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PubMed1995

Innovative programs for integrated delivery systems.

These programs are most effective under a MCO setting, but will succeed only if there are individuals within the organization to champion these programs. Many pharmacists have taken the lead and are working closely with manufacturers to identify the best use of these programs. These individuals ensure that the programs are implemented and that the appropriate pathways are followed. The pharmacist can assist in identifying those who are not using products appropriately. Using the manufacturer's resources (sales force) to supply the provider with educational material can help the provider follow the pathways and focus on appropriate use. The pharmacist can monitor the data and offer suggestions on program modifications. Therefore, the pharmacist plays a key role in meeting the challenges presented by outcomes performance programs and in creating an opportunity for the patient care organization to achieve its financial goals. With the MCO and manufacturer as partners, these programs will be successful and can increase the quality of care to MCO members who receive care in an institutional or community managed care setting.

Capitation Fee↗

PubMed2003

International Academy of Astronautics 5th cosmic study--preparing for a 21st century program of integrated, Lunar and Martian exploration and development (executive summary).

This report is an initial review of plans for a extensive program to survey and develop the Moon and to explore the planet Mars during the 21st century. It presents current typical plans for separate, associated and fully integrated programs of Lunar and Martian research, exploration and development, and concludes that detailed integrated plans must be prepared and be subject to formal criticism. Before responsible politicians approve a new thrust into space they will demand attractive, defensible, and detailed proposals that explain the WHEN, HOW and WHY of each stage of an expanded program of 21st century space research, development and exploration. In particular, the claims of daring, innovative, but untried systems must be compared with the known performance of existing technologies. The time has come to supersede the present haphazard approach to strategic space studies with a formal international structure to plan for future advanced space missions under the aegis of the world's national space agencies, and supported by governments and the corporate sector.

Cost-Benefit Analysis↗

PubMedDate not supplied

[Community in medical education programs of integral general medicine].

This paper includes the chief considerations about the community work in the Integral General Medicine Program Called Plan A36. General considerations are made abour the four years of trainign program in which the medical student in exposed to be in close contac with the most common medical and health problems in his country, and during this period of time, he becomes capable to develop all the techniques to act as a primary contac physicain.

Community Medicine↗

PubMed1992

The Integrated Trauma Program: a model for cooperative trauma triage.

The Integrated Trauma Program (ITP) is the cooperative trauma triage service of the University of Toronto trauma and burn hospitals and the Ontario Ministry of Health. It provides physicians in referring hospitals direct access to a trauma team leader (TTL) in one of several trauma centers through a single phone number. Three adult trauma centers, one pediatric trauma center, and one burn center, all affiliated with the University of Toronto, participate in this program. This article describes the system during the first two years of operation. From July 1989 to June 1991, 1530 requests for patient transfers from a total of 97 hospitals were processed. Of these transfer requests, 77% were accepted by the TTL to a trauma service as multiple trauma cases, 16% were accepted directly to a surgical service without involving the trauma team, 4% were refused by the TTL as inappropriate referrals, and 3% of requests were cancelled by the referring physician. The transfer requests are distributed to a specific trauma center by request of the referring physician (10%), according to a rotation (70%), or as selected by the ITP (20%) when the scheduled hospital is not readily available. Closure of all adult trauma centers occurred on 43 occasions. During these closures, 48 patients bypassed the Toronto trauma centers and were transferred to other cities. The ITP office also keeps an ongoing data base of patients transferred. The mechanism of injury in the majority of cases is vehicular crashes. The mean Injury Severity Score is 24 for adults and 17 for children.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2003

Evaluation of the Tzu Chi Institute for Complementary and Alternative Medicine's Integrative Care Program.

OBJECTIVE: There are an increasing number of clinics providing integrative health care using new and innovative delivery models. The purpose of this study was to quantitatively and qualitatively evaluate the Integrative Care Program offered at the Tzu Chi Institute for Complementary and Alternative Medicine, Vancouver, British Columbia, Canada. DESIGN: At enrollment, data are collected on demographics, health history, current health concerns and diagnoses, quality of life/health status (SF-36) and patient satisfaction. The measures are repeated 6 months into the program. Descriptive analysis was used to summarize the data. Focus groups were also included as part of the study design. RESULTS: Patients seeking integrative care are a highly complex population living with numerous comorbid chronic conditions. Although their baseline scores on the SF-36 are lower than Canadian population norms across all subscales, significant improvement occurred from baseline to 6 months. Qualitative data support that patients were pleased with the clinical care they received and aligned with the philosophical underpinnings of the program. DISCUSSION: This is one of the first studies to evaluate integrative health care. Studies like this are needed to develop appropriate methods to assess models of integrative health care delivery.

