South Carolina Community Block Grants for Education Pilot Programs: Year 1 Report

The South Carolina General Assembly created the South Carolina Community Block Grant for Education Pilot Program by Proviso 1.94 in the 2014-15 General Appropriation Act. The purpose of the proviso was to encourage and sustain partnerships between a community and its public school district for the implementation of innovative, state-of-the-art education initiatives and models to improve learning. Any public school, including a charter school, was eligible to submit a grant application. The proviso asserts that the success of the grant program is best served when there is vigorous community support, which is integral to the development and implementation on innovative initiatives for young people. Through this proviso, one million dollars was allocated for the block grants with direct allocations to school districts. Grants awarded were to be implemented for a period of one year beginning July 1, 2015 until June 30, 2016.

Medición de la cultura de seguridad del paciente en un hospital público de primer nivel en el municipio de Villeta

Esta investigación midió la percepción del personal asistencial sobre la cultura de seguridad de los pacientes en un hospital de primer nivel de complejidad por medio de un estudio descriptivo de corte transversal. Se utilizó como herramienta de medición la encuesta ‘Hospital Survey on Patient Safety Cultura’ (HSOPSC) de la Agency of Healthcare Research and Quality (AHRQ) versión en español, la cual evalúa doce dimensiones. Los resultados mostraron fortalezas como el aprendizaje organizacional, las mejoras continuas y el apoyo de los administradores para la seguridad del paciente. Las dimensiones clasificadas como oportunidades de mejora fueron la cultura no punitiva, el personal, las transferencias y transiciones y el grado en que la comunicación es abierta. Se concluyó que aunque el personal percibía como positivo el proceso de mejoramiento y apoyo de la administración también sentía que era juzgado si reportaba algún evento adverso.

Intervenção com pais de crianças deficientes auditivas: elaboração e avaliação de um programa de orientação não presencial

As orientações aos pais favorecem a aceitação da deficiência auditiva e esclarecem possibilidades e condutas que viabilizam o desenvolvimento da criança. Devem ser cuidadosas, a fim de evitar insegurança, ansiedade, expectativas irreais ou reações inadequadas dos pais. Essas orientações são oferecidas no diagnóstico e no acompanhamento, mas as restrições de tempo e financeiras são dificuldades dos pais para o comparecimento freqüente a programas que forneçam um suporte contínuo. A proposta deste trabalho foi elaborar e avaliar um programa de orientação não presencial para pais de crianças com deficiência auditiva severa e profunda, de dois a seis anos de idade. O programa, estruturado em quatro unidades, foi aplicado a 30 pais atendidos no Hospital de Reabilitação de Anomalias Craniofaciais da USP, em Bauru/SP. As unidades foram formuladas com base nas orientações que os especialistas de diferentes áreas transmitem durante o diagnóstico da deficiência auditiva e nas dificuldades e interesses dos pais, identificando-se o conhecimento sobre as avaliações e acompanhamentos, opiniões sobre desempenho e necessidades da criança, deles próprios e das famílias. Para avaliação do programa foram analisadas as respostas dos pais aos questionários das unidades e às entrevistas finais. As análises revelaram que o programa forneceu aos pais, como eles desejavam, informações claras e sugestões de atividades que pudessem ser adequadas ao contexto familiar e colaborassem para o desenvolvimento da criança. Alguns pais encontraram dificuldade em se expressar por escrito e realizar algumas atividades, mas nas entrevistas, foi verificado que tal fato não inviabilizou o entendimento e a participação no programa.

Tailored advice on exercise - Does it make a difference?

Objectives: A controlled trial to compare the effectiveness of verbal advice from a family physician (FP) combined with either standard or tailored written information on physical activity in increasing the levels of physical activity in sedentary patients. Design: Sedentary patients (n = 763) were recruited through ten family practices and allocated to a control group or one of two intervention groups, Brief advice on physical activity was given by the FP during the consultation and either a standard or tailored pamphlet was mailed to the home address of patients assigned to the intervention groups within two days of their visit to the FP. Results: The response to follow-up, via a postal survey at one, six, and twelve months after the index consultation was 70%, 60%, and 57%, respectively. Treating all nonresponders as sedentary, the results revealed that although more tailored subjects reported some physical activity at each follow-up compared with the standard group, these differences were not significant, Furthermore, there was no significant difference in movement across the stages of readiness to exercise at follow-up between subjects in the tailored group who received material targeting their current stage (precontemplation or contemplation) and the standard group who received generic material that addressed both stages. Conclusion: These findings do not concur with the results from previous research in the areas of nutrition and smoking cessation where additional benefits were seen with a tailored intervention. Future research on the application of the principles of tailoring to the promotion of physical activity should focus on identifying which, if any, physical, social, psychological or environmental variables should be addressed to produce improved outcomes over and above the effects of well designed generic materials. (C) 1999 American Journal of Preventive Medicine.

