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Journal of Human Lactation : Official... May 2017Breastfeeding is the optimal method for infant feeding. In the United States, 81.1% of mothers initiate breastfeeding; however, only 44.4% and 22.3% of mothers are...
BACKGROUND
Breastfeeding is the optimal method for infant feeding. In the United States, 81.1% of mothers initiate breastfeeding; however, only 44.4% and 22.3% of mothers are exclusively breastfeeding at 3 and 6 months, respectively. Research aim: The Centers for Disease Control and Prevention provides guidance and funding to state health departments to support strategies to improve breastfeeding policies and practices in the hospital, community, and worksite settings. In 2010, the Hawaii State Department of Health received support from the Centers for Disease Control and Prevention to launch the Baby-Friendly Hawaii Project (BFHP) to increase the number of Hawaii hospitals that provide maternity care consistent with the Ten Steps to Successful Breastfeeding and increase the rate of women who remain exclusively breastfeeding throughout their hospital stay.
METHODS
For this article, we examined the BFHP's final evaluation report and Hawaii breastfeeding and maternity care data to identify the role of the BFHP in facilitating improvements in maternity care practices and breastfeeding rates.
RESULTS
Since 2010, 52 hospital site visits, 58 trainings, and ongoing technical assistance were administered, and more than 750 staff and health professionals from BFHP hospitals were trained. Hawaii's overall quality composite Maternity Practices in Infant Nutrition and Care score increased from 65 (out of 100) in 2009 to 76 in 2011 and 80 in 2013, and Newborn Screening Data showed an increase in statewide exclusive breastfeeding from 59.7% in 2009 to 77.0% in 2014.
CONCLUSION
Implementation and findings from the BFHP can inform future planning at the state and federal levels on maternity care practices that can improve breastfeeding.
Topics: Breast Feeding; Hawaii; Humans; Infant; Infant Health; Infant, Newborn; Mothers; Program Development; Program Evaluation; Public Health
PubMed: 28135119
DOI: 10.1177/0890334416683675 -
GMS Journal For Medical Education 2019The Master Plan for Medical Studies 2020 places additional emphasis on curricular development processes. In addition, institutes may recognize a need to optimize their...
The Master Plan for Medical Studies 2020 places additional emphasis on curricular development processes. In addition, institutes may recognize a need to optimize their courses, for example because of poor evaluations. Frequently, however, the resources required for comprehensive optimizations are not available. In the present study, we aimed to use the example of a biochemistry seminar that takes place in the preclinical part of the medical degree at Ulm University Medical School to show how a course can be successfully optimized in small steps and evaluation results can be used for quality assurance. Similar to a continuous improvement process (CIP), over the course of five years a biochemistry seminar was gradually optimized in three steps. This process used structural, methodological, and content components, such as vertical integration, the inverted classroom method, and competence orientation. For quality assurance, we analyzed the official, standardized evaluation sheets from a total of n=1248 students. We evaluated the optimization process on the basis of responses to evaluation statements that were arranged into categories such as "organization, structure, implementation" and "quality of teaching," free text information, and the results of a pilot study conducted in parallel. We then determined the usefulness of the students' evaluation results for evaluating the optimization process. Each developmental step resulted in a significantly more positive overall evaluation of the seminar by the students. This result was independent of whether the development was on a structural or methodological/content-related level. In addition, the evaluations of the categories that were optimized were significantly better. For example, the vertical integration and introduction of the inverted classroom method were accompanied by a better evaluation of the "quality of teaching" and a change in the structure led to a higher score in the category "organization, structure, implementation." A comparison with the free text evaluation sheets and the results of the pilot study supports the results. Although optimization of a curriculum or course is a major task, it can also be successfully completed in small steps. With this approach, new learning goals, for example as required in the Master Plan for Medical Studies 2020, can be continuously integrated and student satisfaction with a course can be increased. Student evaluation results can represent a kind of quality assurance in this process and can provide important impulses for optimization.
