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A program to educate school nurses about mental health interventions.

Concerned with the increasing incidence of mental health problems in children and adolescents and the impact of these problems on students' school success and predisposition to self- and other-directed violence, the Multnomah Education Service District Department of School Health Services determined to become proactive by providing preventive interventions for students experiencing actual or potential mental health problems. An educational program was designed to assist school nurses in the identification of potential mental health problems. In addition, information about appropriate interventions for students at risk for aggression, violence, and other mental health pathology was presented. The program involved education on mental health assessment and intervention, as well as expert psychiatric clinical support for the development of student support groups. School nurses were then challenged to develop practice improvement projects incorporating this knowledge for a group of students in their work setting. This introductory article describes the project's general rationale and implementation process. The four articles following in this issue of The Journal of School Nursing describe the goals, implementation, and outcomes of the practice improvement projects developed for early intervention with students exhibiting attention disorders, school absenteeism, social withdrawal, and depression.

Adolescent↗

Genetics in occupational therapy education: a survey of professional entry-level programs.

PURPOSE: Advances in genetics indicate a need for occupational therapists to develop literacy and skills in genetics as it relates to lifestyle and occupation. The purpose of this study is to identify genetics content areas taught, instructional methods used, and the importance of teaching genetics at the entry-level in occupational therapy curricula. METHOD: A questionnaire was sent to all entry-level occupational therapy educational programs (N=157). Structured mailing and follow-up were used. RESULTS: The response rate was 63.9%. Most respondents (47%) rate teaching genetics as "moderately important." Genetics content is predominately taught at the introductory or knowledge level rather than at the integration and application level. Respondents indicate a lack of time and space for genetics content and of faculty interest and expertise. DISCUSSION: As occupational therapy practice evolves to include new genetics, curriculum change will need to be implemented. Development of teaching materials and methods addressing genetics is recommended.

Curriculum↗

Physician-system alignment: introductory overview.

The papers in this Special Supplement are based on research funded by the participating members of the joint Center for Health Management Research (CHMR) and Center for Organized Delivery Systems (CODS), and supported by the National Science Foundation under its Industry-University Cooperative Research Center Program. This 3-year research initiative from 1996 through 1999 involved 69 physician organizations (primarily organized medical groups as opposed to IPAs) associated with 14 organized delivery systems. The groups ranged in size from three to 958 with an average size of 76.4 and a median size of 25.0. Comparisons of the study groups with United States physician groups overall are shown in Table 1. The study groups are larger and more likely to be multispecialty than all groups in the United States. The organized delivery systems range in size from one hospital to 80 hospitals with an average of 21 hospitals per system and a median of 11 hospitals per system. They average 4.6 affiliated medical groups with a range from one to 23. The organized delivery systems range in total revenues in 1998 from $340 million to $6.2 billion with an average of $2.1 billion. All the study systems are not-for-profit. Most are located in single market areas, but several are located in multiple markets. For the most part, they represent some of the larger most experienced organized delivery systems in the country. Among the primary objectives of the study was to identify the factors most strongly associated with physician alignment with the health care system and the consequences for the implementation of evidence-based care management practices. The study was also designed to identify the barriers and facilitators to achieving such alignment and its consequences.

Delivery of Health Care, Integrated↗

Ultrasound training for emergency physicians--a prospective study.

OBJECTIVES: Bedside ultrasound examination by emergency physicians (EPs) is being integrated into clinical emergency practice, yet minimum training requirements have not been well defined or evaluated. This study evaluated the accuracy of EP ultrasonography following a 16-hour introductory ultrasound course. METHODS: In phase I of the study, a condensed 16-hour emergency ultrasound curriculum based on Society for Academic Emergency Medicine guidelines was administered to emergency medicine houseofficers, attending staff, medical students, and physician assistants over two days. Lectures with syllabus material were used to cover the following ultrasound topics in eight hours: basic physics, pelvis, right upper quadrant, renal, aorta, trauma, and echo-cardiography. In addition, each student received eight hours of hands-on ultrasound instruction over the two-day period. All participants in this curriculum received a standardized pretest and posttest that included 24 emergency ultrasound images for interpretation. These images included positive, negative, and nondiagnostic scans in each of the above clinical categories. In phase II of the study, ultrasound examinations performed by postgraduate-year-2 (PGY2) houseofficers over a ten-month period were examined and the standardized test was readministered. RESULTS: In phase I, a total of 80 health professionals underwent standardized training and testing. The mean +/- SD pretest score was 15.6 +/- 4.2, 95% CI = 14. 7 to 16.5 (65% of a maximum score of 24), and the mean +/- SD posttest score was 20.2 +/- 1.6, 95% CI = 19.8 to 20.6 (84%) (p < 0. 05). In phase II, a total of 1,138 examinations were performed by 18 PGY2 houseofficers. Sensitivity was 92.4% (95% CI = 89% to 95%), specificity was 96.1% (95% CI = 94% to 98%), and overall accuracy was 94.6% (95% CI = 93% to 96%). The follow-up ultrasound written test showed continued good performance (20.7 +/- 1.2, 95% CI = 20.0 to 21.4). CONCLUSIONS: Emergency physicians can be taught focused ultrasonography with a high degree of accuracy, and a 16-hour course serves as a good introductory foundation.

