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PubMed1999

Medical students' education in the ambulatory care setting: background paper 1 of the Medical School Objectives Project.

The present article is the first MSOP Background Paper. In planning the Medical School Objectives Project (MSOP), the Association recognized that certain changes in medical students' education were occurring already in some schools, and that it would be important to gain insight into and monitor these changes to provide ideas and information to help schools design curricular changes to foster students' achievements of the objectives and recommendations set forth in the MSOP Reports published in 1998 and reprinted in Academic Medicine. This background paper provides an overview of the strategies being developed by medical schools to carry out education in the ambulatory care setting. This report is based on site visits in 1997 to 26 U.S. medical schools conducted by two of the authors (CEH and GAK), who also used information from 12 additional schools that were not visited and consulted individuals responsible for the evaluation of five grant programs dedicated to national curriculum reform. The authors define and discuss in detail the use of the three main strategies that their research uncovered: (1) longitudinal preceptorships, (2) multispecialty clerkships, and (3) activities that are community oriented and population based to provide medical students the kinds of educational experiences they need to understand and practice in the ambulatory care setting. The authors then discuss issues and challenges related to the implementation of these curricular changes: curricular management issues; developing and maintaining a network of practicing physicians willing to serve as preceptors; evaluating curricular innovations; and assessing students' performances. The authors conclude with general observations about the need for ambulatory care education, the difficulties that have been--and continue to be--met and overcome to implement it, and the recommendation that relevant learning experiences should be incorporated into existing course work or clinical experiences.

Ambulatory Care↗
PubMed2006

Developing an interdisciplinary, community-based education program for health professions students: the Rochester experience.

To successfully meet the nation's changing health needs, future health professionals must learn skills in applied health promotion and disease prevention. To achieve these goals, the Center for Rochester's Health (the Center), a collaboration of the Monroe County Department of Public Health and the University of Rochester School of Medicine and Dentistry and School of Nursing, all located in Rochester, New York, developed an innovative education program that gives interdisciplinary teams of students opportunities to partner with community agencies engaged in research-oriented health improvement initiatives. The Center started this course in 1998, under the auspices of a national initiative supported by the Health Resources and Services Administration and the Institute for Healthcare Improvement. The authors discuss the challenges related to the implementation and institutionalization of this interdisciplinary population-based education program. They describe their experiences over a seven-year period, from 1998 to 2005, including the various factors that enabled them to make necessary changes in the program activities and the ways in which the Center was able to bring departments together to consider new course directions for engaging students in the community health improvement process. They discuss the different stages of program development, including the early years of program planning and later curriculum changes that involved the development of an online population health curriculum. The authors conclude that by understanding changes in the education goals of various health professions schools and by adapting education programs to meet the needs of students from these schools, program planners will have more opportunities to sustain community-based education programs.

Academic Medical Centers↗
PubMedDate not supplied

Controlling blood glucose levels to reduce infection.

Achieving and maintaining tight glucose control in the critically ill patient is becoming the standard of care across the country. It is well established that hyperglycemia is common in critically ill patients, and recent studies have shown a possible connection between hyperglycemia and the ability to fight infection. Healthcare providers face many challenges when choosing to implement this evidence-based practice into their standard of patient care. The purpose of this article is to share one hospital's collaborative approach to tight glucose control.

Blood Glucose↗
PubMed2003

Adapting MARSSIM for FUSRAP site closure.

The Multi-Agency Radiation Survey and Site Investigation Manual (MARSSIM) provides a coherent, technically defensible process for establishing that exposed surfaces satisfy site cleanup requirements. Unfortunately, many sites have complications that challenge a direct application of MARSSIM. Example complications include Record of Decision (ROD) requirements that are not MARSSIM-friendly, the potential for subsurface contamination, and incomplete characterization information. These types of complications are typically the rule, rather than the exception, for sites undergoing radiologically-driven remediation and closure. One such site is the Formerly Utilized Sites Remedial Action Program (FUSRAP) Linde site in Tonawanda, New York. Cleanup of the site is currently underway. The Linde site presented a number of challenges to designing and implementing a closure strategy consistent with MARSSIM. This paper discusses some of the closure issues confronted by the U.S. Army Corps of Engineers Buffalo District at the Linde site and describes how MARSSIM protocols were adapted to address these issues.

Decontamination↗
PubMed2000

Developing child abuse prevention, identification, and treatment systems in Eastern Europe.

