[Basic assumptions of the 5-year plan of public health development in the USSR for 1971-1975].
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Health Planning↗
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Functional health development model: a tool for planning.
This paper describes a functional model (gross style) taking available information about the health sector e.g. indicators of health status, types of service utilization, source allocations and placing these quantities into a systematic framework as a tool for planning for health services in a developing area. The major advantages of functional models over trial-and-error for planning have been presented. The functional model described could contribute to the sorting out of desirable from less desirable policy alternatives for a specific population. The output from the model is useful for matching resources to program development, taking into consideration costs and effectiveness.
Computer Simulation↗
The campus at the University of Maryland at Baltimore.
The University of Maryland at Baltimore (UMAB) is an urban professional school campus. Its 36 acres include 39 buildings, both historic and new. The campus fabric is marked by diversity. The new facilities master plan was developed to reflect the strategic planning process for the campus. Design guidelines are intended to create a common theme while still encouraging each building to have a unique identity. The new Health Sciences Library/Information Services building will sit diagonally from Davidge Hall, built in 1812 and the symbolic center of the campus.
Academic Medical Centers↗
Advantage of protons compared to conventional X-ray or IMRT in the treatment of a pediatric patient with medulloblastoma.
PURPOSE: To compare treatment plans from standard photon therapy to intensity modulated X-rays (IMRT) and protons for craniospinal axis irradiation and posterior fossa boost in a patient with medulloblastoma. METHODS: Proton planning was accomplished using an in-house 3D planning system. IMRT plans were developed using the KonRad treatment planning system with 6-MV photons. RESULTS: Substantial normal-tissue dose sparing was realized with IMRT and proton treatment of the posterior fossa and spinal column. For example, the dose to 90% of the cochlea was reduced from 101.2% of the prescribed posterior fossa boost dose from conventional X-rays to 33.4% and 2.4% from IMRT and protons, respectively. Dose to 50% of the heart volume was reduced from 72.2% for conventional X-rays to 29.5% for IMRT and 0.5% for protons. Long-term toxicity with emphasis on hearing and endocrine and cardiac function should be substantially improved secondary to nontarget tissue sparing achieved with protons. CONCLUSION: The present study clearly demonstrates the advantage of conformal radiation methods for the treatment of posterior fossa and spinal column in children with medulloblastoma, when compared to conventional X-rays. Of the two conformal treatment methods evaluated, protons were found to be superior to IMRT.
Cerebellar Neoplasms↗
The emulation theory of representation: motor control, imagery, and perception.
The emulation theory of representation is developed and explored as a framework that can revealingly synthesize a wide variety of representational functions of the brain. The framework is based on constructs from control theory (forward models) and signal processing (Kalman filters). The idea is that in addition to simply engaging with the body and environment, the brain constructs neural circuits that act as models of the body and environment. During overt sensorimotor engagement, these models are driven by efference copies in parallel with the body and environment, in order to provide expectations of the sensory feedback, and to enhance and process sensory information. These models can also be run off-line in order to produce imagery, estimate outcomes of different actions, and evaluate and develop motor plans. The framework is initially developed within the context of motor control, where it has been shown that inner models running in parallel with the body can reduce the effects of feedback delay problems. The same mechanisms can account for motor imagery as the off-line driving of the emulator via efference copies. The framework is extended to account for visual imagery as the off-line driving of an emulator of the motor-visual loop. I also show how such systems can provide for amodal spatial imagery. Perception, including visual perception, results from such models being used to form expectations of, and to interpret, sensory input. I close by briefly outlining other cognitive functions that might also be synthesized within this framework, including reasoning, theory of mind phenomena, and language.
Brain↗
Improving services for people with a psychotic disorder and problematic substance use: a multifaceted approach to project evaluation.
OBJECTIVE: The objective of this study was to conduct a multifaceted formative evaluation of the Central Sydney Area Health Service (CSAHS) Psychosis and Substance Use Project. METHOD: Four evaluative methods were used: (i) description and interpretation of the Project's documented processes and outcomes; (ii) a benchmark comparison of the Project processes and outcomes against three of the 11 National Standards for Mental Health Services; (iii) a survey of the Project's key stakeholders; and (iv) interviews with 12 purposefully sampled key informants. RESULTS: The Project achieved its aim to develop a strategy to improve services for people with comorbid psychosis and problematic substance use. Three of the five Project objectives were fully achieved: examination of current clinical services, development of a clinical services plan, and development of a staff education programme. The Project partially achieved two objectives: development of an information system, and a research agenda. The Project and CSAHS performed well when measured against three of the National Mental Health Standards. Project participants perceived the Project to have been successful and worth continuing, identified some shortcomings and made recommendations for the second phase. CONCLUSIONS: The participatory approach to the Project and the evaluation was successful. With some improvements the Project is worth continuing into a second phase. A multifaceted approach and qualitative research methods are useful for formative evaluation of health service programmes.