Topics: Biochemistry; Curriculum; Education, Medical; Germany; Humans; Pilot Projects; Program Development; Program Evaluation
PubMed: 31844645
DOI: 10.3205/zma001281 -
Rural and Remote Health 2007This article reviews the Researcher Development Program (RDP) component of the Australian Government's Primary Health Care Research, Evaluation, and Development (PHC... (Review)
Review
CONTEXT
This article reviews the Researcher Development Program (RDP) component of the Australian Government's Primary Health Care Research, Evaluation, and Development (PHC RED) strategy, examining critical aspects of program performance and suggesting strategies that might increase the involvement of rural GPs in research.
ISSUE
Primary health care research capacity can only be built by providing sustainable, dedicated funding and a dedicated redistribution of workload from practice to research. The PHC RED funds and program supports only provide incentives to redirect existing capacity within primary health care from patient care to research for the time during which incentives are in place, generally as a part-time funded position for less than one-year's duration. The one-year time constraint is the most serious impediment to the success of the program. There is no formal provision for the continuing status of clinician/researchers. Continuation depends on the capacity of the mentor agencies, academic departments of general practice or university departments of rural health, to continue to support them, and on the time they can make available from their practice. Existing measures of program success, published research and new knowledge incorporated into practice settings, are too ambitious for researchers given a one-year time frame, working part time. Clinician/researchers have a demonstrated willingness to devote time to developing and answering a research question, but often lack the time and administrative support to get through the processes required, including ethics application and writing for publication.
LESSONS LEARNED
A better way to capture success of the RDP program might be through a multi-objective composite set of measures of research performance that captures different types of outputs, with weighting factors assigned to different measures of research output. Development of peer-review panels to replace or augment annual reporting to assess the progress of PHC RED programs might also serve both to measure success and to promote collaborative ventures. Small scale research projects are more conducive to practising GPs than randomised controlled trials or large scale observational studies. Smaller projects can still lead to important discoveries and improvements to the healthcare system. Examples include guideline development, descriptive studies, and small-number analytical epidemiological studies. In order to engage the rural primary care community in redirecting clinical time to research, the needs of clinicians must be met, as well as those of funders, academic mentors and collaborators. Structures and systems that can be developed through PHC RED, including research networks, will determine whether efforts to increase research in primary-care settings succeed and are sustainable. Sustainable networks need sustainable funding.
Topics: Australia; Biomedical Research; Congresses as Topic; Family Practice; Government Programs; Humans; Program Development; Program Evaluation; Rural Health Services
PubMed: 17696757
DOI: No ID Found -
Cell Biology Education 2004A typical undergraduate biology curriculum covers a very large number of concepts and details. We describe the development of a Biology Concept Framework (BCF) as a... (Review)
Review
A typical undergraduate biology curriculum covers a very large number of concepts and details. We describe the development of a Biology Concept Framework (BCF) as a possible way to organize this material to enhance teaching and learning. Our BCF is hierarchical, places details in context, nests related concepts, and articulates concepts that are inherently obvious to experts but often difficult for novices to grasp. Our BCF is also cross-referenced, highlighting interconnections between concepts. We have found our BCF to be a versatile tool for design, evaluation, and revision of course goals and materials. There has been a call for creating Biology Concept Inventories, multiple-choice exams that test important biology concepts, analogous to those in physics, astronomy, and chemistry. We argue that the community of researchers and educators must first reach consensus about not only what concepts are important to test, but also how the concepts should be organized and how that organization might influence teaching and learning. We think that our BCF can serve as a catalyst for community-wide discussion on organizing the vast number of concepts in biology, as a model for others to formulate their own BCFs and as a contribution toward the creation of a comprehensive BCF.
Topics: Biology; Curriculum; Humans; Program Development
PubMed: 15257339
DOI: 10.1187/cbe.03-10-0014 -
Journal of Pain and Symptom Management Dec 2015Specialist palliative care (PC) often embraces a "less is more" philosophy that runs counter to the revenue-centric nature of most health care financing in the U.S. A... (Review)
Review
Specialist palliative care (PC) often embraces a "less is more" philosophy that runs counter to the revenue-centric nature of most health care financing in the U.S. A special business case is needed in which the financial benefits for organizations such as hospitals and payers are aligned with the demonstrable clinical benefits for patients. Based on published studies and our work with PC programs over the past 15 years, we identified 10 principles that together form a business model for specialist PC. These principles are relatively well established for inpatient PC but are only now emerging for community-based PC. Three developments that are key for the latter are the increasing penalties from payers for overutilization of hospital stays, the variety of alternative payment models such as accountable care organizations, which foster a population health management perspective, and payer-provider partnerships that allow for greater access to and funding of community-based PC.