Adult↗

PubMed1981

The role of neuroleptics in an integrated treatment program for chronic schizophrenics.

An integrated treatment programme for patients with psychoses and hospitalization syndromes is presented. Most of the patients are schizophrenics with many years of hospital care. Neuroleptics are used in conventional doses and since 1971 flupenthixol decanoate is the drug of choice. The residual states are analyzed as well from a medical as from a social psychological point of view. Psychotherapy and social training inside and outside the hospital were means to reach treatment progress. Behaviour therapy was successful on the most deteriorated patients and in young patients a more psychodynamic approach was used including family therapy. Forty-two patients were activated to a life in flats. In 21 patients living near the hospital an economic analysis was made. The economic benefits of the treatment are large. The results show that patients suffering from chronic mental diseases must be treated with a composed programme including medical, social, and psychological parts.

Adult↗

PubMed2003

Developing an integrative therapies program in a tertiary care cardiovascular hospital.

This article describes one hospital's approach to developing an inpatient integrative therapies program and the foundation for a broader integrative healthcare vision. Since the program's inception, additional evidence has accumulated in the literature supporting the impact of integrative therapies strategies on patients' quality of life during inpatient stays. These findings and our own evaluation processes have encouraged continued program growth. Several elements were critical to the program's success. Review of the literature and investigation of other programs served as preparation before the actual program started. It was necessary to have administrative, nursing, and physician champions who were able to envision the program and see the value of this approach for patients. We appreciated the need for evidence-based outcomes research and demonstrable patient outcomes. Finally, a program manager was hired who was able to understand the culture of the hospital and the organizational change process. Each of these basic steps, which called for interdisciplinary collaboration, allowed us to accomplish the goal of using integrative therapies as adjuncts to conventional medical care and thereby supported an integrative approach. Consistently linking the integrative vision to patient needs and requirements helped us to identify many new avenues to expand upon this work. The process of program development described may be useful to other inpatient cardiovascular programs inclusive of critical care settings. Adaptations of our experience to other populations in critical care and across other hospital settings may be possible.

Cardiac Care Facilities↗

PubMed1991

A practicum in clinical nutrition as the internship component of an integrated masters/internship program.

In September 1990, Chedoke McMaster Hospitals (CMH) admitted two students to the Practicum in Clinical Nutrition. This program was developed at CMH in affiliation with the graduate programs in nutrition offered at McMaster University and the University of Guelph. This is the first program in Canada to integrate a graduate nutrition degree at the Master's level with a clinical nutrition training program. The purpose of this paper is to describe the need, goals, educational philosophy, developmental process and anticipated benefits of this practicum.

Curriculum↗

PubMed2002

Effect of an integrated nutrition program on child morbidity due to respiratory infection and diarrhea in northern Viet Nam.

Infectious disease and poor diet are the two proximal causes of malnutrition in children. During the 1990s, integrated nutrition programs implemented by Save the Children (SC) in Viet Nam reduced severe child malnutrition, but it has not been clear if this impact was due primarily to improved diet or reduced disease. The aim of this study was to determine whether a community-based, integrated nutrition program in Viet Nam reduced child morbidity due to diarrhea or acute respiratory infections. Children 5 to 25 months old were randomly selected from randomly assigned intervention and comparison communes. Caregivers of children from the intervention and comparison groups (n = 119 per group) were interviewed about their child's morbidity at program baseline and at study months 2, 4, 6, and 12. Multiple logistic regression and general estimating equations (GEE) were used to evaluate the effect of the intervention on the occurrence of any diarrhea and respiratory illness in the preceding two weeks. Respiratory illness, mainly upper respiratory illness, was more common than diarrheal disease at baseline (54% vs. 6%, respectively). During follow-up, children in the intervention communes had approximately half the respiratory illness experienced by those in comparison communes (AOR = 0.5; p = .001). Diarrheal disease was also lower in the intervention group, although differences were not statistically significant. We conclude that SC's integrated nutrition program was associated with reduced upper respiratory illness, perhaps due to improved hygiene practices and/or improved micronutrient intakes.

Adult↗

PubMed1995

Visions realized and dreams dashed: Helen Penhale and the first basic integrated baccalaureate program in nursing in the west, at the University of Alberta 1952-1956.