Clinical Competence↗

Students' studying and approaches to learning in introductory biology.

This exploratory study was conducted in an introductory biology course to determine 1) how students used the large lecture environment to create their own learning tasks during studying and 2) whether meaningful learning resulted from the students' efforts. Academic task research from the K-12 education literature and student approaches to learning research from the postsecondary education literature provided the theoretical framework for the mixed methods study. The subject topic was cell division. Findings showed that students 1) valued lectures to develop what they believed to be their own understanding of the topic; 2) deliberately created and engaged in learning tasks for themselves only in preparation for the unit exam; 3) used course resources, cognitive operations, and study strategies that were compatible with surface and strategic, rather than deep, approaches to learning; 4) successfully demonstrated competence in answering familiar test questions aligned with their surface and strategic approaches to studying and learning; and 5) demonstrated limited meaningful understanding of the significance of cell division processes. Implications for introductory biology education are discussed.

Biology↗

Mission, role, and functions of the P & T Committee.

This introductory article in a series on P & T Committees discusses the mission, role, and function of the committee in a hospital. With increasing complexity of drug therapy, the committee's mission has evolved into a multifaceted program related to promotion of rational and safe drug therapy within the institution. Components of the mission, the committee's responsibilities and functions, including formulary, policies and procedures, drug utilization review, drug administration, investigational drug studies, and education, are introduced and briefly discussed in terms of their role in the institution, accreditation standards, and published standards of practice. Future articles will provide fuller consideration of these topics.

Drug Therapy↗

[A questionnaire study among 171 medical candidates enrolled in a PhD program. Three elements in the PhD education: supervision, research courses and international relations].

One hundred and seventy-one medical doctors (median age 34 years) registered as Ph.D.-students at the Medical Faculty, University of Aarhus, were given a questionnaire concerning the Ph.D-program (91% reply rate). The Ph.D.-students had typically graduated four years before enrollment and had gained basic clinical experience. Eighty-four percent had been involved in research projects prior to their formal research education. In general, the Ph.D.-students found the supervision offered by senior researchers adequate, although, more Ph.D.-students in clinical than in preclinical departments would have liked their main supervisor to be more enthusiastic and have more specific expertise. By tradition, the Medical Faculty in Aarhus offers a broad introductory course on research methodology, this was appreciated by the Ph.D.-students. However, they found that too much time was allocated for this purpose. The Ministry of Education recommends that Ph.D.-students gain experience from international collaboration, preferably from a stay abroad. However, only 24% of Ph.D.-students had stayed at an international collaborating institution. Although the overall evaluation of the medical Ph.d.-program was positive, the Ph.D.-students pointed out weaknesses and conflicts requiring adjustment.

Adult↗

FMTUTOR: a computer-aided instructional system for teaching fetal monitor interpretation.

FMTUTOR is a computer program for instruction in the interpretation of fetal monitor recordings. The system runs on IBM-PC-compatible microcomputers and uses text and computer graphics to illustrate and reinforce important concepts. By means of a 2-hour introductory tutorial session and generation and guided interpretation of an unlimited variety of tracings, it simulates one-on-one instructor-student interactions and allows rapid accumulation of a store of information and experience in monitor tracing interpretation. FMTUTOR is currently used to teach third- and fourth-year medical students at the University of New Mexico. Acceptance has been enthusiastic, and development of more advanced instructional systems targeting nurses, residents, and obstetricians is underway.

Computer-Assisted Instruction↗

Spinal cord injuries in children and adolescents: a review.