Topics: Biomedical Research; Humans; Palliative Care; Program Development; United States
PubMed: 26297853
DOI: 10.1016/j.jpainsymman.2015.06.013 -
Globalization and Health May 2015Global health programs, as supported by organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President's Emergency Plan for AIDS Relief...
BACKGROUND
Global health programs, as supported by organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President's Emergency Plan for AIDS Relief (PEPFAR), stand to make significant contributions to international medical outcomes. Traditional systems of monitoring and evaluation, however, fail to capture downstream, indirect, or collateral advantages (and threats) of intervention selection, design, and implementation from broader donor perspectives, including those of the diplomatic and foreign policy communities, which these programs also generate. This paper describes the development a new métier under which assessment systems designed to consider the diplomatic value of global health initiatives are described and applied based on previously-identified "Top Ten" criteria.
METHODS
The "Kevany Riposte" and the "K-Score" were conceptualized based on a retrospective and collective assessment of the author's participation in the design, implementation and delivery of a range of global health interventions related to the HIV/AIDS epidemic. Responses and associated scores reframe intervention worth or value in terms of global health diplomacy criteria such as "adaptability", "interdependence", "training," and "neutrality". Response options ranged from "highly advantageous" to "significant potential threat".
RESULTS
Global health initiatives under review were found to generate significant advantages from the diplomatic perspective. These included (1) intervention visibility and associations with donor altruism and prestige, (2) development of international non-health collaborations and partnerships, (3) adaptability and responsiveness of service delivery to local needs, and (4) advancement of broader strategic goals of the international community. Corresponding threats included (1) an absence of formal training of project staff on broader political and international relations roles and responsibilities, (2) challenges to recipient cultural and religious practices, (3) intervention-related environmental concerns, and (4) a lack of prima facie consideration of intervention diplomatic and foreign policy consequences.
CONCLUSIONS
Global health interventions stand to generate significant diplomatic advantages for donor and recipient countries and organizations when appropriately selected, designed, targeted, and delivered. Conversely, in the absence of the application of standards such as those developed under the Kevany Riposte, threats to diplomacy and international relations may occur. With the application of related systems to other global health programmes and settings, comparative results on the relative worth of alternate approaches from the diplomatic perspective may be generated to better inform political, strategic, and global health policy and programmatic decisions.
Topics: Diplomacy; Global Health; Humans; Internationality; Program Development; Retrospective Studies
PubMed: 26013278
DOI: 10.1186/s12992-015-0108-x -
Epilepsy & Behavior : E&B Jan 2020Specialized vocational rehabilitation (VR) programs in epilepsy have routinely performed more successfully than general or state-federal VR programs. This article...
Specialized vocational rehabilitation (VR) programs in epilepsy have routinely performed more successfully than general or state-federal VR programs. This article presents the key areas of emphasis in successful epilepsy VR program development to include initial program drivers, choice of VR services model, perspectives on program elements, clients, staffing, service evaluation metrics, operational considerations, and the partnering sponsor's personnel support. Considerable emphasis is placed on the importance and diversity of funding in sustaining a specialized epilepsy VR program. This template of considerations provides potential program implementers with a general framework for successful epilepsy VR program development.
Topics: Employment; Epilepsy; Humans; Program Development; Rehabilitation, Vocational
PubMed: 31785487
DOI: 10.1016/j.yebeh.2019.106698 -
Implementation Science : IS Oct 2015Schools have long been viewed as a good setting in which to encourage healthy lifestyles amongst children, and schools in many countries aspire to more comprehensive,... (Review)
Review
BACKGROUND
Schools have long been viewed as a good setting in which to encourage healthy lifestyles amongst children, and schools in many countries aspire to more comprehensive, integrated approaches to health promotion. Recent reviews have identified evidence of the effects of school health promotion on children's and young people's health. However, understanding of how such programmes can be implemented in schools is more limited.