The first basic degree program in nursing in Canada was established at the University of British Columbia in 1919. This program and those that followed elsewhere were of the non-integrated form, wherein a diploma program offered by a hospital was supplemented by university courses in the arts, humanities, and sciences. In 1942 an innovative basic baccalaureate program in nursing was established at the University of Toronto; courses in nursing, given by the university, were offered in conjunction with university courses in other subjects. Only two other attempts were made to set up integrated programs in Canada prior to release of the Report of the Royal Commission on Health Services of 1964; McMaster University established a program in 1946, and, in an attempt that was ultimately unsuccessful, a program was established at the University of Alberta in 1952. The purpose of this study was to examine the conditions surrounding the initiation and termination of a basic degree program in the 1950s at the University of Alberta, in order to understand the key issues in the movement to establish basic university degree programs for nurses, and the gender discrimination relative to nurses and nursing students that has prevailed in health and education. Although the conflict at the University of Alberta was a very difficult one for the nurses involved, and although the Director who had the temerity to establish the program relinquished her position when the program was summarily terminated, this episode in Canadian nursing history provides insight into the climate in which baccalaureate nursing education existed and into some of the issues relative to its development.

Alberta↗

PubMed1999

A method of teaching clinical research in a community hospital residency program.

BACKGROUND: To provide clinical research experience in community hospital programs, we integrated research training with the daily work of surgical residency. METHODS: Teaching conferences and daily care of patients served as a source of projects. Emphasizing team work, high-yield projects are assigned to principal resident investigators, who lead a project team. Regular meetings with the faculty provides guidance and supervision, working to meet an abstract deadline. RESULTS: Over a 3-year period, 10 of 16 trainees participated in at least one project. Thirteen projects were presented at national meetings and 13 articles (including 6 from presentations) were published. Three projects were abandoned for lack of progress, and 5 manuscripts have been rejected. CONCLUSION: The integrated program trains multiple residents/projects with low requirements in space and funding, but high demands of organization and faculty time.

Curriculum↗

PubMed1998

New approaches to smoking prevention in the north.

Morbidity and mortality rates of noncommunicable diseases (NCD) are very high in Siberia. The prevalence of NCD risk factors is also very high, smoking being one of the most widespread risk factors. Prevention and cessation of smoking may improve the health of the population. Within the framework of the WHO MONICA (Monitoring Cardiovascular Diseases) project, we have conducted three population surveys in Novosibirsk within a 10-year period (1984-1995) to show trends of cardiovascular diseases and their risk factors. We also conducted similar surveys in some Siberian regions. Economic crisis and social stress greatly affect the health of the population, and new methods and approaches to disease prevention are needed. As participants in the WHO CINDI program (Countrywide Integrated Program for Disease Prevention), we started our work to reduce and control the main NCD risk factors. Smoking being widespread in Siberia, we started an anti-smoking campaign in Novosibirsk as participants in the international "QUIT & WIN" campaign in 1994. In 1995 we arranged a similar contest at the local level in the city; and now in May 1996 we are again taking part in the QUIT & WIN campaign.

Adult↗

PubMedDate not supplied

The nature and effectiveness of program models for adolescents at risk of entering the formal child protection system.

This article compares rationales and outcome research for five areas of programming for adolescents: adolescent competence and skill development programs, family- and parent-focused programs, social integration programs, multiple component programs, and neighborhood transformation programs. The article examines program evidence for maltreated teens as well as teens coping with a variety of other challenges. The study uses a framework based on common developmental challenges and risk factors for adolescents to select and review programs.

Adolescent↗

PubMed1999

Integrating Application Programs for Bioinformatics Using a Web Browser.

We have constructed a general framework for integrating application programs with control through a local Web browser. This method is based on a simple inter-process message function from an external process to application programs. Commands to a target program are prepared in a script file, which is parsed by a message dispatcher program. When it is used as a helper application to a Web browser, these messages will be sent from the browser by clicking a hyper-link in a Web document. Our framework also supports pluggable extension-modules for application programs by means of dynamic linking. A prototype system is implemented on our molecular structure-viewer program, MOSBY. It successfully featured a function to load an extension-module required for the docking study of molecular fragments from a Web page. Our simple framework facilitates the concise configuration of Web softwares without complicated knowledge on network computation and security issues. It is also applicable for a wide range of network computations processing private data using a Web browser.

Journal Article↗

PubMed1998

MoldaNet: a network distributed molecular graphics and modelling program that integrates secure signed applet and Java 3D technologies.

MoldaNet is a molecular graphics and modelling program that integrates several new Java technologies, including authentication as a Secure Signed Applet, and implementation of Java 3D classes to enable access to hardware graphics acceleration. It is the first example of a novel class of Internet-based distributed computational chemistry tool designed to eliminate the need for user pre-installation of software on their client computer other than a standard Internet browser. The creation of a properly authenticated tool using a signed digital X.509 certificate permits the user to employ MoldaNet to read and write the files to a local file store; actions that are normally disallowed in Java applets. The modularity of the Java language also allows straightforward inclusion of Java3D and Chemical Markup Language classes in MoldaNet to permit the user to filter their model into 3D model descriptors such as VRML97 or CML for saving on local disk. The implications for both distance-based training environments and chemical commerce are noted.

