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PubMed1998

Sustaining curricular change at Sherbrooke through external, formative program evaluations.

In this case study, the authors discuss external, formative program evaluation as a means to monitor and sustain ongoing curricular change and to prepare for periodic accreditation reviews. The Faculty of Medicine at Sherbrooke (in Quebec, Canada), following a major curricular reform begun in the mid-1980s, held three external, formative program evaluations in 1988, 1991, and 1994, using expert judgment and "connoisseur" models of evaluation. The authors present the goals of the evaluations (e.g., to evaluate the implementation of intended curricular changes) and the 17-step process used (e.g., "involve as many faculty and students as possible before and during the visit"), and describe the preparation for the evaluations, the selection of the external evaluators (e.g., a chief medical officer from the World Health Organization, a high-profile basic sciences teacher, the chairman of the previous accreditation team, and others), and on-site activities and reporting. Recommendations from the evaluators and the subsequent actions taken (and in a few cases, not taken) by the school are presented and discussed in terms of program planning, curricular content, basic sciences, problem-based learning and tutors' training, assessment of students, resource constraints, clerkships, community orientation, students' self-directedness, and medical humanism. The three evaluations helped guide and support the major curricular undertakings and encouraged continued changed and refinements. They also had a significant effect on the curriculum itself, on the faculty, and on the socioeducational climate of the school.

Curriculum↗
PubMed1999

Levels and loops: the future of artificial intelligence and neuroscience.

In discussing artificial intelligence and neuroscience, I will focus on two themes. The first is the universality of cycles (or loops): sets of variables that affect each other in such a way that any feed-forward account of causality and control, while informative, is misleading. The second theme is based around the observation that a computer is an intrinsically dualistic entity, with its physical set-up designed so as not to interfere with its logical set-up, which executes the computation. The brain is different. When analysed empirically at several different levels (cellular, molecular), it appears that there is no satisfactory way to separate a physical brain model (or algorithm, or representation), from a physical implementational substrate. When program and implementation are inseparable and thus interfere with each other, a dualistic point-of-view is impossible. Forced by empiricism into a monistic perspective, the brain-mind appears as neither embodied by or embedded in physical reality, but rather as identical to physical reality. This perspective has implications for the future of science and society. I will approach these from a negative point-of-view, by critiquing some of our millennial culture's popular projected futures.

Artificial Intelligence↗
PubMed2005

A developmental model for rural telepsychiatry.

Telepsychiatry represents a promising means to increase access to care for rural American Indian communities. This article describes rural telepsychiatry clinics operated by the American Indian and Alaska Native Programs at the University of Colorado Health Sciences Center through a partnership with the Department of Veterans Affairs, the Indian Health Service, and local tribal health services that target American Indian veterans with posttraumatic stress disorder. A six-stage model for developing such services is presented. The model consists of needs identification, infrastructure survey, partnership organization, structure configuration, pilot implementation, and solidification. This article traces program development, presents challenges in implementing these services, and offers potential solutions. The model can guide the development of telepsychiatry services for American Indians specifically and rural populations in general.

Health Services Accessibility↗
PubMed1999

Implementation and evaluation of an interdisciplinary health professions core curriculum.

An interdisciplinary core curriculum has been implemented in the College of Health Professions at Armstrong Atlantic State University since spring 1996. The curriculum is designed to provide students with the knowledge, skills, and values necessary for interprofessional practice. The courses are taught by interdisciplinary teams and are offered as electives or as part of major requirements in nursing, health science, physical therapy, dental hygiene, medical technology, radiologic sciences, and respiratory therapy. In addition to ongoing evaluation methods, a survey designed to assess the student and faculty perceptions of the experience has been conducted. Both groups agreed that the experience has had a positive impact on the students' professional performances, patient interactions, understanding of the health care delivery system, and health career preparation. Faculty agreed that teaching in an interdisciplinary team was a positive experience. The collaboration among the health professions' faculty has resulted in increased respect for one another and for others' disciplines. Although the experience places an additional burden on their workload, they agreed that the experience is beneficial, their efforts are worthwhile, and they would be willing to continue to teach interdisciplinary courses.

Allied Health Personnel↗
PubMedDate not supplied

Adherence to universal precautions among laboratory personnel in Lebanon.

