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Selected AbstractsContinuing Medical Education, Continuing Professional Development, and Knowledge Translation: Improving Care of Older Patients by Practicing PhysiciansJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2006David C. Thomas MD Many community-based internists and family physicians lack familiarity with geriatrics knowledge and best practices, but they face overwhelming fiscal and time barriers to expanding their skills and improving their behavior in the care of older people. Traditional lecture-and-slide-show continuing medical education (CME) programs have been shown to be relatively ineffective in changing this target group's practice. The challenge for geriatrics educators, then, is to devise CME programs that are highly accessible to practicing physicians, that will have an immediate and significant effect on practitioners' behavior, and that are financially viable. Studies of CME have shown that the most effective programs for knowledge translation in these circumstances involve what is known as active-mode learning, which relies on interactive, targeted, and multifaceted techniques. A systematic literature review, supplemented by structured interviews, was performed to inventory active-mode learning techniques for geriatrics knowledge and skills in the United States. Thirteen published articles met the criteria, and leaders of 28 active-mode CME programs were interviewed. This systematic review indicates that there is a substantial experience in geriatrics training for community-based physicians, much of which is unpublished and incompletely evaluated. It appears that the most effective methods to change behaviors involved multiple educational efforts such as written materials or toolkits combined with feedback and strong communication channels between instructors and learners. [source] Meeting the ecological challenges of agricultural change: editors' introductionJOURNAL OF APPLIED ECOLOGY, Issue 6 2003S. J. Ormerod Summary 1The global need for agricultural production has never been greater. Nor has it ever been more complex due to the needs to balance global food security, optimum production, technological innovation, the preservation of environmental functions and the protection of biodiversity. The role of ecologists in finding this balance is pivotal. 2In support of this role, ecologists now have very substantial experience of agricultural systems. We can understand, recognize and sometimes predict, at least qualitatively, the effects of pesticide applications, fertilizer use, drainage, crop choices and habitat modifications on farmland organisms, agro-ecosystems or other ecosystems influenced by agricultural land. 3In instances of greater uncertainty, for example under changing climates, where environmental stresses on ecosystems are interactive, and where ecosystem management or restoration must adapt to new technologies, the investigative skills and experience of ecologists are even more crucial in problem solving. 4There are, nevertheless, contrasting examples of good and bad practice in knowledge-transfer between ecologists and the communities who need our knowledge. The UK farm-scale evaluations of genetically modified crops, for example, involved ecologists at all stages from design and data collection to advocating policy. By contrast, many European agri-environment projects appear to have been developed and evaluated with only modest ecological advice. We advocate fuller involvement of ecologists in the development and evaluation of the European Union Common Agricultural Policy. 5This special profile of seven agriculturally related papers illustrates effectively the array of approaches used by applied ecologists in addressing agricultural questions: modelling, meta-analysis, surveys, transect studies, classical experiments, seedbank assays and process studies based on modern ecological methods. With over 20% of recent papers in the Journal of Applied Ecology reflecting agricultural issues, agro-ecology continues to represent one of the pre-eminent areas of applied ecology that is unlikely to diminish in importance. [source] Universal Health Insurance and the Effect of Cost Containment on Mortality Rates: Strokes and Heart Attacks in JapanJOURNAL OF EMPIRICAL LEGAL STUDIES, Issue 2 2009J. Mark Ramseyer For more than four decades, Japan has offered universal health insurance. Despite the demand subsidy entailed, it has kept costs low by regulatorily capping the amounts it pays doctors, particularly for the most modern and sophisticated procedures. Facing subsidized demand but stringently capped prices on complex procedures, Japanese physicians have had little incentive to invest in specialized expertise. Instead, they have invested in small private clinics and hospitals. The resulting proliferation of primitive clinics and hospitals has cut both the number of complex modern medical procedures performed, and the number of hospitals with any substantial experience in those procedures. With a quarter of the heart disease in the United States, Japan performs less than 3 percent as many coronary bypass operations and less than 6 percent as many angioplasties. Of the 855 cities and regions in Japan, 77 percent lack any hospital with substantial experience in the sophisticated modern treatment (defined below) of cerebrovascular disease, and 89 percent lack much experience in angioplasties. In this article, I estimate one of the costs of this regulatorily-driven lack of expertise. Toward that end, I combine mortality data from 855 cities with information on local hospital expertise and local demographic composition. In the typical city, I find that the addition of one hospital with substantial experience in modern stroke treatment would cut annual stroke mortality by 7 to 16 deaths. The addition of one hospital with substantial experience in angioplasties would cut the annual deaths from heart attacks in the city by over 19. [source] Resource Utilization of Living Donor Versus Deceased Donor Liver Transplantation Is Similar at an Experienced Transplant CenterAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2009J. C. Lai Although living donor liver transplantation (LDLT) has been shown to decrease waiting-list mortality, little is known of its financial impact relative to deceased donor liver transplantation (DDLT). We performed a retrospective cohort study of the comprehensive resource utilization, using financial charges as a surrogate measure,from the pretransplant through the posttransplant periods,of 489 adult liver transplants (LDLT n = 86; DDLT n = 403) between January 1, 2000, through December 31, 2006, at a single center with substantial experience in LDLT. Baseline characteristics differed between LDLT versus DDLT with regards to age at transplantation (p = 0.02), male gender (p < 0.01), percentage Caucasians (p < 0.01) and transplant model for end-stage liver disease (MELD) score (p < 0.01). In univariate analysis, there was a trend toward decreased total transplant charges with LDLT (p = 0.06), despite increased surgical charges associated with LDLT (p < 0.01). After adjustment for the covariates that were associated with financial charges, there was no significant difference in total transplant charges (p = 0.82). MELD score at transplant was the strongest driver of resource utilization. We conclude that at an experienced transplant center, LDLT imposes a similar overall financial burden than DDLT, despite the increased complexity of living donor surgery and the addition of the costs of the living donor. We speculate that LDLT optimizes transplantation by transplanting healthier and younger recipients. [source] Towards an inclusive school culture , but what happened to Elton's ,affective curriculum'?BRITISH JOURNAL OF SPECIAL EDUCATION, Issue 3 2003Gerda Hanko The inclusion debate is no longer concerned merely with the extent to which mainstream schools are able to accommodate all children regardless of need but increasingly focuses on institutional improvement in understanding the range of their needs. In spite of our better understanding of how children learn and of how their emotional and social realities can be used as a source of learning that is relevant to the needs of all, ,difficult' children continue to be seen by many as impeding their teachers' pedagogical effectiveness and as damaging the educational chances of others. In this article, Gerda Hanko, an education consultant and staff development tutor who has substantial experience in teaching and teacher training, offers an overview of the development of practical approaches to professional development which, by deepening teachers' insight into emotional and social factors in children's learning, have been shown to supersede the need to exclude the disaffected , as already suggested in the Elton Report. Gerda Hanko's own publications, initially developed under the auspices of a London Institute of Education associateship when she was Head of Education at a teacher training institution, promote collaborative problem-solving approaches among staff , ideas that she takes forward in this paper. [source] | ||||||||||