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At least 1,783 records · Page 99Linked to original sources
PubMed2002

Understanding team-based quality improvement for depression in primary care.

OBJECTIVE: To assess the impacts of the characteristics of quality improvement (QI) teams and their environments on team success in designing and implementing high quality, enduring depression care improvement programs in primary care (PC) practices. STUDY SETTING/DATA SOURCES: Two nonprofit managed care organizations sponsored five QI teams tasked with improving care for depression in large PC practices. Data on characteristics of the teams and their environments is from observer process notes, national expert ratings, administrative data, and interviews. STUDY DESIGN: Comparative formative evaluation of the quality and duration of implementation of the depression improvement programs developed by Central Teams (CTs) emphasizing expert design and Local Teams (LTs) emphasizing participatory local clinician design, and of the effects of additional team and environmental factors on each type of team. Both types of teams depended upon local clinicians for implementation. PRINCIPAL FINDINGS: The CT intervention program designs were more evidence-based than those of LTs. Expert team leadership, support from local practice management, and support from local mental health specialists strongly influenced the development of successful team programs. The CTs and LTs were equally successful when these conditions could be met, but CTs were more successful than LTs in less supportive environments. CONCLUSIONS: The LT approach to QI for depression requires high local support and expertise from primary care and mental health clinicians. The CT approach is more likely to succeed than the LT approach when local practice conditions are not optimal.

Aged↗
PubMed1993

Enhancing maternal interactive behavior and child social competence in low birth weight, premature infants.

Effects of a comprehensive early intervention program for low birth weight, premature infants--the Infant Health and Development Program--on mother-child interaction were examined at 30 months (N = 683). Small significant positive effects were found: Intervention mothers had higher ratings on quality of assistance; intervention children had higher ratings on persistence and enthusiasm and on an overall child rating of competence and involvement and lower ratings on percentage of time off-task; intervention dyads were rated as more synchronous. Of a set of initial status variables indexing biological and environmental risk, only 2 treatment interactions were found. Intervention group black children had higher ratings on enthusiasm and lower percentage of time off-task. Independent of treatment, maternal ethnicity and education were significant predictors of maternal and dyadic ratings, while ethnicity and birth weight predicted child ratings. Implications for early intervention and center-based care are discussed.

Adult↗
PubMed1990

[Residents and the teaching role: review of the literature].

We reviewed the available data on residents' teaching role in the clinical setting to develop programs to improve their teaching skills. Articles published from 1966 to 1989 were identified through a computerized search of MEDLINE, and the bibliographies of identified papers were reviewed. Articles directly related to the topic were included and analysed. Taking into account their quality, we extracted data relevant to specific issues. Approximately 15% to 25% of an average work week was spent by residents in different teaching activities. Students acknowledged the importance of their contribution to clinical teaching. Residents benefitted from teaching by increasing their medical knowledge and promoting the development of important attitudes. Insufficient preparation for this task and the numerous practical problems faced by residents may explain their modest performance as teachers. Nevertheless, programs directed to residents might improve the quality of their teaching. We suggest some guidelines for the development of programs to improve their teaching skills and for future research.

Internship and Residency↗
PubMedDate not supplied

Recognizing the talent within: preparing clinicians for a role in professional development.

BACKGROUND: Ongoing professional development is recognized as crucial to the psychiatric and mental health nursing profession; however, implementing effective professional development programs has proved problematic. The Centre for Psychiatric Nursing Research and Practice in Victoria, Australia, developed a clinician-trainer course to overcome some of the identified problems. METHOD: An evaluation was conducted to measure participant satisfaction with the program. RESULTS: The initial evaluation suggests the course delivery and content were considered useful and relevant to participants, although areas for improvement were identified. CONCLUSION: The model developed is potentially effective but a longitudinal evaluation is required to determine the impact of the course on the implementation of professional development in the clinical domain.