To evaluate the present situation and plan future directions with regard to implementation of universal precautions in laboratories testing blood samples, we carried out a national cross sectional study in 2003 on a representative sample of laboratories in Lebanon. We compared the results with those of a 1993 study. We found that the education profile of staff had improved, being now more specialized in laboratory science. The discrepancies between what technicians knew, believed in and practised and what was observed in the field improved to some extent in most variables. Disposal of needles and syringes had improved greatly but disposal of blood-contaminated material had not. Given the risks of improper practice, a policy of universal precautions is essential and regular training should be carried out so that staff know and practise the universal precautions and correct laboratory procedures.

Attitude of Health Personnel↗
PubMed1994

Childbearing motivations, desires, and intentions: a theoretical framework.

After briefly reviewing different approaches in the social and behavioral sciences to conceptualize the reasons that humans become motivated to bear children, I present a theoretical framework that incorporates many elements of these approaches. The framework is based on a four-step psychological sequence: the formation of traits, the activation of traits into desires, the translation of desires into intentions, and the implementation of intentions in the form of behavior. I use data from 401 married couples to develop regression models of the two middle steps of this sequence that indicate how childbearing motivational traits lead to childbearing desires and how the latter lead to childbearing intentions. I also develop a regression model that indicates how childbearing motivation affects an individual's perception of his or her spouse's childbearing desires.

Adult↗
PubMed2002

Implementing a medicine-spirituality curriculum in a community-based internal medicine residency program.

OBJECTIVE: To promote greater sensitivity to and heightened awareness of the relevance and therapeutic potential of integrating medicine and spirituality in the healing process of patients cared for by our medical residents. Strategies for clear, effective, and empathetic communication are integrated into the curriculum. DESCRIPTION: With the support of The University of Massachusetts Medical School Macy Initiative in health communication, funded by the Josiah Macy, Jr. Foundation, we have fully implemented a medicine-spirituality curriculum as an integral aspect of our residency program. Current strategies include (1) new house officers participate in the workshop "Communicating Bad News," which is based on a videotaped interaction and experiential role-play about the challenging "art" of sharing bad and often traumatic news; (2) a monthly lecture series that looks at various aspects of religious and spiritual practices and their implications on science and health with topics including the following: taking a spiritual history, exploring world religious views from a Judeo-Christian perspective, studying Eastern philosophies such as Buddhism and Hinduism, and discussing cultural diversity's effect on how people understand and cope with illness; (3) residents receive a comprehensive, evidence-based syllabus that encompasses all of the medical literature relating to spirituality, religion and health; (4) local hospice professionals give end-of-life care lectures about pain management, palliation, advanced directives, and ethical implications; (5) our residents spend one or two days per year with our pastoral care leaders and one to two days per year with our hospice team; (6) monthly ward rounds with a faculty member who emphasizes the spiritual dimension of a particular case and the faith-based resources in our hospital and community. DISCUSSION: Traditionally, graduate medical education has not emphasized the importance of spirituality as a "target" for routine inquiry, understanding, and sharing in the context of patient care. We are beginning to see that residents need to be aware of the relationship between spirituality and health, as a consequence of this curriculum. Because the curriculum is seamlessly integrated into a preexisting infrastructure (e.g., noon conferences, ambulatory off-site experiences, walk-rounds, etc.), it has been relatively easy to implement. Focusing on the literature has also provided a "scientific door" that has made this more palatable. Over time, we will foster a growing alliance of the medical and faith communities in our rural area. This has potent implications for community health initiatives. Two of our residents have already volunteered to give talks at local congregations. Spirituality and religion are sensitive and personal areas that can be awkward to embrace and openly discuss. By remaining sensitive and respectful of all views, we strive to diminish the obstacles and enable a more provocative, enlightening residency experience. As a consequence, we are forced to reconsider what it is to be a "healer" and what it is to be "healed." Annual verbal and written feedback will allow us to refine our curriculum. I anticipate this to be a permanent aspect of our residents' training.

Community Health Services↗
PubMed2002

Green chemistry: science and politics of change.

The chemical industry plays a key role in sustaining the world economy and underpinning future technologies, yet is under unprecedented pressure from the effects of globalization and change in many of its traditional markets. Against this background, what will be needed for the industry to embrace efforts to make it "greener"? We explore some of the issues raised by the development of "green chemistry" techniques and identify potential barriers to their implementation by industry.

Carbon Dioxide↗
PubMed2004

A novel model for extending international co-operation in science and education.