How can and do Australian doctors promote physical activity?

Background. Physical inactivity is recognized as an important public health issue. Yet little is known about doctors' knowledge, attitude, skills, and resources specifically relating to the promotion of physical activity. Our survey assessed the current practice, perceived desirable practice, confidence, and barriers related to the promotion of physical activity in family practice, Methods. A questionnaire was developed and distributed to all 1,228 family practitioners in Perth, Western Australia. Results. We received a 71% response (n = 789). Family practitioners are most likely to recommend walking to sedentary adults to improve fitness and they are aware of the major barriers to patients participating in physical activity. Doctors are less confident at providing specific advice on exercise and may require further skills, knowledge, and experience, Although they promote exercise to patients through verbal advice in the consultation, few use written materials or referral systems, Conclusions. There are significant differences between self-reports of current practice and perceived desirable practice in the promotion of physical activity by doctors, Future strategies need to address the self-efficacy of family physicians and involve resources of proven effectiveness. The potential of referral systems for supporting efforts to increase physical activity by Australians should be explored. (C) 1997 Academic Press.

International Society for Sexual Medicine`s Guidelines for the Diagnosis and Treatment of Premature Ejaculation

Introduction. Over the past 20 years our knowledge of premature ejaculation (PE) has significantly advanced. Specifically, we have witnessed substantial progress in understanding the physiology of ejaculation, clarifying the real prevalence of PE in population-based studies, reconceptualizing the definition and diagnostic criterion of the disorder, assessing the psychosocial impact on patients and partners, designing validated diagnostic and outcome measures, proposing new pharmacologic strategies and examining the efficacy, safety and satisfaction of these new and established therapies. Given the abundance of high level research it seemed like an opportune time for the International Society for Sexual Medicine (ISSM) to promulgate an evidenced-based, comprehensive and practical set of clinical guidelines for the diagnosis and treatment of PE. Aim. Develop clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of PE for family practice clinicians as well as sexual medicine experts. Method. Review of the literature. Results. This article contains the report of the ISSM PE Guidelines Committee. It affirms the ISSM definition of PE and suggests that the prevalence is considerably lower than previously thought. Evidence-based data regarding biological and psychological etiology of PE are presented, as is population-based statistics on normal ejaculatory latency. Brief assessment procedures are delineated and validated diagnostic and treatment questionnaires are reviewed. Finally, the best practices treatment recommendations are presented to guide clinicians, both familiar and unfamiliar with PE, in facilitating treatment of their patients. Conclusion. Development of guidelines is an evolutionary process that continually reviews data and incorporates the best new research. We expect that ongoing research will lead to a more complete understanding of the pathophysiology as well as new efficacious and safe treatments for this sexual dysfunction. Therefore, it is strongly recommended that these guidelines be re-evaluated and updated by the ISSM every 4 years. Althof SE, Abdo CHN, Dean J, Hackett G, McCabe M, McMahon CG, Rosen RC, Sadovsky R, Waldinger M, Becher E, Broderick GA, Buvat J, Goldstein I, El-Meliegy AI, Giuliano F, Hellstrom WJG, Incrocci L, Jannini EA, Park K, Parish S, Porst H, Rowland D, Segraves R, Sharlip I, Simonelli C, and Tan HM. International Society for Sexual Medicine`s guidelines for the diagnosis and treatment of premature ejaculation. J Sex Med 2010;7:2947-2969.

Basic fibroblast growth factor and fibroblast growth factor receptors in adult olfactory epithelium

Basic fibroblast growth factor (FGF2) stimulates proliferation of the globose basal cells, the neuron:ll precursor in the olfactory epithelium. The present study investigates the expression of basic fibroblast growth factor and fibroblast growth factor receptors in the adult olfactory epithelium. FGF2 immunoreactivity was expressed widely in the olfactory epithelium, with the highest density of immunoreactivity in the supporting cells. In contrast, most cells in the epithelium expressed FGF2 mRNA. Fibroblast growth factor receptor-1 (FGFr1) immunoreactivity was densest in the basal cell and neuronal layers of the olfactory epithelium and on the apical surface of supporting cells. In the lamina propria FGF2 immunoreactivity and mRNA were densest in cells close to the olfactory nerve bundles. FGFr1 immunoreactivity was heaviest on the olfactory ensheathing cells. Using reverse transcriptase-polymerase chain reaction analysis, the olfactory epithelium was shown to express only three receptor splice variants, including one (FGFr1c) with which basic fibroblast growth factor has high affinity. Other receptor splice variants were present in the lamina propria. Taken together, these observations indicate endogenous sources of FGF? within the olfactory epithelium and lamina propria and suggest autocrine and paracrine pathways via which FGF2 might regulate olfactory neurogenesis. The observation of only three receptor splice variants in the olfactory epithelium limits the members of the fibroblast growth factor family which could act in the olfactory epithelium. The widespread distribution of receptors suggests that fibroblast growth factors may have roles other than proliferation of globose basal cells. (C) 2001 Published by Elsevier Science B.V.

