expertise is in using community based and community development program strategies to plan health programs. These programs are specifically developed to address the health needs of the communities they serve--in this case, Toronto's francophone community. Also demonstrated are new approaches to nursing care within a community setting. From health promotion to disease prevention, from community development to research, the practice of community health nursing is complex and exciting.

Community Health Nursing↗
PubMed1996

Automated imaging and quantitation of tumor cells and CFU-GM colonies in microcapillary cultures: toward therapeutic index-based drug screening.

Human colony forming units (CFUs) from both malignant and hematopoietic tissues can be assayed in vitro in microcapillary cultures, an alternative cloning system to the Petri dish methodology. For technical reasons, microcapillary culture may be ideally suited for new drug screening by therapeutic index. To achieve the high output required by screening programs, automated quantitation of CFUs is required. Toward this end, this paper reports the development of a prototype CapScan, an image analysis system that uses a novel axial laser illumination system to detect tumor cell colonies and, with technical modifications, CFU-granulocyte-macrophage (CFU-GM) colonies in microcapillary cultures. As currently configured, the CapScan can quantify colonies grown in a rack of 18 microcapillary cultures in 30 minutes or less. The sensitivity and detection specificity of tumor cell colonies is >90% with a coefficient of variance of 5-40%, dependent upon colony number. Over a range of colony numbers, CapScan and manual colony counts showed a linear correlation > -0.9, and yielded identical results in assays of doxorubicin inhibition of clonogenic P388 cells. As an additional advantage, the growth kinetics of individual colonies can also be monitored with the CapScan, making distinctions between cytotoxic and cytostatic drugs possible; colonies of freshly isolated human tumor cells can also be quantified. Thus, a microcapillary-based human tumor cloning assay that tests for resistance and/or sensitivity to chemotherapeutic agents may be useful in drug development programs and may also facilitate the development of chemotherapy for individual patient tumors, especially when tumor availability is limited.

Animals↗
PubMed1996

Occupational health programs: envisioning the next generation.

1. As the health care system changes, occupational health programs will play a key role in defining the new relationship between employers and health care providers. 2. Occupational health program development in the 1980s concentrated on treating injuries and increasing the revenues for the health care provider. 3. As employers become more sophisticated and cost sensitive, they will require occupational health programs to improve quality and control costs. 4. To succeed in this new environment, occupational health programs will need to focus on the prevention of illness and injury, develop more cost effective treatments, and use superior information systems which allow them to measure and improve outcomes.

Cost Control↗