Education, Nursing, Continuing↗
PubMed1992

Family planning in St Vincent, West Indies: a population history perspective.

St Vincent's population history, first as a slave society, then, after Emancipation, as a migration-oriented society, has strongly influenced cultural attitudes towards sexuality and fertility. In contemporary St Vincent, sexual activity and procreative ability are highly valued and linked to social status for both men and women. This paper assesses historical and contemporary factors influencing population dynamics in St Vincent, West Indies, and Vincentians' reactions to programs developed to curb population growth. The efforts of private and government programs to introduce family planning and change pronatalist attitudes are evaluated for their cultural appropriateness. Shifting migration patterns and modernization are also affecting gender roles, the social and economic value of children, and the acceptability of contraception to contribute to recent fertility declines.

Adolescent↗
PubMed1993

Proposed fellowship training program in pediatric emergency medicine for emergency medicine graduates.

Interest in pediatric emergency medicine has grown steadily during the past decade among pediatricians and emergency physicians. With the rapid proliferation of pediatric emergency medicine programs for pediatricians has come extensive and valuable experience with this type of fellowship education. As a result, the structure and scope of these programs have become increasingly well established. Because the number of pediatric emergency medicine fellowship programs for emergency physicians has yet to reach "critical mass," no similar de facto standards exist for these programs. The recent establishment of guidelines for pediatric emergency medicine subspecialty certification by the American Board of Emergency Medicine and the American Board of Pediatrics brings new importance to fostering such standards for the training for emergency physicians. To this end, we present a proposed pediatric emergency medicine fellowship program developed during a retreat that included physicians from an emergency medicine program and two pediatric hospitals. We also review some of the significant events that have occurred in the evolution of pediatric emergency care.

Algorithms↗
PubMed1998

Prenatal irradiation: a major concern for the developing brain.

Irradiation of the mammalian foetus produces a broad spectrum of congenital abnormalities, growth retardations, developmental delays, and functional deficits, depending upon the dose and the specific gestational phase of irradiation. The developing brain is particularly susceptible to production of deleterious effects, with decreased brain size, behavioural alterations, and mental retardation having been documented. Supplementing the limited human data, rodent models have been extensively used to investigate the specific processes by which relatively low doses, with correspondingly minor cellular damage to the developing neocortex, can produce dramatic postnatal consequences in brain structure and function. The effects of a variety of physical (dose, linear energy transfer, dose rate, fractionation) and biological (species, strain, gestational age, time course post-irradiation) parameters have been examined in an attempt to provide much needed information on such critical aspects as dose response, threshold doses for effect, and extrapolation to human risk estimates. Various acute cellular responses (e.g. appearance of pyknotic cells and macrophages) observed in the developing neocortex 0-24 h after in utero irradiation can be associated with postnatal effects. Moreover, it is possible to correlate thinning of specific layers of the cerebral cortex with specific behavioural aberrations, allowing prediction of brain structural changes from functional alterations, and vice versa. Thus, it is possible to speculate as to the mechanisms and targets for extremely sensitive, radiation-induced cellular damage in the developing foetal brain, that will interfere with the orderly and precisely programmed development of the mammalian brain, leading finally to postnatal expression as delays in growth and development, perturbations in behaviour, and alterations in brain structure.

Animals↗
PubMed1996

Occupational health and safety in the biotechnology industry--a survey of practicing professionals.