This introductory review provides an overview of pediatric-onset spinal cord injury, emphasizing unique clinical and epidemiologic features, pathophysiology, medical and musculoskeletal complications, and psychosocial and management issues. Developmental factors influence the approach to bowel and bladder programs, mobility, patient education, and management of complications. Rehabilitation goals must be set for each developmental stage, with the final goal being that of a satisfying and productive adult life.

Adolescent↗

The use of music on Barney & Friends: implications for music therapy practice and research.

This descriptive study examined the music content of 88 episodes from the PBS television show Barney & Friends, which aired from September 1992 to September 1998, in an attempt to quantify musical examples and presentations that may be considered introductory music experiences for preschoolers. Using many of the procedures identified by Wolfe and Stambaugh (1993) in their study on the music of Sesame Street, 25% of Barney & Friends' 88 episodes were analyzed by using the computer observation program SCRIBE in determining: (a) the temporal use of music; (b) performance medium; and (c) intention of music use. Furthermore, each structural prompt presentation (n = 749) from all 88 episodes was examined for: (a) tempo; (b) vocal range; (c) music style; (d) word clarity; (e) repetition; (f) vocal modeling; and (g) movement. Results revealed that the show contained more music (92.2%) than nonmusic (7.8%), with the majority of this music containing instrumental sounds (61%). The function of this music was distributed equally between structural prompt music (48%) and background music (48%). The majority of the structural prompt music contained newly composed material (52%), while 33% consisted of previously composed material. Fifteen percent contained a combination of newly composed and previously composed material. The most common tempo range for presentations on the show was 80-100 bpm, while vocal ranges of a 9th, 8th, 6th, and 7th were predominant and most often sung by children's voices. The adult male voice was also common, with 84% of all adult vocals being male. The tessitura category with the greatest number of appearances was middle C to C above (n = 133), with the majority of the presentations (n = 435, 73%) extending singers' voices over the register lift of B above middle C. Children's music and music of the American heritage were the most common style categories observed, and these two categories combined on 260 (35%) presentations. The use of choreographed movement and props/costumes was also prevalent, and may have contributed to high interobserver reliability of tempo. Implications for music therapists and teachers working with young children and music researchers examining various epistemological questions of music learning and behavior are discussed.

Child, Preschool↗

Comparing Social Security reform options.

Social Security is widely recognized as the nation's most effective anti-poverty program for the elderly and widow(er)s. It is so popular that it has often been dubbed the "third rail" of American politics ("touch it and you die"). As a result, changes have come slowly. For instance, in spite of years of warning in advance of the cash flow crisis of 1983, Congress waited until the last minute to act--and when it did, the action it took included a combination of tax increases and benefit reductions. By the mid-1990s, then-President Clinton was talking about the long-term financing issues faced by Social Security, but Congress did not act. President Bush has raised the same issues since 2000, and has now taken to the road to convince the nation that action should be taken now to assure the program's long-term solvency. Because Social Security is a sensitive, complicated, and emotional political topic, many concepts have been discussed but few elected officials have been willing to put forth detailed plans for fear of political backlash. The public, quite naturally, wants to know how they will be affected by "reform." In this introductory section, Figure S-1 seeks to provide a simple response to that question by following the method used in the Trustees' report, where earners maintain a constant percentage of the average wage. Take the year closest to when you were born, the earnings closest to your expected earnings this year (2005), and follow across the columns to see how much your annual benefit would be in today's dollars if you start taking benefits at age 65. For an example of a specific individual: Your 30-year-old child (born in 1975) makes a 2005 salary around $16,500. Under current law, your child's initial annual Social Security retirement benefit would be dollar 11,200 in today's dollars. However, given the projected funding shortfall currently facing the program, this promised benefit is not likely to materialize unless some sort of change is made to the program. This analysis compares "Model 2" from the President's 2001 Commission to Strengthen Social Security (which appears to have the principles for an individual account plan favored by the Bush administration) with three basic options: Current-law benefits with taxes raised to cover the shortfall over the 75-year actuarial period, by removing the existing dollar 90,000 annual wage cap and including all workers. Maintain current benefits until the revenue shortfall occurs, when a "cliff" benefit cut is imposed. A gradual reduction in current-law benefits.

Aged↗

Evolving strategies for the incorporation of bioinformatics within the undergraduate cell biology curriculum.