Audit and comprehensive health assessment programme in the primary healthcare of adults with intellectual disability: a pilot study

International research has demonstrated significant shortcomings in the health of adults with intellectual disability (ID). Because general practitioners (GPs) are the main providers of primary healthcare for this population, strategies to improve general practice care are an important aspect of rectifying these shortcomings. The present pilot study aimed to determine the effect of various interventions on health maintenance activities and to assess their acceptability to GPs, with a view to informing larger scale studies. The GPs were recruited through an earlier questionnaire-based postal survey. The GPs identified all their adult patients with ID, then obtained consent for participation from three patients randomly selected by the investigators. The GPs completed two self-evaluation forms and case note audits 12 months apart, read a synopsis of the relevant literature provided by the researchers, and completed a comprehensive health assessment (CHA) of their three patients. Forty-five GPs agreed to participate in the CHA programme (CHAP), and 15 completed the project. Thirty-eight patients completed the project. The number of patient-GP dyads who completed the project was too small to demonstrate statistically significant changes in health issues over time. The GPs found that the synopsis of the literature was the best intervention for increasing knowledge and was also the most practical to use in general practice. The CHAP was the intervention that prompted the most action from the GP which would not have been undertaken otherwise. The CHAP appeared to provide a superior review process compared to the other interventions used in the present study. The numbers of health maintenance activities found to be overdue and the number of health issues detected as a result of the process were considerable. The CHAP served as a communication tool and an educative instrument, providing a basis for future studies and strategies to improve the general practice care of adults with ID.

Guidelines for the treatment of postmenopausal osteoporosis for general practitioners

BACKGROUND: Osteoporosis Australia has been committed to the education of general practitioners and the community with a series of updated guidelines on the management of osteoporosis. Since the last series was published in Australian Family Physician (August 2000), there have been further advances in our understanding of the treatments involved in both prevention of bone loss and the management of established osteoporosis. OBJECTIVE: This article represents updated guidelines for the treatment of postmenopausal osteoporosis to assist GPs identify those women at risk and to review current treatment strategies. DISCUSSION: Osteoporosis and its associated problems are major health concerns in Australia, especially with an aging population. While important principles of management are still considered to be maximising peak bone mass and preventing postmenopausal bone loss, new clinical trial data about drugs such as the bisphosphonates, raloxifene and oestrogen have recently become available and the relative role of various agents is gradually becoming clearer. The use of long term hormone replacement therapy has mixed risks and benefits that requires individual patient counselling.

How well do general practitioners deliver palliative care? A systematic review

General practitioners (GPs) deliver the majority of palliative care to patients in the last year of life. This article seeks to examine the nature of GP care, perceptions of the GPs themselves and others of that care, the adequacy of palliative care training, issues relating to accessibility of GPs to palliative care patients, and strategies that may be of use in encouraging more effective delivery of palliative care by GPs. Medline and PubMed databases from 1966 to 2000 were searched, and 135 references identified. Sixty-six of these described studies relevant to GP palliative care. GPs value this part of their work. Most of the time, patients appreciate the contribution the GP makes to palliative care particularly if the GP is accessible, takes time to listen, allows patient and carer to ventilate their feelings, and is seen to be making efforts made regarding symptom relief. However, reports from bereaved relatives suggest that palliative care is performed less well in the community than in other settings. GPs express discomfort about their competence to perform palliative care adequately. They tend to miss symptoms which are not treatable by them, or which are less common. However, with appropriate specialist support and facilities, GPs have been shown to deliver sound and effective care. GP comfort working with specialist teams increases with exposure to this form of patient management, as does the understanding of the potential other team members have in contributing to the care of the patient. Formal arrangements engaging GPs to work with specialist teams have been shown to improve functional outcomes, patient satisfaction, improve effective use of resources and improve effective physician behaviour in other areas of medicine. Efforts by specialist services to develop formal involvement of GPs in the care of individual patients, may be an effective method of improving GP palliative care skills and appreciation of the roles specialist services can play.

