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At least 253 records · Page 14Linked to original sources
PubMed2004

Robotic totally endoscopic coronary artery bypass: program development and learning curve issues.

BACKGROUND: The introduction of new procedures in heart surgery is a critical phase that includes learning curves and the risk of increased mortality or morbidity. Totally endoscopic coronary artery bypass grafting using robotic techniques represents such an innovative procedure. The aim of this report is to demonstrate the safe introduction of totally endoscopic coronary artery bypass grafting using a stepwise and modular approach. METHODS: From June 2001 until December 2002, 50 procedures were performed using the da Vinci telemanipulator system. After baseline training the following procedure modules were carried out in a stepwise manner: robotically assisted endoscopic left internal thoracic artery harvesting and completion of the procedure as conventional coronary artery bypass grafting, minimally invasive direct coronary artery bypass, or off-pump coronary artery bypass (n = 19), robotically assisted suturing of left internal thoracic artery to left anterior descending anastomoses during conventional coronary artery bypass grafting (n = 15), totally endoscopic coronary artery bypass grafting on the arrested heart using remote access perfusion and aortic endocclusion coronary bypass grafting (n = 15). One patient was excluded intraoperatively from a robotic procedure due to pleural adhesions. RESULTS: A significant learning curve was observed for left internal thoracic artery takedown time, y(min) = 181 - 39 x ln(x) (x = procedure number) (P <.001), and total operative time in totally endoscopic coronary artery bypass grafting, y(min) = 595 - 87 x ln(x) x = (procedure number) (P =.028). The conversion rate in totally endoscopic coronary artery bypass grafting was 2/15. Intensive care unit stay correlated significantly with total operative time (r =.427, P =.002). There was no hospital mortality. CONCLUSION: Totally endoscopic coronary artery bypass grafting can be safely implemented into a heart surgery program. Learning curves are steep for robotic left internal thoracic artery takedown and for performance of totally endoscopic coronary artery bypass grafting. Long operative times translate into prolonged intensive care unit stay in specific cases but not into increased mortality.

Adult↗
PubMed1991

Resident, faculty, and residency program development. An integrated approach through annual retreats.

Retreats during residency training have evolved as an escape from the daily routine. Recognizing that the retreat format could also be used as a foundation for program design and personal development, we have designed annual retreats for each of the 3 years of pediatric residency training. The sessions vary in length and agenda, but serve as the basis for an ongoing effort fostering growth and maturation of the department and its component participants. The effectiveness of the program (and the morale of the residents) is greatly influenced by this program.

Chicago↗
PubMed1983

Antiepileptic drug development program.

The Epilepsy Branch of the National Institute of Neurological and Communicative Disorders and Stroke has responded to the need for new, more effective, and less toxic antiepileptic drugs by cooperating with pharmaceutical companies in key areas of development. The ADD Program screens large numbers of compounds for anticonvulsant activity in appropriate animal models and sponsors clinical trials of promising new drugs for the treatment of epilepsy. The use of investigative techniques developed since the late 1960s allows documentation of seizure type and seizure frequency for maximal objectivity of clinical trial data.

Anticonvulsants↗
PubMed1997

Health promotion and early detection of cancer in older adults: needs assessment for program development.

The greatest risk factor for developing cancer is age, yet little is known about the cancer-related knowledge, attitudes and beliefs of the older adult (age > 55 years). A community-based needs assessment was conducted to understand these dimensions in a large metropolitan community. Ten focus groups (n = 158 older adults) and 9 individuals were interviewed. Content analysis for the audiotaped sessions was completed. The study participants focused on "being active" and living a healthy lifestyle. Many worried about illness interfering with their ability to do what they wanted to do. Many had had exposure to cancer through family members or friends, but still had many unanswered questions about cancer. Age was not seen as a risk factor for cancer, and a range of attitudes existed regarding cancer prevention and early detection. Overall, despite fearing cancer, participants thought older adults needed to know about cancer and suggested a wide range of approaches to disseminate information effectively to older adults.