A survey was created to gauge how health and safety (H&S) resources are allocated in the biotechnology industry and to help understand the concerns of industry H&S professionals. A questionnaire was distributed to "the person most responsible for health and safety" at 34 companies; 12 commercial firms responded. Nearly 68% of the work force monitored did not fall into any biohazard classification. Almost 80% of work involving biohazards was considered "exempt" or "BL-1" under the Centers for Disease Control and Prevention classification system, indicating that most work was performed involving organisms of low pathogenic potential. H&S program development and administration is mature; 100% of respondents report having written programs for chemical, biological, and physical hazards. Chemical safety programs occupied, on average, the greatest percentage of the H&S professionals' time (46%), followed by biosafety (29.6%) and physical hazards (16.4%). The person most responsible for H&S averaged 65% of work time on H&S issues, while only 25% described their full-time responsibilities as H&S related. Staffing levels for companies with more than about 100 technical workers approximated 1.0-1.5 full-time H&S staff equivalents per 100 technical workers. This figure compares favorably with levels reported in a benchmarking survey of hospitals. Investigation into accident rates as a measure of H&S program effectiveness suggests that the biotechnology industry is a relatively safe one. Lost time injury and illness rates were significantly lower for the 12 participating companies than the accident frequency rates in the Standard Industrial Classification codes selected for comparison.

Accidents, Occupational↗
PubMed2003

Where are the healthcare leaders" the need for investment in leadership development.

Is there a crisis in healthcare leadership? In order to understand this question we must first look at what is meant by the term leadership. We prize and admire leadership skills, yet we have little understanding of how and why some persons are more effective leaders than others. This paper describes the changing concept of leadership in the context of both corporate and healthcare settings. The approaches taken in corporate leadership development programs are contrasted with the way in which leaders have been developed in healthcare. The authors assert that there are unique characteristics of health systems and organizations that warrant a tailored approach. A new model of developing healthcare leaders is proposed, one that could transform the educational process and improve outcomes. The authors call for a "back to basics" about how adults learn and outline an approach to leadership development in healthcare that includes principles of competency-based development, interdisciplinary and team learning and continuous assessment. Their conclusion is that leadership development is not done solely to improve the leadership skills of one individual but is an essential component of the development of the organization as a whole. Progressive health systems that invest in leadership development for the entire senior management team will have the more significant return on investment in terms of organizational effectiveness.

Administrative Personnel↗
PubMed1993

Autonomy and care for the frail elderly. A one-year project identifies effective interventions for congregate housing residents.

In 1989 the St. Louis-based Cardinal Ritter Institute (CRI) conducted a demonstration project to determine how effective its interventions were in enabling the elderly to age in place. Preliminary screenings of persons at a congregate living site for the elderly revealed four major areas of concern: deficient knowledge of medication regimens, side effects, and purposes; need for basic social interaction; depression-related primarily to loneliness and isolation; insufficient knowledge of community resources. A multifaceted program developed by CRI staff helped alleviate many of these problems. The program's success shows that early identification of frail elderly at risk for losing their independence can guide interventions that allow them to age in place.

Activities of Daily Living↗
PubMedDate not supplied

[Evolution of MIR-repeats in coding regions of the human genome].

A search for new members of the mammalian interspersed repeat (MIR) family has been done over the coding regions of human genome from GenBank-116. Only 254 nucleotide sequences contained MIRs in coding regions, of which 45 MIR copies were unknown before, including 17 that occurred in translated gene regions. The program developed by the authors has been demonstrated to surpass the CENSOR program in the search power. The evolution of the MIR copies located in translated regions of human genome is discussed.

Base Sequence↗
PubMed1992

Use of neurodevelopmental treatment as an intervention: annotated listing of studies 1980-1990.

This annotated bibliography presents a listing of research investigations on the effectiveness of neurodevelopmental treatment, an approach developed by the Bobaths in managing the neuromotor problems of infants, toddlers, children, and adults with neuromotor disorders. The annotated listing of 19 articles appearing in peer-reviewed journals between 1980 and 1990 is presented by category of experimental design (single-subject, quasi-experimental, and experimental). Each research article was reviewed for research question, conceptual framework, research design, findings, and limitations. The bibliography should be useful for educators, clinicians, and researchers in evaluating current research and in developing strategic plans for research. The implications for clinical practice and program development are discussed.

Activities of Daily Living↗
PubMedDate not supplied

Professional development framework. Pathway to the future.