Avaliação das necessidades educacionais dos cuidadores de pessoas com esquizofrenia: contribuição para a validação de um questionário

RESUMO: Os programas psicoeducacionais para cuidadores de pessoas com esquizofrenia são muitas vezes construídos sem terem em conta as necessidades educacionais destes utilizadores dos serviços de saúde mental. Apresenta-se uma revisão da literatura sobre esquizofrenia, família, intervenções familiares e avaliação de necessidades educacionais. Conduziu-se um estudo transversal descritivo com características exploratórias numa amostra de conveniência de principais cuidadores (N=74) de pessoas com esquizofrenia em tratamento no Departamento de Psiquiatria e Saúde Mental do Hospital de S. Francisco Xavier. A metodologia utilizada é do tipo qualitativo e quantitativo. Objectivos: Descrever as características de uma amostra de principais cuidadores de pessoas com esquizofrenia e as suas necessidades educacionais, bem como contribuir para a validação do Educational Needs Questionnaire (ENQ). Instrumentos: Educational Needs Questionnaire (ENQ) e Inventário Sócio-Demográfico para Familiares (RSDS). Resultados: O doente com esquizofrenia é cuidado sobretudo pela família, sendo as mães os cuidadores por excelência. Trata-se de mulheres idosas que cuidam do doente há muitos anos e que necessitam saber mais sobre como obter ajuda dos serviços de saúde mental. Conclusões: Os cuidadores sentem que os serviços de saúde mental não lhes dão o apoio de que necessitam e estão preocupados sobretudo com o estigma e com o que acontecerá aos seus doentes após a sua morte. A versão portuguesa do ENQ mostrou possuir boa fiabilidade, recomendando-se o desenvolvimento de estudos que dêem continuidade ao esforço de validação aqui iniciado.-------------ABSTRACT: The psychoeducational programs for caregivers of people with schizophrenia are often built without regard for the educational needs of users of mental health services. We present a review of the literature on schizophrenia, family, family interventions and evaluation of educational needs. We conducted a cross-sectional study with exploratory characteristics in a convenience sample of primary caregivers (N = 74) of people with schizophrenia being treated in the Department of Psychiatry and Mental Health at the Hospital of St. Francisco Xavier. We used a qualitative and quantitative methodology. Objectives: To describe the characteristics of a sample of primary caregivers of people with schizophrenia and their educational needs, as well as contribute to the validation of the Educational Needs Questionnaire (ENQ). Instruments: Educational Needs Questionnaire (ENQ) and Inventário Sócio-Demográfico para Familiares (RSDS). Results: Patients with schizophrenia are cared by the family, mothers are the caregivers for excellence. They are older women who take care of the patient for many years and they need to know more about how to get help from mental health services. Conclusions: Caregivers feel that mental health services don‟t give them the support they need and they are especially worried about the stigma and what will happens to their patients after their death. The Portuguese version of the ENQ proved to have good reliability and we recommend the development of studies that give continuity to the validation effort here started.

Quand référer aux urgences un patient présentant une elévation sévère de la pression artérielle [When should a patient with severe hypertension be referred to the emergency ward?].

When a severe elevation of blood pressure occurs in conjunction with failure of a target organ, immediate referral of the patient to hospital is an easy decision for the primary care physician. However, when severe elevation of blood pressure is observed in the absence of any significant symptom, it is a much more difficult decision to take. Indeed, if some clinical situations require an immediate and aggressive anti-hypertensive therapy, such a treatment can be clearly deleterious for a number of other cases. This paper attempts to clarify in which situations the primary care physician should refer hypertensive crisis to the emergency department.

The use of classification and regression trees to predict the likelihood of seasonal influenza.

Background Individual signs and symptoms are of limited value for the diagnosis of influenza. Objective To develop a decision tree for the diagnosis of influenza based on a classification and regression tree (CART) analysis. Methods Data from two previous similar cohort studies were assembled into a single dataset. The data were randomly divided into a development set (70%) and a validation set (30%). We used CART analysis to develop three models that maximize the number of patients who do not require diagnostic testing prior to treatment decisions. The validation set was used to evaluate overfitting of the model to the training set. Results Model 1 has seven terminal nodes based on temperature, the onset of symptoms and the presence of chills, cough and myalgia. Model 2 was a simpler tree with only two splits based on temperature and the presence of chills. Model 3 was developed with temperature as a dichotomous variable (≥38°C) and had only two splits based on the presence of fever and myalgia. The area under the receiver operating characteristic curves (AUROCC) for the development and validation sets, respectively, were 0.82 and 0.80 for Model 1, 0.75 and 0.76 for Model 2 and 0.76 and 0.77 for Model 3. Model 2 classified 67% of patients in the validation group into a high- or low-risk group compared with only 38% for Model 1 and 54% for Model 3. Conclusions A simple decision tree (Model 2) classified two-thirds of patients as low or high risk and had an AUROCC of 0.76. After further validation in an independent population, this CART model could support clinical decision making regarding influenza, with low-risk patients requiring no further evaluation for influenza and high-risk patients being candidates for empiric symptomatic or drug therapy.