In September 1994 the University of Twente, the Netherlands, and Zhejiang University, China, decided to cooperate in the field of science, education and management. After several visits of delegations from both sides it was considered worthwhile to explore further opportunities for mutual cooperation. The directors of international cooperation on each side jointly commissioned a project to investigate the potential in a systematic way and to establish further contacts where appropriate. This paper reports on the results of the research cum matching project. To reveal promising matches between multiple departments of both academic institutions a matching model for universities was designed. The study was carried out along two parallel lines. In the research line the theoretical framework was developed into a model for international university co-operation. Moreover, an analysis was carried out on internal, external and cultural aspects resulting in a set of thirty four influencing factors. In the matching line a total of seventy interviews were held in order to identify promising matches between units at both universities. This line resulted in eleven promising matches for further co-operation. The novel model appeared useful in analyzing the variety of factors and in developing matches between both universities. In the further implementation of the model the issues of "level of co-operation" and "top-down versus bottom-up" need to be addressed in more detail.

China↗
PubMedDate not supplied

Conducting nutrition education research in junior high schools: approaches and challenges.

This article describes some of the approaches used and challenges encountered conducting nutrition education research in junior high schools. The Teens Eating for Energy and Nutrition at School (TEENS) study recruited 16 schools and over 3800 seventh graders to participate in an intervention to increase students' intakes of fruits, vegetables, and lower fat foods for the purpose of reducing their future risk of cancer. The TEENS intervention included a classroom curriculum as well as a school environment and family component. This article describes some of the issues faced in the design and implementation of the study including recruiting schools and teens, maximizing the number of students within each intervention school exposed to all components of the intervention, and implementing elements of nutrition education in a classroom setting. The methods used to meet these challenges and the success of the methods attempted are described.

Adolescent↗
PubMedDate not supplied

[Pedagogical Project for the Graduate Nursing Program at UFAL: adaptations to curricular guidelines].

This is an analysis of the adaptation of the Pedagogical Political Project of the Nursing Graduate Program at Alagoas Federal University (PPP/Enf/UFAL) to new Brazilian curriculum guidelines, evidencing convergence points and some points that need to be approached, taking into account that the present project was established prior to the existence of the current curricular guidelines. Our analysis shows that the main difficulties presented by the newly implemented curriculum lie in the ones inherent to the process of changing conceptions on the educational process in Nursing and in the work conditions imposed by the current situation of the Brazilian Public University System. It calls for a review on strategies and contents related to the basis of research and expansion in Nursing Sciences, as well as the search for alternatives to integration with domain areas from Humanistic and Health Sciences.

Brazil↗
PubMedDate not supplied

[A research agenda for health policies and services in northeast Brazil].

The aim of this paper is to gather elements for a discussion on health policies and services in northeast Brazil. The author begins with an analysis of the population's main health problems, the health system's limitations, and current opportunities for implementing health programs. She highlights the following research priorities: people's health situations according to their material living conditions and life styles; the private health sector's characteristics and development; the current decentralization process; and proposed innovations in services, programs, and systems. The author points out further that the policy-making process in science and technology should assure a balance between researchers' freedom and people's health needs, regional focus, and universal issues.

Brazil↗
PubMed1980

Health planning as a regulatory strategy: a discussion of its history and current uses.

Federally mandated health planning is one of the most significant responses to the cost crisis of American medicine. Portrayed as an objective and rational mechanism of determining the future, planning is a socially acceptable means of exerting third-party control over a sector of the economy long able to escape meaningful controls on its growth and development. However, far from being the neutral science which it is heralded to be, the planning process serves the interests that are able to control its use. Health planning agencies must be studied in the context of the current emphasis on cost containment and reorganization of health services. Supported and enfranchised largely by major third-party payors, planning smooths the implementation of changes in the health sector. Despite its progressive potential, planning serves the interests of these third-party payors by masking their attempts to control the future development of the health system.

Delivery of Health Care↗
PubMed1982

Systemic consultation in a general hospital.