Australia↗
Strategies for recruiting nursing students.
When the authors' baccalaureate nursing school was experiencing a decline in enrollment and faculty positions were being threatened, a structured recruitment plan was developed, implemented, and evaluated. This plan increased prospective applicants' access to reliable information about not only the school of nursing but also the profession of nursing. The components of the plan included publicity, prospective applicant contacts, and alumni involvement. The increased number of new entering freshmen with a major in nursing and faculty retention demonstrated the plan's effectiveness.
Educational Measurement↗
A technique of intensity-modulated radiosurgery (IMRS) for spinal tumors.
This study is to demonstrate the feasibility of spinal radiosurgery using an image-guided intensity-modulated radiosurgical (IMRS) procedure. A dedicated Novalis shaped beam surgery unit equipped with a built-in micro-multileaf collimator (mMLC) with a single 6 MV photon beam was used. Each patient was simulated in the supine position using an AcQsim CT simulator with infrared sensitive markers for localization. A variety of different treatment plans were developed, but the most common plan was the use of seven coplanar intensity-modulated beams to minimize radiation to critical organs such as the spinal cord and kidneys. An automatic localization device based on infrared and video cameras was used to guide the initial patient setup. Two keV x-ray imaging systems were used to identify potential deviations from the planned isocenter. A total of 25 patients with spinal tumors have been treated using this procedure with a single prescription dose ranging from 6 to 12 Gy. The final verification images indicated that the average isocenter deviation from the planned isocenter was within 2 mm. The phantom verification of isocenter doses indicated that the average deviation of measured isocenter doses from the planned isocenter doses for all patients treated with intensity-modulated beams was less than 2%. Film dose measurement in a phantom study demonstrated good agreement of above 50% isodose lines between the planned and measured results. Preliminary experience shows that precision delivery of high dose radiation could be administered to the planned target volume while the dose to the critical organs is kept within tolerable limits.
Computer Simulation↗
A participant observation study using actors at 30 publicly funded HIV counseling and testing sites in Pennsylvania.
OBJECTIVES: This study was designed to augment an evaluation of Pennsylvania publicly funded HIV counseling and testing sites, particularly of the staff-client interaction. METHODS: Actors were trained as research assistants and sent to 30 randomly chosen sites to be tested and counseled for HIV disease. Instruments based on Centers for Disease Control and Prevention (CDC) guidelines were designed and used to evaluate them. RESULTS: Data were generated that identified the range of compliance with CDC guidelines and state policy. Among the findings were that 10 of 30 sites required signed consents despite a state policy allowing anonymous testing. Only 17% of providers developed a written risk reduction plan, even though 69% of all sites surveyed by mail asserted that such plans were developed. Only 2 of 5 HIV-positive actors were offered partner notification services, even though 100% of sites visited by an interviewer claimed to offer such services. CONCLUSIONS: The findings suggest that although evaluation methods such as mail surveys and site visits are useful for evaluating the existence of appropriate policies and protocols and gathering baseline data, they might not be sufficient for assessing actual staff-client interaction.
AIDS Serodiagnosis↗
Process evaluation of Nebraska's Team Training Project.
BACKGROUND: A process evaluation of the Nebraska Drug Free School/Community Residential Team Training Project is described. This training project utilizes a "system approach" in the formation and implementation of localized strategic (action) plans targeting alcohol and other drug (AOD) abuse prevention. METHODS: In June of 1990, training participants completed a pre-post survey in conjunction with the four-day training. The majority of the participants (51.2%) were teachers, 19.2 percent were parents, 13.6 percent administrators, and 9.6 percent were counselors. RESULTS: Although the overall attitudes of the participants (N = 125) were positive initially, they became even more so by the end of the training (N = 121). Prior to training participants felt they could have a significant impact on their local AOD abuse problem, and this attitude became more positive by the completion of training (p < 0.05). CONCLUSIONS: The Nebraska team training process immerses team members in an active planning process allowing teams to develop a plan of action for their school and community. During this process, participants experience a positive growth in attitudes reflecting not only the training experience itself, but even more importantly their ability to meaningfully affect AOD abuse and related destructive behaviors in their homes, schools, and community.
Adult↗
Skills, knowledge, aptitudes, and attitudes colloquium.
Three projects recently funded by the American Veterinary Medical Association (AVMA) through the National Commission on Veterinary Economic Issues (NCVEI) focused on the veterinary school applicant pool, leadership skills in the veterinary profession, and a veterinary teaching hospital business model, respectively. The Skills, Knowledge, Aptitude, and Attitude (SKAs) Colloquium was designed to present the results of these three projects, to discuss their importance for the future of the veterinary profession, and to develop action plans accordingly. In all, 24 veterinary colleges were represented at the workshop and a total of 72 attendees participated, achieving a broad representation of the veterinary profession ( both academic and non-academic). Through an orchestrated combination of general sessions and facilitated small group discussions, recommendations for implementation and initial action plans for next steps were developed. From these, a list of potential AAVMC follow-up activities was developed, including advocating and facilitating programs across schools to engage and educate faculty regarding the results of these projects; developing realistic information on careers in veterinary medicine; organizing an AAVMC leadership consortium; working toward further development and implementation of the veterinary teaching hospital (VTH) business model; coordinating and sponsoring a national forum on the future of the VTH; reviewing admissions processes; integrating leadership into veterinary curricula; and organizing opportunities for faculty development in leadership.