Coronary heart disease in primary care: accuracy of medical history and physical findings in patients with chest pain - a study protocol for a systematic review with individual patient data.

BACKGROUND: Chest pain is a common complaint in primary care, with coronary heart disease (CHD) being the most concerning of many potential causes. Systematic reviews on the sensitivity and specificity of symptoms and signs summarize the evidence about which of them are most useful in making a diagnosis. Previous meta-analyses are dominated by studies of patients referred to specialists. Moreover, as the analysis is typically based on study-level data, the statistical analyses in these reviews are limited while meta-analyses based on individual patient data can provide additional information. Our patient-level meta-analysis has three unique aims. First, we strive to determine the diagnostic accuracy of symptoms and signs for myocardial ischemia in primary care. Second, we investigate associations between study- or patient-level characteristics and measures of diagnostic accuracy. Third, we aim to validate existing clinical prediction rules for diagnosing myocardial ischemia in primary care. This article describes the methods of our study and six prospective studies of primary care patients with chest pain. Later articles will describe the main results. METHODS/DESIGN: We will conduct a systematic review and IPD meta-analysis of studies evaluating the diagnostic accuracy of symptoms and signs for diagnosing coronary heart disease in primary care. We will perform bivariate analyses to determine the sensitivity, specificity and likelihood ratios of individual symptoms and signs and multivariate analyses to explore the diagnostic value of an optimal combination of all symptoms and signs based on all data of all studies. We will validate existing clinical prediction rules from each of the included studies by calculating measures of diagnostic accuracy separately by study. DISCUSSION: Our study will face several methodological challenges. First, the number of studies will be limited. Second, the investigators of original studies defined some outcomes and predictors differently. Third, the studies did not collect the same standard clinical data set. Fourth, missing data, varying from partly missing to fully missing, will have to be dealt with.Despite these limitations, we aim to summarize the available evidence regarding the diagnostic accuracy of symptoms and signs for diagnosing CHD in patients presenting with chest pain in primary care. REVIEW REGISTRATION: Centre for Reviews and Dissemination (University of York): CRD42011001170.

Physicians' attitudes towards prevention: importance of intervention-specific barriers and physicians' health habits.

BACKGROUND: Several studies have explored physicians' attitudes towards prevention and barriers to the delivery of preventive health interventions. However, the relative importance of these previously identified barriers, both in general terms and in the context of a number of specific preventive interventions, has not been identified. Certain barriers may only pertain to a subset of preventive interventions. OBJECTIVES: We aimed to determine the relative importance of identified barriers to preventive interventions and to explore the association between physicians' characteristics and their attitudes towards prevention. METHODS: We conducted a cross-sectional survey of 496 of the 686 (72.3% response rate) generalist physicians from three Swiss cantons through a questionnaire asking physicians to rate the general importance of eight preventive health strategies and the relative importance of seven commonly cited barriers in relation to each specific preventive health strategy. RESULTS: The proportion of physicians rating each preventive intervention as being important varied from 76% for colorectal cancer screening to 100% for blood pressure control. Lack of time and lack of patient interest were generally considered to be important barriers by 41% and 44% of physicians, respectively, but the importance of these two barriers tended to be specifically higher for counselling-based interventions. Lack of training was most notably a barrier to counselling about alcohol and nutrition. Four characteristics of physicians predicted negative attitudes toward alcohol and smoking counselling: consumption of more than three alcoholic drinks per day [odds ratio (OR) = 8.4], sedentary lifestyle (OR = 3.4), lack of national certification (OR = 2.2) and lack of awareness of their own blood pressure (OR = 2.0). CONCLUSIONS: The relative importance of specific barriers varies across preventive interventions. This points to a need for tailored practice interventions targeting the specific barriers that impede a given preventive service. The negative influence of physicians' own health behaviours indicates a need for associated population-based interventions that reduce the prevalence of high-risk behaviours in the population as a whole.