Consultation psychiatry has long offered the potential for psychiatrists to impact on the mental health of large numbers of individuals. However, workers in consultation psychiatry have often described it as a stressful, ungratifying experience. Over the last fifty years, since the initiation of consultation psychiatry, a series of models of consult work has been presented in the literature. These models have increasingly become more complex in the system of organization in which they operate. Moreover, there has been a constant movement toward viewing the function of the psychiatrist as intervening in behavior outside of the patient. After reviewing the history of consultation psychiatry, the authors conclude that a logical development would be a systemic model in which the entire hospital system is seen as the focus of consultation and in which the goal of the consultant's work is seen as creating a more open and flexible hospital system. The authors, therefore, describe a systemic model in which the potential crisis offered by any request for consultation work is seen as a tool for intervening with the hospital system. The difficulties of attaining the objectivity necessary for implementing a systemic intervention are discussed. A method of systemic diagnosis of the hospital is presented as well as a number of strategies of intervention with the hospital system. The authors conclude that using a systemic model (with the hospital as the focus of consultation) can lead to the development of a more comprehensive science of consultation which will lead to an increase of gratification for the psychiatrist and a more healthy functioning hospital system.

Adolescent↗
PubMed1995

Computer mediated learning experiences spanning the globe: a pilot study between schools of nursing in the United States and the Netherlands.

The use of telecommunications in health care, education, and our daily lives has become a popular topic in both the professional and lay literature. The promise of the "Information Superhighway" and the expanded use of the Internet by other professionals have precipitated the examination of computer mediated communication as an instructional tool that transcends geographic boundaries and time barriers. This paper will discuss the development and implementation of a pilot project to foster collaborative learning experiences for nursing students between two schools of nursing in two different countries. The pilot is framed within the context of a Global Collaborative Learning Project in Nursing Informatics. A pilot project was initiated between the Schools of Nursing at the University of Colorado Health Sciences Center and the Hogeschool Holland during the 1994-95 academic year. Each school taught a nursing informatics course and assignments were designed to allow students from each school to participate in a collaborative learning experience. The presentation will highlight the outcomes of this pilot project and project future plans.

Colorado↗
PubMed1997

FDA perspective on specifications for biotechnology products--from IND to PLA.

Quality standards are obligatory throughout development, approval and post-marketing phases of biotechnology-derived products, thus assuring product identity, purity, and potency/strength. The process of developing and setting specifications should be based on sound science and should represent a logical progression of actions based on the use of experiential data spanning manufacturing process validation, consistency in production, and characterization of relevant product properties/attributes, by multiple analytical means. This interactive process occurs in phases, varying in rigour. It is best described as encompassing a framework which starts with the implementation of realistic/practical operational quality limits, progressing to the establishment/adoption of more stringent specifications. The historical database is generated from preclinical, toxicology and early clinical lots. This supports the clinical development programme which, as it progresses, allows for further assay method validation/refinement, adoption/addition due to relevant or newly recognized product attributes or rejection due to irrelevance. In the next phase, (licensing/approval) specifications are set through extended experience and validation of both the preparative and analytical processes, to include availability of suitable reference standards and extensive product characterization throughout its proposed dating period. Subsequent to product approval, the incremental database of test results serves as a natural continuum for further evolving/refining specifications. While there is considerable latitude in the kinds of testing modalities finally adopted to establish product quality on a routine basis, for both drugs and drug products, it is important that the selection takes into consideration relevant (significant) product characteristics that appropriately reflect on identity, purity and potency.

Antibodies, Monoclonal↗
PubMed2005

Behavioral management of chimpanzees in biomedical research facilities: the state of the science.

The current status of the behavioral management of chimpanzees housed in US research facilities is examined, and recent advances are described. Behavioral management includes the application of environmental enrichment, animal training, and environmental design for improving animal welfare. Authors surveyed the six major chimpanzee holding facilities and found that the vast majority of chimpanzees are housed socially, with access to the outdoors. The institutions currently invest in behavioral scientists, enrichment specialists, and, most recently, chimpanzee trainers to implement and study chimpanzee behavioral management. This review is based on the substantial scientific literature related to managing social behavior, identifying the behavioral effects of restricted socialization, evaluating various forms of enrichment, and describing positive reinforcement animal training. Authors outline recent accomplishments in behavioral management, summarize behavioral issues that have been evaluated, and identify issues for future consideration. It is proposed that the enhanced application of behavioral management techniques, including training, could significantly reduce chimpanzee stress that is generally associated with experimental manipulations, and could improve animal welfare and the quality of biomedical research. The next challenge is to implement effectively and thoroughly the approaches that have been shown to be beneficial.

Academies and Institutes↗