Although the dissolution of the Soviet Union in 1989 brought a welcome end to the Cold War, the subsequent reestablishment of independent Eastern European countries revealed a host of problems. Among these was frequent child abuse and neglect, although lack of epidemiological data precluded any accurate estimate of prevalence. In an effort to address the problem of child abuse within this rapidly changing sociopolitical environment, the Children's Mental Health Alliance and the Soros Foundation organized the Eastern European Child Abuse and Child Mental Health Project in 1995. The authors describe the development of this multidisciplinary initiative involving collaboration with professionals from 17 countries in Eastern Europe. They highlight the goals, principles, and major phases of the project, as well as some of the challenges involved in its implementation.

Child↗
PubMed1999

The effect of patient-focused redesign on midlevel nurse managers' role responsibilities and work environment.

OBJECTIVE: The authors determine the effect of patient-focused redesign on midlevel nurse managers' role responsibilities and perceptions of work environment. BACKGROUND: Patient-focused redesign models have been initiated in a number of hospitals over the past 10 years. Few studies of the impact of these models on nurse leaders' roles and work responsibilities have been conducted. METHODS: Nine midlevel nurse managers were interviewed about their redesigned leadership roles and the challenges they experienced in implementing patient-focused redesign. RESULTS: Several themes emerged from the data. These themes focused on role change, ambiguity, position power, and environmental uncertainty and turbulence. Each of the nurse managers described feelings of frustration, disconnectedness, and inadequacy and spoke of how difficult it was to be the central figure in the eye of the storm. They noted that previously successful administrative strategies were not producing the same effect as in the past. CONCLUSION: This study provides beginning information about the magnitude of the impact of organizational redesign on midlevel nurse managers. Midlevel managers in this study struggled to keep up with the demands of the change and their own recognition of the importance of remaining committed to the uncertain goals of the institution. They were frustrated by their perceived inability to fix the situation and to meet the multiple needs of the staff. Nonetheless, they supported senior executives and attempted reasonable solutions to the problem.

Humans↗
PubMedDate not supplied

The promise and perils of a weekend nursing program.

In 1996, a weekend nursing program was created as an addition to the traditional weekday schedule to accommodate an increased number of qualified applicants seeking admission to the baccalaureate nursing program. Five years after the inception of the program, a comprehensive evaluation study was conducted to examine the impact of the weekend course schedule on students and faculty. The opportunities and challenges associated with the implementation of an alternative program schedule for entry-level nursing students are presented.

Adult↗
PubMedDate not supplied

Lights, camera, action: using feature films to stimulate emancipatory learning in the RN to BSN student.

Nurse educators are continually challenged to develop and implement effective activities to stimulate reflective learning in the RN to BSN student. The authors discuss the successful use of the feature film My Life as a reflective learning activity for a family health systems course.While feature films have been used constructively to teach family systems and social development, there is scant literature on the use of feature film as a teaching strategy within the discipline of nursing. The authors present evidence of how a film promoted stimulating and powerful transformative learning.

Education, Nursing↗
PubMedDate not supplied

A different kind of clinical experience: poverty up close and personal.

Nursing faculty are faced with the dilemma of how to teach the complex health and social issues about poverty to students because most nursing students have limited exposure to the impoverished. A seminar-driven clinical experience at a crisis center was implemented to address this challenge. Preclinical and postclinical exposure questions helped both students and faculty alike identify growth in students' awareness of social responsibility, client advocacy, and ethical issues.

Attitude of Health Personnel↗
PubMedDate not supplied

Promoting an active clinical learning environment for associate degree nursing students.

Nurse educators are challenged to develop and implement clinical learning opportunities. The authors discuss their experiences to include the planning process, clinical coordination and faculty roles, positive student experiences in diverse settings, and their successful outcomes. Recommendations are included which highlight a deliberate, thoughtful approach.

Attitude of Health Personnel↗
PubMedDate not supplied

Competency program development across a merged healthcare network.

Competency validation from initial entry through continued employment is essential to ensure nursing personnel provide safe professional practice. With hospital mergers it becomes quickly apparent that varying methodologies for competency verification exist. Nursing staff educators need a system-wide competency program to ensure a single high standard for the entire healthcare network. This article addresses one healthcare network's response to the challenge of developing and implementing a standardized competency-based program across a wide variety of settings.

Clinical Competence↗
PubMed2003

Developmental robotics: manifesto and application.