Aged↗
PubMed2001

[ A registry of ischaemic cardiopathies among active workers at Electricité de France-Gaz de France. Program development and first results].

BACKGROUND: The social security department of the French national electric and gas company has established an ischemic heart disease register among a population of about 140 000 employees based on sick leaves as well as deaths recorded with their medical cause. METHODS: History of the illness, medical tests and treatments were known retrospectively from the consulting physicians of the company. Acute coronary events recorded were: inaugural angina pectoris, myocardial infarction, sudden coronary death and fortuitous discovery of coronary disease. RESULTS: A first study conducted on employees during the 1993-1995 period showed infarction incidence age rates similar to those estimated from the French MONICA registers for France as a whole. Regional discrepancies were observed for myocardial infarction rates: Nord-Pas de Calais, Champagne-Ardennes, Lorraine, Franche-Comté and Limousin were at the most elevated risk (SIR=131, 155, 169, 125 and 178 resp). Large variations according to socio-economic status were observed. CONCLUSION: This register will permit studies on the links between socio-economic status at different professional career points and the occurrence of ischemic heart disease and the evaluation of the impact of psychosocial factors such as previous depressive disorders.

Absenteeism↗
PubMed1999

An interdisciplinary national program developed at Baylor to make science exciting for all K-5 students.

The achievement gap in science begins in elementary school, where many students lose interest in science-related studies, particularly students from traditionally underrepresented groups. The "My Health My World" Project (hereafter, "the Project"), developed at Baylor College of Medicine with the assistance of federal funds, is a national effort to address this problem. The Project's goals are to make science appealing and relevant for elementary school students (i.e., kindergarten through grade five), including those from underrepresented minorities (URMs), and easy to teach for teachers and parents. It is achieving this goal by the development of interdisciplinary instructional materials that use environmental health issues as a unifying theme. The Project provides its materials (including take-home materials for parents) and training for teachers at seven dissemination centers across the country, established in 1997. Workshops are also held to train facilitators, chosen from among local science education leaders, who in turn hold workshops to train other teachers. Each center receives a mini-grant to cover costs related to the training it provides, and all coordinate their training to offer comparable experiences for all participants. Field tests in 1995, 1996, and 1997 involving culturally, racially, and ethnically diverse students and teachers in two sites indicate that the participating teachers found that the Project's materials promote science learning and enthusiasm for science and are easy to use and engaging for teachers. Ratings for workshops in 1998 were also high for all characteristics evaluated. All signs after the Project's first full year of dissemination activities (1998) indicate that it will continue to reach more teachers and students across the nation and will eventually help more students from all backgrounds achieve in science-related studies.

Child↗
PubMed2004

Using mobile DXA to improve access to osteoporosis care: unit design, program development, implementation, and outcomes.

Osteoporosis diagnosis and monitoring is best accomplished with dual X-ray absorptiometry (DXA), but technology availability can hinder access to care. We designed a mobile DXA program incorporating a Hologic Delphi-C trade mark bone densitometer housed in a specially configured 30-ft Winnebago trade mark. The mobile DXA program provided osteoporosis testing and education at the convenience of the patient's primary care site within our rural health care system. DXA results were sent electronically to the patient's physician within 48-72 h. The mobile DXA patient group tended to be older and at high risk for future fracture. The service provided was rated as excellent by patients. Given the volume of patients studied, the program was financially self-sustaining. Other healthcare systems or groups should consider development of a similar program.

Absorptiometry, Photon↗
PubMed1983

Preadmission programs: development, implementation and evaluation.

Preparation of children for hospitalization is utilized to mitigate the stresses which may accompany the experience. Preadmission programs provide preparation for the patient and family on a prehospital basis. The authors describe the development of family-centered, developmentally based programs which foster continuity and consistency in a large, pediatric tertiary care setting. Implementation and evaluation of the programs which contribute to quality patient care are discussed.

Adolescent↗
PubMed2001

The Breast Cancer Distance Education Program: development and evaluation of a course for specialist breast care nurses.