Recent advances in genomics and structural biology have resulted in an unprecedented increase in biological data available from Internet-accessible databases. In order to help students effectively use this vast repository of information, undergraduate biology students at Drake University were introduced to bioinformatics software and databases in three courses, beginning with an introductory course in cell biology. The exercises and projects that were used to help students develop literacy in bioinformatics are described. In a recently offered course in bioinformatics, students developed their own simple sequence analysis tool using the Perl programming language. These experiences are described from the point of view of the instructor as well as the students. A preliminary assessment has been made of the degree to which students had developed a working knowledge of bioinformatics concepts and methods. Finally, some conclusions have been drawn from these courses that may be helpful to instructors wishing to introduce bioinformatics within the undergraduate biology curriculum.

Biology↗

Nutrition intervention group program based on preaction-stage-oriented change processes of the Transtheoretical Model promotes long-term reduction in dietary fat intake.

OBJECTIVE: To develop and evaluate the long-term effectiveness of an intervention program, based on preaction-stage-oriented change processes of the Transtheoretical Model of Behavior Change, that could be delivered in a group setting to help participants lower dietary fat intake. DESIGN: An enhanced version of the nonequivalent control group experimental design was used. Entire sections of an undergraduate introductory nutrition science course were assigned to an experimental, pretest/posttest control, or posttest-only control group. Daily fat intake and stage of change of the experimental and pretest/posttest control groups were determined at the pretest and posttest and 1-year later at a follow-up test. Every 1 to 2 weeks during the study, stage of change of the experimental group was assessed. Daily fat intake of the experimental group was assessed at study midpoint. Daily fat intake and stage of change of the posttest-only control group was determined at the posttest. Pretest results were used to place participants of the experimental and pretest/posttest control groups in either the preaction stage (i.e., precontemplation, contemplation, or preparation) or the action/maintenance stage. SUBJECTS/SETTING: The sample consisted of 38, 30, and 42 undergraduate students who were assigned to the experimental, pretest/posttest control, and posttest-only control groups, respectively. INTERVENTION: The experimental group participated in a group-based, dietary fat intake intervention that included a series of 11 lessons taught over a 14-week period. Each lesson was based on 1 or 2 of the preaction-stage-oriented change processes of the Transtheoretical Model. MAIN OUTCOME MEASURES: Data were evaluated to determine the effects of the intervention program on long-term dietary fat reduction and stage of change progression. STATISTICAL ANALYSIS PERFORMED: Analysis of variance, repeated-measures analysis of variance, and paired t tests. RESULTS: For pretest and posttest dietary fat intake scores, stage and time were significant, and there was a significant time-by-stage interaction. Time was significant for pretest and posttest stage scores. Subjects in the preaction-stage experimental group significantly increased their mean stage of change and reduced their fat intake between the pretest and posttest; these changes persisted for 1 year. Pretest/posttest control group participants who began in a preaction stage also significantly increased their mean stage and reduced fat intake by the posttest, but these changes did not endure until the follow-up test. APPLICATIONS/CONCLUSIONS: This intervention program produced an enduring, significant reduction in mean dietary fat consumption and a significant progression in mean stage of change of subjects in the experimental group who were in the preaction stage. It may be appropriate to design group interventions to use preaction stage processes rather than the more traditionally used action and maintenance stages change processes.

Adolescent↗

Training in laparoscopic surgery--have we got it right yet?

Training in laparoscopic surgery started with short two to three-day courses, frequently unstructured and unaccredited, in a rush to provide surgeons with supposedly adequate training in laparoscopic techniques before performing laparoscopic cholecystectomy in patients. The high incidence of complications with this situation led to guidelines on training, credentialling and auditing being drawn up by several responsible professional bodies. Almost a decade after the introduction of laparoscopic cholecystectomy, the situation with training in laparoscopic surgery is still unresolved in many countries. This article reviews the current opinion on training in laparoscopic surgery, and presents the various teaching models and techniques employed to facilitate this process. Training in laparoscopic surgery should form part of the general surgery training programme, and should involve a combination of short introductory courses with hands-on animal models, and a period of preceptorship following this.

Animals↗

The relationships between public and private pension schemes: an introductory overview.

