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PubMed1983

Continuing education needs assessment and program development: an alternative approach.

Continuing education has become increasingly important to the professions, including dietetics. There is some concern, however, that continuing education programs too seldom focus on practice-related problems and do not have a large enough impact on daily practice. A research and development endeavor is in progress to create an alternative approach to continuing education programming. Utilizing a process called the Practice Audit Model, this approach brings practitioners (or their representatives) and educators together to develop continuing education programs that focus on learning needs identified through an empirical assessment of practitioner performance.

Dietetics↗
PubMed2000

Procedural and methodological issues in telepsychiatry research and program development.

OBJECTIVE: The authors reviewed the literature related to telepsychiatry-applications of videoconferencing technology for mental health care-which offers hope for an affordable means of solving long-standing workforce problems, particularly in geographical areas where specialist providers are not readily available. METHODS: To conduct a comprehensive review of the telepsychiatry literature, the authors searched the MEDLINE database (1970 to February 2000), using the keywords telepsychiatry, telemedicine, and videoconferencing. Studies were selected that included the use of videoconferencing technology for the provision of any form of mental health care services. RESULTS AND CONCLUSIONS: Psychiatric interviews conducted by telepsychiatry appear to be generally reliable, and patients and clinicians generally report high levels of satisfaction with telepsychiatry. A significant limitation of the literature is the lack of empirical research on telepsychiatry, especially cost analyses and clinical outcome studies. The authors outline a research agenda addressing the procedural and methodological issues that should shape future research: study design, outcome measurement, consideration of patient characteristics, and program design.

Consumer Behavior↗
PubMed2006

Provider attitudes toward pay-for-performance programs: development and validation of a measurement instrument.

OBJECTIVE: To develop an instrument for assessing physician attitudes toward quality incentive programs, and to assess its reliability and validity. DATA SOURCES: Study involved primary data collection. A 40-item paper and pencil survey of primary care physicians in Rochester, New York, and Massachusetts was conducted between May 2004 and December 2004. Seven-hundred and ninety-eight completed questionnaires were received, representing a response rate of 32 percent (798/2,497). STUDY DESIGN: Based on an extensive review of the literature and discussions with experts in the field, we developed a conceptual framework representing the features of pay-for-performance (P4P) programs hypothesized to affect physician behavior in that context. A draft questionnaire was developed based on that conceptual model and pilot tested in three groups of physicians. The questionnaire was modified based on the physician feedback, and the revised version was distributed to 2,497 primary care physicians affiliated with two of the seven sites participating in Rewarding Results, a national evaluation of quality target and financial incentive programs. DATA COLLECTION: Respondents were randomly divided into a derivation and a validation sample. Exploratory factor analysis was applied to the responses of the derivation sample. Those results were used to create scales in the validation sample, and these were then subjected to multitrait analysis (MTA). One scale representing physicians' perception of the impact of P4P on their clinical practice was regressed on the other scales as a test of construct validity. PRINCIPAL FINDINGS: Seven constructs were identified and demonstrated substantial convergent and discriminant validity in the MTA: awareness and understanding, clinical relevance, cooperation, unintended consequences, control, financial salience, and impact. Internal consistency reliabilities (Cronbach's alpha coefficients) ranged from 0.50 to 0.80. A statistically significant 25 percent of the variation in perceived impact was accounted for by physician perceptions of the other six characteristics of P4P programs. CONCLUSIONS: It is possible to identify and measure the key salient features of P4P programs using a valid and reliable 26-item survey. This instrument may now be used in further studies to better understand the impact of P4P programs on physician behavior.

Attitude of Health Personnel↗
PubMed2001

Can assessment of psychosocial orientation assist continuing education program development in psychosocial oncology?