METHODS
We conducted a realist review to identify the conditions and actions which lead to the successful implementation of health promotion programmes in schools. We used the international literature to develop programme theories which were then tested using evaluations of school health promotion programmes conducted in the United Kingdom (UK). Iterative searching and screening was conducted to identify sources and clear criteria applied for appraisal of included sources. A review advisory group comprising educational and public health practitioners, commissioners, and academics was established at the outset.
RESULTS
In consultation with the review advisory group, we developed four programme theories (preparing for implementation, initial implementation, embedding into routine practice, adaptation and evolution); these were then refined using the UK evaluations in the review. This enabled us to identify transferable mechanisms and enabling and constraining contexts and investigate how the operation of mechanisms differed in different contexts. We also identified steps that should be taken at a senior level in relation to preparing for implementation (which revolved around negotiation about programme delivery) and initial implementation (which centred on facilitation, support, and reciprocity-the latter for both programme deliverers and pupils). However, the depth and rigour of evidence concerning embedding into routine practice and adaptation and evolution was limited.
CONCLUSIONS
Our findings provide guidance for the design, implementation, and evaluation of health promotion in schools and identify the areas where further research is needed.
Topics: Child; Health Promotion; Humans; Program Development; Program Evaluation; School Health Services; United Kingdom
PubMed: 26510493
DOI: 10.1186/s13012-015-0338-6 -
Advances in Physiology Education Jun 2020Anatomy and Physiology courses taught at community colleges tend to focus laboratory hours primarily on anatomy as opposed to physiology. However, research demonstrates...
Anatomy and Physiology courses taught at community colleges tend to focus laboratory hours primarily on anatomy as opposed to physiology. However, research demonstrates that, when instructors utilize active learning approaches (such as in laboratory settings) where students participate in their own learning, students have improved outcomes, such as higher test scores and better retention of material. To provide community college students with opportunities for active learning in physiology, we developed two laboratory exercises to engage students in cardiac and skeletal muscle physiology. We utilized low-cost SpikerBox devices to measure electrical activity during cardiac (electrocardiogram) and skeletal muscle (electromyogram) contraction. Laboratory activities were employed in Anatomy and Physiology courses at two community colleges in southeast Michigan. A 2-h laboratory period was structured with a 20-min slide presentation covering background material on the subject and experiments to examine the effects of environmental variables on nervous system control of cardiac and skeletal muscle contraction. Students were asked to provide hypotheses and proposed mechanisms, complete a results section, and provide conclusions for the experiments based on their results. Our laboratory exercises improved student learning in physiology and knowledge of the scientific method and were well-received by community college students enrolled in Anatomy and Physiology. Our results demonstrate that the use of a SpikerBox for cardiac and skeletal muscle physiology concepts is a low-cost and effective approach to integrate physiology activities into an Anatomy and Physiology course.
Topics: Adult; Anatomy; Cost-Benefit Analysis; Curriculum; Female; Heart; Humans; Male; Medical Laboratory Science; Muscle, Skeletal; Physiology; Problem-Based Learning; Program Development; Students; Universities; Young Adult
PubMed: 32243218
DOI: 10.1152/advan.00149.2019 -
Journal of Health Organization and... 2015The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the...
PURPOSE
The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care.
DESIGN/METHODOLOGY/APPROACH
A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning.
FINDINGS
Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term "governance for quality and safety" assisted in gaining an understanding of the more traditional term "clinical governance". The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations
RESEARCH LIMITATIONS/IMPLICATIONS
The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals.
PRACTICAL IMPLICATIONS
The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety.
ORIGINALITY/VALUE
Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.
Topics: Clinical Governance; Ireland; Patient Safety; Program Development; Qualitative Research; Quality of Health Care
PubMed: 26045190
DOI: 10.1108/JHOM-03-2014-0046