Staff development educators in a large midwestern university hospital developed a framework for professional development. The framework, applicable to all nurses, has four levels of professional development, from professional awareness to professional mastery. Within each developmental level five dimensions of nursing practice are identified: nursing process and practice skills, communication/collaboration, leadership, professional integration, and research/evaluation. This framework for professional development is reported and its potential use in the areas of planning, development and evaluation of staff development programs; restructure of a clinical ladder for nurses; and individual career development is discussed.

Communication↗
PubMed1970

Coordination of regional libraries with Regional Medical Program projects.

The Medical Library Assistance Act authorized the Regional Medical Library Program to improve information services in health fields, as well as other programs designed to help the health worker. Both the RMLP and the Regional Medical Program are based on regional cooperation to enhance the value of available resources, and to enable health workers away from main centers to use them. Services which Regional Medical Libraries must supply are described. As this program develops, more than conventional library services will be provided. Regional Medical Programs stress the continuing education of health-related personnel, and their need for health information; libraries are necessarily involved in such programs. The regions of the RMP are smaller than those of the RMLP, and the smaller regional focus may be an advantage. Specific examples of the coordination of library services and library-oriented programs are given.

Information Services↗
PubMed1995

Development of a program teaching laparoscopic sterilization using local anesthesia.

A program teaching laparoscopic sterilization using local anesthesia was developed and implemented in a large residency program in which sterilization using general anesthesia was already being taught in a traditional fashion. Important steps for the development of such a program included the designation of an individual with overall responsibility for the program, identification of potential obstacles along with feasible solutions, and training of residents and staff in the new techniques. The major obstacles to implementation included opposition from anesthesia personnel, the need for additional training in the new techniques for both residents and faculty, nursing staff resistance, and the uncertainty of patient acceptance. Solutions included involving anesthesia personnel in program planning as well as in the ultimate performance of the procedures, practicing local techniques during cases under general anesthesia, limiting initial cases to candidates anticipated to be uncomplicated, and using nondirective counseling of patients. Similar strategies can be useful both to other residency programs and individuals wishing to offer local anesthesia as an option for laparoscopic sterilization at their hospitals.

Anesthesia, Local↗
PubMedDate not supplied

A guide to competency-based orientation. Develop your own program.

Nursing orientation should provide the requisite knowledge and skills to enable a nurse to perform competently in a new work environment. This article provides a step-by-step guide to the development of a competency-based orientation program that is supported by well-developed preceptors. It is written in a "how-to" format, providing the guidance and tools necessary for a nurse educator to develop a program that is institution specific.

Clinical Competence↗
PubMed1998

Training in clinical hypnosis, a historical perspective: the Montana experience.

When Dr. D. Corydon Hammond invited me to write a paper for this symposium on hypnosis training, it was obvious that its greatest contribution could be a description of the rather intensive program developed over 2 decades at the University of Montana. However, it became apparent that the Montana program was only part of some 50 years experience developing professional education in hypnosis, psychotherapy, and graduate training in general. At the risk of being accused of immodesty I must therefore write much of this contribution in the first person.

Education↗
PubMed2004

Application of the transtheoretical model to health education for older adults.

The application of theory to practice can be challenging. This article describes the experiences of one organization in applying the Transtheoretical Model (TTM) to a health promotion program for older adults, Health Stages. The concepts of the model, especially stage of change, were successfully used for program planning, curriculum development, and program evaluation. A Programming Grid was developed to guide curriculum development and evaluate if programs were reaching out to people at all stages of readiness to make healthy changes. Other TTM constructs, including self-efficacy, decisional balance, and processes of change were incorporated into the Health Stages curriculum. Evaluation showed that the pilot sites increased their offering of action- and maintenance-oriented programs, filling in the gaps in current programming. Older adults were receptive and interested in the model. The TTM enhanced the program by providing a framework for design and a method for reaching a wider audience of older adults with important health information.

Aged↗