BACKGROUND: A pilot study was designed to aid in the development of a formal, interdisciplinary curriculum in psychosocial oncology for front-line health care professionals. METHOD: A 190-item questionnaire was distributed to psychosocial (PP) and non-psychosocial (NPP) oncology professionals attending a psychosocial skills workshop. A 38-item attitudinal survey of psychosocial orientation was used in an attempt to identify unperceived needs of the learners. RESULTS: Of the 150 questionnaires distributed, 104 (69%) were completed and returned. Overall scores for satisfaction with the workshop were high, and significantly higher in the PP group. No interdisciplinary difference existed in the preferred learning formats for future events, and both groups preferred interactive, experiential forums for developing skills relevant to patient management. The two groups' perceived learning needs differed. NPPs wanted to focus on skills such as communication, counseling, crisis intervention, palliative care, and coping with life-threatening illness. The attitudinal survey results demonstrated a significant difference between the psychosocial orientations of PPs and NPPs and suggested that NPPs would benefit from: 1) information to correct misconceptions about patients' psychosocial needs and experiences, 2) demonstrations of how to overcome contextual barriers to the delivery of psychosocial care. CONCLUSIONS: Front-line oncology professionals in many disciplines are interested in continuing education in psychosocial oncology. The attitudinal survey provided insight into unperceived learning needs that can help in designing future curricula. Its value as a tool to measure impact of these programs is worthy of future study.

Adult↗
PubMed2007

Listening to seniors: successful approaches to data collection and program development.

This paper provides guidelines for high quality data collection with community-residing older adults with illustrations drawn from the authors' practice. A mixed-method approach is described as a means to obtain the highest quality information from the sample. This approach combines focus groups and interviews along with mailed, closed-ended surveys to access both the "depth" of the seniors' responses as well as the "breadth" of responses; that is, the qualitative aspects provide the opportunity to identify and define relevant issues in the voices of respondents, while mailed surveys provide the kind of coverage necessary to make accurate predictions to the larger population of community-residing seniors.

Activities of Daily Living↗
PubMed1981

Funding of health-related facilities and other projects under the Public Works and Development Facilities Program--Economic Development Administration. Interim rule.

This interim rule modifies two regulations setting forth requirements for funding certain types of projects under the Public Works and Development Facilities Program. One regulation is amended to clarify its scope by noting that its requirements apply to Public Works Impact Program projects. The other regulation is amended to tighten its standards relating to economic impact and to specify that projects involving health-related facilities must be reviewed and approved by the Department of Health and Human Services and, if appropriate, the State Health Planning and Development Agency. In addition, a third regulation regarding project modification is amended to clarify the scope of one provision.

Financing, Government↗
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↗
PubMedDate not supplied

Ten-year NEDO BVAD development program: moving forward to the clinical arena.

Since 1995, the Baylor Group has been developing a totally implantable NEDO BVAD system. This 10-year program was completed in March 2005, and preparation for clinical trials is underway. This article summarizes the entire 10-year NEDO program and describes the strategy for clinical trials. The project aimed to achieve: (1) dual centrifugal pumps with the ability of full biventricular support, (2) a compact system implantable into small adults, (3) a totally implantable system with transcutaneous energy transmission system (TETS), (4) a durable system with a lifetime of over 5 years, and (5) a system free of thrombus and with minimal hemolysis. The final goals are to complete preclinical system evaluations and commence the clinical trials in the near future. In vitro studies have demonstrated a pump capacity of over 8.5 l/min and an Index of Hemolysis of <0.004 g/100 l. The pump-bearing life expectancy was over 5 years. To date, eight pumps endured in vivo studies of over 3 months without complications, including thromboembolic events. The in vitro endurance studies of eight pumps are longer than 1 year. There were no mechanical malfunctions or pump failure. A stepwise clinical trial is being planned: Step1, a wearable BVAD/VAD will be clinically studied; Step 2, the BVAD/VAD will be implanted intracorporeally without TETS; and, Step 3, a totally implantable system will be clinically evaluated. The NEDO BVAD system has completed preclinical testing. Clinical trial preparation is underway.

Animals↗
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↗