Only recently have social insurance and private pensions, collectively, come to be thought of in terms of a total social security benefit package. The economic problems brought on by the 1974 oil crisis initially triggered consideration of a common, integrated role for the two systems. The second oil crisis reinforced the relative expansion in private pension programs, as a supplement to social security. Before these events, private and public pension programs interacted in only a limited number of ways, confined to relatively few countries. These interactions were largely confined to collective bargaining, whereby private pensions were gradually extended to nearly all employees in France and Sweden; mandating, or legally requiring private supplementation of social security, debated in several countries in the early 1970's, but postponed by the 1974 oil crisis; and contracting out, or covering a part of the social security benefit under a private plan, as in the United Kingdom. Overall, the tradition of private pensions was not very strong or broadbased. The current debate centers on which public/private pension mix is desirable from the point of view of an old-age income-maintenance program. A new element is the rising support for a "third pillar"--individual tax-encouraged savings--not only as a supplement, but as an alternative to social insurance.

Aged↗

Identification of novel cytochrome P450 1A genes from five marine mammal species.

Marine mammals, being endangered by the chronic exposure of hydrophobic environmental contaminants as an assorting result of global pollution, are especially focused as indicators for organochlorine pollution. The use of contaminant-induced xenobiotic metabolizers, particularly P450 (CYP) 1A, in marine mammals can be effective as potential biomarkers of the contaminant exposure and/or toxic effects. In this study, we identified the first marine mammalian CYPs. Six novel CYP1A cDNA fragments were cloned from the livers of marine mammal species, minke whale (Balaenoptera acutorostrata), dall's porpoise (Phocoenoides dalli), steller sea lion (Eumetopias jubatus), largha seal (Phoca largha), and ribbon seal (Phoca fasciata) by the method of reverse transcription/polymerase chain reaction (RT/PCR); two distinct fragments were from steller sea lion and one fragment each was obtained from the other species. Five of the fragments, one from each species, were classified in the subfamily of CYP1A1, and the other fragment cloned from steller sea lion was designated CYP1A2. Degenerate PCR primers were used to amplify the fragments from liver cDNAs. The deduced amino acid sequences of these fragment CYP1As showed identities ranging from 50.0 to 94.3% with other known vertebrate CYPs in the subfamily of CYP1A, including those from fish, chicken, and terrestrial mammals. The isolated fragments were used to construct a molecular phylogeny, along with other vertebrate CYP1A cDNAs cut down in size to the corresponding region of 265 bp in which those newly determined fragments were cloned. This phylogenetic analysis by the maximum parsimony method using the PHYLIP program suggests two distinct evolutional pathways for aquatic mammalian CYP1As, compatible to a conservative taxonomy. Pinniped genes are clustered together with dog gene, forming a carnivore group, and cetaceans form another branch. Identification of CYP1A genes in marine mammals will be an introductory step to provide new insights into the metabolic or toxicological functions of CYP1As in these animals.

Amino Acid Sequence↗

Undergraduate education in implant dentistry.

A special interest group meeting devoted to clinical educational programs in implant dentistry for undergraduate students was held in March 1994 at the annual session of the American Association of Dental Schools in Seattle, Washington. Summaries of the presentations of representatives from three United States dental schools and the moderator's introductory remarks are included in this article.

Curriculum↗

Development and validation of a food use checklist for evaluation of community nutrition interventions.

We developed a new dietary assessment instrument, the Food Behavior Checklist (FBC), which measures food use related to adopting lower-fat and higher-fiber diets. The FBC is a simplification of the 24-hour diet recall that consists of 19 simple yes/no questions about foods consumed during the previous day. To develop the FBC, an expert committee generated a list of foods based on our intervention program, and we used focus groups and random-digit dialing pretests to refine the format and clarify items. To validate the FBC, we compared responses of 96 women on the FBC to information collected during a professionally administered 24-hour diet recall. For most items, agreement between the FBC and 24-hour recall, based on the kappa statistic, was good to excellent. Agreement was poor for items requiring detailed knowledge about food composition (e.g. high-fiber cereal). There was a trend to over-report general food categories (e.g. luncheon meats) but not specific food items (e.g. ice cream). In an embedded randomized study, we found that a set of introductory items designed to serve as a memory retrieval cue did not improve agreement between the FBC and 24-hour recall. These data provide preliminary evidence supporting the use of short checklist questionnaires on the previous day's food use as a means to assess diet at the group or community level. This relatively inexpensive and rapid measure can be used to inform the design of public health nutrition programs and as an evaluation tool in intervention research.

Diet↗