We argue that all embodied organisms, whether robots or animals, face the same challenge: of adapting to bodies, brains and environments that undergo constant and inevitable change. After highlighting the evidence for the universal role of a class of molecular factors called neurotrophic factors in the response of animals to this challenge, we suggest that implementing models of neurotrophic interactions on robots may confer on them the adaptability and robustness exhibited by animals. We briefly review a mathematical model of neurotrophic interactions and then discuss its application in a robotic context. Finally, we examine the potential, or otherwise, of our approach to developmental robotics.

Adaptation, Physiological↗
PubMed1998

Time-resolved crystallography.

Time-resolved crystallography has been successfully applied on the time scale from seconds via milliseconds and nanoseconds to picoseconds on a variety of systems. This brief review largely deals with macromolecular systems, on which there has been substantial recent progress. The strategies for design of a successful experiment that eliminates or minimizes potential artefacts have been identified, and the specifically crystallographic components of these strategies have been implemented. The remaining computational challenge is to identify and extract time-independent structures, each corresponding to a distinct reaction intermediate, whose populations vary with time and give rise to the time-dependent X-ray diffraction data. The fourth dimension, time, has been added to the three spatial dimensions of crystallography; it can no longer be regarded as purely a static technique.

Animals↗
PubMed1998

Evaluating community efforts to decategorize and integrate financing of children's health services.

Publicly funded categorical programs for children often differ in eligibility rules, allowable services, and criteria for provider participation, making it necessary for families to navigate through several programs to piece together care for their children. Recognizing these problems, the Robert Wood Johnson Foundation launched a national demonstration project in 1991 with the goal of decategorizing children's health services in nine communities. It was hoped that by releasing funds from categorical restrictions on their use, scarce public resources could be directed where they might have the greatest impact. However, the demonstration sites confronted a number of challenges in designing and implementing decategorization strategies: an absence of existing models and effective technical assistance; political hurdles in gaining cooperation from the multiple local agencies engaged in service provision; and difficulties in carrying out major programmatic changes when the health care system itself was rapidly being transformed. The proposition that decategorization holds promise as a tool for improving access to health care deserves further investigation.

Adolescent↗
PubMed2005

Bayesian inferences on predictors of conception probabilities.

Reproductive scientists and couples attempting pregnancy are interested in identifying predictors of the day-specific probabilities of conception in relation to the timing of a single intercourse act. Because most menstrual cycles have multiple days of intercourse, the occurrence of conception represents the aggregation across Bernoulli trials for each intercourse day. Because of this data structure and dependency among the multiple cycles from a woman, implementing analyses has proven challenging. This article proposes a Bayesian approach based on a generalization of the Barrett and Marshall model to incorporate a woman-specific frailty and day-specific covariates. The model results in a simple closed form expression for the marginal probability of conception, and has an auxiliary variables formulation that facilitates efficient posterior computation. Although motivated by fecundability studies, the approach can be used for efficient variable selection and model averaging in general applications with categorical or discrete event time data.

Adult↗
PubMed2005

Language, therapeutic relationships and individualized care: addressing these issues in mental health care pathways.

Care pathways are used extensively in inpatient medical and surgical services to facilitate the delivery of evidence-based health care. There is a growing interest in their use in the mental health arena. However, questions remain about their acceptability to service users and staff. Most current literature is aimed at communicating the value of care pathways. Consequently, issues that are particularly pertinent to mental health, like language, therapeutic relationships and individualized care have not been fully addressed. This paper reports on the development of a care pathway in residential services in Nottingham. It will illustrate how by working in multidisciplinary groups with service users and carers these issues were incorporated into a comprehensive pathway that follows the service user's journey from admission to discharge. The paper concludes by highlighting some of the challenges of care pathway implementation and suggests ways they can be overcome.

Communication↗
PubMed2004

Evaluating decision aids--where next?

Decision aids have been developed to help patients become involved in decision-making about their individual health care. During the evaluation of a particular decision aid in maternity care--a set of 10 'Informed Choice' leaflets--we considered the lessons learnt for evaluation of decision aids in the future. Decision aids have been tested mainly in explanatory trials and have been found to be effective. We argue that existing decision aids should be subjected to more pragmatic trials to test their effectiveness in the real world. The small amount of evidence on their use in the real world shows that they face challenges, resulting in poor implementation. Therefore, we propose that implementation strategies are developed which take heed of the findings of research on getting evidence into practice, and in particular address structural barriers such as the lack of time available to health professionals. We recommend that these 'decision aid implementation packages' are developed in conjunction with both health professionals and patients, and identify and address potential barriers to both the delivery of patient involvement in decision-making, and the use of decision aids, in the real world. These 'packages' can then be submitted to pragmatic evaluation.

Decision Support Techniques↗