The Breast Cancer Distance Education Program is the first tertiary-based education program for specialist breast care nurses in Australia. The program covers current treatment options, psychosocial issues, and professional development issues relating to breast cancer nursing. For the first two student intakes (n = 53), precourse, postcourse, and 3-month follow-up surveys were conducted to assess the perceived value of the course, identify any limitations, and note changes in practice that arose. Before taking the course, most of the students had experience in breast cancer nursing, but lacked confidence and hoped to learn more about responding effectively to psychosocial issues through communication, counseling, and provision of support to patients and their carers. After taking the course, the students were very positive about the course content, resources, and teaching support. They reported learning new skills for addressing psychosocial issues and symptom management arising from a diagnosis of breast cancer, stating a desire to implement these new skills. Comparison between results from the three surveys indicated that students' confidence in providing breast cancer support increased significantly in most areas of practice, and was maintained at 3-month follow-up survey. Results suggest that students met the course objectives successfully, and in most cases subsequently translated their knowledge into improved practice.

Adult↗
PubMed1993

Serving the dually diagnosed homeless: program development and interventions.

In this paper the authors present the specific characteristics of the dually diagnosed (severely mentally ill and substance abusers) population and describe a hybridized program and interventions which have been empirically shown to be effective in working with these multiply impaired individuals. The article is based upon a three-year federally funded demonstration project. The following interventions were found to be effective: engagement, care and nurturing, structure, limit setting and the development of responsibility, positive reinforcement, and self esteem. The authors describe these interventions and highlight their impact in both staff management and working with funding sources.

Adult↗
PubMed1999

Changing patterns of care for war-related post-traumatic stress disorder at Department of Veterans Affairs medical centers: the use of performance data to guide program development.

This study traces the development of services for war-related post-traumatic stress disorder (PTSD) provided at Department of Veterans Affairs (VA) medical centers. During the 1980s, long-stay inpatient programs were the major source of specialized VA treatment for PTSD, and an initial effort at development of specialized outpatient clinics resulted in incomplete implementation. In 1988, a full continuum of inpatient and outpatient services was designed and a national program of performance monitoring and outcome assessment was implemented to standardize program structure, monitor delivery, and evaluate outcomes. A series of multisite outcome studies showed significant but modest improvement in association with specialized outpatient treatment; they also showed that traditional long-term inpatient programs were no more effective and were far more costly than short-term specialized inpatient programs. Since 1995, the VA has shifted the emphasis of care substantially from inpatient to outpatient settings. National monitoring efforts have documented maintenance of specialized PTSD treatment capacity, increased access, improvement on available administrative measures of quality of care, and improved inpatient outcomes. Although there have been major changes in the treatment of mental illness in most health care systems in recent years, change in the treatment of PTSD at VA medical centers is unique in that it has been guided by the results of multisite outcome studies conducted in a "real-world" setting and has been supported by ongoing nationwide performance monitoring.

Ambulatory Care↗
PubMed1990

Launching a multidisciplinary staff development program for liver transplantation.

This article describes a collaborative effort between specialty areas at a large urban medical center to develop a comprehensive liver transplant educational program. The historical overview, needs assessment, and program planning are discussed. The implementation, planning, and evaluation phases are examined. The process presented here can serve as a framework for clinical educators confronted with major new initiatives.

Curriculum↗
PubMed1976

Accreditation of occupational health programs: development and validation of criteria.

Defined standards and a mechanism for evaluation of performance can help promote new and improve existing occupational health programs. Criteria must be based on sound principles, be comprehensive, discriminating and attainable. They should apply to small and large establishments with varying hazards. A successful program requires a multi-disciplinary effort involving physicians, nurses, industrial hygienists, health physicists, safety professionals, managers, technicians and labor. Assessment by on-site peer review is necessary. The criteria and process for their use must be accepted by the professions, labor and management. The Occupational Health/Safety Programs Accreditation Commission plans to use the document entitled Standards, Interpretations and Audit Criteria for Performance of Occupational Health Programs in its accreditation activities. The development and validation of this document and its use are described.

Accreditation↗