Animals↗
[Description of shift team workers health in north districts of Tomskaya Oblast].
In northern regions of Siberia, chronic stress induced by north geophysical and climate living conditions, under additional impact of social and technological negative factors transform first into prepathologic and then into pathologic states. At these conditions, even in younger people exhaustion of reserve possibilities of body occurs very drastically. Due to cause mentioned above, in northern shift team workers chronic diseases develop in younger age. Properly planning of development of health care system in North conditions and establishing of social economic priorities needs to consider characteristics of physiologic, biochemical immune, mental and social processes of human health development in extreme conditions.
Catchment Area, Health↗
Adjust the labour force structure and energetically develop the tertiary industry.
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Asia↗
[Contraception--with us and others].
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Contraception↗
Wayfinding in dementia of the Alzheimer type: planning abilities.
This paper reports on wayfinding in dementia, in particular the ability to develop decision plans for solving wayfinding problems in unfamiliar settings. Fourteen patients diagnosed as having mild to moderate dementia of the Alzheimer type (DAT), and 28 normal elderly were asked to reach a destination in a large hospital setting, and to return to the point of departure. Verbalizations of all subjects were recorded, transcribed, and content-analyzed in order to identify the decisions made during the trip and to establish their functional relationships revealing their planning abilities. Results showed that all DAT patients failed to reach the destination and return to the point of departure without errors. Compared to normal elderly subjects, their overall decision plans were poorly structured, indicating basic problem-solving disorders. However, they were able to solve well-defined problems and develop sub-plans in routine situations when the necessary information was readily available. Nondiscriminatory reading of irrelevant information was also observed and tended to interfere with problem-solving.
Aged↗
Population change, health planning and human resource development in the health sector.
As a result of the demographic and epidemiological transitions now occurring rapidly in many developed countries, a dramatic shift in the age structures of populations and the burden of disease towards the middle-aged and elderly is expected to take place over the next several decades. In the 1990s, however, there remains great diversity across countries in fertility levels and mortality patterns. The World Bank's 1993 World Development Report assessed the global burden of disease in order to define the minimum packages of public health measures and clinical interventions that would improve health conditions in low-income countries in a cost-effective and affordable way. Strategically implementing these programmes will require that government investments be directed toward a limited number of cost-effective health interventions, delivered equitably to the entire population. At the same time, steps must be taken to improve the efficiency and contain the costs of health care delivery in the public and private sectors. Such a population-based health strategy will require the development of a wide range of scientific, analytical and technical capacities, currently rare in most ministries of health. This will require the involvement of epidemiologists, demographers, sociologists, analysts, operations research specialists and environmental health scientists. Building up these capabilities in health ministries, universities or the private sector will be an essential ingredient of health system reform.
Adolescent↗
Factors associated with the development of vasospasm after planned surgical treatment of aneurysmal subarachnoid hemorrhage.
OBJECT: The goal of this study was to determine factors associated with the development of symptomatic vasospasm among patients with aneurysmal subarachnoid hemorrhage (SAH) who participated in the randomized, double-blind, placebo-controlled trials of tirilazad between 1991 and 1997. METHODS: Data obtained from 3567 patients entered into trials of tirilazad were analyzed using uni- and multivariate logistic regression to determine factors that predict the development of symptomatic vasospasm. Symptomatic vasospasm was defined by clinical criteria accompanied by laboratory- and radiologically determined exclusion of other causes of neurological deterioration. Transcranial Doppler ultrasonographic and/or angiographic confirmation was not required. In these patients, the aneurysms were scheduled to be treated surgically, and no patient undergoing endovascular treatment was included. A multivariate analysis showed that factors significantly associated with vasospasm were age 40 to 59 years, history of hypertension, worse neurological grade, thicker blood clot on the cranial computerized tomography (CT) scan obtained on hospital admission, larger aneurysm size, presence of intraventricular hemorrhage (IVH), prophylactic use of induced hypertension, and not participating in the first European tirilazad study. CONCLUSIONS: Symptomatic vasospasm was associated with the amount of SAH on the CT scan, the presence of IVH, and the patient's neurological grade. The association with patient age may reflect alterations in vessel reactivity associated with age. A history of hypertension may render the brain more susceptible to symptoms from vasospasm. The explanation for the relationships with aneurysm size, use of prophylactic induced hypertension, and the particular study is unclear.
Adult↗
Developing a human resource plan.
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Hospital Bed Capacity, 100 to 299↗