Computer Graphics↗

PubMed2026

Digital Structured Education With Behavioral Nudge Tools for Adults With Type 2 Diabetes: Multicenter Randomized Controlled Trial.

BACKGROUND: Digital interventions offer scalable alternatives to traditional face-to-face diabetes education, but often face challenges related to inconsistent clinical effectiveness, and declining user engagement. However, whether a digital structured education program integrated with behavioral nudge tools can improve metabolic, behavioral, and psychological outcomes in adults with type 2 diabetes remains unclear. OBJECTIVE: This study aimed to evaluate the effectiveness of a digital structured education program integrated with behavioral nudge tools in improving metabolic, behavioral, and psychological outcomes among adults with type 2 diabetes. METHODS: This multicenter randomized controlled trial was conducted in the endocrinology departments of 4 hospitals in China. Adults with type 2 diabetes were randomly assigned to an intervention group receiving a digital structured education program integrated with behavioral nudge tools (n=146) or a control group receiving standard digital diabetes education (n=147). Assessments were conducted at baseline and 12-week follow-up. The primary outcome was hemoglobin A1c (HbA1c) at 12 weeks, adjusted for baseline HbA1c, and study center. Secondary outcomes included fasting blood glucose (FBG), weight, BMI, waist circumference, blood pressure, lipid profiles, self-management behaviors, self-efficacy, and habit strength. RESULTS: Among 293 participants (mean age 49.19, SD 10.02 y), 287 (97.9%) completed follow-up. At 12 weeks, the intervention group demonstrated significantly greater improvements than the control group in HbA1c (adjusted mean difference -0.38%, 95% CI -0.68% to -0.09%; P=.01), FBG (adjusted mean difference -0.75, 95% CI -1.27 to -0.44 mmol/L; P<.001), weight (adjusted mean difference -0.84, 95% CI -1.61 to -0.07 kg; P=.03), BMI (adjusted mean difference -0.38, 95% CI -0.65 to -0.11 kg/m²; P=.01), systolic blood pressure (adjusted mean difference -2.71, 95% CI -4.62 to -0.79 mm Hg; P=.01), diastolic blood pressure (adjusted mean difference -2.92, 95% CI -4.47 to -1.37 mm Hg; P<.001), and total cholesterol (adjusted mean difference -0.27, 95% CI -0.48 to -0.05 mmol/L; P=.02). The intervention was also associated with significantly greater improvements in self-management behaviors, self-efficacy, and habit strength (all P<.05). CONCLUSIONS: Digital structured education integrated with behavioral nudge tools improved metabolic outcomes and strengthened psychological and behavioral determinants of self-management among adults with type 2 diabetes over a 12-week period. These findings suggest that a digital structured education program integrated with behavioral nudge tools may enhance diabetes self-management beyond standard digital diabetes education. Further studies with longer follow-up and real-world implementation are warranted to evaluate the sustainability, generalizability, and long-term clinical impact of this integrated intervention.

Humans↗

PubMed1980

Automated determination of salts in water-soluble certifiable color additives by ion chromatography.

A previously developed ion chromatographic method for the determination of salts in water-soluble certifiable color additives was automated, using a Model 12 Dionex ion chromatograph equipped with a program controller and programmable computing integrator. Programs were written for the program controller for continuous automated analysis of up to 59 samples in about 20 h, with periodic regeneration of the suppressor column and automatic shut-down. All data were processed through the integrator, programmed to give results in weight/weight percent. Recoveries were performed on 4 anions: chloride, phosphate, bromide, and sulfate. Twenty-five color additives could be analyzed by the method. Standard deviations in the determinations ranged from 0.01 to 0.16 at addition levels of 0.20-9.45% with 6 replications. Recoveries for addition levels of 0.2-5.0% with 2 replications fell within the range of 84.0-105.0%. Approximate lower limits of detection for each anion were as follows: chloride, 0.07%; phosphate, 0.10%; bromide, 0.06%; sulfate, 0.07%.

Anions↗

PubMed1978

How evaluation findings can be integrated into program decision making.

The paper describes difficulties in integrating the findings of research and evaluation studies back into the ongoing process of decision making. The paper suggests how to present information in such a way as to improve its intellectual understandability and to decrease affective resistances to the acceptance of new information. The paper also describes common blocks that are met in the attempt to implement recommendations and describes methods to overcome them.

Affect↗